J. Fenimore Cooper

A clinical appraisal of post‐irradiation biopsy in prostatic cancer

Twenty patients with adenocarcinoma of the prostate were reviewed clinically and by serial biopsy to demonstrate the spectrum of difficulties encountered. Only three patients recurred locally during their lifetime. In spite of positive biopsies, 17/20 patients had negative clinical exams at 2–7 years. Deaths were mainly secondary to disseminated disease. There is yet no good correlation between clinical evaluation and the biopsy response pattern. The significance of no residual tumor or fibrosis with scattered tumor nests on post‐irradiation biopsies has yet to be defined.

Urethral diverticulum in adult female. Clinical aspects, operative procedure, and pathology.

Abstract The literature dealing with urethral diverticulum has been reviewed with particular reference to previous surgical procedures. In addition, clinical findings, diagnostic methods, race distribution, type of infection as well as pathology and origin have been discussed. A surgical procedure has been described which promises cure of the disease and if complications should occur, these are correctable.

Antireflux Ureteroileal Anastomoses in Humans

It is now apparent that the standard total cystectomy and Bricker procedure, by eliminating the ureterovesical junction with its reliable antireflux mechanism, markedly reduces the protection of the upper urinary tracts. In an attempt to restore this protective principle, the subserosal ileoureteral antireflux procedure was devised and subsequently performed in 6 patients with infiltrating bladder carcinoma. The operation is technically easy to perform, it is not time consuming and has consistently prevented ileoureteral relux without causing obstruction. There have been no serious complications, no episodes of pyelonephritis or urinary leakage and no evidence of renal functional deterioration as measured by serum creatinine and IVP. Although it is still to early to predict the eventual long-term results our experience with the first 6 patients with the antireflux ileoureteral anastomosis suggests that this modification of the original Bricker procedure offers superior protection to the upper urinary tracts.

Excessive proliferation of peripelvic fat of the kidney.

Excessive proliferation of the peripelvic fat of the kidney (EPPF) is a benign process with an innocuous effect on the patient. However, this condition may assume major clinical significance by producing pyelocalyceal deformities that may be mistaken for true renal masses. Rarely, EPPF may masquerade as a renal pelvic tumor. We present the second reported case of EPPF simulating a renal pelvic tumor and review the history as well as the characteristic radiographic and sonographic features of this condition.

Distribution of prostatic acid phosphatase isoenzymes in normal and cancerous states

We have studied the IEF (isoelectric focusing) profiles and the sedimentation characteristics of intracellular and secretory prostatic acid phosphatase (PAP) in normal and cancerous states. IEF studies show a similar relative distribution of tartrate inhibitable pI 4.9 (approximately 80%) and 5.6 (approximately 20%) forms of this enzyme in normal as well as cancerous prostate. The same IEF profile is obtained regardless of whether an enzymatic or RIA method is utilized for detection of PAP. Of these two isoenzymes, only the form of pI 4.9 predominates in prostatic and seminal fluids and in Stage IV serum. Sedimentation analysis shows that the purified enzyme is exceptionally stable since it retains an S020,w value of 5.7 at low concentrations (ng/ml). While only the 5.7S form is observed in normal and cancerous tissues as well as in prostatic fluid, analysis of Stage IV serum reveals an additional form at 8.7S. Control experiments suggest that the 8.7S form is not induced by non-specific association with normal serum proteins or by the inhibitor tartrate. Our results suggest that: (a) of the two major isoenzymes in tissue, only the pI 4.9 isoenzyme predominates in secretion, (b) this relationship of intracellular to secretory forms is unaltered in the transition from normal to cancerous tissue, and (c) the utility of PAP as a tumor marker is derived at least in part by the intrinsic stability of the 5.7S form. The significance of the 8.7S form is unknown at the present time, but it does not distort the clinical (RIA) measurement of PAP in serum.

Identification of structural and secretory lectin-binding glycoproteins of normal and cancerous human prostate

We have utilized the technique of lectin-loading of SDS gels with iodinated concanavalin A and wheat germ agglutinin to identify glycoproteins in prostatic and seminal fluids as well as in prostate tissue fractions. The following subunits which bound both lectins were detected: (a) 50, 43 and 38 kDa subunits common to prostatic and seminal fluids, and an additional 55 kDa subunit which predominates only in prostatic fluid; (b) 78, 55, 50 and 43 kDa subunits in prostatic tissue cytosol and (c) 195, 170, 135, 116 and 95 kDa subunits present in the particulate fractions of prostatic tissue. Immunoblotting using specific rabbit antibodies revealed the 50 kDa band to be prostatic acid phosphatase and the 38 kDa band to be prostate-specific antigen. Interestingly, antibodies directed toward prostatic acid phosphatase were found to cross-react with the 43 kDa band. Fractionation on sucrose gradients showed that several of these particulate glycoproteins were associated with a vesicle fraction enriched in adenylate cyclase activity, implying that they are plasma membrane glycoproteins. Comparison of soluble and particulate fractions of normal and cancerous tissue homogenates was made by densitometric scanning of autoradiograms of lectin-loaded gels. Similar relative intensities of lectin-binding were obtained for corresponding proteins in normal and cancerous tissue fractions. Also, immunoblotting showed no differences in prostatic acid phosphatase or prostate-specific antigen between normal and cancerous soluble homogenate fractions. Our results suggest that major lectin-binding proteins are conserved in the transition from normal to cancerous tissue. These results may be useful in developing a multiple-marker profile of metastatic prostate cancer and for the design of imaging agents, such as monoclonal antibodies, to prominent soluble and particulate prostate glycoproteins.

The effect of antibody on human prostatic acid phosphatase activity—I: Temperature and pH stabilization of acid phosphatase enzyme activity by rabbit antibody to acid phosphatase

Abstract Prostatic acid phosphatase was purified from prostatic fluid. Monospecific antisera to the purified acid phosphatase was then produced in rabbits. When antibody was coupled with acid phosphatase, the enzymatic activity was markedly stabilized against pH and temperature degradation. Both acid phosphatase and rabbit anti acid phosphatase were non specifically coupled to Sepharose-4B using cyanogen bromide. Under these circumstances slight stability occurred when antibody was bound to Sepharose, and then acid phosphatase added to the gel antibody complex. When acid phosphatase was complexed to Sepharose, no stabilization occurred.

Recurrence patterns in the non-seminomatous germinal testicular tumors

Abstract The authors have evaluated 80 consecutive patients with non-seminomatous testes tumor by studying local recurrence patterns in both surgical and irradiated regions to judge the relative effectiveness of these therapeutic modalities. Employing this analysis, there were 6 patients of 32 failures in the N0, N1–N2, N3 and N4 categories who migbt have benefited by more intensive irradiation to nodal areas because of a failure to disseminate in less than 1 year. In the N1–N2 patients, 12 of 14 successes were in the 3500–4500 rad region. Recommendations for treatment are as follows: 1. 1. Patients with negative nodes (N0) require adequate retroperitoneal node dissection alone. 2. 2. Patients with resectable histologically involved nodes (N1–N2) should probably receive post-operative radiotherapy to the involved retroperitoneal region with doses of 5000–5500 rad. 3. 3. Unresectable retroperitonal lymph node disease (N3) probably requires a systemic approach with localized irradiation administered to the involved nodes only. 4. 4. Patients presenting with supradipharagmatic disease (N4 or M1b & M1c) have disseminated tumor and radiotherapy is used for palliation of local masses not controlled by chemotherapy. 5. 5. Prophylactic mediastinal irradiation is not routinely indicated in any stage of the disease.

The effect of antibody on human prostatic acid phosphatase. Substrate utilization by enzyme or enzyme-antibody complex.

Abstract Rabbit antibody to human prostatic acid phosphatase stabilizes the enzyme activity against thermal inactivation at antigen-antibody equivalents of two or greater. The pH optimum of the enzyme itself and the enzyme-antibody complex varies with different substrates. As the size of the substrate increases the activity of the enzyme alone decreases and antibody inhibition of enzymic activity is enhanced.

Gamma a Myeloma with Hyperviscosity and Obstructive Uropathy

A patient with gamma A myeloma, hyperviscosity and an obstructive uropathy is described. Operation revealed a proteinaceous mass obstructing the right renal pelvis. Immunoprecipitin and immunofluorescent analysis of this mass and concentrated urine demonstrated the presence of gamma A myeloma protein, kappa light chains and albumin. This is the first description of an obstructive uropathy in multiple myeloma owing to a proteinaceous matrix containing paraprotein.