Biomedical subjects
Publications and source records attributed to Imre Romics.
We report a case of bilateral renal cell carcinoma in a horseshoe kidney. To the best of our knowledge this is the second reported case in the international literature. We performed different radiological examinations preoperatively to identify of blood supply, because correct preoperative location of vessels is mandatory.
PURPOSE: In this prospective study we evaluate the effect of combined transurethral resection of early muscle invasive bladder cancer and immunotherapy with bacillus Calmette-Guerin (BCG) in patients unfit for radical cystectomy or refusing more aggressive therapies. MATERIALS AND METHODS: A total of 22 patients with a mean age 73.6 years were included in the study. Inclusion criteria were histologically proven muscle invasive transitional cell carcinoma of the bladder with a tumor-free second resection and negative staging examinations in patients unfit for radical cystectomy or refusing more aggressive therapies. All patients received 6 weekly instillations of 120 mg. BCG starting 14 to 21 days after the last transurethral resection of the tumor. Followup at 3 months included cystoscopy, urinary cytology, ultrasound of the abdomen and chest x-ray. Every 6 months computerized tomography of the abdomen and bone scans were performed. RESULTS: The overall 5-year survival rate was 69.1%, while the disease specific 5-year survival rate was 94%. One muscle invasive recurrence was noted at 69 months, which was again treated with the same regimen but ultimately led to radical cystectomy 21 months later. One patient died of progressive recurrence in the upper urinary tract. The 5-year recurrence-free survival rate was 46.5%. The only severe complication was BCG pneumonitis. CONCLUSIONS: The data show encouraging results for transurethral resection of bladder tumor with intravesical BCG therapy in select patients with T2a bladder cancer who are not candidates for radical cystectomy.
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INTRODUCTION: The treatment of prostate cancer is still controversial. One of the most common treatment form is the use of LHRH analogs, but its way of action is still not cleared enough. AIMS: The aim of this study was to determine the predictive value of some histological and immuno-histochemical parameters based on repeated biopsies taken from prostate carcinoma patients. PATIENTS/METHOD: At the time of diagnosis by needle biopsy the TNM stage, serum PSA level, Gleason's grade, apoptotic and mitotic index, as well as Ki67, p53 and bcl2 expression were investigated in 60 prostate carcinoma patients. Anti-androgen therapy supplemented with surgical or chemical castration (with LHRH analogs) was administered. Serum PSA-test and needle biopsy were repeated 13-14 weeks after starting the therapy, simultaneously with determination of the apoptotic and mitotic index, Ki67, p53 and bcl2 expression. RESULTS: Forty-seven patients were alive at the end of the study (average 23.46 +/- 8.6 months) and thirteen patients died (average 25.3 +/- 14.8 months). Initial TNM stage and Gleason's score proved to be of prognostic value. Decrease in mitotic index and increase in apoptotic index during therapy proved to predict favourable long-term response to androgen ablation therapy. Similarly, lower Ki67 and (mutant) p53 expression in the first and also in the second biopsy pointed to a favourable effect of antiandrogen and especially of LHRH analog treatment. Since the ratio between Ki67 percentage and apoptotic index strongly decreased in the survivors upon therapy, changes in Ki67/apoptosis ratio may be recommended as a histologically detectable predictive factor. However, bcl2 expression did not show significant correlation with the outcome of the disease. CONCLUSION: Histological evaluation of parameters such as mitotic and apoptotic index as well as Ki67 and p53 expression in repeated biopsies during treatment may contribute to predicting the value of the actual treatment and may be useful to institute alterations in therapy.
Complete removal of the tumour or deep invasion can be proven by repeated transurethral resection of bladder wall at the previous tumour site. Six weeks after transurethral resection of bladder tumour (TURB), in all but TaG1 cases repeated resection were performed for the evaluation of radicality in 62 patients, 43 males and 19 females, suffering bladder cancer, from October 1998. In the case of positive histology another resection was performed for security reason. In the case of 38 superficial (Tis, Ta, T1) cancers, repeated resection revealed negative, identical or different T stage compared with previous histology in 28, 5 and 5 cases, respectively. In 7 cases repeated resection was applied as second intervention after the incomplete resection of large tumour mass. Indication of repeated resection was insufficient depth of resection and carcinoma in situ in 13 and 4 cases, respectively. Based on our data, we conclude that repeated resection should be performed when tumour-free status is not justified and biopsy according to Bressel was not taken.
A total of 102 (66 untreated and 36 hormone-treated) prostate cancers were examined histologically in order to determine their histological grade and the percentage of apoptotic tumor cells. The less differentiated the tumors were, the higher the spontaneous apoptotic activity was. Hormone therapy increased the apoptotic index in the prostate cancers. The increase was of greater significance in grade I than in grade II and grade III tumors. The therapeutic consequences of these findings and the possibility of different oncogene-expressions in various histological types of prostate cancer are discussed.