[Low frequency of cancer in the urinary organs when macroscopic hematuria is associated with bacteriuria]

Frequency of cancer in the urinary organs was significantly lower in patients with macroscopic hematuria associated with bacteriuria compared to those without bacteriuria. The predictive value of macroscopic hematuria was <1% in patients ≤ 75 years of age with concomitant bacteriuria. CT-urography added no diagnostic value over and above cystoscopy in patients with macroscopic hematuria with bacteriuria.Bacteriuria with other bacteria than E. coli or S. saprophyticus was associated with findings of bladder tumors.

Risk factors for refractory febrile neutropenia in urological chemotherapy

During chemotherapy, patients are more susceptible to infectious complications as a result of bone marrow suppression, leading to neutropenia. The purpose of this study is to investigate risk factors for refractory febrile neutropenia (FN) during urological chemotherapy. Our method for suppressing FN is to use granulocyte colony-stimulating factor and prevent upper respiratory infection by masking and gargling. We studied 47 episodes of FN in 39 patients that occurred during urological chemotherapy for urothelial cancer, testicular cancer, and prostate cancer. Among our cases, there were 5 patients with refractory FN; we set risk factors for refractory FN and performed statistical analyses. The average age of the 39 patients was 60.6 years (range, 18-80 years). In 47 FN episodes, the chemotherapy regimen before the occurrence of FN included 15 (31.9 %) MVAC (methotrexate, vinblastine, adriamycin, cisplatin) for urothelial cancer, 5 (10.6 %) DE (docetaxel, estramustin) for prostate cancer, and 3 (6.4 %) TIP (paclitaxel, ifosfamide, cisplatin) for testicular cancer. The antibiotics used to treat FN included 17 (36.3 %) meropenem and 23 (49.0 %) cefepime, and the average duration of antibiotics was 4.4 days (range, 1-12). We investigated risk factors for refractory FN and showed a significant relationship between refractory FN and indwelling urinary catheter or smaller Multinational Association for Supportive Care in Cancer score by multivariate analysis. A future prospective study is needed for further evaluation for risk factors and establishing treatment protocols and guidelines for FN.

Aerobic bacterial flora of the vagina and prepuce of California sea lions (Zalophus californianus) and investigation of associations with urogenital carcinoma

To investigate the association between genital bacterial infection and urogenital carcinoma in California sea lions (Zalophus californianus), vaginal and preputial swabs for bacterial isolation were taken from 148 free-ranging and 51 stranded California sea lions including 16 animals with urogenital carcinoma. Cytological examination of vaginal or preputial smears showed a majority (65.5%, 57/87) of animals examined had mild or no inflammation. Aerobic bacteria were isolated from 116 (78.4%) wild sea lions and 100% of stranded animals. A total of 403 isolates were identified representing 51 unique bacterial species. The median number of isolates per animal increased with age in the wild group, but there was no difference in the number of isolates per animal between wild and stranded adults. The most common bacteria isolated from the wild sea lions were Psychrobacter phenylpyruvicus (39 isolates), non-hemolytic Streptococcus (35 isolates), Corynebacterium spp. (30 isolates), and Escherichia coli (20 isolates). More bacterial species were isolated from stranded animals than wild animals (33 versus 26) and there was significantly less growth of P. phenylpyruvicus, Corynebacterium spp., and Moraxella-like spp. in the stranded animals. Beta-hemolytic Streptococcus was the only bacterium significantly associated with urogenital carcinomas in California sea lions, but only in females.

Absence of human papillomavirus in squamous cell carcinomas of nongenital skin from immunocompromised renal transplant patients

BACKGROUND AND DESIGN

Human papillomavirus (HPV) is accepted as a factor in the pathogenesis of genital squamous cell carcinomas. The incidences of both HPV infection and squamous cell carcinoma are increased in immunocompromised renal transplantation patients. The purpose of this study was to determine if HPV DNA is present in squamous cell carcinomas of nongenital skin in immunosuppressed patients. Amplification of HPV DNA was performed using the polymerase chain reaction. The sensitivity and specificity of the polymerase chain reaction was assessed on 19 positive and six negative control specimens. Twenty genital squamous cell carcinomas from nonimmunocompromised patients and 28 nongenital squamous cell carcinomas from renal transplantation patients were then analyzed.

RESULTS

Human papillomavirus DNA was identified in 18 of 19 positive control specimens and zero of six negative control specimens. Human papillomavirus DNA was identified in four of 20 genital squamous cell carcinoma specimens. In comparison, no HPV DNA was identified in 28 nongenital squamous cell carcinomas from immunosuppressed hosts (Fisher's Exact Test, P < .025).

CONCLUSIONS

These findings support a role for HPV in genital skin cancers and suggest that HPV does not play a role in the increased incidence of squamous cell carcinoma in renal transplantation patients.

[HPV in oncogenesis]

During recent years, advances have been made in understanding the functions of the viral oncoproteins E6 and E7. E6 und E7 code for proteins forming complexes with cellular proteins, which regulate the cell cycle. This leads to a disturbance of the physiological control mechanism and to increased proliferation of the infected cells. Enhanced expression of viral oncogenes in cells infected by genital "high risk" HPV types results in chromosomal instability and in an accumulation of mutational events. Cutaneous HPV types apparently follow other strategies to transform their host cells.

Human papillomavirus identified by nucleic acid hybridization in concomitant nasal and genital papillomas

Presence of human papillomavirus (HPV) as the etiologic agent in nearly all upper respiratory tract recurrent papillomas is well-established. The technique of nucleic acid hybridization now allows specific typing of HPV with a high degree of accuracy. This article reports a series of nine consecutive patients treated for nasal papillomas over the past 9 years. Eight of these patients had a personal history of genital papillomas (seven patients) or exposure (one patient). With the use of in situ hybridization and autoradiographic technique on paraffin-embedded tissue sections, HPV RNA type 6/11 was expressed in eight of nine nasal papillomas, and corresponding HPV types were also found in the two cases with which concurrent anogenital papilloma tissue was also available for analysis. Human papillomavirus RNA types 16 and 18 were not detected in any of the specimens. Signals of HPV messenger RNA type 6/11 were stronger in the fungiform areas than in the inverted areas of papillomas.

Triple cancers in the urogenital area of a patient with aplastic anemia

Three epithelial neoplastic lesions, perineal Bowenoid papulosis, uterine cervical carcinoma, and bladder transitional cell carcinoma, which occurred in a mildly immunosuppressed patient who had aplastic anemia were studied for human papillomavirus (HPV) infection. In the Bowenoid papulosis, HPV type 16 DNA was identified by polymerase chain reaction (PCR) and by in situ hybridization (ISH). In contrast, in the uterine cervical carcinoma, HPV 16 was not detected, although possibly another unidentified type of HPV in the lesion was suggested by the ISH findings. In the bladder transitional cell carcinoma, neither papillomavirus genus-specific (PGS) antigen nor HPV DNA was found.

[Studies of human papillomavirus (HPV) in urological tumors]

Urological tumors were examined for the presence of human papillomavirus (HPV) DNA by using Southern blot hybridization. In 20 male patients with condyloma acuminatum, HPV type 6 was found at 85% (17/20), HPV type 11 at 95% (19/20), HPV type 16 at 5% (1/20) and HPV type 18 at 0% (0/20). In 2 female patients with condyloma acuminatum, HPV types 6, 11, 16 and 18 were found at 100% (2/2), 100% (2/2), 50% (1/2) and 0% (0/2), respectively. All 6 of the patients who were positive for HPV type 6, were also positive for HPV type 11. Two patients were positive for HPV types 6, 11 and 16, the last of which was frequently found in penile cancer and uterine cervical cancer. In 6 patients with penile cancer, two patients were positive for HPV type 16 and negative for HPV types 6, 11 and 18. The remaining 4 patients were negative for all these HPV types. One patient who was positive for HPV type 16 had penile cancer after three previous episodes of penile condyloma acuminatum. From this information, a malignant change in the condyloma acuminatum was assumed to indicate the possible association of HPV type 16 with the process of malignant degeneration. HPV types, 6, 11, 16 and 18 were not detected in a female patient with vulvar cancer. Although HPV was thought to participate in the development of urological tumors except for external genital tumors, all patients examined, consisting of 2 with benign prostatic hypertrophy, 5 with prostatic cancer and 24 with bladder cancer, were negative for HPV types 6, 11, 16 and 18. Eight patients with bladder cancer were negative for HPV type 33.

Human papillomavirus types in anogenital warts of children

Tissue from anogenital warts of 25 children, 10 of whom were suspected of being victims of sexual abuse, was investigated by dot blot and Southern blot techniques for human papillomavirus (HPV) types. HPV DNA was detected in 22 children, two of whom had double infections. The genital HPV types 6 and/or 11 were detected in 20 children, and in three children other HPV types were found. One had HPV 18 (as well as 11); in a second child a possible skin type, HPV 2, was detected; and the third child was infected with an unidentified type. In three cases genital wart material was available from one of the parents, and in all three the HPV type was the same as that of the child. For nine other children one or both parents were reported to have genital warts. The source of infection appeared to be the adult genital tract, but sexual contact might not be the only means of transmission.

[Persistence of herpes simplex virus and adenoviruses in lymphocytes of patients with urogenital tumors]

Certain viruses with neoplastic potential are known to be capable of participating in tumor formation to impair the immune system. In the present study, this association was investigated in patients with urogenital tract tumors. In studies of latent virus carrier state by means of immunofluorescence techniques using specimens from 118 patients with malignant tumors and 70 control persons it was found that in more than 50% of the patients, latent antigens of herpes simplex virus or adenoviruses were present in 1-3% of circulating lymphocytes. In the control group, virus carrier state in lymphocytes was demonstrated in only few patients. Using lymphocyte blastogenesis test, the effect of nonspecific mitogen (phytohemagglutinin) induced transformation of only 10-50% lymphocytes to lymphoblast cells in patients with malignant tumors, the percentage of transformation being also dependent on the stage of the tumor process. In the control group, treatment of lymphocytes with phytohemagglutinin resulted in transformation of 55-85% of lymphocytes into lymphoblasts. The lymphocytes of the majority of patients with tumors became sensitive to specific herpes-virus and adenovirus antigens, mainly the lymphocytes of the patients whose blood cells were also virus carriers.

Sensitive detection of nucleic acids and protein of human papillomavirus type 6 in respiratory and genital tract papillomata

We have developed a sensitive method to detect and localize HPV-6 viral DNA, mRNA and protein in biopsy specimens of genital and respiratory tract lesions by using in situ hybridization and immunoperoxidase assays on sections of plastic-embedded tissue. This modified in situ hybridization technique, using ultrathin sections and strand-specific 3H-labelled riboprobes, offers the advantages of superior morphological preservation and detection of viral genomes at low copy number with good resolution. This modified immunocytochemistry provides better sensitivity when compared to previous methods using paraffin-embedded materials. In respiratory tract lesions, immunoperoxidase assay detected only a few capsid antigen positive cells, while in the genital tract lesions, there were more capsid antigen positive cells. Southern transfer analyses and in situ hybridizations demonstrated the presence of more viral nucleic acids in genital tract papillomata than respiratory tract papillomata. Epithelial cells throughout the papillomata were infected by HPV-6 as evidenced by positive hybridization, with more viral DNA present in superficial cells. Our results suggest that genital tract epithelium is more permissive for HPV-6 replication than respiratory tract epithelium. Using stand-specific probes synthesized from subgenomic fragments of the HPV-6 genome in conjunction with nuclease digestions, we were able to demonstrate that HPV-6 transcripts specific to open reading frames (ORFs) E6, E7, E1, L1, and L2 occur in maturing superficial cells. In contrast, transcripts specific to ORFs E1, E2, E4, E5a, and E5b could be detected throughout the whole of the epithelium with more signals noted at the basal cell areas. In addition, the distribution of HPV-6 nucleic acids and protein in a carcinoma in situ of the larynx was analyzed. In comparison to benign respiratory tract papillomata, more viral DNA was found in the malignant lesion, but the pattern and distribution of transcription and capsid antigen was similar.

Detection of human papillomavirus in formalin-fixed, invasive squamous carcinomas using the polymerase chain reaction

We analyzed 88 formalin-fixed, paraffin-embedded invasive squamous carcinomas for human papillomavirus-related DNA sequences (HPV types 16 and 18) following in vitro gene amplification using the polymerase chain reaction. HPV DNA sequences were found in 35 of 50 (70%) carcinomas of the anogenital region, including four of four (100%) anal, six of eight (75%) vulvar, nine of 14 (64%) vaginal, two of five (40%) penile, and 14 of 19 (74%) cervical tumors. Nine of 25 (36%) oropharyngeal squamous carcinomas contained HPV DNA sequences, including four of 10 (40%) laryngeal, three of eight (38%) buccal, and two of seven (29%) glossal tumors. HPV DNA sequences were not found in 13 esophageal carcinomas. Of the 44 cases that contained viral DNA, HPV-16 was detected in 41 cases (93%) and HPV-18 in five cases (11%), while both types were found in two cases (one anal and one vulvar). HPV DNA sequences were found in 43 of 83 (52%) nonverrucous and in one of five (20%) verrucous carcinomas, but this difference was not significant. These findings demonstrate that HPV DNA sequences are more frequently associated with anogenital than oropharyngeal squamous carcinomas and can be readily detected in routinely processed tissues using the polymerase chain reaction.

Shedding of herpes simplex virus type 1 into saliva after surgery for oral and genital or urological cancer patients

The shedding of herpes simplex virus type-1 (HSV-1) into the saliva was compared in 28 patients with oral cancer and 26 patients with genital or urological cancer. All subjects tested positive for HSV-1 specific antibody. A statistically significant (p less than 0.001) difference was found: infectious viruses were isolated from 12 (39.8%) of the oral cancer patients versus only 2 (7.6%) of the genital or urological patients. This indicates that direct stimulation of peripheral nerves during surgery was responsible for the greater reactivation of HSV-1.

Isolation of a human papillomavirus from a patient with epidermodysplasia verruciformis: presence of related viral DNA genomes in human urogenital tumors

The DNA genome of a human papillomavirus (HPV), tentatively designated HPV-EV, was molecularly cloned from hand to leg lesions of a patient with epidermodysplasia verruciformis, a chronic skin disease associated with a 30% risk of developing cancer. Using stringent hybridization conditions, we observed less than 5% homology between HPV-EV and the cloned genomes of HPV-1, HPV-4, HPV-5, and HPV-5a. HPV-EV DNA showed approximately 6% homology with HPV-2 and 36% homology with HPV-3. These data suggest that HPV-EV is partially related to HPV-3. Using 32P-labeled cloned HPV-EV as probe in Southern blot hybridization experiments, we detected HPV-EV-related DNA in the carcinoma in situ (Bowenoid lesion) of the vulva of the patient from which HPV-EV was isolated. HPV-EV-related DNA was detected in 2 of 10 vulva carcinomas and in 2 of 31 cervical carcinomas. Related DNA sequences were found in papillomas from each of two patients with condyloma acuminata (anogenital warts), which is of interest considering that condylomas have been reported to convert occasionally to carcinomas. The positive vulva DNAs were also probed with other cloned HPV DNAs: HPV-1, HPV-4, and HPV-5a-related sequences were not detected; HPV-3 and HPV-2 DNA probes detected strong and weak DNA bands, respectively, of the same size as found with HPV-EV. The HPV DNA sequences were present in the positive tumors mainly as free viral DNA molecules; no evidence for integration into cellular DNA was found. The emerging biological picture with papillomaviruses is that cells transformed by these viruses are maintained in a transformed state by free episomal genomes. Thus, our findings are consistent with the idea, but by no means establish, that HPVs play a role in human cancer by a similar mechanism.

Analysis of human genital warts (condylomata acuminata) and other genital tumors for human papillomavirus type 6 DNA

32P-labelled cloned HPV 6 DNA was used as probe to analyze human genital tumors for DNA sequences homologous to HPV 6 DNA. Ninety three percent of all condylomata acuminata (41 out of 44) were found to harbor HPV 6 DNA. Of the remaining three, one contained HPV 1 DNA. No papillomavirus DNA was identified in the two other tumors. All three invasively growing giant condylomata acuminata (Buschke-Löwenstein tumors) investigated also contained HPV 6 DNA. Two out of six atypical condylomata of the cervix hybridized with HPV 6 DNA under stringent conditions, one only under conditions of low stringency. All DNA preparations from malignant tumors studies (54 cervical carcinomas, 10 penile carcinomas, two vulvar carcinomas) failed to anneal with HPV 6 DNA, even under conditions of low stringency. Although all HPV 6-positive condylomata acuminata analyzed in this study revealed HPV 6 DNA of regular molecular weight (5.1 x 10(6)), two of the Buschke-Löwenstein tumors, as well as one of the two positive atypical condylomata of the cervix, contained HPV 6 DNA with a remarkable size classes occurred in a supercoiled form without evidence for integration into host cell DNA.

Herpes simplex virus infection: problems and prospects as perceived by a peripatetic pediatrician

The multivaried aspects of the herpes simplex viruses (HSV) types 1 and 2 and the infections they produce are discussed. Points emphasized are: (1) the need for considering these (and other viruses) from an evolutionary perspective; (2) the necessity of disseminating current methods for virus identification; (3) the great progress in molecular-virological aspects and in the genetics of the virus which provide new tools for epidemiological and immunological studies and define more convincingly the possible causal role of HSV-2 in cervical carcinogenesis; (4) the problems with vaccines and the therapeutic advances and failures; (5) the great psychosocial aspect of some herpetic infections and the need to be sympathetic and supportive to afflicted patients and their families; (6) the overreaction regarding HSV that currently exists among physicians, nurses, the public, and the press resulting in increased misery for those afflicted or misdiagnosed, or in poor advice or management given by some physicians pressured in part by the fear of malpractice suits. The problems then are many but the prospects for their solution are in sight as more research at all levels is being conducted today in all corners of the world on the complex herpes simplex viruses.

C-type virus particles in human urogenital tumours after heterotransplantation into nude mice

C-type viruses were formed in heterotransplants of 5/14 human urogenital tumours which had been serially transferred in nude mice of NIH(S) background. Except for one case in which C-type particles were present in the epithelial cells as well as the connective tissue, the viruses were only found within the stroma of the heterotransplanted tumours. Peroxidase labelling with anti-mouse serum demonstrated that the connective tissue supporting the transplanted human tumours was of mouse origin. Competition radioimmunoassays demonstrated that MuLV interspecies viral protein was present in high titre in the transplanted tumour extracts and also in extracts of 2 spontaneous mouse-tumour extracts. These data suggest that endogenous viruses of the nude mice are activated by the graft, and only subsequently infect the human tumour cells and form particles.

Histology of benign virus induced tumors of the skin

The majority of findings in relation to warts have been passed on from one textbook to the other since the end of the last century. More recent studies have been carried out with the electron microscope. But information is lacking as to histology, histochemistry, examination with the phase-contrast microscope, with the interference microscope, microradiography and other new techniques. Warts are a proliferation of the epidermis caused by a virus, and we know that the culprit acts in the epidermis itself. Warts are acanthomas, and a transition to malignancy is possible in predisposed persons. It is most remarkable that in the malignant tumors of epidermodysplasia verruciformis, no virus could be found. As the demonstration of viruses with the electron microscope and other techniques cannot be made as a matter of routine, we have to search for a simpler method with the light microscope. With the application of more elaborate procedures, new information about epidermal proliferation will certainly be obtained.

Detection of viral-like cores from the urine of patients with genito-urinary malignancies

Simultaneous detection assays on the core structures derived from the cerebrospinal fluid samples of patients with various types of central nervous system tumors have demonstrated the feasibility of this technique in detecting some of the diagnostic features of RNA tumor viruses. Similar assays done on urine samples from patients iwth various types of tumors in their genitourinary tracts have shown that of the 18 such samples from tumor patients, 15 or 83% were found to be positive. The control samples consisted of three from patients with benign prostatic hypertrophy and four from normal persons. None of these gave a positive reaction. [3H]DNA probes synthesized from the core structures from them hybridized readily to their corresponding polysomal RNAs but no to control tissues. The densities of particles from these samples have been found to be 1.168 g/ml for bladder carcinoma and 1.165 for prostatic carcinoma, the same densities as those found RNA tumor viruses.

The clinical utility of plasma and urinary carcinoembryonic antigen in patients with genitourinary disease

Carcinoembryonic antigen was measured in the urine and plasma of 108 patients with several types and various stages of genitourinary cancer. The value of the carcinoembryonic antigen assay as an early indicator of neoplastic disease was evaluated and a correlation was made between the extent of disease and the concentration of urinary and plasma carcinoembryonic antigen. Patients were classified according to stage of tumor involvement as follows: no evidence of disease, non-malignant disease, non-invasive disease, no known metastasis, regional metastasis and disseminated metastasis. The urinary carcinoembryonic antigen levels more closely paralleled the extent of disease than did the plasma carcinoembryonic antigen levels in patients with bladder cancer. Neither urinary nor plasma carcinoembryonic antigen levels were useful in assessing the extent of disease in patients with prostatic or testicular cancer. Studies related to microbiological interference in the carcinoembryonic antigen assay indicated that bacterial counts up to 10(5) organisms per ml. did not interfere. Cytological studies indicated that the presence of white blood cells, atypical cells and malignant cells could result in elevated urinary carcinoembryonic antigen levels.

Detection of oncornavirus antigenic activity in human urothelial tissues

Our studies indicate that certain urologic tissues demonstrate evidence of proteins which compete with the interspecies antigens of C-type ribonucleic acid viruses for binding sites of the feline and murine oncornavirus antiglobulins. This fact indicates either the association of viral antigens within these tissues or the presence of a protein so similar to the interspecies antigen that it cross reacts. Studies are now underway to localize reacting antigens within these urologic cells, to correlate the immunologic properties with enzymatic properties known to be specific for oncornaviruses and to assay the activity of patient sera with isolated interspecies antigens. Sera from patients with urologic malignancies will be tested to determine whether the sera can effectively absorb reactivity from tissue extracts or compete with reagent rabbit antisera raised against the interspecies component of the viruses. Should either activity be detected in patient sera, clinical screening will be undertaken to determine if this approach is applicable to early detection of urologic malignancies.

Herpesvirus type 2 in the male genitourinary tract

A population study of 190 randomly selected male patients with no history of genital herpesvirus infection revealed a high incidence of herpesvirus type 2 in genitourinary specimens. This indicates that men serve as a reservoir of genital herpesvirus.