Renal-sparing surgery for renal and transitional cell carcinoma.
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Carcinoma, Renal Cell↗
Biomedical subjects
R K Lawson
Publications and source records attributed to R K Lawson.
Chromosomal defects in renal cell carcinoma.
Numerous chromosomal defects have been identified in hereditary and sporadic renal cell carcinoma (RCC) tumor cells. Current data indicate that visible, and/or submicroscopic lesions on the 3p are fundamental to RCC development; other chromosomal abnormalities are identified less frequently and may be secondarily involved in RCC production in some cases. Oncogenesis may be initiated via inactivation of suppressor allele pairs, or through activation of oncogenes via translocation to areas of increased gene expression, migration to a chromosomal breakpoint, or gene amplification.
Carcinoma, Renal Cell↗
Color Doppler ultrasonography in the evaluation of the acute scrotum.
Color Doppler ultrasonography was used to assess 20 patients with the acute onset of scrotal pain. Patients were categorized into 3 groups according to the initial clinical impression of the examining physician: ischemia, inflammation or trauma. Color Doppler ultrasonography correctly predicted the need for surgery in 8 of 9 operated patients (89%) and correctly predicted the outcome in all 11 nonoperated patients (100%). The anatomical resolution possible, as well as information regarding blood flow made color Doppler ultrasonography a useful tool in the assessment of acute scrotal processes.
Acute Disease↗
Color Doppler sonography in the evaluation of the adult acute scrotum.
Color Doppler sonography (CDS) was used to evaluate 35 adult males with acute scrotal discomfort. Correlative nuclear scintigraphy was performed in 15 patients. Surgical correlation was available in 10 patients with clinical follow-up in the remaining 25. The complete absence of intratesticular color flow was used as our criterion for testicular ischemia. This was found to be 100% sensitive and 100% specific in 8 patients with surgically confirmed testicular ischemia. Spontaneous detorsion was noted in one patient with hyperemia demonstrated by color imaging. Increased color flow was found in 20 patients with the clinical impression of scrotal inflammation. Nuclear scintigraphy and color Doppler imaging had 100% agreement in 15 patients. Color Doppler sonography is a useful and highly accurate diagnostic method in the evaluation of patients with the acute scrotal syndrome. Color flow imaging is comparable to nuclear scintigraphy in the diagnosis of testicular ischemia.
Acute Disease↗
Benign prostatic hyperplasia and growth factors.
A great deal of work has been accomplished in the attempt to determine the cause of benign prostatic hyperplasia (BPH). Early work by morphologists suggests that BPH starts as a stromal disease and that the hyperplastic stroma secretes a substance that stimulates the growth of epithelial cells. The quantitative morphometric data also suggest that BPH is primarily a stromal disease. Experimental embryology data have shown that the basic fibroblast growth factor, bFGF, is involved in early embryogenesis and is the primary inducer of mesodermal tissue. Work in mouse embryos has shown that a powerful inducer for prostatic epithelial growth is elaborated by the urogenital mesenchyme. Both of these findings fit the hypothesis that stromal hyperplasia may be initiated by a growth factor and that a second growth factor stimulates epithelial growth. Work in our laboratory has established that bFGF is the primary growth factor present in human BPH. We have also found that bFGF is synthesized by prostate fibroblasts and bFGF may be in higher concentration in the periurethral tissues of BPH. At this time, no definite link between growth factors and hyperplastic growth of the prostate has been established. However, circumstantial evidence has lead us to formulate several hypothesis regarding the role of growth factors in BPH. Hopefully, these hypothesis will be of some assistance in guiding future work on growth factors and BPH.
Fibroblast Growth Factors↗
Transcatheter renal artery embolization in treatment of ureterocutaneous fistula.
We report a case of a critically ill patient who had a ureterocutaneous fistula develop after placement of a Dacron bypass graft from the aorta to the right popliteal artery and the left femoral artery. We describe a successful nonsurgical method to terminate renal function in this patient, who was a poor operative risk.
Aorta, Abdominal↗
Posttransplant hypersplenism.
Posttransplant hypersplenism, manifested by leukopenia and azathioprine intolerance, can be diagnosed with a high degree of accuracy and promptly reversed by emergency splenectomy. Functioning cadaver kidney homograft survival rates in patients undergoing posttransplant splenectomy are equal to that of patients undergoing pretransplant splenectomy and are statistically superior (p less than 0.01) to recipients who have never had their spleens removed. However, mortality (21%) for posttransplant splenectomy is excessively high when compared to our mortality (1.3%) for pretransplant splenectomy.
Azathioprine↗
Prostatic osteoblastic factor.
Cell cultures of fetal rat osteoblasts and organ cultures of fetal rat calvaria were used to study the effects of extracts of prostatic tissue on bone cell growth. Extracts of bening prostatic hyperplasia, but not an undifferentiated prostatic carcinoma, stimulated the incorporation of 3H-thymidine and 14C-proline into fetal rat osteoblasts, calvaria, and skin fibroblasts. Extracts of well-differentiated prostatic cancer and normal postpubertal prostate also stimulated 3H-thymidine incorporation by fibroblasts. These findings support the hypothesis that a potentially unique factor found in prostatic tissue induces the osteoblastic response of bone to metastatic prostatic cancer.
Adenocarcinoma↗
An animal model for the growth of human tumor cell lines.
Newborn rats were thymectomized at less than 24 hr of age and received antilymphocyte serum and heterologous human tumor cells. This model allows the growth of large primary tumors with a high metastatic percentage. This model may be applicable to the study of a wide variety of genitourinary tumors.
Animals↗
Special problems in pediatric renal transplantation.
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Arm↗
Renal transplantation in pediatric patients.
Thirty-five transplants have been performed in 29 children, 1 week to 16 years old. Of these patients 79 per cent are surviving from 9 months to 14 years post-transplantation. Eighteen of these patients have required different surgical procedures for transplantation than adult patients. Immunosuppressive therapy has been essentially the same as in adult patients. A striking difference between the living related donor and the cadaver donor transplant functional survival as seen in this series is unexplained at the present time. Linear growth has been good in those children who have required minimal doses of corticosteroids to maintain adequate renal function.
Acute Kidney Injury↗
Renal transplantation in cystinosis.
Three children from 6 1/2 to 10 years old received kidney allografts from their parents 2 1/2 to 4 1/2 years ago. Renal function has been stable and the patients have been doing well. Studies of renal tubular function as well as morphologic studies by light and electron microscopy, and microdissection of renal tubules fail to reveal evidence of recurrent disease in the allografted kidneys.
Biopsy↗
Pediatric renal transplantation.
Thirty-one children received 38 kidney transplants from 22 live and 16 cadaver donors. Among the 31 patients, 25 received one transplant each, 5 received two transplants each and 1 received three transplants. Peritoneal or hemodialysis (or both) was carried out in 22 patients, with an average dialytic maintenance of 12 weeks before transplantation. Posttransplant immunosuppressive therapy included prednisone and azathioprine. Antilymphocyte globulin was administered to 33 recipients as adjunctive immunosuppressive therapy. At present, 23 patients have functioning allografts, 3 are on hemodialysis and 5 are dead. Of 22 live kidney transplants, 18 are presently functioning two months to 14 years after transplantation with an average of 36 months. Of 16 cadaver kidney transplants, 5 are presently functioning 9 to 57 months after transplantation with an average of 32 months. Actuarial live donor allograft survival for one year was 76 percent, for two years was 66 percent and for three years was 64 percent. Cadaver allograft survival was 50 percent, 40 percent and 40 percent, respectively. Complications were urologic and infection related. Of nine recipients with sustained hypertension, in six the condition was due to chronic rejection, while in one it was due to recurrence of the original disease in the allograft. Linear growth was measured in 15 children who were less than 14 years of age at the time of transplantation and in whom allografts survived more than one year. Maximum average linear growth velocity occurred during the first year after transplantation. Our experience indicates pediatric renal transplantation can be successfully used in the treatment of terminal renal failure.
Adolescent↗