Tumor enzymes and prognosis in transitional cell carcinoma of the bladder: prediction of risk of progression in patients with superficial disease.

The activities of 6 enzymes of carbohydrate metabolism were estimated in superficial transitional cell carcinomas from 103 patients undergoing transurethral resection of the bladder for the first time. The patients were followed by quarterly endoscopic examinations for a maximum of 81 months (median 33 months). During followup 24 patients had progressive disease. The activities of phosphofructokinase and phosphohexose isomerase were significantly lower in tumors from patients whose disease had superficially invaded the lamina propria (stage pT1) than in others in whom it was confined to the bladder mucosa (stage pTa). Similarly the activities of the 2 enzymes were significantly higher in well differentiated (grade 1) than in moderately well differentiated (grade 2) carcinomas. Univariate analyses using the log rank test showed that neither pathological stage nor malignancy grade of the carcinoma was a significant factor in predicting the risk of progression. Of the 6 enzymes, below median activities of phosphofructokinase, lactate dehydrogenase and phosphohexose isomerase were associated with a significantly increased risk of progression in these patients. Multivariate analyses using Cox's proportional hazards model showed that the activity of lactic dehydrogenase in superficial transitional cell carcinoma is an independent prognostic factor in predicting the risk of progression. It is postulated that the measurements of the activities of the 3 enzymes in tumors from patients with superficial transitional cell carcinoma might help to select individual patients with a high risk of progression for adjuvant intravesical treatments.

Ten cases of transitional cell carcinoma of bladder causing ureteric obstruction.

A review was carried out on 10 patients with superficial transitional cell carcinoma of the bladder (Ta lesions) that were causing ureteric obstruction. Evidence of upper tract obstruction did not necessarily indicate deep invasion.

Enzyme studies in human transitional cell carcinoma of the urinary bladder.

The activities of six enzymes of carbohydrate metabolism were estimated in tissue samples from 99 patients with transitional cell carcinoma of the urinary bladder undergoing transurethral resection. The results were analysed according to the stage of the disease and the malignancy grade of the carcinoma. There were statistically significant differences in the activities of three enzymes between various stages and grades. The activities of phosphofructokinase (PFK), alpha-glycerolphosphate dehydrogenase (alpha-GPDH), and phosphohexose isomerase (PHI) showed significant decreases with increased stage and grade. Of the total of 64 patients with superficial disease at presentation, five developed progressive disease during the course of this investigation. The activities of the three enzymes in these patients were compared to the median values for the group of patients with superficial disease. The activity of PFK was observed to be below the median value in all the five patients whereas the activities of alpha-GPDH and PHI showed similar patterns in four of the five patients. These preliminary data indicate that, in association with established clinical parameters, the measurement of the activity of these three enzymes may prove useful in selecting patients with an increased potential for developing progressive disease.

Divergent effects of interferons on the growth of human benign prostatic hyperplasia cells in primary culture.

Epithelial cells from human benign prostatic hyperplasia tissues were grown in primary cultures for up to 21 days and the effects of interferons on the growth of the cells were investigated. Interferon-alpha (Wellferon) showed growth inhibition both in the presence and in the absence of 3 x 10(-10)M testosterone propionate (TP) whereas interferon-gamma stimulated growth in a dose dependent manner under similar conditions. Interferon-beta had little effect on growth at the dose levels used in the study. The growth inhibition by interferon-alpha can be induced after stimulation of growth is achieved either with TP or with interferon-gamma. Implications of these findings for clinical use of these lymphokines is discussed.

A new technique for the management of urethral injuries.

A new technique for the management of urethral trauma is described. Initial suprapubic catheterisation is followed by endoscopic assessment after approximately 2 weeks. Realignment over a splinting catheter may then be achieved by instrumentation and endoscopy via both suprapubic and urethral routes. The development of the technique and the early results of a small series of patients are presented.

Appendicitis presenting with painless hematuria.

Microscopic hematuria is a well recognized, incidental finding in many patients presenting with acute appendicitis. We report a case of gross, painless hematuria as the late and only presenting feature of appendicitis.

An assessment of computerised isotopic renal section scanning.

The basic non-invasive investigation of renal space occupying lesions by excretion pyelography was coupled with ultrasonic scanning. Forty-one patients who have undergone isotopic section scanning as part of their investigative assessment were studied. The conditions investigated included solitary cysts, polycystic kidneys, renal tumours, tumefactive xanthomatous pyelonephritis, renal infarct and non-functioning kidneys. An analysis of the accuracy of isotopic section scanning in these different pathological states was made. Computerised isotopic section renal scanning offers a new non-invasive renal investigative technique.

Hyperthermia in the treatment of bladder tumours.

High temperature bladder irrigation was employed in 4 men as an alternative to cystectomy because of their age and frailty. Hyperthermic irrigation of the bladder from 63 degree C for 70 minutes to 82 degree C for 25 minutes caused partial, but not total, necrosis of the bladder. Transitional cell carcinoma appears to be resistant in vivo, in some cases, to heating at temperatures that destroy adjacent normal structures. Hyperthermic irrigation of the bladder at these high temperatures may be hazardous. In view of these findings we cannot recommend high temperature bladder irrigation as an alternative to cystectomy even in poor risk patients.