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Biomedical subjects

W F Whitmore

Publications and source records attributed to W F Whitmore.

At least 307 records · Page 17Linked to original sources
PubMed1977

Urethral cytology following cystectomy for bladder carcinoma.

There is a high probability of urethral carcinoma in patients who have had cystectomy for carcinoma of the urinary bladder, and their survival is poor when the disease is sufficiently advanced to be symptomatic or tumor is visible endoscopically. This study was undertaken to evaluate urethral cytology as a means of detecting and diagnosing in situ and invasive carcinoma of the urethral remnant following cystectomy. A total of 109 cytology specimens were examined from 65 patients who had cystectomy for bladder cancer. "Positive" or "suspicious" cytologic diagnoses of cancer were made on 28 patients; 24 had urethrectomy and 11 proved to have invasive carcinoma, 10 had carcinoma in situ and three had atypia or metaplastic changes in the urethra. One of 37 patients with "negative" cytologic diagnoses was found to have a low-grade carcinoma. It is suggested that all patients who undergo cystectomy without urethrectomy be followed with urethral cytological examination at regular intervals for an indefinite period.

Adult↗
PubMed1977

The significance of retroperitoneal lymph node morphology in testicular tumours.

The role of the regional lymph nodes in cancer is controversial. Non-neoplastic changes in lymph node histology can be correlated with prognosis for some tumour types and reactivity has been interpreted as evidence of an immune response to the tumour. Attempts to correlate the patterns of retroperitoneal lymph node activity with prognosis in patients with seminoma and non-seminoma germinal testicular tumours have not been successful. The implications of these findings are discussed.

Dysgerminoma↗
PubMed1977

The effect of flutamide on testosterone metabolism and the plasma levels of androgens and gonadotropins.

Flutamide, a nonsteroidal antiandrogen, was given to 11 men with prostate cancer, in doses of 750 to 1500 mg daily for 0.5--7 months. Four patients had a clinical remission and seven showed no response. All the patients showed a profound change in the peripheral metabolism of testosterone: markedly increased conversion to androsterone (A) and correspondingly decreased conversion to etiocholanolone (E); the A/E ratio rose to levels never before observed consistently in any group of healthy or diseased humans. This change was probably due to alteration by flutamide of the relative activities of steroid 5alpha and 5beta reductase in favor of the former. 24-Hour mean plasma testosterone was increased in five of the six patients studied for this parameter, for the group as a whole, testosterone rose from 279 ng/dl to 484 ng/dl (P less than .05). 24-Hour mean values for plasma dihydrotestosterone, dehydroisoandrosterone, LH and FSH showed no significant change, for the group as a whole, in the same six patients. Since flutamide did not change the metabolic clearance rate or volume of distribution of testosterone tracers, the increased plasma levels of the hormone were probably due to increased production.

Aged↗
PubMed1977

Cryosurgery in the treatment of bone metastases from renal cell carcinoma.

Solitary metastasis is uncommon, occurring in 1.6% to 3.2% of patients with renal cell carcinoma. Because of the potential of survival, amputation of an extremity with a metastasis is frequently advocated, particularly after successful nephrectomy. The cure rate with amputation is approximately 30%. Cryosurgery for treatment of localized and limited bony metastasis in an alternative to more radical surgery. This is a report of follow-up observation of the original series of cases as well as the addition of 4 new cases with multiple metastasis.

Adenocarcinoma↗
PubMed1976

Immune evaluation with skin testing. A study of testicular, prostatic, and bladder neoplasms.

Fifty patients with testicular carcinoma, 45 with prostatic neoplasm, 84 with bladder carcinoma, and 13 with benign bladder papilloma were evaluated for skin reactivity to DNCB and other intradermal antigens. Correlation between pathologic staging and skin-test reactivity was sought. Reaction to DNCB among patients with testis tumors was more significantly depressed by chemotherapy than by the extent of retroperitoneal or distant metastatic disease indicating that skin testing as a means of following the course of disease or of predicting survival may be limited by alterations caused by chemotherapy. DNCB reactivity did not correlate with the prognosis for the different stages of disease, but follow-up studies of individual patient survival are needed for substantiation. Depression of DNCB reactivity exists among patients with prostatic carcinoma whether the disease is localized or widely metastatic. Only lengthy follow-up will determine if there is any correlation of reactivity with survival in individual patients. DNCB reactivity among patients with bladder tumors shows progressive reduction with increasing stage disease and lends support to the evidence suggesting immune deficiency in patients with bladder neoplasm.

Adolescent↗
PubMed1976

Transitional cell carcinoma of the urethra in men having cystectomy for bladder cancer.

Charcteristics of urethral transitional cell carcinoma in patients who have undergone cystectomy for bladder cancer have been reviewed. The retained urethra was the site of urothelial malignancy in 7 per cent of 348 patients who underwent cystectomy alone. Urethras removed during prophylactic cystourethrectomy in 110 patients showed unsuspected carcinoma in situ and marked atypic in 12.5 per cent. Patients with urethral cancer were at greater risk for meatal and upper tract tumors, a reflection of multicentric tumor neogenesis, and at greater risk for perineal tumors and inguinal metastases, a reflection of direct invasion. Cytology is advocated for examining the retained urethra. However, urethrectomy to include a fossa navicularis and glandular meatus at the time of cystectomy seems justified as a definitive means of guarding against the often asymptomatic and potentially lethal urethral occurrences of transitional cell carcinoma. Furthermore, incontinuity removal of the bladder and urethra more nearly satisfies the requirements for cancer surgery by avoiding transection of a tumor containing viscus.

Carcinoma in Situ↗
PubMed1976

Urethral meatal carcinoma following cystourethrectomy for bladder carcinoma.

The multicentric potential of urothelial malignancy is well recognized, and the occurrence of urethral neoplasm after cystectomy is attributed to this characteristic of urothelial tumors. Eight instances of tumors in the glandular urethral remnant after subtotal urethrectomy illustrate the necessity of excising the fossa navicularis and urethral meatus when performing urethrectomy.

Aged↗
PubMed1976

Prognostic significance of regional lymph node histology in cancer of the bladder.

The regional lymph nodes from 47 patients with carcinoma of the bladder who had undergone radical cystectomy and bilateral pelvic lymphadenectomy were classified into 3 histologic patterns that correlated with immunologic function. Lymph nodes were designated as stimulated if they exhibited prominent germinal centers (B cell proliferation) and expansion of the deep cortex (T cell proliferation), depleted if they appeared markedly hypocellular and fibrotic, and unstimulated if they resembled a normal resting lymph node. Correlation of the histologic pattern with the extent of disease revealed that patients whose nodes appeared stimulated had fewer metastases (p less than 0.05) than those with either unstimulated or unstimulated combined with a depleted pattern. A markedly improved 5-year survival rate was seen in patients with a stimulated pattern (p less than 0.0001) compared to those patients who exhibited a depleted and/or unstimulated lymph node pattern. The survival advantage related to the stimulated pattern was observed primarily among patients with advanced disease. It is suggested that stimulated nodes reflect proliferation of T and B lymphocytes engaged in cell-mediated and humoral immune responses to the bladder tumor and that this favorably influenced survival in those patients. Patients whose lymph nodes showed a depleted pattern fared poorly despite the extent of the disease and those with an unstimulated pattern were intermediate in survival. A depleted pattern may represent a state of local immune paralysis, exhaustion of the draining lymph nodes as a result of exposure to excess tumor-derived products such as antigen or toxic substances or simply an atrophic node incapable of response. In the absence of a local immune response such patients might be expected to do poorly. These results suggest that morphologic evaluation of the lymph nodes regional to bladder cancer may provide a clue to their immunologic function and a more accurate guide to prognosis of patients with this neoplasm.

Adult↗
PubMed1976

Cancer of the undescended or maldescended testis.

An analysis of 45 cryptorchids (by history or examination) with a testicular cancer treated at Memorial Hospital, between 1934 and 1973, is presented. Twenty-five patients had the cryptorchid state repaired at ages four to 27 years, either spontaneously or by orchiopexy or hormonal therapy. Ipsilateral (24) or contralateral (one) intrascrotal testis tumors developed four to 47 years later. Twenty cryptorchid patients presented with ipsilateral inguinal (eleven), abdominal (seven), or contralateral intrascrotal (two) tumors. There were 18 pure seminomas, 17 embryonal carcinomas, nine teratocarcinomas, and one reticulum cell sarcoma. Five year survival rates as estimated by the product-limit method were 60% for the unrepaired cases and 41% for the repaired cases. The survival seems to follow histologic type and anatomical stage, whether the testis is within the scrotum or not. Five year survival similarly estimated was 78% in the seminomas and 29% in the other tumors. Twelve of thirteen survivors (including nine with seminoma) received postoperative irradiation to the regional lymphatics and eleven were without recurrent tumor for periods ranging from six to 28 years.

Adolescent↗
PubMed1976

Cis-dichlorodiammineplatinum(II) in advanced bladder cancer.

Cis-dichlorodiammineplatinum(II) (DDP) was given at a dose of 1.25 or 1.6 mg/kg to 24 patients with advanced measurable, urinary tract cancer. Eight patients (35%) achieved a partial remission and four additional patients had a minor response. There were 14 patients with epidermoid (transitional cell) bladder cancer who had had no prior chemotherapy and all eight partial responders were in this group. DDP appears to be one of the more active antineoplastic agents in bladder cancer.

Aged↗
PubMed1976

Decreased ability of blood leukocytes from patients with tumors of the urinary bladder to act as stimulator cells in mixed leukocyte culture.

Blood leukocytes from patients with active neoplasms of the urinary bladder were found to have a decreased ability to stimulate in one-way mixed leukocyte culture (MLC). The ability of the patients' leukocytes to act as stimulator cells in one-way MLC was assessed by simultaneous comparison to the ability of leukocytes from normal individuals to stimulate. In addition, the ability of the patients' leukocytes to act as responder cells in the one-way MLC was evaluated. Cells from 31 (56%) of 55 patients with active disease exhibited subnormal stimulatory activity in the MLC while 26 of these 31 patients (84%) had normal responsiveness. Cells from 9 of the 55 failed to respond normally. Poor stimulation occurred with both early and advanced disease, and the stimulatory activity increased after tumor removal in 12 of 15 patients who had previously shown subnormal stimulation. Six patients without active disease at the time of testing, in addition to the 55, exhibited normal levels of stimulation and responsiveness. This defective stimulatory activity is suggestive of an acquired, disease-related phenomenon and is not necessarily associated with decreased blood leukocyte responsiveness.

Adult↗
PubMed1976

The rate of skin allografts within the prostate.

There is good evidence demonstrating the absence of lymphatic drainage in the normal glandular prostate. In other organs, such as the brain and anterior chamber of the eye, this property is associated with an impaired response to foreign tissue antigens. We have examined the first set allograft survival of normal skin transplanted between strains of male inbred rats (Lewis leads to Fisher) to various sites including the prostate. The resulting data indicate that the prostate is not an immunologically privileged site when compared to the anterior chamber of the eye. However, prolonged first set allograft survival is seen in the prostate when compared to grafts placed orthotopically. These differences appear to be exaggerated or diminished, depending upon the particular foreign tissue used.

Animals↗
PubMed1976

The use of spermatic cord lymphatics in the relief of surgically created lower extremity edema. A preliminary report of experiments in dogs.

When lower extremity lymphedema is not amenable to control by medical methods, attempts to ameliorate the problem surgically have generally been unsatisfactory. The intact testis and spermatic cord provide a potential bridge that may permit communication between the unobstructed lymphatics of the gonadal system and the obstructed lymphatics of the lower extremity. Preliminary experience in male dogs wherein lower extremity lymphedema is first induced surgically and is treated by testicular implantation into the edematous thigh shows that lympholymphatic communications between the lower extremity and the gonadal system may result.

Animals↗
PubMed1975

Primary carcinoma of the ureter: a prognostic study.

Fourty-one patients with primary invasive carcinomas of the ureter were seen at Memorial Hospital from 1947 to 1972. Overall survuval patterns were similiar in 19 patients with and 22 patients without prior or concomitant urothelial cancers elsewhere in the urinary tract, with 5-year survival rates, as estimated by the product-limit methos, of41% for both groups. Prognosis was determined primarily by anatomical stage of ureteral cancer. In 11 Stage A (submucosal) patients, 7 Stage B (muscular), 12 Stage C (periureteric fat), and 9Stage D (extraureteral), the similarly estimated 5-year survival rates were 91%, 43%, 23%, and nil, respectively. None of Stage A cases had metastases for periods ranging from 5 to 11 years after surgery alone. Seventy-eight percent of patients with more advanced stages died within 3 years of treatment, withmetastases mainly in pelvic and para-aortic lymph nodes.

Adult↗