Biomedical subjects

S Horenblas

Publications and source records attributed to S Horenblas.

79 records · Page 5Linked to original sources

PubMed1993

Neoadjuvant therapy in prostate cancer--is it of any use?

Since 1941, when the androgen dependency of prostatic carcinoma was described first, the question whether neoadjuvant hormone manipulation enhances surgical curability has been of actual importance. With the availability of reversible luteinizing hormone-releasing hormone analogues and non-steroidal antiandrogens, interest in preoperative hormonal manipulation has recently been reinnovated. An overview of the published, sometimes conflicting clinical and pathological studies evaluating the value of neoadjuvant hormone manipulation is given. We conclude that further well-controlled clinical investigations comparing downstaging and downgrading percentages, percentages of local control and survival are needed to prove the benefit of neoadjuvant treatment in patients with locally confined prostatic carcinoma.

Androgen Antagonists↗

PubMed1992

Squamous cell carcinoma of the penis. II. Treatment of the primary tumor.

The treatment of the primary tumor in 110 patients with squamous cell carcinoma of the penis seen between 1956 and 1989 was reviewed. Small tumors had generally been treated by penis conserving methods, such as circumcision, local excision and external radiotherapy alone or after circumcision or local excision. Since 1982 we have used the neodymium:YAG laser as a penis conserving method. In 51 patients (46%) penis conserving treatment had been performed and 59 (54%) had undergone some form of amputation. Overall, 16 of 110 patients (15%) had local recurrence. The risk of local recurrence after penis conserving therapy was significantly related to T category, with 10% local recurrences in stage T1 tumors in contrast to 32% and 100% in stages T2 and T3 tumors, respectively. All of the recurrences in patients with stage T1 tumors were strictly local and all were salvaged. In our view penis conserving therapy is a safe procedure in patients with stage T1 tumors and should always be attempted first. Amputation is considered to be overtreatment in these cases. Of 6 recurrences in the conservatively treated stage T2 disease group 4 were strictly local. These were all well or moderately differentiated tumors, not exceeding 3.5 cm. in diameter. We suggest penile conservation for this subgroup of T2 tumors. However, partial amputation is recommended for poorly differentiated stage T2 tumors. Local failure was observed in all stage T3 tumors treated with external radiation. In general, penis conservation in stage T3 tumors should not be attempted with the treatment modalities available to date. Comparing the different methods of penis conservation, used in 49 stages T1 and T2 tumors, no difference in local recurrence rate (18%) was observed among surgery, laser and external beam radiation. In view of the low morbidity, cutting and coagulation properties and minimal tissue changes, use of the neodymium:YAG laser would be our first choice of treatment modality. Penile conservation should be attempted only when frequent and long lasting followup is guaranteed, since local recurrences can appear as late as 8 years after primary treatment.

Adult↗

PubMed1992

Functional and histological damage in the mouse bladder after photodynamic therapy.

Bladders of anaesthetised mice were illuminated with laser light of 630 nm at 24 h after intraperitoneal administration of the photosensitiser Photofrin II (10 mg kg-1). A range of light doses, at a power setting of 100 mW, was delivered intravesically by a fibre optic inserted into the centre of the bladder via the urethra. Functional bladder damage was assessed from increases in urination frequency and the presence of urethra. Functional bladder damage was assessed from increases in urination frequency and the presence of haematuria at 1 to 26 weeks after treatment. Whole bladder illumination with incident light doses exceeding 18.75 J cm-2 caused extensive oedema, haemorrhage and necrosis of the bladder wall and mice had to be sacrificed within 24 h. PDT with incident light doses of 3.75 to 15.0 J cm-2 caused haematuria and increased urination frequency during the first week in nearly all mice, but there was complete functional recovery by 6 to 10 weeks after doses of up to 7.5 J cm-2. Recovery was slower after higher doses and up to 50% of mice still had some increased urination frequency at 10 weeks after greater than or equal to 11.25 J cm-2, although haematuria was rare at this time. Histologically, early damage (one day after PDT) consisted of epithelial sloughing, submucosal oedema, fibrin imbibition, vascular ectasia and, rarely, thrombosis. Doses exceeding 7.5 J cm-2 were often associated with foci of necrosis. In some instances, necrosis was complicated by bacterial infection, resulting in an acute transmural inflammation with a tendency to suppuration. After doses of up to 11.25 J cm-2 there was a gradual recovery and only a mild degree of fibrosis of the bladder wall (with some increase in vascularity) remained at 6 months.

Animals↗

PubMed1992

Detection of lymph node invasion in prostatic carcinoma with iliopelvic lymphoscintigraphy.

Eleven patients, ranging in age from 58 to 79 years and referred for 125I implantation because of localised prostatic carcinoma, were subjected to iliopelvic lymphoscintigraphy (IPL) prior to lymph node dissection. Scintigraphy was performed by perianal injection into the ischiorectal fossa of 0.2 ml 99mTc radio-labelled antimony sulphide colloid. The sensitivity of IPL was 100% and the specificity 13%, with a prevalence of positive nodes of 27%. It was concluded that IPL is not useful as a non-surgical method of detecting lymph node invasion in localised prostatic carcinoma because of the low specificity.

Aged↗

PubMed1991

Squamous cell carcinoma of the penis: accuracy of tumor, nodes and metastasis classification system, and role of lymphangiography, computerized tomography scan and fine needle aspiration cytology.

Among 118 patients with squamous cell carcinoma of the penis treated at our cancer institute between 1956 and 1989, we analyzed the accuracy of classification, using the tumor, nodes and metastasis system. We analyzed the role of lymphography, computerized tomography and fine needle aspiration cytology as additional staging procedures. The primary tumor (T category) was classified incorrectly in 26% of the cases. Overstaging was noted in 10% of the cases because of unsuspected infiltration and overstaging was noted in 16%. Overstaging occurred because of edema and infection masking the actual size and giving a misconception of infiltration, and also because of primary presentation as large exophytic tumors with no or minimal histopathological infiltration. When the regional lymph nodes were categorized simply as positive or negative 80% of the tumors were classified correctly and 20% incorrectly (13% were false positive and 7% were false negative). Regional lymph node invasion that escaped clinical examination was not detected by any imaging examination or fine needle aspiration cytology study. Positive findings were found only in patients with clinically suspected nodes. The classification of regional nodes by clinical examination only is hardly improved by additional imaging studies. Clinical decisions with respect to the management of regional lymph nodes should not be based on negative findings of lymphangiography, computerized tomography or fine needle aspiration cytology. In patients with proved metastasis additional imaging may be of some help in the detection of pelvic node invasion and the determination of the extent of involvement. We recommend lymphangiography as the examination of choice.

Adult↗

PubMed1990

Chemical stability of suramin in commonly used infusion fluids.

The chemical stability of suramin in NaCl 0.9%, dextrose 5%, and lactated Ringer's injection was investigated. The admixtures were stored in glass infusion bottles at 4 degrees C in the dark, and at room temperature (22 degrees C) both protected from light and under normal room fluorescent light conditions in a day-night rhythm. The initial concentration of suramin was approximately 1 mg/mL. Samples withdrawn immediately after preparation and at four hours, one, two, three, five, and seven days were analyzed by HPLC with ultraviolet (UV) detection. Samples were also inspected for visual changes and tested for changes in pH. Accelerated stability studies in NaCl 0.9% injection were executed at 90 degrees C. The drug appeared to be stable under the chosen storage conditions with no visual changes or changes in pH. The accelerated experiments revealed that suramin degrades in NaCl 0.9% at 90 degrees C with a half-life of about 5.5 hours. It is concluded that suramin 1 mg/mL is stable in NaCl 0.9%, dextrose 5%, and lactated Ringer's injections when stored in glass infusion bottles at 4 degrees C in the dark and at 22 degrees C under normal room light conditions in a day-night rhythm or protected from light for at least seven days.

Chromatography, High Pressure Liquid↗

PubMed1984

A case of a postmenopausal ruptured pyosalpinx. A rare finding at laparotomy for an acute abdomen.

A case is described of an 84-yr-old woman with a ruptured tubo-ovarian abscess. This condition, which is rare in postmenopausal women, is usually diagnosed during laparotomy. Neither the medical history, nor the physical examination, nor the laboratory examination gives specific clues concerning the right diagnosis. The treatment is primarily a surgical one and consists principally of an abdominal hysterectomy and bilateral salpingo-oopherectomy.

Abdomen, Acute↗