Ectopic production of human chorionic gonadotropin by poorly differentiated transitional cell tumors of the urinary tract

We performed a 5-year histopathological review of 41 consecutive cases of transitional cell carcinoma. Of these cases 8 were positive for human chorionic gonadotropin immunoperoxidase tissue staining. All tumors were grade III and stages ranged from A to D. Three patients presented with gynecomastia as the clinical manifestation of elevated serum levels of beta-human chorionic gonadotropin. These findings document the association of this phenomenon with lesions of an aggressive nature. As with the loss of cell surface antigens, the appearance of human chorionic gonadotropin within the tumor cells may be further evidence of dedifferentiation. Human chorionic gonadotropin production may be a potential marker to gauge tumor response to chemotherapy and, perhaps, a predictor of future aggressiveness and over-all progression.     

A novel xanthine derivative counteracting in vivo tumor necrosis factor alpha toxicity in mice.

The xanthine derivative A 802715 (1-(5-hydroxy-5-methyl)hexyl-3-methyl-7- propyl-xanthine, Hoechst AG) caused dose-dependent protection against lipopolysaccharide (LPS)-induced lethal shock in mice. In animals which had received the compound, the LPS-induced increase of serum tumor necrosis factor (TNF alpha) levels was not significantly affected. Protection against LPS-induced lethality was observed not only when A 802715 was given 1 hr before or simultaneously with LPS but also when administered 1 hr after LPS challenge. Administration of 200 mg/kg of the compound 1 hr before challenge also fully protected against lethal shock induced by intravenous administration of recombinant murine TNF alpha. It is concluded that A 802715 counteracts TNF alpha toxicity and that the drug bears the potential of therapeutic intervention in septic shock.     

Viral load of high-risk human papillomavirus in cervical squamous intraepithelial lesions.

OBJECTIVES: This case-control study was conducted to investigate the role of viral load of high-risk human papillomaviruses (HPVs) in the development of cervical squamous intraepithelial lesions (SILs) and invasive cancers. METHODS: A total of 30 female cases who had histological evidence of low-grade SIL (n=10) or high-grade SIL and above (n=20) were identified as the case group at the Tri-Service General Hospital, Taipei between September 1998 and March 1999. In addition, 80 female controls who had normal cervical cytology were enrolled and individually matched on age (+/-5 years) and date of recruitment to each case. Cervical swabs collected from study subjects were tested for the positivity and viral load of high-risk HPVs by Hybrid Capture II assay. Additionally, subjects completed a risk factor questionnaire. RESULTS: Among sex behavioral factors studied, younger age at first intercourse was associated with a significantly elevated risk of cervical SIL and invasive cancers. With respect to HPV infection, high-risk HPV DNA was present in 70% (21/30) of case and 21% (17/80) of control subjects, resulting in an odds ratio (OR) of 6.6 [95% confidence interval (C.I.)=2.6-17.0]. Moreover, women who had a high viral load were at significantly greater risk for cervical SIL and invasive cancers than those who were infected with a low viral load (OR=18.0, 95% C.I.=3.0-108.5). CONCLUSIONS: Among the variables tested, infection with a high viral load of high-risk HPVs is the strongest determinant for cervical SIL and cervical cancers in Taiwan.     

Use of reversed nephroureteral stent as suprapubic cystoureteral catheter

By the reversal of the existing nephroureteral stent system a vesicoureteral stent exiting through the suprapubic site is created. The major advantages of this system include avoidance of side holes along the stent, avoidance of a urethral catheter, ease of access for contrast medium studies to monitor healing, comfort and ease of removal. The major application of the system would be for lower ureteral surgery. Development of a 5F catheter with a shorter kidney-to-bladder length would permit use of this system in children.     

The efficacy of sonic and ultrasonic appliances on root canal debridement

The purpose of this study was to compare the debridement efficacy of hand, sonic (MM-3000), and ultrasonic (Cavi-Endo) appliances, utilizing the same K-type files and a constant flow irrigation system, in the mesial root canals of extracted human mandibular 1st and 2nd molars. Only those roots with a canal curvature of between 10 and 30 degrees, by Schneider's method, were used in this study. The instrumentation time per mesial root canal for each treatment group was also evaluated. Following canal preparation and histological processing, the middle and apical cross-sections were examined to determine the percentage of canal and isthmus cleanliness, and the percentage of planed canal walls in the main canal area. Statistical analysis indicated no significant difference in canal and isthmus cleanliness at the middle and apical levels. All techniques achieved a high level of canal cleanliness. However, step-back hand instrumentation had the greatest percentage of planed canal walls in the main canal area at every portion of the root. Sonic instrumentation, in this study, was significantly faster than hand instrumentation in preparing the root canal system.     

Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi

Background and Objectives:

Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi.

Methods:

We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and postoperatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging.

Results:

Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted.

Conclusions:

Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach.     

Initial experience with the radiotracer anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid with PET/CT in prostate carcinoma.

Conventional imaging techniques have serious limitations in the detection, staging, and restaging of prostate carcinoma. Anti-1-amino-3-(18)F-fluorocyclobutane-1-carboxylic acid (anti-(18)F-FACBC)is a synthetic l-leucine analog that has excellent in vitro uptake within the DU-145 prostate carcinoma cell line and orthotopically implanted prostate tumor in nude rats. There is little renal excretion compared with (18)F-FDG. The present study examines anti-(18)F-FACBC uptake in patients with newly diagnosed and recurrent prostate carcinoma. METHODS: Fifteen patients with a recent diagnosis of prostate carcinoma (n = 9) or suspected recurrence (n = 6) underwent 65-min dynamic PET/CT of the pelvis after intravenous injection of 300-410 MBq anti-(18)F-FACBC followed by static body images. Each study was evaluated qualitatively and quantitatively. Maximum standardized uptake values were recorded in the prostate or prostate bed, and within lymph nodes at 4.5 min (early) and 20 min (delayed), and correlated with clinical, imaging and pathologic follow-up. Time-activity curves were also generated for benign and malignant tissue. RESULTS: In the 8 patients with newly diagnosed prostate carcinoma who underwent dynamic scanning, visual analysis correctly identified the presence or absence of focal neoplastic involvement in 40 of 48 prostate sextants. Pelvic nodal status correlated with anti-(18)F-FACBC findings in 7 of 9 patients and was indeterminate in 2 of 9. In all 4 patients in whom there was proven recurrence, visual analysis was successful in identifying disease (1 prostate bed, 3 extraprostatic). In 3 of these patients, (111)In-capromab-pendetide had no significant uptake at nodal and skeletal foci. Malignant lymph node uptake in both the staging and restaging patients was significantly higher than benign nodal uptake. Though uptake faded with time, in all 6 patients with either lymph node metastases or recurrent prostate bed carcinoma, there was intense persistent uptake at 65 min. CONCLUSION: Anti-(18)F-FACBC is a promising radiotracer for imaging prostate carcinoma. Radiotracer uptake was demonstrated in primary and metastatic disease. Future research should investigate the mechanism of radiotracer uptake in normal and pathologic tissue and develop a clinical imaging strategy for initial staging and restaging.