MHC-dependent cytolysis of autologous tumor cells by lymphocytes infiltrating urothelial carcinomas.

Tumor-infiltrating lymphocytes (TIL) were grown from 23 urothelial carcinomas. Phenotyping analysis showed that the TIL cultures were mainly CD3+. Although CD4+ and CD8+ T-cell sub-sets were grown in culture, CD4+ T-cell sub-sets predominated over CD8+ T cells. Immunohistochemical studies performed on 5 tumor specimens confirmed this observation, and indicated that CD4+ T cells surrounded the tumor islets, whereas CD8+ T lymphocytes were localized among the tumor cells. Five short-term carcinoma cell lines established from these urothelial tumors were used as target cells in cytolysis assays in order to investigate the functional anti-tumor activity of autologous TIL. TIL from 4/5 tumors were lytic and 3 TIL lines displayed MHC-class-I-dependent cytotoxicity directed against autologous tumor cells. CD4+ T-cell-depletion experiments performed on TIL line 07 confirmed that CD8+ MHC-class-I-dependent CTL were the predominant effectors. Finally, experiments performed on 6 allogeneic urothelial-cancer cell lines matched for HLA-class-I molecules showed that TIL07 exhibited selective lytic activity toward tumor 07. These data indicate that CD8+ MHC-class-I-dependent CTL present in urothelial carcinomas are functional and may participate in the anti-tumor immune response.

[Problems raised by representation of activities in urology. Cooperative study by the urology services of the AP - HP (Public Services - Paris Hospitals)]. / Problèmes posés par la représentation de l'activité en Urologie. Travail coopératif des services d'urologie de l'AP-HP.

Paris public hospital urology departments conducted a study which had three objectives: - to test the indicators of activity to determine whether they were well adapted to measurement of the surgical activity performed, - to determine the contribution of the PMSI to the measurement of this activity, - to propose actions designed to improve the representation of the surgical activity actually performed by urology departments. The results of this study show that one half of the operations performed do not correspond to the field of PMSI (day-only admissions, outpatients department). The indicators currently used for budget allocation or interdepartment comparisons of activity are inadequate and, most importantly, induce deformities, variable from one department to another, which severely affect the image of the activity produced by these indicators. Two main reasons can explain these deformities: - the use of the NGAP and the score to measure activity: there is a marked variation of the score for the same operation, from one department to another. - the very poor census of activity performed in outpatient surgery. These two reasons are not related to the medical activity. Definition of a unique nomenclature for surgical procedures would constitute a great progress, provided that this nomenclature allows us to accurately describe our activity and can be modified according to our needs. Although the PMSI is a marked improvement of the information system, its application, in its current state, will not radically change the situation. The PMSI must be enlarged in one way or another, to outpatient activity including procedures performed in the outpatients department. For these measuring tools of activity, which determine the calculation of our budgets, to be adapted to our practice, we must be able to analyse their relevance and introduce changes. We need to develop this field of medico-economic research in urology.

[Neoplastic ureteral obstruction: drainage by percutaneous nephrostomy or double J catheterization]. / Obstruction urétérale néoplasique: drainage par néphrostomie percutanée ou par sonde double J.

OBJECTIVES: Neoplasic obstruction of the ureter is observed in patients with pelvic or extra-pelvic cancer. Indications of upper urinary tract drainage need to be clarified. METHODS: Percutaneous nephrostomy or double J catheter drainage was performed in 104 patients with ureteral obstruction due to pelvic cancer (bladder, prostate, uterus, ovary, rectum) or extra-pelvic cancer (usually breast and digestive cancers). Percutaneous nephrostomy or double J catheter was the first drainage procedure in 85 and 76 patients respectively. RESULTS: Success rate in first intention drainage was 74.5% with the double J catheter. When this procedure was impossible, percutaneous nephrostomy was always performed. In 52 cases we attempted to convert the nephrostomy to double J catheter drainage. Success rate was 68.8%. The main complications observed were ineffective drainage (12.5%) and infection (10.5%). CONCLUSION: These patients have a mean survival of 6.8 months despite the chemotherapy which is facilitated by the improved renal function.

Acute primary hyperparathyroidism: experience of 59 cases.

Acute primary hyperparathyroidism is a rare disease with a high mortality rate in some series. Between 1960 and 1986, 1000 patients were treated for primary hyperparathyroidism, among them 59 patients with acute hyperparathyroidism. All these patients were successfully operated on; none of them died before surgery. This study reveals the importance of resuscitation and urgent surgery. It is necessary to rehydrate, to correct electrolyte disorders and to lower serum calcium levels, but it is not necessary to obtain normal serum calcium levels before surgery.