Radiologic Findings in Renal Oncocytoma

The imaging findings of 36 renal oncocytomas in 32 patients were evaluated retrospectively. Twenty-two patients underwent ultrasound (US), 16 CT, 25 angiography, 19 urography, and 6 fine-needle biopsy. At US 8 of the oncocytomas were isoechoic, 7 hyperechoic, and 7 hypoechoic. The structure was homogeneous in 59% and nonhomogeneous in 41 %. At plain CT 12 oncocytomas were homogeneously hypodense, 3 isodense, and one hyperdense. Contrast enhancement was homogeneous in 10 and inhomogeneous in 4 cases. A stellate scar was detected in one case, and in one case a contrast study was not performed. At angiography the oncocytomas were hypervascular in 21, hypovascular in 3 cases, and one was not detected. Nineteen of the tumors were well delineated. A spoke-wheel arterial pattern was detected in 3 tumors. The cytologic diagnosis was benign renal oncocytoma in 4 cases and highly suggestive of oncocytoma in 2 cases. We conclude that the homogeneity of a renal tumor at US and at CT may suggest the possibility of oncocytoma. US-guided fine-needle biopsy is a useful diagnostic tool in patients who need a precise presurgical diagnosis.

The presence of visual neglect after thrombolytic treatment in patients with right hemisphere stroke

Visual neglect (VN) is a common consequence of right hemisphere (RH) stroke. The aims of this study were to explore the presence of VN after RH stroke in the patients with (T+) or without (T−) thrombolytic treatment, and to determine whether thrombolysis is a predictor of VN. The study group consisted of 77 RH infarct patients. VN was evaluated with six conventional subtests of the Behavioural Inattention Test (BIT). Stroke severity was assessed using the National Institute of Health Stroke Scale (NIHSS). In the neuropsychological examination, 22% of all RH stroke patients had VN. VN was present in 15% of the patients in the T+ group and in 28% of the patients in the T− group, but the difference was not statistically significant. Despite that, patients in the T− group had a higher risk of VN than patients in the T+ group. Our results suggest that thrombolysis independently predicted absence of VN.

Effect of adjuvant androgen deprivation on thyroid function tests in prostate cancer patients

Androgen deprivation (AD) used in the treatment of prostate cancer is known to alter concentrations of sex hormones and their binding globulins. Less is known as to its effect on thyroid hormones. In this prospective study the effects of AD on thyroid function were clarified. Levels of serum thyroid stimulating hormone (TSH), free thyroxine (FT4) and thyroid binding globulin concentrations were measured in prostate cancer patients treated with either radical radiotherapy and androgen deprivation for 12 months (AD) or radical radiotherapy alone (RT). Measurements were made at baseline, and at 3, 6 and 12 months. At baseline and at 3 months the results of thyroid function tests did not differ significantly between groups. A significant decline in serum testosterone in the AD group was accompanied by a significant decline in FT4 at 6 and 12 months, while no significant changes in thyroid function were observed in the RT group. The decline in FT4 among AD patients did not evoke a normal TSH response. Prolonged use of AD hampers the interpretation of thyroid test results. This finding has substantial implications for the follow-up of patients in hormonally treated prostate cancer.

Androgen deprivation and cognition in prostate cancer

Androgen deprivation (AD) is commonly used in neoadjuvant and adjuvant setting with prostate cancer (PC) radiotherapy. This prospective study assessed whether cognitive functioning is impaired during 12 months of AD therapy. Longitudinal testing of 25 patients treated with AD and curative radiotherapy was undertaken at baseline, and at 6 and 12 months. CogniSpeed software was used for measuring attentional performances. Other cognitive performances were evaluated using verbal, visuomotor and memory tests. The Beck depression inventory was employed to evaluate depressive mood and EORTC QLQ-C30 for quality of life (QoL). During longitudinal testing of the AD group, no impairment in cognitive performances was found. Instead, improvement was observed in object recall (immediate, P=0.035; delayed, P<0.001), and in semantic memory (P=0.037). In QoL, impairment in physical function was observed. Androgen deprivation of 12 months appears to be associated with preserved cognitive functioning, although physical impairment occurs. These results have implications for counseling and psychosocial support of patients in the context of treatment options in PC.

Leiomyoma of the urinary bladder

We report a case of rare benign bladder leiomyoma. The patient was a 42-year old man complaining impotence. Digital rectal examination revealed a palpable pelvic tumor. Transurethral ultrasonography, computed tomography (CT), and magnetic resonance image (MRI) examinations all showed a cystic tumor measuring 10 x 8 cm. On the basis of these findings leiomyoma was suspected already before operation. The tumor was removed by open resection of bladder, and the diagnosis was confirmed by histology and positive immunohistochemistry.

Leiomyoma of the urinary bladder

We report a case of rare benign bladder leiomyoma. The patient was a 42-year old man complaining impotence. Digital rectal examination revealed a palpable pelvic tumor. Transurethral ultrasonography, computed tomography (CT), and magnetic resonance image (MRI) examinations all showed a cystic tumor measuring 10 x 8 cm. On the basis of these findings leiomyoma was suspected already before operation. The tumor was removed by open resection of bladder, and the diagnosis was confirmed by histology and positive immunohistochemistry.

Measurement of circulating forms of prostate-specific antigen in whole blood immediately after venipuncture: implications for point-of-care testing

BACKGROUND

The purpose of this study was to validate the use of whole-blood samples in the determination of circulating forms of prostate-specific antigen (PSA).

METHODS

Blood samples of hospitalized prostate cancer and benign prostatic hyperplasia patients were collected and processed to generate whole-blood and serum samples. Three different rapid two-site immunoassays were developed to measure the concentrations of total PSA (PSA-T), free PSA (PSA-F), and PSA-alpha(1)-antichymotrypsin complex (PSA-ACT) to detect in vitro changes in whole-blood samples immediately after venipuncture. The possible influence of muscle movement on the release of PSA from prostate gland was studied in healthy men by measuring the rapid in vitro whole-blood kinetics of PSA forms before and after 15 min of physical exercise on a stationary bicycle.

RESULTS

Rapid PSA-T, PSA-F, and PSA-ACT assays were designed using a 10-min sample incubation. No significant changes were detected in the concentrations of PSA-T, PSA-F, and PSA-ACT from the earliest time point of 12-16 min compared with measurements performed up to 4 h after venipuncture. Physical exercise did not influence the concentrations of the circulating forms of PSA. Hematocrit-corrected whole-blood values of PSA-T and PSA-F forms were comparable to the respective serum values. Calculation of the percentage of PSA-F (PSA F/T ratio x 100) was similar irrespective of the sample format used, i.e., whole blood or serum.

CONCLUSIONS

We found that immunodetectable PSA forms are likely at steady state immediately after venipuncture, thus enabling the use of anticoagulated whole-blood samples in near-patient settings for point-of-care testing, whereas determinations of PSA (e.g., PSA-T, PSA-F, or PSA-ACT) performed within the time frame of the office visit would provide results equivalent to conventional analyses performed in serum.

Management of testicular cancer--16 years' experience from southwest Finland

OBJECTIVE

This study investigated the outcome of testicular cancer treatment in Finland.

MATERIAL AND METHODS

Data on 88 testicular cancer patients treated in Turku University Central Hospital between 1976 and 1992 were studied to analyse outcome and survival.

RESULTS

The histological diagnosis was seminoma for 39 patients and non-seminoma for 49 patients. Two seminoma patients relapsed (5%) and one patient died of progressive disease (3%; initially stage II seminoma). Eleven non-seminoma patients relapsed (22%), nine of whom were cured with chemotherapy. Four non-seminoma patients died of progressive disease (8%; initially one stage I non-seminoma and three stage III non-seminomas). The median time to relapse after the completion of treatment was 9 months (range 3-50 months). Non-seminoma patients had significantly more relapses than seminoma patients (p = 0.03). Most relapses (73% of the non-seminoma relapses) were found among the stage I non-seminoma patients who had not received adjuvant chemotherapy, while none of the stage I seminoma patients relapsed (p = 0.007).

CONCLUSIONS

Close surveillance is important for all non-seminoma patients to guarantee the early detection and treatment of recurrent disease. Treatment and surveillance should be covered by national guidelines and be conducted in centres with special interest in this rare but mostly curable cancer.

Increased expression of cyclooxygenase-2 and nitric oxide synthase-2 in human prostate cancer

Cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase-2 (NOS-2) each have an important role in angiogenesis. The expression of these genes was investigated in human prostate cancer by immunohistochemistry, the expression of COX-1 and COX-2 being confirmed by mRNA analysis. Prostate cancer specimens from 12 patients were compared to control prostates from 13 patients operated on for bladder carcinoma. The intensity of COX-2 and NOS-2 immunostaining was significantly stronger in prostate cancer cells than in the non-malignant glandular epithelium of the control prostates. COX-2 and NOS-2 were clearly also expressed in the lesions of prostatic intraepithelial neoplasia (PIN) in control prostates. COX-2 was detected in the muscle fibres of the hyperplastic stroma of some control prostates. No significant difference was detected in COX-1 expression between control and cancer prostates. These results indicate that the expression of COX-2 and NOS-2 is elevated in prostatic adenocarcinoma and in PIN.

Human complement factor H related protein test for monitoring bladder cancer

PURPOSE

The BTA stat test is a rapid, noninvasive, qualitative urine test that detects bladder tumor associated antigen (human complement factor H related protein) in urine. We compared BTA stat test to voided urine cytology in patients monitored for bladder cancer in a prospective trial, and determined whether this test is effective in detection of recurrence not seen by regular cystoscopy.

MATERIALS AND METHODS

A total of 445 consecutive patients with bladder cancer were studied. A voided urine sample was obtained before cystoscopy and divided for culture, cytology and BTA stat testing. In cases of a positive BTA stat test but negative cystoscopy, excretory urography or renal ultrasound, random biopsies and collected ureteral urine samples for ureteral cytology were obtained. The overall sensitivity and specificity as well as positive and negative predictive values for BTA stat test, cytology and their combination were calculated.

RESULTS

Of the 445 patients 118 (26.5%) had bladder cancer recurrence on cystoscopy, which was detected by BTA stat test and cytology in 63 (53.4%) and 21 (17.8%), respectively. Of the remaining 327 patients not having recurrent tumor on cystoscopy 81 (24.8%) had a positive BTA stat test. Excretory urography or renal ultrasound and random biopsies in 48 (59.3%) of these patients revealed 7 recurrences, making the total number of recurrent tumors 125 of 412 (30.3%). The overall sensitivities and specificities for the BTA stat test, cytology and their combination were 56.0%, 19.2%, 60.0% and 85.7%, 98.3% and 85.0%, respectively.

CONCLUSIONS

The sensitivity for detection of recurrent tumor on BTA stat test is superior to that of voided urine cytology in all bladder cancer categories, whereas the specificity of voided urine cytology is higher than that for BTA stat test. However, a sixth of the patients with apparent false-positive BTA stat test results chosen for further investigation had recurrent tumors that were not found on routine cystoscopy. Although the sensitivity and specificity were highest when both tests were used, the differences were not significant overall. Therefore, the BTA stat test could potentially replace urine cytology for followup of superficial bladder cancer.

Interferon-alpha inhibits cyclooxygenase-1 and stimulates cyclooxygenase-2 expression in bladder cancer cells in vitro

The enzymes cyclooxygenase-1 (Cox-1) and cyclooxygenase-2 (Cox-2) catalyze the initial step in the formation of prostaglandins (PGs). PGs are known to be involved in numerous processes, for example inflammation, immune responses, carcinogenesis, and tumor angiogenesis. The formation of PGs is stimulated in various cancers since the expression of Cox-2 is upregulated. Interferon (IFN)-alpha is used in the treatment of bladder cancer, although not all of the effects of such treatment are thoroughly known. Therefore, we investigated the expression of cyclooxygenases in two bladder cancer cell lines, 5637 and T24, under basal conditions and in the presence of human recombinant IFN-alpha (100, 1,000, and 10,000 U/ml). The mRNA of Cox-1 and Cox-2 was expressed in both cultured bladder carcinoma cell lines. The level of Cox-1 expression was low in 5637 cells and higher in T24 cells. In contrast, Cox-2 expression was prominent in 5637 cells and low in T24 cancer cells. The highest IFN-alpha concentration (10,000 U/ml) decreased the expression of Cox-1 to 47 and 28% of the control levels in 5637 and T24 cells, respectively. In contrast, Cox-2 expression increased in both cell lines. In 5,637 cells, Cox-2 expression increased 1.3-fold with 10,000 U/ml of IFN-alpha. In T24 cells, the maximum effect was achieved by 1,000 U/ml of IFN-alpha, which increased the expression of Cox-2 up to 2.4-fold. These findings may have relevance in the outcome of patients treated with IFN-alpha because upregulated Cox-2 expression may suppress the cell-mediated defense system. On the other hand, the inhibition of Cox-1 could be beneficial because Cox-1 is known to stimulate angiogenesis.

The role of Borrelia burgdorferi in interstitial cystitis

BACKGROUND/AIMS

Borrelia burgdorferi spirochete has been found both in bladder biopsies and the urine of patients with Lyme disease (LD) as well as in experimental animals. The urological symptoms in borreliosis resemble those of interstitial cystitis (IC): frequency, urgency and nocturia. The aim of this studies is to find the role of B. burgdorferi in interstitial cystitis.

METHODS

We studied antibodies against B. burgdorferi from serum samples of 50 IC patients with two separate EIA tests. Patients with positive serology in both tests underwent cystoscopy and a bladder biopsy was taken. The presence of borrelia DNA was studied with borrelia-specific polymerase chain reaction (PCR), and with universal bacterial PCR.

RESULTS

IgM class antibodies to B. burgdorferi were not found, but IgG antibodies were found in four samples (8%). This was higher than in the control material (2%). One patient's sample was strongly positive, whereas three samples were weakly positive. Bladder biopsies taken from the 4 patients were negative for borrelia DNA in both PCR tests. None of the seropositive patients had any symptoms consistent with LD.

CONCLUSION

These results indicate that persistent infection of B. burgdorferi has no role in the etiology of IC. On the other hand a connection with a past borrelia infection and IC is not excluded.

Brain ethanol levels after voluntary ethanol drinking in AA and Wistar rats

Brain ethanol was monitored in the nucleus accumbens with one minute microdialysis and headspace gas chromatography in male Wistar and alcohol preferring AA (Alko Alcohol) rats after voluntary limited access consumption without food restriction. The rats drank 0.93 +/- 0.14 (Wistar) and 0.73 +/- 0.07 g/kg (AA), with a resulting mean maximal brain ethanol level of 15.9 mM and 14.1 mM, respectively. Maximum brain ethanol levels for individual AA rats were in the range 9.4-33.6 mM, median 15.5 mM and for the individual Wistar rats in the range 2.5-35.2 mM, median 17.8 mM. There was a significant but not perfect correlation between the amount ethanol drunk and the resulting ethanol level in the nucleus accumbens, probably because of the rats not being food deprived before the experiment. The results show that rats drink pharmacologically meaningful doses in a voluntary limited access situation and that blood samples can give us a hint about the level attained in the brain, but to know the early brain concentration after drinking, microdialysis is an excellent tool.

Prospective randomized trial of interferon alfa-2a plus vinblastine versus vinblastine alone in patients with advanced renal cell cancer

PURPOSE

The combination of interferon alfa-2a (IFNalpha2a) plus vinblastine (VLB) induces objective tumor responses in patients with advanced renal cell cancer. However, no prospective randomized trial has shown that this treatment prolongs overall survival. We compared overall survival after treatment with IFNalpha2a plus VLB versus VLB alone in patients with advanced renal cell cancer.

PATIENTS AND METHODS

We prospectively randomized 160 patients with locally advanced or metastatic renal cell cancer to receive either VLB alone or IFNalpha2a plus VLB for 12 months or until progression of disease. In both groups, VLB was administered intravenously at 0.1 mg/kg every 3 weeks, and in the combination group IFNalpha2a was administered subcutaneously at 3 million units three times a week for 1 week, and 18 million units three times a week thereafter for the second and subsequent weeks. For patients unable totolerate IFNalpha2a at 18 million units per injection, the dose was reduced to 9 million units.

RESULTS

Median survival was 67.6 weeks for the 79 patients receiving IFNalpha2a plus VLB and 37.8 weeks for the 81 patients treated with VLB (P =.0049). Overall response rates were 16. 5% for patients treated with IFNalpha2a plus VLB and 2.5% for patients treated with VLB alone (P =.0025). Treatment with the combination was associated with constitutional symptoms and abnormalities in laboratory parameters, but no toxic deaths were reported.

CONCLUSION

The combination of IFNalpha2a plus VLB is superior to VLB alone in the treatment of patients with locally advanced or metastatic renal cell carcinoma. This is the first study to demonstrate that survival can be prolonged by using IFNalpha2a for these patients.

The cytostatic effect of 9-cis-retinoic acid, tretinoin, and isotretinoin on three different human bladder cancer cell lines in vitro

Retinoids have been shown to have activity in both preclinical and clinical bladder cancer studies but their exact role in its treatment and prevention remains obscure. In this study cytostatic activity of a novel 9-cis-retinoic acid (9-cis-RA) was compared with two other retinoids: tretinoin and isotretinoin, in three different bladder cancer cell lines: RT4 (well differentiated), 5637 (moderately differentiated) and T24 (poorly differentiated). The three retinoids were incubated at concentrations of 0.3, 3 and 30 microg/ml with bladder cancer cells in microtitre plates for 3 and 6 days. The cytostatic effect was estimated by using luminometric measuring of ATP activity of viable cells in suspension. Compared with the older retinoids, tretinoin and isotretinoin, the highest concentration of 9-cis-RA had a cytostatic efficacy in all three bladder cancer cell lines tested. A clear dose response relationship was observed in isotretinoin-treated cultures after 6 days and in all 9-cis-RA-treated cultures. Tretinoin was either ineffective or had a stimulating effect on poorly differentiated tumour cells. To conclude, isotretinoin and 9-cis-RA had a cytostatic effect on human bladder cancer cells in vitro. However, the possibility of stimulating cancer growth at small doses, at least with tretinoin, and toxicity at high doses must be considered when planning clinical trials.

Urinary bladder transitional cell carcinogenesis is associated with down-regulation of NF1 tumor suppressor gene in vivo and in vitro

The NF1 gene product (neurofibromin) is known to act as a tumor suppressor protein by inactivating ras. The best documented factors involved in urinary bladder transitional cell carcinoma (TCC) are ras proto-oncogene activation and p53 suppressor gene mutations. This is the first study reporting alterations in NF1 gene expression in TCC. We examined NF1 gene expression in a total of 29 surgical urinary bladder TCC specimens representing grades 1 to 3 and in three cell lines, RT4, 5637, and T24 (representing grades 1 to 3, respectively). Decreased NF1 gene expression was observed in 23 of 29 (83%) TCC specimens as estimated by immunohistochemistry, the decrease being more pronounced in high-grade tumors. NF1 mRNA levels were markedly lower in TCC tissue compared with adjacent non-neoplastic urothelium, as studied by in situ hybridization for grade 3 TCC. Immunohistochemistry and Western blotting demonstrated that TCC cell lines expressed NF1 protein at different levels, expression being almost undetectable in T24 (grade 3) cells. Northern blotting for cell lines demonstrated reduced NF1 mRNA levels in grade 3 TCC cells. Reverse transcription polymerase chain reaction for cell lines and selected grade 2 and grade 3 tissue samples demonstrated NF1 type II mRNA isoform predominance in all samples studied. Our results show that both NF1 mRNA and protein levels are decreased in high-grade TCC, suggesting that alterations of NF1 gene expression may be involved in bladder TCC carcinogenesis.

Dopamine release during ethanol drinking in AA rats

The dopamine overflow in the nucleus accumbens of rats from the high alcohol drinking AA line was measured by microdialysis before, during, and after one-half hour sessions of cued drinking of ethanol flavored with saccharin and peppermint or, as a control, saccharin-peppermint drinking. The animals had had extensive previous experience with ethanol drinking. Self-administration of the ethanol solution did not raise the dopamine level substantially: there was a small (17%) but significant increase only during the first 10 min after the onset of drinking. Giving the rats a cue for ethanol, which was part of their daily routine drinking regime, did not raise the dopamine level before ethanol was presented to the rats (i.e., during "anticipation"). The results are consistent with our previous studies showing a lack of a large ethanol-induced dopamine response in rats with previous experience of drinking ethanol and with the idea that although dopamine may play some role in alcohol drinking, it is not the central substrate producing the reinforcement from ethanol in AA rats.

Percutaneous sclerotherapy for varicocele embolization

Varicocele is a common cause of male infertility and can be treated surgically or by angiographic occlusion of the internal spermatic (testicular) vein. The treatment of clinical as well as subclinical varicoceles has been reported to improve sperm parameters. Varicocele also can cause scrotal pain and discomfort. We treated 89 patients using percutaneous sclerotherapy on an outpatient basis. Our technique proved to be simple and effective and was associated with low morbidity. At follow-up only three failures occurred.

Perforation of continent urinary reservoirs. Scandinavian experience

In a questionnaire survey of urological departments in Sweden, Denmark, Finland and Norway, 20 episodes of perforation of continent urinary pouches were found to have occurred in 18 patients, representing an incidence of 1.5%. This complication occurred with ileal as well as colonic segments, without predilection. In one case there was perforation of an appendiceal outlet. Noticeable findings were (a) a long delay (median 10h) to treatment and (b) that investigational procedures such as enterocystography and enterocystoscopy were not commonly employed. Treatment of this potentially lethal complication was by oversewing the perforation, and there were no subsequent major complications. This complication should be strongly suspected if a patient with continent urinary reconstruction presents with acute abdominal pain.

Prolactin and prolactin receptors are expressed and functioning in human prostate

Prolactin is widely expressed in different tissues, and it is presumed to have both local and systemic actions. In males it is known to influence reproductive functions but the significance and mechanisms of prolactin action in male accessory reproductive tissues are poorly understood. Here we show that prolactin acts as a direct growth and differentiation factor for human prostate, as measured by changes in DNA synthesis and epithelial morphology of organ cultures. Furthermore, we report the expression in human prostate of a short prolactin receptor form in addition to the long form, based upon ligand cross-linking studies and RT-PCR analysis of mRNA expression. The highest density of prolactin receptors was detected in the secretory epithelial cells by immunohistochemistry. Finally, we report that prolactin is locally produced in human prostate epithelium, as evidenced by marked prolactin immunoreactivity in a significant portion of prostate epithelial cells, with parallel expression of prolactin mRNA in human prostate. Collectively, these data provide significant support for the existence of an autocrine/paracrine loop of prolactin in the human prostate and may shed new light on the involvement of prolactin in the etiology and progression of neoplastic growth of the prostate.

Clinical experience with the detubularized ileocecal reservoir and continent appendicoumbilical stoma in urinary diversion

OBJECTIVE

To obtain clinical experience of a reservoir using a detubularized ileocecal segment (Mainz pouch) and continent appendiceal stoma connected to the umbilicus.

METHODS

The operation was performed in 23 patients. The submucosally placed in situ appendix was connected to the umbilicus acting as the continence mechanism and route for self-catheterization. The follow-up period was 8-62 months.

RESULTS

No operative mortality occurred. In 2 patients the postoperative period was complicated by catheter perforation of the appendix. In 4 patients stomal stenosis required excision of the stricture and reanastomosis. All patients are completely continent and catheterization is easy.

CONCLUSION

Both functional and cosmetic results are very satisfactory.

Effect of prior ethanol experience on dopamine overflow in accumbens of AA and ANA rats

The purpose of this study was to investigate the effect of repeated ethanol administration on dopamine overflow in the nucleus accumbens of alcohol-preferring AA (Alko Alcohol) and alcohol-avoiding ANA (Alko Nonalcohol) rats. Dopamine is a possible mediator of the reinforcing effects of ethanol, but it has previously been shown that ethanol-naïve alcohol-preferring AA and alcohol-nonpreferring ANA rats do not differ in their dopaminergic reaction to an intraperitoneal ethanol injection (0.5-2.0 g/kg), as assessed by measuring extracellular dopamine in the nucleus accumbens with in vivo microdialysis. Here a group of AA rats drank 10% (v/v) ethanol voluntarily-continual access for 5-15 days, limited access for 3 weeks-while a yoked group of AA rats and a yoked group of ANA rats received the same amount intragastrically by intubation. The rats were implanted with guide cannulas on the fourth week of limited access. Dopamine overflow was monitored in the microdialysis perfusate after 1 g/kg i.p. ethanol. The AA and the ANA rats that received ethanol non-contingently showed the same dopaminergic response to this as naïve animals have before. The group that had ingested the ethanol voluntarily showed, however, a significantly smaller increase in dopamine after 1 g/kg ethanol i.p. This suggests that the active behavior associated with obtaining the contingent drug may have an important impact on the reactions of the dopamine system to the drug, producing different results than when the same drug is administered by other routes. The hypothesis that dopamine mediates ethanol reinforcement in AA rats is not supported by the results.

Absence of bacterial DNA in the bladder of patients with interstitial cystitis

PURPOSE

Although bacterial infection has been long considered a possible cause of interstitial cystitis (IC), no definitive proof for or against this hypothesis has been presented so far. We have used 16S rDNA bacterial polymerase chain reaction to study bladder biopsies and sterile urine samples from patients suffering from IC. This method is sensitive and detects all known eubacteria.

MATERIALS AND METHODS

Bladder biopsies and sterile urine samples obtained by transabdominal puncture were studied from 11 patients with IC. As controls we studied 4 patients with other urological problems leading to partly similar symptoms and 5 healthy individuals.

RESULTS

All samples from the IC patients were negative. One positive sample was obtained from a woman with a history of urinary tract infections who suffered from nonIC ulcerative cystitis. Her sterile urine sample yielded Lactobacillus acidophilus.

CONCLUSION

These results indicate that an ongoing bacterial infection is not the cause of interstitial cystitis.

Viruses and interstitial cystitis: adenovirus genomes cannot be demonstrated in urinary bladder biopsies

Microbes may be involved in the pathogenesis of interstitial cystitis (IC). Adenoviruses and BK virus (BKV) can infect epithelial cells in urinary bladder and they are causative agents for hemorrhagic cystitis. We therefore studied the presence of adenovirus and BKV genomes in urinary bladder tissue specimens of patients with IC using polymerase chain reaction (PCR) and in situ hybridization (ISH). Controls were specimens from cases with transitional cell carcinoma of the bladder. Nucleic acids were extracted from paraffin sections of the bladder tissue for PCR. Primers detecting all adenovirus types were used. In situ hybridization was carried out for the paraffin sections using digoxigenin-labeled DNA probes for adenovirus and BKV. The adenovirus DNA PCR was able to detect one to two infected cells/specimen. All the seven IC cases studied and six controls were negative for adenovirus DNA by PCR and ISH. The ISH test for BKV genomes was also considered negative in IC cases and controls. The specimens which were negative in PCR tests yielded a signal with beta-globin primers, thus being amplifiable. We conclude that adenovirus and BKV do not play a major pathogenetic role in interstitial cystitis.

Alternating mitomycin C and bacillus Calmette-Guerin instillation prophylaxis for recurrent papillary (stages Ta to T1) superficial bladder cancer. Finnbladder Group

PURPOSE

We attempted to prove if alternating chemoprophylactic and immunoprophylactic instillations improved efficacy and decreased toxicity in patients with recurrent superficial bladder cancer.

MATERIALS AND METHODS

A total of 188 patients with rapidly recurring stage Ta or T1 cancer was randomly treated with mitomycin C (group 1) or alternating mitomycin C and Pasteur strain bacillus Calmette-Guerin (BCG) instillations (group 2) for 2 years. Mean followup was 34 months.

RESULTS

Median times to initial recurrence were 12 months in group 1 and 7 months in group 2 (p = 0.976), and treatment failed in 21.5% and 18.9%, respectively. Recurrence rates during the instillation period were 1.01 in group 1 and 0.86 in group 2 (p = 0.376). There was no difference in the disease-free interval between the 2 groups (p = 0.976). Instillations were discontinued because of adverse effects in 6 cases (6%) in both groups.

CONCLUSIONS

Efficacy of alternating mitomycin C and BCG was equal to mitomycin C monotherapy, and both methods were effective in prophylaxis of recurrent papillary bladder cancer. Less toxicity occurred in the alternating treatment group compared to earlier BCG monotherapy results.

Effect of ethanol on extracellular dopamine in the nucleus accumbens of alcohol-preferring AA and alcohol-avoiding ANA rats

The role of central monoamines in the genetically determined influences on voluntary ethanol consumption were examined by studying the extracellular levels of monoamines in the nucleus accumbens of the alcohol-preferring AA (Alko Alcohol) and alcohol-avoiding ANA (Alko Nonalcohol) rats with in vivo microdialysis. Dialysate samples for the assay of monoamines with small bore HPLC were collected from freely moving animals at 15 min intervals after administration of ethanol (0.5, 1, or 2 g/kg, i.p.). Ethanol significantly increased the extracellular levels of dopamine, DOPAC, and HVA, suggesting stimulation of dopamine release by ethanol, while the effect on 5-HIAA did not reach significance. No difference in the extent or time course of stimulation of dopamine release between the AA and ANA rats was found. The results could so far give no indication that the differential ethanol consumption by AA and ANA rats could be explained in terms of differences in ethanol-induced stimulation of dopamine release in the nucleus accumbens.

Expression of acid cysteine proteinase inhibitor (ACPI) in the normal human prostate, benign prostatic hyperplasia and adenocarcinoma

Acid cysteine proteinase inhibitor (ACPI or cystatin A) is a protein (12 kDa) which inhibits the action of several cysteine proteinases, e.g. cathepsins B, H, L and S. In this study the cellular location of ACPI has been immunohistochemically investigated in the normal human prostate, in benign prostatic hyperplasia (BPH) and in adenocarcinoma. ACPI was found in the basal epithelial cells of the normal prostate. The secretory epithelial cells did not express ACPI. In the hyperplastic prostate, the expression of ACPI was decreased and it was also expressed more focally in the basal cells. Hyperplastic basal cells also expressed ACPI. In prostatic adenocarcinoma, no ACPI expression was found. The absence of ACPI expression was obvious and if the sections contained both benign and malignant cells, only the benign glandular structures always expressed ACPI. The results suggest that expression of ACPI might be related to prostatic epithelial cell proliferation and differentiation. Possibly the detection of ACPI in tissue sections might be helpful in identifying prostatic adenocarcinoma, especially in cases with small carcinomatous foci.

Immunohistochemical localization of estrogen-specific 17 beta-hydroxysteroid oxidoreductase in the human and mouse prostate

The estrogen-specific 17 beta-hydroxysteroid oxidoreductase (17 beta-HSOR) enzyme protein was stained immunohistochemically in the newborn and adult human prostate as well as in the mouse prostate. In the newborn human prostate, ductal and urethral epithelia were faintly stained, whereas in the adult human prostate, intense staining for 17 beta-HSOR enzyme antigen could be detected in the epithelium of the collecting ducts and urethral epithelium as well as in the epithelium of the intraprostatic vas deferens and seminal vesicle epithelium. Immunostaining was weak in the prostatic tissues of both newborn and adult prostate. No positive cells were found in stroma. The activity of NADPH-dependent 3H-estrone reductase was detectable in cell-free homogenates prepared from human prostatic tissues. The activities showed a good correlation with immunocytochemical findings. In the mouse, neonatal estrogenization resulted in intensively stained epithelium of the collecting ducts at the age of 14 days. Moreover, when adult control and neonatally estrogenized mice were implanted with 17 beta-estradiol, the metaplastic epithelium of the periurethral collecting ducts of neonatally estrogenized mice was intensively stained with 17 beta-HSOR. These findings suggest that metaplastic epithelium rises from 17 beta-HSOR-positive cells. The similar distributions of 17 beta-HSOR-positive cells confirm the concept of homology in the posterior estrogen-responsive periurethral region (containing the periurethral ducts and periurethral glands) of the mouse and humans. Our findings further suggest that the 17 beta-HSOR-positive cells may have the same origin and hormonal control in both species.

Brain ethanol in AA, ANA, and Wistar rats monitored with one-minute microdialysis

A microdialysis system for measuring the ethanol concentration curve in the nucleus accumbens of the rat brain was developed and tested in three different rat lines (AA, ANA, and Wistar) after an intraperitoneal (IP) and an intragastric (IG) dose of 1.0 g/kg ethanol. The flow rate of the modified Ringer solution was set at 5 microliters/min; samples were taken every minute after ethanol administration and analyzed with headspace gas chromatography. After IP administration, the brain ethanol levels rose much more rapidly than tail blood ethanol levels in the same animals. The maximum brain ethanol level after IG administration was lower and occurred later, and were similar to the tail blood levels in AA and ANA rats. No clear difference between the lines was found after IP administration but there was some indication that ANA rats may absorb alcohol after IG intubation faster than AA or Wistar rats.

Sonographic technique in diagnosis of urethral strictures in men

Sixteen male patients were examined by sonography, urethrography and urethroscopy because of a clinical suspicion of urethral stricture. For sonography the urethra was filled with anesthetic gel using an inflexible plastic syringe. Ten strictures were identified by urethroscopy; 9 of them were also seen in urethrography and 5 in sonography. All the membrane-like strictures (4), and 1 very proximal stricture remained unvisualized in sonography. Sonography revealed also 1 diverticulum and 1 posttraumatic fistula, which were also seen in urethrography. The presented sonographic method for visualizing the male urethra proved to be useful.

Genetically determined influences on voluntary ethanol consumption: extracellular levels of ethanol and monoamines in the nucleus accumbens of the alcohol preferring AA and alcohol avoiding ANA rat lines

The role of central monoamines and the distribution of ethanol to the brain in the genetically determined influences on voluntary ethanol consumption were examined by studying the extracellular levels of ethanol and monoamines in the nucleus accumbens of the alcohol preferring AA (Alko Alcohol) and alcohol avoiding ANA (Alko Non-Alcohol) rats with in vivo microdialysis. The results show that there is a steep rise in brain ethanol concentration within minutes after the injection of ethanol (1 g/kg ip), but there does not seem to be a difference in the distribution of ethanol into the brain of the two lines of rats. There was, however, some indication that ANA rats may absorb ethanol after intragastric administration faster than AA rats. Ethanol (0.5, 1, or 2 g/kg ip) significantly increased the extracellular levels of dopamine, DOPAC, and HVA, but not that of 5-HIAA, suggesting stimulation of dopamine release by ethanol. No difference in the extent or time course of stimulation of dopamine release between the AA and ANA rats was found.

Urinary tract fistulas following abdominal hysterectomy

Sixteen patients with urinary tract fistulas (14 vesicovaginal and two ureterovaginal) following simple abdominal hysterectomy were treated over a period of 17 years. Most vesicovaginal fistulas were treated by a transvesical technique, which proved to be a comfortable and successful method in our hands. Closure of the fistula followed usually more than four weeks after diagnosis. Earlier repair, which has been forwarded as an alternative therapy, might give equally good results and would save the patient from the severe hygienic problem of continuous urinary leakage. Conservative treatment with an indwelling urinary catheter led to spontaneous closure of the fistula in one patient. Two ureterovaginal fistulas were corrected by an anti-reflux ureteroneocystostomy.

Hormone regulation of human prostate in organ culture

We have established organ cultures of human prostate for in vitro analysis of the hormone responsiveness of prostatic carcinoma. Tissue samples were obtained from total prostatectomies for localized cancer. Normal prostate tissues with age-related hyperplastic changes were obtained from cystoprostatectomies of bladder cancer patients representing the same age group, and they wer cultivated as controls. The explants of prostates were cultured for 7 days in basal medium containing 5% dextran charcoal-treated fetal calf serum, insulin (0.08 IU/ml), and dexamethasone (10(-7) M) with or without dihydrotestosterone (DHT) (10(-7) M) or estradiol (10(-9) M). Control prostates showed involutive changes of morphology when cultured in basal medium. These changes were prevented by DHT, which also maintained a strong epithelial immunostaining for PSA (prostate specific antigen), which was used as a marker for tissue-specific functions. The concentration of PSA in the medium was high. The rate of [3H]thymidine incorporation into DNA was stimulated by DHT in some cultures of control prostates, but no increase was seen in the others. Androgen stimulation of [3H]thymidine incorporation was consistently inhibited by the antihormone cyproterone acetate. The main morphological response of cultured control prostates to estradiol was induction of squamous metaplasia. This was associated with increased incorporation of [3H]thymidine, which was radioautographically localized to the basal layer of epithelium. Estradiol effects were counteracted by the antihormone toremifene. The expression of androgen receptor mRNA and protein in cultured control prostate was demonstrated by Northern blotting and immunohistochemistry, respectively. Also, the expression of estrogen receptor was demonstrated by the polymerase chain reaction analysis of total mRNA from cultured control and cancer prostate. The cultured explants of prostate cancer maintained the overall morphology of the original carcinoma. However, the presence of DHT improved the morphology of cancerous acini in all better differentiated carcinomas (3 grade I and 5 grade II), and corresponding responses to DHT were observed in the rate of DNA labeling with [3H]thymidine. In 2 of 3 grade I carcinomas, DHT increased DNA synthesis, but in grade II cancers the patterns of hormone responses were more variable. The poorly differentiated grade III prostatic carcinomas did not respond to either hormone as measured by [3H]thymidine uptake, and no hormone effects could be seen in morphology. Immunostaining for PSA differed from that in control prostates: besides cancerous acini, the surrounding stroma was also intensively stained, which suggests unpolarized and impaired secretion of PSA by the cancer cells.(ABSTRACT TRUNCATED AT 400 WORDS)

Randomized controlled study of chemoprophylaxis in transurethral prostatectomy

We studied 599 evaluable patients with benign prostatic hypertrophy at 7 urological units. Before transurethral prostatectomy the patients were randomized into 3 groups: group 1--197 patients given single-dose ceftriaxone (2 gm.), group 2--203 patients given 160/800 mg. trimethoprimsulfamethoxazole and group 3--199 controls given no antimicrobial prophylaxis. Patients with a preoperative indwelling catheter, positive urine culture, signs of active infection or preoperative antibiotic treatment were excluded. Postoperative infectious complications were demonstrated in 15 of 197 (7.6%), 25 of 203 (12.3%) and 43 of 199 (21.6%) patients in the study groups, respectively. The difference in infectious complications between groups 1 and 3 was statistically highly significant (p < 0.01) and between groups 2 and 3 it was significant (p < 0.05). Single-dose antibiotic prophylaxis proved to be useful in the prevention of serious infectious complications after transurethral prostatectomy.

Radioimmunodetection of prostate cancer by 111In-labeled monoclonal antibody against prostatic acid phosphatase

Purified human prostate acid phosphatase (PAP) was used to generate a specific monoclonal antibody (FC 3001) for detection of PAP expressed by some prostatic carcinomas. DTPA derivatives of MoAb-F(ab')2-fragments were labeled with indium-111 chloride. This labeled antibody was tested in 15 prostate cancer patients who underwent staging pelvic lymphadenectomy; 9 of them received labeled antibody alone whereas 6 received simultaneous injections of labeled and unlabeled antibody with two dose levels (40 or 80 mg). Biodistribution data obtained by direct blood measurements and imaging procedures indicated that simultaneous injection of unlabeled antibody reduced both the blood elimination rate and the accumulation in the liver. Accumulation of the radionuclide in pelvic lymph node metastases was observed in some patients but in a couple of patients accumulation was noted also in normal lymph nodes. The method cannot in its present design replace staging pelvic lymphadenectomy and further studies are needed for elaboration of clinically useful radioimmunodetection methods.

Effect of calcitonin on the alcohol drinking of rats

Previous work has shown that calcitonin inhibits eating by rats and that it affects several neurotransmitter systems suspected to play a role in alcohol consumption. The present study was an initial test of whether calcitonin does affect voluntary alcohol consumption by male Wistar rats with prolonged alcohol experience. Calcitonin (20 IU/kg) or saline was injected subcutaneously on 10 consecutive days when the rats (n = 20) had continual access to 10% (v/v) ethanol solution, and to food and water. Using a cross-over design, the effects of 40 IU/kg calcitonin vs. saline were then examined in a second 10-day treatment period. Similar patterns of effects were obtained with both calcitonin doses, but the patterns differed with alcohol, food, and water intake. Alcohol drinking showed biphasic changes with both doses, producing highly significant Treatment x Day interactions (p < 1E-10 and p = 6E-7): it was significantly reduced on the first day of calcitonin treatment and significantly increased on the last few days. Food intake was reduced on all calcitonin days although most markedly on the first. Water drinking was not altered on the first calcitonin day, but was greatly increased on the second, then gradually returned toward the baseline. In a second experiment, the animals were switched to 1 hr of alcohol access per day, and calcitonin (20 IU/kg) was administered periodically to one group 4 hr before the alcohol access. Alcohol drinking was significantly reduced in all cases when the calcitonin injection was preceded by at least 1 day without calcitonin.(ABSTRACT TRUNCATED AT 250 WORDS)

The limited access paradigm: description of one method

Restricting access to alcohol to a short period daily causes rats, in effect, to drink on command. They usually begin drinking alcohol immediately when it is first made available each day and consume a rather constant amount during each access period. The procedure thus has a variety of useful applications. The specific method reported here in detail provides continual access to food and water, but access to unflavored 10% ethanol solution only 1 h/d, all in the home cage, and produces mean alcohol intakes from 0.5-1.0 g/kg in the access hour.

Cytostatic effect of different strains of Bacillus Calmette-Guérin on human bladder cancer cells in vitro alone and in combination with mitomycin C and interferon-alpha

The cytostatic activity of five Bacillus Calmette-Guérin (BCG) strains (Pasteur, Evans, Tice, RIVM and Connaught) on human transitional cell cancer T24 cells was examined. A striking effect was noted even in 2-day cultures, and the effect was more pronounced when the cells were incubated for 5 days with different BCG strains alone. The concentrations needed were about the same as those used in clinical practice (10(9) colony-forming units of Pasteur strain in 100 ml buffered saline solution). Combination with mitomycin C or interferon-alpha-2b potentiated the cytostatic effect. A slight difference in cytostatic activity between different BCG strains was found.

Radiologic findings in renal oncocytoma

The imaging findings of 36 renal oncocytomas in 32 patients were evaluated retrospectively. Twenty-two patients underwent ultrasound (US), 16 CT, 25 angiography, 19 urography, and 6 fine-needle biopsy. At US 8 of the oncocytomas were isoechoic, 7 hyperechoic, and 7 hypoechoic. The structure was homogeneous in 59% and nonhomogeneous in 41%. At plain CT 12 oncocytomas were homogeneously hypodense, 3 isodense, and one hyperdense. Contrast enhancement was homogeneous in 10 and inhomogeneous in 4 cases. A stellate scar was detected in one case, and in one case a contrast study was not performed. At angiography the oncocytomas were hypervascular in 21, hypovascular in 3 cases, and one was not detected. Nineteen of the tumors were well delineated. A spokewheel arterial pattern was detected in 3 tumors. The cytologic diagnosis was benign renal oncocytoma in 4 cases and highly suggestive of oncocytoma in 2 cases. We conclude that the homogeneity of a renal tumor at US and at CT may suggest the possibility of oncocytoma. US-guided fine-needle biopsy is a useful diagnostic tool in patients who need a precise presurgical diagnosis.

Prostate-specific antigen in the follow-up of prostatic adenocarcinoma treated with external beam radiation

Prostate-specific antigen (PSA) has been shown to be a more sensitive tumor marker than prostatic acid phosphatase (PAP) in prostatic adenocarcinoma: PSA was positive in 54 of our 117 patients (46%) and PAP was positive in 24 (21%). In order to compare the usefulness of these markers during and after radiotherapy serum samples from 24 patients treated with external beam irradiation were analyzed. PAP was only slightly positive in 1 patient (4%) after radiotherapy. His PSA level was highly elevated and he died of progressive disease. In the other 23 patients the cancer was in local control. However, the serum PSA level remained positive in 5 of these patients indicating vital cancer cells may still have been present. An alternative possibility is that metaplastic prostatic cells which secrete PSA were left after radiotherapy, as has been shown to be the case in prostatic hyperplasia. Before radiotherapy increased PSA levels were measured in 3 patients. In 2 of them the level declined to normal within 6 months after radiotherapy. The PAP levels were normal. It is concluded that PSA (positive in 25% of patients after radiotherapy) might be more sensitive than PAP (positive in 4%) in monitoring the effect of radiotherapy in prostatic cancer patients.

Intravesical epirubicin with and without verapamil for the prophylaxis of superficial bladder tumours

Seventy-five patients with recurrent bladder carcinoma were randomized after electroresection to receive either epirubicin (E) or epirubicin + verapamil (E + V) instillation of the bladder at regular intervals for 2 years. Samples of the bladder wall, tumour tissue and peripheral blood were taken from 20 patients. The average follow-up period was 21 months. Fifty per cent of the patients in the E group and 37% in the E + V group developed recurrent tumours. Recurrence rates (RR) were 6.3 and 4.7, respectively. Before the instillation therapy the RR was 16.0. There was a highly significant reduction of RR during the instillation therapies; in group E p less than 0.005 and in group E + V p less than 0.001. The difference between the treatment groups was not statistically significant. Verapamil increased epirubicin concentrations in both the bladder wall and the tumour tissue, but did not affect concentrations in the peripheral blood. Side effects were few and did not lead to discontinuation of treatment.

Radiologic diagnosis of renal colic: the role of plain films, excretory urography and sonography

The accuracy of plain films, excretory urography and ultrasound for the clinical work-up of renal colic for detecting urinary calculi was evaluated prospectively in 49 patients. Excretory urography was the most sensitive and specific test. Plain films and sonography each had a sensitivity of approximately 60%, but combined yielded a sensitivity of 80%; specificity did not improve. A diagnostic algorithm where sonography was performed first followed by an excretory urography in case of a negative sonography was highly sensitive (93%) and rather specific (79%). This algorithm appears also to have a good cost-benefit rate.

Prostate-specific antigen as a marker of adenocarcinoma of prostate

Prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) serum levels were measured in 117 patients with prostatic adenocarcinoma, in 9 patients with prostatic hyperplasia and in 14 patients with other malignancies to compare the clinical usefulness of the PSA and PAP levels. PSA was elevated (PSA+) in 14 of 18 untreated patients (78%) with prostatic cancer. PAP was elevated (PAP+) only in 3 of these untreated cases (17%). Also in previously treated patients PSA was more often positive than PAP. PSA was positive in 40 of the 99 treated patients (40%), PAP was elevated only in 21 cases (21%). There was a significantly (P less than 0.001) higher tendency towards elevated PSA in the prostatic cancer patients: 32 (27%) patients with PSA+ and PAP- compared with only 2 cases (2%) with PAP+ and PSA-. The PSA+/PAP- patients were analyzed further. In seven of them the PSA level also returned to its normal level after orchiectomy or/and radiotherapy. In two patients the PSA levels indicated tumor progression earlier than PAP, their PAP levels did not rise until bone metastasizing was evident. There were also progressive disease in some patients evidenced only by increased PSA levels. In addition to cancer patients the PSA level was increased in three (30%) of the prostatic hyperplasia patients. It was also elevated in three patients with other malignancies. However, these three patients also had prostatic hyperplasia and the increase in the PSA level is considered more likely to be due to that.(ABSTRACT TRUNCATED AT 250 WORDS)

Single-stage salvage cystectomy: results and complications in 20 patients

Twenty patients with bladder carcinoma underwent total cystectomy and one-stage urinary diversion after a definitive external radiotherapy. The indication for surgery was a persistent or locally recurrent tumor and/or intractable voiding symptoms. There was no operative mortality. Early or late complications occurred in 14 patients (70%) and in 7 of these cases a reoperation was necessary. The overall 5-year survival rate after the operation was 61%. The prognosis of the patients was dependent on the pathological stage of the tumor in cystectomy specimens.