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Results of Clinical Studies
Many of you signed up for participation in studies that were overseen
by the joint Committee on Clinical Investigation at The Johns Hopkins
Hospital. I am most grateful for your participation and would like
to share with you a brief summary of some of the results.
MRI STUDY
In an effort to identify spread of cancer beyond the prostate,
some of you participated in our study of MRI using the endorectal
coil. Although this technique provides excellent images of the
prostate, it did not improve the ability of the radiologist to detect
spread of cancer beyond the prostate. The reason for this is becoming
increasingly clear. When prostate cancer cells escape the prostate,
they creep along the edges of the gland just millimeters away from
the edge as they progress toward the seminal vesicles. Unfortunately,
it is almost impossible to detect this microscopic spread.
HEMODILUTION STUDY
In an effort to reduce the need for autotransfusion of blood, we
evaluated a technique known as hemodilution. At the time of surgery,
just after the epidural anesthetic is placed, 3 units of blood were
drawn acutely from the patient and the blood volume was restored using
solutions containing salt and starch. At the end of the case all 3
units were readministered to the patient. We learned that this
technique was as safe and as effective as the donation of 3 units of
blood prior to surgery However, this technique can only be used in
patients who have an excellent cardiovascular status.
- Ness, P.M., Bourke, D.L., and Walsh, P.C.: A randomized
trial of perioperative hemodilution versus transfusion of
preoperatively deposited autologous blood in elective surgery.
Transfusion 32:226-230, 1992.
EPIDURAL STUDY
In an attempt to improve the techniques of pain control, we evaluated
the use of ketorolac, a non--steroidal anti-inflammatory agent
similar to Motrin or Advil that can be given intravenously. We
learned that ketorolac not only improved pain control but also
permitted bowel function to recover more rapidly. As a result of
this study, and studies at other institutions, ketorolac is now
playing a major role in the postoperative management of patients.
We now understand that most of the nausea which occurred following
surgery was caused by the narcotic pain medications and that by
eliminating narcotics from postoperative pain control we can now
discharge patients on their 4th or 5th postoperative day.
- Grass, J.A. et. al.: Assessment of ketorllacasan
adjustment to fentanyl patient-controlled epidural analgesia after
radical retropubic prostatcctomy. Anesthesiology 78:642-648, 1993.
NERVE-GRAFT STUDY
Experimentally we demonstrated that nerve grafts restored sexual
function in rats. We then embarked upon a study to determine whether
or not nerve grafts would improve the recoverv of sexual function
in men who underwent wide excision of one nerve. Many of you had
18 months of suspense waiting to find out whether or not you
underwent a nerve graft. By now that suspense is over.
Unfortunately, we were not able to answer the question about whether
nerve grafts worked because too few patients required wide excision
of their nerves. This actually is good news because it demonstrates
how prostate cancer today is being detected at an earlier more
curable stage. Unfortunately, we may never know the answer to this
question.
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