The etiology of bladder cancer--are there any new clues or predictors of behavior?

It is well documented that the etiology of bladder cancer involves environmental factors. Most chemical carcinogens probably affect the urothelial cells via their presence in the urine. As an important cofactor, cell proliferative activity may be increased by urinary bladder infection, irritation by bladder stones or through the action of a variety of endogenously produced direct acting chemicals or agents. Among the known causative factors, avoidable major ones are occupational exposure to certain chemicals such as benzidine and 4-aminobiphenyl, cigarette smoking and bilharzial infection, which could be eradicated by a combination of praziquantel, antihelminth therapy, education and improvements in social welfare. An anticarcinogenic drug, cyclophosphamide, used as an immunosuppressive agent also seems to be associated with a high risk of idiopathic induction of bladder cancer and physicians should therefore pay particular attention to its diverse effects when considering its prescription. In contrast to the above, the consumption of coffee and tea including artificial sweeteners is now thought unlikely to be major risk. So far there is no good biochemical tool to predict individual exposure to bladder carcinogens/or relative risk of bladder cancer development. However, acetylation capacity can be applied to assess susceptibility to carcinogenic amines in people exposed in their working environment. Progress in molecular biological analysis will hopefully bring to light etiology-specific DNA damage in the bladder tumors and prove useful for prediction of tumor behavior in the near future.

[The scintigraphic effect of extracorporeal lithotripsy: prospective series of 25 cases]. / Le retentissement scintigraphique de la lithotritie extra-corporelle: série prospective de 25 cas.

25 patients with non complicated renal stones were treated by extracorporeal shockwave lithotripsy (ESWL) using Sonolith 3000 an electrohydraulic generator type. They were evaluated before, 15 days and 3 months after ESWL by renal scintigraphy, using for 15 of them technetium -99m dimer captosuccinic acid and technetium -99m-diethylene-triamine acetate for the last 10. This follow up scintigraphic study shows no reduction of glomerular filtration rate after ESWL but some focal parenchymal lesions. Very few of these lesions persist at 3 months. These parenchymal damages seem to be less frequent and less persistent than with piezo-electric lithotripter.

Influence of cholesterol derivatives on cytoskeletal organization of human carcinoma cells.

Recent developments of immunotherapeutic approaches have shown that artificial ordering of tumor cell membranes with cholesterol hemisuccinate (CHS) or 25-hydroxycholesterol (25-OH) may significantly enhance the immunogenicity of human renal adenocarcinoma cells. To gain further insight into the molecular mechanism of these sterols, we investigated cytoskeletal modification, which is related to the cell membrane. After treatment of human renal carcinoma cells with these cholesterol (at 10(-6) and 10(-7) M) for 5 days, we observed a disorganization of the submembrane end of the cytoplasmic actin stress fibers by cytofluorescence. The microtubule network was not affected. Thus, in the present study, we found that changes in membrane physicochemical properties impaired the anchorage of actin microfilaments in the plasma membrane of human renal cancer cells. Under the same experimental conditions, such modifications were not observed in normal cells (human fibroblasts) or in human hepatoma cells. We suggest that incubation of cancer cells with these sterols induced a redistribution of the cholesterol-rich membrane microdomains which are linked to the cytoskeleton through submembrane proteins.

[Rhabdomyosarcoma of the prostate. Diagnostic course and current therapy. Report of a case of a 17-year-old boy]. / Le rhabdomyosarcome de la prostate. Evolution diagnostique et thérapeutique actuelle. A propos d'un cas chez un garçon de 17 ans.

The authors report a case of rhabdomyosarcoma in a 17 year old boy which recurred after combination chemotherapy and radical prostatectomy, followed by death of the patient due to haematological complications of second-line chemotherapy. The diagnosis of these rhabdomyosarcomas is facilitated by the various immunohistochemical stains now available. Chemotherapy is undeniably effective and, combined with surgery and radiotherapy, ensures a 5-year survival of 47% to 93% depending on the stage. The first-line chemotherapy avoids the need for radiotherapy in the early stages and allows less mutilating surgical procedures, while maintaining the survival rate.

[Importance of MRI in hydronephrosis caused by acute or chronic ureteral obstruct. Prospective study]. / Intérêt de la RMN dans l'évaluation du retentissement rénal des obstructions urétérales aiguës ou chroniques. Etude propective.

Magnetic resonance imaging (MRI) of the normal kidney shows in T1 weighted sequence a spontaneous corticomedullary differentiation. In case of ureteral obstruction the corticomedullary differentiation tends to disappear, the medullary signal intensity in T1 weighted sequence is lower and the whole kidney signal intensity in T2 weighted sequence is greater in acute phase. 16 patients with lithiasis ureteral obstruction were evaluated in MRI study. A T1 weighted S.E. 500/28 sequence in axial and frontal planes (7 mm thick-section) and a T2 weighted E.G. 2000/40 sequence in axial plane were used to study the hydronephrotic kidney and to compare it with contralateral normal kidney. Ultrasounds and intravenous pyelography (IVP) were performed to assess the renal dysfunction. MRI realize a morphologic study of the kidney which can be compared with ultrasounds and IVP. MRI assess renal function by the signal intensity but the time of obstruction and the time of medical treatment before MRI are of interest.

[Localized hyperthermia of the prostate via the rectum in chronic inoperable urinary retention]. / L'hyperthermie localisée de la prostate par voie rectale dans les rétentions urinaires chroniques inopérables.

Local transrectal hyperthermia of the prostate was used to treat 16 poor surgical risk patients who had an indwelling catheter because of chronic urinary retention caused by benign prostatic hypertrophy. We used the Brucker (Prost-care) model with a rectal applicator, a water cooling system and a microwave generator operating at 915 MHz. Intraprostatic temperatures of 42 degrees to 44 degrees C were measured by a radiometric system. 12 patients received a complete treatment which consists in 6 to 10 sessions of one hour and was controlled at least one month later. 8 of them no longer need a catheter. Uroflowmetry was between 7.5 and 17.6 ml/sec and residual urine appreciate by ultrasounds was less than 60 cm3.

[Epidemiology of bladder cancer]. / Epidémiologie du cancer de la vessie.

The urinary bladder cancer mortality varies in different countries. The highest rates are noted in Denmark, UK, Belgium and Italy, the lowest rates in Japan, Singapore and Venezuela. The mortality rates are increasing for both males and females. In France, the highest rates are observed in the South of France contrary to other cancer sites. The highest incidence rates are observed in Europe, in USA and in some countries of Africa. In these same areas, the rates are higher for males and are increasing with time. The mortality is high in the first years after diagnosis. The five-year relative survival rates are 41%, for males and 35% for females. Tobacco, and especially cigarettes, is a well known risk factor. A dose effect relation appears to exist. The occupational risk factors are potentiated by tobacco and modifications are noted and are in relation with new factors. Ground coffee is associated with urinary bladder cancer and appears to be a co-carcinogenic factor with tobacco. Some drugs, such as antimitotics, phenacetin, radiation and urinary bilharziosis, are etiological factors of this cancer. The role of artificial sweeteners, alcohol and nutrition is less well documented.

Multiple tumors in the same kidney: incidence and therapeutic implications.

Conservative surgery is proposed by many authors for small kidney tumors. We reviewed retrospectively the pathology reports of 727 operated patients. In 257, tumor diameter was less than or equal to 5 cm, in 158 it was less than or equal to 4 cm, and in 78 it was less than or equal to 3 cm. The number of multiple tumors were 26 (10.1%), 17 (10.75%), and 10 (12.8%) respectively, which means that there is a 10% potential risk of leaving a tumor in situ in case of conservative surgery. There is no security size limit. These parameters have to be considered before proposing conservative surgery for small kidney tumors as a standard treatment.

[Secondary bladder amyloidosis: a case of salvage cystectomy for massive hematuria]. / L'amylose vésicale secondaire: un cas de cystectomie de sauvetage pour hématurie massive.

Amyloidosis of the bladder associated with systemic amyloidosis secondary to rheumatoid arthritis is a rare disease. Due to the absence of routine screening, its incidence appears to be understimated and only 11 cases, all symptomatic, have been reported in the literature. The symptoms of this disease are dominated by macroscopic haematuria, always massive, which may be life-threatening. We report a case in which the severity of this haematuria required emergency cystectomy to ensure haemostatis, which revealed amyloidosis on histological examination.

[Current treatments of cancer of the prostate]. / Traitements actuels du cancer de la prostate.

Cancer of the prostate mainly occurs in elderly men and is becoming more frequent as the general European population gets older. Only through continuing progress in the already well developed therapeutic methods will mortality due to this cancer be curtailed. Prognosis of cancer limited to the prostate gland has been improved by radical surgery which reduces morbidity and mortality and advanced radiotherapy techniques. The potentially curable forms, still mainly detected by systematic rectal examination, can be defined better with magnetic resonance imagery and biological markers. Hormonal treatment for more extended or metastatic cancers is now based on several effective, well tolerated products. Chemotherapy has not been able to solve the problem of hormonal escape for which other therapeutic techniques are now under study.

[Our experience of spinal anesthesia for transurethral resection of the bladder and prostate. Retrospective study of 334 patients operated in 1986]. / Notre expérience de la rachianesthésie pour résection transurétrale de vessie et de prostate. Etude rétrospective de 334 patients opérés en 1986.

Retrospective study of one years is performed on 334 patients who undergo transurethral surgery. Spinal anesthesia is used in 263 cases, general anesthesia in 71. Spinal administration of local anesthetics (lidocaine hyperbaric 5% or bupivacaine 0.5%) or opioid (Pethidine 1 mg/kg) have been used in old patients without any complication. The advantages are less blood uses, early stand up, no discontinuity in oral nutrition. For our team there are only few contra-indications for spinal anesthesia: blood coagulation abnormalities or some very rare heart diseases.

The staging of M+ disease.

Patients with newly diagnosed prostatic cancer should be investigated with regard to the presence or absence of distant metastases by: (1) Clinical history especially of weight loss, recent pain, or analgesics intake. (2) Physical examination, looking especially for hepatic enlargement, peripheral lymph nodes, local bone tenderness. (3) Performance status. (4) Hemoglobin, creatinine, PSA and/or PAP, alkaline phosphatases, liver tests, testosterone. (5) Bone scan with X-ray of doubtful hot spots. (6) Chest X-ray. (7) Ultrasound scans (liver, kidney, lymph nodes) or CT scan may be indicated if abnormal blood parameters or in specific situations. (8) Other investigations are only indicated in special circumstances. Follow-up should include: (1), (2), (3), (4) every 3 months. For patients in clinical trials, depending on the end point, bone scan should be repeated every 6 months or possibly depending on the prognostic group (good: every 12 months; bad: 3 to 6 months). For routine clinical management, it could be repeated only when markers (PAP, PSA, alkaline phosphatase) show significant (25-50%) increase and provided the result will influence treatment. Other investigations should only be repeated or performed if abnormal at the start of if clinical data require them.

Increased immunogenicity of human renal carcinoma cells following treatment with cholesterol derivatives.

Tumor cells isolated from human renal cell carcinoma biopsies were treated with cholesteryl hemisuccinate or 25-hydroxycholesterol and the subsequent changes in their membrane fluidity and capacity to induce skin reactivity in the homologous patient were investigated. Both cholesterol derivatives were found equally efficient in decreasing membrane fluidity when measured by fluorescence polarization of diphenylhexatriene. Using trimethylammonium-diphenylhexatriene, a specific cell surface probe, 25-hydroxycholesterol, appeared much more efficient than cholesteryl hemisuccinate in inducing a membrane rigidification in the carcinoma cells. Cells treated with cholesteryl hemisuccinate induced a strong positive skin reaction compatible with delayed-type hypersensitivity in 54% of the patients, whereas 25-hydroxycholesterol-treated cells were less potent (36% positive skin reactions). Thus, manipulation of the physicochemical state of the membrane of human renal carcinoma cells could increase their immunogenicity in the autologous patient, although this seemed not to be related only to membrane rigidification.

[Stimulation of antigenicity of renal adenocarcinoma cells]. / Stimulation de l'antigénicité des cellules d'adénocarcinome rénal.

It was hypothesized that membrane rigidification of tumor cells could enhance the expression of tumor associated antigens (6) For this purpose, we treated in vitro hypernephroma cell with cholesterol hemisuccinate (CHS) or 25-hydroxysterol (250HC) and we evaluated their immunogenicity by skin-tests in 26 patients after radical nephrectomy. The skin-tests were positive in 50% cases with CHS treated cells, and in 35% with 250HC treated cells. The immune responses were characterized as delayed hypersensitivity. However determinations of all membrane fluidity suggested that membrane rigidification was not the unique factor involved. These results could therefore be of clinical interest in the treatment of renal carcinoma by active immunotherapy.

[Radical cystectomy for invasive tumors of the bladder in patients over 70 years of age]. / Cystectomie radicale pour tumeur infiltrante de vessie pour les patients de plus de soixante-dix ans.

The authors present a series of forty patients operated for invasive bladder tumors by radical cystectomy. All patients were older than 70 and had a complicated medical history. Mortality was 1 in 40 and the morbidity was low. The conclusion is that radical cystectomy is a safe procedure in elderly patients.