ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.08981.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.08992.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective To evaluate the restoration of the ureter of the dog after resection of a 5 cm‐long middle segment.Materials and methods Eight dogs underwent resection of the middle segment of the ureter, after which a 6–8 F Bard ureteric stent modelling catheter was inserted into both remaining portions of the ureter for 3 months. One month after removal of the stent the animals were killed and their ureters examined both grossly and microscopically. Paraffin‐embedded sections were subjected to microscopic and immunohistochemical studies.Results The continuity of the ureter was restored but the reconstructed segment was narrowed to a variable extent. The wall of the ureter was lined by normal urothelium but consisted of fibrous connective tissue which failed to produce a regular coat. The reconstructed segment showed no smooth muscle cells (negative staining with azan and a negative reaction with monoclonal antibodies against desmin). A few smooth myocytes were found only at the border with intact portions of the ureter.Conclusions The surgical procedure resulted in the restoration of ureteric continuity by repair and not by regener

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.08893.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective To estimate the prevalence and morbidity of long‐term catheterization (LTC) of the urinary bladder.Patients and methods A postal survey was conducted over two successive years from February 1989 to determine the incidence of LTC in three Bristol Health Districts with a total population of 827 595. During the first year the number of patients requiring emergency treatment for complications of LTC was also monitored over a 6‐month period. In the second year, 54 patients were selected from the first survey and each was visited by one investigator every 2 weeks for 12 weeks to obtain information on catheter management, the incidence and type of complications, the attitudes of the patients or carers about the catheter and to assess the pH and microbiology of the patient's urine.Results The initial surveys identified 457 and 467 patients with long‐term catheters during the 2 years, respectively; there were similar numbers of men and women in both years. The survey of catheter complications recorded 506 emergency referrals during the 6 months and the detailed study of 54 patients showed that 48% experienced catheter blockage, 37% reported urine by‐passing the catheter and 30% noted haematuria. Patients found the catheter uncomfortable and depended on nursing support. Catheter blockage was associated with bladder stones, a high urinary pH and the presence ofProteusspp in the urine.Conclusion The prevalence and high morbidity of LTC cause a considerable demand on the available District and Hospital nursing services; most patients with long‐term catheters are elderly, disabled or debilitated and more nurses need to be trained in the technique of catheterization and the management of the catheterized patient. Further research is required to reduce the morbidity of LTC by investigating measures to reduce catheter blockage and encrustation at the urine/bi

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.09074.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives To quantify tumour angiogenesis in bladder cancer and determine whether it correlates with tumour stage, grade and survival.Patients and methods Archival samples from a total of 113 patients newly presenting with transitional cell carcinomas of the urinary bladder were graded and staged, and analysed for angiogenic blood vessel density by a double immunohistochemical technique. The findings were correlated with the information obtained during a minimum follow‐up of 12 years.Results Univariate analysis showed that TNM stage (P=0.02) and mean vessel count (P=0.01) were significant predictors of death from bladder cancer. Blood vessel density was significantly correlated with tumour stage (P=0.01) and the presence of vascular invasion (P=0.007). Trained observers were essential for the accurate counting of blood vessels to prevent excessive inter‐observer variability. Multiple regression analysis showed that the combination of mean vessel count and stage was a significant prognostic indicator.Conclusion Angiogenesis in primary bladder cancer is a predictor of death from the disease. Further work to determine whether it predicts invasion and recurrences in superficial tumours may

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.08475.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective To evaluate whether the intravesical instillation of epirubicin is effective in preventing the recurrence of tumour in the bladder where dysplastic mucosa remains after transurethral resection of tumour.Patients and methods Biopsy specimens were taken from apparently normal areas of the bladder mucosa in patients undergoing transurethral resection of the primary tumours. Of the 75 evaluable patients, 18 (24%) had abnormalities in at least one or more specimens. The patients were divided into two groups, 57 with normal and 18 with abnormal biopsy results. Intravesical chemotherapy with epirubicin (20 mg/40 mL saline) was randomized to patients in each group. Tumour recurrence rates were estimated and compared amongst the groups. Factors related to tumour recurrence were evaluated using univariate and multivariate analyses.Results The risks of tumour recurrence and progression were evaluated in 18 patients with concomitant mucosal abnormalities. All 10 patients with abnormal biopsy results who were treated with epirubicin had recurrence of tumour within a mean interval of 9 months, whereas six of eight controls had recurrence within a mean of 10.9 months. While there was progression in grade in four of 10 patients with abnormal biopsy results and treated with epirubicin, none of the recurrent tumours in six control patients with mucosal abnormalities progressed in grade. The overall recurrence‐free rate of the patients with mucosal abnormalities was higher in controls than in those receiving epirubicin, but the difference was not statistically significant. There were no significant differences in recurrence rate for those treated with epirubicin and controls in the 57 patients with normal biopsy results. Univariate analysis showed that the recurrence‐free rates were significantly influenced by tumour multiplicity and the mucosal biopsy results (P<0.001 andP=0.02, respectively). In a Cox proportional‐hazards model, tumour multiplicity alone had prognostic significance for tumour recurrence (P=0.002).Conclusions The prophylactic intravesical instillation of epirubicin had no effect in preventing tumour recurrence and, conversely, it may promote tumour progression in bladders with dysplasti

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.08486.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives To determine the effect of pH on the cytotoxicity of mitomycin C on a wide range of established cell lines.Materials and methods Cultures of three human tumour cell lines, including two bladder carcinomas and one renal adenocarcinoma, and two mouse cell lines were treated with mitomycin C (concentration range 320 pm‐50 μm) at a range of pH (5.8–7.8) for 2 h. The cytotoxicity of mitomycin C over this range was determined using a tetrazolium‐dye‐based microtitration assay.Results The cytotoxicity of mitomycin C was significantly greater (confidence level≥95%) in acidic conditions (pH 5.8–6.0) than in neutral to alkaline pH (7.2–7.8) for three of the five cell lines. The same trend, although less marked, also occurred in the other two cell lines.Conclusion The cytotoxicity of mitomycin C was greater under acidic conditions for all these cell lines confirming that the activity of mitomycin C depends on pH and suggesting that the pH of the vehicle used for intravesical chemotherapy may be an important factor in the successful treatment of bladder carcinomas. The modification of pH by urine may explain some of the variation in success rates among patients treated int

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.09017.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective To determine whether it is possible to predict the behaviour of prostate tumours by identifying cellular characteristics, specifically specific heat shock proteins (HSPs).Materials and methods An immunohistochemical study staining for HSP 27 and 90 was undertaken on 15 benign and 13 malignant samples of freshly frozen prostatic tissue obtained from patients with a similar age range in each group (benign, mean age 71.6 years, range 61–86; malignant, mean age 72.7 years, range 58–87). Gleason scores for the tumours ranged from 2 to 8.Results Consistent patterns of cytoplasmic staining were seen in all sections of tissue from benign prostatic hyperplasia (BPH). The stroma stained strongly positive for HSP 27, but negatively for HSP 90 and glandular epithelium showed positive apical staining for both HSPs. Stromal patterns in prostatic carcinoma tissue were similar to that of BPH tissue for both HSP 27 and 90. Areas of prostatic intra‐epithelial neoplasia stained as strongly as did adjacent areas of BPH. For HSP 27, there was varied staining of individual epithelial cells, suggesting cellular heterogeneity, with an apparent reduction in staining with increasing Gleason score and invasiveness. For HSP 90, this pattern was less marked, with a predominance for positive staining throughout all grades of carcinoma.Conclusions The distribution of HSPs, primarily HSP 27, may aid in identifying different cell populations within prostatic carcinomas and thus help forecast biologi

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.09058.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective To investigate the clinical application of a new technique for imaging prostatic malignancy using planar imaging and single‐photon emission tomography (SPET) with technetium‐99m‐labelled antibody to a prostatic cell surface membrane antigen.Patients and methods Prostatic malignancy was imaged by radioimmunoscintigraphy (RIS) using a99mTc‐labelled monoclonal antibody, CYT‐351, raised against a newly identified membrane antigen present in normal and malignant prostatic tissues. The protocol involved taking serial images and assessing the changes in activity, as the uptake of specific antibody increased with time and non‐specific uptake decreased. Data from planar images were collected at 10 min, 6 and 24 h after injection with antibody, and by SPET at 6 and 24 h using a Siemens Orbiter Large Field of View gamma camera. Twenty‐two RIS scans were evaluated, which included six patients with clinically localized disease, six patients with previous incidental carcinoma at prostatectomy for apparently benign disease, four patients with evidence of local recurrence after radical prostatectomy and six patients with metastatic disease.Results Primary tumours and secondary lymphatic and bone metastases were demonstrated. Only one minor side‐effect was experienced.Conclusion This RIS technique was capable of imaging primary prostatic malignancy and metastatic disease in lymph nodes and bone. Its clinical application remains to be defined, but potentially it provides a new means for tumour staging based upon tissue characterization. It may be particularly useful before radical prostatectomy and it is capable of imaging local recurrence following radical treatment of localized disease. Future applications include monitoring the progression of disease

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.09099.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective To compare the results of contact laser vaporization and transurethral resection of the prostate (TURP) in a double‐blind randomized controlled clinical trial.Patients and methods The study comprised 148 patients with clinical benign prostatic hypertrophy (BPH) who were recruited and allocated randomly to undergo either TURP (72 patients) or laser ablation of the prostate (76 patients). The outcome was assessed using the American Urological Association (AUA −7) symptom score after 1 and 3 months as the primary measure and by urinary flow rates, haematological factors and the duration of hospital stay and length of catheterization.Results With 90% statistical power, the results at 3 months showed no clinical or statistical difference between the treatments in change in AUA symptom score. A lower blood loss, hospital stay and duration of catheterization significantly favoured the laser treatment, although the failure rate of trial without catheter and the rate of re‐operation were higher after laser treatment.Conclusions These early data are encouraging for this technique, although the outcome after one year requires evaluation before advocating the widespread uptake o

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.98310.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY