Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging

The purpose of this study was to compare fast dynamic magnetic resonance imaging (MRI) with colpocystodefecography (CCD) in the evaluation of pelvic floor descent in women. Thirty-five women with clinical evidence of pelvic floor descent were studied. A fast single-shot MR sequence was performed in the supine position during pelvic floor relaxation and during maximal pelvic strain. On the same day, a dynamic CCD was performed with the patient seated on a stool-chair. The degree of descent of the bladder, vagina, and anorectal junction was evaluated as the vertical distance between the pubococcygeal line and the bladder base, the vaginal vault, and the anorectal junction, respectively. A bulge of more than 3 cm measured as the distance between the extended line of the anterior border of the anal canal and the tip of the rectocele was interpreted as a rectocele. MRI was compared with CCD during maximal pelvic strain (CCD 1) and during voiding and defecation (CCD II). CCD was considered as the gold standard. Compared with clinical examination, CCD I showed a larger number of involved compartments, except for the middle compartment. CCD II was superior to clinical examination in all cases. In comparison with CCD I and especially CCD II, MRI had a lower sensitivity, especially for the anterior and middle compartment. Even four enteroceles seen on CCD II were not detected by MRI. When CCD I and CCD II were compared, a cystocele, a vaginal vault prolapse, an enterocele, and a rectocele were more readily seen on CCD II than with CCD I. When compared with CCD, supine dynamic MRI is unreliable, especially in the anterior and middle compartment. Even in the detection of enteroceles CCD was superior to MRI. In general, the best results with MRI can be expected for evaluation of the rectum.

Acute obstruction of the renal collecting system: the intrarenal resistive index is a useful yet time-dependent parameter for diagnosis

The aim of this study was to determine whether the intrarenal resistive index (RI) can be used for the diagnosis of acute obstruction in patients with renal colic and to determine whether the index is time-related. Seventy patients referred to the Emergency Department with acute renal colic and without known associated renal disease underwent duplex Doppler ultrasonography to determine the intrarenal RI at the symptomatic and asymptomatic side. The age range of the patients was 18-72 years. An RI greater than 0.68 and/or an interrenal difference in RI greater than 0.06 and/or an increase in RI of more than 11% compared with the normal side proved reliable cut-off values to diagnose acute renal obstruction. In addition, time dependency of the increase in RI was noted. No significant differences were observed within the first 6 h after the onset of symptoms. From 6 to 48 h, however, the mean RI in the affected kidney (0.70 +/- 0.06; mean +/- SD) was significantly different from that in the normal kidney (0.59 +/- 0.04) (P < 0.001). In the same period the mean difference in RI was 0.08-0.13 (P < 0.001). After 48 h the sensitivity of RI dropped substantially. It is concluded that renal duplex Doppler ultrasonography is useful for diagnosing acute renal obstruction between 6 and 48 h after the onset of symptoms.

[Primary retroperitoneal extragonadal germ cell tumor]

A case is presented of a primary extragonadal retroperitoneal germ cell tumor (seminoma) in a 51-year-old male. The ultimate diagnosis was only achieved after curative surgical resection of the tumor. There was no demonstrable testicular neoplasm.

Partial nephrectomy for renal cell carcinoma can achieve long-term tumor control

PURPOSE

Partial nephrectomy is becoming more widely accepted as alternative treatment for small renal cell carcinoma. To analyze its value in tumor control and its complication rate a retrospective study was done.

MATERIALS AND METHODS

A total of 76 patients underwent kidney sparing surgery, which was required in 25 and in the presence of a normal contralateral kidney in 51. Tumor size varied between 0.9 and 15 cm. Simple enucleation was done in 4 and partial nephrectomy in all other cases. The patients were followed every 3 months during year 1, every 4 months during years 2 and 3, and every 6 months during years 4 and 5 postoperatively. Mean followup is 75 months.

RESULTS

Eight patients had postoperative complications, most often hemorrhage. None of the patients had local recurrence, although in 3 systemic disease developed.

CONCLUSIONS

Nephron sparing surgery is more challenging than radical nephrectomy and, therefore, can be more complicated. The selection of suitable candidates is the key to success. Many patients can benefit from nephron sparing surgery for small easily resectable renal cell carcinoma even in presence of a normal contralateral kidney. Randomized trials are needed to establish the definitive role of this approach in kidney cancer treatment.

Partial nephrectomy for renal cell carcinoma can achieve long-term tumor control

PURPOSE

Partial nephrectomy is becoming more widely accepted as alternative treatment for small renal cell carcinoma. To analyze its value in tumor control and its complication rate a retrospective study was done.

MATERIALS AND METHODS

A total of 76 patients underwent kidney sparing surgery, which was required in 25 and in the presence of a normal contralateral kidney in 51. Tumor size varied between 0.9 and 15 cm. Simple enucleation was done in 4 and partial nephrectomy in all other cases. The patients were followed every 3 months during year 1, every 4 months during years 2 and 3, and every 6 months during years 4 and 5 postoperatively. Mean followup is 75 months.

RESULTS

Eight patients had postoperative complications, most often hemorrhage. None of the patients had local recurrence, although in 3 systemic disease developed.

CONCLUSIONS

Nephron sparing surgery is more challenging than radical nephrectomy and, therefore, can be more complicated. The selection of suitable candidates is the key to success. Many patients can benefit from nephron sparing surgery for small easily resectable renal cell carcinoma even in presence of a normal contralateral kidney. Randomized trials are needed to establish the definitive role of this approach in kidney cancer treatment.

Transitional cell carcinoma in a renal allograft

A large urothelial tumor was detected by ultrasonography in the dilated collecting system of a well-functioning renal allograft 15 years after transplantation. The tumor was confirmed at computed tomography. Nephrectomy showed a transitional cell carcinoma. The occurrence of malignant tumors in renal allografts is a well known but rare complication.

Is intravenous urography still used in patients with prostatism?

The value of intravenous urography in patients with prostatism was retrospectively evaluated. One thousand four hundred ninety five intravenous urograms of male patients referred by the department of urology were reviewed. Based on the clinical information, only patients with complaints of prostatism as a single symptom were selected. Patients with associated symptoms (i.e. hematuria, urinary infection) were excluded. Forty seven patients could be included based on these criteria. In 29 of 47 cases (61.7%) no abnormalities were found. Abnormalities found in 18 cases included dilatation of the excretory system, urinary calculi, congenital anomaly, acquired small kidney, renal cysts and retroperitoneal fibrosis. In 5 cases (10.1%) the intravenous urography necessitated further treatment and/or follow up. In 3.1% prostatism was the indication for the examination. The number of relevant abnormalities at intravenous urography performed for prostatism is low and this is in accordance with results reported in literature. These results provide further evidence for the continuously changing indications for intravenous urography.

Cell kinetic measurements in prostate cancer

PURPOSE

Two approaches have been suggested for escalating the total dose in radiotherapy treatment of prostate cancer. One is conformal radiotherapy; the other is hyperfractionation using many small fractions. Both imply some possible prolongation in overall treatment time. To judge whether prolonged treatment schedules would be detrimental, it is necessary to know the proliferation rates in human prostate tumors, specifically, the potential doubling time (Tpot). There is a lack of data on this parameter in the literature.

METHODS AND MATERIALS

Seven patients with adenocarcinoma of the prostate were studied. A tracer dose of 100 mg/m2 of IUdR was infused intravenously 4-12 h before biopies were taken. Biopsies were fixed in 70% ethanol, stored at 4 degrees C, and later prepared and stained by standard methods for flow cytometry, using the red fluorescence signal for DNA and the green fluorescence signal (fluorescein isothiocyanate) for 5-iodo-2'-deoxyuridine. The duration of DNA synthesis (Ts) was determined by the relative movement (RM) method, knowing the interval between tracer administration and biopsy. Tpot was calculated as the quotient of Ts by labeling index (LI).

RESULTS

In two of the seven tumors the LI was too low (<0.6%) for a reliable estimate of RM to be made, so no determination of Tpot was possible for these tumors. The mean LI values in the other five tumors were 2.4%, 1.4%, 1.0%, 3.0%, and 0.9%. The durations of Ts were 13.2, 9.5, 10.0, 11.7, and 12.7 h, respectively. The resulting values of Tpot were 23, 28, 42, 16, and 61 days, respectively.

CONCLUSION

The low labeling indices in prostate tumors, also reported by others, made estimation of Ts by RM impossible in about a third of these tumors. However, five tumors yielded long estimates for Tpot, implying that prolongation from 6 to about 8 weeks should not be detrimental.

Non-Hodgkin's lymphoma of the prostate in a young male

A case of non-Hodgkin's lymphoma (NHL) involving the prostate and the urinary bladder in a 24-year-old male is reported. Although none of the currently available imaging modalities is specific for the diagnosis of NHL of the prostate, this diagnosis must be considered because of its amenability to treatment. The heterogeneity of the mass at CT and MRI might be suggestive of high-grade NHL. The patient was treated with intensive combination chemotherapy.

Large egg-shell-like calcified cyst in a case of renal cell carcinoma

A serendipitous case is reported of a large egg-shell-like calcified renal mass without irregularities covering a solid nodule suggestive of a renal cell carcinoma on CT. This was confirmed after radical nephrectomy.

A new low-incidence antigen in the Kell blood group system: VLAN (KEL25)

A multilaboratory investigation has identified a new low-incidence antigen "VLAN' on the red cells of a blood donor. The VLAN antigen is destroyed by 2-aminoethylisothiouronium bromide treatment of the donor's red cells suggesting an association with the Kell system. Monoclonal antibody-specific immobilization of erythrocyte antigen analysis with anti-VLAN and with several mouse monoclonal antibodies directed at epitopes on the Kell glycoprotein gave positive results, indicating that the VLAN antigen is located on the Kell glycoprotein. The VLAN red blood cells have the common Kell phenotype: KEL:-1,2,-3,4,5,-6,7,-10,11,12,13,14,-17,18,19,-21,22,-23,-24. Additional serologic data indicate that the VLAN antigen is not part of any other ISBT blood group system, collection or series. A family study showed that the VLAN antigen is inherited since the red cells of two sisters and one niece of the propositus are also VLAN+. The ISBT Working Party on Terminology for Red Cell Surface Antigens has assigned VLAN to the Kell blood group system as KEL25 (number for computer listings 006025).

The case against fine-needle aspiration cytology for small solid kidney tumors

Conservative renal cell cancer surgery in elective conditions can be applied if the tumor is solitary and well delineated on the CT scan and easily resectable within a rim of healthy parenchyma. A number of solid tumors will prove not to be malignant on definite pathological examination. The radiological preoperative differential diagnosis of a small renal mass is not always obvious. The efficacy of fine-needle aspiration cytology in recognizing the pathology of the tumor before surgery is limited and major complications have been reported. Moreover, it can render a conservative surgical procedure less safe. Thus fineneedle aspiration cytology is not recommended if conservative surgery is planned, unless renal involvement by metastasis or lymphoma is suspected.

[The significance of focal hypoechoic lesions in the peripheral zone of the prostate]

Hypoechoic lesions in the peripheral zone of the prostate gland are one of the commonest abnormalities at transrectal ultrasonography (TRUS). 90% of all carcinomas originating in the peripheral zone present as a hypoechoic lesion. Hypoechogenicity though is not specific, as many benign lesions are also hypoechoic. In this retrospective study, based on TRUS alone 57% of the hypoechoic lesions showed carcinoma in the biopsy core (43% of the biopsy cores were benign). The number of positive biopsies increased up to 75% when the hypoechoic lesion was palpable at digital rectal examination. 5.2% of the hypoechoic cancers would have been missed when non-palpable lesions would not have had a biopsy. When the hypoechoic lesion was associated with increased serum concentration of prostate specific antigen (PSA > 4 ng/ml) 74% of the biopsies were positive. 20% to 25% of all hypoechoic cancers would not have had a biopsy. The positive predictive value was 85% when the hypoechoic lesion was palpable at digital rectal examination and the PSA-concentration was > 4 ng/ml (and 90% when volume-adjusted PSA-parameter would have been applied).

The history of uroradiology

In the first period (1896-1910), investigation was made through plain abdominal film with description and differential diagnosis of the different calcifications in the right hypochondrium. Second period (1911-1924): indirect signs of liver and gallbladder pathology were described. Via pneumoperitoneum and gastro-intestinal opacification the pathology in the right hypochondrium was delineated and interpreted. Third period (1924 until now): due to the development of contrast agents for the gallbladder and biliary tree, these organs could be directly visualized either by intravenous injection, or by peroral administration; sometimes direct injection of contrast in the bile ducts was used.

Neoadjuvant hormonal therapy before radical prostatectomy decreases the number of positive surgical margins in stage T2 prostate cancer: interim results of a prospective randomized trial. The Belgian Uro-Oncological Study Group

PURPOSE

We investigated the effect of neoadjuvant treatment before radical prostatectomy for clinically localized prostate cancer.

MATERIALS AND METHODS

A total of 130 patients with stages T2b and T3 prostate cancer was randomized in a multicenter study: 62 underwent immediate radical prostatectomy and 65 received 560 mg. estramustine phosphate daily for 6 weeks preoperatively.

RESULTS

For clinical stage T2b tumors the neoadjuvant treatment resulted in a significant decrease in positive surgical margins compared to the nonpretreated group. This difference was not found for clinical stage T3 tumors. The impact on progression and survival still must be analyzed.

CONCLUSIONS

Neoadjuvant treatment can be beneficial for clinical stage T2 prostate cancer. Optimal treatment for stage T3 tumors remains controversial.

Retroperitoneal schwannoma

A case of an incidentally found retroperitoneal schwannoma is reported. A schwannoma is a rare, benign tumor affecting the soft tissues and the viscera. In the presented case, the US and CT images suggested the nature of this benign tumor. Angiography confirmed the mass effect on the portal vein and subsequently the potential risk of portal thrombosis. The diagnosis was confirmed at surgery.

Extramedullary hematopoiesis encasing the pelvicalyceal system: CT findings

A rare case of symmetric renal extramedullary hematopoiesis is hypothesized in a patient with long-standing Vaquez' disease and myelofibrosis. At CT, soft tissue densities were found in the renal hilar area encasing the pelvicalyceal system. Although there is nothing specific about the CT findings, the diagnosis can be suggested in the proper clinical setting. The association with generalized osteosclerosis is another diagnostic clue.

A novel common Kell antigen, TOU, and its spatial relationship to other Kell antigens

A 47-year-old native American (TOU) was admitted to hospital for hip surgery. His serum agglutinated all red blood cells (RBCs) tested except Ko and DTT-treated RBCs and was weakly reactive with RBCs known to have a weak expression of Kell antigens, namely Kmod, McLeod, Kp(a+b-) (KEL:3,-4) and K:-13 (KEL:-13) phenotypes. RBCs from three siblings, a son and a daughter were incompatible with TOU's antibody. TOU's RBCs had the common Kell phenotype: K-k+Kp(a-b+c-)Ku+Js(a-b+)Ul(a-)K:11,-17K:14,-24K:12,13,18,19, 22,-23(KEL:-1,2,-3,4,5,-6,7,-10,11,12,13,14,-17,18,19,-21,22,-23,-24). Since TOU's RBCs were not agglutinated by an unidentified Kell-related antibody (IAN), tests were performed to show that TOU and IAN were mutually compatible. IAN is a Latino female hospitalised for a hysterectomy. The TOU antigen was shown to be located on the Kell glycoprotein by a monoclonal antibody immobilisation of erythrocyte antigen (MAIEA) assay. The unique pattern of reactivity obtained with TOU and IAN antibodies using this assay indicated the TOU epitope to be in an area remote from other Kell antigens, namely K, k, Kpa, Kpb, Kpc, Ku, Jsa, Jsb, U1a, K11, K12, K13, K14, Wka, K18, K19, K22 and K24 (KEL1, KEL2, KEL3, KEL4, KEL5, KEL6, KEL7, KEL11, KEL12, KEL13, KEL14, KEL17, KEL18, KEL4, KEL5, KEL6, KEL7, KEL11, KEL12, KEL13, KEL14, KEL17, KEL18, KEL19, KEL21, KEL22 and KEL24) but close to the low-incidence antigen K23 (KEL23).(ABSTRACT TRUNCATED AT 250 WORDS)