3-month formulation of goserelin acetate ('Zoladex' 10.8-mg depot) in advanced prostate cancer: results from an Italian, open, multicenter trial.

OBJECTIVES: To determine the endocrine effects, efficacy and tolerability of the 3-month formulation of goserelin acetate ('Zoladex' 10.8-mg depot; 'Zoladex' is a trade mark of the AstraZeneca group of companies) in the treatment of patients with advanced prostate cancer. METHODS: Between February 1996 and October 1997, this open, multicentre study enrolled 120 patients with locally advanced (T3/4) or metastatic (N+ or M1) disease, or an increase in prostate-specific antigen (PSA) level after radical prostatectomy. Patients received goserelin acetate 10.8-mg depot every 12 weeks until clinical progression or interruption for adverse events or other reasons. RESULTS: The mean testosterone concentrations were suppressed to the castration range (< or =2 nmol/l) after 4 weeks of treatment and remained suppressed throughout the study. In total, 99/115 (86%) patients had a serum PSA response, and the mean PSA value decreased significantly during treatment (p = 0.006). The mean PSA level at baseline was significantly lower in patients without disease progression compared to those who experienced disease progression (p = 0.0002). Goserelin acetate 10.8-mg depot was well tolerated and there were no injection site reactions. CONCLUSIONS: The goserelin acetate 10.8-mg depot is well tolerated with no injection site reactions. It produces PSA responses and provides reliable suppression of serum testosterone.

[Echodynamics of the cervical ureter junction]. / Ecodinamica della giunzione cervico uretrale.

Transrectal dynamic ultrasonography is a 3 dimensional study that identifies accurately bladder neck (B.N.) diseases during micturition, providing precise noninvasive images of the B.N. orifice and the posterior urethra. This technique requires a 7-10 Mhz high frequency linear transducer. Benign Prostaic Hyperplasia (BPH) may restrict the urethral lumen and deviate its intra prostate tract. The images obtained allow a detailed and precise analysis of the B.N. and intravesical development of the median lobe. The urethra classically has a stretched and elongated appearance. This technique is useful in the diagnosis and in the follow up of neuropathic bladder. It is also useful in morphological and dynamic study of the B.N. after TURP. Diagnosis of B.N. hypertrophy or sclerosis is easy if a posterior beak at internal meatus level and positive stop test are present. After radical prostatectomy or radical cystectomy with orthotopic neobladder, this technique is useful to evaluate the internal urethral meatus and voluntary skeletal sphincter providing to a continence mechanism. We believe dynamic transrectal echography should become a procedure to be included as a part of the routine pre-surgical investigation of the B.N. diseases, for its non invasive nature, easiness to perform, and highly useful information.

[Echo-color doppler in the topographic study of varicocele]. / Eco color Doppler nello studio topografico del varicocele.

The echo color doppler allows an easy topographical distinction of the spermatic reflux (in front of the deferens) from cremasteric one (back to the deferens). This distinction consents a rational surgical choice, the selective interruption of the refluent vein and a less morbidity due to the surgical intervention. We evaluated 20 infertile patients (mean age 23 years) with echo color doppler testicular vessels (B & K 7.5 Mhz transducer). Seven varicoceles were clinically evident, 13 varicoceles were subclinic. After locating the deferens, we evaluated the venous reflux in the spermatic and cremasteric veins. The evaluation has been performed at rest and during Valsava maneuver. We used, in the correction of the anterior (spermatic) reflux, a retroperitoneal surgical access, while in the back (cremasteric) reflux isolated or combined, we performed middle or under inguinal access. The mean follow up has been of 4 months. In all cases the veins with reflux have been easily characterized. In 16 patients (80%) the spermatic vein was concerned; in an isolated case (5%) the reflux concerned only the cremasteric vein, in 3 patients (15%), with clinical varicocele, the reflux was present in both the veins (Coolsaet III type). In the 16 spermatic varicoceles, treated with retroperitoneal access (Palomo), the echo color doppler check demonstrated the absence of venous reflux. In the 4 varicoceles regarding the isolated or associate cremasteric vein treated with middle or under inguinal access, the existence of extra funicular varix was highlighted and after surgery the echo color doppler check was negative. In our few cases the echo color doppler diagnosis demonstrated a total correspondence with the surgical finds and with the doppler follow up. This diagnostic approach allows to reserve the retroperitoneal surgery to the spermatic pure reflux avoiding the false relapses due to the persistence of an undiagnosed cremasteric reflux. The middle or under inguinal approaches, generally loaded from a greatest morbidity, could be only employed in presence of an isolated or combined cremasteric reflux.

HER-2/neu in bladder carcinoma.

A total of 66 bladder cancer patients were studied to verify possible relationships between HER-2/neu alterations and pathological characteristics, and to define a poor prognosis patient subgroup with respect to time to recurrence, time to progression and survival. Tumor and healthy tissue specimens were analyzed for HER-2/neu DNA amplification and protein overexpression by Southern and Western blot techniques and evaluated statistically. 13% of cases were amplified and 39% were overexpressed. HER-2/neu alterations were not significantly associated with pathological staging or tumor grading. Multifocal tumors had a higher percentage and overexpression with respect to monofocal tumors. Actuarial analyses did not show a significant statistical correlation between HER-2/neu amplification and overexpression and clinical outcome. Clinical evaluation of HER-2/neu status showed that this gene is not related to tumor relapse, progression or patient survival.

Inverted papilloma of the ureter.

The inverted urothelial papilloma described herein is the fourth case developing in the ureter. The association with a well-differentiated conventional papilloma of the renal pelvis is the noteworthy feature of this case.

Adenocarcinoma of the rete testis 21 years after orchiopexy: case report and review of the literature.

Adenocarcinoma of the rete testis is a rare tumor. In nearly all patients metastases occur early to the lymph nodes, lungs, corpus testis, skin, liver and bone. Patients seldom survive longer than 1 year. Treatment consists of inguinal orchiectomy but the metastatic lesions have been resistant to radiation and/or chemotherapy.