Biomedical subjects
Publications and source records attributed to A Lindner.
The presentation of renal angiomyolipoma as an acute abdominal condition, together with hypovolemic shock, is very rare. 3 such cases are described herein with special reference to the diagnostic problems and recommended management.
The national Prostatic Cancer Project has evaluated single and combination chemotherapeutic agents for the treatment of patients with advanced prostatic cancer that has been unresponsive to hormonal therapy. Although regression rates have been modest, a number of drugs have shown some efficacy and are now undergoing testing in combination. Current trials of the LH-RH agonists and the antiandrogen flutamide are in progress. These trials have demonstrated a role for chemotherapy in the treatment of the patient who has failed hormonal therapy.
To evaluate the cost-effectiveness of liver and bone isotope scans, results of scans were reviewed in 60 patients with renal cell carcinoma. In no patient did the results of the scans influence or change the treatment plan. Routine utilization of radioisotope scans as part of the preoperative evaluation of patients with renal cell carcinoma should be discouraged.
An extended phase II trial of human leukocyte (alpha) interferon was done in 48 patients with measurable metastatic renal cell carcinoma, 43 of whom were evaluable. Of these patients 1 (2.5 per cent) had a complete response that was maintained after 19 months, 6 (14 per cent) had a partial response and an additional 23 per cent had either a minimal response or stabilization of previously growing metastases for greater than 3 months. Toxicity caused termination of treatment in only 1 patient and generally was tolerable. Major toxicity consisted of fever (80 per cent), fatigue (80 per cent) and hematologic toxicity (42 per cent), which was severe in only 2 patients. Characteristics of patients responding to therapy were good performance status, previous nephrectomy and metastases limited to the lungs. The results achieved with human leukocyte interferon were superior to those achieved by immunotherapy or chemotherapy at this and other institutions, and further trials are warranted.
We treated 9 patients with Peyronie's disease for 1 to 8 years in duration with a 4-week course of beta-aminopropionitrile free base as the pure liquid. The drug was applied topically to the plaques twice daily. Patients were followed with ultrasound imaging of the plaques and saline inflations of the corpora cavernosa with photographic documentation of the deformity. No significant adverse effect was noted. Three patients experienced a subjective response but did not demonstrate objective change on the aforementioned studies. It was concluded that topical beta-aminopropionitrile was not effective in reversing the deformity of Peyronie's disease. Further investigation into specific anti-collagen drugs for the treatment of this condition may be warranted.
Since December 1977, 78 patients with severe urinary incontinence have been treated by insertion of an artificial sphincter at our medical center. In 53 patients the device was inserted and activated at the same time. Of these 53 patients 21 (40 per cent) are perfectly dry, 8 (15 per cent) are improved but are occasionally wet and 24 (45 per cent) have failed. In 25 patients activation of the sphincter was delayed. Of this group 14 patients (56 per cent) are perfectly dry, 2 (8 per cent) are occasionally wet and 9 (36 per cent) have failed. The delayed activation technique has reduced the failure rate from 45 to 36 per cent and we recommend its use in high risk patients.
Of 143 prostatic cancer patients treated with radical prostatectomy 38 had undergone transurethral resection of the prostate before the prostatectomy. After radical prostatectomy 5 per cent of the patients who did not have a resection and 8.1 per cent of those who did were severely incontinent. This difference is not statistically significant.
This paper describes our initial clinical findings in a small group of patients with acute oliguric renal failure, who were resistant to extracellular volume expansion and furosemide in large doses. Based on our experience in an experimental model of acute renal failure in the dog, we administered a combination of low-dose dopamine (1-3 micrograms/kg/min i.v.) and furosemide (100-200 mg every 6-8 h). This combination was uniformly effective in inducing a brisk, lasting diuresis and was associated with either stable or reduced serum creatinine levels in two-thirds of the patients. No toxicity was found. These findings would warrant extensive study of this drug combination in a larger, well-controlled, randomized group with oliguric renal failure.
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Blood lymphocytes from rats bearing transitional cell carcinoma (TCC) of the bladder were studied for their cytotoxicity in vitro against xenogeneic YAC-I target and against syngeneic TCC cells. Control lymphocytes were obtained from age and sex-matched syngeneic rats. The following differences were observed: (1) lymphocytes from TCC-bearing rats were cytotoxic to syngeneic TCC target cells whereas those from control rats were not; (2) lymphocytes from TCC-bearing and control rats were cytotoxic to NK sensitive YAC-I cells; however, NK cells from TCC-bearing rats were more adherent to nylon wool-columns than NK cells from control rats. The adherent and non-adherent cells from TCC-bearing rats were both cytotoxic to syngeneic TCC target cells. Levamisole treatment of effector cells from TCC-bearing rats did not affect the NK activity, yet it increased the cytotoxicity of non-adherent cells on TCC target cells. Treatment of the adherent cells with poly-I:poly-C increased slightly their NK activity on YAC-I cells and their anti-TCC cytotoxicity. However, a marked increase in the cytotoxicity by both adherent and non-adherent cell fractions was observed on TCC target cells pretreated with poly-I:poly-C. A disease-related cytotoxicity of lymphocytes from rats bearing TCC has been observed. Treatment of TCC target cells with poly-I:poly-C increased their susceptibility to lysis by the activated effector cells.
A retrospective analysis of 27 patients seen at UCLA in whom transitional cell carcinoma of the bladder developed at age forty or younger was conducted. Forty-one per cent had tumors manifesting known characteristics of aggressive and lethal potential: high histologic grade, muscular invasion, severe epithelial atypia, and frequent multifocal recurrence. One of these patients had extensive pelvic node metastases. The time from the first symptom, usually hematuria, to endoscopic diagnosis exceeded six months in 8 patients. The results of segmental cystectomy were very poor, in the absence of narrowly defined criteria for selection of this mode of therapy. No evidence was found to suggest that transitional cell carcinoma of the bladder in patients forty years of age and under differs clinically or morphologically from that of older patients. Treatment should be determined by the stage of the tumor and other indices of potential lethality.
Vena caval extension of renal cell carcinoma occurs in 4 to 10 per cent of the patients and usually is considered a poor prognostic sign. To ascertain the true effect of vena caval extension on survival a retrospective analysis was done of 27 patients who had undergone radical nephrectomy and removal of vena caval thrombus between 1970 and 1980. An additional 46 cases were collected from series in the literature and composite statistics were compiled. Extension to the vena cava alone had a limited impact on prognosis (survival for 2 years--81 per cent, 5 years--53 per cent, median--81 months). Capsular invasion negatively influenced survival (2-year survival 66 per cent). Disease in the regional lymph nodes had a much greater impact on survival, with a 2-year survival rate of 35 per cent and no patient survived 5 years (median survival 24 months). Only 5 per cent of the patients with distant metastases survived 2 years and none survived 5 years (median survival 8.5 months). In conclusion, the prognosis of patients with vena caval tumor thrombus is influenced primarily by known adverse prognostic factors: capsular invasion, nodal disease and distant metastases. Aggressive surgery in patients with gross nodal involvement or distant metastases is unwarranted since it contributes nothing to survival and only 7 per cent of the patients had significant signs or symptoms secondary to the vena caval thrombus itself. Patients with vena caval extension alone have a cure rate approaching that of patients with stage I renal carcinoma following radical nephrectomy and complete removal of the vena caval thrombus.
To evaluate the cost-effectiveness of liver and bone isotope scans results were reviewed in 114 patients with invasive transitional cell carcinoma of the bladder. In 100 patients cystectomy was performed. In no patient has the results of the scans influenced or changed treatment. Routine use of isotope scans is not warranted for the preoperative evaluation of bladder cancer patients.
Complications and their management in 1,207 cases of semirigid rod prosthesis for erectile failure are presented. Major complications occurred in 7.8 per cent of the cases. Complications and management of 84 cases of impotence treated with inflatable penile prostheses also are discussed. Mechanical problems occurred in 44 per cent of the cases and medical complications occurred in 10 per cent.
Sucking habits and their relationship to posterior cross-bite were studied in 4-year-old children (n = 588) living in the municipality of Huddinge on the outskirts of Stockholm. Previous or persisting sucking habits were registered for 88% of the children with dummy sucking as the dominating type (78%). At the age of 4 years 48% of all children still exhibited some form of sucking habit. The incidence of normal buccolingual occlusion steadily decreased in cases where sucking habits persisted. The increase in unilateral cross-bite occurrence was most pronounced in cases where the children continued sucking after 2 years of age. The variable "intensity of sucking habit" was significantly correlated to the occurrence of unilateral cross-bite (P less than 0.05). From a dental point of view these results indicate that sucking habits in children should be brought under control by 2 years of age.
The value of 111In-oxine platelet imaging to assess abnormal platelet deposition at different vascular access sites was studied in 19 hemodialysis patients. Platelets were labelled immediately following dialysis and imaging was performed 2 and 48 h later; abnormal platelet deposition was defined as a localized increase in activity over time when compared to the opposite, control extremity. 10 patients had bovine grafts, 4 had arteriovenous fistulae, and 5 had Gore-Tex grafts. 111In-oxine platelet imaging demonstrated abnormal platelet deposition in 13 out of 19 patients. Positive images were obtained in some patients with each type of vascular access. Preliminary evaluation showed no clear relationship between image positivity and the history of prior graft occlusion. The imaging method provided in vivo evidence of the efficacy of treatment with the antiplatelet agent sulfinpyrazone in half of the treated patients. Following 1 week of sulfinpyrazone, 200 mg t.i.d., in 6 patients, 3 showed a definite decrease in platelet deposition, 2 showed a probable decrease, and 1 showed no change following therapy. We conclude that platelet imaging may provide organ-specific, in vivo evidence for abnormal platelet deposition in several types of vascular access sites, and may be useful in assessing the thrombogenicity of prosthetic materials and the efficacy of antithrombotic drugs.
Angiotensin-converting enzyme inhibitor was used in dogs with uranyl nitrate-induced acute renal failure to evaluate (1) a possible protective effect of angiotensin blockade and (2)the role of angiotensin II in the generation of renal failure in this model. Angiotensin-converting enzyme inhibitor treatment attenuated the fall in glomerular filtration rate and renal blood flow during the first 6 hours after injection of the nephrotoxic agent. A protective effect of similar magnitude was observed whether angiotensin-converting enzyme inhibitor treatment preceded, or shortly followed, the administration of uranyl nitrate. This indicates that angiotensin-converting enzyme inhibitor delivery to its intrarenal site of action remains effective after administration of the nephrotoxin. In addition, protection of glomerular filtration rate correlated with sodium and renal solute excretion. However, combined treatment with angiotensin-converting enzyme inhibitor and furosemide enhanced solute excretion but did not further improve the protection of renal function. Finally, the protective effects of angiotensin-converting enzyme inhibitor on renal function and hemodynamics were abolished by intravenous indomethacin. In conclusion, early, continuous blockade of angiotensin II protects partially against th initiation of acute renal failure. These findings support a major pathogenic role for angiotensin II in the generation phase of acute renal failure in this model. Furthermore, they suggest that an imbalance between vasoconstrictive (angiotensin II) and vasodilating factors (prostaglandins) may be operative in the early phase of uranyl nitrate-induced acute renal failure in the dog.