Biomedical subjects

D C Utz

Publications and source records attributed to D C Utz.

At least 55 records · Page 3Linked to original sources

PubMed1980

Management of carcinoma in situ of the bladder: the case for surgical management.

In view of the foregoing observations of the distinctive characteristics of in situ cancer of the bladder, our position on this disease is as follows. The variability in the biologic activity and in the chronicity of carcinoma in situ of the bladder is acknowledged. However, it is clear that most, if not all, cases of invasive bladder cancer represent a progression of the in situ stage, which is usually currently detectable in an undifferentiated or anaplastic cellular state. Until the advent of biochemical predictors of unqualified reliability for the identification of the crucial time of invasion, we recommend radical cystectomy for cure of in situ carcinoma provided the patient is a reasonable surgical risk, is severely symptomatic, has histologic evidence of extension of the lesion into the vesical neck, urethra, or terminal ureter, and has either histologic or cytologic persistence of cancer after a 6 to 12 month course of intravesical chemotherapy. Most patients with incidentally discovered or asymptomatic in situ carcinoma seem to have a more focal variety of the disease. Under these circumstances, a 6 to 12 month trial of intravesical chemotherapy would be reasonable if scrupulous assessment of the progress of the cancer were possible.

Carcinoma in Situ↗

PubMed1979

Primary carcinoma in situ of the ureter and renal pelvis.

Primary carcinoma in situ of the ureter or renal pelvis is rare. We describe 3 patients, each of whom had a different mode of presentation. When malignant cells in the urine from the upper urinary tract are associated with urographic evidence of an appropriate lesion, aggressive surgical therapy is indicated. In the absence of such a urographic abnormality patients with positive cytologic examinations should be followed closely because the exfoliated cells usually are from poorly differentiated neoplasms.

Aged↗

PubMed1979

Urine cytology of transitional cell neoplasms.

The extrinsic and intrinsic factors which influence the interpretation of cytologic findings are explained in detail. Although plagued by limitations that have yielded false-positive and false-negative results, through research, attempts are being made to improve the efficacy of urine cytology in the detection of neoplasms of the urinary tract.

Adult↗

PubMed1978

The treatment of renal cell carcinoma with solitary metastasis.

Between 1950 and 1970, 44 patients (2.5 per cent) with renal cell carcinoma and a solitary metastatic lesion were treated at our clinic. Generally, treatment was aggressive, involving nephrectomy and excision of the metastatic lesion when possible. Patients presenting with the primary and metastatic lesion at the same time did not do as well as patients who presented with metastasis after nephrectomy. An operation for the metastatic lesion seemed to offer the best results in patients who presented with the solitary metastatic lesion after nephrectomy. The prognosis was uniformly poor in patients presenting with the primary and secondary lesion together, regardless of the mode of therapy. However, an operation seemed to be better marginally and did produce an occasional long-term survival.

Adenocarcinoma↗

PubMed1977

Clinical observations on sixty-nine cases of in situ carcinoma of the urinary bladder.

In the course of screening 35,000 urological outpatients with urine cytological examinations, cytological indication of cancer was found in 106 patients in the absence of a cystoscopically visible bladder tumor. Sixty-nine of the 106 patients have biopsy-proven in situ carcinoma of the bladder, all transitional in type and anaplastic. Follow-up data on effects of therapy are available on 58 patients treated by various means, including total cystectomy, partial cystectomy, transurethral fulguration, intravesical thiotepa, and external radiation. The duration of symptoms before diagnosis was remarkably long, and the prolonged course of the in situ lesion was also noteworthy. Differences in the observed behavior of in situ bladder carcinoma may be due, in addition to differences in host resistance, to the existence of two pathogenetic forms of bladder cancer, one arising in an extensive field of abnormal epithelium and the other developing in a focal area of abnormality.

Adult↗

PubMed1976

Postpartum onset of urinary incontinence associated with ureteral ectopia.

The onset of urinary incontinence in adult women in association with extrasphincteric ureteral ectopia is rare. Herein we report 2 cases of this unusual occurrence. The incontinence in both patients began after significant obstetric trauma. Ureteral ectopia should be included in the differential diagnosis of incontinence beginning in the immediate postpartum period.

Adult↗

PubMed1976

Hypernephroma in the solitary kidney: experience with 20 cases and review of the literature.

Twenty patients with renal cell carcinoma in anatomically or functionally solitary kidneys were treated and followed for up to 18 years. Factors pertinent to management and survival of these patients and 66 other well documented similar patients reported in the literature are analyzed. Most of the patients were unusually young and a significant number had had nephrectomy for contralateral renal cell carcinoma. Survival was closely related to the earlier presence of malignant disease in the other kidney, the duration of the interval between detection of the 2 neoplasms and the stage of the lesion in the solitary kidney. Partial nephrectomy has been the most successful treatment. The mean survival in the Mayo Clinic series has been 6 years for patients still alive and 2.4 years for those dead at the time of this analysis. Results in this and other series emphasize the importance of thorough long-term followup after nephrectomy for hypernephroma and of aggressive therapy when the remaining kidney becomes involved. It is foolhardy to abandon hope merely because there is a malignant tumor in a solitary kidney.

Adenocarcinoma↗

PubMed1976

Significance of urinary cytology in the early detection of transitional cell cancer of the upper urinary tract.

Cytologic study of urine from 100 patients with transitional cell cancer of the upper urinary tract revealed that findings on the voided and catheterized specimens correlated well with grade and stage of the tumor. However, there was a significantly greater positive yield with urine specimens obtained by ureteral catheterization than by voiding. Consequently, because concomitant bladder tumors, diagnosed or not, can give questionable positive results ureteral catheterization specimens should be used for cytologic study.

Aged↗

PubMed1976

Morphological and clinical observations of patients with early bladder cancer treated with total cystectomy.

In 21 cases, early bladder cancer was detected by urine cytology, although not by cystoscopy, and was treated by total cystectomy. The neoplasms, all transitional cell carcinomas of moderate to high degrees of anaplasia, were entirely in situ in 17 of the 21 patients; in 4, although mainly in situ, the tumors showed additional minimal microinvasion. Widespread mucosal involvement was demonstrated in every case by step-sectioning, and extension into the prostatic ducts occurred in 7 of the 19 male patients and into the mucosa of one or both distal ureters in 12 patients. Premalignant atypia of the mucosa was also widespread and direct intramucosal spread of cancer cells was a significant factor, particularly along the prostatic ducts and ureters. The duration of significant symptoms (follow-up for 9 years before cystectomy in several cases and for 8 years in 1 histologically proved case) suggests that the evolution of these tumors may be considerably longer than previously documented.

Aged↗

PubMed1975

Inverted papillomas of the urinary bladder.

Study of 20 patients with inverted papilloma of the urinary bladder and urethra revealed that the lesion is a true neoplasm, benign in its histologic morphology and clinical behavior. The lesion is believed to arise from the trigone and bladder outlet as a result of chronic proliferative cystitis. It occurs predominantly in men who are past middle age. The most commonly associated clinical symptoms are hematuria and those of urinary obstruction. The lesion may be easily mistaken for a low-grade papillary transitional cell carcinoma, although the histologic appearance is distinctly different, as is its subsequent behavior.

Adult↗

PubMed1975

Clinical management of carcinoma of prostate, associated with bilateral ureteral obstruction.

A review of 34 cases of bilateral ureteral obstruction secondary to carcinoma of the prostate indicates that aggressive treatment in selected cases can increase survival without an associated increase in morbidity. In our series various modalities of treatment were used in 25 patients and the remaining 9 patients received no treatment. Bilateral ureteral obstruction in cases of carcinoma of the prostate should not uniformly imply a terminal event or hopeless prognosis.

Diethylstilbestrol↗

PubMed1975