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Biomedical subjects

A F Althausen

Publications and source records attributed to A F Althausen.

At least 37 records · Page 2Linked to original sources
PubMed1992

Extra-adrenal pheochromocytoma.

Extra-adrenal pheochromocytomas may arise in any portion of the paraganglion system, although they most commonly occur below the diaphragm. The most common site of occurrence of extra-adrenal pheochromocytoma is the superior para-aortic region between the diaphragm and lower renal poles. Although the traditional teaching has been that 10% of all pheochromocytomas are at extra-adrenal sites, this may be an underestimation. Extra-adrenal pheochromocytomas probably represent at least 15% of adult and 30% of childhood pheochromocytomas. They may be malignant in up to 40% of the cases, although conflicting data add to the uncertainty of this point. Patients with tumors arising at extra-adrenal sites commonly present with headache, palpitations, sweating and hypertension. The diagnosis is most often confirmed by demonstrating increased catecholamine production, usually by measurement of urinary catecholamines and/or their metabolites. CT scanning is presently the imaging procedure of choice for localization. The roles of MRI and 131I-MIBG scintigraphy in the localization process are still being determined. Thorough preoperative pharmacological preparation, attentive intraoperative monitoring and aggressive surgical therapy all have an important role in achieving the safest and most successful outcome. Complete surgical excision is the treatment of choice for primary extra-adrenal pheochromocytoma as well as recurrent or metastatic disease. When residual tumor cannot be resected, medical therapy for symptomatic relief is preferred, since radiotherapy and chemotherapy have limited effectiveness. Extra-adrenal pheochromocytomas are more likely to recur and to metastasize than their adrenal counterparts, making lifelong followup with annual determinations of catecholamine production essential.

Humans↗
PubMed1992

Radiotherapy and chemotherapy in invasive bladder cancer with potential bladder sparing.

The standard treatment in the United States for patients with muscle infiltrating tumors is radical cystectomy with or without radiation treatment. The results of such treatment have been generally unsatisfactory, with 40% or more patients developing systemic disease with a 5-year survival rate of less than 50%. Combination chemotherapy employing both cisplatin and methotrexate can produce a 30% to 50% clinical complete response rate (negative biopsy, negative urinary cytology) of the primary tumor. Although the optimal combination of chemotherapeutic agents has not yet been determined, it is unlikely that combination chemotherapy alone, even in completely responding patients, will be adequate to rid the bladder of a primary invasive transitional cell carcinoma. Additional therapy by either surgery or external beam radiotherapy seems warranted owing to the high likelihood that there will be residual microscopic tumor in the bladder. Concomitant systemic chemotherapy and external beam radiotherapy produces complete remissions in 65% to 90% of patients. Follow-up of from 3 to 5 years following full chemoradiotherapy will be necessary to be certain that the bladder has been sterilized of cancer. Combined cisplatin and external beam radiation (using a boost technique that spares the section of the bladder uninvolved with tumor) does not seem to enhance local soft-tissue toxicity (relative to the radiotherapy alone) with the exception of the neurotoxicity seen with intra-arterial cisplatin. Debulking TURB tumor appears to improve the local success rate for patients being considered for bladder preservation with the use of the combination of systemic chemotherapy and/or radiotherapy. Not all patients respond to concomitant chemotherapy and radiation therapy. Our current approach is that the selection process must be carried on at several points during the treatment. Only patients who respond completely to the initial courses of chemotherapy and radiation should be carried to a full radiation dose. In the absence of a complete response following upfront chemotherapy and 4000 cGy in combination with additional cisplatin courses, cystectomy at that point is the recommended treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Cisplatin↗
PubMed1991

Biopsy after external beam radiation therapy for adenocarcinoma of the prostate: correlation with original histological grade and current prostate specific antigen levels.

We obtained post-irradiation biopsies in 37 men with initially stage T3 prostatic adenocarcinoma treated by external beam radiotherapy. Eligibility for post-irradiation biopsy included no clinical local failure, interval since treatment of 24 months or more and no endocrine therapy. Of the 37 patients 23 (62%) had negative biopsies while 14 (38%) had positive biopsies. Of 23 patients whose original cancer was well or moderately differentiated 18 (78%) had negative biopsies, compared to only 5 of 14 (36%) of those with poorly differentiated cancer (p less than 0.03). Among 19 patients whose current serum prostate specific antigen (PSA) value is less than 2.5 ng./ml. 15 (79%) had negative biopsies, compared to only 4 of 14 (29%) with a PSA level of greater than 2.5 ng./ml. (p less than 0.02). These results strongly suggest that there is a low probability of positive post-irradiation biopsy regardless of its significance in men with a normal prostate by palpation and a normal serum PSA value. However, short followup since biopsy precludes analysis of the predictive value of post-irradiation biopsy on long-term local and distant disease status.

Adenocarcinoma↗
PubMed1991

Prognostic factors in invasive bladder carcinoma in a prospective trial of preoperative adjuvant chemotherapy and radiotherapy.

Clinical and pathologic factors were analyzed in 40 patients with localized muscle-invasive bladder carcinoma treated in a prospective bladder-preserving program consisting of transurethral tumor resection, neoadjuvant chemotherapy (methotrexate, cisplatin, and vinblastine [MCV]), and 4,000 cGy radiotherapy with concurrent cisplatin. Patients with biopsy-proven complete response after chemotherapy and 4,000 cGy radiation received full-dose radiotherapy (6,480 cGy) with cisplatin. Cystectomy was recommended to patients with residual disease. Distant metastasis rate was associated with tumor stage and size: 0% in T2 patients, 39% in T3-4 patients (P = .035), 6% for tumors less than 5 cm, and 59% for tumors greater than or equal to 5 cm (P = .002). Risk of bladder tumor recurrence was higher in patients with tumor-associated carcinoma in situ (CIS; 40%) than those without CIS (6%; P = .075). Papillary tumors and solid tumors both had similar treatment outcomes. By multivariate analysis, tumor stage T2 (P = .04) and absence of CIS (P = .03) were significant predictors of complete response; CIS was predictive of local bladder recurrence (P = .07); and tumor size (P = .03), response after chemoradiotherapy (P = .02), and vascular invasion (P = .08) were associated with distant metastasis. Six of eight local bladder tumor recurrences were superficial tumors. The low actuarial distant metastasis rate of T2 patients (0% at 3 years), the 3-year actuarial overall survival rates for T2 (89%) and T3-4 (50%) patients, and the similar treatment outcomes for papillary versus solid tumors are encouraging when compared with published historical controls. These results provide preliminary evidence (median follow-up, 30 months) that the current chemoradiotherapy regimen may have beneficial effects in the treatment of muscle-invasive bladder carcinoma. The true efficacy of neoadjuvant chemotherapy remains to be proven by ongoing randomized trials.

Adult↗
PubMed1990

Spermatic cord sarcomas: sonographic and CT features.

Five patients with sarcomas of the spermatic cord were imaged with sonography and/or computed tomography (CT). The former modality is most helpful in demonstrating the extratesticular origin of the mass and evaluating its scrotal extension for local staging. CT is necessary for pelvic staging and searching for distant metastasis. The fat in liposarcomas was easily identified by CT, although it was not echogenic on sonography. Sonography should be the primary imaging modality for scrotal or inguinal masses. If a neoplasm is found, CT should be used for staging, prior to definitive surgical treatment.

Aged↗
PubMed1990

Preliminary results in invasive bladder cancer with transurethral resection, neoadjuvant chemotherapy and combined pelvic irradiation plus cisplatin chemotherapy.

Preliminary data are presented of a clinically feasible pilot study to select a significant subgroup of patients among those with muscle-invading bladder tumors for local cure and bladder preservation, while also to offer all patients the possibility of preventing the development of distant metastases. Transurethral debulking surgical resection was combined with neoadjuvant methotrexate, cisplatin and vinblastine chemotherapy plus 2 additional courses of cisplatin and 4,000 cGy. If tumor was found on cystoscopic re-evaluation by biopsy and for cytology after cisplatin and partial irradiation (4,000 cGy.) immediate cystectomy was advised. If tumor was not found consolidation by a radiotherapy boost to a total of 6,480 cGy. plus 1 additional course of cisplatin was given. Of 53 consecutive patients the planned treatment was completed in 42 (79%). With a median followup of 26 months (range 15 to 42 months), 72% of all entered patients were alive, 70% have not required cystectomy and 74% have not had distant metastases. Among the 42 patients who completed the planned protocol chemotherapy dose reductions were required in 39% for stomatitis, bone marrow depression and/or renal dysfunction. There were 2 serious complications but no treatment-related sepsis, deaths or significant renal dysfunction. Eight patients underwent immediate radical cystectomy because of positive biopsy and/or cytology results after 4,000 cGy., while 34 completed full chemotherapy and radiotherapy without any significant bladder or bowel injury. Of 42 patients 22 (52%) have maintained the bladder without any recurrence, and of those selected for full chemotherapy and radiotherapy this number increased to 65%. To date 12 patients have persistent or recurrent bladder tumors: 5 (15%) had invasive tumors treated by cystectomy and 7 (21%) had carcinoma in situ treated by intravesical therapy. The true success of this or other selective bladder-preserving treatments will require 3 to 5 years of followup to be confident that such treatment has sterilized the bladder of cancer. This feasibility study has been clinically practical, modestly well tolerated and encouraging for the significant proportion of patients with a sustained complete response and for the 70% over-all survival rate at 2 years. To evaluate critically the efficacy of methotrexate, cisplatin and vinblastine chemotherapy in the prevention of occult distant micrometastases and in increasing the rate of successful bladder preservation, in May 1988 we began a randomized phase 3 trial with and without neoadjuvant methotrexate, cisplatin and vinblastine chemotherapy.

Aged↗
PubMed1989

Malacoplakia: a 25-year experience with a review of the literature.

Our experience with 9 cases of genitourinary malacoplakia is reviewed. The bladder was involved in 4 patients, ureter in 2, prostate in 1, testis in 1 and a combination of prostate, bladder, rectum and pelvic adnexae in 1. The female-to-male ratio was 2:1. Escherichia coli was present in 7 of 8 available urine cultures. Of 9 patients 2 had associated immunocompromised conditions. A variety of therapeutic approaches were chosen, depending mainly on location and extent of disease. These varying combinations of medical and surgical therapies produced resolution of disease in 8 of 9 patients. Generally, upper tract involvement requires surgical intervention, while most cases of lower tract involvement can be managed with antibiotics and endoscopic resection. Rare cases of extensive lower tract malacoplakia may require extirpation for cure.

Female↗
PubMed1988

Radiation therapy for localized prostate carcinoma: experience at the Massachusetts General Hospital (1973-1981).

The success following irradiation in 370 patients with clinically localized prostate carcinoma was measured by overall patient survival as well as the cumulative incidence with time of treated patients who developed either local tumor regrowth or progression with distant metastases. With a minimum follow-up of 5 years in living patients, we evaluated the cumulative frequency curves using both univariate and multivariate (Cox) analyses. Overall patient survival and probability of progression with distant metastases were significantly influenced by initial tumor stage and the degree of histologic differentiation. The results at 8 years are significantly better for patients with T2 (B) tumors (local regrowth in 8%, distant metastases in 18%) than for patients with T3-T4 (C) tumors (local regrowth in 28%, distant metastases in 60%). Patient tolerance of external-beam radiation therapy was carefully analyzed in 121 consecutively treated patients in 1980 and 1981 for subsequent radiation-related sequelae. Minor transient intestinal and urologic sequelae were observed in 21% and 23% of the patients, respectively. These mild to moderate symptoms resolved in all but 7% of the patients who are continuing with mild symptoms. One patient had a major complication, i.e., a cystectomy required for persistent bleeding. Erectile potency has been maintained in 63% of potent patients. No specific benefit or detriment in outcome was seen in the minority of 51 patients who were irradiated by iodine-125 implantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1987

Significant renal hemorrhage following extracorporeal shock wave lithotripsy: imaging and clinical features.

Extracorporeal shock wave lithotripsy (ESWL), either alone or in combination with percutaneous or retrograde techniques, has rapidly become the procedure of choice for the treatment of intrarenal and upper ureteral calculi. Complications have been few so far and usually have been urinary obstructions or hemorrhages. Most fluid collections observed after ESWL are asymptomatic and their detection usually does not prolong hospitalization or alter therapy. In five patients out of 2,149 patient treatments symptomatic renal hematomas developed within a few hours after ESWL for renal calculi. In two of these patients the partial thromboplastin time was mildly prolonged. In four patients blood volume replacement was required to treat a falling hematocrit reading or hypotension. Diagnosis of the hematomas was initially made with sonography, although computed tomography and magnetic resonance imaging were used to further define the distribution and extent of retroperitoneal hematomas. Severe ipsilateral flank pain and rapid decrease in the hematocrit reading after ESWL strongly suggest significant bleeding from the treated kidney and require prompt radiologic confirmation and careful clinical treatment until there is evidence that the hemorrhage has stopped.

Aged↗
PubMed1986

Further experience with staged ureterocolocolostomy urinary diversion.

Disenchantment with the long-term results with ureterosigmoidostomy and ileal loop urinary diversion led to increased use of the nonrefluxing colon conduit. In 1978, we reported our initial experience with 3 adult patients in whom such a diversion was initially performed followed by conversion with an end-to-side colocolostomy achieving a staged nonrefluxing ureterocolocolostomy. We believed that a staged procedure would allow decompression of the upper urinary tract away from the fecal stream, that one could confirm the adequacy of the nonrefluxing tunnels prior to exposure to the fecal stream, and that this might have a lower instance of electrolyte problems and pyelonephritis. Further follow-up on these original 3 patients as well as our experiences with two others, as reported here has somewhat tempered our initial enthusiasm.

Adult↗
PubMed1986

Chromosome anomalies suggestive of malignant transformation in bilateral renal oncocytoma.

A patient with bilateral renal oncocytoma is presented, and the clinical, radiological and pathological characteristics of this uncommon, clinically benign renal tumor are discussed briefly. Chromosomal analysis studies revealed the following clonal abnormalities: trisomy of chromosome 7, and monosomy of chromosomes 3 and 14, and the X chromosome. A possible clonal abnormality of chromosome 10 and 3 nonclonal anomalies also were identified. The same anomalies were present in both tumors. These karyotypic anomalies are compatible with malignant transformation of the cells of these tumors and, since benign tumors rarely are associated with demonstrable cytogenetic changes, they suggest that oncocytoma, although clinically benign, may have malignant potential.

Adenoma↗
PubMed1982

Role of abdominal computed tomography in evaluating left upper quadrant masses.

The etiology of abdominal masses in the left upper quadrant may be confusing because of the anatomic relationships of the organs involved. In three representative cases presented, computed tomography (CT) clearly defined masses as being nonurologic in origin, although conventional radiologic diagnostic techniques originally yielded results that suggested a renal or adrenal origin. In two other cases, masses thought to originate from the spleen or retroperitoneum were shown by CT to be renal tumors. In a sixth case, a large mass thought to be of renal origin but not evaluated by CT was found at surgery to be a pancreatic cyst. Abdominal CT is more sensitive than other imaging modalities in clarifying organ relationships and the origin of masses in the left upper quadrant.

Abdominal Neoplasms↗
PubMed1980

Ileal conduit undiversion: experience with tunneled vesical implantation of tapered conduit.

Reconstruction of the urinary tract after ileal conduit diversion was done in 9 patients by antirefluxing vesical implantation of the tapered conduit. Of the patients 5 required prior operative rehabilitation of the lower tracts, while 4 had urodynamically normal lower tracts. Reoperation for post-undiversion reflux was necessary in 2 patients; reimplantation was satisfactory in 1 but ileocecocystoplasty was required in the other. Followup showed a stable or improved upper tracts and renal function in the remaining patients.

Adolescent↗
PubMed1979

Malacoplakia of the ureter.

Malacoplakia of the urinary tract affects primarily the bladder and secondarily the distal ureter. Characteristic gross and microscopic lesions have been well described. A case of malacoplakia is reported in a 55-year-old woman who presented with hydronephrosis in a solitary kidney. The only lesion in the urinary tract was an apple-core type mass of the distal ureter, which was resected. This represents a rare and unusual presentation of malacoplakia. The differential diagnosis and pertinent literature are discussed.

Female↗