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Biomedical subjects

R G Middleton

Publications and source records attributed to R G Middleton.

At least 19 recordsLinked to original sources
PubMed1992

An evaluation of various treatments to increase sperm penetration capacity for potential use in an in vitro fertilization program.

OBJECTIVE: To select in vitro fertilization (IVF) patients with a low sperm penetration assay (SPA) value and to determine if the penetration rate, fertilization rate, and the pregnancy rate (PR) can be improved in these patients by treating sperm with refrigeration, calcium ionophore A23187, prostaglandin E1, prostaglandin E2, or heparin. DESIGN: The study consists of three parts: identification of patients with poor SPA values, analysis of treatments to improve the SPA value, and evaluation of the treatments to improve fertilization and PRs. RESULTS: The data indicate that treatment of sperm with refrigeration can improve fertilization and PRs during IVF in selected patients previously shown to have an improved SPA value with the treatment. CONCLUSIONS: Three points are emphasized: (1) the treatments analyzed in this study can improve SPA values in some of the patients with low sperm penetration capacity; (2) of the treatments studied, sperm refrigeration resulted in the largest improvement in sperm penetration capacity; and (3) sperm refrigeration can increase fertilization and PRs during IVF in this select group of patients.

Acrosome↗
PubMed1992

Extracorporeal piezoelectric lithotripsy in unanesthetized children.

Extracorporeal piezoelectric lithotripsy is an effective method for treating renal pelvic stones in children. Treatment with the Wolf lithotriptor is essentially painless and can be performed without anesthesia on an outpatient basis. Real-time ultrasound is used to localize stones. In a 1-year period at the University of Utah, extracorporeal piezoelectric lithotripsy was administered to eight children with nine renal units. Of the eight children, aged 5 to 17 1/2 years, only two required sedation and only one received retreatment. No stents were placed. At 1 month posttreatment, all children were stone-free, and no significant complications occurred.

Adolescent↗
PubMed1991

A 2-year experience with the Wolf piezoelectric lithotripter: impact of repeat treatment on results and complications.

During a 2-year period, 884 extracorporeal piezoelectric lithotripsy treatments have been performed on stones in 388 renal units (kidney and upper ureter) using a Wolf Piezolith device.* Lithotripsy routinely was performed on an outpatient basis without use of anesthesia or premedication. Often, the maximum number of pulses allowable by a Food and Drug Administration protocol (4,000) was delivered and retreatments frequently occurred on successive days. Of the patients 75% were stone-free 3 months after treatment, while another 20% had only residual small fragments. No intrarenal or perinephric hematomas were observed and only 1 patient has had hypertension requiring medication. Renal colic from passage of stone fragments occurred in only 10% of the patients. An aggressive treatment policy using repeat treatments as necessary provides for superior results with this device without an incision or complication.

Adult↗
PubMed1991

Long-term follow-up after radical prostatectomy. Identification of prognostic variables.

We report one of the largest series of patients treated by radical prostatectomy followed for a minimum of 10 years. The tumor-free survival rate at 10 years seems superior to that achieved with alternative methods of treatment. Pathologic stage, DNA histograms, and tumor grade all correlate with prognosis but none is sufficiently powerful as an independent factor to allow selection of patients for surgery. Although a survival benefit has not been demonstrated, adjuvant treatment such as postoperative irradiation or early hormonal therapy may be indicated in patients with established poor prognostic factors.

Follow-Up Studies↗
PubMed1990

A fifteen-year study of alterations in semen quality occurring after vasectomy reversal.

Semen quality was evaluated in 256 men at 2, 4, 6, and 12 months after vasectomy reversal. Total sperm counts were normal and averaged 91 X 10(6) sperm per ejaculate. The percentage of live sperm was decreased below normal to 36% and hypo-osmolarity values indicated only 41% of the sperm with normal membranes. Progressive motility and the total progressively motile sperm count were reduced and averaged 25% and 27 million, respectively. Approximately 50% of the patients had positive titers of sperm agglutinating and/or sperm immobilizing antibodies. Sperm morphology indicated tail and head shape defects with increases in both tapered and immature sperm. A fertility score combining several sperm parameters averaged only 37% of normal. All of these values remained constant with time after reversal except for progressive motility (increased), oval head shapes (increased), and tapered sperm (decreased). This study has demonstrated that characteristic defects occur in sperm (decreased). This study has demonstrated that characteristic defects occur in sperm motility, sperm membrane function and morphology, in addition to specimen fertility scores, after a vasectomy reversal and need to be taken into consideration when advising and treating these patients for subsequent fertility difficulties.

Cell Survival↗
PubMed1990

Selection of patients with stage B prostate cancer for radical prostatectomy.

There are several areas of concern in dealing with clinical stage B disease. First, understaging is common. Second, recognition of extension into the seminal vesicles is important. Third, the patient's predicted life expectancy must be taken into account. Moreover, even clinically localized prostate cancer may have metastasized, and the need for surgical staging by lymph node dissection has been a significant factor in the authors' preference for radical retropubic rather than radical perineal prostatectomy. Neither of the two serum markers in clinical use is an absolute predictor of stage. Analysis of tumor ploidy may prove useful, and transrectal ultrasound warrants further study. In the elderly patient, the urologist certainly may elect to monitor the tumor without definitely deciding on operative versus conservative treatment.

Acid Phosphatase↗
PubMed1988

Artificial insemination: a comparison of pregnancy rates with intrauterine versus cervical insemination and washed sperm versus serum swim-up sperm preparations.

A four-cycle artificial insemination protocol was undertaken, with luteinizing hormone (LH) timing, to compare washed sperm and serum swim-up sperm preparations and cervical and intrauterine insemination. Of the 75 patients entered into the protocol series, 63 finished all 4 cycles. During the treatment period, 24 patients became pregnant, 20 of whom were donor (AID) pregnancies (out of 52 patients) and 4 were husband (AIH) pregnancies (out of 11 patients). Seventy-five percent of the pregnancies were intrauterine, whereas only 25% were from cervical inseminations. Sixty-two percent of the pregnancies were due to serum swim-up sperm preparations, and 38% were due to washed sperm preparations. The data indicate substantially higher pregnancy rates can be obtained with intrauterine insemination and suggest that additional studies are necessary to determine if the method of sperm preparation significantly influences pregnancy rates.

Cervix Uteri↗
PubMed1988

Value of and indications for pelvic lymph node dissection in the staging of prostate cancer.

Pelvic lymphadenectomy is valuable as a staging procedure prior to radical prostatectomy in patients with clinical stages A2, B1 (except low-grade lesions), and B2 prostate cancer who seem to be good candidates for an attempt at curative surgery. Survival rates are promising in patients with negative pelvic lymph nodes and local tumors who undergo radical prostatectomy. In the presence of positive nodes, there is little reason to proceed with radical prostatectomy. Noninvasive alternatives to pelvic node dissection are appealing, but lymphangiography, ultrasound, computed tomography scanning, and magnetic resonance imaging are all less reliable than pelvic lymphadenectomy. Some morbidity is associated with surgical staging, and it is important that this be minimized. Pelvic lymph node dissection can play a role in treatment planning for patients who will be given external-beam radiation therapy. However, the role depends on the physician's treatment philosophy. In a recently reported series of patients receiving radiation therapy for localized prostate carcinoma, prior surgical staging by pelvic lymphadenectomy is uncommonly performed.

Humans↗
PubMed1987

A 15-year followup of a nonmicrosurgical technique for vasovasostomy.

A 15-year followup was summarized for patients who had nonmicrosurgical vasectomy reversal. Over-all pregnancy rates were 45 per cent (43 per cent for the first 8 years and 49 per cent for the next 7 years) and 73 per cent of the pregnancies occurred within 1 year after vasectomy reversal. Patients who achieved pregnancy compared to those who did not had significantly better sperm motility and a lower incidence of antisperm antibodies. The data indicate that nonmicrosurgical techniques can be used successfully to reverse vasectomy more economically and more rapidly than the microsurgical approach, while contributing to a reasonable pregnancy rate.

Female↗
PubMed1986

A simple and effective technique for increasing pregnancy rates in couples with retrograde ejaculation.

Seven of 12 patients with retrograde ejaculation, who had at least occasional samples with reasonable sperm numbers and motility, underwent a protocol including luteinizing hormone-timed, intrauterine insemination with washed sperm recovered from the urine. Seven pregnancies have occurred to date in six patients; the one other patient is still early in the protocol period. The described technique for collecting sperm, ovulation timing, sperm recovery, and washing and intrauterine insemination are relatively simple and cost-effective and appear to be effective in contributing to pregnancies in many couples with retrograde ejaculation.

Ejaculation↗
PubMed1986

Patient survival and local recurrence rate following radical prostatectomy for prostatic carcinoma.

From 1970 to 1980, 153 patients with stages A2, B1 and B2 prostatic cancer and proved negative pelvic lymph nodes underwent radical prostatectomy (84 underwent radical perineal and 69 underwent radical retropubic prostatectomy). Seventeen patients were lost to followup. Of 136 patients who were followed for 5 years or until death 128 (94 per cent) were alive at 5 years, including 118 (87 per cent) who were without evidence of recurrence. Patients with microscopic invasion of the prostatic capsule have a better outcome at 5 years than those with microscopic involvement of the seminal vesicles. Only 46 of the patients could be assessed at 10 years or had died 6 to 10 years postoperatively. Results at 10 years are considered preliminary, since many more patients will reach the 10-year milestone within the next few years.

Follow-Up Studies↗
PubMed1986

The Young-Dees operation for the correction of retrograde ejaculation.

Retrograde ejaculation can be a significant problem when it interferes with fertility. Sympathomimetic drugs and sperm retrieval from the urine with insemination of the wife are the common methods of treatment. When these methods have not been successful we have used the Young-Dees type of bladder neck reconstruction to convert retrograde ejaculation into normal or antegrade ejaculation. The operation has been successful in 4 of 5 patients.

Adolescent↗
PubMed1986

Modern concepts in the diagnosis and treatment of male infertility.

The use of modern techniques to manipulate sperm has assisted many couples in their effort to achieve pregnancy. Use of the techniques is dependent upon adequate and complete diagnostic data to determine if the techniques would be beneficial for a particular couple. The participation of a urologist in these techniques can take many forms but should be active to assure the best treatment for the male patient with fertility difficulties and to prepare the sperm with the available techniques prior to use for insemination or in-vitro fertilization. The future looks exciting and is sure to bring many more new developments that will benefit couples with fertility problems.

Animals↗
PubMed1985

Implications of volume of nodal metastasis in patients with adenocarcinoma of the prostate.

We divided 73 cases of pelvic nodal metastases from prostatic cancer into subgroups based upon the volume and extent of nodal disease. Of the patients with gross nodal disease 15 per cent survived 5 years without progression compared to 27 per cent of those with microscopic involvement of more than 1 node and 44 per cent with a single positive node. On the other hand, 52 per cent of the patients with gross disease died of prostatic cancer within 5 years compared to 37 per cent of those with multiple microscopic nodes and 28 per cent with a single node. Although other variables also influence prognosis, the differences in survival demonstrable within these subgroups may have important implications regarding selection of therapy and interpretation of treatment results.

Adenocarcinoma↗
PubMed1985

Pubectomy in urological surgery.

Pubectomy has been useful, particularly for the treatment of traumatic disruption of the deep urethra after a preliminary cystostomy. This procedure provides unparalleled exposure for mobilization of the apex of the prostate and distal urethral segment, and the accomplishment of an end-to-end anastomosis. Results have been good. Pubectomy has been helpful in selected cases of chronic osteitis pubis. Experience with the technique was helpful during radical pubectomy in 2 patients with chondrosarcoma of the pubis.

Adult↗
PubMed1979

Surgical approach to large müllerian duct cysts.

Failure of the müllerian duct system to undergo complete involution in the male embryo may result in cystic dilation of these remnants. When these cysts attain great size, they may become paopable abdominally and cause voiding symptoms. A case is presented and the operative approach described. A suprapubic approach affords the best exposure for the complete removal of large müllerian duct cysts.

Adult↗