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Biomedical subjects

D G Skinner

Publications and source records attributed to D G Skinner.

At least 163 records · Page 9Linked to original sources
PubMed1987

Reassessment of the role of adjunctive surgical therapy in the treatment of advanced germ cell tumors.

We treated 30 patients for stage B3 or B3C germ cell tumors between December 1978 and December 1983. After initial, high dose, platinum-based combination chemotherapy, all patients underwent adjunctive resection of all clinically evident residual disease. Residual malignant elements were found in the retroperitoneum in 35 per cent of 26 nonseminomatous germ cell tumor patients and in 40 per cent of those with residual lesions beyond the retroperitoneum following chemotherapy. After additional chemotherapy, including platinum plus etoposide for patients with residual malignant elements, 80 and 75 per cent of those with stages B3 and B3C disease, respectively, achieved a complete sustained remission at a mean followup of 30 to 38 months, respectively. The strongest predictors of ultimate treatment failure were the presence of extensive pulmonary disease at presentation and the finding of residual malignant elements in resected lesions. Of 4 patients with seminoma 3 achieved sustained complete remission, while 1 died of recurrent embryonal carcinoma. These data support the role of adjunctive resection of clinically evident residual lesions following initial platinum-based chemotherapy in advanced metastatic germ cell tumors, and demonstrate the efficacy of additional platinum-etoposide-based chemotherapy in the 35 to 40 per cent of patients who harbor residual malignant disease in resected lesions.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Continuing experience with the continent ileal reservoir (Kock pouch) as an alternative to cutaneous urinary diversion: an update after 250 cases.

The continent ileal reservoir as conceived by Kock produces a low pressure, high capacity reservoir with continent and nonrefluxing valves constructed from ileum. From August 1982 through August 1985, 250 patients underwent this type of surgery at our institution. Of these patients 171 underwent simultaneous radical cystectomy for cancer, 60 had had a previous urinary diversion of another type and 19 had a neurogenic bladder. Our experience represents a series of expected complications and ongoing modification to the surgical technique. A total of 42 patients (16 per cent) suffered early complication resulting in an operative mortality rate of 2 per cent (5 of 250). One or more late complications necessitating 85 revisions occurred in 77 patients (31 per cent). The end result has been an overwhelming success tempered only by the need for reoperation. It is believed that the surgical modifications described will decrease further the incidence of late complications. The basic surgical premise as conceived by Kock remains a low pressure, high capacity reservoir with continent and nonrefluxing valves that can be constructed from ileum. The concept is sound and offers a genuine alternative to the patient who requires cutaneous urinary diversion.

Adolescent↗
PubMed1987

Management of late complications of the Kock pouch form of urinary diversion.

Urinary diversion via the continent ileal reservoir has been performed at our institution since 1982. During a 3-year period 250 patients have sought this procedure as an alternative to other forms of cutaneous urinary diversion. We analyzed our data in terms of late complications resulting directly from the operation or from this form of urinary diversion. In this context 77 of the 245 patients who survived the operation have suffered 1 or more late complications, requiring 85 reoperations. The late complications mainly have involved problems with continence or ease of catheterization and they were detected within 6 months. We report our experience and describe the technical aspects of treatment.

Adolescent↗
PubMed1987

An update on the Kock pouch for continent urinary diversion.

The authors continue to feel, based on a 4 1/2 year clinical experience in more than 400 patients, that the Kock continent urostomy offers an important alternative to noncontinent forms of diversion. Not only can it provide an improved body image, but the Kock pouch can also help to salvage, both physically and emotionally, those patients with unsatisfactory results from conduit diversion.

Adolescent↗
PubMed1986

Extension of renal cell carcinoma into the vena cava: clinical review and surgical approach.

Between 1972 and 1983, 25 patients were treated for renal carcinoma with tumor extension into the vena cava but without other clinical evidence of disseminated disease. Of these patients 12 had vena caval tumor thrombus extension up to the level of the hepatic veins (group 1), 10 had extension into the intrahepatic vena cava (group 2) and 3 had tumor extending into the right atrium (group 3). A perioperative management plan and an anatomical surgical approach have been developed to allow safe en bloc removal of these extensive tumor thrombi without removal of the vena cava. Successful management is dependent upon preoperative evaluation to determine precisely the extent of the disease, prophylaxis against pulmonary embolism and a well planned surgical method. For patients without evidence of metastatic or perinephric disease, the 5-year actuarial survival rate of 33 per cent is comparable to that of other patients without thrombus. Complete resection was possible in 20 patients (80 per cent), with a 5-year actuarial survival rate of 36 per cent. While patients with metastatic tumor cannot be cured, short-term palliation can be achieved for patients who have an imminent risk of vena caval occlusion or pulmonary embolism by an en bloc removal of tumor and thrombus, even for those with intra-atrial extension. Over-all, operative intervention was successful, with 22 of 25 patients leaving the hospital alive.

Adult↗
PubMed1986

Imaging of the Kock continent ileal urinary reservoir.

The Kock continent ileal urinary reservoir (Kock pouch) is a new urinary bypass system that can overcome some of the principal complications associated with other forms of urinary diversion. It is important to understand the anatomy and radiology of this new technique since radiologists play an important role in evaluating the function of the Kock pouch as well as assessing its complications. The authors review the clinical and radiographic findings in 193 patients who had undergone Kock pouch urinary diversion. Patients are evaluated radiographically in the immediate postoperative period and at regular postoperative intervals for as long as 3 years. Routine evaluation consists of Kock pouch cystography followed by intravenous urography. When indicated, computed tomography, ultrasound, and interventional radiologic procedures are used. The normal anatomy as well as the radiographic appearance of the Kock pouch is presented. In addition, the radiographic appearance of pouch complications and their frequency are reviewed.

Adolescent↗
PubMed1986

[The Kock continent ileal urinary reservoir: surgical technic and clinical results].

From July 1985 through January 1986, 43 patients underwent urinary diversion that included creation of a continent reservoir from an ileal segment, according to the method described originally by Kock. An important modification included removal of a narrow strip of mesentery for 8 cm along the afferent and efferent limbs of the pouch to allow adequate ileal intussusception and fixation of the nipple valves to prevent reflux and to ensure continence. A strip of PGA mesh serves as a collar to fix the afferent-efferent limb to the pouch once the intussusception technique has been accomplished. The use of a narrow Marlex strip allows fixation to the abdominal wall both lateral and medial to the stoma site (insert). This strip is important in preventing a parastomal hernia and helps fix the continence valve mechanism to the posterior abdominal wall. Previous urinary diversion was by ureterosigmoidostomy in 2 patients, standard ileal conduit in 8 and chronic dialysis after nephrectomy of solitary kidney and cystectomy in 1. A total of 32 patients underwent simultaneous anterior exenteration or radical cystectomy for pelvic malignancy. There were 4 postoperative deaths and early complications occurred in one patient. Late complications occurred in only 3 patients: they required reoperation and revision of the continence valve mechanism. The end result in 39 of 43 patients has been an overwhelming success. Patients perform self-catheterization every 4 to 6 hours during the day and once at night for volumes ranging up to 1,400 cc. Serum electolytes have remained normal in all patients. X-ray of the Kock pouch have shown no evidence of reflux, and all excretory urograms have demonstrated either normal upper tracts without obstruction or improvement in patients with preoperative hydronephrosis. Although preliminary, this clinical trial suggests that the quality of life for patients considered previously to be candidates for cutaneous diversion can be improved markedly by a modified Kock continent ileal reservoir. During the same time, 21 patients out of 278 patients who underwent creation of a Kock continent ileal urinary reservoir since August 1982, underwent revision of Kock pouch. Two of those required subsequent reoperation and revision of the continence valve mechanism. The end result in all patients has been an overwhelming success.

Adult↗
PubMed1986

Recombinant interferon alpha-2 (INTRON A) in a phase II study of renal cell carcinoma.

Because two of five patients with renal cell carcinoma in a Phase I study had partial response to recombinant alpha-2 interferon (IFN), we treated 26 patients with advanced renal cell carcinoma with a 3-month regimen of IFN. Patients were randomized to receive IFN either subcutaneously (2 X 10(6) IU/m2 3 times a week) or intravenously (3 X 10(7) IU/m2 for 5 consecutive days every 2-3 weeks). Patients whose disease was responding or stable were treated further, while those with progressive disease on subcutaneous treatment were offered intravenous therapy. Sites of metastasis included lung (14 patients), bone (7 patients), soft tissue (7 patients) and liver (2 patients). Twenty patients were evaluable for response. One patient had a partial response at the end of the third course of intravenous IFN and subsequently had complete disappearance of a 12 X 7 cm subcutaneous mass after the seventh course of treatment. The disease was stable in 13 patients including two minor responses, and six patients had progressive disease (5 with subcutaneous treatment; 1 with intravenous treatment) including one mixed response. All patients experienced early flu-like symptoms of fever, chills, and rigors during the first few days of treatment and most had mild to moderate fatigue. Three patients left the study because of fatigue, and one had an urticarial rash. From these results and our previous experience, it appears that IFN has activity against renal cell carcinoma with acceptable toxicity.

Adult↗
PubMed1985

Seminoma with elevated human chorionic gonadotropin. The case for retroperitoneal lymph node dissection.

An elevated serum level of human chorionic gonadotropin (HCG) in a patient whose primary tumor histologically appears to be a pure seminoma implies the presence of syncytiotrophoblastic giant cells either detectable by careful step sectioning of the primary tumor or present in metastatic disease. Inasmuch as the malignant potential and radioresponsiveness of syncytiotrophoblastic giant cells are unknown and the serum elevation of HCG may signal metastatic embryonal carcinoma, retroperitoneal lymph node dissection with adjuvant chemotherapy dependent on pathologic staging should be considered for patients with seminoma and postorchiectomy elevated HCG levels. An illustrative case is herein reported.

Adult↗
PubMed1985

Emphysematous pyelonephritis: a 5-year experience with 13 patients.

Emphysematous pyelonephritis is a life-threatening necrotizing renal infection characterized by the production of gas. Of 8,105 admissions to our diabetes service during the last 5 years we identified 13 cases. The patients were managed aggressively with fluids and antibiotics, followed by immediate nephrectomy. The mortality rate is 40 to 50 per cent, primarily owing to sudden septic complications.

Adult↗
PubMed1985

A simple and practical technic for detecting cancer cells in urine and urinary bladder washings by flow cytometry.

DNA measurement by flow cytometry has been demonstrated to be a potentially useful technic in the diagnosis of bladder cancer by detecting neoplastic cells in bladder washings and urine specimens. The authors' goal was to develop a simple and practical method utilizing the new generation of cytofluorographs designed for use in the clinical laboratory. This method combined direct fixation with cell lysis yielding fixed intact nuclei. Following RNase and pepsin digestion, the nuclei were separated from debris and aggregates on a sucrose barrier, stained with ethidium bromide, and analyzed with an argon laser analytic cytofluorograph. Urines and bladder washings from 14 patients with positive urinary cytology and histologically diagnosed bladder cancers were compared with specimens from patients without urothelial malignancies. DNA histograms clearly delineated aneuploid from diploid populations and often identified S, G2M, and G1 phase nuclei. Aneuploid populations have been detected in all tumor specimens with positive cytologies studied to date.

Aged↗
PubMed1984

Vena cava tumor thrombus from renal cell carcinoma arising from adrenal vein.

Renal cell carcinoma is a highly vascular tumor with the propensity to propagate along venous channels. Vena cava tumor thrombi are reported to occur in approximately 4-10 per cent of cases and requires modification of the standard radical nephrectomy. We report the first 3 cases of vena caval tumor thrombus emanating not from the renal vein, but from the adrenal vein. The recognition of this occurrence is essential in order to avert an intraoperative catastrophe.

Adenocarcinoma↗
PubMed1984

Current status of adjuvant chemotherapy after radical cystectomy for deeply invasive bladder cancer.

Between March, 1976, and December, 1982, 70 of 157 patients (45%) undergoing single-stage radical cystectomy with pelvic lymphadenectomy and urinary diversion with the intent to cure invasive bladder cancer were found to have pathologic Stage P3B, P4 and/or N + disease. Thirty-four of the 70 patients received adjuvant prophylactic chemotherapy after cystectomy and 36 patients were followed expectantly. From 1976 through 1977 adjuvant chemotherapy consisted of cyclophosphamide 1 Gm/M2 each month for six months; from 1978 through June, 1980, adjuvant chemotherapy consisted of cis-platinum 100 mg/M2 each month for four months with the exception of 1 patient treated more aggressively with combination chemotherapy (CISCA). Since July, 1980, a prospective study has been utilized in which patients were randomized into two groups, Group A receiving combination chemotherapy and Group B followed up expectantly; adjuvant chemotherapy appears to result in a slight delay in time to relapse but no influence in overall survival was observed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Bilateral renal cell carcinoma and renal cell carcinoma in the solitary kidney.

We report on 43 patients with renal cell carcinoma in a solitary kidney, 39 of whom underwent a potentially curative resection. Of 36 patients who had a nephron salvaging procedure only 4 required ex vivo surgical resection. The survival curves of patients with solitary or bilateral lesions are similar, and depend more on the adequacy of tumor resection and tumor stage than on the fate of the contralateral kidney. Crude survival in this series was 64 per cent for patients followed for more than 1 year.

Adenocarcinoma↗