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Biomedical subjects

Wade J Sexton

Publications and source records attributed to Wade J Sexton.

8 recordsLinked to original sources

Lack of BK virus DNA sequences in most transitional-cell carcinomas of the bladder.

BK virus (BKV), a common human polyomavirus infection latent in the kidneys, can reactivate with immunosuppression to cause renal disease. Some have suggested that BKV may contribute to the development of bladder cancer, and BKV sequences have been reported from bladder tumors. To further examine the role of BKV in human bladder cancer, a series of bladder tumors was investigated for BKV genomic sequences. Fresh-frozen specimens from 76 transitional cell carcinoma tissues and 46 paired adjacent normal urothelial tissues archived at the H. Lee Moffitt Cancer Center were studied. All tissues were histopathologically reviewed. DNA extracted from the tissues was tested by quantitative real-time polymerase chain reaction (QPCR) assays to detect BKV DNA sequences in the VP1 coding region. Amplification of ERV-3 was conducted separately to quantify cell copy number. Conventional PCR targeting the BKV T-antigen (T-Ag) coding region and immunohistochemistry for BKV T-Ag were also conducted on all tissues that tested positive for BKV by QPCR. Seventy-three bladder tumors yielded >/=3,000 copies of ERV-3, 4 (5.5%) of which tested positive for BKV with average copy numbers of 7.9, 15.8, 0.4 and 0.3 per 1,000 cells. Paired normal tissue was available for 2 of these BKV-positive tumors, 1 of which was BKV-positive (14.6 copies/1,000 cells). No other normal tissues were BKV-positive by QPCR. The 6 BKV-positive tissues by QPCR were also positive by conventional PCR, but all stained negative for BKV T-Ag by immunohistochemistry. BKV is unlikely to be involved in the etiology of most bladder tumors.

Aged↗

Delayed metastatic renal carcinoma to prostate.

Renal cell carcinoma metastatic to the prostate is a rare entity. We report a delayed (9 years) metachronous solitary metastasis presentation of renal cell carcinoma to the prostate. Including our patient, only 5 cases of metastatic renal cell carcinoma to the prostate have been reported. Four patients presented with hematuria and two with bladder outlet obstruction; one had an incidental finding after prostate biopsy. Radical prostatectomy could be considered for patients with the prostate as the only site of disease.

Carcinoma, Renal Cell↗

Management of locally advanced renal cell carcinoma.

BACKGROUND: Renal cell carcinoma accounts for approximately 3% of adult malignancies and over 90% of primary renal tumors. Recurrence rates for patients with locally advanced renal cell carcinoma (LARCC) remain high. METHODS: The authors review literature regarding prognostic factors, potential biomarkers, surgical strategies, and adjuvant therapy trials for patients with LARCC. RESULTS: Molecular tumor markers may improve existing staging systems for predicting prognosis. Surgery is the best initial treatment for most patients with clinically localized renal tumors, although complete surgical resection can be challenging for patients with large tumors, bulky regional lymph node involvement, or inferior vena cava tumor thrombus. Significant recurrence rates for patients with LARCC undergoing nephrectomy indicate the presence of undetected micrometastases at the time of surgery. Adjuvant radiation, chemotherapy, and immunotherapy have been ineffective. Other trials of adjuvant therapy are ongoing. CONCLUSIONS: Aggressive surgical resection alone for LARCC is not sufficient to prevent disease recurrence in a significant number of patients. Adjuvant therapies are needed to improve cancer-specific survival.

Biomarkers, Tumor↗

Evaluation of mechanical bowel preparation methods in urinary diversion surgery.

OBJECTIVES: We performed the first prospective, randomized, multi-center comparison of overall quality and patient tolerability of polyethylene glycol (PEG) and sodium phosphate (NaP) solution for mechanical bowel preparation prior to urinary diversion surgery. METHODS: Between 2001 and 2003, 36 patients at six institutions underwent major urological reconstructive surgery incorporating small intestine (35 radical cystectomy with urinary diversion and 1 bladder augmentation). Patients were prospectively randomized to receive either oral polyethylene glycol (group 1, n = 16) or sodium phosphate (group 2, n = 20) for mechanical bowel preparation prior to surgery, according to our multi-institutional IRB-approved protocol. All patients completed a questionnaire the morning of surgery to assess the tolerability and side effects of each agent. Quality of the bowel preparation was recorded based on intraoperative findings of the attending surgeon, who was blinded to the preparation method. RESULTS: Both bowel cleansing regimens were safe and well tolerated. Patient-reported ease of use and subjective incidence of side effects were statistically similar in the two groups, and a statistically non-significant trend to more bloating in the PEG group was also noted (p = 0.085). Surgeon-scored overall quality of preparation adequacy revealed no significant differences between oral sodium phosphate and polyethylene glycol solutions (p = 0.555). Postoperative complications were rare for each bowel preparation agent. CONCLUSIONS: Performance characteristics of oral sodium phosphate and polyethylene glycol bowel preparations appear to be similar. Each method is safe, efficacious, and well-tolerated when used prior to urinary diversion surgery. The cost for the NaP preparation was $1.40 versus $19.70 for the PEG bowel preparation. Sodium phosphate may have a slight advantage because of its convenience and economic advantage.

Cathartics↗

Pathologic variables and recurrence rates as related to obesity and race in men with prostate cancer undergoing radical prostatectomy.

PURPOSE: To determine if obesity is associated with higher prostate specific antigen recurrence rates after radical prostatectomy (RP), and to explore racial differences in body mass index (BMI) as a potential explanation for the disparity in outcome between black and white men. PATIENTS AND METHODS: A retrospective, multi-institutional pooled analysis of 3,162 men undergoing RP was conducted at nine US military medical centers between 1987 and 2002. Patients were initially categorized as obese (BMI > or = 30 kg/m(2)), overweight (BMI 25 to 30 kg/m(2)), or normal (BMI < or = 25 kg/m(2)). For analysis, normal and overweight groups were combined (BMI < 30 kg/m(2)) and compared with the obese group (BMI > or = 30 kg/m(2)) with regard to biochemical recurrence (prostate-specific antigen > or = 0.2 ng/mL) after RP. RESULTS: Of 3,162 patients, 600 (19.0%) were obese and 2,562 (81%) were not obese. BMI was an independent predictor of higher Gleason grade cancer (P <.001) and was associated with a higher risk of biochemical recurrence (P =.027). Blacks had higher BMI (P <.001) and higher recurrence rates (P =.003) than whites. Both BMI (P =.028) and black race (P =.002) predicted higher prostate specific antigen recurrence rates. In multivariate analysis of race, BMI, and pathologic factors, black race (P =.021) remained a significant independent predictor of recurrence. CONCLUSION: Obesity is associated with higher grade cancer and higher recurrence rates after RP. Black men have higher recurrence rates and greater BMI than white men. These findings support the hypothesis that obesity is associated with progression of latent to clinically significant prostate cancer (PC) and suggest that BMI may account, in part, for the racial variability in PC risk.

Black People↗

Repeat retroperitoneal lymph node dissection for metastatic testis cancer.

PURPOSE: We report pathological results, perioperative complications and patient outcome in 21 men after repeat retroperitoneal lymph node dissection for metastatic testis cancer. MATERIALS AND METHODS: We reviewed an institutional tumor registry at our cancer center and identified 417 patients who underwent retroperitoneal lymph node dissection for testis cancer during a 21-year period. Of these 417 patients 21 underwent repeat retroperitoneal lymph node dissection. We reviewed preoperative patient characteristics, operative data and pathological findings from repeat lymphadenectomy, and determined patient disease status, morbidity and mortality after surgery. RESULTS: We identified viable germ cell tumor in 5 patients (24%), teratoma in 14 (67%) and fibrosis or necrosis only in 5 (24%). Intraoperatively subadventitial dissection of the aorta occurred in 2 cases, which was severe enough in 1 to require an aortic graft. The most common postoperative complications were prolonged ileus or partial bowel obstruction and chylous ascites in 6 and 3 patients, respectively. Six patients died, including 5 of disease progression and 1 of postoperative pulmonary embolus. At a mean followup of 4.7 years (range 0.1 to 14) 15 patients (71%) were alive and 14 (67%) were disease-free. CONCLUSIONS: Repeat retroperitoneal lymph node dissection is safe and effective in the majority of patients with recurrent or residual retroperitoneal masses after initial multimodality treatments for metastatic testis cancer. Overall perioperative morbidity and mortality are low and yet the potential for significant vascular complications warrants careful preoperative planning and intraoperative judgment.

Adolescent↗