Salah Al-Askari

Renal cell carcinoma: Survival and prognostic factors

Three hundred twenty-six patients treated at New York University from 1970 to 1982 were studied for survival in relationship to surgical stage, type of therapy, and pathologic characterization of the primary tumor. At the time of diagnosis 25.5 per cent of tumors were Stage I, 15 per cent Stage II, 28.5 per cent Stage III, and 31 per cent Stage IV. The retrospective study showed that patients with tumor confined within the capsule achieved the highest five- and ten-year survivals of 88 per cent and 66 per cent, respectively. Survivals decreased as tumor invaded perirenal fat (67% and 35%) or regional lymph nodes (17% and 5%). Tumor invasion into the renal vein alone did not significantly change five-year survival (84%) but lowered ten-year survival to 45 per cent. Patients with metastases at the time of nephrectomy did poorly regardless of site of metastases or kind of adjuvant therapy, except for those managed by surgical extirpation of the secondary lesion. Certain tumor characteristics were associated with a better prognosis, e.g., size below 5 cm in diameter, lack of invasion of collecting system, perirenal fat or regional lymph nodes, and predominance of clear or granular cells growing into a recognizable histologic pattern.

Extended Pelvic Lymphadenectomy for Prostatic Cancer

Thirty patients with clinically localized prostatic carcinoma underwent extended pelvic lymph-adenectomy, including the presacral and presciatic (lateral sacral) areas. The first echelon of pelvic nodes to be involved by metastases was the external iliac, obturator, presacral and presciatic. The deep presacral-presciatic nodes were involved almost as often as the more superficial external iliac-obturator group. Metastases limited only to the deep pelvic nodes were found in 14 per cent of the cases.

Cat scanning in staging of prostatic cancer

Forty-six patients with histologically proved adenocarcinoma of the prostate underwent pelvic lymphadenectomy after CAT scanning. The accuracy, specificity, and sensitivity of the CAT scan in detecting nodal metastasis were 70, 93 and 30 per cent, respectively; this compares favorably with pedal lymphangiography. Seventeen of the patients had radical prostatectomy. The accuracy, specificity, and sensitivity of the CAT scan in depicting local extent of the tumor were 47, 100, and 18 per cent, respectively; although low, no other clinical or biochemical method provides a better result.

Radical prostatectomy for stage D1 prostate cancer: Prognostic variables and results of treatment

Surgical extirpation of the primary tumor together with the involved regional nodes has been considered ineffective treatment for locally disseminated prostatic carcinoma. We retrospectively reviewed our experience with 42 patients with Stage D1 disease who underwent radical prostatectomy and bilateral pelvic lymphadenectomy and who had a follow-up of one to thirteen years (mean 5 years). The following variables affecting survival and tumor progression were analyzed: (1) tumor grade and local extent; (2) number of positive lymph nodes, and (3) adjuvant therapy. The overall five- and ten-year survival was 79.5 per cent and 28 per cent compared with the expected survival of an age-matched control group of 88 per cent and 28 per cent, respectively. The degree of tumor differentiation had no effect on prognosis, but local tumor bulk and the number of involved lymph nodes significantly changed the disease progression and survival rate. Patients with low local tumor bulk and one positive node survived as long as the age-matched male population group. Our data suggest that radical prostatectomy may represent a valuable treatment in selected patients with Stage D1 prostate carcinoma.

Radical prostatectomy for stage D1 prostate cancer

Abstract Surgical extirpation of the primary tumor together with the involved regional nodes has been considered ineffective treatment for locally disseminated prostatic carcinoma. We retrospectively reviewed our experience with 42 patients with Stage D1 disease who underwent radical prostatectomy and bilateral pelvic lymphadenectomy and who had a follow-up of one to thirteen years (mean 5 years). The following variables affecting survival and tumor progression were analyzed: (1) tumor grade and local extent; (2) number of positive lymph nodes, and (3) adjuvant therapy. The overall five- and ten-year survival was 79.5 per cent and 28 per cent compared with the expected survival of an age-matched control group of 88 per cent and 68 per cent, respectively. The degree of tumor differentiation had no effect on prognosis, but local tumor bulk and the number of involved lymph nodes significantly changed the disease progression and survival rate. Patients with low local tumor bulk and one positive node survived as long as the age-matched male population group. Our data suggest that radical prostatectomy may represent a valuable treatment in selected patients with Stage DI prostate carcinoma.

Aggressive Treatment of Metastatic Renal Cancer

Radical nephrectomy and excision of metastases were performed in 21 patients with metastatic renal cell carcinoma. Followup was 12 years. Eight patients had metastases at the time of diagnosis and survived an average of 54 months, with 50 per cent alive 5 years postoperatively. Metastases developed after nephrectomy for localized disease in 13 patients. After extirpation of the secondary lesions these 13 patients survived an average of 38 months and 25 per cent were alive at 5 years. Survival varied with the length of time free of disease. Patients in whom metastases developed later than 2 years after nephrectomy survived 55 months compared to only 22 months for those in whom metastases developed earlier. Survival also was influenced by tumor aggressiveness (reflected by prognostic index number) and completeness of surgical excision of the secondary lesion.

Anterior urethral valves.

Three cases of anterior urethral valves, a rare congenital anomaly are reported. Anterior urethral valves probably represent an attempt at duplication of the urethra in the first twelve to fourteen weeks of intrauterine life. The most common type is cusp-like and most frequently located in the bulbar urethra. The presenting complaints are lower tract symptoms, and the diagnosis is usually made by a voiding urethrogram.

35 – THE PREPARATION AND PURIFICATION OF TRANSFER FACTOR*

Publisher Summary Transfer factor (TF) is the active moiety present in a particular population of circulating blood leukocytes of specifically sensitive human subjects that transfers cutaneous reactivity of the delayed type to nonsensitive individuals. TF preparations have equal potency when compared to the equivalent number of viable parent leukocytes from which transfer factor is derived. For the preparation of TF, the preliminary step involves the isolation and concentration of leukocytes from the plasma of heparinized venous blood— a procedure facilitated by the addition of a macromolecule to hasten erythrocyte sedimentation. The most important condition to be met if successful transfer is to occur is the selection of a donor with an intense degree of delayed cutaneous reactivity to the specific antigen under study. The use of leukocyte preparations obtained from donors who have negative skin reaction to the particular antigen will not result in a transfer of sensitivity no matter how often the recipient is skin tested with antigen.

Bilateral testicular germ cell malignancy

The other testicle was involved in 6 of 235 patients (2.69 per cent) with a history of testicular germ cell tumor. It occurred more often following seminoma (4 of 113, 3.5 per cent cases). The mean age at occurrence of the first tumor (twenty-five years) was earlier than expected, and the mean interval between tumors was 8.8 years. Accurate clinical staging of second tumors is impeded by alteration in the routes of metastatic dissemination, and treatment options are limited by previous therapy for the first tumor.

In vivo hypothermic perfusion during renal surgery.

Abstract In vivo hypothermic renal perfusion was successfully employed for complete removal of advanced staghorn calculi. The kidney after being perfused and cooled to 10°C, tolerated two hours of vascular occlusion with preservation of renal function. The technical aspects and clinical potentials of this technique are presented.