Blocking antibodies and T cell subsets in long-term survivors of renal allografts.

Fc-receptor blocking antibodies as well as T cell subsets were studied in a group of 12 long-term survivors of renal allografts. The absolute number of T suppressor cells was similar to that found in a control group, but there was a significant decrease in the total number of T helper lymphocytes and a decreased helper/suppressor ratio. Sera from all patients tested showed inhibitory activity in the erythrocyte antibody model against leukemic B lymphocytes, demonstrating the presence of Fc-receptor blocking antibodies. Also inhibited was the ability of normal human lymphocytes to form E rosettes and to induce a local xenogeneic graft-versus-host reaction. These findings indicate that the Fc blocking antibodies are beneficial to the patient, possibly by abrogating the cellular and humoral immune mechanism that is detrimental to the kidney allograft.

Adrenocortical oncocytoma in pregnancy.

BACKGROUND: Adrenal oncocytomas are uncommon, nonfunctioning tumors occurring most often in endocrine organs. CASE: A 32-year-old woman presented at 25 weeks' gestation complaining of right flank pain. Abdominal ultrasonography and computed tomography revealed a 9 x 10-cm solid right-sided adrenal mass. Endocrine evaluation was normal. At 36 weeks' gestation, she underwent cesarean followed by resection of the adrenal mass. Histopathologic and ultrastructural studies revealed a benign adrenocortical oncocytoma. CONCLUSION: Although rare, adrenocortical oncocytomas should be included in the differential diagnosis of solid, nonfunctioning, adrenal tumors in pregnancy.

Value of transrectal ultrasonography for diagnosis and treatment of prostatic abscess.

A new diagnostic and therapeutic application of transrectal ultrasonography (TR-US) is described. TR-US demonstrated one or more well-defined hypoechogenic areas in the prostate gland of 6 patients who presented with clinical signs of urinary tract infection and had only partial response to antibiotic therapy. The presence of a collection of pus in the prostate was confirmed in 4 of 6 patients by transperineal aspiration guided by TR-US, and by prostatic massage or transurethral prostatectomy in the other 2 patients. Ultrasonography also confirmed the resolution of abscesses in 5 patients.

Increased incidence of diabetes mellitus in the patients with transitional cell carcinoma of urinary bladder.

The progression of bladder cancer to invasive disease is highly dependent on its ability to penetrate basement membrane of urothelium. Studies on diabetic nephropathy have shown a reduction in proteoglycan content of the glomerular basement membrane. Based on the well-known fact that proteoglycans are one of the main components of basement membrane and extracellular matrix we assessed the relationship between diabetes mellitus, bladder cancer incidence and its behavior. These studies include 252 patients with microscopically confirmed transitional cell carcinoma of bladder, and 549 patients with other urological disorders who served as controls. The prevalence of diabetes mellitus in each group was assessed. The group of patients suffering from transitional cell carcinoma was divided according to etiological risk factors such as cigarette smoking, diabetes and patients that were non-smokers and did not suffer from diabetes mellitus. We assessed the features of bladder cancer behavior in each group. Logistic regression model estimation for statistical analysis was used, with transitional cell carcinoma as a dependent binary variable and age, sexes smoking and diabetes as independent variables. Statistical significance was considered at two levels: p

Clot retention and spontaneous rupture with secondary pneumatosis of bladder wall following routine cystoscopy.

In this article we report an unusual case of spontaneous rupture of bladder wall following office-cystoscopy. It took place in a patient who suffered from low-stage highgrade carcinoma of bladder with the different aggressive behavior. Finally, he underwent radical cystectomy, which showed micropapillary carcinoma and pneumatosis within the bladder wall. The cause of the latter finding is rather puzzling and has been never reported previously.

The value of early and double phase 99Tcm-sestamibi scintimammography in the diagnosis of breast cancer.

The aim of this study was to assess the additional value of early and double phase scintimammography (SMM) with 99Tcm-sestamibi in the detection of breast cancer following initial evaluation by palpation and mammography. Altogether, 322 women with breast lesions evaluated prospectively by palpation, fine-needle aspiration and mammography were assigned a malignancy risk according to the results. Scintimammography was performed in all patients in the prone breast dependent position. Immediate and delayed views were obtained. Acquisition of immediate tracer uptake was termed 'early phase' SMM, whereas a combination of both immediate and delayed phase images was termed 'double phase' SMM. All patients underwent breast biopsy. Both early phase and double phase SMM detected eight of nine tumours in the low-risk group (88.8% sensitivity). In the uncertain cases (moderate-risk group), early phase SMM detected all malignant tumours, but double phase SMM missed one (92.3% sensitivity). In the high-risk group, early phase SMM missed two breast cancers (94.6% sensitivity) and double phase SMM missed four (89.2% sensitivity). Overall, early phase SMM had a sensitivity of 94.9% and a specificity of 80.2% in detecting breast cancer, whereas double phase SMM had a sensitivity of 89.8% and a specificity of 94.3%. Both methods had 100% sensitivity for tumours larger than 1 cm. In conclusion, SMM detected additional breast cancers following an initial evaluation by palpation, fine-needle aspiration and mammography. Our results suggest that double phase SMM is more specific than early phase SMM, although early phase SMM is more sensitive. Whether the interpretation of SMM results should rely on both early and delayed images, or early images alone, should be based on the relative risk of malignancy of the breast lesion as estimated by the initial evaluation.

Cryoablation of the prostate: technical recommendations.

The European Association of Urology guidelines on prostate cancer state that cryotherapy is a true therapeutic alternative for patients with clinically localized prostate cancer. The aim of this paper is to establish a uniform practice for performing prostate cryoablation. A collaboration has been set up among five European centres with experience in almost 1000 prostate cancer patients on the use of cryotherapy. The present recommendations were developed through sharing of experience and thorough discussions within the group. This first paper from the group establishes the technical recommendations for use of prostate cryotherapy.

Is there an association between cigarette smoking and gland size in benign prostatic hyperplasia?

Several studies have implied a potential inhibitory effect of smoking on the development of clinical benign prostatic hypertrophy (BPH). None of these studies compared gland size and smoking habits. We prospectively test the hypothesis that the identified "negative risk factor" that cigarette smoke has on the development of clinical BPH is mediated through inhibition of gland growth. One hundred and ninety-five men underwent transrectal ultrasonography with prostate volume calculations. A self-administered questionnaire detailing smoking habits was completed by the subjects. Correlations were looked for between various smoking habit parameters and gland size. Prostate gland size did not differ between current smokers, ex-smokers, and never smokers. Prostate volume did not correlate with smoking years (duration of exposure), nor with intensity of exposure (cigarette packyears). Smoke-mediated changes in enzymatic and endocrine pathways that regulate prostatic growth have been well documented. However, whatever "protective" effects smoke may have on BPH, they are not mediated via direct inhibition on gland growth. Alternatively, cigarette smoke may be involved in changing the dynamic component of BPH. Further testing, with special emphasis on irritative and obstructive symptoms, may help elucidate this possibility.

Effects on pain and anxiety of patients viewing their cystoscopy in addition to a detailed explanation: a controlled study.

OBJECTIVE: To compare the effect of allowing patients to watch their cystoscopy on closed-circuit television and with an explanation during the procedure, with an explanation alone, as involving patients in the process of minimally invasive procedures like colonoscopy or colposcopy has been reported to alleviate pain and anxiety, but these effects may differ in patients who desire participation and those who do not. PATIENTS AND METHODS: Of 51 patients undergoing cystoscopy for the first time, 27 watched the procedure and received explanations, and 24 received explanations alone. They completed an anxiety questionnaire and visual analogue scales (VAS) of anxiety before and after the procedure. Before the procedure they also completed an assessment of desire to be involved in medical decisions and procedures (Kranz Health Opinion Survey, KHOS), and afterwards recorded the pain they had experienced on a scale of 1-10. RESULTS: Anxiety (assessed by VAS) declined after the procedure (P < 0.001) but the anxiety questionnaire showed no change. There was a positive correlation between the KHOS and VAS after the procedure; the more the patient was an 'information seeker' the higher the anxiety. Neither pain nor anxiety were affected by watching the monitor, whether or not KHOS scores were entered as a cofactor. Age and sex had no effect on the results. There were no complications. CONCLUSION: There was no effect of watching the cystoscopy on anxiety and pain. Possibly the explanation received by both groups left no room for further improvement in the intervention group.

Acute prostatitis in middle-aged men: a prospective study.

OBJECTIVES: To determine the clinical outcome of middle-aged men with acute prostatitis, the optimum time for re-assessing their prostate-specific antigen (PSA) levels, and to detect any possible echotextural and vascular changes that remain as a consequence of acute inflammation. PATIENTS AND METHODS: Persistent fever prompted a re-evaluation for prostatic abscess formation in 28 middle-aged men, using transrectal ultrasonography (TRUS) colour Doppler imaging, undertaken at the 3-, 6- and 12-month visits. The results of TRUS were compared with laboratory data and clinical outcome. RESULTS: Two abscesses were detected; 19 (68%) of the patients remained infection-free at the 3-month visit. Serum PSA levels were elevated in 11 (39%) of the patients at this visit; three prostate carcinomas were diagnosed. Increased intraprostatic colour flow was detected in 68% and there were hypoechoic areas in 46% of the patients. CONCLUSION: The re-evaluation for abscess formation should not be postponed for > 48 h. Patients with acute prostatitis tend to have persistent infection. PSA levels could be high even up to 3 months after an acute episode. Middle-aged men with carcinoma could be missed during the acute phase of inflammation. PSA and TRUS monitoring are strongly recommended.

Changes in the sexual behavior of couples after prostatectomy. A prospective study.

Sexual behavior after prostatectomy was observed in 90 couples, with a follow-up of 3-6 years. Retropubic prostatectomy was performed on 53 patients (58.7%), transvesical prostatectomy on 12 patients (13.7%), and transurethral prostatectomy on 25 patients (27.7%). In order to have a reliable figure of the sexual behavior after surgery, all the couples underwent personal interviews separately before and 3-6 years after surgery. The interview included 4 main subjects: erection allowing sexual intercourse; antegrade ejaculation; orgasm, and libido. The separate identical double interviews were performed in order to achieve a high reliability in answer to sexual performance, this being the main unsolved question in previous studies. The results of the interviews were assessed by a computer-processing program and statistically analyzed. Our results imply that prostatectomy has an unfavorable influence on sexual activity: 33% of the potent preoperative patients became impotent after surgery.

Prostatic abscess in the antibiotic era.

The clinical and bacteriologic features of 269 cases of prostatic abscess (PA) reported during the last 40 years were reviewed. In the pre-antibiotic era, PA not uncommonly had a dramatic presentation and frequently was caused by Neisseria gonorrhoeae. Currently, PA may be difficult to differentiate from prostatitis and other diseases of the lower urogenital tract. Prostatic enlargement is found in 75% of cases, whereas fever and urinary retention each occur in only one-third of cases. The organisms most frequently isolated from PA are Escherichia coli and other gram-negative bacilli; other isolates include Staphylococcus species and an expanding spectrum of bacteria and fungi. PA due to Staphylococcus species may also occur in neonates. Transrectal ultrasonography and computerized tomography are valuable methods for the preoperative diagnosis of PA. Although transurethral resection of the prostate is the most commonly used therapy for PA, transperineal aspiration of pus guided by transrectal ultrasonography appears to be promising.

Seminal vesicle congestion as a cause of postprostatectomy dysuria.

A series of benign prostatic hypertrophy patients were routinely evaluated, including transrectal echography, before and at regular intervals following surgery. Five patients had persistent symptoms of dysuria at 14-30 months after surgery. There was no infection, residual urine or malignancy to explain their symptoms. The seminal vesicles (SVs) were severely dilated on transrectal echography, a finding which was definitely not present on initial examination. The patients were treated by transrectal echo-guided aspiration of the SVs by the perineal approach. The fluid aspirated was examined, and antibiotics were directly injected into the SVs. In 4 of the patients, there was a dramatic relief of symptoms with prolonged improvement. In only 1 case, following transurethral resection, there was but slight improvement. Dilated, obstructed SVs after prostatectomy, clearly diagnosed on transrectal echography, may be the cause of persistent irritative urinary symptoms. Treatment can be instituted by echo-guided aspiration of the fluid with simultaneous injection of a potent antibiotic, resulting in probable immediate relief.

Incidental finding of rectal carcinoma during transrectal US for prostatic diseases.

During transrectal ultrasound (TRUS), rectal carcinoma was an incidental finding in seven patients among a series of 5,000 TRUS examinations. TRUS was performed in seven patients with symptoms characteristic of prostatic diseases. All seven patients underwent examination by at least one physician before TRUS and, except for abnormal prostatic findings, no tumors were detected during digital rectal examination (DRE). The tumors were clearly visualized with TRUS and were easily palpated during DREs performed after TRUS. They were large and were located mainly along the posterior and lateral walls of the rectum. All the tumors were diagnosed by means of proctoscopy; the biopsy findings were positive, and the pathologic staging indicated advanced disease: adenocarcinoma of the rectum with a minimum grade of Dukes C. It is recommended that, in addition to evaluation of scans obtained in the transverse plane, the multiplane transducer be used to evaluate the longitudinal plane of the rectum for detection of possible undiscovered tumors.

A comparison between digitally-guided fine needle aspiration and ultrasound-guided transperineal core needle biopsy of the prostate for the detection of prostate cancer.

OBJECTIVE: To prospectively examine the accuracy of fine needle aspiration (FNA) for the detection of prostate cancer. Ultrasound-guided core needle biopsy of the prostate was used as the standard to which the FNA results were compared. PATIENTS AND METHODS: One-hundred patients who had been referred for urological evaluation were suspected of having prostate cancer on the basis of digital rectal examination (DRE) and/or transrectal ultrasound (TRUS). All were further evaluated by digitally guided transrectal FNA and by TRUS-guided transperineal core needle biopsy. RESULTS: Prostate cancer was identified in 54 patients by core needle biopsy and in 45 by FNA. The sensitivity of FNA was 81% and both specificity and positive predictive value were 98%. CONCLUSION: FNA is easily performed, has negligible morbidity and offers prompt results. These data suggest that FNA is a reasonable initial diagnostic procedure for the detection of prostate cancer. Core needle biopsy may be reserved for patients with negative cytology who are clinically suspected of having prostate cancer. In selected patients, FNA may be used as an alternative to core needle biopsy for diagnosis, treatment planning and follow-up.

Colitis cystica profunda: self-inflicted by rectal trauma? Report of a case.

Colitis cystica profunda (CCP) is a rare benign condition with a controversial etiology. We report a case of CCP in a patient with a history of anal masturbation, supporting an acquired traumatic etiology. Diagnosis was assisted by transrectal ultrasound. The patient was successfully treated by local excision.