Victor Fray Marshall: twentieth century renaissance urologist.

PURPOSE: Victor Fray Marshall (1913 to 2001) contributed to advancements in a variety of fields within urology, including incontinence, oncology, stone disease and pediatrics. MATERIALS AND METHODS: We reviewed historical records from the New York Hospital archives as well as the original publications of Marshall. Personal experiences of former residents and others were recounted. RESULTS: While Marshall may be most recognized for Marshall-Marchetti-Krantz vesicourethral suspension, designed to correct stress urinary incontinence, he was among the earliest advocates of surgical extirpation for bladder cancer and helped introduce the use of urinary cytology for the diagnosis of urothelial malignancy. At the same time Marshall contributed to the development of ureteroscopy for stone disease. His contributions to pediatric urology include the description of a nonrefluxing ureteral re-implantation technique for the surgical correction of reflux as well as his investigation of the embryology and surgical repair of bladder exstrophy. CONCLUSIONS: The contributions of Victor Marshall to urology are notable in breadth and significance.

Five-alpha-reductase expression in benign and malignant urothelium: correlation with disease characteristics and outcome.

OBJECTIVES: To evaluate 5-alpha-reductase (5alphaR) expression in benign and malignant urothelium and to assess the relationship between 5alphaR expression and tumor stage, tumor grade, and clinical outcome in patients with urothelial carcinoma/transitional cell carcinoma. METHODS: We performed immunohistochemistry for 5alphaR on 53 urothelial specimens from 36 patients with transitional cell carcinoma treated at our institution between June 2002 and July 2003. For each tumor and the adjacent nontumor urothelium, a semiquantitative staining score was calculated. We used t tests and analysis of variance to compare the staining score across groups. Kaplan-Meier and logistic regression analyses were performed to assess the relationship between 5alphaR expression and clinical outcome. RESULTS: 5alphaR was expressed throughout the non-neoplastic urothelium. Nontumor urothelium had greater mean staining scores than did tumor specimens (160.1 versus 105.5, P <0.01). Low staining scores were associated with high grade (P <0.05), Stage pT3, pT4, and pTis (P <0.05), and disease progression (P <0.05). A staining score less than the median was a risk factor for progression (odds ratio 6.2, P <0.01) on univariate regression analysis. Patients with a staining score less than the median had a greater likelihood of disease progression (log-rank P <0.05) and cause-specific mortality (log-rank P <0.05). CONCLUSIONS: We demonstrated 5alphaR expression in human urothelium and found that expression is decreased in transitional cell carcinoma in relation to tumor grade and stage. Decreased 5alphaR expression was associated with disease progression and cause-specific mortality.

Neutron detection via bubble chambers.

Research investigating the application of pressure-cycled bubble chambers to fast neutron detection is described. Experiments with a Halon-filled chamber showed clear sensitivity to an AmBe neutron source and insensitivity to a (137)Cs gamma source. Bubble formation was documented using high-speed photography, and a ceramic piezo-electric transducer element registered the acoustic signature of bubble formation. In a second set of experiments, the bubble nucleation response of a Freon-134a chamber to an AmBe neutron source was documented with high-speed photography.

The nonsteroidal effects of diethylstilbestrol: the rationale for androgen deprivation therapy without estrogen deprivation in the treatment of prostate cancer.

PURPOSE: During the last 2 decades there has been an increase in the number of men with prostate cancer placed on luteinizing hormone releasing hormone (LH-RH) agonist therapy. In addition, the duration of individual therapy has extended from what was once only a few months to, in many cases, several years. As a result there has been an increase in the incidence of side effects, including osteoporosis, decreased cognitive abilities, vascular stiffness and fatigue. We explored the use of estrogen in the form of diethylstilbestrol (DES) as an alternative treatment for men with prostate cancer, and introduce the concept of androgen deprivation without estrogen deprivation. In doing so we hope to elucidate some of the nonhormonal nonsteroidal effects of DES. Furthermore, we hope to define the mechanisms by which DES can be useful when LH-RH agonist therapy or orchiectomy has failed. MATERIALS AND METHODS: We comprehensively reviewed the literature from 1935 to the present regarding estrogen and antiandrogen therapy. Our search focused on issues pertaining to side effects, efficacy and nonsteroidal effects of antiandrogens and estrogens. RESULTS: It is readily apparent from the literature that androgen deprivation with DES can achieve effective prostate cancer control with demonstrable benefits compared to conventional LH-RH agonist therapy. In particular, rates of bone resorption and osteoporosis are less with the use of estrogen therapies. Estrogen has a clear beneficial effect on cognitive function. The estrogen metabolite 2-methoxyestradiol has significant antiangiogenic and pro-apoptotic effects. These effects give estrogens an added anticancer effect not otherwise seen in conventional LH-RH agonist therapy. CONCLUSIONS: The efficacy of 1 mg DES extends well beyond its androgen suppressive effects. Androgen deprivation without estrogen deprivation is a concept that deserves further attention in the urological community.