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Biomedical subjects

E E Fraley

Publications and source records attributed to E E Fraley.

At least 37 records · Page 2Linked to original sources
PubMed1988

Radiation therapy as adjuvant treatment after radical prostatectomy.

Between 1977 and 1984, adjuvant radiation therapy was administered after radical prostatectomy to 71 patients at high risk for recurrence of carcinoma of the prostate. In 35 patients, tumor remained at the surgical margin (stage C2 disease) and/or the disease had invaded the seminal vesicles (stage C3). Thirty-six patients had microscopic metastases in the pelvic lymph nodes (stage D1a). Radiation therapy was administered only after full recovery from surgery, which included full recovery of continence. The average period between surgery and initiation of radiation therapy was 3 months. Serious or long-term complications attributable to irradiation occurred in 7% of the patients. Tumor recurred locally in only 2 patients. Five-year actuarial survival, disease-related survival, and disease-free survival for patients with stage C2 and C3 disease were 86%, 96%, and 80%, respectively. These survival values for patients with stage D1a disease were 74%, 90%, and 69%, respectively. Our results suggest a greater therapeutic benefit from radical prostatectomy and adjuvant radiation therapy than from radical prostatectomy alone for stages C2 and C3 disease or from radical prostatectomy alone or radiation therapy alone for stage D1a disease; however, the length of follow-up, number of patients treated, and problems in comparing our results with those from historical controls do not allow us to draw firm conclusions about the benefits of this combined therapy. Controlled, randomized studies clearly are required. The serum levels of prostate-specific antigen, but not prostatic acid phosphatase, were invariably elevated in patients at the time of clinical detection of disease recurrence and predicted recurrence up to 4 years before the event.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Neoplasm↗
PubMed1988

Circadian-based infusional chrono-chemotherapy controls progressive metastatic renal cell carcinoma.

We treated 25 patients with progressive metastatic renal cell carcinoma with continuous infusion of 5-fluoro-2-deoxyuridine (FUDR) by implanted pump. FUDR was infused for 14 days at monthly intervals. Starting dose was 0.15 mg/kg/day intravenous or 0.25 mg/kg/day intra-arterial; intravenous doses were increased or decreased in increments of 0.025 mg/kg/day as permitted by toxicity. Circadian time modification of the infusion shape (sinusoidal with the peak centered around 6 p.m.) significantly lowered serious intravenous infusion-associated toxicity, allowing higher dose intensity. In 24 evaluable patients, two complete responses (8%), six partial responses (25%), and one minor response were seen. One secondary partial response was observed after infusional velban (total objective response rate 37.5%). Previously progressive disease was controlled in greater than 80% of our patients. During a median follow-up period of 8 months (range of 2-26 months), the overall survival for all 25 patients is 75%. Our results indicate that metastatic renal cell cancer responds to infusional chemotherapy and that the circadian shape of infusion markedly affects our ability to deliver effective doses.

Adult↗
PubMed1987

Primary adenocarcinoma of urinary bladder. Clinicopathologic study of 16 cases.

The clinicopathologic and immunohistochemical features of 16 pure adenocarcinomas primary in the urinary bladder were reviewed. Only 3 patients were found to have disease confined to the urinary bladder. Of 13 cases with follow-up only 3 are free of disease. Histologically, the tumors were classified as signet ring cell (3), colloid (3), colonic type (5), clear cell (1), and not otherwise specified (NOS, 4). Immunohistochemically, all tumors but one colloid carcinoma were immunoreactive for cytokeratin and epithelial membrane antigen, and most tumors were likewise immunoreactive for carcinoembryonic antigen. Eight cases were immunoreactive for Leu M1 antigen. Prostate specific antigen, S-100 protein, and placental alkaline phosphatase were uniformly negative. No correlation between immunohistochemical profile and histologic type or clinical outcome was found. The utility of immunohistochemistry and other pathologic findings is reviewed.

Adenocarcinoma↗
PubMed1987

Bladder replacement after cystoprostatectomy: efforts to achieve total continence.

Total bladder replacement with tubular sigmoid colon and detubularized ileocecal bowel segments was performed on 17 patients after cystoprostatectomy for bladder cancer. There were few complications and patient acceptance was excellent. Daytime continence was achieved in most patients but voiding patterns were superior with detubularized segments. However, enuresis was common with both segment types. Total urinary continence (day and nighttime continence) was achieved in 7 patients with an artificial urinary sphincter that was activated only at night. Total bladder replacement is an acceptable form of urinary diversion after cystoprostatectomy in appropriate patients.

Aged↗
PubMed1987

Fertility issues in the therapy of nonseminomatous testicular tumors.

Given the data described herein, there is reason for even greater optimism about the possibility of fertility among patients with testicular cancer. Fertility issues have been and will continue to be important as different therapies for nonseminomatous cancer are proposed. For example, we previously calculated that the difference in fertility between patients who are treated with expectant therapy versus lymph-adenectomy for clinical stage I disease was only 16 patients in favor of expectant therapy. If new data on relapse rates after expectant therapy (e.g., 30 per cent) and better ejaculation preservation rates after lymphadenectomy (e.g., 85 per cent) are incorporated into this calculation, the number benefited falls to 6 patients. It has also been proposed that patients with low-volume stage IIB disease should receive initial chemotherapy and that lymphadenectomy should be reserved for those patients with residual disease. Applying these calculations along with certain additional assumptions, the difference in fertility between these two treatment alternatives is only 4 patients in favor of initial chemotherapy (P.H. Lange; manuscript in preparation). However, this approach has significantly greater toxicity. Much more must be done to improve our understanding and management of infertility in patients with testicular cancer. Additional tasks include the need to establish the exact ratio of patients with testicular cancer who have infertility that precedes or is a result of their disease, and to develop methods for predicting fertility status so that treatment can be tailored accordingly. Also, we must consolidate and improve the indications, techniques, and results for fertility-sparing lymphadenectomy in ways that have been described herein. In addition, the exact damage-to-benefit ratio for the number of courses and types of chemotherapy administered to patients will need to be studied carefully and prospectively, preferably in cooperative groups. The accelerating advances in in vitro fertilization and cryopreservation must be watched carefully, and their application to appropriate patients with nonseminomatous cancer should be encouraged. Cryopreservation before therapy should continue to be advocated. All of these tasks are extremely difficult because they require precise analysis of carefully generated statistics and difficult judgments about individual human values.

Humans↗
PubMed1985

Cancer of the penis. Prognosis and treatment plans.

Sixty-one patients with clinical low-stage (Jackson Stage I) and 22 patients with clinical high-stage (Jackson Stage II or III or T3-4N0-1M0) carcinoma of the penis who were seen between 1952 and 1979 and followed for at least 3 years or until death were reviewed. The majority of patients with Stage I cancer were treated with partial penectomy, either with or without ilioinguinal lymphadenectomy. The remainder of patients with these early small lesions were treated with local excision or circumcision. Forty-one of the patients with this early penile cancer (Jackson Stage I or Tcis, T1N0M0 or T2N0M0) survived at least 3 years and were considered cured. The other 20 patients died of cancer (12 cases) or unrelated disease (8 cases). If the patients who died of other diseases are excluded, the corrected 5-year survival rate was 77%. Treatment failure was primarily due to metachronous inguinal metastases after initial treatment of the primary tumor and failure of response of metastatic disease to salvage treatment. Four factors probably were associated with a poor prognosis: large primary tumor, moderately to poorly differentiated cancer, younger age at onset, and inadequate initial treatment. In advanced (Jackson Stages II and III) disease, treatment by partial or total penectomy alone or in combination with radiation to inguinal nodes after penectomy produced 3-year or longer survival in only 2 of 9 patients, whereas treatment by early extended excision of both the primary lesion and the ilioinguinal lymph nodes produced 3-year or longer survival in 11 of 13 patients. The results suggest that local excision is appropriate only for carcinoma in situ. Partial penectomy and monthly follow-up for at least 1 year is appropriate for patients with small, well-differentiated primary tumors. Patients who have large or moderately to poorly differentiated primary tumors probably should undergo partial or total penectomy and immediate ilioinguinal lymphadenectomy.

Adult↗
PubMed1985

Surgical treatment of patients with stages I and II nonseminomatous testicular cancer.

We analyzed treatment outcomes for 98 consecutive patients who underwent retroperitoneal lymphadenectomy for nonseminomatous germ cell testicular cancer between 1972 and early 1979. There were no surgical deaths. Major and minor complications occurred in 8 and 15 patients, respectively. Of the 57 patients with pathological stage I tumors 9 (16 per cent) had recurrences and were given chemotherapy, and all 57 are well 2 or more years after completion of treatment. Of the 12 patients with stage IIA disease who received no adjuvant treatment 5 had relapse, 2 of whom died. Relapse occurred in 13 of 14 patients with stage IIB disease who received no adjuvant treatment and 2 of 4 who received adjuvant radiation. All 3 patients with stage IIC tumor who received no adjuvant treatment had relapse. In contrast, none of the 7 patients with stage II disease who received adjuvant vinblastine and bleomycin with or without cisplatin had relapse. Our long-term survival rates are 100 per cent for patients with stage I and 88 per cent with stage II disease, and all of the patients who died either were treated before the introduction of cisplatin-based chemotherapy or did not complete the treatment protocol as recommended. In experienced hands retroperitoneal lymphadenectomy with chemotherapy, either as adjuvant or as needed for patients with stage I, IIA and IIB disease, remains the most cost-effective treatment for nonseminomatous testicular cancer and has the least short-term and long-term morbidity.

Adolescent↗
PubMed1985

Bilateral renal oncocytoma: report of 2 cases and literature review.

We report on 2 patients with bilateral renal oncocytoma treated in the last 5 years. One patient underwent bilateral partial nephrectomy for a solitary tumor in each kidney. Both tumors were confirmed to be renal oncocytomas by light and electron microscopic examination. After 4 years this patient had no evidence of local recurrence or distal metastasis. The second patient presented with bilateral multiple renal oncocytomas. Transabdominal bilateral renal exploration revealed 2 tumors in the right kidney and 3 tumors in the left kidney. Right radical nephrectomy and enucleation of the left renal tumors were performed. Examination by light and electron microscopy confirmed that all tumors from both kidneys were oncocytomas. Only 8 cases of bilateral renal oncocytoma have been reported in the literature, including our 2 cases. In 6 of these 8 cases the tumors were multicentric, which may be a characteristic of bilateral renal oncocytoma. Recognizing the coexistence of multicentricity and bilaterality is important because more conservative treatment is required. However, a favorable prognosis may still be anticipated.

Adenoma↗
PubMed1984

Pursuit of the renal mass. Is ultrasound enough?

The accuracy of ultrasonography in evaluating renal masses was assessed retrospectively in 260 renal lesions detected by intravenous urography in 242 patients. The ultrasonographic diagnosis was confirmed by cyst puncture, surgery, or autopsy. Of the lesions, 168 were benign cysts, and all were diagnosed correctly by ultrasonography. The remaining 92 lesions were renal carcinomas, and 90 were diagnosed correctly by ultrasonography. In retrospect, it was clear that the two missed cancers did not fulfill all the ultrasonographic criteria for a cyst. An algorithm is presented for the differential diagnosis of renal masses primarily by ultrasonography, and the arguments in favor of operative diagnosis of renal masses are rebutted. With the approach described, invasive studies such as cyst puncture and arteriography will be required for a definitive diagnosis in fewer than 10 percent of patients, and the morbidity and expense of the diagnostic approach will be minimized, with no decrease in accuracy.

Adult↗
PubMed1984

Differentiation potential of human embryonal carcinoma cell lines.

We have established 17 embryonal carcinoma (EC) cell lines from human testicular germ cell tumors by using three different methods of in vitro cultivation. Cultures of only three of these cell lines, and of clones derived from two of them, differentiate extensively when the cells are seeded at low density. A comparison is presented of the results obtained with the three methods used to establish and maintain these cell lines, and some properties of the three pluripotential EC lines are summarized.

Cell Line↗
PubMed1984

Transurethral treatment of bladder diverticula. Alternative to open diverticulectomy.

Since October, 1980, we have used transurethral fulguration of the diverticular mucosa and incision of the diverticular neck in combination with electrohydraulic lithotripsy of bladder stones and transurethral prostatic resection to treat all aspects of diverticula in 11 patients. In comparing the results with those of open diverticulectomy, we found the transurethral procedure to be equally effective while being safer, faster, and less expensive.

Aged↗
PubMed1984

Malignant urachal lesions.

Urachal cancers are uncommon malignancies with a location that often permits considerable local extension before they are discovered. The most common histological type is adenocarcinoma, which may produce mucus that is a valuable aid in diagnosis. The presence of stippled calcification in a midline abdominal wall mass is almost pathognomonic for urachal carcinoma. More commonly, however, the symptoms are less specific, such as hematuria and an abdominal mass. Many lesions are visible endoscopically and, thus, the diagnosis can be made preoperatively from a biopsy. Most treatment failures occur because the tumor is not controlled locally by the initial operation and, therefore, we recommend en bloc cystectomy with umbilectomy and pelvic lymphadenectomy unless the tumor is known to be a sarcoma or early stage (I) carcinoma. If these patients are undertreated and there is a local recurrence then the patient usually is not salvageable. Because of the difficulty in identifying the origin of a bladder adenocarcinoma, any tumor on the dome or anterior wall should be approached initially as if it were a urachal tumor.

Adult↗
PubMed1984

Production of virions with retrovirus morphology by human embryonal carcinoma cells in vitro.

Embryonal carcinoma (EC) cell lines established from human testicular germ-cell tumours produce, at low frequency, virions morphologically identical to type C retroviruses that have been observed by other workers in human placental tissues. The virus particles are formed while budding from the cell surface, and their numbers are increased by inducing the EC cells with 5-iodo-2'-deoxyuridine and dexamethasone. Assays for RNA-dependent DNA polymerase (reverse transcriptase) associated with purified virions suggested a low level of activity. In addition, another type of virus is occasionally produced by induced cells of three EC lines. These particles also form during the process of budding from the cell surface, but they have surface projections (spikes). Extracellular spiked virions frequently are pleomorphic, with a condensed, eccentric nucleoid, and thus morphologically resemble type B retroviruses. No virions of either type were detected with or without induction in cultures of differentiated EC cells or in cultures of yolk sac carcinoma or teratoma cells, both of which are considered malignant but differentiated derivatives of EC cells. The lack of virion production by these differentiated cells suggests developmental regulation of virus replication.

Cell Line↗
PubMed1983

Endoscopic re-establishment of urethral continuity after traumatic disruption of the membranous urethra.

We report 3 cases of complete traumatic disruption of the membranous urethra treated by transurethral section of the scar tissue with transvesical endoscopic guidance and digital rectal control. Postoperatively, the patients required an average of 3 subsequent urethrotomies. They remain well, continent and free of voiding symptoms for 28, 11 and 14 months after re-establishment of urethral continuity. We suggest that this treatment be considered as an alternative to conventional surgical repair, particularly in elderly and other high risk patients.

Adult↗
PubMed1983

Microsurgical vasovasostomy: an outpatient procedure under local anesthesia.

We performed microsurgical vasovasostomy on 25 outpatients using spermatic cord block anesthesia, an infrapubic incision and the 1 1/2-layer anastomosis technique. The average operating time was 2 hours 18 minutes and patients usually were discharged home after approximately 1 hour in the recovery room. Of the 21 patients who have had sperm counts performed 3 or more months postoperatively 19 have counts equal to or more than 20 million per ml., with an average motility of 43 per cent. Exclusive of the surgeon's fee, which is the same for inpatient and outpatient vasovasostomies, the average cost of the operation was +650, a savings of 41 per cent over the cost of an outpatient microsurgical vasovasostomy under general anesthesia and of 61 per cent over the cost of the procedure done on an inpatient basis under general anesthesia. The operation as described is safe and economical with minimal morbidity and has results comparable to those obtained with more complex and extensive vasovasostomy techniques.

Adult↗