Assessment of Micral-Test microalbuminuria test strip in the laboratory and in diabetic outpatients.

We have evaluated a semi-quantitative dry immunochemical screening method (Micral-Test) for the detection of low concentrations of albumin in urine. The stability of Micral-Test strips on storage was good, especially with regard to temperature, light and humidity. Changes in urine osmolality (urea and creatinine concentration), pH and sodium and potassium concentration did not have a significant analytical effect on the Micral-Test measurement; extremes of temperature altered the rate of colour development. The depth of dipping the strip into the sample and the timing of reading colour development were critical. We measured the albumin concentration in 184 urine samples from diabetic outpatients by the Micral-Test and by our in-house immunoturbidimetric method; a Micral-Test result of 20 mg/L had a sensitivity of 91% and specificity of 97% to predict a discriminating urine albumin concentration greater than 30 mg/L by the in house method. The Micral-Test is suitable for use by non-laboratory personnel and is capable of producing analytically acceptable results for use in diabetes clinics and by general practitioners.

Ureteronephroscopic marsupialization of obstructing peripelvic renal cyst.

Flexible ureteronephroscopy has been used for numerous therapeutic applications in the upper urinary tract. We report a case of a large peripelvic renal cyst causing obstruction to the ureteropelvic junction, which was treated by incising the wall of the cyst into the renal pelvis with the ureteronephroscope.

Sonographic and pathological staging of patients with clinically localized prostate cancer.

We evaluated 64 patients with clinically localized prostate cancer (on the basis of rectal examination, serum acid phosphatase, bone scan and pelvic computerized tomography scan) by transrectal sonography before radical prostatectomy. Of the 48 patients with histologically proved localized prostate cancer sonography overstaged the disease in 5 (10%) and correctly staged it in 43 (90%). All overstaged cancer patients were scanned after either prostatic biopsy (4) or transurethral prostatectomy (1) established the diagnosis of prostate cancer. Of the 16 patients with histologically proved, locally advanced prostate cancer (that is extracapsular extension and/or seminal vesicle invasion) sonography understaged the disease in 10 (62%) and correctly staged the disease in 6 (38%). These data suggest that sonography is associated with considerable staging errors when used to evaluate men with clinically localized prostate cancer.

Mechanisms of action of intravesical bacillus Calmette-Guerin for bladder cancer.

Though superficial bladder-cancer patients have been treated with intravesical BCG since 1976, the mechanisms of action remain unknown. Evidence points towards an immune mechanism of BCG-induced antitumor activity. Although specific antitumor immunity may play a role in BCG immunotherapy, additional work is needed to more clearly define this possibility. Several investigators have noted a clinical association between favorable response to BCG therapy and a systemic response (DTH) to BCG antigen, indicated by conversion to a positive purified protein derivative (PPD) skin test. Additional animal studies have, in turn, documented evidence of specific binding between BCG and fibronectin found in the urothelial basement membrane, which appears necessary for the development of both the DTH response and antitumor activity. Other studies have suggested which cellular components of the immune system and lymphokines may be involved in the antitumor response. Further work will be needed to better understand BCG mechanisms, as these findings may be important to other forms of cancer therapy. Questions of immune suppression, genetic influence on the immune response, and immunocompetence at the time of surgery may assume increasing importance. A strong effort will therefore be needed to better understand these mechanisms so that patients may be selected, treated, and followed in a more effective manner.