John H. Texter

Role of computed tomography in the evaluation and management of carcinoma of the prostate

Between January 1978 to March 1980, 25 patients with biopsy-proven prostate carcinoma were evaluated by computerized tomography (CT). CT differed from clinical stage in 7 of 25 patients (28%). In 6 of the 7 patients, change in stage resulted because of demonstration of extracapsular extension and/or pelvic lymph node involvement. Twelve of the 25 patients (48%) underwent surgery with histological confirmation of CT findings. Ct identified nodal involvement accurately in 10 of 12 patients (83%). We recommend use of CT for initial staging, treatment planning and assessment of response in the management of prostate cancer.

Monoclonal antibodies in ovarian and prostate cancer

Radioimmunoscintigraphy (RIS)--using radiolabeled monoclonal antibodies (MoAbs) to image disease--is a growing subspecialty of nuclear medicine. RIS of the reproductive tracts of men and women has shown encouraging results in imaging both primary lesions and metastases of these cancers. Ovarian cancer is the most fatal gynecologic cancer in the United States, and prostate cancer is the most prevalent form of cancer in men. Several MoAbs against reproductive tumor antigens were used with limited success in clinical trials before 1989. Most recently, MoAbs CYT-103 (satumomab pendetide) and OV-TL 3 have shown promise as safe, sensitive imaging tools for ovarian cancer. Although to date more agents have been used to image ovarian carcinoma than prostate cancer, research has been restimulated in prostate carcinoma imaging because of development of a promising MoAb conjugate, CYT-356. Radionuclide indium-111 appears to be the most promising radiolabeled to date for ovarian and prostate carcinoma RIS performed in the United States. In future clinical trials, consideration of safety issues and a standardization of methods among institutions using RIS are needed before the use of MoAb technology in cancer imaging will become routine. Comparative studies with more traditional methods like computed tomography are needed, as well as more trials comparing radioimmunoscintigraphic findings with pathological evidence.

Pheochromocytoma of the urinary bladder: A broad clinical spectrum

A case of pheochromocytoma of the urinary bladder is reported, and 35 perviously reported cases are analyzed. This interesting entity can present with symptoms of catecholamine excess and severe hypertensive spells (often micturition-induced) or as asymptomatic hematuria without hypertension. The present case represents the severest end of the clinical spectrum, with advancing acute retinopathy and visual loss, very high blood pressure and greatly increased catecholamine excretion. Several special precautions were utilized during diagnostic studies and surgery. On the whole, prognosis is excellent in nonmalignant cases properly handled, and the location of the tumor provides opportunity for early case finding and complete cure.

Ureteral rejection in isolated allograft ureter

Ureteral rejection has been studied in the dog utilizing the isolated transplanted ureter technique. While on adequate immunosuppressive therapy, the allograft ureter remains functionally and histologically normal. When the drugs are discontinued, progressive destructive changes occur within the ureteral wall. As the muscle wall is destroyed the rejection process becomes irreversible. This process helps explain some of the findings seen during clinical renal transplantation.

Endobronchial metastasis from prostatic cancer in patient with renal cell carcinoma

A patient was seen with a right upper lobe endobronchial mass initially thought to be brochogenic carcinoma. There was a history of prostatic carcinoma, and subsequent investigation demonstrated a hypernephroma. Thoracotomy and special studies proved the endobronchial metastasis to be prostatic in origin, a rare cause of endobronchial metastasis.

The isolated ureter. A model for study of ureteral rejection.

Abstract An animal model is demonstrated in which it is possible to study the histologic and functional characteristics of the isolated ureter. This is possible by means of a staged procedure and demonstrates that blood flow sufficient to maintain a viable ureter will develop from the bladder by four weeks following reimplantation. This isolated ureter, if not obstructed or dilated, will continue to produce normal action potentials and contractions when stimulated and will have normal histologic appearance when biopsied. This model is suggested as a means to investigate the problem of ureteral allograft rejection without the influence of renal rejection.

Complications of the Gianturco Coil in Preoperative Infarction of Renal Cell Carcinoma

Percutaneous artery occlusion has been described for a multitude of clinical problems, including preoperative infarction of the kidney for renal cell carcinoma. The Gianturco wool coil provides a relatively new method for occlusion. Few complications with this device have been reported. We describe our experience with complications in 3 patients and discuss methods of their prevention.

Evaluation and management of early stages of carcinoma of prostate.

Abstract If the current treatment modalities are to be used effectively in the management of prostatic cancer, the clinician must be aware of the anatomic extent of the disease prior to initiating therapy. The use of the A, B, C, D staging classification is no longer adequate. Because of the growth characteristics and varying metastatic potential, the staging classification should be subdivided. Also clinical staging of the tumor by use of digital rectal examination, transurethral resection tissue examination, and routine x-ray examination findings are not reliable and are associated frequently with understaging of the actual extent of tumor. While therapeutic benefits of bilateral pelvic lymph node dissection remain controversial, the diagnostic importance is clearly recognized in the early stages of prostatic cancer. Clinical Stage A 1 adenocarcinoma is unlikely to have either lymph node or capsular extension, but this is not true with higher stage malignancies. It is therefore imperative that Stage A 2 through Stage B 2 tumors have pathologic examinations of the pelvic lymph nodes. In general, the higher the clinical stage, the more likely tumor positive lymph nodes will be found. Similarly, it is important to distinguish the high-grade tumor from the low-grade malignancies since less differentiated cancers are associated more frequently with tumor extension to the lymph nodes. Evaluation of past experience in the treatment of localized prostatic carcinoma is difficult since most studies are not randomized; prospective double blind and long-term survival figures are based on inaccurate clinical staging. The time-honored radical surgery using either perineal or retropubic total prostatectomy is appealing since the objective is removal of all malignant tissue. This surgery remains the standard by which all other treatments are compared. For those clinicians who would prefer one of the less invasive techniques, one can find support for either the external beam radiotherapy or the use of interstitial radioactive sources. The early results of radiotherapy are encouraging despite the appearance of recognizable malignant cells in follow-up biopsy specimens. Whether or not the radiotherapy measures up to or exceeds that of radical surgery, can be judged only when long-term survival statistics based on anatomic staging and careful grading are known.

Single Stage Urethroplasty as Treatment for Stricture Disease

The use of a full thickness free skin graft for a single stage urethroplasty in stricture disease has been popularized recently by Devine and Horton. From 1973 to 1977, 40 patients at our hospitals have been treated with single stage urethroplasty using this technique. Excellent results have been noted on followup evaluation.

Paraganglioma of urinary bladder wall

A classic case of pheochromocytoma of the urinary bladder is presented. The history of headaches and palpitations during micturition is the result of sudden release of catecholamines into the general circulation. The diagnosis using selective arteriography as well as the medical and surgical management are described.