[Testicular toxoplasmosis: a rare case of a testicular mass]. / Toxoplasmosis testicular: un caso raro de masa testicular.

Toxoplasma gondii is an intracellular protozoan infecting birds and mammals. Acute infection is asymptomatic in immune competent people. For immune deficient patients (acquired immune deficiency syndrome, lymphoma patients or those under steroids to prevent organ transplantation rejection) infection may be lethal. We describe an uncommon case of testicular toxoplasmosis in patient under steroids after organ transplantation with no positive serum test for HIV and/or systemic toxoplasmosis.

Natural rubber latex sensitisation and allergy in patients with spina bifida, urogenital disorders and oesophageal atresia compared with a normal paediatric population.

BACKGROUND: Natural rubber latex (NRL) contains proteins which, after repeated contact with latex products and an allergic predisposition (atopy), can lead to sensitisation (specific IgE against NRL proteins) or allergy (type 1 allergy with symptoms from urticaria to allergic shock). Spina bifida patients are known to be a high risk group for latex allergy and sensitisation due to numerous operations beginning soon after birth. In the study presented here we compared spina bifida patients with patients who also underwent repeated operations beginning soon after birth (urological malformations) or underwent surgery once in the neonatal period but had numerous anaesthesias because of repeated treatment with a bougie (oesophageal atresia). In this setting the influence of surgery and anaesthesia on NRL-sensitisation was investigated. MATERIALS AND METHODS: We investigated the prevalence of NRL-specific IgE (> 0.35 kU/l, ImmunoCAP system, Pharmacia) in a normal paediatric population (neither atopic nor having undergone surgery) (group I), spina bifida patients (group II), children with urogenital malformations (group III) and children with oesophago-tracheal malformations (group IV). RESULTS: The highest rate of NRL-sensitised patients was found in the spina bifida group (II) (48 %), followed by groups III and IV with 17 % each, compared to 4 % for the control group. NRL-allergic reactions were noted only in the patients with spina bifida and the urological malformation group (18 % in group II, 8 % in Group III). Apart from atopy the number of operations could be identified as a risk factor for the development of NRL-sensitisation and allergy (group II, III). The prevalence of latex allergy was lower after repeated anaesthesia (group IV) than after repeated surgery. CONCLUSIONS: In addition to the known high risk group of spina bifida patients, other patients with congenital malformations and early surgery also have a significant risk for latex sensitisation. When treating patients with malformations requiring repeated surgery, prophylactic measures similar to those for spina bifida patients should be considered.

High-throughput tissue microarray analysis of 3p25 (RAF1) and 8p12 (FGFR1) copy number alterations in urinary bladder cancer.

Studies by comparative genomic hybridization revealed that the chromosomal regions 3p25 and 8p11-p12 are recurrently amplified in bladder cancer. To investigate the prevalence of DNA copy number alterations in these chromosomal regions and study their clinical significance, we used probes for the RAF1 (3p25) and FGFR1 (8p12) genes for fluorescence in situ hybridization. A tissue microarray containing 2317 tumors was analyzed. The analysis revealed RAF1 amplification in 4.0% and FGFR1 amplification in 3.4% of interpretable tumors. In addition, deletions were found at the 3p25 locus in 2.2% and at the 8p11-12 locus in 9.9% of interpretable tumors. Both amplifications and deletions of RAF1 and FGFR1 were significantly associated with high tumor grade (P < 0.0001), advanced stage (P < 0.0001), and poor survival (P < 0.05) if tumors of all of the stages where analyzed together. RAF1 amplifications were associated with subsequent tumor progression in pT1 carcinomas (P < 0.05). The marked differences in the frequency of all of the analyzed changes between pTa grade 1/grade 2 and pT1-4 carcinomas support the concept of these tumor groups representing different tumor entities.

Vinorelbine in androgen-independent metastatic prostatic carcinoma--a phase II study.

The purpose of this study was to evaluate the efficacy of vinorelbine treatment in terms of prostate-specific antigen (PSA) response and clinical benefit (decrease of pain or analgesic score for the subgroup of patients with pain), as well as its toxicity in patients with progressive metastatic androgen-independent prostatic carcinoma. 44 patients with prostatic carcinoma progressing after orchiectomy or during treatment with hormonal agents were treated with vinorelbine at a dose of 30 mg/m(2) intravenously (i.v.) on days 1 and 8 of a 21-day cycle. Inclusion criteria were metastatic progressive prostatic carcinoma with prostate-specific antigen (PSA) serum levels >/=3 x upper limit of normal, World Health Organization (WHO) performance status /=2 was observed on the day of scheduled vinorelbine administration. 9 patients received less than three cycles, 6 due to rapid tumour progression. Treatment at day 1 had to be delayed in 13.7% of 183 cycles. Treatment at day 8 had to be omitted in 19.7% of all cycles. Grade >/=3 granulocytopenia occurred in 18% of patients. 4 patients had severe constipation. In 7 patients (15.9%, Confidence Interval (CI) 6.6-30.1%), a PSA response (>/=50% reduction of PSA levels) was observed. Among 8 patients with measurable disease, 3 had partial remission and 1 no change. Median time to PSA progression in 43 assessable patients was 11.9 weeks (range 3-52 weeks). Median duration of PSA response was 14 weeks (9-30 weeks). Clinical benefit was seen in 7 of 31 cases (23%) with baseline pain, there was no association with PSA response. Vinorelbine is a fairly well tolerated drug with a moderate single agent activity in patients with androgen-refractory prostate cancer.

Transitional cell carcinoma of the vagina with pagetoid spread pattern.

A distinctive variant of a papillary noninvasive transitional cell carcinoma (TCC) of the vagina removed from a postmenopausal woman is described. The neoplasm was evaluated by immunohistochemistry. The designation of this neoplasm as a TCC is supported by its morphological features and its coexpression for cytokeratin (CK) 7 and CK 20. Its main feature is pagetoid infiltration into adjacent vaginal epithelium. This is the second reported case involving a transitional cell metaplasia (TCM) of the vagina, a possible precursor lesion of the TCC.

Congenital diverticulum of male urethra.

Congenital diverticulum of the male urethra is an uncommon condition. Urinary tract infection, urethral obstruction, and disturbances in micturition are the most common symptoms. Six cases of congenital diverticulum of the male urethra were studied with regard to diagnosis and treatment. Four patients underwent endoscopic treatment of the diverticulum. The procedure is simple and rapid, with low incidence of complications and high rates of success.

Use of bisphosphonates can dramatically improve pain in advanced hormone-refractory prostate cancer patients.

INTRODUCTION: Approximately 85% of patients who die from prostate cancer present the spread of bone metastases. Even though the radiological appearance of such metastases is osteoblastic, it is now known that these lesions coexist in their microenvironment with blastic and lytic lesions. The process always begins with bone lysis by osteoclast proliferation, paralleling nearby bone deposition. The treatment options are palliative and have poor clinical response with short-lived improvement. We have studied the clinical effect of bisphosphonates (clodronate) in the treatment of skeletal complications from prostate cancer. MATERIALS AND METHODS: In an open prospective study, 58 patients with hormone-refractory prostate cancer with bone metastases were assessed from November 2000 to September 2003. The mean age was 70.3 y (range: 51-87 y). Bone scintigraphy, plain X-ray, assaying of prostate-specific antigen (PSA) and biochemical tests were requested before and following treatment. Patients were previously and subsequently assessed using the visual pain scale (0-10) and Karnofsky's index after the first and second intravenous (i.v.) infusions (administration of i.v. clodronate every 28 days) and every 4-6 months thereafter. Student's t-test was used for statistical analysis. RESULTS: A total of 53 patients (91.4%) showed improvement after the first and/or second cycle, which persisted for at least 4 months (average 6.3 months). The averages on the visual pain scale improved from 7.4 (range: 2-8) to 2.4 (0-7) and on Karnofsky's index from 43 (32-58) to 73 (50-82). The radiological appearance of the metastases improved in 27 patients (46.5%) and there were few relapses (six patients; 10.3%). CONCLUSIONS: Clodronate was effective in the treatment of skeletal complications from prostate cancer. There was an objective response in 91.4% of treated patients, with a marked improvement in the subjective visual pain scale evaluation as well as on Karnofsky's index, with low side effects.

Reduction of latex sensitisation in spina bifida patients by a primary prophylaxis programme (five years experience).

Spina bifida patients represent a group with the highest risk for latex sensitisation and allergy with life-threatening symptoms mostly during surgery. At the end of 1995 we initiated a primary latex prophylaxis around and during surgery and anaesthesia of all spina bifida patients. The aim of our study was to investigate the prevalence of latex sensitisation in the spina bifida patients born during the five years after establishing latex prophylaxis in the Cologne Children's Hospital in December 1995. We investigated 34 serum samples of 27 spina bifida patients (mean age 2.4 years) for specific IgE antibodies against latex allergens (CAP system) and compared these patients born after 1995 with 38 spina bifida patients up to 5 years of age (mean 3.1 years) born before. In the prophylaxis group two of 27 patients (7 %), one of them with two operations outside the Children's Hospital, had low specific IgE against latex ( 100 kU/l (mean 22.6 kU/l, min 0.4 kU/l). Sera of 22 patients remained negative for latex IgE (min. 1, max. 19, mean 4.3 operations). By primary latex prophylaxis during surgery, anaesthesia and in paediatric wards the prevalence of latex sensitisation can be significantly reduced even in the high risk group of spina bifida patients. Problems can arise by the need for surgery in hospitals not experienced in the treatment of spina bifida patients, where latex prophylaxis is neglected.

[Oxalate urolithiasis--an occupational disease? (author's transl)]. / Calciumoxalatnephrolithiasis als Berufskrankheit?

A patient working as a stove-fitter suffers from calciumoxalate urolithiasis. The exploration of his typical occupation and the special investigation of lithogenic factors in urine and serum points to deterioration of oxalate urolithiasis.

[Autonomous hyperparathyroidism--diagnostic values of laboratory parameters (author's transl)]. / Autonomer hyperparathyreoidismus--diagnostischer Stellenwert von Laborparametern.

The diagnostic parameters of HPT in 22 patients with recurrent urinary stone disease and high levels of PTH were investigated with particular reference of their practical value and reliability. Among the diagnostic parameters PTH and ionized calcium in serum and calcium/creatinine ratio, TRP p. c. and c-AMP in urin after overnight fasting have the best reliability.

[Intrarenal calcium crystallization. An electron microscopy study]. / Die intrarenale Kalzium-Kristallisation. Eine elektronenmikroskopische Untersuchung.

Male Wistar rats were treated by ethylene glycol (0.8 Vol% in water) or a diet low in magnesium (70 mg/kg). The intrarenal crystallisation and stone formation of calcium oxalate was investigated by SEM, TEM and energy dispersive X ray analysis. The first stage in crystallisation was amorphous deposits of calcium surrounding microvilli of the lower part of the nephron, followed by multicentric, intratubular calcium crystals. Finally calcium plaques of the papilla seemed to be precursors of the urinary stone.

[Primary extragonadal choriocarcinoma of the bladder. A case report with a compilation of the 19 cases published so far]. / Primär extragonadales Chorionkarzinom der Harnblase. Ein Fallbericht mit Zusammenstellung der 19 bisher publizierten Fälle.

We report on a 73-year-old man with a primary extragonadal choriocarcinoma of the urinary bladder associated with transitional cell carcinoma. So far only 19 cases of choriocarcinoma of the bladder have been published in the literature. With reference to the cases reported in the English literature, the relationships between serum beta-HCG level, mode of therapy and clinical course are pointed out. Finally, the possible explanations for pathogenesis are discussed and the signs and symptoms that are mandatory for diagnosis of this entity are defined.

[Plasma and urinary CEA-assay in patients with urological tumours (author's transl)]. / CEA-Bestimmung in Urin und Plasma bei Patienten mit Tumoren des Urogenitaltraktes

Plasma and urinary carcino-embryonic antigen (CEA) assays were performed in 151 patients with urological tumours. CEA measurement is unreliable in renal cell carcinoma and carcinoma of the prostate. However, CEA-assays permit the diagnosis of bladder tumours. The test is particularly useful in the followup and therapeutic control of patients with carcinoma of the bladder.

[New aspects in the treatment of oxalate lithiasis (author's transl)]. / Neue Gesichtspunkte in der Behandlung des Oxalatsteinleidens

The causes of hypercalciuria and simple diagnostic criteria for the various forms of hypercalciuria are outlined. Indications, effectiveness, limitations, and side effects of cellulose phosphate are described. Emphasis is placed on the biochemical pathogenesis and classification of hyperoxaluria. The problems of measuring and controlling oxalate excretion in patients with hyperoxaluria and calcium oxalate stones are discussed. Succinimide offers a partly successful approach to the reduction of endogenous oxalate synthesis.

Comparison of positivity frequency of bcl-2 expression in prostate adenocarcinoma with low and high Gleason score.

CONTEXT: Multiple genetic and epigenetic factors have been implicated in the oncogenesis and progression of prostate cancer. The major difficulty is in that the clinical management stems from the reality that reliable and accurate prognostic biomarkers are not available and that effective treatment regimens forming hormone-resistant prostate cancers are yet to be developed. Among the most important regulators of apoptosis and programmed cell death is the bcl-2 gene and its related proteins. Elevated levels of bcl-2 protein may contribute to the progression of prostate cancers to a metastatic and hormone-insensitive state characterized by poor responses to chemotherapy. OBJECTIVE: To characterize the expression of bcl-2 proteins as a prognostic factor in humans. DESIGN: A retrospective approach. SETTING: Urology section, Federal University of São Paulo. DIAGNOSTIC TEST USED: Immunohistochemical analysis using bcl-2 protein antibody and normal staining by hematoxylin-eosin. MAIN MEASUREMENTS: Prognostic relations and protein expression were evaluated considering the total sample (28) divided into two groups, high (8 to 10) and low (2 to 4), separated according to the histological differentiation grade (Gleason score) with 10 and 18 samples, respectively. RESULTS: The differentiation of grade into two groups separated according to the Gleason score in low and high types presented different bcl-2 expression (P < 0.001). CONCLUSION: The higher frequency of bcl-2 immunostaining in tumor samples was observed in association with more advanced Gleason scores and suggests that an increase in the ratio of this anti-apoptotic protein often occurs during progression of prostate cancers.

Influence of microinvasion of the capsule and/or micrometastasis of regional lymph nodes on disease free survival after radical prostatectomy.

Since 1976, 126 patients with clinically localized carcinoma of the prostate have been managed by radical retropubic prostatectomy. All patients with tumour spread beyond the capsule or metastasis in lymph nodes received radiotherapy. Tumour category pT3 was divided into invasion of the capsule or infiltration of the seminal vesicle. The disease-free 10-year survival rate in patients with minimal invasion of the capsule was 72% and in patients with infiltration of the seminal vesicles it was 26%. Unilateral lymph node metastases were classified as microscopic disease or macroscopic infiltration. The disease-free 10-year survival rate in patients with metastasis in 1 lymph node (micro- and macro-metastasis) was 65% in contrast to 0% in patients with bilateral disease.

Prostate specific antigen. Experimental and clinical observations.

A commercially available radioimmunoassay (RIA) for prostate specific antigen (PSA) was investigated in respect to its analytical specificity and its clinical applicability for the diagnosis of prostate cancer. PSA detected in serum by RIA was immunochemically identical to PSA found in seminal plasma. PSA is not a single protein but rather a group of isoproteins with different isoelectric points (pI) in the pH range 6-8. Furthermore PSA could be split in subunits by means of denaturing electrophoresis under reducing conditions. Unlike prostatic acid phosphatase (PAP) serum PSA was stable at room temperature. In sera of patients with benign hyperplasia of the prostate (BPH) two significantly different populations were found. The lower group (0.5-5.8 ng/ml PSA) had PSA values comparable to the control group of apparently healthy males (0.5-6.3 ng/ml). The higher group between 7.7 and 12.2 ng/ml was also characteristic for early stages of prostate cancer (T0 and T1). PSA seemed to be correlated to the tumor volume and allowed to differentiate between early carcinomas of the prostate and BPH or possibly T0/1 staged prostate carcinoma. PSA may be a screening method for early cancer of the prostate.

[Prevention of urinary calculi in spite of painless lithotripsy?]. / Harnsteinprophylaxe trotz schmerzloser Steinzertrümmerung?

Localization, stone-size as well as type of lithotriptors influence the extent of disintegration of stones and the individual rate free of stones after treatment with extracorporeal shock wave lithotripsy. The piezoelectric lithotriptors do not require anaesthesia, but perform insufficient stone disintegration requiring no repeated treatments. Another draw-back is stone localization by ultrasound, which prevents treatment of some ureteral stones. Used voltage and rate of shock waves per treatment affect the extent of damage no the renal parenchyma. Risk of hypertension, residual disintegrated stones, which don't clear the renal pelvis, the higher recurrency rate and injury to the urothelium of the renal pelvis demand a concomitant meta- and prophylaxis of urolithiasis.