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Biomedical subjects

R R Augspurger

Publications and source records attributed to R R Augspurger.

12 recordsLinked to original sources

Intraoperative and early complications of staging pelvic lymph node dissection in prostatic adenocarcinoma.

Pelvic lymphadenectomy is the final staging procedure before institution of therapy for patients with clinically locally confined adenocarcinoma of the prostate, a normal acid phosphatase, and a bone scan free of metastatic disease. The pathologic information it provides cannot be accurately acquired at the present time by any other method. Extraperitoneal lymphadenectomy is associated with some morbidity intraoperatively and in the early postoperative period. We enumerate our results with 284 extraperitoneal lymphadenectomies.

Adenocarcinoma↗

Stage D1 adenocarcinoma of prostate.

The natural history of Stage D1 adenocarcinoma of the prostate remains unclear. In a series of 50 patients with positive pelvic lymph nodes at the time of staging lymphadenectomy, metastatic disease developed in 43 per cent of the patients treated for cure within the period of time of follow-up. Several series from the literature confirm those findings. Positive pelvic lymph nodes most probably represent systemic disease, and the patients are incurable by current surgical and radiotherapeutic modalities.

Adenocarcinoma↗

Acid phosphatase: its influence on the management of carcinoma of the prostate.

Of 343 patients who underwent pelvic lymph node dissection during treatment for carcinoma of the prostate 25 had persistently elevated serum enzymatic acid phosphatase levels preoperatively: 15 (60 per cent) had metastases to the pelvic lymph nodes and 10 (40 per cent) had negative nodes. Bone metastases occurred in 10 of 12 (83 per cent) and 5 of 7 patients (71 per cent), respectively, who were followed for a minimum of 2 years. Of the 318 patients with normal serum enzymatic phosphatase levels 70 (22 per cent) had positive nodes. A persistently elevated serum enzymatic acid phosphatase level in patients with proved carcinoma of the prostate, with elimination of infrequent causes of enzyme elevation, indicates metastases and has significant implications regarding staging and, thus, therapy of this disease.

Acid Phosphatase↗

Prostatic carcinoma. Influence of tumor grade on results of pelvic lymphadenectomy.

Two hundred fifteen patients have undergone pelvic node dissection in clinical Stages A1, A2, B1, and B2 adenocarcinoma of the prostate as a final staging procedure. Two hundred four patients have had the tumor grade assessed adequately and the influence of the grade on the results of the node dissection evaluated. As the grade of the primary tumor worsens in each clinical stage, the incidence of positive nodes increases.

Adenocarcinoma↗

Pitfalls of the Rosen anti-incontinence prosthesis.

There were 17 male patients with urinary incontinence who underwent insertion of the Rosen anti-incontinence prosthesis. Of the 17 patients 9 (53 per cent) have a functioning prosthesis, 4 (23.5 per cent) have a non-functioning prosthesis and are awaiting replacement and 4 (23.5 per cent) have had the prosthesis removed. The longevity of the prosthesis is unknown, with our longest functioning prosthesis at 26 months.

Humans↗

Prevention of obturator nerve stimulation during transurethral surgery.

The obturator nerve passes in close proximity to the inferolateral bladder wall, bladder neck and lateral prostatic urethra. During a transurethral operation resection in these areas may result in stimulation of the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To block this reaction d-tubocurarine and succinylcholine can be used during general anesthesia. However, it often is preferable to use spinal anesthesia during transurethral operations. Local anesthetic blockade of the obturator nerve as it passes through the obturator canal if effective for adductor spasm during spinal anesthesia. We herein describe the anatomy, pharmacology, technique and results of local obturator nerve blockade.

Anesthesia, Spinal↗

Cushing's syndrome: complication of triamcinolone injection for urethral strictures in children.

We report 2 cases of Cushing's syndrome following intralesional triamcinolone acetonide injections of urethral strictures in children. The pharmacology of triamcinolone and its 2 parenteral forms, triamcinolone acetonide and triamcinolone diacetate, is discussed. For children we recommend the short-acting triamcinolone diacetate at 4-week intervals with dosage adjusted to age. In adults either type of triamcinolone may be used but triamcinolone acetonide should be given at 6-week intervals.

Child↗

Lack of usefulness of bone marrow enzymes and calcium in staging patients with prostatic cancer.

Bone marrow acid phosphatase has been reported to be a sensitive indicator of early bony metastasis from adenocarcinoma of the prostate. In order to evaluate this hypothesis, we measured bone marrow acid and alkaline phosphatase, lactic dehydrogenase, and calcium levels in a group of 84 patients with a variety of problems, including 18 with cancer of the prostate. We found that the bone marrow acid and alkaline phosphatase and lactic dehydrogenase were elevated and calcium was depressed in most patients. Among patients with prostate cancer, bone marrow acid phosphatase was not significantly different between those with or without bone metastases. In addition, the patients with prostatic cancer did not have higher levels of bone marrow acid phosphatase than subjects with other malignant and nonmalignant conditions. The level of acid and alkaline phosphatase, lactic dehydrogenase and calcium varied predictably with the aspiration technique used and was independent of sex, disease state or method of chemical determination. Due to this variation, we believe that bone marrow enzyme and calcium levels are of no value in the detection of metastases in patients with prostate cancer.

Acid Phosphatase↗

Bladder injuries associated with cesarean section.

Bladder injury during cesarean section is unusual and may occur by failure to empty the bladder preoperatively, inadequate bladder flap reflection or incision into the vagina rather than the lower uterine segment. Three bladder injuries during cesarean section are reported. Although 2 women recovered normally 1 has persistent vesicoureteral reflux. With liberalization of indications for cesarean section bladder injuries may be seen more frequently.

Adult↗