Lymphocytes and bladder cancer

Assessment of protein energy malnutrition in older persons, Part II: Laboratory evaluation

A large proportion of chronic diseases affecting older persons can be either prevented or significantly improved by improving nutrition. This places an increased burden on health care professionals caring for older persons. Screening for malnutrition at an early stage allows the intervention to be most successful. History, physical examination, and anthropometric measurements are essential parts of any nutritional evaluation. However, these tools can be highly subjective and rely heavily on the knowledge and experience of the evaluator. Incorporating biochemical measurements in the routine nutritional assessment provides an often-needed objective dimension. Interpreting these measurements must take into consideration the normal biological changes seen with aging. In this article, we review many of the biochemical parameters used in nutritional assessment and their relation to morbidity and mortality, with a special focus on normal changes seen with aging.

Absolute peripheral blood lymphocyte count and subsequent mortality of elderly men. The Baltimore Longitudinal Study of Aging

In this 16-year longitudinal study of 105 healthy elderly men, we analyzed one aspect of immunosenescence--a decline in the absolute number of peripheral blood lymphocytes--with particular reference to its relationship with subsequent mortality. It was found that there was a significantly (P less than .01) lower absolute lymphocyte count (1432 +/- 55/mm3; mean +/- SEM) within three years of death when compared with five years (1719 +/- 89/mm3) or 10 years (1715 +/- 98/mm3) before death. There was no relationship between this decrease in lymphocytes and age at death, smoking status, or prior cardiac illness. Previous cross-sectional studies have yielded conflicting data on age-related decreases in lymphocytes which may have been the result of an unrecognized selection process that either eliminated or included subjects who were close to death.

The value of urinary fibrin/fibrinogen degradation products as tumor markers in urothelial carcinoma

Urinary fibrin/fibrinogen degradation products as biological tumor markers in urothelial carcinoma have been studied and compared to urinary cytology. In 93 per cent of the patients with urothelial carcinoma urinary fibrin/fibrinogen degradation product levels were elevated significantly. There was excellent correlation when the urinary cytology and urinary fibrin/fibrinogen degradation product results were compared together to cystoscopic findings.

Bladder instillation of adriamycin in the treatment of bladder cancer

Intravesical Adriamycin instillation was used in 10 patients with transitional cell carcinoma of the bladder as postoperative prophylactic treatment against recurrence. The protocol for bladder instillation was 20 mg/10 ml of Adriamycin twice weekly for a total of eight doses. One patient developed recurrence in 3 months and three, in 6 months. The main local side-effects were frequency and dysuria which occurred in four cases. Leukopenia and increased SGOT and SGPT values each occurred in one case. No cases of cardiotoxicity, fibrosis, or atrophy of the bladder mucosa were found. Further studies are necessary to achieve the best possible results.

Does cyclophosphamide induce bladder cancer?

An increasing incidence of bladder neoplasms temporally associated with chemotherapy, usually cyclophosphamide, is being reported. These secondary primary bladder malignancies are characteristically found in two groups of patients: those with lymphoproliferative or myeloproliferative tumors, and those with immunosuppression after organ transplantation. A case of adenocarcinoma of the bladder associated with malignant lymphoma is reported, and the known cases of second primary bladder malignancies after cyclophosphamide therapy as reported in the literature are reviewed. Studies relating to the enhanced occurrence of second primary cancers in lymphoproliferative disorders are presented. The recognized urologic toxicities of cyclophosphamide, including cytopathologic changes in animals and humans, are discussed. The observed association between immunosuppression and second primary malignancies is explored, as supported by studies on congenital immunodeficiency in humans, viral oncogenesis in experimental animals, and neoplasia after organ transplantation. Possible mechanisms of carcinogenesis associated with cyclophosphamide are reviewed, including suppression of humoral and cell-mediated immune defense mechanisms, direct carcinogenesis, or cocarcinogenesis. A plea is made for the orderly reporting and careful documentation of bladder tumors in patients receiving cyclophosphamide. It is suggested that prospective studies in these patients and in patients receiving cyclophosphamide for nonmalignant disorders would be of value in assessing the culpability of cyclophosphamide as a carcinogen.

Levamisole in the treatment of non-invasive and invasive bladder cancer: a preliminary report

We have done a double-blind, randomized, controlled study on 37 patients with transitional cell carcinoma in which levamisole was used as an immune adjuvant in addition to the standard therapy for non-invasive and invasive bladder cancer. Levamisole is administered easily and is well tolerated, especially when compared to other immune adjuvants, such as bacillus Calmette-Guérin or Corynecbacterium parvum. Recall antigens, dinitrochlorobenzene reactivity and total lymphocyte count demonstrated little correlation to the initial stage of disease. Monocyte chemotaxis was increased significantly in patients receiving levamisole. Since our study is ongoing on data exist as yet to make any statement regarding the efficacy of levamisole in the treatment of bladder cancer.

Re-evaluation of hydrostatic pressure treatment for malignant bladder lesions

We reviewed 50 cases of bladder cancer treated with the hydrostatic pressure technique. Results were encouraging when 1) single or multiple papillary tumors were not located around the ureteral orifice, with a presumed depth of tumor infiltration within T2, I) there was no history of open operations, 3) there was observed activity of immunological surveillance, for example a positive reaction to a tuberculin test, and 4) management of anesthesia was satisfactory. Hydrostatic pressure therapy is not palliative treatment for far-advanced cases of bladder cancers but should be the first choice for new cases beyond the scope for transurethral operations and when indications in tumor and host condition are satisfied.

Immune reactivity in renal cancer: a sequential study

We evaluated 18 patients with adenocarcinoma of the kidney immunologically in a linear fashion. Delayed cutaneous hypersensitivity was significantly altered in patients with metastatic disease. In vitro studies have shown a progressive decline in the absolute number of circulating lymphocytes and the T cell subpopulations that parallels the advance of the maligant process. Evaluation of lymphocyte function by the response to mitogens appears to be of little significance in a sequential study.

Mononuclear cell content of human solid tumors

The mononuclear cell content and mononuclear cell function of human solid tumors were determined. Twenty-eight primary, and 17 metastatic solid tumors, including 6 lymph node metastases, were obtained from 45 patients. Cells were released from the tumors by mincing, scraping, and sieving. Analysis of the cellular content was determined by light microscopy, and tumor lymphocyte function was determined by stimulation of blastogenesis with PHA, PWM, Con-A, MLC, and SLO. A median of 3.3 X 10(7) tumor cells with 12.5% viability was obtained per gram of tumor, and a median of 7.8 X 10(6) lymphocytes with a viability of 96% and 0.35 X 10(6) macrophages with a viability of 85% was also obtained per gram of tumor. Significant lymphocyte responses to various mitogens and antigens were obtained in 31-40% of the tumor lymphocyte preparations. From 9.4% to 23% had vigorous responses with a stimulation index greater than 10. Primary tumors contained significantly more lymphocytes than metastatic tumors; thus, the percent lymphocytes in primary tumors was 13.5% compared to 5% for metastatic tumors. In contrast, some of the lymphocyte responses were significantly greater for metastatic tumors than primary tumors. These data suggest that the direct study of lymphocytes infiltrating primary and metastatic tumors may be a useful approach to understanding tumor immunity in man.

Evaluation of biological markers in bladder cancer

The value of biological markers of bladder cancer was studied in 66 patients. The markers included serum and urine carcinoembryonic antigens, serum and urine fibrinogen degradation products, total lymphocyte counts, urine lymphocytes and urine cytology. A high degree of accuracy (90 per cent) was found in correlating cytology and urinary fibrinogen degradation products with the activity of the disease. Serum and urine carcinoembryonic antigens, serum fibrinogen degradation products, total lymphocyte counts and urine lymphocytes were found to have no value in screening bladder cancer patients. Urinary fibrinogen degradation products and cytology in combination are recommended for screening and followup of patients at high risk.

Staged treatment of invasive carcinoma of bladder

A three-stage approach to carcinoma of the bladder consists of preliminary urinary diversion, radiation therapy, and simple total cystectomy. We have used this method for more than ten years. The survival rates are the same as generally published, and the morbidity and mortality contrast favorably with other reports. To date no patient has died within two months of completion of the course of therapy.