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Biomedical subjects

E C Skinner

Publications and source records attributed to E C Skinner.

12 recordsLinked to original sources
PubMed1995

Radical cystectomy and lower urinary tract reconstruction after cardiac allograft transplantation.

The risk of a malignancy developing as a consequence of long-term immunosuppression after allograft transplantation is well documented. To our knowledge we report on the first cardiac allograft recipient to undergo radical cystectomy with lower urinary tract reconstruction using a continent Kock ileal reservoir with bilateral ureteroileal urethrostomy for squamous cell carcinoma that developed 4 years after transplantation.

Carcinoma, Squamous Cell↗
PubMed1995

Indications for lower urinary tract reconstruction in women after cystectomy for bladder cancer: a pathological review of female cystectomy specimens.

PURPOSE: In an attempt to identify women who may be appropriate candidates for orthotopic lower urinary tract reconstruction, archival cystectomy specimens from female patients undergoing cystectomy for primary bladder cancer were reviewed. These pathological findings should provide a better understanding of tumor involvement at the bladder neck (vesicourethral junction) and urethra in women with transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Cystectomy specimens of 67 consecutive women undergoing surgery for biopsy proved transitional cell carcinoma of the bladder between July 1982 and July 1990 were pathologically reviewed. RESULTS: Histological evidence of tumor (carcinoma in situ or gross carcinoma) involving the urethra was present in 9 patients (13%). Tumor was confined to the proximal and mid urethra, and the distal urethra was not involved. All patients with carcinoma involving the urethra had concomitant evidence of carcinoma involving the bladder neck. A total of 17 patients (25%) had tumor involvement of the bladder neck and those with an uninvolved bladder neck also had an uninvolved urethra. The association between the presence of tumor in the bladder neck and urethra was highly significant (p < or = 0.00012). Tumor involving the bladder neck and urethra tended to be more commonly associated with high grade and stage tumors, and node-positive disease. CONCLUSIONS: Although the fate of the retained urethra following cystectomy for bladder cancer in women is unknown, these results show that women with transitional cell carcinoma of the bladder without evidence of tumor involving the bladder neck are at low risk for urethral malignancy. These patients may be offered lower urinary tract reconstruction that includes preservation of and diversion through the urethra (orthotopic diversion). Urethral surveillance will be necessary, as it is in men after orthotopic urinary diversion.

Carcinoma in Situ↗
PubMed1995

Communication between the pathologist and urologist. Focus on prostate cancer.

Open communication between the pathologist and surgeon is crucial for optimum patient care and job satisfaction. Communication must occur in both directions and should include a free exchange of clinical information and explanation of the thought processes used by both physicians. Various means can improve communication, and the authors focus on the special clinical problems posed by prostate cancer diagnosis and treatment.

Aged↗
PubMed1994

Management and evaluation of localized amyloidosis of the bladder: two case reports.

Localized amyloidosis of the bladder is a rare cause of hematuria, which is often confused with bladder cancer. We present case histories of two patients which illustrate the evaluation and management of this entity. The diagnosis is usually made with biopsy and subsequent pathologic examination. Conservative management is attempted initially but must be individualized according to the clinical course of each patient. Transurethral resection will suffice in most instances but occasionally cystectomy is indicated to control local disease.

Amyloidosis↗
PubMed1993

Squamous cell carcinoma of the bladder associated with cyclophosphamide therapy for Wegener's granulomatosis: a report of 2 cases.

Cyclophosphamide has been used to treat a variety of malignant and nonmalignant diseases. The association of this agent with the development of urothelial tumors has been well documented. Although most bladder cancers associated with prior cyclophosphamide therapy are transitional cell carcinoma, to our knowledge there have been 6 reports of cyclophosphamide-induced squamous cell carcinoma of the bladder. We report 2 additional cases of squamous cell carcinoma of the bladder that occurred in patients after cyclophosphamide treatment for Wegener's granulomatosis. Any patient with a history of prolonged cyclophosphamide ingestion needs careful long-term monitoring of the lower urinary tract, since there is at least a 9-fold increase in the incidence of lower urinary tract malignancy in such patients.

Adult↗
PubMed1993

Preservation of ejaculation through a modified retroperitoneal lymph node dissection in low stage testis cancer.

We studied ejaculatory function in 47 patients who underwent modified retroperitoneal lymph node dissection for nonseminomatous germ cell tumors of the testis from 1983 to 1989. Our goal was to assess the effectiveness of a modified node dissection in preserving ejaculatory function while eliminating the risk of retroperitoneal recurrence. There were 13 left and 34 right tumors. Of the patients 45 had clinical stage A cancer, and 2 had clinical stage B2 disease and received preoperative chemotherapy. The template method of dissection was used, which spares the preaortic area below the inferior mesenteric artery, including the sacral promontory. Average operating time was 3 hours 40 minutes. There was no operative mortality. Spontaneous recovery of ejaculation occurred in 38 patients (81%), more commonly with right (88%) than with left dissections (62%). The mean interval to recovery of ejaculation was 5 months (92% within 12 months). Five patients (10%) had recurrence, with a mean followup of 28 months. All recurrences were in the lungs 4 to 8 months after retroperitoneal lymph node dissection, and all patients were salvaged with chemotherapy and are disease-free. We confirmed that a modified template-type retroperitoneal lymph node dissection can be accomplished safely with preservation of ejaculation in more than 80% of the patients without increasing the risk of local recurrence.

Adult↗
PubMed1990

Technique of left adrenalectomy for autotransplantation to the caudate nucleus in Parkinson's disease.

Autotransplantation of the adrenal medulla to the caudate nucleus is a new neurosurgical treatment under investigation for severe Parkinson's disease. The success of the procedure is reliant partly on the ability of the urologist to remove the adrenal gland safely and atraumatically with minimal morbidity. We describe our technique using a posterior 12th rib approach, which is extrapleural and extraperitoneal. In the initial 10 patients there was no significant morbidity from the operation and all patients were discharged from the hospital within 3 to 7 days postoperatively. The importance of using a no touch technique in mobilizing the gland is emphasized, since any hemorrhage within the adrenal medulla may make it impossible to recover the tissue for stereotactic implantation. Hemorrhage occurred in 1 of our patients, who was elderly and obese. The technique described allows for adequate exposure while maintaining acceptably low morbidity from the procedure.

Adrenal Medulla↗
PubMed1984

Radical cystectomy in the elderly patient.

A total of 77 patients 65 or more years old underwent radical cystectomy with urinary diversion for invasive bladder cancer during a 10-year interval. The preoperative medical condition of the patients, operative mortality and morbidity, and preliminary survival data are reviewed by age group. Two-thirds of the patients had previous medical or surgical problems that increased the surgical risk. The over-all mortality rate was 3.9 per cent. Early complications occurred in 31 per cent of the patients, with an increased risk of complication associated with previous illness and major pelvic surgery, and preoperative radiation therapy. The complication rate was not related directly to age, with patients 65 to 69 and more than 75 years old having lower rates than those 70 to 74 years old. The 3-year survival rate free of disease ranged from 58 per cent in the youngest group to 39 per cent in the oldest group, which is comparable to survival statistics for younger patients undergoing cystectomy. Only 5 patients have died of intercurrent illness, while 20 have died of metastatic disease.

Aged↗