Lithiasis of the distal ureter: ESWL or URS

Human herpesvirus 8 (HHV-8) is a newly discovered virus closely associated with Kaposi's sarcoma and primary effusion lymphomas. When they occur in patients with AIDS, these B-cell lymphomas frequently harbor another human herpesvirus, Epstein-Barr virus (EBV). To determine the molecular mechanisms of the regulation of early gene expression by the immediate-early gene products of HHV-8 and to assess possible molecular interactions between HHV-8 and EBV, we studied the regulation of the HHV-8 thymidine kinase (TK) promoter in cell lines harboring either or both viruses. The constitutive chloramphenicol acetyltransferase (CAT) activity of the TK promoter was low in all six cell lines tested. A putative immediate-early gene product of HHV-8 ORF50, which is a homolog of EBV BRLF1, was cloned into an expression vector and tested for its transactivating capacity. In the presence of 12-O-tetradecanoyl-phorbol-13-acetate (TPA), the CAT activity of the TK promoter was increased 7- to 720-fold by cotransfection with the ORF50 clone in EBV-producing cell lines (Ramos/AW, P3HR-1, and BC-1) but not in EBV-negative cell lines (BCBL-1 and Ramos), nor in the latently EBV-infected cell line Raji. The TK promoter contains three consensus SP1- and two AP1-binding sites. In electrophoretic mobility shift assays, the cellular factor SP1, but not AP1, was found to bind specifically to the TK promoter. To determine whether the increased CAT activity resulted from the interaction of SP1 with the ORF50 gene product, we introduced mutations into two SP1-binding sites. Both mutated SP1 sites had reduced SP1-binding activity and greatly decreased TK promoter responsiveness to ORF50 transactivation, suggesting that upregulation of TK promoter by ORF50 is SP1 dependent.     

Lithiasis of the extrahepatic bile ducts--its diagnosis and treatment

This article details the activities of the Chinese Medical Centres at Bath and Manchester, UK, both of which were set up by Sino-European Clinics Ltd (SEC) to promote traditional Chinese medicine (TCM) as a rational body of knowledge in the West. Both Centres are staffed by highly trained Chinese consultants providing complementary treatments such as acupuncture, herbs, moxibustion, and massage. In the last 5 years about 5,000 patients have been treated, many successfully. This article also discusses the growing professional interest in TCM and some significant recent developments in this field. It is the aim of this article and SEC to promote the integration of TCM and Western biomedicine in the West.     

Lithiasis and ectopic pelvic kidney. Therapeutic aspects

Kidney in ectopic position is dysplasic, and associated to other malformations. The advent of a lithiasis in these conditions rises questions about therapeutic options. We report on five observations of pelvic ectopic kidney with urinary lithiasis. Patients were aged from 16 to 42 years. Kidney was non functional in two cases, or with normal appearance sized 10 to 12 cm. We performed total nephrectomy in two cases, pyelolithotomy in the other cases. Surgical approach was subperitoneal via iliac route. A dismembered pyeloplasty was associated in one case. All patients did well. Radiologic control at 6 and 12 months showed no recurrence in a well functioning kidney. Surgical lithotomy is advocated as a treatment in urinary lithiasis affecting ectopic kidney. It is an easy procedure which permits correction of other associated malformations.     

Comparison of prostatic electro-vaporization and transurethral resection in the treatment of benign prostatic hypertrophy

The objectives of this study was to compare electrovaporization (EVAP) of the prostate to transurethral resection of the prostate (TURP). A prospective evaluation of 60 patients treated for benign prostatic hypertrophy (BPH) was carried out between November 1994 and November 1996. Twenty five patients were treated with TURP and 35 patients with EVAP. All patients had a minimum 12 month follow-up. The results obtained were comparable in terms of surgical procedure time with a bloodless surgical field using EVAP. EVAP was advantageous in reducing the time with indwelling urinary catheter postoperatively and reducing hospital stay. At 12 month follow-up results of flow rates and symptom scores were similar for both TURP and EVAP. Reoperation rate for residual BPH in the EVAP group was higher than for TURP, suggesting that EVAP should probably be limited to smaller sized glands. This study suggests that EVAP is a viable alternative to TURP in selected patients. It requires no specialized equipment and may allow a reduction in catheterization and hospital stay.     

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

The cytologic localization and cellular levels of myc oncoprotein in the human ovary during follicular growth, regression and atresia were examined by the avidin/biotin immunoperoxidase method with a specific antibody to myc oncoprotein. In primordial follicles, only the oocyte showed intense immunostaining for myc protein, whereas the granulosa cells were negative for the staining. In preantral follicles, both the oocyte and granulosa cells were moderately immunostained for myc protein. In antral and preovulatory follicles, there was no appreciable staining for myc protein in the granulosa or theca cells, while myc protein staining in the oocyte persisted with less intensity. It is of interest that myc protein expression in granulosa cells was apparent only during the preantral follicle stage. Corpora lutea during the early and mid luteal phase were negative for myc protein staining, whereas in regressing corpora lutea during the late luteal phase, peripheral theca lutein cells adjacent to the central core of scar tissue were immunostained for myc protein. Corpora albicans showed no staining for myc protein. In atretic follicles, granulosa cells and theca interna cells demonstrated positive staining for myc protein. Ovarian stromal cells were negative for the immunostaining throughout the menstrual cycle. This demonstrates that myc protein is expressed in a stage-limited manner in the human ovary during follicular growth and regression. The abundant expression of myc protein in the oocyte at the primordial and preantral follicle stages and in the granulosa cells at the preantral follicle stage suggests a role for myc expression in the initial growth of the oocyte as well as in the autonomous growth of granulosa cells during the preantral stage seemingly independent of gonadotropic stimulation. Furthermore, notable expression of myc protein in the granulosa cells and theca interna cells of atretic follicles and in the peripheral theca lutein cells of regressing corpora lutea implies the possible participation of myc expression in remodelling the ovarian local tissue following atresia and luteolysis in the human ovary.     

Prostate specific antigen in the expressed prostatic fluid of men with benign prostatic hyperplasia and prostate carcinoma

PURPOSE: We tested the hypothesis that the histochemically demonstrated prostate specific antigen (PSA) content of prostate carcinoma cells does not necessarily reflect PSA production and secretion by evaluating expressed prostatic fluid. MATERIALS AND METHODS: Expressed prostatic fluid and serum from 152 men with clinical benign prostatic hypertrophy (BPH), 132 with histologically proved BPH and 46 with prostate carcinoma were analyzed with the Hybritech PSA assay. RESULTS: Expressed prostatic fluid PSA levels from carcinoma patients (median 1.70 mg./ml., mean 2.25) were significantly higher than in the histologically proved BPH group (median 1.28 mg./ml., mean 1.42, p < 0.05). CONCLUSIONS: PSA concentration is increased in the expressed prostatic fluid of prostates of men with carcinoma compared to those with histological BPH. This finding may be a functional manifestation of a field change or paracrine effects within the prostate.     

Cardiovascular complications in the treatment of prostatic carcinoma

Cardiovascular complications in patients with carcinoma of the prostate have been studied in relation to 3 methods of treatment, namely stilboestrol, estramustine phosphate (Estracyt) and bilateral orchiectomy. One hundred and sixteen patients were studied over a 4-year period on a prospective basis, 48 being treated with stilboestrol, 31 with estramustine and 37 with bilateral orchiectomy. The incidence of the cardiovascular side effects of these 3 treatment regimes in the first year of treatment was recorded after the patients had been divided into those with localised (MO) disease and advanced disease with metastases (M1). In patients treated with stilboestrol 29% had cardiovascular complications with a mortality rate of 16%. With estramustine 25% had complications with a 16% mortality rate, but with orchiectomy the complication rate was only 8% with a 3% mortality rate. It is recommended that stilboestrol and estramustine phosphate should not be used in the presence of cardiovascular disease and that the primary form of treatment in prostatic carcinoma should be bilateral orchiectomy, especially in patients with localised disease.     

Errors in the diagnosis of benign prostatic hyperplasia

Monitor blood glucose level before, during and for up to 24 hours after exercise. Ensure refined carbohydrate snack is taken prior to exercise. Reduce insulin dosage if possible. Inject insulin away from any exercising muscle. Remember that glycogen stores are replenished in two phases: immediately after the exercise and two to three hours later. These are the key risk times for hypoglycaemia. If blood glucose control is poor (14 mmol/litre or higher) prior to exercise, the 'stress' effect of the exercise may cause further increases in the blood sugar level unless control is achieved.     

Gn-RH agonists in the treatment of prostatic carcinoma

About 80% of advanced prostate cancers are hormone dependent. Androgen withdrawal by either surgical castration or medical castration is the first-line treatment for this disease. As the patient's choice and quality of life are now being taken into account, reversible medical castration with GnRH analogues has emerged as a new palliative treatment. The use of these compounds alone or in combination with anti-androgens and the timing of initiating the hormone therapy were reviewed. Unfortunately, relapses after androgen ablation occur in most patients, as their cancer becomes insensitive to androgens. Management of hormonal refractory cancer remains a challenge to clinicians. No clinical trial using promising new therapeutic approaches such as GnRH antagonists, GnRH analogues linked to cytotoxic radicals, or a combination of GnRH analogues with somatostatin analogues or bombesin/GRP antagonists have been published until now.     

Lithiasis of gallbladder in the IX region. Study of the autopsies in a zone with a high proportion of Mapuche population

The frequency of gallbladder stones in he IXth Region of Chile with a large indigenous population, was studied in forensic necropsies from 1980 to 1989. Among 2,505 autopsies, 85% were males and 15% females. At least 1 "mapuche" surname occurred in 27% of cases. Stones were found in 34% of females and 12.7% of males. No differences were found between "mapuche" and non mapuche cases. Cholecystectomy had been performed in 2.3% of males and 9.1% of males. These results do not differ from those reported from other regions in Chile.     

Influence of prostatic secretion protein on uptake of androgen-receptor complex in prostatic cell nuclei

Prostatic secretion protein (PSP) is a major component of rat prostatic cytosol, and this protein is also found in the prostatic fluid. Purified PSP was found to inhibit the nuclear uptake of the [3H]methyltrienolone-receptor complex in vitro. Furthermore, purified PSP inhibited the binding of this androgen-receptor complex to DNA-cellulose. It is suggested that these effects of PSP may represent an intracellular control system regulating the concentration of PSP. Administration of estramustine, the dephosphorylated metabolite of the anti-cancer drug estramustine phosphate (Estracyt), to rats was found to decrease the weight of the prostate gland but to maintain the concentration of PSP, calculated as mg PSP/mg protein, at a constant level. In contrast, castration or administration of estradiol-17 beta valerate decreased the weight of the prostate gland as well as the concentration of PSP. These findings indicate that the mechanism of action of estramustine is at least partially different from that of estradiol-17 beta. Furthermore, it is suggested that estramustine may exert part of its action through its effects on the concentration of PSP.     

Molecular staging of prostatic cancer

Despite the improvement current evaluation techniques, approximately 30% of prostatic cancers clinically localized to the gland are understaged. RT-PCR is a sensitive and specific screening method for circulating prostatic cells, proposed as a molecular staging tool. The results obtained with this method and reported in the literature are critically discussed. These results, concerning the detection of circulating PSA- or PSMA-positive prostatic cells, are only indicative, as none of the teams used the same method. No consensus has been reached concerning the equipment used, the choice of oligonucleotide primers, the number of cycles to be applied or even the type of method, classical or "nested". Another possible application of this method is early detection of circulating prostatic cells, possibly neoplastic, during the follow-up of patients treated by radical prostatectomy. Once again, the results of the literature are contradictory. The reliability and reproducibility of molecular biology techniques in routine practice must therefore be demonstrated before these techniques can influence the therapeutic decision concerning prostatic cancer.