IL-2 in combination with IFN- alpha and 5-FU versus tamoxifen in metastatic renal cell carcinoma: long-term results of a controlled randomized clinical trial.

We conducted a prospectively randomized clinical trial to compare the efficacy and safety of subcutaneous interferon-alpha2a, subcutaneous interleukin-2 and intravenous 5-fluorouracil as home therapy against oral tamoxifen in 78 patients with progressive metastatic renal cell carcinoma. Treatment courses consisted of interferon-alpha2a 5 x 10(6) IU m(-2), day 1 weeks 1 + 4; days 1, 3, 5 weeks 2 + 3; 10 x 10(6) IU m(-2), days 1, 3, 5 weeks 5-8; interleukin-2 10 x 10(6) IU m(-2), twice daily days 3-5 weeks 1 + 4; 5 x 10(6) IU m(-2), days 1, 3, 5 weeks 2 + 3; and 5-fluorouracil 1000 mg m(-2), day 1 weeks 5-8. The tamoxifen group received tamoxifen 80 mg twice daily over 8 weeks. Among 41 patients treated with interleukin-2, interferon-alpha2a and 5-fluorouracil there were 7 complete (17.1%) and 9 partial responders (21.9%), with an overall objective response rate of 39.1% (95% CI, 24.2-55.5). An additional 15 patients (36.6%) were stable throughout therapy. The overall survival was 24 months (range 5-76+). In 37 patients receiving tamoxifen no objective remissions occurred. 13 patients (35.1%) had stable disease and 24 patients (64.9%) showed continued disease progression. The overall survival was 13 months (range 3-73+). In summary, this home-based therapy regimen of interferon-alpha2a, interleukin-2 and 5-fluorouracil demonstrated significant therapeutic efficacy in patients with progressive renal cell carcinoma when compared to hormonal therapy.

[Significance of bacterial prostatic colonization for nosocomial urinary tract infections after transurethral prostate resection]. / Die Bedeutung der bakteriellen Prostatabesiedlung für nosokomiale Harnwegsinfektionen nach transurethraler Prostataresektion.

Nosocomial urinary tract infections (UTI) are frequent complications after transurethral prostatectomy. The resection itself, postoperative catheterization and the prostate are possible causes of these infections. In this prospective study we investigated the influence of bacterial prostatic colonization on the incidence of postoperative urinary tract infections and inflammatory complications. In 78 patients we observed in 42 cases (53.8%) a bacterial prostatitis. In 14 patients (17.9%) we found nosocomial UTI's and in 12 patients (15.4%) inflammatory complications. The incidence of postoperative UTI's increase significantly in patients with positive prostate-cultures. On the other hand we only found corresponding prostate- and postoperative urine-cultures in less than 50%. The presented data are not sufficient to conclude the kind of relevance of bacterial prostatic colonization for postoperative UTI's in transurethral prostatectomy. Under consideration of the significant increase of nosocomial UTI's in patients with positive prostate cultures a perioperative antibiotic prophylaxis seems to be required in general.

Nosocomial infections after transurethral prostatectomy.

In spite of new techniques transurethral prostatic resection (TURP) remains the gold standard in operative therapy of benign prostatic hyperplasia. There are some suggested risk factors for TURP which could affect the rate of postoperative complications. In this prospective study we investigated whether the suggested risk factors have any relevance for the occurrence of nosocomial urinary tract infections (UTIs) after TURP and what kind of influence these infections may have on the clinical course. In general we found no statistically significant influence on the analyzed risk factors for the incidence of nosocomial UTIs. On the other hand in the group of patients with nosocomial UTIs both the rate of other nosocomial infections (i.e. septicemia) and the rate of inflammatory complications were significantly higher compared to the group without postoperative UTIs (p < 0.001). We conclude that all patients undergoing TURP should receive perioperative antimicrobial prophylaxis.

[Urologic complications after implantation of aortofemoral blood vessel prosthesis]. / Urologische Komplikationen nach aortofemoraler Gefässprothesenimplantation.

After implantation of aorto-femoral grafts, primary ureteral lesions and secondary ureteral obstructions are the most important urological complications. Surgical repair carried out as quickly as possible, including reanastomosis without tension and covering with a peritoneal patch or omentum interposition, seems the best means of preventing secondary complications. In the case of secondary obstructions, the interval between implantation of the graft and the diagnosis of obstruction has to be considered. A wait-and-see strategy is justified in the case of early obstruction without symptoms during the 1st year because of the high rate of spontaneous remission. Obstructions that appear more than 1 year after operation or symptomatic obstructions have to be treated immediately (i.e. duodenojejunal stent, percutaneous nephrostomy). If repeated obstructions after removal of stents or nephrostomies are noted, surgical repair seems to be indicated. Stents or nephrostomies as definitive procedures are appropriate only in patients in whom surgical revision is not possible or desirable.

Extracorporeal shock wave lithotripsy for ureteral stones: a retrospective analysis of 417 cases.

We treated 417 patients with upper ureteral stones with extracorporeal shock wave lithotripsy. All patients with obstructing stones underwent retrograde manipulation, which was successful in 57 per cent. Management of obstructing stones in situ (215 patients) with and without decompression of the collecting system required additional treatments in 13 per cent and ancillary procedures in 25 per cent. Nonocclusive ureteral stones were not manipulated. Treatment of these stones in situ slightly increased the need for postoperative ancillary procedures, compared to successful repositioning into the kidney (5.9 versus 3 per cent). Secondary treatments, however, were necessary as often as with occlusive stones. The main reason for failure of extracorporeal shock wave lithotripsy was the lack of fluid around an impacted stone. An energy absorptive effect of muscle tissue for stones projecting on the psoas muscle could not be demonstrated. The best and most consistent results were obtained when the stone was manipulated successfully into the renal collecting system.

Combined treatment of branched calculi by percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy.

Eighty-seven patients with branched renal calculi were treated by a combination of percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy. Stone debulking was achieved by percutaneous nephrolithotomy and residual stone fragments were destroyed by shock wave lithotripsy. Of the patients 70 (80 per cent) required 2 to 3 treatments, 12 (14 per cent) required 4 treatments and 5 (6 per cent) required 5 to 6 treatments. Results after 3 months indicated that 58 patients were free of stones, 3 had recurrent stones and 12 had disintegrated stone particles (less than 3 mm.) in the collecting system, while 13 were lost to followup. One patient had undergone nephrectomy. This treatment plan minimized the disadvantages of either technique when used alone and made open operative intervention unnecessary. Procedural and fluoroscopy times were reduced drastically compared to reported data on percutaneous nephrolithotomy only. We believe that more than 90 per cent of all branched calculi can be treated with this combined technique.

[Value of NMR tomography in the diagnosis and staging of prostatic neoplasms]. / Wertigkeit der Kernspintomographie bei der Diagnostik und Stadieneinteilung von Prostataneoplasmen.

MR imaging (MRI) possesses good sensitivity in diagnosis of carcinoma of the prostate. It is often not possible to distinguish clearly between carcinoma of the prostate and prostate hypertrophy. MRI can assess the local extension of a prostate carcinoma with a high degree of accuracy (85%); this applies in particular to periprostatic infiltration. MRI possesses only moderate sensitivity in diagnosis of regional lymph node metastases in the minor pelvis.

Giant hydroureteronephrosis. Case report and review of the literature.

A case of giant hydroureteronephrosis in a man is reported. Diagnostic evaluation included ultrasound, urethrocystoscopy and percutaneous puncture to assess the outline of the urinary tract and to locate a suspected ectopic ureteral orifice. Standard treatment usually consists of primary nephroureterectomy. A review of the literature with respect to etiology, diagnostic criteria and treatment modalities is presented.

[The so-called liposarcoma of the kidney. A case report and review of the literature]. / Das sogenannte Liposarkom der Niere. Fallbericht und Literaturübersicht.

A case of perirenal liposarcoma is described. The pathological criteria for diagnosis are discussed. A strict separation of perirenal liposarcomas, intrarenal hamartomas and sarcomatoid renal cell carcinomas is required. The diagnostic and therapeutic modalities are reviewed according to the recent literature.

[Value of nuclear magnetic resonance tomography in the diagnosis and stage determination of urinary bladder neoplasms]. / Wertigkeit der Kernspintomographie bei der Diagnostik und Stadienbestimmung von Harnblasenneoplasmen.

We arrived at the following conclusions in our study on the ranking of magnetic resonance tomography in diagnosis and staging of urinary bladder neoplasms: MR tomography possesses high sensitivity but only low specificity in diagnosing the local spread of the tumour. Sensitivity of MR seems to be better in respect of determining the paravesical tumorous spread, than that of other methods. However, it is not possible to determine the tumour status of a space-occupying growth. No advantages of MR over other methods, especially computed tomography, were seen in the examination of lymph node metastases in the minor pelvis.

Pyelocalyceal diverticula.

The aim of the present paper is to report on the frequency of pyelocalyceal diverticula and the relation to other renal abnormalities in 5000 routine IVPs. Pyelocalyceal diverticula are mostly occasional findings and they usually cause symptoms when complicated by inflammation or stones. These complications will characterize the symptoms. There is an indication for surgical treatment when the diverticula are complicated by stones or inflammation which fail to respond to simple antibiotic treatment. According to our experience, the removal of the diverticulum bearing renal segment is a safe procedure with good postoperative results.

Electrocardiographic findings in cystometric procedures.

Twenty-eight elderly patients, mostly with minor electrocardiographic abnormalities, underwent cystometry and simultaneous recording of the electrocardiogram in order to assess the influence of intravesical pressure elevation with regard to electrocardiographic changes. During cystometry intra-atrial, atrioventricular and ventricular conducting time remained unaffected, while the cardiac rate showed a moderate but significant increase without any serious impairment of cardiac function. It is concluded that slow filling without overdistension of the bladder can be considered safe even in elderly patients with cardiovascular problems.

Effects of the antioestrogen tamoxifen on steroid induced morphological and biochemical changes in the castrated dog prostate.

The effect of the antioestrogen tamoxifen (TA) was investigated in different types of steroid-induced benign prostatic hyperplasia (BPH) in the castrated dog by histological, histochemical and biochemical analysis. A 6 months treatment with oestradiol-17 beta (E2) alone resulted in cystic and stromal hyperplasia and squamous epithelial metaplasia with a striking prostatic weight increase DNA and RNA content of the total glands increased significantly. The histochemical results and zinc values indicated the loss of normal epithelial function due to metaplatic transformation. The E2 induced cystic and metaplastic hyperplasia was prevented by TA while the stromal proliferation was significantly decreased but not abolished. Biochemical determinations revealed an effect similar to castration. After combined treatment with E2 and 3 alpha-androstanediol (3 alpha-diol) TA completely suppressed squamous metaplasia. A 3 alpha-diol induced glandular proliferation, monitored by a positive histochemical reaction, and significantly elevated zinc, DNA and RNA contents prevailed. A partial stromal stimulation indicates stimulating effects of 3 alpha-diol too on the stroma. The antioestrogenic effects of tamoxifen on experimentally induced BPH mainly manifest at the E2 induced epithelial alterations. The abolishing effects at the stromal level are distinct but not so impressive.

Phenotypic modulation of the canine prostate after long-term treatment with androgens and estrogens.

Fine structural alterations of the canine prostate induced by long-term treatment of castrated adult animals with estrogens and/or androgens and also in combination with antiandrogens and/or antiestrogens for six months have been studied with particular respect to their topographic location within the gland. Three major patterns of structural responses of the epithelium have been distinguished: squamous metaplasia, atrophy, and hypertrophy, while in stroma, regression, hypertrophy, or sclerosis were observed. In addition to cellular alterations of stromal fibrocytes and smooth muscle cells, characteristic changes in the arrangement, distribution, and pattern of the different stromal elements occurred. General squamous metaplasia of the epithelium and regressive alterations of stromal cells were most obvious in animals treated with estradiol plus androstanediol. Atrophy of the epithelium and stromal sclerosis were the salient features of antiandrogen-treated castrated animals, while hypertrophy or hyperplasia of both the epithelium and stroma was a major finding in androstanediol-substituted castrated animals. Combined treatment caused rather heterogeneous structural patterns seemingly dependent on the location within the gland. The results indicate that the prostatic epithelial cells dispose of a broad variety of structural reaction patterns that, in case of combined hormonal treatment, are expressed in a manner typical for their locations within the ductal system of the gland. However, with the exception of combined treatment with estradiol, tamoxifen, and androstanediol of castrated dogs, none of the experimental protocols used induced a morphologic response of the gland comparable to that seen in human benign prostatic hyperplasia. The canine prostate therefore is of rather limited value as a model for human BPH.

Plasma renin activity and cardiovascular changes in patients with chronic bladder distension.

Arterial plasma renin activity, arterial blood pressure, heart rate and respiratory frequency were measured in 10 patients with chronically distended bladder due to benign prostatic hyperplasia before and after bladder drainage. After suprapubical bladder puncture there was a decrease in all the values. Similar changes were also found in 3 patients with artificially induced acute bladder distension, who did not suffer from infravesical obstruction. A significant correlation was found between the changes of the arterial pressure and arterial plasma renin activity. It is therefore suggested that the renin-angiotensin system might be involved in patients with bladder distension.

[Xanthogranulomatous pyelonephritis (author's transl)]. / Xanthogranulomatöse Pyelonephritis.

Xanthogranulomatous pyelonephritis, a special form of pyonephrosis, is hard to differentiate from other inflammatory or tumourous changes of the kidney. This is due to manifold clinical symptoms and uncharacteristic X-ray findings. The diagnosis is made histologically. The disease was observed in four female patients ages 11 to 53 years. Nephrectomy leads to cure in diffuse forms of the disease. In localised forms organ preserving operations with partial renal resections are sufficient.

Complications after extravesical antireflux operations.

The antireflux operation according to Lich-Grégoir (L-G) poses no particular technical problems and involves no major surgical stress to the patient. Of its intraoperative complications lesions to the bladder mucosa have to be considered in the first place. Its postoperative complications calling for reoperation comprise recurrence of reflux, ureteral stricture and ureteral fistula. Results of the Lich-Grégoir operation performed in 176 instances are reported. The complication rate was 4.5 per cent. The complications are commented upon, and the types and time of reoperations are discussed.

Influence of L-thyroxine upon enzymatic activity in the renal tubular epithelium of the rat under normal conditions and in mercury-induced lesions. I. Histochemical studies of alkaline phosphatase, acid phosphatase, adenosine- tri-phosphatase and leucine-aminopeptidase.

HgC12-induced renal tubular lesions in the rat present histochemically with a transitory decrease of alkaline phosphatase, adenosinetriphosphatase (ATPase), and leucine-aminopeptidase activity. The toxic alterations of enzyme activity were more pronounced in the pars recta of the proximal tubule and in the loop of Henle, as compared with the tubulus contortus I. L-thyroxine treatment leads to an accelerated reversal of that enzymatic defect, followinga characteristic pattern, and to a differentiating increase of acid phosphatase and ATPase activity in certain parts of the normal renal tubule. The observations are discussed with reference to the specific mode of action of sublimate and l-thyroxine upon the tubular enzymes and to the well-known metabolic and functional influences of thyroid hormone on the kidney.