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Biomedical subjects

G Lieskovsky

Publications and source records attributed to G Lieskovsky.

At least 55 records · Page 3Linked to original sources
PubMed1995

Concurrent abdominal aortic aneurysm and urologic neoplasm: an argument for simultaneous intervention.

This report describes the surgical management of 24 patients with concurrent abdominal aortic aneurysm (AAA) and urinary tract neoplasm. The patient population consisted of 22 men and two women whose average age was 65.5 years. AAA sizes ranged from 3.1 to 9.0 cm (mean 5.2 cm) in diameter. Urinary tract neoplasms included transitional cell carcinoma (TCC) of the bladder (n = 19), adenocarcinoma of the prostate (n = 3), and TCC of the renal pelvis (n = 2). Urologic procedures included radical prostatectomy, radical nephroureterectomy, and radical cystoprostatectomy with continent or ileal loop urinary diversion. The AAA was resected at the time of the urologic procedure in 12 patients (group I) or prior to the urologic procedure in five patients (group II) and was left in situ in seven patients (group III: AAA diameter 3.1 to 5.5 cm). All patients but one in group I recovered without complications. One patient developed an infection postoperatively as a result of fluid collection anterior to the aortic vascular graft; the fluid was successfully drained and the patient subsequently recovered uneventfully. All patients in group II had a marked retroperitoneal desmoplastic reaction at the time of the urologic procedure as a result of prior aneurysmectomy, which complicated the ureteral dissection. One patient later required an ileal ureteral reconstruction for obliterative fibrosis of the ureter. At a mean follow-up of 34 months, no infectious or mechanical complications of the vascular prosthesis occurred in group I or II. Eight patients in group I and two in group II are alive. Three have died of metastatic disease and two of myocardial infarction. Of the seven patients in group III, four subsequently required AAA resection for an increase in AAA size and three have died.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1995

Incidence of occult lymph node metastases in pathological stage C (pT3N0) prostate cancer.

PURPOSE: To determine the incidence of occult lymph node metastases in patients with stage pT3N0 prostate cancer. MATERIALS AND METHODS: Lymph nodes from 95 patients with stage pT3N0 prostate cancer were analyzed by immunohistochemistry for extrinsic epithelial cells using epithelial-specific monoclonal antibodies. The extrinsic epithelial cells were also tested for prostate specific antigen expression. RESULTS: Occult lymph node metastases were identified in 15 cases (16%) and were more frequent in patients with high primary Gleason grade tumors and seminal vesicle invasion (p = 0.03). In all cases the extrinsic cells were of prostate origin based on prostate specific antigen expression. CONCLUSIONS: Occult lymph node metastases can be detected in a substantial proportion of patients with stage pT3N0 prostate cancer, are associated with known predictors of disease progression, and may be useful in identifying patients at risk for recurrence and progression.

Humans↗
PubMed1995

Indications for lower urinary tract reconstruction in women after cystectomy for bladder cancer: a pathological review of female cystectomy specimens.

PURPOSE: In an attempt to identify women who may be appropriate candidates for orthotopic lower urinary tract reconstruction, archival cystectomy specimens from female patients undergoing cystectomy for primary bladder cancer were reviewed. These pathological findings should provide a better understanding of tumor involvement at the bladder neck (vesicourethral junction) and urethra in women with transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Cystectomy specimens of 67 consecutive women undergoing surgery for biopsy proved transitional cell carcinoma of the bladder between July 1982 and July 1990 were pathologically reviewed. RESULTS: Histological evidence of tumor (carcinoma in situ or gross carcinoma) involving the urethra was present in 9 patients (13%). Tumor was confined to the proximal and mid urethra, and the distal urethra was not involved. All patients with carcinoma involving the urethra had concomitant evidence of carcinoma involving the bladder neck. A total of 17 patients (25%) had tumor involvement of the bladder neck and those with an uninvolved bladder neck also had an uninvolved urethra. The association between the presence of tumor in the bladder neck and urethra was highly significant (p < or = 0.00012). Tumor involving the bladder neck and urethra tended to be more commonly associated with high grade and stage tumors, and node-positive disease. CONCLUSIONS: Although the fate of the retained urethra following cystectomy for bladder cancer in women is unknown, these results show that women with transitional cell carcinoma of the bladder without evidence of tumor involving the bladder neck are at low risk for urethral malignancy. These patients may be offered lower urinary tract reconstruction that includes preservation of and diversion through the urethra (orthotopic diversion). Urethral surveillance will be necessary, as it is in men after orthotopic urinary diversion.

Carcinoma in Situ↗
PubMed1995

Continent and orthotopic urinary diversion following radical cystectomy. Should these reconstructive procedures now be considered standard of care?

Our extensive operative experience with various forms of the continent ileal reservoir in more than 1000 patients over the past 12 years has demonstrated clearly the extreme reliability and durability of this diversion system. Reflux reliably can be prevented and the upper urinary tracts protected. Patients can void or catheterize with confidence. Orthotopic diversions should now be available to most patients, both male and female. Patients should be able to live a more normal life style with a positive self image. We believe that because our modifications of the ileal reservoir systems have decreased the need for reoperation, these forms of continent urinary diversion have emerged as optimal operations and even as the standard of care in cystectomy patients. Ileal conduits should be reserved for poor-risk candidates with short-term life expectancy or for those patients not motivated for continent diversion. The most vocal advocates of the procedures remain those continent diversion patients who have had urinary diversion by another method. Patients still must be aware that complications can occur. Appropriate patient motivation and a thorough understanding of the continent diversion technique and its potential problems continue to be essential prerequisites of the operation. Although minor refinements to these systems will continue to be made, we feel that continent diversion, most often in the form of orthotopic reconstruction, can be offered safely and wisely most to patients.

Cystectomy↗
PubMed1994

Phase II study of low dose cyclophosphamide and intravenous interleukin-2 in metastatic renal cancer.

Thirteen patients with metastatic renal cancer were treated in a phase II trial with interleukin-2, 21.6 million IU/m2 intravenously daily for five days on two consecutive weeks, starting 3 days after the administration of low dose cyclophosphamide 350 mg/m2 intravenously. Treatment cycles were repeated every 21 days. No responses were seen (95% Confidence Interval: 0-22%). The most common toxicities were fever, fatigue, hypotension, nausea/emesis, and myalgia/arthralgia. There were 11 episodes of Grade III toxicity including Grade III hypotension in 7 patients. Because of the significant toxicity and the lack of observed response, the study was discontinued. Cyclophosphamide and interleukin-2 at the dose and schedule used in this study has considerable toxicity and is unlikely to improve on response rates previously seen with other IL-2 based regimens in metastatic renal cancer.

Adult↗
PubMed1994

Lower urinary tract reconstruction following cystectomy in women using the Kock ileal reservoir with bilateral ureteroileal urethrostomy: initial clinical experience.

Since June 1990, 14 women 31 to 70 years old (mean age 57 years) have undergone lower urinary tract reconstruction by bilateral ureteroileal urethrostomy using a Kock ileal reservoir. Indications for cystectomy included transitional cell carcinoma in 9 patients, urachal adenocarcinoma in 2, cervical carcinoma in 1, mesenchymal tumor of endometrial origin in 1 and a fibrotic radiated bladder in 1. Early and late complications have been few, occurring in 2 patients and 1, respectively. Excellent continence has been achieved during the day and night in 100% of patients. Of the 14 patients 12 void volitionally per urethra without high residual volume, while 2 require intermittent catheterization. All patients are completely satisfied. Tumor recurred in the pelvis in 1 patient with an extensive mesenchymal tumor necessitating conversion to a continent cutaneous Kock reservoir. All patients are currently alive without evidence of disease. This initial experience with lower urinary tract reconstruction in women has yielded extraordinary results and we believe that the option of lower urinary tract reconstruction following cystectomy can be offered safely to selected female patients.

Adult↗
PubMed1994

Stenosis of the afferent antireflux valve in the Kock pouch continent urinary diversion: diagnosis and management.

Between August 1982 and May 1988, 503 patients underwent construction of a continent ileal reservoir (Kock pouch) for cutaneous urinary diversion at our university. Stenosis of the afferent antireflux valve resulted in upper urinary tract obstruction in 11 patients (2%). In addition, 2 patients underwent Kock pouch diversion elsewhere and upon referral to our institution they had afferent valve stenosis. To date 13 patients have been identified with this problem. Hydronephrosis was present in 100% of the functional kidneys in these patients. Radiographs of the Kock pouch were uniformly normal without evidence of reflux or other pathological condition. The most common presenting symptom was flank pain in 7 patients (54%) and the most common presenting sign was creatinine elevation above baseline in 7 (54%). Infections recurred with or without sepsis in 5 patients (38%). Ureteroileal anastomotic strictures were not present in any patient. The interval from creation of the Kock pouch to the diagnosis of stenosis ranged from 2 to 75 months (mean 39). All patients underwent endoscopic evaluation of the Kock pouch confirming stenosis of the afferent antireflux valve, and subsequent mechanical dilation of the stenotic valve. Dilation procedures were repeated in 6 patients (46%), 4 of whom subsequently required open surgical revision of the afferent valve. Of these patients 3 are clinically stable and 1 died of the primary malignancy. The remaining 2 patients are clinically and radiographically stable after multiple dilations. Of the 7 patients (54%) requiring only a single dilation 6 are clinically stable and 1 died of the primary malignancy. Stenosis of the afferent antireflux valve of the Kock pouch, previously unreported to our knowledge, is a rare late complication leading to flank pain, hydronephrosis, recurrent infection and elevation of serum creatinine levels. Approximately 50% of the patients respond to a single dilation of the nipple valve. However, most patients who require repeat dilation will need open surgical revision.

Adult↗
PubMed1994

Adjuvant radiation, chemotherapy, and androgen deprivation therapy for pathologic stage D1 adenocarcinoma of the prostate.

OBJECTIVES: A retrospective analysis of the results of an aggressive multimodal approach combining radical prostatectomy with adjuvant radiation, chemotherapy, or androgen deprivation therapy for patients with pathologic Stage D1 prostate carcinoma was performed to assess the impact of these therapies on survival, recurrence, local control, and morbidity. METHODS: Case records of 76 patients with pathologic Stage D1 tumors were reviewed. All had radical retropubic prostatectomy and were recommended adjuvant therapy based on the pathologic extent of the primary tumor and the number of involved lymph nodes. RESULTS: With a median follow-up of 7 years, overall survival was estimated to be 88% and 66% at 5 and 10 years, respectively, and equaled age- and race-matched controls. Prostate cancer-specific survival at 5 and 10 years was 88% and 74%, respectively. The probability of developing a clinically detectable recurrence (excluding prostate-specific antigen [PSA]) was 29% and 62% at 5 and 10 years, respectively. When PSA was added to the detection data, the probability of developing a recurrence increased to 58% and 78% at 5 and 10 years, respectively. Recurrence and cause-specific survival correlated with Gleason sum. Univariate analysis of the adjuvant therapies demonstrated no effect on survival, but adjuvant radiation alone and in combination with androgen deprivation increased the time to recurrence. Local control was excellent, surgical morbidity was equivalent to that of all patients undergoing prostatectomy during the same time period, and the morbidity of adjuvant therapy was minimal. CONCLUSIONS: Survival equivalent to age- and race-matched controls, with excellent control of the extensive primary tumor, can be achieved in patients with Stage D1 prostate carcinoma by a combination of radical prostatectomy and radiation therapy without the need for routine androgen deprivation therapy.

Acid Phosphatase↗
PubMed1994

Results of radical prostatectomy and adjuvant therapy in the management of locally advanced, clinical stage TC, prostate cancer.

Fifty-seven patients with locally advanced, clinical stage TC, adenocarcinoma of the prostate underwent treatment consisting of surgery, external beam radiation therapy and, in selected patients, early hormonal ablation and/or systemic chemotherapy. Surgical morbidity from radical retropubic prostatectomy and limited pelvic lymph node dissection was acceptable with an early complication rate of 11%. Followup ranged from 3.5 to 19.9 years (median 5.4 years). Actuarial 5 and 7.5 years survival rates for all patients was 91.2% and 77.6%, respectively. Of the 57 study patients 19 (33%) were alive with no evidence of disease, including a prostate specific antigen (PSA) less than 0.4 ng/ml at all times during follow-up. The estimated 5 year probability of clinical recurrence was 18.6% and the 5 year probability of clinical and PSA recurrence (> 0.4 ng/ml) was 54.5%. Local recurrence occurred in only 3 patients. This included 2 (4%) patients who received adjuvant radiotherapy. Our results suggest that patients with locally advanced prostate cancer can be successfully treated with low morbidity using a combination of radical prostatectomy and planned adjuvant radiotherapy.

Adenocarcinoma↗
PubMed1994

[Reconstruction of the lower urinary tract after cystectomy. Experiences and results in 126 patients with the Kock ileum reservoir in conjunction with bilateral ureteroileourethrostomy].

Between May 1986 and February 1990, 126 consecutive men underwent lower urinary tract reconstruction by means of bilateral ureteroileal urethrostomy using a Kock ileal reservoir. The early complication rate was 11.1%. Late complications requiring rehospitalization or reoperation have been surprisingly few: 1 for prolapse of the afferent antirefluxing nipple valve, 1 for calculi and 4 for artificial urinary sphincter placement due to unsatisfactory continence. Good continence has been achieved in 94% of the patients during the day and in 84% at night. Tumor recurred in the pelvis in 5 patients, with 4 requiring cutaneous urinary diversion. All patients had progression or died of metastatic disease. Our experience has yielded extraordinary results in terms of patients acceptance with few late complications or need for reoperation.

Adult↗
PubMed1993

Impact of autologous blood transfusions on patients undergoing radical prostatectomy using hypotensive anesthesia.

We report on a retrospective study consisting of 71 consecutive patients who underwent radical retropublic prostatectomy under controlled hypotensive anesthesia, examining the impact of a preoperative autologous blood collection program on perioperative blood requirements. The population consisted of 34 patients who elected not to use autologous blood (group 1) and 37 patients who underwent radical prostatectomy after storing 1 to 3 units of their own blood (group 2). Median operative time and estimated blood loss were not statistically different. In group 1, 20 homologous blood units were used by 7 patients (21%). In group 2, 37 of 41 units transfused were autologous units and only 3 patients (8%) received homologous blood. However, for every unit of autologous blood deposited preoperatively there was a corresponding decrease in admission blood concentrations and 21 of 37 patients were anemic at hospitalization. In addition, the study suggests that in many patients the anemia produced by preoperative phlebotomy does not resolve preoperatively. In response, the effectiveness of preoperative autologous blood collection is decreased by this preoperative anemia. Although inefficient, we nevertheless conclude that an autologous blood collection program decreases homologous transfusion exposure and efforts should be directed to increase the erythropoietin response to the anemia produced by preoperative phlebotomy. Presently, it is an expensive program that offers only a modest benefit for patients undergoing radical retropubic prostatectomy.

Adenocarcinoma↗
PubMed1993

The rationale for en bloc pelvic lymph node dissection for bladder cancer patients with nodal metastases: long-term results.

From August 1971 through June 1989, 591 consecutive patients underwent curative pelvic lymphadenectomy with en bloc radical cystectomy for bladder cancer. Of these patients 132 (22%) had pathologically proved nodal metastases. The incidence of positive nodes increased with increasing pathological stage of the primary tumor: stage PIS (0.75%), stage P1 (13%), stage P2 (20%), stage P3a (24%), stage P3b (42%) and stage P4 (45%). The median followup for the 31 patients still alive was 5.5 years (range 2.6 to 18.8). Recurrent bladder cancer was documented in 89 patients (67%) with a median interval to progression of 1.5 years. Pelvic recurrence as the first site of progression was uncommon, occurring in 15 patients (11%). The actuarial 2, 3, 5 and 10-year survival rates were 55%, 38%, 29% and 20%, respectively. Increased risk of progression and death was associated with advanced pathological tumor stage (stage P3b or greater, p < 0.001 and p < 0.001, respectively) and 6 or more positive nodes (p < 0.001 and p = 0.012, respectively). There was no significant difference in survival and interval to progression among patients who received preoperative irradiation or adjuvant chemotherapy compared to those treated with surgery alone. This retrospective analysis further substantiates the philosophy that single stage pelvic lymphadenectomy with en bloc radical cystectomy can provide long-term progression-free survival, particularly for patients with localized primary tumors and minimal metastatic nodal disease.

Aged↗
PubMed1993

Radical retropubic prostatectomy and postoperative adjuvant radiation for pathological stage C (PcN0) prostate cancer from 1976 to 1989: intermediate findings.

Between 1976 and 1989, 114 patients undergoing radical retropubic prostatectomy and bilateral pelvic lymph node dissection for prostatic adenocarcinoma were found to have stage PcN0 lesions. Postoperative adjuvant radiation therapy without hormonal treatment was given to 95 of these patients (83%): 26 (27%) with stage C1, 37 (39%) with stage C2 and 32 (34%) with stage C3 disease. The median radiation dose was 45 Gy. given at 180 cGy. daily. Median followup was 4.4 years (range 1.4 to 13.3). The overall 5 and 10-year actuarial rates for the patients were 94% and 70%, respectively. Disease-specific 5 and 10-year actuarial survival rates were 99% and 78%, respectively. At 5 and 10 years the chance of clinical recurrence was estimated as 6% and 13%, respectively, and the chance of recurrence (clinical or indicated by prostate specific antigen levels) was estimated to be 34% and 46%, respectively. Patients with high Gleason scores (8 to 10) and seminal vesicle involvement (stage C3) fared worst. There were 5 patients with clinical distant metastases, 1 with a clinical local recurrence and 1 with both conditions. Detectable elevation of prostate specific antigen without clinically evident recurrence was noted in 25 patients. Radiation therapy was well tolerated with minimal morbidity. Disease-specific survival and survival without clinical recurrence were improved over historical control in patients with stage PcN0 prostate cancer treated by radical prostatectomy alone. These data support a role for adjuvant radiation therapy in stage PcN0 prostate adenocarcinoma following radical prostatectomy.

Adenocarcinoma↗
PubMed1992

Salvage surgery plus androgen deprivation for radioresistant prostatic adenocarcinoma.

We report on 34 patients with persistent local radiation resistant prostate cancer who underwent salvage surgical resection and hormonal deprivation. Initially, salvage prostatectomy was done in 11 patients but in 1 disease recurred locally and cystectomy was performed, for a total of 24 patients undergoing cystoprostatectomy. There were no postoperative complications in the prostatectomy group and the average postoperative stay was 7.6 days (range 6 to 12 days). Of 11 patients 4 (36%) are completely continent. There were 2 complications in the cystoprostatectomy group (1 small bowel obstruction and 1 prolonged ileus). The average postoperative stay without complication was 11 days (range 7 to 16 days). Of the 34 patients 24 (71%) are alive without radiographic evidence of disease, including 2 with detectable prostate specific antigen values at a mean of 53 months after surgery (range 25 to 93 months). Of the patients 3 (9%) are alive with radiographically evident recurrent disease (mean 53 months, range 49 to 77 months) and 7 (21%) are dead of disease (mean 52 months, range 20 to 120 months).

Adenocarcinoma↗
PubMed1992

Experience with fossa recurrence of renal cell carcinoma.

We describe the surgical management and followup of 11 patients with local recurrence of renal cell carcinoma in the renal fossa, 10 of whom demonstrated no evidence of distant metastatic disease at the time of recurrence. Average interval to recurrence was 31 months from nephrectomy, with the majority of patients presenting with symptoms of weight loss, fatigue and lumbar discomfort. A total of 13 resections of recurrent carcinoma was performed with 3 immediate postoperative complications, including a retroperitoneal abscess, jejunal necrosis requiring resection and a duodenal obstruction requiring duodenojejunostomy. There were 2 postoperative deaths, 2 patients died of disseminated disease at 8 and 22 months, and 3 died of causes unrelated to cancer recurrence at 4 months, 6 months and 10 years. Four patients were without disease at a followup of 35, 46, 48 and 211 months. We include in this review a report on 1 patient who maintains a disease-free survival of 17 years after resection of a recurrent spindle cell carcinoma. We conclude that an aggressive surgical approach to recurrent renal cell carcinoma within the renal fossa can produce long-term disease-free survival and is justified when compared to the results reported for chemotherapy.

Adult↗
PubMed1991

Study of antireflux nipple valves of Kock ileal urinary reservoir. Experimental investigation in dogs.

To better assess the construction, maintenance, and function of the Kock ileal urinary reservoir with its continent antirefluxing nipple valves, laboratory investigations in dogs were done simultaneously with clinical trials in humans in 1983. Fifteen dogs underwent creation of hemi-Kock ileal reservoirs (without the efferent valve and limb) that were anastomosed to their bladders as enterocystoplasties. The afferent antirefluxing nipple valves were intussuscepted after 7 cm of underlying mesentery had been removed. The nipples were further stabilized with metal and absorbable (Polysorb) staples and Marlex collars. The right ureters were anastomosed to the afferent limb of the reservoirs with the contralateral systems left intact as controls. Ten dogs were able to be followed at the vivaria for twelve to thirty-six months and then studied. All nipple valves remained intact, viable, and nonrefluxing without revision. All kidneys remained histologically normal except those in dogs with dilated ureters secondary to ureteroileal stenosis with concurrent calculi formation. Calculi formed on exposed metal staples and Marlex. The absorbable staples were found to promote appropriate healing and were never the nidus for stone formation. It appears that the intussuscepted nipple valve (with its mesentery removed) is reproducible and functionally reliable in preventing reflux. It also appears these valves can histologically preserve diverted kidneys if the upper urinary tract drainage is normal and calculi are minimized. The proper placement of staples and the elimination of Marlex-anchoring collars are indicated to minimize calculi.

Anastomosis, Surgical↗