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Biomedical subjects

E E Fraley

Publications and source records attributed to E E Fraley.

At least 73 records · Page 4Linked to original sources
PubMed1980

Acclerated growth of testicular cancer after cytoreductive surgery.

Surgical removal of bulky metastases of non-seminomatous germ-cell testicular cancer has been advocated as an adjuvant to chemotherapy in patients whose disease probably is too extensive to be cured by chemotherapy or surgery alone. However, in 8 of our patients, cytoreductive surgery was followed by a sudden and dramatic exacerbation of the disease. In some cases, a marked rise in the serum levels of alpha-fetoprotein and human chorionic gonadotropin was the only evidence. The cause and prevalence of such exacerbations are unknown. Cytoreductive surgery in patients with advanced testicular tumor is accepted treatment and should be advocated, but it appears that in some cases such surgery may adversely alter the course of the malignancy. This must be considered in planning treatment for patients with advanced disease.

Adolescent↗
PubMed1980

Vinblastine, bleomycin and cis-diamminedichloroplatinum in the treatment of advanced testicular carcinoma. Possible importance of longer induction and shorter maintenance schedules.

Twenty-eight patients with stage III or recurrent stage I or II testicular cancer were treated with four to six cycles of vinblastine, bleomycin and cis-diamminedichloroplatinum, and then with vinblastine maintenance for one year. With a median follow-up of more than 20.5 months for all patients, complete remission has been achieved with chemotherapy and operation in 23 (82 per cent). One of these 23 patients has had a relapse, and only three are still receiving maintenance therapy. The toxicity incurred by the extra cycles of chemotherapy in patients with extensive disease was no greater than that experienced by patients receiving smaller doses of drugs. These results confirm the high response rate reported for this combination of drugs and strongly suggest that some relapses after complete remission can be prevented by longer remission induction schedules. The value of maintenance therapy is questionable and needs further study.

Adolescent↗
PubMed1980

Is SP-1 a marker for testicular cancer?

We measured the serum levels of the pregnancy-associated protein SP-1 by radioimmunoassay in 91 patients with a diagnosis of germ cell testicular cancer. Sixty-seven of the men had active disease, and of these, 52 per cent had elevated levels of SP-1. In contrast, all 24 patients with inactive disease had normal levels. Elevations of SP-1 were associated more often with elevated levels of human chorionic gonadotropin than with elevated levels of alpha-fetoprotein, but elevated SP-1 levels also occurred in patients with normal levels of both of these established tumor markers. We studied serial samples from 21 patients, and in 5 the SP-1 level provided clinically valuable information not provided by the other two markers. SP-1 is a clinically useful marker in germ cell testicular cancer. Further studies are needed to determine the role of the two forms of protein, alpha and beta, and to define the conditions under which the SP-1 level is elevated.

Adult↗
PubMed1980

Obstructive uropathy, renal failure, and sepsis in the neonate--a surgical emergency.

Two infants who had obstructive uropathy accompanied by renal failure and sepsis are reported herein. Diagnostic and therapeutic techniques used to treat this type of surgical emergency are discussed in the order they were performed, as follows: (1) resuscitation for severe fluid and electrolyte disturbances; (2) gathering of cultures and initiation of antibiotic therapy; (3) the decision of whether or not dialysis is required, as well as when and how diagnostic evaluation should proceed; (4) the decision of whether dialysis is necessary or whether correction of obstructive uropathy can begin; and (5) the choice of the best operative procedure for this individual. This article emphasizes the necessity for a multidisciplinary team approach to these patients.

Acute Kidney Injury↗
PubMed1980

Serum alpha-fetoprotein and human chorionic gonadotropin in patients with seminoma.

We analyzed the case histories of 31 patients who initially had a diagnosis of seminoma and elevated serum levels of alpha-fetoprotein or human chorionic gonadotropin. We concluded that an elevated alpha-fetoprotein level is firm evidence of the presence of non-seminomatous germ cell tumor and that the patient should be treated accordingly. However, if the level of human chorionic gonadotropin alone is elevated the diagnosis may be either non-seminomatous tumor or seminoma. Patients with seminoma and an elevated level of human chorionic gonadotropin do respond well to radiation therapy if they have low stage disease but if metastatic seminoma is present an elevated human chorionic gonadotropin level appears to be a poor prognostic sign if conventional treatment is given. A plan of treatment is proposed for these patients.

Adult↗
PubMed1980

Incidental carcinoma of the prostate: a review of the literature and critical reappraisal of classification.

The problem in treating incidental carcinoma of the prostate is that of distinguishing between tumors that will have a long, benign natural history and those that will progress rapidly. A review of the English literature concerning incidental prostatic carcinoma reveals that patients with focal low grade tumors have a good prognosis, while patients with high grade lesions often suffer rapid tumor progression. By contrast, the clinical significance of high volume, low grade tumor is unknown. A method has been developed to evaluate the distribution of prostatic cancer using 4-quadrant transurethral prostatic resection. A detailed method for staging these cancers based on a comprehensive, segmental histopathological analysis also is presented. A precise definition of the stages of prostatic cancer should eventually improve our understanding of the natural history of this disease.

Adult↗
PubMed1980

Renal cancer invading the inferior vena cava: clinical review and anatomical approach.

Renal cell carcinoma invades the inferior vena cava in approximately 5 per cent of the patients. The only effective therapy for intravascular renal cell carcinoma is radical nephrectomy and complete removal of the tumor thrombus. To formulate a reasonable operative approach to intracaval renal cell carcinoma we have reviewed our experience with 6 cases as well as the experience of other investigators. In addition, we studied the collateral circulation of the renal veins as described by various anatomists, and to this information we have added our experience with inferior venacavography and with intraoperative and autopsy dissections. Herein we describe a new preoperative staging system for intravascular renal cell carcinoma. The operative approach to each stage is discussed in detail beneficial intraoperative maneuvers are described and illustrated.

Adenocarcinoma↗
PubMed1980

Abdominal staging of testicular tumors using ultrasonography and computed tomography.

There were 36 patients with testicular tumors who underwent abdominal staging by ultrasonography, computed tomography or both before removal and pathologic examination of the retroperitoneal lymph nodes. Results showed that ultrasonography and computed tomography are accurate in predicting retroperitoneal metastases in more than 80 per cent of the patients, although computed tomography is more accurate and specific. The 1 falsely negative result with both methods occurred in a patient with microscopic (pathologic stage IIA) retroperitoneal disease. The falsely positive results with either technique were found in patients with borderline enlargement of the nodes (1 to 1.5 cm). Either computed abdominal tomography or abdominal ultrasonography is recommended for pre-treatment staging of testicular tumors.

Abdominal Neoplasms↗
PubMed1980

Stereotactic hypophysectomy for intractable pain secondary to metastatic prostate carcinoma.

Stereotactic radiofrequency transfrontal hypophysectomy was carried out in 7 patients with osseous metastasis from prostatic carcinoma resulting in intractable pain. 86% experienced significant pain relief with 5 of 7 demonstrating marked decrease in medication requirement and improved level of function. The procedure was done under local anesthesia only with no mortality and minimal morbidity. Total destruction of the pituitary gland and the development of diabetes insipidus were shown not to be necessary conditions for pain relief.

Aged↗
PubMed1980

Cell line derived from a metastasis of a human testicular germ cell tumor.

A cell line, designated 833K-E, has been established from a metastasis of a human testicular germ cell tumor that consisted of four histological types of tumor cells. The 833K-E cells have morphological and ultrastructural characteristics of epithelial cells and a hyperdiploid karyotype indicative of their human male origin. The cells grow in agar cultures and produce in nude mice tumors which have the hstological features of embryonal carcinoma without differentiated elements. Many of the cells express a stage-specific mouse embryonic antigen, and low levels of the major histocompatibility antigens and beta 2-microglobulin also were detected on a large percentage of the cells. A lymphoblastoid cell line (833K-LC) established from the same tumor specimen expresses major histocompatibility antigens and beta 2-microglobulin but does not express the embryonic antigen.

Animals↗
PubMed1980

Nonrandom abnormalities in chromosome 1 in human testicular cancers.

Trypsin G banding was performed on metaphase chromosomes from 14 cell lines derived from primary tumors or metastases of 11 patients with testicular cancer. Most of the cell lines, 11 of 14, have a modal number between 51 and 61. All lines have numerical and structural changes involving chromosome 1 with trisomy of the q arm being the common aberration. Break points in chromosome 1 were nonrandom, being concentrated in the regions of p12, q12, p36, and p22, which resulted in morphologically identical marker chromosomes in different cases. These changes probably are not artifacts of cell culture. In one instance, three lines derived from the same patient, one from tissue removed at operation, and two from separate metastases removed at autopsy nearly 3 years later after unsuccessful radiotherapy and chemotherapy had identical chromosome compositions. In another case, lines derived from a primary tumor and a metastasis from the same patient also had identical marker chromosomes. The consistent involvement of chromosome 1 in aberrations may be associated with the highly malignant nature of testicular cancers.

Adult↗
PubMed1979

A, B, H antigens in transitional cell tumors of the urinary bladder: correlation with the clinical course.

The A, B, H blood group antigens can be detected in normal transitional epithelium of the urinary bladder by the red cell adherence (RCA) test. We examined the possibility that the reactivity for these antigens is lost or decreased in transitional cell carcinomas and that such a change may reflect the future evolution of these tumors. We studied several bladder biopsies from 60 patients who presented with noninvasive transitional cell carcinomas and were followed for at least 5 years or until muscle invasion was histologically demonstrated. Eighty-one percent of patients whose tumors were RCA positive in the initial biopsy did not subsequently develop invasive tumors and 27% of these patients had no recurrences. All 34 patients whose tumors were negative in the initial biopsy experienced recurrences and 62% of them developed invasive lesions. In 81% of patients, the recurrent tumors retained the same pattern of RCA reactivity for blood group antigens on serial biopsies. These results suggest that the presence of readily detectable A, B, B antigens correlates with a favorable prognosis whereas their absence denotes an aggressive potential.

ABO Blood-Group System↗
PubMed1979

Insertion of Gibbons ureteral stents using endourologic techniques.

We describe our technique for the antegrade insertion of the redesigned Gibbons ureteral stent. We have used this technique for 19 kidneys without failures or complications. The advantages of internal drainage and of antegrade stent placement are discussed.

Catheters, Indwelling↗