Clinical and pathological nodal staging score for urothelial carcinoma of the bladder: an external validation.

PURPOSE: Radical cystectomy (RC) and pelvic lymph node dissection (LND) are standard treatments for muscle-invasive urothelial carcinoma of the bladder. Lymph node staging is a prerequisite for clinical decision-making regarding adjuvant chemotherapy and follow-up regimens. Recently, the clinical and pathological nodal staging scores (cNSS and pNSS) were developed. Prior to RC, cNSS determines the minimum number of lymph nodes required to be dissected; pNSS quantifies the accuracy of negative nodal staging based on pT stage and dissected LNs. cNSS and pNSS have not been externally validated, and their relevance for prediction of cancer-specific mortality (CSM) has not been assessed. METHODS: In this retrospective study of 2,483 RC patients from eight German centers, we externally validated cNSS and pNSS and determined their prediction of CSM. All patients underwent RC and LND. Median follow-up was 44 months. cNSS and pNSS sensitivities were evaluated using the original beta-binominal models. Adjusted proportional hazards models were calculated for pN0 patients to assess the predictive value of cNSS and pNSS for CSM. RESULTS: cNSS and pNSS both pass external validation. Adjusted for other clinical parameters, cNSS can predict outcome after RC. pNSS has no independent impact on prediction of CSM. The retrospective design is the major limitation of the study. CONCLUSIONS: In the present external validation, we confirm the validity of both cNSS and pNSS. cNSS is an independent predictor of CSM, thus rendering it useful as a tool for planning the extent of LND.

Endogenous BTG2 expression stimulates migration of bladder cancer cells and correlates with poor clinical prognosis for bladder cancer patients.

BACKGROUND: The B-cell translocation gene 2 (BTG2) is considered to act as a tumour-suppressor gene because of its antiproliferative and antimigratory activities. Higher levels of BTG2 expression in tumour cells have been linked to a better clinical outcome for several cancer entities. Here, we investigated the expression and function of BTG2 in bladder cancer. METHODS: The expression of BTG2 in bladder cancer cells was silenced by RNA interference. Cell motility was investigated by wound healing and Boyden chamber assays. The protein expression of BTG2 in bladder cancer was studied by immunohistochemistry. RESULTS: We observed that targeted suppression of BTG2 by RNA interference did not result in growth stimulation but led to a substantial inhibition of bladder cancer cell motility. Tissue microarray analyses of bladder cancer cystectomy specimens revealed that higher BTG2 expression levels within the tumours correlated strongly with a decreased cancer-specific survival for bladder cancer patients. CONCLUSION: These results indicate that endogenous BTG2 expression contributes to the migratory potential of bladder cancer cells. Moreover, high levels of BTG2 in bladder cancers are linked to decreased cancer-specific survival. These findings question the conception that BTG2 generally acts as a tumour suppressor and typically represents a favourable clinical marker for cancer patients.

Comparison of inguinal approach, scrotal sclerotherapy and subinguinal antegrade sclerotherapy in varicocele treatment: a randomized prospective study.

We compared outcome and complications of three simple varicocelectomy techniques. Groups were divided according to whether they would receive the Ivanissevich technique (n = 55), Tauber's technique (n = 51) or subinguinal sclerotherapy (n = 49). Selection criteria were: infertility >1 year, subnormal semen, sonographic diameter of veins >3 mm and time of regurge >2 s. Patients were randomly assigned to the groups of treatment, with follow-up every 3 months for 1 year. Improvement was only in sperm count and total motility for all groups. Pregnancy rates were 20, 13.73 and 12.24%, respectively, with no significant difference between groups. Hydrocele occurred only in the group which received the Ivanissevich technique (5.5%). Tauber's technique is simple; however, it has the disadvantage of multiple branching of small veins.

Chemical waves.

Spatial structures may occur in nonlinear systems far from equilibrium. Chemical waves, which are concentration variations of chemical species propagating in a system, are an example of such structures. A survey is given of some experiments on chemical waves by spectroscopic and microphotographic techniques, arranged according to different types of waves, different geometries, and various properties.

Curvature and propagation velocity of chemical waves.

The collision of circular chemical waves in an excitable medium, the Belousov-Zhabotinskii reaction, leads to characteristic cusplike structures. The high curvatures of these structures are especially suitable for experimentally verifying the predicted proportionality between the velocity and the shape of traveling waves. A computerized spectrophotometric video technique with microscopic resolution was used to determine the proportionality factor (2 x 10(-5) square centimeter per second), which in this case is the diffusion coefficient of the autocatalytic species of the reaction system. A numerical calculation of the spatiotemporal evolution of the cusp structure is in good agreement with the experimental observations.

The reversal and splitting of waves in an excitable medium caused by an electrical field.

The reversal and splitting of traveling concentration waves was observed in a one-dimensional Belousov-Zhabotinski reaction medium under the influence of low-intensity electric field gradients ( approximately 10 V per centimeter). The wave reversal and splitting were strongly correlated with a characteristic transformation of the shape of both the wave front and the refractory tail of a wave in the local field gradient. The secondary role of generated hydrodynamic flow on wave transformation was also investigated.

Curiosities in periodic precipitation patterns.

Observations have been made of several types of Liesegang patterns that are more complex than the usual concentric ring or parallel bands of precipitate. The structures observed show radial gaps, segmentation, irregular patterns within concentric rings, add the formation of spiral precipitation bands instead of sets of parallel Lisegang bands.

The structure of the core of the spiral wave in the belousov-zhabotinskii reaction.

The quantitative structure of the core of the spiral-shaped traveling wave of chemical activity appearing in a thin excitable layer of the Belousov-Zhabotinskii reaction, in which the oxidation and decarboxylation of malonic acid by bromate ions is catalyzed by ferroin, was analyzed experimentally. Light absorption by ferroin as the reduced reaction catalyst and indicator was measured by means of a video-and computer-based two-dimensional spectrophotometer with 10-micrometer spatial, 2-second temporal, and 256-digital units intensity resolution. The spiral core is a singular site (diameter, 30 micrometers or less) at which intensity modulations due to ferroin-ferriin distributions are at least ten times smaller than in the surrounding area of spiral propagation. Archimedian spirals were fitted to isoconcentration lines.

Rotating spiral waves created by geometry.

The Belousov-Zhabotinsky reagent and numerical simulations were used to show that under high-frequency stimuli, rotating spiral waves can be initiated in a homogeneous excitable medium in the vicinity of domain boundaries or inexcitable barriers with sharp corners.

Spatial patterns from oscillating microtubules.

Microtubules are fibers of the cytoskeleton involved in the generation of cell shape and motility. They can be highly dynamic and are capable of temporal oscillations in their state of assembly. Solutions of tubulin (the subunit protein of microtubules) and guanosine triphosphate (GTP, the cofactor required for microtubule assembly and oscillations) can generate various dissipative structures. They include traveling waves of microtubule assembly and disassembly as well as polygonal networks. The results imply that cytoskeletal proteins can form dynamic spatial structures by themselves, even in the absence of cellular organizing centers. Thus the microtubule system could serve as a simple model for studying pattern formation by biomolecules in vitro.

[Life-threatening bleeding from ileal conduit venous varices in a patient with portal hypertension]. / Vitalitätsgefährdende Blutungen aus einem Ileumconduit bei Varikosis im Rahmen einer portalen Hypertension.

Life-threatening bleeding from portosystemic varices is a feared complication of portal hypertension. Particularly, varices in atypical locations-so-called ectopic varices-pose a challenge for diagnosis and therapy. In the present article, we describe the case of a patient with liver cirrhosis and recurrent bleeding from an ileal conduit resulting from peristomal varicosis. The difficult and hence delayed diagnosis led to a life-threatening hemorrhage that was successfully treated with interventional radiological variceal embolization and TIPS (transjugular intrahepatic portosystemic shunt) implantation.

Malignant mixed mullerian tumor of the urinary bladder in a 73 year old woman.

A giant tumor of the urinary bladder in a 73 year old female patient consisting of mesenchymal and epithelial parts turned out to be the first case of a Malignant Mixed Muellerian tumor of the urinary bladder.

MR imaging of the prostate at 3.0T with external phased array coil - preliminary results.

INTRODUCTION: Among all imaging modalities, MRI of the prostate has the highest sensitivity to predict extracapsular tumor spread, seems to have added value for the preoperative treatment planning. It is an adjunct tool in patients with high suspicion of prostate cancer and so far negative TRUS-guided biopsies. Due to the higher intrinsic signal, it is expected that 3.0T enables to image the prostate without endorectal coil. Aim of this study was to evaluate the diagnostic accuracy of phased array coil 3.0T MRI in patients with suspicion of prostate cancer. MATERIAL AND METHODS: A high spatial resolution T2-w 3.0T pulse sequence (0.47 x 0.47 x 3mm voxel size) was performed in 26 patients prior to US-guided biopsy. Qualitative analysis comprised visual signal to noise, tissue contrasts and motion artifacts. MR diagnoses were correlated with histology. Diagnostic indices for the detection of prostate cancer in the peripheral zone were calculated. RESULTS: Histopathologic examination revealed pro?state cancer in 12 and benign prostate disorders in 14 patients. Motion artifacts due to peristalsis were rated moderate. Mean visual signal to noise was high. Contrast between peripheral and central zone of the prostate was excellent. MRI had 4 false negative and 2 false positive diagnoses (sensitivity 66.7 %, specificity 86.7 % diagnostic accuracy 76.9%). CONCLUSION: At 3.0T, diagnostic indices for cancer detection seem to be comparable to data reported about endorectal 1.5T MRI. Thus 3.0 T offers new options for MR imaging of the prostate in selected patients who cannot or are not willing to be examined with the endorectal coil.

Kidney's nightshift, kidney's nightmare? Comparison of daylight and nighttime kidney transplantation: impact on complications and graft survival.

BACKGROUND: Organ distribution and internal procedures often delay kidney transplantation into nighttime. Consequently, surgeons start the operation at a time different from normal working hours, and nighttime work is accompanied by higher incidence of complications. Surgical complications in kidney transplantation often require reoperation, and graft survival can be affected. The aim of our study was to evaluate the impact of the time starting transplantation had on complications and graft survival. METHODS: Between 1994 and 2004, a total of 260 patients underwent kidney transplantation. Of these, 166 of 260 (64%) operations were initiated between 8 a.m. and 8 p.m. (day-kidney) and 94 of 260 operations (36%) between 8 p.m. and 8 a.m. (night-kidney). Mean follow-up was 43 months (range, 0-121 months). RESULTS: Overall graft failure rate was 8.1% 12 months and 12.7% 60 months after engraftment, respectively. Nighttime operation was associated with a higher risk of graft failure. Twenty-four of 260 patients (9.1%) underwent reoperation within 30 days after transplantation. Reoperation rates (night-kidney: 16 of 94 patients [16.8%], day-kidney: 8 of 166 patients [6.4%]) differed significantly between both groups. Reoperation was associated with risk of graft failure (P < .05, Cox proportional hazard). CONCLUSIONS: Nighttime surgery enhances the risk for complications and graft failure. Delaying kidney transplantation of a night-kidney to the following day may be worthwhile, even risking prolonged cold ischemia time.

[Neuromuscular dysfunction of the lower urinary tract dysfunction beyond spinal cord injury and multiple sclerosis. A challenge for urologists]. / Neuromuskuläre Funktionsstörungen des unteren Harntraktes jenseits von Querschnittlähmung und multipler Sklerose. Eine Herausforderung für den Urologen.

Neurogenic bladder subsequent to paraplegia serves as a paradigm when classifying the type of disorder analogous to the level of paralysis. In cases of multiple sclerosis micturition symptoms already present a manifold picture that changes in the clinical course. Rarer neurological disorders, on the other hand, such as infantile cerebral palsy, Parkinson's disease, multisystem atrophy, Alzheimer's disease, cerebrovascular disorders, Guillain-Barré syndrome, AIDS, herpes zoster, systemic lupus erythematosus, and herniated lumbar disc, often cause uncertainty with regard to necessary diagnostic tests and treatment.This review considers the available knowledge about voiding disorders and urinary incontinence associated with specific neurologic and neuromuscular diseases and provides recommendations for diagnostic work-up and pragmatic therapy.

[CpG island hypermethylation of the DNA. Perspectives of a molecular biomarker for prostate cancer]. / CpG-Insel-Hypermethylierung der DNA. Perspektiven eines molekularen Biomarkers für das Prostatakarzinom.

The exact classification of clinically significant versus insignificant prostate cancer displays one of major problems in current urological practice. Using novel molecular biomarkers, we are trying to decrease overdiagnosis of insignificant cancer. CpG island hypermethylation as a common epigenetic event is a well-recognized phenomenon during carcinogenesis. We have shown that hypermethylation at several gene loci distinguishes between benign and malignant forms of prostatic disorders. Furthermore using tests in cancer tissue and serum samples, one can draw prognostic conclusions and predict biochemical failure following radical prostatectomy with curative intent.

[Prostate cancer research. Biomarkers as promising options for optimized diagnosis and treatment]. / Prostatakarzinomforschung. Biomarker als Hoffnung für optimierte Diagnostik und Therapie.

A better understanding of signal transduction and gene regulation during prostate carcinogenesis will allow the development of novel diagnostic and prognostic biomarkers and a better prediction of the individual course of prostate cancer disease. It will also enhance the design and development of specific small molecular components aiming for specific therapies. The research groups in Bonn succeeded in the competition for an endowed professorship supported by the Rudolf Becker Stiftung (German Science Endowment Fund) settled in the"Centrum für integrierte Onkologie" funded by the German Cancer Aid. This should be the perfect breeding ground for future research in the field of prostate cancer.

[Pediatric renal cell carcinoma. A rare differential diagnosis of Wilms' tumor]. / Das Nierenzellkarzinom beim Kind. Eine seltene Differenzialdiagnose zum Wilms-Tumor.

Renal cell carcinoma (RCC) is a very rare pediatric disease and should be treated as an entity of its own because of differences in symptoms, therapy, and prognosis from the adult form of the disease. Our objective is to discuss the difficulties in clinical diagnosis, prognosis, and therapy of this very rare disease in children and to provide a review of the current literature.

[The role of superselective transcatheter arterial embolisation in management of complications after kidney surgery]. / Radiologisch-interventionelle superselektive Embolisation - universeller Einsatz bei verschiedensten Blutungskomplikationen nach renaler Chirurgie.

PURPOSE: Transcatheter arterial embolisation (TAE) is replacing open procedures in terms of vascular malformations or traumatic haemorrhage. Furthermore, the role of TAE is established in post-surgery bleeding complications. We report on a number of patients with severe haemorrhage after kidney surgery and successful management by TAE. MATERIALS AND METHODS: Gross renal haemorrhage was observed after pyelocalicolithotomy and open kidney-sparing surgery. One patient developed a large arteriovenous fistula after kidney transplantation preceded by open biopsy. Technique of TAE: In all cases the bleeding vessel was located by transfemoral arteriography. Embolisation was performed by dropping platinum coils or gelfoam pellets. RESULTS: TAE stopped the haemorrhage in all patients and occluded the arteriovenous fistula in the renal allograft. No complications were observed. CONCLUSION: TAE can be considered as the treatment of choice for a widespread range of complications after kidney surgery. It should always be taken into consideration before open surgical revision.

[Lutetium-177-PSMA radioligand therapy : Consensus within the framework of GKV-funded care between the university hospitals in Aachen, Bonn, Düsseldorf, Essen, and Cologne and the MDK Nordrhein]. / Lutetium-177-PSMA-Radioligandentherapie : Konsensus im Rahmen der GKV-finanzierten Versorgung zwischen den Hochschulkliniken in Aachen, Bonn, Düsseldorf, Essen und Köln und dem MDK Nordrhein.

In the last 3 years, Lutetium-177 prostate-specific membrane antigen radioligand therapy (Lu-177-PSMA-RLT) has received increasing attention in nuclear medicine as a new form of treatment for castration-resistant metastatic prostate cancer. This therapy combines the radionuclide Lutetium-177, which has been therapeutically used in nuclear medicine for many years, with a molecular target of the transmembrane prostate-specific membrane antigen expressed by prostate cancer cells. Since there are no prospective randomized studies on Lu-177-PSMA-RLT and the question of reimbursement has repeatedly been the subject of review by the MDK Nordrhein (Medischenische Dienst der Krankenversicherung), there was a desire because of the increasing number of patients being treated to clarify under which circumstances Lu-177-PSMA-RLT can be reimbursed by German statutory health insurance. The goals of this article are to help treating physicians understand how this new therapy option works, to integrate it in the overall therapy concept for castration-resistant metastatic prostate cancer, and, above all, to use Lu-177-PSMA-RLT-based on the current data-at the right place in the therapy sequence of castration-resistant metastatic prostate cancer.