Lymphadenectomy in Urology.

Surgical radicality in tumours of the urinary tract with lymphonodular deposits requires extirpation of the adjacent and regional lymphadenoid tissues, in particular of the lymph nodes. The theoretical and practical aspects of lymphadenectomy in testicular and renal tumours are discussed, and the technical problems are outlined. The importance of early diagnosis and the benefits of surgery of adequate radicality involving lymphadenectomy are emphasized.

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.

[Surgical treatment of ureterectasia]. / Chirurgische Behandlung von Uretererweiterungen.

Ureterectasia can be congenital (mega-ureter) or acquired (hydro-ureter). Mega-ureters can be of reflux and non-reflux (obstructive) type. The essence of primary non-reflux mega-ureters is the presence of a prevesical adynamic segment which causes functional obstruction. The musculature of this segment is abnormal in both function and structure. A surgical solution of the malformation is recommended mainly in children and young adults. In 10 years, 17 patients were subjected to 22 operations. After removal of the obstructive segment and straightening of the ureter, it was implanted into the vesicle through an intravesical tunnel. With the exception of two cases where nephrectomy had to be done and a case with persisting reflux, the other operations were successful. Narrowing of the ureter was not done. Ureteral neo-implantation is preferred to Boari's operation. Isolated pelvis ureters are operated only in the case of complications.

Repeated biopsies in evaluation of therapeutic effects in prostate carcinoma.

BACKGROUND: Apoptosis is one of the major events following total androgen blockade (TAB). The aim of this study was to determine the predictive value of some histological parameters including apoptosis and gene products which influence apoptosis, based on repeated biopsies taken from the same patients. METHODS: At the time of diagnosis by needle biopsy TNM stage, serum PSA, Gleason's grade, apoptotic and mitotic index, Ki67, p53, and bcl(2) expression were investigated in 60 prostate carcinoma patients. Antiandrogen therapy supplemented with surgical or chemical castration was administered. Serum PSA-test and needle biopsy were repeated 13-14 weeks after starting the therapy, simultaneously with determination of the apoptotic and mitotic index, Ki67, p53, and bcl(2) expression. RESULTS: Forty-seven patients were alive at the end of the study, 13 patients died. Decrease in mitotic, increase in apoptotic index predicted favourable long-term response to antiandrogen therapy. Lower Ki67 and (mutant) p53 expression in the first and also in the second biopsy pointed to favourable effect of antiandrogen treatment. Since the ratio between Ki67 and apoptotic index strongly decreased in the survivors upon therapy, changes in Ki67/apoptosis ratio is recommended as a histologically detectable predictive factor. bcl(2) expression did not show significant correlation with the outcome of the disease. CONCLUSIONS: Histological evaluation of mitotic and apoptotic index, Ki67, and p53 expression in repeated biopsies contributes to predicting the value of the actual treatment and may be useful to institute alterations in therapy.