Immediate dual energy X-ray absorptiometry reveals a high incidence of osteoporosis in patients with advanced prostate cancer before hormonal manipulation.

OBJECTIVE: To examine the incidence of osteoporosis in patients with advanced prostate cancer (using forearm densitometry) before commencing androgen deprivation therapy (ADT), as osteoporotic fractures are more frequent in patients with prostate cancer who have undergone either medical or surgical castration, because of rapid loss of bone mass. PATIENTS AND METHODS: In all, 174 patients (mean age 74.6 years, range 46-90) with advanced prostate cancer presented over 2 years. Their forearm bone densitometry values were compared with those from 106 age-matched controls (mean age 74.3 years, range 66-90). RESULTS: Of the 174 patients, 73 (42%) were osteoporotic (t score

Measurement of oxygen concentration in delivery systems used for hyperbaric oxygen therapy.

Efficient delivery of oxygen is important during hyperbaric oxygen therapy. We compared two systems in common use, and developed a method to ensure that O2 delivery was adequate during treatment. The systems were a demand valve system with an oral-nasal mask, and a continuously ventilated hood. Five groups were studied over two different time periods, and a further trial was undertaken to examine exhaled O2 levels. The results showed that an acceptable Fio2 could be reliably achieved only with the continuously ventilated hood system or when trained staff supervised their colleagues using the demand system. Inasmuch as the oral-nasal mask system is the standard equipment for the North Sea diving industry, this work shows the importance of ensuring that the correct dose of O2 is delivered. The study indicates, however, that identification of the problem does not always allow a complete solution, and that a hood-based system is more reliable.

Occupational x-ray exposure of anaesthetists.

Lithium fluoride thermoluminescent dosimeter chips were used to measure the radiation dose received by anaesthetists caused by the use of image intensification during a typical 4-week period in an orthopaedic theatre. These were used to estimate an annual dose, for comparison with dose limits, to ascertain if anaesthetists should be included in personnel monitoring services. Doses proved to be below detectable limits; hence anaesthetists are at minimal risk from occupational exposure to radiation. The orthopaedic theatre is believed to use more x-rays than other theatres, so exposure elsewhere should also be undetectable.

Levels of circulating intercellular adhesion molecule-1 in patients with metastatic cancer of the prostate and benign prostatic hyperplasia.

Current reports suggest a role for intercellular adhesion molecule-1 (ICAM-1) in the progression of malignancy. The availability of a new antibody makes it possible to measure circulating ICAM-1 (cICAM-1) in human body fluids including serum; this might help in monitoring tumour burden and in providing additional prognostic information. In this study, serum levels of cICAM-1 were measured by an ELISA assay in patients with benign prostatic hyperplasia (BPH; n = 20) and metastatic cancer of the prostate (CaP; n = 25). Serum ICAM-1 concentrations were also measured in a group of healthy men (n = 8). The mean +/- S.E.M. cICAM-1 level for BPH was 339.52 +/- 15.30 ng/ml compared with 263.55 +/- 18.54 ng/ml for CaP. Even though the difference between the two groups was significant (P < 0.005), there was a marked overlap between the individual values in both groups, thus minimising the prognostic value of these measurements in prostate cancer. Endocrine therapy had no notable effect on the serum levels of cICAM-1. The mean +/- S.E.M. cICAM-1 concentrations in serum from a younger group of healthy volunteers was 204.1 +/- 10.38 ng/ml, and this value was significantly lower than that measured in serum from either BPH or CaP. We also undertook some immunohistochemical studies to examine the distribution of ICAM-1 in prostate tissue. We observed focal epithelial cell membrane staining which was exceedingly patchy in both the BPH and cancer specimens. On the basis of these studies, we suggest that cICAM-1 levels do not provide additional information on patients with metastatic CaP.

Retinoblastoma and p53 genes as prognostic indicators in urological oncology.

Recent studies of the malignant phenotype have suggested that cumulative genetic changes are necessary for a malignant cell to develop. Alterations in particular genes associated with cell growth and division have been identified and two main classes of genes have been characterized. Oncogenes are those genes which when mutated promote tumour growth, whereas tumour suppressor genes (antioncogenes) inhibit tumour growth. Oncogenes have been investigated in some depth, but relatively little is known about tumour suppressor genes. Recent studies have shown that inactivation of normal tumour suppressor genes is a common mechanism in cancer progression and this may be of prognostic value. The present review focuses on the potential of tumour suppressor genes as prognostic markers in urological cancers.

A cooling jacket to reduce renal damage during transplantation.

There is evidence that warming of the cadaver kidney during transplantation is deleterious to its subsequent function. A simple cooling jacket to delay kidney warming during implantation is described. A controlled study of the temperature rise in 5 porcine kidneys exposed to body temperature showed significant reductions in renal core and cortical temperatures at 60 min from above 30 degrees C to below 13 degrees C when using the jacket. Advantages of this device in practice and some practical points in its use are discussed.

Vascular surgical audit-arterial reconstructions and amputations for lower limb ischaemia.

There were 750 arterial reconstructions and 2134 major amputations in hospitals within the South West Regional Health Authority (SWRHA) from 1974-1978, according to a Hospital Activity Analysis (HAA) based survey of all patients undergoing these operations for atherosclerotic limb ischaemia. Those undergoing arterial reconstruction fared better than amputees in terms of hospital mortality (5.2% vs. 21%) and length of hospital stay (21.4 days vs. 47 days). Comparison of the HAA results with case records and operating theatre books at Bristol Royal Infirmary showed a failure-of-inclusion rate of 10% for arterial reconstructions and 9.3% for amputations. There was a difference in the proportion of arterial reconstructions to major amputations (2.5:1) at Bristol Royal Infirmary compared with SWRHA hospitals (1:3), but hospital stay and operative mortality were similar.