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J E Pontes

Publications and source records attributed to J E Pontes.

At least 19 recordsLinked to original sources
PubMed1992

Relapsing disease.

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Antigens, Neoplasm↗
PubMed1992

Accuracy of frozen section examination of testicular tumors.

Benign testicular masses are recognized with increasing frequency and testis-sparing surgery, based on benign frozen section diagnosis, is practiced more often. However, there is a paucity of information in the medical literature regarding the accuracy of frozen section diagnoses of testicular tumors, and misdiagnoses could have dire consequences. We reviewed thirty frozen section examinations that were performed between 1962 and 1991, a period in which five hundred inguinal orchiectomies were performed. The entire testicle was available for histologic evaluation in 26 cases. Frozen sections correctly identified all of twenty-four malignant and two benign testicular masses. This study demonstrates that frozen section examinations can accurately diagnose testicular cancer.

Adult↗
PubMed1992

Synergy of radiation therapy and immunotherapy in murine renal cell carcinoma.

The treatment of metastatic renal cell carcinoma with immunotherapy has resulted in objective anti-tumor responses in 15-30% of patients. To enhance the therapeutic effects of immunotherapy, it is becoming evident that this approach should be combined with other treatment modalities. In this study, a spontaneously metastasizing murine renal adenocarcinoma (Renca), transplanted under the renal capsule, was treated with either radiation therapy, immunotherapy or a combination of both. In order to distinguish between the local and systemic effects of radiation therapy, total body irradiation was compared to irradiation of the tumor-bearing kidney only, or irradiation of the whole mouse with the tumor-bearing kidney shielded. Immunotherapy was administered with interleukin-2 (IL-2) alone or with IL-2 and lymphokine activated killer (LAK) cells. Combined radiation and immunotherapy induced a better anti-tumor response than either modality alone. The best response was obtained by local tumor irradiation and IL-2 therapy and resulted in a significant reduction in primary tumor size, elimination of lung metastases and a significant increase in survival.

Animals↗
PubMed1991

Coexistence of autologous antibodies and decay-accelerating factor, an inhibitor of complement, on human renal tumor cells.

Autologous immunoglobulin was detected on the cell surface of tumor cells freshly isolated from cancerous kidneys of patients with renal cell carcinoma by flow cytometry after staining with murine anti-human IgG monoclonal antibodies. Cells isolated in parallel from macroscopically normal regions of the tumorous kidneys were not specifically stained with the anti-human IgG reagents. In further studies, tumor cells were stained with an antibody to decay-accelerating factor (DAF), a known inhibitor of complement. Flow cytometry of these cells revealed that nearly all tumor cells expressed DAF, and that the intensity of staining with the anti-DAF monoclonal antibody correlated with the staining of cells with anti-IgG. The results suggest that tumor cells coated with autologous antibody may be resistant to complement-mediated cytotoxicity in vivo through the expression of high levels of DAF.

Antibodies, Monoclonal↗
PubMed1991

Trisomy 10 in renal cell carcinoma.

We report four renal cell carcinomas, grade II, with trisomy 10 (+10) as the only karyotypic change. We propose that this cytogenetic anomaly may be associated with low-grade renal carcinoma, although more cases will have to be studied to support the hypothesis.

Adult↗
PubMed1991

Resection of inferior vena cava tumor thrombi from renal cell carcinoma.

Renal cell carcinoma is an unusual cancer with the propensity to invade not only the renal vein but to propagate into the inferior vena cava (IVC) as a tumor thrombus. Experience has recently confirmed that MRI will be valuable in evaluating the extent of the tumor thrombus. The surgical techniques used to remove the thrombus are dependent on the extent of the cancer. For lesions involving the infrahepatic IVC, only proximal and distal control of the IVC are necessary. For a thrombus involving the intrahepatic IVC, isolation of the suprahepatic IVC, hepatic circulation, and infrahepatic IVC or cardiopulmonary bypass can be used. For the large thrombus in the supradiaphragmatic IVC or atrium, cardiopulmonary bypass either with or without deep hypothermic circulatory arrest is appropriate. In a review of 48 cases with renal cell carcinoma with IVC tumor thrombi, the tumor thrombus was removed intact in 58 per cent and in multiple fragments ("piece-meal") in 42 per cent of the patients. Cardiac bypass has been used in 26 cases with 22 undergoing deep hypothermic circulatory arrest. The postoperative mortality of 48 cases between 1965 and 1987 was 4 per cent. Removal of the most complicated and extensive renal cell carcinoma tumor thrombi is now technically feasible. In patients with large tumor thrombi, however, the ultimate outlook remains poor in the absence of effective systemic adjuvant therapy.

Carcinoma, Renal Cell↗
PubMed1991

Renal cell carcinoma with inferior vena cava tumor thrombi.

Renal cell carcinoma is a unique neoplasm because of its common propensity to propagate into the renal vein and inferior vena cava (IVC) as tumor thrombus. Historically, the surgical difficulties encountered in removal of these cancers limited the ability of a single institution to obtain experience with large numbers of instances. Between January 1956 and July 1987, 68 patients with renal cell carcinoma extending into the IVC or right atrium underwent radical nephrectomy with vena cava thrombus extraction at the Cleveland Clinic. Twenty-five patients had partial resection of the IVC with reconstruction. Fifteen patients had partial resection and reconstruction of the IVC; however, because of narrowing of the infrarenal IVC, persisting bland thrombus in the proximal IVC or iliac veins or concern regarding postoperative pulmonary emboli, the infrarenal IVC was either ligated or clipped. Seven patients underwent cavectomy with division of the IVC. A right atriotomy was performed upon 14 patients and cardiopulmonary bypass was used in 20 patients, with 17 also having deep hypothermic circulatory arrest. The tumor thrombus was removed intact in 64 per cent of the patients and in multiple small fragments ("piecemeal") in 36 per cent of the patients. The mortality rate was 7 per cent. Survival was examined relative to extent of vena caval thrombus. Patients with extension into the atrium had a significantly worse prognosis than those with other levels of vena caval involvement. Other factors, such as lymph node status, perinephric fat involvement, resection of IVC and intact or "piecemeal" extraction, did not influence the survival rate. Patients with pre-existing metastases preoperatively had an extremely poor survival rate. The techniques now available for surgical resection of all levels of tumor thrombus of the IVC make resection feasible in most patients. In our opinion, the addition of deep hypothermic circulatory arrest has been a significant advance.

Carcinoma, Renal Cell↗
PubMed1990

Influence of nephrectomy on the growth of a murine Wilms tumor: a study using parabiotic rats.

It has been reported that unilateral nephrectomy causes acceleration of the growth of a Wistar/Furth rat Wilms tumor. We studied this phenomenon in parabiotic rats by measuring tumor growth after either sham nephrectomy, or excision of 1, 2 or 3 kidneys. We observed no stimulation of tumor growth in the experimental groups. Renal function was significantly decreased after removal of 2 or 3 kidneys. Serum creatinine levels were significantly different between right and left members of parabiotic pairs in these 2 groups. The effect of unilateral and bilateral nephrectomy on tumor growth in single rats also was examined. In these rats progressive increases in tumor growth were observed after unilateral and bilateral nephrectomy. Our inability to demonstrate a tumor-stimulating factor in the parabiotic model may be due partly to incomplete sharing of humoral factors between parabionts. Serum transfer studies in vitro may prove more fruitful in demonstrating such a factor.

Animals↗
PubMed1990

Resection of nonrenal retroperitoneal tumors with large vena caval thrombi using cardiopulmonary bypass and hypothermic circulatory arrest.

Cardiopulmonary bypass with deep hypothermic circulatory arrest is a useful adjunct in the operative management of renal cell carcinoma associated with large vena caval thrombi. We present 2 patients with nonrenal retroperitoneal tumors and extensive vena caval thrombi who underwent successful surgical treatment with this method. The primary tumor was a leiomyosarcoma of the vena cava in 1 patient and a pheochromocytoma with hepatic invasion in 1. Cardiopulmonary bypass with deep hypothermic circulatory arrest is effective in decreasing the operative risk and improving the feasibility of resection in complex surgical cases. Consideration should be given to its use in a wider range of indicated procedures.

Adrenal Gland Neoplasms↗
PubMed1990

Magnetic resonance imaging for assessment of vena caval tumor thrombi: a comparative study with venacavography and computerized tomography scanning.

We assessed the accuracy of magnetic resonance imaging in demonstrating the presence and extent of vena caval tumor thrombi. The study group included 20 patients with vena caval thrombi from renal cell carcinoma (18), renal pelvic transitional cell carcinoma (1) and adrenal pheochromocytoma (1). Preoperative diagnostic studies included magnetic resonance imaging in all patients, inferior venacavography in 16 and computerized tomography scanning in 15. All patients underwent an operation in which the presence and extent of the vena caval thrombus were confirmed. Magnetic resonance imaging accurately delineated the presence and extent of the thrombus in all 20 patients (100%). Venacavography was accurate in 15 patients (94%) but 8 (50%) required a retrograde and antegrade study. Computerized tomography scanning demonstrated the presence of a tumor thrombus in all 15 patients but accurately delineated the cephalad extent of the thrombus in only 5 (33%). In patients with vena caval tumor thrombi magnetic resonance imaging can provide accurate information regarding the extent of vena caval involvement while avoiding the need for an invasive contrast imaging study.

Adrenal Gland Neoplasms↗
PubMed1990

Right renal mass with vena caval thrombus.

This case illustrates the difficulties that sometimes occur in the evaluation of patients with a nonfunctioning kidney. Because of the clinical presentation, suggestive of renal cell carcinoma, no urinary cytology study was obtained from the affected kidney. This study certainly would have led to the correct diagnosis. Despite this fact, the operative management would not have changed except for complete removal of the ureter. In our case we elected to follow the distal ureter by ureteral washings and ureteroscopy during follow-up cystoscopy studies to preclude a further operation. Although no data are available on the role of adjuvant therapy in these patients, because of the poor prognosis associated with such extensive disease we gave our patient 2 courses of M-VAC in an attempt to prevent progression of the disease.

Aged↗
PubMed1990

Prognostic implications of disappearance rate of biologic markers following radical prostatectomy.

Six patients with localized prostatic carcinoma undergoing radical prostatectomy were studied by serial sample collection from the time of surgical removal of the prostate up to one week in the postoperative period. Of the three markers studied (PAP, PSA, LASA), half-life of specific prostatic markers were calculated. Half-life of PAP was found to be 7.25 hours +/- SE of 0.7 hours. For PSA the half-life could be obtained in 4 of 6 patients and was found to be 45.5 hours +/- SE 4.9 hours. In 2 patients PSA did not fall in a regular fashion and half-life could not be obtained. In both patients metastatic disease has developed within six months of surgery. LASA demonstrated progressive increase following surgery, most likely due to associated inflammatory reaction. These studies confirm previous observations that PSA is a more sensitive marker than PAP, and that the presence of an elevated PSA after radical prostatectomy denotes the presence of residual disease.

Acid Phosphatase↗
PubMed1990

Experience with cardiopulmonary bypass and deep hypothermic circulatory arrest in the management of retroperitoneal tumors with large vena caval thrombi.

From June 1984 to September 1989, 43 patients with large vena caval tumor thrombi from retroperitoneal malignancies underwent surgical treatment with cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). The primary malignancies were renal cell carcinoma (RCC) (n = 39), renal pelvic transitional cell carcinoma (n = 1), adrenal pheochromocytoma (n = 1), and renal (n = 1) or retroperitoneal (n = 1) sarcoma. The level of the caval thrombus was either suprahepatic (n = 27), intrahepatic (n = 14), or subhepatic (n = 2). In all cases the primary tumor and caval thrombus were completely removed. Concomitant procedures included coronary artery bypass grafting (n = 5), pulmonary resection (n = 2), and hepatic lobectomy (n = 1). The time of circulatory arrest ranged from 10 to 44 minutes (mean, 23.5 minutes). There were two operative deaths (4.7%), neither of them due to to the use of DHCA. Major postoperative complications occurred in 13 patients (30.2%). There were no ischemic or neurologic complications and no cases of perioperative tumor embolization. The median postoperative hospital stay was 9 days. Twenty-two patients (51%) are alive and enjoying a good quality of life. The 3-year patient survival rates in patients with localized (n = 24) versus metastatic (n = 15) RCC are 63.9% and 10.9%, respectively (p = 0.02). We conclude that CPB with DHCA facilities excision of retroperitoneal malignancies with large caval thrombi and provides the potential for cure with low morbidity and mortality rates.

Adult↗