Transitional cell carcinoma of the vagina with pagetoid spread pattern

A distinctive variant of a papillary noninvasive transitional cell carcinoma (TCC) of the vagina removed from a postmenopausal woman is described. The neoplasm was evaluated by immunohistochemistry. The designation of this neoplasm as a TCC is supported by its morphological features and its coexpression for cytokeratin (CK) 7 and CK 20. Its main feature is pagetoid infiltration into adjacent vaginal epithelium. This is the second reported case involving a transitional cell metaplasia (TCM) of the vagina, a possible precursor lesion of the TCC.

A phase II study of oral idarubicin as a treatment for metastatic hormone-refractory prostate carcinoma with special focus on prostate specific antigen doubling time. Swiss Group for Clinical Cancer Research, Berne, Switzerland

BACKGROUND

Treatment of hormone-refractory prostate carcinoma with chemotherapy is purely palliative, and reported response rates have been low. At the time this study was conducted, there was an urgent need for a trial using potentially efficacious drugs, with quality of life (QL), and serial prostate specific antigen (PSA) behavior as endpoints.

METHODS

In this Swiss multicenter Phase II study, 30 patients were enrolled to receive oral idarubicin. Patients were administered 35 mg idarubicin on Days 1 and 8 of each cycle, and treatment was repeated every 3 weeks. Assessment was based on response rates, sequential PSA measurements in serum, toxicity, and selected aspects of QL.

RESULTS

Twenty-six of 30 patients were evaluable for response, and none of them achieved a response. Three patients had stable disease as their best response, and their PSA levels also remained stable. In all other patients, PSA increased exponentially over time; the median PSA doubling time was 2.1 months (mean, 2.6; range, 0.7-6.1). Toxicity was minimal and consisted mainly of myelosuppression and nausea/vomiting. QL did not change significantly during therapy with regard to general well-being, fatigue, or nausea/vomiting. However, there were improvements in patient-rated and physician-rated pain.

CONCLUSIONS

At the dose and schedule used in this study, oral idarubicin showed only minimal efficacy against hormone-refractory prostate carcinoma. In patients who did not respond, PSA doubling times were similar to those in patients who relapsed while receiving only antiandrogen therapy. In future clinical trials, QL and serial PSA behavior should be included in analysis.

Impact of minimal lymph node metastasis on long-term prognosis after radical prostatectomy

OBJECTIVES

In the management of clinically localized prostate cancer, understanding is of major concern. There is a considerable therapeutic dilemma in those patients in whom staging lymphadenectomy prior to intended radical prostatectomy reveals lymph node metastases.

METHODS

Pelvic lymph node dissection and radical retropubic prostatectomy were performed in 132 consecutive patients. Patients with extracapsular disease and/or positive lymph nodes received adjuvant radiotherapy. Median follow-up after surgery was 7 years and 2 months. To study the influence of minimal lymph node metastasis, category pN1 was further subdivided into pN1.1 and pN1.2. Involvement of the prostatic capsule was either classified as infiltration (pT3.1) or performation (pT3.2) of the capsule.

RESULTS

Disease-free survival after 10 years was 58% in patients with negative nodes, 37% in category pN1.1, 25% in category pN1.2 and 10% in category pN2. Corrected overall survival was 83% for node-negative patients and 73% for category pN1.1, but it was only 33% for pN1.2 and 29% for pN2. Patients in category pT3.1 had a statistically significant better survival than those in pT3.2.

CONCLUSIONS

We conclude that radical prostatectomy combined with adjuvant radiotherapy is a valuable option in prostate cancer patients with minimal lymph node metastasis. When compared to infiltration of the capsule, complete capsular perforation does adversely affect prognosis.

Isoelectric focusing of Tamm-Horsfall glycoproteins: a simple tool for recognizing recurrent calcium oxalate renal stone formers

Tamm-Horsfall glycoproteins (THPs) from healthy probands and a majority of recurrent calcium oxalate renal stone formers reveal different physicochemical properties when analyzed using isoelectric focusing (IEF). The pI values of THPs from healthy probands are approximately 3.5 while THPs from recurrent renal stone formers have pI values of between 4.5 and 6. The two groups of THPs exhibit completely different protein patterns. The differences in IEF analysis allow differentiation between THPs from healthy probands and recurrent calcium oxalate stone formers and may possibly be used as a simple diagnostic method for the recognition of recurrent calcium oxalate renal stone formers.

Intracytoplasmic sperm injection (ICSI) with testicular sperm extraction (TESE) in non-obstructive azoospermia--two case reports

Intracytoplasmic sperm injection (ICSI) with microsurgical epididymal sperm extraction (MESA) or testicular sperm extraction (TESE) can be offered to azoospermic men. We report our initial experience of two cases with ICSI-TESE in non-obstructive azoospermia. Both couples had a successful ICSI with embryo transfer. An ongoing triplet pregnancy at 21 weeks is observed.

Tamm-Horsfall glycoprotein: role in inhibition and promotion of renal calcium oxalate stone formation studied with Fourier-transform infrared spectroscopy

Tamm-Horsfall glycoprotein (THP) from healthy probands inhibits the precipitation of calcium oxalate, whereas THP from individuals who repeatedly develop calcium oxalate stones has no effect or even promotes precipitation. Using Fourier-transform infrared spectroscopy, we found a structural differentiation between these functionally different THPs: a decisive difference in sialic acid content. Quantitative analysis for sialic acid showed the same results. THP from healthy probands had a high sialic acid content (51 +/- 9 g/kg), whereas THP from recurrent stone formers had a decreased sialic acid content (21 +/- 4 g/kg). This explains the dual role of THP in the precipitation of calcium oxalate and the formation of renal stones and shows the importance of glycosylation in the function of this glycoprotein.

Tamm-Horsfall glycoprotein: role in inhibition and promotion of renal calcium oxalate stone formation studied with Fourier-transform infrared spectroscopy

Tamm-Horsfall glycoprotein (THP) from healthy probands inhibits the precipitation of calcium oxalate, whereas THP from individuals who repeatedly develop calcium oxalate stones has no effect or even promotes precipitation. Using Fourier-transform infrared spectroscopy, we found a structural differentiation between these functionally different THPs: a decisive difference in sialic acid content. Quantitative analysis for sialic acid showed the same results. THP from healthy probands had a high sialic acid content (51 +/- 9 g/kg), whereas THP from recurrent stone formers had a decreased sialic acid content (21 +/- 4 g/kg). This explains the dual role of THP in the precipitation of calcium oxalate and the formation of renal stones and shows the importance of glycosylation in the function of this glycoprotein.

Investigations on macromolecular precipitation inhibitors of calcium oxalate

Certain important aspects of the urine oxalate tolerance test (OTT) have been revised. The stirring system has been changed and the test has been adapted to the kinetics of calcium oxalate precipitation. True equilibrium conditions are now ensured during the measurements. Furthermore, the endogenous oxalate concentration is determined and taken into consideration. As a result of these changes, the significance of the test results has greatly improved. The effects of the addition of small amounts of zinc on the precipitation of calcium oxalate have been used in a new variation of the OTT. This new test makes it possible to discriminate much faster and more simply between recurrent stone-formers and other subjects. Tamm-Horsfall protein (THP) has been tested for its effect on the precipitation of calcium oxalate by means of OTT. THP inhibits the precipitation of calcium oxalate, but THP of stone-formers has a diminished inhibitory activity. The inhibitory activity of this protein strongly depends on the method by which it is isolated.

31P MR spectroscopy and 1H MR imaging of the human prostate using a transrectal probe

1H magnetic resonance imaging and 31P magnetic resonance spectroscopy of the human prostate using transrectal surface coils are discussed. 1H MR images were characterized by a high sensitivity, revealing many details in the prostate. Localized 31P spectra acquired during the same investigation showed phosphorous metabolites, which may help differentiate between benign prostatic hyperplasia and prostate carcinoma. An endoscopic transmit-receive radio frequency (RF) antenna is also described which can be used with very low RF power.

[Primary extragonadal choriocarcinoma of the bladder. A case report with a compilation of the 19 cases published so far]

We report on a 73-year-old man with a primary extragonadal choriocarcinoma of the urinary bladder associated with transitional cell carcinoma. So far only 19 cases of choriocarcinoma of the bladder have been published in the literature. With reference to the cases reported in the English literature, the relationships between serum beta-HCG level, mode of therapy and clinical course are pointed out. Finally, the possible explanations for pathogenesis are discussed and the signs and symptoms that are mandatory for diagnosis of this entity are defined.

Does microinvasion of the capsule and/or micrometastases in regional lymph nodes influence disease-free survival after radical prostatectomy?

Since 1976, 126 patients with clinically localised carcinoma of the prostate have been managed by radical retropubic prostatectomy. All patients with tumour spread beyond the capsule or metastasis in lymph nodes received radiotherapy. Tumour category pT3 was divided into invasion of the capsule or infiltration of the seminal vesicle. The disease-free 10-year survival rate in patients with minimal invasion of the capsule was 72% and in patients with infiltration of the seminal vesicles it was 26%. Unilateral lymph node metastases were classified as microscopic disease or macroscopic infiltration. The disease-free 10-year survival rate in patients with metastasis in 1 lymph node (micro- and macro-metastasis) was 65% in contrast to 0% in patients with bilateral disease.

[Prevention of urinary calculi in spite of painless lithotripsy?]

Localization, stone-size as well as type of lithotriptors influence the extent of disintegration of stones and the individual rate free of stones after treatment with extracorporeal shock wave lithotripsy. The piezoelectric lithotriptors do not require anaesthesia, but perform insufficient stone disintegration requiring no repeated treatments. Another draw-back is stone localization by ultrasound, which prevents treatment of some ureteral stones. Used voltage and rate of shock waves per treatment affect the extent of damage no the renal parenchyma. Risk of hypertension, residual disintegrated stones, which don't clear the renal pelvis, the higher recurrency rate and injury to the urothelium of the renal pelvis demand a concomitant meta- and prophylaxis of urolithiasis.

[Therapy of metastatic prostatic cancer by orchiectomy plus Anandron versus orchiectomy plus placebo. Initial results of a randomized multicenter study]

In the course of a randomized double blind trial conducted by 7 Swiss urological centres, 51 patients with advanced, not pretreated carcinoma of the prostate were included. Following orchiectomy the patients were either administered 300 mg Anandron daily (Roussel RU 23908) or Placebo. Twelve months later the Anandron-group shows a slightly better objective response whereas there is no difference in survival rates. The adverse effects of Anandron-treatment are described.

Epidermal growth factor receptor in adenocarcinoma of the kidney

Epidermal growth factor receptor (EGF-R) was estimated in Hypernephroma by saturation analysis using 125-I EGF as ligand. Tissue levels of this oncogene related protein were increased five-fold (24 to 99 fmol/mg protein) in comparison with the surrounding tumor free tissue (3 to 18 fmoles/mg protein). There was no apparent correlation to the stage of tumor growth or tumor differentiation and there was no correlation of EGF serum levels with tumor growth. EGF serum levels in the tumor patients did not exceed levels in control patients.

Stone formation in human kidney

Microscopic crystals were found by SEM analysis in kidneys of stone forming patients as well as in kidneys of non-stone formers. In most samples calcifications were intratubular in the collecting ducts near the papillary tip. 1-2 micron sized particles lay in a gelatinous substance on the epithelium. The only difference in crystal composition is the higher phosphate content in the kidneys of the non-stone forming group. A correlation between the element concentration of the tissue and the occurrence of microliths is given by the cadmium content of the kidney samples. Both groups showed higher cadmium values in the cortex or medulla when crystals were found in the corresponding papillary samples. Urine supersaturation with respect to calcium oxalate was higher in the stone forming group caused by a higher calcium and oxalate but a lower magnesium excretion.

[Diagnosis and therapy of candidiasis in the premature infant]

Extension of intensive care seems to have increased the risk of systemic candida infection. We report the incidence of systemic candida infection in 8 low-birth-weight infants (gestational age 27-32 weeks, birth weight 710-1,550 g). All infants required respiratory treatment. Various silastic catheters were inserted. Antibiotic therapy was started on the first day of life, usually a combination of ampicillin and gentamycin. Candida septicaemia was diagnosed at the age of 8-69 days of life based on blood and urine cultures, in two children at autopsy. There were no specific clinical symptoms in regard to candida infection. Sonographic technique revealed hydronephrosis in 3 infants due to candida mycelium. Antimycotic therapy included amphotericin B (dosage 0.44-1.0 mg/kg X day) and 5-fluorocytosine (80-100 mg/kg X day) as well as a monotherapy of 5-fluorocytosine (100-200 mg/kg X day). Four children were treated successfully. We like to advice a regular search for candida in urine, blood, tracheal secretion, stool and skin in low-birth-weight infants under intensive care conditions. If antimycotic therapy is started in time, therapy can be successful.

[Intrarenal calcium crystallization. An electron microscopy study]

Male Wistar rats were treated by ethylene glycol (0.8 Vol% in water) or a diet low in magnesium (70 mg/kg). The intrarenal crystallisation and stone formation of calcium oxalate was investigated by SEM, TEM and energy dispersive X ray analysis. The first stage in crystallisation was amorphous deposits of calcium surrounding microvilli of the lower part of the nephron, followed by multicentric, intratubular calcium crystals. Finally calcium plaques of the papilla seemed to be precursors of the urinary stone.

The oxalate-tolerance-value: a whole urine method to discriminate between calcium oxalate-stoneformers and others

In undiluted urine portions the oxalate-concentration required for precipitation (= oxalate-tolerance) can be obtained by titration with sodium-oxalate and turbidimetric detection. The corresponding urinary calcium-concentration was measured and the two values plotted against each other. With regard to a standard-curve (measurements in synthetic urine) different behaviour between urines of stone forming patients and others can be observed.

Fluoridation of drinking water: effects on kidney stone formation

The influence of fluoride in drinking water on stone formation was studied in animals and in "in vitro" crystallization experiments. In male Wistar rats fluoride inhibits ethylenglycol induced calcification of the kidneys and stone formation. The in vitro results performed in synthetic urine exhibited a dose-dependent delay of crystal growth.

Tissue polypeptide antigen (TPA) and prostatic acid phosphatase in serum of prostatic cancer patients

Tissue polypeptide antigen (TPA) and prostatic acid phosphatase were both detected by radioimmunoassay in the sera of a male population (age greater than 45 years) consulting the clinic for urological problems or check-up on treatment. Increased concentrations of TPA were associated mostly with advanced stages of prostatic carcinomas, parallel to PAP. Some enhanced TPA concentrations were detected with haematuria and adenomas of the prostate.