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Biomedical subjects

T W Jarrett

Publications and source records attributed to T W Jarrett.

45 records · Page 3Linked to original sources

Inhibition of bladder tumor cell implantation in cauterized urothelium, without inhibition of healing, by a fibronectin-related peptide (GRGDS).

BACKGROUND: Local recurrence after transurethral resection of bladder tumors (TURB) is common and might be diminished if free tumor cells within the bladder are prevented from reattaching. METHODS: In vitro inhibition of murine bladder tumor cells to an approximation of urothelial matrix with agents that might block attachment to components of the extracellular matrix, and in vivo inhibition of attachment in cautery-injured murine bladder. RESULTS: GRGDS, (0.1-2.5 mg/ml), a fibronectin-related peptide, mannose-6-phosphate, (0.1-20 mg/ml), a carbohydrate, and heparin (1-625 units/ml) all inhibited attachment in vitro in a dose-dependent fashion. YIGSR (0.1-2 mg/ml), a laminin-related peptide, did not. Mannose (10 mg/ml) did not significantly inhibit attachment of tumor cells to cauterized urothelium in vivo, whereas there was a 77% reduction of attachment in bladders irrigated with GRGDS (6.25 mg/ml) (p < 0.05), and the appearance of subsequent tumors in the bladder was inhibited. Finally, GRGDS (6.25 mg/ml) did not inhibit healing of the cautery ulcer. CONCLUSIONS: RGD-containing peptides may be useful as adjuvant therapy to decrease local recurrence after TURB and perhaps in other circumstances in which tumor cells spilled into a wound or body cavity threaten surgical success.

Animals↗

Laparoscopic enterolysis and placement of an intestinal sling before radiation therapy for the treatment of prostate cancer.

We present an interesting application of laparoscopy in a man who was otherwise not a candidate for radiotherapy because of an adherent loop of small bowel in the proposed treatment field. Laparoscopic enterolysis was performed and the involved segment was displaced out of the pelvis; a synthetic mesh was placed to serve as a sling to prevent caudal migration back into the pelvis. The patient had a rapid recovery and subsequently completed a full course of radiotherapy. The experienced laparoscopist may find this a good alternative to open surgery in patients with a fixed loop of small bowel who require radiation therapy for pelvic malignancies.

Adenocarcinoma↗

Fibrous coagulum: a new cause of retained fragments following extracorporeal shock wave lithotripsy.

PURPOSE: A previously unrecognized cause of retained fragments following extracorporeal shock wave therapy is identified. MATERIALS AND METHODS: Nine patients referred for percutaneous stone extraction following failure of multiple shock wave lithotripsy treatments had retained fragments embedded in soft tissue. The stones were evaluated by chemical analysis and the tissue was evaluated histologically. RESULTS: All stones contained calcium and histopathology confirmed the presence of fibrous tissue. Radiographs were unable to predict the presence of the substance preoperatively. CONCLUSIONS: We identified fibrous coagulum as a cause of retained fragments following shock wave lithotripsy. The material is soft tissue and cannot be ablated by further shock wave lithotripsy. These findings confirm that repeated shock wave lithotripsy is contraindicated, since stone fragmentation and passage may be inhibited by fibrous coagulum.

Blood Coagulation↗

Model of human transitional cell carcinoma: tumor xenografts in upper urinary tract of nude rat.

An in vivo model for the study of human transitional cell carcinoma (TCC) in the urinary tract is desirable. Orthotopic xenografts are useful in order to approximate better the behavior of human tumor cells in situ. Prior models have been described in the urinary bladder of the nude mouse and rat. We have developed the first model of implantation of human TCC in the upper urinary tract of an experimental animal. The kidneys of homozygous nude rats 4 weeks of age were inoculated with 1-5 x 10(6) cells of the RT4 well-differentiated papillary human TCC line through bilateral flank incisions, with transparenchymal injection of tumor cells into either the collecting system (renal pelvis) or the parenchyma. The overall implantation rate was 92% (54/59 kidneys). However, implantation into the collecting system occurred in only 45% (18/45) of the group. Ligation of the ureter prior to inoculation to produce urine stasis improved the mucosal implantation rate. Despite suspect urine cytology findings in the renal pelvis injection group, no distal seeding of the urinary tract was seen. Intraparenchymal tumor growth was less differentiated and had a higher fraction of mitotic cells than mucosal tumors. Vascular and lymphatic invasion were commonly seen; however, distant metastasis was not observed. This model will prove useful in determining the role of seeding in recurrent disease and in developing less invasive modalities for the treatment of upper tract TCC.

Animals↗

Laparoscopic transperitoneal bladder diverticulectomy: surgical technique.

A large bladder diverticulum causing poor emptying in an 84-year-old man was removed laparoscopically in a 6.5-h operation. The patient was discharged from the hospital on the third postoperative day, having had minimal analgesic requirements. A Council catheter and stylet in the diverticulum greatly facilitated identification of the sac with the laparoscope. Difficulties with intracorporeal knot tying were avoided by using the Lapra-Ty system. Experienced laparoscopic surgeons may find this method of diverticulectomy valuable. With experience, the operating time should be reduced.

Adenocarcinoma↗

Accuracy of computerized tomography in the diagnosis of colovesical fistula secondary to diverticular disease.

We reviewed 9 consecutive patients with colovesical fistula secondary to diverticulitis during a 2-year period. Preoperative evaluation included computerized tomography (CT) and a barium enema or colonoscopy in all patients (8 underwent cystoscopy). All patients subsequently underwent laparotomy with a single or multiple staged repair. Using CT criteria for diagnosis of colovesical fistulas, the study accurately predicted the presence and location of fistula in 8 patients, and was suspicious in 1. Findings at cystoscopy only diagnosed 3 fistulas and were suspicious in 4. The remaining diagnostic tests, including excretory urography, barium enema, abdominal plain films, colonoscopy and cystogram, were unremarkable except for a single cystogram and barium enema. In addition to documenting the fistula, CT provided important intraluminal and extraluminal pathological findings helpful in planning subsequent surgery. Thus, CT should be included in the initial evaluation of patients with suspected colovesical fistula.

Aged↗

Percutaneous management of transitional cell carcinoma of the renal collecting system: 9-year experience.

PURPOSE: We establish the effectiveness of percutaneous resection of transitional cell carcinomas of the renal collecting system. MATERIALS AND METHODS: A retrospective analysis was done of 36 kidneys treated during a 9-year period. Adjunctive therapy with bacillus Calmette-Guerin was given in 19 cases. RESULTS: Of 36 kidneys 6 were treated by immediate nephroureterectomy for aggressive disease, leaving 30 units treated by a complete course. The recurrence rate was 33%, which varied with histology as specific recurrence rates for grades 1 to 3 tumors (18%, 33% and 50%, respectively). The only cancer related mortalities occurred with grade 3 tumors. These tumors also had a higher incidence of understanding and vascular complications. Bacillus Calmette-Guerin therapy showed no significant improvement in survival. CONCLUSIONS: With vigilant followup, percutaneous management of transitional cell carcinoma of the renal collecting system is an acceptable alternative to nephroureterectomy in patients with grade 1 disease, grade 2 disease who are at risk for renal insufficiency and medical contraindications to a major open operation.

BCG Vaccine↗

Extensive dilation of distal ureter for endoscopic treatment of large volume ureteral disease.

Two patients with large volume disease in markedly dilated ureters were treated endoscopically by wide dilation of the ureteral orifice and passage of larger nonureteroscopic endoscopes. The larger instruments provided better vision and the ability to work with larger tools, which greatly facilitated treatment without complication in patients who otherwise would have undergone an open procedure.

Adult↗

Endourologic management of complications in renal allografts.

Because of the altered anatomy, the presence of immunosuppression, the possibility of graft rejection, and the serious implications of a problem involving a solitary kidney, the transplanted kidney presents unique challenges in the diagnosis and treatment of urologic complications. Historically, the mortality rate in these patients has been as high as 68%, and as many as 15% of the allografts have been lost. Today, endourologic procedures are used for prompt diagnosis, temporization, and even definitive management of many urologic complications, and many patients and allografts are being saved. The authors review present techniques and suggest others that may be available in the future.

Humans↗