Biomedical subjects

M L Blute

Publications and source records attributed to M L Blute.

At least 109 records · Page 6Linked to original sources

PubMed1993

Clinical Stage B0 or T1c prostate cancer: nonpalpable disease identified by elevated serum prostate-specific antigen concentration.

A retrospective study was performed to evaluate the clinical and pathologic characteristics of 60 patients with a palpably benign prostate gland, but with biopsy-proved prostate cancer. All patients underwent prostate biopsy because of elevated serum prostate-specific antigen (PSA) concentration, and subsequently underwent radical retropubic prostatectomy (RRP). Similar analysis was performed for a randomly selected group of 60 clinical Stage B1 prostate cancers from the same period (control cohort). Patients with nonpalpable prostate cancers had a higher preoperative PSA level as compared with the clinical Stage B1 group (median value: 12.3 ng/mL versus 4.6 ng/mL, p < 0.001). There was no significant difference between the two groups with regard to clinical parameters (voiding symptoms, hematuria, age). The nonpalpable prostate cancers exhibited a significant tumor volume (mean: 7.4 cc; range: 0.3-56 cc), and 18 (30%) demonstrated capsular perforation to involve the periprostatic tissues. Of these, three (5%) had seminal vesicle invasion, and one (2%) had pelvic lymph node involvement. There was no difference between these pathologic characteristics and those of the clinical Stage B1 prostate cancers. These findings suggest that nonpalpable prostate cancers identified by an elevated serum PSA level can be of clinical significance and warrant therapeutic consideration. Although nonpalpable, these cancers are peripherally located and were clinically suspected prior to biopsy. Therefore, we propose that these cancers be classified as clinical Stage B0 in the Whitmore-Jewett staging system; in the new TNM staging system, they are designated as clinical Stage T1c.

Adult↗

PubMed1993

Renal angiomyolipoma in association with pulmonary lymphangioleiomyomatosis: forme fruste of tuberous sclerosis?

From 1976 to 1989, 27 patients with pulmonary lymphangioleiomyomatosis were seen at our institution. Twenty-five had no signs or symptoms of tuberous sclerosis; 21 of these had abdominal imaging or surgical exploration to make the diagnosis of renal angiomyolipoma in seven patients, all female. Three presented with symptoms secondary to renal disease, three with pulmonary manifestations, and one with both. Renal disease was bilateral in four patients; four patients underwent nephrectomy and two tumors were embolized. All patients experienced spontaneous pneumothoraces during the course of their disease. There was one respiratory death. It is our belief that any patient presenting with angiomyolipoma and a history of pulmonary problems should be evaluated for pulmonary lymphangioleiomyomatosis with a limited computed tomography scan of the chest at the time of abdominal imaging. The surgical treatment of angiomyolipoma when associated with lymphangioleiomyomatosis is predicated on the ability to adequately manage the complicating lung disease perioperatively.

Adult↗

PubMed1993

Biopsy-proved prostate cancer in 100 consecutive men with benign digital rectal examination and elevated serum prostate-specific antigen level. Prevalence and pathologic characteristics.

To determine whether a significant percentage of patients with a benign digital rectal examination (DRE) and an elevated serum prostate-specific antigen (PSA) level harbor a prostatic malignancy, 100 consecutive patients underwent transrectal ultrasound (TRUS)-guided biopsy of the prostate. The biopsy results were correlated with the pre-biopsy serum PSA level and ultrasound findings. Overall, the cancer detection rate was 35 percent (S.E. 4.8%). When the biopsy results were analyzed according to the PSA level, the rate of cancer detection increased with advancing PSA levels, irrespective of ultrasound findings. In the 60 patients with ultrasound abnormalities, the cancer detection rate was 47 percent compared with 18 percent for those without ultrasound abnormalities. Comparison of TRUS-negative and TRUS-positive biopsy results revealed a more than two-fold increase in cancer detection for the TRUS-positive group in each PSA range. Cancer detection in the TRUS-positive, PSA 4.1-10, 10.1-20.0, and > 20 ng/mL groups was 40 percent, 56 percent, and 67 percent, respectively; in the TRUS-negative group, cancer detection was 12 percent, 27 percent, and 33 percent, respectively. Twenty (57%) of the patients with prostate cancer underwent radical retropubic prostatectomy. The mean tumor volume was 4.7 cc. Seventy percent had organ-confined disease, 30 percent demonstrated capsular penetration only, and no patients had seminal vesicle or pelvic lymph node invasion. These data indicate that a significant percentage of patients with a benign DRE and an elevated serum PSA value harbor a clinically significant, but potentially curable prostatic malignancy.

Adenocarcinoma↗

PubMed1993

Transurethral microwave thermotherapy for management of benign prostatic hyperplasia: results of the United States Prostatron Cooperative Study.

The primary objective of the study was to determine the safety and efficacy of transurethral microwave thermotherapy for the treatment of symptomatic benign prostatic hyperplasia. From March to August 1991, 150 patients were entered into a multi-site study and treated with transurethral microwave thermotherapy under a Food and Drug Administration approved protocol. Only patients with symmetrical trilobar or bilobar prostatic hypertrophy, peak flow rate of less than 15 cc per second (on 2 voided volumes of 150 cc or greater) and a total Madsen symptom score of more than 8 were treated. Transurethral microwave thermotherapy was performed with a 20F catheter and 1,296 MHz. microwave antenna for 60 minutes. The mean power achieved for this single session was 32.1 watts, with a mean power at maximum urethral temperature of 41.1 watts. Mean urethral temperature was 44.3C and the mean rectal temperature was 42.2C. The rectal and urethral temperatures were continuously monitored. Mean peak urinary flow rates, Madsen symptom score, post-void residual volume and improvement in motivating symptom to seek treatment were measured at 6 weeks, and 3, 6 and 12 months. Mean peak urinary flow rates improved 33% at 12 months (p < 0.0001). Overall, the mean Madsen symptom score improved 61% (p < 0.0001). The obstructive score and the irritative score improved 67% and 43%, respectively. Of 17 patients 12 (71%) reported improvement in weak stream when that was the motivating symptom to seek treatment. Of 28 men 18 (64%) reported improvement in nocturia, while 11 of 30 (37%) reported improvement in daytime frequency and 12 of 17 (71%) reported improvement in urgency. There was no statistically significant difference in post-void residual volume at 12 months from baseline. The treatment was well tolerated by all patients, and side effects were considered mild and transitory. Our study demonstrates the safety, effectiveness, patient tolerability and durability of transurethral microwave thermotherapy.

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↗

PubMed1987

Bilateral Wilms tumor.

Despite institutional variation in the treatment of synchronous bilateral Wilms tumor, a 76 per cent over-all 3-year survival rate has been achieved. We reviewed 145 patients with stage V disease (synchronous bilateral Wilms tumor) registered with National Wilms Tumor Studies 2 and 3. The majority of the patients (94, or 65 per cent) underwent initial surgical resection followed by chemotherapy with or without radiation, with a 3-year survival rate of 82 per cent. However, survival of 45 patients who underwent initial biopsy, postoperative chemotherapy and second-look surgery was 57 per cent at 3 years, a result not significantly different statistically from the 82 per cent figure. Only 38 per cent of the patients had all tumor resected at 1 or more operations. Therefore, emphasis is being placed on chemotherapy as the predominant treatment modality for this disease. Unfavorable histology was found in 10 per cent of the patients and 6 patients (4 per cent) had discordant histology, that is unfavorable histology on 1 side with contralateral favorable histology. Better prognostic factors were patient age less than 3 years at diagnosis, lower stage of the most advanced lesions, favorable histology and negative nodal involvement. Currently, routine bilateral biopsy of tumors is recommended, followed by chemotherapy according to the stage of the most advanced lesion. Impressive shrinkage of tumor can be expected with the hope that surgery will allow renal preservation (excisional biopsy or partial nephrectomy) rather than nephrectomy.

Adolescent↗