Synchronous pulmonary metastases from renal cell carcinoma--a whole nation study on prevalence and potential resectability.

BACKGROUND: At the time of diagnosis, almost one third of patients with renal cell carcinoma (RCC) have metastasis. We studied the prevalence, survival, and potential resectability of synchronous pulmonary metastases (SPMs) in a well-defined cohort of RCC patients. MATERIAL AND METHODS: A retrospective whole nation study including RCC patients with SPM diagnosed 1970-2005 in Iceland. Imaging studies and histology were reviewed, the TNM system used for staging the primary tumors, and disease-specific survival estimated. Eligibility for SPM removal was evaluated using different criteria from the literature on surgical management of SPM, including solitary SPM and SPMs confined to one lung. RESULTS: Altogether, 154 patients (16.9%) had SPMs. In 55 of these patients (35.7%) the lungs were the only site, with detailed information available in 46 cases. Of these 46 patients with SPMs, 15 were unilateral, and of those 11 were solitary. All of these 11 patients were in good physical condition and were deemed eligible for surgical resection; however, only one of them was operated with metastasectomy. Disease-specific survival at five years for patients with solitary SPM was 27.2%, as compared to 12.7%, 7.1%, and 12.0% for patients with unilateral SPMs, all patients with SPMs, and patients with extrapulmonal metastases, respectively (p = 0.33). CONCLUSION: At the time of diagnosis, 16.9% of RCC patients had SPM. In one in three of these SPM patients metastases were confined to the lungs, while one in five had solitary pulmonary metastases. Although the benefit of pulmonary metastasectomy in RCC is still debated and criteria for resection are not well defined, it appears that many RCC patients with SPM are potentially eligible for pulmonary metastasectomy.

Renal cell carcinoma in young compared to older patients: comparison of clinicopathological risk factors and survival.

OBJECTIVE: Renal cell carcinoma (RCC) is primarily a disease of the elderly, most patients being diagnosed in their mid-60s. However, a significant number of patients are diagnosed at a younger age. The true effect of age at diagnosis on survival has been debated, tumor stage and grade being the strongest prognostic factors of survival. The aim of this nationwide study was to study the significance of young age at diagnosis as a prognostic factor in RCC. MATERIAL AND METHODS: This retrospective study included all living patients with histologically verified RCC in Iceland diagnosed between 1971 and 2000 (n = 629). Different clinicopathological factors of patients diagnosed aged < 50 years (n = 99) were compared to those of patients diagnosed aged > or = 50 years (n = 530). Disease-specific survival was compared and multivariate analysis was used to evaluate prognostic variables. RESULTS: Clinical presentation, TNM stage, grade, tumor size and histological subtypes were comparable between the two groups. Prognostic factors were the same in both groups, most of them having a stronger prognostic value in younger patients. Both 5- and 10-year disease-specific survival was significantly higher in the younger group (66.4% vs 54.5% at 5 years). CONCLUSIONS: The clinicopathological profiles are comparable in RCC patients aged < and > or = 50 years. The reason for the more favorable survival of younger patients is not known. Further studies are needed, including studies on possible differences in age-specific host-tumor response.

[Validation of an Icelandic version of the Geriatric Depression Scale (GDS).].

OBJECTIVE: Health-related quality of life (HRQL) is increasingly used to estimate needs for medical treatment, to evaluate its outcome and quality of care. The aim of this study was to compare the HRQL of several diagnostic groups before and after treatment with the HL-test (HL = IQL, Icelandic Quality of Life test) and to study its validity for measuring changes in quality of life. MATERIAL AND METHODS: Patients on waiting lists for coronary catheterization, orthopedic or urologic operations, patients in psychiatric out-patient treatment and patients entering treatment for alcohol dependence were asked to fill in the HL-test, a total of 1195 patients. Three months after treatment they were retested. The results of tests were standarized with population norms available to make them directly comparable with those of the general population. RESULTS: The response rate was 75% in each round. The HRQL of all patients was reduced in all aspects compared to that of the general population, that of the heart and urology patients less so than that of the orthopedic and psychiatric patients. Each group had a specific profile, especially marked for the orthopedic and psychiatric patients. Following treatment the HRQL or some aspects of it improved in all groups, especially for those which it had been most impaired. CONCLUSIONS: Studies of HRQL provide information useful for planning and delivery of health services. The HL-test is an instrument with good validity and reliability which is easy to use for such studies.

Metanephric adenoma.

A 59-year old woman was diagnosed with a tumour in her right kidney. A nephrectomy was performed, and a 45 mm diameter tan-pink coloured tumour was found. Microscopy revealed small, dark cells in organized arrays of small round acini and tubules with glomeruloid infoldings. A diagnosis of metanephric adenoma was made. The tumour cells proved diploid on flow cytometry and immunohistochemical staining was positive for CAM 5.2 and AE-3. FISH analysis of three chromosomes did not reveal any abnormal karyotype. It is important to differentiate metanephric adenoma from renal cell carcinoma and adult Wilm's tumour, since it has a benign course.

[Wilms' tumor in Iceland 1961-1995. A retrospective study.].

OBJECTIVE: Wilms' tumor is a malignant disease in the kidneys that usually affects young children. Information about the clinical behaviour of this tumor in Iceland has been scarce. The aim of this study was to find the incidence, clinical presentation, treatment and survival of patients with Wilms' tumor. MATERIAL AND METHODS: Included in the study were all patients diagnosed with Wilms' tumor in Iceland from 1st of January 1961 to 31st of December 1995. Altogether, there were 17 patients, 15 children, mean age 33 months (standard deviation 19, range 5-77 months) and two adults (age 25 and 29), with M/F ratio 0.7. Information was gained from each patient's record and the cancer registry of the Icelandic Cancer Society. All the tumors were re-evaluated by a pathologist and staged according to the NWTS staging system. RESULTS: Age adjusted incidence during the study period was 0.2/100,000 per year (1.0 for children under 15 years). Abdominal mass (65%) and abdominal pain (53%) were the most common symptoms. Histology was typical in all cases except one with anaplasia and another with sarcomatous growth. One patient was diagnosed in stage I (6%), six in stage II (35%) and seven in stage III (41 %). Two patients had pulmonary metastases (stage IV) and one had bilateral tumor (stage V). Nephrectomy was performed in all cases. The operative mortality was 12%. Of the 15 patients surviving surgery, 12 received radiotherapy, 12 chemotherapy and nine both treatments. Crude five-year-survival for the whole group was 42%, 25% for the patients diagnosed 1961-1976 and 61% for those diagnosed 1977-1995 (p=0.13). The patient with bilateral tumor was still alive 13 years after diagnosis. CONCLUSION: As in other Western countries, Wilms' tumor is rare in Iceland and has similar incidence and clinical presentation. Two thirds of the patients were diagnosed in stage II or III. Even patients with distant metastases can be cured with multimodal treatment: surgery, chemotherapy and radiotherapy. There was a trend toward better survival during the study period.

[A retrospective study on Icelandic men diagnosed with non-seminomatous testicular cancer 1971-1995.].

INTRODUCTION: Survival of patients with testicular cancer has changed dramatically over the last two decades. This is mainly related to more successful chemotherapy, using combinations of drugs including cisplatinum. Therapy with cisplatinum was started in 1978 in Iceland. The survival of Icelandic men with non-seminoma testicular cancer, before and after this change in therapy, is not known. OBJECTIVE: Therefore a retrospective population-based study was carried out on all Icelandic males diagnosed with non-seminoma testicular cancer between 1971 and 1995. MATERIAL AND METHODS: Fifty-seven males with an average age of 29.1 years (range 17-52) were included in the study. Clinical information was obtained from the Icelandic Cancer Registry and hospital records. All specimens were reexamined by a pathologist and the modified staging system of Boden and Gibb was used for staging the disease. Crude survival was evaluated with the Kaplan-Meier method. RESULTS: Age standardized incidence for non-seminoma testicular cancer was 1.8 / 100,000 males per year for the whole period. Among the 57 patients, testicular swelling (93%) and pain (56%) were the most common symptoms at diagnosis. All 57 patients underwent orchiectomy, and 37 received chemotherapy as well. The most common histological type was embryonal carcinoma (44%) and average tumor diameter was 4.3 cm with a range of 1-12 cm. Tventy-six (51%) patients had stage I disease at diagnosis but 10 (17%) had stage IV. Crude five and 10 year survival for the whole group was 85% and 83%. From 1971 to 1977 the crude five year survival was 36% but 98% for the period 1978-1995. In December 1995 seven (64%) of 11 patients diagnosed between 1971-1977 have died of the disease. On the other hand only two patients (4%) diagnosed after 1977 have died as of december 1995. One because of acute myelogenic leukemia, nearly seven years after diagnosis of testis cancer. The other died of teratocarcinoma 12 months after diagnosis despite intensive chemotherapy including cisplatinum. CONCLUSION: Survival of patients with non-seminoma testicular cancer in Iceland has improved dramatically after the introduction of cisplatinum based chemotherapy in 1978. Of 46 patients diagnosed after 1977 only one (2%) has died because of the disease and median follow up was eight years. The incidence is low compared to other Western countries if Norway and Danmark are not included, were the incidence is much higher. Clinical presentation of the disease is similar between these countries.

A population-based analysis of survival and incidental diagnosing of renal cell carcinoma patients in Iceland, 1971-1990.

The significance of incidental diagnosing in relation to survival of renal cell carcinoma (RCC) patients is not known. A retrospective, population-based study was carried out in order to evaluate the survival of RCC patients, with emphasis on incidental diagnosing. Included in the study were all patients diagnosed with RCC in Iceland between 1971 and 1990. The tumours were classified and the extent of the disease staged by Robson's method. Crude probability of survival was evaluated for every stage, and multivariate analysis applied in order to determine prognostic factors. Out of 408 patients, 15% were diagnosed incidentally between 1971 and 1980 and 20% between 1981 and 1990 (p > 0.1), most often by intravenous urography. Only 5 tumours were detected incidentally by ultrasound techniques and 4 by CT scans. Crude five-year survival was 76% for stage I disease and 11% for stage IV disease. After correction for staging by multivariate analysis, incidental diagnosis and the year of diagnosis were not independent significant prognostic factors for mortality. As in many other studies, our data indicate that incidentally diagnosed RCCs are at a lower stage at the time of diagnosis. On the other hand, the results of our population-based study show that ultrasound and CT scanning have not significantly increased the number of incidentally diagnosed tumours. It is therefore not very surprising that surviving of RCC patients in Iceland has remained the same for the last two decades.

[Can finasteride reverse the progress of benign prostatic hyperplasia? A two-year placebo-controlled study.].

OBJECTIVE: To study if placebo-induced improvement in men with symptomatic benign prostatic hyperplasia (BPH) is maintained over two years, and to study the efficacy and safety from intervention with finasteride 5 mg for 24 months. METHODS: This was a multicenter, double-blind, placeba-controlled study involving 707 patients with moderate symptoms of BPH enrolled at 59 centers in five Scandinavian countries. Following enrollment and a four-week single-blind placebo run-in period, patients were randomized to receive finasteride 5 mg once daily or placebo for 24 months. Urinary symptoms, urinary flow rate, prostate volume, postvoiding residual urinary volume, and serum concentrations of prostate-specific antigen together with laboratory safety parameters were measured at entry and at months 12 and 24. Interim physical and laboratory examinations were performed when indicated clinically. RESULTS: In finasteride-treated patients the total symptom score improved throughout the study, with a significant difference between the two groups at 24 months (p<0.01) whereas in placebo-treated patients, there was an initial improvement in the symptom score but no change from baseline at 24 months. The maximum urinary flow rate decreased in the placebo group, but improved in the finasteride group, resulting in a between-group difference of 1.8 mL/s at 24 months (p<0.01). The mean change in prostate volume was +12% in the placebo group versus -19% in the finasteride-treated group (p%lt;0.01). Finasteride was generally well tolerated throughout the two-year study period. CONCLUSIONS: The efficacy of therapy with finasteride 5 mg in improving both symptoms and maximum urinary flow rate and reducing prostate volume has been shown to be maintained during 24 months while patients receiving placebo experienced a return to baseline or deterioration of these parameters during the study. These results demonstrate that finasteride can reverse the natural progression of BPH.

[Good survival of Icelandic men diagnosed with testicular seminoma between 1971 and 1990 - A retrospective study.].

Testicular cancer is the most common cancer diagnosed in males aged 20 to 34 in Iceland. A retrospective population-based study was carried out on all Icelandic males diagnosed between 1971 and 1990 to evaluate presentation and survival of seminoma in Iceland. Fortyseven males with average age of 36 years (range 21-71) were included. Clinical informations were gained from the Icelandic Cancer Registry and hospital records. The staging system used was a modification of the system orginally proposed by Boden and Gibb and crude probability of survival was evaluated with the Kaplan-Meier method. Age standardized incidence for seminoma was 2.0/ 100,000 males per year for the whole period. Forty-five patients were diagnosed with symptoms where testicular swelling (98%) and pain (42%) were the most common symptoms. Two patients were diagnosed incidentally. All the patients except one underwent orchiectomy, 66% also received radiotherapy and 9% chemotherapy. Average tumor diameter was 8 cm before 1981 but 5.2 cm after 1981 (p=0.02). Most patients were diagnosed in stage I (73%), but 27% had disseminated disease at diagnosis (stage II-IV), most commonly retroperitoneal lymphnode metastases (85%). Crude five and 10 year survival was 89% and 84% respectively. Nine patients have died (August 1994) but none of seminoma. The incidence of seminoma is moderate in Iceland compared to the Nordic countries. Clinical symptoms and stage at diagnosis are similar. Survival is excellent for the group as a whole. For small localized tumors orchiectomy and surveillance seem to be an appropriate approach.

[Renal cell carcinoma in Iceland: 1971-1990. Survival and incidental diagnosis].

Incidence and mortality of renal cell carcinoma (RCC) is very high in Iceland. Studies have shown increased incidence of incidentally diagnosed RCCs. The significans of incidental diagnosis relating to survival of RCC patients is not known. A retrospective population-based study was carried out on all patients diagnosed with RCC between 1971 and 1990 in Iceland. The aim of the study was to evaluate survival of RCC patients in Iceland with emphasis on incidental diagnosis. By incidental diagnosis we mean tumours that were detected due to imaging techniques or an operation for other than RCC symptoms or signs. Of 236 males and 172 females diagnosed, 308 patients underwent radical nephrectomy with operative mortality of 2.6%. The tumours were classified and staged by Robson's method. Crude probability of survival was evaluated for every stage and multivariate analysis used to find prognostic factors. 224 patients presented with symptoms, the most common of which were abdominal pain, hematuria and weight loss. Between 1971 and 1980 15% of the patients were diagnosed incidentally and 20% between 1981 and 1990 (p>0.1), most often because of intravenous urography. Only 5 tumours were detected by ultrasound and 4 by CT-scans. Five year survival was 76% for stage I and 11% for stage IV. Advanced age, low haemoglobin and high ESR at diagnosis are significant independent risk factors of mortality in multivariate analysis. The year of diagnosis is not a significant prognostic factor after correction for stage. Survival of RCC patients in Iceland is comparable to that in neighbouring countries. Patients diagnosed incidentally have better survival because of a lower stage. The use of ultrasound and CT-scans has not significantly increased incidentally diagnosed tumours. Survival has remained the same for the last two decades.

[Impotence among Icelandic males 1986-1991].

The estimated prevalence of impotence in western societies approximates 7%. A retrospective descriptive study was performed on 282 Icelandic males (mean age 53.5 years, range 19-79) referred for evaluation of impotence during the period 1986-1991. Diagnostic modalities included measurements of nocturnal penile tumescence (NPT) and penilebrachial index (PBI), hormonal profile and cavernosography. In 55% the NPT was abnormal. In contrast, only 8.2% of PBI was abnormally low. By logistic regression abnormal NPT results correlated with increasing age. Measurements of hormonal profile was performed in 73.4% of the patients. Testosterone was found to be below normal in 12.1%. However, primary or secondary hypogonadism was only found in 3.9% and elevated prolactin in 2.8%. By cavernosography, venous leakage was demonstrated in 3.2% of the men and subsequently ligation of the dorsal penile vein was performed. A trial of testosterone treatment was given in 39.4% of the patients. Impotence is a common complaint among men. Psychological factors predominate in young men and the contribution of somatic etiologic factors increases with age. In the majority of patients relatively simple studies can give useful information on the etiology of impotence.

Antibiotic prophylaxis in transurethral surgery. Ceftriaxone versus cephradine versus control. A randomized, prospective study in low risk patients.

In this prospective, randomized study, the efficacy of one dose ceftriaxone or 48 hour cephradine therapy was compared to a control group to prevent urinary infection in 179 patients undergoing TUS. Only patients with low risk of developing infections were included. Both cephalosporins significantly reduced the incidence of UTI (ceftriaxone 11.9%, cephradine 17.6% compared to controls 47.2%; p less than 0.0005). Ceftriaxone seemed to have the definite edge in antibacterial spectrum and was easier to administer. Both regimens were well tolerated. Culture of prostatic chips did not have any significant predictive value to determine which patients would develop UTI.

Spontaneous retroperitoneal hemorrhage as first presentation of carcinoma of the kidney. A case report.

In a case of renal adenocarcinoma the presenting features were sudden appearance of an abdominal mass and hypovolemia due to spontaneous retroperitoneal hemorrhage. The diagnosis was established following emergency nephrectomy.