Detection of bacillus Calmette-Guerin in the blood by the polymerase chain reaction method of treated bladder cancer patients

PURPOSE

Following intravesical bacillus Calmette-Guerin (BCG) instillation, we attempted to detect BCG in the blood using the polymerase chain reaction (PCR) method and correlate these findings with the occurrence of major complications due to this treatment.

MATERIALS AND METHODS

Intravesical BCG immunotherapy was given to 22 consecutive patients with superficial bladder tumors. In 2 patients the BCG instillation had to be discontinued due to serious side effects of therapy. Blood samples (252 aliquots) were obtained from 126 BCG courses in 22 cases, and 2 additional samples (4 aliquots) were obtained from 1 patient 1 and 3 months after cessation of therapy. All blood samples were analyzed by the PCR technique for detection of deoxyribonucleic acid tuberculosis Mycobacterium tuberculosis.

RESULTS

Of the 126 blood samples 9 (7.1%) were PCR positive for M. tuberculosis. These 9 positive samples belonged to 3 patients, all of whom were among those 4 patients who had major clinical side effects.

CONCLUSIONS

We demonstrated that rapid and sensitive detection of mycobacteremia by PCR correlated with the clinical course of these patients. We also demonstrated that PCR can be used to monitor BCG in the blood after antituberculous therapy. The early, fast and accurate diagnosis of BCG in the blood by PCR may alter the serious clinical course of these patients by initiation of specific treatment early. However, further extensive studies are needed to validate these results.

Long-term treatment of nocturnal enuresis with desmopressin intranasal spray

The purpose of this study was to determine the efficacy and safety of long-term treatment of nocturnal enuresis with desmopressin intranasal spray. Sixty-five children with primary nocturnal enuresis with a mean age of 11.3 years (range 7-17) underwent a 2-week observation period followed by dose titration period of 1 week. Those children completely dry with desmopressin entered a randomized, placebo-controlled, double-blind phase lasting 2 weeks, followed by a 6-month open treatment. The enuretic status of the children was documented for 2 weeks after the treatment was stopped. Eleven children had no change from baseline wetting with desmopressin. Thirty-two children receiving 20 mg and 9 children with 40 mg desmopressin were completely dry. Thirteen children were wet 1-2 nights per week, which was better than in the pretreatment period. During the 6-month open-treatment period, the effect of desmopressin was found to be stable. No side effects or adverse reactions were encountered. Two weeks after the treatment was stopped, 25 children were still completely dry (38% of the initial study population, 50% of the responders). The cure rate appeared to continue beyond 18 months after discontinuation of the treatment.

Quantitative evaluation of renal parenchymal mass with 99mtechnetium dimercapto-succinic acid scintigraphy after nephrolithotomy

PURPOSE

We detected renal parenchymal damage after nephrolithotomy.

MATERIALS AND METHODS

We studied 12 patients with renal stones treated with nephrolithotomy. Renal function was determined with serum blood urea nitrogen (BUN) and creatinine values, and 99mtechnetium dimercapto-succinic acid scintigraphy of renal parenchymal tissue was performed before, and 7 days and 3 months after nephrolithotomy. Qualitative and quantitative analyses were done with the Wilcoxon signed rank test.

RESULTS

There was no visual difference in size and appearance of the nephrotomy site between preoperative and postoperative visual scintigraphic evaluations. Quantitative data did not reveal any significant difference between kidneys with and without a nephrotomy incision (p > 0.05), as well as between nephrotomy regions and intact parenchyma within the same kidney (p > 0.05) 3 months after nephrolithotomy. There was no significant difference in serum BUN and creatinine levels between values preoperatively and 3 months postoperatively (p > 0.05).

CONCLUSIONS

There was no significant change in renal cortical function and functioning renal parenchymal mass after nephrolithotomy as shown by serum BUN and creatinine levels, and 99mtechnetium dimercapto-succinic acid scintigraphy.

A modified BEP protocol: reduction of hospitalization without reducing the efficacy

OBJECTIVE

We have aimed at assessing whether a condensed bleomycin/etoposide/cisplatinum (BEP) regimen would be as effective as the conventional protocol in the treatment of patients with metastatic testicular tumors.

METHODS

Sixty-four consecutive patients with metastatic germ cell testicular tumors were included into this modified BEP protocol between April 1991 and January 1995. The condensed regimen consisted of a single daily dose of cisplatin (100 mg/m2) and bleomycin (30 mg) plus 3 consecutive days of etoposide (150 mg/m2).

RESULTS

Of the 64 patients, 34 (54%) achieved a complete response with chemotherapy alone. An additional 23 (35%) patients in addition to chemotherapy have undergone surgery and became tumor free after resection of the residual masses and additional chemotherapy. The mean hospitalization period of 64 patients who received a total of 289 therapy courses was 65.4 (49-192) h for each course. The creatinine clearances did not differ significantly before and after treatment in neither of the chemotherapy courses.

CONCLUSIONS

We would thus like to suggest that this condensed BEP protocol is cost-effective and improves patient compliance and quality of life. Furthermore, this is achieved with comparable efficacy to conventional therapy without increasing the toxicity. However, prospective randomized trials with similar results are needed to determine the efficacy of this regimen, and only then this regimen may replace the conventional therapy.

Ureteroscopic management of lower ureteral stones: two years' experience

A total of 140 ureteroscopies in 119 patients done between January 1992 and December 1994 at the Department of Urology, Hacettepe University Hospital, were reviewed. Factors such as previous ESWL therapy, previous surgery and use of in situ lithotripsy were noted. Success was defined as complete removal or disintegration and partial removal of the lower ureteral stones. All successes were confirmed by plain abdominal X-rays postoperatively. Of 140 stone manipulations attempted in 119 patients 106 (75.7%) were successful (in 80 by retrieval and in 26 by disintegration using electrohydraulic or laser). Perforation occurred in 4 of 13 cases where electrohydraulic lithotripsy was used for disintegration of stones. Extraction by ureteroscopic manipulation following extracorporeal shock wave lithotripsy (ESWL) was successful in all of the 12 cases of lower ureteral calculi. The success rate was found to be low for lower ureteral stones in patients with previous open surgery (2/9). A total of 43.2% of the patients were medically indicated to be hospitalized following the procedure with a mean hospitalization time of 5 days (ranging in between 1 to 7 days). Ureteroscopy is an effective method for management of lower ureteral stones. Use of the electrohydraulic lithotriptor may be associated with a high percentage of complications. Previous ESWL may be associated with a high rate of success. Results in patients with previous open surgery are not encouraging. Although all patients can be subjected to the procedure on an outpatient basis, a significant percentage need a short hospitalization.

Six chromophobe cell carcinomas and one mixed renal cell carcinoma with chromophobe cell features: clinical and pathological implications

OBJECTIVE

To determine the incidence and clinical and pathological features of chromophobe cell carcinoma (CCC) among renal cell carcinomas (RCCs).

MATERIALS AND METHODS

The records and nephrectomy samples from 166 patients who were operated on and followed up thereafter with a diagnosis of RCC were re-evaluated. New sections were cut and specific staining performed when deemed necessary.

RESULTS

Of 166 patients with RCC, six were diagnosed as having CCC and, unusually, one patient had a mixed RCC with areas of CCC. Neither the symptoms nor radiological features of these seven patients differed from those of the patients with RCC; the serum ferritin levels of these seven patients were also within the normal range. These patients appeared to have a favourable clinical course.

CONCLUSION

Chromophobe cell carcinoma is a distinct entity and must be distinguished particularly from oncocytoma and other variants of RCC. Although it seems to have a low malignant potential, metastatic CCC may have a worse prognosis.

Primary carcinoid of the kidney

A rare case of primary renal carcinoid tumour is presented. The diagnosis was based on immunohistochemically diffuse cytoplasmic positivity for chromogranin A and neuron-specific enolase, in addition to histologic findings. Only 14 previous cases of this tumour have been documented in the literature.

Is routine stenting necessary in pyeloplasty?

Although the evaluation of surgical procedures for the repair of ureteropelvic junction obstruction continues, open pyeloplasty is still the gold standard in the management of pediatric cases. The use of stents in open pyeloplasty is subject to discussion among pediatric urologists. To clarify this question on the basis of our experience, we retrospectively reviewed our 28 stented and 15 unstented pediatric pyeloplasty operations in terms of hospital stay, early and late complications, and success rates. While there were no differences between both groups in terms of early and late complications and success rates, hospital stay favored the unstented cases. We have concluded that routine stenting in pyeloplasty is not necessary unless a perfect anastomosis is accomplished.

Clinical significance of serum ferritin in patients with renal cell carcinoma

OBJECTIVES

We examined the serum ferritin levels in 158 patients with renal cell carcinoma and 101 healthy control subjects between 1987 and 1994 to investigate the value of this intracellular protein as a tumor marker.

METHODS

Preoperative and postoperative serum ferritin values were analyzed and the patients were stratified to three groups accordingly: group 1, patients with normal values (N-N); group 2, those with preoperative high and postoperative normal (H-N); and group 3, those with preoperative normal or high with postoperative high ferritin levels (H-H).

RESULTS

The mean serum ferritin level in 101 healthy control subjects was 85.7 +/- 63.6 ng/mL (range, 3.7 to 265.2). The upper limit of normal, which was calculated by adding 2 standard deviations to the mean was 219.9 ng/mL. Mean serum ferritin in patients with renal cell carcinoma was 274.2 +/- 276.3 ng/mL, which was significantly higher than that of control values (P < 0.01). The sensitivity, specificity, and overall accuracy rate for ferritin increase was 94%, 50%, and 61%, respectively. Multivariate analysis showed that the aforementioned grouping and stage of the disease were the two independent prognostic parameters. Preoperative ferritin levels lost its significance on multivariate analysis.

CONCLUSIONS

Our study shows that although serum ferritin was a useful tool in diagnosing and staging patients, it was not ideal in early stages. However serum ferritin seems to be more valuable for follow-up; postoperative values, indeed, predict the prognosis.

Enuresis nocturna: new concepts in pathophysiology

Although nocturnal enuresis was first described centuries ago, there is still a lot unknown about its pathophysiology. The functional bladder capacities, diurnal vasopressin levels, urine osmolalities and urine output of enuretic and normal children were compared. We have concluded that enuretics have normal bladder capacities insufficient for increased nocturnal urine volumes because of loss of diurnal variation in serum vasopressin levels and related decrease in urinary osmolalities.

Sequential bilateral germ cell tumours of the testis

Bilateral germ cell tumours of the testis are rare but a rise in their incidence is expected since with the new therapeutic possibilities a significant improvement in prognosis has been achieved even in patients with advanced metastatic spread. Of the 210 patients treated for malignant germ cell tumours at our Department, six (2.9%) developed a contralateral testicular tumour. All patients had metachronous tumours and the second tumours occurred after an interval ranging between 1 and 22 years. The epidemiology, histology, diagnosis, therapy and prognosis are discussed, and the significance of regular self-examination of the remaining testis in patients with testicular tumour is emphasized.

Surveillance-only policy in clinical stage-I non-seminomatous germ-cell tumors of the testis

With the advanced imaging techniques, the sensitive assays for tumor markers and the curability of small-volume metastatic disease with cis-platinum-based chemotherapy, surveillance has gained popularity in clinical stage-I non-seminomatous germ-cell tumors. This study reports our experience on 58 patients who have been included in a surveillance protocol. Patients with normal tumor-marker levels following surgery, no evidence of metastases on the CT scans of the abdomen and the chest and no residual tumor at the surgical margin were followed. Relapsing patients were treated with cis-platinum-based combination chemotherapy. Of the 58 patients, 17 relapsed (29.3%) in a period of 2-18 months (median 5 months). None of the relapsing patients later presented with evidence of disease in the follow-up period 14-79 months (median 39 months) after chemotherapy. Prognostic factors were evaluated by univariate analysis and the data for risk factors, such as the presence of embryonal carcinoma, absence of yolk-sac elements and scrotal violation, were evaluated by multivariate analysis. Statistical analysis showed that none of the risk factors were significantly different in predicting the relapse. Of the 6 relapsing patients with preorchiectomy elevated tumor-marker levels, 4 had shown a slower decline in tumor-marker levels than expected and they all relapsed with elevated levels of the same tumor markers. A surveillance-only policy actually seems to be a safe and logical approach if the patients are properly selected and cooperate fully.

How significant are serial bone scans in monitoring advanced prostatic cancer?

We report a total of 169 serial bone scan studies conducted in 21 patients with histologically proven metastatic cancer of the prostate. Aim of the study was to investigate the concordance of findings on bone scans with serum acid phosphate (AP) levels and the clinical performance status (CPS) of the patients, and to see how important bone scan is by itself in determining the metastatic progression in the follow-up. Eighty-seven and 86% of scans demonstrated changes concordant with AP and CPS levels subsequently. It was also found that 100% of the progressions on bone scans along with elevated levels of AP had been confirmed as metastatic progression, whereas only 41% of progressions on bone scans solely had been shown to be metastases in the follow-up investigations. Findings on bone scans not in correlation with clinical findings and serum AP levels are mostly misleading. Use of bone scans in conjunction with serum AP levels and most probably with prostate-specific antigen and CPS is the most reliable and therefore treatment modality changes should not be based on bone scans only.

A solitary and synchronous metastasis of renal cell carcinoma to the bladder

We report a case of renal cell carcinoma with solitary metastasis to the bladder which occurred and was treated synchronously. The mode of spread and possible treatment modalities are discussed with relevant information from the literature.

Postchemotherapeutic surgery for metastatic testicular germ cell tumors: results of extended primary chemotherapy and limited surgery

OBJECTIVE

Postchemotherapy surgery has become an increasingly important treatment for residual masses in germ cell tumors of the testis. However, it is still a challenge to find the optimal combination of chemotherapy and surgery for better survival and cure rates with lowest morbidity. This study evaluated the effectiveness of extended chemotherapy followed by surgery resecting only the residual masses.

METHODS

After an extended course (one or two additional courses after there is no decrease in tumor size and/or after the normalization of tumor markers) of combination chemotherapies with cisplatin-based regimens, 32 patients underwent surgery for metastatic germ cell tumors of the testis. Complete excision of radiologically determined residual masses and macroscopically suspicious neighboring nodes was performed rather than a conventional retroperitoneal lymph node dissection.

RESULTS

Histopathologic examination of the resected specimens revealed teratoma in 17 (55%), fibrosis and/or necrosis in 9 (26.5%), and active residual tumor in 8 (23.5%) of the patients. The patients with residual tumor have been treated with additional chemotherapy. In the follow-up (mean, 28.5 months) 4 patients have relapsed, and 1 died. None of the patients with residual teratomas have shown relapse. Only 1 of the 32 patients has had retrograde ejaculation.

CONCLUSIONS

A more conservative approach, such as excision of the residual masses after an extended course of chemotherapy, has given excellent results both in the outcome of the patients in the follow-up and in the rate of retrograde ejaculation. We therefore suggest that this approach would be a good alternative to nerve-sparing surgery following chemotherapy.

Detection of urinary interleukin-2, interleukin-2 receptor, and tumor necrosis factor levels in patients with superficial bladder tumors after intravesical BCG immunotherapy

OBJECTIVES

To investigate the presence of urinary cytokines, after bacillus Calmette-Guérin (BCG) therapy, in order to provide further insight into the mechanisms of action of intravesical BCG therapy.

METHOD

Urine levels of interleukin-2 (IL-2), interleukin-2 receptor (IL-2R), and tumor necrosis factor alpha (TNF alpha) levels were determined in 34 patients with superficial bladder tumors after a six-week course of intravesical BCG therapy. The urine samples were obtained at the fifth hour following the sixth course of therapy and the determinations were made by using an (enzyme-linked immunosorbent assay (ELISA)) technique.

RESULTS

The pre-BCG levels of IL-2, IL-2R, and TNF (32.1 ng/L, 21.1 ng/L, 37.6 micrograms/L, respectively) were increased significantly after therapy (175.2 ng/L, 54.4 ng/L, 625.9 micrograms/L, respectively). These levels remained significantly increased after all patients were stratified according to tumor and patient characteristics.

CONCLUSION

The results of this study provide further evidence for the immunologic basis of the mechanism of action of intravesical BCG therapy.

Bilateral adrenal metastases of renal cell carcinoma: a case report

We report a case of renal cell carcinoma presenting with bilateral adrenal masses diagnosed by ultrasonography four years after nephrectomy. The histopathological examination of the trucut biopsy specimens obtained percutaneously by ultrasound guidance revealed bilateral adrenal mestastases of renal cell carcinoma.

The effect of nifedipine and verapamil on rhythmic contractions of human isolated ureter

The effect of calcium antagonists nifedipine and verapamil on spontaneous rhythmic contractions of human isolated ureter obtained from donor subjects undergoing kidney transplantation was investigated in comparison with a nonsteroidal antiinflammatory drug indomethacin. Stop-times i.e. the time elapsing from application, were determined for each drug. The rank order of potency at 10(-8) and 10(-7) M concentrations of the drugs was: nifedipine > verapamil > or = indomethacin. However, no significant difference of the stop-times was observed at 10(-6) M concentration of the drugs tested. The rhythmic contractions were re-activated by PGF2 alpha after stoppage with indomethacin but not with nifedipine or verapamil. These results suggest that not only endogenous PG synthesis but also an influx of calcium from the extracellular space is responsible for the spontaneous rhythmic activity of human ureter. The beneficial effects of using calcium antagonists in the treatment of ureteric colic is discussed.

Bleomycin lung toxicity detected by technetium-99m diethylene triamine penta-acetic acid aerosol scintigraphy

In this study we investigated bleomycin-induced pulmonary toxicity in patients with germ-cell tumour by means of technetium-99m diethylene triamine penta-acetic acid aerosol scintigraphy. Twenty untreated patients who had no clinical or radiological evidence of pulmonary disease received four courses of etoposide, cisplatin and bleomycin chemotherapy. Aerosol lung scintigraphy and pulmonary function tests were performed in all patients before bleomycin treatment and after administration of 180 and 360 mg bleomycin. On the basis of the scintigrams the percentage decline in activity per minute (Kep) was evaluated, which represented an accurate parameter of lung membrane permeability. Pretreatment Kep values (0.891 +/- 0.286) were significantly lower than those obtained following 180 and 360 mg bleomycin treatment (1.176 +/- 0.336 and 1.389 +/- 0.477, respectively; P < 0.0005). The Kep values obtained with 180 and 360 mg bleomycin treatments were also significantly different (P < 0.005). In contrast, no significant change was observed in the results of pulmonary function tests. Our results demonstrate that evaluation of the pulmonary clearance of 99mTc-DTPA represents a useful means of monitoring the functional status of the lung epithelial membrane during bleomycin treatment. Further prospective studies are needed to assess the relationship between increase in permeability and development of lung toxicity in order to decide which patients should discontinue bleomycin therapy.

Genital infections in men associated with Chlamydia trachomatis

The advent of new diagnostic procedures has made it possible for urologists to detect chlamydial presence in genital infections. Many studies have shown chlamydial association with urethritis. However, its presence in prostatitis and epididymitis has not been clearly defined yet. In this study we investigated the presence of Chlamydia trachomatis using enzyme linked immuno assay (ELISA) antigen and antibody detection method in sexually active men with different genital infections. We have found that in 32.1% of patients with non-gonococcal urethritis chlamydial antigen is detectable. We also have been able to detect chlamydial antigen in two patients with chronic non-bacterial prostatitis, but in no patients with epididymitis. We conclude that besides its presence in urethritis, there is an association between chlamydia and chronic prostatitis. Yet, further studies are needed to delineate this association more clearly.

Dual radioisotopic study: a technique for the evaluation of vasculogenic impotence

Arterial and venous systems are the main points for the evaluation of vasculogenic impotence. To evaluate both of these systems in the same study we propose a dual radioisotopic study in which 99mtechnetium (99mTc) and 133xenon (133Xe) were used. The changes in 99mTc and 133Xe radioactivities administered intravenously and intracavernously, respectively, were monitored before and after intracavernous papaverine injection. These changes were determined as time activity curves, which were generated from the region of interest over the penis. A 99mTc penogram index derived from the 99mTc time activity curve was significantly different in the control and arteriogenic impotence groups (131.67 +/- 74.6 versus 62.94 +/- 51.6, p less than 0.01). A meaningful correlation between 99mTc penogram index results and duplex ultrasonographic findings were observed (r = 0.905). 133Xe penogram index, derived from the 133Xe washout curve was significantly different in the control and venogenic impotence groups (-25.65 +/- 24.9 versus -56.09 +/- 13.4, p less than 0.01). Also, a meaningful correlation was obtained between pharmacocavernosometry and 133Xe penogram index results of venogenic impotent patients (r = 0.86). These findings suggest that the dual radioisotopic study will be a useful technique in the evaluation of the entire vascular system of the penis, since it is a noninvasive method.

Dynamic cavernosography in the evaluation of impotence

Dynamic cavernosography before and after papaverine injection into the corpus cavernosum of 6 sexually normal volunteers and 44 impotent patients was performed with digital subtracting angiography technique. The average infusion rates in 26 patients with venous leakage were 325.5 ml/min for induction of erection and 161 ml/min for maintenance. The results for the remaining 18 impotent patients without venous leakage were 128.8 ml/min for induction and 56.9 ml/min for induction and 58.3 ml/min for maintenance. After papaverine injection the average infusion rates decreased to 131 ml/min (induction) and 59 ml/min (maintenance) in patients with venous leakage, 38.4 ml/min and 14.6 ml/min in the impotent patients without venous leakage and 35 ml/min and 14.1 ml/min in the control group, respectively. It was also noticed that in the control group filling of the superficial and deep veins may occur during the flaccid phase which disappeared with induced erection. Therefore we suggest intracavernous papaverine injection with dynamic cavernosography. The digital subtracting technique eliminates unnecessary images, providing a more accurate diagnosis of venous incompetence.

Correlation between intracavernous papaverine injection, Doppler analysis and cavernosography in impotent patients

Forty-four patients with impotence were evaluated by intracavernous papaverine injection, penile brachial index (PBI) determination and dynamic cavernosography. The correlation between these diagnostic procedures and their diagnostic value were investigated. It was concluded that the papaverine test is an efficient diagnostic procedure and can be used as the first step for the routine work-up of impotent patients.

Screening of asymptomatic siblings of patients with vesicoureteral reflux

Familial trait in vesicoureteral reflux (VUR) has been revealed in many studies. This paper reports on 36 siblings of 25 patients operated for vesicoureteral reflux at our Department. Siblings aged 2 to 21 years were evaluated by urine examination, urine culture and voiding cystourethrogram (VCU) for VUR. All of the siblings were asymptomatic and VUR was found in only 4 of them (11%), unilateral in 3 cases and bilateral in one case. It is concluded that evaluation of siblings for VUR will be suitable for revealing the presence of urinary infection, and assessing them by VCU at the time they are first seen.

Diclofenac sodium and spasmolytic drugs in the treatment of ureteral colic: a comparative study

Forty-nine patients with ureteral colic were included in this prospective double-blind study investigating the analgesic efficacy and side effects of a prostaglandin synthetase inhibitor Diclofenac sodium (Voltaren) versus a spasmolytic drug Tropenzilium bromide (Palerol). The analgesic efficacy and side effects of the calcium antagonist Nifedipine (Nidilat) applied sublingually in ureteral colic were also investigated. It was concluded that diclofenac sodium was more efficient for relieving pain due to acute ureteral obstruction and had fewer side effects than spasmolytic drugs. Nifedipine proved to have an analgesic effect equivalent to that of Tropenzilium bromide.

Immunohistochemical detection of beta-human chorionic gonadotropin in urothelial carcinoma

Histologic sections from the specimens of 60 patients with urothelial carcinoma were stained immunohistochemically to search for beta-human chorionic gonadotropin (B-HCG) production. There were 6 doubtful, 5 weak and 1 strong positive B-HCG stainings among 65 sections from 60 patients. De novo acquisition of B-HCG production capability of tumour cells seemed to be predictive for early haematogenous dissemination of the disease, but the data obtained in this particular study were insufficient to suggest B-HCG as a routine prognostic marker.

Raveron versus placebo in the conservative treatment of benign prostatic hyperplasia (BPH)

Thirty patients with BPH were randomized into two groups to receive Raveron and placebo for 6 weeks. The subjective and objective signs associated with BPH were evaluated before and after treatment. There was no significant difference between the effects of Raveron and placebo.

Histopathological changes in adult cryptorchid testes

The histological specimens of 73 patients who presented with undescended testes after puberty were re-evaluated. None of the specimens revealed carcinoma in situ but in the specimens of 5 patients severe atypia was detected. None of the patients, including 5 with severe atypia, has shown any evidence of invasive testicular tumour during follow-up.

Significance of scrotal violation in the prognosis of patients with testicular tumours

Thirty-five patients with testicular cancer who had scrotal contamination during or prior to their primary treatment were compared with 70 patients who had undergone radical inguinal orchiectomy. The survival curves, disease-free intervals and 2-year survival rates of the two groups did not differ significantly and we do not advocate additional aggressive surgical treatment to the scrotum and superficial inguinal lymph nodes in these patients.

Primary carcinoma of the renal pelvis and ureter. A collective review

During an 18-year period, 17 patients with renal pelvic and 8 with ureteral carcinoma were seen in our clinic. The lesion was transitional cell carcinoma in 23 patients, and epidermoid and anaplastic carcinoma, respectively, in 2 others. Because of frequent tumour recurrence in the lower tract, we recommend total nephroureterectomy including a cuff of the bladder as the treatment of choice for renal pelvic neoplasms. For ureteral tumours, less aggressive and conservative procedures can be considered.

[Fournier's gangrene: report of 6 cases]

6 patients with Fournier's gangrene a rare but life threatening disease, who were successfully managed are presented. Mortality rates between 17-45 percent have been reported for this disease, but through the use of broad-spectrum antibiotics, aggressive surgical debridement and when possible with multiple drainage incisions to avoid skin defects, the mortality rate has been reduced to 0 percent. We have found an association with diabetes mellitus in 2 cases, which is one of the serious predisposition factors and should not be forgotten.

Tissue alpha-fetoprotein and human chorionic gonadotrophin in non-seminomatous testicular tumours. A comparative study with serum levels

The correlation between tissue localisation and serum levels of alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG) was studied in 20 tissue samples from 18 patients with non-seminomatous testicular tumours. Specific immunoperoxidase stains were used for tissue staining and serum measurements were made by radioimmunoassay. There was a close correlation between the tissue demonstration of AFP and HCG and elevated levels of serum markers. The cellular localisations of AFP and HCG were different and no cell stained concomitantly for both AFP and HCG. From these results and from the demonstration of tumour markers in the tissue of some patients with normal serum marker levels, it was concluded that immunocytochemical localisation of the tumour markers was more sensitive than serum measurements.

Association between HLA antigens and bladder tumors

HLA antigen type was studied in 55 patients with transitional cell carcinoma of the bladder. The results showed high HLA-B5 and low HLA-BW35 frequencies. Histological grade, stage, and recurrence rate of tumors were also evaluated separately. The results were more significant in recurrent tumors.

Prognostic factors in superficial bladder cancer

A retrospective analysis of 91 patients with superficial transitional cell carcinoma (stages Ta and T1) is reported. In all of the patients transurethral resection was the treatment of choice. With the recurrence rate as the primary endpoint of interest it appeared that the number of tumours at presentation, invasion of the lamina propria, and histological grade were to be of prognostic importance. The frequency of tumour progression in our group was found to be 10 per cent. All of the patients who developed muscle invasion had lamina propria invasion at presentation.

Fracture of the penis and long-term results of surgical treatment

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

The role of delay in stage III testicular tumours

Twenty-nine patients with stage III testicular tumours seen between 1979 and 1984 were analysed for the relation between delay in both diagnosis and chemotherapy, and prognosis. The complete response (CR) rate was 40% for patients who were treated within 6 months from onset of symptoms, and 26.3% for patients who had an interval longer than 6 months. We believe that delay in diagnosis and chemotherapy may affect the response to treatment. Health education of the male population for self-examination of the testes is an important factor to minimize this delay.

Incidental carcinoma of the prostate: factors influencing prognosis

Thirty-four patients with TO carcinoma of the prostate were reviewed in an attempt to correlate their clinical progress with the histopathological features of the tumour at presentation. Two different grading systems were used. It was found that no matter which system was used, the poorer the histopathological grade the poorer the prognosis.

The role of delay in stage-III testicular tumors

Twenty-eight patients with stage-III testicular tumors seen between 1979 and 1984 were analyzed for the effect of delay on diagnosis and chemotherapy and prognosis. A statistically significant relation was determined between the symptom-diagnosis interval and extent of the disease. The complete response (CR) rate was 67% for patients treated within 6 months of symptoms, on the contrary only 16% of patients with interval longer than 6 months to treatment had CR (p less than 0.05). We believe that delay in diagnosis and chemotherapy may affect the response to treatment. Health education of the male population for self-examination of the testes is an important factor for minimizing this delay.

Haemoglobin F levels in patients with testicular tumours

This study was designed to examine haemoglobin F levels prior to therapy in 39 patients with testicular tumours (10 seminoma, 29 non-seminomatous tumours) and 20 controls. HbF levels were significantly increased in the group with testicular tumours (1.66 +/- 0.12%) compared with normal controls (0.99 +/- 0.08%) (P less than 0.001). Non-seminomatous tumours had more pronounced levels than seminomas (P less than 0.001). No correlation was found between HbF level and stage of the disease. We suggest that HbF production could be significantly reactivated in adult patients with testicular tumours and may be a useful marker.

The advantages of bilateral simultaneous stone removal from the upper urinary tract

An anterior transperitoneal approach was used to remove the stones from both kidneys and/or ureters simultaneously in 18 patients. The morbidity of this type of surgery in our study was very low and there were no surgical difficulties in exposing the intrarenal structures. Furthermore, especially in secondary cases, this approach was easier and more time-saving than the classical flank approach. We recommend its use at least in selected groups of patients in whom peritoneal gross contamination is not expected.

Surgical management of vesicoureteral reflux in children

The authors report on ten years of experience in ureteroneocystostomies on 80 ureters in 50 children suffering from vesicoureteral reflux. Complete follow-up was obtained in all cases. Postoperative radiograms revealed cure of reflux in 85 per cent of the renal units. A slightly modified Politano-Leadbetter procedure was used in all of the cases. Postoperative urinary tract infection occurred in 13 patients. This relatively low success rate is discussed briefly.

Biopsy of apparently normal bladder mucosa in patients with bladder carcinoma and its prognostic importance

A total of 100 cold cup biopsies were obtained from apparently normal vesical mucosa of 25 patients admitted to Hacettepe University Hospital between 1980 and 1981. Dysplasia was found to occur in 40.49, hyperplasia in 17.35, squamous metaplasia in 9.91 per cent. Dysplasia was shown to be increasing parallel with the increase in the grade and stage of the tumour. The frequency of dysplasia and hyperplasia in the recurrent and non-recurrent groups differed significantly (p less than 0.001). In other words, recurrence was seen more frequently in patients with positive random biopsies. Although recurrence phenomena cannot be explained on the basis of mucosal abnormalities alone, this study shows that these subendoscopic lesions do have some prognostic role in recurrences.

Effects of diethylstilbestrol diphosphate on serum and tissue ribonuclease levels in prostatic carcinoma

Thirty-six patients with prostatic carcinoma and benign prostatic hyperplasia (BPH) were studied. Transurethral resection (TUR) was performed in all, and serum and tissue ribonuclease (RNase) levels were determined with the spectrophotometric method using yeast RNA as the substrate. In patients with untreated prostatic carcinoma, statistically significant increased RNase levels were found in serum and tissue. Treatment with diethylstilbestrol diphosphate (DESDP) led to a decrease in RNase levels. In the same patients RNase serum levels after DESDP treatments also showed a parallel decrease with serum prostatic acid phosphatase (sPAP) levels. We have concluded that the serum RNase measurement may be useful for TNM classification and immunostaging.

Herpes simplex type 2 neutralization antibodies in patients with cancers of urinary bladder, prostate, and cervix

In the blood samples obtained from a total of 68 patients with cancers of the urinary bladder, prostate, and cervix, who applied to the Departments of Urology, Obstetrics, and Gynecology of Hacettepe Medical Faculty, neutralizing antibodies were sought for against herpes simplex type 2 by neutralization test. The same test was applied to 35 control patients with no known malignancies. In contrast to the presence of the antibody in 62.86% of the control subjects, this ratio was 90.70% in patients with cancer of the urinary bladder, 87.50% in those with prostatic carcinoma, and 88.89% in those with cancer of the cervix.

Tissue acid and alkaline phosphatase in prostatic carcinoma

Twenty-eight patients admitted with infravesical obstruction symptoms were studied. Fourteen of these patients were suffering from prostatic carcinoma defined as inoperable. The remaining 14 patients were diagnosed as benign prostatic hyperplasia (BPH) and transurethral resection (TUR) was performed to all of them. Specimens obtained by TUR were used to analyze tissue activities of total and tartarate labil acid phosphatase, and alkaline phosphatase. Enzymatic levels in the tissue were estimated by using fluorimetric method (FU/mg). The estimated averages seemed to vary in favor of the malignant tissue, however this variation was not found to be statistically significant. Different inhibition levels were observed in benign and malignant tissue with the addition of L(+) tartarate. The average levels of the alkaline phosphatase were found to be lower than those of acid phosphatase, but the former showed no difference between the malignant and benign groups.