Human papilloma virus (HPV) and p53 immunostaining in advanced tonsillar carcinoma--relation to radiotherapy response and survival.

BACKGROUND: Human papilloma virus (HPV), which is frequently present in tonsillar carcinoma seems to be a prognostically favourable factor for patient survival and also for low risk of relapse. Since HPV may abrogate the function of wild type p53 and hence influence radiosensitivity we attempted to analyse if HPV and p53 status in tonsillar carcinoma affected tumour response to radiotherapy (RT) and patient survival. MATERIALS AND METHODS: Pre-treatment primary tonsillar carcinoma specimens were obtained retrospectively from 40 patients, 21 complete responders (CR) and 19 non-complete responders (non-CR) of which 38/40 were stage III and IV tumours. The paraffin-embedded biopsies were analysed for presence of HPV DNA, by general and type specific PCR, and for p53 overexpression by immunohistochemical staining with the murine Mab DO-1. RESULTS: It was possible to analyse HPV in 34 and p53 in 39 patients. Presence of HPV DNA (HPV+) and p53 immunostaining (p53+) were not correlated with response to RT, since 8/18 CR patients and 6/16 non-CR patients were HPV+ and 11/21 CR patients and 8/18 non-CR patients were p53+. A tendency towards a survival benefit in patients with HPV+ tumours was observed and this tendency was significant for patients with stage IV HPV + tumours (p = .0431), and in particular HPV+/p53- cancers (p = .0195). A difference in survival between patients with p53+ cancer as compared to patients with p53- lesions was not demonstrated. In conclusion, although presence of HPV and p53 immunoreactivity in tonsillar carcinoma could not be related to RT response, determination of HPV and p53 status may still prove useful as predictive/prognostic markers.

Human papillomavirus (HPV) DNA in tonsillar cancer: clinical correlates, risk of relapse, and survival.

Human papillomavirus (HPV) is more commonly found in tonsillar cancer than in other head and neck cancers. The importance of HPV status in tonsillar cancer for prognosis remains unclear. The aim of the present study was to investigate the frequency of HPV in tonsillar cancer and to correlate the presence of HPV with tumor stage, nodal status, grade of differentiation, risk of relapse, and survival. HPV DNA and HPV type were determined, using PCR, in pre-treatment biopsies from 60 cases of primary tonsillar cancer. All patients had undergone full-dose radiotherapy, 45% as the only treatment modality, and 55% in combination with surgery. HPV 16 was detected in 43% (26/60) of the cancers including 1 double infection of both HPV 16 and HPV 33. Patients with HPV(+) tonsillar cancer showed less risk of relapse within 3 years after diagnosis, with a better odds ratio of 4.18 as compared with HPV(-) patients (p = 0. 025). Furthermore, cause specific survival was significantly (p = 0. 047) better in patients with HPV(+) tonsillar carcinomas. At 3 years after diagnosis the survival rate was 65.3% in the HPV(+) group and 31.5% in the HPV(-) group, and at 5 years the survival rate was 53. 5% and 31.5%, respectively. The better outcome for patients with HPV(+) tonsillar cancer was independent of TNM stage, nodal status, gender and age. These results indicate that HPV status is a significantly favorable prognostic factor in tonsillar cancer and may be used as a marker in order to optimize the treatment of patients with this type of cancer.

Adult X-linked immunodeficiency (XID) mice, IGM-/- single knockout and IGM-/- CD8-/- double knockout mice do not clear polyomavirus infection.

The importance of antibodies for elimination of polyomavirus infection and the prevention of virus induced oncogenesis was studied, X-linked immunodeficiency (XID) mice, IgM-/- single knockout and IgMI-/- CD8-/- double knockout mice, all defective in antibody production, and normal control mice were infected with polyomavirus as adults. The mice were followed for presence of polyoma DNA with a polyoma specific polymerase chain reaction (PCR) over 6 weeks post infection (p.i.), a time point at which polyomavirus DNA is no longer detected in normal adult infected mice. As expected, virus DNA was not detected in normal mice 6 weeks p.i. In both IgM-/- single knockout and IgM-/- CD8-/- double knockout mice a disseminated infection was still observed by 6 weeks p.i. and the latter group of mice succumbed around two months p.i. In XID mice, only one third of the mice were still positive for viral DNA 6 weeks p.i. No polyomavirus induced tumors were observed in any of the mice during the 2-4 month observation period.

Ureteroscopy under local anaesthesia with and without intravenous analgesia.

In a prospective study of 302 ureteroscopic procedures, 161 were commenced and 133 completed without the use of general or regional anaesthesia. In 15 patients ureteroscopy (URS) was performed with lignocaine jelly in the urethra only, and in 118 with additional intravenous analgesia. Alfentanil, a synthetic morphine derivative, was used for intravenous analgesia. Ureteroscopy was performed prior to extracorporeal shock wave lithotripsy in 46 patients, for stone basketing in 40, for stone fragmentation in 29, for diagnostic purposes in 14 and for cold knife ureterotomy in 4. Ureteric lesions were observed in 9 patients (6.8%) treated under intravenous sedoanalgesia. This percentage is within the range reported in other series of patients treated under general anaesthesia. The findings suggest that URS, when performed without general or regional anaesthesia, does not increase the risk of complications or compromise the results of treatment.

Changes in erythropoietin serum levels by extracorporeal shock wave lithotripsy.

Erythropoietin (EPO) serum levels were measured in 30 patients before, during and immediately after shock wave treatment by an enzyme immunoassay. Shock wave treatment was performed in the Dornier lithotripter HM3 under a constant voltage of 18 kV. In 16 out of 30 patients, an increase in the EPO serum level of over 10 U/l more than the value obtained prior to the treatment was observed. Differences ranged from 11 to 50 U/l. In 3 patients EPO serum concentration after shock wave treatment rose above the physiological limit of 54 U/l. Increased EPO serum levels have been observed after applications both under and over 1,000 shock waves. The small number of cases does not allow a statistical correlation between the number of shock waves and the elevation of the EPO serum concentration. Further investigations are necessary to define the circumstances by which an increase in EPO serum level occurs under shock wave treatment.

[Seminal duct malformations: clinical picture, diagnosis and therapy]. / Missbildungen der Samenwege: Klinik, Diagnostik und Therapie.

Seminal duct abnormalities occur more often than generally assumed. In most cases, they remain undetected if diagnostic measures are not undertaken because of infertility or recurrent urinary tract infections. An IVP should be performed if aplasia of the vas is detected, since ipsilateral agenesis of the kidney may also be present. In spite of the improved techniques available today, reconstructive surgery on seminal duct abnormalities usually yields poor results.

[Crossed dystopia of the kidney and an ectopic ureteral orifice]. / Gekreuzte Dystopie der Niere und ektope Harnleitermündung.

We report on a case of crossed renal ectopia with fusion and a refluxing single ectopic ureteral orifice in the prostatic urethra in a renal transplant recipient. The diagnosis was made on the basis of a chronic urinary tract infection and a refluxing ectopic ureteral stump. Crossed ectopia with fusion was found intraoperatively. Nephroureterectomy cured the urinary tract infection.

[Results with the Marshall-Marchetti bladder neck suspensionplasty in female stress incontinence]. / Ergebnisse mit der Blasenhals-Suspensionsplastik nach Marshall-Marchetti bei der weiblichen Stress-Inkontinenz.

Bladder neck suspension as described by Marshall and Marchetti 1949 is the procedure of first choice for vertical descensus of the urinary bladder. Our experiences with this operation between January 1979 and January 1982 are reported on 23 cases. The procedure was successful in 78% although there were previous operations in 14 out of 23 patients. The rate of complications such as wound-infection, urinary tract infection and ostitis pubis was low. There was no mortality. Treatment failures only occurred in obese women, who gained weight considerably in the postoperative period.

[Significance of postoperative substitution of plasma proteins]. / Uber die Bedeutung der postoperativen Zufuhr von Plasmaproteinen.

In the course of a pilot study 30 patients, who had to undergo extensive urological-abdominal surgery, were randomized and divided into two groups. One group received 500 ml of the stored serum Biseko on the day of operation as well as on the first postoperative day, the other group was given a placebo. The two groups were compared with regard to their complications rates (wound healing disturbance, respiratory disturbance on account of septicemia). It turned out, that there occurred clearly less complications in the group treated with Biseko than in the control group.

[Transposition of penis and scrotom (author's transl)]. / Transposition von Penis und Skrotum.

A complete transposition of penis and scrotum with cleft of the glans penis and penile hypospadia is described in a 43-year-old man. The embryology of this rare malformation is discussed and the literature reviewed. The surgical correction of the reported case is described.

[Failure following fertility vasectomy]. / Misserfolge nach Fertilitätsvasektomie.

PIP: Although rare, failure of vasectomy can occur and should be avoided. Incidence of failure is put at 0-3%. Causes of failure are: 1) non-severance of vas deferens, 2) non-observance of period to sperm-free ejaculate after successful vas ligation, 3) recanalization of vas deferens after ligation, and 4) duplication of vas deferens was not recognized. The vas deferens is occasionally confused with neighboring structures especially in a bloody field. Verification of vas deferens resection should be done histologically. Spermatozoa can be found up to several months after successful vas ligation. They originate from seminal vesicle glands and vas deferens. Intraoperative injection of 5 ml. 0.9% aqueous nitrofurantoin solution in the central ductus stump results in inhibition of sperm motility and azoospermia. No coitus without contraceptive protection should be undertaken until proof of azoospermia is established. First spermiogram is done 6-8 weeks after procedure. Spontaneous recanalization may occur depending on vasectomy method. Factors in this process may be proliferation of ductus endothelium, formation of sperm granulomas, and tissue necrosis leading to reattachment of severed ends. Recanalization can be prevented by large resection (3-5 cm), electrocoagulation of stump epithelium or doubling over of ligated stumps. Spermatozoa antibodies develop in 50% of all vasectomized men. They cause permanent sterility even in successful vasectomy reversal. Duplication of testis and vas deferens is rare and an unlikely cause of vasectomy failure. Couples seeking vasectomy should be informed of possible failure and especially of pregnancy possibility without azoospermia.^ieng

[Ectopia of vas deferens with opening into the ureter (author's transl)]. / Ektopie des Ductus deferens mit Einmündung in den ureter.

A 13 years old boy with a 2 year history recurrent rightsided epididymitis was found to have an ectopic orifice of the vas deferens opening into the distal part of the left ureter of a hypoplastic left kidney. Because of possible interference with fertility vasovesiculography was not done. Therefore it could not be identified whether the vas deferens was of right or left sided origin. The genesis of this extremely rare malformation is discussed.

[Sonographic examination in diseases of the scrotal area (author's transl)]. / Sonographische Untersuchung bei Erkrankungen des Skrotalinhaltes.

Sixty-two patients with diseases of the scrotal area were examined sonographically. In 11 out of 12 testicular tumors, a preoperative diagnosis could be confirmed by examination with ultrasonication, including one case with large accompanying hydrocele, which made an exact palpation of the testicles impossible. Despite the still small number of cases, we feel that ultrasonic examination of the testicles makes it possible to speed up the diagnosis of testicular tumors, which is often drawn out over weeks or months, and to provide the patients with early operative therapy.

[Treatment of chlamydial urethro-adnexitis with erythromycin]. / Behandlung von Chlamydien-Urethro-Adnexitiden mit Erythromycin.

Besides mycoplasmas and ureaplasmas chlamydias are able to cause an urethro-adnexitis in men. Jeasts, trichomonas and herpes-viruses are in our patients of less importance. Therapy with erythromycine of chlamydial urethroadnexitis is successful.

Pharmacokinetics of cefamandole in patients with normal and impaired renal function.

The pharmacokinetics of cefamandole, a new cephalosporin, were investigated in 23 patients with urinary tract infections and normal or varying degrees of impairment of renal function. A daily dose of 1.5 to 3.0 g administered intramuscularly was tolerated well and resulted in very high urine concentrations. The pharmacokinetics of the antibiotic were compared with isotopically labeled [(131)I]hippurate and [(125)I]iothalamate, which were used for determination of effective renal plasma flow and glomerular filtration rate, respectively. It was shown that cefamandole was excreted by glomerular filtration as well as by active tubular secretion. Probenecid inhibited the tubular secretion of cefamandole. The serum half-life of cefamandole in patients with normal renal function was approximately 1.5 h and increased in patients along with increasing impairment of renal function. Our studies indicate that a dosage regimen of 1 g of cefamandole every 8 h in patients with normal renal function results in urine concentrations sufficiently high for treatment of most common urinary tract infections. In patients with impaired renal function, the dosage interval should be increased or the dosage lowered according to the serum creatinine values.

[The infrared contact coagulator for hemostasis in the renal parenchyma (author's transl)]. / Blutstillung am Nierenparenchym mit dem Infrarot-Kontakt-Koagulator

Investigations on hemostasis with the infrared contact coagulator (ICC) after renal pole resections in dogs with and without clamping of the renal vessels are reported. Clamping the renal vessels led to less bleeding, but the coagulation time was distinctly prolonged. In addition the use of ICC in renal pole amputations in humans is described in two cases of urogenital tuberculosis. In both cases we were able to stop the bleeding quickly and satisfactorily without clamping the renal vessels. The results of animal experiments and the significance of using the ICC in man are discussed.

Crossed ectopia of seminal vesicles, renal aplasia and ectopic ureter.

A unique case of left ureteral opening into a seminal vesicle, ipsilateral renal hyperplasia and crossed ectopia of the seminal vesicles is reported. This 24-year-old white man underwent a nephroureterectomy for relief of symptoms of lower urinary tract infection. The embryological development of this abnormality is discussed briefly.