Biomedical subjects
Publications and source records attributed to H J Jewett.
We describe 2 patients with an absent segment of the bulbomembranous urethra, in 1 of whom the defect extended from the triangular ligament to the scrotal area. A simple method to restore continuity is presented, which is applicable to a wide variety of conditions resulting in the absence of a long segment of the bulbomembranous urethra.
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Computer assisted image analysis was used to determine quantitative and reproducible nuclear morphology of 17 totally excised pathological specimens from stage B-2 prostatic cancer in an attempt to correlate histopathological analysis with clinical prognosis for the individual patient. We describe a nuclear roundness factor that correlates with the clinical outcome of the individual patient. This nuclear shape factor appears to identify prostatic tumors with a high metastatic potential from tumors that are less aggressive. Quantitative nuclear image analysis, its accuracy, and reproducibility are described and discussed. This technique may provide the pathologist with a valuable tool for analyzing prostatic cancer cells in a quantitative manner, thereby contributing precise information to the urologist relevant to the prognosis of the individual patient.
A new technique has been developed that helped in an accurate prediction of the prognosis of 27 patients with stages B1 and B2 prostatic cancer following radical prostatectomy. This method involves computer-assisted image analysis of histological specimens of the primary lesion removed at the time of radical perineal prostatectomy. On the basis of a nuclear shape factor, known as nuclear roundness, we have been able to distinguish those tumors with a high metastatic potential from tumors that are less aggressive. This technique provides pathologists with quantitative information about the metastatic potential of a tumor, which may aid in the management of the individual patient.
To refine the criteria for radical surgery in clinical stage B2 prostatic cancer a retrospective study was made of 53 patients who underwent radical perineal prostatectomy between 1951 and 1963. The 15-year survival free of tumor was 25 per cent, significantly less than the 51 per cent survival rate in a series of patients with clinical B1 disease undergoing radical perineal prostatectomy during the same period. Sixty-six per cent of the patients had extraprostatic extension of tumor on histological examination. The 15-year survival free of tumor in these patients was only 13 per cent, whereas those patients with tumor histologically confined to the prostate had a 15-year survival rate of 50 per cent, equal to an age-matched control population. Thus, although prolonged survival was demonstrated in patients without extraprostatic extension only a third of all clinical B2 cases were in this favorable category. Consequently, until improved reliable techniques for detection of extraprostatic extension become available it seems unwise to recommend radical prostatectomy as the treatment of choice for all men with clinical stage B2 disease.
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Of 447 patients who underwent radical perineal prostatectomy and were examined during the 54 years of study only those with a 1 to 2 cm. nodule within an otherwise clinically normal prostate have, on the average, done well. When the current staging segregation has been used, these cases were labeled B1 or occasionally B1n, and were nearly always grade 1 or 2, although 77 per cent were diffuse microscopically within the gland. No patient with a grade 3 cancer has lived 15 years free of disease. Biopsy is mandatory for diagnosis and for eliminating grade 3 cancer. The immunochemical determination of prostatic acid phosphatase in the bone marrow, not used in these reported cases, may prove to be the most sensitive test for otherwise unrecognized osseous metastases. So far no non-invasive test is infallible in detecting micrometastases in lymph nodes but these are rare when the tumor is a 1 to 2 cm. nodule. In such cases the operation, so far, provides a 15-year survivorship better than that of any other modality.
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Recent concepts may provide the basis for new insights into the etiology and prognosis of bladder cancer. Experimental observations related to the physiology, carcinogenesis and tumor growth of the bladder epithelium are providing useful information to the urologist and may soon extend our understanding of the characteristics of this disease. This article provides an overview of some of these theoretical and experimental considerations.
Since 1943 we have attempted to stage infiltrating tumors of the bladder. This original grouping required minor revisions as time went on in order to furnish information of prognostic value. The original classification of tumors into A, B1, B2, and C, widely used in the United States and abroad, was improved by Marshall's addition fo O and D, and especially by its conversion into the Tumor Nodes and Metastasis (TNM) System. This latter now appears to be standard for the western World. It is disappointing that the surgical results are not better for the superficial group, even after external radiotherapy. Most probably a markedly improved success rate will depend on new anticancer agents.
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The natural history of prostatic cancer is incompletely understood. Small cancers may have a very slow or rapid growthrate, and the majority are differentiated. Cells may leave the prostate by blood or lymph without penetrating capsule or invading the seminal vesicles. The predication of latency or of biologic activity in any givne case is impossible. Stage A cancer should be separated into A1 (focal) and A2 (diffuse). Stage A1 cancer that is low grade is best lfet alone. Stage A2 cancer and high grade cancer probably should be treated by megavoltage radiation. Stage B includes many cancers that are microscopically stage C. If this stage is separated into clinical stage B1 (tumors grossly involving less than one lobe), and B2 (tumors involving one lobe or more) the underestimation of microscopic extent in B1 will be less than in 10 per cent of the cases. In clinical stage B2 cancer, 50 per cent are microscopically stage C. Radical prostatectomy for cure should be limited to clinical B1 cases without distant spread. It is not a cure-all, but it provides the best 15-year survival rate more completely, more quickly, less expensively, and with fewer discomforts than other methods. The alternative options are no treatment, endocrine treatment, and radiation. The first is risky in many instances and may allow an ac-ive cancer to get out of control. The second rarely destroys all of the cells in the total cell population and gives one a false sense of security. The last should be reserved for cases well beyond stage B1, but without distant metastases, where its usefulness exceeds that of radical excision.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.