S. D. Shetty

Activated CD4‐positive T‐lymphocytes and impaired cell‐mediated immunity in patients with carcinoma of the urinary bladder with schistosomiasis

Patients with schistosomiasis of the urinary bladder (SB) associated with carcinoma of the bladder (SCB) or carcinoma of the prostate (SCP) have a variety of immunologic abnormalities, including the presence of HLA‐DR+ and interleukin‐2 receptor‐positive (IL‐2R+) T‐lymphocytes in circulating blood. This study demonstrated that, the HLA‐DR+ and IL‐2R+ antigens are selectively expressed on majority of the CD4+ T‐lymphocytes of patients with SCB, whereas, these antigens are expressed almost equally on both CD4+ and CD8+ T‐lymphocytes of patients with SB and SCP. Expressions of HLA‐DR+ and IL‐2R+ antigens in CD4+ T‐lymphocytes, and a depressed response of this T‐cell subset to phytohemagglutinin and Concanavalin A stimulations seems to be the characteristic feature of these patients with SCB. In addition, the autologous mixed lymphocyte reaction (AMLR) and allogenic mixed lymphocyte reaction (MLR) was depressed in patients with SCB. However, patients with SCP demonstrated a normal MLR, even though the AMLR was highly depressed. The immunoregulatory role of the HLA‐DR+, IL‐2R+, CD4+ helper/inducer T‐lymphocytes, and the AMLR and MLR abnormalities we have identified in patients with SCB may be important and could play a role in the pathobiology of these diseases in humans.

Specific investigations in chronic urinary bilharziasis

Seventy-two patients with histologically confirmed chronic urinary bilharziasis were studied for the reliability of some specific investigative tools in diagnosing this disease, namely urinalysis, serology, urography, and cystoscopy. Of the 72 patients 36 (50%) had hematuria and only 3 (4%) had ova of Schistosoma haematobium on urinalysis. Sixty-two patients (86%) had features of bilharziasis on intravenous urography (IVU). Of the remaining 10 patients with negative urography 6 underwent serology and all had positive results. Of the total patients 52 underwent serology and 49 had significant bilharzial antibody titer (94.2%). At cystoscopy all patients (100%) had features of bilharziasis. It is concluded that the most reliable diagnostic tools in chronic urinary bilharziasis are cystoscopy, serology, and to a lesser extent urography. Unlike early bilharziasis, chronic bilharziasis can be missed if total reliance is placed on urinalysis for screening a population at risk.

Soluble interleukin-2 receptor levels and immune activation in patients with schistosomiasis and carcinoma of the urinary bladder

Soluble interleukin‐2 receptor (sIL‐2R) level in serum is a marker of immune regulation and lymphocyte activation. Highly elevated levels of sIL‐2R in serum were observed in patients of schistosomiasis with carcinoma of the bladder (SCB) and carcinoma of the bladder without schistosomiasis (CB) compared with patients with carcinoma of the prostate with or without schistosomiasis and normal healthy controls. Patients with SCB, who had an elevated percentage of cells expressing CD38+ activation antigen and CD71+ transferrin receptors in circulation, also had elevated levels of sIL‐2R in serum. There were few interleukin‐2 receptor (CD25+) positive cells in circulation in some patients with SCB. Despite this, the sIL‐2R levels were extremely elevated. Our data suggest that in SCB, CD38+ and CD71+ cells may be the source of secretion of sIL‐2R in serum. This relationship was confirmed by phenotypic characterizations of mononuclear cells and sIL‐2R levels in individual patients. Measurements of sIL‐2R levels in serum may provide a sensitive method of immune activation in patients with SCB.

T-cell abnormality and defective interleukin-2 production in patients with carcinoma of the urinary bladder with schistosomiasis

Patients with schistosomiasis of the urinary bladder (SB) and schistosomiasis with carcinoma of the urinary bladder (SCB) had significantly increased percentage of IL-2R-, HLA-DR-, and transferrin receptor (T9)-bearing T cells in circulation. The percentage of these activated T cells decreased byin vitro culture with PHA but increased bySchistosoma haematobium soluble egg antigen. These patients with SB and SCB had a PHA-specific defect in IL-2 production. A functional defect with induction of IL-2R-positive suppressor monocytes appears to correlate with the defective PHA-induced IL-2 production by CD4+ T cells and monocytes. Disordered regulation of PHA-induced IL-2 production by the CD4+ T cells and monocytes may be the key feature in the highly depressed cell-mediated immune response in schistosomiasis. However, immune activation and significantly elevated IL-2 production in response to disease-specificS. haematobium soluble egg antigen may be related with the pathogenesis of SB and SCB. Thus,S. haematobium-specific CD4+ T cells are present in schistosomiasis, and their function is determined by adequate release of IL-2-and/or IL-2R-bearing CD11+ suppressor monocytes.

Is intravenous urography mandatory in the management of benign prostatic hyperplasia

Fifty-four consecutive patients with uncomplicated benign prostatic hyperplasia (BPH) underwent intravenous urography (IVU) and ultrasonography (US) to observe the benefits of IVU over US. The parameters used were upper tract abnormalities detected on both modalities and the influence of radiological prostatic impression (RPI) on the route of surgery and its comparison to digitally estimated prostatic size (DEP). Both RPI and DEP were compared to the adenoma weight (AW). Correlation of RPI and DEP was excellent (87.5%) in grade III but poor in grades I and II. RPI and AW correlated well in grade III (100%) and was also significant in grades I and II, whereas DEP correlated well with AW in all grades. Both RPI and DEP could predict the route of prostatectomy accurately in grades I and III, whereas in grade II, RPI was marginally better in predicting the route. There was no upper tract abnormalities that were detected on IVU and missed by US. In conclusion, IVU did not add any additional information beyond that obtained by rectal examination and US to alter the surgical approach and hence the routine use of urography in uncomplicated BPH should be questioned in Saudi Arabia.

Bilharzial and nonbilharzial bladder cancer in Asir: A comparative clinicopathological study.

A total of 48 bladder cancer patients out of 96 consecutive genitourinary cancer cases were divided into bilharzial and nonbilharzial groups on a histological basis in order to investigate the impact of bilharziasis on tumor behavior. Despite being a bilharzial endemic area, only 10/48 (21%) of our patients had bilharzial cancer (BC) of whom 8 (80%) had squamous cell carcinoma (SCC) and 2 (20%) had adenocarcinoma. Out of 38 patients with nonbilharzial cancer (NBC), 35 (92%) had transitional cell carcinoma (TCC), and 3 (8%) had SCC. BC in males presented at a younger age than NBC (P<0.05). All ten patients with BC presented with deeply invasive (T3 and T4) tumors as compared to 22/38 (58%) with NBC (P<0.05). Comparison of clinical and laboratory features in both groups in both groups did not reveal any significant difference. We conclude that in the Asir region, TCC is the most common bladder cancer. However, with bilharziasis, bladder cancer tends to be of the squamous type and presents at an earlier age and at an advanced stage.

Ultrasound Scanning in Scrotal Disorders: Correlation of Clinical and Operative Findings

Seventy-five patients presenting with or suspected to have a scrotal disorder were prospectively investigated by scrotal ultrasonography using a real-time ultrasound scanner with either linear (3.5...