Biomedical subjects

W F Hendry

Publications and source records attributed to W F Hendry.

At least 127 records · Page 7Linked to original sources

PubMed1985

Etoposide and cisplatin with or without bleomycin as first-line chemotherapy for patients with small-volume metastases of testicular nonseminoma.

Between December 1981 and September 1982, a phase II study of etoposide and cisplatin was carried out in 17 patients with small-volume metastases of testicular nonseminoma to see whether the toxicity associated with bleomycin could be avoided without loss of therapeutic effect. Of 16 evaluable patients followed for 13-23 months (median, 18.5), four failed to achieve complete remission and three had disease progression. Conversely, all 18 equivalent patients treated with bleomycin, etoposide, and cisplatin between January 1981 and November 1982 (observation time, 12-34 months; median, 25) achieved complete remission and have been continuously disease-free since treatment (P = 0.07). The results suggest that bleomycin contributes significantly to the combination chemotherapy for testicular nonseminoma, and although its omission led to a marked reduction in toxicity, loss of therapeutic activity was also apparent. Prolongation of the intervals between cycles of etoposide and cisplatin from 3 to 4 weeks may significantly reduce the effectiveness of the two-drug combination, whereas no evidence of this was seen in patients treated with bleomycin, etoposide, and cisplatin.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1985

Plasma concentrations of pituitary and testicular hormones of fertile and infertile men.

The serum concentrations of prolactin (PRL), follicle stimulating hormone (FSH) and luteinizing hormone (LH) and the plasma concentrations of testosterone, 5-alpha-dihydrotestosterone (DHT) and oestradiol were measured in 80 infertile men and 38 men of known fertility. The infertile men had a lower mean concentration of prolactin and a higher mean concentration of FSH than the fertile controls. The mean FSH was particularly high in infertile men without antisperm antibodies but with oligospermia (sperm density up to 20 million/ml), who also had a higher mean serum LH level than the fertile controls. Both FSH and LH showed an inverse relationship with sperm density. There were no significant differences in plasma testosterone, DHT or oestradiol between fertile and infertile men. In both the fertile and infertile groups strong positive associations were found between the concentrations of FSH and LH, and between testosterone and DHT. Weaker relationships were found between DHT and oestradiol, and between testosterone and PRL. In the fertile men, positive associations were also found between LH and testosterone, and between oestradiol and both FSH and LH. Testosterone and oestradiol were associated only in infertile men. The relevance of these findings to the aetiology of male infertility is discussed.

Dihydrotestosterone↗

PubMed1985

A long term follow-up of patients with advanced prostatic cancer treated with buserelin.

Thirty consecutive patients with newly diagnosed symptomatic, locally advanced or metastatic prostate cancer were treated with intranasal buserelin, a long-acting analogue of gonadotrophin releasing hormone, in divided dosages of either 600, 1000 or 1200 micrograms daily. Suppression of testosterone occurred in 1 of 5 patients treated with 600 micrograms daily and in all of 25 patients receiving 1000 or 1200 micrograms regimens. Two of 5 patients treated with the 600 micrograms regimen and 23 of 25 patients receiving the higher dosage regimens showed subjective and objective evidence of response. Follow-up was from 1 to 31 months. During this period 11 patients have relapsed. The mean duration of remission was 16 months. Buserelin offers an effective alternative of equivalent efficacy to conventional treatments for prostatic cancer, without any significant side effects.

Buserelin↗

PubMed1984

Post-chemotherapy surgery in advanced non-seminomatous germ-cell testicular tumours: the significance of histology with particular reference to differentiated (mature) teratoma.

Of a total of 307 patients treated with chemotherapy for advanced non-seminomatous germ-cell testicular tumours between 1976 and 1983, 73 (23.8%) had masses excised after treatment. Resected tissue showed residual malignancy in 16 (22%), fibrosis and necrosis in 25 (34%) and differentiated (mature teratoma) in 32 (44%). Of the 16 patients with tumour only 7 (44%) are alive and disease-free compared with 21/25 (84%) and 27/32 (84%) for fibrosis/necrosis and differentiated teratoma respectively. In addition to histological evidence of residual tumour, elevated serum markers at the time of surgery and/or incomplete excision of residual masses were adverse prognostic features. Of 12 patients with differentiated teratoma or fibrosis who had incomplete resections or densely adherent masses excised with difficulty, 7 subsequently relapsed. The majority of differentiated teratoma patients (75%) had evidence of differentiation in their primary tumours; 88% showed cystic change in metastases and almost one-third showed an increase in the size of metastases during chemotherapy. The data suggest that post-chemotherapy surgery may have a therapeutic as well as a diagnostic role and that complete excision of residual disease should be attempted even if resection at one site has shown either fibrosis or differentiated teratoma. The significance of these findings in relation to treatment induced differentiation is discussed.

Combined Modality Therapy↗

PubMed1984

The prognosis of male subfertility: a survey of 1025 men referred to a fertility clinic.

A retrospective survey of 1025 consecutive men referred to a male fertility clinic was carried out: 180 (18%) produced a pregnancy while attending the clinic. There was an overall inverse relationship between age and the production of pregnancy, although the majority of pregnancies were in the partners of men aged 25 to 39 at referral. The proportion of pregnancies rose from 4% for men presenting with azoospermia to 27% for those with initial sperm counts of 11 to 20 million/ml. The relationship between production of pregnancy and sperm density was inconsistent for men with sperm densities above 20 million/ml. There was no significant difference in the sperm motility at referral between those who did or did not produce a pregnancy. Success was highest for men whose duration of infertility at referral was between 2 and 3 years. The importance of these findings to the investigation of infertile men is discussed.

Adolescent↗

PubMed1984

Urological problems following treatment of carcinoma of the cervix.

One thousand one hundred and sixty-one cases of carcinoma of the cervix presenting over a 20-year period to 1982 were considered: 326 (28%) of these women developed urological problems, of whom 82 (7%) had major complications. Fistula formation occurred in 46 cases (4%), and was associated with active malignant disease in 33. Significant progressive ureteric obstruction occurred in 15 patients, 11 of whom had active malignancy. Overall, 35 (43%) of 82 patients with major urological problems had no evidence of active disease. Urinary diversion by ileal conduit proved to be a relatively simple and effective way of dealing with the serious problems, especially for patients with fistula formation and progressive ureteric obstruction, 67% and 73% of whom, respectively, underwent this procedure. More complex reconstructive surgery proved successful in a small number of selected patients, in whom there was no evidence of active tumour. Attempts to compromise with less definitive or over-ambitious procedures resulted in further complications and prolonged hospitalisation.

Female↗

PubMed1983

Treatment with gonadotrophin releasing hormone analogue in advanced prostatic cancer.

Repeated administration of long acting analogues of gonadotrophin releasing hormone diminishes gonadal function and in men decreases testosterone concentrations; for this reason the effect of the analogue buserelin was studied in prostatic carcinoma. Twelve consecutive patients with newly diagnosed locally advanced or metastatic carcinoma of the prostate were treated. Each patient received intranasal buserelin in divided dosages of either 600 or 1000 micrograms daily. Suppression of the gonadotrophins and testosterone occurred in all patients. Objective and subjective signs of regression of disease were seen in nine patients. Buserelin offers an effective treatment of metastatic prostatic cancer without the side effects and cardiovascular risks associated with oestrogen treatment.

Administration, Intranasal↗

PubMed1983

A comparative study of zinc, copper, cadmium, and lead levels in fertile and infertile men.

Eighty infertile men and 38 men of known fertility were studied for investigation of both the importance of zinc, copper, cadmium, and lead to fertility and the possible interrelationships between these trace elements. The infertile men had higher mean concentrations of plasma copper than those of proven fertility. The difference was statistically significant (P less than 0.01) but was of small magnitude (approximately 1.5 mumol mean difference). The concentrations of plasma zinc, erythrocyte zinc, whole blood lead and cadmium, and seminal plasma zinc and copper did not differ significantly between infertile and fertile men. There was a significant positive relationship between sperm density and seminal plasma zinc concentration in the fertile, but not in the infertile, men. The infertile men with antisperm antibodies or counts greater than 20 million/ml had significantly higher mean levels of seminal plasma zinc than infertile men with oligospermia. The higher semen zinc in these two groups may reflect an abnormal fragility of the spermatozoa, resulting in the release of zinc, but the absence of significant overall differences between fertile and infertile men suggests that measurement of the concentration of zinc in plasma or zinc and copper in seminal plasma has little value in the routine investigation of infertility.

Adult↗

PubMed1983

The treatment of metastatic germ-cell testicular tumours with bleomycin, etoposide and cis-platin (BEP).

Between July 1979 and December 1981, 43 patients with metastatic germ-cell tumours (36 testicular non-seminomas and 7 testicular seminomas) were treated with 2-6 cycles of bleomycin, etoposide and cis-platin (BEP). Forty (93%) are alive, 37 (86%) with no evidence of disease. Of 36 men with testicular non-seminoma 30 (83.3%) are alive and disease-free at 8-38 months (median 17.0 months). In the latter group 25/28 (89.3%) who had had no prior irradiation are alive and disease-free. Fourteen non-seminoma patients had small volume metastases and 13 are in complete remission, as are 12/14 patients with bulky disease. All 7 patients with advanced seminoma are alive and disease-free. It is concluded that BEP is a well tolerated and effective first line treatment for patients with metastatic germ-cell tumours.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1983

Carbon dioxide versus water for cystoscopy: a comparative study.

In a prospective study of 120 patients, the cystoscopic views provided by carbon dioxide (CO2) insufflation of the bladder were compared with the views obtained during standard water cystoscopy. The clarity of vision was uniformly good during CO2 cystoscopy and in 21 patients with haematuria the views were significantly better than those obtained by standard water cystoscopy. There was no evidence of any significant absorption of CO2. This safe and simple technique would seem to have considerable advantages in the investigation of patients with haematuria.

Carbon Dioxide↗

PubMed1983

Occult germ-cell testicular tumours.

Eighteen men presenting with metastatic germ-cell malignancy in whom no primary tumour could be palpated in either testis are described. All patients had both testes in the scrotal sac and none had a history of maldescent. All had abdominal node involvement, in most cases associated with metastases at other sites. Ten men presented with Stage 4 disease, five with Stage 3 and three with Stage 2. The most common histological sub-type associated with an occult primary testicular tumour was trophoblastic malignant teratoma (9/18 patients). Abdominal pain (12 patients) and systemic symptoms (10 patients) were common presenting features. There was a history of testicular atrophy in eight patients and seven had experienced episodes of transient testicular pain up to 18 months before presentation. In three of four patients in whom the testis was examined histologically following a history of atrophy and/or pain, there was evidence of a primary tumour, manifest as spontaneous tumour regression (one), differentiation (one) or a small micro-primary trophoblastic teratoma (one). In a fifth patient an ultrasonic scan showed a 1-cm echogenic mass in an atrophic testis. In 10 patients the diagnosis of germ-cell malignancy was established by laparotomy. Obstructive uropathy was present in six patients, associated with haematuria in four patients.

Humans↗

PubMed1983

Treatment of advanced prostatic cancer with buserelin, an analogue of gonadotrophin releasing hormone.

Twenty-two consecutive patients with newly diagnosed symptomatic, locally advanced or metastatic prostate cancer were treated with intranasal buserelin, a long-acting analogue of gonadotrophin releasing hormone, in divided dosages of between 600 and 1000 micrograms daily. Suppression of testosterone occurred in 1 of 5 patients treated with 600 micrograms daily and in all 17 patients receiving 1000 micrograms daily. Two of 5 patients treated with the 600 micrograms regimen and 16 of 17 patients receiving the 1000 micrograms regimen showed subjective and objective evidence of disease regression. Follow-up was from 1 to 16 months (mean 7.1 months); 6 patients have relapsed during this period. Buserelin offers an effective alternative medical treatment of carcinoma of the prostate and, apart from impotence, does not have the side effects of oestrogens.

Administration, Intranasal↗

PubMed1983

Orchiectomy alone for Stage I testicular non-seminoma. A progress report on the Royal Marsden Hospital study.

Eighty-four patients with clinical Stage I non-seminomatous germ-cell testicular tumours were entered into a prospective study after orchiectomy to evaluate a policy of close surveillance without lymph node irradiation or node dissection; 16 (19%) have manifested evidence of metastatic disease and received chemotherapy. All patients in the study are alive, 3 of the 16 relapsing patients are receiving chemotherapy and the 13 who have completed it are in complete remission at 4 to 43 months (mean 21). Relapses were diagnosed at 2 to 8 months (mean 5.3 months) after orchiectomy and were not invariably associated with elevated serum markers. The relapse rate was significantly higher for malignant teratoma undifferentiated (MTU) primary tumours than malignant teratoma intermediate (MTI) (40.7 and 6.8% respectively) and preliminary data suggest that the association of MTU with vascular invasion places the patient at high risk of relapse. Pre-orchiectomy serum marker status was not a significant prognostic factor. Despite sub-optimal surgical management in 11/84 patients no example of scrotal recurrence has been encountered. It is concluded that a rigorously monitored policy of close surveillance after orchiectomy is a feasible and successful method of management in Stage I testicular non-seminoma. Further experience should allow patients requiring immediate post-orchiectomy chemotherapy to be identified.

Castration↗

PubMed1983

Evaluation of radiotherapy and/or surgicopathological staging after chemotherapy in the management of metastatic germ cell tumours.

Thirty of 83 patients with metastatic germ cell tumours undergoing cytotoxic chemotherapy have required post-treatment surgicopathological staging and in ten of these, viable malignancy was detected. In 8, cystic mature teratoma was excised. Though this surgery can be extremely difficult and in 12 of the 30 cases necrotic tissue only was excised, the toxicity and distress of continuing unnecessary chemotherapy for the patients with necrotic tissue or mature teratoma, and the chance to cure patients with persistent malignant disease with second-line chemotherapy, mean that the early use of this surgery will continue to be an extremely important element in the management of patients with malignant teratoma. However, for patients with metastatic pure seminoma, given the difficulty of removing residual necrotic tissue because of dense fibrous tissue and the exquisite sensitivity to single agent cisplatinum therapy demonstrated in this paper, it is preferable to delay surgery until post-treatment regression has ceased.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1983

Semen analysis in testicular cancer and Hodgkin's disease: pre- and post-treatment findings and implications for cryopreservation.

Over a 7-year period, seminal analysis has been performed on 208 patients with testicular tumours, after orchiectomy, but before any other treatment. Only 22% of 54 patients with seminomas, and 29% of 154 patients with teratomas or mixed tumours, had sperm counts exceeding 10 million per ml. Very low sperm counts were observed in some patients who had previously fathered children. Post-treatment sperm counts were done in 117 patients, 80 of whom had received multiple drug chemotherapy: 42 of these men had pre- and post-treatment sperm counts. Overall, 24% of men receiving chemotherapy recovered sperm counts greater than 10 million per ml up to 3 years after therapy. Surprisingly, such recovery was seen in 35% of 23 men with initially poor sperm counts, but in only 26% of 19 with good initial counts. Only 27% of 49 patients with Hodgkin's disease had initial sperm counts of more than 10 million per ml; after chemotherapy only 1 of 29 patients recovered to this level. Only one quarter of these young men had semen which was adequate for cryopreservation. Artificial insemination with semen preserved in liquid nitrogen has been performed in 15 couples: 2 normal babies have been produced and a third pregnancy is progressing normally.

Dysgerminoma↗

PubMed1983

Exploratory scrototomy in 168 azoospermic males.

In 168 azoospermic males with normal or only slightly raised serum FSH levels, serum antisperm antibodies were measured, and the site of obstruction or the nature of the failure of spermatogenesis was defined by exploratory scrototomy with inspection of epididymes, vasography and testicular biopsy. When possible, surgical reconstruction was done by side-to-side epididymovasostomy, with vasovasostomy when necessary using 6/0 Prolene and no splints. Acquired blocks of cauda epididymis (34 cases) and vas (23 cases) were significantly more commonly associated with serum antisperm antibodies than congenital bilateral absence of vasa (29 cases) or blocks at the caput epididymis (48 cases), most of which were associated with sinusitis, bronchitis or bronchiectasis (Young's syndrome). Many of the former patients came from abroad, whereas most of the latter came from the British Isles. Sperm counts of 10 million per ml or more were produced by 23 (45%) of 51 adequately followed up patients with acquired blocks following surgical reconstruction, and 11 pregnancies (21.5%) were produced. Amongst those with spermatozoa in the ejaculate after surgery, serum antisperm antibodies were found significantly less often in those whose wives became pregnant compared with those who failed to produce pregnancies. It is concluded that failure of surgical treatment in some of these cases may have an immunological basis. No success was achieved with other groups.

Antibodies↗

PubMed1983

The value of the mixed antiglobulin reaction (MAR test) as an addition to routine seminal analysis in the evaluation of the subfertile couple.

A mixed erythrocyte-spermatozoa antiglobulin reaction (MAR test) for IgG antibodies has been done on semen specimens supplied by the male partners in 720 subfertile couples during a two-year period. The test was possible in all except 69 patients (9.5%). Antisperm antibodies were detected in 48 (10%) of 484 men with normal sperm counts, 18 (23%) of 78 with low sperm motility, and 19 (15%) of 128 with low counts. In 204 patients, antisperm antibodies were also measured by serum sperm-agglutination tests: The results showed a highly significant correlation with the results of MAR testing. It is concluded that the MAR test should be a routine part of seminal analysis, since the presence of IgG antisperm antibodies can be established in about 10% of men who might otherwise be passed as normal, and such antibodies can be positively excluded in a further 78% of the male partners of infertile marriages.

Autoantibodies↗

PubMed1982

Orchidectomy alone in testicular stage I non-seminomatous germ-cell tumours.

53 patients with clinical stage I non-seminomatous germ-cell testicular tumours were entered into a prospective study to receive no treatment other than orchidectomy until unequivocal clinical evidence of metastases was established. Of this group, 9 men (17%) have relapsed, 8 within six months of orchidectomy. All 9 are alive and disease-free after chemotherapy. The relapse rate was higher in patients with malignant teratoma undifferentiated (embryonal carcinoma) primary tumours than in those with malignant teratoma intermediate (teratocarcinoma); 42.8 and 3.4%, respectively. The results were compared with those from 157 men treated by orchidectomy and radiotherapy for stage I disease. In this group, 49 patients (25.8%) relapsed and 85% of relapses occurred within one year of orchidectomy. The tempo relapse was identical for embryonal carcinoma and teratocarcinoma. Of 32 patients in whom serum markers were measured before orchidectomy, 24 (75%) had raised levels of alphafetoprotein and/or beta human chorionic gonadotropin. These preliminary results imply that routine lymphadenectomy or lymph node irradiation in clinical state I testicular non-seminoma may be unjustifiable.

Dysgerminoma↗