[Brachytherapy for urinary bladder cancer]. / Braquiterapia en el cáncer de vejiga urinaria.

OBJECTIVE: To present the results achieved by brachytherapy in the treatment of bladder cancer and to review the literature on this subject. METHODS: 120 patients with bladder cancer were treated with brachytherapy at two Dutch Centres. Selection criteria were good general condition allowing anesthesia, good bladder function (capacity of 300 ml), solitary tumor maximum 5 cm diameter, T1G3, T2, T3a. Before the implant an extensive transurethral resection was performed. The urologist carried out a cystostomy and the radiation oncologist did the implant using iridium-192 wires. The administered tumor dose was 60 Gy at a dose rate of 60-90 cGy/hour. RESULTS: The 5-year overall survival and disease-free survival was 67% and 73%, respectively. By stage, the 5-year disease-free survival was 100% in T1, 80% in T2 and 67% in T3. Local failure was observed in 15 patients (13%). Six of these relapses were salvaged by cystectomy. Ten patients had a superficial tumor Ta-T1 in bladder sites other than the original tumor site. Acute and late complications were unusual. The results compare quite well with those of other series published in the literature. CONCLUSION: Brachytherapy achieves excellent results in selected patients with solitary bladder cancer maintaining a fully functional bladder. Acute and late complications of this treatment modality are relatively infrequent.

Armadillo coactivates transcription driven by the product of the Drosophila segment polarity gene dTCF.

The vertebrate transcription factors TCF (T cell factor) and LEF (lymphocyte enhancer binding factor) interact with beta-catenin and are hypothesized to mediate Wingless/Wnt signaling. We have cloned a maternally expressed Drosophila TCF family member, dTCF. dTCF binds a canonical TCF DNA motif and interacts with the beta-catenin homolog Armadillo. Previous studies have identified two regions in Armadillo required for Wingless signaling. One of these interacts with dTCF, while the other constitutes a transactivation domain. Mutations in dTCF and expression of a dominant-negative dTCF transgene cause a segment polarity phenotype and affect expression of the Wingless target genes engrailed and Ultrabithorax. Epistasis analysis positions dTCF downstream of armadillo. The Armadillo-dTCF complex mediates Wingless signaling as a bipartite transcription factor.

Tamsulosin, the first prostate-selective alpha 1A-adrenoceptor antagonist. A meta-analysis of two randomized, placebo-controlled, multicentre studies in patients with benign prostatic obstruction (symptomatic BPH). European Tamsulosin Study Group.

OBJECTIVE: This meta-analysis of two European studies evaluated the efficacy and safety of modified-release tamsulosin 0.4 mg once daily compared with placebo in patients with benign prostatic enlargement, lower urinary tract symptoms and prostatic obstruction (symptomatic BPH). METHODS: Patients entered a 2-week placebo run-in period, followed by randomization to treatment with tamsulosin (382 patients) or placebo (193 patients) once daily for 12 weeks. RESULTS: Maximum urinary flow rate improved to a greater extent in the tamsulosin group (1.6 ml/s, 16%) than the placebo group (0.6 ml/s, 6%) (p = 0.002). Total Boyarsky symptom score also improved to a greater extent in the tamsulosin group (3.3 points, 35.1% reduction) than the placebo group (2.4 points, 25.5% reduction) (p = 0.002). Significantly more tamsulosin patients (66%) than placebo patients (49%) had a > or = 25% decrease in total symptom score at endpoint (p < 0.001). Twelve weeks of treatment with tamsulosin also produced significant improvements in average urinary flow rate (p = 0.005) and voiding or "obstructive" (p = 0.008) and storage or "irritative' (p = 0.017) symptom scores. The incidence of drug-related adverse events was comparable for the tamsulosin and placebo groups (13 and 12% respectively, p = 0.802). The same applies to the incidence of adverse events commonly attributed to alpha 1-adrenoceptor antagonists, such as dizziness, headache, postural hypotension, syncope, asthenia, somnolence and rhinitis. There were no clinically significant changes in blood pressure or pulse rate in tamsulosin patients compared with placebo patients both in hypertensive and normotensive BPH patients. CONCLUSION: Tamsulosin 0.4 mg once daily is safe, well-tolerated and improves both the symptoms and urinary flow rate in patients with benign prostatic obstruction (symptomatic BPH).

Nephroptosis: a considerable cause of renovascular hypertension.

Four females were admitted with hypertension. Other causes of hypertension were excluded on clinical grounds. Digital substraction angiography performed in 3 patients revealed no stenosis of the renal arteries. The 99mTc-Mag3 renogram showed diminished perfusion and excretion on the affected side. Right-sided nephropexy was performed in all 4 cases via lumbotomy after which all 4 patients became normotensive. We conclude that nephroptosis is a considerable cause of renovascular hypertension and deserves particular attention in cases of possible renovascular hypertension when angiography shows no stenosis. We also conclude that renography is the preferred diagnostic method in the diagnosis of renovascular hypertension due to nephroptosis.

Multicystic mesothelioma presenting as a pelvic tumour: case report and literature review.

We report the clinical, radiological and pathological findings of a big polycystic tumour in the pelvic region which proved to be a multicystic mesothelioma affecting the pelvic peritoneum. Clinical and histological differential diagnosis are given and a therapy option. Surgical excision for localized tumours and debulking for more extensive tumours.

A pelvic mass: bladder diverticulum with haemorrhage in Ehlers-Danlos patient.

We report on a case of haemorrhage in a large bladder diverticulum, impressing as a pelvic mass, in a patient with the Ehlers-Danlos syndrome. A review of the literature revealed 14 other cases of bladder diverticula and the Ehlers-Danlos Syndrome. Conservative treatment is first choice, unless complications occur.

Evaluation of brachytherapy implants using the "natural" volume-dose histogram.

The "natural" volume-dose histogram as described by Anderson visualises graphically even small differences between source arrangements, making it a useful tool to compare planned and realised source configurations. In this study the histogram is applied to demonstrate that the introduction of an applicator in oral cavity implants or of iridium wire spacers used as templates in bladder implants improved the quality of the implants considerably, resulting in close agreement between the planned and the realised source configuration.

Synchronous bilateral seminoma testis treated with unilateral orchiectomy and contralateral irradiation: a therapeutic option.

In the past 20 years, 14 cases of simultaneous bilateral seminoma testis treated with bilateral orchiectomy and adjuvant radiotherapy have been reported in the literature. A case is now described in which treatment consisted of unilateral orchiectomy, with radiotherapy to the contralateral tumor and the lymph nodes.

Ultrasonically guided transperineal seed implantation of the prostate: modification of the technique and qualitative assessment of implants.

During the period 1988-1991, 23 patients with prostatic carcinoma were treated by transperineal iodine seed implantation guided by transrectal ultrasound. We introduce a refinement of the implantation technique using a rigid column of seeds and spacers. The uniformity parameter based on the peak width of the natural volume-dose histogram demonstrated quantitatively that this refinement resulted in a more accurate seed arrangement.

Psoas abscess and giant fistula twenty-one years after nephrectomy.

Vague abdominal complaints and low back pain are common in modern medicine. We describe the case of a patient who presented these symptoms twenty-one years after a nephrectomy accompanied by persistent elevated erythrocyte sedimentation rate for unknown reason. CT and fistulography showed a psoas abscess and a giant fistula.

Dose determination in bladder and rectum during intracavitary irradiation of cervix carcinoma.

The radiation dosage in the base of the bladder and in the anterior wall of the rectum during intracavitary irradiation of cervix carcinoma can be determined easily by use of intracavitary transvesical and transrectal ultrasound and simultaneous radiography. In case of excessive doses to the organs at risk, the dose can be lowered by rearrangement of the vaginal gauze packing in the same sitting.

Hematuria as a presenting symptom of an aortic-vena caval fistula from ruptured aortic aneurysm.

We describe a patient with an abdominal aortic aneurysm and gross hematuria caused by rupture of the aneurysm into the vena cava who was treated successfully.