[Bilateral nephrectomy as a life saving procedure in a young woman with recurrent bacteremic shock]. / Obustronna nefrektomia jako zabieg ratujacy zycie u mlodej kobiety z nawracajacym wstrzasem bakteriemicznym.

On the basis of the recurrent bacteremic shock in young woman with bilateral reflux nephropathy and recurrent urinary tract infections (UTI) from early childhood we present diagnostic and therapeutic problems of complicated UTI. Negative results of localization diagnosis of UTI and clinical suspicious on renal microabscesses as a cause of recurrence bacteremic shock were the reason of bilateral nephrectomy--as a life saving procedure--and initiation of CAPD programme.

[Results of surgical treatment of adrenal gland tumors: own 15-year long experience]. / Wyniki chirurgicznego leczenia guzów nadnerczy--wlasne 15-letnie doswiadczenie.

In the present communication we present the results of surgical treatment of tumours of the adrenal glands, basing on the material from our clinical department. During 1983-1997 at the Department of Clinical Urology Central Clinical Hospital of the Military University School of Medicine (CSK WAM) 27 patients (15 men, 12 women) with tumors of the adrenal glands were treated. Among the operated patients 3 were diagnosed with Cushing's syndrome, 3 with pheochromocytoma, 1 with Cohn's syndrome, while in the remaining 20 the tumours were hormonally inactive. Surgical treatment included 15 right, 10 left and 2 bilateral adrenalectomies. There was no intraoperational mortality. In all patients with hypersecretion, the symptoms disappeared after adrenalectomy. The size of tumours ranged 4-20 cm. In 3 patients there appeared a need for broadening of the size of surgical intervention--2 splenectomies and 2 nephrectomies and 1 resection of pancreatic tail--all due to regional infiltrations with tumorous tissues. During surgery there occurred 2 cases of iatrogenic pleuric injury. Postoperative complications included 1 case of pneumonia and 1 case of wound infection. In case of unilateral tumours of the adrenal glands the best method for surgery appears to be the lateral (lumbal) resection and in case of large tumours and/or bilateral tumours the most convenient appears to be the anterior (transperitoneal) resection. The most applicable method for diagnosis of tumours of the adrenal glands appears to be CT and NMR.

[The results of treatment of chronic prostatitis on the background of anaerobic bacterial and fungal infections]. / Wyniki leczenia prostatitis chronica na tle zakazen bakteriami beztlenowymi i grzybami.

More than 25% of patients who declare indisposition of the urinary tract suffer from prostate infection. Progress in the medical treatment of this type of infection has been achieved largely due to the introduction of new sorts of antibiotics and development of modern diagnostic methods. The aim of the study is to determine the causes of prostate infections. A bacteriological examination of the prostate secretion in 28 patients after "per rectum" massage were conducted in the Urology Clinic of the Central Clinical Hospital of Military Academy in Warsaw from March 1995 to September 1997. All the patients had previously undergone medical treatment and long-term pharmacotherapy. A high percentage of fungal infections as well as the increased occurrence of Chlamydia trachomatis have been observed.

[Infra-red thermography testicular studies of patients with short spermatic cords and quality of sperm morphology]. / Badania moszny termografia w podczerwieni u pacjentów z krótkimi powrózkami nasiennymi a wartosci cech morfologii nasienia.

116 patients with too short spermatic cords were examined by infra-red thermography and semen analysis. Examinations of semen included number, mobility, viability and pathological forms of spermatozoa. The values of the thermographic index of scrotum were compared with the control parts of the body. The incidence of hyperthermia of scrotum in observed men was 79%. In analysis of semen there were 79% teratozo-ospermia, 73% oligozoospermia, 59% astenozoospermia and good viability in 70%. We suppose that hyperthermia of scrotum in infra-red thermography, oligoteratozoospermia in semen analysis and no progress in pharmacological treatment may be an excellent qualification method for surgical treatment of too short spermatic cords.

[Sperm cytology in azoospermia]. / Cytologiczna ocena nasienia w azoospermii.

UNLABELLED: 21 patients with azoospermia were examined by cytological techniques of semen. STUDY RESULTS: 4 specimens contained spermatogenesis cells, 1 specimen contained spermatozoons, 16 specimens did not contain round cells. Specimens with spermatozoons also included leucocytes. Appearance of leucocytes in semen points to a patency of semen tract. We suggest to examine semen by cytological techniques in azoospermia before testicular biopsy.

[Bone metastasis in patients with urogenital neoplasms]. / Przerzuty do kosci u chorych na nowotwory narzadów ukladu moczowo-plciowego.

The clinical data of 91 patients with bone metastases were reviewed. The renal cell carcinoma and prostatic carcinoma were diagnosed respectively in 53% and 47% of the patients. 48% of the patients had tumour size stage T3 and 71% had histopathological stage II (G2). 21% of the patients presented a bone pain. In patients with renal cell carcinoma, the level of serum bone alkaline phosphatase and erythrocyte sedimentation rate were correlated with the concentration of serum ferritin (respectively p = 0.008 and p = 0.055). The relationship between the histopathological grade (G) and the stage of tumour size (T), and the concentration of serum ferritin was noted. In patients with prostatic carcinoma, the relationship between general condition and the concentration of prostatic specific antigen (PSA) as well as the relationship between PSA and the intensity of bone pain were observed. Only relationship between the histopathological grade and the concentration of PSA had a statistical significance (p < 0.05).

[Wilms' tumor in a 22-year old woman during pregnancy]. / Guz Wilmsa u 22-letniej kobiety w ciazy.

A case of a 22-year patient with Wilms tumor is presented due to its rarity in adults. Moreover, the tumor coexisted with pregnancy making both diagnosis and therapy difficult. An intensive combined therapy (surgical, radio- and chemotherapy) has led to the complete and long-lasting remission.

[Epidemiology and risk factors in prostatic cancer]. / Epidemiologia i czynniki ryzyka w raku stercza.

The epidemiological data is presented on morbidity, mortality, and dependence of these indices on the age of the patient with prostatic cancer in Poland and in the world. The unquestionable risk factors included age and race, while the remaining risk factors for the development of this malignancy are presently the subject of controversy and are being studied further.

Transrectal hyperthermia as palliative treatment for advanced adenocarcinoma of prostate and studies of cell-mediated immunity.

During a fifteen-month period, 15 patients with progressive adenocarcinoma of the prostate (CaP) were treated with transrectal microwave hyperthermia (TRHT). There were 5 Stage T4 and 11 Stage T3 patients including 6 patients with skeletal metastases. Nine of the patients had severe and 6 had moderately severe signs and symptoms of CaP. TRHT was given six times at 2,450 MHz with temperature controlled at 43.5 degrees for thirty minutes. Cell-mediated immunity tests were performed before TRHT and at two, four, and six months post-therapy. The results of these tests were compared with those of 15 patients with benign prostatic hyperplasia (BPH) treated with the same TRHT and with 30 untreated normal volunteers. TRHT was well tolerated with mild acute toxicity noted in 3 patients (20%). Of the 15 patients treated, 2 (13%) showed scintigraphic evidence of regression of bone metastases. Five patients survived more than five years since treatment, and in 3 patients there was no evidence of CaP. A decrease of marked or moderate degree in signs and symptoms of CaP was noted in 8 patients (53%). The results of cell-mediated immunity tests were of interest. The 15 CaP patients prior to TRHT had lower OKT4/OKT8 ratio, lower PHA transformation index, and lower Con-A induced T-cell suppressor activity as compared with the 15 BPH patients and 30 healthy volunteers, who had normal immune parameters (p < 0.01). Following TRHT there was a significant increase in the monitored immune parameters noted in the 15 CaP patients (p < 0.01). This immune stimulation peaked at two months and gradually decreased to near pretreatment levels at six months. In the 15 BPH patients post-TRHT changes in immune tests were less apparent. The results of this small study, if confirmed, could be of clinical importance in patients with advanced prostate cancer.

[The role of clinical examination in early diagnosis of testicular malignancies]. / Rola badania klinicznego we wczesnym rozpoznawaniu nowotworów jadra.

Sixty-seven patients were subjected to a retrospective analysis, who had been referred to the Department of Urology with suspected testicular malignancy. In every patient history was taken carefully with special attention paid to lacking testicular descensus in the past, testicular enlargement, pain, symptoms related to metastases, duration of symptoms until the beginning of appropriate treatment, the type of treatment, they had obtained before admission to the department. It was found that the most common symptom was painless testicular enlargement (82% of patients). However, there was a very long time between noting of the change by the patient and the beginning of appropriate treatment (on the average about 7.8 months).

[Metastasis of penile cancer to the heart in a 20-year-old patient]. / Przerzut raka pracia do serca u 20-letniego chorego.

A case of penile cancer was observed in a 20-year-old patient with very extensive remote metastases. On autopsy metastases were found to the heart and brain which are exceptionally rare in penile cancer.

The prognostic value of prostate-specific antigen and prostatic acid phosphatase in serum of patients with prostate cancer after orchidectomy.

Correlations between the serum levels of PAP and PSA before and 1, 3 and 6 months after orchidectomy in 27 prostatic cancer patients (advanced clinical stages C and D according to Whitemore scale) were studied. The PSA values correlated more distinctly than PAP with the general clinical condition. PSA is a reliable tumour marker when used at regular intervals, especially for monitoring therapeutic results. A high preoperative PSA level correlates with a high postoperative level and progression of the disease.

Effects of local prostatic hyperthermia on human NK and T cell function.

Studies on lymphocyte subsets, mitogen transformation and NK cytotoxicity of blood mononuclear cells (BMNC) were performed in 30 patients who received transrectal microwave hyperthermia (TRHT) of the prostate. Of the 30 patients, 15 had advanced adenocarcinoma of the prostate (CAP) and 15 had severely symptomatic benign prostatic hyperplasia (BPH). Local TRHT was given twice a week for a total of six sessions. The treatments were administered at 2450 MHz or 434 MHz using a water-cooled rectal applicator. Each TRHT session lasted for 30 min at steady-state temperature controlled on the rectal mucosa at 45 degrees C. Studies of immune reactions were performed before TRHT, at the completion of six TRHT sessions, and at 1, 2, 4, and 6 months from therapy. Identical studies at the same time-interval were performed in 30 healthy male volunteers. In the 15 CAP patients the results of the immune studies obtained before TRHT, including CD4+/CD8+ ratio, PHA and Con-A transformation indices were significantly lower (p less than 0.01) than in the 15 BPH patients and in the 30 normal volunteers. The 15 BPH patients and the 30 normal volunteers all had immune parameters within the normal limits. Following the administration of TRHT in the 15 CAP patients, a transient significant (p less than 0.01) stimulation of the tested cell-mediated immune parameters was observed when compared with the pretreatment values. The peak effect of this stimulation was noted at 2 months with a subsequent decrease. In the 15 BPH patients a lesser degree of immune stimulation was noted. As expected there was no substantial change in the measured cell-mediated immune parameters in the 30 normal volunteers. A significant increase of NK cytotoxic activity was noted following TRHT in CAP patients when compared with the pretreatment results. This activity reached 120-130% of the individual initial values, being significant at p less than 0.01. The finding of transient stimulation of cell-mediated immune reaction, following local hyperthermia in patients with CAP, may be of some clinical relevance and of clinical importance. Additional studies are being formulated to confirm these interesting findings.

A comparison of transurethral and transrectal microwave hyperthermia in poor surgical risk benign prostatic hyperplasia patients.

From 1987 to 1989, 36 poor surgical risk patients with benign prostatic hyperplasia (BPH) were treated with transrectal or transurethral microwave hyperthermia. Most of the 36 patients treated (85%) had severe signs and symptoms of urinary outflow obstruction. Of the patients 22 (61%) underwent transrectal and 14 (39%) underwent transurethral hyperthermia. Followup ranged from 10 to 28 months (mean 19 months) for the transrectal hyperthermia group and 7 to 16 months (mean 10 months) for the transurethral hyperthermia group. The patients were given 6 hyperthermia sessions of 30 minutes each with the temperature controlled on the rectal or urethral surface at 45C. Hyperthermia was well tolerated with mild acute toxicity and no late complications were observed. In the important subjective and objective parameters, major improvement was noted more frequently in the 14 transurethral than in the 22 transrectal hyperthermia treated patients (p less than 0.05). The Food and Drug Administration severity score, prostate volume, post-voiding residual volume and urethral flow showed substantial improvement in 79, 86, 79 and 79%, respectively, of the 14 transurethral hyperthermia treated patients compared to 41, 45, 82 and 82%, respectively, for the 22 transrectal hyperthermia treated patients. A prospective randomized trial comparing transrectal and transurethral hyperthermia is required to define the role of each treatment mode in patients with BPH.

Local microwave hyperthermia in treatment of advanced prostatic adenocarcinoma.

Fifteen patients with advanced (T3-4, Nx-2, M0-1) prostatic adenocarcinoma were treated with local microwave hyperthermia (LMwH) applied as the sole method of therapy (automatically controlled set generating 2,450 MHz microwaves with intrarectal applicator). All patients were monitored with a battery of tests, including USG image and volumetry of prostate, bone scintigraphy, serum alkaline phosphatase and serum level of PAP. LMwH sessions were well tolerated and did not cause pain except a moderate sensation of heating in the pelvic region. 8 of these 15 patients responded to the therapy (3x complete remission and 5x partial remission). Involution of the prostatic tumor in responders was accompanied by improvement of the general clinical and urological state. In two responders bone metastases, documented scintigraphically before therapy, disappeared. 7 patients did not respond to LMwH, mostly patients with very large primary tumors.