James F. Glenn

Experience with Gleason’s Histopathologic Grading in Prostatic Cancer

The inaccuracy of clinical staging as a predictor of the biologic potential of prostatic cancer has prompted evaluation of additional methods of assessment. We reviewed 228 patients with prostatic adenocarcinoma who presented during a 4-year period. Of the 228 patients 144 with no detectable bony disease underwent staging pelvic lymphadenectomy with or without preliminary bilateral pedal lymphangiography. Histopathologic specimens of the primary diagnostic prostatic biopsy were classified with Gleasons grading system of tumor differentiation. Of the patients with Gleasons sum of 8, 9 or 10, 93 per cent had regional nodal metastases, regardless of preliminary clinical stage. Furthermore, no patient with Gleasons sum of 2, 3 or 4 had nodal metastatic disease. The incidences of falsely positive and falsely negative lymphangiograms were 29 and 35 per cent, respectively, reflecting the unreliability of pedal lymphangiography to predict nodal involvement accurately in patients with prostatic cancer. The Gleason system of histopathologic grading was reliable and reproducible, and afforded an accurate prediction of the surgical stage of disease.

The clinical spectrum of prostate cancer

Review of 206 consecutive patients with prostatic carcinoma and a potential for 10-year followup indicates the efficacy of vigorous surgical or hormonal management. Satisfactorily documented followup was achieved in 88 per cent of the group for 5 years and 82 per cent of the group for 10 years. Among 33 patients undergoing radical perineal prostatectomy survival rates were 84 per cent at 5 years and 58 per cent at 10 years. In the entire series, irrespective of modality of treatment, approximately half of the patients survived 5 years and a fourth for 10 years. Hormonal therapy of choice was orchiectomy combined with relatively high doses of estrogens, with no indication of significant cardiovascular morbidity or mortality. Interestingly, stage A disease (often diffuse, anaplastic and unsuspected) demonstrated a significantly increased mortality risk when compared to stage B (localized and usually well differentiated) carcinoma of the prostate.

Prospects and Challenges

Stephen W. Freiman and George Y. Onoda Jr. Ceramics Division, NIST Gaithersburg, MD 20899 Introduction Forecasting the applications and market for advanced ceramics at the beginning of the 21st Century is a daunting task. One need only look back over this century, when advanced ceramics came into being, to see the difficulties of predicting the future. In certain instances, advances in new technology drove the exploration for better ceramic materials—the need for improved sparkplug insulators for internal combustion engines, for example. In other cases, new ceramics, often discovered through serendipity, have enabled technologies—as in the discovery of new dielectric ceramics as the prime component in miniaturized wireless communication. Changes in economic factors and the political environment also play a significant role. When efforts were just beginning to develop silicon nitride and other non-oxide ceramics as materials for gas turbine engines, fuel economy was a major impetus for their development. The projected increases in oil prices did not materialize, making development of a more expensive gas turbine engine less attractive. In addition, increased pressure for a balanced federal budget has caused government R&D spending to remain constant or even decrease, limiting the prospect of bringing new materials to the marketplace. Corporate R&D efforts have followed a similar trend. If we cannot foresee the ceramics of the next century, or the applications for which they may be needed, are there positive steps we can take to assist in the development of advanced ceramics in the U.S.? We believe that the answer is yes. AMPTIAC AMPTIAC A D VA N C E D M AT E R I A L S A N D P R O C E S S E S T E C H N O L O G Y

Enucleative Surgery for Renal Malignancy

Bilateral renal cell carcinoma, malignant tumors of a solitary kidney or renal carcinoma in the presence of a contralateral kidney with compromised function may be treated by simple enucleation of the tumor, usually pseudoencapsulated, permitting relatively avascular removal. We treated 5 such patients by surgical enucleation of renal cell carcinoma who have survived for intervals of 9 months to 5 years without evidence of recurrent local or metastic disease. The simplicity of the technique offers several advantages, primarily those of applicability to lesions of any portion of the kidney and the minimal disturbance of renal hemodynamics and renal function.

The curability if invasive bladder cancer treated by radical cystectomy.

174 patients with transitional cell carcinoma of the urinary bladder were treated by radical cystoprostatectomy, with or without adjunctive radiation therapy, and followed for at least 5 years or until death. Survivorship relates to both grade and stage of disease at the time of treatment. Adjunctive radiotherapy improved survival in patients with extensive bladder wall and extravesical involvement in this series. Best results were achieved in patients with a low pathologic stage of disease, poorest results--predictably--with high stage, high grade tumors.

Primary Non-Urachal Adenocarcinoma of the Bladder

The clinical course of 34 patients with non-urachal adenocarcinoma of the bladder was reviewed and compared to the world experience. The 5-year survivorship was 19 per cent, with only 1 patient being free of disease. Metaplasia with formation of glandular elements reflects the unstable potential of the transitional cell and may be associated with the biologic aggressiveness of the tumor.

Foreign bodies and urinary stones

Experimental and clinical aspects of calculogenesis about foreign bodies are reviewed. Factors such as infections, urine dilution, urinary pH, and suture materials are discussed from an investigative point of view. The various kinds of clinical foreign body stones reported are categorized according to the manner of introduction into the urinary tract and anatomic locations.

Minimal mortality of renal surgery.

Eight hundred fourteen renal operative procedures were reviewed to determine overall mortality and to identify patients at risk. The over-all mortality was 1.35%, but as high as 30% in patients with uremia and spesis. Carcinomatosis contributed to higher mortality in other groups. In the absence of these three factors renal surgery was associated with very low or no postoperative (thirty day) mortality.

Anterior Urethral Diverticulum Associated with Posterior Urethral Valves

Abstract The association of anterior urethral diverticulum with posterior urethral valves has not been reported previously. We report a case of anterior urethral diverticulum at the penoscrotal junction and type I posterior urethral valves. Immediate drainage and later fulguration of the posterior valves and marsupialization of the anterior diverticulum yielded a good result. The association of the anterior urethral diverticulum and posterior urethral valves fits the theory of a wide spectrum of mesenchymal defects including megalourethra.

Comparison of absorbable sutures in urinary bladder

Experimental cystotomy wounds in dogs were closed with sutures of polyglactin-910, polyglycolic acid, and chromic catgut. Animals were sacrificed at intervals of five to thirty days, and wounds were examined grossly and microscopically. This study reconfirms the benignity of early tissue reaction to catgut and points out the similarity of tissue reaction to polyglycolic acid and polyglactin-910 suture in the urinary bladder, the reaction characterized by early separation and invasion of suture fibers by cellular infiltration.