摘要:

Patients suffering from renal cell carcinoma have a generally poor prognosis. Even cases that are clinically in comparable stages can, however, take quite different courses. The basic prognostic factors, histological grade and TNM stage do not do justice to the heterogeneous biological behavior of this tumor entity. In this study, the possible prognostic indicators, DNA content and proliferation rate, assessed with Ki-67, were compared with the histological grade and the TNM stage. Though there was no correlation between the proliferation rate (Ki-67) and the two, there was a significant correlation between DNA content and both histological grade and TNM stage.

ISSN:0042-1138    

DOI:10.1159/000282669

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The influence of various prostatic manipulations, including digital rectal examination, cystoscopy, transrectal ultrasonography and transrectal needle biopsy, on the serum prostatic-specific antigen (PSA) levels in 170 men, were examined. We found that digital rectal examination, cystoscopy and transrectal ultrasonography had no significant effect on PSA levels, except for transrectal needle biopsy, which caused an immediate increase of serum PSA in 96.2% of the patients lasting more than 2 weeks in 42.3% of the cases. In conclusion, serum PSA determination after digital rectal examination, after cystoscopy and after transrectal ultrasonography is accurate and reliable. On the other hand, we must wait about 6 weeks after needle biopsy before measuring PSA in the serum of patients with prostatic diseases.

ISSN:0042-1138    

DOI:10.1159/000282670

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The present study was undertaken to compare the ability of magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) to identify the presence or absence of extracapsular tumor extension and seminal vesicle involvement in patients with clinically localized (stages A and B, T1-T2) prostatic cancer. Sixty-four patients (ages 44–77 years) underwent radical retropubic prostatectomy and pelvic lymphadenectomy after staging with both MRI and TRUS. Surgical specimens were step-sectioned and examined at multiple levels. Radiographic staging was correlated with pathological staging. Both MRI and TRUS demonstrated better staging accuracy than conventional digital rectal examination [42% for digital rectal examination (DRE), 63% by TRUS, and 67% by MRI], although they suffered from understaging (31% by TRUS and 22% by MRI). The positive predictive value (PPV) for stage B disease was disappointingly low (42% for DRE, 53% for TRUS and 59% for MRI). However, the PPV for stage C disease was higher (81% for TRUS and 77% for MRI). In the evaluation of extracapsular invasion, the PPV of TRUS (81 %) was higher than that of MRI (77%). The negative predictive value (NPV), however, for both TRUS and MRI was low (58 and 56%, respectively). In the evaluation of seminal vesicle invasion, both TRUS and MRI demonstrated poor PPV (50 and 40%, respectively), but the NPV was excellent (90% for TRUS and 96% for MRI). MRI failed to detect metastatic lymph nodes in 4 of 6 patients while falsely predicting their presence in 4 patients. TRUS is a valuable adjunct to DRE for the staging of patients with clinically localized prostate cancer as it allows more accurate staging and allows for seminal vesicle biopsy. The role of an MRI with an abdominal coil, in this patient population, is questionable owing to its low predictive value and poor sensitivity in metastatic lymph node detection. The value of imaging increases with the extent of the disease as both TRUS and MRI are associated with an acceptable PPV for the identification of stage C diseas

ISSN:0042-1138    

DOI:10.1159/000282671

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Radical prostatectomy was carried out in 30 patients with an incidental carcinoma of the prostate. A tumor stage Tla (Al) was present in 7 cases and a tumor stage Tib (A2) in 23 cases. None of the 30 patients died postoperatively. As intraoperative complication, a rectum perforation occurred in 1 case. In the 23 patients with a Tib tumor, a pT2pN0M0 lesion was found in 10 cases and pT3pN0M0 lesion in 11 cases on pathohistological examination after radical prostatectomy. In 5 out of 30 patients the carcinoma could no longer be detected in the radical prostatectomy specimen. In 1 patient with a T1a tumor, pelvic lymphadenectomy revealed a single lymph node metastasis. Tumor progression did not occur in any of the 7 patients with a Tla tumor after an observation period of 9 months up to 16 years (average 4.6 years). The percentage of progression-free patients in stage Tib was calculated as 81.4% 10 years after surgery. The calculated overall survival time of patients in stage Tib was 76.3% after 10 years and the tumor-related survival was 87.5%.

ISSN:0042-1138    

DOI:10.1159/000282672

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The aim of this study is to present preliminary experience with 137Cs medium dose rate (MDR) afterloading transurethral radiotherapy for small-sized ( < 2.5 cm) prostatic carcinomas. The phase II protocol comprises 46 Gy of external beam radiotherapy, followed by two insertions (1 week apart) of 137Cs MDR transurethral brachytherapy, each one delivering 8 Gy to a point 0.5 cm from the urethral walls. The treatment is completed with a 14-Gy boost to the prostatic area through lateral external beam fields. Up to now, 9 patients have been treated. The transurethral insertion is a simple procedure, requires no anesthesia and the ultrasonographic observation precisely and easily guided the positioning of the applicator. All 9 patients are alive and disease-free 12-––36 months after the end of radiotherapy. One of them presented a mild degree of urethral stricture and none developed chronic proctitis or cystitis. Seven patients were sexually potent before radiotherapy and all of them maintained their potency. Transurethral radiotherapy for prostatic carcinoma requires further investigation. The radiation dose that the procedure delivers to the prostate is higher than the one prescribed for external beam irradiation regimens. Rectal and bladder dose is substantially reduced. Although the prostatic urethra receives a higher dose, the incidence of urethral stricture is low probably because of the small tissue volume (8 cm3) in the high radiation dose a

ISSN:0042-1138    

DOI:10.1159/000282673

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Recent experimental work has demonstrated that nitric oxide (NO) is the neurotransmitter responsible for cavernous smooth muscle relaxation. Different studies on the performance of the direct NO donor linsidomine chlorhydrate (SIN-1) in patients with erectile dysfunction have had conflicting results. We performed a single-blind cross-over trial in 20 patients with erectile dysfunction of mixed etiology comparing prostaglandin E1 (PGE1) to SIN-1 at two different dosages (1 and 2 mg, respectively) in order to determine the effectiveness of SIN-1. PGE1 always achieved the best response, SIN-1 performed statistically significantly poorer irrespective of the dosage used. There were only a few side effects with no significant difference. SIN-1 is not a useful alternative to PGEi in the treatment of erectile dysfunction.

ISSN:0042-1138    

DOI:10.1159/000282674

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The prevalence of Chlamydia trachomatis and other microbes was studied in 94 semen samples from asymptomatic infertile males. Simultaneously, we sought evidence for inflammation of the genital tract by determining the polymorphonuclear granulocyte (PMN)-elastase concentration in the seminal plasma. The C. trachomatis genome was detected in 8 cases using in situ hybridization. The antigen, however, was undetectable by enzyme-linked assay (Chlamydiazyme) in the same samples. Ureaplasma urealyticum was isolated from 16 cases. The PMN-elastase concentration in the semen positive for the C. trachomatis genome was significantly higher than in C trachomatis-negative and U. urealyticum-positive cases, but no significant difference was observed between C. trachomatis-mgative and U. urealyticum-positive cases. C. trachomatis in situ hybridization-positive cases correlated well with C trachomatis-specific IgA antibody positivity and a PMN-elastase concentration over 250 ng/ml. These findings suggest that in situ hybridization is a reliable method for the detection of C. trachomatis infection and that the presence of C. trachomatis, but not U. urealyticum, in the male genital tract correlated well with evidence of inflammation.

ISSN:0042-1138    

DOI:10.1159/000282675

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

We report a case of infertility due to obstructive azoospermia determined by papillary cystadenoma of the epididymis. The 28-year-old patient had other signs of von Hippel-Lindau syndrome and died from neurological complications. The possibility of finding an epididymal neoplasm should be kept in mind in any case of azoospermia with epididymal enlargement.

ISSN:0042-1138    

DOI:10.1159/000282676

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A patient with previously undiagnosed asymptomatic chronic lymphocytic leukaemia presenting with acute on chronic retention is reported. The relevant literature is discussed.

ISSN:0042-1138    

DOI:10.1159/000282677

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A nephrogenic adenoma of the bladder in a 4-year-old girl with a past history of urologic surgery for vesicorenal reflux is described. The multifocal tumor was treated by transurethral resection. Relapse occurred 15 months later and was again treated by transurethral resection. Pathological aspects, clinical features and therapeutic considerations of this proliferative lesion are reviewed and discussed.

ISSN:0042-1138    

DOI:10.1159/000282678

出版商:S. Karger AG    

年代:1994

数据来源: Karger