Biomedical subjects
Publications and source records attributed to H Grabstald.
We report 2 cases of ureteral stump calculi presenting years after nephrectomy. Stones in the ureteral stump are extremely uncommon, and their occurrence has led us to review the possible mechanisms underlying their etiology.
Histologic sections from the testes of 32 autopsied patients with acquired immune deficiency syndrome (AIDS) were examined. Almost invariably the testes displayed decreased spermatogenesis, and 20 of the 32 cases showed marked hypospermatogenesis with Sertoli cells predominantly lining the tubules. Although the seminiferous tubules were generally of normal size, the tunica propria at the periphery of the tubules was mildly to moderately thickened in 19 cases and markedly thickened in 10. The interstitial cells of Leydig were unaltered in most patients, with only 4 testes showing Leydig cell hyperplasia. The testicular blood vessels were slightly thickened in many patients, but 5 exhibited moderate to marked intimal proliferation with narrowing of the lumen. Mononuclear inflammatory infiltration of the testicular interstitium was slight in 11 cases, moderate in 6. Only 7 of the 28 AIDS patients with opportunistic infections had evidence of direct involvement of the testes by the infectious organisms. We concluded that the extragonadal endocrine balance of AIDS patients may be deranged due to the infectious process and so deserves clinical evaluation.
We report a case of tumor dissemination via needle aspiration of a solid hypovascular renal mass. This case emphasizes how needle aspiration of these masses does not always lead to proper management and may be detrimental to the patient.
Cis-diamminedichloride platinum II (DDP), 50--70 mg/m2 iv, q 3w was administered to 25 patients with Stage D adenocarcinoma of the prostate. Since the assessment of tumor regression in a disease-oriented phase II study demands a clear end-point of response, case selection was restricted to patients who had objectively measurable lesions, i.e., nodes, skin, lung, and liver metastasis. Partial remission occurred in 3 (12%) and stabilization of disease in 1 patient. Responders lived 53 weeks vs. 20 weeks for non-responders. In the dosage and schedule used in this protocol, DDP was not an active agent in the treatment of prostatic cancer. Various patient characteristics are examined and correlations made between remission rates and survival in this study vs. 4 other response schemata. A critical analysis of patient selection, "lead time" -- diagnosis to chemotherapy, and the definitions of the terms "measurable" lesions, "evaluable" parameters, "objective response", stabilization of disease and response criteria employed in the 4 schemata are also discussed.
A retrospective review of 218 consecutive nephrostomies done on uremic cancer patients has revealed an alarming incidence of postoperative morbidity and mortality. This review has raised legitimate questions regarding the value of palliative urinary diversion. We present a rationale to assist physicians in the management of this clinical problem.
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The clinical courses are presented for 6 patients with sarcoma of the spermatic cord seen between 1967 and 1976. There were 3 fibrosarcomas, 2 liposarcomas and 1 malignant fibrous histiocytoma, making the total reported cases of spermatic cord sarcoma 212. Management of spermatic cord sarcoma is discussed.
Twenty-one patients with testicular tumors had gallium scans prior to retroperitoneal lymph node dissection. Eleven of 14 patients found to have nodal involvement had positive scans, and 2 of 7 patients with negative nodes had false positive scans. Bleomycin scans were positive in 4 of 5 patients with nodal metastases. While these scans provide a simple, non-invasive and occasionally useful technique for the clinical staging of testis neoplasms, they do not, in our experience, significantly supplement other staging procedures.
Forty-two patients with measureable, advanced, genito-urinary cancer received Adriamycin. Significant clinical responses (CR/PR) occurred in only five (14%) of 35 adequately treated patients. Four additional patients achieved a minimal response anf four others showed stabilization of their disease for 4 to 9 months. Review of the literature suggests an overall response rate of 20%. Patients with a urinary diversion lived significantly longer (P 0.006) than patients who did not have this procedure (42.5 months vs 21.5 months). The need to define various patient characteristics in future chemotherapeutic trials in bladder cancer is discussed.
This report surveys the results of two programs of preoperative irradiation with radical cystectomy for bladder cancer in 205 patients. Irradiating the true pelvis to 4000 rads in 4 weeks with radical cystectomy after 6 weeks was implemented in 119 patients (Group 1) from 1959 to 1965; 2000 rads given in 1 week to the true pelvis and radical cystectomy within the following week was implemented in 86 patients (Group 2) from 1966 to 1970. Determinate survival without evidence of recurrence at 5 years was 43% in Group 1 and 42% in Group 2. Mortality with recurrence of bladder cancer in 5 or more years was 44% in group 1 and 42% in group 2. Pelvic complications occurred in 13% of group 1 and 9% of group 2.
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Rectal invasion by benign prostatic hyperplasia occurred subsequent to an open transrectal biopsy of the prostate gland. Frequent transrectal resections of the prostate controlled this unusual lesion initially. However, massive intrarectal regrowth of this clinically malignant but histologically proved benign prostatic enlargement required eventual pelvic exenteration.
Carcinoembryonic antigen was measured in the urine and plasma of 108 patients with several types and various stages of genitourinary cancer. The value of the carcinoembryonic antigen assay as an early indicator of neoplastic disease was evaluated and a correlation was made between the extent of disease and the concentration of urinary and plasma carcinoembryonic antigen. Patients were classified according to stage of tumor involvement as follows: no evidence of disease, non-malignant disease, non-invasive disease, no known metastasis, regional metastasis and disseminated metastasis. The urinary carcinoembryonic antigen levels more closely paralleled the extent of disease than did the plasma carcinoembryonic antigen levels in patients with bladder cancer. Neither urinary nor plasma carcinoembryonic antigen levels were useful in assessing the extent of disease in patients with prostatic or testicular cancer. Studies related to microbiological interference in the carcinoembryonic antigen assay indicated that bacterial counts up to 10(5) organisms per ml. did not interfere. Cytological studies indicated that the presence of white blood cells, atypical cells and malignant cells could result in elevated urinary carcinoembryonic antigen levels.
A series of 6 patients with ureteral metastases from breast carcinoma treated by radiation therapy has been evaluated. Most patients received a tumor dose of 3,600 rads in 3 to 4 weeks, and showed remarkable clinical improvement, with relief of the ureteral obstruction and reversal of symptoms and signs of uremia after radiation therapy. One patient died before an adequate dose of radiation therapy could be given. Early recognition and early treatment of ureteral metastases have been stressed. Radiation therapy techniques have been described.
This is a summary presentation on certain aspects of an experience with the use of radical cystectomy with or without prior irradiation in the treatment of selected patients with bladder cancer at the Memorial Sloan-Kettering Cancer Center.
Solitary metastasis is uncommon, occurring in 1.6% to 3.2% of patients with renal cell carcinoma. Because of the potential of survival, amputation of an extremity with a metastasis is frequently advocated, particularly after successful nephrectomy. The cure rate with amputation is approximately 30%. Cryosurgery for treatment of localized and limited bony metastasis in an alternative to more radical surgery. This is a report of follow-up observation of the original series of cases as well as the addition of 4 new cases with multiple metastasis.