Diagnostic methods in the detection of prostate cancer: a study of a randomly selected population of 2,400 men.

We investigated the value of digital rectal examination, transrectal ultrasonography and prostatic specific antigen (PSA) analysis as aids in general clinical practice and in the early detection of prostate cancer. Of a randomly selected population of 2,400 men 55 to 70 years old who were offered examination with digital rectal examination, transrectal ultrasound and PSA analysis, 1,782 (74%) accepted and prostate cancer was detected in 65 (3.6%). When the transrectal ultrasound results were also considered the detection rate of digital rectal examination (2.3%) was increased by 50% and the number of stage T2A or less tumors was doubled. At reexamination due to markedly high PSA values (7 micrograms/l. or more) only a few additional cancers (5%) were detected. However, it is noteworthy that 80% of the detected cancers were found among the subgroup with abnormal PSA values (4 micrograms/l. or more) and comprising 17% of the study population, which suggests the possibility of selecting a risk group at mass screening. Moreover, the positive predictive value increased from 4% (when only digital rectal examination was positive) to 71% for the combination of positive digital rectal examination, positive transrectal ultrasound and an increased PSA concentration (that is 7 micrograms/l. or greater).

Digital rectal examination versus transrectal ultrasound in detection of prostate cancer. Preliminary results from a study of a randomly selected population.

In a study of 2,400 randomly selected men (age 55-70 years) for early detection of prostate cancer the authors have compared the diagnostic value of digital rectal examination (DRE), transrectal ultrasound (TRUS) and prostate specific antigen (PSA). Altogether 62 prostate cancers were detected, corresponding to a detection rate of 3.5% but by use of DRE the detection rate was only 2.3%. The study showed that TRUS added significantly to the detection rate. If radical surgery is restricted to stages T1 and T2A, the combined use of DRE and TRUS detected twice as many cases fit for this treatment than DRE alone. The authors advocate randomized studies for evaluation of early radical treatment of prostate cancer. Before results of such studies have appeared they recommend methodological studies aimed at development and enhancement of the accuracy of the diagnostic tools.

Conventional heparin and semisynthetic heparin analogue (SSHA) alteration of blood coagulation after embolic occlusion of human renal circulation.

Blood coagulation and fibrinolytic variables were measured in a peripheral vein in a study of 21 consecutive patients before and after angio-embolization of renal carcinoma. The first ten patients received conventional heparin, 5000 IU twice daily, and the following eleven a semi-synthetic heparin analogue (SSHA), 50 mg twice daily, for 5 days. The first injection was given 2 hours before embolization and the last injection at least 12 hours before the last blood sampling. Both groups showed increased levels of FPA on day 5-7, indicating that the anticoagulant influence had ceased. F VII levels decreased only in the SSHA group from embolization to day 3, but were increased in both groups on day 5-7. Levels of thrombin-antithrombin complexes (TAT) were significantly increased in the heparin group 2 hours after embolization, indicating that thrombin activity had been formed. The corresponding TAT level in the SSHA group was not significantly increased. The differences could possibly indicate a different mechanism of action on blood coagulation of SSHA as compared with heparin, with involvement of extrinsic pathway and maybe by-passing antithrombin III inhibition.

Blood coagulation alterations after embolic occlusion of the renal circulation.

Alterations in blood coagulation and fibrinolysis after embolic occlusion of renal adenocarcinoma were investigated in 11 patients. Peripheral vein blood was collected before, 2 hours after and on the first, third and fifth to seventh day after embolization. Five patients had renal vein blood sampling before and 2 hours after embolization. Increased levels of fibrinogen, plasminogen and antiplasmin were found on days 1-3. Antithrombin III showed a slight decrease between days 1 and 3 after embolization. All measured variables were lower in renal vein compared with simultaneous samples from peripheral vein. In renal vein samples, consumption of antiplasmin and antikallikrein was indicated. Fibrinopeptide A (FPA) was increased, with a mean maximum 2 hours after embolization. The findings seemed mainly to monitor acute phase reaction but also activation of blood coagulation and fibrinolysis. Embolization might be used as a human model of coagulation activation and acute phase reaction.

Antibiotics to patients with urinary infections in connection with transurethral prostatectomy.

79 male patients with bladder neck obstruction and urinary tract infection were randomly divided into two groups prior to transurethral prostatectomy. One group (37 patients) was treated preoperatively and for 10 days postoperatively with cephazolin-cephalexin, and the other group (42 patients) was treated with methenamine hippurate in the same way. In the first group, 2 patients developed chills postoperatively without untoward effect on their general condition. In the second group, 7 patients developed postoperative sepsis with systemic symptoms while on therapy with methenamine hippurate: therapy was then changed to cephazolin--cephalexin and the patients were cured. Urinary cultures 4--9 weeks postoperatively did not show bacterial growth in 21/37 treated with cephalosporins and in 11/42 treated with methenamine hippurate. This difference is statistically significant (P = 0.0082).

A biochemical basis for grouping of patients with urolithiasis.

The urinary excretion of calcium, magnesium, oxalate, creatinine, phosphate and urate was investigated in patients with urolithiasis and in normal subjects. The excretion of oxalate and urate per mole creatinine and the quotients calcium/magnesium, calcium X oxalate/magnesium and calcium X oxalate/(magnesium X creatinine) were significantly higher in stone formers than in normal subjects. The mean creatinine-correlated urinary excretion of calcium was higher and of magnesium lower in patients with urolithiasis, but the differences were statistically not significant. The urine investigation was supplemented with analysis of calcium, magnesium, creatinine, urate, bicarbonate and chloride in serum and a qualitative analysis of stone composition. A simple schedule for a biochemical grouping of patients with urolithiasis is presented and on the basis of the analytical findings it was possible to classify 67% of patients with so-called 'idiopathic stone disease' according to these principles.

Thorotrast-induced renal tumours after retrograde pyelogram.

Seven cases of 'thorotrast kidney' after retrograde pyelogram with reflux are dealt with. In five instances cancer of the kidney developed, four of them obvious renal pelvic carcinoma between 14 and 41 years after the thorotrast pyelogram. In some cases the contrast deposits were misinterpreted and in one case the follow-up was also inadequate. There is a high risk of malignancy to connection with 'thorotrast kidneys'. These cases should be follewed up with intravenous pyelogram and exfoliative cytology from renal pelvis. Provided these tests are negative, nephro-ureterectomy should be put off.

The diurnal urinary excretion of oxalate and the effect of pyridoxine and ascorbate on oxalate excretion.

The diurnal urinary oxalate excretion has been determined in 11 patients with urolithiasis and in 7 normal subjects. Increased excretion following meals was observed. The variation from hour to hour was most pronounced in the stone patient group. The relation between oxalate concentration and urinary volume was found to follow a biphasic exponential course. Pyridoxine administration increased oxalate excretion in 9 out of 12 subjects and decreased the excretion in 3 subjects. Ascorbate administration increased oxalate excretion in all 7 subjects studied.

Treatment of renal adenocarcinoma by embolization: a follow-up of 38 cases.

The experience from 38 patients treated with embolization are presented. The technique and results are discussed. Other techniques intended to cause embolization as well as further possibilities within this field are discussed.

The treatment of low differentiated germinal cancers of the testis using mithramycin.

Twenty-six patients with metastases from a germinal cancer of the testis were treated with Mithramycin. After an observation time of between one-half-3 one-half years, 18 are still alive, of which 12 appear to be free from cancer. The 2-year survival rate is 50% (5/10). The side effects of Mithramycin therapy are described and discussed.

Effect of circulating norepinephrine on the renin release from the denervated kidney.

The effect of renal denervation on the reactivity of the renin release mechanism to circulating norepinephrine was studied in six dogs with renal autografts. The renin release was determined simultaneously in the transplanted and the untouched kidney. Both kidneys showed an increased release of renin when norepinephrine was given. A slight reduction in renal blood flow and increase in arterial blood pressure was recorded. Propranolol blocked the release of renin induced by norepinephrine without affecting either the reduced blood flow thorugh the autograft or the elevated blood pressure. The denervation of the autotransplanted kidney was histochemically verified. The findings indicate that the renin release induced by circulating norepinephrine is independent of the intrarenal adrenergic nerves, and rather suggest that it is the result of an action of norepinephrine directly on the renin-producing juxtaglomerular cells. In this mechanism a beta-adrenergic receptor system appears to be involved.