Biomedical subjects
Publications and source records attributed to H Rübben.
In the diagnostics of subfertility three main factors have to be considered: Endogenous testicular heat exposure, genitourinary tract infection and endocrinologic abnormality. The possibility of exogenous heat exposure is emphasized. An exact anamnesis is important, because exogenously induced subfertility is reversible in general.
The organic matrix accounts for 2-3% of the total stone weight and has been considered to play a role in stone formation and growth. Thus far, fractionation of the matrix proteins has been insufficient due to low resolution and reproducibility. In this report the matrix proteins of 22 stones were resolved by means of high-performance liquid chromatography. Following pulverization, the organic matrix was obtained by dialysis against EDTA. The average content of nondialyzable extractable proteins was 1.6% of the total stone weight. Analysis of the matrix proteins with high-performance gel permeation liquid chromatography and high-performance ion-exchange liquid chromatography has indicated that the protein composition of the stone matrix is identical regardless of the mineral composition. The major component of the matrix proteins was identified as glycoprotein and/or proteoglycan from their absorption to a concanavalin A Sepharose column. Higher molecular weight matrix proteins seem to be polymers or condensation products, since they have been degraded into lower molecular weight subfractions by sodium dodecyl sulfate treatment.
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The extratesticular manifestation of a tumor of the germ cells without apparent involvement of the testicle is a rare disease. During the last few years, seven patients with extragonadal tumors of the germ cells have been treated at our hospital. Tumor site was the retroperitoneum in four patients and the mediastinum, the lung, and the pineal body in one patient each. Based on the clinical courses of the seven cases, the authors discuss the diagnostic and therapeutic experiences with extragonadal tumors of the germ cells of various histologies and localizations. In order to make possible a curative therapy, the treatment should be performed according to the therapeutic conceptions existing for comparable histologic grades of primary testicle tumors.
The glycosaminoglycan (GAG) content in human urothelial carcinomas was biochemically determined and compared to that of normal urothelium and bladder wall of the calf. The total GAG content was elevated in urothelial carcinomas, and the distribution pattern differed from that of normal urothelium and bladder wall. Whereas urothelial carcinomas contained heparan sulphate, dermatan sulphate, chondroitin 4-sulphate and chondroitin 6-sulphate, only heparan sulphate could be detected in the normal urothelium. The GAG determination was based on hexosamine analysis and thin layer chromatography after elution on Dowex 1 X 2 columns.
Glycosaminoglycans (GAG) were described by histochemical staining procedures in the normal urothelium of the urinary bladder; they are supposed to be involved in the antibacterial defense mechanism. Our quantitative analysis, however, demonstrated only heparan sulfate in the normal calf urothelium (less than 600 nmol/Gm d.wt.); only trace amounts of other GAG were to be analyzed. High concentrations of GAG were found in the submucosa and muscle layers as to be expected in mesoderm originating tissues. According to these results there were no GAG with the exception of heparan sulfate at the surface of the normal urothelium; therefore, glycoproteins detected in mumol/Gm d.wt. ranges are more likely to be involved in the antibacterial defense mechanism.
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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.
Screening for early cancer detection is of value if (i) appropriate tests are available, (ii) the detected tumor can be treated, and (iii) the treatment improves the quality of life or the mortality rate of the patients. It is demonstrated whether carcinomas of the prostate and urinary tract, renal cell carcinoma, penile carcinoma and testicular tumors satisfy these conditions. Screening for early cancer detection may be indicated in prostatic and urinary tract carcinomas. The clinical examination should include the male genitalia. The indication for sonography of the kidneys to detect renal cell carcinomas is investigated at the moment. Instruction to perform self-examination of the testes should be given to all males older than 20 years.
In this animal experiment it was investigated if intravesical combination therapy is superior to single drug therapy to reduce the growth of N-butyl-N(4-hydroxybutyl)-nitrosamine (BBN)-induced bladder carcinomas in the rat. The evaluation of the histological data gave the following results: intravesical instillation of cytostatic drugs in concentrations similar to that used in man reduce the growth of BBN-induced tumors. The effectiveness of mitomycin C or adriamycin alone is similar to that of alternative administration of mitomycin C and adriamycin.
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Topical instillation of adriamycin for treatment of superficial bladder carcinomas is of little value (complete response less than 40%) in comparison to transurethral resection. Instillation therapy may be indicated in carcinoma in situ (objective response about 70%). Value of topical chemoprophylaxis is not proven in prospective randomized clinical studies up to now. Chemical cystitis is described as local side effect in about 40%, systemic side effects are not expected. Effectiveness of instillation therapy in BBN-induced tumors in the rat can be shown 2 and 8 weeks but not 5 month after the last instillation. Instillation therapy leeds to severe dysplasia and epithelial proliferation in the normal rat mucosa. Up to now topical instillation therapy with adriamycin is indicated in carcinoma in situ (therapeutic) and in multiple, recurrent or poorly differentiated T1 carcinomas (prophylactic).
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TNM classification of urological tumors was reviewed by the UICC in 1978 and should remain unchanged for ten years. Nevertheless the minimum requirements concerning the N-category may be discussed, especially since German urologist did not contribute to the draft of 1978. Lymphangiography should not be included in the minimum requirements to classify renal cell carcinomas, because therapy planning does not depend on regional lymph node metastases, and juxtaregional lymph nodes can not be visualized in general. In bladder- and prostatic carcinomas the staging operation should be included in the minimum requirements; metastases proven by histology should be marked within the TNM system. The minimum requirements should include computed tomography, ultrasound and lymphography. Biopsy, staging operation and lymphography should be considered in case of penile carcinoma.
A retrospective study with an adequate follow-up of three years or longer of 315 superficial transitional cell carcinomas (Ta--T2) is reported. Patients had transurethral resection in 80% and open excision or resection in 20% for cure or control. It is demonstrated, that in addition to the grade and the stage of the tumor, multifocal tumor growth and whether it is a primary or recurrent tumor influence the frequency of recurrences and the tumor progression. The overall percentage of recurrences after resection of Ta, T1 and T2 tumors within three years is 60%. A primary tumor recurs in 45%, the first recurrence in 84%, solitary tumors in 46% and multifocal tumors in 73%. Tumor progression is observed in solitary tumors in 24%, in multifocal tumors in 44%, in primary and recurrent Ta and primary T1 tumors in 20 to 25%, in recurrent T1 tumors in 56%. Therefore, when planning therapy, stage, grade, multifocal tumor growth and whether it is a primary or recurrent tumor should be considered. Ta tumors can be treated sufficiently by transurethral resection, even in case of several recurrences; more aggressive therapy should be considered, when multifocal or recurrent T1 or T2 tumors recur again as invasive carcinomas.
The minimum requirements of the International Union against Cancer (UICC) to assess the TNM-classification of urothelial bladder cancer include since 1978 the clinical examination, urography, cystoscopy, bimanual palpation under anesthesia and biopsy or transurethral resection of the tumor. The single biopsy of the tumor should be supplemented by multiple biopsies of all bladder walls in combination with the resection of the tumor to diagnose multifocal tumor growth. The exfoliative urinary cytology should be included in the routine diagnostic regimen: cytology is helpful in detection of severe dysplasia and controls the histologically determined grade of the tumor. In selected cases computer tomography improves the accuracy of clinical evaluation of the depth of tumor infiltration. In our hands the lymphangiography can not assess the regional lymph node metastases: therefore, the staging operation is recommended before radical cystectomy is performed.