Continence, potency and morbidity after radical perineal prostatectomy.

PURPOSE: We investigated continence, potency and morbidity rates associated with radical perineal prostatectomy. MATERIALS AND METHODS: We assessed 220 consecutive men who underwent radical perineal prostatectomy for clinically localized prostate cancer between January 1984 and July 1995. Concomitant pelvic lymphadenectomy was performed in 181 patients. Potency was assessed in a subset of 50 consecutive men with good preoperative potency and a minimum 18-month followup who were otherwise candidates for a nerve sparing procedure (22 bilateral and 28 unilateral). Continence and potency were prospectively evaluated. RESULTS: Continence was preserved in 208 of the 220 men (95%), and it returned in 23% by 1 month, 56% by 3, 90% by 6 and 95% by 10. Advanced age was the only significant risk factor. All 12 incontinent men (5%) were 69 years old or older and they represented 12% of that age group (12 of 103). After nerve sparing potency was preserved in 35 of the 50 fully potent men (70%), returning in 24% by 6 months, 50% by 12, 64% by 18 and 70% by 24. Unilateral nerve sparing preserved potency in 19 of 28 men (68%). There were no deaths but serious morbidity developed in 5 patients (2%). Anastomotic stricture, inadvertent proctotomy and venous thromboembolism occurred in 3 men (1%), respectively. Median operative blood loss was 600 ml. and 208 men (95%) had blood loss of 1,200 ml. or less. Median total hospital stay is now 2 days. CONCLUSIONS: Radical perineal prostatectomy is safe. In our 220 patients there were no deaths and serious morbidity developed in 2%. The continence rate was 95% and 70% of a select group recovered potency.

Failure of focal prostate cancer on biopsy to predict focal prostate cancer: the importance of prevalence.

PURPOSE: We investigated whether the reported correlation between focal prostate cancer on biopsy and the presence of clinically insignificant cancer applies to men with an elevated serum prostate specific antigen level or a positive biopsy from an area of palpable abnormality. MATERIALS AND METHODS: A total of 33 men with these findings and focal cancer on biopsy underwent radical perineal prostatectomy, with step-section pathological analysis of all specimens and volume determination of all stage pT2a tumors. RESULTS: Pathological examination revealed that 17 tumors (52%) were stage T3, 10 (30%) stage T2b to c and 6 (18%) stage T2a, with 4 (12%) significant (volumes 0.8 to 1.2 ml.) and 2 (6%) insignificant (volumes 0.1 and 0.3 ml.) neoplasms. Thus, focal prostate cancer on biopsy correlated with significant cancer in 94% of the cases. CONCLUSIONS: In patients with another variable controlling for a high prevalence of significant prostate cancer, the focal nature of a positive biopsy probably reflects only sampling limitations and should not influence treatment. To restrict prostate biopsy to men with a high prevalence of significant cancer, targeted area biopsy alone must replace sextant biopsy in men with a palpable prostatic abnormality but a normal prostate specific antigen level.

Patterns of positive specimen margins and detectable prostate specific antigen after radical perineal prostatectomy.

Positive specimen margins and detectable postoperative prostate specific antigen (PSA) levels were analyzed after 200 consecutive radical perineal prostatectomies for clinical stages T1 and T2 adenocarcinoma of the prostate. Clinical parameters that correlated with lymph node metastases in concomitant pelvic lymphadenectomies were also noted. At a mean followup of 35 months 79% of the patients had undetectable PSA levels. Step-section pathological analysis of specimens obtained by either nerve sparing or extended radical modifications revealed that 41% of the tumors were organ confined and 56% had negative margins. Selective sacrifice of the posterolateral periprostatic fascia and the enclosed neurovascular bundle achieved negative margins and undetectable PSA levels despite capsular penetration in 15% of all patients. Of all positive margins with the perineal approach, solitary positive apical and posterolateral margins were infrequent (7% and 16%, respectively) but solitary positive anterior margins were more so (25%). Of those positive anterior margins 41% appeared to be artifactual and 45% might have been eliminated by avoiding avulsion of the puboprostatic ligaments. Pelvic lymphadenectomy could have been eliminated in 58% of the patients (clinical stage T2b or less, biopsy Gleason score 6 or less and PSA level 11 or less, for a node negative predictive value of 99%).

Aberrant expression of gangliosides in human renal cell carcinomas.

Aberrant and elevated ganglioside expression has been observed in neoplasms, and has been shown to be an important marker of tumor progression. We therefore studied the gangliosides of renal cell carcinoma (RCC) by analyzing gangliosides from 18 RCC biopsies, 10 RCC lines and 5 normal kidney biopsies. A comparison of tumor with normal tissue revealed a significant difference in individual ganglioside expression in which the former consistently expressed eight major gangliosides, GM3, GM2, GM1, GD3, GD1A, GD2, GD1B and GT1B, according to the nomenclature of Svennerholm. There was a notable significant mean increase in the expression of GM2, GM1 and GD1A and a significant decrease in the expression of GD3 in tumor tissue compared with normal kidney tissue. Compared with tumor biopsy tissue, RCC cell lines showed a significant decrease in the expression of GM3, but a significant increase in GM2, GM1 and GD2. There was a marked increase in a pathway gangliosides (GM2, GM1, and GD1a) in RCC biopsies and cell lines compared with normal kidney. These studies indicating that RCC have markedly aberrant ganglioside expression similar to neural origin tumors may relate to the activation of a ganglioside pathway enzymes. Gangliosides expressed on RCC tumors may be important markers of tumor progression and target antigens for immunotherapy.

Automated direct sequencing of polymerase chain reaction-amplified fragments of the human Ha-ras gene.

We present modifications to polymerase chain reaction-base DNA sequence analysis which avoid the need for M13 cloning and allow one set of sequencing primers to be used for analysis of any desired DNA sequence. This procedure employs nested amplification primers including short 5'-terminal sequences suitable for the attachment of fluorescent markers or for sequencing with M13 universal and reverse sequencing primers. Our modifications provided adequate single-stranded DNA for reliable automated sequence analysis of selected Ha-ras gene regions, starting with less than 1 microgram of genomic DNA.

Prognosis of patients with stage D1 prostate carcinoma following radical prostatectomy with and without early endocrine therapy.

Early endocrine therapy after radical retropubic prostatectomy was compared to radical prostatectomy alone (nonearly endocrine therapy) for the treatment of carcinoma of the prostate with lymph node metastases. Our retrospective analysis demonstrated that the 2 cohorts were similar with respect to patient age, Gleason sum score, seminal vesicle invasion, lymph node involvement, tumor volume and pathological stage of the primary tumor. The cause-specific survival of the entire group was 84% at 60 months and 78% at 98 months. The cause-specific curves for the early and nonearly endocrine therapy group were not significantly different (p less than 0.194), although the estimated 9-year survival rates were 91 and 71%, respectively. Survival free of disease was significantly prolonged in the early endocrine therapy group (p less than 0.030), with a 9-year estimated rate free of disease of 67% versus 32% in the nonearly endocrine therapy group. Followup prostate specific antigen serum levels were analyzed and the value as a progression marker is discussed. These data suggest that a radical operation plus early endocrine therapy is effective palliation in selected patients with low volume lymph node metastases, producing clinical survival free of disease in most patients.

DNA alterations in prostatic adenocarcinoma and benign prostatic hyperplasia: detection by DNA fingerprint analyses.

DNA fingerprinting can be utilized to examine a large number of autosomal loci throughout the human genome. Alterations in banding patterns observed on DNA fingerprint analyses reflect DNA alterations ranging from single base changes to complex chromosomal rearrangements. In this report, we describe the application of this technique to prostatic adenocarcinoma (CAP) and benign prostatic hyperplasia (BPH). The majority of CAP cases (12 of 14) displayed alterations in at least 1 of the approximately 30 resolvable bands obtained by fingerprint analyses when compared with DNA obtained from peripheral white blood cells. Unexpectedly, 5 of the 12 cases of BPH examined revealed at least 1 identifiable band alteration in the prostatic tissue. These findings demonstrate the usefulness of fingerprint analyses in the examination of cancer-associated genetic alterations. They also suggest the presence of observable genetic alterations in BPH.

Relation between DNA ploidy and the clinical behavior of phyllodes tumors.

We studied the DNA histograms obtained by flow cytometry from a series of six giant fibroadenomas and ten phyllodes tumors to determine if the analysis of DNA ploidy would help to predict clinical behavior. We were unable to document any relation between ploidy and histologic appearance, recurrence, metastasis, lesion size, or patient age. DNA aneuploid stem cell lines were seen in 75% of histologically benign phyllodes tumors, 50% of histologically malignant phyllodes tumors, and approximately 33% of giant fibroadenomas.

Genitourinary imaging and procedures by the emergency physician.

Optimal imaging of the urinary tract in the Emergency Department does not require sophisticated or rare equipment. The supervising physician must review each ExU, cystogram, or RUG film as it becomes available and decide upon the proper course of action. Indications for contrast studies in injured patients continue to evolve, with a trend away from investigation of stable patients with microscopic hematuria on the first urine. Urethral catheterization and suprapubic cystostomy are complementary options for bladder drainage. Careful attention to details of anatomy and technique allow for success in the majority of patients. There are substantial pitfalls in the diagnosis and treatment of male genital emergencies. The acute treatment of priapism is rapidly changing as understanding of penile physiology becomes more complete. Acute scrotal pathology can be difficult to categorize without surgical exploration. Urologic consultation, therefore, is mandatory in these conditions.

Detection of onco-fetal bladder antigen in urine of patients with transitional cell carcinoma.

Studies of antigens associated with transitional cell carcinoma were extended by using murine IgM monoclonal antibody E7, developed earlier by this laboratory. These antibodies react preferentially with human bladder tumors and transitional cell carcinoma (TCC) cell line 647V. We now report that monoclonal antibody E7 detected the presence of antigen in midgestational and third trimester amniotic fluids, and in urine of patients with advanced transitional cell carcinoma. Western blot analysis showed that the antigen present in amniotic fluids consists of a sharp band with molecular weight greater than 200 kdaltons. A similar molecular weight pattern was seen with the solubilized membrane of 647V. A sensitive and convenient sandwich ELISA was developed and the urine of patients with bladder cancer was assayed for the presence of the E7 antigen. Antigen was detected in the urine of patients with advanced transitional cell carcinoma but not in the urine of normal adults or in urine from patients with prostate cancer, renal cell carcinoma, or benign prostate hyperplasia. An inhibition enzyme immunoassay was developed with monomeric forms of the E7 antibody and confirmed the presence of antigen in the urine of patients with TCC. We conclude that the E7 antigen is an onco-fetal antigen expressed in patients with transitional cell carcinoma of the bladder.

[Hemoglobin, XXXI. Analysis or the primary structure of the monomeric hemoglobin CTT I (erythrocruorin) of Chironomus thummi thummi, Diptera]. / Hämoglobine, XXXI. Analyse der Primärstruktur des monomeren Insektenhämoglobins CTT I (Erythrocruorin) aus Chironomus thummi thummi, Dipera.

The sequence analysis of the monomeric hemoglobin CTT I (erythrocruorin) of Chironomus thummi thummi is given. The tryptic peptides were separated and sequenced by automatic Edman degradation. The alignment was established with help of some peptic peptides. In CTT I two polypeptide chains are present. They differ in position 98, where we found alanine and threonine in the ratio 1:1. CTT I is compared with human myoglobin and the monomeric component CTT III. The dimeric components of CTT are also included into the discussion, because CTT I seems to have an enlarged heme pocket like them. We particularly compare the amino acid residues involved in the heme contacts. The lack of a Bohr effect is discussed.

[On mucoepidermoid tumors with rare locations in laryngological areas (author's transl)]. / Uber Mukoepidermoidtumoren im Hals-, Nasen- und Ohrenbereich

Report of three cases of mucoepidermoid tumors with rare locations in laryngological areas (fundus of the tongue, retromolar trigonum, nasopharynx and sinuses). In two cases the tumors could be removed radically, the third case resulted in an extensive tumorous destruction of the right half of the face after a protracted course of the disease, as the consequence of which the patient died. With the aid of the literature on the subject, the location, clinical features, pathological anatomy and histology, origin, biological valence and the prognosis of mucoepidermoid tumors are discussed. It is generally agreed that they are optionally malignant tumors which can induce a locally infiltrating or destructive growth, show a tendency to recurrence and may lead to distant metastases. The recommended therapy is the radical exstirpation of the tumor.