Biomedical subjects

F F Marshall

Publications and source records attributed to F F Marshall.

At least 73 records · Page 4Linked to original sources

PubMed1994

Relationship between antisperm antibodies and testicular histologic changes in humans after vasectomy.

OBJECTIVE: To determine whether or not there is an association between testicular histologic changes and antisperm antibodies in vasectomized men. METHODS: Morphometry was performed on testicular biopsy specimens obtained from 19 vasectomized men and 21 fertile control subjects. Antisperm antibody status was determined on the serum of each patient and control subject using the indirect immunobead assay. RESULTS: Significant increases in seminiferous tubule wall thickness (p < 0.001), focal interstitial fibrosis (p < 0.001), and percent composition of interstitium (p < 0.01) were observed in vasectomized men as compared with control subjects. Serum antisperm activity was present in 74 percent of the vasectomized men but none in the control subjects (p < 0.001). There was no association between testicular histologic changes and immune status. CONCLUSIONS: Vasectomized men exhibit significant testicular histologic changes and increased autoimmune activity as compared with fertile control subjects. These histologic changes are not directly associated with antisperm antibody status, suggesting that some other pathophysiologic process must be responsible.

Adult↗

PubMed1994

Renal tumors.

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Humans↗

PubMed1993

High efficiency gene transfer into primary human tumor explants without cell selection.

Preclinical studies with murine tumor models have demonstrated that autologous tumor cell vaccines engineered to secrete certain cytokines in a paracrine fashion elicit systemic immune responses capable of eliminating small amounts of established tumor. These results have engendered much interest in developing this strategy for gene therapy of human cancer. The major limitation to creating genetically modified autologous human tumor vaccines is efficient gene transfer into primary tumor explants, since the majority of human tumors fail to proliferate in long-term culture. Using the retroviral vector MFG in conjunction with short-term culture techniques, we have achieved, in the absence of selection, a mean transduction efficiency of 60% in primary renal, ovarian, and pancreatic tumor explants, and we have developed an autologous granulocyte-macrophage colony-stimulating factor secreting tumor vaccine for clinical trials.

Adenocarcinoma↗

PubMed1993

Renal cell carcinoma with situs inversus totalis.

A case of renal cell carcinoma in a patient with situs inversus totalis is reported. Only 8 cases of malignant neoplasms have been reported in situs inversus totalis, and our case represents the second case report of renal cell carcinoma in a patient with situs inversus totalis. The frequency of situs inversus totalis is between 1 in 8,000 and 1 in 20,000. Cardiac and pulmonary anomalies are common in patients with situs inversus totalis. Renal anomalies, including agenesis, dysplasia, hypoplasia, ectopia, polycystic kidney, and horseshoe kidney, have been reported. Because of the association between situs inversus and cardiac, pulmonary, renal, and vascular anomalies, management of the patient with situs inversus and urologic disease requires careful preoperative evaluation.

Aged↗

PubMed1993

Mini-laparotomy staging pelvic lymphadenectomy (minilap). Alternative to standard and laparoscopic pelvic lymphadenectomy.

In a mini-laparotomy staging pelvic lymphadenectomy (minilap) a 6-cm lower midline abdominal incision is used to perform a complete pelvic lymphadenectomy. If the pelvic lymph nodes were positive for prostate cancer, the incision was closed without pelvic drains. If the pelvic lymph nodes were clinically negative for disease, the incision was extended, and a radical retropubic prostatectomy was done under the same anesthetic. The minilap was performed on 16 patients. Three patients who had grossly positive pelvic lymph nodes confirmed by frozen section examination were denied a radical retropubic prostatectomy and had a two to three-day hospital stay. The other 13 patients had an uneventful radical retropubic prostatectomy. We conclude that the minilap is an attractive alternative for patients requiring staging pelvic lymphadenectomy.

Aged↗

PubMed1993

Nuclear morphometry accurately predicts recurrence in clinically localized renal cell carcinoma.

Despite careful clinical staging, as many as 30 percent of patients with pathologically, specimen-confined renal cell carcinoma (RCC) have unpredictable recurrence following surgery. Present pathologic and clinical staging systems cannot accurately predict those patients with high risk of disease recurrence from those who are cured by surgery alone. Advances in immunotherapy including gene therapy for RCC have dictated the need to identify RCC patients for adjuvant therapy protocols who have a high probability of recurrence following nephrectomy. Nuclear morphometric techniques developed at our institution have predicted prognosis for a variety of genitourinary tumors; it was used to predict recurrence among patients undergoing nephrectomy for localized RCC. This report is a retrospective study of 26 patients with RCC of similar age, stage (pT1-pT3), and grade. Fifteen were free of disease at a mean of 75.2 months, and 11 had distant disease recurrence at a mean of 27.1 months. Statistical analysis of a variety of nuclear shape descriptors accurately separated this group of patients based on disease recurrence. No nuclear shape descriptor predicted disease recurrence when nuclei within the region of the tumor with the highest grade were analyzed. However, the range of nuclear ellipticity (p = 0.007) best predicted disease recurrence when nuclei were selected in a random fashion. Multivariate analysis of the four best shape descriptors better predicted disease recurrence (p = 0.002) with a sensitivity of 73 percent and specificity of 100 percent. These results are encouraging and suggest that this technique might be used in identifying patients for adjuvant gene therapy.

Adult↗

PubMed1993

Tumor suppressor gene allelic loss in human renal cancers.

It is now apparent that multiple genetic alterations, including oncogene activation and tumor suppressor gene inactivation, are necessary steps in carcinogenesis. We have studied this concept in renal cancers by looking at specific tumor suppressor genes implicated in several allelotyping studies. Primary, predominantly low stage renal tumors of varying grades and histologic subtypes were investigated for allelic loss of 3p, 17p and the p53 gene, the DCC gene and the Rb gene and its product. 3p loss occurred in 47% of tumors studied and was much more common in clear cell cancers (85%). 17p and p53 gene loss were relatively uncommon events with only 6 of 42 tumors demonstrating loss. None of the tumors with typical histologies had allelic loss of the DCC gene, though loss did occur in leiomyosarcoma and a collecting duct tumor. Allelic loss of the Rb gene occurred in one clear cell tumor, the leiomyosarcoma, and, interestingly, in both collecting duct tumors in this series. Allelic loss of the Rb gene was correlated with little or no RB protein expression as judged by immunohistochemistry. At all loci studied, allelic loss did not appear to correlate with tumor grade or stage. These results suggest that inactivation of the p53, Rb, and DCC genes by allelic loss are uncommon events in the early stages of renal carcinogenesis.

Blotting, Southern↗

PubMed1993

The natural history of renal angiomyolipoma.

Of 35 patients with 48 angiomyolipomas 24 patients were followed clinically to determine the natural history of angiomyolipoma. Average patient age at presentation was 50 years (range 17 to 74) and of the patients 94% were women, 17% had tuberous sclerosis and 25% overall had bilateral disease. The patients could be divided into 2 distinct groups based on tumor size of 4 cm. or less and greater than 4 cm. Those with tumors less than 4 cm. were less likely to be symptomatic (24%) and patients with angiomyolipomas greater than 4 cm. were more often symptomatic (52%). No surgery was required for tumors less than 4 cm. but for 30% of the tumors greater than 4 cm. surgical intervention was necessary. Unlike any previously reported large series this study included radiological and historical followup available for 24 patients with angiomyolipoma with a mean followup time of 4 years (range 0.5 to 14). Moreover, to our knowledge we report for the first time documented growth during the study period of 27% of angiomyolipomas less than 4 cm. (4 of 15 tumors) and 46% of angiomyolipomas greater than 4 cm. (6 of 13 tumors). All patients with tumors less than 4 cm. were asymptomatic and only 1 required surgery. In contrast, tumors greater than 4 cm. were more frequently symptomatic (46%) and required surgery (54%). Patients with tuberous sclerosis and angiomyolipomas were distinctly different from patients with angiomyolipoma only, since they tended to present at a younger age, had a higher incidence of bilateral renal involvement, were more symptomatic, had larger tumors that were more likely to grow, and frequently required surgery. Based on this study, a modified approach to the current management of angiomyolipoma is recommended.

Angiomyolipoma↗

PubMed1993

Vitamin B12 deficiency in patients with ileocolic neobladders.

The terminal ileum is widely used for reconstruction of the lower urinary tract. Since the terminal ileum exclusively absorbs vitamin B12, removal of ileum from the gastrointestinal trace for use in lower urinary tract reconstruction may predispose patients to vitamin B12 deficiency. In a prospective study serial vitamin B12 levels were obtained postoperatively in 24 patients who underwent cystectomy for malignancy and ileocolic neobladder urinary diversion with a mean followup of 25 months (range 6 to 53). Any patient who had a low vitamin B12 serum level (less than 200 pg./ml.) underwent a Schilling test to confirm malabsorptive vitamin B12 deficiency. Six patients (25%) had low serum vitamin B12 levels, of whom 3 (13%) had an abnormal Schilling test. No patient had megaloblastic anemia. One patient with malabsorptive vitamin B12 deficiency had neurological symptoms 53 months postoperatively. We conclude that vitamin B12 deficiency can occur following ileocolic neobladder reconstruction. Patients with true vitamin B12 deficiency should be identified and placed on lifelong parenteral vitamin B12.

Adult↗

PubMed1992

Intraoperative sonography of renal tumors.

Intraoperative sonography (7.5 MHz. transducer with Doppler probe) was used to evaluate renal masses in 41 kidneys to determine its correlation with pathological findings. This intraoperative determination of the extent of the renal lesion prompted occasional changes in surgical management. We conclude that intraoperative sonography is most useful in partial nephrectomy, and helps to determine the extent of tumor, multicentricity, venous extension and associated cysts. These findings may not be appreciated with intraoperative, visual inspection of the kidney.

Humans↗

PubMed1991

Malignant renal schwannoma.

Renal schwannomas are rare tumors. There have been only 4 cases (2 benign and 2 malignant) reported in the literature. We report a third case of a malignant renal schwannoma and review the literature on this subject.

Female↗

PubMed1991

Adenocarcinoma of urinary bladder: classification and management.

Adenocarcinoma of the urinary bladder is an uncommon, often aggressive urologic cancer. In an attempt to classify and define management of this tumor, 28 patients with vesical adenocarcinoma were studied. Excluded were patients with mixed transitional cell carcinoma and adenocarcinoma. Three major classes of tumor were identified: primary vesical adenocarcinoma, urachal adenocarcinoma, and extravesical adenocarcinoma involving the bladder. Signet ring cell tumors appeared to behave more aggressively than other cell types. Radical surgery was the most effective treatment.

Adenocarcinoma↗

PubMed1991

Antibiotics: potential hazards to male fertility.

Individual agents within each of the major classes of antibiotics have been shown to have significant adverse effects on spermatogenesis or spermatozoal function in mammals. For humans, infertility or significant alterations in semen parameters have been well documented for the nitrofurans and for patients on sulfasalazine. Other commonly used antibiotics, such as minocycline, have been shown to be toxic to sperm at any concentration. Until further information is available, clinicians must keep in mind that treatment with antibiotics may adversely affect the fertility potential of men. It is possible that some classes of antibiotic agents, such as the penicillins or the quinolones, may have minimal effects on male fertility and maintain the clinical efficacy for patients requiring long-term antibiotic suppressive therapy. Further investigation is needed into the relative toxicity of antibiotics and the mechanisms by which antibiotics affect spermatogenesis and spermatozoal function. A background of the current state of knowledge regarding the adverse effects of antibiotics on male fertility is presented in this review.

Animals↗

PubMed1991

Ileocolic neobladder post-cystectomy: continence and potency.

Incontinence and impotence are 2 of the primary complications associated with total bladder reconstruction after cystectomy for carcinoma. These and other features are addressed in 25 patients who underwent total neobladder reconstruction following cystectomy for transitional cell carcinoma. Of these patients 20 had a urethral anastomosis. No patient had to wear a pad or device. Enuresis was rare. When the radical cystoprostatectomy population was contrasted with a radical prostatectomy patient population, continence was achieved more rapidly in the neobladder group. Potency was maintained in 15 of 21 (71%) evaluable patients. This ileocolic neobladder produces a large volume and low pressure, and provides excellent day and night continence. With preservation of the neurovascular bundle potency can be maintained in the majority of patients.

Carcinoma, Transitional Cell↗

PubMed1991

Transesophageal echocardiography in renal cell carcinoma: an accurate diagnostic technique for intracaval neoplastic extension.

Between 4 and 10% of patients with renal cell carcinoma have tumor involving the inferior vena cava and many of these patients have suprahepatic extension. In patients with intracaval neoplastic extension precise definition of the superior aspect of the tumor thrombus is critical. Transabdominal ultrasonography, computerized tomography (CT), magnetic resonance imaging (MRI) and inferior venacavography are all currently used to evaluate the inferior vena cava in these patients. Intraoperative transesophageal echocardiography was used to image the inferior vena cava in 5 patients with renal cell carcinoma and intracaval neoplastic extension. In each patient transesophageal echocardiography correctly revealed the superior extent of tumor thrombus. In 3 patients tumor thrombus was found at a higher level by transesophageal echocardiography than by CT, MRI and inferior venacavography. In all patients tumor imaging by transesophageal echocardiography correlated well with the gross appearance and extent of tumor found at operation. Echocardiography also documented the absence of residual gross tumor after resection. Transesophageal echocardiography was also useful to assess left ventricular function. Although each of these patients had a pulmonary artery catheter as well transesophageal echocardiography can be useful in situations when right atrial tumor thrombus prevents right heart catheterization. This small series demonstrates that intraoperative transesophageal echocardiography can accurately evaluate the extent of tumor thrombus and provides a means to assess myocardial function complementary to the pulmonary artery catheter.

Carcinoma, Renal Cell↗

PubMed1991

Ileocolic neobladder after cystectomy.

The ileocolic neobladder has been successful, and we remain enthusiastic about it. As older and less favorable patients are selected, the rates of potency and continence may decrease.

Age Factors↗

PubMed1991

Carcinogenesis and the use of intestinal segments in the urinary tract.

Intestinal conduits appear to have a low risk of malignancy. The increased risk of neoplasia after ureterosigmoidostomy is well known and may be multifactorial. Other forms of urinary reconstruction and diversion may also increase the risk of cancer. The reports of adenocarcinoma after ileocystoplasty are striking, as the intact ileum rarely undergoes malignant change. Long-term surveillance of patients after urinary reconstruction with intestinal segments is therefore mandatory.

Adenocarcinoma↗

PubMed1991

Radical cystectomy (anterior exenteration) in the female patient.

Anterior exenteration in the female patient can be performed accurately with a disciplined anatomic approach. The lymphadenectomy provides staging for the carcinoma. Excision of the uterus, a portion of the vagina, and the urethra reduces the potential for pelvic recurrence. Vaginal reconstruction and continent urinary diversion provide a better quality of life with maintenance of sexual function and urinary continence.

Carcinoma, Transitional Cell↗