[Spreading infectious endocarditis: an example of vascularitis].
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Adolescent↗
Biomedical subjects
R Dumont
Publications and source records attributed to R Dumont.
Risk groups in patients with bladder cancer treated with radical cystectomy: statistical and clinical model improving homogeneity.
PURPOSE: In this study we identified homogeneous risk groups, with no survival overlap among the subgroups that make up each risk group, in patients with transitional cell carcinoma of the bladder treated with radical cystectomy alone. MATERIALS AND METHODS: Predictive factors for tumor death were analyzed with univariate and multivariate analysis among a group of 298 patients with transitional cell carcinoma of the bladder treated with radical cystectomy alone. Independent variables were progressively incorporated according to their statistical power in a stepwise process identifying a model with independent subgroups. The risk groups were identified according to different survival cutoff points including subgroups with similar survival. To search a clinical application and to check the strength of this model a new model was also set up using the weight score based on the size of hazard ratio from multivariate analysis. RESULTS: Univariate analysis demonstrated that lymphatic invasion status, pathological stage (P), lymph node status (N) and prostatic stroma status (St) were predictive variables for tumor death, and the latter 3 were independent variables in the multivariate analysis. By taking the most powerful, N, as the reference variable, and progressively incorporating additional variables, a model was found including 7 independent subgroups. In this model only 2 subgroups, N1 and N2-3, included more than 1 category and their survival was also calculated. Three risk groups were identified establishing different survival cutoffs. The 5-year cancer specific survival rate was 86.4% for low risk (P1-2N0St-), 64.4% (range 60.9% to 65.3%) for intermediate risk (P1-2N1St-, P3N0St-, HR = 2.7) and 28.1% (range 0% to 47.7%) for high risk (N2-3, P4, St+, N1P3, HR = 8.7). This model was also reproduced using the weight score based on the size of the hazard ratio from the multivariate analysis CONCLUSIONS: Three homogeneous risk groups were identified with high statistically significant survival differences among them and no survival overlap among subgroups that make up the risk groups.
Adult↗
Late oncological occurrences following radical cystectomy in patients with bladder cancer.
PURPOSE: To evaluate the prognoses and predictive factors of late oncological occurrences and its impact on follow-up strategy in patients with bladder tumours treated with radical cystectomy. MATERIALS AND METHODS: Late oncological occurrences were considered when they took place after three years from cystectomy or when early recurrence was controlled with therapy and patients developed recurrence again after a three-year disease-free interval. Univariate and multivariate analysis of predictive factors for late oncological occurrences were carried out on 215 patients at risk of late oncological recurrences. RESULTS: Among 357 patients treated with cystectomy, 163 (45.6%) relapsed, 149 (41.7%) of them as early recurrence and 17 (4.7%) were considered as late oncological events. This incidence increased up to 8% when patients at risk were considered. Three patients with early recurrence reached a complete response after treatment and relapsed again as late recurrences. Distant metastases and local recurrence represented 78.5% of early recurrence as opposed to 11.7% in late oncological occurrences, whereas, extravesical urothelium recurrences represented 8.6% and 70% respectively (p<0.01). Among patients with late oncological occurrences, nine (53%) were disease-free, seven with urothelial recurrence and two of three with lymph-node recurrence whereas only eight (5.6%) patients with early recurrence were free of tumour (p<0.0001). Multiple tumours, prostate involvement and organ-confined tumours in cystectomy specimen were the independent variables for predicting late oncological occurrences in multivariate analysis. CONCLUSIONS: Recurrences in the remaining urothelium prevail as the pattern of late oncological occurrences. The prognosis of these events is significantly better than an early recurrence. Patients at risk of late oncological occurrences are those with multiple tumours, prostate involvement and with organ-confined tumours in cystectomy specimen. After three years from cystectomy, the follow-up schedule of these patients be limited to performing an annual CT-scan and urinary cytology to detect essentially upper urinary tract recurrence and extrapelvic lymph-nodal recurrence. Afterwards an annual intravenous urography might replace to CT-scan since lymph-nodal involvement was not detected.
Adult↗
The 3-month clinical response to intravesical therapy as a predictive factor for progression in patients with high risk superficial bladder cancer.
PURPOSE: We analyzed the 3-month clinical response to intravesical therapy as a factor predictive of progression in patients with high risk superficial bladder cancer. MATERIAL AND METHODS: We evaluated 191 patients with high risk superficial bladder cancer, 111 with secondary or associated bladder carcinoma in situ and 80 with stage T1 grade 3 disease who were treated with intravesical therapy. We considered only clinically complete and no responses at the 3-month endoscopic study. To determine the predictive value of the 3-month clinical response we differentiated progression into superficial and invasive types. RESULTS: At a median followup of 73 months 91 patients (47.6%) had progression, which was superficial in 48 (25. 1%) and invasive in 43 (22.5%). Invasive progression was associated with significantly higher cause specific mortality than superficial progression (p = 0). In the latter cases cause specific mortality was higher than in those without progression (p = 0.001). Although cystectomy significantly decreased the cause specific mortality rate in patients with invasive progression (p = 0.0001), this rate was high at 46.3%. Univariate and multivariate analyses revealed that the 3-month clinical response was a significant predictive factor for progression. Moreover, stratifying this variable showed that this response was the only independent factor predictive of invasive progression in cases of no response with stage T1 grade 3 tumor, bladder carcinoma in situ, or prostate mucosa or duct involvement (p = 0). In our series 41 patients (21.5%) did not respond after intravesical therapy at the 3-month evaluation, including 29 with stage T1 grade 3 disease, bladder carcinoma in situ, or prostate mucosa or duct involvement. Progression in 24 of these 29 patients (82.3%) was classified as invasive in 21 (73.6%). CONCLUSIONS: Invasive progression threatens the cause specific survival of patients with high risk superficial bladder cancer even when cystectomy is performed. The 3-month clinical response was an excellent predictive factor for invasive progression. Early cystectomy should be considered when stage T1 grade 3 tumor, bladder carcinoma in situ, or prostate mucosa or duct involvement is present at the 3-month clinical evaluation.
Administration, Intravesical↗
Effectiveness of a single immediate mitomycin C instillation in patients with low risk superficial bladder cancer: short and long-term followup.
PURPOSE: We analyze the impact of a single mitomycin C instillation in patients with low risk superficial bladder cancer with short and long-term followup. MATERIALS AND METHODS: A total of 131 patients with low risk superficial bladder cancer were included in a prospective randomized controlled trial. All patients had a 3 cm or less single, papillary, primary or recurrent tumor and were disease-free for more than 1 year. Patients with muscular invasion, G3 tumor or bladder carcinoma in situ on pathological examination were excluded from study. The tumor was completely resected before patients were randomized into 2 arms of no further treatment (control group) and a single immediate instillation of 30 mg mitomycin C (mitomycin C group). Recurrences were considered early within the first 2 years of followup. RESULTS: At 24-month followup the recurrence-free interval was significantly increased, and recurrence, and recurrence and tumor per year rates were decreased in the mitomycin C compared to the control group. However, at long-term followup these differences were not statistically significant and the recurrence-free interval curves were parallel. A shorter hospital stay and catheterization period were noted in the mitomycin C group compared to the control group, which were not significant. Early recurrences were concentrated in the first year in the control but not in the mitomycin C group. A significant relationship between early and late recurrences was found in the mitomycin C but not in the control group. CONCLUSIONS: Our analysis confirms the positive effect of a single immediate mitomycin C instillation in patients with low risk superficial bladder cancer. This benefit is limited to early recurrence and is not maintained with long-term followup. Thus, this approach is an alternative to observation or endovesical chemotherapy. Our study also suggests that cell implantation as a mechanism of early recurrence can be controlled with a single mitomycin C instillation.
Administration, Intravesical↗
User needs and demands of a computer-based patient record.
Prior to the implementation of a computer-based patient record, it is necessary to outline the requirements of the medical personnel. The paper is an account of a survey on information needs and demands on computer-based patient records. The study was conducted among physicians, nursing staff and therapists in two Dutch hospitals. In order to conduct the study, a measuring-instrument in form of a questionnaire was developed. Based on the results, it may be concluded, that health service staff does not only require improved input- and consultation uses with regard to the hard copy, but is also in need of additional functions. The developed measuring instrument appeared to be a proficient aid in outlining the information needs and demands of the health service staff. Through the developed questionnaire, the staff was able to obtain an idea of the possibilities of the computer-based patient record and state their own interest in same.
Adult↗
Upper urinary tract involvement in patients with bladder carcinoma in situ (Tis): its impact on management.
OBJECTIVES: To analyze the biologic behavior and etiologic mechanism of upper-tract involvement in patients with bladder cancer in situ (Tis) and its impact on management of these patients. METHODS: One hundred thirty-eight patients with bladder Tis, 786 with superficial bladder cancer, and 179 patients with invasive bladder cancer treated by cystectomy were studied: 34 (24.6%), 18 (2.3%), and 7 (3.9%) developed upper-tract involvement in each group, respectively. Sixty-three patients with primary urothelial upper-tract tumors were also studied. Taking progression-free survival as an end point, univariate and multivariate analyses were performed. RESULTS: The upper-tract recurrence rate was significantly higher in patients with bladder Tis than in patients with superficial bladder tumors (P <0.001); it was also significantly higher in patients treated with cystectomy because of bladder Tis compared with those treated because of invasive tumors (P <0.01). Patients with bladder Tis and upper-tract involvement showed high rates of upper-tract bilaterality (32.3%) and prostate involvement (67.4%). On pathologic examination, the upper tract showed predominantly superficial (Ta-T1-Tis) tumors (67.4%) and distal ureter location as the only finding (47%). In patients with bladder Tis, upper-tract involvement alone does not have a negative impact on the survival rate according to univariate and multivariate analysis (P = NS). CONCLUSIONS: In patients with bladder Tis, upper-tract involvement represents a diffuse process; therefore, a close evaluation of both the prostate and the upper tract is recommended. Upper-tract involvement has no impact on bladder-preservation strategy. Many of these patients could also be offered a conservative management for the involved upper tract.
Aged↗
Extravesical involvement in patients with bladder carcinoma in situ: biological and therapy implications.
PURPOSE: The biological and therapeutic implications of extravesical involvement in patients with bladder carcinoma in situ were analyzed. MATERIALS AND METHODS: Of 138 patients with bladder carcinoma in situ 87 (63%) had extravesical involvement, including the prostate in 53, the upper urinary tract in 11 and both structures in 23 (pan-urothelial involvement). With survival free of disease as an end point, univariate and multivariate analyses were done. RESULTS: Patients with extravesical involvement had worse survival than those with bladder carcinoma in situ alone (p < 0.001). In multivariate analysis prostate involvement (p = 0.0007) and pan-urothelial involvement (p = 0.0001) were selected as significant variables. When pathological patterns were considered prostatic stromal invasion (p = 0.0002) was the only variable selected. With these data 3 patient groups with disease mortality risk were defined. CONCLUSIONS: Prostate involvement and pan-urothelial involvement behave as independent prognostic factors, with the latter probably reflecting an extremetly diffuse character of carcinoma in situ. However, the upper urinary tract had no influence on survival. In patients with upper urinary tract and/or prostatic involvement limited to the mucosa treatment can be conservative. Patients with ductal or stromal involvement should undergo radical treatment. For upper tract involvement conservative approaches may be considered if there are no radiological signs of invasion or low grade tumor.
Adult↗
Preservation of antegrade ejaculation in retroperitoneal lymphadenectomy due to residual masses after primary chemotherapy for testicular carcinoma.
We report 18 consecutive patients with testis cancer and retroperitoneal residual masses with normal tumor markers, who underwent lymphadenectomy. Aiming to preserve the antegrade ejaculation, we carried out surgical modifications which basically attempt to preserve: (1) both sympathetic lumbar trunks, (2) the superior hypogastric plexus and (3) some of the postganglionic branches. With a mean follow-up of 28.1 months (range 6-62 months), 15 (83.3%) of the 18 patients preserved ejaculation, without significant differences between ejaculation volumes before and after lymphadenectomy. At the present time, 3 of 4 possible patients have fathered children. Mass size seems to be an important predictive factor of ejaculation preservation. One patient relapsed in the retroperitoneal dissection area, representing a recurrence rate of 5.5%. The disease-free survival rate was 94.4%, and 1 patient died due to disease progression with lung recurrence. Thus preservation of ejaculation was possible in most of these patients.
Adult↗
Feasibility of transurethral resection for muscle-infiltrating carcinoma of the bladder: prospective study.
A prospective study was done to evaluate treatment of patients with muscle-infiltrating bladder cancer by transurethral resection exclusively. Inclusion criteria for this study were histological confirmation of muscular bladder infiltration, endoscopic radical transurethral resection, disappearance of hardened areas after transurethral resection, and negative biopsies of the depth and periphery of the tumor bed. The study began in April 1981. The average followup in series 1 (April 1981 to December 1986, 59 patients) was 55.4 months. Actually, of the patients 31 (52.5%) are without evidence of recurrence and 28 (47.5%) have recurrent disease. Of the latter patients 11 (18.6%) had invasive bladder recurrence, including 7 (11.9%) who had recurrence at 3 months, which indicated clinical understaging. Three patients (5%) had metastases without bladder tumor. The remaining 14 patients (23.7%) had superficial bladder recurrence. The overall survival rate was 83% (49 of 59 patients) and 43 patients (72.8%) still retain the bladder. The present data are confirmed by the results of series 2 (December 1986 to August 1989). Therefore, the data would justify conservative management in a selected group of patients with muscle-infiltrating bladder cancer.
Aged↗
Corpus cavernosum invasion and tumor grade in the prediction of lymph node condition in penile carcinoma.
Of the 101 patients with penile cancer, we have analyzed 66 from whom we had enough information: 42 (63.3%) patients with corpora cavernosa invasion (T2-3) and 24 (36.6%) without (T1). With respect to the tumor grade, in 36 (54.3%) patients it was well differentiated (G I), in 23 (34.8%) moderately (G II) and in 7 (10.6%) poorly differentiated (G III). We also analyzed the inguinal lymph node condition. Of the 66 patients, 28 (42.4%) developed nodal metastases, and 38 (57.6%) were considered free of nodal metastases and disease with an average follow-up of 76.2 months (range 38-192). The presence of metastatic nodes was influenced by both tumor stage and grade with significant differences between T2-3 and T1 (p = 0.001) and between G II-III and G I (p < 0.01), but each of them alone was not a sufficiently reliable predictive factor. In order to associate local stages and tumor grades in relation to the presence of metastatic nodes, we checked that none of the patients with T1, G I (group 1) developed nodal metastases, and therefore, 'wait and see' should be the suitable approach. Twenty (80%) of the patients with T2-3, G II-III (group 2) developed metastatic lymph nodes, thus, in this group, an early lymphadenectomy should be performed. In the remaining 22 patients with T1, G II-III and T2, G I (group 3), 8 (36.4%) showed metastatic lymph nodes; in this group, other factors such as age, cultural level and obesity should be taken into account when deciding on lymphadenectomy.
Adult↗
Recurrence of superficial bladder tumors in prostatic urethra.
Of our 276 patients with superficial bladder carcinoma, 242 were male, and 36 of these had recurrence in prostatic urethra, 26 with macroscopic tumors, and 10 with tumors in situ (TIS). These recurrences represent an incidence of 13.3%, with an average follow-up of 34.3 months. When the urethral tumor was limited to the mucosa, we chose conservative therapy, and the patients entered a random program with Mitomycin or Adriamycin administered endovesically. With this program, we could control the disease in 59.3% of the patients. However, 22.2% of them had recurrence with prostatic stromal infiltration, so that we performed a more exhaustive exploration of the prostate, taking biopsies not only at the 5 and 7 o'clock positions, but also making a wider resection in order to find the incipient infiltration of the prostatic stroma, and trying to avoid a possible understaging. When the urethral tumor had infiltrated the prostatic stroma, we performed cystoprostatourethrectomy, getting a survival rate free of disease of 40%. An association with vesical TIS was detected in 61.1% of these patients, with terminal ureteral tumor in 8.3% and with the anterior urethra in 11.1%, showing the diffuse pattern of the disease. We conclude that when recurrence of prostatic urethra is present, it is necessary to monitor the whole urothelium during follow-up.
Administration, Intravesical↗
Carcinoma in situ associated with superficial bladder tumor.
In a sample of 306 patients with superficial bladder tumors (Ta, Tl), 48 were affected by associated carcinoma in situ (TIS). We included 40 of them in a random program with Mitomycin C or Adriamycin, administered endovesically. We found that those patients with associated TIS whose progression rate had increased to 37.1% compared to 8.8% in the original series (p less than 0.01), had a worse prognosis. Besides, 10 of them required radical cystectomy. With this chemotherapy program, we achieved a high rate of complete response (70%), but its duration was limited by a recurrence rate of 42.9%, with a time free of disease of 26.2 months. In the whole group, the survival rate free of disease was 77.5%, with an average follow-up of 37.3 months. On the other hand, we found extravesical recurrences not only in the prostatic urethra (13; 32.5%) but also at the end of the ureter (3; 7.5%).
Actuarial Analysis↗
Concentrations of cefpodoxime in plasma and pleural fluid after a single oral dose of cefpodoxime proxetil.
Eighteen patients of either sex with pleural effusions underwent aspiration 3, 6 or 12 h after receiving a single oral dose of cefpodoxime proxetil equivalent to 200 mg cefpodoxime. The mean concentrations of cefpodoxime in pleural fluid were, respectively, 0.62, 1.84 and 0.78 mg/l for these three time intervals, the corresponding ratios between pleural fluid and plasma concentrations being 0.24, 0.67 and 1.07. The findings indicate that there is good penetration of cefpodoxime into pleural fluid. Concentrations between 3 and 12 h after dosing were equal to or above the MIC90 for most of the organisms commonly found in lower respiratory tract infections.
Administration, Oral↗
[Stage T4 bladder cancer. Impact of neoadjuvant chemotherapy on T4b tumors].
The present article studied the biological behaviour of T4a versus T4b tumors. Of 29 patients with T4a tumors, 24 were treated by radical cystectomy and 5 were treated by diversion alone on detecting pathologic gross adenopathies at laparotomy. Of these 10/28 (35.7%) are alive and tumor-free. Of 11 patients with T4b tumors, 7 were initially treated with systemic chemotherapy (6 M-VAC and 1 5-FU + ADM) which achieved a clinical response in 4; 1 (14.2%) was RCc. Posteriorly, all these patients underwent radical cystectomy that revealed 2 had RPp and 2 had tumor progression (N+), accounting for an RPp rate of 28.5% and tumor progression of 71.5%. Overall, with a mean follow-up of 13.3 months, only 1 patient is tumor free. The foregoing findings show the different behaviour of these two groups of patients with an incidence of tumor positive adenopathies of 48.2% and 72.7% and tumor-free survival of 35.7% and 9.0% for patients with T4a and T4b, respectively.
Adult↗
A novel synthesis of colchicide and analogues from thiocolchicine and congeners: reevaluation of colchicide as a potential antitumor agent.
Desulfurization of thiocolchicine with Raney nickel in a hydrogen atmosphere yielded tetrahydromethoxycolchicine (2), which was readily separated from unreacted thiocolchicine by chromatography and was smoothly oxidized to 10-demethoxycolchicine (colchicide) by Pd/C in refluxing toluene. Several analogues of colchicide were prepared from the corresponding thiocolchicines by this procedure. Treatment of colchicide with concentrated sulfuric acid yielded 2-demethylcolchicide. Colchicide and its analogues were found to be inactive in a tubulin-binding assay. Evidence is presented that colchicide prepared earlier from thiocolchicine with Raney nicel in aerial atmosphere was contamination with 1-2% thiocolchicine.
Animals↗
Identification of phenolic antioxidants in elastomers for pharmaceutical and medical use.
Phenolic antioxidants were identified by thin-layer chromatography (TLC) in 102 samples of pharmaceutical and medical rubber articles. Despite the large number of antioxidants proposed for elastomers, only eight compounds were found in the articles analyzed. The choice of antioxidants apparently does not depend on the sterilizing processes or on the use or brand of articles.
Antioxidants↗
Precursors of the mammalian synthesis of morphine: (+)-salutaridine and (-)-thebaine from (+)-6-demethylsalutaridine, and (-)-N-13CH3-thebaine from (-)-northebaine.
Standard samples of pure (+)-salutaridine and (-)-thebaine required to study the mammalian origin of morphine, were prepared from (+)-6-demethylsalutaridine by published procedures and were characterized by CD spectra and physical data. Reductive N-methylation of (-)-northebaine afforded (-)-thebaine, and when 13C-labeled formalin was used, (-)-thebaine with a 13C label on the N-methyl carbon atom resulted. The latter represents a model procedure to prepare ultimately N-14CH3-labeled (-)-thebaine and 14C-labeled congeners.
Animals↗