Treatment of high-grade, high-stage prostate cancer with estramustine phosphate or diethylstilbestrol. A double-blind study. The SPCG-1 Study Group. Scandinavian Prostate Cancer Group.

Between 1984 and 1989, 197 patients with T1-4, NX, M1, G2-3 or G3 prostate cancer were randomized to treatment with 560 mg estramustine phosphate (EMP, Estracyt, Emcyt) or 3 mg diethylstilbestrol (DES) per day in a double blind study with stratification on presence or absence of cancer pain at start. A total of 194 patients were evaluated for efficacy of therapy. Time to progression (p = 0.054), to treatment failure (p = 0.036), cancer-specific survival (p = 0.068) as well as overall survival (p = 0.021) were longer in the DES group. There were more patients with prognostic parameters indicating bad prognosis in the EMP group. This trial was designed to study whether EMP had better effect than DES as the primary treatment of high-grade, disseminated prostate cancer. The results did not confirm this hypothesis. On the contrary, treatment with DES had relatively good effect on this very aggressive form of prostate cancer.

Oat mesophyll protoplasts: their response to various feeder cultures.

Oat (Avena sativa L.) mesophyll protoplasts were recently demonstrated to be capable of dedifferentiation, repeated divisions, and colony formation. Since the development of oat mesophyll protoplasts is decisively influenced by the nature of the used feeder culture (species, variety and concentration), we conducted a systematic study of this parameter. Generally, graminaceous feeders promoted protoplast proliferation, while dicot species repressed protoplast divisions. The beneficial effect of those feeders that promote divisions was counterbalanced by a factor that causes necrosis. The correct balance between promotion of divisions or necrosis depended on the nature of the feeder and its plating density.

Colony formation from mesophyll protoplasts of a cereal, oat.

Differentiated leaf cells of gramineous plants, among them the cereals with their immense importance for human nutrition, are considered extremely recalcitrant to, if not incapable of, reentering the cell cycle. This recalcitrance is related to the poor wound response of the monocots-in contrast to most dicots-and the difficulties encountered in monocot tissue culture. We report here the highly reproducible induction of sustained divisions at high frequency (up to 95%) and colony formation from mesophyll protoplasts of a cereal, oat, demonstrating that-contrary to most earlier evidence-mesophyll cells of a gramineous plant have not irreversibly lost their potential for cell division.

Cytogenetics of protoplast cultures of Brachycome dichromosomatica and Crepis capillaris and regeneration of plants.

Callus derived protoplasts of Brachycome dichromosomatica (2n=2x=4) and Crepis capillaris (2n=2x=6) have been regenerated into karyologically normal plants, i.e. plants without visible alterations of the diploid chromosome set. However, metaphase analysis of protoplast cultures derived from both callus as well as mesophyll cells showed karyological changes in the overwhelming majority of cells in both species leading to multinucleated, polyploid and aneuploid cells. Furthermore, callus derived protoplasts sometimes exhibited changes at the chromosome level as indicated by translocations. The vast majority of aberrant karyotypes arose from failures during mitosis and cytokinesis, pointing to inadequate microtubules as a possible underlying cause. Karyological events of the kind described herein greatly affect the plating efficiency of isolated protoplasts and the viability of protoplast derived calli. Plant regeneration, although demonstrated in this study for the first time in both species, seems to be limited to rarely occurring, protoplast-derived colonies with a relatively stable genome. Our experiments, performed with chromosomal model species, emphasize the need for controlled, non-mutagenic culture conditions.

Renal vasodilation after unilateral renal ablation.

Renal blood flow was studied in rats 120 minutes after unilateral renal ablation. The influence of endogenous prostaglandin formation was evaluated by indomethacin treatment prior to the ablation. Radioactive microspheres were used for estimation of the total renal and cortical blood flow, and the renal medullary blood flow was determined with the 86-Rb chloride extraction method. The total blood flow in the remaining kidney was increased by 80% following contralateral ablation, with augmentation in all areas, particularly in the deep medullary region. Indomethacin treatment in intact rats evoked increased blood flow as compared with the indomethacin control group. The results indicated that the renal blood vessels respond to ablation of the contralateral kidney with dilation in all kidney regions, and that this vascular dilation may be prostaglandin-mediated.

The effect of intraarterial infusion of prostacyclin on the tubuloglomerular feedback control in the rat.

Effects of intraarterial prostacyclin (PGI2) infusions on interstitial hydrostatic and oncotic pressures and on the tubuloglomerular feedback (TGF) control of glomerular filtration rate (GFR) were studied in rat kidneys. The hilar lymph flow rate was used as a measure of interstitial hydrostatic pressure and the lymph protein concentration was used for interstitial oncotic pressure estimation. In the micropuncture experiments the stop-flow pressure technique was employed for determining the TGF characteristics, i.e. stop-flow pressure (PSF), maximal reduction of PSF (delta PSF) and turning point (TP), defined as the end-proximal flow rate at which 50% of delta PSF was obtained. Non-hypotensive doses of PGI2 (50 to 100 ng X kg-1 B.W. X min-1) infused in 30 min evoked an increase in urine and lymph flow rates and a decrease in lymph protein concentration, but did not affect GFR. delta PSF was reduced (9.9 +/- 1.0 mmHg versus 4.7 +/- 2.2 mmHg) and TP increased (22 +/- 2 nl/min versus 34 +/- 2 nl/min), but the PSF was unaffected. These changes were seen during the infusion period and during the immediate post-infusion control period of 30 min. Our data indicate that non-hypotensive doses of PGI2 in some way can affect the renal interstitial pressure and the TGF control system.

Prevention of interstitial pressure change at unilateral nephrectomy by prostaglandin synthesis inhibition.

The mechanisms underlying the adaptive process in the remaining kidney after unilateral nephrectomy are not well known. In the present study adaptive changes in interstitial pressure conditions following uninephrectomy were investigated in male Sprague-Dawley rats. Direct subcapsular hydrostatic pressure recordings were made via microcatheters , renal lymph was collected for lymph flow rate estimations and determinations of lymph protein content and the urine flow rate and urinary excretion of sodium and potassium were measured, before and after contralateral nephrectomy. There was a significant rise in subcapsular hydrostatic pressure by about 50%, and in the lymph flow rate, by more than 100%, within 1 hr after nephrectomy. The protein concentration in collected renal lymph was significantly decreased (from 2.30 +/- 0.25 to 1.45 +/- 0.26 g/dl), compared with control collections in sham-operated animals (from 2.22 +/- 0.23 to 1.78 +/- 0.19 g/dl). These findings indicate an increased hydrostatic and decreased intersititial pressure in response to contralateral nephrectomy. Urine flow rate and electrolyte excretion were significantly elevated (urine flow rate by 92%, sodium excretion from 0.210 +/- 0.035 to 0.352 +/- 0.067 mumoles/min and potassium excretion from 0.306 +/- 0.074 to 1.617 +/- 0.228 mumoles/min). Inhibition of prostaglandin synthesis prior to nephrectomy abolished the lymph flow increase and oncotic pressure decrease and also the diuretic and natriuretic responses. The adaptively increased potassium excretion was, however, only blocked by diclofenac sodium and not by indomethacin. These results demonstrate the important role of the renal interstitium and the prostaglandin system in the renal adaptation to nephron loss.

Indomethacin inhibits renal functional adaptation to nephron loss.

Immediately after unilateral nephrectomy, the glomerular filtration rate (GFR) and urinary excretion rate increase in the remaining transplanted rat kidney. In a previous study, we found that GFR in a transplanted kidney was reduced through an activation of the tubuloglomerular feedback control. Excision of the rat's own remnant kidney then reduced feedback sensitivity and thereby allowed GFR to rise. The present study aimed at investigating whether prostaglandins are involved in this functional adaptation. Clearance and micropuncture experiments were performed before and after administration of indomethacin and after subsequent unilateral nephrectomy. GFR and the urinary excretion rate of electrolytes and water were measured. From proximal tubular stop-flow pressure (PSF) measurements the feedback characteristics were determined as the maximal stop-flow pressure response (delta PSF) to an increase in distal flow and the turning point (TP), i.e. the end proximal flow rate that caused 50% reduction of delta PSF. The results showed that following nephrectomy the tubuloglomerular feedback sensitivity was decreased, with an increased TP and reduced delta PSF. Pretreatment with indomethacin (2 mg/kg BW) prevented not only the change in feedback sensitivity at nephrectomy but also the rise in GFR. These results suggest that the prostaglandins play a possible role as one link in the chain of adaptive events occurring immediately after nephron loss.

The effect of tubular perfusion with PGE2, PGF2 alpha, and PGI2 on the tubuloglomerular feedback control in the rat.

The prostaglandins (PG) of the renal medulla might affect the nephron and the cortical arteriolar function via the tubular route. To investigate this question PGE2 (1 microgram/mL), PGF2 alpha (10 micrograms/mL), or PGI2 (1 ng/mL) was added to the tubular perfusion solution when the characteristics of the tubuloglomerular feedback (TGF) control were measured. The experiments were performed on Sprague-Dawley rats. The proximal tubular stop-flow pressure (PSF) was measured upstream to a wax block, while at the same time the distal nephron was perfused with prostaglandin-containing or prostaglandin-free solutions at different flow rates varying from 0 to 50 nL/min. The maximal drop in PSF (delta PSF) and the tubular flow rate at which 50% of the delta PSF response was obtained, the turning point (TP), were determined. When PGE2 or PGF2 alpha was added to the tubular perfusion solution in the control animals a significant increase in feedback sensitivity was found. After 10 min of tubular PGI2 perfusion the feedback sensitivity was almost completely abolished, with a delta PSF of 0.8 mmHg (1 mmHg = 133.322 Pa) (control 8.4 mmHg) and a TP of greater than 40 nL/min (control 22 nL/min). After nephrectomy the feedback sensitivity was reduced, with a delta PSF of 2.0 mmHg and a TP of greater than 40 nL/min. When PGE2 was added to the tubular perfusion solution in the uninephrectomized animals, the feedback sensitivity was increased to the control level, with a delta PSF of 8.2 mmHg and a TP of 20.0 nL/min.(ABSTRACT TRUNCATED AT 250 WORDS)

Microsurgical replantation of an amputated penis.

The microneurovascular replantation of a completely amputated penis is described. Fifteen hours after the replantation an arterial reanastomosis was performed due to a secondary thrombosis. The result after 3 months is excellent, with returned capacity of erection.

Vesical neck closure versus balloon catheter in suprapubic prostatectomy: a controlled clinical trial.

In a randomized trial comprising 102 cases of suprapubic prostatectomy a modified Hryntschak technique of vesical neck closure was compared to the balloon compression method. There were no statistically significant differences between the 2 groups in operative and postoperative blood loss, duration of operation or postoperative hospital stay. In the vesical neck closure group compared to the balloon catheter group more patients experienced catheters falling out prematurely, as well as more postoperative strictures and more cases of incontinence at followup 1 year later. Our data do not justify the adoption of the vesical neck closure technique in suprapubic prostatectomy.

[Microscopic investigation of the partial stages of dissolution processes in urinary calculi (author's transl)]. / Mikroskopische Untersuchung der Teilschritte von Auflösungsvorgängen an Harnsteinen

The formation of urinary calculi cannot yet be prevented with certainty. Consequently the dissolution of stones remains a focus of medical interest. The speed of solution of a calculus is not a quantity typical of the substance, but depends largely on the structural formation of the urinary calculi. With very different types of structure (e.g. Whewellite and Weddellite stones) the rate of dissolution can therefore fluctuate between wide limits in spite of similar phase composition. Consequently, type of structure, course of solution and rate of solution can be clearly correlated. Stones with relatively uniform structure formation (e.g. Struvite stones) on the other hand show largely similar solution rates. Medically, it is of interest that in certain structural types, solution may lead to disintegration of the stone into isolated solution residues.