Effects of adrenergic antagonists on cocaine-induced changes in respiratory function.

Cocaine-induced changes in respiratory rate (f), tidal volume (VT), total pulmonary ventilation (VE), dynamic lung compliance (Cdyn) and total pulmonary resistance (RL) were measured in anesthetized, spontaneously breathing Sprague-Dawley rats using a whole-body plethysmograph and an esophageal manometer. Carotid arterial pressure and heart rate were simultaneously monitored. An intravenous (i.v.) dose of 10 mg/kg of cocaine was lethal in all rats tested with death resulting from respiratory failure occurring between 0.25 and 1.5 min after dosing. At an i.v. dosage of 5 mg/kg, cocaine was nonlethal, although a reduction in VE was evident during the first minute after dosing. This reduction in VE was due to a decrease in f and the lack of a compensatory increase in VT. A slight decrease in RL also became evident approximately five minutes after dosing. Pretreatment with the nonselective alpha-adrenergic antagonist phentolamine (10 mg/kg) prevented the cocaine-induced depression in VE by reducing the decrease in f and blocking the inhibition of a compensatory increase in VT. In contrast, pretreatment with the nonselective beta-adrenergic antagonist propranolol (1 mg/kg) potentiated the cocaine-induced decrease in VE by enhancing the depression of f. Pretreatment with propranolol also caused a cocaine-dependent decrease in Cdyn. At a dosage of 0.3 mg/kg, labetalol, a compound possessing both nonselective alpha- and beta 1-antagonist activity (1:7) appeared to cause only a minimal potentiation of the cocaine-induced depressions in VE and f. Pretreatment with propranolol or labetalol also resulted in the death of 20% of the rats administered 5 mg/kg of cocaine.(ABSTRACT TRUNCATED AT 250 WORDS)

Yield of cancer tissue from prostatic needle biopsy.

This study concerns the quality of human prostatic cancer needle biopsy specimens for routine diagnosis and for bioassay. We examined routine hematoxylin and eosin-stained microscopic sections from 20 prostatic cancer patients, 159 needle cores in all, 71 positive for tumor. Linear core measurements were made with a calibrated ocular micrometer, each segment counted positive if it contained any tumor. Among all subjects there were 35.5 cm of tumor-bearing core length, 26 per cent of the total core length but 60 per cent of the length if completely negative cores were excluded. From these data we calculate a 91 per cent probability of detecting any cancer present if at least 4 cores are taken.

Use of intravesical cisplatin and mitomycin-C for recurrent transitional cell carcinoma of bladder refractory to thiotepa.

Superficial transitional cell carcinoma of the bladder (TCCaB) has a high incidence of recurrence. Intravesical thiotepa is the drug used most often for treatment. Intravesical mitomycin-C also has shown promise. Cisplatin has proven activity in patients with metastatic TCCaB and in experimental bladder cancer models. Patients who have no response to one intravesical agent such as thiotepa may respond to other agent(s) such as mitomycin-C or cisplatin. In this report we have evaluated 10 patients with superficial recurrent TCCaB who showed no response to intravesical thiotepa and were subsequently treated with mitomycin-C or cisplatin. Six patients were treated with cisplatin and 4 with mitomycin-C. The 4 treated with mitomycin-C had complete response or partial response within three months. Of the 6 treated with cisplatin, 4 had complete response within three months, and 2 had no response.

Cystadenocarcinoma of the kidney: a profile of 13 cases.

Cystadenocarcinoma is an uncommon variant of renal cell carcinoma that is cystic in appearance. Our experience with 13 of these tumors is presented. The biological behavior was similar to renal cell carcinoma in general, although a greater proportion presented as stage I lesions. Computerized tomography and cyst aspiration may be helpful to differentiate these tumors from simple cysts.

Radical prostatectomy with adjuvant radioactive gold for prostatic cancer: a preliminary report.

A total of 71 patients with prostatic carcinoma underwent radical prostatectomy combined with instillation of radioactive gold seeds between January 1, 1977 and July 1, 1982. Gold seeds were implanted intraoperatively into the region of the prostatic vascular pedicles and surrounding fibrolymphatic tissue after removal of the prostate and seminal vesicles. Of the patients with disease confined to the prostate clinically 46.7 per cent had microscopic extraprostatic local tumor extension. We believe that patients with extraprostatic local tumor derive therapeutic benefit from the addition of adjuvant radioactive gold seeds at prostatectomy. Because of the inaccuracy of clinical staging by rectal examination, we have elected to use radioactive gold seeds in all of our patients at prostatectomy. To date, local recurrence has been noted in 5.6 per cent of our patients and systemic progression in 14.1 per cent.

Long-term followup in patients with an inflatable penile prosthesis.

An inflatable penile prosthesis was implanted in 95 patients between 1977 and 1983. The patients were divided into 3 groups with roughly equal numbers studied during 2-year intervals. Of the prostheses 48 per cent have been revised or removed, or have failed during followup. The complication rate increased with the duration of followup.

Experience with the Jonas penile prosthesis.

Between April 1981 and June 1983 the Jonas penile prosthesis was inserted in 57 patients. There were 10 early complications (17.5 per cent), with 8 operations for revision or removal (14 per cent). Late complications were rare and the over-all success rate was 96 per cent.

Cryotherapy.

Since 1969 cryosurgical perineal destruction of the prostate has been developed at the University of Iowa for treatment of patients with prostatic cancer. The technique of this procedure has been the subject of previous reviews. This is a summary of our experience of patient survival and the effect on local prostatic cancer growth in those patients with various stages of the disease subjected to perineal cryosurgical destruction of their cancer. We also report briefly on our experience in the laboratory where the Dunning tumor model is used to study the effect of cryosurgery as well as combinations of immunological modifications.

Ureterovesical reflux in an adolescent and adult population.

The records and radiographic data on 177 adolescents and adults with vesicoureteral reflux were reviewed. The anatomic characteristics of 255 renal units and ureterovesical junctions were characterized using criteria reported previously. A total of 125 renal units demonstrated grades III to V reflux (International). Abnormal ureteral orifices were observed in 145 renal units and 155 submucosal tunnels were short or absent. Excretory urograms outlined renal scars in 192 renal units. Pre-treatment and post-treatment creatinine clearances were analyzed in 188 renal units. Ureteral reconstruction resulted in stabilization or improvement in the mean creatinine levels in 53 renal units. Other forms of surgical and medical treatment also resulted in improved renal function during observation.

Cryosurgery in prostatic cancer: elimination of local lesion.

From 1969 through 1976, we performed cryosurgery in 229 cases of prostatic cancer. Most of these patients had bulky, locally extensive primary tumors, and one-half had disseminated disease. Through the open perineal approach, which gives exposure for an adequate freeze, cryosurgery has been well tolerated. The primary surgical goal has been to reduce or eliminate the local lesion to minimize subsequent cancer-related lower urinary tract problems and to cure those patients with truly localized disease. In every case cryosurgery produced dramatic shrinkage of the local lesion. After four to eight weeks a local recurrence was suspected in 13 per cent, and 41 per cent eventually had some evidence of a recurrent cancer nodule or persistent cancer in the bladder neck. In a series of statistical analyses we have related these recurrences to other clinical factors. Cryosurgery has been a safe, effective way to reduce or eliminate the primary prostatic cancer, even in patients with large local lesions.

Bladder cancer: factors affecting survival.

The identification of factors present at the time of initial evaluation may be important to predict the prognosis in patients with bladder tumor. Attempts were made to identify predictive factors of recurrence involving comparisons based on the 12-month recurrence rate and time to recurrence in a prospective clinical investigation of 468 patients with bladder tumor observed during a 5-year interval. In newly diagnosed bladder cancer patients stage, grade and size of the largest tumor at initial evaluation were significant factors affecting survival, and these factors acted independently. Age and stage were significant factors in patients with a history of bladder tumor. We herein estimated survival curves using the product-limit estimate. Comparisons of survival curves and analyses involving more than 1 potential prognostic factor were accomplished using Cox's proportional hazards model.

Morbidity from pelvic lymphadenectomy in staging carcinoma of the prostate.

A retrospective review of 150 patients with adenocarcinoma of the prostate was done to determine the morbidity associated with lymphadenectomy performed as an independent procedure. A total of 77 complications, 17 of which were considered major, was noted in 50 patients. Wound drainage and transection of the spermatic cord were associated with increased morbidity. Systemic antibiotic therapy afforded no protection against wound infections, while intraoperative irrigation was protective. Lymphoceles and lower extremity edema occurred infrequently in our series, although only a few patients underwent postoperative pelvic irradiation therapy.

Carcinoma of the penis: analysis of 219 cases.

Carcinoma of the penis is rare in this country. A total of 219 patients diagnosed to have carcinoma of the penis were analyzed retrospectively. The primary penile lesion was treated by partial amputation in 160 patients. Forty-two patients had inguinal node dissection. Forty-six patients received radiation therapy to the inguinal region. Sixty-five per cent of the patients with no palpable nodes at initial diagnosis survived for six or more years. Twenty-eight per cent of the patients with palpable nodes survived for three to five years, and 15% for six or more years. Ten per cent of the patients died of a second primary tumor.

Transverse colon conduit urinary diversion.

We studied 62 patients who had undergone transverse colon conduit urinary diversion. This procedure was done for malignant disease in 57 patients and for benign conditions in 5. The immediate postoperative complication rate was 25 per cent, while in 13 per cent of the patients long-term complications were observed.

Cryosurgery in prostatic cancer: survival.

From 1969 through 1976 we performed cryosurgery in 229 cases of prostatic cancer. This article presents survival in cryosurgery and other treatment groups. In every stage, despite a preponderance of large primary tumors and poor-risk patients, cryosurgery matched total prostatectomy and compared favorably to other modalities, including radiation therapy, at our center and elsewhere. According to previous authors, and in view of the present data, eradication of the local lesion is associated with better survival even in advanced cases. Cryosurgery provides a safe, effective method.

Experience with germ cell tumors of testicle at University of Iowa.

Between 1964 and 1979, 219 patients with germ cell testicular tumors were treated at the University of Iowa. In 79 nonseminomatous germ cell tumors various chemotherapeutic regimens were used. The response, salvage, and survival rates are compared. There is a definite trend toward better response rates and survival using the combination cisplatinum, vinblastine (Velban), and bleomycin. With this combination, 75 per cent of Stage II and III patients survived two years. The over-all response rate was 85 per cent, and 87 per cent of those with a complete response survived two years. Eighty per cent of deaths occurred within two years and 90 per cent within three years.