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Biomedical subjects

F F Marshall

Publications and source records attributed to F F Marshall.

At least 91 records · Page 5Linked to original sources
PubMed1990

Advanced small cell carcinoma of the bladder. Successful treatment with combined radical cystoprostatectomy and adjuvant methotrexate, vinblastine, doxorubicin, and cisplatin chemotherapy.

Undifferentiated small cell carcinoma of the bladder is a rare tumor with pathologic features similar to those of oat cell carcinoma of the lung. This neuroendocrine neoplasm of the bladder has a highly malignant biological behavior; most patients present with either locally advanced or distant metastatic disease and die despite aggressive therapy. Here the histologic, immunocytochemical, and ultrastructural features of small cell carcinoma of the bladder are reviewed in detail. In addition, two patients with advanced small cell carcinoma of the bladder who were treated successfully with radical cystoprostatectomy and adjuvant methotrexate, vinblastine, doxorubicin, and cisplatin chemotherapy (M-VAC) are presented. Both men had regional lymph node involvement and are disease free at follow-up of 1 year and 2.5 years, respectively. This is the first report of combined surgical and M-VAC chemotherapy in the treatment of undifferentiated small cell carcinoma of the bladder.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Local recurrence and survival following nerve-sparing radical cystoprostatectomy.

From March 1982 through July 1988, 76 men underwent nerve-sparing radical cystoprostatectomy for carcinoma of the bladder at our hospital. Of the 76 patients 2 (2.6%) had positive surgical margins (dome of the bladder and left ureter) and neither had positive margins at the site of nerve-sparing modifications. Of 3 patients (3.9%) who had local recurrence none had positive surgical margins. The 5-year actuarial local recurrence rate is 7.5%. Thirteen of 76 patients (17%) died of transitional cell carcinoma and 7 (9%) died of other causes, while 53 (70%) are alive without evidence of disease with a mean followup of 38.4 months. The 5-year actuarial survival rates are 64% over-all, 68% without disease and 78% disease-specific. Of the 42 evaluable men who underwent cystoprostatectomy alone 27 (64%) are potent, compared to 2 of the 12 men (17%) who also underwent urethrectomy. We conclude that the nerve-sparing modifications do not compromise cancer control, that local recurrence and survival rates are at least comparable to those achieved with standard radical cystoprostatectomy, and that it is possible to preserve potency in most men undergoing this procedure.

Actuarial Analysis↗
PubMed1990

Preservation of sexual function in men during radical pelvic surgery.

Recent neuroanatomical findings making it possible to intraoperatively identify the branches of the pelvic plexus that innervate the corpora cavernosa have been used to modify standard radical prostatectomy and cystoprostatectomy to prevent postoperative sexual dysfunction.

Cystostomy↗
PubMed1989

Specific genetic change in tumors associated with von Hippel-Lindau disease.

Previous reports showed that the loss of DNA sequences on the short arm of chromosome 3 (3p) is consistently found in sporadic renal cell carcinomas. To evaluate the significance of this genetic change, we looked for the loss of 3p alleles in hereditary renal cell carcinomas and other tumors from patients with von Hippel-Lindau disease. Specific loss of alleles from chromosome 3p was detected with polymorphic DNA markers in 11 renal cell carcinomas, one pheochromocytoma, two spinal hemangioblastomas and one cerebellar hemangioblastoma from von Hippel-Lindau patients. Multiple renal cell carcinomas in individuals with von Hippel-Lindau disease showed loss of the same chromosome 3p alleles, which demonstrated that the same chromosome was deleted in each tumor. Analysis of haplotypes indicated that the loss of chromosome 3p alleles was from the chromosome bearing the balancing, wild-type allele of the VHL gene. These results are consistent with the concept that the VHL gene is a recessive oncogene. Renal cell carcinoma, pheochromocytoma, and spinal and cerebellar hemangioblastomas develop in predisposed family members when somatic mutational events lead to loss of chromosome 3p sequences bearing the wild-type allele of the VHL gene.

Alleles↗
PubMed1989

Enhanced anti-tumor effects of recombinant human tumor necrosis factor plus VP-16 on metastatic renal cell carcinoma in a xenograft model.

A nude mouse renal subcapsular and subcutaneous implantation xenograft model utilizing the SN12C human renal carcinoma cell line was investigated. In the absence of treatment, renal subcapsular implantation of SN12C resulted in metastatic spread (lung, liver and lymph nodes) and death of all animals. Radical nephrectomy of the tumor-bearing kidney after various periods of tumor implantation demonstrated that surgery alone after 18 days of tumor growth resulted in no statistically significant increase in survival with 100% of the nephrectomized animals succumbing to local recurrence and distant metastases. Recombinant human tumor necrosis factor (rTNF) and VP16 (etoposide), both well known cytotoxic and cytostatic anticancer agents, were tested singly and in combination against this metastatic model of human renal adenocarcinoma. Single agent rTNF or VP16 therapy after radical nephrectomy demonstrated only minimal efficacy with no significant decrease in local recurrence and distant metastases as compared to nephrectomy only control animals. In contrast, the combination of rTNF plus VP16 when given after nephrectomy resulted in a significant decrease in local recurrence and no gross evidence of metastasis in any animal. Subcutaneously growing SN12C tumor nodules were also treated with the same rTNF, VP16 and combination regimens. Regression in tumor size was noted only in the combination treatment group. rTNF or VP16, as single agents, demonstrated only slight growth inhibition that was not statistically significant. These results suggest that by combining TNF plus VP16, a synergistic enhancement of antineoplastic activity against local as well as metastatic human renal cell carcinoma can be produced.

Animals↗
PubMed1989

Endoscopic reconstruction of traumatic urethral transections.

Total traumatic urethral transections can be reconstructed endoscopically if the obliterated segment is short (less than 3 cm). A small trocar is passed under radiographic control, and balloon dilatation is performed over a guidewire. Scar is resected, and triamcinolone is injected. An additional urethrotomy is usually required later. Ten patients have had this technique of reconstruction. Seven have good results with long-term follow-up; three are voiding well but have only short follow-up.

Adult↗
PubMed1988

Cystine calculi: clinical management and in vitro observations.

Although cystine stones account for 1 to 3 per cent of renal calculi, many of these patients are difficult to manage because of recurrent urolithiasis. Seven cases of homozygous cystinuria are summarized. The evolution to the present treatment of percutaneous extraction and chemolysis appears to be the preferred form of treatment although extracorporeal shock wave lithotripsy (ESWL) may also be utilized. In addition, in vitro experiments were conducted to study the effectiveness of different chelating agents and buffers at different urinary pHs. The effect of cystinuric and noncystinuric urines was also evaluated.

Acetylcysteine↗
PubMed1988

A prototype device for nonimmersion shock wave lithotripsy using ultrasonography for calculus localization.

Extracorporeal shock wave lithotripsy has revolutionized the clinical treatment of renal calculi. A device was constructed with a spark gap for shock wave generation and a water-filled ellipsoidal reflector to focus the shock wave energy. A membrane coupled the device to the pig and an ultrasonic transducer was used for stone visualization. Initial in vitro experiments and in vivo studies using dwarf pigs demonstrated fragmentation of calculi.

Animals↗
PubMed1988

Evidence for cyclophosphamide-induced transitional cell carcinoma in a renal transplant patient.

Cyclophosphamide treatment has been associated with bladder cancer in a number of case reports but no causal relationship has been proved since nearly all of these patients were treated with the drug for malignant disease. We describe a patient who received cyclophosphamide after cadaveric renal transplantation to prevent rejection. Transitional cell carcinoma developed in the native bladder and in the donor transplanted ureter (20-year-old donor) 13 years later despite no identifiable risk factors. This case strengthens the argument that cyclophosphamide has a carcinogenic potential on the urinary tract epithelium.

Carcinoma, Transitional Cell↗
PubMed1988

Surgical management of renal cell carcinoma with intracaval neoplastic extension above the hepatic veins.

Cardiopulmonary bypass, hypothermia, temporary cardiac arrest and exsanguination represent the next logical step in the evolutionary management of intracaval neoplastic extension with renal cell carcinoma. This method of management provides control of the circulation of the entire body and allows for careful dissection in a bloodless field with less risk of embolization. From 1981 to 1986, 15 patients were treated with intracaval neoplastic extension of renal cell carcinoma above the level of the most inferior hepatic veins. In 6 patients mobilization of the vena cava with division of the hepatic veins to the caudate lobe allowed excision of the tumor and tumor thrombus without cardiopulmonary bypass (group 1). The remaining 9 patients underwent cardiopulmonary bypass and hypothermia (group 2). There was 1 postoperative mortality in the entire group. Most patients had advanced regional disease but the feasibility of this technique has been demonstrated. Survival appeared to be less in the bypass group. Although some of the patients have had metastatic disease, the quality of life and survival have been prolonged in many of these acutely ill patients.

Actuarial Analysis↗
PubMed1988

Creation of an ileocolic bladder after cystectomy.

A divided segment of ileum and colon is used to create a neobladder after cystectomy with a cecourethral anastomosis to provide volitional voiding with continence. Such a bladder provides for good sensation with a large low pressure reservoir and an antireflux ureteral anastomosis. The standard nerve-sparing cystoprostatectomy is performed and no segment of the bladder or prostate is left to compromise the cancer operation. In female or male patients with diffuse carcinoma in situ a similar reservoir with a plicated ileocutaneous anastomosis also can provide continence with intermittent catheterization. Four patients with a urethral anastomosis have day and nighttime continence, and 2 with a cutaneous stoma have 4 to 5-hour dry intervals. Ultimately, it is possible for a patient to void with good urinary control and to have sexual function after cystectomy.

Adult↗
PubMed1988

Synchronous and metachronous transitional cell carcinoma of the urinary tract: prevalence, incidence, and radiographic detection.

Six hundred forty-five cases of transitional cell carcinoma (TCC) of the bladder, ureter, and/or kidney were reviewed retrospectively to determine the frequency of synchronous and metachronous lesions elsewhere in the urinary tract. Among 597 patients with TCC of the bladder, 23 (3.9%) developed an upper-tract lesion, after an average delay of 61 months. Metachronous upper-tract tumors developed in 13% of 38 patients with primary ureteral TCC and in 11% of 63 with renal TCC, after average delays of 28 and 22 months, respectively. Synchronous TCC was found in 2.3% of patients with bladder TCC, 39% of those with ureteral TCC, and 24% of those with renal TCC. Seventeen percent of the subsequent upper-tract lesions would have been demonstrated by intravenous or retrograde urography performed 1 year after the initial onset of primary bladder cancer, and 61% would have been demonstrated by studies performed within 2 years. Therefore, the authors recommend annual radiologic evaluation of the upper urinary tract for 2 years after initial diagnosis and treatment of an upper-tract or bladder TCC.

Carcinoma, Transitional Cell↗
PubMed1988

Radical cystectomy for transitional cell carcinoma of the bladder. Long-term survival in high risk patients.

Debilitated, sometimes old, previously radiated patients with transitional cell carcinoma of the bladder may present with many poor prognostic features including: high grade, diffuse, carcinoma; invasion of perivesical tissue; ureteral obstruction; a fixed pelvic mass, and vascular and lymphatic invasion. Improvements in anesthesia, medical management, and nutrition have allowed radical cystectomy and long-term survival in 4 such high risk patients with locally advanced transitional cell carcinoma of the bladder, including 1 patient who had excision of his urinary tract.

Adult↗
PubMed1988

Renal cell carcinoma: surgical management of regional lymph nodes and inferior vena-caval tumor thrombus.

Aggressive surgical management is the primary effective treatment of renal cell carcinoma, even with regional spread to lymph nodes or the vena cava. The extent of regional lymphadenectomy with radical nephrectomy and excision of vena-caval tumor thrombi are defined. In the future, with increasingly effective adjuvant therapy, these adjuncts to radical nephrectomy will continue to be important in the treatment of renal cell carcinoma.

Carcinoma, Renal Cell↗
PubMed1987

CT diagnosis of unsuspected von Hippel-Lindau disease.

Von Hippel-Lindau disease is a hereditary disorder with complex, multi-organ involvement including retinal, central nervous system, and abdominal manifestations. We report a case of clinically unsuspected von Hippel-Lindau disease identified during computed tomography (CT) evaluation of a renal mass. The CT demonstration of a coexisting pancreatic tumor and renal cell carcinoma suggested the correct diagnosis of von Hippel-Lindau disease, which was subsequently confirmed. This case reemphasizes the value of preoperative assessment of renal tumors by CT. The finding of coexisting renal and pancreatic tumors should stimulate the search for further evidence of von Hippel-Lindau disease.

Angiomatosis↗