[Adjuvant immunotherapy with keyhole limpet hemocyanin in category PT 2 N+ and PT 3-4, No-N+, Mo renal cell carcinoma]. / Adjuvante Immuntherapie mit Keyhole Limpet Hemocyanin (KLH) beim Nierenzellkarzinom der Kategorie PT 2 N+ und PT 3-4, No-N+, Mo.

This study was a prospective randomized trial to compare adjuvant immunotherapy with Keyhole Limpet Hemocyanin (KLH) after radical nephrectomy. From January 1983 to December 1988, 50 patients underwent radical nephrectomy for category PT 2 N+ and PT 3-4, No-N+, Mo renal cell carcinoma. Postoperatively 25 patients were given adjuvant treatment with the biological response modifier, Keyhole Limpet Hemocyanin (KLH), and 25 patients were in the control group. In each group 2 patients were lost to follow-up. The mean follow-up time was 55 months. Adjuvant treatment with KLH did not appear to improve the prognosis in renal cell carcinoma patients. The 5-year survival rate was 60% in the KLH group and 56.5% in the control group. Progress was seen in 9/23 in the KLH group, 10/23 in the controls. The median survival in patients showing progress was 27 and 28 months in the two groups, respectively. Studies with a combination of low dose cyclophosphamide and KLH revealed a positive immunostimulating effect, which may provide the rationale for further research concerning different KLH doses, schedules or therapeutic combinations.

[Urothelial cancer of the upper urinary tract]. / Das Urothelkarzinom des oberen Harntrakts.

Uretero-nephrectomy with bladder cuff was performed in 61 patients with renal pelvis and ureter carcinoma between 1982 and 1987. A retrospective study was done on 54 patients, with a mean follow up of 56.9 months. The 5-year survival was 61.6%. The average age was 68.8 years with a male-to-female ratio of 1.7:1. Macrohaematuria was the most frequent symptom, occurring in 77.7% of the patients. In 92.5% of the urothelial tumours the diagnosis was confirmed by intravenous pyelogram (IVP) and retrograde pyelography. Between grade G1 and G3 and stage pTa and pT3-4 a statistically significant difference (P < 0.05) in the 5-year survival rate could be seen, as expected.

The potential use of prostatic secretory protein of 94 amino acid residues (PSP94) as a serum marker for prostatic tumor.

The serum concentrations of prostatic secretory protein of 94 amino acid residues (PSP94) as well as those of prostate-specific antigen (PSA) were determined in 40 patients with established prostatic carcinoma, prior to transurethral resection of the prostate. In a comparison with a control group of healthy men (n = 40) and a group of patients with histologically established benign prostatic hyperplasia (n = 40) no significant differences in PSP94 serum concentrations between the groups were observed. Similarly, correlations of PSP94 serum concentrations with prostatic carcinoma stages or grades were not detected. In contrast, and as expected, PSA behaved as a prostate tumor marker of known sensitivity and specificity. A correlation of PSP94 and PSA concentrations in sera of patients with benign prostatic hyperplasia and/or prostatic carcinoma could not be verified. PSP94 apparently does not fulfill the criteria of a serum marker for monitoring adenomas and/or carcinomas of the prostate.

[Combination therapy with recombinant interferon alpha-21 (rIFN alpha 2a) and recombinant interleukin 2 (rIL-2) in metastatic renal cell cancer]. / Kombinationstherapie mit rekombinantem Interferon alpha-2a (rIFN alpha 2a) und rekombinantem Interleukin-2 (rIL-2) beim metastasierten Nierenzellkarzinom.

Sixteen patients with histologically-proven metastatic renal cell carcinoma (RCC) were treated after nephrectomy with a daily continuous 24-hour i.v. infusion of recombinant human interleukin-2 (rIL-2) at a dosage of 18 x 10(6) IU/m2 daily for 5 days per week and of recombinant interferon alpha-2a (rIFN-alpha 2a) 5 x 10(6) IU/m2 subcutaneously on days 2 and 4. The treatment cycles were repeated at 3-weekly intervals. Altogether 38 treatment cycles were given, but only 14/16 patients were evaluable for response rates. The main toxic side effects were fever, nausea, chills, anorexia, hypotension and hepatotoxic syndrome (Toxicity grades I-III, WHO). There were 3 objective responses among the 14 evaluable patients (21%); 2 patients have remained in complete remission for 12 and 8 months, respectively until now whilst 1 has shown a partial response for 21 months.

Clinical evaluation of a new prostate-specific antigen sandwich ELISA which employs four monoclonal antibodies directed at different epitopes of prostate-specific antigen.

A known radioimmunometric prostate-specific antigen (PSA) test based on monoclonal antibodies, as well as a new PSA-ELISA utilizing 4 monoclonal antibodies directed against different epitopes of PSA were compared in a clinical evaluation. For the investigation, collectives of patient sera from patients with independently diagnosed prostatic carcinoma (PCA) as well as benign prostatic hyperplasia (BPH) were employed. The results of the evaluation demonstrated that although the PSA immunoradiometric test and the PSA-ELISA yielded different numerical values for PSA serum concentrations, they possess comparable diagnostic sensitivities as well as specificities. The nonradioactive PSA-ELISA could therefore substitute the PSA-IRMA in a clinical routine diagnostic of PCA.

Combined treatment (goserelin plus flutamide) versus monotherapy (goserelin alone) in advanced prostate cancer: a randomized study.

This study compared goserelin monotherapy with goserelin plus flutamide in the treatment of stage C or D prostatic cancer. Patients were stratified according to whether distant metastases were present or absent. After a mean follow-up of 33 months, combined treatment with goserelin and flutamide produced a higher response rate and a more rapid normalization of abnormal levels of prostatic acid phosphatase and prostatic specific antigen than treatment with goserelin alone. A more prompt relief of bone pain was also evident. An advantage, though not statistically significant, in terms of progression and survival was demonstrated in the combination group when metastases were present before the start of treatment. In both groups, the median for progression as well as the PCA-related and nonrelated death was not achieved during the study period.

[Acute hemorrhagic cystitis following chlordimeform poisoning ]. / Akute hämorrhagische Zystitis nach Intoxikation mit Chlordimeform.

A 19-year-old and a 50-year-old man who together had cleaned a water-tank as part of their duties in a tank protection and cleaning firm developed that same evening lower abdominal pain, dysuria and haematuria. Cystoscopy revealed haemorrhagic cystitis in both patients, a finding confirmed by bladder mucosa biopsy. 4-chlor-2 methylaniline (concentration less than 1 mg/l) was found in hydrolysed serum of both. This metabolite of the pesticide chlordimeform was also found in the urine of the 51-year-old patient (16 mg/l). The haematuria regressed within two days of the patients having increased their fluid intake. Dysuria improved within a week. It is likely that chlordimeform had previously been transported in the water-tank. In case of haemorrhagic cystitis possibly caused by occupational or other poisoning, serum and urine should always be obtained for toxicological tests.

[Obstructive urine transport disorders of the upper urinary tract--pregnancy and iatrogenic lesions]. / Obstruktive Harntransportstörungen des oberen Harntraktes--Gravidität und iatrogene Läsionen.

The most important disturbances of pregnancy excluding the birth canal are complications due to diseases and alterations of the kidney and the urinary tract. The urinary transport disorders are of significant importance; frequency and clinical relevance and follow-up are presented. In the second part an overview to urinary tract disorders due to iatrogenic injuries is given.

[Spontaneous kidney transplant rupture--effect of immunosuppressive therapy on incidence of rupture]. / Die spontane Nierentransplantatruptur--Einfluss des immunsuppressiven Therapieregimes auf die Rupturfrequenz.

In an analysis of 302 cadaveric kidney transplantations performed from 1986 to 1988 the frequency of spontaneous kidney allograft ruptures could significantly reduced by introduction of cyclosporine therapy. Therefore, the importance of rejection in the etiology of allograft rupture is emphasized. In comparison with an earlier analysis the prognosis of rupture with respect to organ repair has been impaired (41 vs. 68%). The importance of intense and effective immunosuppressive therapy in the early period after kidney transplantation is emphasized.

[4-way immunosuppression in pre-sensitized recipients of allogenic cadaver kidney transplants]. / Vierfach-Immunsuppression bei präsensibilisierten Rezipienten allogener Leichennierentransplantate.

As a result of introduction of quadruple immunosuppression using cyclosporine, antithymocyte globulin, azathioprine and prednisone in immunological high-risk patients with a presensitization greater than or equal to 80% and/or multiple grafts the rate of immediate graft function could significantly increased, the frequency of rejection and graft rupture was reduced and the patient survival rate could improved to 100%. The problem of vascular rejection should resolved by a more aggressive biopsy approach.

Effect of increased donor age on kidney transplant outcome.

Donors over the age of 50 years provided kidneys for 28 of our 226 recipients (12.4%) transplanted from January 1, 1987 to December 31, 1988. Immediate function following transplantation occurred in 36% of the kidneys from donors both over and under the age of 50. The overall 3-month graft survival rate for transplants from donors over 50 years was 89%, compared with 78% for transplants from donors under 50 years (p greater than 0.05). Thus kidneys from well-selected older donors make an important contribution to the total pool of organs available for transplantation.

[Optimized follow-up after kidney pelvis-plasty using sonography and functional scintigraphy]. / Optimierte Verlaufskontrolle nach Nierenbeckenplastik durch Einsatz von Sonographie und Funktionsszintigraphie (FSG).

The results of the operative treatment in 33 patients suffering from pelviureteral obstruction and of the follow-up control using ultrasonography and renography are presented. A reduced radiation exposure and diminished treatment costs are the results of this changed diagnostic and therapeutic strategy.

[Personal experiences with kidney transplantation in the elderly]. / Unsere Erfahrungen mit der Nierentransplantation bei älteren Patienten.

From January 1987 to December 1988 226 cadaveric renal allotransplants were performed in the Kidney Transplant Center of the Friedrichshain Hospital. 38 of the recipients (17%) were older than 50 years. The results of transplantation are comparable with younger recipients, except a higher frequency of age-related urological complications of benign prostatic hyperplasia.