Phase II study of estramustine and vinorelbine in hormone-refractory prostate carcinoma patients

The purpose of this study was to evaluate the antitumor activity of vinorelbine and oral estramustine phosphate in patients with metastatic, hormone-refractory prostate cancer. We evaluated the activity of this association using the following schedule: estramustine phosphate 600 mg/m2/day orally days 1-42 and vinorelbine 25 mg/m1 days 1, 8, 22, 29 cycles repeated every 56 days. Twenty-five patients were included in the study, 24 being evaluable for response and 25 for toxicity. Out of 5 patients with measurable disease, none had an objective response. Of the 24 assessable patients with bone metastases, 9 patients had a > or = 65% decline in pretreatment prostate-specific antigen (PSA) level, stable disease was observed in 10 and 5 patients progressed. Toxicities were minimal. Anemia was observed in 5 patients, alopecia in 4 and nausea and vomiting was observed in 6 patients. Anorexia and weight loss of more than 10% were observed in 2 patients. This combination is active and well tolerated in hormone-resistant prostate cancer. These results support the therapeutic strategy of combining agents that impair microtubule function.

[Management of non-functioning renal graft]

On a series of 315 consecutive Renal Transplants (RT), the authors analyze the effects from any situation capable of causing the graft's renal failure, whether accompanied or not of oligoanuria. To begin with, the exploratory approach promoted by the ¿non-functioning kidney¿ is established recognizing three typical stages depending on the time of appearance: early, medium-term and long-term. The breakthroughs obtained in the prevention of Acute Tabular Necrosis (A.T.N.) are verified through the use of the receptor's hyperhydration, as well as the good results in the treatment of rejection since the arrival of Cyclosporin and the recent introduction of OKT3. Chronic rejection, is, today, the major cause of our transplantectomies (TX), since our attitude towards the exeresis of all irreversibly non-functioning grafts is well known. Vascular thrombotic problems have a very high percentage of losses among affected kidneys. Little can be done once the problem arises. Prevention is the best weapon available and special attention should be paid to the meticulousness of bank surgery and the suitable final positioning of the organ in the fossa iliaca, having into account the highly close relationship between this problem and the pathological and iatrogenic anomalies displayed by the organs to be transplanted in their arterial tree. The excretory tract problems are repaired in 83% cases, but the rest may even result in the loss of the kidney. In these complications, early surgery is the best way to avoid subsequent amputation surgery.

Urinary infection and stone formation as complications of Gil-Vernet's antireflux procedure

The authors describe two cases of urinary infection and stone formation as late complications of Gil-Vernet's antireflux treatment. The immediate cause of these complications was the migration to the mucosal surface of the nonabsorbable sutures employed in this technique.

[Review of 45 cases of renal oncocytomas published in our country, and presentation of 2 new cases]

A review is made on the characteristics presented by the 45 cases of renal oncocytomas published in the specialized literature in our country, which are compared to major publications on the subject in the international literature in which a recent review reports 200 cases. Also, two new cases are presented. These tumours are included within the 17 benign renal tumours accumulated in our centre (11.7%) accounting for 2.27% of all renal tumours diagnosed by our group. The renal oncocytoma opens a significant controversy with regard to its definitive identity and, therefore, with regard to its possible therapy whether radical or conservative.

Bladder involvement in systemic amyloidosis causing massive hemorrhage in hemodialysis

We report a chronic hemodialyzed patient with bladder involvement of a secondary amyloidosis that presented as isolated hematuria evolving quickly to a massive hemorrhage and vesical rupture. We believe that this is the first report of bladder amyloidosis involvement in the course of hemodialysis. This knowledge may help in managing dialysis patients with hematuria.

[Solitary contralateral, asynchronous adrenal metastasis of renal adenocarcinoma. Review of the literature]

A case of solitary, contralateral, asynchronous adrenal metastasis that appeared 5 years following nephrectomy is described herein. To our knowledge, ours is the fifth case reported in the world literature.

[Ureteral metastasis of prostatic adenocarcinoma. Review of the literature]

We report a case of prostate adenocarcinoma metastatic to the ureter. This is the 25th case reported in the literature. The patient was submitted to surgery with the diagnosis of prostate carcinoma and unclassified ureteral tumor since the available preoperative diagnostic methods did not permit determining the nature of the tumor. Conservative ureteral surgery was performed and the prostate excised followed by androgenic block.

[Effectiveness and tolerance of norfloxacin compared with trimethoprim-sulfamethoxazole in the treatment of uncomplicated urinary tract infections]

Forty patients with uncomplicated urinary tract infections were randomized to receive norfloxacin (400 mg) twice daily or trimethoprim-sulfamethoxazole (160-800 mg) twice daily for 10 days. The percentage of patients with bacteriological outcomes of eradication was significantly greater (p = 0.0310) with norfloxacin (90%) than the obtained percentage with trimethoprim-sulfamethoxazole (55%). The clinical response was, also, significantly better (p = 0.0012) in the norfloxacin group (100%) than in the trimethoprim-sulfamethoxazole group (55%). Two patients receiving trimethoprim-sulfamethoxazole experienced clinical side effects-gastrointestinal in nature but the treatment was not discontinued. In the norfloxacin group clinical side effects were not observed. No adverse hematological or biochemical changes were noted. From these results, we conclude that norfloxacin is more effective than trimethoprim-sulfamethoxazole in the therapy of uncomplicated urinary tract infections.

Association of renal xanthogranuloma and urological neoplasia

Seven of 66 cases of renal xanthogranuloma (RXG) were associated with urinary tumors (10.6%). The diagnostic and surgical problems can be difficult because of the similarities to a neoplasm and because of the inflammatory nature of RXG. Obstruction and infection seemed to be causative factors in 5 of the 7 cases. It was not possible to demonstrate an immunological deficit in these patients. A review of the literature shows the rarity of this association: 20 cases together with our 7 cases gives a total of 27 out of the 676 cases of RXG that have been published (an incidence of 4%).

Urinary cytology in the diagnosis of renal xanthogranulomatosis

We present our 4-year experience on the preoperative diagnosis of renal xanthogranulomatosis by sequential urinary cytology. The usefulness of this method is evident due to the absence of any other possible means of preoperative diagnosis of this disease. The possibility of obtaining foam cells by ureteral catheter washouts and translumbar aspiration in the patients, where spontaneous urine cytologies were negative, is also pointed out.

Preoperative diagnosis of renal xanthogranulomatosis by serial urinary cytology: preliminary report

The search for foam cells in the urinary sediment of patients with possible renal xanthogranulomatosis can constitute a harmless and useful diagnostic method for this frequently occurring renal disease, which previously has been diagnosed with certainty only by histological examination or biopsy. Of 5 cases studied the search was positive in 80 per cent.

Personal technique for surgical repair of balanic hypospadias

A personal technique is described for the surgical correction of balanic hypospadias. The result of this technique is a large neourethra and satisfactory esthetics in 1 operation.

[Transcervical adenomectomy with prior hemostasis (author's transl)]

After giving a brief description of the anatomy of the prostate, with special emphasis on the irrigation of same, the authors discuss 226 cases of adenoma of the prostate operated on transcervically with prior hemostasis, the transfusion consisting of a total of 111 of blood. In 68% of the cases, the urine became clear within 24 h after the operation. The probe was removed within the first 5 days in 70% of the cases. The complications found included: 9 cases of epididymitis (keeping in mind that deferent ducts are never linked), 4 cases of postoperative incontinence (in 3 cases the incontinence was temporary and disappeared within 3 months), and 3 deaths 2 weeks after the operation (1.3%) due to ictus, bronchopneumonia, and pneumonia, respectively. The hospital stay lasted 9 days, on the average. There were no cases of late hemorrhaging, fistula, or vesicle atony.