[Hemostasis technics in partial nephrectomy]

The authors describe an original haemostasis technique during partial nephrectomy, combining provisional pressure haemostasis of the renal parenchyma using atraumatic vascular clamps, and application of haemostatic sutures on a strip of Gore-Tex Reinforcement Tissue. This technique, which has been used three times, appears to be simple, facilitates exposure of the renal section, and ensures effective haemostasis. It does not require control or clamping of the pedicle or local hypothermia. No postoperative complication (urinary fistula, secondary haemorrhage, Gore Tex infection) was observed.

[Familial forms of cancer of the urogenital tract: clinical and genetic features]

Familial forms of renal urinary tract and testicular cancers are rare (1 to 2%), in contrast with prostatic cancer (20%). Among these familial cancers, hereditary forms related to a genetic abnormality transmitted to the offspring are now better known and are of particular practical value for the clinician. Their diagnosis can modify the modalities of the patient's treatment in view of the multifocal nature of the tumours within the same organ and/or the frequent bilateral involvement of paired organs. The risk of transmission of the deleterious gene to the offspring requires information and close surveillance of relatives to allow early diagnosis and a better prognosis. When the predisposing gene is known, surveillance can be exclusively directed towards subjects possessing the deleterious gene in view of the increased cancer risk compared to the general population. This is the case for renal cancer in Von Lippel Lindau disease, and nephroblastoma and exceptional tumours of the urinary tract in Lynch syndrome. In the case of prostatic cancer, the most frequent familial cancer, in which hereditary forms represent 9% of cases, the predisposing gene has not been identified, which means that screening should be proposed to all male members of the family over the age of 40 years, due to the earlier age of development of these forms.

Identification of endothelin receptors in normal and hyperplasic human prostate tissues

Specific endothelin-1 (ET1) binding sites have been demonstrated in membranes derived form normal (NP) and benign hyperplasic (BPH) human prostate using an 125I-ET1 binding assay. 125I saturation experiments and Scatchard analysis demonstrated the existence of a homogeneous population of binding sites with high affinity (Kd(app)) and density (B(max)), respectively, 106 +/- 15 pM and 1086 +/- 399 fmol/mg protein for NP (n = 5) and 168 +/- 26 pM and 964 +/- 445 fmol/mg protein for BPH (n = 5). We demonstrated the presence of two subtypes of ET1 receptors, ETA and ETB, by means of the following ET1 competitors: ET2, ET3, and BQ123 (which is selective for the ETA receptor), and IRL1620 and sarafotoxine c (S6c) (which are selective for the ETB receptor). The displacement curves allowed us to conclude that the large majority (85%) of the ET1 receptors in normal and hyperplasic human prostate are of the A subtype.

[Sexually transmitted diseases in men]

Sexually transmitted diseases (STD) constitute a frequent presenting complaint. The epidemiology of human immunodeficiency virus (HIV) infection is identical to that of STD and must therefore be systematically investigated in the presence of any STD. Chlamydia trachomatis (CT) is involved in the majority of cases of urethritis and epididymitis in young subjects and is present in the urethra of 10% of subjects with a genital ulcer. Genital ulcers are due to either Treponema Pallidum, Haemophilus ducreyi, or Herpes simplex virus: there is little clinicobacteriological correlation and it is therefore essential to perform laboratory examinations in order to establish the diagnosis. The prevalence of venereal vegetations due to HPV viruses has increased markedly over recent years and require effective treatment and surveillance because of the risk of carcinoma induced by viral oncogenesis. Other viral diseases such as hepatitis B are also classified as STD. The main diagnostic techniques used at the present time for each STD are reviewed and the consensually accepted therapeutic protocols are also proposed.

Human prostatic cells in culture: different testosterone metabolic profile in epithelial cells and fibroblasts from normal or hyperplastic prostates

The prostate gland depends on androgens for its development and the maintainance of its differentiated structures and secretory function. We have characterized the metabolic pathways of testosterone in isolated epithelial (NE) and fibroblast cultured cells from normal (NF) and hyperplastic (BPHF) prostates, in order to provide a tool for the study of androgen function in the prostate in defined conditions. In NE, 5 alpha-reductase (5 alpha-R) is the predominant metabolic pathway whereas in NF 17 beta-hydroxysteroid dehydrogenase (17 beta-OHSDHase) is the main activity. However, 5 alpha-R in NF is 5-10-fold higher than in NE. Furthermore, a striking increase in both enzyme activities is observed in fibroblasts from hyperplastic prostates (5 alpha-R x 8; 17 beta-OHSDHase x 250 relative to NF). delta 4-androstenedione could serve as a reservoir for testosterone or could be a tentative protective mechanism directing testosterone metabolism towards an inactive molecule. In conclusion, human epithelial and stromal cells maintain in culture their main metabolic characteristics. The knowledge derived from these studies should facilitate the reconstitution and analysis of their interactions, which in vivo may modify their respective metabolism.

Argon laser induced autofluorescence may distinguish between normal and tumor human urothelial cells: a microspectrofluorimetric study

PURPOSE

To assess the ability of argon laser-induced autofluorescence spectroscopy (LIAFS) to discriminate normal from tumor human urothelial cells.

MATERIALS AND METHODS

Emission spectra of single living cells excited at 488 nm. have been studied with confocal microspectrofluorimeter.

RESULTS

Cellular autofluorescence appeared as a broad band with a maximum in the same "green" spectral range, 550 to 560 nm., probably corresponding to oxidized flavoprotein emission. However, the maximum autofluorescence intensity of normal urothelial cells was much higher, 10 times (p<0.0001) that of any of the tumor cell types tested.

CONCLUSIONS

These results, suggesting a significantly reduced oxidized flavoprotein concentration in tumor urothelial cells, should prompt us to evaluate argon LIAFS as a potential tool to detect occult urothelial severe dysplasia and carcinoma in situ.

[The PROGENE study, the French project of genetic analysis of familial prostatic cancer: recruitment and analysis]

OBJECTIVES

To initiate a genetic linkage study in order to localize one or several predisposition gene(s) for hereditary prostatic cancer (PC), as various epidemiological studies have demonstrated a possible family aggregation in about 25% of cases. A family segregation study [14] has also shown that a genetic predisposition, with autosomal dominant transmission and high penetrance (88% at 85 years) could be responsible for 9% of all PC.

METHODS

A national collection of families with at least 2 cases of PC allowed: 1) identification of families with hereditary forms of PC, 2) creation of a constitutional DNA bank after collecting blood samples from subjects belonging to these families, and 3) a simulation study of genetic linkage analysis prior to microsatellite genotyping.

RESULTS

From July 1994 to September 1995, we included 67 families (180 cases of PC). Another 45 families are currently being included. 24 of these 67 families (89 PC, 54 survivors) satisfied at least one of the criteria defined in the study by CARTER et al. for hereditary forms of familial PC. Two families were also included as the 3 patients with PC were second degree relatives. A total of 26 families therefore presented a hereditary form, 18 of which (73 PC, 46 survivors) were considered to be informative for a genetic linkage study (lod score = 4 for theta = 0.001 with an 8 allele marker). The constitutional DNA of 271 individuals of these informative families was extracted from circulating cells obtained from blood samples, immortalized lymphocytes, and the genotyping was initiated for 216 microsatellite markers distributed throughout the genome, an average of every 20 cM.

CONCLUSION

Although the recruitment allowed us to identify many informative families for an inherited risk of PC, the predictive study suggested a high probability for localization of a predisposition gene by genetic linkage analysis. It would therefore be possible to identify, within the families concerned, the subjects carrying the genetic anomaly and consequently at high-risk of PC. Finally, the demonstration of the locus would allow cloning and identification of the gene (s) involved.

Plasma neuroendocrine markers in patients with benign prostatic hyperplasia and prostatic carcinoma

PURPOSE

Approximately 50% of all malignant prostatic tumors contain neuroendocrine cells, which cannot be attributed to small cell prostatic carcinoma or carcinoid-like tumors, and which represent only 1 to 2% of all prostatic malignancies. Only limited data are available concerning the plasma levels of neuroendocrine markers in patients with prostatic tumors. Therefore, we determine the incidence of high plasma levels of neuroendocrine markers in patients with benign and malignant prostatic disease.

MATERIALS AND METHODS

The presence of elevated plasma neuropeptide levels was investigated in 135 patients with prostatic carcinoma and 28 with benign prostatic hyperplasia. Plasma chromogranin A, neurone-specific enolase, substance P, calcitonin, somatostatin, neurotensin and bombesin levels were analyzed by immunoassays, and were compared to clinical and pathological stages of disease. Plasma prostatic acid phosphatase and prostate specific antigen levels were also determined. All patients were followed for at least 2 years after inclusion in the study.

RESULTS

Significantly elevated levels of chromogranin A were detected in 15% of patients with prostatic carcinoma before any treatment. During hormone resistant prostate cancer progression plasma chromogranin A and neuron-specific enolase levels were elevated in 55% and 30% of the patients, respectively. In patients with stage D3 disease survival curves were generated by the Kaplan-Meier method, and log rank analysis revealed a statistically significant difference between groups positive and negative for chromogranin A. Substance P and bombesin were also occasionally elevated in prostatic tumors. Determination of neuroendocrine differentiation by neuron-specific enolase or chromogranin A immunoassays was not helpful in the prediction of progressive localized prostatic carcinoma.

CONCLUSIONS

Future studies of plasma neuropeptide levels should confirm whether these parameters can be used as prognostic markers during late progression of prostatic carcinoma or for the selection of patients suitable for evaluation of new antineoplastic drugs to be active against neuroendocrine tumors.

Laparoscopic fibrin glue ureteral anastomosis: experimental study in the porcine model

Laparoscopic suturing is still difficult and time-consuming. The aim of this study, using the porcine model, was to evaluate the feasibility, safety, and efficacy of laparoscopic fibrin glue ureteral anastomosis without stay sutures for approximating the ureteral ends. In five pigs, after bilateral cystoscopic insertion of a 7F ureteral catheter, each upper ureter was laparoscopically dissected free and transected with scissors. The ureteral ends were then approximated with two atraumatic grasping forceps, and the fibrin glue was applied over the anastomotic site using a specially designed catheter (Duplocath). After waiting 5 minutes for the sealant to adhere, the forceps were removed, and the anastomotic site was examined for any early disruption. The ureteral stents were then pulled back to the distal ureter, and retrograde ureteropyelography was accomplished bilaterally in order to assess the immediate patency of the anastomoses. The animals were sacrificed and the ureteral anastomoses surgically removed for histologic examination. The operative time after insertion of the trocars averaged 15 minutes for each anastomosis, and no early disruption was observed after withdrawal of the grasping forceps. Immediate ureteral fluoroscopic patency was achieved in all 10 ureteral anastomoses, without leakage in 8 and with minimal leakage in 2. Histologic examination revealed a mild inflammatory reaction in the serosa with no modifications of the mucosa or the muscularis. Subsequently, two pigs were subjected to the same procedure bilaterally and not sacrificed. These two animals died with enormous urinomas on postoperative days 6 and 8. In each case, the anastomotic site was completely disrupted on one side, while the other side remained grossly patent. However, histologic examination of these latter anastomoses revealed no real coaptation of the ureteral ends, while demonstrating complete eversion of the mucosa. In conclusion, fibrin glue ureteroureterostomies, although easy to accomplish, are not safe enough to be used without stay sutures in laparoscopic surgery.

Establishment of permanent human endothelial cells achieved by transfection with SV40 large T antigen that retain typical phenotypical and functional characteristics

The plasmid pMK16 containing-SV40 replicated origin defective gene was efficiently introduced into early-passage human umbilical vein endothelial cells (HUVEC) using positively charged liposomes. The resulting cell line acquired an almost infinite lifespan, was morphologically unchanged, expressed SV40-antigen, and coexpressed von Willebrand factor (vWF), tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), angiotensin conversion enzyme (ACE), and endothelin converting enzyme (ECE). In addition, these are the first immortalized human endothelial cells, to our knowledge, that biosynthesized and secreted interleukins (IL-1 beta and IL-6) in both a constitutive and regulated fashion and endothelin-1 (ET-1), the most potent vasoactive peptide, which has been suggested to be implicated in the pathogenesis of hypertension. Interestingly enough, both of the immortalized cells and the early-passage HUVEC from which the immortalized cells were obtained biosynthesized and secreted the same levels of ET-1 suggesting full maintenance of its biosynthetic pathway including the presence of active ECE, which cleaves big endothelin-1 (big-ET-1) to ET-1 and regulation factors. Moreover, the immortalized cells retained the ability to express the functional specific amino acid Na(+)-independent system Y+ transporter, which mediates L-arginine transport into endothelial cells from which endothelium-derived relaxing factor (EDRF, nitric oxide) is formed via the action of nitric oxide-synthase. Obtaining these immortalized human endothelial cells without alteration of the differentiated characteristics constitutes a useful model: (a) to study ET-1 secretion, gene regulation, and human ECE, which may be an important therapeutic target in disease conditions in which ET-1 is to be implicated; (b) to study L-arginine transport, which is a key step in the formation of EDRF; (c) to study IL-1 beta and IL-6 secretions, and gene regulations; (d) to substitute large quantities of HUVEC; and, finally, (e) to reproduce, starting with different primary endothelial cells both from human and animal origin.

Loss of heterozygosity at 7q31 is a frequent and early event in prostate cancer

It is widely accepted that an accumulation of genetic alterations plays an important role in the genesis of human cancers, but little is known about prostate cancer in this respect. Recent studies have identified regions on chromosome arms 8p, 10q, 16q, and 18q that are frequently deleted in human prostate cancer. We have previously described a loss of heterozygosity (LOH) at the Met locus on chromosome band 7q31 in a study of 20 localized prostate tumors. To determine whether a region on the 7q arm is important in the initiation and/or progression of prostate cancer, prostate tissue from 13 patients with confined prostate tumors, 17 with local extracapsular extension, and 13 with metastatic forms were analyzed for LOH, using a DNA probe for RFLP (pMetH) and 8 CA microsatellite repeats (7 on 7q21-q33 and 1 on 7p). Twenty (47%) of the 43 cases studied showed LOH at one or more 7q loci. The most frequently deleted region was chromosome 7q31.1-7q31.2, whereas the centromeric locus on 7q21 was generally conserved. The percentage of LOH was normally distributed around the D7S480 locus. Moreover, the rate of LOH in the 7q31 region was lower in metastatic tumors than in localized tumors. These results strongly suggest the presence of a tumor suppressor gene on the chromosome band 7q31 with an important role in the early stages of prostate cancer.

A microdissection approach to detect molecular markers during progression of prostate cancer

To investigate the underlying mechanisms of carcinogenesis, we have developed a technique to determine the frequency of genetic changes in prostatic carcinoma tissue. We have demonstrated that at a ratio of between 1:4 and 1:9 mutant-normal alleles, the signal from a mutant TP53 allele is not apparent after polymerase chain reaction (PCR) amplification and further direct sequencing or single-strand conformation polymorphism (SSCP) analysis. To bypass this problem, which is inherent in the heterogeneity of the prostate tissue and of the tumour, we selected areas of graded prostate tumours (Gleason score) from cryosectioned preparations and microdissected these cells (20-100 cells). After anionic resin removal of proteins, PCR amplification of TP53 gene exons 5/6 and SSCP analysis, an abnormal SSCP band shift was observed in suspected tumour cells, compared with microdissected stromal cells used as an internal control, while (1) a crude preparation of tissue DNA carrying the tumour did not show any abnormality and (2) immunostaining by a set of monoclonal antibodies against TP53 protein remained negative. Nucleotide sequence analysis of the different bands confirmed the presence of a mutation in the TP53 gene exon 6 position 13,336 in an abnormal band for one specimen, while no mutation was detected in the normal SSCP band. By targeting recognised tumour cells we can find DNA mutations which are undetectable using the standard technique of whole-tissue DNA extraction, particularly in a heterogeneous tumour such as carcinoma of the prostate.

Recurrent cytogenetic alterations of prostate carcinoma and amplification of c-myc or epidermal growth factor receptor in subclones of immortalized PNT1 human prostate epithelial cell line

To develop an experimental prostate cancer model, we immortalized normal human prostate adult epithelial cells with SV40 large-T antigen. Two sublines were derived in culture, namely PNT1A and PNT1B. They retained the characteristics of prostate epithelial cells, but did not clone in soft agarose. PNT1A occasionally formed undifferentiated adenocarcinoma tumors in nude mice, but only in the presence of matrigel. PNT1A and PNT1B displayed common cytogenetic alterations: a 10q arm deletion, which is a recurrent alteration in prostate carcinoma, chromosome losses and a translocation involving chromosome 5. An extensive study of oncogenic alterations occurring in these cells showed that PNT1A displayed c-myc gene amplification, forming an hsr on chromosome 4, as well as gene amplification, forming an hsr on chromosome 4, as well as c-myc mRNA overexpression, with a faster doubling time (25 hr); moreover, it seemed less sensitive to EGF than PNT1B. PNT1B had a doubling time identical to that of normal cells (48 hr) but displayed EGF receptor gene amplification accompanied by an increased number of EGF binding sites and sensitivity to EGF. Because both cell lines displayed cytogenetic and oncogenic alterations found in prostate cancer, as well as differing malignant potentials, they represent an interesting model for studying the progression of prostate tumors.

[Functional properties of a new line of immortalized human endothelial cells]

An immortalized human endothelial cell line was obtained by transfecting umbilical vein endothelial cells in primary culture with plasmid pMK16 containing SV40 replicated origin defective gene. The essential functional properties demonstrated in these immortalized human endothelial cells also retaining the classical phenotypical characteristics of endothelial cells in primary culture are: (1) endothelin-1 secretion; (2) capacity to convert big endothelin-1 into endothelin-1; (3) the capacity to secrete IL1 beta and IL6 interleukins both spontaneously and after lipopolysaccharide (LPS) stimulation; (4) arginine transfer from the extracellular to the intracellular medium. Such stable cell line could facilitate studies of regulation of endothelin-1 production; (5) No-synthase activity; (6) binding and metabolisation of acetylated low-density lipoproteins.

Subcutaneous urinary diversions for palliative treatment of pelvic malignancies

PURPOSE

We developed 2 subcutaneous urinary diversion techniques, pyelovesical bypass and anterior cutaneous nephrostomy, to improve the quality of life of patients undergoing permanent palliative percutaneous nephrostomy.

MATERIALS AND METHODS

A total of 21 patients underwent either pyelovesical bypass (19) or anterior cutaneous nephrostomy (13). Technically, the percutaneous nephrostomy tube is replaced by a self-retaining expanded polytetrafluoroethylene-silicone tube tunneled underneath the skin. The distal extremity can be either introduced into the bladder, creating a pyelovesical bypass, or brought out directly through a cutaneous orifice, creating an anterior cutaneous nephrostomy.

RESULTS

No tube was dislodged and none became obstructed due to incrustation or angulation. Standard percutaneous nephrostomy was necessary in 1 patient in each group. Improvement in the quality of life was stressed by all patients. Pyelovesical bypass eliminates external drainage and anterior cutaneous nephrostomy performed when the bladder is no longer functional allows for the creation of a single, easily dressed anterior stoma.

CONCLUSIONS

Pyelovesical bypass and anterior cutaneous nephrostomy constitute valuable alternatives to standard permanent palliative percutaneous nephrostomy.

[Genetic alterations in localized cancers of the prostate: identification of a common region of deletion on the chromosome 18q]

Prostate cancer is one of the most common malignancies in men. Few authors have attempted to identify consistent genetic alterations at the molecular level in adenocarcinoma of the prostate, but those most frequently reported are loss of heterozygosity (LOH) involving chromosome arms 8p, 10q, 16q, and 18q and inactivation of the TP53 tumor suppressor gene. In order to determine if alterations frequently found in other adenocarcinomas (breast, ovarian, colorectal), including losses of genetic material from chromosome arms 1p, 3p, 7q, 8p, 11p, 17p, 17q, and 18q, are also involved in prostate cancer, we examined 20 localized early-stage prostate tumors. We detected no mutations of the TP53 gene. Allelic losses were found from 7q (33%), 8p (50%), 10q (20%), and 18q (33%). Furthermore, as the first step toward isolating tumor suppressor genes on 18q, we used six polymorphic markers and identified a small common deleted region between the chromosome 18 centromere and the D18S19 locus.

[Carcinoma of Bellini's tubules]

Carcinoma of the papillary ducts of Bellini is a rare form of renal cancer. Patients are usually asymptomatic middle-aged men who frequently have metastatic disease at the time of diagnosis. The diagnosis is based on histological examination of the nephrectomy specimen with a precise immunohistochemical examination. Radical nephrectomy is the first-line treatment and adjuvant chemotherapy, recommended by certain authors, does not appear to improve the usually poor prognosis of these tumours.

[The role of the laser in urology]

There is currently a renewed interest in laser in the field of urology, essentially for the treatment of benign prostatic hypertrophy, as a result of recent developments in the field of fibres. Laser is light coherent in time and space emitted continuously or in pulses. Only its thermal and photochemical properties are used in urology. Endoscopic coagulation of superficial bladder tumours by Nd YAG laser does not seem to be better than classical endoscopic resection, at the present time, as although it is less haemorrhagic, it does not decrease the recurrence rate. Photochemotherapy of bladder carcinoma in situ still constitutes a complex treatment protocol reserved for specialized centres. Lastly, upper urinary tract tumours can be treated by Nd YAG laser coagulation, in rare indications which are the same as those of ureteroscopic or percutaneous resection. The recent development of lateral firing laser fibres and contact tip fibres has led to a renewed interest in laser in benign prostatic hypertrophy. Two different techniques have been proposed: Nd YAG laser coagulation under direct visual or ultrasound control (TULIP), which gives delayed objective results (two or three months) and contact tissue vaporization (Nd YAG, diode), whose effects are more immediate. In both cases, intraoperative bleeding is minimal and the length of hospital stay is decreased, but the duration of urine drainage remains to be defined. Endoscopic pulsed laser urinary lithotripsy (dye, Ho YAG), although effective and atraumatic, is not justified at the present time because of its high cost compared to mechanical percussion lithotripters. Lastly, laser treatment for urethral stricture has not been found to be superior to classical scalpel urethrotomy and laser tissue welding is still in the experimental stages. In conclusion, laser technology, especially fibers, has currently reached an important phase of development with applications for urological disease, essentially in the treatment of benign prostatic hypertrophy in order to reduce the morbidity of classical endoscopic resection. However, other urological applications of laser could be validated in the near future due to the development of less expensive lasers (diode) and/or with multiple functions (Ho YAG).

Tumour-associated trypsin inhibitor and renal cell carcinoma

In the absence of a specific marker for renal cell carcinoma (RCC), we evaluated the tumour-associated trypsin inhibitor (TATI) in patients with RCC. Between November 1990 and November 1993, 63 patients with RCC and 23 patients with benign renal disease underwent a competitive radioimmunoassay of TATI. The cutoff value was defined on a series of serum samples of 96 healthy subjects (normal n < 20 micrograms/l, then 25 micrograms/l after April 1993). We related the value of TATI to the tumour stage and compared the sensitivities of TATI and other markers (CEA, CA 15-3, CA 125, CA 19-9, ferritin). In 24 patients the TATI assay was repeated 3-12 months after radical nephrectomy. 15 patients with benign disease had a normal value of TATI (specificity: 65%). 44 of the 63 patients had a value of TATI above the cutoff point (sensitivity: 69%). Sensitivities of CEA, CA 15-3, CA 125, CA 19-9 and ferritin were 5, 10, 13, 5, 35%, respectively. The TATI value was correlated with the stage of the disease. Among the 15 patients without metastasis, the mean preoperative value was 112 micrograms/l (14-760) versus 46 micrograms/l (24-180) postoperatively. In the 9 patients with metastasis, the preoperative mean value was 100 micrograms/l (20-434) versus 240 micrograms/l (22-544) postoperatively. TATI showed a better sensitivity than other markers for RCC but its specificity is limited. Nevertheless it can be useful for a postoperative follow-up. TATI remains one of the best serum markers for RCC.

Oncogene amplifications in early-stage human prostate carcinomas

Oncogene amplifications are frequently found in solid tumours and are often associated with more aggressively growing forms of human cancer. The proto-oncogenes c-myc, c-erbB2/neu and the 11q13 band are the most frequently amplified regions in adenocarcinomas of various origins. The present study was undertaken to define whether c-myc, int2/FGF3 (11q13 region) and c-erbB2/neu genes are involved in prostate tumorigenesis. Tumours and peripheral lymphocyte DNA from 21 localized early-stage prostatic carcinomas were analysed by Southern-blot electrophoresis for amplification of the c-myc and c-erbB2/neu genes and the 11q13 region (int2/FGF3). We detected no amplification of these 3 oncogenes in our panel.

Genetic alterations in localized prostate cancer: identification of a common region of deletion on chromosome arm 18q

Accumulation of mutations in oncogenes and tumor suppressor genes transforms a normal cell into a malignant cell by allowing it to escape from normal control of growth. In prostate tumorigenesis, the current model envisages specific mutations of the TP53 tumor suppressor gene and loss of loci, detected by loss of heterozygosity (LOH), on chromosome arms 8p, 10q, 16q, and 18q. In order to determine if alterations frequently found in other adenocarcinomas (breast, ovarian, gastric, colorectal), including losses of genetic material from chromosome arms 1p, 3p, 7q, 8p, 11p, 17p, 17q, and 18q, are also involved in prostate cancer, we examined 20 localized early-stage prostate tumors. We detected no mutations of the TP53 gene. Allelic losses were found from 7q (33%), 8p (50%), 10q (20%), and 18q (33%). Furthermore, as the first step toward isolating tumor suppressor genes on 18q, we used six polymorphic markers and identified a small common deleted region between the chromosome 18 centromere and the D18S19 locus.

Anatomic study of the lumbar region applied to multiplanar imaging techniques: importance and use of oblique vertical sections

This anatomic study of the lumbar region (as defined by Rouvière [11]) applied to multiplanar imaging techniques was carried out both in the cadaver and in vivo. The cadaver study (5 cases) consisted of anatomic sections (transverse, sagittal, frontal and oblique) and computerised three-dimensional reconstructions after CT studies on subjects injected with colored and radio-opaque latex. The in vivo study (4 cases) used MRI sections and three-dimensional ultrasound sections coupled with the pulsed doppler. The spatially referenced oblique vertical sections revealed the structures from unusual aspects, situating them amidst the retroperitoneal area with the maximum of topographic landmarks. The transposition of these results (obtained by sectional anatomy of the retroperitoneal region) to the new techniques of multiplanar formatting after MRI, ultrasound or CT data acquisition should optimise the investigation of certain retroperitoneal structures by specifying the ideal planes of section for each organ, while diminishing certain artefacts specific to acquisitions in the traditional planes of section. Oblique vertical sections seem eminently suitable for ultrasound location of the suprarenal compartments, study of the renal pedicles and topographic retroperitoneal location. This oblique vertical visualisation constitutes a fundamental resource for the development of video-monitored surgical procedures as it corresponds exactly to the axes of the access routes in percutaneous surgery of the kidney and the adjacent anatomic structures.

Immunocytochemical comparison of cultured normal epithelial prostatic cells with prostatic tissue sections

By analyzing a culture system of human prostatic epithelial cells (HPEC) and human prostatic fibroblasts (HPF) for expression of several determinants by immunocytochemistry, we have shown that long-term cultures are able to preserve the phenotypic characteristics of the normal tissue from which they are derived. The cytoskeletal elements, prostate-specific proteins, and steroid receptor profiles were compared to those of prostatic epithelium and stroma in situ. When cultured in low serum and low calcium medium, the adult HPEC grew as two layers of cells, the upper one of which retained the differentiation characteristics observed in the luminal fraction of normal prostatic epithelium. This cell type is the likely origin of prostatic neoplasia, with expression of CK8, 18, and 19 but not CK14. Androgen receptors, prostatic-specific antigen, and prostatic acid phosphatase are also expressed in vitro but at lower level than in situ. The lower cell layer expressed most of the same determinants but at a much lower level, suggestive of a stem-cell type. The HPF cultured in RPMI serum supplemented media retained the stromal pattern of the cells observed in situ. Culture systems which conserve the characteristics of their normal counterparts in vivo should provide useful models for studying in vitro genetic and epigenetic factors associated with differentiation and proliferation, but also with tumorigenic progression in the prostatic gland.

Distinct androgen 5 alpha-reduction pathways in cultured fibroblasts and immortalized epithelial cells from normal human adult prostate

All androgen-sensitive peripheral tissues and cells, including the prostate, are commonly believed to possess the ability to metabolize testosterone. We report on the in vitro metabolism of tritiated testosterone performed in immortalized human adult normal prostatic epithelial cells and in human adult normal prostate fibroblastic cells (stromal cells). These two cell types were incubated separately with increasing testosterone concentrations (1 to 50 nM.) for 2 and 4 hours, after which the testosterone metabolic profile was analyzed. Data analysis provided evidence, for the first time, of the existence of two different 5 alpha-reduced metabolic pathways. Stromal cells preferred the androsterone pathway via the oxidative androstenedione formation, whereas epithelial cells preferred the reductive 5 alpha-dihydrotestosterone pathway. These two 5 alpha-reduced metabolites were produced in nearly equal quantities regardless of testosterone concentration or time of incubation. Since interactions between epithelial and stromal cells are involved in the development of the prostate, the availability of defined epithelial and stromal cells suitable for in vitro experiments provides a useful tool for the study of the contribution of androgens to these interactions. The model presented in this study would permit a better evaluation of the intraprostatic regulation of androgen metabolism and the contribution of the anti-5-alpha-reductase drugs to the management of benign prostate hyperplasia.

[Natural history and prognostic factors of prostate cancer]

Our present knowledge of the natural history of cancer of the prostate has been acquired from anatomical and clinical observations. They have led to identification of the main prognostic factors of the disease, but as long as the biological and molecular mechanisms implicated in its development remain obscure, our knowledge is incomplete and treatment of its various stages can only be orientated empirically. The main problems which should be resolved by prognostic indications are found at two critical points of the disease: 1) in the case of localised cancer, avoiding radical treatment (surgery or physiotherapy), either for a small, stable tumour discovered by chance (occult cancer) or for an apparently localised tumour but where surgery alone would be ineffective because of a high positive margin or a high metastatic potential; 2) in the case of advanced cancer, to estimate the beneficial effects of early hormonal or nonhormonal treatment on the quality of life and on patient survival. Identification of simple prognostic parameters also aims to reduce the health cost involved in this type of cancer and to increase patient comfort by simplifying initial and subsequent investigations. Prognostic factors include both clinical data and laboratory chemistries. The latter are still the object of numerous and diverse studies involving basic science. The increasing diversity of such studies and preliminary publication without correlated large series has so far precluded judging the reliability of such factors for clinical use. In practice, tumoural volume and stage remain the two factors which can estimate the risk of progression when prostatic cancer is detected microscopically.(ABSTRACT TRUNCATED AT 250 WORDS)

Computation of eyeball growth by magnetic resonance imaging (26.11.93)

The computation of eyeball growth has a wide field of applications in orbital and ocular pathology. An anatomic and MRI study to compute eyeball growth has been done. The anatomic study was made to determine the best MRI parameters to calculate the ocular surface; then this surface was computed by MRI in the neuro-ocular plane in fetuses and children aged from 0 to 13 years. The curve of eyeball growth shows rapid growth in utero and until 18 months, followed by a phase of slower growth. This method allows measurement in two dimensions, which we find complementary to ultrasound in the antenatal search for certain congenital malformations.

Anatomic study of the orbital septum (22.10.93)

The orbital septum separates the intraorbital fat from the palpebral part of the orbicularis oculi m. An anatomic study after injection of colorant into the intraorbital fat allows definition of a fibroadipose layer anterior to the orbital septum. This consists of radial fibers and extraorbital fatty lobules. The septum is derived embryologically from the mesenchyme of the second arch, but the structure of the anterior layer remains controversial. The septum has an important mechanical function in containing the orbital fat and is involved in orbital movements. A knowledge of these different layers facilitates surgical approaches and helps to define the anatomic landmarks in palpebral surgery for conditions such as ptosis and in blepharoplasty.

[Laparoscopic treatment of vesico-ureteral reflux in the pig. Preliminary report]

Laparoscopic urological surgery is currently in a phase of development. In order to evaluate the possibility of treating vesicoureteric reflux by laparoscopy, we performed an elongation of the submucosal ureteric tract via an extravesical approach (Lich-Gregoir) in 4 pigs. After creating a pneumoperitoneum, 4 trocars were introduced into the abdominal cavity. The peritoneum was incised at the level of the iliac vessels and the ureter was released at its middle portion as far as the ureterovesical junction. After coagulation, the detrusor was then incised proximally in relation to the ureterovesical junction, revealing 3 to 4 cm of vesical mucosa. The ureter was buried in the muscular groove, the edges of which were brought together by means of 6 metal staples. In 3 pigs, the bladder and ureter were immediately removed by laparotomy. On macroscopic examination, the staples correctly approximated the muscle layer without transfixing the bladder mucosa or ureter. The patency of the ureter was assessed with a probe. The submucosal tract was sufficiently large, preventing any ureteric compression. In 1 pig, the ureteric meati were incised endoscopically to create reflux. After laparoscopic elongation of the submucosal tract on one side, only the untreated ureter continued to reflux. Correction of vesicoureteric reflux is technically feasible in the pig. Longer studies are necessary before considering the application of this technique to man.

Exploration and endoscopic treatment of unilateral primary haematuria: is non-specific diffuse pyelitis a real entity?

Chronic unilateral primary haematuria is rare and raises difficult problems of diagnosis and treatment as most of the knowledge in this field has been based on a very limited number of patients. This clinical entity needs critical reevaluation as recent progress in endourological investigations has revealed that lesions other than the classical submucosal haemangioma are just as frequently responsible for unilateral primary haematuria. These endoscopic lesions have generally been poorly defined up to now and our data based on a retrospective review of 8 patients emphasises the persistent gaps in our understanding of the pathophysiology of this disease. Among the lesions responsible for unilateral primary haematuria, diffuse petachiae of the renal pelvis and cavities represent the most frequent endoscopic lesion described in our experience (50% of cases). Histologically, these diffuse lesions correspond to non-specific pyelitis, consisting of simple oedema of the lamina propria. In addition to its diagnostic role, endoscopy can also be used to effectively treat the lesions responsible for unilateral primary haematuria, using either electrocoagulation or nitrate cautery, provided a retrograde approach can be completed by a percutaneous approach, with an overall success rate of 75% of cases with a mean follow-up of 16 months.

Endourological treatment of lumbar and iliac ureteral stones. A comparative study of 49 cases

The efficacy of the Lithoclast has been described extensively in the recent literature. However, to our knowledge, few articles have dealt with the safety of this technique. We present a retrospective study of 49 patients with stones of the lumbar and iliac ureter treated between 1989 and 1992 either by means of the Lithoclast (17 patients), by electrohydraulic shock waves (16 patients), or by trapping the stones in a wire stone basket (16 patients). The success rates were 88% for the Lithoclast and wire stone baskets and 62% for electorhydraulic shock waves. The mean dimensions of the stones were 10 mm for the Lithoclast and electrohydraulic shock wave groups, and 7 mm for the wire stone basket group. Complications consisted of 7 ureteral lesions (2 cases with the Lithoclast, 4 cases with electrohydraulic shock waves and 1 case with the wire stone basket) and 1 stripping of the lower ureter following stone extraction with a wire stone basket, which required open reimplantation. This study demonstrates the efficacy and safety of the Lithoclast for the treatment of large stones of the lumbar and iliac ureter.

Variations in arterial blood supply and the risk of hemorrhage during percutaneous treatment of lesions of the pelviureteral junction obstruction: report of a case of testicular artery arising from an inferior polar renal artery

Acute hemorrhage during percutaneous surgery on the pelviureteric junction obstruction has been estimated to be 2-3%. Following the experience of peroperative bleeding from a vascular variation, the authors discuss the arterial anomalies of the renal pedicle which may carry the risk of hemorrhage during percutaneous surgery in this region. Arteries in front of or behind the renal pelvis are the cause of ureteropelvic function obstruction in 15-52% of cases and because of their close relationship with the upper urinary tract can complicate the procedure of endopyelotomy. Endourological techniques are inadequate for avoiding the risk of vascular damage during the necessary maneuvers. Inferior polar arteries occur in 9% of the population and their different courses are described. They are not always responsible for the vascular obstruction in the pelviureteric syndrome, and it is the exact determination of this responsibility that makes imaging essential. Arteriography performed in our case allowed embolisation of the damaged inferior polar artery and also showed the anomalous origin of the testicular artery from this polar artery; this appears to be only the second description of this anomaly. This variation is discussed in a review of the literature. In fact the testicular artery has a high or aberrant origin in 20% of cases; in 5-6% of these the origin is from a main or supernumerary renal artery. Origin from an inferior polar artery is exceptional.

Anatomic basis of laparoscopic surgery in the male pelvis

Laparoscopic surgery of the male pelvis remains a risky procedure, with around 15% of perioperative complications, as compared to 0.03% in laparoscopic surgery for gynecologic and obstetric conditions. Many of these complications are due to the surgeon's being faced with an unfamiliar anatomic situation in his approach through the laparoscopic operative field. We have added to the data of the literature our anatomic and clinical experience in order to define the anatomic basis of surgical risk in this type of procedure. While dissection lateral to the iliac vessels (surgery of the spermatic cord) is safe, dissection medial to these vessels is more risky because of the confined anatomic relationships and their variations (particularly vascular anomalies and variable relations of the ureter).

[The value of MRI in ruptures of the corpus cavernosum]

MRI has only recently been described in the evaluation of traumatic rupture of the corpora cavernosa. Our case report emphasises the perfect correlation between the MRI findings and the anatomical lesion. This examination therefore constitutes a valuable aid in the pretreatment assessment of rupture of the corpora cavernosa.

IGF binding protein-3 secreted by the prostate adenocarcinoma cells (PC-3): differential effect on PC-3 and normal prostate cell growth

Deregulation of growth in malignant cells has been suggested to be the result of increased secretion by these cells, of autocrine growth factors; alternatively, this deregulation has been assumed to be related to loss of sensitivity by malignant cells to secreted inhibitory molecules. The results of the present publication lend new support to both hypotheses. We recently showed that human prostate adenocarcinoma cells (PC-3 cells) secreted insulin-like growth factor binding proteins (IGFBP) of 45, 34 and 25 kDa. From medium conditioned by dense cultures of PC-3 cells, we have now purified two IGFBPs of M(r) 45 kDa and 34 kDa. The N-amino terminal sequences were determined, and it was shown that they are IGFBP-3. IGFBP-34 appeared to be a deglycosylated form of IGFBP-45. The two IGFBPs had more affinity for IGF-II than for IGF-I. IGFBP-45 and IGFBP-34 were growth-inhibitory factors of chick embryo fibroblasts (CEF): they totally inhibited DNA synthesis stimulated by serum in CEF. Our results point to a clear difference between the effects of these IGFBPs upon growth of normal prostate cells and malignant PC-3 cells. At a concentration of 150 ng/ml, they inhibited growth of normal prostate cells even in the presence of 1 microgram/ml insulin. This suggests that such inhibition was not simply the result of a decrease by the IGFBP of stimulation induced by serum IGF or IGF secreted by the cells. At a concentration of 150 ng/ml, IGFBP did not modify the growth of PC-3 cells. In contrast, it stimulated growth of PC-3 cells when added at a concentration lower than 50 ng/ml (about 1 nM). Our results thus provide new insight concerning the regulation of growth in PC-3 cells.

Percutaneous extra-anatomic nephrovesical diversion: preliminary report

We propose a new approach to total ureteric replacement based on the use of a new spiraled composite tube. This tube is inserted percutaneously into the renal pelvis, then tracked subcutaneously and introduced into the bladder via a short incision. The tube is maintained in place by anchoring its spirals along the subcutaneous tract, and only the two silicone extremities are in continuous contact with the urine. We have used this technique for total replacement of the ureter in one renal transplant patient with a follow-up of 8 months and no complication. A longer follow-up is obviously necessary, but this new, minimally invasive approach, using a newly designed tube, would appear to give a new lease of life to an old, abandoned principle.

Outcomes of non-self-expandable metal prostheses in strictured human ureter: suggestions for future developments

The success of metal stents in the urethra led us to implant flexible metal stents unilaterally in the ureter in four patients. Radiographic and endoscopic controls during follow-up showed an obstruction in three cases. We describe the different aspects of these unfavorable outcomes and propose changes to be made in metal stents for use in the upper urinary tract.

[The treatment of metastasized kidney cancer. Current data and perspectives]

Metastatic renal cancer has a poor prognosis because of the limited impact of traditional treatment modalities on this tumour. The few long-term survivals obtained after isolated surgical resection of the primary tumour or its metastases can be attributed to the occasionally unpredictable natural history of this tumour and isolated surgical resection generally does not appear to improve the survival of these patients. Among non-surgical treatments, radiotherapy is purely palliative and hormone therapy has been shown to be ineffective. New therapeutic approaches have been recently developed, suggesting a possible improvement in the prognosis of metastatic renal cancer. A better understanding of the mechanisms of chemoresistance of renal cancer should lead, in the near future, to the use of drugs capable of increasing the efficacy of cytotoxic chemotherapy in this tumour. The results obtained with new forms of immunotherapy open up prospects for combined immunosurgical modalities.

[Prostatic growth factors and benign hypertrophy of the prostate. Current knowledge and perspectives]

The importance of growth factors in prostatic regulation has been demonstrated for several years. These "prostatic" growth factors are ubiquitous polypeptides which are not specific to the prostate. To date, three principal families of growth factors appear to be potentially involved in the development of benign prostatic hypertrophy: Epidermal Growth Factor (EGF), Fibroblast Growth Factor (FGF), Transforming Growth Factor beta (TGF beta). The FGF and TGF beta families probably play a central role in the pathogenesis of benign prostatic hypertrophy. A better definition of the respective roles of growth factors and androgens in the control of prostatic growth opens up prospects for the future in the field of basic treatment of benign prostatic hypertrophy.

Anatomical bases of percutaneous surgery for calculi in horseshoe kidney

Horseshoe kidney is a renal fusion which combines three anatomic abnormalities: ectopia, malrotation and vascular changes. These anomalies can be recognised separately to varying degrees in unfused kidneys. Necessary modifications of the standard technique for percutaneous nephrolithotomy (PNL) are directly deducible from analysis of the anatomic data of the imaging of horseshoe kidneys. We report our experience with 5 patients (7 kidneys) who underwent PNL for calculi in horseshoe kidneys. The percutaneous approach was performed under ultrasound and fluoroscopic monitoring. In situ disintegration by ultrasonic lithotripsy and nephrostomy drainage were necessary in all cases. Modifications of the standard PNL procedure are related to the anatomic changes. The lower abdominal position of a horseshoe kidney necessitates upper or middle calyceal puncture, while the malrotation necessitates a more posterior puncture. Monitoring of the puncture needle by fluoroscopy as it is advanced postero-anteriorly is more difficult and the risk of the surgeon's hand entering the radiation path is increased. The renal pelvis is deep and a long endoscope may be required. Aberrant segmental vessels may create potential hazards. The majority of problems in location can be avoided by use of an ultrasonically guided needle. Percutaneous nephrolithotomy is the treatment of choice for calculi in horseshoe kidneys for the following reasons: the high incidence of recurrent lithiasis in horseshoe kidney and the complexity of repeated surgical approaches diminish the acceptable results of open surgery; difficulties in focussing on the calculi and drainage problems militate against the success of extracorporeal shock wave lithotripsy (ESWL); PNL has a good success rate and the least morbidity.

[Pericardial fatty fringes: preoperative anatomo-radiographic value of their use in the protection of bronchial sutures]

Bronchial sutures grafts by epiplooplasty is a method used to allow a better vascularisation of the bronchial sutures. The authors purpose an other method using the pericardial fatty fringes (P.F.F.). The vascularisation of P.F.F. was studied on 30 fresh cadavers and 8 patients before surgery. Angiography of the internal thoracic artery was done in the first group and M.R.I. in the second group. M.R.I. is better than angiography because numerous parietal vessels project in the angiogram, and they overlap pericardial fat fringes vessels.

[Transplantation of a horse-shoe kidney. Report of a case and review of the literature]

The authors report a case of transplantation of a horseshoe kidney in two recipients. Based on this case and a review of the literature, they emphasise the technical precautions required for collection and transplantation of these malformed kidneys.

Modifications of the skull base in artificial deformations of the circumference of the head

Four artificial deformations of the skull (collection of the Laboratoire d'Anthropologie of the Musée de l'Homme) have been analysed in terms of their morphology and osteometry. The study of the endocranial base in the three planes of space was made possible by a computerised three-dimensional reconstruction based on data gathered by CT. These four skulls were paired as regards their shape (2 annular and dolichocephalic and 2 tabular and brachycephalic) and as regards their age (2 skulls of children and 2 of adults). Certain modifications of the base, such as a tendency to platybasia and to an antero-superior tilt of the posterior fossa around an axis passing through the basion, could be observed in the two modalities of deformation studied. The existence of a region little subject to modelling combining the body of the sphenoid and the basilar and lateral portions of the occiput was confirmed as regards the chondrocranium, whereas the peripheral structures of the base were remodelled like the membranous structures of the vault of the neurocranium.

Double ureter and congenital diverticulum of the ureter

The ureteral duplication is a relatively common malformation and usually has no pathologic consequences. On the contrary, congenital diverticula of the ureter are rare and often give rise to urinary complications. A double malformation combining left ureteral duplication and a congenital diverticulum of the right ureter is reported and discussed. This rare case illustrates one and the same malformational process arrested at different stages of development.

Immortalization of human adult normal prostatic epithelial cells by liposomes containing large T-SV40 gene

Simian virus SV40 has been widely used to immortalize epithelial cells of mammalian origin. We report here, for the first time to our knowledge, the immortalization of normal adult prostatic epithelial cells in culture by transfection of a plasmid containing SV40 genome with a defective replication origin (SV40 ori-) encapsulated into liposomes. These cells (PNT1) have now been cultured for more than 12 months, and shown to contain the SV40 genome. They express large T protein, present the phenotype of differentiated luminal prostatic cells (positive with antibodies to cytokeratin 18, 19, weakly positive for prostatic acid phosphatase and prostatic specific antigen, negative with anticytokeratin 14 and KL2 antibody). PNT1 cells contain high affinity receptors for dihydrotestosterone. These cells provide a useful tool to study the biology and the pathology of adult prostatic epithelial cells, specially to understand the steps leading to prostatic transformation.