Biomedical subjects

S Rannikko

Publications and source records attributed to S Rannikko.

At least 55 records · Page 3Linked to original sources

PubMed1991

A complex between prostate-specific antigen and alpha 1-antichymotrypsin is the major form of prostate-specific antigen in serum of patients with prostatic cancer: assay of the complex improves clinical sensitivity for cancer.

We have studied the forms of prostate-specific antigen (PSA) in serum of patients with prostatic cancer and benign prostatic hyperplasia. Fractionation of serum by gel filtration and assay of the fractions for PSA showed that a considerable part of the PSA immunoreactivity in serum consisted of complexes that were larger than PSA. The complexes were assayed by time-resolved immunofluorometric assays based on an antibody against PSA on the solid phase and europium-labeled antibodies against various protease inhibitors as indicator antibodies. In addition to its monomeric form, PSA was found to occur in complex with alpha 1-antichymotrypsin. The proportion of the alpha 1-antichymotrypsin complex was a major form of PSA and it increased with increasing PSA concentrations, being over 85% at PSA levels exceeding 1000 micrograms/liter. A complex with alpha 1-protease inhibitor was also observed in serum of patients with prostatic cancer and very high levels of PSA. Complexes with alpha 2-macroglobulin and inter-alpha-trypsin inhibitor were detected, but their concentrations were low and similar in sera of cancer patients, normal men, and normal women, suggesting that they were not prostate derived. Commercial immunoradiometric assays for PSA were found to measure free PSA and its complexes with alpha 1-antichymotrypsin but not the complexes with alpha 2-macroglobulin and inter-alpha-trypsin inhibitor. The proportion of the PSA-alpha 1-antichymotrypsin complex was higher in patients with prostatic cancer than in those with benign hyperplasia. Therefore, assay of the complex had a higher sensitivity for cancer than assay of total PSA immunoreactivity.

Antigens, Neoplasm↗

PubMed1991

Combination of a GnRH agonist with an antiandrogen or bromocriptine in the treatment of prostatic cancer; slight potentiation of antigonadal effects.

The effect of combined treatment with a GnRH agonist (buserelin depot, BUS, 6.6 mg every 2 months) with an antiandrogen (cyproterone acetate, CPA, 300 mg day-1) or a prolactin-suppressing agent (bromocriptine, BR, 20 mg day-1) on pituitary-testicular function were studied in patients with advanced prostatic carcinoma. The patients (n = 5-6 per group) were treated in this fashion for 6 months and thereafter orchidectomized. Serum testosterone and gonadotrophin responses were followed during treatment, and histology and certain endocrine parameters were studied using testicular tissue obtained at orchidectomy. Serum LH was suppressed in all treatment groups from mean levels of 4-6 IU l-1 to less than 0.1 IU l-1, whilst serum FSH levels decreased in all groups during the first month of therapy from 4.5-7 to 1-2 IU l-1, but recovered thereafter. Only minor increases in serum gonadotrophin levels were evident 3 months after castration. No differences in gonadotrophin responses were seen between the different treatment groups. Serum levels of testosterone were suppressed from 15-20 nmol l-1 to the castrate range (approximately 1 nmol l-1), in each of the treatment groups. Testicular weight decreased significantly more (P less than 0.05) in the BUS + CPA group, compared to the other treatments. No differences were found in the testicular concentration of testosterone, or LH and FSH receptors between the three treatment groups. On histological examination, spermatogenesis was found to be impaired severely in all groups, with the lowest Johnsen score in the BUS + BR group (2.16 +/- 0.13, vs. 2.73 +/- 0.25 with BUS alone, P less than 0.05). Seminiferous tubular diameters were reduced similarly in all treatment groups. In conclusion, the combination of CPA or BR with BUS in the treatment of prostatic carcinoma does not potentiate the suppression of gonadotrophin or testosterone secretion, evidently because the GnRH agonist exerts a maximal suppressing effect. However, other antigonadal effects were enhanced slightly, including suppressed testicular weights by CPA and further suppression of spermatogenesis by BR.

Adult↗

PubMed1991

Orchiectomy versus oestrogen in the treatment of advanced prostatic cancer.

The primary clinical efficacy of orchiectomy and the combination therapy of intramuscular polyoestradiol phosphate 80 mg monthly and oral ethinyl oestradiol 0.15 mg daily was evaluated by progression and cancer mortality rates in a series of 277 prostatic cancer patients representing part of the Finnprostate study. After a follow-up of 5 years there was a significant difference between the groups in terms of progression rate and prostatic cancer deaths. The oestrogen combination was more effective in delaying progression of the disease. The overall mortality rate was similar in both groups. About one-third of the patients were alive after 5 years.

Administration, Oral↗

PubMed1991

Renal function after partial nephrectomy with the Nd-YAG laser. Experimental study in piglets.

Twelve partial nephrectomies were performed in 12 piglets using either the combination (contact and non-contact) Nd:YAG laser technique or a steel scalpel. Additional haemostasis was attempted with ligatures. The renal artery was not clamped and renal cooling was not attempted. Total nephrectomy was performed on the contralateral side. Serum creatinine and urea levels were measured, and 99mTc-DTPA renography was performed pre-operatively and 1 and 2 weeks post-operatively. One week post-operatively the mean serum creatinine level was 35% higher than the pre-operative level in the laser group and 30% higher in the steel scalpel group. Two weeks post-operatively the respective differences were 34 and 24%. The mean urea level 1 week after operation was 50% higher than the pre-operative level in the laser group and 17% higher in the steel scalpel group. Two weeks post-operatively the respective differences were 38% in the laser group and 20% in the steel scalpel group. The mean DTPA disappearance rate was 34% lower 1 week after operation in the laser group and 23% lower in the steel scalpel group when compared with the preoperative state. Two weeks post-operatively the respective changes were 48 and 25%. These data indicate that there is no significant difference in renal function when the Nd: YAG combination laser technique is used in partial nephrectomy as compared with the steel scapel.

Animals↗

PubMed1991

Nd: YAG contact laser in partial nephrectomy. An experimental study in piglets.

The Nd: YAG contact laser technique with 12 W power output was used in partial nephrectomies in six piglets. Blood loss, total time and number of ligatures needed for haemostasis were compared in six partial nephrectomies performed with a steel scalpel. Mean blood loss was 53 g with the laser and 108 g with the steel scalpel (p less than 0.04). The mean time needed for haemostasis were 9.5 and 16.2 min respectively (p = 0.2) and the average number of ligatures required 1.5 and 8.8, respectively. The mean temperature rise at 5, 10 and 20 mm distance from the resection line was 5.3, 1.2 and 0.3 degrees C, respectively. The use of laser reduced blood loss and shortened the operation time. Further studies are needed concerning renal function after kidney surgery with a laser.

Animals↗

PubMed1991

Efficacy and complications of the Nd:YAG laser in partial nephrectomy: experimental study in piglets.

Twenty-four partial nephrectomies were performed in 18 piglets using either the combination Nd:YAG laser technique (contact and noncontact) or a steel scalpel. Additional haemostasis was attempted with ligatures. Blood loss, operation time, and number of ligatures were compared in the two treatment groups. Twelve piglets had a two-week follow-up. The mean blood loss with the laser was 72 +/- 10 g and 83 +/- 13 g with the steel scalpel (no significant difference). The resection time until complete haemostasis was 9.8 +/- 0.9 min with the laser and 14.3 +/- 1.3 min with the steel scalpel (p = 0.0076). The number of ligatures needed for complete haemostasis was 2.8 +/- 0.4 with the laser and 7.5 +/- 1.0 with the steel scalpel (p = 0.0051). Three piglets in the steel scalpel group developed urinomas. There were two perirenal abscesses, one in each group. In the steel scalpel group there was one intussusception. In conclusion, it seems that the combination Nd:YAG laser method offers no definitive advantage over the standard technique for partial nephrectomies in the pig.

Animals↗

PubMed1991

Hormone-resistant metastatic prostate cancer. Comparisons between estramustine phosphate and low-dose epirubicin treatments.

We compared the effect and toxicity of estramustine phosphate and weekly low-dose epirubicin in a prospective randomized trial in 41 patients with metastatic prostate cancer refractory to hormonal manipulation. No significant difference between treatment modalities was seen. Palliation was reached in over 60% of patients. The median survival was 15 months in both groups. Toxicity was mild. Further, we investigated the effect of epirubicin after the failure of preceding estramustine phosphate therapy in additional 20 patients. Pain relief was achieved in 50% of these patients. The median survival was 10 months. Toxicity was acceptable.

Aged↗

PubMed1991

Results of the management of ureteric stones with the ureterorenoscope.

Eighty ureterorenoscopies (URS) were performed for stone removal in 67 patients between January 1985 and April 1988. The success rates for stone removal were 54% in the lower third of the ureter, 70% in the middle third, 38% in the upper third, and 33% in the renal pelvis. The overall success rate was 42%. Open ureterolithotomy was performed after failed ureteroscopy nine times. There were two perforations of the ureter: one by the hook of the forceps and the other by the dormia basket. No significant late complications occurred in 51 patients after six to 36 months postoperatively. At the moment ureteroscopy is of value particularly in the treatment of lower or middle ureteric stones.

Adult↗

PubMed1990

Efficacy of orchiectomy versus high dose polyoestradiol phosphate (160 mg) in relieving infravesical obstruction in patients with prostatic cancer.

Post voiding residual urine volume (78 patients) and maximum urinary flow rate (59 patients) were measured in prostatic cancer patients treated by orchiectomy or oestrogen (polyoestradiol phosphate 160 mg i.m. monthly) to compare the effects of these endocrine treatments on bladder outlet obstruction caused by prostatic carcinoma. The relieving effect of orchiectomy seemed to be more apparent than that of high dose oestrogen during the first six months of therapy.

Aged↗

PubMed1990

Comparison of primary orchiectomy and polyoestradiol phosphate in the treatment of advanced prostatic cancer. Finnprostate Group.

The primary clinical efficacy of orchiectomy and polyoestradiol phosphate (PEP) 160 mg/month i.m. was evaluated by progression and cancer mortality rates in a Finnish multicentre study comprising 200 prostatic cancer patients. After the minimum follow-up time of 2 years there was a significant difference between the groups--orchiectomy delayed progression of the disease more effectively. The follow-up time is rather short for prostatic cancer, but on the basis of this preliminary study the dose of PEP seems to be insufficient in the treatment of advanced prostatic cancer.

Aged↗

PubMed1990

Serum acid phosphatase in patients with localised prostatic cancer, benign prostatic hyperplasia or normal prostates.

Serum acid phosphatase levels were determined in 247 men with surgically confirmed intracapsular prostatic cancer (30 patients), benign prostatic hyperplasia (BPH) (114 patients) or palpably normal prostates (103 men). Both radioimmunoassay (245 cases) and an enzymatic method (218 cases) were used. Using radioimmunoassay, the mean serum prostatic acid phosphatase (PAP) level was significantly higher in patients with BPH than in patients with intracapsular cancer or men with normal prostates. The weight of hyperplastic tissue removed during operation in the BPH group correlated closely with PAP concentrations. Age or the presence (or absence) of an indwelling catheter had no effect on PAP concentration. Using the enzymatic method, the highest levels of acid phosphatase were also detected in patients with BPH but the difference was less marked. It was concluded that intracapsular cancer does not elevate serum acid phosphatase levels as determined by radioimmunoassay or an enzymatic method. BPH alone leads to significant rises in PAP concentrations. The degree of BPH correlates with PAP levels.

Acid Phosphatase↗

PubMed1990

The effect of parenteral estrogen versus orchiectomy on blood coagulation and fibrinolysis in prostatic cancer patients.

The effects of parenterally given polyestradiol phosphate (80 or 160 mg i.m. monthly) and bilateral subcapsular orchiectomy on blood coagulation and fibrinolytic parameters were compared in 11 patients with prostatic carcinoma. Estrogen therapy lowered antithrombin III, plasminogen and plasminogen activator inhibitor activities, whereas these parameters remained unchanged in orchiectomized patients. There were no significant changes in platelet count, fibrinogen, factor VII, protein C and alpha 2-antiplasmin in either group. Estrogen had unfavorable effects on hemostatic laboratory parameters in the direction of a hypercoagulable state. However, no thromboembolic complications were encountered.

Aged↗

PubMed1990

Effects of orchiectomy and polyestradiol phosphate therapy on serum lipoprotein lipids and glucose tolerance in prostatic cancer patients.

In 17 prostatic cancer patients, changes in the plasma lipoprotein pattern, including high density lipoprotein (HDL) subfractions, and in glucose tolerance were compared after 6 months on parenteral polyestradiol phosphate (PEP; Estradurin, 80 or 160 mg/month) with the respective changes in orchiectomized patients. In the estrogen group there was no change in the total serum cholesterol level, whereas in the orchiectomy group an increase of 10% was observed. Estrogen therapy resulted in a significant increase of serum HDL (11%) and HDL2 cholesterol (26%) levels; in the orchiectomy group these fractions remained unchanged. Estrogen therapy induced a significant decrease in total serum triglycerides (24%) and in low density lipoprotein triglycerides (27%); in the orchiectomy group reverse changes were observed. PEP treatment caused changes in the serum lipoprotein pattern, which apparently decreases the risk of atherosclerosis.

Aged↗

PubMed1990

Radical prostatectomy as treatment of localized prostatic cancer. Early results, with special focus on transrectal ultrasound for local staging.

Radical prostatectomy was performed for localized prostatic cancer on 68 patients (mean age 65 years). Rectal palpation alone was used to determine local operability in the first 38 cases, and its accuracy proved to be 63%. Transrectal ultrasound in conjunction with clinical examination was used instead in the last 30 patients, with 80% accuracy. There was one perioperative death and the total complication rate was 37%. Postoperatively three patients were totally incontinent and five had mild stress incontinence. Of the 29 patients operated on with the nerve-sparing Walsh technique, 11 had penile erections 6 months postoperatively. The mean follow-up time was 34 (4-69) months. Local recurrence or distant metastases were found in 11 cases (16%). In ten of them the primary tumour was locally advanced (pT3 or pT4), and in one it was intracapsular (pT2) but poorly differentiated. Radical prostatectomy is concluded to be safe and its complication rate acceptable. Careful preoperative evaluation of the extent of disease is essential for cure, and transrectal ultrasound increases staging accuracy.

Aged↗

PubMed1989

Steroid sulfates in testis tissue of prostatic cancer patients treated for six months with the gonadotropin releasing hormone agonist buserelin.

In order to assess the extent of inhibition of testicular steroidogenesis during long-term treatment of prostatic cancer with GnRH agonist, we measured the intratesticular levels of 5 steroid sulfate conjugates in human testis tissue removed from patients after 6 months of intranasal treatment with buserelin. The most pronounced decreases were found in testosterone and pregnenolone sulfates, to 1.6 and 7.1%, respectively, of concentrations measured in testis tissue from primarily orchiectomized prostatic cancer patients. In contrast, clearly smaller decreases were found in three other steroid sulfates measured, those of dehydroepiandrosterone (to 26%), 17-hydroxyprogesterone (to 27%) and 5-androstene-3 beta, 17 beta-diol (to 62%). These results are in keeping with our previous analyses of unconjugated steroids in similar tissue samples, and indicate that testicular steroidogenesis per se is not totally blocked by long-term intranasal treatment with GnRH agonist. Testicular steroid sulfate conjugation may be specifically suppressed since the total concentration of these conjugates decreased more than free steroid levels in our earlier measurements.

Aged↗

PubMed1989

Urinary oestrogen excretion in benign prostatic hyperplasia and prostatic cancer.

Urinary oestrogen excretion was measured in 20 healthy middle-aged men (controls), in 30 patients with benign prostatic hyperplasia (BPH) and in 32 prostatic cancer (PC) patients. The mean oestradiol (E2) excretion was significantly lower in the PC patients than in the controls and BPH patients. No other significant differences were found in oestrone (E1), oestriol (E3) and total oestrogen (E1 + E2 + E3) excretion between the 3 groups. The decreased E2 excretion in the PC patients is in accordance with our previous finding concerning significantly lower E2 plasma levels in PC patients. It seems possible that elderly men with lower endogenous oestrogen levels are at higher risk of developing cancer. On the other hand, the age-dependent increased oestrogen levels may play an aetiological role in BPH.

Aged↗

PubMed1989

Early experience with percutaneous nephrolithotomy.

Fifty-four percutaneous nephrolithotomy (PNL) procedures were performed in 41 patients between May 1986 and December 1987. Six patients required more than one procedure and there was one failure which was treated by open ureterolithotomy. Most of the stones were initially found in the pelvicalyceal system, one in the lower third and nine in the middle or upper third of the ureter. There were five significant complications: one "steinstrasse" (accumulation of stone fragments in the distal ureter after the procedure), one massive perirenal haematoma, one intramural perforation by a ureteric catheter and two extravasations of irrigation fluid one of which necessitated intensive care. Most of the renal and upper ureteric stones have now been successfully removed percutaneously with good patient tolerance.

Female↗

PubMed1988

Pretreatment plasma levels of testosterone and sex hormone binding globulin binding capacity in relation to clinical staging and survival in prostatic cancer patients.

Pretreatment plasma concentrations of total testosterone (T), sex hormone binding globulin binding capacity (SHBG). T/SHBG ratio, and free testosterone (fT) were measured in 123 patients with prostatic cancer categorized into groups according to the UICC classification. The patients were randomized to orchiectomy or estrogen therapy and the mean follow-up time was 48 months. The mean plasma levels of T were higher in patients without metastases and with intracapsular cancer, but the differences were not statistically significant. The calculated ratio of T/SHBG was noticed to be significantly higher (p less than 0.05) in the M0 category. The prognostic significance of pretreatment T and, more impressively, T/SHBG ratio and fT was confirmed. Low pretreatment values indicated poorer prognosis. This study supports the view that there are differences in the pretreatment T and fT levels in prostatic cancer patients in relation to the stage of tumor and that these hormone assays could be used as prognostic factors.

Aged↗