Bent L. Sørensen

Carcinoma in situ of contralateral testis in patients with testicular germ cell cancer: study of 27 cases in 500 patients.

Carcinoma in situ in the contralateral testis was diagnosed in 27 of 500 patients (5.4%) with unilateral testicular germ cell cancer. Eight of the 27 patients received intensive chemotherapy for spread of their initial testicular cancer. Follow up biopsy studies did not detect changes of carcinoma in situ in any of these patients, and none developed a contralateral testicular tumour (observation time 12-88 months). Of the remaining 19 patients with carcinoma in situ, seven developed contralateral testicular cancer. The estimated risk of developing invasive growth was 40% within three years and 50% within five years. None of the 473 patients without carcinoma in situ detected by screening biopsy developed contralateral testicular cancer (observation time 12-96 months). No serious complications arose from the biopsy procedures. All patients with unilateral testicular germ cell cancer should be offered biopsy of the contralateral testis.

Screening for carcinoma in situ of the contralateral testis in patients with germinal testicular cancer.

Two hundred and fifty biopsy specimens from the contralateral testis in patients with unilateral germinal testicular cancer were analysed by light microscopy for carcinoma-in-situ changes. Changes were found in 13 (5.2%) patients. One-third of patients with an atrophic contralateral testis (volume less than or equal to 12 ml) and one-fifth of patients with a history of cryptorchidism had changes in the remaining testis. In the present series 85% of cases with carcinoma-in-situ changes would have been diagnosed if the one-fifth of the patients having an atrophic testis or a history of cryptorchidism or both had been screened. Since the natural course of carcinoma in situ in the contralateral testis of patients with germinal testicular cancer has not been established, the patients are being re-evaluated frequently. To date two patients with carcinoma in situ have developed a second cancer.

Neoadjuvant Chemotherapy with Cisplatin and Methotrexate in Patients with Muscle-Invasive Bladder Tumours

This prospective, randomized study based on two associated trials was designed to evaluate the effect of neoadjuvant chemotherapy with cisplatin and methotrexate with folinic acid rescue or no chemotherapy prior to local treatment in patients with T2-T4b, NX-3, MO transitional cell carcinoma of the bladder. In the first trial, local treatment consisted of cystectomy (DAVECA 8901) and in the other trial the treatment was radiotherapy (DAVECA 8902); 153 eligible patients were randomized. The majority of the patients (89%) completed the protocol. The overall time to progression for all 153 patients was 12.9 months. Median time to progression was 14.2 months with chemotherapy and 11.4 months without chemotherapy. The actuarial 5-year overall survival rate for all 153 patients was 29%, and 29% for both treatment groups. Multivariate analyses showed that T-stage, tumour size and serum creatinine were independent prognostic factors for survival. The cystectomy trial included 33 patients. Median survival was 78.9 months, 82.5 months with chemotherapy and 45.8 months without chemotherapy (p=0.76). The radiotherapy trial included 120 patients. The median survival was 17.6 months. Median survival was 19.2 months in the group receiving chemotherapy and 16.3 in the group not receiving chemotherapy. The 5-year survival rate was 19% in the group receiving chemotherapy and 24% in the groups not receiving chemotherapy (p=0.98). Late toxicity grade 3 or 4 of the bladder was recorded in 25% of the patients (actuarial rate). Neoadjuvant chemotherapy with cisplatin and methotrexate did not significantly improve disease-free or overall survival in 153 randomized patients with invasive bladder cancer.

Incidence of carcinoma in situ of germ cells in contralateral testis of men with testicular tumours.

Biopsy specimens from the contralateral testicle in 50 consecutive patients with germinal testicular cancer were examined for carcinoma in situ. Three out of 21 men with seminomas and one out of 29 with other types of germinal cancer (8%) had carcinoma in situ in the contralateral testicle without any clinical signs. One of these men developed early invasive germ-cell cancer 46 months after carcinoma in situ was first diagnosed. The others have been followed up for less than a year without signs of tumour growth. If these results are confirmed routine biopsy of the contralateral testicle in patients with germinal cancer may be indicated.

Urological Situation Five Years after Spinal Cord Injury

OBJECTIVE To evaluate bladder emptying methods and urinary tract problems five years after spinal cord injury (SCI). MATERIAL AND METHODS Neurological level, method of bladder emptying and urological investigations were retrieved from the records for all 165 patients admitted to our Centre for Spinal Cord Injured with a traumatic SCI sustained from 1984 to 1988. RESULTS A total of 77 patients with completed 5-year control were included in the final analyses. We found that 64% had suprasacral bladder dysfunction, while 23% had infrasacral bladder dysfunction. Plasma-creatinine was normal, both at the initial examination and the 5-year control. From the time in the SCI centre to the 5-year control a trend towards less intermittent catheterization and more use of abdominal pressure was observed. During the follow-up period nine patients (12%) experienced urinary calculi. Six bladder- stones were removed endoscopically. Five had kidney stones; three were left untreated, one was removed by extracorporeal shock wave lithotripsy and one by open surgery. Four patients (5%) had renograms with functional distribution outside the limits 40-60%. Three patients had bladder neck incision performed, one had a sacral anterior root stimulator implanted and one had a continent Kock reservoir. No sphincterotomies were performed. Fifty-one had received medicine to facilitate bladder emptying. Eighty-one percent had been treated for at least one urinary tract infection (UTI), 22% had 2-3 UTI/year, and 12% 4 or more UTI/year. Twelve percent had been on prophylactic low-dose antibiotics. CONCLUSION The final outcome regarding urological complications is satisfactory even with our conservative handling of the SCI individuals.

Testicular carcinoma in Denmark 1976-1980. Stage and selected clinical parameters at presentation.

Since Jan. 1, 1976 practically all new cases of germ cell tumours of the testis in Denmark have been included in the Danish Testicular Carcinoma Study (DATECA), permitting detailed registration of data concerning histology and stage at the time of diagnosis. The incidence of carcinoma of the testis in Denmark continues to be high with a crude rate of 8 to 9/100 000 males per year. During the past 5 years the size of the primary tumours has decreased. Parallel to this, the rate of metastatic spread has decreased for seminoma, while no such change has been observed for non-seminomatous tumours. Data are presented on histology and stage for 1058 consecutive patients.

Administration of a retinoid as prophylaxis of recurrent non-invasive bladder tumors.

A controlled study has been conducted to ascertain whether administration for 8 months of a vitamin A-acid analog, Tigason, could prevent recurrences of non-invasive bladder tumors. Eligible were 73 patients, 33 in the Tigason group, and 40 in the placebo group. The results indicate that Tigason, as used in this study, is ineffective as prophylaxis. Side effects to Tigason urged 17 patients to drop out from the study mostly due to symptoms from skin and mucous membranes. The discussion considers different reasons for the lack of effect and concludes that more tolerable vitamin A-acid analogs are needed if further studies of prevention of non-invasive bladder tumors are to be carried out.

Secondary surgery in patients with malignant germ cell tumors

A total of 102 men treated for germ cell tumor with chemotherapy containing cisplatin was referred for a secondary operation with signs of tumor in the retroperitoneum or chest. Of the patients 85 underwent laparotomy, 14 underwent thoracotomy and 3 had both operations. Residual tumors were completely resected in 66 patients and incompletely resected in 30, while no tumor was found in 6. The resected specimen was malignant in 18 patients, of whom 11 had complete removal of all malignant tissue. All patients with malignancy in the resected specimen received further chemotherapy. Long-term disease-free status was obtained in 75% of those patients who had a complete resection, compared with 14% in the group with incomplete resection. There was no evidence of malignant disease at operation in 78 patients but 5 of them later died of the disease. Malignant tissue was present in the residual tumor in only 1 of 15 patients whose primary tumor was seminoma alone. Resection was attempted in 14 patients despite abnormal tumor markers preoperatively. Only 5 of these patients achieved a disease-free status and 2 of them died later of malignant disease. Over-all 79 of the 102 patients are without evidence of disease (medium postoperative observation 23 1/2 months). We conclude that a secondary operation constitutes an important part of the treatment of patients with germ cell cancer.

Silent Iliac Compression Syndrome as a Cause of Renal Vein Trombosis after Transplantation

A case of acute venous trombosis in the transplanted renal vein and the iliac vein is reported. The operative findings at transplantation, transplantectomi and retransplantation are reviewed. It is assumed that a silent iliac compression syndrome exists, and that the mechanical obstruction of the venous outflow from the left leg may be an important cause of acute renal vein trombosis after renal transplantation.

Secondary Surgery in Advanced Testicular Germ-Cell Tumors

Twenty-four patients with residual tumor after intensive chemotherapy for advanced testicular germ-cell tumors were subjected to secondary surgery. Twenty patients had complete resection with the following distribution of histological types: 4 embryonal carcinoma, 9 mature teratoma and 7 fibrous tissue. Eighteen of these patients remain free of disease. Four patients had incomplete resection. Two of these patients with embryonal carcinoma died later despite further treatment; 2 patients with teratoma remain free of disease. Secondary surgery is recommended in cases where residual tumor is found after intensive chemotherapy and where tumor markers are not elevated.