A retrospective study of 315 patients with superficial transitional cell carcinoma (stages Ta to T2) and an adequate followup of 3 years or longer is reported. Transurethral resection was done in 80 per cent of the patients and open excision or resection was done in 20 per cent for cure or control. We herein demonstrate that, in addition to grade and stage, multifocal tumor growth and whether the tumor is primary or recurrent influence the frequency of recurrences and tumor progression. The over-all recurrence rate after resection of stages Ta, T1 and T2 tumors within 3 years was 60 per cent. Recurrences after a primary tumor were noted in 45 per cent of the patients and were followed by a second recurrence in 84 per cent, with solitary tumors occurring in 46 and multifocal tumors in 73 per cent. Tumor progression was observed in 24 per cent of patients with solitary tumors, 44 per cent of those with multifocal tumors, 20 to 25 per cent of those with primary and recurrent stage Ta and primary stage T1 tumors, and 56 per cent of those with recurrent stage T1 tumors. Therefore, when therapy is planned stage, grade, multifocal tumor growth and whether the tumor is primary or recurrent should be considered. Stage Ta tumors can be treated sufficiently by transurethral resection even in the case of several recurrences. More aggressive therapy should be considered when multifocal or recurrent stage T1 or T2 tumors recur as invasive carcinomas.
Since 1979 a prospective randomized trial was done to examine the efficacy of intravesical doxorubicin as prophylaxis against recurrence. After complete transurethral resection of the tumor, patients were divided into 3 groups at random: group 1-no further treatment after transurethral resection, group 2-doxorubicin twice weekly for 6 weeks and group 3-doxorubicin for 1 year. A total of 268 patients entered the study. Neither frequency of recurrences, tumor progression nor survival rate was improved significantly by the adjuvant treatment, so that only a limited number of patients will profit by instillation therapy. Analysis of previously reported data suggests that patients with superficial bladder tumors can be stratified into groups with appreciable differences in risk of progression. With regard to these results a differentiated use of a "wait and see" adjuvant intravesical therapy and more aggressive treatment after transurethral resection of superficial bladder tumors seems to be indicated rather than a general practice of chemoprophylaxis.
The mechanical activity of isolated strips from different areas of the pyeloureteral system was investigated in 10 pigs: calyx, renal pelvis, pyeloureteral junction and ureter. Additionally, electrical activity was measured in some pyeloureteral preparations using the sucrose-gap technique. Regular spontaneous activity with an average frequency of 9.5/min was recorded in calyceal strips, decreasing to 5.4/min in renal pelvis, 5.7/min in pyeloureteral preparations and to 1.2/min in ureteral preparations. The activity of renal pelvis, pyeloureteral and ureteral preparations was less regular, and bursts of fast activity (near 10/min) could be observed in all these preparations. The membrane potential of pyeloureteral strips showed spontaneous generator oscillations of about 10/min. Variations in the pattern of ureteral peristalsis are due to different coupling ratios of membrane potential oscillations to contractions. Adrenaline (10––5 mol/l) increased the frequency of the oscillations and enhanced their manifestation in the mechanical recordings, whereas tetraethylammonium (5–20 mmol/l) only increased the coupling ratio. The following concept for the generation of ureteral peristalsis in multicalyceal kidneys is developed: several (primary) oscillators exist in the calyces; in the pyeloureteral junction a (secondary) pacemaker exists which has an intrinsic frequency similar to that of the calyceal pacemakers; both processes cooperate in the generation of ureteral peristalsis.
The positive outcome of these animal experiments suggests this system would be useful for human bladder substitution. Standardized industrial production of the prostheses will be needed prior to implantation in humans.
During a 4-year period 9 cases of severe recurrent cystine stones and cystinuria were treated with mercaptopropionylglycine. The oral long-term administration revealed the high effectiveness of the drug and resulted in no further stone formation. Mercaptopropionylglycine is free of side effects and more effective than D-penicillamine.
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