Ihor S. Sawczuk

DEXAMETHASONE DOES NOT SIGNIFICANTLY CONTRIBUTE TO THE RESPONSE RATE OF DOCETAXEL AND ESTRAMUSTINE IN ANDROGEN INDEPENDENT PROSTATE CANCER

PURPOSEnWe evaluated the independent response rate of dexamethasone before docetaxel and estramustine administration as measured by changes in serum prostate specific antigen (PSA) in patients with androgen independent prostate cancer.nnnMATERIALS AND METHODSnA total of 12 patients received 20 mg. dexamethasone orally every 6 hours for 3 doses repeated every 3 weeks before starting cytotoxic therapy with estramustine and docetaxel. After progression on dexamethasone 280 mg. estramustine orally 3 times daily on days 1 to 5 and 70 mg./m.2 docetaxel intravenously for 1 hour on day 2 were given.nnnRESULTSnNone of the patients initially treated with dexamethasone monotherapy (median 1 cycle, range 1 to 5) had a PSA decline of 50% or greater. Median PSA increase on monotherapy was 47% (range 0% to 22%). On estramustine and docetaxel therapy PSA decreased 50% or greater in 11 patients (92%, 95% confidence intervals [CI] 60 to 99) and 80% or greater in 7 (58%, 95% CI 29 to 84), and normalized in 5 (42%, 95% CI 16 to 71), with a median duration of response of 153 (range 42 to 371), 132 (range 84 to 287) and 84 (range 21 to 174) days, respectively. Median times to reach 50% and 80% decreases in baseline PSA were 21 (range 21 to 209) and 63 (range 21 to 138) days, respectively. In 9 patients (75%, 95% CI 43 to 93) PSA decreased at least 50% by week 9. Of 4 patients with bidimensionally measurable disease 3 had a partial response. Median time to progression was 263 days (range 91 to 378).nnnCONCLUSIONSnAdministration of 20. mg. dexamethasone orally every 6 hours for 3 doses every 3 weeks does not significantly contribute to the PSA response rate of estramustine and docetaxel.

Association of radionuclide bone scan and serum alkaline phosphatase in patients with metastatic renal cell carcinoma

OBJECTIVESnWe assessed the frequency of bone metastases, their association with serum alkaline phosphatase (AP), and prognostic capabilities of AP in patients with renal cell carcinoma (RCC), using bone scan as the reference standard for diagnosis.nnnMETHODSnWe conducted a retrospective review of patients with metastatic RCC treated with either autologous ex vivo activated T-lymphocytes and cimetidine (ALT) or cimetidine alone.nnnRESULTSnTwenty-eight of 90 patients (31%) had evidence of bone metastases by bone scan. With 100 mg/ dL as the upper limit of normal, 11 of 28 (39%) patients with bone metastases had normal AP levels. Of these 11 patients, 8 had bone pain. Of the 3 asymptomatic patients with bone metastasis and normal AP levels, only 1 had bone as the only site of metastasis and would have been incorrectly staged without the scan. Patients with bone metastases had a significantly shorter median survival than those without bone metastases (13.8 versus 25.3 months; P < 0.05). Among patients without bone metastases who had elevated AP levels, those treated with ALT had significantly longer median survivals than those treated with cimetidine alone (27.6 versus 14.5 months; P < 0.05). Overall, patients treated with ALT had a significantly longer median survival than the ones treated only with cimetidine (21 versus 8.5 months; P < 0.05). Overall, the median survival for patients with elevated AP levels (10 months) was not significantly different from that of those with normal AP levels (13 months).nnnCONCLUSIONSnIn a high-risk group of patients with metastatic RCC, 31% had bone metastases. Elevated AP levels, the presence of bone pain, or the presence of other metastases correctly predicted bone metastasis in all but 1 patient. A bone scan may safely be omitted in patients with RCC, normal AP levels, and no bone pain. However, AP elevation itself had little prognostic capability in these patients.

Diagnosis and Surgical Correction of the Pediatric Varicocele

We reviewed our experience with the diagnosis and management of varicoceles in 40 patients 9 to 18 years old. Of the patients 29 underwent varicocelectomy and 11 are being managed conservatively with periodic followup. The results of therapy and criteria for surgical intervention are discussed.

Primary transitional cell carcinoma of prostatic periurethral ducts

Primary transitional cell carcinoma of the prostatic periurethral ducts is a distinct histologic variety of prostate carcinoma. Traditional methods of therapy for adenocarcinoma of the prostate are ineffective. A review of the literature suggests that appropriate radical surgical therapy should be considered for early control of this disease.

Transperineal prostate needle biopsy guided by transurethral ultrasound in patients without a rectum

OBJECTIVESnPatients with elevated prostate-specific antigen (PSA) and no access to the rectum present a diagnostic challenge to the urologist. This study was undertaken to determine the efficacy of transperineal prostate biopsy using transurethral ultrasound guidance for the detection of prostate cancer.nnnMETHODSnFive men status post either total colectomy or abdominoperineal resection (age range: 58 to 73 years, mean age 65.8 years) were referred to us for the evaluation of an elevated PSA (range: 5.6 to 21.4 ng/dL, mean 16.1 ng/dL). Seven procedures were performed utilizing transurethral ultrasound to guide transperineal prostate biopsies in these men.nnnRESULTSnBiopsy results revealed benign prostatic hyperplasia in 4 procedures and prostate cancer in 3 procedures.nnnCONCLUSIONSnTransurethral ultrasound enables the practitioner to perform accurate sonographic assessment and precise biopsy of the prostate in such patients.

CT findings in addison's disease caused by tuberculosis

Tuberculosis of the adrenal glands can present as adrenal insufficiency. The computed tomographic (CT) findings of this disease both prior to and after therapy are presented.

High incidence of asymptomatic brain lesions in metastatic renal cell carcinoma.

SummaryThe metastatic pattern of renal cell carcinoma has been well established. Studies have revealed a relatively high incidence of spread to lung, liver, bone and brain. A retrospective review of the records of ninety patients with metastatic renal cell carcinoma showed seven to have evidence of brain metastases. Six of the seven were asymptomatic at time of diagnosis. This study shows a significant incidence of asymptomatic brain metastases in patients with metastatic renal cell carcinoma. Subsequent to our chart review, an additional two patients have presented to our institution with asymptomatic brain lesions from metastatic renal cell carcinoma.

Idiopathic renal infarction

We describe the course of acute renal infarction, without a demonstrable cause, in an otherwise healthy young male. Renal function was not compromised, and the infarct failed to progress. Literature on relevant diagnostic and therapeutic modalities is reviewed.

Testis tumor in an adult presenting with torsion of testis

Abstract A testicular tumor presenting as torsion is reported in a fifty-two-year-old man. This is the first reported case in a patient more than twenty-eight years old.

Use of lymphoscintigraphy in chyluria

The roentgenographic procedure of choice in delineating lymphatic channels has been lymphangiography. Recently, radionuclide lymphoscintigraphy has been used to outline lymphatics in patients with various lymphatic disorders. We present and compare the results of lymphangiography and lymphoscintigraphy in 2 patients with chyluria. Since the results of lymphoscintigraphy correlated with lymphangiography, the application of this less invasive technique in the diagnosis and management of chyluria may be warranted.