Diagnostic efficacy of fluorescence cystoscopy for detection of urothelial neoplasms.

BACKGROUND AND PURPOSE: A major problem diagnosing bladder cancer using conventional white-light cystoscopy is that flat and tiny papillary neoplasms can be overlooked. Fluorescence cystoscopy is based on the detection of protoporphyrin IX (PpIX)-induced fluorescence in urothelial neoplasms through the topical administration of 5-aminolevulinic acid (ALA). The diagnostic efficacy of fluorescence cystoscopy in urothelial neoplasms was evaluated in this study. The focus of this investigation was to ascertain whether fluorescence cystoscopy could make a major contribution to staging and improving the choice of adjuvant therapy after transurethral resection. PATIENTS AND METHODS: A series of 62 patients with suspected bladder cancer were investigated by fluorescence cystoscopy. An intravesical instillation of ALA was conducted 2 hours prior to fluorescence. A total of 274 tissue samples were obtained from the fluorescing and nonfluorescing areas of the bladder. RESULTS: The sensitivity and negative predictive value of fluorescence cystoscopy were 98.0% and 94.7%, respectively, but the specificity was low (42.9%). Among a total of 148 lesions of urothelial neoplasm, 58 foci (dysplasia in 5, carcinoma in situ in 19, stage Ta in 15, T1 in 15, above T2 in 4) that were invisible under white-light cystoscopy were detected by fluorescence cystoscopy. The final histopathologic status was changed in 45% of patients (28/62) according to this technique. Among these patients, eight (13%) needed additional therapy, including a radical cystectomy in one patient and intravesical therapy in 10. CONCLUSIONS: The ALA-based fluorescence cystoscopy technique is a safe and simple procedure that enhances the detection of flat and papillary urothelial neoplasms. Moreover, it will be able to provide useful information that will enable proper staging and appropriate further treatment.

Regulation of the beta 2-adrenergic receptor and its mRNA in the rat lung by dexamethasone.

Glucocorticoids increase beta 2-adrenergic responsiveness and receptor density in the lung, but the underlying mechanisms have not been clearly elucidated. To determine whether changes in beta 2-adrenergic receptor gene expression are involved in vivo, we measured beta 2-adrenergic receptor mRNA levels and beta 2-adrenergic receptor density in lungs from Sprague-Dawley rats treated with a daily injection of dexamethasone (1 mg/kg subcutaneously) for 1, 3, or 7 days. Animals were sacrificed either 2 or 24 h after receiving the last injection. beta 2-Adrenergic receptor mRNA levels were significantly (p < .05) elevated compared to saline-treated controls in the lungs of animals sacrificed 2 h after dexamethasone injection for 1 day (174 +/- 12%), 3 days (236 +/- 18%), and 7 days (220 +/- 11%). Receptor mRNA levels measured 24 h after dexamethasone injection did not differ significantly from the control group. Induction of beta 2-adrenergic receptor mRNA by dexamethasone was transient, since no significant cumulative or sustained increase in receptor mRNA levels was observed during the study period. Treatment with dexamethasone increased beta 2-adrenergic receptor density as expected, but no significant increase in receptor density was detected until 24 h after the third daily injection of dexamethasone, when levels reached 2045 +/- 150 fmol/mg protein compared to 1292 +/- 34 fmol/mg protein in the control group. Receptor density then remained at this elevated level through 7 days of treatment. These results show that dexamethasone up-regulates both the beta 2-adrenergic receptor and its mRNA in vivo in the lung. The induction of beta 2-adrenergic receptor mRNA levels indicates that glucocorticoids may regulate receptor density in the lung through modulation of gene expression. However, the difference between the time course of induction for the beta 2-adrenergic receptor and its mRNA suggests that additional translational or post-translational mechanisms may also be involved.

Primary localized amyloidosis of the bladder--a case report.

Primary localized amyloidosis is a rare disease with an excellent prognosis in most cases. We report a case of primary localized amyloidosis of the bladder that was treated with transurethral resection.

Comparison of glucose-consumption and thymidine-incorporation endpoints in histocultured human superficial bladder tumors.

Glucose consumption and tritiated thymidine incorporation were monitored for 54 days in histocultured human superficial transitional cell carcinoma of the bladder, indicating that long-term histoculture of human transitional cell carcinoma of the bladder is feasible. The glucose-consumption rate was relatively similar among the histocultured specimens and depended on the size of the explant in histoculture. Tritiated thymidine incorporation, on the other hand, varied greatly between the histocultured specimens. In addition, [3H]thymidine incorporation varied in single histocultures between cells in the original explant and those invading the gel. From these results, we conclude that the glucose consumption rate in histocultured human superficial bladder tumor is more reliable and sensitive than thymidine incorporation. The glucose-consumption endpoint is simple to measure and nondestructive, allowing multiple measurements on a single culture, unlike the thymidine incorporation endpoint.

The measurement of glucose consumption in histoculture to determine effects of doxorubicin and cisplatinum on human gastric carcinoma.

We have developed a chemosensitivity assay of human tumors growing on collagen-sponge-gel-supported histoculture. This assay is thus termed the Histoculture Drug Response Assay (HDRA). In the HDRA, the end points of [3H]thymidine incorporation measured by histological autoradiography and tetrazolium dye reduction were initially used and found to have good in vitro-in vivo correlations, including that determined in clinical trials. We have now developed glucose consumption as an endpoint in histoculture. We have monitored glucose consumption for 11 weeks with histocultured stomach cancer tissue that was obtained from a patient with stomach cancer metastatic to the lymph node. The histocultured lymph node specimens were treated with various concentrations of doxorubicin and cisplatinum. The glucose-consumption rate decreased with greater concentrations of both drugs. The results correlated with the thymidine labeling index. From these results, we conclude that the glucose-consumption-rate endpoint in histocultured cancer tissue is non-destructive, unlike the [3H]thymidine and tetrazolium dye end points, allowing serial determinations over extended periods in culture. Thus, the glucose consumption end point may enhance the development of optimal treatment doses and schedules. We also conclude that long-term histoculture drug response studies of metastatic stomach cancer are possible.

Incidence estimation of genitourinary cancer in Korea.

A nation-wide study was performed to estimate the incidence of bladder, kidney, renal pelvis and ureter, prostate, testicular and other genitourinary cancer among Koreans in Korea using medical records of the inpatients of the beneficiaries of the Korea Medical Insurance Corporation (KMIC) from Jan. 1, 1989 to Dec. 31, 1989. The crude incidence rate of bladder cancer (ICD-9 188) is estimated to be 4.43 and 0.98 per 100,000 in males and females, respectively. Around 1,093 new cases of bladder cancer (895 male and 198 female) are estimated to occur in a year. The adjusted rate for the world population is 7.76 in males and 1.19 in females which is similar to that of Japanese in Osaka and Chinese in Shanghai, but lower than in American whites and blacks. The crude incidence of kidney, renal pelvis and ureteral cancer (ICD-9 189) is estimated to be 1.61 and 0.87 in males and females, respectively. Around 507 new cases of kidney, renal pelvis and ureteral cancer (332 male and 175 female) are estimated to occur in a year. The adjusted rate for the world population is 2.69 in males and 1.04 in females. In the prostate (ICD-9 185), the crude incidence rate of cancer is estimated to be 1.36. Around 274 new cases of prostate cancer are occurring in a year. The adjusted rate for the world population is 2.98 which is similar to the Chinese rate. The incidence of genitourinary cancer continuously increases with age.

Portal and superior mesenteric venous gas with retroperitoneal abscess--CT diagnosis (case report).

We present a case of portal and superior mesenteric venous gas in a 31-year-old diabetic woman with a left-sided retroperitoneal abscess. Five years prior to admission, patient was diagnosed with diabetes mellitus and developed emphysematous pyelonephritis, requiring nephrectomy on the left side. A CT examination showed air distributed throughout the portal venous system and superior mesenteric vein.

Pedunculated leiomyoma of scrotum.

Leiomyoma may originate at any anatomic location of smooth muscle in the genitourinary system. The kidney capsule is the most common site for the genitourinary leiomyomas. Leiomyoma origination from the scrotum is rare. The previous reported cases presented as small, firm, nontender, slowly enlarging freely movable masses within the scrotum. We report a case of leiomyoma of the tunica dartos, a benign lesion arising from the wall of the left scrotum. It presented as a pedunculated lesion with a surface ulceration, which need to be differentiated from squamous carcinoma of the scrotum. It was treated with a simple surgical excision.