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Biomedical subjects

Z Wajsman

Publications and source records attributed to Z Wajsman.

At least 55 records · Page 3Linked to original sources
PubMed1987

Needle aspiration and needle biopsy procedures.

Needle biopsy of the prostate, employing large "core" needles and performed via the transperineal or transrectal routes, is a well-established method for diagnosing prostatic malignancy. This procedure can be performed safely under local anesthesia in an outpatient setting. Rectal cleansing and prophylactic antibiotics have minimized infectious complications following transrectal biopsy, and it remains the favored technique in patients with small lesions. Repeat biopsy under anesthesia is indicated when the clinical suspicion of malignancy remains high despite negative biopsies. In contrast to "core" needle biopsy, which obtains a cylinder of tissue for histologic examination, the fine-needle biopsy obtains a specimen for cytologic examination. If cytologic expertise is unavailable locally, the specimen may be fixed in the office and shipped to a major medical center for interpretation. Fine-needle aspiration may be safely employed to biopsy the prostate, pelvic masses, and inguinal and pelvic lymph nodes. Biopsy of palpable masses can be done simply and safely with morbidity akin to venipuncture. Nonpalpable tissues may be biopsied under radiographic guidance. Fine-needle aspiration biopsy is safe and cost-effective, has resulted in a significant improvement in the accuracy of our clinical staging, and has spared many patients unnecessary surgical procedures.

Ambulatory Care↗
PubMed1986

Intraoperative autotransfusion in urologic oncology.

The value of autotransfusion is widely recognized in the surgical community and may be of increasing importance in prevention of acquired immunodeficiency syndrome and hepatitis. The concern of potential contamination of the blood with viable tumor cells has resulted in limited use of autotransfusion in cancer surgery. The objective of this study was to examine the benefits and safety of autotransfusion in patients undergoing major surgery of genitourinary tumors. Autotransfusion was used in 49 consecutive patients. Twenty-four patients had radical cystectomy, ten had radical prostatectomy, 13 had radical nephrectomy, and two had other types of operations. An autotransfusion machine (Haemonetics Cell Saver) was used. The follow-up included physical examination, chest roentgenogram every three months, and bone scan and computed tomographic scan if clinically indicated. Liver and renal profiles were routinely performed every three months. Five of 49 patients developed metastases during follow-up examination from 12 to 23 months. The low incidence of metastatic spread and the pattern of spread fall to implicate autotransfusion as a cause of tumor dissemination. Autotransfusion and predeposited blood banking may result in elimination of or significant reduction in homologous transfusions.

Adult↗
PubMed1986

Duplicated inferior vena cava simulating retroperitoneal lymphadenopathy in a patient with embryonal cell carcinoma of the testicle.

Computerized tomography has become the most widely applied staging technique in the assessment of retroperitoneal lymph nodes in patients with nonseminomatous testicular carcinoma. Errors in clinical staging of testicular carcinoma can have serious implications for the treatment afforded these patients. We describe a duplicated inferior vena cava that simulated retroperitoneal lymphadenopathy on abdominal computerized tomography in a patient with embryonal cell carcinoma of the testicle. The embryology and implications of anomalous lymphatic drainage of the testicle are discussed.

Adult↗
PubMed1986

Spontaneous regression of testicular seminoma: case report.

A 33-year-old man had a 1-year history of a painless testicular mass and a 2-month history of an enlarging left supraclavicular mass. Biopsy of the supraclavicular mass showed classical seminoma. Massive abdominal lymphadenopathy was demonstrated by computerized tomography. Radical orchiectomy was performed and examination of the specimen showed only fibrous scar tissue consistent with regression of a primary tumor in the testis. While complete regression of a primary testicular tumor with progressive growth of metastases is well recognized in cases of nonseminomatous germ cell tumors, this phenomenon is reported rarely with seminoma.

Adult↗
PubMed1986

Oncocytoma in a horseshoe kidney.

Renal oncocytoma is an unusual tumor that has been identified with increasing frequency during the last decade, and more than 150 cases have been reported in the literature, including multifocal and bilateral tumors. We report a case of oncocytoma in a horseshoe kidney. Oncocytoma and tumors in horseshoe kidneys are discussed.

Adenoma↗
PubMed1985

Prognostic factors in localized prostatic carcinoma.

Serial histological sections were performed in 54 radical prostatectomy specimens in an attempt to identify prognostic factors responsible for dissemination of prostatic cancer. Factors considered in the study included clinical versus pathological staging, histological grading of the biopsy specimen compared to the final pathological result, intraprostatic tumor distribution and deoxyribonucleic acid analysis of the tumor by flow cytometry in the last 33 cases. In patients with clinical stages A2 and B1 disease pathological findings were in accord in 78 per cent (11 of 14). However, only 3 of 40 patients with clinical stage B2 tumor had pathological stage B2 disease. Histologically, 72 per cent of the tumors were bilateral. Microscopic involvement of the capsule per se did not appear to influence lymph node invasion, since only 1 of 27 patients with microscopic capsular involvement had pelvic lymph node metastasis. However, 9 of 13 patients with seminal vesicle involvement had pelvic lymph node metastasis. The addition of flow cytometry to the Gleason score improves the predictive value of histological grade in higher stage lesions.

Carcinoma↗
PubMed1985

Preoperative angioinfarction of localized renal cell carcinoma using absolute ethanol.

A total of 25 patients with renal cell carcinoma underwent angioinfarction of the tumor using absolute ethanol. An average of 15 ml. absolute ethanol was injected into the main renal artery through a balloon occlusion catheter. Complete cessation of renal arterial flow could be demonstrated in all cases. The post-embolization syndrome of pain, nausea, vomiting, hypertension and fever was minimal compared to other methods of renal artery occlusion. Of the patients 21 underwent post-infarction transabdominal radical nephrectomy without intraoperative or postoperative complications attributable to the injection of absolute ethanol. No damage to extrarenal tissue was noted at operation. Subsequent surgical dissection was facilitated, particularly in cases of large tumors when control of the renal pedicle often is difficult. Median blood loss was 725 ml. In light of recent reports concerning the benefit of angioinfarction and nephrectomy in metastatic disease a similar approach may be applicable to localized disease. This pilot study shows the safety of preoperative angioinfarction with absolute ethanol and may be used as a reference for future randomized prospective studies comparing angioinfarction and nephrectomy to nephrectomy alone for localized renal cell carcinoma.

Adult↗
PubMed1985

Salvage surgery following radical radiotherapy for adenocarcinoma of the prostate.

The development and proliferation of modern radiotherapy techniques, and their application in the 1970s to the treatment of localized adenocarcinoma of the prostate have led to substantial improvement in therapy of this disease. However, treatment failures occur. Among these patients is a small subset who have local recurrence of disease confirmed by biopsy without evidence of metastatic disease, and who still are relatively young and healthy. We report on 7 patients who satisfy these criteria. All 7 patients underwent a salvage operation with removal of the prostate gland following attempted curative radiotherapy: 3 underwent cystoprostatectomy and urinary diversion, and 4 underwent radical prostatectomy. Operating times averaged 4.9 hours and average blood transfusion was 5.3 units. Postoperative hospital stay averaged 13 days. Significant morbidity included 2 patients with rectal lacerations (1 of whom suffered a rectourethroperineal fistula that closed spontaneously), 2 with temporary urinary incontinence, and 1 with idiopathic thrombocytopenia and pseudomembranous colitis. As illustrated by these patients salvage surgery is difficult and there is substantial morbidity. However, this treatment option with its potential for cure can be offered to patients as a reasonable and rational approach to the problem.

Adenocarcinoma↗
PubMed1985

Histological patterns of treatment failures in testicular neoplasms.

We reviewed 77 consecutive autopsies performed between 1965 and 1982 on patients who had been treated for germ cell tumors of the testis at our institute. Identifiable germ cell tumor was present at autopsy in 64 cases. On review, a single pattern was seen at autopsy in the majority of the cases (69.7 per cent) compared to the primary tumors, in which single patterns were seen in only 45 per cent. The occurrence of yolk sac tumor as the sole element in 6 of 29 autopsy specimens of nonseminomatous tumors after the introduction of the current standard 3-drug therapy and only once in 32 autopsies before 1976 appears significant. A possible explanation for this finding is that the yolk sac element was obscured by more aggressive and rapidly growing varieties of tumor in the earlier years but proved less responsive to chemotherapy.

Adolescent↗
PubMed1984

Studies of mitomycin C absorption after intravesical treatment of superficial bladder tumors.

Mitomycin C is an active drug in the treatment of superficial bladder cancer. Although clinical safety of intravesical mitomycin C has been well accepted there are no data on absorption of this drug from the bladder in patients with damaged bladder mucosa. We studied 18 patients for evidence of absorption of mitomycin C after transurethral resection and/or radiation therapy. Mitomycin C is absorbed on intravesical instillation and the degree of absorption depends on the degree of damage to the bladder. Despite some evidence of absorption no systemic effect on bone marrow was observed and no evidence of deoxyribonucleic acid damage was found in any of these patients. Mitomycin C appears to be a safe drug but further studies are indicated to document its safety when used for maintenance therapy.

Antibiotics, Antineoplastic↗
PubMed1984

Evaluation of bladder washings and urine cytology in the diagnosis of bladder cancer and its correlation with selected biopsies of the bladder mucosa.

We report a prospective study of 136 patients with biopsy proved bladder tumor who underwent 311 evaluations with cystoscopy, urinary cytology, bladder washing and, when indicated, bladder biopsies. Cytology results from bladder washings were superior to routine urinary cytology studies in detecting abnormal cells. Also, there was a significant increase in the number of positive cytology studies in bladder washings from patients with no evidence of tumor by cystoscopy but who had biopsy proved dysplasia. Multiple selective bladder biopsies showed a higher incidence of mucosal abnormalities if the primary tumor was of a higher grade.

Biopsy↗
PubMed1984

Cisplatin and full dose irradiation for patients with invasive bladder carcinoma: a preliminary report of tolerance and local response.

Twenty-seven patients with invasive bladder carcinoma (clinical stages T2 to T4) who were not candidates for cystectomy were treated by transurethral resection, cis-diamminedichloroplatinum (cisplatin) and full dose radiotherapy according to protocol 8 of the National Bladder Cancer Collaborative Group A. Nausea and vomiting occurred in 74 per cent of the patients but were mild in 41 per cent. Maximum followup was 27 months and during that time 3 significant toxic reactions occurred: renal failure, systemic sepsis and a transient partial small bowel obstruction. Of 17 evaluable patients complete responses of the primary bladder cancer to the treatment were achieved in 11 of 13 with stages cT2 and cT3 cancer and in 2 of 4 with stage cT4 disease. The members of National Bladder Cancer Collaborative Group A have found transurethral resection, cisplatin and full dose external beam radiotherapy practical clinically. Longer followup will be necessary to determine if the observed high initial complete response rate of the tumor indicates real lasting benefit for these patients.

Acute Kidney Injury↗
PubMed1984

The treatment of poor risk nonseminomatous testicular tumors.

A total of 14 patients with nonseminomatous testicular tumors presenting with characteristics indicative of a poor prognosis were treated with cytoreductive chemotherapy, surgery and immediate reinduction chemotherapy. Of the 14 patients 12 presently are alive without evidence of disease (median followup 18 months). This new approach has improved significantly the outcome of these patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Therapeutic embolization of pelvic metastases of renal cell carcinoma.

The results of arterial embolization of symptomatic pelvic osseous metastases associated with extensive soft tissue tumors in 5 patients with renal cell carcinoma are presented. Of the 5 patients 4 experienced significant relief of pain and improved performance status, as well as objective evidence of bone recalcification or tumor reduction at an average followup of 10 months. One significant complication occurred in a patient with previous local irradiation. Possible advantages over conventional external beam radiation therapy of metastatic renal cell carcinoma and future applications of arterial embolization of bulky metastatic tumors are discussed briefly.

Adenocarcinoma↗
PubMed1984

Immediate postoperative feeding in urological surgery.

The value of immediate postoperative enteral hyperalimentation with an elemental diet (high nitrogen Vivonex, full strength) at 125 cc per hour for 4 days was assessed in patients after radical urological surgery. Of 32 patients studied 21 received an elemental diet using a Vivonex Moss tube, which is a 3-lumen tube with esophagogastric decompression and simultaneous duodenal feeding, and the remaining 11 had a nasogastric tube only without nutritional support. We have used a selected group of parameters, including serum albumin, serum transferrin, creatinine height index, weight loss, total lymphocyte count, nitrogen balance and plasma fibronectin. All patients in the Moss tube group approached or achieved positive nitrogen balance by 4 days postoperatively, whereas the nasogastric tube group remained in negative nitrogen balance. Postoperative paralytic ileus was prevented in the majority of patients in the Moss tube group while receiving full nutritional support. We have found that the use of the Moss tube is a reasonable approach for postoperative alimentation. The tube is relatively easy to insert and well tolerated, and its use is a less expensive alternative to parenteral hyperalimentation.

Enteral Nutrition↗
PubMed1983

The treatment of Stage III nonseminomatous testicular tumors. Roswell Park Memorial Institute results (1970-1979).

A review of 92 patients with Stage III nonseminomatous tumors treated at Roswell Park Memorial Institute between 1970-1979 was undertaken to verify changes in concepts as related to multiple agent chemotherapy and cytoreductive surgery. Each patient had a minimal follow-up of 18 months. Fifty-three patients were seen before 1975. Eighteen had metastasis to the lungs only. These were treated with a variety of single chemotherapeutic agents and cytoreductive surgery. The survival of this group was 38%. Among 35 patients with lung and visceral involvement seen at the same time, only one patient is alive. Thirty-nine patients were seen after 1975 and treated with multi-drug chemotherapy and cytoreductive surgery. The current survival rate of 23 patients with lung metastasis only is 69%. Among 16 patients with lung and visceral involvement, the present survival rate is 31%. This report confirms the effectiveness of multi-drug therapy in conjunction with cytoreductive surgery in the treatment of disseminated testicular tumors.

Antineoplastic Agents↗