R. W. Schlick

Single potential analysis of cavernous electric activity —a possible diagnosis of autonomic impotence?

SummaryThe aim of our study was to examine the cavernous smooth-muscle electric activity in normal and impotent patients as well as in those with (presumably) well-defined neurologic lesions. Single potential analysis of cavernous electric activity (SPACE) was done in 12 consecutive impotent patients, 34 normal patients, and 19 patients referred especially for SPACE. In the normal patients, similar potentials with a mean duration of 9.5 s, a mean amplitude of 153 μV and a mean polyphasity of 8.5 were recorded (cutoff frequencies, 2–2000 Hz), with cutoff frequencies set at 0.5–500 Hz, the mean duration was 12.8 s, amplitude was 444 μV and the mean polyphasity was 13.8 Upper spinal cord lesions showed potentials of long duration as well as whips and bursts. Patients with lower motor-neuron lesions showed either short potentials of high amplitude or potentials of small amplitude. In 49% of the impotent patients, abnormal SPACE was found. Our results suggest that SPACE is a reproducible and minimally invasive method for the diagnosis of autonomic neurogenic impotence.

Metastatic renal cell carcinoma (RCC): Spontaneous regression, long-term survival and late recurrence

AbstractWe report 4 cases of metastatic renal cell carcinoma (RCC) with long-term survival either following radical nephrectomy alone or in combination with radioor hormonal therapy.Two patients with lymph node metastases showed a long-term survival of 12 or more years following radical tumour nephrectomy (with lymphadenectomy) and radiotherapy. One of them exhibited a histologically proven tumour recurrence nearly 12 years after primary surgical treatment and died shortly later; the other one is still without any evidence of metastatic disease.Two other patients exhibited spontaneous regression of pulmonary metastases: one regression occurred after radical tumour nephrectomy alone, the other one after successful primary hormonal treatment and subsequent radical tumour nephrectomy.The following important aspects are emphasized:1.Renal cell carcinoma is a very unpredictable tumour. Once the diagnosis of renal cell carcinoma is proved, a patient can never be considered cured.2.Although adjuvant palliative nephrectomy has produced contradictory results in several reports, radical tumour nephrectomy either alone or in combination with other adjuvant therapies such as radiotherapy, hormonal or immunological treatment, can be worthwhile. Cases with long-term survival and spontaneous regression of distant metastases are proof of this. Besides, if carefully selected, the mortality rate of different adjuvant therapies is not significantly higher in patients with metastatic disease than in patients without metastases. The world literature on this subject is reviewed.

Proliferative behaviour and cytogenetic changes in human renal-cell carcinoma

SummaryFrom 1986 until 1990, in vivo proliferation rates (PRs) in 110 patients with renal-cell carcinoma (RCC) were immunohistochemically determined by the Ki-67 assay. It could be demonstrated that the PRs of RCCs range between only 1% and 15%. Due to its low proliferative kinetics in vivo, tumor cytogenetic investigations of this malignancy remain rare. During short-term in vitro culture, the PRs of this neoplasm increased (21%–82%). Therefore, 36 untreated human RCCs were cultured in vitro for cytogenetic analysis using the G-banding technique. In all, 77.8% (28/36) of the renal malignancies investigated exhibited an aberration of chromosome 3, which seems to serve as a marker for this malignancy. Whereas tumor stage showed no correlation with PR, tumor grade exhibited a strong correlation with this parameter. According to the data presented herein, immunohistochemical determination of the tumor-specific PR using the monoclonal antibody Ki-67 is a practicable, reliable and reproducible method that complements conventional histological tumor grading and staging. This parameter appears to be useful in identifying RCC patients at high risk, especially at early stages that are identical in tumor stage and grade.

Effects of magnesium citrate and phytin on reducing urinary calcium excretion in rats.

SummaryThe aim of this study was to determine and compare the effects of both magnesium citrate and phytin on reducing urinary calcium excretion under high-calcium-diet conditions during single and combined treatments. An animal experiment was carried out over a period of 4 weeks in 35 male rats. Urinary calcium excretion was reduced significantly by magnesium citrate and/or phytin in rats fed on high-calcium diets. The hypocalciuric effect of magnesium citrate was more evident than that of phytin. Urinary magnesium excretion was high in all experimental groups. However, the urinary magnesium/calcium ratios showed a consistent increase only in the groups treated with magnesium citrate. Urinary citrate excretion showed a relative increase with the introduction of magnesium citrate plus phytin; however, in both the high-calcium-diet group and the magnesium-citrate group this was found to be reduced. Urinary phosphate excretion was slightly higher in the groups treated with phytin. There was no definite difference in urinary oxalate concentration between the groups. No significant change was noted in the serum concentration of calcium, magnesium, or phosphate.

In vitro sensitivity testing of human renal cell carcinoma with cytostatic agents and interferon alpha-2a

SummarySamples of 38 human renal cell carcinomas (RCC) were subjected to routine histopathological examination but also to in vitro sensitivity testing with mitomycin C, vinblastine and interferon Alpha-2a at various concentrations corresponding to serum titers recommended to be effective in vivo, employing a monolayer assay. Extending earlier in vitro studies, both tumor cell kill rates (TCKR) and proliferation rates (PR) were assessed. Following in vitro preparation the tumor cell cultures were simultaneously exposed to the anticancer drugs listed above. The proliferation rates were determined immunocytochemically using the monoclonal antibody Ki-67. Nine (23.7%) of the tumors investigated revealed temporary and limited response with respect to either TCKR or PR. Improvement of this percentage could only be obtained by increasing drug concentration to titers with toxicity intolerable for in vivo administration. The in vivo data presented correspond to clinical temporary and limited remissions in patients with metastatic RCC ranging up to 25%.

Clinical Relevance of Proliferation Rates in Renal Cell Carcinoma

Flemming (1882) and Waldeyer (1888) were the first to describe the histomorphological conception of cell division, mitosis and cell proliferation in human malignancies [5]. In different malignant tumors, pathologists found a correlation between mitosis rate determined in histological specimens and the clinical course of patients with malignancies. Mitosis, however, plays only a small part in the active cell cycle and is therefore only an indirect parameter of the proliferative pattern of the tissue. A long time passed before direct detection of tumor-specific proliferation rates (PRs) was possible. Through autoradiographic studies using the thymidine incorporation assay direct measurement of the portion of DNA synthesizing cells became available. In 1979, H.M. Rabes and his coworkers presented a clinical report of PR in renal cell carcinoma (RCC) using this technique [10]. They found a correlation between PR and recurrence rate in a series of ten patients. The main disadvantages of the thymidine incorporation technique are (a) extracorporal organ perfusion (ex vivo) after tumor nephrectomy and (b) radioactivity; therefore, it is not a practicable technique for routine diagnosis.