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Biomedical subjects

F Freiha

Publications and source records attributed to F Freiha.

At least 19 recordsLinked to original sources
PubMed1999

Laparoscopic vesicopsoas hitch for infiltrative ureteral endometriosis.

OBJECTIVE: To report the technique and outcome of a laparoscopic vesicopsoas hitch used for the treatment of infiltrative ureteral endometriosis. DESIGN: Case report. SETTING: A tertiary care center. PATIENT(S): A 36-year-old woman with infiltrative endometriosis of the ureter. INTERVENTION(S): A laparoscopic vesicopsoas hitch. MAIN OUTCOME MEASURE(S): The return of normal ureteral function as measured by IV pyelography and ultrasonography. RESULT(S): After partial ureteral resection, it was noted that a tension-free anastomosis to the bladder was not possible. Thus, a laparoscopic vesicopsoas hitch was performed. CONCLUSION(S): A vesicopsoas hitch can be performed successfully by laparoscopy.

Adult↗
PubMed1996

A randomized trial of radical cystectomy versus radical cystectomy plus cisplatin, vinblastine and methotrexate chemotherapy for muscle invasive bladder cancer.

PURPOSE: Standard treatment for muscle invasive transitional cell cancer of the bladder is radical cystectomy. Despite careful staging, the majority of cancers with regional lymph node involvement and/or invasion to adjacent organs eventually recur. We investigated the benefit of chemotherapy with cisplatin, methotrexate and vinblastine (CMV) after radical cystectomy. MATERIALS AND METHODS: A prospective trial was done in which patients were randomized after cystectomy to receive either 4 cycles of CMV chemotherapy or observation. At relapse, patients were treated with standard CMV chemotherapy for metastatic disease at our institution. RESULTS: Of 55 patients who entered this trial 1 was ineligible and in 4 it is too soon to be evaluated. Of the 50 evaluable patients 25 were randomized to receive adjuvant CMV chemotherapy and 25 were observed. In the CMV arm 12 (48%) and in the observation arm 5 (25%) never had recurrence. With a median followup of 62 months and no patient with less than 2 years of followup, the freedom from progression in the adjuvant chemotherapy group was superior to that in the observation group (median 37 versus 12 months, respectively, p = 0.01). Median survival in the adjuvant group was 63 months compared to 36 months for the observation group. Surprisingly, some cases with relapse could be salvaged with CMV chemotherapy, perhaps contributing to this lack of difference in overall survival (p = 0.32). CONCLUSIONS: Treatment with CMV chemotherapy after radical cystectomy is an acceptable approach in patients with stages p3b and p4N0 or N1 transitional cell carcinoma of the bladder. Further studies must be performed to determine whether these results can be extrapolated to patients with more limited disease (stages p2 and p3a) who are currently treated with radical cystectomy or definitive irradiation.

Adult↗
PubMed1994

Utility of preoperative serum prostate-specific antigen concentration and biopsy Gleason score in predicting risk of pelvic lymph node metastases in prostate cancer.

OBJECTIVES: To determine the accuracy of the preoperative serum concentration of prostate-specific antigen (PSA) plus the Gleason pathology score of biopsy specimens in predicting the presence of disease in the pelvic lymph nodes in patients with prostate cancer. METHODS: The medical records of all patients treated for prostate cancer at eight medical centers from January 1988 to June 1993 were reviewed. There were 932 patients with newly diagnosed prostate cancer for whom all relevant data were available who had undergone pelvic lymphadenectomy with (n = 912) or without (n = 20) radical prostatectomy. The rate of false-negative predictions of metastases based on combined preoperative biopsy Gleason score and serum PSA concentration was analyzed. A multivariate logistic regression analysis was performed to assess the value of preoperative serum PSA and biopsy Gleason scores individually and in combination in predicting pelvic lymph node metastases. RESULTS: The false-negative rate of metastases was 0% for preoperative PSA concentrations < or = 6 ng/mL and biopsy Gleason scores < or = 5 (n = 142) and 1.0% for PSA concentrations < or = 10 ng/mL and Gleason scores < or = 6 (n = 388). The 95% upper confidence limit for the rate of false negativity at this PSA cut-off level was 2.0%. A combination of preoperative serum PSA levels and biopsy Gleason scores provided the best prediction for the false-negative rates. CONCLUSIONS: For patients with newly diagnosed prostate cancer who have biopsy Gleason scores < or = 6 and preoperative PSA concentrations < or = 10 ng/mL (42% of our series), a staging pelvic lymphadenectomy appears to be unnecessary. The substantial cost associated with both cross-sectional imaging and staging lymphadenectomy may therefore be avoidable in this group of patients.

Biopsy↗
PubMed1993

Stanford pouch ileal neobladder: clinical, radiologic, and urodynamic follow-up.

The Stanford pouch is an orthotopic neobladder which consists of a reservoir made from 30 cm of detubularized ileum and an antireflux segment based on a series of intestinal pleats. The clinical, radiologic, and urodynamic follow-up of 40 patients who have undergone the operation and have been followed for at least six months is presented. Renal function, based on serum creatinine levels, has remained stable. Voiding cystourethrograms obtained in 34 patients revealed that 38 percent of patients had no reflux. Of the 62 percent of patients with reflux, 49 percent had grades I-II/V reflux and 51 percent had grades III-IV/V reflux. Imaging of the upper urinary tracts in 32 patients revealed mild hydronephrosis in 3/64 (4.7%) of renal units. Daytime continence was attained in 95 percent of patients, and nighttime continence in 59 percent of patients. Urodynamic studies in 30 patients revealed an average capacity of 695 cc, phasic contractions whose mean pressure was less than 40 cm water, and a low basal neobladder pressure of 21.9 cm water at capacity. Twenty-four-hour voiding diaries in 24 patients revealed an average voided volume of 267 cc, a mean maximum voided volume of 445 cc, and a mean frequency of urination of one hundred eighty-two minutes. Based on these results, the Stanford pouch is a viable form of continent diversion to the urethra.

Adult↗
PubMed1993

Functional and urodynamic characteristics of an ileal neobladder.

We examined the urodynamic characteristics and symptoms of 28 patients who had undergone the Stanford pouch bladder substitution following cystoprostatectomy. Urodynamics were obtained a mean of 18 months (range 6 to 43) after construction of the neobladder. Mean cystometric capacity was 699 cc (range 366 to 1,370). All patients voided by the Valsalva maneuver and achieved good peak flow rates (mean 19 cc per second). Of the patients 23 emptied to near completion with a mean post-void residual of 34 cc, while 5 had post-void residuals of greater than 150 cc (mean 630 cc). The neobladders demonstrated good compliance for the storage of urine, with a mean basal pressure of less than 15 cm. water at volumes of less than 500 cc at which most bladders function, and of 22.4 cm. water (range 1 to 72) at 100% capacity. Phasic neobladder contractions were present during filling cystometrography. While the number increased at higher neobladder volumes, the mean length and mean pressure did not. The mean pressure of contractions was less than 40 cm. water at lower and higher volumes. Daytime continence was attained in 26 of 28 patients (93%), while 17 (61%) attained nighttime continence. Of these 17 patients 14 (82%) had to void at least once at night to stay dry. Daytime incontinent patients had decreased neobladder compliance at high volumes compared to daytime continent patients (p < 0.05) but there was no difference in the maximal urethral closure pressure or the pressure of phasic contractions between these 2 groups. No difference was found in any urodynamic parameter between nighttime continent and incontinent patients. Patients with poor emptying ability (defined as a post-void residual of more than 150 cc) had increased neobladder compliance relative to patients with good emptying ability, as well as a statistically significant increased capacity (1,067 cc versus 623 cc). There was no difference in any important urodynamic parameter between patients who had and had not received postoperative chemotherapy. We conclude that a neobladder constructed from detubularized ileum achieves adequate capacity at low pressures with a satisfactory continence rate. Most patients empty the bladder to completion by Valsalva's maneuver. Low compliance at high volumes appears to be a factor in daytime incontinence.

Adult↗
PubMed1991

Stage T1 bladder cancer: grade is the primary determinant for risk of muscle invasion.

Tumor characteristics believed to predict for deep muscle invasion after transurethral resection of superficial bladder cancer alone were analyzed in 51 patients with stage T1 (stage A) transitional cell carcinoma of the bladder. All patients were treated at Stanford University Medical Center and none had intravesical chemotherapy at any time during the median followup of 78 months. No patient had carcinoma in situ. A total of 14 patients (27%) had deep muscle invasion. None of the patients with grade 1, 5 (22%) with grade 2 and 9 (50%) with grade 3 to 4 tumors had deep muscle invasion. Comparison of the risk of muscle invasion using pathological tumor grade at diagnosis, highest grade at any cystoscopic biopsy before the diagnosis of muscle invasion or highest grade at cystoscopic biopsy immediately antecedent to the cystoscopy at which muscle invasion was diagnosed all showed similar probability of muscle invasion. Mean interval to development of muscle invasion was 6 and 12 months in the grades 2 and 3 to 4 groups, respectively. At 36 months the cumulative probability of invasion-free survival was 62% for grade 2, compared to 50% for grades 3 to 4 cancer patients (p less than 0.005, Gehan). Univariate regression analysis demonstrated grade to be the only significant factor in predicting for invasive disease (p = 0.005), with tumors in the bladder neck to be of borderline significance (p = 0.159). On multivariate logistic regression analysis, grade remained the single tumor variable predicting for invasive bladder cancer (p = 0.004). These data suggest that of routinely available data at diagnosis and during subsequent followup cystoscopic examinations, tumor grade is the most important biological predictor of progression to muscle invasive cancer.

Aged↗
PubMed1989

Keratin immunoreactivity as an aid to the diagnosis of persistent adenocarcinoma in irradiated human prostates.

Postirradiation prostatic biopsy is believed by many to be the best measure of radiation effectiveness in prostatic cancer. Therapeutic irradiation may induce prostatic glandular atypia, which in its severe form can be confused with persistent adenocarcinoma on prostatic biopsies. In the current study, 37 postirradiation prostate biopsy specimens were evaluated by immunohistochemistry using a specific monoclonal anticytokeratin antibody (KA1) that reacts with the basal cells of normal or hyperplastic glands, but is nonreactive with the lumenal cells or with prostatic carcinoma cells. Persistent carcinoma was observed in 19 cases in which antibody staining was absent. The noncarcinomatous glands retained reactivity, but this reactivity appeared in a new and previously undescribed pattern. The irradiated lesion was characterized by cellular pleomorphisism, with enlargement of nuclei and loss of polarity. The immunoreactivity was seen in the enlarged basal cells and was seen to focally extend to involve the lumenal cell layer. In five of 37 cases, glands were seen that were so atypical on the routinely stained sections that a distinction from cancer could not be made. These same glands in the adjacent section reacted with KA1 in each case allowing us to conclude that the changes were benign. We conclude that the interpretation of postirradiation prostatic biopsy specimens may be aided by immunohistochemistry with this anticytokeratin antibody.

Adenocarcinoma↗
PubMed1989

Orchiectomy only for clinical stage I nonseminomatous germ cell testis tumors: comparison with pathologic stage I disease.

Twenty-three men with nonseminomatous germ cell tumors confined within the tunica albuginea of the testis and negative metastatic evaluation were placed on surveillance after radical orchiectomy. Metastatic disease developed in 3 for a relapse rate of 13 percent. During the same period, 17 men with pathologic Stage I disease were followed up in the same manner, and metastatic disease developed in 3 for a relapse rate of 18 percent. All six men were treated with either combination chemotherapy or retroperitoneal lymphadenectomy, and all are alive without disease for at least two years from end of therapy. If strict criteria are followed, surveillance has a place in the management of carefully selected young men with clinical Stage I disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. II. Radical prostatectomy treated patients.

Serum prostate specific antigen was determined (Yang polyclonal radioimmunoassay) in 102 men before hospitalization for radical prostatectomy. Prostate specimens were subjected to detailed histological and morphometric analysis. Levels of prostate specific antigen were significantly different between patients with and without a Gleason score of 7 or greater (p less than 0.001), capsular penetration greater than 1 cm. in linear extent (p less than 0.001), seminal vesicle invasion (p less than 0.001) and pelvic lymph node metastasis (p less than 0.005). Prostate specific antigen was strongly correlated with volume of prostate cancer (r equals 0.70). Bivariate and multivariate analyses indicate that cancer volume is the primary determinant of serum prostate specific antigen levels. Prostate specific antigen was elevated 3.5 ng. per ml. for every cc of cancer, a level at least 10 times that observed for benign prostatic hyperplasia. Prostate specific antigen is useful as a preoperative marker because no patient with lymph node metastasis had serum levels of less than 10 ng. per ml. (4 times the upper limit of normal range). Of the patients with greater than 50 ng. per ml. two-thirds had microscopic lymph node metastasis and 90 per cent had seminal vesicle invasion. Serum prostatic acid phosphatase levels showed a significantly weaker correlation with cancer volume (r equals 0.51) and every other pathological parameter. Of the patients 73 per cent had serum prostatic acid phosphatase levels in the normal range (0 to 2.1 ng. per ml.), including 7 per cent who had pelvic lymph node metastasis. Postoperative prostate specific antigen values were available in 97 of 102 patients, with a mean and maximum followup of 12 and 38 months. No patient with pelvic lymph node metastasis achieved an undetectable prostate specific antigen level without adjunctive therapy (hormonal or radiation). No difference in preoperative or postoperative prostate specific antigen levels, cancer volume, seminal vesicle invasion or incidence of pelvic lymph node metastasis was seen between patients with no capsular penetration and those with minimal capsular penetration (1 cm. or less total linear extent of full thickness penetration), providing the first quantitative evidence that small amounts of capsular penetration may not be of biological or prognostic significance.

Acid Phosphatase↗
PubMed1987

Failure of adjuvant chemotherapy in testicular cancer.

Two cases of failure of adjuvant chemotherapy after retroperitoneal lymph node dissection of Stage II nonseminomatous germ cell tumors are described. In both cases, initial surgical resection was complete, and two cycles of chemotherapy with cisplatin, vinblastine, and bleomycin were administered in an appropriate dose and schedule. Although one patient remains without evidence of disease 12 months after initiation of salvage chemotherapy with cisplatin, etoposide, and bleomycin, the other patient died of progressive disease despite intensive treatment with cisplatin and etoposide. Adjuvant therapy for Stage II germ cell tumors is not conventional treatment, and should be applied only in investigative settings where the long term effects and toxicity can be monitored, and does not reduce the need for frequent and thorough follow-up of treated patients.

Adult↗
PubMed1987

Superficial bladder cancer: the primacy of grade in the development of invasive disease.

Tumor characteristics thought to predict for development of deep muscle invasion after resection of superficial bladder cancer were retrospectively analyzed in 252 patients with transitional cell carcinoma of the bladder at Stanford University Medical Center. Stage 0 patients accounted for 190 of the patient population (75.5%), while stage A and B1 comprised 51 (20%) and 11 (4.5%), respectively. The median follow-up time was 62 months. Forty-three patients subsequently developed deep muscle invasion; these included 24 (12.6%), 14 (27.5%), and 5 (45.5%) of stage 0, A, and B1 patients (P = .002), or 15 (10%), 15 (9%), and 13 (33%) of grade 1, 2, and 3 tumors (P = .001), respectively. When analyzed by univariate logistic regression, grade (P = .0001) and stage (P = .0118) were significant predictors for invasive disease. Site of tumor and number of tumors at presentation were not significant factors for invasion deep into the bladder wall. When multiple logistic regression was performed, only grade remained as a significant tumor variable to predict for invasive disease (P less than .0091). Risk of invasive disease did not appear to increase with increasing number of recurrences, remaining at approximately an 11% invasion rate through 12 recurrences. In this analysis, grade was the most significant tumor variable in superficial bladder cancer predicting for the development of invasive carcinoma. Future clinical trials for definitive or adjuvant therapy of this disease must stratify for this variable.

Adult↗
PubMed1984

Tamoxifen in advanced prostatic carcinoma. A dose escalation study.

Patients with advanced prostatic carcinoma who had received minimal or no prior therapy were treated with tamoxifen citrate in escalating doses from 10 to 50 mg orally twice a day. Twenty-nine courses were evaluated in 17 patients. Entry was limited to patients with measurable sites of disease. There were no objective responses at any dose level in these measurable sites. Acid and alkaline phosphatase were reduced in 0% and 18% of courses, respectively. Serum testosterone increased by an average of 119 ng/ml. Most increases were transient; no tumor flares were observed. Transperineal prostate biopsies in selected patients after completion of treatment showed no evidence of tumor necrosis or alteration in histologic grade of the tumors. Tamoxifen citrate, over the range of doses evaluated, has no activity in metastatic prostatic carcinoma.

Acid Phosphatase↗
PubMed1984

External beam radiation salvage for residual or recurrent local tumor following radical prostatectomy.

External beam radiation therapy was used as a means of salvage in 32 patients with either incomplete excision or palpable local recurrence following radical prostatectomy. Patients were divided into 2 groups consisting of 13 patients who were referred within 4 months of incomplete excision (group 1) and 19 who were referred only after palpable local recurrence had developed (group 2). The 5 and 10-year actuarial survival free of disease in group 1 was 57 per cent, compared to 40 and 20 per cent for group 2 (p equals 0.05). Fourteen patients with an elevated pre-radiation therapy serum acid phosphatase level and/or bladder invasion had an especially poor prognosis, with a median survival free of disease of only 2.4 years. Ten complications were recorded in 5 patients (16 per cent), which were slightly higher than experienced in irradiated patients without a previous radical operation. The data support the contention that external beam radiation therapy may offer a means of post-radical prostatectomy salvage for selected patients with incomplete excision or palpable local recurrence. The best results were obtained in patients who were referred within 4 months of prostatectomy because of incomplete excision rather than waiting for palpable local recurrence to develop.

Adenocarcinoma↗
PubMed1983

Dorsal approach to upper urinary tract.

One hundred patients with benign disease of the upper urinary tract were operated on: 50 through the standard flank approach and 50 through the dorsal approach. The analgesic requirement for control of postoperative pain was less for patients operated on through the dorsal incision, and these patients had a shorter postoperative ileus and a hospital stay an average of 4.29 days less than those operated on through the flank approach. The dorsal lumbotomy incision is recommended for certain operations on the kidney and proximal ureter.

Adolescent↗
PubMed1981

Macroscopic vasovasostomy.

Ninety-six males underwent vasovasostomy from 1976-1978. Seventy-six of 83 patients who returned for a semen analysis demonstrated sperm in the ejaculate for a 92% surgical patency rate. Thirty-two of 71 eligible patients initiated a pregnancy for a functional success rate of 45%. A statistically significant correlation was found between postoperative motility and pregnancy rate but none between sperm count and pregnancy rate.

Adult↗