Long-term results of treatment for prostate carcinoma by staging pelvic lymph node dissection and definitive irradiation using low-dose rate temporary iridium-192 interstitial implant and external beam radiotherapy.

BACKGROUND: The objective of this study was to evaluate long-term treatment outcome of definitive irradiation by using temporary interstitial implant and limited dose of external beam radiotherapy in treatment of localized prostate carcinoma. METHODS: In total, 536 patients with biopsy-proven adenocarcinoma of the prostate, classification T1-T3, underwent staging pelvic lymph node dissection and brachytherapy delivering an average tumor dose of 30 grays (Gy), supplemented by external beam radiation therapy for an additional dose of 36 Gy delivered over 4 weeks. One hundred of 536 (18%) patients had pathologic D1 disease. A total of 181 patients had undergone transurethral prostatectomy before the treatment. Repeat prostate biopsy was performed on 132 patients 18 or more months after treatment. None of the patients received neoadjuvant or adjuvant hormone therapy. RESULTS: Cumulative disease free survival (DFS) including biochemical DFS at 10 and 15 years for classification T1B,C was 78% and 72%; for T2A, 78% and 78%; for T2B,C, 68% and 66%; and for T3A-C, 45% and 45%, respectively. Cause specific survival for the entire group at 10 and 15 years was 89% and 87%, respectively. Severe complications occurred only in the early developmental phase of the study. CONCLUSIONS: In univariate analysis, the clinical stage, histologic grade, pretreatment PSA level, lymph node status, and results of repeat posttreatment biopsy were all independently significant prognostic factors. However, the authors' study indicates that in multivariate analysis, only two factors emerged with statistical significance-the status of pelvic lymph nodes and the results of posttreatment biopsy. This signifies the importance of local tumor control to achieve ultimate cure and the importance of assessment of pelvic lymph nodes before definitive local therapy other than radical prostatectomy, especially in the high-risk group.

Temporary iridium-192 implant in the management of carcinoma of the prostate.

The controversy about the treatment of carcinoma of the prostate has increased in the last decade, with most urologists favoring radical prostatectomy rather than primary irradiation. Several reports of persistent tumors in 50% to 90% of patients after external irradiation and permanent iodine-125 implantation of the prostate have been disturbing. From July 1977 to December 1985, 200 patients with adenocarcinoma of the prostate were treated by combining bilateral pelvic lymphadenectomy and temporary interstitial iridium-192 implantation of the prostate, followed by external irradiation. Seventy-four (36%) patients underwent biopsies of the prostate 4 months to 2 years after completion of the irradiation. Only 12 (16%) patients had persistent tumors. Complications were minimized subsequently by dose modifications.

Laser-assisted vasectomy reversal: experience in 32 patients.

A Food and Drug Administration approved protocol using a microsurgical carbon dioxide laser to assist in vasectomy reversal was instituted in January 1987. Between January 1987 and December 1988 the procedure was performed on 32 patients, 31 of whom submitted sperm and were available to evaluate. Success rates for sperm in the ejaculate in patients who underwent vasectomy less than 10 years previously were excellent, approaching 95%. The pregnancy rate in this group was 35%. In patients whose vasectomy was performed more than 10 years before reversal the results were much poorer. The success rate for sperm in the ejaculate was only 36% and the pregnancy rate was only 9%. The advantage of laser-assisted vasectomy reversal is that it is a simpler technical procedure that requires considerably less time than a 2-layer microsurgical technique. There were no significant complications, sperm granuloma, or even significant swelling or hematoma in any patient operated upon. Laser-assisted vasectomy reversal is at least equal to conventional microsurgical techniques and definitely easier to perform surgically.

Comparative study of sodium, potassium, ionized calcium, urea and creatinine circadian rhythm documented in samples of capillary and venous blood from healthy subjects.

Circadian rhythms of sodium, potassium, ionized calcium, creatinine and urea concentrations were determined in venous and capillary blood of practically healthy volunteers (10 women and 8 men). Electrolytes were determined on the ionoselective analyzer Microlyte (KONE, Finland). Circadian rhythmicity of parameters was revealed in venous and capillary blood by means of group-mean cosinor analysis. Acrophases of the rhythms occurred in the late evening (Na) or in the first (K, venous ionized Ca) and in the second half (creatinine, urea) of sleep. Circadian rhythms of electrolytes (except ionized Ca rhythm) and final products of nitrous metabolism in capillary blood turned out to be the markers of the corresponding indices rhythms of venous blood.

K.T.P. 532 laser in treatment of urethral strictures.

We have had experience in the treatment of 20 patients with 22 strictures with this new laser that has a unique ability to cut and coagulate with minimal forward scatter to help prevent the formation of new scar tissue. All of the patients have had attempts of treatment of the strictures unsuccessfully in the past. The laser was effective in 68.2% of the patients to keep the urethra open and patent although the follow-up periods have been short at the time of this report ranging from six months to fourteen months. This new laser may have some promise in the treatment of urethral stricture disease.

Use of Nd:YAG laser in treatment of bladder cancer.

A total of 53 patients were treated with neodymium:yttrium-aluminum garnet (Nd:YAG) laser and followed up for two years. Three patients had carcinoma in situ (CIS); 4 had Ta lesions; and 28 had TINxMo, 8 had T2NxMo, and 10 had T3NxMo lesions. The patients with CIS received a combination of Nd:YAG laser and intravesical bacillus Calmette Guérin (BCG) instillation. The remainder of the patients received no supplementary chemotherapy. No tumor recurrence was noted in those with Ta lesions. Tumor recurred in 18 per cent of patients with T1 lesions, and 33 per cent of those with T2 lesions; 80 per cent of patients with T3 lesions had resistant or residual tumors. In patients with CIS, there was no tumor recurrence. Nd:YAG laser is effective in Ta, T1, and T2 bladder cancers, with low recurrence rate and minimal complications. In very select, high-risk patients with small lesions, and in those who refuse cystectomy, there may be a place for laser therapy for either palliation or definitive treatment of T3 invasive tumors of the bladder.

Use of bupivacaine as block to relieve postoperative pain in pediatric orchiopexy and hernia repair.

Bupivacaine was utilized for postoperative analgesia in patients undergoing orchiopexy and hernia repair. In a study of 75 pediatric patients, ranging in ages from twelve months to twelve years, who had undergone orchiopexy and hernia repair during a three-year period, 42 received bupivacaine hydrochloride as a local infiltration block anesthesia to relieve postoperative pain; 33 patients did not receive bupivacaine. Patients receiving bupivacaine had less postoperative pain and were more comfortable when leaving the hospital within a few hours after surgery.

Treatment of interstitial cystitis with the neodymium-YAG laser.

Five patients with severe interstitial cystitis that had not responded to conventional means of therapy were treated with the neodymium-YAG laser. Of the 5 patients 4 demonstrated cessation of severe bladder pain and frequency of urination within several days after therapy. These patients also were studied objectively by measuring bladder capacity, which was found to be increased over-all. Complication rates from this modality of therapy were extremely low. The patients have been followed for 3 to 15 months after treatment and to date have had no recurrent symptoms of severe interstitial cystitis, although some have had mild recurrent voiding symptoms.

Pheochromocytoma with hypercalcemia: case report and review of literature.

We report a case of severe hypercalcemia and a pheochromocytoma of the right adrenal gland. The patient underwent adrenalectomy, following which the hypercalcemia disappeared. Parathormone assay of the adrenal tumor revealed high levels of activity despite normal serum parathormone activity. This suggests that the etiology of hypercalcemia in patients with pheochromocytoma is related to ectopic secretion of a parathormone ectopic peptide-like substance.

The use of lipid emulsion as an intravesical medium to disperse light in the potential treatment of bladder tumors.

An obstacle to satisfactory treatment of early bladder cancer with hematoporphyrin derivative-photoradiation therapy is nonuniform illumination of the bladder mucosa. This study was done to determine the characteristics and attenuation of laser light passing through the dispersion medium. Bladder simulation was achieved with the use of 5 different sizes of round-bottom flasks. Intralipid was the dispersion medium. For each flask, 6 different concentrations of the dispersion medium were used. An Argon ion laser was used to stimulate a dye laser at 630 nm. The laser was directed toward the center of the flasks via a fiberoptic cable and energy concentration at 7 different angles was measured. We concluded that the optimal medium was a 1:100 dilution of Intralipid with water, which produced an almost uniform dispersion of light on the walls of the flask. There is a linear correlation between power as measured at the fiber tip and the amount of radiation detected on the walls of the flasks. After determining optimal concentration of medium, we calculated the amount of time needed for a desired energy (Joules/cm.2) to treat a tumor. This calculation was based on the size of the bladder and the power as measured at the fiber tip. The results indicate it is possible to treat the entire mucosa of the bladder with a uniform dose of photoradiation energy.

Laser photoradiation therapy of cancer: an update of the experience at the University of California, Irvine.

This update of the experience at the University of California at Irvine with laser photoradiation therapy (PRT) encompasses the period between May 1981 and June 1983. The results of treatment of 77 patients are reported (head and neck, 39; breast, 33; and lung 5). Head and neck cancer patients received treatment to 114 sites with a complete response (CR) in 28, partial response (PR) in 42, stable disease (SD) in three, and no response (NR) in 34, and an undetermined response in seven. Breast cancer patients were treated in 395 sites with CR in 222, PR in 74, SD in one, NR in 92, and undetermined response in six. The lung cancer patients in this series responded poorly, if at all. In addition to the above patient trials, we have investigated the interaction of laser hematoporphyrin derivative (HPD)-PRT with a chemotherapeutic agent, Cisplatin, against an experimental tumor (RIF-1) in an animal model. We have been unable to demonstrate an additive effect of laser HPD-PRT at total light doses of 25 J/cm2 and 75 J/cm2 with Cisplatin at a dose of 7 mg/kg. However, no additional toxicity was observed in combination therapy, suggesting that sequential application of laser HPD-PRT and Cisplatin may be safely employed in clinical situations. Another area of investigation has been the evaluation of the light-scattering characteristics of a lipid emulsion designed for laser HPD-PRT of bladder tumors. We have demonstrated that it is feasible to gain uniform illumination of the bladder surface with the use of this light-dispersing medium.(ABSTRACT TRUNCATED AT 250 WORDS)