Eywin Bruun

Prevalence of Carcinoma in Situ and other Histopathological Abnormalities in Testes of Men with a History of Cryptorchidism

The incidence of invasive testicular cancer is increased in men with a history of cryptorchidism. Previous studies based on relatively small series indicated that the risk of carcinoma in situ of the testis also is increased in these men. In our study 500 consecutive men 20 to 30 years old, who were previously admitted to a department of surgery with the diagnosis of testicular maldescent, were asked to participate in a screening for carcinoma in situ of the testis. Of the men 300 consented to testicular biopsy. The biopsies were evaluated by light microscopy for carcinoma in situ and other histopathological abnormalities. Carcinoma in situ was diagnosed in 5 patients (1.7%, 95% confidence limits 0.5 to 3.9%). However, the true risk of carcinoma in situ might be higher, since 2 men who had been treated for testicular cancer before they were offered biopsy were excluded from the study. Advanced spermatogenesis, including the spermatid stage in all tubules, was found in biopsy specimens from only 37% of the men. In 80% of these specimens even the number of late spermatids was decreased. Thus, our study, based on a large number of testicular biopsies from an unselected group of men with testicular maldescent, provided further evidence that these men have an increased risk for carcinoma in situ of the testis. Our data combined with the results of other Scandinavian studies indicate that the true prevalence of carcinoma in situ in men with a history of cryptorchidism is approximately 2 to 3%. Additionally, we confirmed that spermatogenic function is severely impaired in maldescended gonads. Invasive testicular cancer can be prevented if the neoplasm is detected at the stage of carcinoma in situ. In our opinion the magnitude of prevalence of carcinoma in situ found in men with a history of cryptorchidism justifies that these men should be offered testicular biopsy when they reach adulthood.

A Randomized Trial of Postoperative Radiotherapy Versus Observation in Stage II and III Renal Adenocarcinoma: A Study by the Copenhagen Renal Cancer Study Group

Between 1979 and 1984 the Copenhagen Renal Cancer Study Group randomized 72 patients nephrectomized for stages II and III renal adenocarcinoma in a prospective study of postoperative radiotherapy versus observation. Radiotherapy was 50 Gy in 20 fractions to the kidney bed, ipsi- and contralateral lymph nodes. 7/72 were excluded from further analysis because of major protocol violations. 33/65 were in stage II, 32/65 in stage III. Relapse was found in 31/65 = 48% during the follow-up period without any difference between the two groups. 12/27 = 44% had significant complications from stomach, duodenum or liver, median 5 mo., range 1-44 mo. after radiotherapy. In 5/27 = 19% did the postirradiatory complications contribute to the death of the patients. Patients with stage II tumours survived significantly better than those with stage III tumours (p less than 0.05), but no significant differences in survival could be demonstrated between patients randomized to postoperative radiotherapy or observation. It is concluded that postoperative radiotherapy as given in the present study is without any beneficial effect on relapse rate and survival. Moreover, the treatment is associated with an unacceptable complication rate.

Stereological estimation of mean nuclear volume in prostatic cancer, the reproducibility and the possible value of estimations on repeated biopsies in the course of disease

The reproducibility of stereological estimates of mean nuclear volume by using the principle of volume estimation of particles of arbitrary shape is investigated together with the possible prognostic value of the estimates in the course of advanced prostatic cancer.

TUR Syndrome After Transurethral Resection of the Prostate Using Suprapubic Drainage

In a retrospective study of 522 consecutive patients who were subjected to transurethral resection of the prostate with suprapubic trocar technique, six patients were suspected of having transurethral prostatic resection syndrome. The majority of the transurethral resections were performed by surgical or urological trainees.Only two patients fulfilled the criterion for TUR syndrome caused by absorption of irrigating fluid and defined as an electrolyte dilution corresponding to a plasma sodium level below 120 mmol/l.In the present paper the symptomatology and treatment of TUR syndrome are outlined with reference to the literature. The trocar technique clearly has minimized the risk of TUR syndrome, which emphasizes the value of the method.

Solitary Cyst and Clear Cell Adenocarcinoma of the Kidney: Report of 2 Cases and Review of the Literature

We report 2 cases of a solitary simple cyst of the kidney harboring clear cell adenocarcinoma in the wall of the cyst. Cysts of the kidney may be divided into solitary cysts, that is large, unilocular cysts with a thin wall, and multilocular cysts, that is sharply demarcated multilocular epithelial-lined cysts with compression of the adjacent renal parenchyma. There are 4 types of tumor and cyst that occur in the same kidney, and our cases belonged to type 3. Suspicion of malignancy was raised by preoperative cytological examination of the fluid of the cysts. Perioperatively, however, no gross evidence of malignancy was found in either case. Frozen section biopsy in case 1 failed to confirm the diagnosis. The cysts were removed by partial nephrectomy. Patient 1 died within 2 years of widespread metastases. Patient 2 had undergone nephrectomy and was well. Based on the literature and our findings we strongly recommend the surgical approach of partial nephrectomy followed by total nephrectomy when the diagnosis has been confirmed.

ETIOLOGY OF URETHRAL STRICTURE FOLLOWING TRANSURETHRAL PROSTATECTOMY A Retrospective Study

A retrospective review of 417 transurethral prostatectomies was made regarding the significance of possible etiologies of postoperative urethral stricture. Clinically significant stricture developed in 9% of the patients. Of the studied factors, only indwelling catheter for a short period (1-7 days) within the last preoperative month showed statistically significant correlation with postoperative urethral stricture.

Ramiprilate Inhibits Functional Matrix Metalloproteinase Activity in Crohn's Disease Fistulas

Increased expression of matrix metalloproteinase (MMP)-2, -3 and -9 has been demonstrated in Crohns disease fistulas, but it is unknown whether these enzymes are biologically active and represent a therapeutic target. Therefore, we investigated the proteolytic activity of MMPs in fistula tissue and examined the effect of inhibitors, including clinically available drugs that beside their main action also suppress MMPs. Fistula specimens were obtained by surgical excision from 22 patients with Crohns disease and from 10 patients with fistulas resulting from other causes. Colonic endoscopic biopsies from six controls were also included. Total functional MMP activity was measured by a high-pressure liquid chromatography (HPLC)-based, fluorogenic MMP-substrate cleavage assay, and the specific activity of MMP-2, -3 and -9 by the MMP Biotrak Activity Assay. The MMP inhibitors comprised ethylene-diamine-tetraacetic acid (EDTA), the synthetic broad-spectrum inhibitor, GM6001, the angiotensin-converting enzyme (ACE) inhibitor, ramiprilate, and the tetracycline, doxycycline. In Crohns disease fistulas, about 50% of the total protease activity was attributable to MMP activity. The average total MMP activity was significantly higher (about 3.5-times) in Crohns fistulas (471 FU/μg protein, range 49-2661) compared with non-Crohns fistulas [134 FU/μg protein, range 0-495, (p < 0.05)] and normal colon [153 FU/μg protein, range 77-243, (p < 0.01)]. MMP-3 activity was increased in Crohns fistulas (1.4 ng/ml, range 0-9.83) compared with non-Crohns fistulas, [0.32 ng/ml, range 0-2.66, (p < 0.02)]. The same applied to MMP-9 activity [0.64 ng/ml, range 0-5.66 and 0.17 ng/ml, range 0-1.1, respectively (p < 0.04)]. Ramiprilate significantly decreased the average total MMP activity level by 42% and suppressed the specific MMP-3 activity by 72%, which is comparable to the effect of GM6001 (87%). Moreover, MMP-9 activity was completely blunted by ramiprilate. Doxycycline had no effect on MMP activity. Increased functional MMP activity, notably MMP-3 and -9, is present in Crohns fistulas and may be inhibited by ramiprilate, a widely available ACE inhibitor.

The Effect of Buserelin Versus Conventional Antiandrogenic Treatment in Patients with T2-4NXM1 Prostatic Cancer: A Prospective, Randomized Multicentre Phase III Trial

A prospective, randomized multicentre phase III trial was undertaken to compare the effectiveness and safety of Buserelin, a gonadotropin-releasing hormone analogue (GnRHa), with conventional antiandrogenic treatment in patients with painful metastases from T2-4NXM1 prostatic cancer. Seventy-two patients received Buserelin, 22 received estrogens and 46 were subjected to orchiectomy. The trial was completed one year after allocation of the patients. No significant differences as regards suppression of testosterone or survival were found in favour of one of the three treatment modalities. The performance index improved significantly both during the first months of treatment with Buserelin and following orchiectomy. No detectable improvement of performance index was seen during treatment with estrogens. Treatment with estrogens also failed to alleviate pain or general symptoms of cancer. Tolerability, safety and compliance of Buserelin was although administered intranasally clearly evidenced as palliation of advanced symptomatic cancer and the efficacy and sideeffects were fully comparable to those following orchiectomy.

Intravesical Therapy of Noninvasive Bladder Tumors (stage Ta) with Doxorubicin: Initial Treatment Results and The Long-term Course

A total of 64 consecutive patients with noninvasive bladder tumors (stage Ta) between 1977 and 1983 underwent treatment with intravesical instillation of doxorubicin. The total response rate was 85 per cent and 57 per cent of the patients had a complete response after 16 weekly instillations. Half of the patients with a complete response had recurrences within 12 to 16 months. Ten per cent of all patients had an invasive tumor during the observation period. We conclude that doxorubicin can render some patients with noninvasive bladder tumors (stage Ta) free of disease but there currently is nothing to indicate that the same results could not be obtained by transurethral resection.

Incidental Versus Manifest Prostatic Carcinoma

The problem in managing incidental prostatic carcinoma is whether deferred treatment or active therapy should be preferred. Eighty-six consecutive patients with prostatic carcinoma diagnosed at TUR-P during 1979–83 were studied retrospectively. Seventeen of the patients (20%) had incidental prostatic carcinoma. Incidental carcinomas were significantly more well differentiated histologically than manifest carcinomas. The striking difference between incidental and manifest prostatic carcinomas appeared when the clinical course was considered. Only one patient with incidental carcinoma developed symptoms requiring endocrine therapy, against 31 patients with manifest carcinoma (p<0.01). It is therefore concluded that the distinction between manifest and incidental prostatic carcinoma is justified and that deferred treatment is sufficient in most patients presenting with incidental prostatic carcinoma at TUR-P.