Retinal detachment and convexity intracranial meningioma: an uncommon association.

CASE REPORT: A 70-years-old woman presented with a one week history of progressive loss of vision in the right eye (RE) diagnosed as retinal detachment from 7 to 1 o' clock with retinal break at the 10.30 o' clock associated. Gadolinium enhanced magnetic resonance imaging (MRI) scan of the brain and orbits with fat suppression showed a convexity meningioma. Scleral buckling with a segmental sponge, subretinal fluid drainage and cryopexy were performed with detachment repair. CONCLUSION: In our patient with retinal detachment and convexity meningioma without significant neurological symptoms, performing ocular surgery and close follow up care seemed to be the optimal treatment option.

Spontaneous in-the-bag intraocular lens luxation into the vitreous cavity: last-stage complication of pseudoexfoliative syndrome after phacoemulsification.

PURPOSE: We describe 8 cases of late spontaneous in-the-bag intraocular lens (IOL) luxation into the vitreous cavity, which occurred at the Department of Ophthalmology and Neurosurgery of the University of Siena between January and December 2006. METHODS: In this interventional case series, the medical records of all patients with posterior luxation of in-the-bag IOLs - who had undergone a pars plana vitrectomy with IOL removal and scleral fixation IOL implantation between January and December 2007 at the Department of Ophthalmology and Neurosurgery of Siena, Italy - were retrospectively reviewed. RESULTS: The final post- operative visual acuity was 20/30 or better in 6 patients, while myopic macular degeneration and total retinal detachment limited visual acuity in the remaining 2 patients. CONCLUSION: The high prevalence of pseudoexfoliation (PEX) in the patients who had been operated for cataract phacoemulsification in our department could explain the occurrence of 8 posterior luxations of in-the-bag IOLs in only 1 year. Our study suggests that for the next years we will expect an increase in occurrence of spontaneous in-the- bag IOL luxations in the vitreous cavity. This condition could represent the last stage of PEX syndrome.

The prognostic significance of nuclear DNA content in prostatic carcinoma.

The prognostic significance of ploidy level was studied in prostatic carcinoma and compared with the prognostic significance of morphologic grade and clinical stage. A nonselected group of 145 patients was studied in whom prostatic carcinoma was diagnosed by fine-needle aspiration biopsy at the Karolinska Hospital in 1966. All patients had endocrine therapy and were observed for 23 years or until death. Ploidy level was determined from cytophotometric measurements of Feulgen-stained tumor cell nuclei. The original May-Grünwald-Giemsa-stained cytologic slides, on which the cancer diagnoses were based in 1966, were destained and subsequently Feulgen stained for cytophotometric analysis. From the Feulgen-DNA data, the tumors were classified as near-diploid, near-tetraploid, and highly aneuploid, variants D-type, T-type, and A-type, respectively. The A-type tumors progressed rapidly, and 96% of the patients with this type died of the tumor within 5 years and all patients with this type died within 7 years. D-type and T-type tumors progressed much more slowly. None of the patients with these types of tumors died of the tumor disease within the first 5 years after diagnosis. As many as 12% of the patients (crude survival rate; corresponding to a relative survival rate of 43%) were still alive 15 years after diagnosis. According to multivariate Cox regression analysis, ploidy compared with grade and tumor stage was the strongest predictor of survival.

Squamous metaplasia in hormonally treated prostatic cancer. Significance during follow-up.

A prospective study of 59 hormonally treated prostatic cancer cases was undertaken during follow-up with sequential transrectal palpation and fine-needle aspiration. At initiation of therapy patients' ages ranged from forty-eight to eighty-two years (median, 68 years). The usual follow-up interval was 6 +/- 3 months, and follow-up periods ranged from six months to one hundred twenty months (median 48 months). The cytologic findings were categorized under four cytologic response types and palpation findings under five response grades. Four different degrees of squamous metaplasia (1+, 2+, 3+, 4+) were observed in smears, depending on semiquantitative determination of squamous metaplastic cells in relation to the total amount of benign and malignant epithelial cells in the smear. There were 341 follow-up observations in which both transrectal fine-needle aspiration cytology and palpation were done. In 306 of these, cytologic findings were found to be adequate. Comparison of squamous metaplasia with cytologic response types revealed a highly significant difference between the benign state and recurrence/frank malignancy. This was also true when frequency of squamous metaplasia was compared with palpatory response grades. It was found that squamous metaplasia can be a valuable adjunct to other cytomorphologic changes such as shrinkage of tumor cell size and decrease in size of nucleoli or its disappearance, in determining response to hormonal therapy.

Indomethacin modulation of monocyte cytokine release following pelvic irradiation for cancer.

Pelvic irradiation for urogenital cancer reduced monocyte release of tumour necrosis factor alpha (TNF-alpha). Addition of indomethacin to monocyte cultures increased TNF-alpha production after but not before irradiation. E. coli lipopolysaccharide (LPS) increased TNF-alpha release before as well as after radiation therapy and addition of indomethacin to LPS-stimulated monocytes further increased TNF-alpha production following radiotherapy. Spontaneous interleukin-1 (IL-1) release was increased in the cancer patients and was not significantly affected by radiation therapy. LPS increased IL-1 release before as well as after irradiation, but indomethacin did not further change IL-1 secretion. These findings suggest that prostaglandins differentially regulate TNF-alpha and IL-1 release. Administration of cyclo-oxygenase inhibitors during radiation therapy might increase TNF-alpha release in vivo and thereby enhance the host defence against tumours.

Improved early detection of recurrence in prostatic carcinoma following hormonal therapy. Combined use of palpation and fine needle aspiration cytology.

Fifty-nine hormonally treated prostatic carcinoma patients were prospectively followed by rectal examination and fine needle aspiration cytology at six-month intervals for periods ranging from six to one hundred twenty months (median follow-up 48 mos). The cytologic findings and clinical impressions were divided into four or five categories, respectively, ranging from benign to clearly malignant. Cytologic material and clinical descriptions suitable for evaluation were available for 306 follow-up examinations. Of these, 209 were cytologically benign (including 191 without and 18 with clinical evidence of malignancy). The remaining 97 examinations showed cytologic evidence of malignancy of which 50 were clinically apparent (51.5%). While the correlation of clinical and cytologic findings was good (91.4%) in cases with no evidence of disease activity, our findings indicate that many recurrences which are occult to clinical examination may be detected by cytologic examination.

Adjuvant bestatin (Ubenimex) treatment following full-dose local irradiation for bladder carcinoma.

The clinical value of adjuvant bestatin (Ubenimex) immunotherapy has been examined in a group of patients with urinary bladder cancer. Patients with non-metastatic transitional cell carcinoma of the bladder, scheduled for full-dose local irradiation therapy (64 Gy), were randomly allocated to adjuvant oral bestatin treatment (30 mg daily for at least 1 year), starting at completion of irradiation, or no bestatin. The trial included 194 evaluable patients with a follow-up period of 1.5-9.5 years. The overall survival of the two groups of patients did not differ statistically significantly (97 patients in each). Subgrouping of the patient material gave no evidence that the clinical efficacy of bestatin is related to sex, tumor category or malignancy grade.

Recombinant leukocyte interferon alpha-2a and medroxyprogesterone in advanced renal cell carcinoma. A randomized trial.

In a randomized study of advanced renal cell carcinoma 60 patients were allocated to treatment with either recombinant interferon alpha-2a or medroxyprogesterone acetate. Correlation between the dose of interferon alpha-2a and plasma-concentration indicated linear kinetics. Survival was similar in the two treatment groups. Only one complete and one partial response were seen in the interferon group and only one complete response in the medroxyprogesterone group, indicating a low therapeutic potential of both interferon and medroxyprogesterone. Interferon influenced the serum liver enzyme levels; increased transaminases were seen in 17 patients treated with interferon but in only four patients in the medroxyprogesterone group. Two patients had very high serum liver-enzyme levels concomitant with intolerable tiredness, in both patients the symptoms disappeared and the enzymes normalized after discontinuation of the interferon treatment. Antibodies to interferon developed frequently in patients receiving high dose oligomeric interferon therapy but rarely in patients receiving low dose monomeric interferon treatment.

Determination of false negative rate in fine-needle aspiration of prostate. Study of sequential aspirations in 30 untreated carcinoma patients.

Despite several studies comparing the diagnostic accuracy of core needle biopsy and fine-needle aspiration (FNA) in the diagnosis of prostatic adenocarcinoma, no clear picture of the false negative rate for FNA is available. We studied 101 follow-up FNA evaluations in 30 patients with untreated well-differentiated carcinoma. The patients were followed for a median of two years and seven months and had from two to seven FNA follow-up evaluations (median = 2.5 evaluations per patient). If three inadequate evaluations are omitted, the combined rate of positive plus suspicious FNA biopsies was 92.9 percent (88.8% plus 4.1%, respectively). The residual false negative rate was 7.1 percent. The clinical features and follow-up data are described. A semiquantitative definition of "suspicious for malignancy" is suggested. We conclude that in experienced hands. FNA is a highly efficacious method for the diagnosis of prostatic adenocarcinoma.

Adjuvant Bestatin immunotherapy in patients with transitional cell carcinoma of the bladder. Clinical results of a randomized trial.

The first clinical results of an ongoing, prospective trial to determine the value of adjuvant Bestatin immunotherapy in the management of bladder cancer are presented. Patients with nonmetastatic transitional cell carcinoma of the bladder, scheduled for full dose local radiation therapy (64 Gy), were randomly allocated to adjuvant oral Bestatin treatment (30 mg daily for at least 1 year), starting at completion of irradiation, or no Bestatin. The longest follow-up period of the 151 evaluable patients is 6 years. The results have shown that the disease-free survival of the patients taking Bestatin is significantly improved compared to the controls (p = 0.04). However, the overall survival of the patients was not affected by the Bestatin treatment. The beneficial effect of Bestatin seemed to be more marked among men than women. Furthermore, statistical analyses of the patient material according to T tumor categories suggested that compared to the controls, patients with less advanced disease (T1 and T2) benefitted more from Bestatin treatment than those with more advanced tumors (T3 and T4). The results of this ongoing trial thus show that patients with bladder cancer benefit from adjuvant Bestatin treatment in terms of disease-free survival.

Phenotypes of placental-type alkaline phosphatase in seminoma sera as defined by monoclonal antibodies.

PLAP-like enzymes could be detected in serum of patients with primary testicular tumors, in particular seminomas. The use of a panel of monoclonal antibodies (MAbs) permitted typing into 6 different testicular serum phenotypes, of which one appeared similar to a placental type (II) and 2 have not been previously described. Most tumor sera belonged to type I, as described for seminoma tissues. With a more advanced tumor the mean serum PLAP-like levels increased. After operation, after radiotherapy or with no evidence of disease lower or non-detectable enzyme levels were found. In typing the tissue PLAP-like antigen in serum of the same patient or sera from recurrences of a seminoma in the same patient, the same phenotypes of PLAP-like antigen were usually but not always found. None of the 6 phenotypes appeared to confer a poorer prognosis. We conclude that the expression of PLAP-like antigen is eutopic and is enhanced by testicular malignancy, especially in seminoma cells.

Irradiation therapy with multiple small fractions per day in urinary bladder cancer.

In a clinical trial 168 patients with carcinoma of the bladder, T2-T4, were randomized to one of two treatments; 1 Gy 3 times a day to a total of 84 Gy or 2 Gy once a day to a total of 64 Gy. Local eradication of the tumour in the bladder cystoscopically and cytologically at 6 months after completion of treatment and patient survival were analyzed. The results favoured significantly the patients treated with 84 Gy. All patients were followed 5-9 years. The survival was significantly improved in patients with T3 lesions treated with 84 Gy (p less than 0.01). Complications in the bowel requiring surgical treatment were not significantly different between the two groups of patients. The results indicate a therapeutic gain by hyperfractionated radiotherapy in comparison to conventional fractionated radiotherapy.

Combined bleomycin and radiation therapy in carcinoma of the penis.

Cancer of the penis is an uncommon disease in the western part of the world but it represents a significant portion of male cancer in other countries as in Asia, Africa, and South America, where in certain areas it accounts for 20% of the cancer occurrence in male patients. The treatment has been based mainly on surgical excision with or without regional lymphadenectomy. Chemotherapy with bleomycin has had some effectiveness in advanced disease. A mode of combination therapy with bleomycin and irradiation has been evaluated in patients with carcinoma of the penis. The results compare favorably with surgical treatment with respect to cure of the disease and patient survival, and it has the advantage of preserving sexual function in most of the cases. This combined therapy is useful even in patients with relatively extensive local tumor.

Interferon therapy in disseminated renal cell carcinoma.

Twenty patients with pulmonary metastases of renal cell carcinomas have been treated in a randomized study with either leucocyte interferon in daily doses of 3 x 10(6) I.U.i.m or irradiation of both lungs in a calculated mean central dose of 10 Gy in 4 weeks in combination with bleomycin and vincristine. Most patients had a short time to progression of their disease. Three patients in the interferon group had complete response (CR) and partial response (PR) and one patient in the other group had PR. The numbers of patients in both arms of the study are too small to allow any conclusions whether beneficial effects are more frequent in one group than in the other, but there is a more favourable tendency in the interferon group.

Granulocytopoietic precursor cells and regulatory factors in irradiated human bone marrow.

The effects of irradiation on committed granulopoietic progenitor cells (CFU-C) and granulopoietic humoral regulators were studied in 17 X-ray treated patients with carcinoma of the breast or of the prostate. After 45 or 70 Gy, the CFU-C decreased to 14 +/- 10% in irradiated areas. This remaining CFU-C population probably reflects a combination of radioresistance and survival in situ, and migration of CFU-C from protected marrow areas. The frequency of peripheral blood CFU-C did not change after irradiation. Endogenous colony stimulating activity (CSA), i.e., release of CSA within the marrow cell population, in post-irradiation bone marrow persisted on roughly the same level, indicating a fairly low radiosensitivity of the CSA-producing cells in the bone marrow. Colony stimulating activity in peripheral blood cells and serum remained unchanged, but there were great interindividual variations, and some of the patients with hypercellularity and CFU-C increase in nonirradiated marrow areas also had increased CSA. Serum lipoprotein inhibitors were higher in the post-treatment patients than in healthy control patients.

Carcinoembryonic antigen in cytological specimens of urothelial carcinoma.

A peroxidase-antiperoxidase (PAP) technique was developed for the detection of carcinoembryonic antigen (CEA) in urothelial transitional cells of 52 bladder cancer patients. The percentage of CEA-containing malignant cells varied from 10% to 100%. As a mean, 65% of the malignant cells stained for CEA, while the corresponding figure for benign-looking cells was 24%. The results were compared with cytological evaluations, flow cytophotometric results, and immunofluorescent (IF) staining for CEA. With increasing malignancy, more CEA was detected with the PAP technique, whereas the IF technique failed to show this trend. 18 of 20 malignant-tumors had an aneuploid DNA pattern. The two diploid cases were moderately well differentiated. Samples from bladders with heavy inflammation should be avoided in the PAP technique, since the unspecific staining of granulocytes disturbed a correct evaluation of the transitional cells. The PAP technique used on cytological material is recommended for antigen determinations, since good morphology is obtained.

Chemotherapy in advanced urinary bladder cancer.

In our investigation of different chemotherapy protocols, the best results in recent years were obtained with a combination of cisplatinum and doxorubicin in patients with recurrent urinary bladder cancer. This applied both to the local bladder tumor and the metastases. With respect to the cases of advanced localized bladder cancer, refined surgery or more developed equipment in radiotherapy, even developing new particles or rays, presumably will give only marginal effects on eradication of the tumor. A new approach may be to give a combined therapy of CDDP and doxorubicin before surgery and/or radiotherapy; a pilot study is going on in Stockholm. Experience so far has shown that CDDP together with radiotherapy or after preoperative irradiation followed by cystectomy is not tolerable to the patients. Between 40 and 50 per cent of them failed to fulfill the treatment.