The management and clinical course of testicular seminoma: 15 years' experience at a single institution.

Testicular seminoma is one of the most curable solid neoplasms, with 5-year survival rates in excess of 90%. However, controversy persists around its optimum management, particularly for Stage I disease. The outcome of 314 patients with testicular seminoma who were treated at a single institution is reported. A comparison of adjuvant radiotherapy and surveillance for Stage I is presented, and the possible prognostic influence of an elevated serum beta-human chorionic gonadotrophin (beta hCG) is assessed. The 5-year disease-free survival for all stages of presentation was 95.5%. There were more relapses in Stage I patients undergoing surveillance (14/94, 15%) than postorchidectomy radiotherapy (6/144, 4%; P = < 0.05). However, survival was identical irrespective of treatment policy, with no disease-related deaths in either group of Stage I patients. There were eight tumour-related deaths from advanced disease and 14 deaths from non-tumour causes. Three were due to cardiorespiratory disease, four to an unrelated second malignancy, two from infection and one from suicide; in four patients, the cause was unknown. Preoperative beta hCG was elevated in 29 (18%) of Stage I patients and in 24 (62%) of those presenting with Stage II disease. Patients were more likely to have advanced disease (> or = Stage II) if beta hCG was elevated (P < 0.001). Neither disease-free nor overall survival were influenced by the preoperative level of beta hCG. Surveillance appears to be a safe alternative to postorchidectomy radiotherapy for Stage I disease, provided the patient is prepared for intensive long term follow-up. An increased risk of relapse, but not of tumour death, can be expected and unnecessary treatments avoided.

Stage I seminoma of the testis: is post-orchidectomy surveillance a safe alternative to routine postoperative radiotherapy?

Experience with the management of 128 patients with Stage I testicular seminoma over a 10-year period, 1980-1989, is presented. Fifty-six patients were treated with post-orchidectomy radiation therapy and 72 patients were put on surveillance. Patients thought to be at higher risk of relapse were generally treated with radiotherapy. There have been no tumour related deaths in this series; 5.4% of the irradiated group and 18% of patients on surveillance have relapsed to date. All relapses have been salvaged with further therapy and are currently in complete remission. In this interim analysis, surveillance appears to be a safe alternative to adjuvant radiation therapy provided regular, prolonged follow-up can be ensured. Surveillance is, however, time consuming and resource demanding, and should be undertaken only as part of a formal clinical study. Adjuvant post-orchidectomy radiotherapy should be considered the treatment of choice until further long-term data are available.

Reticulate pigmentation due to bleomycin: light- and electron-microscopic studies.

An unusual case of extensive reticulate pigmentation due to bleomycin is reported. Light- and electron-microscopic studies showed a marked increase of melanin pigment in the basal keratinocytes and a number of melanophages in the upper dermis. The number of melanocytes appeared to be normal. Electron microscopy also revealed damage to subcellular organelles. The increase in pigmentation is thought to be a consequence of this focal damage.

Germ cell tumours of testis: prognostic factors and results.

Prognostic features regarding the outcome of 232 patients with testicular germ cell tumours treated from 1980 to 1987 in Sheffield are reviewed. Delay in diagnosis was a constant feature. The majority had a swelling for over 3 months. After 6 months mortality doubled, compared with patients with a shorter history. Initial serum levels of alpha-fetoprotein and beta-human chorionic gondadotropin, particularly if both were elevated over 100, and more so 500 IU/l, indicated a subsequent mortality in non-seminomatous tumours of 24 and 37%, respectively, while only 1.5% died if both values were below 100. The overall survival rate was 97% in seminomas and 78% in non-seminomas; no patients with well or moderately differentiated tumours died. There were no deaths after the 3rd year. Surveillance treatment in stage-I tumours was safe and mortality-free.

Relative importance of estrogen and progesterone receptor assays as prognostic indicators in primary breast cancer: a short-term study.

This short-term study of the relative importance of estrogen and progesterone receptors shows that progesterone receptor correlates better than estrogen receptor with tumor recurrence regardless of lymph-node status. Life-table analysis has effectively identified only two groups of patients that may be classified by progesterone receptor status alone. Progesterone-receptor negativity correlated well with tumors of histological Grade III; estrogen-receptor positivity correlated with Grade I and II tumors. The earlier recurrence of Grade III breast tumors may explain why progesterone receptor is a better prognostic indicator than estrogen receptor in short-term studies.

Dimensional changes of isolated endomysia on heating.

The role of endomysial shrinkage in determining cooking loss was investigated directly by observations on the dimensional changes of isolated endomysial sheaths on heating up to 80°C. Maximum shrinkage of 70% in diameter and 40% in length was observed, corresponding to a volume decrease of over 90%. The temperature at which half the maximal shrinkage occurs is in the range 52-61°C. Minor differences in shrinkage behaviour were observed depending on the methods used to support the endomysia. The dimensional changes of the isolated endomysial sheaths are greater than those reported for whole meat. It is concluded that endomysial shrinkage has the potential to completely account for fluid expulsion from meat on cooking.

A double blind trial of nitroglycerin vasodilator ointment in patients undergoing cytotoxic chemotherapy.

A randomized double blind controlled trial has shown that topical, nitroglycerin vasodilator cream applied to the intended injection site in patients undergoing cytotoxic chemotherapy for various malignancies, produced detectable vasodilation and a decrease in minor aids to venepuncture compared to placebo. It did not decrease the number of attempts at cannulation needed nor the overall cannulation failure rate and cannot be recommended for general use in cytotoxic chemotherapy clinics.

The value of 6-phosphogluconate dehydrogenase (6-PGDH) activity as a marker of tumour cellularity and prognostic indicator in primary breast cancer.

The value of 6-phosphogluconate dehydrogenase (6-PGDH) activity as a cytosolic marker of tumour cellularity has been assessed, together with its use as a prognostic indicator for primary breast cancer in 87 patients over 4 years. 6-PGDH activity shows a good correlation with histologically-assessed tumour cellularity in a sample of 114 patients (correlation coefficient = 0.83). Patients whose primary breast tumour had a high 6-PGDH activity showed poor relapse-free survival times when compared to those with low 6-PGDH activities (Log Rank chi 2 = 6.87, P less than 0.01). This compared with a Log Rank chi 2 of 2.22, P less than 0.20 for oestrogen positive and negative patients. These results suggest that 6-PGDH activity is a better prognostic indicator in primary breast cancer than oestrogen receptor status.

The rôle of epimysial, perimysial and endomysial collagen in determining texture in six bovine muscles.

Epimysium, perimysium and endomysium were purified in high yield by a new extraction method from six bovine muscles of increasing toughness. In each case, the mean perimysial collagen fibre diameter, the total collagen content, the relative proportions of the major collagen types (I and III) and the collagen cross-link content were measured. Correlations were found between both collagen fibre diameter and collagen content of perimysial and endomysial connective tissue and meat toughness. No meaningful link could be made between textural quality of the meat and the relative content of types I and III collagen. Significant differences were seen, however, in both the total heat-stable cross-link content and the proportion of heat-stable collagen cross-links relative to heat-labile cross-links present in epimysium, perimysium and endomysiuim and the relative toughness of each muscle. The results are discussed with respect to the rôle of collagen in determining meat texture and toughness.

Characterization of muscle epimysium, perimysium and endomysium collagens.

In the past it has been proven difficult to separate and characterize collagen from muscle because of its relative paucity in this tissue. The present report presents a comprehensive methodology, combining methods previously described by McCollester [(1962) Biochim. Biophys. Acta 57, 427-437] and Laurent, Cockerill, McAnulty & Hastings [(1981) Anal. Biochem. 113, 301-312], in which the three major tracts of muscle connective tissue, the epimysium, perimysium and endomysium, may be prepared and separated from the bulk of muscle protein. Connective tissue thus prepared may be washed with salt and treated with pepsin to liberate soluble native collagen, or can be washed with sodium dodecyl sulphate to produce a very clean insoluble collagenous product. This latter type of preparation may be used for quantification of the ratio of the major genetic forms of collagen or for measurement of reducible cross-link content to give reproducible results. It was shown that both the epimysium and perimysium contain type I collagen as the major component and type III collagen as a minor component; perimysium also contained traces of type V collagen. The endomysium, the sheaths of individual muscle fibres, was shown to contain both type I and type III collagen as major components. Type V collagen was also present in small amounts, and type IV collagen, the collagenous component of basement membranes, was purified from endomysial preparations. This is the first biochemical demonstration of the presence of type IV collagen in muscle endomysium. The preparation was shown to be very similar to other type IV collagens from other basement membranes on sodium dodecyl sulphate/polyacrylamide-gel electrophoresis and was indistinguishable from EHS sarcoma collagen and placenta type IV collagen in the electron microscope after rotary shadowing.

Hodgkin's disease and chronic renal failure.

A case of uremia resulting from bilateral Hodgkin's lymphomatous infiltration of kidneys is reported. Uremia was an initial feature in the case and was the eventual cause of death.