Thomas J. Rohner

Altered in vitro adrenergic responses of dog detrusor muscle after chronic bladder outlet obstruction

Muscle strips from the bladder body and dome of normal and control dogs usually demonstrate a relaxing (beta-adrenergic) response to norepinephrine. After bladder outlet obstruction was caused by urethral constriction, all body muscle strips from 7 of 12 dogs (58 per cent) demonstrated contractile (alpha-adrenergic) responses to norepinephrine. Bladder base muscle strips continued to show alpha-adrenergic responses. Desensitization or decreased beta-adrenergic receptor activity may play a part in causing the low compliance and detrusor instability seen in patients with bladder outlet obstruction.

Clinical effect of aminoglutethimide, medical adrenalectomy, in treatment of 43 patients with advanced prostatic carcinoma

The initial treatment of patients with Stage D prostatic carcinoma with orchiectomy or estrogens is successful in giving objective and subjective improvement for variable periods of time. However, after initial endocrine treatment patients generally relapse, and go on to further progression of their disease. However, a subgroup of approximately 22% of these Stage D prostatic cancer patients respond to either surgical adrenalectomy or hypophysectomy, indicating some degree of continued hormonal responsiveness. Forty‐three previously castrated patients with Stage D prostatic carcinoma were treated with 1000 mg of aminoglutethimide and 40 mg of hydrocortisone daily and have been evaluated using the criteria of the National Prostatic Cancer Project. Progression of disease after initial hormonal therapy has varied from 3 to 25 months. One patient has had a complete response, and continues in remission after 290 weeks of therapy. Partial objective responses have been observed in 6 patients, and 10 patients have remained objectively stable for an average of 35 weeks in this latter group.

Clinical and Biochemical Effect of Aminoglutethimide in the Treatment of Advanced Prostatic Carcinoma

Treatment of male patients with advanced prostatic carcinoma and disease progression after initial endocrine therapy frequently is unsatisfactory. However, approximately 20 per cent of these patients respond to surgical adrenalectomy or hypophysectomy, indicating continued hormonal responsiveness. A total of 25 previously castrated men with stage D carcinoma received 1,000 mg. aminoglutethimide and 40 mg. hydrocortisone daily. The patients were evaluated using the criteria of the National Prostatic Cancer Project. One patient has had a complete response and is in remission after 275 weeks of therapy. A partial response was noted in 4 patients, while the disease was objectively stable in 6. Pre-treatment testosterone and dihydrotestosterone levels were measured in 9 of 25 patients and were significantly reduced statistically during aminoglutethimide therapy (p less than 0.01). Response and drug toxicity are discussed.

Profile of Urinary Incontinent Elderly in Long-Term Care Institutions

This article presents a profile of incontinent elderly in long‐term care institutions. One hundred thirty‐three frail elderly women were recruited from seven nursing homes in central Pennsylvania for a three‐year clinical trial to test the effectiveness of a behavioral therapy on urinary incontinence. All of the patients had more than one medical diagnosis. Eighty percent had cardiorespiratory conditions; the most prevalent diagnoses were cardiovascular diseases. Eighty percent had one or more neurological diseases, including “organic brain syndrome”(47%) and senile dementia (30%); 44% had arthritis/rheumatism. Half of the patients showed severe cognitive impairment; only 12% showed no cognitive impairment. Sixty‐three percent were totally dependent; 68% used wheelchairs, 61% were chairbound; 50% had impairments in vision, one‐third in hearing, and 14% in speech. Normal bladder capacity, absence of detrusor instability, and satisfactory bladder emptying, as evidenced by low residual urines, was found in 41% of the patients, suggesting that incontinence in this elderly group may not be a primary bladder problem, but rather that mental and physical disabilities may be a more important underlying cause of incontinence in these patients. An important finding in this study is that 34% of the patients had detrusor instability. It is theoretically possible that pharmacologic therapy with anticholinergic agents or imipramine could improve incontinence in this group. Five percent were found to have large residual urine volumes in association with high‐capacity bladders suggesting overflow incontinence as the cause of their daily leakage. Pelvic relaxation and stress leakage was far less common in this elderly group of nursing home patients than in young and middle‐aged women.

Evidence for the Association of Cytomegalovirus with Carcinoma of the Prostate

A human genital isolate of cytomegalovirus is shown to have transformed human embryonic lung cells in vitro. These cells produce tumors when injected into athymic nude mice. Two cell lines derived from tissue from human prostatic carcinoma have survived more than 20 passages in vitro and demonstrate cytomegalovirus-specific membrane antigen. Significant humoral antibody titers against cytomegalovirus have been demonstrated. Cell-mediated lymphocytotoxicity against these transformed cells has been demonstrated in patients with urinary tract tumors. This evidence indicates that an association between cytomegalovirus and human prostatic cancer may be more than coincidental.

The Role of Intermittent Catheterization in the Management of Children with Myelomeningocele

Of 114 patients with myelomeningocele 44 (40 per cent) have no significant urologic disability. Intermittent catheterization has been used in 51 children and was helpful in 13 (26 per cent). Cystometrograms and urethral pressure profiles have been useful as predictive parameters. Causes of intermittent catheterization failures are discussed.

Preliminary Evaluation of Urinary Polyamines in the Diagnosis of Genitourinary Tract Malignancy

Normal ranges for urinary polyamines have been obtained. Non-malignant genitourinary tract disease is not associated with elevated urinary polyamines. A high correlation exists between the presence of active urologic cancer and elevated urinary excretion of polyamines. Post-treatment polyamines correlate with the continued presence or absence of genitourinary tract malignancy.

Cardiovascular evaluation before circulatory arrest for removal of vena caval extension of renal carcinoma.

The use of cardiopulmonary bypass, deep hypothermia and circulatory arrest has decreased the risks of hemorrhage, tumor embolization, incomplete thrombus resection, and warm hepatic and renal ischemia associated with resection of renal cell carcinoma extending into the inferior vena cava above the hepatic veins. Patients about to undergo this operation frequently have significant coronary artery and carotid artery disease, and are at risk for perioperative myocardial infarction and stroke. Preoperative evaluation of the coronary artery and carotid artery circulation by coronary angiography, duplex carotid artery scan and digital subtraction carotid angiography is recommended. Depending upon the severity and location of the cardiovascular disease a sequential or simultaneous operation may be performed. This surgical approach can be used in selected patients to facilitate complete tumor thrombectomy with a low operative risk.

Transitional cell carcinoma in an ileal conduit

A 73‐year‐old man with a history of invasive transitional cell carcinoma of the urinary bladder developed synchronous recurrent transitional cell carcinoma at the ureteroileal anastomosis and the right renal pelvis. Hematuria was the presenting sign in six of the seven previously reported patients with ileal conduit cancer. The pathologic findings, diagnostic procedures and treatment are briefly reviewed.

Metastatic seminoma with regression of testicular primary: ultrasonographic detection.

We report a case of seminoma of the testis metastatic to the retroperitoneum. Biopsy of the retroperitoneal mass revealed anaplastic seminoma. No testicular mass could be palpated. Testicular ultrasonography showed a hypoechoic 3 X 2 cm. area in the left testis suggestive of a primary testicular tumor, most likely a seminoma. Histological evaluation of the resected testis revealed fibrous tissue but no definable tumor.