Head-to-head comparison of retropubic, perineal and laparoscopic radical prostatectomy

OBJECTIVE: As more patients are diagnosed with prostate cancer at an early stage, it is becoming increasingly important to refine the technique of surgical excision. For this purpose we have generated objective data comparing three different surgical approaches used by three experienced surgeons. METHODS: We prospectively compared three contemporary personal series of 50 consecutive radical prostatectomy (RP) patients. The health-related quality of life was evaluated preoperatively and in months 1, 3, 6, 12 and 24. RESULTS: Considering in turn the patients undergoing retropubic, perineal and laparoscopic RP, the median procedure time was 2 h and 27 min, 1 h and 50 min and 4 h, with a transfusion rate of 2, 0 and 8%, respectively. In the perineal group there were more wound infections. Median catheter drainage was 7, 10 and 7 days and zero, 13 and one patients needed reinsertion of a catheter. Early continence varied considerably, with 57.4, 11.4 and 6.3% of patients pad-free after 1 month, but there were no differences in social continence (zero or one pad) with 97.8, 97.8 and 91.9% after 2 years. The Litwin score for incontinence (preoperative minus postoperative) was -24, -41 and -63% after 1 month and -13, +3 and -29% after 2 years. Twenty-nine, five and 15 patients had a preoperative five-item version of International Index of Erectile Function (IIEF-5) score of > or = 17 points and a nerve-sparing procedure. After 2 years, 48.1, 0 and 0% had an IIEF-5 score of > or = 17 points without the use of phosphodiesterase type 5 (PDE-5) inhibitors, but when including patients using inhibitors there were no significant differences. CONCLUSIONS: A comparison of morbidity, short-term convalescence and long-term side-effects of different surgical techniques is strongly biased by both the preoperative status of patients and the skill of the surgeons. Overall, we found some differences in the short-term results (e.g. early continence) and comparable long-term results.     

Setting out the frame conditions for feasible use of FFPE derived RNA

Introduction

The usage of formalin-fixed paraffin embedded (FFPE) tissue is characterized by its long shelf-life and simple handling. Therefore it is the most commonly available tissue specimen in routine diagnostics and histological studies. Formaldehyde fixation may result in RNA degradation and cross linking with proteins, while storage conditions also affect RNA integrity. The present study was designed to investigate the influence of these factors on RNA analysis.

229. Der Einflu? von variablen Anox?miezeiten auf das Knochenl?ngenwachstum

Zusammenfassung In einer experimentellen Studie wurde die Auswirkung variabler Anoxämiezeiten von 0, 2, 4 und 8stündiger Dauer, wie sie bei traumatischen Amputationen auftreten, auf das künftige Längenwachstum von jugendlichen Knochen untersucht. Nach einer festgesetzten Wachstumsperiode konnte ein Minderwachstum des Knochens festgestellt werden, welches von der gesetzten Anoxämiezeit abhängig war. Histologisch zeigten sich in Übereinstimmung damit Destruktionen der Epiphysenfugen.     

Prostate cytology. 12 years' experience with transrectal fine needle biopsy

From January 1970 until November 1982 7814 fine needle biopsies of the prostate were performed in 5856 patients in the urological clinic of the University of Munich. Our experience with this method demonstrates, that the technique is not as easy and must be taught carefully. The diagnostic accuracy depends mostly on the clinician who performs the procedure, less on the cytopathologist. It is possible to distinguish a normal cytological pattern as well as different degrees of infection and different types of tumour-malignancy of the prostatic cancer. Therapy-induced tumour-regression also can be diagnosed. Because of few complications and its high diagnostic reliability the method deserves increased use.     

247. Das lysosomale Enzymspektrum und Proteinaseninhibitoren menschlicher Leukocyten

Zusammenfassung In experimentellen Untersuchungen wurden Zusammenhänge zwischen posttraumatischen leukocytären Infiltrationen des Lungeninterstitiums und ödematösen Lungenveränderungen aufgezeigt. Aus menschlichem Frischblut wurden Leukocytenkonzentrate hergestellt, deren Lysosomen isoliert und Enzyme extrahiert. Vier neutrale Proteinasen konnten nachgewiesen und durch ihre spezifischen Substrate Bowie ihr Inhibitorspektrum charakterisiert werden. Die leukocytäre Kininogenase ist durch den therapeutisch anwendbaren polyvalenten Proteinaseninhibitor Trasylol®, hemmbar. In Tierversuchen wurde die pathogenetische Bedeutung der Kinine für die Ödembildung nachgewiesen. Der polyvalente leukocytäre Proteinaseninhibitor ist nur in geringer Menge nachweisbar.

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Lysosomal enzymes and proteinase inhibitors of human leukocytes

Summary Experimental investigations were carried out to correlate posttraumatic leukocyte infiltration of lung interstitium and edema formation. From human leukocyte lysosomes, four different neutral proteinases could be extracted and characterized by means of their specific substrates and their inhibitor spectra. Granulocyte kininogenase was sensitive to inhibition by Trasylol®, a polyspecific therapeutic proteinase inhibitor. In morphologic experiments on rabbits, the participation of kinins in the events leading to pulmonary edema is made obvious. The existence of small amounts of a polyvalent proteinase inhibitor of leukocyte origin could be shown.

     

Acrosome reaction in Chlamydia-positive and negative patients

Chlamydia trachomatis infections might have a detrimental effect on various sperm functions. Data concerning the effect of C. trachomatis on the capacitation activity of sperms are lacking. The study was undertaken to evaluate whether chlamydial infection influences acromsome reaction (AR). Three groups of men were investigated for ARs -Chlamydia negative (n = 46) and positive (n = 30) patients, and healthy men (n = 53) undergoing vasectomy. The fluorescence technique for the evaluation of AR was applied. The normal range for the induction of AR was assumed DeltaAR > 12.5% for this technique. Seminal plasma was examined for IgA antibodies against C. trachomatis. There was a significant difference in AR between healthy volunteers, Chlamydia-negative and Chlamydia-positive patients. DeltaARs were 15.8 +/- 1.6% in healthy volunteers versus 12.15 +/- 2.4% in Chlamydia-negative and 9.08 +/- 1.8% in Chlamydia-postive patients, respectively (P < 0.05). Significant elevated titres of C. trachomatis-specific IgA in seminal plasma showed a negative correlation with the AR of spermatozoa. AR seems to be a valuable marker, especially in couples with idiopathic infertility.     

One 10-core prostate biopsy is superior to two sets of sextant prostate biopsies

OBJECTIVES: To compare the efficiency of different transrectal ultrasonography (TRUS)-guided prostate biopsy techniques for detecting prostate cancer. MATERIALS AND METHODS: In all, 81 prostates from radical prostatectomy were used and two consecutive sets of sextant biopsies and one 10-core biopsy taken in each specimen. The 10-core biopsy consisted of a sextant biopsy and four cores from the far lateral areas of the prostate. To simulate a transrectal biopsy procedure, all biopsies were taken under TRUS guidance. RESULTS: In the first set of sextant biopsies 44 prostate cancers (54%) were detected and in the second set 51 (63%). Combining both sets of sextant biopsies 57 (70%) of the carcinomas were detected. One set of 10-core biopsies detected 66 (82%) of all prostate cancers. Overall, with the 10-core biopsies 16% more prostate tumours were diagnosed than with two consecutive sets of sextant biopsies. To find the same number of prostate cancers as with the 10-core technique, 14% of patients undergoing sextant biopsy would require a second set and 11% at least a third set of biopsies. CONCLUSIONS: The 10-core prostate biopsy technique is superior to the commonly used sextant technique and could spare patients unnecessary repeated biopsy. Even after including a second set of sextant biopsies, the total detection rate with these 12 biopsies was inferior to the 10-core technique.     

Hohe Prävalenz der APC-Resistenz (Faktor-V-Leiden-Mutation) bei Patienten mit postthrombotischem Syndrom

BACKGROUND AND OBJECTIVE: APC resistance (Factor V Leiden mutation) is the most often diagnosed hereditary thrombolytic defect. Data about the prevalence in patients with leg ulcers, especially postthrombosis, are limited of this defect. PATIENTS/METHODS: APC resistance was determined in 100 patients with venous leg ulcers. 53 patients had ulcers caused by postthrombotic syndrome and 47 patients ulcers associated with primary varicosities. A control group of 96 healthy volunteers was also studied. RESULTS: 19 of 53 patients (36%) with postthrombotic ulcers and 3 of 47 patients (6%) with varicosity-related ulcers had APC resistance. In the control group APC resistance was detected in 5 of 96 volunteers (5%). CONCLUSIONS: APC resistance should be considered as a risk factor for the development of venous leg ulcers.