A.W. Bruce

Intracavitary Bacillus Calmette-Guerin in the Treatment of Superficial Bladder Tumors.

&NA; Patients with recurrent superficial bladder tumors have been treated by vesical and intradermal administration of Bacillus Calmette‐Guerin. The pattern of recurrence in 9 patients has been altered favorably. Although the findings are still preliminary they appear to hold promise of a new therapeutic approach to the treatment of a group of neoplasms for which effective therapy is still lacking.

The Role of Chlamydiae in Genitourinary Disease

The incidence of chlamydial organisms in early morning urine specimens obtained from 53 men and 50 women without evidence of urinary tract pathology was 2 per cent in both groups. Early morning urine specimens and/or prostatic fluid or semen was examined in 50 patients with chronic prostatitis and 39 (56 per cent) yielded this organism. Of 31 patients with epididymo-orchitis the early morning urine specimens yielded chlamydiae in 12 (39 per cent) and in those with the acute form of disease the incidence was 56 per cent. The chlamydia recovery rate was 27 per cent in 119 women with cystourethritis. Within these groups of patients approximately 50 per cent of sexual partners had urine cultures positive for chlamydia. The importance of reinfection and the need for careful treatment of patients and consort should be stressed. An appropriate transport medium is necessary for specimen collection and adequate culture facilities are required to achieve effective chlamydial recovery. Trimethoprim-sulfamethoxazole and tetracycline were used effectively in the study for primary and secondary drug therapy.

Carcinoma of the prostate: a critical look at staging.

To stage accurately the extent of the disease comprehensive investigations were done on 75 patients with histologically documented carcinoma of the prostate. Estimation of bone marrow acid phosphatase appears to be the most sensitive test to detect blood-borne metastases. Serum acid phosphatase appears to be of little value in the detection of early blood spread and may have a role only in monitoring the effect of treatment on advanced disease. Bone scanning with technetium compounds has the disadvantage of non-specificity but has far greater sensitivity than a skeletal survey. Bone marrow cytology was not rewarding in the detection of early metastatic disease. Pedal lymphangiography is a highly inaccurate method to detect lymphatic spread of carcinoma of the prostate and pelvic lymphadenectomy, when indicated, remains the only truly adequate method to assess lymph node involvement. There was a 37 per cent incidence of metastatic lymph node pathology in 30 patients undergoing this procedure before either radical prostatectomy or deep x-ray therapy. A close correlation was found between stage and grade of disease and incidence of nodal pathology. There was some correlation between degree of nodal involvement and evidence of blood spread as detected by elevated bone marrow acid phosphatase levels. The significance of this finding remains unclear.

Urethral Pressure Profile in Female Stress Incontinence

The accuracy of the urethral pressure profile as a measure of sphincteric competence was examined in female subjects. Most profile measurements selected proved to be significantly different in patients with stress incontinence from those in controls. However, the measurement that seemed to have the highest potential for diagnostic accuracy was the maximum closure pressure in the continence zone, recorded with the bladder full and the patient standing. The concept of the continence zone and incorporating the effect of standing were believed to be the main reasons for this high accuracy. The second best measurement was the maximum closure pressure with the bladder full and the patient surpine. To lessen the chances of a diagnostic error it was recommended that both of these measurements should be obtained. The physiological implications of these findings and the clinical role of the urethral pressure profile examination in the assessment of female patients with urinary incontinence are discussed.

Immunohistochemical Evaluation of Prostatic Carcinoma Before and After Radiotherapy

Immunohistochemical procedures were applied to the examination of human tissues for prostatic acid phosphatase. With antisera against purified human prostatic acid phosphatase 173 normal and neoplastic tissues were tested. Samples of 45 non-prostatic carcinomas and their respective normal tissues were negative. Of 4 seminal vesicles studied 2 showed weak reactivity. The epithelial cells of normal prostatic acini were uniformly positive in 25 patients studied. In contrast to normal prostatic tissue the malignant acini in 53 of 55 patients with prostatic carcinoma had variable but positive reactivity. Of 27 patients receiving radiotherapy for adenocarcinoma of the prostate variable staining was observed in the neoplastic cells of 24, 8 to 52 months after treatment. The continued production of prostatic acid phosphatase in the malignant cells after radiotherapy suggests that they also may maintain metabolic activities necessary for growth and metastasis.

The Treatment of the Uninhibited Bladder with Dicyclomine

Symptomatic treatment of the uninhibited bladder has presented a challenge because of the lack of an effective, well tolerated smooth muscle relaxant for the bladder that can be used during an extended interval. In a preliminary study oral dicyclomine produced resolution or significant improvement of symptoms in 24 of 27 patients and an increase in bladder capacity by an average of 137 plus or minus 26 ml. (91 plus or minus 22 per cent) after 8 weeks of therapy. Additional controlled trials definitely are warranted.

Bone marrow acid phosphatase by radioimmunoassay

A double‐antibody radioimmunoassay was developed and utilized to measure prostatic acid phosphatase in bone marrow aspirates. One hundred‐eighteen patients with carcinoma of the prostate in various clinical stages, and fifty with benign prostatic hyperplasia were studied. In patients with carcinoma, levels of prostatic acid phosphatase in bone marrow aspirates were found to correlate well with increasing clinical stage of the disease. Determination of bone marrow prostatic acid phosphatase by radioimmunoassay may be a valuable adjunct to clinicopathologic staging of prostatic carcinoma.

The Treatment of Peyronie’s Disease with Parathyroid Hormone

AbstractPatients with Peyronie’s disease have been treated with intralesional injections of parathyroid hormone. The results have been encouraging and this approach is recommended as an alternative to other therapeutic modalities. The rationale for the use of parathyroid hormone is presented.

The Prognostic Significance of Histological Grading and Pathological Staging in Carcinoma of the Prostate

Histological grading and pathological staging are relevant factors in the prognosis of patients with prostatic cancer. Of 115 consecutive patients with carcinoma of the prostate that was staged fully before treatment 16 had stage A2 disease. Low grade neoplasms were present in 6 of these patients and evidence of nodal metastases was documented at lymphadenectomy in 2. Similarly, 4 of 35 patients with low grade stage B1 disease had nodal metastases. With the enzymatic and/or radioimmunoassay techniques for acid phosphatase determination we were unable to select those patients with nodal metastases. From these studies we believe that low grade, low stage carcinoma of the prostate retains a potential for metastatic disease and that acid phosphatase determinations are unreliable in detecting bulky regional nodal involvement.

Prostatic Acid Phosphatase by Radioimmunoassay Tumor Marker in Bone Marrow

Bone marrow acid phosphatase was determined by radioimmunoassay and enzymatic analysis in 95 patients with benign prostatic hypertrophy, 50 patients with disseminated prostatic carcinoma and 36 patients with non-prostatic malignancy. The results indicate superior specificity of the radioimmunoassay. A brief review of the topic and the clinical implications are discussed.