Bladder cancer: a review of diagnosis and management.

Bladder cancer is the fourth most commonly diagnosed malignancy in men and the eighth most common in women. It represents a spectrum of disease, ranging from superficial, well-differentiated disease, which does not significantly impact survival, to highly malignant tumors for which long term survival may be dismal. Transitional-cell carcinoma, which constitutes the vast majority of bladder cancers in the United States, may develop as carcinoma in situ or as invasive carcinoma. This article focuses on transitional-cell carcinoma with a review of the major aspects of the disease, including the epidemiology, diagnosis and staging, and management (including organ preservation). Therapeutic options are explored, including surgery, radiotherapy, chemotherapy, and combined modality therapy.

Genital malformations and coexistent urinary tract or spinal anomalies in patients with imperforate anus.

PURPOSE: Urinary tract malformations have been described in up to 50% of patients with imperforate anus but genital anomalies have been less well analyzed in the same patient population. We sought to evaluate the frequency of coexisting genital, urinary and spinal malformations in a population with imperforate anus. MATERIALS AND METHODS: We reviewed 128 cases of imperforate anus, focusing on genital malformations and their relationship to anomalies of the urinary tract and spine. The series included 69 boys and 59 girls with low (59), intermediate (22) and high (47) imperforate anus. RESULTS: Boys were much more likely to have a genital or upper urinary tract problem than girls (26 or 50 versus 5 or 30%, respectively). The risk for both sets of problems increased with the level of the anorectal lesion. The incidence of genital malformations increased from 14 to 26% in the presence of a renal lesion and from 10 to 23% with an associated spinal problem. Conversely, the incidence of urinary and spinal anomalies increased in patients with genital malformations. CONCLUSIONS: The genitalia of children with imperforate anus should be carefully examined. Patients with anorectal malformations should also be evaluated for urinary tract and spinal problems. The yield of such studies increases in patients with recognized genital malformations.

Nuclear morphometry in automatic biopsy and radical prostatectomy specimens of prostatic carcinoma. A comparison.

Nuclear shape analysis performed upon prostatectomy specimens of prostatic carcinoma distinguished individual patients with good and poor prognoses. In order to be useful for prognosis assessment preoperatively, nuclear morphometry must be measured on needle biopsy specimens. We compared nuclear morphometry on automatic biopsy and radical prostatectomy specimens in 20 patients with prostatic carcinoma. Nuclear size was smaller (paired Student t test, P < .0001) in biopsy specimens (perimeter 17.0 +/- SD 4.9 microns, area 29.9 +/- 6.6 microns2) than in prostatectomy specimens (perimeter 24.6 +/- 4.4 microns, area 48.2 +/- 8.7 microns2). Nuclear shape was more abnormal in automatic biopsy specimens (nuclear roundness factor 82.0 +/- 18.8, ellipticity 90.5 +/- 27.7) than in surgical specimens (nuclear roundness factor 43.5 +/- 8.8, ellipticity 54.0 +/- 14.7) (P < .0001). Study of specimens obtained by automatic biopsy preoperatively and automatic biopsy of the prostatectomy specimens at various steps of processing revealed that nuclear swelling and rounding occurred after 2-24 hours of formalin fixation. Automatic prostate biopsies may more accurately reflect true nuclear morphometry and should be studied for preoperative prognosis prediction in patients with clinically localized prostatic carcinoma.

Long-term treatment of hypertension with methyldopa. III. Tolerability.

Tolerability data recorded during long-term administration of methyldopa are presented here. Since diuretics and other antihypertensive agents were frequently coadministered with methyldopa, no attempt was made to assign possible drug relationships for any particular adverse effect. The most common clinical adverse effects among the entire study population were drowsiness and dizziness. Impotence was reported by 16% of 258 men.

Relationships between selenium and other parameters in drinking water and blood of subjects from high and low cardiovascular disease rate areas of Georgia.

Plasma, erythrocyte and home tap water samples were taken from life-long residents of two counties (Evans-rural and Chatham-urban) in the high cardiovascular disease (CVD) belt of southeastern Georgia and from Habersham County, a rural county of North Georgia which is outside of the CVD belt. One-half of the subjects from each cohort had a serious CVD problem and the remaining half were healthy controls. Water samples were analyzed for hardness, total dissolved solids, pH and selenium (Se) content. Blood samples were analyzed for Se (by neutron activation analysis) and glutathione peroxidase (GSHPx). Se levels in all water samples were less than 0.01 ppb. Water hardness and total dissolved solids levels were higher in the CVD belt counties. There were no significant differences (P greater than 0.05), but water hardness and total dissolved solid levels were inversely correlated (p greater than 0.01) with the activity of erythrocyte GSHPx, a selenium containing enzyme which detoxifies oxidized fats.