Increased rate of positive biopsies using a combination of MR-Tomography, spectroscopy and diffusion-weighted magnetic resonance imaging prior to prostate biopsies in patients with persistent elevated prostate-specific antigen values: A retrospective analysis.

PURPOSE: Persistently elevated prostate-specific antigen (PSA) values following negative biopsies result in a diagnostic dilemma. In order to improve detection rates in patients with former negative biopsies and persistently elevated PSA values, magnetic resonance tomography (MRT), magnetic resonance spectroscopy (MRS), and diffusion-weighted magnetic resonance imaging (DW-MRI) were performed prior to prostate rebiopsies. MATERIALS AND METHODS: Over a 14-month period, 67 patients (mean age of 66 years) with a history of 1-5 negative biopsies underwent endorectal magnetic resonance imaging (MRI) using T2-weighted MRT MRS and DW-MRI before an additional prostate biopsy was performed. Subsequently, 5 contrast-enhanced transrectal ultrasound-guided biopsies were performed according to a 10-core systematic scheme. Out of the 67 men, 25 patients had positive biopsies and opted for radical prostatectomy. Histological evaluation of cancer localization, PSA, diameters of primary tumors, numbers and diameters of satellite tumors, prostate volume, and staging pathology was performed. These findings were compared with MRI and MRS results. RESULTS: Serum PSA levels ranged from 3.1 to 19.5 g/ml (median level of 7.96 ng/ml). After the 25 patients underwent radical prostatectomy, analysis of 20 whole-mount sections of 25 radical retropubic prostatectomy (RPE) specimens presented results agreeing with the tumor location from MRI and MRS data. CONCLUSIONS: The aim of image-guided diagnostics should be to provide more critical information prior to biopsy. Furthermore, the acquisition of such data is important for better risk stratification in therapeutic decisions.

[Treatment of Fournier's gangrene. A review based on 3 new cases]. / Die Behandlung der Fournier'schen Gangrän. Eine Ubersicht anhand von 3 neuen Fällen.

We describe three new cases of Fournier's gangrene-a necrotizing fasciitis of urogenital or anorectal origin. Though in the initial report the disease was believed to be idiopathic, the source of infection or immuncompromising factors can be identified in nearly all cases today. We present a combination of aggressive surgical therapy and adjunctive use of Imipenem which was successful in the treatment of all our cases. By using fully resorbable nutrition colostomy could be avoided successfully.

[Mastopathy in partial testicular feminization]. / Mastopathie bei partieller testikulärer Feminisierung.

We report on a patient with synchrony of mastopathic alterations and incomplete testicular feminization. In the 54-year old patient, typical climacteric complaints as well as mastopathy-associated symptoms occurred. After orchiectomy and subsequent oestrogen substitution, clinical symptoms disappeared.

Microscopic venous infiltration as predictor of relapse in renal cell carcinoma.

In a retrospective analysis at a single institution we evaluated the significance of various pathological phenomena on the disease-free survival of patients with radically resected renal cell carcinoma. Parameters considered were tumor extension (pT stage) according to the International Union Against Cancer, tumor invasion into the renal vein or vena cava (V stage), standard histological grading (G stage), nuclear grading (F stage) and microscopic venous infiltration. The pT stage had a significant impact on disease-free survival (p = 0.0004) of patients with radically resected tumors, as did G stage (p = 0.0001) and F stage (p = 0.002). In contrast to some previously reported results tumor extension to the renal vein and vena cava showed no influence on disease-free survival (p = 0.077). On the other hand, microscopic venous infiltration, defined as local tumor infiltration through all vessel structures including the endothelial layer leading to a free tumor extension into the vessel, had a significant impact on disease-free survival (p less than 0.0001). When stratifying either tumor size or nuclear differentiation against microscopic venous infiltration, the latter retained a superior influence on disease-free survival (p = 0.01 and p = 0.0079, respectively). We conclude that microscopic venous infiltration is the most important predictor of relapse in renal cell carcinoma.

Organ-preserving surgery in patients with urothelial tumors of the upper urinary tract.

The Austrian Urological Oncology Group reports on 55 organ-preserving operations in 52 patients with tumors of the upper urinary tract epithelium. The data were gathered from 12 urological departments in the country. There was no evidence of distant metastases in any of the patients at the time of surgery. The observation period ranged from 0.5 to 12 years. 69.2% (36 of 52) of the patients were alive and recurrence-free at the time of data collection, after a mean observation period of 41.4 months. 9.6% died for reasons other than cancer after an average of 18.8 months, and 21.2% were still alive with or had died due to recurrent tumors. The recurrence rate after open surgery was similar in tumors of the upper ureter or pelvis (15.3%) as in tumors of the lower ureter (17.6%). After endoscopic treatment 4 of 9 patients showed recurrences. 92% (22 of 24) of the patients with no compelling indication for organ-preserving therapy were alive and recurrence-free or had died due to other causes. Therefore organ-preserving surgery appears to be appropriate in tumors of the upper urinary tract epithelium.