Treatment of prostatic cancer with Estracyt (estramustine phosphate).

The experience gained with Estracyt, kindly supplied by AB LEO, Sweden, is reported. On the basis of former data in the literature we only used the drug in estrogen resistant and advanced cases. Estracyt (estramustine phosphate) is a nitrogen mustard derivative of the urethan type, attached to oestradiol-17-phosphate. In histologically verified cases, it was administered in daily doses of 300 mg intravenously for three weeks, followed by maintenance doses of 300 mg a week in tablets for three months. During treatment, liver and bone marrow function was checked systematically. The changes in morphological picture were studied by means of biopsies during and at the end of treatment. In agreement with the data in the literature a favourable effect was observed in estrogen resistant patients, with no toxic effect whatever on the bone marrow. At the same time GOT and GPT and BSP retention examinations demonstrated a hepatotoxic side effect. The pathological values returned to normal after withdrawal of the drug. Histological examinations showed that the tumour cells had changed but failed to disappear after treatment.

Real-time ultrasonography: a new tool for the intraoperative localization of renal calculi (preliminary communication).

A B-scan real-time ultrasonic equipment providing three-dimensional information was used for intraoperative localization of renal calculi. Simplicity, non-invasiveness and ability to demonstrate radiolucent calculi or matrix are stress as the main advantages of the method. Its current use on a larger scale is expected and regarded as desirable.

Four-channel radioisotope renography (complex investigations).

An attempt has been made at a fuller utilization of the information content of 131I-Hippurate in four-channel renography, recording the activities over the kidneys, heart and bladder. The four-channel system was supplemented with a digital scaler, which enabled also the volume of residual urine to be determined after renography. In functional disorder of the upper outflow tract, the examinations were performed in both supine and sitting positions. The expanded procedure has rendered the familiar method of renography more valuable and has often given essential diagnostic help when used in combination with other clinical data.

Ten years of diagnostic ultrasound in renal disease.

Observations with diagnostic ultrasound in renal disease over a 10-year period are reviewed. The advantages of diagnostic methods involving the least possible discomfort to the patient are emphasized. Ultrasonography is regarded as a reliable non-invasive method for the diagnostic differentiation between renal tumours and cysts. It was used by the authors for this purpose in 740 cases. Renal tumours were found by this method in 622, and renal cysts in 118 cases. Of the 740 patients, 726 underwent surgery. The preoperative ultrasonic diagnosis of renal tumour proved to be correct in 91.8 per cent, that of renal cyst in 88.9 per cent of the respective surgical cases. Ultrasonography also lends itself to the follow-up of polycystic disease of the kidney, being suited for its early diagnosis, as well as to its identification in the stage of renal failure when the traditional diagnostic methods are no longer practicable.

Estimated frequency of acute and chronic renal insufficiencies in a Transdanubian region of Hungary.

The literature on the incidence of chronic and acute renal insufficiency is reviewed and the results of own investigations in an area with a population of 1,560,000 are presented. Data were collected in questionnaires. The yearly incidence of patients with chronic uraemia requiring active therapy was estimated at 33 per 1 million population. The number of acute cases was 45 per million. The necessity of increasing the dialysis capacity is stressed. The importance of peritoneal dialysis in the therapy of uraemia cases which do not meet the requirements of the acute and chronic dialysis programmes is emphasized.

Ultrasonic measurement of residual urine: a method requiring no catheter.

Residual urine was measured with the two-dimensional and the gray-scale equipments (Kretz-Technik) in 26 cases each. The results were checked by catheterization. The difference between the ultrasonographic and the catheter values was 20 to 40 ml for the two-dimensional, but only 5 to 10 ml for the gray-scale apparatus. Ultrasonography is regarded as a reliable and entirely harmless procedure, suited for the measurement of residual urine.

Study of hydroxyproline excretion in patients with prostatic cancer.

Urinary hydroxproline concentrations were measured in 36 prostatic cancer patients. Metastases were ruled out by radiography in 24, and confirmed in 12 cases.14 patients with no malignant disease served as controls. In patients with no metastases excretion was similar to that in the controls, in some of them it was higher. In the patients with higher values the studies were repeated six months later: deposits were found in all cases but one. In the group in which deposits had been present at the outset the values of the untreated patients were significantly higher than in the controls, whereas in the treated patients no consistent values were found.

Diagnostic ultrasound in urology.

Diagnostic ultrasound has been used over the last eight years for the demonstration of various space-occupying lesions of the urogenital tract, for the estimation of the prostate size and for the identification of intrascrotal processes and tumours. 918 patients were studied by this method. In 595 (87.3 per cent) of the 682 surgical cases in this series ultrasonic diagnosis was confirmed by the surgical finding. False-positive and false-negative results totalled 17.7 per cent. The method is particularly suited for the differential diagnosis of renal cysts from tumours without the need for other procedures involving discomfort to the patients. This procedure, which is free from any iatrogenic hazard, provides accurate information on the size and structure of space-occupying lesions.

The investigation of cellular and humoral immune reactivity in patients with tumours of the bladder.

The authors investigated the cellular immune reactivity by measuring the lymphocyte blast transformation, immune globulins and some glycoproteins in the sera of patients with papilloma and carcinoma of the bladder. They found a change in the cellular immune reactivity, but none in immune globulin concentration. Among the glycoproteins the acute phase reactant proteins changed significantly.

[Ureteroureterostomy following Coffey operation (author's transl)]. / Termino-Laterale Ureteroureterostomie nach Coffey-Operation.

Ipsilateral end-to-side uretero-ureterostomy of a duplicated ureter was carried out following a Coffey operation for bladder contracture. The advantages of this procedure over an additional uretero-intestinal anastomosis are outlined.

[The value of rectal examination in the diagnosis of prostatic cancer (author's transl)]. / Wertigkeit des rektalen Tastbefundes bei der Diagnostik des Prostatacarcinoms.

Rectal examination is the basic step in the diagnosis of carcinoma of the prostate. However its accuracy is limited because cancerous nodules are often difficult to differentiate from certain benign conditions which cause areas of induration. Needle biopsy is necessary for establishing the diagnosis of cancer. 699 men with palpable lesions of the prostate underwent transperineal biopsy. Out of 251 patients with advanced lesions only 171 (68.1%) had a histologically proved carcinoma of the prostate. Out of 119 men with an isolate firm nodule 50 (42%) had a positive biopsy whereas in only 62 (18.8%) of 267 biopsies of glands with changes in consistency and indurations histological examination confirmed the diagnosis of prostatic carcinoma.