[Fluorescence cystoscopy in the diagnostics and treatment of superficial urinary bladder tumors]. / Fluorescencní cystoskopie a její místo v diagnostice a lécbe povrchových nádoru mocového mechýre.

BACKGROUND: 5-aminolevulinic acid induced fluorescence cystoscopy can detect more tumour lesions comparing to standard cystoscopy. The goal of our study was to assess the influence of fluorescence cystoscopy used during transurethral resection on the recurrence rate and the length of tumor-free interval in stage Ta, Tl transitional cell carcinoma of the urinary bladder. METHODS AND RESULTS: In prospective randomized study 109 patients with primary or recurrent stage Ta Tl bladder transitional cell carcinoma treated with transurethral resection were enrolled. 17 patients with high grade tumors were evaluated separately. In group A the transurethral resection was performed with standard white light endoscopy, in group B with fluorescence cystoscopy. The patients were followed using standard cystoscopy and urinary cytology. Recurrence free interval was evaluated in whole groups and also for single and multiple and for primary and recurrent tumors separately. The median time to recurrence was 8.05 months in group A and was significantly shorter than 13.54 months in group B (p = 0.04, log-rank test). In separate analyses the median time to recurrence was significantly shorter using fluorescence cystoscopy in multiple (p = 0.004) and in recurrent (p = 0.02) tumors, but not in solitary and primary tumors. CONCLUSIONS: 5-aminolevulinic acid induced fluorescence cystoscopy used during transurethral resection reduces the early recurrence rate in stage Ta Tl bladder transitional cell carcinoma.

[Fluorescence cystoscopy using 5-aminolevulinic acid]. / Fluorescencní cystoskopie za pouzití 5-aminolevulové kyseliny.

BACKGROUND: Fluorescence diagnosis has an increasing importance in different medical fields. In the presented paper, comparison of cystoscopy in white light with fluorescence cystoscopy after intravesical administration of 1 g of 5-aminolevulinic acid is presented. METHODS AND RESULTS: From the group of 63 persons examined, no difference between findings in white and blue light was found in 39 cases. In 21 patients more pathological spots were found in blue light (10 cases) or, in agreement with histology, pathology was detected in the blue light only (11 cases). CONCLUSIONS: The intravesical administration of 5-aminolevulinic acid had no side effects. Our study has definitely proved the advantages of fluorescence cystoscopy.

Efficacy and acceptability of tadenan (Pygeum africanum extract) in the treatment of benign prostatic hyperplasia (BPH): a multicentre trial in central Europe.

Pygeum africanum extract is available as Tadenan in many countries, including those in central and eastern Europe, for the treatment of mild to moderate BPH. Its efficacy and acceptability have been demonstrated in numerous open and placebo-controlled studies in large populations. The present open three-centre efficacy and safety study was conducted according to common protocol at urology clinics in the Czech and Slovak Republics and in Poland, in order to confirm the therapeutic profile of Pygeum africanum in conditions of daily practice, using International Prostate Symptom Score (IPSS) and flowmetry assessments. Men aged 50-75 years and in compliance with the selection criteria (including IPSS > or = 12, quality of life (QoL) score > or = 3, and maximum urinary flow < or = 15 ml/s) were first examined then recalled after two weeks during which no treatment was provided (washout and check of stability). If still compliant, they were entered at this point into a two-month period of treatment with Pygeum africanum extract 50 mg twice daily. There followed a further one-month period without treatment, the objective being to evaluate the persistence of any effects observed during the previous two months of Pygeum africanum administration. The primary efficacy parameter investigated was IPSS; the other efficacy parameters were QoL, nocturnal frequency, maximum urinary flow, average urinary flow, post-voiding residual volume and prostatic volume, after one and two months of Pygeum africanum treatment and one month after stopping treatment. A total of 85 patients were evenly distributed between the three centres and completed the entire study. At inclusion their mean IPSS was 16.17, QoL was 3.60 and nocturia was 2.6 times per night. The changes in subjective scores, IPSS and QoL after the two-month treatment period were highly statistically significant with mean improvements of 40% and 31%, respectively. Nocturnal frequency was reduced by 32% and the mean reduction was again highly statistically significant. Mean maximum urinary flow, average urinary flow and urine volume were also statistically significantly improved, but the modest improvement in post-voiding volume did not reach statistical significance. The improvements, which exceeded those observed with placebo in earlier studies, were maintained after one month without treatment indicating an interesting persistence of clinically useful activity. Prostatic volume and quality of sexual life remained unchanged throughout. No treatment-related adverse effects were observed. In conclusion, under conditions of daily practice, Pygeum africanum extract induces significant improvement in IPSS and uroflowmetry parameters. These positive effects are accompanied by a very satisfactory safety profile with the overall result of a substantial improvement in QoL.

Performance of two clinical decision rules for knee radiography.

We designed a prospective observational study to attempt to validate two recently described clinical decision rules for knee radiography. Consecutive patients aged > or = 15 yr with acute knee injuries occurring less than 1 wk prior to presentation were included for study. Patients with distracting conditions, open knee injuries, or previous surgery were excluded. Each patient was assessed for 7 historical and 15 physical examination criteria that were recorded on a standardized data collection instrument. Radiographs were ordered at the discretion of the attending physician and were read by two board-certified radiologists. When radiographs were not ordered, structured telephone follow-up was performed after 3 wk. The main outcome parameter was the presence or absence of a clinically significant fracture. There were 351 patients in the study; 26 (7%) had knee fractures. Fractures were significantly associated with an increased prevalence for two of the three criteria in the rule derived by Bauer: inability to weight bear immediately or in the emergency department (ED; 76.9% of patients with a fracture vs. 29.8% of patients without a fracture) and effusion (53.8% vs. 28.9%, respectively). Ecchymosis was not significantly associated with fracture (19.2% with fracture vs. 9% with no fracture). Use of the Bauer rule would have led to a radiographic evaluation of 22 of the 26 patients with knee fractures (sensitivity = 84.6%, specificity = 48.9%). Fractures were associated with a significantly increased prevalence for three of the five criteria in the decision rule proposed by Stiell: isolated patella tenderness (30.8% with fracture vs. 14.5% with no fracture), inability to flex the knee to 90 degrees (42.3% vs. 19.7%, respectively), and inability to weight bear immediately and in the ED (57.7% vs. 18.8%, respectively). Age > or = 55 yr (23.1% vs. 12.0%, respectively) and fibula head tenderness (11.5% vs. 5.5%, respectively) were not significantly associated with fracture. Use of the Stiell rule would have led to radiographic evaluation of 22 of the 26 patients with knee fractures (sensitivity = 84.6%, specificity = 49.8%). We conclude that neither clinical decision rule is 100% sensitive. Further refinement will be necessary to identify all patients with knee fractures.

Epitestosterone in human blood and prostatic tissue.

Epitestosterone, a C19-steroid with anti-androgenic activity, was determined in the plasma of 234 boys and men from the ages of 6-86 years, and in the prostate tissue of 15 men 55-82 years of age. It was documented that, while in adulthood the concentration of epitestosterone is about ten times lower than the concentration of testosterone, in the pre-pubertal period the level of epitestosterone is similar or even higher than that of testosterone. In the hyperplastic prostate tissue the content of epitestosterone is comparable to that of androstenedione, it is about twice as high as the content of testosterone and approximately half that of the content of dihydrotestosterone. At least in the case of pre-pubertal boys and in the prostatic tissue it is therefore possible to include epitestosterone into consideration as a regulatory factor for the androgen-dependent events.

[Renal oncocytoma]. / Renální onkocytom.

Renal oncocytomas are infrequent solid tumours of the renal parenchyma. Usually they are diagnosed incidentally. As to treatment conservative surgery predominates. The authors submit their experience with the treatment of eight patients during the past two years where they performed five times transperitoneal nephrectomy and three times resection of the tumour.

The concentrations of the endogenous C19-steroids in hyperplastic prostatic tissue and the effect of finasteride treatment.

The concentrations of the antiandrogenic endogenous steroid epitestosterone (epiT) and of testosterone, dihydrotestosterone (DHT) and androstenedione in the prostate were determined in tissue samples obtained from 21 patients who underwent suprapubic prostatectomy for benign prostatic hyperplasia. Fifteen patients received no hormonal treatment before surgery and the other 6 patients were pretreated for 8 weeks before surgery with an oral dose of 5 mg/day finasteride. The steroids were extracted and separated by high pressure liquid chromatography and determined by specific radioimmunoassays. The concentration of epiT (mean 58.4 +/- 40.4 S.D., range 14.0-144.0 fmol/mg protein) exceeded that of testosterone and was nearly as high as that of DHT. The prostatic tissue from the patients treated with finasteride for 8 weeks showed a significant decrease not only in DHT but also in androstenedione and epiT, whereas the concentration of testosterone increased significantly.

Concentration of the endogenous antiandrogen epitestosterone and androgenic C19-steroids in hyperplastic prostatic tissue.

Epitestosterone (epiT, 17 alpha-hydroxy-4-androsten-3-one), an endogenous C19-steroid in humans, was considered for a long time as a physiologically inactive steroid. Recently, its antiandrogenic properties have been discovered. For the evaluation of its biological availability in the target organs the tissue concentration is of importance. EpiT, testosterone, dihydrotestosterone, and androstenedione concentrations in prostatic tissue were determined in 15 prostate samples obtained by suprapubic prostatectomy for benign prostatic hyperplasia. The steroids were extracted and separated by high-pressure liquid chromatography and determined by specific radioimmunoassay (RIA) methods. The concentration of epiT (mean 58.4 +/- 40.4 SD, range 14.0-144.0 fmol/mg protein) exceeded that of testosterone and was approximately as high as that of dihydrotestosterone. EpiT level increased with age and the correlation was significant (P < 0.05). It did not correlate significantly with testosterone but did with androstenedione and dihydrotestosterone (P < 0.05, each). As expected, a positive correlation was found between testosterone and dihydrotestosterone levels.

[The efficacy of x-ray skeletal diagnosis in chronic alcoholics]. / Die Effektivität röntgenologischer Skelettdiagnostik bei chronischen Alkoholikern.

Within an interdisciplinary study of diseases accompanying alcoholism skeletal changes were investigated in dependent alcoholics. We scanned 147 patients for osteoarthropathy, osteoporosis/osteomalacia and posttraumatic conditions. The monitored regions show trends confirming the results from the literature. If we consider, that according to our selection principle relatively early stages of alcoholism were analyzed. In the conclusions we are recommending to investigate alcohol-induced skeletal effects more closely and specifically, primarily with regard to osteoporosis/osteomalacia. Even if the effectiveness of the study may be lower, it should be extended to relapses and non-cooperative cases.

[Aplasia cutis congenita]. / Aplasia cutis congenita.

Aplasia cutis congenita is a rare disease with circumscribed absence of the dermis and the subcutis. Genetic constitution is a predisposing factor; the disease has a variable expressivity. The lesions show spontaneous healing after several months; corrective surgery is seldom indicated. The prognosis is good.