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Biomedical subjects

D G Skinner

Publications and source records attributed to D G Skinner.

At least 127 records · Page 7Linked to original sources
PubMed1991

Radiotherapy following radical prostatectomy in patients with adenocarcinoma of the prostate.

From 1973 to 1986, 160 patients with adenocarcinoma localized to the prostate were treated with radical prostatectomy and pelvic lymphadenectomy. In 78 (49%) patients more advanced stage of disease was found at surgery and they received local pelvic irradiation (RT). This consisted of 45 Gy for microscopic and 55 Gy for macroscopic residual disease. RT was given at 1.8 Gy a day, using the four-field "box" technique with the 23 MV X ray beam. Pelvic lymph node metastases were found in 28 (36%) patients who, in addition to RT, received systemic therapy: 20 with cyclophosphamide alone, 4 combined with 5-Fluorouracil, and 4 patients received DES. The 5- and 10-year overall actuarial survival was 95 and 77%, respectively, and the 5- and 10-year disease-free survival was 58 and 43%, respectively. Recurrent tumor was found in 34 (44%) patients. Of these 34 patients, 32 (94%) had distant metastatic tumor and 2 (6%) had local recurrence in the pelvis. The presence of metastatic disease in pelvic lymph nodes had clinical significance since it influenced disease-free survival and the incidence of tumor recurrence. The 10-year disease-free survival for the 50 patients with no lymph node metastases was 51%, as compared to 28% for the 28 patients with such metastases, p = 0.001. Similarly, recurrent tumor was found in 28% of the former and 68% of the latter patients, p = 0.002. Other important parameters predicting recurrence were: clinical stage, p = 0.018, histological grade, p = 0.013, and Gleason's grade, p = 0.002. This treatment program was very well tolerated and of low toxicity. There was no surgical mortality. Surgical complications were seen in 10 (13%) patients including: minor in 5 and major in 5. At 1 year, 77% of the patients remained continent, while 10% had mild stress incontinence. Of the remaining 13% only 3 (4%) patients had severe incontinence (greater than 5 pads daily). RT toxicity was mild with 38% experiencing diarrhea. Severe toxicity was seen in 2 (3%) patients who, early in the study, developed scrotal and lower extremity edema. Severe chemotherapy complications were seen in 1 (4%) patient who had severe neutropenic sepsis. Postoperative radiotherapy is a well tolerated, safe and effective treatment in patients who have microscopic or macroscopic residual tumor following radical prostatectomy.

Adenocarcinoma↗
PubMed1991

Lower urinary tract reconstruction following cystectomy: experience and results in 126 patients using the Kock ileal reservoir with bilateral ureteroileal urethrostomy.

Between May 1986 and February 1990, 126 consecutive men underwent lower urinary tract reconstruction by means of bilateral ureteroileal urethrostomy using a Kock ileal reservoir. The early complication rate was 11.1%. Late complications requiring rehospitalization or reoperation have been surprisingly few: 1 for prolapse of the afferent antirefluxing nipple valve, 1 for calculi and 4 for artificial urinary sphincter placement due to unsatisfactory continence. Good continence has been achieved in 94% of the patients during the day and in 84% at night. Tumor recurred in the pelvis in 5 patients, with 4 requiring cutaneous urinary diversion. All patients had progression or died of metastatic disease. Our experience has yielded extraordinary results in terms of patient acceptance with few late complications or need for reoperation.

Adult↗
PubMed1991

The role of adjuvant chemotherapy following cystectomy for invasive bladder cancer: a prospective comparative trial.

We assigned 91 patients with deeply invasive, pathological stage P3, P4 or N+ and Mo transitional cell carcinoma of the bladder (with or without squamous or glandular differentiation) to adjuvant chemotherapy or to observation after radical cystectomy and pelvic lymph node dissection. For most patients chemotherapy was planned as 4 courses at 28-day intervals of 100 mg./M.2 cisplatin, 60 mg./M.2 doxorubicin and 600 mg./M.2 cyclophosphamide. A significant delay was shown in the time to progression (p = 0.0010) with 70% of the patients assigned to chemotherapy free of disease at 3 years compared to 46% in the observation group. Median survival time for patients in the chemotherapy group was 4.3 years compared to 2.4 years in the observation group (p = 0.0062). In addition to treatment groups, important prognostic factors included age, gender and lymph node status. The number of involved lymph nodes was the single most important variable. We recommend adjuvant chemotherapy for patients with invasive transitional cell carcinoma after definitive surgical resection.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Urinary tract stones: a complication of the Kock pouch continent urinary diversion.

Urinary tract stone disease has been found to be a later complication associated with the construction of the Kock pouch continent urinary diversion. Of 383 patients who underwent Kock pouch diversion between August 1982 and December 1986 stones developed in the pouch in 64 (16.7%), usually on exposed staples or eroded Marlex used to construct the nipple valves. Stones have recurred in 13 of the 64 patients (22%). Most stones were removed endoscopically with techniques similar to those used for percutaneous stone removal. Risk factors for stone formation include Marlex collar erosion and acute pyelonephritis. Changes in surgical techniques with elimination of the Marlex collar and a reduction in the number of staples have reduced the incidence of this later complication to 10%.

Female↗
PubMed1991

Primary adenocarcinoma of bladder.

Between April 1983 and December 1987, we have treated and followed 16 patients at the University of Southern California for adenocarcinoma of the bladder. In 10 patients, the cancer originated from a nonurachal source; all underwent radical cystectomy, bilateral pelvic lymph node dissection, and urinary diversion. The other 6 patients had an apparent urachal origin of their cancer. Half of these patients were treated with radical cystectomy and urinary diversion and half were treated initially with segmental cystectomy. Presenting characteristics (age, sex ratio, and symptoms) were similar for both groups. Three-year adjusted acturial tumor-free survival rates for the two groups were 48 percent and 31 percent, respectively. We advocate an aggressive approach of radical cystectomy, bilateral pelvic lymph node dissection, and urinary diversion for all invasive adenocarcinoma of the bladder, regardless of location.

Actuarial Analysis↗
PubMed1991

Kock pouch bladder replacement.

Between May 1986 and February 1990, 126 consecutive male patients have undergone lower urinary-tract reconstruction by means of Kock bladder replacement at our institution. The early and late complication rates have been minimal. Good continence has been achieved in 94% of patients during the day and in 84% at night. Our experience with bladder replacement has yielded extraordinary results in terms of patients acceptance. It is anticipated that our experience as well as the experience of others with this surgery will encourage patients afflicted with high-grade bladder cancer and their physicians toward an earlier decision for aggressive therapy by cystectomy while cure is still possible.

Adult↗
PubMed1990

Allelic loss of chromosome 17p distinguishes high grade from low grade transitional cell carcinomas of the bladder.

Forty-three transitional cell carcinomas of the bladder of differing grades and stages were examined for reduction to homozygosity for chromosomes 9q, 11p, and 17p. Allelic loss of chromosome 9q was seen in 24 of 38 informative grades II, III, and IV tumors providing further evidence for a bladder tumor suppressor gene on this chromosome. In contrast to the grade-independent involvement of chromosome 9q, allelic losses of chromosomes 11p and 17p were seen only in grade III and IV tumors. The results with chromosome 17p were particularly striking and showed that 0 of 10 grade II versus 20 of 31 grade III and IV tumors had allelic losses for this chromosome harboring the p53 tumor suppressor gene often mutated in other human cancers. The data suggest that cumulative genetic damage is sustained in transitional cell carcinomas and that one of the underlying molecular mechanisms distinguishing low grade from high grade tumors involves chromosome 17p.

Alleles↗
PubMed1990

Allelic losses of chromosomes 9, 11, and 17 in human bladder cancer.

Twenty-five human bladder tumors were examined for loss of heterozygosity of markers on chromosomes 6p, 9q, 11p, 14q, and 17p. These studies show that all of the markers were reduced to homozygosity in at least some of the tumors. They also confirmed earlier studies by Fearon et al. [Nature (Lond.), 318: 377-380, 1985] that approximately 40% of bladder tumors were reduced to homozygosity for markers on chromosome 11p. However, the greatest frequency of allelic loss was seen for chromosomes 9q (67% of informative cases) and 17p (63% of informative cases) with both chromosomes being lost concordantly in 10 out of 20 informative tumors. Allelic loss of chromosome 9q has not been previously observed with other human cancers; however, deletions of 17p have been reported in breast, lung, and colorectal carcinomas. The data raise the interesting possibility that allelic losses of specific chromosomes might be a feature of cancer in a particular differentiated cell type whereas loss of other chromosomes harboring more generally acting tumor suppressor genes might be a common feature of human cancers.

Alleles↗
PubMed1990

Development of upper tract carcinoma after cystectomy for bladder carcinoma.

Two hundred twenty patients who underwent a radical cystectomy and en bloc pelvic lymph node dissection with urinary diversion were reviewed to define the incidence of upper tract carcinoma developing after cystectomy. Each patient was followed for at least five years or until death. In 5 of 220 (2.4%) upper tract lesions developed, with a disease-free interval from cystectomy of twenty-two to fifty-four months. All patients died within two to twenty-seven months of diagnosis. Common pathologic features included the presence of high-grade multifocal lesions or carcinoma in situ (CIS) in the cystectomy specimen, tumor invasion of the intramural ureter, and positive findings on urethrectomy specimens. Although the incidence of this disease process is low, heightened surveillance of the upper urinary tracts would seem appropriate in patients displaying these pathologic features.

Aged↗
PubMed1990

The role of radical cystectomy in the management of high grade superficial bladder cancer (PA, P1, PIS and P2)

Between January 1979 and 1987, 411 consecutive patients were considered candidates for bilateral pelvic iliac lymph node dissection and radical cystectomy for the management of bladder cancer. From this group 160 were identified as having pathological stage P2 or less disease, including 11 who also had positive nodes. The 5-year actuarial survival rate for the respective stages at 95% confidence limits was 100% for stage P0/A, 80% for stage P1, 78% for stage P1 with stage PIS, 85% for pure stage PIS, 76% for stage P2 and 87% for stage P2 with stage PIS. Additionally, we identified a group of patients with stage P2 transitional cell carcinoma who were at significant risk for development of metastatic disease. Of 46 patients with stage P2 transitional cell carcinoma 18 had vascular space invasion resulting in 6 of 18 cancer-related deaths (33%). Our study demonstrates that radical cystectomy has been highly effective in curing patients with high grade superficial disease, including those with superficially invasive disease associated with nodal metastases.

Carcinoma, Transitional Cell↗
PubMed1990

Nonrefluxing ileal ureteral replacement using the intussuscepted ileal nipple: laboratory studies.

A new technique for nonrefluxing ureteral replacement using ileum has been developed. Five adult mongrel dogs were operated using this nonrefluxing ileal ureteral technique. Subsequent reoperation showed in every case the preservation of renal function, a nonrefluxing system and no evidence of pyelonephritis or hydronephrosis. Based on the intussuscepted ileal nipple used in the Kock continent ileostomy, this technique has application in candidates for urinary undiversion, situations of ureteral loss due to trauma and fibrosis, and in patients with tuberculous strictured ureters.

Animals↗
PubMed1990

Total pelvic exenteration with simultaneous bowel and urinary reconstruction.

The technique of total pelvic exenteration with simultaneous bowel and urinary reconstruction is described as a surgical option for the management of pelvic sarcoma in adults and for highly selected patients with other types of advanced pelvic malignancy. The surgical technique is presented in detail as performed in a 43-year-old man who presented with extensive primitive pelvic sarcoma. We believe that this approach may provide the benefits of an exenterative operation without the undesirable psychosocial sequelae of a permanent colostomy and external urinary diversion.

Adult↗
PubMed1990

A juvenile animal model to study the growth potential of bowel segments in the urinary tract.

A juvenile animal model has been developed to study the growth potential of ileum in the urinary tract. Patch ileocystoplasties of known surface area were constructed in dogs of Group 1. Nonrefluxing ileal nipple valves of known length were created to replace one ureter in dogs of Group 2. After the juvenile animals grew and at minimum doubled their weight, they were reoperated and augmentation surface areas were remeasured at various physiologic intravesical pressures. Nipple valve lengths were remeasured after cystograms ruled out reflux. Results show that the bowel augmentation and an identical control segment increased in surface area proportionate to animal growth and that hydrostatic dilation caused further surface area increase. Nipple valves did not grow and in fact shortened, but remained nonrefluxing. The conclusion is that in the pediatric population, consideration should be given to downscaling the size of bladder augmentations or diversions in anticipation of future bowel growth, but that one should not shorten the ileal nipple valves.

Animals↗
PubMed1989

The value of regional lymph node dissection in genitourinary cancer.

Regional lymph node dissection in the management of genitourinary (GU) neoplasms is controversial but is based on a 17 year clinical experience and the achievement of survival figures as good or better than those achieved by any other modality of therapy. Lymphadenectomy has proved to be effective in curing patients with metastatic testicular cancer, renal cell carcinoma and transitional cell carcinoma. Its efficacy in prostate cancer is much less certain and remains largely a staging procedure.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Prospective study of metabolic abnormalities in patient with continent Kock pouch urinary diversion.

Metabolic alterations as a result of bowel being employed in the urinary tract are well documented. To investigate this phenomenon in the continent ileal reservoir urinary diversion, 106 patients who had undergone Kock pouch surgery were followed in a prospective study at the University of Southern California between 1985 and 1987. Serum chemistries and urine osmolality determinations were performed approximately every three months for a year. Mean patient values for each time period were then compiled and compared with the norms and with the preoperative values. The mean serum electrolyte values were found to be within normal limits during all follow-up periods. Fourteen patients were identified, however, as having values falling intermittently outside of the normal range. These patients were investigated and found to be abnormal during episodes of acute renal failure usually secondary to dehydration or obstruction at which time they usually became acidotic and occasionally hyperchloremic. These problems disappeared when the renal failure was corrected. This study corroborated our previously reported findings that hyperchloremic acidosis or other metabolic alterations requiring replacement therapy do not routinely occur in this population.

Acute Kidney Injury↗
PubMed1989

Intravenous papaverine in constructing continent urinary reservoir.

The use of intravenous papaverine as an adjunct in the construction of a continent urinary reservoir is a safe and effective method to facilitate an important but sometimes restrictive portion of this procedure. Additionally, it does not seem unreasonable to extend this technique to other procedures which involve the use of small bowel.

Humans↗
PubMed1989

Results of local and/or systemic adjuvant therapy in the management of pathological stage C or D1 prostate cancer following radical prostatectomy.

Between 1976 and 1984, 47 of 108 patients (44%) who underwent radical retropubic prostatectomy and pelvic lymphadenectomy for clinical stage A2 or B adenocarcinoma of the prostate were found to have pathological stage C or D1 disease. A total of 31 consecutive patients with pathological stage C disease received 45 to 55 Gy. adjuvant external beam radiation postoperatively. Actuarial 5 and 10-year survival rates free of disease were 92%, with a local recurrence rate of 3% and a distant recurrence rate of 6% at a mean followup of 5 years. Sixteen consecutive pathological stage D1 cancer patients received 45 to 60 Gy. adjuvant external beam radiation alone (4), adjuvant cytotoxic chemotherapy alone with cyclophosphamide (5) or combined adjuvant radiation and chemotherapy (7). Actuarial 5 and 10-year survival rates free of disease were 86% with no local recurrences and a distant recurrence rate of 12% at a mean followup of 5 years. These results provide further evidence to support the use of adjuvant external beam radiation therapy in the management of pathological stage C disease. Our preliminary results suggest that an aggressive, multidisciplinary approach is warranted in pathological stage D1 disease and that adjuvant chemotherapy, with or without adjuvant radiation, may have a role in prolonging survival free of disease in this high risk group.

Combined Modality Therapy↗