Warren W. Koontz

Superficial Bladder Cancer: Progression and Recurrence

The tumors in 249 patients presenting initially with stages Ta and T1 bladder cancer were analyzed for tumor progression and recurrence. Only transurethral resection and/or fulguration was used before the first recurrence. Patients who received intravesical chemotherapy after the first tumor recurrence were excluded from an analysis of progression. Progression according to stages Ta and T1, and grades I, II and III was 4, 30, 2, 11 and 45 per cent, respectively. All differences were statistically significant. Progression also correlated with nontumor dysplasia and size. High tumor grade, lamina propria invasion, atypia elsewhere in the bladder, positive urinary cytology, tumor multiplicity and large tumors were associated with shorter intervals free of disease.

Long-term Fate of 90 Patients with Superficial Bladder Cancer Randomly Assigned to Receive or not to Receive Thiotepa

We assigned randomly 90 patients treated previously for superficial transitional cell carcinoma to conventional followup or prophylactic treatment. This followup study details the late incidence of recurrence (29 of 45 patients in the prophylactic group and 34 of 45 controls), the progression of tumor grade and stage, the deaths and causes (24 patients), and the influence of initial stage, grade, carcinoma in situ and positive cytology on the outcome of treatment.

Immunohistochemical detection of c-erbB-2 protein in human benign and neoplastic prostate☆

Both the polyclonal anti-c-erbB-2 peptide antiserum pAB 60 and the monoclonal anti-c-erbB-2 protein antibody mAB-1 detect the c-erbB-2 protein in human breast adenocarcinomas. We investigated c-erbB-2 expression in adult human benign hyperplastic and neoplastic prostates, using the avidin-biotin complex immunoperoxidase method. Formalin-fixed, paraffin-embedded specimens of benign hyperplastic prostate (13), prostatic adenocarcinoma (22), and prostatic adenocarcinoma lymph node metastases (two) were tested with pAB 60. Ten formalin-fixed, paraffin-embedded specimens of prostate adenocarcinoma, 11 frozen sections of benign hyperplastic specimens, and eight frozen sections of prostate adenocarcinoma were tested with mAB-1. Our results demonstrated consistent detection of c-erbB-2 immunohistochemically in frozen sections of both benign and malignant prostate. Preincubation of pAB 60 with the immunizing peptide blocked subsequent reactivity with prostatic tumor tissue, indicating specificity. However, fixation and processing protocols significantly affected the reactivity of the antigenic determinants detected by these antibodies, as mAB-1 was nonreactive with formalin-fixed, paraffin-embedded prostatic tissues. Differential reactivity of pAB 60 with malignant rather than benign glands was maximized by exposure of the specimen to the antibody at 4 degrees C rather than 22 degrees C. The most frequently observed staining pattern with both antibodies was cytoplasmic. However, mAB-1 produced distinctly membranous staining in two frozen specimens of benign hyperplasia and one specimen of prostate cancer.

Gangrene of bladder: Complication of hypogastric artery embolization

Abstract A case of gangrene of the bladder is reported which subsequently developed after embolization of the hypogastric artery and thrombophlebitis. Regeneration of the bladder occurred after temporary urinary diversion.

Role of computed tomography in the evaluation and management of carcinoma of the prostate

Between January 1978 to March 1980, 25 patients with biopsy-proven prostate carcinoma were evaluated by computerized tomography (CT). CT differed from clinical stage in 7 of 25 patients (28%). In 6 of the 7 patients, change in stage resulted because of demonstration of extracapsular extension and/or pelvic lymph node involvement. Twelve of the 25 patients (48%) underwent surgery with histological confirmation of CT findings. Ct identified nodal involvement accurately in 10 of 12 patients (83%). We recommend use of CT for initial staging, treatment planning and assessment of response in the management of prostate cancer.

Urethral strictures in boys.

Our experience with urethral strictures in boys during a 15-year period confirms the findings of others that the most common etiology is iatrogenic. Traumatic and inflammatory strictures are rare. The congenital stricture differs fundamentally from acquired types of urethral strictures and would be termed more appropriately congenital urethral membrane. Urethral dilation and/or urethrotomy was unsuccessful in 47% of our patients, leading to secondary formation of a new stricture in 2 instances. However, urethroplasty was successful in 83% of our cases and seems to be indicated when 2 or more dilations are required.

The Effect of Polyethylene Glycol-Superoxide Dismutase Administration on Histological Damage Following Spermatic Cord Torsion

Oxygen free radicals generated during the ischemic/reperfusion period have been suggested as a possible cause for tissue damage in different organs. In this study we address the question of whether administration of polyethylene glycol-superoxide dismutase, an oxygen free radical scavenger, can alleviate histological damage associated with testicular torsion. The study included 67 Sprague-Dawley rats. In 60 rats the left testicle was rotated 720 degrees clockwise through a scrotal incision. Torsion duration was 3 hours. Five minutes before and 5 minutes after detorsion the testicle color was evaluated and scored. The remaining 7 rats underwent a sham operation. After randomization 8,000 units per kg. polyethylene glycol-superoxide dismutase were injected intraperitoneally in the treated group 1 hour before detorsion. After 14 days histological evaluation was performed on both testicles of 58 rats (2 rats died before the evaluation). No statistically significant difference was demonstrated between the treatment (28 rats) and the control groups (30 rats). Testicular color after detorsion correlated with the histological damage.

Deep vein thrombosis and prostatectomy

A research protocol to evaluate the prevention of deep vein thrombosis in sequential patients undergoing prostatectomy is presented. There is an overall incidence of deep vein thrombosis in 8 per cent of patients. There was no advantage with intermittent leg compression when compared with elastic stockings.

The Effect of Hyperthermia on Human Prostatic Carcinoma Cell Lines: Evaluation in Vitro

The effect of hyperthermia on established human prostate carcinoma cell lines (PC-3, DU-145) and related sublines (1-LN, 125-1L) was investigated in vitro. Cells were exposed to heat treatment at 43C or 37C for varying time intervals, (one hr or two hrs) and cell survival was evaluated by the colony formation assay and by measurement of cellular growth rate. While one hr exposure at 43C did show a mean inhibition of colony formation, ranging from 29 to 41%, a statistically significant increase in inhibition rate (p less than 0.001) was observed at two hr exposure, ranging from 57 to 92%. This study is a report of the cytotoxic effect of hyperthermia on established human prostatic tumor cell lines. These in vitro results indicate that hyperthermia may become a potentially useful form of adjunctive therapy for local control of prostatic cancer. However, the temperature and exposure time may have an important impact on cell kill when this new modality for cancer treatment is proposed for a clinical trial.

ENDOSALPINGIOSIS OF BLADDER

Mullerianosis refers to lesions of mullerian origin, includ- ing endometriosis, endocervicosis and endosalpingiosis.1 These lesions have been found in isolation but are more commonly found in association with one another. They are found beyond their tissue of origin and are well documented in the bladder2 and ureter.3 Histologically, nondescript glands lined with tubal type epithelium characterize the lesion of endosalpingiosis. To date only 5 cases of endosalpin- giosis of the bladder have been reported, which were uni- formly found in association with other forms of mulleriano- sis.2, 3 It is noteworthy that the affected population is typically premenopausal. To our knowledge we report the first case of pure endosalpingiosis confined to the bladder in a postmenopausal woman. CASE REPORT A 67-year-old white woman presented with a 2-year history of noncyclical suprapubic pain. No history of symptomatic urinary tract or genital infection, trauma or lithiasis was elicited. Medical and surgical histories were significant for hypertension, 3 cesarian sections and total abdominal hys- terectomy with bilateral salpingo-oophorectomy for ovarian cysts. The patient had not received hormone replacement therapy. Physical examination revealed suprapubic tenderness and no palpable mass on bimanual examination. Hematuria was present on urinalysis, and urine cytology showed reactive urothelial cells. Computerized tomography of the abdomen and pelvis demonstrated normal appearing upper and lower urinary tracts. Cystoscopy reveale da2t o 3c m.lesion with a thin epithelial covering at the dome of the bladder. The lesion was completely resected and submitted in its entirety for pathological evaluation. Histologically, the mass consisted of thickened bladder mucosa punctuated by nondescript glands with tubal type epithelium. This appearance is diagnostic of endosalpingiosis. No evidence of endocervicosis or endome- triosis was identified (figs. 1 and 2). The patient was followed with repeat cystoscopy 4 months and 9 months postoperatively, with no evidence of suspicious lesions. Following the procedure, she has been treated for 2 urinary tract infections. She still complains of periodic su- prapubic pain. However, the last cystoscopy, which was per- formed 26 months postoperatively, showed no regrowth of suspicious tissue. DISCUSSION