The role of magnetic resonance imaging in the staging of bladder carcinoma

The clinical staging of bladder carcinoma traditionally has relied on transurethral resection of the bladder tumor, urinary cytology, excretory urography and an examination with the patient under anesthesia. Recent evidence has shown magnetic resonance imaging to be effective in the staging of bladder cancer. Whether magnetic resonance imaging is more accurate than conventional clinical staging techniques has not been answered. To determine the usefulness of magnetic resonance imaging in this regard 34 patients with bladder carcinoma underwent staging by this technique before radical cystectomy. The magnetic resonance imaging stage and conventional clinical stage were compared to the final pathological stage. Magnetic resonance imaging had an over-all accuracy of 50 per cent versus 57 per cent for conventional staging techniques and it identified 2 of 5 patients with nodal disease. To date magnetic resonance imaging does not appear to be better than conventional clinical staging techniques in patients with bladder carcinoma.

Phase I clinical trial and human pharmacokinetics of 2,4-diamino-5-adamantyl-6-methyl pyrimidine ethane sulfonate (DAMP-ES): a lipid-soluble antifolate

A phase I and pharmacokinetic study of a novel lipid-soluble antifolate, 2,4 diamino-5-adamantyl-6-methyl pyrimidine ethane sulfonate (DAMP-ES) has been carried out on two schedules: I--daily x5; II--24-h continuous infusion. In schedule I, doses of 10-90 mg/m2 per day were evaluated. Dose-limiting toxicity was hematologic, but nausea and vomiting, skin rash, diarrhea, anorexia, alopecia, mucositis, and neurotoxicity were also noted. In schedule II, doses of 192 and 240 mg/m2 were evaluated. Dose-limiting toxicity was neurotoxicity, but hematologic toxicity was also marked. Recommended starting doses for phase II studies are 75 mg/m2 per day for 5 days or 192 mg/m2 by continuous infusion for 24 h. Pharmacokinetic studies indicated a beta-phase plasma half-life of 12.4-24 h and a large and variable volume of distribution.

Prolactin and luteinizing hormone-releasing hormone receptors in human benign prostatic hyperplasia and prostate cancer

Using a sensitive micromethod for the determination of prolactin (PRL) binding sites based on 125I-human PRL ligand, PRL receptor levels in specimens of benign prostatic hyperplasia (BPH) and human prostate cancer were estimated by the one-point assay system. Ten of 19 BPH specimens (53%), showed significant PRL binding, four being in the 9-12 fmol/mg range. All ten of these cases had an histological diagnosis of nodular glandular hyperplasia. Of ten adenocarcinomas examined, four samples (40%) exhibited positive PRL binding, the highest receptor levels being 10.2 fmol/mg protein. To characterize the receptors from BPH membranes, samples were then separately pooled according to the results obtained in one-point assays. In the PRL-negative pool no displacement could be detected. In the PRL-positive pool, the Scatchard analysis revealed one class of receptors with an average affinity Kd = 1.1 X 10(-9) M and capacity Bmax = 287 fmol/mg protein. In the prostate cancer specimens, luteinizing hormone-releasing hormone receptors with a high affinity and a low capacity were also found. The results indicate the presence of prolactin receptors in prostate cancer and in BPH. The clinical implications of such findings are not clear, but it is possible that a certain proportion of BPH and prostate cancers might be in part PRL dependent. Further studies are necessary to ascertain this hypothesis in an attempt to improve the treatment of BPH and prostate cancer.

Resection of large inferior vena caval thrombi from renal cell carcinoma with the use of circulatory arrest

Removal of a large extension of renal cell carcinoma into the inferior vena cava can be a difficult operation. Circulatory arrest is an operative technique that recently has been used to assist in resection of tumors that extend into the vena cava above the level of the hepatic veins. At our clinic 18 patients were operated on with the intent of using circulatory arrest during radical nephrectomy and inferior vena caval thrombectomy. Of the 18 patients 13 ultimately underwent this procedure, since the remaining 5 had unresectable tumors. One patient died intraoperatively of an adverse reaction to protamine after technically successful removal of the tumor and thrombus. Resection was successful in 12 patients and 9 remained free of disease with short followup. We believe that the addition of circulatory arrest during resection of a large inferior vena caval thrombus allows for an opportunity to resect the tumor in a controlled situation that reduces the potential for sudden massive blood loss or a major vascular injury, and ultimately makes the operation safer.

Conservative surgery for transitional cell carcinoma of the renal pelvis

From 1972 to 1986, 14 patients underwent a conservative operation for transitional cell carcinoma of the renal pelvis. Most of these patients had low grade (12), noninvasive (10) tumors involving a solitary functioning kidney (12). The operations performed were open pyelotomy with tumor excision and fulguration (8 patients), partial nephrectomy (5) and percutaneous nephroscopic fulguration (1). There was 1 operative death. Of the 13 surviving patients 8 (62 per cent) remained free of transitional cell carcinoma postoperatively, while 5 (38 per cent) had recurrent disease. Six patients (46 per cent) presently are free of tumor 6 months to 5 years postoperatively. Conservative surgical techniques can provide satisfactory treatment for selected patients with renal pelvic transitional cell carcinoma when preservation of functioning renal parenchyma is necessary to avoid kidney failure.

Selection of the type of urinary diversion in conjunction with radical cystectomy

Several different methods of urinary diversion currently are available for use in conjunction with radical cystectomy. The method of urinary diversion performed at the time of radical cystectomy was reviewed for patients undergoing surgery from April 1984 through March 1986. A total of 91 urinary diversions was performed. Of the patients 74 per cent had a diversion with an external appliance (including 68 per cent with an ileal conduit), 14 per cent had a continent urinary reservoir (Kock pouch) and 11 per cent had an internal reservoir anastomosed to the urethra and, thus, avoided any stoma. There are inherent disadvantages to each form of urinary diversion and patient selection will be important to identify the most appropriate method of diversion for an individual.

Continent urinary diversion using a sigmoid reservoir

Continent urinary diversions are now accepted procedures for selected patients undergoing cystoprostatectomy. We describe a procedure in which a segment of sigmoid colon is used as a continent reservoir. Effective ureteral antireflux procedures have protected the upper tracts. All patients have good daytime urinary control with some night-time urinary incontinence controlled by condom drainage.

Study of microscopic porphyrin fluorescence

A technique of porphyrin (hematoporphyrin derivative [Hpd]) fluorescence microscopy was evaluated by studying Hpd uptake, retention, and loss in established human cancer cell lines. Hpd uptake appeared to be qualitatively identical in the three cell lines used, but the rate of loss was slowest in the renal-carcinoma-derived line, suggesting a cellular characteristic. The technique was readily applied to demonstrate porphyrin fluorescence in exfoliated cells in urine of bladder cancer patients.

Secondary urinoma mimicking recurrent tumor as a cause of bilateral ureteral obstruction

A case is reported of a previously resected adenocarcinoma of the rectum presenting with recurrent tumor in the pelvis and an abdominal mass that was found to be a large urinoma. Dialysis was discontinued after drainage of the extravasated urine, and the patient's condition became stable. A review of the literature is also discussed.

Simple method for the management of hematuria caused by radiation or cytoxan

A simple method of continuous bladder irrigation with two catheters is described for the management of hematuria caused by radiation or cytoxan. This simple method seems to be more effective than traditional irrigation with a three-way catheter.

Specific immunotherapy with suppressor function inhibition for metastatic renal cell carcinoma

In this pilot clinical investigation we have investigated the concept of modulating suppressor T lymphocyte (Ts) function to augment delayed type hypersensitivity (DTH) and antitumor immunity in patients with metastatic renal cell carcinoma. Cyclophosphamide (CY) was used for modulating Ts function. We used three doses of CY per 100 mg/m2, 500 mg/m2, and 1000 mg/m2. Cyclophosphamide was administered i.v. 24 h prior to the first of 6 weekly immunizations with irradiated autologous tumor cells mixed with Corynebacterium parvum. Twenty of 26 patients were evaluable for response. Five of these 20 (25%) evaluable patients had responses, one complete response and four partial responses. Fifteen patients had post-treatment skin testing with autologous tumor cells. Four of these 15 (26%) patients developed DTH to autologous tumor cells. Of the four patients acquiring skin test positivity three also had clinical responses, whereas among the 11 skin-test negative patients, only one clinical response was observed. Six of six (100%) patients who had serial T lymphocyte subset studies done had increases in their mean T helper/inducer:T suppressor/cytotoxic ratios after CY administration and immunization. These observations in an exploratory study suggest that further investigations of Ts modulation, autologous tumor cell skin testing, and T lymphocyte subsets may be of value.

Pelvic rhabdomyosarcoma: a review of the RPMI experience

Between 1959 and 1983, 16 patients with pelvic rhabdomyosarcoma were treated at Roswell Park Memorial Institute (RPMI). A multidisciplinary approach was utilized consisting of surgery, radiotherapy (XRT), and combined chemotherapy which resulted in prolonged survivals of thirteen to one hundred forty-four months in 10 patients. This improved survival was observed despite the fact that 63 per cent of the patients (10/16) presented with advanced stages of the disease. Herein we present a retrospective study of these 16 patients.

Ureteropyeloscopy in the evaluation of upper tract filling defects

We studied prospectively 12 patients with upper tract filling defects to determine the clinical value of ureteropyeloscopy in this setting. All of the patients underwent a standard diagnostic regimen, including cystoscopy and retrograde pyelography, at which time upper tract cytology studies were obtained with or without saline lavage or brushings. Computerized tomography scans or ultrasonography also was obtained when indicated. Ureteropyeloscopy with or without transureteroscopic biopsy then was performed. An operation was done when clinically indicated and a definitive diagnosis ultimately was available in all cases. The provisional diagnosis from the standard diagnostic regimen was accurate in 7 of the patients (58 per cent), while the results of ureteropyeloscopy proved to be correct in 10 (83 per cent). Ureteropyeloscopy appears to be more accurate than a standard diagnostic regimen in the evaluation of upper tract filling defects and we recommend its inclusion as a routine part of the evaluation of these patients.

Evaluation of effect of treatment for primary lesions of stage D2 prostatic cancer by means of transrectal ultrasonotomography

The effect of treatment for primary prostatic lesions of Stage D2 prostatic cancer was evaluated by means of transrectal ultrasonotomography and was compared with that for distant metastatic lesions. A new score system was introduced to assess the effect of treatment for the primary lesions of prostatic cancer from the ultrasonic findings of the prostate on a single examination after treatment. In 19 subjects evaluated as effective or moderate in the treatment of primary lesions, 9 were also evaluated as effective or moderate in the treatment of metastatic lesions, while 10 were judged as poor in the treatment of metastatic lesions. In 12 subjects which were evaluated as poor in the treatment of primary lesions, 3 were judged as moderate in the effect of treatment of metastatic lesions, while 9 were judged as poor. It was proved that the correct evaluation of the primary prostatic tumor was required to perform adequate treatment for Stage D2 prostatic cancer.

Cytogenetic studies of tumor tissue from patients with nonfamilial renal cell carcinoma

A method combining an enzymatic technique and short term culture was applied to 27 tumor tissues from 22 patients with nonfamilial renal cell carcinoma in order to establish the chromosome changes in these tumors. Chromosome analyses were successfully carried out in quinacrine mustard-Hoechst 33258 and G-banded preparations of 14 tumors from 12 patients, including 2 cases in which established cell lines were obtained after 43 and 64 days in culture and maintained for 25 and 30 passages in an in vitro system, respectively. The modal chromosome numbers ranged from 38-46 in 11 samples, involving chromosomes in structural and numerical changes and 72 chromosomes in one case, with the remaining 2 samples showing a variety of chromosome numbers. Banding analysis revealed 45 clonal aberrations in 11 tumor samples from 10 patients and nonclonal aberrations in the remaining 3 samples from 2 of the patients. Rearrangements of chromosome 3 were observed in 12 tumors, with the breakpoints on this chromosome almost totally clustered from p11 to p21. In one case both primary and metastatic tumors were studied, and an isochromosome for the long arm of chromosome 1 was observed as clonal in origin in the metastatic tissue. Two cases showed nonclonal changes. The remaining case had one clonal abnormality, i.e., deletion of 6q. Of the remaining 33 clones, chromosomes 1, 2, 6, 11, and 17 were frequently involved. These results suggest that renal cell carcinoma may be cytogenetically classified into 3 categories: (a) tumors with changes of chromosome 3: (b) tumors with other clonal aberrations; and (c) tumors without clonal changes. Rearrangements of chromosome 3 may be possibly associated with the genesis and/or progression of renal cell carcinoma.

Bilateral solid renal masses in a young man

Bilateral solid renal masses presenting in a young patient in the absence of systemic manifestations or genetic abnormalities, such as Von Hippel-Lindau's disease, are difficult diagnostic challenges. Primary renal lymphomas are exceedingly rare. More commonly, renal involvements are caused by lymphoma in the retroperitoneal area. It is important for a urologist to be aware of this diagnostic possibility, since unnecessary removal of a kidney and extensive surgery may be avoided, and because appropriate staging can be performed at exploration.

Chromosome changes in germ cell tumors of the testis

Chromosome analysis was performed on short-term cultures established from samples of six tumors of the testis. Histologically, four tumors were embryonal cell carcinomas (three primary, one metastatic) and two of mixed histology with predominance of teratoma. The modal chromosome number was hypotriploid in four tumors, triploid in one, and hypertriploid in another. All tumors contained structurally abnormal chromosomes, ranging in number from 1 to 10 in different cases. A small metacentric marker chromosome, identified as an isochromosome of the short arm of chromosome #12 [i(12p)], was present in all tumors analyzed. Unlike other marker chromosomes, this one was invariably present in at least two copies per metaphase in all cases; all other chromosome markers were present in single copy in all tumors. Together with the previous reports on the presence of i(12p) in seminoma and teratoma of the testis, our findings suggest that this karyotypic abnormality is characteristic for all histologic varieties of germ cell tumors of the testis.

A possible specific chromosome change in transitional cell carcinoma of the bladder

Chromosome changes were ascertained in nine tumor samples from seven untreated patients with transitional cell carcinoma of the urinary bladder. All tumors analyzed showed abnormal karyotypes. In one tumor, a single numerical abnormality (+7) was the sole detectable change. From 1 to 19 structurally abnormal chromosomes could be identified in the remaining 8 tumors. The same abnormality, an isochromosome of the short arm of chromosome #5, was found in five tumors from four patients. We have previously described the presence of this marker chromosome in three of nine cases of transitional cell carcinoma of the bladder. We therefore conclude that i(5p) constitutes the most consistent nonrandom chromosome abnormality in this malignancy. Other chromosomes most frequently involved in structural changes in the present series of tumors were chromosomes #1, #6, #11, and #13.

Early complications of combined pelvic lymphadenectomy and radical prostatectomy versus lymphadenectomy alone

A comparison of the early morbidity of pelvic lymphadenectomy plus radical prostatectomy versus lymphadenectomy alone is reported. Fifty-one patients underwent the combined procedure; 26 had lymphadenectomy alone. Incidence of early complications was 35% in patients undergoing prostatectomy and node dissection and 27% in patients undergoing lymph node dissection only, a difference which is not statistically significant. Thrombophlebitis and pulmonary embolus occurred after the combined procedure. There was one postoperative death in the combined surgery group. The results of this study suggest that lymph node dissection may be performed at the time of radical prostatectomy rather than as a staging procedure, and emphasize the importance of pelvic lymph node dissection in the evaluation and treatment of clinically localized prostate cancer.

Sexual function after radical prostatectomy

Forty-five patients undergoing radical retropubic prostatectomy by a standard technique modified by the author (JEP) were interviewed regarding their sexual function prior to and after the operation. Thirty-five patients were sexually potent prior to the surgery. Post-operatively, 19 patients retained erectile potency (54%), although in 15 partial erections of varying degrees were noted. In 4 of these patients, erections were not satisfactory for sexual intercourse. It is evident that a significant number of patients retained sexual function after radical prostatectomy, even when no particular attention was made to preserve the neurovascular supply.

Prognostic factors in localized prostatic carcinoma

Serial histological sections were performed in 54 radical prostatectomy specimens in an attempt to identify prognostic factors responsible for dissemination of prostatic cancer. Factors considered in the study included clinical versus pathological staging, histological grading of the biopsy specimen compared to the final pathological result, intraprostatic tumor distribution and deoxyribonucleic acid analysis of the tumor by flow cytometry in the last 33 cases. In patients with clinical stages A2 and B1 disease pathological findings were in accord in 78 per cent (11 of 14). However, only 3 of 40 patients with clinical stage B2 tumor had pathological stage B2 disease. Histologically, 72 per cent of the tumors were bilateral. Microscopic involvement of the capsule per se did not appear to influence lymph node invasion, since only 1 of 27 patients with microscopic capsular involvement had pelvic lymph node metastasis. However, 9 of 13 patients with seminal vesicle involvement had pelvic lymph node metastasis. The addition of flow cytometry to the Gleason score improves the predictive value of histological grade in higher stage lesions.

The effect of nitrofurantoin on bladder tumor cell lines: in vitro growth and implantation in the cauterized mouse bladder

Nitrofurans compounds and derivatives demonstrate antineoplastic activity in vitro as well as in vivo. Nitrofurantoin caused in vitro growth inhibition of a FANFT-induced murine bladder tumor (MBT2) and a human transitional cell carcinoma cell line (GIBB) in concentrations of 125 microM, 250 microM and 500 microM. The implantation and growth of MBT2 in the cauterized mouse bladder was inhibited by 250 microM nitrofurantoin. The bladder mucosa of two groups of C3Hf/HeHa female mice was electrically cauterized. In group I, 1 X 10(6) MBT2 cells were injected into the bladders of 42 mice, while in group II 1 X 10(6) MBT2 cells in 250 microM nitrofurantoin solution were injected into the bladders of 51 mice. Positive tumor implantation was seen in 25 bladders (59.5 per cent) of group I as compared to 15 bladders (29.5 per cent) of group II. All tumors in group I were large, occupying more than 50 per cent of bladder cross sectional area with 24 per cent showing extravesical extention. Sixty-six per cent of tumors in groups II were less than 25 per cent of bladder cross sectional area and 13.4 per cent had extravesical extention.

Characterization of a renal cell carcinoma cell line suitable as a target for immunological studies in vitro and in the nu/nu mouse

A continuous human renal carcinoma cell line designated RPMI-SE was established from a patient with a poorly to moderately differentiated renal cell carcinoma. The cells are anchorage dependent, have a well defined globular shape with pseudopod-like structures, a doubling time in vitro of 24 hr. and are able to grow subcutaneously in female ICR Swiss nu/nu mice. RPMI-SE cells obtained from tissue culture and the nude mouse had the chromosome number of near-tetraploidy. Common morphologic rearrangements were present in both the cell line and nu/nu mouse tumor. RPMI-SE was evaluated as a target cell line in an in vitro Indium-111 release assay. Three patterns of cytotoxicity were observed at an effector to target cell ratio of 100:1. The highest degree of cytotoxicity (75 per cent) was obtained with autologous lymphocytes. An intermediate level of cytotoxicity (50 per cent) was obtained with allogeneic lymphocytes. The lowest level of cytotoxicity (27 per cent) was obtained with normal lymphocytes and was comparable to the level of cytotoxicity observed with the NK sensitive K562 target cell line. Morphologic data and chromosomal analysis indicate that the RPMI-SE cell line has maintained characteristics of the original tumor. This cell line will be useful for immunological studies as a target cell line in vitro as well as in vivo in the nude mouse.