Stig Colleen

Clinical multi-colour fluorescence imaging of malignant tumours - initial experience

Purpose: the detection of malignant tumours relies on a variety of diagnostic procedures including X-ray images and, for hollow organs, endoscopy. the purpose of this study was to present a new technique for non-invasive tumour detection based on tissue fluorescence imaging Material and Methods: A clinically adapted multi-colour fluorescence system was employed in the real-time imaging of malignant tumours of the skin, breast, head and neck region, and urinary bladder. Tumour detection was based on the contrast displayed in fluorescence between normal and malignant tissue, related to the selective uptake of tumour-marking agents, such as haematoporphyrin derivative (HPD) and δ-amino levulinic acid (ALA), and natural chromophore differences between various tissues. in order to demarcate basal cell carcinomas of the skin, ALA was applied topically 4–6 h before the fluorescence investigation. for urinary bladder tumour visualisation (transitional cell carcinoma of different stages including carcinoma in situ), ALA was instilled into the bladder 1–2 h prior to the study. Malignant and premalignant lesions in the head and neck region were imaged after i.v. injection of HPD (Photofrin). Finally, the extent of in situ and invasive carcinomas of the breast was investigated in surgically excised specimens from patients that received a low-dose injection of HPD 24 h prior to the study. the tumour imaging system was coupled to an endoscope. Fluorescence light emission from the tissue surface was induced with 100-nslong optical pulses at 390 nm, generated from a frequency-doubled alexandrite laser. with the use of special image-splitting optics, the tumour fluorescence, intensified in a micro-channel plate, was imaged in 3 selected wavelength bands. These 3 images were processed together to form a new optimised-contrast image of the tumour. This image, updated at a rate of about 3 frames/s, was mixed with a normal colour video image of the tissue Results: A clear demarcation from normal surrounding tissue was found during in vivo measurements of superficial bladder carcinoma, basal cell carcinoma of the skin, and leukoplakia with dysplasia of the lip, and in in vitro investigations of resected breast cancer Conclusions: the initial clinical experience of using multi-colour fluorescence imaging has shown that the technique has the potential to reveal malignant tumour tissue, including non-invasive early carcinoma and also precancerous tissue. Further investigations are needed to fully develop the method

URODYNAMIC FACTORS INFLUENCE THE DURATION OF ESCHERICHIA COLI BACTERIURIA IN DELIBERATELY COLONIZED CASES

PURPOSE We evaluated the influence of urodynamic factors on the establishment of bacteriuria, after deliberate intravesical inoculation with Escherichia coli. MATERIALS AND METHODS Nine women and 7 men with recurrent symptomatic urinary tract infections underwent intravesical injection of E. coli 83972. This strain had documented ability to persist in the urinary tract and it lacks expressed virulence factors associated with urinary tract infection. RESULTS Successful long-term colonization (5 months to 3 years) was achieved in 6 of 12 patients with neurogenic bladder disorder, including normal or high bladder capacity, normal or low detrusor pressure and residual urine. Short-term bacteriuria (13 days) occurred in 1 but long-term bacteriuria was not established in the 4 patients with normal lower urinary tract function. Occasionally urine samples from the colonized patients contained other bacterial strains, which cleared spontaneously except for a Klebsiella strain that became established in 2 and subsequently eliminated E. coli 83972. CONCLUSIONS E. coli 83972 bacteriuria could only be established in a subset of patients with defective bladder voiding, suggesting that urodynamic defects permit a nonvirulent strain to establish in the urinary tract, but that additional host factors determine if bacteriuria will persist.

The Detubularized Right Colonic Segment as Urinary Reservoir: Evolution of Technique for Continent Diversion

Continent diversion of urine via a cecal-right colonic reservoir has been performed at our university hospital since 1977. Several modifications of surgical technique have been devised to prevent problems of urinary leakage and difficulties in catheterization. The current technique, used during the last 3 years on 14 patients, involves use of a detubularized right colonic segment as a reservoir, ileal mesenteric exclusion, fashioning the intussuscepted ileal nipple valve with staples and anchoring of a fascia strip sling around the nipple base to the anterior rectus sheath. Complication from the reservoir outlet occurred in only 1 patient.

Urinary Tract Infections in Men Caused by Staphylococcus saprophyticus

Clinical data of 49 male patients, whose urine contained Staphylococcus saprophyticus (greater than 10(5) bacteria/ml), were analyzed. The median age of the patients was 70 yr (range 7-83). Of the patients, 25 had catheter à demeure. Among the remaining patients, 22 had symptoms of acute urinary tract infection, 8 of whom had symptoms suggesting engagement also of the upper urinary tract. One 17-yr-old man had acute epididymitis. One patient was symptomless. No obstructive uropathy could be revealed in 13 (54%) of the 24 patients without catheter.

Immunoglobulins in urine from patients with ileal and colonic conduits and reservoirs.

Gel chromatography of proteins in urine from continent cecal urinary reservoirs revealed an abundance of high molecular weight proteins, especially secretory immunoglobulin A. Quantitation of immunoglobulins in urine from ileal and colonic conduits and ileal and cecal reservoirs showed secretory immunoglobulins A, G and M in amounts considerably greater than in urine from normal urinary tracts, whether or not bacteriuria was present. More secretory immunoglobulin A was found in reservoir than in conduit urine, but there was no such difference for immunoglobulin G and immunoglobulin M. In hemagglutination-inhibition tests, immunoglobulin A antibodies from cecal reservoir urine in 1 patient inhibited adherence (mannose-resistant) to human and animal erythrocytes of Escherichia coli obtained from reservoir urine from that same patient. High levels of secretory immunoglobulin A may constitute a host defense mechanism against urinary tract infection in patients with reservoirs and conduits.

Experience with a Detubularized Right Colonic Segment for Bladder Replacement

A detubularized right colonic segment was used as bladder substitute in ten men who underwent cystoprostatectomy for carcinoma of the bladder. Postoperative complications unrelated to the replacement procedure occurred in three cases. Stricture of the urethrocaecal anastomosis developed during follow-up in one case. Day-time continence with convenient micturition intervals was achieved in all cases. Nocturnal continence was also maintained if the patients awoke once or twice to void. Urodynamic studies revealed adequate capacity, little or no residual urine and pressure waves of low amplitude at high-level filling. The technique employed for creation of a bladder substitute offers the advantage of technical simplicity. The bowel it utilizes is of secondary importance for intestinal absorption, and the result is a low-pressure, capacious neobladder.

The Microbial Flora of the Continent Cecal Urinary Reservoir, its Stoma and the Peristomal Skin

The bacteria occurring in reservoir urine, on the cutaneous stoma and on the abdominal skin were studied in 9 patients who had undergone urinary diversion via a continent cecal reservoir. Aerobic and/or facultatively anaerobic bacteria were isolated persistently from reservoir urine in 3 patients but only occasionally in the remainder. These organisms were isolated in pure culture. Anaerobic bacteria also were found, although infrequently and only in conjunction with facultative anaerobes. Most stomal cultures showed heavy growth of Staphylococcus epidermidis, while fewer microbes were isolated in the abdominal skin cultures. Propionibacterium acnes, present in most skin cultures, was absent or scantily represented on the stoma. Microbial antibiosis was demonstrated in vitro between stomal and urinary reservoir bacteria in 6 patients. However, bacteria from stomal isolates had no antagonistic effect against bacteria belonging to the family of Enterobacteriacae or against anaerobic species isolated from urine. Antibiosis may influence the microbial ecology of the urine reservoir and cutaneous stoma.

Cardiovascular complications of estrogen therapy for nondisseminated prostatic carcinoma. A preliminary report from a randomized multicenter study.

In a prospective multicenter study, 244 men with highly or moderately differentiated prostatic cancer in stage I, II or III (VACURG) were consecutively randomized to three groups of treatment: Group A (77 patients) received polyestradiol phosphate (Estradurin, Leo) 80 mg i.m. every fourth week + ethinyl estradiol (Etivex, Leo) 150 micrograms daily, group B (72 patients) estramustine phosphate (Estracyt, Leo) 280 mg twice daily, and group C (76 patients) no therapy. Only men without current or previous other malignancy and without cardiovascular disease were admitted to the study. After 4 1/2 years 125 of the 244 patients had left the study, 9 because of cancer progression (stage IV, VACURG). The most serious complications were cardiovascular, including ischemic heart disease, cardiac decompensation, cerebral ischemia and venous thromboembolism, which occurred in 24 patients from group A and 9 from group B as compared to only one patient in group C. The subgroup superficial or deep venous thrombosis comprised 11 group A and 2 group B patients. Estrogens (E + e) offered as palliative treatment to patients with non-generalized prostatic carcinoma is burdened with a high incidence of serious cardiovascular complications.

Staging of bladder carcinoma with computed tomography.

In a series of 24 patients with bladder carcinoma. 17 of whom underwent cystourethrectomy, the discriminatory power of computer tomography (CT) in staging of the tumours was compared with the clinical evaluation. In low-stage tumours the accuracy of staging was not increased by CT. In high-stage tumours CT was greatly superior to clinical examination for assessing neoplastic extension. CT is recommended in bladder carcinoma for which cystourethrectomy is planned, so as to achieve maximum accuracy of information concerning depth of infiltration.

Urine from continent caecal reservoirs: studies on chemical composition and bacterial growth

The composition of urine from 11 patients with continent caecal reservoir was examined with regard to promotors and inhibitors of bacterial growth, and was compared with that of urine from individuals (controls) with intact urinary tracts. Reservoir urine was found to have a higher and less variable pH than control urine. The concentration of urea was lower in reservoir urine, probably due to the larger 24-hour urinary output, while the concentration of albumin was higher. Although these findings could suggest reservoir urine to be a more favourable medium for bacterial growth than normal urine, such a difference was not found in growth studies of common urinary pathogens. The increased prevalence of urinary tract infection in patients with caecal reservoir may be due to contamination on catheterization, residual urine and defective function of the reservoir outlet rather than differing qualities of the urine.