[Results of 15 years of radical prostatectomy]

From July 1969 to May 1994, radical prostatectomy was performed in 630 patients with clinically localized prostate cancer at the Department of Urology, University of Würzburg Medical School. These included 74 patients subsequently followed up for 15 years or more 15 years (15-23 years, mean 17.5 years), who were the subjects of the present study. Of these 74 patients 59 had pT2 tumors and 10 had pT3 tumors according to the staging criteria of the 1992 edition of the UICC TNM classification. The remaining 5 patients had microscopic lymph node metastases detected at staging pelvic lymphadenectomy (stage pT2-3pN1-2). Patients with lymph node involvement were treated by immediate orchiectomy. All other patients received no further treatment until progression occurred. The overall 15-year survival rate actually observed the 74 patients was 50% (37/74) and the disease-free survival rate was 43.2% (32/74 pts). Stage-related overall and disease-free survival rates were found to be 54.2% and 49.1%, respectively, for patients with pT2 tumors, 40% and 30% for those with pT3 tumors, and 20% and 0 for patients with lymph node metastases. Progression (either local recurrence or distant metastatic spread) was noted in 22 of the 74 patients (29.7%) within the 15-year period following radical prostatectomy. Mean time to progression was 7.9 years (3 months to 17 years). Within the follow-up period, 17 patients (23%) died of prostate cancer. These actual 15-year follow-up data show radical prostatectomy to be the most effective means of achieving long-term disease-free survival, if not cure, in patients with clinically localized prostate cancer.

Effects of adding various oils to the diet on growth, feed conversion and chemical composition of carp (Cyprinus carpio)

The suitability of various vegetable and fish oils was tested as feed components for one-summer-old carp fingerlings. Five diets were used: a basal diet, which served as control feed, was supplemented with 10% corn-germ oil, 10% sunflower oil, 10% fish oil or 10% rapeseed oil, respectively. By means of the lipid supplementation the crude protein content decreased from 35.5% in the basal diet to 31.9% in the test diets, whereas the gross energy level increased from 16.3 to 18.9 MJ/kg. The diets were fed over a period of 84 feeding days and water temperature was 23 degrees C. Weight gain, feed conversion ratio and protein utilization were superior in all groups of carp which received the fat-enriched high energy diets. Considering the gain in % of the initial weight, the control fish reached less than 400% whereas all carp in the test groups, which consumed the oil-enriched diets, reached 455 to 485%. A significant influence of the kind of lipid on growth and feed conversion could not be recognized. The lipid-enriched diets with higher energy content resulted in increased fat levels of the carp. Fatty acid composition of the carp reflected that of the diets. In the control group and the fish oil group the levels of palmitic, palmitoleic, eicosapentaenoic and docosahexaenoic acid were especially high corresponding to the fatty acid profile of the diets. In carp fed the diets supplied with corn-germ oil and sunflower oil linoleic acid was dominant whereas the carp fed the rapeseed diet were characterized by a high level of oleic acid.

Calorimetric investigation of thermal stability and ligand-binding characteristics of disulfide-bond-cleaved ribonuclease T1

A combination of differential titration calorimetry and differential scanning calorimetry was used to study the effect of disulfide bond cleavage and reaction with iodoacetamide of ribonuclease T1 on both the binding of nucleotides and the thermal stability of the free enzyme species. Although guanosine monophosphates still bind to the active site of the modified protein the transition temperature of unfolding and the transition enthalpy decrease drastically indicating a relatively loose structure. The calorimetric data presented in this study suggest a cooperative linkage between the site of the disulfide bonds, the ligand-binding site, and the general thermodynamic stability of the enzyme.

Malignant neurofibroma of the urinary bladder

We report a case of a large malignant neurofibroma of the urinary bladder occurring in a 33-year-old patient with Recklinghausen's neurofibromatosis. Urologic manifestations of neurofibromatosis are infrequent; a neurofibroma of the bladder with malignant degeneration is an extreme rarity. To date only 3 cases have been described in the literature.

Expression of recombinant antibody and secreted alkaline phosphatase in mammalian cells. Influence of cell line and culture system upon production kinetics

The growth and productivity of an Sp2/0 cell line, F3b10, expressing a recombinant antibody (rAb) and BHK21 cells expressing either the same rAb from the same plasmids (BHK.IgG) or secreted alkaline phosphatase (SEAP) (BHK.SEAP) were investigated. The F3b10 line was grown as a single cell suspension. The BHK lines were grown either as suspended natural aggregates or on Cytodex 3 microcarriers. The data for F3b10 showed that the cell-specific rAb production rate (QsrAb) increased in parallel with increases in the specific growth rate (mu). A similar result was obtained for suspended aggregate cultures of both recombinant BHK cell lines. In contrast, for microcarrier cultures of both BHK cell lines, Qsproduct increased as mu decreased. This report shows that the relationship between cell growth and Qsproduct for the cell lines and products studied is dependent upon the culture process. In systems where recombinant cells are growing as a single cell suspension or within a natural suspension aggregrate, Qsproduct increased with increases in mu. In such systems, the cells have a rounded morphology. When cells were grown on microcarriers. Qsproduct decreased as mu increased. Cells growing attached to a surface are flat and elongated. The observed differences in the relationship of Qsproduct to mu are correlated with changes in cell morphology. The relationship between Qsproduct and mu is also affected by the choice of cell line.

Screening retroviral packaging cells for highly efficient virus production by using a combined selection procedure

To facilitate the screening for clones of transfected packaging cells producing a high yield of recombinant retrovirus, we present a fast and simple method for the isolation of overexpressing cells. By this method the efficiency of virus production can generally be enhanced 10- to 100-fold by application of high selection pressure. Cell lines which exhibit titers of up to 10(8) CFU/ml were obtained.

Are auxiliary methods necessary prior to ESWL in patients with a solitary kidney?

Between January 1985 and October 1991, 54 patients with calculi in a solitary kidney were treated by ESWL using the Dornier HM-3 lithotriptor. The mean age of the patients was 53.9 years (range 24-77 years). In 51.9% of the cases the stones measured > 1 cm in diameter, in 42.6% between 0.4 and 1 cm, and in 5.5% < 0.4 cm in diameter. In 39 of the 54 patients (72.2%) the calculi could be disintegrated by a single ESWL treatment. In 12 patients (22.2%) 2 ESWL treatments were necessary, and another 3 patients (5.6%) needed 3 ESWL treatments. In 6 cases (11.1%) percutaneous nephrostomy (PCN) was needed, and in 8 other patients ureteric stents were inserted prior to ESWL because of obstruction of the upper urinary tract, causing impending urosepsis in 8 of these 14 cases. Following ESWL, PCN was performed in 4 cases (7.4%) and a ureteric stent was inserted in 2 patients (3.7%) because of urinary obstruction. At discharge from the hospital 15 of the 54 patients (27.8%) were stone-free and 34 patients (63.0%) had small residual fragments of < 0.4 cm in diameter. One year after treatment, 42 patients could be evaluated at a control examination. 37 of these 42 patients (88.1%) were stone-free and 3 patients (7.1%) showed residual fragments of < 0.4 cm. In conclusion, our results demonstrate that, if there is no ureteric obstruction present prior to ESWL, the majority of patients with a solitary kidney do not present extraordinary problems and do not need auxiliary procedures.

Radical prostatectomy in patients with incidental prostate carcinoma

Radical prostatectomy was carried out in 30 patients with an incidental carcinoma of the prostate. A tumor stage T1a (A1) was present in 7 cases and a tumor stage T1b (A2) in 23 cases. None of the 30 patients died postoperatively. As intraoperative complication, a rectum perforation occurred in 1 case. In the 23 patients with a T1b tumor, a pT2pN0M0 lesion was found in 10 cases and pT3pN0M0 lesion in 11 cases on pathohistological examination after radical prostatectomy. In 5 out of 30 patients the carcinoma could no longer be detected in the radical prostatectomy specimen. In 1 patient with a T1a tumor, pelvic lymphadenectomy revealed a single lymph node metastasis. Tumor progression did not occur in any of the 7 patients with a T1a tumor after an observation period of 9 months up to 16 years (average 4.6 years). The percentage of progression-free patients in stage T1b was calculated as 81.4% 10 years after surgery. The calculated overall survival time of patients in stage T1b was 76.3% after 10 years and the tumor-related survival was 87.5%.

Detection of mycoplasma contaminations by the polymerase chain reaction

The polymerase chain reaction (PCR) has been used for the general detection of Mollicutes. 25 Mycoplasma and Acholeplasma species were detected including important contaminants of cell cultures such as M. orale, M. arginini, M. hyorhinis, M. fermentans, A. laidlawii and additional human and animal mycoplasmas. PCR reactions were performed using a set of nested primers defined from conserved regions of the 16S rRNA gene. The detection limit was determined to be 1 fg mycoplasma DNA, which is equivalent to 1-2 genome copies of the 16S rRNA coding region. The identity of the amplification products was confirmed by agarose gel electrophoresis and restriction enzyme analysis. DNA from closely and distantly related micro-organisms did not give rise to specific amplification products. The method presented here offers a much more sensitive, specific and rapid assay for the detection of mycoplasmas than the existing ones.

Treatment of a human renal cell carcinoma in nude mice with recombinant human tumor necrosis factor alpha and etoposide

The effect of treating a human renal cell adenocarcinoma xenografted into Balb/c-nu/nu (nude) mice with recombinant human tumor necrosis factor alpha (TNF alpha) and the cytostatic agent etoposide (ETP) as monotherapy or combination has been studied. Antitumor effects were evaluated by determining growth of the tumor implants by external caliper measurements and tumor cell proliferation by determining the labelling index (LI) after pulse labelling with 3H-thymidine. The toxicity of the treatment with TNF alpha and/or ETP was also studied by measuring the animal weight. Monotherapy with TNF alpha had no effect on tumor growth or proliferation. Treatment with ETP as a single agent, TNF alpha plus ETP applied concurrently and TNF alpha plus ETP two days later led to a slight inhibition of tumor growth and also to a slight decrease of the LI. In contrast to a monotherapy with TNF alpha, all therapeutic modalities containing ETP showed an increased toxic effect on the animals represented by a distinct weight loss. This suggests that the minute efficacy of the treatment observed could well be due solely to its toxicity. In contrast to two other studies, no additive or synergistic effect of the antineoplastic activity of TNF alpha and/or ETP was found. The intertumoral variation of human renal cell carcinomas could be one reason for the different results with this therapeutic regimen.

[Synchronous growth of a mixed mesodermal tumor and an adenocarcinoma of the urinary bladder]

The case of synchronous growth of a mesodermal mixed tumour and an adenocarcinoma in the bladder is presented. This is a rare phenomenon. Mesodermal mixed tumours are malignancies with both epithelial (carcinoma) and mesenchymal (sarcoma) differentiation. The term carcinosarcoma is frequently used in the literature. In most cases the prognosis of mesodermal mixed tumours, which depends mainly on the high rate of local recurrences, is poor. Therefore, cystectomy with suprapubic urinary diversion is the treatment of choice. However, results reported in the literature show that transurethral resection of the tumour may be adequate when there is only superficial growth of mesodermal mixed tumours. Short follow-up intervals are absolutely essential for patients treated this way.

[Pneumoscrotum. Case report and review of the literature]

The rare case of a pneumopenis and pneumoscrotum after a thoracic operation is reported. Two subtypes--pneumatocele and subcutaneous emphysema of the scrotum--are differentiated on the basis of anatomy. The cases reported in the literature so far are reviewed. A therapeutic regimen is recommended.

[Treatment of ureteral calculi in bone coverage using in situ ESWL in prone position]

From January 1988 to February 1992, a total of 26 patients with calculi in the middle third of the ureter underwent primary in situ ESWL in the prone position. All treatments were performed in sedoanalgesia using the Dornier HM 3 lithotriptor. During and after ESWL in the prone position, severe complications did not occur. Of the 26 patients, 10 (38%) were treated by a single application of ESWL. No auxiliary measures were necessary, and they became stone-free within 3 months following treatment. In another 9 patients (35%) auxiliary measures were required for visualization of radiolucent calculi or to relieve a urinary tract obstruction with incipient septicemia. All these auxiliary measures could be performed in sedoanalgesia. In the remaining 7 patients (27%), in whom stone disintegration following ESWL was incomplete, ureteroscopic lithotripsy techniques had to be applied. One of these 7 patients had to undergo an additional open operative procedure. The results of the present study demonstrate that a majority of patients with calculi in the middle portion of the ureter can become stone-free without invasive lithotripsy techniques following ESWL in the prone position, if necessary plus auxiliary measures, in sedoanalgesia. From these results it can be concluded that primary ESWL in the prone position should be considered for patients with calculi in the middle third of the ureter before invasive lithotripsy techniques are applied.

Mycoplasma detection by PCR analysis

The polymerase chain reaction (PCR) method was used to detect mycoplasma contamination in a panel of 42 continuous cell lines. According to the microbiological cultivation assay on agar, 29 cell lines were chronically infected and 13 cell lines were negative. Sets of outer and inner primers (nested double-step PCR) were applied which anneal to DNA sequences coding for conserved regions of the 16S rRNA. These oligonucleotides allow for the amplification of DNA regions found in at least 25 mycoplasma species (including the ones most commonly found in cell cultures), but do not cross-hybridize with DNA from eukaryotic cells. Mycoplasma-positive cell lines showed distinctive bands in ethidium bromide-stained gels, both after the first round of amplification as well as after the second PCR; all agar-negative cell lines were also unambiguously negative in the PCR assay. Thus, neither false-positive nor false-negative results occurred. Provided that the proper PCR working conditions are scrupulously observed, the PCR amplification has several outstanding advantages: high sensitivity, specificity, reliability, objectivity, speed, and simplicity.

[Immunotherapy of metastatic renal cell cancer]

In the treatment of advanced renal cell carcinoma, cytokines such as interferons, interleukin-2, tumor necrosis factor and immune therapy with autologous tumor cells and tumor cell vaccines have been tested on a large scale. A definitive cure of a patient with advanced renal cell cancer treated with cytokines or immune therapy has so far not been reported in the literature. The rates of objective remissions (PR and CR) are disappointing and rarely exceed 20% overall. The combination of interferon-alpha and interleukin-2 administered subcutaneously seems to offer the best results with the lowest morbidity. However since standard treatment protocols do not exist, treatment of patients with renal cell carcinoma using these substances should only be performed in prospective trials. Immunotherapy with interferons, interleukin-2, tumor necrosis factor, autologous tumor cells or tumor cell vaccines has to be regarded as experimental.

Specificity and sensitivity of polymerase chain reaction (PCR) in comparison with other methods for the detection of mycoplasma contamination in cell lines

The polymerase chain reaction (PCR) amplification was used for the detection of mycoplasma contamination in 42 continuous cell lines. Using the microbiological cultivation on agar as the reference method, 29 cell lines were regarded as positive and 13 cell lines as negative. The double-step PCR analysis employed nested primers that anneal to gene sequences coding for the evolutionarily conserved 16 S rRNA of some 25 different mycoplasma species (including the ones most commonly found in cell cultures). In terms of the positivity or negativity of mycoplasma infection the results were identical for the agar assay and PCR amplification. All positive cell lines displayed distinct, unequivocal, objectively discernible bands on agarose gels while the non-infected specimens showed no DNA amplification. A simultaneously performed comparison with four other commonly used detection methods (DNA-RNA hybridization in solution, DAPI DNA fluorescence staining, immunostaining with a monoclonal antibody and an ELISA) showed that PCR produced significantly less false-negative or false-positive results than all the other methods. Furthermore, in dilution experiments, PCR correctly detected the infecting mycoplasmas at the lowest level of 1/10(4) whereas the other assays were less sensitive. It is concluded that double-step PCR employing nested primers is superior to other mycoplasma detection methods in many respects: simplicity and speed, high specificity and extreme sensitivity, objectivity and accuracy.

Dicistronic transcription units for gene expression in mammalian cells

Dicistronic vectors utilizing the internal ribosomal entry site sequence of poliovirus as the intercistronic region were constructed for gene expression in mammalian cells. We have developed two monocistronic expression vectors which facilitate the creation of dicistronic expression plasmids. The dicistronic expression plasmids encode transcription units which allow the coordinated translation of the two genes. Using internal luciferase and secreted alkaline phosphatase, we show the correlated expression of both reporter genes and expression levels comparable to those achieved by the respective monocistronic expression vectors.

Arthroscopic treatment of full-thickness rotator cuff tears: 2- to 7-year follow-up study

This study analyzes the midterm follow-up results of 40 full-thickness rotator cuff tears treated by arthroscopic subacromial decompression and debridement. Patients were selected for this prospective study based on a variety of factors, including physiologic age, handedness, activity level in occupation or avocation, and preoperative estimate of repairability. Patients were divided into three groups based on the size of the tear as measured during surgery; results were evaluated on the UCLA shoulder rating scale. This study emphasizes the importance of patient selection when applying arthroscopic treatment for full-thickness rotator cuff tears. Small (0-2 cm) tears (n = 10) in older individuals not involved in strenuous activities did well (90% satisfactory). Patients with larger (2-4 cm) repairable tears (n = 8) did poorly (50% satisfactory) in comparison with our previous study of the results of open repair (84% satisfactory). Arthroscopic treatment in patients with massive, irreparable tears (n = 22) did not restore lost strength or range of motion, but there was significant pain relief, and 86% were satisfied with the results on a limited-goals basis. The study concludes that with proper patient selection, arthroscopic treatment has a valuable, but limited, role in the treatment of full-thickness rotator cuff tears.

Value of prostate-specific antigen as a tumor marker

Prostate-specific antigen (PSA) is the most important tumor marker for prostate cancer. However, the diagnostic limits of PSA have to be taken into consideration because PSA is also secreted by normal prostate tissue and, with benign prostatic hyperplasia, false positives are possible. Although there is a direct correlation between the serum PSA concentration and the clinical stage of the tumor, PSA is not sufficiently reliable to determine the stage of the disease on an individual basis. Low serum PSA concentrations (less than 20 ng/ml) in patients with previously untreated prostate cancer seem to be predictive for a negative bone scan. Serum PSA values also reflect the prognosis of the patient. With respect to monitoring patients after definitive therapy, PSA is a very sensitive tumor marker. However, in a small number of patients PSA-negative tumor recurrences occur.

Pharmacokinetic aspects of interferon alfa-2b after intrahepatic or intraperitoneal administration

The pharmacokinetics of interferon alfa-2b (IFN-alpha-2b) were determined following intraperitoneal (IP) infusion of escalating doses, ie, 5, 10, and 15 million units (MU) and intrahepatal-intraarterial (IA) (IA, bolus v 24 hours continuous infusion of 3 and 5 MU) administration in patients with metastatic cancer. Pharmacokinetic parameters show that bioavailability of IFN-alpha-2b after IP administration is 30 times higher for the peritoneal fluid (PF) than for peripheral blood (PB) explaining also the low incidence of side effects. The high affinity of IFN-alpha-2b to the peritoneal cavity is furthermore substantiated by the total compartment clearance, which is only about 1 1/minute for the PF in comparison to about 30 1/minute as determined for PB. IFN-alpha-2b is eliminated from the PF with a half life (t1/2) of elimination 10 to 32 hours and from the blood with t1/2 of 5 to 13 hours. After IA bolus, IFN is distributed from the blood with a t1/2 below, 2 hours, with dose-dependent serum peak concentrations (c = 47 IU for 3 MU and 145 IU for 5 MU). Twenty-four-hour infusion leads to a steady state within 4 to 6 hours and maximum concentration of 8.5 or 12.5 IU/mL, respectively. During infusion IFN alpha-2b is slowly eliminated with a t1/2 of 16 hours. The lower area under the curve levels after bolus injection may suggest a better tissue uptake of IFN-alpha-2b by the liver. Further studies on pharmacokinetics are warranted to establish exact dose recommendations for an optimal schedule using this route and mode of IFN-alpha-2b administration in mono- and combination therapies.

M-VAC versus CisCA--chemotherapy in the treatment of advanced bladder cancer

The results of this study do not demonstrate a superiority of M-VAC chemotherapy over a modified CisCA regimen chemotherapy. M-VAC, however, proved less toxic than CisCA in terms of side effects. Neither CisCA nor M-VAC was effective as a curative treatment for patients with distant metastases. A durable complete remission of 22.5 months was seen in only 2 of the 12 patients with locally advanced tumors without distant metastases treated with M-VAC, and one of 35 months was observed in only 1 of the 6 cases with locally advanced tumors treated with CisCA chemotherapy.