O. Cussenot

Plasma neuroendocrine markers in patients with benign prostatic hyperplasia and prostatic carcinoma

PURPOSEnApproximately 50% of all malignant prostatic tumors contain neuroendocrine cells, which cannot be attributed to small cell prostatic carcinoma or carcinoid-like tumors, and which represent only 1 to 2% of all prostatic malignancies. Only limited data are available concerning the plasma levels of neuroendocrine markers in patients with prostatic tumors. Therefore, we determine the incidence of high plasma levels of neuroendocrine markers in patients with benign and malignant prostatic disease.nnnMATERIALS AND METHODSnThe presence of elevated plasma neuropeptide levels was investigated in 135 patients with prostatic carcinoma and 28 with benign prostatic hyperplasia. Plasma chromogranin A, neurone-specific enolase, substance P, calcitonin, somatostatin, neurotensin and bombesin levels were analyzed by immunoassays, and were compared to clinical and pathological stages of disease. Plasma prostatic acid phosphatase and prostate specific antigen levels were also determined. All patients were followed for at least 2 years after inclusion in the study.nnnRESULTSnSignificantly elevated levels of chromogranin A were detected in 15% of patients with prostatic carcinoma before any treatment. During hormone resistant prostate cancer progression plasma chromogranin A and neuron-specific enolase levels were elevated in 55% and 30% of the patients, respectively. In patients with stage D3 disease survival curves were generated by the Kaplan-Meier method, and log rank analysis revealed a statistically significant difference between groups positive and negative for chromogranin A. Substance P and bombesin were also occasionally elevated in prostatic tumors. Determination of neuroendocrine differentiation by neuron-specific enolase or chromogranin A immunoassays was not helpful in the prediction of progressive localized prostatic carcinoma.nnnCONCLUSIONSnFuture studies of plasma neuropeptide levels should confirm whether these parameters can be used as prognostic markers during late progression of prostatic carcinoma or for the selection of patients suitable for evaluation of new antineoplastic drugs to be active against neuroendocrine tumors.

TARGETED SCREENING FOR PROSTATE CANCER IN HIGH RISK FAMILIES: EARLY ONSET IS A SIGNIFICANT RISK FACTOR FOR DISEASE IN FIRST DEGREE RELATIVES

PURPOSEnTargeted screening for prostate cancer in high risk families is generally suggested by ages 40 to 45 years in first degree relatives. We support this concept by reporting higher risk and earlier onset of the disease in these families.nnnMATERIALS AND METHODSnWe proposed serum prostate specific antigen (PSA) testing in 40 to 70-year-old first degree relatives of 435 patients with prostate cancer treated between July 1994 and June 1997. A previous systematic genealogical analysis allowed us to define the familial prostate cancer status of each patient as sporadic or familial.nnnRESULTSnOf the 747 potential candidates 442 (59%) accepted into the study have been screened, including 240 who were 40 to 49 years old (mean age 44.8) and 202 who were 50 to 70 years old (mean age 57.4). Two of the 240 subjects (0.8%) had PSA greater than 4 ng./ml. in the 40 to 49-year-old group. Prostate biopsies were negative in 1 relative but diagnostic for prostate cancer in the other. In the 50 to 70-year-old group 25 of 202 subjects (12.4%) had a PSA of greater than 4 ng./ml. Prostate cancer was diagnosed in 9 individuals (4.5%), 9 had negative biopsy results, 1 died before biopsy and 6 refused biopsy. The proportion of relatives with PSA greater than 4 ng./ml. and prostate cancer detection was not different according to familial status (sporadic or familial) but it was significantly higher in first degree relatives with early onset prostate cancer in the family at ages younger than 65 years (p = 0.037 and 0.012, respectively).nnnCONCLUSIONSnOur results emphasize the usefulness of PSA screening in high risk families, including those without obvious hereditary features. Furthermore, early onset prostate cancer is a significant risk factor for prostate cancer in first degree relatives.

Telomerase activity as a potential marker in preneoplastic bladder lesions

Objective To assess telomerase activity (involved in cell immortalization and detectable in most malignant tumours but not in normal somatic tissues) as a marker in cancer diagnosis.

Variations in arterial blood supply and the risk of hemorrhage during percutaneous treatment of lesions of the pelviureteral junction obstruction: report of a case of testicular artery arising from an inferior polar renal artery

SummaryAcute hemorrhage during percutaneous surgery on the pelviureteric junction obstruction has been estimated to be 2–3%. Following the experience of peroperative bleeding from a vascular variation, the authors discuss the arterial anomalies of the renal pedicle which may carry the risk of hemorrhage during percutaneous surgery in this region. Arteries in front of or behind the renal pelvis are the cause of ureteropelvic function obstruction in 15–52% of cases and because of their close relationship with the upper urinary tract can complicate the procedure of endopyelotomy. Endourological techniques are inadequate for avoiding the risk of vascular damage during the necessary maneuvers. Inferior polar arteries occur in 9% of the population and their different courses are described. They are not always responsible for the vascular obstruction in the pelviureteric syndrome, and it is the exact determination of this responsibility that makes imaging essential. Arteriography performed in our case allowed embolisation of the damaged inferior polar artery and also showed the anomalous origin of the testicular artery from this polar artery; this appears to be only the second description of this anomaly. This variation is discussed in a review of the literature. In fact the testicular artery has a high or aberrant origin in 20% of cases; in 5–6% of these the origin is from a main or supernumerary renal artery. Origin from an inferior polar artery is exceptional.RésuméLes complications hémorragiques immédiates des cures de syndrômes de la jonction pyélo-urétérale par voie percutanée peuvent êtres estimées à 2–3 %. A partir dune variation anatomique vasculaire originale ayant provoqué un saignement per-opératoire, les auteurs discutent les anomalies artérielles du pédicule rénal qui font courir un risque hémorragique au cours des techniques de chirurgie percutanée dans cette indication. Les artères pré ou rétro-pyéliques sont en cause dans 15 à 52 % de ces syndrômes et peuvent par les rapports intimes quelles contractent avec le haut appareil urinaire, compliquer de telles endo-pyélotomies. Les techniques endo-urologiques qui permettent de limiter le risque de plaies vasculaires au cours de ces manoeuvres sont insuffisantes. Les artères polaires inférieures existent dans 9 % de la population et leurs différents modes de disposition sont rappelés. Toutes ne forment pas de brides vasculaires responsables du syndrôme de jonction pyélo-urétérale et cest à la détermination précise de cette responsabilité que se heurtent les examens iconographiques. Lartériographie réalisée dans cette observation a permi lembolisation de lartère polaire inférieure lésée et la mise en évidence de la naissance anormale de lartère spermatique à partir de cette artère polaire ; il ne sagit que de la seconde description de ce type. Cette éventualité est discutée dans le cadre dune revue de la littérature. En effet, dans 20 % des cas, les artères spermatiques ont une origine haute ou aberrante : cest le cas des 5 à 6 % qui naissent dune artère rénale principale ou surnuméraire. La naissance à partir dune artère polaire inférieure est exceptionnelle.

In vivo model mimicking natural history of dog prostate cancer using DPC-1, a new canine prostate carcinoma cell line

Dog prostate cancer is usually considered to be highly relevant to human prostate cancer. We report the isolation of a new canine prostate cancer epithelial cell line designated DPC‐1.

Anatomical bases of percutaneous surgery for calculi in horseshoe kidney

SummaryHorseshoe kidney is a renal fusion which combines three anatomic abnormalities: ectopia, malrotation and vascular changes. These anomalies can be recognised separately to varying degrees in unfused kidneys. Necessary modifications of the standard technique for percutaneous nephrolithotomy (PNL) are directly deducible from analysis of the anatomic data of the imaging of horseshoe kidneys. We report our experience with 5 patients (7 kidneys) who underwent PNL for calculi in horseshoe kidneys. The percutaneous approach was performed under ultrasound and fluoroscopic monitoring. In situ disintegration by ultrasonic lithotripsy and nephrostomy drainage were necessary in all cases. Modifications of the standard PNL procedure are related to the anatomic changes. The lower abdominal position of a horseshoe kidney necessitates upper or middle calyceal puncture, while the malrotation necessitates a more posterior puncture. Monitoring of the puncture needle by fluoroscopy as it is advanced postero-anteriorly is more difficult and the risk of the surgeons hand entering the radiation path is increased. The renal pelvis is deep and a long endoscope may be required. Aberrant segmental vessels may create potential hazards. The majority of problems in location can be avoided by use of an ultrasonically guided needle. Percutaneous nephrolithotomy is the treatment of choice for calculi in horseshoe kidneys for the following reasons: the high incidence of recurrent lithiasis in horseshoe kidney and the complexity of repeated surgical approaches diminish the acceptable results of open surgery; difficulties in focussing on the calculi and drainage problems militate against the success of extracorporeal shock wave lithotripsy (ESWL); PNL has a good success rate and the least morbidity.RésuméLe rein en fer à cheval est la malformation reconnue comme la fusion du pôle inférieur des reins. Toutefois, elle associe à des degrés divers trois types danomalies anatomiques qui peuvent ête reconnues sur des reins non fusionnés (ectopie, malrotation et vascularisation anormale). Ces modifications observées sur des reins en fer à cheval compliqués de calculs nécessitent une adaptation de la technique de néphrolithotomie percutanée directement déduites des corrélations radio-anatomiques. Une étude réfléchie de lapproche percutanée des reins en fer à cheval permet ainsi, une modélisation des adaptations possibles dune technique opératoire au status anatomique observé dans diverses anomalies rénales. Nous rapportons ici notre expérience chez cinq patients (7 reins) traités pour des calculs sur rein en fer à cheval. Les modifications apportées à la technique standard de néphrolithotomie percutanée ont été principalement une ponction dorsale et une entrée par les calices supérieurs ou moyen en raison de la malrotation et de la situation abdominale basse du rein. A condition dadaptater le geste opératoire à une bonne analyse morphologique, la néphrolithotomie percutanée nous semble le traitement de choix des calculs sur rein en fer à cheval en raison de la fréquence des interventions pour récidives lithiasiques sur ce type de malformation et des anomalies du drainage du système pyélocaliciel qui expliquent les échecs de la lithotritie extracorporelle.

Anatomical histological and mesoscopic study of the adipose tissue of the orbit

Our study aimed to define the organization of the orbital adipose tissue, which is constituted from white adipose tissue. Six orbital samples were taken by dissection from fresh cadavers. After fixation and paraffin-embedding, the blocks were sectioned in the three spatial planes (two in the frontal, two in the sagittal, two in the horizontal). Semi-serial sections of 7xa0μm were then stained with hematein, eosin, safran or Masson trichrome green. We noticed strong areas of adhesion with orbital bones located at the lacrimal gland, the orbital trochlea and the inferior orbital fissure. Our mesoscopic and histological results allowed the description of two types of orbital adipose tissue corresponding to morpho-functional topographic variations. One was constituted of thick conjunctival septa with small adipocytes near muscles and the lacrimal gland. This was a supporting tissue that gave the points of rotation. The other was constituted of thin conjunctival septa with larger adipocytes near the optic nerve, allowing its movements in the orbit. These morphological differences appeared to be correlated with the mechanical role of these two areas. The dense appearance could correspond to the functional trochlea of rectus muscles described. In contrast we did not observe the systematic radial and concentric conjunctival meshwork classically described. This study underlines the specificity of orbital adipose tissue, which could be useful for a better understanding of its normal and pathological partition and its involvement in ocular motility.

Percentage of free serum prostate-specific antigen : a new tool in the early diagnosis of prostatic cancer

Prostate-specific antigen (PSA) is a protease able to bind to serum antiproteases as alpha 1 antichymotrypsin (ACT). Free PSA (FPSA) corresponds to the fraction of total PSA (TPSA) which is unbound to ACT. Specific detection of the FPSA seems to be a valuable tool in the distinction between prostatic cancer (PCa) and benign prostatic hyperplasia (BPH). Our aim was to evaluate retrospectively the FPSA/TPSA ratio in comparison to TPSA or FPSA determination, using two new immunoradiometric assays (PSA-RIACT and FPSA-RIACT, CIS bio international, Gif Sur Yvette, France) in the early diagnosis of PCa. 256 men, with TPSA levels between 0.7 and 44.7 ng/ml (median age = 69 years), including 164 sera obtained from patients with BPH and 92 sera from patients with untreated PCa were assayed. All diagnoses were histologically confirmed and patients tested before any adjuvant treatment. The evaluation of the median FPSA/TPSA ratio in the two groups showed significantly different values (BPH group: 24.2%, PCa group: 12.1%, P < 0.0001). By R.O.C. (Receiver-Operating-Characteristics) analysis, we show that the FPSA/TPSA ratio is the method of choice for discriminating BPH and PCa, since the area under curve is the greatest for the FPSA/TPSA ratio curve, as compared to the TPSA or FPSA curves (P < 0.0001). The best accuracy (number of true positive + true negative/total = 82.4%) was obtained with a FPSA/TPSA ratio < or = 15% with high odds ratio (20.5; confidence interval (CI): 11.2; 37.7). Of interest, similar results were also confirmed even in the subpopulation with serum TPSA levels between 2.5 and 10 ng/ml (161 patients including 99 BPH and 62 PCa). We thus confirm that combined serum measurement of FPSA and TPSA is of particular interest in the early diagnosis of PCa for patients with non-suspicious digital rectal examination and a TPSA value between 2.5 and 10 ng/ml. In those patients, biopsy should be reserved to the cases with FPSA/TPSA below 15%, which allows significant odds ratio (12.8; CI: 5.2; 31.4). Otherwise, to avoid the risk of missing any PCa, usual follow-up with combined TPSA and FPSA determination would be required with the same criteria of biopsy (i.e. FPSA/TPSA ratio < or = 15% when TPSA value is between 2.5 and 10 ng/ml; or TPSA > 10 ng/ml).

Anatomic basis of laparoscopic surgery in the male pelvis

SummaryLaparoscopic surgery of the male pelvis remains a risky procedure, with around 15% of perioperative complications, as compared to 0.03% in laparoscopic surgery for gynecologic and obstetric conditions. Many of these complications are due to the surgeons being faced with an unfamiliar anatomic situation in his approach through the laparoscopic operative field. We have added to the data of the literature our anatomic and clinical experience in order to define the anatomic basis of surgical risk in this type of procedure. While dissection lateral to the iliac vessels (surgery of the spermatic cord) is safe, dissection medial to these vessels is more risky because of the confined anatomic relationships and their variations (particularly vascular anomalies and variable relations of the ureter).RésuméLa chirurgie laparoscopique du pelvis masculin reste une chirurgie à risque, environ 15 % de complications péri-opératoires, si on la compare aux 0,03 % de la chirurgie laparoscopique en milieu gyné-co-obstétrical. Bon nombre de ces complications sont liées à la confrontation de lopérateur à une situation anatomique nouvelle par son approche à travers un champ opératoire laparoscopique. Nous avons confronté aux données de la littérature notre expérience anatomique et clinique afin de préciser les bases anatomiques du risque chirurigical pour ce type dinterventions. Si la dissection en dehors des vaisseaux iliaques (chirurgie du cordon spermatique) est sûre, par contre les rapports anatomiques étroits et leurs variations rendent la dissection sur le bord médial des vaisseaux iliaques plus risquée (anomalies vasculaires et rapports variables de luretère en particulier).

Gene transfer to urethral strictures in rabbits: a preliminary report

Objective To assess the rationale for virus‐mediated gene transfer into the urethra in vivo and in vitro, using a rabbit model, as this is an attractive approach to prevent recurrence after the endoscopic management of urethral strictures.