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Human glutathione S-transferase μ (GSTμ) deficiency as a marker for the susceptibility to bladder and larynx cancer among smokers

The isoenzyme mu of glutathione S-transferase (GST mu) is dominantly inherited and the prevalence of this isoenzyme in the population is about 60%. An increased risk of lung cancer has been previously shown among smokers lacking GST mu in (Seidegard J., Pero R.W., Miller D.G., Beattie E.J. (1986) Carcinogenesis, 7, 751-753). The frequency of the phenotypes of this isoenzyme in bladder cancer patients (n = 75), in larynx cancer patients (n = 78) and healthy controls matched for age and smoking history is reported here. A significantly higher proportion of smokers in the control group had measurable GST mu compared with bladder cancer patients (54.6% vs. 33.3%, P < 0.01) and also compared to larynx cancer patients (55.1% vs. 33.3%, P < 0.01). Odds ratio analysis indicates that smokers with this polymorphic variant have an approximately 2-fold greater risk of developing these cancers.

Orthotopic Renal Transplant and Results in 139 Consecutive Cases

Although a commonly performed technique, heterotopic renal transplantation may be a cause of late graft failure owing to ureteral stenosis, urinary fistula and vesicoureteral reflux secondary to the immune response. The new retroperitoneal lumbar approach to the splenic vessels has allowed the orthotopic technique to be developed using the splenic artery or aorta, the renal vein and a pyelo-pyelic anastomosis. In this manner the renal graft is located in an anatomical position that is well protected, and with the recipient urinary tract the normal physiology is preserved with comparatively low complication and mortality rates. A third transplant attempt also is simplified. This method is the only alternative in some cases. Transplant ureter pathology symptoms are not observed. The results of 139 consecutive cases are presented.

URODYNAMIC EVALUATION IN SIMULTANEOUS INSULIN- DEPENDENT DIABETES MELLITUS AND END STAGE RENAL DISEASE

PURPOSE We evaluated the urodynamic changes produced by insulin-dependent diabetes mellitus with end stage renal disease. MATERIALS AND METHODS A urodynamic evaluation was performed on 51 young patients (mean age plus or minus standard deviation 35 +/- 6 years) with long-term diabetes mellitus (average 21 +/- 6 years) and end stage renal disease (86% on dialysis). RESULTS The urodynamic study was abnormal in 84% of the patients. The bladder was hypersensitive in 39% and hyposensitive in 30% of the cases, and maximum vesical capacity was greater than 600 ml. in 33%. An acontractile detrusor was noted in 6% of the patients, while 4% had detrusor hyperreflexia and 35% had bladder outlet obstruction. CONCLUSIONS A high frequency of vesical alterations was observed, which were modified by association of progressive vesical dysfunction and diabetes mellitus. In diabetes mellitus dialysis protects against detrusor hypocontractility but predisposes the patients to have bladder obstruction.

p53 Expression Predicts Progression and Poor Survival in T1 Bladder Tumours

Objectives: Histological grade (G) is the only parameter proved to have prognostic value for progression in T1 transitional cell carcinoma (TCC) of the bladder, although it is considered inaccurate to make clinical decisions on individuals. The aim of the present study was to evaluate the prognostic relevance of p53 expression in T1 TCC of the bladder.Methods: Clinical records of 207 patients with T1 TCC of the bladder were reviewed for clinical parameters reported to influence the evolution of superficial bladder cancer. Among these 207 patients, 40 developed muscle–invasive disease (20 G2 and 20 G3). A retrospective case–control study was then carried out comparing the latter 40 tumours with 40 control tumours matched by grade, sex, age, number and size of the tumours, chemical exposure and presence of carcinoma in situ. p53 immunostaining with monoclonal antibody was performed in these two groups.Results: Histological grade was the only clinical parameter that influenced evolution. p53 expression correlated with tumour progression, since it was observed in 21 out of 24 p53–positive tumours and in only 20 of 56 p53–negative tumours (p<0.0001), showing a specificity of 93.5% and a sensitivity of 53%. p53 expression correlated as well with patient survival, being 39% in patients with p53–positive tumours and 80% in patients with p53–negative tumours at 60 months (p<0.0001).Conclusions: p53 protein expression has prognostic value for survival and progression in T1 bladder tumours and can be used for early detection of poor–prognosis T1 bladder tumours.

Obstruction and Recanalization of the Ureter during Embryonic Development

Major controversies still exist regarding the terminology, the etiology and the pathogenesis of congenital obstructive diseases of the ureter. To try to provide some additional information to this controversial subject, a comparative study of ureteral development in rat and human embryos, using light and electron microscopy, has been performed. During fetal development we observed and demonstrated the existence of obstructive phenomena, both at the level of the ureterovesical junction (Chwallas membrane) and along the ureter. At the end of the embryonic period, the ureter undergoes a physiologic recanalization process.

Measurement of complexed PSA in the differential diagnosis between prostate cancer and benign prostate hyperplasia .

To enhance the specificity of PSA in diagnosis of cancer, several approaches have been evaluated, having in common the study of fractions of PSA. The aim of this study was to evaluate the usefulness of complexed PSA in the differential diagnosis between benign prostate hyperplasia (BPH) and prostate cancer.

Extracorporeal renal surgery. Work bench surgery.

In cases in which renal repair through conventional in situ surgery is not possible, we have proceeded to remove the organ outside of the human body and placed in on a work bench where exsitu repair is aided by microsurgery, x-ray films, and image amplifiers. In most cases the damaged kidney has recovered its function and a grave problem has been solved. Extracorporeal surgery means a new tactical solution to extreme situations.

Detection of nonprostatic PSA in serum and nonserum samples from women.

Prostate‐specific antigen (PSA) has been characterized as a specific prostate marker, although recent studies have suggested the existence of PSA of nonprostatic sources. We have assessed the presence of PSA by an ultrasensitive assay in 276 serum and nonserum samples from women. Our data show the presence of PSA in 90% of nonserum samples, including milk secretions, breast cysts, amniotic fluids and broncho‐alveolar washings. We have also detected its presence in 58% of the sera tested, although it only exceeded 0.1 μg/l in 6 of the cases. We conclude that PSA can no longer be considered a specific prostate tissue marker; since the concentrations detected in womens serum are ultralow, this finding appears to interfere minimally with its value as a tumoral marker.

Skeletal response to clodronate in prostate cancer with bone metastases.

Bone metastases, together with generalized bone resorption, represent the main complication in patients with advanced prostate cancer, and palliative treatments are required to delay the progression of the metastases and improve the quality of life of these patients. For this reason, the bisphosphonate clodronate was administered to 18 patients (clodronate group) from a total of 30, all of whom were receiving complete androgenic blockade; the remaining 12 formed the control group. Transiliac bone biopsies were taken at the beginning of the study and 6 months later to determine the effect of the bisphosphonate on the skeleton. The results were assessed by bone histomorphometry and showed, although without statistical significance between the groups, an antiresorptive effect of the clodronate expressed as the eroded surface/bone surface and as the osteoclast number/bone surface. However, the bone volume also decreased after 6 months of treatment. Similarly, osteoid formation decreased as indicated by the osteoid surface and by the osteoid volume, probably due to the effect of the drug on the osteoblasts. The mineralization rate was apparently slightly retarded in the clodronate group, although to a lesser degree than in the control group. The results confirm the antiresorptive effect of clodronate and its detrimental effect on osteoblast activity.

Urogenital Diaphragm Raising Maneuver

The urogenital diaphragm raising maneuver, a procedure to facilitate membranous urethral surgery, is described. The technique shortens operating time by permitting easy identification and exposure of the severed urethral ends, thus, allowing for precise re-establishment of urinary tract continuity. Selective membranous urethral surgery can be performed with ease, preserving external sphincter integrity. This maneuver represents an advance over any other technique by almost eliminating the risk of stenosis, urinary fistula and incontinence owing to failure of precise reapproximation of the membranous urethra.