Recurrence and progression of T1G3 transitional cell carcinoma of the bladder treated with intravesical bacillus Calmette-Guérin.

OBJECTIVE: To examine the incidence of recurrence and progression in patients with stage T1, grade-3 carcinoma of the bladder treated with endovesical bacillus Calmette-Guérin (BCG) after complete transurethral resection. MATERIAL AND METHODS: From May 1995 to June 2002, 937 patients with superficial bladder cancer underwent transurethral resection. 46 patients (4.9%) had T1G3 tumors. All patients received endovesical BCG therapy 2-3 weeks after transurethral resection, given in 6 sessions as weekly instillations of 120 ml Pasteur strain BCG in 50 ml saline. Success was defined by normal cytology and cystoscopy, and normal bladder biopsies. Recurrent tumors were resected and a second or third cycle of therapy was given according to pathological status. Progressive tumors were managed by radical cystectomy, radiotherapy and/or chemotherapy depending on the nature of the tumor or clinical status of the patient. RESULTS: During follow-up 60.7% of the patients (28 of 46) remained tumor free after only 1 BCG cycle and 73.9% (34 of 46) after the third BCG cycle, and the bladder was preserved in all. Muscle-invasive progression was noted in 10 (21.7%) patients at the end of the BCG cycles. Radical cystectomy was done in 10 patients. The tumor-free survival rate of all patients including those who underwent cystectomy is 84.8% (39 of 46) with a median follow-up of 61 (range 39-118) months. CONCLUSION: Adjuvant immunotherapy with BCG after complete transurethral resection of the bladder tumor represents a highly effective treatment for bladder preservation in stage pT1, grade-3 carcinoma of the bladder. pT1G3 tumors with early high-grade recurrence after failed immunotherapy should be regarded as candidates for early radical cystectomy.

A case report: Prostatic carcinoma with metastasis to the testicle.

Secondary testicular tumours are rare. We present a 54 years old patient with testicular metastasis from carcinoma of the prostate with a 7 years history of hormonotherapy and chemotherapy for advanced carcinoma.

A case report: adrenal ganglioneuroblastoma in a 59-year old man.

Ganglioneuroblastoma is a common type of tumor in children, but is rarely seen in adults. We present here a case of adrenal ganglioneuroblastoma in a 59-year old man.

The relation of mutant p53 accumulation in transitional cell carcinoma of bladder with pathological stage, grade, recurrence and survival.

In this study prognostic significance and clinical value of mutant p53 gene in bladder transitional cell tumors is investigated. In our clinic, between 1997-2000, transurethral resection was performed in 48 cases, 3 females (6%) and 45 males (94%) with the diagnosis of primary bladder tumor, age ranges between 30-81 years old (average 58.9 +/- 9.9). The patients whose pathology results were transitional cell carcinoma were gathered into two groups as p53 positive and p53 negative by immunohistochemical study. These cases who were followed 1-36 months were compared to each other for pathologic state, tumor grade, recurrence and survival. It's found out that mutant p53 accumulation is related to high grade and pathologic stage tumors. But it's concluded that p53 positivity doesn't effect recurrence and survival rates.

The relation of prostate biopsy results and ratio of free to total PSA in patients with a total PSA between 4-20 ng/mL.

OBJECTIVE: In this study our aim was to investigate the efficacy of free to total PSA ratio in discrimination of benign prostate hyperplasia and prostate cancer. MATERIALS AND METHODS: A total of 194 patients, 52 to 82 years old (mean 66.06 +/- 0.47 years) with PSA levels between 4 to 20 ng/mL were included into this study. Each patient underwent sextant prostate biopsy under transrectal ultrasound guidance. The patients were divided into two groups as PSA 4-10 and 10-20 ng/mL. Patients with benign and malign results were compared with respect to age, total PSA level, free PSA level and free/total (f/t) PSA ratio. RESULTS: Biopsies revealed prostate cancer in 16 of 130 patients (12.3%) with serum PSA 4-10 ng/mL and in 10 of 64 patients (15.6%) with serum PSA 10-20 ng/ml. In both PSA groups free PSA and f/t PSA levels were statistically significant, where total PSA levels were not. In patients with 4-20 ng/mL total PSA levels and a cut off level of < 0.18 for f/t PSA, the sensitivity, specificity and positive predictive value for prostate cancer were 88.5%, 53.6% and 20.4% respectively. CONCLUSION: Higher levels of PSA suggest prostate cancer, but still additional parameters are needed for patients with PSA 4-20 ng/mL, such as free PSA and f/t PSA. Although a cut off level of < 0.18 for f/t PSA seems to be the most accurate one to discriminate benign and malign diseases further studies on larger groups of patients are needed.

Role of interferon-alpha-2B in prevention of testicular atrophy with unilateral mumps orchitis.

OBJECTIVES: To determine the effectiveness of intravenously administered interferon-alpha-2B for the prevention of testicular atrophy in postpubertal men with mumps orchitis. METHODS: Eighteen patients with mumps orchitis were evaluated. The patients were hospitalized, and 3 x 1,000,000 IU intravenous interferon-alpha-2B was administered daily for a total of 7 days. All patients were evaluated by testicular biopsy on the 12th month after interferon treatment. RESULTS: Biopsy results demonstrated total atrophy of the seminiferous tubules in seven (38.8%), 10% atrophy in three (16.6%), and no apparent histopathologic alterations except an arrest in spermatogenesis in eight (44.6%) testes. CONCLUSIONS: Systematic treatment with interferon-alpha-2B does not seem completely effective in preventing testicular atrophy after mumps orchitis. Further investigations involving larger populations are needed.

Primary cyst hydatid of adrenal: a case report.

Adrenal cysts are very rare lesions, especially with parasitic origin. Here, primary cyst hydatid of adrenal in a 51 years old woman who consulted with a left flonk pain, is presented and the literature is reviewed.

Comparision of intracorporeal lithotripsy methods and forceps use for distal ureteral stones: seven years experience.

OBJECTIVES: To evaluate and to compare the safety and efficacy of ureteroscopic lithotripsy methods and forceps use for distal ureteral stones. MATERIALS AND METHODS: 514 patients were evaluated retrospectively who were treated by dye laser, electrohydraulic or ultrasonic lithotripsy or direct forceps extraction for distal ureteral stones between May 1992-October 1999. RESULTS: Laser lithotripsy was determined to be the most effective method with 86.9% success, while ultrasonic lithotripsy was the least effective method with 77.3% success rate. For smaller stones forceps extraction had a 88.5% success rate. CONCLUSION: Ureteroscopic lithotripsy methods are all alternative choice of treatment methods in distal ureteral stones. To our experience, laser lithotripsy is the most effective method of all intracorporeal lithotripsy methods as far as the success and complication rates are concerned.

Conservative management of advanced bladder cancer.

Between January 1991 and October 1993, 32 consecutive patients with documented primary bladder tumours invading muscle received 3 cycles of methotrexate, vinblastin, doxorubicin and cisplatin (MVAC). The disease was re-staged by bimanual examination with the patient under anaesthesia, CT scanning and transurethral biopsy or resection. Of the 32 patients 2 underwent total or partial cystectomy and 30 did not, because re-staging showed no residual tumour in 8 (25%), stage T1-2 in 12 (37.5%) and far-advanced tumour in 10 (31.2%). The median follow-up was 2.8 years. Twelve patients with stage T1-2 tumour have required TUR, and cystectomy has not been necessary. Two patients who underwent total/partial cystectomy were all downstaged pathologically. Of the 10 failures 5 patients died of disease and 5 are alive with metastatic disease. The overall survival rate was 84.3% (27 of 32) and was 96.8% for patients with a functioning bladder. The data suggested that this active regimen can clinically induce downstaging in a significant number of patients with primary muscle-infiltrating bladder tumours. Transurethral resection plus MVAC chemotherapy is important for increased curability in patients with advanced bladder cancer.

Management of testicular cancer with combined-modality treatment.

Thirty consecutive patients with germinal testis tumours were treated with combined-modality programme. Seven patients were entered in the surveillance protocol, 7 patients had irradiation of the paraaortic and ipsilateral pelvic lymph nodes, 16 patients were treated with four courses of chemotherapy. Of the patients 5 underwent surgical removal of residual masses. After the combined-modality treatment 27 (90%) patients had complete remission, 2 patients showed progression on therapy and the other had incomplete resection of residual masses. After a median follow-up period of 41.5 months, 27 (90%) remain continuously disease-free, 2 patients died and one patient is still alive with his enlarged mediastinal lymph nodes. The treatment policy stage by stage was defined by the current roles of surgery, irradiation and chemotherapy in our efforts.

NAG, GGT, creatinine, urea and creatinine clearance before and after ESWL.

N-acetyl-beta glucosaminidase (NAG) and gamma-glutamyltransferase (GGT) were measured in the urine and serum before, 24 hours and one week after extracorporeal shock wave lithotripsy in 25 patients. Although ESWL is the preferred method in the treatment of kidney stones, its effect on renal parenchymal cells has not been sufficiently elucidated. Since radiographic methods remain inadequate in the estimation and management of parenchymal damage, it is useful to establish the specific renal cell proteins in urine and serum, reflecting renal tubular cell destruction.

Relationship between histologic grading and serum prostate specific antigen in prostatic carcinoma.

Prostate specific antigen (PSA) is the most important tumour marker which, used routinely, proved to have a positive correlation with tumour volume and pathological stage. To evaluate the relationship between serum PSA and histologic grading of prostatic carcinoma, preoperative PSA determinations were made in 25 patients with prostatic cancer. Biopsy materials were evaluated and the Gleason scores were adjusted for histologic grading. The higher values of PSA were proportional to the Gleason scores of the primary prostatic biopsy.