Clinical applications of molecular biomarkers in prostate cancer detection.

Prostate cancer is a heterogeneous disease with regard to molecular alterations and clinical course. Early diagnosis of prostate cancer can increase the curative success rate for this disease. Because of the recent developments in the field of molecular biology, an increased interest occurred for molecular biomarkers, as tools for early prostate cancer detection, monitoring disease progression, predicting disease recurrence and therapeutic treatment efficacy. Many molecular biomarkers have been discovered in human serum, urine, seminal fluid and histological specimens.

Urine cytology in the follow-up of patients with transitional cell carcinoma of the urinary bladder: is that enough as a single method?

There were studied 130 patients with Ta, T1 and T2 transitional cell carcinomas of the urinary bladder, all treated by transurethral resection. After transurethral resection the follow-up was performed in 48 cases by cystoscopy and urine cytology and in 82 cases by cytology alone. In the first group there were 27 recurrences; cystoscopy failed to identify recurrences in 3 cases and cytology in one of them; all 3 patients with apparently false positive cytology recurred at 4, 9 and 11 months from the cytodiagnosis. From 82 patients of the second group 42 developed recurrences. Urine cytology was positive in 80.9%, suspect in 14.2% and false negative in 4.7% of cases. There were only 2 unsuspected recurrences with a consecutive delay in the correct diagnosis of recurrence in another one. Our results suggest that urine cytology can replace cystoscopy only when it exists a good correlation between its results with pathological findings (over 80% real positive results).

Cytologic diagnosis of transitional cell carcinoma of the urinary bladder. Comparison with endoscopical and pathological findings on 538 cases.

There were investigated 583 cases with tumors of the urinary bladder and 612 patients with non-malignant diseases of the urinary tract. Samples of voided urine were taken from all cases and direct smears fixed by drying were stained by rapid blue polychrome-tanin Dragan method Cytological results were compared with endoscopical and pathological findings. The overall rate of real positive results was 91.7% and false negative results were noticed in 8.3% of cases. A direct relationship between real positive results and histological "G" was found. Causes for false negative results were: tumor developed in a bladder diverticulum, calcified tumor, irradiated tumor, insufficient quantity of voided urine, chronic urinary infections and underestimation of cytological criteria of cellular malignancy. There were 9 false positive results in patients with nonmalignant diseases, due to lithiasis, chronic renal failure and chronic urinary infections. The cytological grade of differentiation was performed by the method purposed by Friedman and Ash, and concordance with the standard histological finding was 76.4%. Urine cytology is thought to be a useful method in the primary diagnosis and recurrences of transitional cell carcinoma of the urinary bladder, in all patients with hematuria, recurrent infections of the urinary tract and neglected lithiasis.

3D reconstruction of prostate from ultrasound images.

The aim of our study was to obtain a 3D model of the prostate from the ultrasound images and to represent it and calculate its volume. The establishing of prostate volume represents a necessary stage in choosing the method of solving prostate adenoma. The evaluation of the prostate volume can be done by transabdominal or endorectal echography. If the second method is not available it is necessary to use the echographic estimation of the volume of the prostate adenoma by suprapubian examination. This method lacks precision. In order to have a more accurate calculation of the prostate's volume than the ellipsoid approximation given by the echographic equipment, we designed a software tool for handling and management of digital images. The primary information is composed of two 2D digital images obtained by digitising the frames acquired from an 3.5 MHz ultrasound equipment for two incidences: sagittal and transversal. The bitmaps were filtered to reduce the noise and a contour detection algorithm was used. Further, the new 2D detected contours were processed with the help of an interactive image editor toward a 3D reconstruction of the prostate. The examiner can perform rotations and translations on the 2D projections and can adjust the angle between them. The resulting object (the 3D model of the prostate) was adjusted accordingly and its volume was displayed. The software was implemented on a PC system and was used in the Urology Clinic for several cases. It has been shown that, compared with the value provided by the approximation of the echographic equipment, a more accurate value of the volume of the prostate was obtained.

The necessity of urologic ultrasound images processing.

The purpose of the paper is to present a software system for the handling and management of urologic ultrasound images. In particular, the system was used to detect men's prostate in ultrasound images and than to obtain a 3D model for the detected object and to calculate its volume. The software system can be used in hospitals which do not have either CAT scanners or NMR/MRI equipment (the majority of Romanian hospitals). It provides these hospitals with a tool enabling a more accurate diagnosis, which in turn improves the efficiency of the hospital, saves money, and has a profound psychological benefit on the well-being of the patient.

Anuria due to lithiasis associated with septic shock.

During 18 months 38 patients with anuria due to lithiasis were admitted in our department, 8 of them developed septic shock. Twenty eight patients were cured using different procedures and were released from the hospital with normal urinary output. Ten patients died, 6 of them from septic shock, which has a high mortality rate. Emergency restoration of urinary flow, correction of fluid and electrolyte imbalance, massive antibiotherapy may improve results.