The impact of LH, E2, and P level of HCG administration day on outcomes of in vitro fertilization in controlled ovarian hyperstimulation.

OBJECTIVES: The objective of this study was to evaluate the impact of luteinizing hormone (LH), estradiol (E2) and progesterone (P) levels on the day of human chorionic gonadotropin (HCG) administration on outcomes of in vitro fertilization (IVF) in controlled ovarian hyperstimulation (COH). STUDY DESIGN: In this retrospective study, 129 infertile women undergoing IVF/intracytoplasmic sperm injection (ICSI) treatments were included; these cycles were stratified according to LH levels of ≥ 1.12 IU/L or < 1.12 U/L and according to E2 levels of ≥ 1,005.89 pmol/L or < 1,005.89 pmol/L. The main outcome measure was the clinical pregnancy rate. RESULTS: The clinical pregnancy rate was significantly higher in the group with LH ≥ 1.12 IU/L than in the group with LH < 1.12 U/L (43.28% vs. 30.65%, p < 0.05). The clinical pregnancy rate was also higher in the group with E2 ≥ 1,005.89 pmol/L than in the group with average E2 < 1,005.89 pmol/L (42.86% vs. 30.51%, p < 0.05). Among the LH, E2, and P levels on the day of HCG administration, LH level was the most important predictor of outcomes of IVF in COH. The present data showed an adverse effect of low serum LH level (LH < 1.12 IU/L) on the day of HCG administration on clinical pregnancy rate. E2 level can also predict the outcomes of IVF in COH. CONCLUSIONS: Low serum LH level (LH < 1.12 IU/L) and low serum E2 level (average E2 < 1,005.89 pmol/L) on the day of HCG administration led to low clinical pregnancy rates, while the P level on the day of HCG administration may have had little effect on clinical pregnancy.

Vasectomy and prostate cancer risk in China.

Vasectomy has been reported to be associated with an increased risk of prostate cancer in western countries. A hospital-based case-control study was conducted in 12 cities in China to evaluate the relationship between vasectomy and prostate cancer risk in China, a low-risk country with rising incidence and increasing use of vasectomy. Interviews were conducted with 138 histologically confirmed prostate cancer cases diagnosed during 1989-1992 and 638 controls (158 hospital cancer, 158 hospital noncancer, and 322 neighborhood controls) of similar ages. Vasectomy at least 10 years prior to interview was reported by 10% of the cases versus 3% of the controls. Odds ratios for prostate cancer associated with vasectomy were 2.0 (95% confidence interval, 0.7-6.1), 3.3 (95% confidence interval, 1.0-11.3), and 6.7 (95% confidence interval, 2.1-21.6), respectively, when hospital cancer, hospital noncancer, and neighborhood controls were used for comparison. Although detection bias is of concern, the data suggest that in China, men with a history of vasectomy may experience an increased risk of prostate cancer.

PIP: This paper reports the findings of a hospital-based case-control study that was conducted at major teaching hospitals in 12 cities in China. China reports the lowest incidence in prostate cancer of over 100 registries reporting cancer incidence. This investigation evaluated the relationship between vasectomy and prostate cancer and attempted to identify any etiological factor. A total of 138 study patients (index cases) were identified. Controls used in this study included a cancer control and a noncancer control from the same hospital, and 2 neighborhood controls. Chances of having prostate cancer were statistically determined by logistic regression analysis with age group adjustments made. The analysis reviewed 138 cases and 638 controls. Results indicate that, regardless of the variable control used for comparison, an increased risk of prostate cancer was associated with having had a vasectomy. Statistical odds ratio was 2.0 for hospital cancer controls (95% confidence interval [CI]; 0.7-6.1); 3.3 for hospital noncancer controls (95% CI; 1.0-11.3); and 6.7 for neighborhood controls (95% CI; 2.1-21.6). The authors conclude that, as reported for men in Western countries, Chinese men who have had a vasectomy are at significantly increased risk for developing prostate cancer compared to men who never have had a vasectomy. They report a near 2-fold increase in risk (vasectomy vs. non-vasectomy) in developing the disease. Conclusions about cause and effect are premature, but these findings warrant further investigation of several issues. These include: changes in the endocrine system due to vasectomy; systematic and local immunity changes after vasectomy; and other possible biochemical factors that enhance/inhibit cancer growth in the prostate gland.

Preliminary study of the frequency of benign prostatic hyperplasia and prostatic cancer in China.

OBJECTIVES: This study determined the frequency of benign prostatic hyperplasia (BPH) and cancer of the prostate (CaP) in China. METHODS: Prostate specimens from 321 unselected autopsies were collected from 1989 to 1992. Slices were cut vertically every 0.5 cm from apex to base. Five to 12 slices were obtained from each prostate. Specimens were stained with hematoxylin-eosin and Masson trichrome. Sixty surgical specimens obtained from cystoprostatectomies with intact prostate were included to determine the frequency of latent CaP. RESULTS: The frequency of BPH, by age, was as follows: 41 to 50 years, 13.2%; 51 to 60 years, 20%; 61 to 70 years, 50%; 71 to 80 years, 57.1%; 81 to 90 years, 83.3%. The frequency of latent CaP, by age, was as follows: 41 to 50 years, 2.2%; 51 to 60 years, 9.3%; 61 to 70 years, 5.9%; 70 years or older, 25%. Incidental CaP was found in 4.9% (33 of 676) of BPH surgical specimens. The incidence of and mortality from CaP in Beijing were 2.41 per 100,000 men and 1.19 per 100,000 men, respectively, between 1985 and 1987. CONCLUSIONS: BPH was rare in China in the early years of this century, but it has become a common disease in recent decades. The histologic frequency of BPH in China was similar to that in Western countries, but the histologic frequency of latent CaP was less than half that in Western countries. The incidence of and mortality from CaP in China are about 20 times less than those in Western countries. Histologic CaP in a Chinese man is not as likely to evolve into clinical CaP as in a Western man.

Vicissitude of management of ureteral stones.

Following the use of rigid ureteroscopic lithotripsy (URS) in 1984 and extracorporeal shock wave lithotripsy (ESWL) in 1987, the treatment for ureteral stones has undergone significant changes. Our experience showed that the successful rate of URS for 132 patients was 89.4% and for the upper third was rather low, percutaneous antegrade URS should be considered. 376 patients treated with ESWL in prone position with a successful rate of 96.8%. The applicability of open surgery was reduced to 17.8% in 1987 and 14.5% in 1988.

Treatment of urgency and urge incontinence with flavoxate in the People's Republic of China.

Flavoxate is a smooth muscle relaxant widely used to treat urgency and urge incontinence. It has been used in an unblinded, uncontrolled clinical trial in 14 urology departments in universities and major hospitals in the People's Republic of China involving 361 patients with urgency/incontinence of various types. Patients were given 200 mg three times daily, orally, for 2 weeks, although 33 patients received a daily dosage of 1200 mg. Frequency, urgency, dysuria, nocturia and incontinence were assessed and scored clinically prior to and after treatment. Three departments also included urodynamic investigations, e.g. monitoring of the end-residual volume. Results from 336 evaluable patients indicate that 228 (67%) were completely cured of urgency/incontinence symptoms, 66 (20%) were improved and 42 (13%) patients were unchanged. Flavoxate was also effective in 77.4% of patients refractory to previous anti-cholinergic treatment. Treatment did not increase the end-residual volume and adverse events occurred only in four (1.3%) patients, two (0.6%) of which discontinued the therapy. The 1200 mg dose produced a complete cure in 82% of patients and improvement in the remaining 18%, with no side-effects. In conclusion, flavoxate is an effective and well tolerated treatment for urgency/incontinence of various causes.

Multi-organ involvement in urothelial malignancies.

The present study covers 1213 patients with urothelial tumours, of whom 113 have been affected by multi-organ malignancies. The disease was found to spread mostly in direction of the urine flow. Bladder was the most frequently affected organ. The incidence of pelvic cancer in China is higher than in Western countries.

[The incidence of multi-organ involvement in urothelial malignancies].

Attention has long been drawn on the multi-organ involvement of urothelial malignancies both by urologists and pathologists. Urothelial malignancies did occur occasionally in several urinary organs within the same patient. From 1951 to 1986, 12,553 patients were admitted to our urological department, among them 1,213 had urothelial tumors. There were renal pelvic tumors in 130, ureteral in 93, bladder in 925 and urethral in 65. We measured any single individual of the paired-organ, the pelvis or ureter as a single organ. Thus, of the total 1,213 tumors 113 were found to have multi-organ involvement. Long term follow-up rate was 93.6%. In the present study, we noted that the malignant appearance of urothelium involving in multi-organ has generally been with a trend toward urinary flow. i.e. from the proximal to the distal site of urinary tract. One hundred and four patients (92%) had tumors developed the urinary flow direction while only 9 patients (8%) were of refluent direction. Renal pelvis, ureter and urethra showed to be at high preference of multi-organ involvement, accounting for 53.8%, 58.1% and 46.2% respectively, whereas bladder tumor only showing 10.5%, predominated in single organ involvement.

[Clinical significance of random mucosal biopsies in patients with bladder cancer: analysis of 117 cases].

The results of multiple random biopsies from apparently non-tumor bearing mucosa were analyzed in 117 cases with bladder cancer. Of the 687 evaluable specimens, 26.5% showed abnormalities including hyperplasia (12.4%), atypical hyperplasia (5.8%), flat carcinoma in situ (6.0%) and even occult carcinoma (2.3%). The frequency of mucosal lesions increased with advancing histologic grade of visible tumors. The frequency of occult cancerous or precancerous lesions in cases with visible tumors was significantly higher than that of cases with invisible tumors. Undoubtedly the existing of occult cancerous or precancerous lesions is one of the important factors of high recurrence rate after local resection of the bladder tumors. Patients with occult cancerous or precancerous lesions should be given intensive follow-up and intravesical prophylactic therapy.

[The incidences of benign prostatic hyperplasia and prostatic cancer in China].

Step-sections of 321 prostatic specimens from unselected autopsies were examined in order to understand the incidences of benign prostatic hyperplasia (BPH) and prostatic cancer (CaP) in China. The results showed that the incidence of BPH in patients of 51-60, 61-70, 71-80, and 81-90 years old was 20%, 50%, 57.1% and 33.3% respectively. The incidence of latent CaP in the above-mentioned age series, including 60 prostatic specimens from cystoprostatectomies was 9.3%, 5.7%, 26.9% and 16.7% respectively. The Incidence of CaP in BPH surgical specimens was 33/676 (4.9%). The histological incidences of BPH and CaP in China were similar to or half of that of western world. But the epidemiological incidence of CaP in China was only 1/20-1/30. Further investigation about this condition is necessary.

[Abnormalities of anti-oncogene p53 in renal cell carcinoma].

Mutant forms of p53 gene are found in numerous human malignancies. Studies of the p53 mRNA showed different levels of expression in many tumours. But the relationship between the p53 gene and the renal cell carcinoma is less elucidated than the other. In this report we examined p53 gene at mRNA level by Northern blot on the tissues from 21 patients with renal cell carcinoma. Abnormalities of the p53 were found in 12(57%) tumors, in which seven had elevated level of p53 mRNA, and five lacked p53 mRNA. p53 gene alteration occurred in a high percentage in high-grade and advanced tumors. These results suggest that inactivation of p53 gene is common in renal cell carcinoma and may be involved in the progression of this malignancy.

Radioimmunoimaging diagnosis of human bladder carcinoma.

The monoclonal antibody (BDI-1) against human bladder carcinoma has been shown to have selective reactivity for bladder cancer. A total of 19 bladder cancer patients were studied by radioimmunoimaging (RII) and a clear immunoscintigraphy was observed in all. Blood samples collected at 1, 2, 3, days after instillation were shown to be almost free from radioactivity. It is suggested that BDI-1, as a target carrier, might also be for instillation target treatment of superficial bladder cancer.

Cellular origin of renal cell carcinoma--an immunohistological study on monoclonal antibodies.

It has been recognized in recent years that renal cell carcinoma possesses a proximal convoluted tubules origin. In an attempt of further intensive evaluation we assayed 51 renal cell carcinomas and 38 additional normal kidney specimens with 4 kidney segment-specific antibodies (Uro-2/S4, Uro-5/T16, Uro-10/T43, Anti Tamm-Horsfall Protein) directed against the nephrotic cells by indirect immunohistological techniques. Consistently stable staining was developed in the tests. The results showed that the majority of renal clear cell carcinomas expressed nephrogenous properties of proximal convoluted tubules but in part also of distal tubules and collecting ducts. Granular cell carcinoma mostly demonstrated histogenic appearance of distal convoluted tubules.