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Biomedical subjects

R S Foster

Publications and source records attributed to R S Foster.

At least 19 recordsLinked to original sources
PubMed1992

Clinical breast examination and breast self-examination. Past and present effect on breast cancer survival.

Increasing attention to self-detection of breast masses and clinical breast examination during this century have contributed to a progressive reduction in the size of breast cancers at detection and a progressive improvement in survival. Mammography is more sensitive than breast palpation for the detection of breast cancer, however, mammography does not detect all palpable cancers and additional interval cancers become palpable between screenings. Breast self-examination, clinical breast examination, and mammography are complementary screening modalities. In populations where mammography is not available or is not appropriate as a screening modality, clinical breast examination and breast self-examination are particularly important.

Breast Neoplasms↗
PubMed1992

Injury and violence in Los Angeles. Impact on access to health care and surgical education.

The Los Angeles County (California) Trauma Hospital System was designed to ensure that all patients requiring specialized trauma care would be transported directly to a trauma center using established trauma triage criteria. The designation and implementation of all level 1, 2, and 3 (rural) trauma centers were completed between October 1983 and July 1985. However, by February 1, 1985, one level 2 trauma center withdrew, and nine other level 2 and 3 trauma centers followed suit over the next few months and years. The reasons for closure of these 10 trauma centers were almost exclusively related to economic factors. The major impact of trauma center closure on surgical educational programs at the Drew University of Medicine and Science and the Martin Luther King, Jr/Charles R. Drew Medical Center have been additive and cumulative. The high volume of patients with trauma has been cited, sometimes correctly and sometimes incorrectly, as the primary reason for a lack of access to health care for patients without trauma. We have developed a blueprint for survival that, when fully implemented, will improve access to health care for all residents in our catchment area and optimize surgical education. While the Los Angeles County Trauma Hospital System has had many difficulties during the last 9 years, the population it serves is greater than that in 42 states in the United States. The experiences gained in Los Angeles County may be beneficial to statewide systems in the United States and in countries of comparable size.

General Surgery↗
PubMed1992

Testicular ultrasonography after chemotherapy for germ cell neoplasm: significance of highly hyperechoic lesions.

The sonographic appearance of the testis after administration of chemotherapy for metastatic germ cell neoplasm is not well known. Fifty-six patients (60 testes) who were previously treated with chemotherapy for metastatic germ cell neoplasm (originally diagnosed by removal of the contralateral testis or by biopsy of metastatic disease) underwent sonography followed by orchiectomy. The sonographic characteristics found to predict viable intratesticular tumor were: lesion size larger than 5 mm, fewer echoes than adjacent parenchyma (hypoechoic), inhomogeneous echo texture, poor margin definition, cystic areas, or highly hyperechoic foci within a hypoechoic lesion. Fibrosis was predicted by finding single or multiple small, highly hyperechoic lesions. These results suggest the potential for predicting the pathologic diagnosis in some patients after receiving chemotherapy for germ cell neoplasm.

Adolescent↗
PubMed1992

Conversion of an ileal conduit to a continent catheterizable stoma.

A technique is described by which a previously constructed ileal conduit is used as an efferent limb of a continent urinary reservoir. The ileal segment is tapered; 1 end is tunneled submucosally into a reconfigured colonic reservoir and the other end is brought to the skin as a catheterizable stoma. This modification of the Mitrofanoff principle provides a highly continent stoma that is easily catheterized, and allows for preservation of the terminal ileum and ileocecal valve within the gastrointestinal tract.

Adult↗
PubMed1992

Intra-abdominal desmoid tumor: an unusual case of recurrent tumor in a testis cancer patient.

Recurrence of teratoma or carcinoma in testis cancer patients found to have teratoma at post-chemotherapy retroperitoneal lymphadenectomy is well recognized. We report a case of an intra-abdominal desmoid tumor discovered 2 years following post-chemotherapy retroperitoneal lymphadenectomy in a testis cancer patient who had teratoma at the time of lymphadenectomy. To our knowledge this is the first case of an intra-abdominal desmoid tumor discovered in this setting. The characteristics and treatment considerations of this unusual tumor are described. Desmoid tumor should be included in the differential diagnosis of tumor recurrence in testis cancer patients previously subjected to post-chemotherapy retroperitoneal lymphadenectomy.

Abdominal Neoplasms↗
PubMed1992

The modeling of breast cancer deaths in Vermont.

Methodologic issues in modeling breast cancer deaths were investigated through modeling the number of breast cancer deaths in Vermont for the period 1975 to 1988. Age-specific incidence rates, case fatality rates, and secular trends of these rates were necessary to represent the observed trend in breast cancer deaths over this time period. Additional information, such as mortality from other causes, stage distribution, or screening history, was not necessary. Incidence and survival information were obtained from a statewide population-based breast cancer registry in Vermont and the Surveillance, Epidemiology and End Results (SEER) program. SEER incidence rates overestimated the actual number of deaths for long-term survival rates. Case fatality rates and secular trends in incidence and survival reported by SEER were appropriate. These results can be applied to the planning of community intervention studies by providing the essential expected numbers of deaths in control communities.

Adult↗
PubMed1992

Surgical treatment of clinical stage A nonseminomatous testis cancer.

Until clinical staging improves, patients presenting with clinical stage A nonseminomatous testis cancer should be offered the option of initial nerve-sparing RPLND versus surveillance. Either method of management may be successful in the individual patient. We feel each patient with clinical stage A disease must be informed of alternative methods of management and be allowed to choose the method of management that he feels best suits his needs in terms of risk benefit.

Efferent Pathways↗
PubMed1991

Relative effectiveness of methods of breast self-examination.

This study investigated the effectiveness of different methods of breast self-examination (BSE) on coverage of breast area and lump detection, using a factorial design, pairing three search patterns (concentric circle, radial spoke, vertical strip) with two finger palpation techniques (small circular movements, sliding movements). Ninety-seven female undergraduates were randomly assigned to one of six BSE training conditions which were identical except in the BSE search pattern and finger palpation technique explained by the instructor. Following the 20-min, small-group training, subjects' coverage of breast area was assessed by scoring their BSE performance on a breast board. Lump detection was determined by the number of lumps correctly identified in silicone breast models. Results indicated that the vertical strip pattern was associated with significantly greater coverage of the breast area. There were no significant differences in lump detection; however, the sliding finger palpation technique resulted in significantly more false identifications of lumps.

Breast Neoplasms↗
PubMed1991

Transverse colon-gastric tube composite reservoir.

We describe our technique for a new form of continent urinary diversion. This reservoir includes a detubularized segment of transverse colon to provide low pressure urine storage, tunneled ureteral reimplants to prevent reflux, and a tubularized gastric segment used as a continent catheterizable efferent limb. This technique provides a new option for continent diversion in a variety of patients.

Colon↗
PubMed1991

Resection of the inferior vena cava or intraluminal vena caval tumor thrombectomy during retroperitoneal lymph node dissection for metastatic germ cell cancer: indications and results.

A total of 42 patients underwent inferior vena caval resection (40) or intraluminal tumor thrombectomy (2) during retroperitoneal lymph node dissection for bulky abdominal metastatic nonseminomatous germ cell cancer (7% of all post-chemotherapy retroperitoneal lymph node dissection cases). The 3 indications for vena caval resection included tumor clearance (38%), vena caval scar occlusion (14%) and vena caval tumor thrombus (48%). En bloc vena caval resection to achieve tumor clearance was justified by subsequent nodal pathology (cancer in 63% of the specimens and teratoma in 31%). Vena caval resection in the presence of scar occlusion was de facto required by virtue of its incorporation in the specimen. Vena caval resection or thrombectomy is indicated for intraluminal tumor thrombus because thrombus pathology (cancer 35%, teratoma 45% and fibrosis 20%) reflected nodal pathology in 71% of the patients with cancer, 78% with teratoma and 100% with fibrosis. The complications of vena caval resection were generally transitory. The 71% survival rate justifies this intensive surgical approach because these patients had exhausted all chemotherapy options.

Adolescent↗
PubMed1991

Early clinical experience with the transverse colon-gastric tube continent urinary reservoir.

The clinical results of the first 4 patients undergoing reconstruction with the transverse colon-gastric tube urinary reservoir are presented. All patients had a minimum 1-year follow-up. All 4 patients are continent with stable or improved renal function. Two patients required reoperation. Indications as well as possible modifications of this procedure are discussed.

Adult↗
PubMed1991

Detection of antisperm-antibodies in patients with primary testicular cancer.

Serum antisperm-antibodies have been noted to develop as a result of various types of testicular pathology and injury. Their presence sometimes correlates with impaired fertility. We examined 52 patients with non-seminomatous low-stage testicular cancer for the presence of serum antisperm-antibodies to determine whether or not auto-immunity is a factor in the depressed fertility known to exist in these patients. Twenty-one per cent were discovered to have serum antisperm-antibodies using an immunofluorescent technique.

Autoantibodies↗