Biomedical subjects
Publications and source records attributed to C Bollack.
We report a typical case of traumatic ruptured hydronephrosis (moderate trauma, unknown hydronephrosis). Conservative treatment with pyeloplasty appears to be the best solution in these cases when as is frequently the case the major lesions affect the renal pelvis.
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Stimulation of progesterone receptors synthesis by Tamoxifen was tried in 19 patients with renal cell carcinoma. No difference was found between this series and 51 controls.
Patients with newly diagnosed prostatic cancer should be investigated with regard to the presence or absence of distant metastases by (1) Taking a history especially of weight loss and recent onset backache (2) Examining them, looking especially for hepatic enlargement or peripheral lymph nodes (3) Performance status (4) Hemoglobin, Bilirubin, Liver enzymes, Alkaline and Acid phosphatase (5) Chest Xray. (6) Bone scan with specific Xrays directed at hot spots. (7) Ultrasound scan of liver if liver function tests are abnormal. Ultrasound scan of lymph nodes and kidneys is optional. (8) Any other tests indicated in special circumstances. Follow-up, 3-monthly as a rule, should include (1) The presence of pain and analgesic requirements (2) Weight (3) Performance status (4) Hemoglobin, Alkaline phosphatase, Acid phosphatase (5) Chest Xray, three monthly if abnormal. Annually otherwise. (6) Bone scan with Xray of new hot spots, 6-monthly. If there is doubt about the presence of a new hot spot, repeat the bone scan and Xray at 3 months.
We present a case of genital self emasculation in a non-psychotic patient. We discuss here the few problems (surgical, psychiatric, legal and sociologic) that this rare case suggest.
The results of treatment of metastatic renal cell carcinoma have so far been very poor. Many phase II studies have shown that interferon alpha therapy is active in a significant proportion of patients (approximately 10 to 15% complete and partial remission). In the hope of improving these results we have conducted a phase I-II study of the combination of interferon alpha-2a and vinblastine in 21 patients with metastatic renal cell cancer. Side-effects were pronounced and the mean tolerated doses were 12.5 x 10(6) U/m2 interferon alpha three times per week and 0.10 mg/kg vinblastine once every three weeks. We observed a 43% response rate, with 1 complete remission, 8 partial remissions, 4 stabilizations and 8 progressions. These very encouraging results need to be confirmed by large scale studies.
It has been shown previously that secondary structural changes of bPTH-(1-34) (synthetic amino-terminal (1-34) fragment of bovine parathyroid hormone), obtained by oxidation of the methionines 8 and 18, abolished its hypotensive but not its hypercalcemic action. Hence, it has been postulated that the various physiological effects of the hormone are mediated by different receptors that require different regions or configurations of the peptide. To further examine this hypothesis the relative sensitivity of the PTH-responsive adenylate cyclase of microvessels and tubules isolated from rabbit kidney cortex, to oxidized PTH and PTH inhibitors, was examined. In the presence of GTP, bPTH-(1-34) stimulated both microvessel and tubule adenylate cyclase in a dose-dependent fashion and with analogous affinities (ED50 = 52 nM in the microvessels and 85 nM in the tubules). Hydrogen peroxide treatment of bPTH-(1-34) resulted in the loss of the adenylate cyclase stimulating potency in the microvessels while there was substantial enzyme activation (ED50 = 900 nM) in the tubules. Oxidized PTH inhibited the untreated PTH-stimulated adenylate cyclase, suggesting that oxidized PTH still retains an affinity for vascular receptor sites. Similar treatment of the sulfur-free PTH analog [Nle8,18, Tyr34]bPTH-(1-34)NH2, where methionines have been replaced by norleucine, had little or no effect in both fractions. In the microvessels the synthetic PTH antagonist analogs [Nle8,18, Tyr34]bPTH-(3-34)NH2 and [Tyr34]bPTH-(7-34)NH2, strongly inhibited the adenylate cyclase responses to bPTH-(1-34). No inhibition was seen in the tubules with the same molar ratios of inhibitor to native PTH. Together, these results suggest strongly that the differences in the adenylate cyclase response to various PTH fragments most likely represent a difference in the structural requirements for PTH actions between microvessels and tubules.
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In a phase-II study of the EORTC GU Group 34 patients with metastatic renal cell carcinoma were treated by angioinfarction and delayed nephrectomy. The mortality of the procedure was 5.8%. One patient had a complete remission. 80% of the patients showed progression within 6 months after nephrectomy. The median survival of the patients was 25 weeks, 65% of the patients died within 1 year after nephrectomy.
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Usual treatments of metastatic renal cell carcinoma are not efficient. Phase II trials using Interferon alpha showed a low response rate (10 to 15%). We have conducted a phase I-II trial using a combination of Vinblastine and Recombinant alpha 2 A Interferon in 21 patients. The response rate is of 43% including 1 complete and 8 partial remissions, 5 stabilizations and 8 progressive diseases. In spite of important side effects, these results are promising.
Injection of solutions of E. coli leads to vesiculitis which regresses spontaneously, and to interstitial prostatitis. Castration preceding experimental injection of a bacterial solution modifies the progression of the vesiculitis which then becomes chronic. Infection does not seem to diffuse via the lympathic system, even after castration.
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Treatment with V.1326 in the rat induces an increase in prostatic secretion. In men with insufficient prostatic secretion, this treatment also induces an increased secretion.
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