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Biomedical subjects

G Lieskovsky

Publications and source records attributed to G Lieskovsky.

At least 109 records · Page 6Linked to original sources
PubMed1984

Current status of adjuvant chemotherapy after radical cystectomy for deeply invasive bladder cancer.

Between March, 1976, and December, 1982, 70 of 157 patients (45%) undergoing single-stage radical cystectomy with pelvic lymphadenectomy and urinary diversion with the intent to cure invasive bladder cancer were found to have pathologic Stage P3B, P4 and/or N + disease. Thirty-four of the 70 patients received adjuvant prophylactic chemotherapy after cystectomy and 36 patients were followed expectantly. From 1976 through 1977 adjuvant chemotherapy consisted of cyclophosphamide 1 Gm/M2 each month for six months; from 1978 through June, 1980, adjuvant chemotherapy consisted of cis-platinum 100 mg/M2 each month for four months with the exception of 1 patient treated more aggressively with combination chemotherapy (CISCA). Since July, 1980, a prospective study has been utilized in which patients were randomized into two groups, Group A receiving combination chemotherapy and Group B followed up expectantly; adjuvant chemotherapy appears to result in a slight delay in time to relapse but no influence in overall survival was observed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Clinical experience with the Kock continent ileal reservoir for urinary diversion.

From August 1982 through January 1984, 51 patients underwent urinary diversion that included creation of a continent reservoir from an ileal segment, according to the method described originally by Kock. An important modification included removal of a narrow strip of mesentery for 8 cm. along the afferent and efferent limbs of the pouch to allow adequate ileal intussusception, and fixation to prevent reflux and to ensure continence. Previous urinary diversion was by ureterosigmoidostomy in 3 patients, standard ileal conduit in 7 and suprapubic cystotomy in 1. A total of 39 patients underwent simultaneous anterior exenteration for pelvic malignancy. There was 1 postoperative death and early complications occurred in 10 patients. Of these 10 patients 4 required reoperation: 2 for drainage of a pelvic abscess, 1 for conversion to a standard ileal conduit and 1 for bleeding. Late complications occurred in only 8 patients: 5 required reoperation and revision of the continence valve mechanism, and 3 required hospitalization for brief episodes of pyelonephritis. The end result in 49 of 50 patients has been an overwhelming success. Patients perform self-catheterization every 4 to 6 hours during the day and once at night for volumes ranging up to 1,400 cc. Serum electrolytes have remained normal and hyperchloremic acidosis has been encountered in only 1 patient who had had compromised renal function preoperatively with hyperchloremic acidosis as a result of previous ureterosigmoidostomy. X-rays of the Kock pouch have shown evidence of reflux in only 1 patient, and all excretory urograms have demonstrated either normal upper tracts without obstruction or improvement in patients with preoperative hydronephrosis. Although preliminary, this clinical trial suggests that the quality of life for patients considered previously to be candidates for cutaneous diversion can be improved markedly by a modified Kock continent ileal reservoir.

Adult↗
PubMed1984

Indications for urethrectomy in men undergoing single stage radical cystectomy for bladder cancer.

During a 10-year period 174 consecutive male patients underwent radical cystectomy with pelvic lymph node dissection for transitional cell cancer of the bladder. Urethrectomy, either performed en bloc with the cystectomy or secondarily, was required in 23 patients. Of these 23 patients 9 died of metastatic disease and 4 deaths were believed to be directly related to development of tumor in the urethra. A careful review of our data suggests that patient selection is possible so that urethrectomy in all patients undergoing cystectomy may be avoided, while maintaining the ability to treat those at risk for carcinoma in the retained urethra before invasion occurs. We recommend the following indications for urethrectomy: 1) en bloc cystourethrectomy for clinically overt involvement of the anterior urethra with carcinoma or tumor extending into the prostatic urethra, 2) immediate or delayed total urethrectomy either during the initial hospitalization or within 2 months of cystectomy for all patients with pathological evidence of invasion of the prostate (P4) or carcinoma in situ of the prostatic urethra, 3) indefinite close followup of all patients whose bladder specimens demonstrate carcinoma in situ (urethral cytology within 4 months of cystectomy and every year thereafter, and immediate total urethrectomy for any urethral cytology positive for malignant cells), and 4) immediate total urethrectomy for any patient experiencing bloody urethral discharge.

Carcinoma in Situ↗
PubMed1984

Radical cystectomy in the elderly patient.

A total of 77 patients 65 or more years old underwent radical cystectomy with urinary diversion for invasive bladder cancer during a 10-year interval. The preoperative medical condition of the patients, operative mortality and morbidity, and preliminary survival data are reviewed by age group. Two-thirds of the patients had previous medical or surgical problems that increased the surgical risk. The over-all mortality rate was 3.9 per cent. Early complications occurred in 31 per cent of the patients, with an increased risk of complication associated with previous illness and major pelvic surgery, and preoperative radiation therapy. The complication rate was not related directly to age, with patients 65 to 69 and more than 75 years old having lower rates than those 70 to 74 years old. The 3-year survival rate free of disease ranged from 58 per cent in the youngest group to 39 per cent in the oldest group, which is comparable to survival statistics for younger patients undergoing cystectomy. Only 5 patients have died of intercurrent illness, while 20 have died of metastatic disease.

Aged↗
PubMed1984

Contemporary cystectomy with pelvic node dissection compared to preoperative radiation therapy plus cystectomy in management of invasive bladder cancer.

Between August 1971 and August 1982, 197 consecutive patients underwent single stage radical cystectomy with pelvic lymph node dissection and urinary diversion as definitive management of high grade, invasive bladder cancer. In 100 patients 1,600 rad of radiation therapy were given for 4 days preoperatively and 97 patients underwent an operation only. Although not constituting a prospective randomized study, an analysis of these 2 groups of patients managed during an 11-year period by the same surgical team, using identical surgical technique, provides useful information that questions the benefit of preoperative radiation therapy in the management of high grade, invasive bladder cancer. Other factors, such as improved surgical technique with meticulous pelvic node dissection as well as better preoperative and postoperative care, may be responsible for survival results of contemporary surgery only that equal those reported following combination therapy protocols using preoperative radiation therapy. Contemporary surgery with or without preoperative radiation therapy yielded a 5-year survival rate free of tumor of 75 per cent for patients with pathologic stages P2 and P3A disease, 44 per cent with P3A and P3B disease, and 36 per cent with P4 disease and positive pelvic nodes.

Aged↗
PubMed1984

Technique of creation of a continent internal ileal reservoir (Kock pouch) for urinary diversion.

Kock and associates have made a major contribution to the urologic surgical armamentarium by developing a method to create a continent internal urinary reservoir out of ileum. This innovative procedure now offers patients requiring cystectomy for bladder cancer or cutaneous urinary diversion for any reason a real alternative to the standard ileal conduit, which requires wearing an external appliance. Operative technique, including some modifications developed by the authors, is presented.

Humans↗
PubMed1984

Role of lymphadenectomy in the treatment of bladder cancer.

The value of pelvic lymphadenectomy in patients undergoing cystectomy for bladder cancer continues to remain controversial. It has been the authors' policy to perform a complete bilateral pelvic lymphadenectomy on all patients for whom radical cystectomy is potentially curative. They discuss distribution and incidence of nodal disease, limits of pelvic node dissection, the technique of pelvic lymphadenectomy, and their results.

Female↗
PubMed1983

The Turnbull loop stoma.

The stoma is the weak link of external urinary diversion. Improper stomal position or configuration produces the unnecessary burden of leakage for the patient with diversion. Stomal bleeding, incrustation and peristomal dermatitis cause inconvenience and expense. Stomal stenosis is the most common reason for repeat operation of an ileal conduit. The Turnbull loop stoma obviates many of these problems. We have performed 100 urinary diversions using this stoma with minimal stomal complications and no episodes of stomal stenosis from 1 to 7 years postoperatively. The significant complication has been parastomal hernia. Minor modifications of the technique have lowered the incidence of hernia. Loop stomas are our principal form of stomal construction.

Abdominal Muscles↗
PubMed1981

Molybdate and the measurements of androgen receptors in prostate cancer.

Using the sucrose density gradient technique, we have compared androgen receptor values obtained in the presence and absence of sodium molybdate from cytosols of surgically obtained human prostate cancer tissue. In all nine prostates examined, inclusion of molybdate in the buffers resulted in an increase in the amount of androgen receptor detected, in some cases dramatically. Since accurate androgen receptor assays could be valuable for therapeutic decision making in prostate cancer, we advocate the inclusion of sodium molybdate in assay buffers to guard against the possibility of false negative or artificially low values.

Animals↗
PubMed1980

Pelvic lymphadenectomy in the management of carcinoma of the prostate.

Between January 1, 1971 and December 30, 1977, 82 patients underwent bilateral pelvic lymph-adenectomy for carcinoma of the prostate, 65 with associated radical prostatectomy. Lymph node metastases were noted in 27 cases: 1 of 8 with A2, 3 of 16 with B1, 12 of 39 with B2 and 11 of 19 with C tumors. Of the 17 patients undergoing lymphadenectomy only as a staging procedure before definitive radiation therapy 12 had nodal involvement, while 15 of 64 patients with combined lymphadenectomy and prostatectomy had nodal disease. Early complications involved 6 patients with thromboembolic disease, including 1 death while the patient was hospitalized of pulmonary embolism. All 6 thromboembolic complications occurred among 52 patients who had not received anticoagulation, for an incidence of 11.5 per cent compared to no episode of thromboembolism among 30 patients prophylactically anticoagulated with warfarin sodium. Late complications of chronic lymphedema occurred in 15 patients, 10 of whom had postoperative radiation. We recommend lymphadenectomy as an adjunct to radical prostatectomy but its role as a staging procedure before definitive radiation therapy to the pelvis appears to yield increased morbidity in terms of incidence of chronic lymphedema, suggesting that its use be reserved for highly selected patients. We also recommend the prophylactic postoperative administration of anticoagulants and patients awareness of risk factors contributing to chronic lymphedema.

Aged↗
PubMed1980

Significance of serum lactic dehydrogenase in stages B and C non-seminomatous testis tumors.

The incidence of initial elevations of total serum lactic dehydrogenase was 38 per cent in 21 patients with stage B disease and 65 per cent in 17 patients with stage C disease. Conversely, 62 per cent of patients with stage B disease and 35 per cent of patients with stage C disease had normal lactic dehydrogenase values, indicating that measurement of total serum lactic dehydrogenase lacks sensitivity as a useful biologic tumor marker in predicting the presence of tumor. However, there were no falsely positive elevations in these patients--all patients with persistent elevations after therapy have either died or have progressive disease. Therefore, it would seem from our study that total serum lactic dehydrogenase should be measured initially in all patients with advanced disease (stages B3 and C). When elevated, serial measurements will indicate response to therapy. The presence of a persistent elevation of lactic dehydrogenase suggests that current conventional therapeutic modalities are ineffective and alternative therapy should be instituted.

Adult↗
PubMed1979

Assay of nuclear androgen receptor in human prostate.

Nuclei were recovered from normal and hyperplastic human prostates and from well differentiated carcinoma using triton N-101 and discontinuous sucrose density gradient centrifugation. The nuclei were sonicated and dissolved in 2-([2-hydroxy-1,1-bis(hydroxymethyl)ehtyl]amino)ethane sulfonic acid buffer, pH 7.0, containing 0.6 M. sodium chloride. After incubation of the nuclear extract in the presence of 2 to 20 nM. 3H-dihydrotestosterone at 4C for 18 hours, an androgen receptor was isolated by Sephadex G-25/G-200 dual-column chromatography. The receptor demonstrated greater specificity for testosterone and dihydrotestosterone than for cortisol, progesterone and 17beta-estradiol. It was characterized by a sedimentation coefficient of 3 S and a Kd of 4.5 x 10(-9) M. The mean concentration of the nuclear androgen receptor, in terms of molecules per nucleus, was normal prostate-1,000, hyperplastic prostate-1,400 and well differentiated carcinoma-1,900. With this assay the problems associated with the measurement of a cytoplasmic androgen receptor can be avoided.

Aged↗
PubMed1979

Increased ratio of 5 alpha-reductase: 3 alpha (beta)-hydroxysteroid dehydrogenase activities in the hyperplastic human prostate.

The activities of 5 alpha-reductase and 3 alpha (beta)-hydroxysteroid dehydrogenase were assayed in homogenates of eight normal, 21 hyperplastic and four carcinomatous human prostates. Samples consisting of 300--500 microgram tissue protein in Tris buffer, pH 7.0, were incubated at 37 degrees C for 30 min in the presence of 50 nM-[3H]androgen and an NADPH-generating system started with 5 X 10(-4)M-NADP. The yield of 5 alpha- and 3 alpha-reduced metabolites, as established by using t.l.c. and g.l.c., gave an estimate of enzyme activity. The formation of metabolites denoting 5 alpha-reductase activity in normal, hyperplastic and carcinomatous tissue respectively was 28.8 +/- 47 (S.E.M.), 76.8 +/- 8.9 and 3.5 +/- 0.7 pmol 30 min-1 mg protein-1; similarly, that denoting 3 alpha (beta)-hydroxysteroid dehydrogenase activity was 69.3 +/- 6.7, 46.6 +/- 5.7 and 38.8 +/- 22.1 pmol 30 min-1 mg protein-1. In all normal prostates 5 alpha-reductase activity was lower than 3 alpha (beta)-hydroxysteroid dehydrogenase activity. Conversely, in 18 out of 21 hyperplastic prostates, 5 alpha-reductase activity was higher than 3 alpha (beta)-hydroxysteroid dehydrogenase activity. The effect of the increase in 5 alpha-reductase activity without a compensatory change in 3 alpha (beta)-hydroxysteroid dehydrogenase activity was to alter the mean ratio between 5 alpha-reductase and 3 alpha (beta)-hydroxysteriod dehydrogenase activities from 0.47 +/- 0.11 in the normal prostate to 1.84 +/- 0,19 in hyperplastic tissue. It is inferred that this change may predispose the hyperplastic prostate to asymmetrical rates of androgen metabolism and thereby contribute to the abnormal accumulation of dihydrotestosterone.

3-Hydroxysteroid Dehydrogenases↗
PubMed1979

Androgen receptors in benign and malignant prostatic tissue.

A new procedure has been developed to purify prostatic cell nuclei and to achieve a high yield of nuclear material for study. This technique allowed the investigation of the enzyme 5-alpha-reductase and its relationship to the translocation of dihydrotestosterone and androgen receptors into the nucleus of the prostatic cell. The studies revealed that 5-alpha-reductase was localized chiefly to the stromal components of all types of prostatic tissue. Although there is a higher concentration of dihydrotestosterone in carcinoma tissue the 5-alpha-reductase activity is low. Studies on the effect of androgens and antiandrogens on nuclear uptake of androgen revealed that androgens are potent stimulants of receptor translocation, while antiandrogens stimulate little or no translocation.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗