Gerald Sufrin

Drinking Water, Fluid Intake, and Bladder Cancer in Western New York

Fluid intake and consumption of specific beverages were investigated in a study of 351 white male cases for whom transitional cell carcinoma of the bladder had been confirmed histologically during the time period from 1979 to 1985. A total of 855 white male controls was selected from Erie, Niagara, and Monroe counties of western New York state. Total fluid consumption was composed of alcoholic beverages, bottled beverages, soda, milk, coffee, tea, all juices, and glasses of tap water. Tap water included coffee, tea, juices, and glasses of water taken directly from the tap. Total fluid consumption was found to be a strong risk factor for bladder cancer when a number of potential confounding risk factors were controlled for. Risks were higher among those who were less than 65 y of age (odds ratio [OR] = 6.3, 95% C.I. = 2.8-14.0). The OR was 3.4 (95% C.I. = 1.8-6.2) for the highest quartile of fluid consumption among those 65 y of age and older. The tap water component was associated with increased risk in both age categories, and there was a clear dose-response relationship. Risks associated with tap water consumption were higher among those who never smoked cigarettes. Both biological and nonbiological explanations for these results are evaluated. The findings suggest implications for public health, but the limitations of the present investigation preclude definitive conclusions and stress the urgency for replication.

Hormones in Renal Cancer

Plasma renin, erythropoietin and chorionic gonadotropin levels were evaluated in 57 patients with renal adenocarcinoma. Renin elevation, found in 37 per cent, was unrelated to blood pressure levels but was associated with high grade, high stage lesions of mixed histologic cell type and predicted a poor prognosis. Erythropoietin was raised in 63 per cent of patients and was more sensitive than renin in indicating the presence of renal adenocarcinoma. However, it was less specific and did not correlate directly with tumor grade, stage, histologic type, prognosis or hematocrit and hemoglobin levels. None of the patients had elevated chorionic gonadotropin levels. Therefore, we believe that renin and erythropoietin determinations may be of value as biochemical tumor markers in renal adenocarcinoma.

The Page Kidney: A Correctable form of Arterial Hypertension

The Page kidney is a remediable form of renal hypertension. It is usually seen in young male patients with an antecedent history of blunt renal trauma, followed by a subcapsular or perirenal hematoma causing compression of the renal parenchyma and hypertension. Radiographic studies demonstrate the presence of an extrinsic mass compressing the kidney. Divided function studies and renal vein renin determinations confirm the functional significance of this process in the etiology of hypertension. Treatment may initially consist of observation. However, if hypertension persists then decortication and evacuation of the encysted fluid are indicated. In long-standing cases, although nephrectomy may be necessary, the chance of relieving hypertension is excellent.

Diet in the epidemiology of bladder cancer in western New York

We present the dietary epidemiology of bladder cancer while controlling for a number of lifestyle and environmental risk factors in a study of 351 white male cases with histologically confirmed transitional cell carcinoma of the bladder and 855 white male controls selected from Erie, Niagara, and Monroe counties of western New York from 1979 to 1985. Usual diet was estimated by comprehensive interviews with use of a detailed food frequency questionnaire. An increased risk of bladder cancer was associated with higher kilocalorie intake, but only among those under 65 years of age, with the strongest pattern associated with fat intake. Further analyses of fat, carbohydrates, and protein, with adjustment for total kilocalories, resulted in a positive association of risk with fat intake and a decreasing risk with higher protein intake. Of the vitamins, carotenoid consumption appeared to decrease risk with increased consumption for those under 65 years of age. No significant differences between cases and controls were seen for intake of calcium, retinol, thiamin, riboflavin, niacin, vitamin C, vitamin D, and vitamin E. After adjustment for kilocalories and other confounders, higher intake of dietary sodium was associated with increased risk among both age groups, and the trends were statistically significant. The importance of diet in the etiology of bladder cancer is suggested by our findings.

Proliferative activity of benign human prostate, prostatic adenocarcinoma and seminal vesicle evaluated by thymidine labeling.

The thymidine labeling index (TLI) was measured in vitro in the epithelium and stroma of benign prostate glands and seminal vesicles and in the epithelium of prostatic adenocarcinomas. The mean epithelial TLI of normal peripheral (posterior) prostatic zone was 0.12 per cent, and that of the normal central (deep) zone was 0.11 per cent. Mean normal stromal TLIs were 0.08 per cent and 0.06 per cent, respectively. The mean TLI of epithelium in nodular hyperplasia was 0.31 per cent, which differs significantly from normal epithelium (p less than 0.05), and the mean stromal TLI was also increased (0.16 per cent, p less than 0.1). The mean TLI of prostatic adenocarcinomas was 0.90 per cent (range 0.14 to 3.90 per cent) which was significantly higher than for either normal epithelium (p less than 0.001) or epithelium of nodular hyperplasia (p less than 0.05). Trends of increasing TLI with increasing histologic grades and increasing nuclear size and numbers of nucleoli were not significant. The data support participation of both epithelial and stromal proliferation in nodular hyperplasia, and indicate a low basal proliferative rate in normal prostatic glands. The low TLIs of prostatic adenocarcinomas relative to other malignancies are consistent with their frequently slowly progressive course. The very low proliferative rate of seminal vesicular epithelium (mean TLI 0.02 per cent) may account for the rarity of seminal vesicular carcinomas.

Secondary Involvement of the Bladder in Malignant Lymphoma

A study of 599 patients who had died of malignant lymphoma between 1952 and 1972 revealed involvement of the bladder in 13 per cent. Bladder involvement was always a secondary event, occurred in association with disseminated disease and was more common in non-Hodgkins lymphoma than in Hodgkins disease. Direct infiltration from adjacent pelvic foci as well as discrete apparent metastatic foci was noted. Involvement was usually microscopic although the presence of gross disease was invariably clinically manifest. Cystoscopy and cystography were valuable in the diagnosis of gross lesions. In contrast to primary vesical lymphoma the treatment of secondary vesical lymphoma was symptomatic and an operation was indicated rarely. Local radiotherapy was effective in treating the symptoms of secondary vesical lymphoma.

Multiple species of estrogen binding sites in the nuclear fraction of the rat prostate

Abstract Specific estrogen-binding sites have been demonstrated in purified nuclear fractions of prostates from intact rats. Saturation analysis of nuclei over a wide range of [ 3 H]-estradiol concentrations (0.15 to 90 nM) has shown two different types of binding sites: a) one with high affinity (Kd of 0.5–0.8 nM) and low capacity for estradiol (approximately 162 fmole/mg DNA); b) a second with a lower affinity (Kd of 30–40 nM), which shows a higher capacity (approximately 860 fmole/mg DNA), and displays a saturation curve that is sigmoidal and that appears to be similar to those for Type II estrogen-binding sites in rat uterus. These results suggest that the actions of estradiol in the prostate are mediated by specific nuclear binding sites.

Prostatitis in the rat.

A high incidence of spontaneous, non-acute, age-dependent prostatitis was observed in the lateral prostate of Copenhagen rats and Wistar rats. The lumen of infected acini was filled with polymorphonuclear leucocytes, shed epithelial cells and cell residues. Epithelial cells lining such acini showed degenerative changes. Lymphocytes and macrophages were seen in the stroma. A histochemically observed increase in acid phosphatase and beta-glucuronidase activity in affected epithelial cells may indicate an increased lysosomal activity. Some bacteriological cultures of infected lateral prostates were positive for Proteus vulgaris and diphtheroids. It is suggested that this spontaneous rat prostatitis may be a useful model for the study of the pathogenesis and treatment of human non-acute prostatitis.

Coffee, Cigarette Smoking, and Bladder Cancer in Western New York

The association between consumption of coffee and bladder cancer and the effect modification of cigarette smoking was investigated as part of a comprehensive case-control study. The study population consisted of 351 case patients with histologically confirmed transitional cell carcinomas of the bladder among white males and 855 white male control subjects selected from Erie, Niagara, and Monroe counties in New York from 1979 to 1985. Usual diet, coffee consumption, and cigarette use were estimated by comprehensive interviews using a detailed food frequency questionnaire. After adjustment for age, education, and dietary risk factors by multiple logistic regression, risk was found to increase with increasing pack-years of cigarette use with an odds ratio in the highest quartile of 2.7 (95% confidence interval, 1.8 to 4.0) when compared to the lowest quartile. Coffee consumption was associated with an increased risk for bladder cancer among the heaviest coffee drinkers after adjustment for cigarette smoking and other dietary risk factors (odds ratio, 2.1; 95% confidence interval, 1.3 to 3.2). The effect was more pronounced among nonsmokers, especially among those 65 years and older. These findings support the contention that coffee is a weak carcinogen.

Adenosine Deaminase Activity in Patients with Carcinoma of the Bladder

Adenosine deaminase is an important enzyme in purine metabolism, and patients with abnormal lymphocyte and erythrocyte adenosine deaminase levels have been shown to have impaired immune competence. Since immune factors have been shown to be important in patients with transitional cell carcinoma of the bladder we studied adenosine deaminase activity in the hemic cells of 48 patients with this tumor. Lymphocyte adenosine deaminase levels were elevated in patients with transitional cell carcinoma and correlated with stage, activity, clinical course and tumor resection but not with tumor grade. Erythrocyte adenosine deaminase levels also were elevated in patients with transitional cell carcinoma but did not correlate with other disease parameters. Lymphocyte adenosine deaminase activity in patients with transitional cell carcinoma may be a sensitive indicator of disease activity and further studies may provide insight into the host-tumor relationship at the enzyme level.