Bladder carcinoma associated with cyclophosphamide therapy for ovarian cancer occurring with a latency of 20 years.

BACKGROUND: Cyclophosphamide-induced urothelium cancer of the bladder is a well-known entity. The risk for inducing such cancer grows with duration and dosage of cyclophosphamide therapy. The lag time between termination of treatment and development of urothelial cancer has been observed to be between 9 months and 11 years. Single cases have been reported 14, 16, 17, and 21 years after cyclophosphamide treatment. CASE: We report a case of a bladder cancer occurring after a lag time of 20 years after oral therapy with cyclophosphamide for ovarian cancer. The bladder cancer was detected due to gross hematuria. CONCLUSION: It is of great importance for gynecologists to continue to care for patients who have received long-term cyclophosphamide treatment, even if the treatment was completed decades ago. One possible early symptom of cyclophosphamide-induced bladder cancer is painless hematuria. This can easily be used to detect bladder cancer in women at risk, even after a very long latency period.

Elevated tissue expression of hyaluronic acid and hyaluronidase validates the HA-HAase urine test for bladder cancer.

PURPOSE: We examined the expression of 2 bladder tumor markers, hyaluronic acid (HA) and hyaluronidase (HAase), in bladder tissues and correlated tissue staining with the inferences of the HA-HAase urine test, which detects bladder cancer. MATERIALS AND METHODS: A biotinylated HA binding protein and an antiHYAL1 antibody were used to localize HA and HYAL1 type HAase, respectively, in 83 bladder tissues. Immunoblot analysis was performed using an antiHYAL1 antibody to detect HYAL1. RESULTS: A total of 12 normal bladder tissues showed no (66%) to 1+ (34%) HA staining and 0 (83%) to 1+ (17%) HYAL1 staining. The staining intensity of HA and HYAL1 increased in 71 bladder tumor specimens on chi-square analysis (p <0.001). Grade 1 tumors demonstrated 1+ (50%) to 2+ (50%) staining for HA and 1+ to 3+ staining for HYAL1 (37%, 37% and 26%, respectively). Grades 2 and 3 tumors showed 2+ to 3+ HA (94%) and HYAL1 (79%) staining. HA was expressed in tumor associated stroma and in tumor cells, whereas only tumor cells expressed HYAL1. In bladder tumor tissues HYAL1 expression was confirmed by immunoblot analysis. In 33 of the 34 patients (97%) with bladder cancer from whom urine and tumor tissue specimens were obtained at the same time 2+ to 3+ staining of HA and/or HYAL1 in 12 and 21, respectively, constituted a positive HA-HAase urine test (kappa = 0.945). CONCLUSIONS: To our knowledge this is the first report of HA localization in bladder tissues and of HYAL1 in any normal or tumor tissue. A close correlation of elevated HA and HYAL1 levels in tumor tissues with a positive HA-HAase urine test indicates that in patients with bladder cancer tumor associated HA and HYAL1 are secreted in urine, causing the HA-HAase test to be positive.

[Hyaluronic acid and hyaluronidase. 2 new bladder carcinoma markers]. / Hyaluronsäure und Hyaluronidase. Zwei neue Blasenkarzinommarker.

The heterogeneity of bladder cancer concerning progress of recurrence is an essential characteristic of this disease. Hyaluronic acid (HA) and its degrading enzyme hyaluronidase (HAase) are intricately associated with bladder cancer angiogenesis and metastasis. Tumor-associated HA and HAase are secreted in urine. In 513 urine specimens (261 bladder cancer patients, 252 patients without bladder cancer) and 83 bladder tissue specimens (71 bladder tumors, 12 normal bladder tissues), the accuracy of HA and HAase as tumor markers was studied. Elevated urinary HA levels (> or = 500 ng/ml), indicating a positive HA test, suggest the presence of bladder cancer regardless of tumor grade. Elevated urinary HAase levels (> or = 10 mU/mg) indicate high-grade (G2/G3) bladder cancer. The combined HA-HAase urine test showed 91% sensitivity and 84% specificity to detect bladder cancer. The HA-HAase test is equally sensitive for monitoring tumor recurrence. Immunohistochemistry (IHC) staining of HA and HAase in the G1 and G2/G3 bladder cancer specimens was significantly (p < 0.001) higher than in normal bladder tissue. HA and HAase appear to be useful markers in the diagnosis of bladder cancer. When compared with other noninvasive tests, the HA-HAase urine test may be less expensive and more accurate.

[The new uretero-ileal anastomosis technique in Hautmann ileal neobladder]. / La nouvelle technique d'anastomose urétéro-iléale dans la néovessie iléale de Hautmann.

OBJECTIVE: Hautmann neobladder is one of the most widely bladder replacement techniques in the two sexes. The uretero-ileal stenosis rate is estimated to be 11% with the initial CAMEY-LE DUC technique. A new anastomosis technique is presented in order to improve this postoperative complication. MATERIALS AND METHODS: Two 5 to 10 cm ileal segments are prepared at the two extremities of the W of the neobladder to receive the largely spatulated ureters. The anastomosis is performed directly on the ileal resection margin, in a strictly retroperitoneal position. Between December 1996 and December 1998, the technique was performed in 89 patients including 19 women. One hundred and sixty six renal units (RU) were analysed by preoperative renal ultrasound, repeated after 1, 3 and 6 months and then every 6 months. Urine culture was performed monthly for 6 months. RESULTS: Thirteen RU were dilated (grade II and III) preoperatively (7.8%). No secondary anastomotic stenosis was observed with a mean follow-up of 5.8 +/- 7.6 months. Of the 166 RU examined, 129 were normal, 13 preoperative dilatations were improved and 24 RU presented minimal postoperative dilatation (grade I). Ileo-ureteric reflux was observed on the postoperative retrograde cystography in two cases. The only complication was acute pyelonephritis (1.1%) at 1 month. 90% of urine cultures were sterile after 6 months. CONCLUSION: Modification of uretero-ileal anastomosis by the "double chimney" technique is performed without tension by placing the two ureters in an anatomical position without plication or torsion. Preservation of the ureteric blood supply contributes to the low complication rate and a decreased risk of stenosis. However, the technique needs to be validated by analysis of the results with a longer follow-up.

Treatment of high-risk patients with subvesical obstruction from advanced prostatic carcinoma using a thermosensitive mesh stent.

OBJECTIVE: To evaluate the results obtained using a permanent prostatic stent system (Memotherm, Bard/ Angiomed, Karlsruhe, Germany) in high-risk patients with advanced prostatic carcinoma and subvesical obstruction. PATIENTS AND METHODS: The study included 35 patients (mean age 75.3 years, range 53-89) with advanced prostatic carcinoma and persistent subvesical obstruction despite androgen ablation. Because of serious concurrent diseases, 49% of these patients were classified as American Society of Anesthesiologists (ASA) grade 3 and 51% as ASA grade 4. The patients were treated using the Memotherm stent, a thermosensitive Nitinol mesh stent. The outcome was assessed by measuring voiding variables, a symptom score and as the incidence of complications. RESULTS: After inserting the stent, 33 (94%) of the patients were able to void spontaneously and there was a statistically significant improvement in the voiding variables. These results remained unchanged over a mean (range) follow-up of 15.2 months (3-38). There were no serious complications arising from the insertion of the stent. CONCLUSION: For high-risk patients with subvesical obstruction caused by prostatic carcinoma, the insertion of a permanent metal stent system offers a useful alternative treatment to transurethral resection.

Tenodesis versus carbon fiber repair of ankle ligaments: a clinical comparison.

To compare the clinical and functional outcomes after using different reconstruction methods for chronic ankle instability, the authors followed 2 groups of patients after 69 and 72 months, respectively. Thirty patients (mean age, 28; range, 23-39 years) were treated with modified Evans tenodesis. Twenty-three patients (mean age, 32.2; range, 22-39 years) underwent total replacement of the lateral ankle ligaments by carbon fibers. The protocol of the retrospective study included a questionnaire, clinical examination, radiographic stress diagnostics, and gait analysis with use of the EMED-SF system. Dorsiflexion and inversion were significantly restricted after tenodesis in contrast to the carbon fiber replacement. Although radiographic stability was improved after surgery for both groups, progress of the arthrosis could not be stopped. After tenodesis, the measurement of plantar pressure distribution revealed a 20% increase of midfoot loading as compared with the opposite foot, whereas symmetrical loading of both feet was found after carbon fiber replacement. Additionally, the tenodesis feet had a significantly increased loading of the medial side of the foot. It was concluded that tenodesis and anatomic reconstruction of ankle ligaments lead to subjectively similar results. Foot function and range of motion, however, were less influenced after anatomic repair.