Soluble form of carbonic anhydrase IX (CAIX) in transitional cell carcinoma of urinary tract.

We investigated the expression of cell-associated CAIX protein in histological sections of the transitional cell carcinoma (TCC) of the urinary tract and of the soluble form of CAIX (s-CAIX) shed by the tumor into the serum and urine of TCC patients. A total of 23 patients with histologically confirmed TCC or squamous cell carcinoma (SCC) were enrolled in the pilot study. Sixteen healthy individuals served as controls. Membrane-bound CAIX was present in the tumor cells near the endoluminal surface. Necrosis was observed in only 4 samples. Using Western blots, s-CAIX concentrated from urine was visualized as a double band at 50 and 54 kDa. In most cases, the presence of s-CAIX in the urine correlated with CAIX expression in the tumor. On the other hand, s-CAIX did not exceed the normal level in the serum of TCC patients. Urine from patients with TCC of the urinary bladder and renal pelvis contained s-CAIX, allowing the detection of tumors in approximately 70% of the patients. Moreover, two additional patients with suspected, but unconfirmed bladder tumor, with s-CAIX detected in urine, developed tumors identified as TCC within six months. We suggest that after a simple, rapid and sensitive test, monitoring s-CAIX levels in urine will be developed, it may be useful for early detection of relapse in patients following transurethral tumor resection.

[Mutations in tumor suppressor gene NBS1 in adult patients with malignancies]. / Mutace v tumor supresor genu NBS1 u dospelých pacientu s malignitami.

BACKGROUND: Mutations 657del5 and R215W in exon 6 of tumor suppressor gene NBS I are found in 1% Slavic populations. Increased occurrence of cancer was repeatedly reported in adult relatives of patients with Nijmegen breakage syndrome. Among children with oncological problematic, nonsignificantly increased frequency of NBS1 heterozygotes was found, which seems not to play any important role in cancerogenesis in childhood. However, the proportion of NBS heterozygotes among adult patients with malignancies could be significant and their therapy and follow up should respect their hyperradiosensitivity. METHODS AND RESULTS: Mutations in exon were studied in 706 adult patients with malignancies. We found 5 NBS heterozygotes, which not more than the population prevalence (1:129-165). Increased frequency of NBS heterozygotes was found among patients with colon and rectal cancer (2/101), breast cancer (1/60), skin malignancies (1/98). CONCLUSIONS: Surprisingly only one NBS heterozygote was found among 228 patients with nonHodgkin lymphoma, the malignancy which is a common complication in NBS homozygotes. Other types of malignancies were uncommon and only one R215W heterozygote was found. Comparison frequency of NBS heterozygotes with incidence NBS among person older than 70 years shows significant difference. Prevention of malignancies by avoidance from ionisation could be realized also in relatives of patients after identification of their genotype.

Soluble form of carbonic anhydrase IX (CA IX) in the serum and urine of renal carcinoma patients.

Tumour-associated protein carbonic anhydrase IX (CA IX) has two major forms. One is a cell-associated, transmembrane protein seen on Western blots as a twin band of 54/58 kDa, expressed in gastric mucosa and in several types of cancer. The other is a soluble protein s-CA IX of 50/54 kDa, which is released into the culture medium or into the body fluids, most likely by proteolytic cleavage of the extracellular part from transmembrane and intracellular sequences. While TC media of CA IX-positive tumour cell lines or short-term cultures of tumour explants contain a relatively high concentration of s-CA IX (20-50 ng ml(-1)), the level of this antigen in blood serum and urine of renal clear cell carcinoma patients is about 1000 x lower. The concentration of CA IX in the blood and in urine varies within wide limits and there is no obvious correlation with tumour size. After nephrectomy, s-CA IX is cleared from the blood within a few days. Only an extremely low concentration of CA IX was detectable in the sera and in urine of control individuals.

[Diverticula of the female urinary tract--still a problem in urogynecology]. / Divertikl zenské mocové trubice--stále aktuální problém v urogynekologii.

OBJECTIVE: An importance of knowledge of etiology, pathogenesis, diagnosis, differential diagnosis and treatment of female urethral diverticulum in urogynaecological practise. DESIGN: A review article. SETTING: Obstetrics and Gynaecology Department and Urology Department, Charles University 2nd Medical School and Teaching Hospital Motol, Prague. SUBJECT: Often unrecognized or incorrectly diagnosed, urethral diverticulum may be completely asymptomatic or may produce significant symptomathology, such as recurrent urinary tract infections and irritative or obstructive complaints. A full history and careful physical examination are the first steps in screening. Diagnosis is usually made by voiding cystourethrography, positive pressure urethrography, urethroscopy or introital ultrasonography. Complete excision through the anterior vaginal wall is the most successful treatment modality with minimum postoperative complications. Concomitant bladder neck suspension can be performed in women with diverticulum and documented stress urinary incontinence. CONCLUSION: Urethral diverticula may mimic other pelvic floor disorders and result in diagnostic delay. It is partly due to a lack of awareness among clinicians and partly because the condition overlaps the traditional territories of gynaecologists and urologists. The collaboration of both specialists in the diagnostics and treatment of female urethral diverticula is recommended.

[Subjective symptoms before and after prostate surgery. The International Symptom Scoring System, I-PSS]. / Subjektivní príznaky pred a po operaci prostaty. Mezinárodní symptomový skóring I-PSS.

In this thesis are evaluated the questionnaires of the I-PSS retrieved from 415 patients (TVPE 104, TURP 272, TUIP + PRP 25 and TUIP 14) operated on the BPH at the department of Urology, FN Motol, during 1988-1993. The average value of S in the whole group of patients was 18.9 in the pre-surgery period and 6.9 after surgery. Before the surgery, the prominent difficulties were recorded in 50.8% of patients (S = 20-35) and after surgery this number fell down to 7%. Without any major difficulties (S = 0-7) were 66.3% of patients after the surgery. The average value of L before and after surgery was 4.2 and 1.6 respectively. The quality of life after the surgery was perceived by the patients more convenient than should correspond to the symptom scoring value. The best results (both the average S and L) were recorded in patients after TVPE (S 5.1 and L 1.1), followed by TURP (S 7.4 and L 1.7), than TUIP + PRP (S 8.4 and L 2.1) and only TUIP alone closed scale (S 8.9 and L 2.4). The differences of postsurgery S and L are statistically significant (p < 0.05). The comparison between the subjective better performance and the quality of life, when taken from TVPE resp. TURP point of view, does not prove to be the statistical difference. The comparison between S changes after the standard operation (TVPE and TURP) and minor prostatic surgery (TUIP + PRP and TUIP) also does not occur as statistically significant. Only the quality of life (L changes) is recorded by the patients as significantly worse after the minor prostatic surgery (p < 0.05). The pre-surgery worst perceived symptoms are: weak stream, nycturia and polakisuria (questions Nr. 5.7 and 2). After the surgery, nycturia is the leading worst symptom.

[Results of surgical treatment of benign prostatic hyperplasia]. / Výsledky chirurgické lécby benigní hyperplazie prostaty.

The authors have evaluated the results of the BPH surgery in the computer study on 669 patients (out of them 181 after TVPE and 488 after TURP) operated on at the department of Urology, FN Motol during 1988-1992. The average age of the patients was 70.6 years. The occult cancer was found in 6.7%. The incidence of bladder stones rose with the age (in the 8th decade at the quarter of patients). The average weight of the resected tissue was 63.7 gms in TVPE and 16.7 gms in TURP and it rose with the age. The average surgery time 47.1 mins at TVPE and 50.8 mins at TURP did not change statistically. The average demand on the blood transfusion was higher at TVPE (440.1 mls) than at TURP (95.5 mls) and rose with the resected tissue. The death rate was 0.5% among all the patients included (TVPE 0, TURP 0.6%). All three patients after TURP died from myocardial infarction. In this thesis is evaluated the number of early and late complications (incl. the transient incontinence), which have occurred in five consecutive years. The total morbidity was 27.2% and the further surgery was necessary in 2.8% after TVPE and 5.7% after TURP respectively. The pre-surgery performance status was aggravated in 79.4% of patients. In spinal anesthesia was operated on in 84.2% (subarachnoidal 56.5% and epidural 27.7%) and in general anesthesia in only 15.8% of patients. The pre-surgery urinary infection was found in 38.7% and after operation in 29.3%. Out of the latter, 30% were nosocomials. This was in accordance with the higher rate of late complications after both types of operations.

[Sexual consequences of benign prostatic hyperplasia]. / Sexuologické konsekvence benigní hyperplazie prostaty.

In this thesis are evaluated the sexual questionnaires retrieved from 412 patients (TVPE 101, TURP 272, TUIP + PRP 25, TUIP 14), who had been operated on during 1988-1993 for the BPH at the department of Urology, FN Motol. Before the surgery, 69.7% of patients were sexually active yet (28.6% regularly, 41% irregularly). Without sexual intercourse were 29.9% in the time of surgery and 2 patients (0.5% did not respond the questions. The sexual activity was rapidly declining in the 7th decade, in the 8th decade still 41% of the patient argued sexual activity prior to surgery. The libido remained unchanged in 62.9%, worsened in 24.3% and improved in 10.7%. The changes in libido was neither parallel to the aging nor the type of prostatic surgery. After the surgery, the intercourse was admitted only by 49.3% of patients. Without any intercourse remained 50%. The difference compared to the pre-surgery responds is statistically proved (p < 0.01). The erectile dysfunction seemed to be the main cause of sexual intercourse decline. The impotence margin after TVPE or TURP is not statistically significant. On the other hand, the reawakening of the sexual activity at the patients, who had already not experienced intercourse preoperatively, was recorded only in 6 cases (1.5%). The unchanged ejaculation after surgery argued 13.1% of patients, the weaker ejaculation was recorded in 21.6% of patients and ejaculation was completely absent in 62.4% (retrograde ejaculation). Between TVPE and TURP was no significant margin found. The ejaculation damage after minimal prostatic surgery (TUIP + PRP and TUIP alone) is significantly minor (p < 0.01) than after the standard prostatectomy (TVPE and TURP).

[Percutaneous nephrolithotomy]. / Perkutánní nefrolitotomie.

Within eight years, since October 1985 till June 1993, we had been operating on 409 patients, who had been subjected to 500 percutaneous nephrolithotomies. In 30% per cent of all the operations we had used mechanical, electrohydraulic or ultrasound lithotripsy. Out of the total number of the patients, 7 per cent had been discharged with the residual stones, but in 5.6 per cent the ESWL or spontaneous exodus had been presumed. Serious complications we had registered at 10 patients (e.g. 2 per cent of all operations). None of them however had required an emergency nephrectomy. The authors discuss the today's position of the PNL among the other operative methods of treatment of urolithiasis.

[Personal experience with uretero-renoscopy]. / Nase zkusenosti s ureterorenoskopií.

The authors submit evaluation of 188 patients operated on during five years (1989-1993). Using the ureterorenoscopic technique (URS), 207 operations have been performed. The average age in the group of patients was 56.1 years. In general anesthesia 151 operations were completed, in spinal anesthesia 54, in neuroleptanalgesia 1 and without any anesthesia 1. The postoperative ureteric intubation was accomplished 128 times (61.8%). The moderate dilatation of the hollow system of the kidney was proved ultrasonographically in only 7 cases. The average postoperative hospitalization reached 5.8 days. Out of 207 operations, we have reached successful result 177 times (85.5%) and 30 times (14.5%) we were not able to accomplish the operation only by means of the URS. 184 operations were performed because of urolithiasis (88.9%) and 23 (11.1%) for other reasons. Out of 184 URS for urolithiasis, 156 (84.8%) were successful and there was no difference found between pelvic (85.4%) and lumbal (83.6%) localization of urolithiasis in the view of success rate. The authors summarize the causes of mishaps and following solutions. The biochemical analyses of 153 concrements are added.

[Generalized melanoblastoma of the lower urinary tract]. / Generalizovaný melanoblastom dolních mocových cest.

The primary metastatic melanoblastoma presented with macroscopic haematuria as a first sign is described. So far it is our first experience with such a type of tumor in lower urinary tract in ageing man. The references in literature are scarce on this subject.

[A new method of treating male infertility: percutaneous transfemoral embolization of varicoceles with Vilan 500]. / Nová metoda lécby muzské neplodnosti: perkutánní transfemorální embolizace varikokély Vilanem 500.

The authors describe a new method of treatment of male infertility. In 25 men aged 19-45 years with varicocele, after percutaneous transfemoral catheterization, embolization of the spermatic vein with the Czechoslovak preparation Vilan 500 (hydrolyzed co-polymer of polyvinyl acetate and polyvinyl alcohol in 96% ethyl alcohol) was performed. Six patients were treated on account of marked subjective complaints and 19 because of reduced fertility. Of these in 16 after embolization the spermiogram improved. The authors describe the diagnostic procedure, the technique of embolization, its complications and results. The described method is simple, safe, effective and as compared with other embolization methods it is cheaper.