Long-term outcome of hemispheric surgery at different ages in 61 epilepsy patients.

Objective: Hemispheric neurosurgery is an established treatment for severe epilepsy caused by extended unilateral brain pathology. However, it is still an unresolved question at which age surgery should best be performed. In light of decreasing plasticity and the cumulative impact of seizures and anticonvulsants on neurodevelopment, early surgery appears preferable.

Selective bladder preservation by combined modality protocol treatment: long-term outcomes of 190 patients with invasive bladder cancer.

Objectives: To evaluate the outcomes of patients with muscle-invasive Stage T2-4a bladder carcinoma managed by transurethral surgery and concurrent chemoradiation.

Methods: A total of 190 patients were treated on institutional prospective protocols using concurrent cisplatin-containing chemotherapy and radiotherapy after rigorous transurethral resection of the bladder tumor. Patients were re-evaluated by repeated biopsy and urine cytologic analysis after 40 Gy, with the initial tumor response guiding subsequent therapy.

Selective bladder conservation using transurethral resection, chemotherapy, and radiation: management and consequences of Ta, T1, and Tis recurrence within the retained bladder.

Objectives: Although radical cystectomy remains the standard of care for invasive bladder cancer in the United States, many groups are exploring the use of trimodality therapy using transurethral resection of the bladder tumor, radiation, and chemotherapy in an attempt to spare patients the need for cystectomy. As transitional cell carcinoma often arises from a urothelial field change, there is concern that the retained bladder is at risk of subsequent superficial (Ta, T1, Tis) tumors, some of which may have lethal potential. This study reports the outcomes of those patients with superficial relapse of transitional cell carcinoma after trimodality therapy.

Granular cell tumors: a new clinically important histologic finding.

Objective: The objective of this study was to review clinical characteristics, histological findings, and surgical treatment of patients with granular cell tumors of the vulva at Hartford Hospital and examine histologic characteristics associated with those cases that recurred.

Materials And Methods: A retrospective case review of 13 patients diagnosed with granular cell tumors of the vulva at Hartford Hospital from April 1982 through May 1998 was undertaken to compare age, size and location of the lesion, histopathologic features, presenting symptoms, progression of disease, and treatment.

Results: Tumor growth patterns were divided into those with confluent expansile growth (nodular) and those that infiltrated the dermis and soft tissue in a haphazard fashion interdigitating with native connective tissue and skin appendages (infiltrative).

An update of combined modality therapy for patients with muscle invading bladder cancer using selective bladder preservation or cystectomy.

Purpose: We update the results of tri-modality treatment for patients with muscle invading bladder tumors with selection for bladder preservation based on tumor response to induction therapy.

Material And Methods: We reviewed the literature on modern tri-modality bladder preserving approaches using transurethral resection, radiation and concurrent chemotherapy followed by either bladder conservation with careful surveillance for complete responding patients or prompt cystectomy in those whose tumors persist after induction therapy.

Results: The published experiences from 3 centers and 2 prospective trials done by the Radiation Therapy Oncology Group were evaluated for 5-year overall survival of patients selected for bladder preservation or prompt cystectomy (49 to 63%) and for those with a conserved bladder (38 to 43%).