Applications of PET imaging with the proliferation marker [18F]-FLT

[18F]-3'-fluoro-3'-deoxythymidine (FLT) is a nucleoside-analog imaging agent for quantifying cellular proliferation that was first reported in 1998. It accumulates during the S-phase of the cell cycle through the action of cytosolic thymidine kinase, TK1. Since TK1 is primarily expressed in dividing cells, FLT uptake is essentially limited to dividing cells. Thus FLT is an effective measure of cell proliferation. FLT uptake has been shown to correlate with the more classic proliferation marker, the monoclonal antibody to Ki-67. Increased cellular proliferation is known to correlate with worse outcome in many cancers. However, the Ki-67 binding assay is performed on a sampled preparation, ex vivo, whereas FLT can be quantitatively measured in vivo using positron emission tomography (PET). FLT is an effective and quantitative marker of cell proliferation, and therefore a useful prognostic predictor in the setting of neoplastic disease. This review summarizes clinical studies from 2011 forward that used FLT-PET to assess tumor response to therapy. The paper focuses on our recommendations for a standardized clinical trial protocol and components of a report so multi center studies can be effectively conducted, and different studies can be compared. For example, since FLT is glucuronidated by the liver, and the metabolite is not transported into the cell, the plasma fraction of FLT can be significantly changed by treatment with particular drugs that deplete this enzyme, including some chemotherapy agents and pain medications. Therefore, the plasma level of metabolites should be measured to assure FLT uptake kinetics can be accurately calculated. This is important because the flux constant (KFLT) is a more accurate measure of proliferation and, by inference, a better discriminator of tumor recurrence than standardized uptake value (SUVFLT). This will allow FLT imaging to be a specific and clinically relevant prognostic predictor in the treatment of neoplastic disease.

Enhancing soil infiltration reduces gaseous emissions and improves N uptake from applied dairy slurry

Rapid infiltration of liquid manure into the soil reduces emissions of ammonia (NH(3)) into the atmosphere. This study was undertaken to assess the effects of two low-cost methods of assisting infiltration of applied dairy slurry on emissions of NH(3), nitrous oxide (N(2)O), and on crop N uptake. The two methods were removing of solids by settling-decantation to make the manure less viscous and mechanically aerating the soil. Ammonia emissions were measured with wind tunnels as percentage of applied total ammoniacal nitrogen (TAN) while emissions of N(2)O were measured with vented chambers. Mechanically aerating the soil before manure application significantly reduced emissions of NH(3) relative to the nonaerated soil in spring (38.6 to 20.3% of applied TAN), summer (41.1 to 26.4% of applied TAN) and fall (27.7 to 13.6% of applied TAN) trials. Decantation of manure had no effect on NH(3) emissions in spring, tended to increase emissions in summer and significantly decreased emissions in fall (30.3 to 11.1% of applied TAN). Combining the two abatement techniques reduced NH(3) emission by 82% in fall, under cool weather conditions typical of manure spreading. The two abatement techniques generally did not significantly affect N(2)O emissions. Uptake of applied N by Italian ryegrass (Lolium multiflorum Lam.) was generally significantly greater with decanted than from whole manure but the effect of aeration was generally small and not significant. The study shows that low cost methods that assist manure infiltration into the soil may be used to greatly reduce ammonia loss without increasing N(2)O emissions, but efficacy of abatement methods is affected by weather conditions.

[European Association of Urology guidelines on urinary and male genital tract infections]

Today, the classical bacteria that cause venereal diseases, e.g. gonorrhea, syphilis, chancroid and inguinal granuloma, only account for a small proportion of all known sexually transmitted diseases (STDs). Other bacteria and viruses as well as yeasts, protozoa and epizoa must also be regarded as causative organisms of STD. Taken together, all sexually transmitted infections comprise more than 30 relevant STD pathogens. However, not all pathogens that can be sexually transmitted manifest diseases in the genitals and not all infections of the genitals are exclusively sexually transmitted. Concise information and tables summarising the diagnostic and therapeutic management of STDs in the field of urology allow a synoptic overview, and are in agreement with the recent international guidelines of other specialist areas. Special considerations (i.e. HIV infection, pregnancy, infants, allergy) and recommended regimens are presented.

[Aorto-mesenteric artery compression syndrome]

INTRODUCTION

The aim of this paper was to describe a rare gastrointestinal motility disorder caused by vascular compression of the duodenum.

PATIENTS

The authors present two patients with vomiting and severe weight loss. Diagnostic evaluation revealed superior mesenteric artery syndrome.

METHODS

After frustrane treatment with i.v. infusions, surgical intervention with laterolateral duodenojejunostomy or Roux-en-y reconstruction for restoration of the intestinal passage was performed.

RESULTS

Following initial recovery, the first patient showed permanent anorexia. Psychosocial evaluation revealed a severe pathological mother-child relationship. Intensive psychological treatment finally achieved definite weight gain and complete recovery in this patient. The second case subsequently gained weight without psychological evaluation.

CONCLUSION

The authors review the literature, pointing out the anatomy of the duodenojejunal angle, the etiology, and the predisposing factors, as well as diagnostic and therapeutic strategies.

[Therapy of candiduria by alkalinization of urine. Oral treatment with potassium-sodium-hydrogen citrate]

METHOD

Eighteen hospitalized patients with candiduria were treated with oral potassium-sodium-hydrogen citrate to alkalinize the urine. The results obtained were compared with those observed in an untreated retrospective control group. Dosage was adjusted in accordance with the pH of the urine measured immediately before treatment with the aim of achieving a pH of 7 to 7.5.

RESULTS

All patients had an indwelling catheter, which is a predisposing factor for candiduria. In 16 out of 18 patients (89%) treatment with potassium-sodium-hydrogen citrate raised pH and resulted in the disappearance of candiduria. Duration of treatment varied between two days and one month (mean: seven days). In four patients the urine became completely sterile; during treatment 12 out of 18 patients developed significant bacteriuria (in eight cases of these the indwelling catheter had been left in place).

CONCLUSIONS

Alkalinization of the urine is a simple and effective method of treating candiduria in patients with an indwelling catheter. An additional advantage is the metaphylaxis and prophylaxis of renal stone formation in immobilized patients.

[A new method for the surgical treatment of bladder cancer and its immediate results]

The authors describe the method of operation on cystectomy and plasty of the urinary bladder. Results of operations on 46 patients and the following complications are described.

Transprostatic selective cystectomy with an ileal bladder

Since 1987 we have changed our surgical approach to radical cystectomy and ileal neobladder in order to maintain erectile function and urinary continence. The routine diagnostic work-up includes a staging transurethral resection of the prostate in order not to miss any ductal involvement. The selective cystovesiculectomy is performed by cutting through the apex of the prostate, thus leaving a wide, funnel-shaped tunnel of the prostatic urethra for the anastamosis with the M- or W-shaped ileal reservoir. The preliminary results of 27 patients show excellent results concerning erectile function and continence, as requested by our predictive criteria. Especially the continence achieved after a training period of 3 months is reliable. Further observation will show whether the functional improvements and advantages in the operative technique are achieved at the cost of a higher relapse rate of urethral tumors.

[The cadmium content of human tissues from biopsies]

The level of cadmium (cd) concentration was determined in organs of 130 men and women. This study was conducted on living human beings who, in their occupation, haven't had extraordinary cd-exposure. Samples of tissues taken during operation were evaluated as well as urine samples (24 hours specimen), blood, an extended patient history including occupation and the postoperative diagnosis. The average cd-concentration was means = 27.3 +/- 29.7 micrograms/g wet weight in kidney cortex, 9.3 +/- 11.7 micrograms/g in kidney medulla, 1.1 +/- 0.5 micrograms/g in liver, 2.9 +/- 2.5 micrograms/l in blood and 2.6 +/- 2.9 micrograms/l in urine. Concentrations in 7 other tissues were measured. The critical cd-level for liver and kidney was not reached in any case. Cd-concentration is related to age and cigarette smoking, not to the sex of the person. It is quite impossible to make a precise estimation on the kidney load from blood or urine level of an individual patient. Differences in cd-load between patients with cancer and those without are discussed. A synopsis of international studies shows that results achieved through various methods, radiological cd-measurement, autopsies and our biopsies were comparatively the same.

[Nephrolithiasis--correlation of calculus type and pathogen spectrum. Calculus analysis and microbiologic diagnosis in 173 surgically treated patients]

The microbiological findings from intraoperative swabs were correlated with the consistency of the calculi in 173 patients, who had been operated on due to nephrolithiasis. The following parameters were taken into consideration: age and sex of the patients, consistency of calculi and germ spectrum of intraoperative swabs from the upper urinary tract. Three main groups were formed corresponding to the consistency of the calculi (carriers of infection calculi, of calciumoxalate calculi and of uric acid calculi) and these were compared to one another regarding the above mentioned parameters.

[The significance of Chlamydia trachomatis in chronic infectious urethro-adnexitis in the male]

The causative significance of chlamydia trachomatis in chronic urethra-prostatitis can be assumed because of the high incidence in non-gonorrheal and post-gonorrheal urethritis and epididymitis. 158 men with chronic inflammatory urethro-prostatitis were reviewed. In 32.3% the urethral smear and in 29.7% the prostatic fluid were positive for chlamydia trachomatis. Simultaneously leucocyte count and pH of the prostatic fluid as well as the immunoelectrophoresis of the ejaculate were investigated. The correlation of these results with positive chlamydia trachomatis findings demonstrates the significant role of chlamydia trachomatis in chronic inflammatory processes of the urethra and prostate.

[Doxycycline in the treatment of non-specific urethritis and/or prostatitis]

Twenty-five men with non-specific urethritis/adnexitis were treated with 200 mg doxycycline monohydrate daily (Vibramycin Tabs) over a period of 10 days. More than half of the patients suffered from chronic inflammations. Microorganisms isolated from urethral secretion and prostate exprimate comprised aerobes, in particular staphylococcus epidermidis and streptococcus faecalis, as well as mycoplasmae, chlamydiae, and anaerobes, mainly bacteroides species and peptostreptococci. Fourty percent of patients additionally had anatomical alterations such as constrictions or strictures of the lower urinary tract. After 10-day therapy with doxycycline 16 out of 24 patients (67%) could be cured and a further six patients (25%) could be improved. Microbiological cure could be achieved in infections with chlamydiae in all cases, in infections with mycoplasmae in 67%, in infections with anaerobes in 80%, and in infections with aerobes in 57% of cases. Overall, the therapeutical success in the investigated patient population with chronic infections which are difficult to treat has therefore to be regarded as excellent. Therapy had to be discontinued in one patient after 3 days due to diarrhoea and nausea. In the other patients toleration of doxycycline was good.

[Co-trimoxazole concentration in the prostatic fluid of patients with subacute and chronic prostatitis]

Plasma and prostatic fluid (PF) concentrations of co-trimoxazol (TMP/SMZ) were investigated on 16 patients with subacute or chronic prostatitis. Co-trimoxazol-forte was given perorally, 2X 1 tablet (2X 160 mg TMP/800 mg SMZ), daily. TMP-concentrations in PF were 3.3 micrograms/ml and 2.6 micrograms/ml three and six hours after peroral application (days two and three) respectively. Compared to the concentrations of TMP in plasma, there was an increase by the factor 2.0-3.7. The corresponding concentrations of SMZ in PF were 7.7 micrograms/ml and 10.4 micrograms/ml 3 and 6 hours after medication--i.e. 32% of the plasma concentrations.

[Renal sinus lipomatosis, a pseudotumorous transformation]

A case of longstanding chronic pyelonephritis associated with severe recurrent nephrolithiasis followed by excessive lipomatosis, ureteritis cystica and xanthogranulomatous pyelonephritis is presented. In addition to the definition and morphologic description of lipomatosis its differential diagnosis is discussed. This also applies to the pathogenesis of these diseases. The special role of lipomatosis in the perpetuation of a circulus vitiosus is stressed. In special cases it seems to be justified to speak of clinical malignant lipomatosis.

[Co-tetroxazin levels in the prostatic secretion of patients with subacute and chronic prostatitis]

Plasma and prostatic fluid concentrations of co-tetroxacine (TXP/SDZ) were investigated on 12 patients with subacute or chronic prostatitis. Co-tetroxacine was given perorally, 2 x 2 tabl. daily. - Tetroxoprime-(TXP-)concentrations in prostatic fluid were 4.2 micrograms/ml and 4.5 micrograms/ml 3 and 6 hours after peroral application (days 2 and 3) respectively. Compared to the concentrations of TXP in the systemic fluid there was an increase by the factor 3 to 4.3. - The corresponding concentrations of sulfadiazine (SDZ) in prostatic fluid were 11.6 micrograms/ml and 10.0 micrograms/ml - i.e. 62-70% of the plasma concentrations.

[Comparison of the antibacterial effects of gentamycin, tobramycin, dibekacin and amikacin in urinary germs]

We isolated 491 pathogens of urinary tract infections of our urological in-patients. Sensitivity against gentamycin, tobramycin, dibekacin and amikacin was tested in vitro. Our data were compared with the statements of the medical literature. It should be pointed out the great fraction of grampositive staphylococci. Their sensitivity rate of 40% against the tested aminoglycosides was remarkably small. Enterococci had a sensitivity rate of 70% against gentamycin, tobramycin and dibekacin. Their sensitivity rate against amikacin was only 20% as expected, because enterococci do not belong to the proper antibiotic spectrum. The four aminoglycosides are highly effective against gramnegative organisms with with no appreciable differences.

[Ureter-ureterotransversostomy. A method for supravesical urinary diversion with few complications]

A simple method of urinary diversion is described. It is very useful in reduced patients when other methods, e.g. ureterosigmoidostomy, ileal and colonic conduits are impossible. Up to now 14 patients were treated by transuretero-ureterostomy combined with a definitely nephrostoma. In all cases except one an optimal urinary diversion was attained.

[Masked urothel carcinoma of kidney pelvis and ureter]

Behind the typical signs of a staghorn calculus of a kidney and a ureterocele with calculi in x-ray a transitional cell carcinoma of the kidney and the whole ureter was found. The nonfunction of the organ was thought to be due to pyonephrosis. Four other cases reported in the literature are discussed.

Ventricular response to isometric and isotonic exercise. Echocardiographic assessment

The effects of supine isometric handgrip and graded isotonic bicycle ergometer exercise on left ventricular performance were studied echocardiographically in 20 normal subjects, aged 18 to 36. Measurements of the left ventricular minor axis diameter were taken from recordings performed at rest, during each form of exercise, and during recovery. At the completion of isometric exercise, the pressure-rate product increased significantly. There was no significant change in percentage of fractional shortening (%deltaD), while there was a small but significant fall in peak velocity of circumferential fibre shortening (peak Vcf). Isotonic exercise resulted in a significant increase in %deltaD and peak Vcf. The pressure-rate product also increased and showed a positive correlation with peak Vcf. Isotonic exercise produced a much greater stimulus to left ventricular contractility than isometric exercise and may be a useful means of detecting latent left ventricular dysfunction echocardiographically.

Percutaneous insertion of a permanent transvenous pacemaker electrode through the subclavian vein

Insertion of transvenous permanent pacemaker leads through the subclavian vein is relatively safe and simple. This procedure was performed in 29 patients. The only serious complication was dislocation of the lead in eight patients. With this technique the endocardial lead can be positioned quite readily in the right ventricle. Use of the technique should be considered whenever the cephalic vein cannot be located readily or is too small to permit placement of an endocardial lead.