Biomedical subjects
Publications and source records attributed to D A Culp.
Only 10 cases of renal calculi in transplanted kidneys are reported in the literature. Etiology is not uniform in all the cases. Some of these cases were managed conservatively. We herein report a case in which the etiology of the stone may be urinary tract infection. This patient was managed conservatively.
The formulation of a 5-fluorouracil urethral suppository is described. The suppositories have been found extremely successful in the eradication of intraurethral condylomas. They have provided better patient compliance and dosage monitoring, and have extended patient usefulness to male and female subjects.
Open perineal cryosurgical prostatectomy has been reported previously in 154 consecutive prostatic cancer patients at our center. In 37 of these patients post-cryosurgery biopsies of the prostate were obtained. In the present report we compare this tissue to the preoperative biopsies. The data suggest that well differentiated cancers are associated with advantageous survival in cryosurgery patients. Lymphoid and eosinophilic cell infiltrates may represent post-cryosurgical local immune responses, with improved survival. Estrogen therapy seems to suppress this local immune response. One month or more after cryosurgery cancer in the biopsy correlates with palpable local recurrence but prior to 1 month it does not correlate. Cryosurgery by the open perineal approach has been an effective method to eliminate the primary lesion in localized and extensive prostatic cancer.
The computed tomography scan has revealed the location and size of abnormal pelvic masses as an adjunct to other diagnostic studies. We have extended its usefulness by air distension of the bladder, which accommodates to adjacent structures and, therby, highlights abnormalities in its own wall and in other organs. The patients are prepared according to a simple routine. As we attempt further economy and efficiency the cost of each study becomes justified by the information gained.
During the last 50 years 8 patients with adenocarcinoma of the urachus were managed at our hospital. The various modalities of therapy included radiation therapy, transurethral resection, segmental resection of the bladder and total cystectomy. A retrospective analysis of these cases is presented, including the histologic patterns, sites of spread and survival according to therapy.
A retrospective analysis of 30 patients with primary sarcoma of the bladder and prostate is presented. Prognosis seems to be better in adults irrespective of the type of treatment. The survival rate is poor for children with sarcoma of the prostate. Two children were cured of sarcoma of the bladder by a radical operation. Sarcomas of the bladder and prostate are more common in adults more than 50 years old. The type of treatment and the results are reviewed. The place of multimodal treatment in the management of these sarcomas is discussed.
Serum alpha-fetoprotein and beta-human chorionic gonadotrophin levels were estimated in 115 patients. Sixty-nine patients had non-seminomatous germ cell tumours and 34 patients had seminomas. Twenty-six patients showed elevated serum makers.
The survival rate has been improved for rhabdomyosarcoma of all sites in children by combining surgery, radiation and chemotherapy. However, very few children are alive today who have had sarcoma of the prostate. The prognosis appears to be better for sarcoma of the bladder than for sarcoma of the prostate. In our series all the children with prostatic sarcoma died within 7 months. 2 children with sarcoma of the bladder are cured.
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We report herein on the destruction by cryosurgery of the Dunning R3327 adenocarcinoma grown in the prostate. Tumors less than 1,000 mm.3 were destroyed by a single freezing procedure within 2 to 4 weeks, whereas tumors greater than 1,000 mm.3 could not be destroyed completely. We also have been able to demonstrate antibody and cellular immune responses to antigens on the R3327 cells. Species, organ and tumor specific antigens were identified by xenogeneic antiserum produced in the rabbit, while major and minor antigens were identified by alloantisera produced in the rat. Tumor antigens were characterized by a variety of in vitro and in vivo immune responses. In addition to the rabbit xenoantisera used in cytotoxicity assays, mixed lymphocyte tumor interaction produced a demonstrable in vitro immune response, lymphocytes from rats immunized with tumor cells were cytotoxic to radiolabeled tumor cells in culture, rats immunized with tumor cells in adjuvant demonstrated protection against subsequent challenge and immunological stimulation of lymph nodes draining the site of tumor cell inoculation was demonstrated by an increase in lymphocyte trapping. Clearing, the R3327 tumor system in the rat is suitable for immunological studies of prostatic cancer.
An analysis is presented on 45 patients undergoing pedal lymphangiography followed by retroperitoneal lymphadenectomy for non-seminomatous testicular carcinoma. Retroperitoneal node metastases were predicted correctly with the lymphangiogram in 10 of 20 patients (50 per cent). The over-all predictive accuracy was 62 per cent.
A retrospective analysis is presented of 20 patients with primary adenocarcinoma of the bladder treated with non-radical procedures. The survival rate has averaged less than 1 year, regardless of the mode of therapy, with only 1 patient alive 2 years after segmental cystectomy. The male-to-female ratio of patients was only 2 to 1. All patients had deeply infiltrating tumor at the time of initial diagnosis. Chemotherapy in conjunction with irradiation therapy used in the treatment of 1 of the patients proved to be ineffective.
On 40 consecutive patients with prostatic cancer who had pedal lymphangiography during the initial evaluation and, subsequently, underwent pelvic node dissection or biopsy, a surprisingly high number had falsely positive (59 per cent) or negative (36 per cent) x-ray findings. Initially the tumors were considered clinically to be stage B in 24 cases, stage C in 13 and stage D in 3. After lymph node dissection only 17 tumors were still considered to be stage B and 7 were stage C, while 16 tumors were actually stage D. This surgical staging is important for the further management of the patient as well as the prognosis, Pedal lymphangiogrpahy alone is unreliable for accurate assessment of the regional lymph node status in clinically localized prostatic cancer.
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We report on the development of the Dunning R3327 prostatic adenocarcinoma of the Copenhagen rat as a suitable model for human prostatic cancer. Tumors produced by the subcutaneous or intraprostatic injections of viable cells had the macroscopic and microscopic characteristics of human disease. Histologically, these tumors were well differentiated adenocarcinomas with the human disease. Histologically, these tumors were well differentiated adenocarcinomas with the formation of glands and acid secretions within the acini. The intraprostatic tumor, although initially confined to the injected lobe, grew to involve the surrounding tissues and eventually metastasized to the lymph nodes and lungs. Occasional metastatic lesions were found in other organs as well. Acid phosphatase could be demonstrated by histochemical staining of frozen tumor sections and elevated levels of the enzyme were seen in the serum of rats bearing long-term subcutaneous tumors. During investigation of the tumor a fast growing line arose that grew equally as well in female as in male rats. The histology of this tumor was of an undifferentiated anaplastic tumor. Treatment by cryosurgery completely destroyed the prostatic tumor within 2 weeks. A tissue culture line derived from R3327 was capable of producing tumors in recipient rats with characteristics similar to the original Dunning tumor.
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Twenty-five patients with advanced transitional cell carcinoma of the urinary tract were treated with doxorubicin hydrochloride (Adriamycin). Eight evaluable patients who received extensive external irradiation therapy and at least two doses of doxorubicin hydrochloride were studied to assess bone marrow toxicity and possible augmentation of radiation dermatitis. Myelosuppression was similar in both irradiated patients and those who received doxorubicin alone. None of the irradiated patients displayed skin augmentation reactions with doxorubicin. In the dose range used chemotherapy with doxorubicin did not appear to be particularly hazardous in irradiated patients.