Posttraumatic renovascular hypertension after occult renal injury

OBJECTIVE

Hypertension secondary to renal injury is an unusual problem, but one that occurs with some frequency in an active trauma unit. The incidence and management of posttraumatic renovascular hypertension at our Level I trauma center was reviewed.

METHODS

A retrospective review of a trauma database was performed on patients treated by our trauma service between 1977 and 1996. Seven patients were identified who developed arterial hypertension as a direct result of a renal injury.

RESULTS

All of the patients sustained multiple injuries, with five requiring celiotomy to control bleeding. Renal injuries were occult, and there was no compelling reason to suspect injury to the kidney. No patient had a history of hypertension or elevated arterial pressure on admission; however, sustained arterial hypertension was noted within 2 weeks to 8 months of injury. Arteriography was positive in all seven patients, with findings that included lacerations of the main renal artery, its major branches, or intrarenal constriction of the renal artery (presumably from scarring). Renal-vein renin assays localized to the injured kidney in six patients. Treatment included nephrectomy in four cases, revascularization in one case, and medical management in two cases. All of the patients treated operatively had prompt relief of their hypertension. The two patients treated soley by medical therapy had prompt, durable control of their arterial pressure with a single medication. However, medical treatment had failed before operation in several of the patients.

CONCLUSIONS

Because of the serious complications associated with undiagnosed hypertension, new-onset or sustained hypertension after major trauma should be evaluated with attention to a possible renal cause.

Are learning objectives useful in evaluating medical school course and instructor performance?

We tested the hypothesis that learning objectives could be used to evaluate course and instructor effectiveness. Ninety-seven third-year medical students who had their surgical clerkship or their medical clerkship as their first clinical rotation were compared. The surgery clerks received 171 urologic learning objectives. Students taking the surgical clerkship had significantly higher postclerkship recognition of the learning objectives than did medical clerkship students. One year later, these students were again surveyed to determine whether they still knew the correct response to the learning objective. The follow-up survey showed that 50% of the students recognized objectives covered in five of the eight urology lectures, while the other lectures were not effective. Students who recognized the objective on the postclerkship evaluation were more likely to think the objective had been taught on this follow-up survey. These data suggest that learning objectives are useful for evaluating course and instructor effectiveness.

The effects of oral pentoxifylline on interleukin-2 toxicity in patients with metastatic renal cell carcinoma

Interleukin-2 (IL-2) mediates the regression of metastatic renal cell carcinoma, but clinical application has been limited by associated toxicities. Preclinical studies show that pentoxifylline (PTXF), a methylxanthine derivative, inhibits IL-2 toxicity while preserving anti-tumour efficacy. This study was designed to determine whether oral PTXF would alter IL-2-induced toxicities. Patients with disseminated renal cell carcinoma were treated with continuous infusion of 18 x 10(6) IU/m2/24 h for 4 days followed by 3 days without treatment, for 4 consecutive weeks. After a 2-week interval, the 4-week treatment cycle was repeated. All patients concomitantly received oral PTXF (2000 mg/24 h) in five divided doses. Despite the co-administration of PTXF, all patients demonstrated a spectrum and severity of toxicities consistent with previous reports of continuous infusion of IL-2 alone. There was considerably more nausea and vomiting associated with the administration of PTXF which improved on withdrawal of PTXF. Oral PTXF in IL-2 therapy did not show any substantiated benefit. Indeed, patients suffered more severe nausea and vomiting than if they had received IL-2 alone, resulting in the early termination of the trial.

Patient compliance in treatment of prostate cancer with luteinizing hormone-releasing hormone (LHRH) agonist

Luteinizing hormone-releasing hormone (LHRH) agonist therapy is commonly used as a form of hormonal ablative therapy in patients with advanced prostate cancer. It is important to administer LHRH agonist every four weeks. Any delay of more than two weeks is associated with the risk of disease flare. A retrospective review of two groups of patients were compared. Twenty-five patients treated at the Veterans Administration Medical Center, Louisville, Kentucky, showed that 44 percent missed one or more injections and 24 percent had a delay of more than two weeks after the scheduled time for another injection. Twenty-three patients were treated by a private practice group in Louisville, Kentucky. There were no problems with compliance. An office nurse kept a separate register for patients receiving LHRH agonist therapy and their appointments. For LHRH therapy to be effective, we believe that the level of compliance one could expect from an individual should be determined before instituting LHRH agonist therapy. If good compliance is not assured, alternative forms of hormone ablative therapy may be preferable for patients with advanced prostate cancer.

Retroperitoneal tumors with vena caval extension: a multidisciplinary approach

In cases of retroperitoneal tumor with extension to the inferior vena cava (IVC), complete resection improves survival, but may require cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA). Since 1985, eight patients at our institution have had complete resection of retroperitoneal tumors with IVC or right atrial involvement. Preoperative evaluation included intravenous pyelography, computed tomography of the chest and abdomen, renal arteriography, and venography or magnetic resonance imaging of the IVC. Operative technique was determined primarily by the extent of IVC or RA involvement and included combined median sternotomy and laparotomy, control of the intrapericardial IVC, and radical tumor resection. IVC tumor thrombectomy was done using either temporary vascular occlusion, CPB, or CPB with HCA. Complete resection for improved survival of retroperitoneal tumors with IVC extension is technically feasible with acceptable morbidity and mortality rates. A multidisciplinary approach allows optimal management of these extensive tumors.

Extracorporeal shock-wave lithotripsy in transplanted kidney

Urolithiasis is the least described urologic sequela of renal transplantation. We describe a renal transplant patient who presented with painless gross hematuria. An intravenous pyelogram demonstrated a 4 x 7-mm calculi in the region of the ureteropelvic junction, causing moderate hydronephrosis. The patient was treated successfully with extracorporeal shock-wave lithotripsy (ESWL). Serum creatinine and twenty-four-hour creatinine clearance were unchanged from levels prior to ESWL.

Priapism associated with asplenic state

Priapism may be primary (idiopathic) or secondary to sickle cell anemia, trauma, leukemia, drugs, venous thromboembolic diseases, and other less common disorders. This study concerns 21 patients with priapism treated during a period of ten years. Nine patients (43%) had sickle cell anemia. Of the 12 individuals (57%) classified as idiopathic, 3 (25%) had previously undergone surgical splenectomy for benign conditions. Considering the propensity for this unusual condition to develop in patients with hemoglobinopathy-induced hyposplenism, the possibility of a relationship between the asplenic state and priapism is considered.

Diethylstilbestrol in treatment of postorchiectomy vasomotor symptoms and its relationship with serum follicle-stimulating hormone, luteinizing hormone, and testosterone

Vasomotor symptoms such as hot flushes and profuse sweating have been described after bilateral orchiectomy. We evaluated 26 patients who had undergone bilateral orchiectomy for prostatic carcinoma to determine the incidence of vasomotor symptoms and the efficacy of low-dose diethylstilbestrol (DES) in the treatment of those symptoms. Measurements of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone were performed to look for endocrine patterns which may be related to the presence of vasomotor symptoms. Fourteen patients (54%) reported the presence of vasomotor symptoms beginning one to four weeks after surgery. These patients were treated with DES or placebo in a double-blind crossover trial. The frequency and severity of hot flushes were significantly reduced during the time DES was given. This was accomplished with a low dose of 1 mg daily of DES which avoids the cardiovascular complications of higher doses. We found no correlation between the presence, severity, or frequency of hot flushes and serum gonadotropin or testosterone concentrations.

The influence of photodynamic therapy on the ultrastructure of the normal rat bladder

Reduced bladder capacity is a major side effect for patients receiving photodynamic therapy (PDT) for bladder cancer. A rat bladder model has been developed to address both the vascular and tissue effects of the photodynamic treatment of the urinary bladder. Bladders were exteriorized and positioned in a plexiglass tissue bath. Effects on microvasculature were assessed during PDT of the bladder by recording luminal diameter changes in arterioles and venules. Animals receiving Photofrin II (10 mg kg-1) 30 min prior to PDT scored a statistically significant reduction in the diameter of the red blood cell column in the vessels, whereas administration of Photofrin II 48 h prior to PDT was ineffective. Morphological changes included significant endothelial and vascular myocyte damage in the 30 min PDT group alone. Among the other tissue components, the mucosal lining was minimally affected and the response of the muscularis was highly variable. Smooth muscle cell changes ranged from mild contraction to frank necrosis with many of the affected cells located near the altered vascular beds. These data suggest that the clinical symptoms of reduced bladder capacity can be accounted for by vascular damage and myocyte sensitivity. Further refinements in the Photofrin II and light doses used in therapy may reduce bladder complications and allow for better management of bladder cancer.

Treatment of radiation or cyclophosphamide induced hemorrhagic cystitis using conjugated estrogen

Five patients with severe hemorrhagic cystitis induced by radiation and/or cyclophosphamide were systematically treated with conjugated estrogen. Two patients received conjugated estrogen twice each day (1 mg. per kg.) intravenously, followed on day 3 and thereafter by 5 mg. per day orally. Hematuria decreased markedly 6 to 8 hours after the initial dose and urine color became light yellow within 1 to 3 days. The other 3 patients received 5 mg. conjugated estrogen per day orally and urine color became clear within 4 to 7 days. Hematuria did not recur during 12 to 22 months in 4 patients who received daily conjugated estrogen (1.25 mg.). However, transient episodes of mild hematuria persisted in 1 patient during the 3-month followup despite a higher dose of conjugated estrogen (10 mg. per day). Complications, including thromboembolism and other side effects associated with conjugated estrogen, were not observed in these patients. We postulate that conjugated estrogen controls hematuria in hemorrhagic cystitis by decreasing the fragility of the mucosal microvasculature of the bladder.

Infundibulopelvic dysgenesis: a spectrum of obstructive renal disease

Infundibulopelvic dysgenesis is an obstructive process of the pyelocalyceal system that is responsible for a spectrum of congenital renal disorders. The site and degree of narrowing in the infundibulopelvic system produce the various congenital anomalies like hydrocalycosis, calyceal diverticula, ureteropelvic junction stenosis, and multicystic kidney. A classification with illustrative cases is presented showing a common pathogenesis of these congenital obstructive anomalies.

Cytohistologic correlation of urothelial lesions secondary to photodynamic therapy

Qualitative cytologic evaluations of urinary bladder washings were performed on a selected population following photodynamic therapy for recurrent transitional cell carcinoma of the bladder. The seven patients were monitored trimonthly by cystoscopy, multiple biopsies and cytopreparations. Cancers reappeared in two of the five patients who initially responded to therapy. In the remaining two patients, the recurrent neoplasms were therapeutically refractory. Cytology detected recurrent cancer prior to biopsy confirmation and/or cytoscopic identification. Exfoliative cytology was correlated with the histopathology of the concurrent biopsies; a possible source for a false-positive cytodiagnosis was the cellular atypia of reepithelialized bladder mucosa. Dysplasia was not identified cytologically or histologically.

The response of the rat urinary bladder microcirculation to photodynamic therapy

Light activation of dihematoporphyrin ether (photofrin II) has been used in the treatment of bladder tumors, yet the effects of this treatment on the normal urinary bladder microcirculation have not been determined. This study involved the use of in vivo television microscopy to observe the effects of light activation (530 to 560 nm., 175 mW/cm.) on the urinary bladder microcirculation of female Sprague-Dawley rats. Animals pretreated with dihematoporphyrin ether 30 minutes prior to light activation had high serum and low tissue concentrations of the photosensitizer and activation resulted in a statistically significant reduction of red blood cell column diameter in both arterioles and venules. The reduction was primarily due to mural thrombus formation with the occlusion remaining 60 minutes after activation. Animals pretreated 48 hours before activation had low serum and high tissue concentrations of dihematoporphyrin ether and activation had no microcirculatory effects apart from occasional platelet aggregation. These results suggest that the photodynamic effect on normal (non-neoplastic) tissue treated more than 48 hours after administration of dihematoporphyrin ether is probably due to a direct effect of light and the sensitizer on the smooth muscle of the bladder rather than an effect on the microcirculation.

Complications of whole bladder dihematoporphyrin ether photodynamic therapy

Photodynamic therapy with dihematoporphyrin ether was used to treat superficial bladder tumors in 7 patients with a followup of at least 1 year. Each patient received treatment to the whole bladder and those with papillary lesions received additional focal treatment. At 3 months 4 of the 5 patients with papillary tumors (stages Ta and T1) and 1 of the 2 with diffuse carcinoma in situ (Tis) were free of disease. However, at 1 year only 3 patients remained free of disease. Of 5 patients with an increase in irritative bladder symptoms 4 had a contracted bladder, hydroureteronephrosis and vesicoureteral reflux. Deep bladder biopsies showed replacement of smooth muscle by fibrous tissue. Six patients had mild to moderate skin phototoxicity. We conclude that although photodynamic therapy is an attractive and exciting method to treat cancer, its use with dihematoporphyrin ether in cases of bladder carcinoma can be associated with significant complications. The correct treatment parameters for safe, effective therapy are not known to date.

Effects of homoharringtonine on protein glycosylation in human bladder carcinoma cell T-24

Rates of [3H]glucosamine and mannose incorporation into glycoproteins and dolichol-linked oligosaccharides in exponentially growing T-24 bladder cancer cells were examined after exposure to homoharringtonine (HHT). Two-h treatment of HHT (10 ng/ml) reduced [3H]glucosamine and mannose incorporation into the glycoproteins to 61% and 32% of controls. Concomitantly, respective sugar incorporation into dolichol-linked oligosaccharides was elevated 29% and 30% above control. The maximal inhibition of glycoprotein biosynthesis and stimulation of the lipid-linked oligosaccharides occurred within 2 to 4 h after exposure to 50 ng/ml of the drug. Prolonged drug exposure (greater than 8 h) resulted in generalized suppression of glycoprotein biosynthesis and lipid-linked oligosaccharide formation. The kinetic study indicated that the time course on reduction of glycoprotein biosynthesis and accumulation of dolichol-linked oligosaccharides paralleled the decline in protein synthesis. Further, the inhibition of glycoprotein synthesis and stimulation of dolichol-linked oligosaccharides were reversible 4 h after drug withdrawal. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis autoradiographic analysis of the [3H]mannose-labeled glycoprotein revealed no pronounced difference between HHT-treated and control cells. These data suggest that the inhibition of glycosylation results from combined decrease of acceptors for glycoprotein biosynthesis with a simultaneous accumulation of the dolichol-linked oligosaccharides. Collectively these data may account for many of the HHT-induced bioresponses.

Verapamil enhanced in vitro chemosensitivity of a murine bladder carcinoma, FCB

The in vitro enhancement of chemotherapeutic efficacy by verapamil, a calcium antagonist, was assessed using FCB, a transplantable murine transitional cell carcinoma. Exponentially growing FCB cells were partially resistant to treatment with both thiotepa (10(-4) M) and Adriamycin (10(-5) M), however, there was a significant reduction in cell growth when either agent was administered in combination with verapamil (10(-5) M); the effect was evident over a wide range of drug concentrations (10(-4) - 10(-9) M). There was also a pronounced inhibition of DNA precursor incorporation when verapamil was used in combination with either agent. Fluorometric analysis of Adriamycin uptake indicated that verapamil caused an increase in the intracellular concentration of the agent. The data presented are consistent with the postulate that verapamil enhances chemotherapeutic efficacy by altering cellular permeability to the cytotoxic agents. Our study indicates that the use of verapamil in combination with cytotoxic agents for intravesical chemotherapy of bladder tumors may prove to be beneficial in human patients.

In vitro chemosensitivity of J-82 human bladder cancer cells

While chemotherapy offers a valuable adjunct to surgery in the management of intravesical bladder cancer, an accurate in vitro predictive test for chemosensitivity has yet to be developed. Drug sensitivity of the human bladder cancer cell line J-82 was assessed using monolayer, stem cell and [3H]thymidine incorporation assays. The 72-h monolayer assay provided a rapid reflection of in vitro drug sensitivity and when combined with the labeling index the results generally paralleled those obtained with the soft agar stem cell assay without the associated large commitment of time and labor. It is suggested that 72-h monolayer assay alone or in combination with [3H]thymidine labeling index may offer valuable insight into the chemotherapeutic response of bladder tumors.

Ultrastructural evaluation of murine bladder epithelium exposed to verapamil

The effect of single or multiple instillations of high verapamil concentrations on the cytoarchitecture of the bladder epithelium was assessed by electron microscopy. Ruthenium red was used to evaluate the surface mucopolysaccharide coats and the integrity of junctional complexes between luminal cells. No significant cytoplasmic change in the luminal or nonluminal cells was found in any experimental animals, nor was there a breakdown of the junctional complexes between luminal cells. These data suggest that verapamil may be safely used intravesically as adjunct to standard chemotherapy.

Systemic influence of intravesical chemotherapy with verapamil

The influence of the calcium blocker verapamil (VR) on systemic toxicity resulting from the intravesical instillation of Adriamycin (ADM) and thiotepa (THT) was assessed in mice. Eighty per cent of the animals receiving THT + VR developed a generalized alopecia. Data gathered at necroscopy failed to reveal any trauma to the major organs or the presence of a drug-induced myelosuppression. Combination of ADM and VR did not produce an enhancement of systemic toxicity, manifest as myelosuppression. The drug combination did not produce a cardiomyopathy as assessed by histologic examination. The use of VR in combination with antineoplastic agents posed no more of a threat to the animals than did the use of cytotoxin alone.

Comparison of recurrence rates of calculi of the bladder in patients with indwelling catheters following vesicolithotomy, litholapaxy and electrohydraulic lithotripsy

This retrospective review is the first to compare recurrence rates of calculi of the bladder following each of the three common methods. In 39 patients with bladder calculi and indwelling catheters, the recurrence rate of calculi of the bladder within two years was significantly greater following litholapaxy (44.1 per cent) or EHL (50.0 per cent) than vesicolithotomy (7.4 per cent). The average stone-free interval was shorter after litholapaxy (18.4 months) or EHL (13.8 months) than vesicolithotomy (70.8 months).

Verapamil enhancement of chemotherapeutic efficacy in human bladder cancer cells

The calcium influx blocker verapamil has been used to overcome drug resistance in several tumor systems. The possible in vitro enhancement of drug efficacy was assessed in bladder cancer cell line T24. Combination of thiotepa and doxorubicin hydrochloride with verapamil significantly reduced the survival and growth of T24 cells after as little as 1 hour of drug exposure. An increase in doxorubicin hydrochloride-induced inhibition of [3H]thymidine uptake resulted when verapamil was administered. However, this trend was not demonstrated when combined with thiotepa. It appears that verapamil enhances thiotepa-induced cytotoxicity while it potentiates the antimitotic nature of doxorubicin hydrochloride. The data presented is consistent with the postulate that verapamil alters active efflux of drug from malignant cells and suggests that verapamil has a role in the clinical management of bladder cancer.

Abnormal urinalysis in appendicitis

In a retrospective review of 100 consecutive patients (50 adults and 50 children) with acute appendicitis we correlated abnormal urinalysis (positive occult blood and more than 4 red or white blood cells per high power field) with the operative findings. Abnormal results on urinalysis were noted in 18 adults and 12 children. All urine specimens were collected by the clean-catch method. Abnormal findings were found more frequently in female patients. A majority of patients (53 per cent) with abnormal results on urinalysis had a ruptured or inflamed appendix in proximity to the urinary tract.

The management of testicular torsion in the acute pediatric scrotum

From July 1976 through June 1981, 51 children with acute scrotal pain and swelling underwent surgical exploration. Testicular torsion (27 cases) and torsion of an appendage (18 cases) were the most common diagnoses. In the group with testicular torsion 5 testes were considered unsalvageable and these were removed. The remaining 22 testes, including those of questionable viability, were left in place. The early salvage rate of 81 per cent decreased to 50 per cent due to testicular atrophy found in the late followup period. The attempt to salvage all testes except those with obvious necrosis resulted in minimal morbidity. This approach is discussed in view of recent reports of long-term damage to the contralateral testis when an ischemic testis is not removed initially.

The use of ketoconazole to treat systemic blastomycosis presenting as acute epididymitis

We report on a patient with systemic blastomycosis who presented with acute epididymitis that was followed by the appearance of typical skin and pulmonary lesions. An excellent clinical response was obtained with ketoconazole, a new oral antifungal agent. Only 2 cases of systemic blastomycosis that were treated with ketoconazole have been reported and neither patient had genitourinary involvement. The diagnosis and treatment of systemic blastomycosis with genitourinary involvement, and ketoconazole as the treatment of fungal infections are discussed.

Transitional cell carcinoma of the anterior urethra

We report a case of transitional cell carcinoma of the anterior male urethra. Unlike squamous cell carcinoma of the anterior urethra, which usually requires partial penectomy, transitional cell carcinoma of this location can be managed with conservative local resection and preservation of the penis. Possible explanations for the origin of this lesion are discussed.

Living donor nephrectomy: factors influencing morbidity

Recent interest in transperitoneal live donor nephrectomy prompted us to review our experience with 104 live donor nephrectomies performed through a standard flank extraperitoneal approach. There were no deaths and 14.4 per cent of the patients had minor complications that were managed easily. Factors influencing morbidity in the voluntary donor are analyzed.

Bilateral or unilateral ureteroneocystostomy for unilateral reflux

Thirty-five cases of unilateral reflux treated by ipsilateral ureteroneocystostomy have been reviewed to determine the incidence of subsequent contralateral reflux. The low incidence (11 per cent) suggests that bilateral reimplant should not be performed routinely in patients undergoing surgery for unilateral reflux. Analysis of this group of patients failed to show any preoperative findings which would help to predict those in whom contralateral reflux is most likely to develop. Our study and the review of the literature suggest that those who demonstrate reflux in the contralateral ureter at any time prior to surgery are more likely to reflux subsequently; therefore, in this group of patients bilateral reimplantation is indicated.

Autogenous tunica vaginalis graft for Peyronie's disease: an experimental study and its clinical application

Tunica vaginalis autografting was done after patches of tunica albuginea of the penis were excised in 5 dogs. Examination of these grafts 4 to 12 weeks later showed that they were well accepted. A selected group of 5 patients with Peyronie's disease underwent excision of Peyronie's plaques and autogenous tunica vaginalis grafting with satisfactory results in all cases.

Renal abscess: emerging concepts of diagnosis and treatment

A retrospective review of 12 cases of renal abscesses disclosed that gram-negative bacteria were the most common infecting organisms. There was a high incidence of underlying renal disease. Excretory urography was the most reliable investigative procedure, although renal arteriograms were necessary frequently. In carefully selected patients conservative non-operative management can be successfully but an operation was required for the majority of our patients.

Urethral strictures secondary to pelvic injury in children

Surgical repair of a membranous urethral stricture is difficult because of the location and potential risks of incontinence, impotence and infertility. The treatment of 2 such strictures by the Badenoch pull-through urethroplasty is presented. The technique is described and its apparent advantages over other methods of repair are discussed.

Ileal trigonal urinary diversion: 5-year followup evaluation

We anastomosed the intact, undisturbed vesical trigone to the isolated ileal conduit in 24 patients, most of whom have been followed for 5 years. None of these patients has had any pyelographic evidence of upper tract deterioration. There have been no episodes of pyelonephritis, no hydronephrosis, no renal stones and only 4 of the 46 renal units have demonstrated reflux. These data indicate unsurpassed protection of the upper tracts in those patients with neurogenic bladder dysfunction.

Modification of lymphocyte responsiveness by hormone used in the treatment of urologic malignancies

Recognition that the immune system may be important in regulating the clinical evolution of tumors and that corticosteroids suppress immune responses lends relevance to determining the concentrations in which sex hormones, currently used in the treatment of urologic malignancies exert immunosuppressive effects. We have investigated the effects of the sex hormones, diethylstilbestrol, diethylstilbestrol diphosphate, testosterone and progesterone, on in vitro lymphocyte blastogenesis as determined by 3H thymidine incorporation after stimulation with phytomitogens and alloantigens, and compared their effects to the effects of cortisol. Compared to cortisol these sex hormones are relatively weak suppressors of lymphocyte blastogenesis (cortisol 10(-7) M, progesterone 5 times 10(-6) M, testosterone 5 times 10(-5) M, diethylstilbestrol 5 times 10(-5) M and diethylstilbestrol diphosphate 10(-3) M) and probably are not significantly immunosuppressive in commonly used pharmacologic dosages. Similar results were observed with the T lymphocyte mitogens, phytohemagglutinin and concanavalin A, and in the combined T and B cell mitogen pokeweed. The fact that alloantigen-stimulated lymphocyte blastogenesis also was suppressed by diethylstilbestrol indicates that sex hormones exert their effects on the lymphocytes and not on the mitogens. Furthermore, sex hormones were not found to be cytotoxic to lymphocytes. It is postulated that the sex hormones tested act by suboptimal binding to glucocorticoid receptors in the lymphocytes and that the relative immunosuppressive potency of a given hormone is related to its affinity for the glucocorticoid receptor.

Identification of complement-receptor lymphocytes (B cells) in lymph nodes and tumor infiltrates

To monitor the distribution of lymphocyte sub-populations infiltrating tumors, a simplified modification of standard techniques was developed to identify the complement-receptor B lymphocytes in frozen tissue sections. This technique is based on binding of antibody-coated bovine erythrocytes by B lymphocytes in the presence of sub-hemolytic concentrations of mouse complement. B lymphocytes can be identified in frozen tissue sections by adherent sensitized bovine erythrocytes. The specificity of the technique for B lymphocytes was established by 1) absence of spontaneous rosette formation with bovine erythrocytes by human T lymphocytes, 2) specific binding of bovine erythrocyte-antibody-complement complexes to B cell regions of normal lymph nodes and spleen and 3) binding of erythrocyte-antibody-complement to a high proportion of chronic lymphocytic leukemia (a B cell leukemia) lymphocytes. Five transitional carcinomas studied had regions of mononuclear infiltration that were virtually devoid of complement-receptor lymphocytes. The results suggest that lymphocytes infiltrating bladder carcinomas may be predominantly T lymphocytes.

Prognostic value of host immunocompetence in urologic cancer patients

To evaluate the prognostic significance of host immunocompetence in urologic cancer patients, the subsequent clinical course of 95 patients was determined a year after skin testing with dinitrochlorobenzene. A close correlation was demonstrated between dinitrochlorobenzene reactivity and prognosis among 38 transitional carcinoma patients. Of 19 patients with impaired reactivity 13 had tumor recurrences and 11 of these died of cancer within 1 year. Only 5 of 19 patients with normal dinitrochlorobenzene reactivity had recurrences and none died during the same interval. Although not statistically significant, similar results were observed among 10 renal cell carcinoma patients of whom 3 of 5 with impaired dinitrochlorobenzene reactivity had tumor recurrences, while 4 of 5 with normal reactivity remained free of tumor. One testis tumor patient with impaired dinitrochlorobenzene reactivity died of cancer, while 3 of 4 with normal reactivity remained free of tumor. Similarly, 1 patient with carcinoma of the penis with impaired dinitrochlorobenzene reactivity died of cancer, while 2 of 3 with normal reactivity remained free of tumor. In contrast, reactivity to dinitrochlorobenzene did not correlate with the clinical course of 38 prostatic carcinoma patients. Ten of 19 patients with normal dinitrochlorobenzene reactivity and 9 of 19 with impaired reactivity were dead or had symptomatic recurrences within 1 year, while 9 of 19 with normal reactivity and 10 of 19 with impaired reactivity were either free of tumor or asymptomatic. However, a trend toward a correlation between dinitrochlorobenzene reactivity and tumor progression was observed among patients not receiving endocrine therapy. The differences with respect to the prognostic significance of host immunocompetence between transitional carcinoma patients and those with prostatic carcinoma may be explained by fundamental differences in the biologic properties of these tumors, especially the endocrine sensitivity of prostatic carcinoma.