Biomedical subjects
Publications and source records attributed to D M Wallace.
All patients attending the Royal Marsden Hospital with urothelial tumours have their occupational histories taken. About 10% of histories suggest a possibility of past exposure to urinary carcinogens, and on examination 4% indicate definite exposures justifying claims for Prescribed Industrial Disease benefit.
228 bilateral pedal lymphograms in patients with bladder cancer have been correlated with the features of the primary bladder tumour and patient survival. In 70 cases, radiographic findings were correlated with operative node histology. The results show that it is not possible to predict accurately which cases have lymphatic spread without this investigation. Positive lymphograms were found in 91 cases, and were associated with a very poor prognosis. Only 6% of patients with unilaterally involved iliac nodes survived 5 years, and all patients with bilateral iliac or para-aortic disease died within 3 years. Histological correlation was found in 90% of cases, and the results indicate that this investigation slightly underestimates the incidence and extent of microscopic lymphatic metastases. It is concluded that this investigation is essential in planning the treatment of infiltrating bladder tumours.
The preliminary results are presented of a multicentre, co-operative randomised trial, sponsored by the Institute of Urology, London, in which radical irradiation (6,000 rads in 6 weeks) is compared with preoperative irradiation (4,000 rads in 4 weeks) plus radical cystectomy for deeply infiltrating carcinoma of the bladder (Stage T3 or B2C). 189 of the 199 cases entered into the trial between 1966 and 1975 were eligible for study. The overall 3- and 5-year survival rates for combined treatment were 41% and 33%, respectively, compared with 28% and 21% for radical radiotherapy. The operative mortality was 7.8%. The difference between the two treatments in favour of the combined treatment has not yet reached the generally accepted level of significance (P less than 0.05), the p factors for the 3- and 5-year results being 0.064 and 0.077, respectively. Of patients receiving the protocol combined treatment, reduction in tumour stage was found in the surgical specimen in 47% of cases. The overall incidence of nodal metastases was 23% (against the usual figure of 40-50%), and in the presence of a good response of the primary tumour to irradiation, only 8%. The 3- and 5-year survival rates for the down-staged cases were 66% and 55%, respectively, compared with 29% and 22% for patients showing no stage reduction in the surgical specimen. The aim of our future studies is to find effective radiosensitising and cytotoxic agents with which to try and increase the incidence and degree of tumour response to pre-operative irradiation in the combined modality treatment of T3 bladder cancers.
Explore the source record for details and available documents.
The case of a patient with cancer of the sigmoid is presented. Thanks to surgical procedures, radiological treatment and chemotherapy, his life was prolonged by 8 years. It is worth noting that the original tumour gave later distant metastases to the ureter, right kidney, bladder, intestines and lymph nodes.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Somatic and meiotic chromosomes have been studied prospectively in 200 subfertile males. The results have been correlated with clinical, seminal and endocrinological features, with histological findings in testicular biopsies and with response to conventional treatment. Somatic chromosome abnormalities were found in 3-5% of cases and variants of the Y chromosome were found in 10-5%. Definite abnormalities in meiotic chromosomes were observed in 20% of these patients, including supernumerary chromosomes, low chiasma frequency and asynapsis, and translocations. Many of these abnormalities occurred as mosaics, presumably a result of meiotic mutation. In 4 cases, a previously unrecognised abnormality in pachynemas has been defined. Absence of meiosis was found in 12% of cases, which correlated well with the histological findings of germinal cell aplasia and elevated urinary FSH levels.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The results of treatment for patients with seminoma of the testis by orchidectomy and irradiation are so satisfactory that retroperitoneal lymph node dissection is no longer practised. However, this operation is still used routinely in some centres for patients with testicular teratomas despite the lack of evidence that it gives better results than those obtained with irradiation followed by removal of lymphographically demonstrable residual tumour and in the face of the high incidence of ejaculatory impotence which follows. On grounds of preservation of sexual function and fertility there is a great advantage to be gained from the latter form of treatment. Thirty-four of our patients between the ages of 25 and 45 years treated by irradiation to the para-aortic and iliac nodes for testicular tumours fathered 52 children to term after their treatment.
Explore the source record for details and available documents.
Explore the source record for details and available documents.