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Biomedical subjects

M L Blute

Publications and source records attributed to M L Blute.

At least 19 recordsLinked to original sources
PubMed1995

Primary chemotherapy for clinical stage II nonseminomatous germ cell testicular tumors: selection criteria and long-term results.

OBJECTIVE: To determine the treatment option for patients with low-volume stage II nonseminomatous germ cell testicular tumors (NSGCTT) that yields the best survival, is associated with the least morbidity, and avoids "double therapy"--that is, chemotherapy and retroperitoneal lymph node dissection (RPLND). DESIGN: We reviewed our institutional experience with 28 patients with stage II NSGCTT who received primary chemotherapy between August 1983 and October 1992. MATERIAL AND METHODS: The 28 study patients (mean age, 28 years; range, 20 to 52) with low-volume stage II NSGCTT were treated with bleomycin, etoposide, and cisplatin. The correlation of response rates with volume of disease and predominant histologic cell type was determined. The duration of survival was measured from the initiation of chemotherapy to the appearance of progressive disease or death or the date of last follow-up visit. RESULTS: Of the 28 patients treated, 27 (96%) achieved a complete response--20 (71%) with only chemotherapy and an additional 7 (25%) with chemotherapy plus surgical treatment. Twenty-seven patients (96%) remained free of disease after a median follow-up of 72 months. The most frequent complication was cisplatin-associated paresthesias or tinnitus which was noted in 13 patients (46%). In 11 of 15 patients (73%), attempts to have children have been successful. CONCLUSION: Excellent long-term survival rates in patients with stage II NSGCTT can be achieved with primary chemotherapy. In this series, 71% of patients were spared RPLND. The need for postchemotherapy RPLND seemed to be related to the initial metastatic tumor volume and possibly the histologic features of the primary tumor. Continued refinement in surgical techniques and chemotherapeutic regimens will necessitate the comparison of these two treatment approaches in a randomized prospective trial.

Adult↗
PubMed1995

Critical evaluation of salvage surgery for radio-recurrent/resistant prostate cancer.

PURPOSE: A positive post-irradiation prostatic biopsy associated with an increasing prostate specific antigen level but no palpable evidence of local progression may identify a subgroup of patients who could be cured by salvage surgical therapy. MATERIALS AND METHODS: Between 1967 and 1992, 132 patients underwent salvage surgery, including radical retropubic prostatectomy in 79, anterior exenteration in 38, total exenteration in 5 and bilateral pelvic lymphadenectomy only in 10. RESULTS: The 10-year cancer-specific survival rate in the prostatectomy group was 72%. Local control was equivalent among the surgical groups. Radical retropubic prostatectomy patients with negative surgical margins and nonaneuploid tumors demonstrated a significant survival advantage. Adjuvant hormonal therapy improved the disease-free survival rate in patients with nonaneuploid tumors. CONCLUSIONS: Radical retropubic prostatectomy can achieve excellent survival with low morbidity in select patients. Patients with clinical stage T2 or less disease and with prostate specific antigen detected cancers (52% and 75%, respectively) had pathological stage T2 disease. Thus, by using modern diagnostic techniques patients can be identified who may be cured with salvage surgery.

Adult↗
PubMed1995

Morbidity of contemporary radical retropubic prostatectomy for localized prostate cancer.

Complication rates in 1,000 consecutive patients who underwent radical retropubic prostatectomy for clinically localized prostate cancer between November 1989 and January 1992 were assessed and compared to complication rates in a historical group of patients operated on by primarily the same surgeons prior to 1987. In the contemporary series, there were no operative deaths, only 22% of patients required blood transfusion, and only six (0.6%) patients suffered rectal injuries. Early complications, including myocardial infarction, pulmonary embolism, bacteremia, and wound infection, occurred in less than 1% of patients. Vesical neck contracture, the most common late complication, developed in 87 patients (8.7%). At 1 year post-surgery, 80% of patients were completely continent, and fewer than 1% were totally incontinent.

Aged↗
PubMed1994

Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer.

To provide information about long-term outcome after radical prostatectomy for clinically localized prostatic cancer (stage T2c or lower), we undertook a retrospective analysis of 3,170 consecutive patients (mean age 65.3 +/- 6.4 years, range 31 to 81) with a mean followup of 5 years. Complication rates for patients who underwent prostatectomy before 1988 were compared with those who underwent radical prostatectomy more recently. Of the patients 49 (1.5%), 178 (5.6%), 897 (28%) and 2,047 (65%) had clinical stages T1a, T1b, T2a and T2b,c disease, respectively. The Gleason score was 3 or less in 292 patients (9%) and 7 or greater in 782 (25%). Overall, 438 patients (14%) died, 159 (5%) of cancer. The crude 10 and 15-year survival rates for all patients were 75% and 60%, respectively, which is comparable to the expected survival of a control group (67% and 46%). The cause specific survival rates were 90% and 82%, respectively, metastasis-free survival rates 82% and 76%, local recurrence-free survival rates 83% and 75%, overall recurrence-free rates 72% and 61%, and overall recurrence plus prostate specific antigen progression-free (greater than 0.2 ng./ml.) rates 52% and 40%, respectively. Clinical stage did not significantly affect survival but tumor grade was associated: 10 and 15-year cause specific survival rates were 95% and 93%, respectively, for a Gleason score of 3 or less, 90% and 82%, respectively, for a score of 4 to 6, and 82% and 71%, respectively, for a score of 7 or more. Of all patients 26% received adjuvant treatment (hormonal and/or radiation) within 3 months postoperatively because of advanced local pathological stage (pT3 or higher) or margin positive disease. The 30-day mortality rate was 0.3% (0% for 1,728 patients who underwent surgery in 1988 or later). Only 1 patient in the 70 year or older age group died during hospitalization. Complications decreased with time. In a contemporary group the complications were rectal injury in 0.6% of the patients, colostomy in 0.06%, myocardial infarction in 0.4%, deep venous thrombosis in 1.1%, pulmonary embolism in 0.7% and total urinary incontinence (3 or more pads per day) in 0.8%. Recent intraoperative blood loss was a median of 600 ml., and the incidence of recent need for any transfusion was 31% and it is presently less than 5%. In this series patients undergoing radical prostatectomy for clinically localized prostate cancer were usually healthy and, thus, had low co-morbidity. Survival rates at 10 and 15 years compare favorably with those of an age-matched control group.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1992

Transurethral microwave thermotherapy for prostatism: early Mayo Foundation experience.

As part of a multicenter investigative trial, transurethral microwave thermotherapy of the prostate was used in 60 men with symptomatic benign prostatic hypertrophy. A single office treatment on the Prostatron, a device that provides concurrent microwave heating of the prostate and conductive cooling of the urethra, was well tolerated and caused no major adverse events. Symptomatic improvement, especially the decrease in nocturia and urgency, was dramatic, and urinary flow was improved at 6 weeks. Continued follow-up suggests that further improvement will be achieved and that transurethral microwave thermotherapy has a role in the treatment of benign prostatic hypertrophy.

Academic Medical Centers↗
PubMed1992

A prospective randomized comparison of epidural infusion of fentanyl and intravenous administration of morphine by patient-controlled analgesia after radical retropubic prostatectomy.

In a prospective, randomized study, continuous infusion of epidural fentanyl citrate (group E) was compared with patient-controlled intravenously administered morphine sulfate (group P) for analgesia in 66 men after radical retropubic prostatectomy. Although both methods provided satisfactory analgesia, the mean comfort level scores were lower (that is, greater comfort) in group E than in group P at all observation times. The difference in mean resting comfort level scores between groups E and P was statistically significant (P < or = 0.05) at 9 of the 11 observation times. In addition, significant differences in comfort level scores were noted at 8 of the 11 observation times during deep breathing, 5 of 11 during coughing, and 3 of 9 during ambulation. Maximal and minimal comfort level scores recorded by each patient during the course of the study were significantly lower (that is, less pain) in group E than in group P for all four categories of activity. The percentage of patients who reported no pain was significantly higher in group E than in group P at 9 of 11 observation times during resting and 5 of 11 observation times during deep breathing. No significant differences were noted in side effect profiles or duration of hospital stay. In summary, when two effective methods of analgesia used after radical retropubic prostatectomy were compared prospectively, patients who received epidural infusion of fentanyl were more comfortable than those with patient-controlled intravenous administration of morphine, as evidenced by lower mean, maximal, and minimal comfort level scores and a greater proportion of patients with complete relief of pain.

Aged↗
PubMed1991

Extended followup of bilateral Wilms tumor: results of the National Wilms Tumor Study.

The long-term survival of patients with synchronous bilateral Wilms tumor is not well defined. Retrospective review of 185 patients registered with the National Wilms Tumor Study from January 1974 to July 1986 with stage V tumors suggests that the long-term outcome remains good. Over-all survival is 83%, 73% and 70% at 2, 5 and 10 years, respectively. Unfavorable histology, age at diagnosis and the most advanced stage of the individual tumors remain the most important prognostic variables. No significant difference in survival was noted between patients undergoing initial surgical resection of the tumor and those managed with initial tumor biopsy followed by chemotherapy with or without radiotherapy and subsequent surgical resection. Survival does not appear to be compromised by attempting to conserve native renal function with renal-sparing operations.

Age Factors↗
PubMed1991

Radical prostatectomy for stage A adenocarcinoma of the prostate: staging errors and their implications for treatment recommendations and disease outcome.

Of 148 patients with clinical stage A1 (32) or A2 (116) disease who had radical prostatectomy only 63% and 62%, respectively, had pathological stage A disease. Although 25% of those with clinical stage A1 and 9% of those with clinical stage A2 disease had no cancer at radical prostatectomy, 12% and 29%, respectively, had pathological stage C disease or higher. Clinical Mayo grade 1 was never associated with extracapsular disease but 60% of those with grade 3 or higher tumor did have extracapsular disease. Over-all survival was comparable to the expected survival. Clinical stage A2 cancer was associated with a significantly higher progression rate (when prostate specific antigen values were considered, p = 0.0011) and cancer death rate (p less than 0.045) than stage A1 disease, whereas pathological stage was not significantly related to disease outcome, possibly because of the use of adjuvant treatment (hormonal or radiation) for some patients with pathological stage C or higher disease. The vagaries of clinical staging associated with stage A disease, as well as the previously documented progression on long-term followup (8 to 10 years) in younger (60 years old or less) patients with stage A1 prostate cancer make radical prostatectomy with its limited morbidity an acceptable treatment choice.

Adenocarcinoma↗
PubMed1991

Multifocal malignant melanoma arising in vesicovaginal melanosis.

An 80-year-old white woman developed vulvar melanosis and malignant melanoma of the labia majora and clitoris and underwent a simple vulvectomy. She subsequently developed melanosis of the urinary bladder and presented 3 years later with multifocal malignant melanoma involving the vagina, urethra, and urinary bladder in a background of extensive melanosis with variable degrees of atypia. She underwent radical surgery but died 18 months later with liver metastases and liver failure. Malignant melanoma is uncommon in the vulva and vagina and is rare in the urinary bladder. This case illustrates the previously described association between melanosis and malignant melanoma. The unusual features are the widespread distribution of the melanosis (vagina and bladder) and the subsequent development of multifocal malignant melanoma.

Aged↗
PubMed1990

Stage B prostate adenocarcinoma. Flow cytometric nuclear DNA ploidy analysis.

Over a 16-year period (1966 to 1981), 349 patients underwent radical retropubic prostatectomy for pathologic stage B adenocarcinoma of the prostate. Nuclear DNA content was measured by flow cytometry on available archival material of 283 patients. Two hundred sixty-one patients (92%) had high-quality histograms. The ploidy distribution was as follows: DNA diploid, 177 (68%); DNA tetraploid, 74 (28%); and DNA aneuploid, 10 (4%). The average follow-up was 9.4 years. At the time of follow-up, 53 patients (20%) within the study group had developed tumor progression: 22 local, 23 systemic, and 8 both. The ploidy distribution of the population that developed tumor progression was 27 DNA diploid (51%), 16 DNA tetraploid (30%), and 10 DNA aneuploid (19%). This ploidy distribution is significantly different from that found for the nonprogression group with stage B disease. Overall, 31% of patients with DNA nondiploid tumors had tumors that progressed compared with 15% of patients with DNA diploid tumors. All (100%) DNA aneuploid tumors progressed. The DNA ploidy distribution of all pathologic stage B prostate cancers differs significantly from that found in more advanced stages (C and D1) previously reported for the same time interval. However, the ploidy distribution of stage B tumors that progressed closely resembles that of the stage C and D1 tumors. These results further support the working hypothesis that nuclear DNA content has marked prognostic significance for patients with adenocarcinoma of the prostate. It seems to us that analysis of ploidy by flow or static cytometry will become an essential tool for treating patients with localized prostate cancer.

Adenocarcinoma↗
PubMed1990

Intraoperative ultrasonographically guided biopsy in testicular sarcoidosis: a case report.

We present a case of sarcoidosis with involvement of a solitary testis that was discovered incidentally on an ultrasonogram of the scrotum. This appears to be case 8 of sarcoidosis with genitourinary involvement limited to the testis. We believe it is the second report of intraoperative ultrasonography used to locate and perform a biopsy of impalpable testicular lesions. We consider this technique to be useful in instances of solitary gonads or in cases of bilateral lesions.

Adult↗
PubMed1989

Pattern of failure after radical retropubic prostatectomy for clinically and pathologically localized adenocarcinoma of the prostate: influence of tumor deoxyribonucleic acid ploidy.

From 1966 to 1980, 315 patients underwent bilateral pelvic lymphadenectomy and radical retropubic prostatectomy without adjuvant treatment for clinically and pathologically localized adenocarcinoma of the prostate. Followup was 5 to 21 years, with a median of 8 years. The disease was pathological stage A in 24 patients (8%) and pathological stage B in 291 (92%). A total of 45 patients (14.2%) experienced progression. Over-all, 28 patients (8.9%) suffered local recurrence at a mean of 6.6 years postoperatively (median 5.5 years). Local recurrence was noted as late as 15 years postoperatively. Over-all, systemic progression was observed in 25 patients (8%) after a mean of 4.7 years (median 6 years). Eight patients (2.5%) experienced local and systemic failure. The projected local and systemic failure rates at 15 years were 22% and 15%, respectively. Disease-specific survival at 15 years was 93%, since only 11 patients (3.4%) died of prostate cancer. In an age-matched case control analysis, after all prognostic variables were analyzed (Mayo grade, Gleason score, capsule involvement, number of foci, volume of tumor and deoxyribonucleic acid tumor ploidy), progression was related to nondiploid deoxyribonucleic acid tumor ploidy (p less than 0.0004) as determined by flow cytometry in 63% of the patients who evidenced progression versus 8% of the nonrecurrent group.

Adenocarcinoma↗
PubMed1989

Primary signet ring cell adenocarcinoma of the bladder.

Primary signet ring cell adenocarcinoma of the bladder accounts for less than 1 per cent of all primary bladder neoplasms. This tumor is insidious because of its subepithelial infiltrative nature, which makes diagnosis possible only late in the course of the disease. Survival is poor; greater than 50 per cent of the patients are dead within a year after diagnosis. Exenterative procedures offer the only hope of palliation; irradiation and chemotherapy have not been effective. We add 5 cases of primary signet ring cell adenocarcinoma of the bladder and 1 case of high grade transitional cell carcinoma of the bladder with signet ring cell foci to the 14 cases reported in the literature. Pathological correlation supports the origin of this neoplasm from totipotential transitional epithelium.

Adenocarcinoma, Mucinous↗
PubMed1989

Impact of endourology on diagnosis and management of upper urinary tract urothelial cancer.

The technique of transurethral ureteropyeloscopy was used in 43 patients with upper urinary tract urothelial tumors. Diagnosis was confirmed in 19 of 22 renal pelvic tumors (86 per cent) and 19 of 21 ureteral tumors (90 per cent). The major complication rate in this series is low (7 per cent) and did not appear to influence unfavorably subsequent management or outcome. A total of 21 patients underwent conservative endourological management of the upper tract tumor. The local recurrence rate was 20 per cent (1 of 8) for renal pelvic tumors and 15 per cent for distal ureteral tumors (2 of 13). The technique of ureteropyeloscopy should be added to the standard diagnostic regimen for the investigation of upper tract filling defects and conservative endourological techniques can be used safely for management of selected cases of upper tract urothelial tumor.

Aged↗
PubMed1988

Transitional cell carcinoma of the renal pelvis: nuclear deoxyribonucleic acid ploidy studied by flow cytometry.

Nuclear deoxyribonucleic acid ploidy analysis by flow cytometry was performed successfully on 109 formalin-fixed paraffin-embedded tissue specimens of transitional cell carcinoma of the renal pelvis. Tumor tissues were from patients who were operated upon between 1960 and 1975, so that long-term clinical followup was available. There were good correlations among deoxyribonucleic acid ploidy pattern and histological grade, pathological stage and clinical outcome. For high grade, high stage tumors deoxyribonucleic acid ploidy pattern provided no additional prognostically important information. However, for the more common low grade, low stage tumors the occasional detection of deoxyribonucleic acid aneuploidy patterns identified an important subgroup of patients who experienced significantly poorer survival.

Actuarial Analysis↗
PubMed1988

Angiomyolipoma: clinical metamorphosis and concepts for management.

In 10 years the diagnosis of renal angiomyolipoma was made in 44 patients (female-to-male ratio 8:1) at our institution; 4 cases were associated with tuberous sclerosis. Of these patients 29 underwent surgical exploration because of a renal mass; 11 patients with renal masses that were consistent with angiomyolipoma radiologically have not undergone exploration. Of the 4 patients with and the 29 patients without tuberous sclerosis 1 (25 per cent) and 2 (7 per cent), respectively, had renal cell cancer in association with angiomyolipoma. Metachronous involvement of the contralateral kidney has not been noted in any of our patients who underwent nephrectomy for unilateral involvement, nor has there been progression of the contralateral lesion in 3 patients with bilateral disease without tuberous sclerosis during a followup of about 6 years. Furthermore, we have not noted progression of lesions in the 11 patients under observation for a mean followup of almost 3 years. We recommend elective exploration and a renal preserving operation when possible, not only for patients with pain and hemorrhage but also for the complex multiple lesions occasionally seen in patients who do not have tuberous sclerosis. Lesions associated with tuberous sclerosis require surgical intervention only when they become symptomatic or enlarge silently.

Adolescent↗
PubMed1988

Ureteroscopy.

From early 1982 to December 1985, 317 patients underwent 346 transurethral ureteroscopic procedures at our institution. For most patients the intramural ureter was dilated with balloon dilators and all procedures were performed under fluoroscopic control. The over-all success rate for lower ureteral stone removal was 95 per cent, which increased to 97 per cent for stones treated in 1984 and 1985. Ureteroscopy is useful for the evaluation of idiopathic gross hematuria, and for the diagnosis and treatment of ureteral and renal pelvic tumors. The over-all mean hospital stay was 4.9 days and the procedure has been a significant addition to our armamentarium.

Adolescent↗