Treatment of malignancy-associated hypercalcemia with intravenous aminohydroxypropylidene diphosphonate

Treatment of malignancy-associated hypercalcemia remains unsatisfactory. We have prospectively treated 26 consecutive hypercalcemic cancer patients with intravenous (IV) aminohydroxypropylidene diphosphonate (APD). The drug was administered daily as a 15-mg two-hour IV infusion until both serum and urinary calcium had been normalized for 48 hours. Twenty-four patients were fully evaluable (eight head and neck tumors, seven breast cancers, three epidermoid tumors of the lung, and six miscellaneous neoplasms). Whereas rehydration had only inconsistent effects, APD normalized serum calcium in all patients after a mean of three daily doses: serum calcium decreased from 13.3 +/- 0.4 mg/dL (mean +/- SEM) before APD to 8.0 +/- 0.1 mg/dL at the end of treatment. Ionized calcium declined in parallel to total calcium. APD was as effective in hypercalcemia due to bone metastases as in paraneoplastic hypercalcemia. The drug was tolerated without toxicity and had a prolonged effect: serum calcium remained normal during 3+ weeks (1 + to 8 +) in 17 patients who did not receive or did not respond to antitumoral treatment. APD normalized serum calcium by inhibiting bone resorption, as evidenced by the dramatic decrease in urinary excretion of calcium and hydroxyproline. Inhibition of bone resorption was probably also responsible for the decrease in serum phosphorus from 2.9 +/- 0.2 to 2.0 +/- 0.1 mg/dL. In summary, IV APD constitutes a major advance in the treatment of malignancy-associated hypercalcemia: it is very effective, well tolerated, and has a prolonged efficacy.

Calcitonin deficiency in primary hypothyroidism

The relative lack of sensitivity and specificity of current assays for plasma calcitonin (CT) have made it difficult to study possible CT deficiency conditions. Using a new extraction method that considerably improves the sensitivity of the assay for CT monomer, CT levels were measured before and after a short calcium (Ca) stimulation test (2 mg Ca/kg over 5 min) to determine C-cell secretory reserve in women with autoimmune primary hypothyroidism and normal women. Mean basal plasma CT concentrations were lower in the hypothyroid women [0.9 +/- 0.1 (+/- SEM) pg/ml] than in the normal women (1.5 +/- 0.2 pg/ml; P less than 0.01). Serum Ca increased similarly in both groups, but postinfusion CT levels were lower in the women with primary hypothyroidism (3.8 +/- 1.3 pg/ml) than in normal women (15.9 +/- 3.0 pg/ml; P less than 0.001). The functional thyroid status at the time of the study did not influence CT levels; both hypothyroid patients (n = 10) and patients who were euthyroid during T4 treatment (n = 11) were CT deficient to the same extent. Unlike that in primary hypothyroidism, CT secretion was normal in four patients with hypothyroidism of pituitary origin. We conclude that the process that causes hypothyroidism in patients with autoimmune thyroid disease can also cause marked CT deficiency. This first demonstration of spontaneous CT deficiency in adults should contribute to the understanding of CT physiology; it also suggests that bone metabolism should be closely monitored during the treatment of primary hypothyroidism.

Late results of surgical treatment of renal clear-cell carcinoma

Late results of surgical treatment are reported in a group of 140 patients operated for clear-cell renal carcinoma in the years 1960-1974. The mean survival time was 5.61 years for males and 6.59 years for females which is, respectively, 14.19 years and 15.39 years shorter than the mean life expectancy of their peers in the general population. The survival time of males depended in 15.7% on the age at the time of operation and in 68.7% on the tumour progression grade (T). The respective data of females were 13% and 17.6%. The 5-year survival rate was 40% and the 10-year survival rate was 28.6%.

Human chorionic gonadotropin-like substance in plasma of normal nonpregnant subjects and women with breast cancer

To understand ectopic hormone secretion in cancer we compared the plasma concentrations of the hCG-like substance in normal nonpregnant subjects and in women with breast cancer. In 45 normal men the plasma concentrations did not vary with age (median, 5 pg/ml; range, less than 3-169) whereas in 45 normal women they increased after menopause (median, 48 pg/ml; range, less than 5 -569, n = 20, P less than 0.0001). In 56 women with breast cancer the plasma concentrations of the hCG-like substance after menopause were much higher than in normal women (median, 202 pg/ml; range, 14-1561; n = 35; P less than 0.001), with no abnormally high pituitary gonadotropin values and no relationship with the tumor burden (same median after mastectomy, 198 pg/ml; n = 21). This hCG-like substance was glycosylated and similar to standard hCG according to molecular size, ionic strength, and immunoreactivity. Our data are compatible with the following conclusions: 1) the plasma concentration of the hCG-like substance is normally very low but dependent on gonadal function in women. Its source might be the pituitary gland or peripheral tissues. 2) Its concentration is much increased in postmenopausal women with breast carcinoma. This increase is found with normal pituitary gonadotropin values and is independent of the tumor burden, suggesting it is of extrapituitary and nontumoral origin.

Surgical treatment of stenosis of the pyeloureteral junction in pelvic kidney

The late results of surgical treatment of pyeloureteral junction stenosis are reported for 5 patients with pelvic ectopy of the kidney. In all cases the results were good.

Calicopyelocystostomy in auto- and allotransplanted kidneys. Report of 2 cases

A case of calicopyelocystostomy and one of pyelocystostomy are reported. In the first case, the operation was performed on an autotransplanted kidney. The operation was done in a patient with sponge kidney to facilitate spontaneous excretion of calculi. In the second case, the operation was performed in a patient with long-lasting urinary fistula which developed in a cadaver kidney transplant. Although the authors present only 2 cases, calicopyelocystostomy and pyelocystostomy can be recommended as a valuable method in complicated cases of recurrent nephrolithiasis and in patients with nonhealing long-lasting urinary fistulas which developed in transplanted kidneys.

Ureteral duplication with a blind-ending branch

Three cases of ureteral duplication with blind-ending branch are described. Clinical observations are supplemented with a survey of the literature pertaining to the statistics, embryology, method of diagnosis and treatment of this urological developmental anomaly.

Bladder flap for reconstruction of congenital absence of the vagina

An original method for vaginal reconstruction, using a pedunculated bladder wall flap is described. The method can be applied for vaginal reconstruction in cases of congenital absence or hypoplasia, as well as in cases of male transsexualism. 4 patients have been operated by this method without complications. In 2 patients, with 11 and 8 months follow-up, the results are satisfactory. The authors clearly describe the technical method of operation.

Simultaneous repair of post-irradiation vesicovaginal and rectovaginal fistulas

A simultaneous repair of radiation-induced vesicovaginal and rectovaginal fistulas is suggested. Creation of a diverting colostomy must be the preliminary procedure. Both fistulas are closed simultaneously several months later. The vesicovaginal fistula is closed with a rotated flap from the apex of the bladder and is reinforced additionally with omentopexy. The rectovaginal fistula is closed by pulling the descending colon through the rectal stump with its mucosa stripped off. The operation was performed with good results on a 42-year-old patient with grade II cervical carcinoma in whom fistulas developed after combined treatment by radiotherapy and an operation.

Supracystic urine diversion in patients with bladder carcinoma treated by cystectomy preceded by "short radiotherapy" (2000 R)

The authors assessed the results of supracystic urine diversion in 50 patients treated by cystectomy for bladder carcinoma who had "short radiotherapy" (2000 R) before the operation. It was found that preoperative radiotherapy caused no difficulties during subsequent cystectomy and the observed postoperative complications should be related rather to the surgical technique. It seems that indications to urine diversion by the method of Goodwin or Coffey should be considered with greater caution. In patients past the age of 65 years and those with more advanced neoplasms (T-3, T-4) bilateral ureterocutaneostomy should be performed more frequently for suprapubic urine diversion.

Uretero-ureterostomy, transuretero-ureterostomy

The authors describe various possibilities of using uretero-ureterostomy in cases of healthy bladder an in cases of supracystic urinary diversion. The history and the technique of the operation are described. Attention is called to the direction of anastomosis in cases of ureters differing in the width of their lumen. Clinical observations of 21 cases of uretero-ureterostomy are reported. In 17 cases transuretero-uretero-cutaneostomy was done. Stenosis of the recipient ureter did not develop in any of these cases. The main complication in transuretero-ureterostomy was stenosis of the foramen of ureterocutaneostomy. For avoiding this complication of transuretero-ureterocutaneostomy only wide-lumen ureters should be anastomosed to the skin.

Spinal cord damage as a complication of renal artery embolization in patients with renal carcinoma

The authors report three cases of complications of renal artery embolization in patients with renal carcinoma. In two cases renal artery embolization was followed by paraparesis with loss of sphincter control. In these cases nephrectomy was performed on the side of the neoplasm and neurological disturbances disappeared after pharmacological treatment and rehabilitation. The third patient was not treated surgically. Embolization was followed by development of spinal cord damage at the level Th12. The patient died of neoplastic cachexia and cardiorespiratory failure.

The human chorionic gonadotropin-like substance in the plasma of normal nonpregnant subjects is not modulated by the gonadotropin-releasing hormone

To determine whether the hCG-like substance found in the plasma of normal nonpregnant subjects is secreted and regulated like a pituitary gonadotropic hormone or prohormone, we measured its concentration before and 60 min after the acute iv injection of 500 microgram Gonadotropin-releasing hormone (GnRH). The study was performed in 12 normal young men. The hCG-like substance was purified from the other plasma proteins by 2 successive diethylaminoethyl-Sephadex A-50 chromatographies and by gel filtration on Sephadex G-100. Its concentration was measured by a specific RIA, corrected for losses and for possible contamination with human LH (hLH). The median basal concentration in plasma was 19 pg/ml (mean, 41; range less than 5 to 169), and there was no correlation with corresponding hLH concentrations. After the injection of GnRH, the median, mean, and range of concentrations remained constant, whereas the mean hLH concentration increased over 8-fold. This indicates that no significant amounts of the hCG-like substance are acutely releasable from the pituitary gland and that its plasma concentrations are not modulated by GnRH in a fashion similar to hLH. It also constitutes an argument for an extrapituitary origin of the plasma hCG-like substances in normal men.

Encapsulated urinary extravasation (urinoma) as a late complication of ureterolithotomy and pyelolithotomy

The authors report three cases of encapsulated urinary extravasation as a late complication of ureterolithotomy and pyelolithotomy. Surgical treatment saved the kidney in two cases, in the third case nephrectomy had to be done. The pathological mechanism, diagnostic methods and treatment of this complication are discussed in light of the observed cases and a survey of the pertinent literature.