Harry Winkler

Stage D1 Prostatic Adenocarcinoma: Significance of Nuclear DNA Ploidy Patterns Studied by Flow Cytometry

Flow cytometric analysis of nuclear DNA ploidy pattern was performed on 91 samples of prostatic adenocarcinoma from patients with stage D1 disease (metastatic deposits in pelvic lymph nodes). All patients had undergone radical retropubic prostatectomy and bilateral pelvic lymphadenectomy. Clinical follow-up ranged from 5 to 19 years. Nuclei were extracted from paraffin-embedded archival material. Isolated nuclei were stained with propidium iodide. The DNA ploidy pattern was diploid (normal) in 42% of tumors, tetraploid in 45%, and distinctly aneuploid in 13%. Only 15% of DNA diploid tumors progressed locally or systemically, whereas 75% of tumors with an abnormal DNA ploidy pattern (tetraploid or aneuploid) subsequently progressed ( P P

Stage C Prostatic Adenocarcinoma: Flow Cytometric Nuclear DNA Ploidy Analysis

Flow cytometric nuclear DNA ploidy analysis was used to study pathologic stage C prostatic adenocarcinoma (pT3, N0, M0) in 146 patients who underwent radical retropubic prostatectomy and bilateral pelvic lymphadenectomy between 1967 and 1981. Of these tumors, 46% had a DNA diploid pattern, 47% had a DNA tetraploid pattern, and 7% had a DNA aneuploid pattern. Abnormal ploidy patterns were associated more frequently with histologic high-grade tumors than with low-grade tumors. Considered alone, DNA ploidy pattern showed a strong association with subsequent prognosis. The median interval to progression for tumors with DNA tetraploid and DNA aneuploid patterns was 7.8 and 3.5 years, respectively. For the DNA diploid tumors, only 23% progressed within 18 years, the longest follow-up. At 10 years, only 10% of patients with DNA diploid tumors had died of prostatic cancer, in comparison with 28% of the DNA tetraploid and 36% of the DNA aneuploid groups (P less than 0.01). By analysis of a combination of histologic tumor grade and nuclear DNA ploidy pattern, an even stronger association with prognosis was demonstrated. For the 38 patients with histologic low-grade and DNA diploid tumors, progression-free survival was 92% at 10 years, in comparison with 57% for 23 patients with low-grade DNA nondiploid tumors. Patients with high-grade tumor had a poorer prognosis whether the DNA ploidy pattern was diploid or nondiploid. Nuclear DNA ploidy pattern is an important and independent prognostic variable for patients with pathologic stage C prostatic cancer treated by radical prostatectomy.

Nuclear Deoxyribonucleic Acid Ploidy in Squamous Cell Bladder Cancer

Flow cytometric analysis of nuclear deoxyribonucleic acid content was performed on 76 primary squamous cell bladder carcinomas treated between January 1970 and December 1975. Patients were followed for a median of 10.1 years. Nuclei were extracted from paraffin-embedded archival material and isolated nuclei were stained with propidium iodide. Of the 76 tumors 73 were evaluable by flow cytometry providing high quality deoxyribonucleic acid histograms: 27 (37 per cent) showed a deoxyribonucleic acid diploid or normal pattern, 17 (23 per cent) exhibited a significant increase in the 4C peak (deoxyribonucleic acid tetraploid) and 29 (40 per cent) showed a distinct aneuploid peak. High grade (grades 3 and 4) and high stage (stages T2 to T4) tumors had a significantly higher incidence of abnormal (either tetraploid or aneuploid) deoxyribonucleic acid patterns than low grade (grades 1 and 2) and low stage (stages Tis/Ta/T1) tumors (p less than 0.005). The 5 and 10-year rate free of disease for patients with deoxyribonucleic acid diploid tumors was 67 per cent compared to 22 and 18 per cent, respectively, for patients with tumors showing abnormal ploidy patterns (p less than 0.0005). At 5 and 10 years after diagnosis an estimated 18 per cent of the patients with deoxyribonucleic acid diploid tumors will die of bladder cancer. In contrast, an estimated 53 per cent of the patients with tetraploid tumors and 82 per cent and 86 per cent of those with aneuploid tumors will die of squamous cell bladder carcinoma by 5 and 10 years after diagnosis (p less than 0.0001). These results demonstrate that nuclear deoxyribonucleic ploidy measured by flow cytometry is an important objective prognostic variable for patients with squamous cell carcinoma of the bladder.

Primary Squamous Cell Carcinoma of the Male Urethra: Nuclear Deoxyribonucleic Acid Ploidy Studied by Flow Cytometry

Flow cytometry analysis was performed on 30 primary male urethral squamous cell carcinoma specimens. Nuclei were extracted from paraffin-embedded archival material and isolated nuclei were stained with propidium iodide. Bulbomembranous urethral tumors had a higher incidence of abnormal deoxyribonucleic acid ploidy patterns than penile urethral tumors (69 and 29 per cent, respectively). Of the tumors exhibiting a deoxyribonucleic acid diploid pattern and an abnormal (deoxyribonucleic acid tetraploid or aneuploid) histogram 18 and 93 per cent, respectively, showed tumor progression (p less than 0.001). None (0 per cent) of the low grade (grade 1 or 2) tumors with a deoxyribonucleic acid diploid pattern developed local recurrence or distant metastases, whereas 90 per cent of the low grade tumors with an abnormal deoxyribonucleic acid pattern progressed (p less than 0.002). Patients with tumors exhibiting deoxyribonucleic acid diploid ploidy had 5 and 10-year rates free of disease of 85 per cent. In contrast, patients with tumors with abnormal deoxyribonucleic acid ploidy patterns had 5 and 10-year rates of 20 and 0 per cent, respectively (p less than 0.001). Determination of deoxyribonucleic acid ploidy pattern by flow cytometry provides important prognostic information for male patients with primary squamous cell carcinoma of the urethra.

Percutaneous transhepatic lithotripsy with the holmium: YAG laser for the treatment of refractory biliary lithiasis.

Fourteen patients who failed at least 1 endoscopic retrograde cholangiopancreatograpy attempt underwent Holmium laser biliary lithotripsy between 2003 and 2007. Ten had prior biliary surgeries, 7 harbored multiple stones, and 6 had common bile duct strictures. Mean age at surgery was 63.6 years (50 to 80 y), biggest stone burden 30 mm, mean operative time 58.4 minutes (24 to 105), and stone free rate 85.7%. One patient had postoperative bleeding from the choledochostomy tube that eventually resolved spontaneously and 3 patients had postoperative cholangitis managed conservatively. Neither conversions to open surgery nor mortality was recorded. Two patients were diagnosed with cholangiocarcinoma missed by previous endoscopic retrograde cholangiopancreatograpy. After a mean follow-up of 18.9 months (2 to 43) no de novo strictures were recorded. Percutaneous choledochoscopy with holmium laser lithotripsy is a safe and effective minimally invasive technique to treat complex biliary stone disease and may preclude high-risk open biliary tract surgery.

Clinical significance of nuclear DNA ploidy pattern in nonseminomatous germ cell testicular tumors

OBJECTIVE To evaluate the clinical significance of DNA ploidy pattern for patients with nonseminomatous germ cell testicular tumors who did not receive platinum-based chemotherapy. METHODS Flow cytometric nuclear DNA ploidy analysis of paraffin-embedded tissue blocks were used. RESULTS All patients underwent radical orchiectomy with or without retroperitoneal lymphadenectomy between 1960 and 1980. Mean follow-up time was eight years. Nineteen percent of the tumors were DNA diploid and 81 percent were DNA aneuploid. Signs of local tumor extension (spermatic cord involvement or vascular invasion) were found in 20 tumors, all were classified as DNA aneuploid (P < 0.04). After primary treatment 9 patients who were clinically cured experienced disease progression; only 1 of them had DNA diploid tumor; the rest were DNA aneuploid (P < 0.05). The ten-year survival rate was higher for patients having DNA diploid tumors compared with those with DNA aneuploid neoplasms (86% versus 53 percent, P < 0.02). CONCLUSIONS The results of this retrospective study indicate that nuclear DNA content provide important information concerning the natural history and biology of nonseminomatous germ cell testicular tumor.

Can Unenhanced CT Findings Predict Interventional Versus Conservative Treatment in Acute Renal Colic

OBJECTIVE The purpose of this study was to determine the value of clinical parameters and radiologic findings on unenhanced CT to the choice between interventional and conservative management for patients with acute renal colic. MATERIALS AND METHODS Unenhanced CT records of 183 consecutive patients with acute renal colic were retrospectively reviewed. Urolithiasis was confirmed at both unenhanced CT and clinical follow-up findings of 80 patients (study group). Clinical parameters (signs of infection and renal indexes) and unenhanced CT findings (tissue rim sign, hydronephrosis, perinephric and periureteral edema, ureteral dilatation, renal attenuation, and stone characteristics) were graded and correlated with the choice of clinical management. ROC analysis was constructed for the most statistically significant parameters. RESULTS Forty-two patients (52%) were treated conservatively and 38 (48%) underwent interventional treatments. The relationship between shivering, fever, and leukocytosis and interventional treatment had low sensitivity (29%, 26%, and 16%, respectively) but very high specificity (98%, 95%, and 98%, respectively) (p < 0.05). Stone size and density were statistically significantly different between patients treated conservatively and those treated interventionally (size, 4.6 vs 6.7 mm; density, 730 vs 910 HU; p < 0.01). Stones larger than 6.5 mm with an attenuation value greater than 1100 HU and that were proximally located were more likely to be treated interventionally. CONCLUSION Larger stone size, higher density, proximal location, and complaints of shivering, fever, and leukocytosis are the most important parameters for predicting invasive management of acute renal colic. Other clinical and radiologic information may be useful as supportive findings but do not predict the choice of patient management.

MP30-09 URETERIC STENT VERSUS PERCUTANEOUS NEPHROSTOMY FOR ACUTE URETERAL OBSTRUCTION - CLINICAL OUTCOME AND QUALITY OF LIFE: A BI-CENTER PROSPECTIVE STUDY

Background To compare quality of life (QoL) indices between ureteral stent (DJS) and nephrostomy tube (PCN) inserted in the setting of acute ureteral obstruction.