Variations in treatment policies and outcome for bladder cancer in the Netherlands.

AIM: To describe the population-based variation in treatment policies and outcome for bladder cancer in the Netherlands. METHODS: All newly diagnosed patients with primary bladder cancers during 2001-2006 were selected from the Netherlands Cancer Registry (n = 29,206). Type of primary treatment was analysed according to Comprehensive Cancer Centre region, hospital type (academic, non-academic teaching or other hospitals) and volume (< or =5, 6-10 or >10 cystectomies yearly). For stage II-III patients undergoing cystectomy we analyzed the proportion of lymph node dissections and 30-days mortality. RESULTS: 44% of patients with stage II-III bladder cancer underwent cystectomy, while 26% were not treated with curative intent. Cystectomy was the preferred option in three of nine regions, radiotherapy in two, and two regions waived curative treatment more often. Between 2001 and 2006 the number of cystectomies increased with 20% (n = 108). Twenty-one percent (n = 663) of these procedures were performed in 44 low-volume hospitals. In 79% of the cystectomies lymph node dissections were performed, more often in high and medium-volume centers (82% and 81% respectively) than in low-volume hospitals (71%, the odds ratio being 1.5). The overall 30-days post-operative mortality rate was 3.4% and increased with older age. It was significantly lower in high-volume centers (1.2%). CONCLUSION: Treatment policies for muscle-invasive bladder cancer in the Netherlands showed regional preferences and a gradual increase of cystectomy. Cystectomy albeit considered as golden standard, was performed in a minority of the muscle-invasive cases. In high-volume institutions, lymph node dissection rates were higher and post-operative mortality rates were lower.

Advances in sample preparation, electrophoretic separation and detection methods for rat cytochrome P450 enzymes.

A limited overview is given of the separation and detection of specific cytochrome P450 enzymes of the rat. Separation methods include group-specific chromatographic separation and electrophoretic separation in and elution from polyacrylamide gels. Detection methods that are considered include enzymatic analysis with and without chromatographic step using liquid chromatography and immunochemical methods following separation of the cytochrome P450 enzymes by polyacrylamide gel electrophoresis (Western blotting). The advantages and limitations of the various methods have been compared and discussed.

Plasma proteins in growing analbuminaemic rats fed on a diet of low-protein content.

1. Analbuminaemic and Sprague-Dawley (control) rats were fed on low- (60 g/kg) protein and control (200 g protein/kg) diets ad lib. from weaning. Males and females were studied separately. Body-weight and plasma protein concentrations were determined at 10 d intervals from 25 to 75 d of age. Electrophoresis of plasma proteins was performed in samples from day 75. Extracellular fluid volume was measured at 10 d intervals from day 45 onwards. Colloid osmotic pressure was measured in plasma and interstitial fluid (wick technique) at the start and end of the trial. 2. Body-weight increased much less on the low-protein diet than on the normal diet in both strains and sexes. The growth retardation was slightly more pronounced in the male analbuminaemic rats than in the male Sprague-Dawley controls. 3. Plasma protein concentration increased during normal growth in all groups, particularly in the female analbuminaemic rats. This increase was reduced by the 60 g protein/kg diet in all groups, with the exception of the male analbuminaemic rats. 4. Differences in plasma colloid osmotic pressure were similar to those seen in plasma protein concentration. Interstitial colloid osmotic pressure was higher in the control rats than in the analbuminaemic ones. The interstitial colloid osmotic pressure increased during growth in the control but not in the analbuminaemic rats. The difference in interstitial colloid osmotic pressure between the strains was maintained during low-protein intake, but at a lower level than during normal protein intake. 5. Subtracting interstitial from plasma colloid osmotic pressure, resulted in a rather similar transcapillary oncotic gradient in the various groups at 75 d, both on the control protein diet (11-14 mmHg), and on the low-protein diet (9-11 mmHg). 6. All protein fractions were reduced to a similar extent by the low-protein diet in the control rats, whereas in the analbuminaemic rats protein fractions produced in the liver were more severely depressed. 7. Extracellular fluid volume as a percentage of body-weight was similar in all groups, and decreased with increasing age. 8. In conclusion, the analbuminaemic rats were able to maintain the transcapillary oncotic gradient on both diets by reducing the interstitial colloid osmotic pressure. Oedema was not observed. 9. Despite the absence of albumin, the protein-malnourished analbuminaemic rat is no more susceptible to hypoproteinaemia and oedema than its normal counterpart.

The precision of clinical estriol and total estrogen estimations in pregnancy urine.

1. A study of the precision of clinical estriol- and total estrogen determinations in late pregnancy urine was carried out in collaboration with 26 clinical laboratories in the Netherlands and one laboratory in Suriname. 2. Ten urine samples were circulated twice with an interval of 2 weeks. 3. It was shown, that repeated analysis of the same sample in the same clinical laboratory in different assays can yield differences in results up to 40%. This interassay variation can be regarded as the main source of uncertainty of results of clinical estriol and total estrogen determinations. 4. The quantitative differences between results of total estrogen methods and a gas chromatographic method, which measures only estriol, were shown to be caused primarily by the lower recovery of the glucuronide of estriol (both native and added) in the latter method. 5. As expected, methods based on the principle of Ittrich (1960), Acta Endocrinol. 35, 34-48) proved to be more susceptible to the disturbing influence of glucose than a gas chromatographic method that measured estriol specifically. 6. Various recommendations to improve the precision of clinical estrogen determinations in pregnancy urine resulted from this study.