Subject(s)
Erectile Dysfunction/etiology , Penis/radiation effects , Radiotherapy, Conformal/adverse effects , Humans , Male , Penile Erection/physiology , Penis/anatomy & histology , Prostatic Neoplasms/radiotherapy , Surveys and Questionnaires , Urethra/anatomy & histology , Urethra/radiation effectsABSTRACT
Metastatic renal cancer is responsive in some cases to immunotherapeutic agents. Indications for nephrectomy in the face of metastatic disease have traditionally included palliation of symptoms caused by the primary tumor, and nephrectomy combined with metastatectomy in patients with resectable metastases. Recent findings from a Southwest Oncology Group trial strongly suggest that cytoreductive nephrectomy, combined with immunotherapy, may also result in improved survival in patients with unresectable metastases.
Subject(s)
Carcinoma, Renal Cell/surgery , Immunotherapy , Kidney Neoplasms/surgery , Nephrectomy , Carcinoma, Renal Cell/immunology , Carcinoma, Renal Cell/secondary , Combined Modality Therapy , Humans , Infarction/immunology , Kidney/blood supply , Kidney Neoplasms/immunology , Kidney Neoplasms/pathology , PrognosisABSTRACT
The role of cytoreductive surgery in patients with metastatic renal cancer remains controversial. Recent data from our Southwest Oncology Group trial suggest that cytoreduction confers an approximately 50% increase in median survival for such patients when they are treated with interferon-alfa-2b immunotherapy. The timing of cytoreduction, and in which patients it may be most applicable, are discussed herein.
Subject(s)
Carcinoma, Renal Cell/pathology , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Nephrectomy , Carcinoma, Renal Cell/mortality , Humans , Kidney Neoplasms/mortality , Kidney Neoplasms/pathology , Neoplasm Metastasis , Prognosis , Survival RateABSTRACT
The role of cytoreductive nephrectomy in the management of metastatic renal cancer remains controversial. Recent trials, like SWOG 8949 have suggested the usefulness of this approach at least in selected patients with good performance status and other favorable indicators. The timing of cytoreductive nephrectomy has also been controversial and remains so to this time.
Subject(s)
Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Nephrectomy , Carcinoma, Renal Cell/pathology , Humans , Immunotherapy , Kidney Neoplasms/pathology , Neoplasm Metastasis , Prognosis , Time FactorsABSTRACT
BACKGROUND: The mechanisms underlying cyclosporine neurotoxicity remain undefined. Particularly, whether cyclosporine (CyA) enters cerebrospinal fluid (CSF) or brain tissue is disputed. METHODS: We analyzed CSF from 17 lumbar punctures performed in 14 liver recipients receiving CyA and experiencing neurological complications, fever of unknown origin, seizures, or altered mental status. Whole blood samples were assayed for CyA and its metabolites. Liver function tests, serum electrolytes, and cholesterol were also analyzed. RESULTS: Four patients had cyclosporine metabolites in the CSF. These patients had acute renal insufficiency and significantly higher blood urea nitrogen (BUN) and total and direct bilirubin and alkaline phosphatase levels than patients without CyA metabolites in CSF (P < 0.05). Whole blood levels of CyA parent drug were similar between groups. Levels of CyA metabolites in the blood were significantly higher in patients with metabolites in the CSF. CyA parent drug was undetectable in CSF in both groups. CONCLUSIONS: This is the first prospective report of CyA metabolites in the CSF of transplant recipients. Acute renal insufficiency and high bilirubin levels may be associated with entry of CyA metabolites into the CSF.
Subject(s)
Cyclosporine/cerebrospinal fluid , Immunosuppressive Agents/cerebrospinal fluid , Liver Transplantation , Adult , Blood Urea Nitrogen , Cyclosporine/adverse effects , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
An 83-year-old man had episodic dizziness, visual disturbance, and facial and extremity weakness associated with eating. Occlusion of the ipsilateral common carotid artery and stenosis or occlusion of the major collateral sources were demonstrated. We believe this anatomic configuration, combined with increases in demand for external carotid artery blood flow necessitated by the act of chewing, resulted in a vascular steal syndrome. An extended carotid endarterectomy was performed, and there were no additional episodes.