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A Pollack

Publications and source records attributed to A Pollack.

At least 109 records · Page 6Linked to original sources
PubMed1997

Kinetics of serum prostate-specific antigen after external beam radiation for clinically localized prostate cancer.

BACKGROUND AND PURPOSE: To determine the kinetics of serum prostate-specific antigen (PSA) after radiation therapy of localized prostate cancer and to evaluate whether such kinetics provide prognostic information. MATERIALS AND METHODS: Eight hundred forty-one men with serial PSA determinations who underwent external beam radiation without androgen ablation were analyzed to determine postradiation PSA kinetic parameters (half-life and doubling time) and to correlate these parameters with disease outcome. Non-linear regression techniques were used to determine half-lives and doubling times. RESULTS: The postradiation serum PSA data fitted well to first order kinetic models. The median PSA half-life was 1.6 months (range 0.5-9.2 months). There was no correlation between half-life and T-stage or Gleason grade. A significant but quantitatively weak correlation was present between the pretreatment PSA level and half-life; lower pretreatment levels were associated with longer half-lives. Half-life did not correlate with disease outcome whether the endpoint was local recurrence, distant metastasis or rising PSA. In 263 men with a rising postradiation PSA profile the median PSA doubling time was 12.2 months (range 0.8-80.2 months). Faster doubling times were significantly associated with higher T-stage, higher Gleason grade and higher pretreatment PSA levels. Thus, patients with initially adverse disease developed faster rising PSA values after treatment than patients with less adverse disease. The most striking correlation was between rapid doubling time and the likelihood of metastatic relapse. Patients who developed metastases had a median PSA doubling time of 4.2 months compared to a median doubling time of 11.7 months in patients who developed local recurrence. Overall, patients with a PSA doubling time of less than 8 months had a 7-year actuarial metastatic rate of 54%, while patients with a PSA doubling time exceeding 8 months had only a 7% metastatic rate. Particularly ominous was the combination of a doubling time shorter than 8 months which began to rise within the first year; by 3 years 50% of these men had metastases and all were actuarially projected to develop such relapse by 6.5 years. CONCLUSIONS: Overall, the clinical utility of postradiation serum PSA kinetics was small. There were no discernible uses for PSA half-life. In patients with a rising PSA profile the faster the kinetics the more adverse the disease. Doubling times shorter than 8 months, especially if the rise begins in the first year, predict for metastatic relapse. However, in the absence of decisively useful treatment for metastatic prostate cancer the virtues of the early detection of metastases remain unclear.

Aged↗
PubMed1997

Development of exudative age-related macular degeneration after cataract surgery.

The macular status of patients with findings consistent with early dry age-related macular degeneration (AMD) who underwent an extracapsular cataract extraction with intraocular lens implantation was evaluated by fundoscopy and fluorescein angiography pre-operatively and during the first post-operative year. Five patients who developed the exudative form of AMD, and who represent the problems arising when treating patients with AMD and cataract, are described. Patients who received laser photocoagulation responded with recurrent choroidal neovascularisation. We suggest that patients with signs of age-related changes scheduled for cataract surgery should undergo a thorough pre- and post-operative assessment of their retinal status.

Aged↗
PubMed1997

Exudative age-related macular degeneration in patients with diabetic retinopathy and its relation to retinal laser photocoagulation.

PURPOSE: To study the relationship between exudative age-related macular degeneration and diabetic retinopathy and assess the influence of retinal laser photocoagulation for diabetic retinopathy on the occurrence of exudative age-related macular degeneration. METHODS: Two groups, one of diabetic retinopathy patients treated with laser and the other of non-laser-treated diabetic retinopathy patients, were studied by means of fundoscopy and fluorescein angiography for the presence of exudative age-related macular degeneration. RESULTS: Exudative age-related macular degeneration was not observed in 431 patients treated with laser photocoagulation, and was diagnosed in 3.3% of 151 non-laser-treated patients. CONCLUSION: Patients treated by laser photocoagulation for diabetic retinopathy are less prone to develop the exudative form of age-related macular degeneration.

Age Distribution↗
PubMed1997

Repair of retinal pigment epithelium and choriocapillaries after laser photocoagulation: correlations between scanning electron, transmission electron and light microscopy.

Cell-to-cell interactions between retinal pigment epithelial (RPE) cells and vascular endothelium were examined by scanning electron microscopy, which demonstrates many facets of surface topography. The repair process after laser photocoagulation was characterized by a morphologically heterogeneous population of regenerated RPE cells, including normal-looking cells, macrophage-like cells and large elongated RPE cells. The macrophage-like and normal-looking RPE cells were predominantly seen adjacent to growing new choroidal vessels. Large cells appeared mainly in the vicinity of the extracellular matrix, where no viable new vessels were seen. The observed association between a specific phenotype of regenerated RPE cells and neovascularization may further support the hypothesis that regenerated RPE cells have a dual function, exerting both stimulatory and inhibitory effects on endothelial cells.

Animals↗
PubMed1997

Progression of nonischemic central retinal vein occlusion.

Progression of nonischemic central retinal vein occlusion (CRVO) to ischemic CRVO occurs in up to 5-20% of patients with nonischemic CRVO. Eyes presenting with nonischemic CRVO and exhibiting an increase in intraretinal hemorrhages together with angiographic findings of aggravation of venule wall staining were assumed to be showing early signs of progression. Eight eyes of 7 patients were followed prospectively and when they exhibited signs of progression they were assigned to either follow-up or early laser treatment. Four eyes received grid and early panretinal laser photocoagulation. Three of them showed regression of retinopathy and 1 eye progressed to ischemic CRVO. The other 4 eyes did not receive early panretinal photocoagulation; 2 of them received no laser treatment at all and the other 2 received only grid laser photocoagulation. All of these 4 eyes progressed to ischemic CRVO.

Adult↗
PubMed1997

Preoperative chemotherapy for stage IIIB extremity soft tissue sarcoma: long-term results from a single institution.

PURPOSE: To review a single institution's long-term results with doxorubicin-based preoperative chemotherapy for American Joint Committee on Cancer (AJCC) stage IIIB extremity soft tissue sarcoma (STS). PATIENTS AND METHODS: The records of all patients with AJCC stage IIIB extremity STS treated with preoperative chemotherapy between 1986 and 1990 at The University of Texas M.D. Anderson Cancer Center were reviewed to assess rates of response, local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). RESULTS: Seventy-six patients with stage IIIB disease received preoperative chemotherapy. The median sarcoma size was 10 cm. Seventy-two patients (95%) had tumors located deep to the muscular fascia. Most patients received a median of three preoperative cycles of doxorubicin and dacarbazine (ADIC), cyclophosphamide and ADIC (CyADIC), or other doxorubicin-based regimens. Radiographic response rates were as follows: complete response (CR), 9%; partial response (PR), 19%; minor response, 13%; stable disease, 30%; and progression, 30%. The overall objective major response rate (CRs plus PRs) was 27%. At a median follow-up time of 85 months, 5-year actuarial rates of LRFS, DMFS, DFS, and OS with 95% confidence intervals (CIs) were 83% (CI, 73% to 94%), 52% (CI, 41% to 66%), 46% (CI, 35% to 60%), and 59% (CI, 48% to 72%), respectively. Comparison of responding patients (CRs plus PRs) and nonresponding patients did not show any significant differences in LRFS, DMFS, DFS, or OS. CONCLUSION: Preoperative doxorubicin-based chemotherapy was associated with response, DFS, and OS rates similar to those observed in randomized postoperative chemotherapy trials. Responding patients had rates of LRFS, DMFS, DFS, and OS comparable to those of nonresponders.

Adolescent↗
PubMed1997

Abnormal bcl-2 and pRb expression are independent correlates of radiation response in muscle-invasive bladder cancer.

The objective of this study was to determine whether the overexpression of bcl-2, a key protein governing the apoptotic response to radiation, adds to pRb status in estimating the propensity for radiation response in patients with muscle-invasive bladder cancer. Archival formalin-fixed, paraffin-embedded, pretreatment bladder tumor samples were available in 109 of 301 patients treated preoperatively with 50 Gy in 25 fractions followed by radical cystectomy 4-6 weeks later. Radiation response was assessed by clinical-to-pathological tumor downstaging or upstaging. Altered expression of bcl-2 (47% of 107 patients), p53 (56% of 109 patients), and pRb (30% of 98 patients) was assessed by immunohistochemical staining. Morphological criteria were used to calculate the percentage of apoptotic cells. bcl-2 staining correlated with tumor grade; all grade 2 tumors (n = 7) displayed normal bcl-2 expression (negative staining). No correlations between bcl-2 staining and pretreatment apoptosis levels, p53 staining, and pRb staining were observed. In terms of the radiation response parameters, univariate analyses revealed that bcl-2 overexpression was the only factor associated with upstaging. The main predictor of downstaging was the loss of pRb expression (negative staining). Multivariate logistic regression confirmed these findings and also showed that normal pRb expression (positive staining) was significantly related to upstaging. Patient outcome was adversely affected by bcl-2 overexpression, because these patients experienced significantly increased actuarial local failure rates. No difference in distant metastasis or survival rates by bcl-2 staining was seen. The strongest independent correlates of radiation response thus far identified in muscle-invasive bladder cancer are from bcl-2 and pRb immunohistochemical staining. The overexpression of bcl-2 and the normal expression of pRb seem to thwart the apoptotic response to radiation via independent mechanisms. Abnormalities in the expression of proteins that regulate apoptosis may prove to establish a molecular phenotype to characterize which patients should receive radiotherapy.

Actuarial Analysis↗
PubMed1997

Establishment of two human prostate cancer cell lines derived from a single bone metastasis.

Human prostate cancer cell lines are particularly difficult to establish, and most existing cell lines do not exhibit features commonly seen in human prostate cancer. Most available models either grow only in vivo as xenografts or are androgen insensitive and fail to express prostate-specific antigen (PSA). The lack of functionally relevant model systems of advanced prostate cancer has limited prostate cancer research and therapy development. Of 30 processed samples derived from patients with prostate cancer, we established two cell lines (MDA PCa 2a and MDA PCa 2b) that express PSA and androgen receptor, grow in vitro, and are androgen sensitive. Cells from these lines produced tumors in nude mice when injected either s. c. or orthotopically (intraprostatic). Both cell lines were established from a bone metastasis of a patient whose cancer was exhibiting androgen-independent growth. Although both were derived from two samples of the same specimen, they have different genetic features (as assessed by karyotype analysis) and different phenotypes (e.g., morphology and growth rate). It is likely that they are distinct clones isolated by the use of different culture procedures and reflect the genetic heterogeneity of the tumor. These new cell lines are the first available derived from a bone metastasis of an androgen-independent prostatic adenocarcinoma that grow both in vivo and in vitro and have retained PSA expression and androgen sensitivity. They therefore constitute important model systems to address critical questions related to the androgen-independent growth of human prostate cancer and to the complex process of bone metastasis.

Androgens↗
PubMed1996

Liposarcoma: outcome and prognostic factors following conservation surgery and radiation therapy.

PURPOSE: Liposarcoma is among the more common types of soft-tissue sarcoma. This retrospective review was performed to determine the outcome and delineate prognostic factors for this disease when treated by conservation surgery and radiation. METHODS AND MATERIALS: Between 1964 and 1992, 112 consecutive patients with liposarcoma were treated with conservation surgery and radiotherapy. Univariate and multivariate statistics were used to evaluate the outcome with local control, metastatic relapse, and survival as end points, and to delineate independently significant prognostic factors. RESULTS: Preoperative radiation to a mean dose of 50 Gy was used in 36 patients and postoperative radiation to a mean dose of 61 Gy was used in 76 patients. At a median follow-up of 9 years (range 2-25), 34 patients (30%) developed disease progression at some site. Local recurrence developed in 14 patients (13%), and the actuarial local relapse rate was 13% at 10 years. Metastases developed in 23 patients (21%) with an actuarial metastatic rate of 23% at 10 years. Five-, 10-, and 15-year survival rates were 79%, 69%, and 61%, respectively. The most important factor influencing outcome--whether local control, metastases, or survival--was tumor histologic subtype. Well-differentiated (15 patients) and myxoid (including round cell) (71 patients) subtypes had a local control rate exceeding 90% at 10 years. No patient with well-differentiated liposarcoma developed metastases. The actuarial metastatic rate for myxoid tumors was 22% at 10 years and was higher for large than small tumors. The pattern of metastases for this variant was atypical with a preponderance of extrapulmonary sites. Pleomorphic liposarcoma (26 patients) was a highly malignant tumor with a high local recurrence rate of 37% and a metastatic rate of 41% at 10 years. Larger pleomorphic tumors had a significantly higher metastatic rate than smaller ones. These biologic factors were reflected in progressively decreasing 10-year survival rates from 87% for well-differentiated lesions, through 76% for myxoid tumors, to 39% for pleomorphic tumors. Although other factors such as positive resection margins and prior local recurrence were also independently significant determinants of outcome, histology was the overriding factor. CONCLUSION: Liposarcoma is a highly pleomorphic disease whose outcome is greatly determined by its histologic subtype: so greatly that results reported without histologic stratification are likely meaningless. Conservation surgery and radiation achieve excellent local results and with relatively little metastatic risk for patients with well-differentiated and myxoid liposarcomas. The same treatment strategy appears appropriate for pleomorphic liposarcoma, but with a much smaller expectation of a satisfactory outcome. The development of effective systemic therapy is an important goal for this variant of liposarcoma.

Adolescent↗
PubMed1996

Apoptosis and downstaging after preoperative radiotherapy for muscle-invasive bladder cancer.

PURPOSE: To determine the relationship between pretreatment apoptosis levels and clinical-to-pathologic downstaging resulting from preoperative radiotherapy. METHODS AND MATERIALS: Between 1960-1983, 338 patients were dispositioned to receive preoperative radiotherapy 4-6 weeks prior to radical cystectomy for muscle-invasive transitional cell carcinoma of the bladder. Of these, adequate hematoxylin and eosin stained tissue sections for morphologic analysis of apoptosis were available in 158 patients. These patients were treated to a median dose of 50 Gy at 2 Gy per fraction. Median follow-up was 90 months. The apoptotic index (AI) was calculated from the ratio of the number of apoptotic cells divided by the total counted and multiplied by 100. A minimum of 500 cells were counted from each patient. RESULTS: The average AI for the whole group (n = 158) was 2.0 +/- 1.3 (+/- SD), with a median of 1.8. The association of AI to clinical stage was significant with AI averages of 1.8 for Stage T2 (n = 56), 1.9 for T3a (n = 51), and 2.4 for T3b (p = 0.038, Kendall Correlation). The relationship of AI to radiotherapy response also was significant with an average of 2.2 for those who were downstaged (n = 103), 1.9 for those in whom the stage remained unchanged (n = 20), and 1.7 for those who were upstaged (n = 35, p = 0.054, Kendall Correlation). The other significant correlations with AI were for the factors, grade, mitotic index, number of tumors, and gender. The AI was then categorized into three groups ( < or = 1, > 1, and < or = 3, and > 3) to examine the prognostic significance of this parameter. The distributions of patients by clinical stage, grade, mitotic index, number of tumors, radiotherapy response, and hemoglobin level were significantly associated with AI using this grouping. When the analysis of the distribution of patients by radiation response and AI was segregated by stage, a significant correlation was observed only for those with Stage T3b disease (p = 0.006); 93% of T3b patients with an AI > 3 were downstaged, while in 7% the stage remained unchanged and none were upstaged. The relationship of AI to 5-year actuarial patient outcome was investigated using several end points and although no significant correlations were observed, a trend was seen for improved survival when AI was > 3 (71% vs. 41%, p = 0.09) for Stage T3b patients. CONCLUSION: The AI correlated most strongly with radiotherapy response for patients with clinical stage T3b disease, the one subgroup of patients wherein preoperative radiotherapy is likely to be of the most benefit. Further investigation of pretreatment apoptosis levels as a marker of anticancer response is needed, especially for patients treated with chemotherapy and radiotherapy with the goal of bladder preservation.

Aged↗
PubMed1996

Endotoxin and cytokines induce expression of leptin, the ob gene product, in hamsters.

The expression of leptin, the ob gene product, is increased in adipose tissue in response to feeding and energy repletion, while leptin decreases food intake. Because adipose tissue gene expression is regulated by cytokines induced during infection and because infection is associated with anorexia, we tested whether induction of leptin might occur during the host response to infection. Administration of endotoxin (LPS), a model for gram negative infections, induces profound anorexia and weight loss in hamsters. In fasted adipose tissue to levels similar to fed control animals. There is a strong inverse correlation between mRNA levels of leptin and subsequent food intake. TNF and IL-1, mediators of the host response to LPS, also induced anorexia and increased levels of leptin in mRNA in adipose tissue. As assessed by immuknoprecipitation and Western blotting, circulating leptin protein is regulated by LPS and cytokines in parallel to regulation of adipose tissue leptin mRNA. Induction of leptin during the host response to infection may contribute to the anorexia of infection.

Adipocytes↗
PubMed1996

Prostate specific antigen density as a prognostic factor for patients with prostate carcinoma treated with radiotherapy.

BACKGROUND: The pretreatment serum prostate specific antigen level (PSAL) is the most significant predictor of biochemical and local failure in patients treated with definitive radiotherapy. The role of prostate specific antigen (PSA) density (PSAD) relative to PSAL for such patients is controversial. In this article, we describe a comparative analysis of the prognostic value of PSAL and PSAD. METHODS: The study was comprised of 365 patients who were treated with external beam radiotherapy for regionally localized (T1-T4, Nx, M0) adenocarcinoma of the prostate between 1987-1993 and in whom PSAL and pretreatment prostate volume by transrectal ultrasound were available. The mean and median doses were 66.8 Gy and 66 Gy. Median follow-up for those patients living was 27 months. The mean PSAL was 12.7 ng/mL with a median of 9.1 ng/mL. PSAD was calculated by dividing the PSAL by the pretreatment prostate transectal ultrasound volume (in cc). The mean PSAD was 0.44 and the median was 0.31. Biochemical failure was defined as two consecutive increases in follow-up PSAs, one increase by a factor of greater than 1.5 of an absolute increase of greater than 1 ng/mL. RESULTS: The distributions of PSAD and PSAL were similar and were positively skewed. When log-transformed, the distributions of both parameters were normalized and linear regression revealed a high correlation (P < 0.0001). PSAD was significantly associated with several potential prognostic factors, including stage, Gleason score, PSAL, and pretreatment prostatic acid phosphatase. Univariate analyses of PSAD and PSAL revealed that these were the most significant correlates of local and biochemical control. By contrast, stage and Gleason score were the only factors predictive of freedom from distant metastasis. Multivariate analyses using Cox proportional hazards models were then performed to determine if PSAD provided prognostic information independent of PSAL. The manner in which PSAD and PSAL were categorized (four, three, of two groups) dramatically influenced the significance of these covariates. Optimization of these groups for significance showed grouped PSAD to be the stronger predictor of the local control and grouped PSAL to be the stronger predictor of biochemical control. However, when PSAD and PSAL were used as continuous variables, PSAL was the only independently significant prognostic factor for local or biochemical control. CONCLUSIONS: PSAD was highly correlated with actuarial patient outcome in the univariate analyses and appeared to provide independent information when PSAL was between 4 and 20 ng/mL. However, the differences based on PSAD were relatively small and, therefore, not clinically useful.

Adenocarcinoma↗
PubMed1996

Malignant fibrous histiocytoma: outcome and prognostic factors following conservation surgery and radiotherapy.

PURPOSE: Malignant fibrous histiocytoma is the most common type of soft tissue sarcoma. This communication presents an analysis of outcome and prognostic factors based on a retrospective review of patients with this disease treated by conservation surgery and radiotherapy. METHODS AND MATERIALS: From 1966 to 1991, 271 consecutive patients with malignant fibrous histiocytoma were treated with conservation surgery and radiotherapy. The outcome with local control, metastatic relapse, and survival as end points was evaluated by univariate and multivariate statistics to delineate independently significant prognostic factors. RESULTS: Postoperative radiation at a mean dose of 62.8 Gy was used in 195 patients and preoperative radiation at a mean dose of 50 Gy was used in 76 patients. At a median follow-up of 7.3 years, 123 patients (45%) developed disease relapse at some site. Fifty-seven (21%) developed local recurrence leading to an actuarial local relapse rate of 26% at 10 years, 83 (31%) developed metastatic relapse for a 10-year actuarial metastatic rate of 33%, and the 5-, 10-, and 15-year survival rates were 68, 60, and 46%, respectively. For local control, prior local recurrence (in 53 patients) was identified as an adverse factor, yielding a 10-year recurrence rate of 42% compared to 22% for 218 patients without prior disease (p < 0.01). Also, a positive surgical margin (in 46 patients) was adverse with a 10-year local recurrence rate of 39% compared to a recurrence rate of 17% with negative margins (167) (p=0.01). Patients with pathologically undocumented resection margins (58) had a local recurrence rate similar to those with positive margins (41% at 10 years). Tumor site (extremity vs. nonextremity), location (proximal vs. distal), size (< or = 5 cm vs. > 5 cm), and histology (myxoid vs. nonmyxoid) were not significant determinants of local outcome. For metastatic relapse, the major determinants of outcome were histology (myxoid vs. nonmyxoid) and tumor size. Myxoid tumors (59 patients) had a low metastatic propensity (13% 10-year metastatic rate) compared to nonmyxoid tumors (212 patients) (40% 10-year metastatic rate) (p < 0.01). Size was an important covariate for metastases for both myxoid and nonmyxoid tumors. For nonmyxoid tumors the 10-year metastatic rates were 23 and 51% for lesions less than or greater than 5 cm. For myxoid tumors a significant metastatic rate appeared only for tumors exceeding 10 cm (10-year metastatic rates of 8% vs. 44% for tumors less than vs. greater than 10 cm). In this retrospective review we found no evidence that adjuvant chemotherapy decreased the metastatic rate. In multivariate analysis for metastatic relapse and survival, tumor histology (nonmyxoid vs. myxoid) and size (< 5 cm vs. > 5 cm) were the only independent determinants of outcome. CONCLUSION: Malignant fibrous histiocytoma is a heterogeneous disease and its myxoid variant must be recognized as a distinct entity. Both variants are locally aggressive and require equally aggressive local therapy. Conservation surgery striving for negative margins with radiation therapy provides acceptable local control and is the treatment of choice for this disease. Patients with myxoid tumors do not require systemic therapy; patients with nonmyxoid disease exceeding 5 cm are at significant risk for metastases and the development of effective adjuvant treatment is an important research tool.

Adolescent↗
PubMed1996

Conventional vs. conformal radiotherapy for prostate cancer: preliminary results of dosimetry and acute toxicity.

PURPOSE: To compare conformal radiotherapy using three dimensional treatment planning (3D-CRT) to conventional radiotherapy (Conven-RT) for patients with Stages T2-T4 adenocarcinoma of the prostate. METHODS AND MATERIALS: A Phase III randomized study was activated in May 1993, to compare treatment toxicity and patient outcome after 78 Gy in 39 fractions using 3D-CRT to that after 70 Gy in 35 fractions using Conven-RT. The first 46 Gy were administered using the same nonconformal field arrangement (four field) in both arms. The boost was given nonconformally using four fields in the Conven-RT arm and conformally using six fields in the 3D-CRT arm. The dose was specific to the isocenter. The first 60 patients, 29 in the 3D-CRT arm and 31 in the Conven-RT arm, are the subject of this preliminary analysis. RESULTS: The two treatment arms were first compared in terms of dosimetry by dose-volume histogram analysis. Using a subgroup of patients in the 3D-CRT arm (n=15), both Conven-RT and 3D-CRT plans were generated and the dose-volume histogram data compared. The mean volumes treated to doses above 60 Gy for the bladder and rectum were 28 and 36% for the 3D-CRT plans, and 43 and 38% for the Conven-RT plans, respectively (p < 0.05 for the bladder volumes). The mean clinical target volume (prostate and seminal vesicles) treated to 95% of the prescribed dose was 97.5% for the 3D-CRT arm, and 95.6% for the Conven-RT arm (p < 0.05). There were no significant differences in the acute reactions between the two arms, with the majority experiencing Grade 2 or less toxicity (92%). Moreover, no relationship was seen between acute toxicity and the volume of bladder and rectum receiving in excess of 60 Gy for those in the 3D-CRT arm. There was also no difference between the groups in terms of early biochemical response. Prostate-specific antigen levels at 3 and 6 months after completion of radiotherapy were similar in the two treatment arms. There was only one biochemical failure in the study population at the time of the analysis. CONCLUSIONS: Comparison of the Conven-RT and 3D-RT treatment plans revealed that significantly less bladder was in the high dose volume in the 3D-CRT plans, while the volume of rectum receiving doses over 60 Gy was equivalent. There were no differences between the two treatment arms in terms of acute toxicity or early biochemical response. Longer follow-up is needed to determine the impact of 3D-CRT on long-term patient outcome and late reactions.

Adenocarcinoma↗
PubMed1996

Bilateral papilledema with retinal hemorrhages in association with cerebral venous sinus thrombosis and paroxysmal nocturnal hemoglobinuria.

PURPOSE: To report a patient with paroxysmal nocturnal hemoglobinuria who complained of transient obscurations of vision and exhibited bilateral papilledema with retinal hemorrhages. METHODS: Case report. Computed tomography did not demonstrate any abnormality but magnetic resonance imaging disclosed signs of cerebral venous sinus thrombosis. RESULTS: The patient was treated with subcutaneous low molecular weight heparin and intravenous corticosteroids. Symptoms improved within one week and ophthalmoscopic signs resolved within four months. CONCLUSION: Bilateral papilledema with extensive retinal hemorrhages may be a sign of cerebral venous sinus thrombosis, a reported devastating complication of paroxysmal nocturnal hemoglobinuria. Thus, any patient with suspected cerebral venous sinus thrombosis should undergo magnetic resonance imaging, even when results of computed tomography are normal.

Anticoagulants↗
PubMed1996

Prognostic value of p53 in muscle-invasive bladder cancer treated with preoperative radiotherapy.

OBJECTIVES: The relationship of p53 mutations as analyzed immunohistochemically to radiation response and therapeutic outcome was examined in a cohort of 301 patients with muscle-invasive transitional cell carcinoma of the bladder treated relatively uniformly with preoperative radiotherapy (50 Gy in 25 fractions) 4 to 6 weeks prior to radical cystectomy. METHODS: Adequate formalin-fixed paraffin-embedded archival tissue for the immunohistochemical staining of p53 using antibody DO1 was obtained in 109 patients. The median follow-up for those living was 91 months. RESULTS: Overall, p53 staining was positive in 56% of the cases, with 60% positive in Stage T2 (n = 48), 42% in Stage T3a (n = 31), and 63% in Stage T3b (n = 30). Overexpression of p53 did not correlate with actuarial local control, distant metastasis freedom, disease freedom, or overall survival. However, significant associations were seen when these analyses were limited to patients with clinical Stage T3b disease. In this subgroup, the actuarial 5-year rates for patients with p53 positively and negatively stained tumors were 55% and 100%, respectively, for distant metastasis freedom (P = 0.01), 51% and 91% for disease freedom (P = 0.04), and 32% and 91% for overall survival (P = 0.006). Cox proportional hazards models that included p53 staining and other prognostic factors of significance in the univariate analyses revealed p53 to be independently predictive of survival for patients with Stage T3b disease. CONCLUSIONS: The prognostic value of p53 immunostaining rested with Stage T3b patients. Although no correlations were found with radiation response, p53 positivity in this subgroup was associated with a higher rate of distant metastasis and reduced overall survival. For these patients, p53 negativity would indicate that aggressive local treatment (that is, preoperative radiotherapy and cystectomy) is sufficient, whereas p53 positivity would indicate that multiagent chemotherapy is required because of the increased risk of distant metastasis.

Carcinoma, Transitional Cell↗
PubMed1996

Age-related macular degeneration after extracapsular cataract extraction with intraocular lens implantation.

PURPOSE: To evaluate the course of age-related maculopathy after cataract surgery. METHODS: Included were 47 patients with bilateral, symmetric, early age-related macular degeneration (AMD), documented by fluorescein angiography, who underwent extracapsular cataract extraction with intraocular lens implantation in one eye. The fellow eye served as the control. The patients were retrospectively reviewed or prospectively followed. RESULTS: Wet AMD developed in nine eyes (19.1%) that were treated with surgery compared with two fellow eyes (4.3%). It was detected within 3 months of surgery in four (44.4%) of the nine affected eyes and within 6 to 12 months of surgery in four other eyes (44.4%). Progression to wet AMD occurred significantly more often in men than in women (P < 0.05). Soft drusen were found as a significant ocular risk factor (P < 0.05). The final visual outcome was poor in all eyes with such progression. CONCLUSIONS: In this study, progression of AMD occurred more often in the surgical eyes compared with the fellow eyes. However, the reasons for the progression of AMD after cataract surgery are still uncertain. Further prospective studies are needed to investigate this observation.

Aged↗