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Biomedical subjects

W M Murphy

Publications and source records attributed to W M Murphy.

At least 73 records · Page 4Linked to original sources
PubMed1989

Rationale for intravesical chemotherapy in the treatment and prophylaxis of superficial transitional cell carcinoma.

1. A thorough evaluation of the urinary tract is an integral part of the initial management of a patient with transitional cell carcinoma. The site of all urothelial abnormalities must be determined and adequate histologic material obtained and reviewed. The urothelium not involved by obvious tumor should also be evaluated by either cytology or mucosal biopsies. All patients with high grade tumor should have a biopsy from the prostatic urethra. 2. The clinician should determine the risk of progression by evaluating the tumor grade, stage, and the presence or absence of carcinoma in situ. 3. The likelihood of a recurrence following endoscopic resection of a superficial bladder tumor ranges from 20% for a solitary low grade tumor to over 90% for a patient with multifocal high grade cancer. 4. The reasons for the high incidence of a subsequent tumor include new occurrences related to the continued contact of carcinogens with the susceptible urothelium, failure to completely resect all tumor, and possibly the implantation of tumor cells on the altered urothelial surface following endoscopic resection. 5. Intravesical instillation of antineoplastic agents is capable of reducing the incidence of a subsequent tumor when used for prophylaxis. These agents are also capable of eradicating residual tumor. 6. The clinician should determine whether intravesical therapy is being used for treatment or prophylaxis. 7. Thiotepa is a relatively inexpensive and safe intravesical chemotherapeutic agent which, when used for treatment of existing tumor, will provide a complete response rate of from 35 to 45%. There is a suggestion that it is more effective in low grade than high grade tumors. Prospective randomized trials indicate that patients receiving Thiotepa are less likely to develop a subsequent tumor in a given period of time than patients who do not receive intravesical therapy. 8. Mitomycin-C will provide a complete response rate in high risk patients from 35 to 50% when used for treatment of existing tumor. Approximately 15% of such patients will progress to muscle invasion if followed for approximately three years. There are few randomized trials using Mitomycin-C to determine its efficacy for prophylaxis. 9. BCG has been used for treatment and prophylaxis of superficial bladder cancer. It is relatively inexpensive. The side effects vary with the strain. Several strains have been used but they have not been compared in randomized trials. When used for treatment, the complete response rate ranges from 50 to 65%.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Intravesical↗
PubMed1988

The prognostic value of DNA ploidy combined with histologic substaging for incidental carcinoma of the prostate gland.

Although current methods of histologic substaging for incidental prostatic carcinoma are useful, they offer only general indications of potential tumor behavior. To further define the biologic tendencies of stage A cancers, an examination was made of the role of DNA ploidy combined with histologic staging in archival material selected to achieve both a representative sample and long-term follow-up. With histology alone, 36% of stage A2 cancers and 9% of A1 neoplasms were progressive. Adding DNA flow cytometry to histology resulted in a significant improvement in the capacity of pathologic evaluation to predict outcome. Progression occurred in 67% of aneuploid stage A2 prostate cancers and in none of the nonaneuploid stage A1 tumors. Despite current limitations in the interpretation of DNA histograms from archival tissue, flow cytometry has significant potential in the pathologic evaluation of incidental prostatic carcinomas.

Aged↗
PubMed1988

Effect of stocking rate, grazing system, and fenbendazole treatment on subclinical parasitism in dairy heifers.

Average daily weight and fecal parasitic egg count were compared among sixty 7- to 15-month-old Holstein heifers randomly assigned to 8 groups. The following variables were examined: grazing system (continuous vs rotational), stocking rate (3.5 vs 5 heifers/ha), and treatment [control vs dosing with a 10% suspension of fenbendazole (5 mg/kg of body weight) given orally 21 and 49 days after heifers were placed on pasture]. Two heifers from each group were euthanatized 4 weeks after the completion of the 148-day trial to determine the number of parasitic larvae and adults in the abomasum and intestine. Heifers treated with fenbendazole had significantly (P less than 0.001) fewer fecal ova and fewer inhibited abomasal larvae (P less than 0.05) than did controls. Mean total weight gain and mean daily rate of gain of fenbendazole-dosed heifers were significantly (P less than 0.01) increased by 17.3 kg or 0.12 kg/day, respectively, compared with those of nontreated heifers. Seemingly, stocking rate and grazing systems had no marked effect on subclinical parasitism in heifers.

Animal Husbandry↗
PubMed1987

Transitional cell neoplasms of the urinary bladder. Can biologic potential be predicted from histologic grading?

The concept that most transitional cell neoplasms of the urinary bladder exist as either nonaggressive lesions of low cytologic grade or aggressive anaplastic cancers is gradually gaining acceptance. The extent to which the biological potential of these neoplasms is revealed in their pathologic features is the subject of this article. Using guidelines developed in experimental models, a series of 400 transitional cell neoplasms selected for long-term follow-up were classified into the WHO system. The results indicate that (1) almost all transitional cell tumors can be grouped into low and high grades at initial presentation; (2) the low grade lesions (usually designated transitional cell carcinoma, Grade I) are benign and should be called papillomas rather than carcinomas; (3) the risk of progression is not a function of the number of recurrences for these noninvasive, low-grade, papillary tumors; (4) the high-grade neoplasms are aggressive whether papillary or nodular and account for greater than 93% of tumor-related deaths; (5) patients with high-grade lesions have a reduced life expectancy even if progression does not occur; (6) depth of invasion and growth pattern are limited as predictive factors compared with histologic grade; (7) histologic grading of the initial tumor tissue can be highly predictive of outcome.

Adult↗
PubMed1987

The significance of colonic mucosa (intestinal metaplasia) involving the urinary tract.

Although colonic type goblet cells are a relatively common component of reactive urothelial lesions and well-differentiated adenocarcinomas, complete replacement of areas of urothelium by benign appearing intestinal mucosa is a rare condition. All of the 11 documented cases occurred in association with abnormalities leading to chronic irritation and/or infection. In the three cases where the reported period of observation exceeded 2 years, all patients developed carcinoma. Despite its innocuous histology, widespread intestinal metaplasia apparently identifies a disturbed urothelium at high risk for cancer.

Carcinoma↗
PubMed1987

Patterns of approximal wear in cheek teeth of a Romano-British population.

The approximal surfaces of premolars and molars of 376 adult British-Romano skulls were examined for wear facets. The type of wear was designated as convex, concave, sigmoid, or flat, and the degree was categorised on a three-point scale. Concave wear facets were more frequently seen in the older age groups, but the type of wear was similar on right and left sides. Taking all teeth together or as individual tooth types, concave wear was significantly more likely on mesial rather than distal surfaces. The degree of wear was age related and similar on right and left sides in both males and females. It is suggested that the distribution of concave facets may be related to movements between adjacent teeth.

Bicuspid↗
PubMed1987

Kappa light chain nephropathy. A pathologic study.

Percutaneous renal biopsies from 4 patients with clinically unsuspected kappa light chain nephropathy were studied using light, immunofluorescence, and electron microscopy. The diagnosis in each case was established by demonstrating monoclonal kappa light chain deposits in basement membranes and basement membrane-like structures of glomeruli, tubules, and blood vessels by immunofluorescence microscopy. Characteristic electron dense deposits occurred in every case but the intensity and distribution of electron densities did not correlate with the immunofluorescence findings. When light chain aggregation occurred, as evidenced by the distribution of electron dense deposits, it was proportional to the amount of basement membrane-like material as if these immunoglobulins had a particular affinity for structures chemically related to basement membranes. Although active tubulointerstitial lesions were prominent in all biopsies, there was considerable variation in glomerular pathology with only 1 case exhibiting the typical nodular glomerulosclerosis. Correlation of the light, immunofluorescence, and electron microscopic findings in these cases suggests that the pathogenesis of kappa light chain nephropathy is related to light chain nephrotoxicity directed to basement membrane-like structures with subsequent alterations in hemodynamics and structural renal damage.

Adult↗
PubMed1987

Nephrogenic adenoma.

Nephrogenic adenoma is a peculiar reactive process of urothelium which may occur anywhere along the urinary collecting system but rarely if ever arises in the absence of a preexisting urogenital abnormality. Although its histogenesis and biological potential have not been entirely defined, the evidence strongly suggests a metaplastic lesion comprising immature cells which lack the capacity to invade or metastasize. Clinical signs and symptoms are nonspecific and may relate more to the coexisting abnormality than to the nephrogenic adenoma itself. Although nephrogenic adenomas may resemble certain types of urologic malignancies, their histology is distinctive and varies little from lesion to lesion so that once the entity is considered, an accurate pathologic diagnosis is rarely a problem.

Adenoma↗
PubMed1986

Prognostic significance of urine cytology on initial follow-up after intravesical mitomycin C for superficial bladder cancer.

Seventy patients were given courses of intravesical mitomycin C for residual transitional cell carcinoma of the bladder following partial resection or biopsy. The patients were reassessed 3 months after the initiation of treatment by cystoscopy and cytology from cystoscopic urines and bladder washings. Twelve had no visible cancer at cystoscopic study but had positive urine cytologic findings. The incidence of tumor recurrence, cystectomy, radiotherapy, and deaths due to bladder cancer for this group of cytologically positive partial responders was analyzed. Thirty-three percent (4/12) required cystectomy, none underwent radiation therapy and none died of bladder cancer. These outcomes were compared with that of complete responders (negative cystoscopic and cytologic results) and partial responders with visible tumor (reduction by greater than 50%). We conclude that in high-grade carcinomas, particularly carcinoma in situ, positive urine cytologic findings at the initial 3-month follow-up visit following treatment with intravesical mitomycin C is as ominous a prognostic indicator as endoscopic or biopsy evidence of cancer.

Aged↗
PubMed1986

Flow cytometry versus urinary cytology in the evaluation of patients with bladder cancer.

We compared the roles of urinary cytology and flow cytometry in the evaluation of patients with bladder cancer in clinical practice situations at a large general hospital. Specimens included 105 bladder washings from patients being followed for urothelial carcinomas and 28 control washings from individuals undergoing cytoscopy for other reasons. Flow cytometry and cytology were performed on aliquots of the same specimen in all bladder cancer samples. When carcinoma was present at the time of specimen collection it was detected by positive cytology in 75 per cent and deoxyribonucleic acid aneuploidy in 78 per cent of the cases. Combination of flow cytometry and urinary cytology increased the diagnostic yield to 95 per cent. Flow cytometry was slightly more sensitive than urinary cytology for detection of abnormalities in specimens from noninvasive and untreated tumors but the only statistically significant difference between the 2 procedures occurred among specimens from treated invasive cancers in which flow cytometry was a less sensitive method than cytology. Abnormal deoxyribonucleic acid ploidy was documented in a few specimens from noncancer-bearing patients having diseases associated with high urothelial cell turnover rates but the concomitant urinary cytology was negative for neoplasia. When used in conjunction with urinary cytology, flow cytometry was a valuable procedure in the followup of patients with bladder cancer. The diagnostic yield with this combination was such that flow cytometry and cytology may be used to reduce the frequency of cystoscopy and biopsy during clinical management in selected situations.

Aneuploidy↗
PubMed1986

Selective urethrectomy following cystoprostatectomy for bladder cancer.

The poor prognosis in patients who have symptomatic urethral carcinoma after cystoprostatectomy has prompted some investigators to recommend prophylactic urethrectomy. However, this approach subjects the majority of these patients (up to 90 per cent) to an operation for a disease that they might never have and precludes some innovative urinary diversion techniques. From June 1976 to July 1985 we performed 75 cystoprostatectomies for bladder cancer in men. Three patients underwent simultaneous urethrectomy because of tumor in the urethra. Of the remaining 72 patients who were followed by urethral wash cytology studies every 6 months 7 (10 per cent) had positive cytology studies during followup and underwent urethrectomy. Subsequent histological examination showed carcinoma in situ in all 7 specimens. To date 6 of the 7 patients are free of disease. One patient died 18 months after urethrectomy without evidence of transitional cell carcinoma. We have had no false positive urethral wash cytology studies and no patient has had local recurrence in the absence of a positive cytology study.

Adult↗
PubMed1986

Flow cytometry of deparaffinized nuclei compared to histological grading for the pathological evaluation of transitional cell carcinomas.

Recent developments in flow cytometric analyses have resulted in a practical method to examine the deoxyribonucleic acid ploidy of various tissues, including bladder cancers. Although the technique provides information not readily available from usual pathological examinations, its value as a diagnostic test in clinical urology remains to be investigated. We confirm previous reports that flow cytometry can be performed on tissues stored in paraffin and demonstrate a positive correlation among deoxyribonucleic acid ploidy, histological grade and clinical outcome in patients with transitional cell carcinoma. Nevertheless, deoxyribonucleic acid ploidy offered no more prognostic information than histological grading alone when these tests were performed on the initial bladder tumors in 63 patients.

Carcinoma, Transitional Cell↗