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Biomedical subjects

J Adolfsson

Publications and source records attributed to J Adolfsson.

At least 73 records · Page 4Linked to original sources
PubMed1994

Nitric oxide synthase activity in the human urogenital tract.

Nitric oxide (NO) has been suggested as a nonadrenergic non-cholinergic neurotransmitter in the urogenital tract and has previously been shown to have a smooth muscle relaxing effect in the urogenital organs both in various animals and in humans. It has been shown that NO is a mediator of the erection and the dilatation of the bladder neck and urethra. The aim of the study was to analyse nitric oxide synthase (NOS) activity in the human urogenital tract. NOS activity was measured by the conversion of L-[U-14C] arginine to L-[U-14C] citrulline. In the upper urinary tract there was Ca(2+)-dependent NOS activity in the renal pelvis, but no significant NOS activity could be found in the ureter. In the lower urinary tract we found high Ca(2+)-dependent NOS activity in the urethra, intermediate activity in the bladder neck and comparatively low activity in the detrusor muscle. In the male genital tract the testis and epididymis had no significant NOS activity. The vas deferens, prostate, seminal vesicle and corpus cavernosum were found to have high levels of Ca(2+)-dependent NOS activity. Ca(2+)-independent NOS activity was not obtained in the urogenital tract. Our results correspond well with previous functional studies indicating NO to be an important nerve-induced mediator of erection and in the micturition reflex, but also suggest that NO may be involved in several other functions in the human urogenital tract.

Amino Acid Oxidoreductases↗
PubMed1994

Deferred treatment of clinically localized low grade prostate cancer: the experience from a prospective series at the Karolinska Hospital.

From 1978 to 1982, 172 patients with stages T1 to 3NxM0 prostate cancer were included in a surveillance protocol with deferred treatment on symptomatic progression. Median patient age at diagnosis was 68 years (range 38 to 89 years). Mean followup was 80 +/- 32 months. Of the patients 58% had local and 19% had distant progression, and 52% had received treatment at followup. Disease specific survival rate at 10 years was 80% for the total series, 84% for the subgroup with stage T1 or T2 tumor and 92% for those with stage T1 or T2 tumor who were less than 70 years old at diagnosis. For the subgroup with stage T3 tumor the disease specific survival rate at 9 years was 70%. In all subgroups the competing mortality rate was higher than the prostate cancer mortality rate. Deferred treatment appears to be an acceptable option for patients with tumor clinically confined to the prostate and a life expectancy of 10 years or less.

Acid Phosphatase↗
PubMed1994

Localization of nitric oxide synthase activity in the human lower urinary tract and its correlation with neuroeffector responses.

OBJECTIVES: The present study was designed to correlate the localization of nitric oxide synthase (NOS) activity to nerve-induced smooth muscle responses in the human lower urinary tract. METHODS: Nerve-induced smooth muscle activity was studied in the human lower urogenital tract. NOS activity was studied by measurement of citrulline formation and guanylate cyclase activity. RESULTS: Nerve-induced contractions in the human detrusor muscle, bladder neck, and prostatic urethra were not significantly enhanced by the NOS inhibitor N omega-nitro-L-arginine methyl ester (L-NAME). In the prostatic urethra, relaxations to transmural nerve stimulation were obtained after increase in tension. The relaxations were abolished by L-NAME and restored by L-arginine. Nerve-induced relaxations were occasionally obtained in the bladder neck, whereas nerve-induced relaxations were never obtained in the detrusor muscle. Citrulline formation was highest in the prostatic urethra, it was intermediate in the bladder neck, and it was less pronounced in the detrusor muscle. Guanylate cyclase activity was also highest in the prostatic urethra, whereas there was no significant difference in guanylate cyclase activity in the bladder neck and detrusor muscle. CONCLUSIONS: The nerve-induced smooth muscle responses and the localization of NOS activity were in good agreement. Thus, in areas where marked relaxations to nerve stimulation were obtained, there was also a high NOS activity. The data suggest that nitric oxide is a mediator for the neurogenic dilation of the bladder neck and urethra during the micturition reflex.

Amino Acid Oxidoreductases↗
PubMed1994

Iodine-125 brachytherapy for clinically localized prostate cancer: a 5-year follow-up of outcome and complications.

Thirty-seven patients with clinically localized prostate cancer of all grades were treated by suprapubic digitally guided implantation of 125I seeds. The median age at the time of diagnosis was 68 years. The mean follow-up period was 62 +/- 19 months. At last follow-up 18 patients were clinically free of disease; 11 deaths occurred: 9 from prostate cancer and 2 from another disease. Complications occurred in 24 patients most commonly urgency and proctitis, attributable to the treatment. Four patients had severe late rectal complications, and 2 patients died of sepsis secondary to rectal fistulae. Digitally directed retropubic implantation of 125I appears inferior to other treatments of clinically confined prostate cancer both regarding outcome as well as complication rate.

Aged↗
PubMed1994

The TNM system of 1992. Comments from the TNM working group. Consensus Conference on Diagnosis and Prognostic Parameters in Localized Prostate Cancer. Stockholm, Sweden, May 12-13, 1993.

The TNM working group acknowledges the multinational agreement reached in the 1992 TNM classification, but nevertheless gives some suggestions for modifications. The main interest of the group has been to evaluate parameters suitable for further ramification of the system. The group found that parameters such as DNA ploidy, PSA, nuclear roundness factor, are not yet ready for this purpose. Grade is an established parameter and should be incorporated into the TNM-categories of localized disease. In metastatic disease a number of parameters are available to subdivide this category according to prognosis, and these will be more uniformly and extensively studied in the several large trials that are now in progress.

Alkaline Phosphatase↗
PubMed1993

Recent results of management of palpable clinically localized prostate cancer.

BACKGROUND: There is uncertainty regarding if, when, and how localized prostate cancer should be managed. METHODS: To examine evidence of a beneficial effect of aggressive treatment on metastatic failure and disease-specific mortality in clinically localized prostate cancer, the authors compiled data from the literature since 1980 regarding radical prostatectomy, external radiation therapy, and deferred treatment. RESULTS: The weighted mean of reported disease-specific survival at 10 years was 93% for radical prostatectomy, 83% for deferred treatment, and 74% for external radiation therapy. To broaden the database we have also computed, from the recorded number of patients who died of prostate cancer and the number of person-years at risk, a calculated disease-specific survival at 10 years of 93% for radical prostatectomy, 83% for deferred treatment, and 62% for external radiation therapy. The data suggest a favorable treatment effect with regard to disease-specific mortality for radical prostatectomy, but not for external radiation therapy at 10 years of follow-up. This observation must be tempered by the absence of convincing randomized trials and by the possibility of selection biases in the reviewed studies. CONCLUSIONS: As judged from our analysis, clinically localized prostate cancer often has a protracted course associated with a significant competing mortality and marginal benefit from radical prostatectomy at 10 years in terms of the endpoints used.

Adult↗
PubMed1993

Deferred treatment of low grade stage T3 prostate cancer without distant metastases.

Fifty patients with extracapsular prostate cancer without known distant metastases were included in a protocol of surveillance followed by deferred treatment of progression. The median observed followup time was 78 months. The risk of developing distant metastases, if not dying before, was 24% and 37% at 5 and 9 years, respectively. The risk of dying of prostate cancer, if not dying of other diseases before, was 12% and 30% at 5 and 9 years, respectively. Thus, the cancer specific survival was 88% at 5 years and 70% at 9 years.

Aged↗
PubMed1992

Conservative management of localized prostatic cancer.

Radical prostatectomy (RP), irradiation (RT), early endocrine therapy (EET), and expectant treatment (DT) are strategies for the management of clinically localized prostatic cancer. EET has not been systematically studied, but warrants prospective exploration. DT in uncontrolled studies results in disease-specific survival rates at 10 years that appear comparable to those achieved following RP or RT and may be considered a management option in patients with limited life expectancy. Serial observations in untreated patients provide a clinical indication of the rate of tumor progression, but better indicators of growth rate, metastatic potential, and responsiveness to a particular therapy are needed. Decision analysis may ultimately provide a practical supplement to clinical judgment in the choice of treatment.

Humans↗
PubMed1992

Deferred treatment in clinically localised prostatic carcinoma.

A series of 122 patients with a cytological diagnosis of well or moderately differentiated and clinically localised (T1-2) prostatic carcinoma were followed up without any initial anti-tumour therapy. The median observation time was 91 months. During follow-up the local tumour progressed to stage T3 in 67 patients (55%) and distant metastases developed in 17 (14%); 47 patients died (38%), 9 of them (7%) from prostatic carcinoma. The risk of dying from prostatic carcinoma was 1% after 5 years and 16% after 10 years for patients not dying from other causes.

Adult↗
PubMed1991

Comparison of transrectal prostate digital aspiration and ultrasound-guided core biopsies in 99 men.

We compared digital transrectal needle aspiration and transrectal core prostate biopsies obtained with ultrasound guidance in 99 men. Both procedures were effective in identifying prostate cancer; complete sensitivity was 94 percent for aspiration and 90 percent for core biopsy. Aspiration confirmed 87 percent of 38 known cancers and 94 percent of 81 cancers overall, compared with 82 percent and 90 percent with core biopsies. The greatest number of cancers was found when both procedures were considered (95% of known and 98% of all cancers). Grading of both specimens was performed but was not equivalent. Unsatisfactory or inconclusive results by either procedure often obtained when cancer was present. We suggest digital transrectal needle aspiration as a first means of identifying most palpable prostate lesions. Transrectal core biopsies guided by ultrasonography should be used when suspicion of cancer cannot be confirmed by aspiration and when there is no palpable lesion (but clinical suspicion of cancer).

Adenocarcinoma↗
PubMed1991

Natural course of clinically localized prostate adenocarcinoma in men less than 70 years old.

A total of 61 patients, less than 70 years old at diagnosis, with clinical stage T1-2, NX, M0, cytologically well or moderately differentiated prostate adenocarcinoma was prospectively included in a surveillance study. Median patient age was 63 years (range 38 to 69 years). Mean followup was 96 +/- 24 months. The probability of local progression to stage T3 disease after 5 and 10 years was 49 and 72%, respectively. The probability of metastases developing after 5 and 10 years was 8 and 23%, respectively. The probability of dying of prostate adenocarcinoma was 2 and 8%, respectively. Moderately differentiated cancer progressed locally significantly faster than well differentiated disease. The relative number of patients who had metastases or died of prostate adenocarcinoma found in our study was comparable to the relative numbers reported after radical prostatectomy and radiation therapy. Therefore, deferred therapy may be an alternative to active therapy in patients with clinically localized prostate adenocarcinoma and with a life expectancy of less than 10 years.

Adenocarcinoma↗
PubMed1991

Modal DNA-values in prostate cancer patients with deferred therapy or endocrine therapy.

Modal DNA-values were assessed with flow cytometry in 269 patients with newly detected untreated prostate cancer. One hundred and seventy-two patients with low-grade, low-stage, non-metastasized cancers were followed without treatment and in this group initial tumor ploidy had no prognostic value. Ninety-seven patients with clinically more advanced prostate cancers were subjected to endocrine therapy and in this group ploidy was prognostic regarding cancer-related survival.

Adult↗
PubMed1991

Deferred therapy in well and moderately differentiated prostate cancer.

One hundred and twenty-two patients with localized prostate cancer were included in a surveillance study. The risk of developing metastases and dying of prostate cancer after 10 years was 20 and 15% respectively. These figures are comparable with results in recent reports on long-term follow-up of after radical prostatectomy and radiation therapy.

Adult↗
PubMed1991

'Local recurrence' and 'disease-free survival'. Doubtful parameters when comparing non-randomized studies of prostate cancer.

We reviewed recent literature on studies with external radiation of prostatectomy for localized prostate cancer considering the definitions of 'local recurrence' and 'disease-free survival' and the reporting of patients lost to follow-up. Among studies evaluating external radiation, 5/71 (29%) mention that prostate biopsy is used for some patients in determining local recurrence, versus 6/11 (55%) for prostatectomy. Several studies, 15/28 (54%), present figures for disease-free survival without giving a definition of the parameter. In the majority of the reports no comments are made relative to patients lost to follow-up. Three authors consider patients lost to follow-up as dead with disease. Considerations regarding 'local recurrence' and 'disease-free survival' warrant caution in the interpretation of data based on such parameters. In a comparison of non-randomized studies of localized prostate cancer, cancer-specific survival with prostate cancer death defined as 'death wtih diagnosed distant metastases' may be a robust parameter.

Clinical Trials as Topic↗
PubMed1990

The prognostic value of modal deoxyribonucleic acid in low grade, low stage untreated prostate cancer.

We selected for a prospective surveillance study 167 patients with untreated grades 1 and 2 prostate cancer. The tumors were classified regarding modal deoxyribonucleic acid value (ploidy) by flow cytometry, cytological grade by transrectal fine needle aspiration biopsy and local tumor stage. Of the patients 146 could be evaluated. Mean followup was 50 months. The initial ploidy was statistically correlated to cytological grade but not to initial local tumor stage, prostatic acid phosphatase activity or patient age. Initial ploidy and cytological grade had a prognostic value regarding local tumor progression when considered as single predictors and in combination. Two patients with diploid and 8 with nondiploid tumors initially had metastases during the surveillance. Five patients (1 with diploid and 4 with nondiploid disease) died of prostatic cancer. Modal deoxyribonucleic acid value and cytological grade were of prognostic value in untreated prostate cancer.

Adenocarcinoma↗
PubMed1990

Evaluation of tumor progression by repeated fine needle biopsies in prostate adenocarcinoma: modal deoxyribonucleic acid value and cytological differentiation.

Repeated fine needle aspiration biopsies of the prostate were taken during a period of 24 months or more from 84 patients with untreated prostate cancer. Serial followup regarding modal deoxyribonucleic acid values and cytological differentiation of the tumor cells was possible in 72 and 78 patients, respectively. During followup the modal deoxyribonucleic acid values in the tumor cells changed towards an increased aneuploidy in 17 patients and the cytological differentiation decreased in 18. These findings of a change in modal deoxyribonucleic acid values and cytological differentiation of prostate cancer cells during the course of untreated patients support the concept of a gradual dedifferentiation of prostate cancer.

Adenocarcinoma↗
PubMed1990

The natural course of low grade, non-metastatic prostatic carcinoma.

A surveillance study was carried out on 167 patients with low grade, low stage prostatic carcinoma without known metastases; of these, 146 were evaluated, the mean follow-up time being 50 months. Local tumour progression occurred in 77 patients (53%), corresponding to a 5-year cumulative probability of progression of 67%. Ten patients developed metastases, 5 died of prostatic carcinoma and 24 died of other causes. Cox's regression analysis showed that the initial cytological grade of the tumour was of prognostic importance, but initial local tumour stage, prostatic acid phosphatase activity and age had no statistically significant prognostic value. Although the number of patients developing metastases and dying of prostatic carcinoma was low, most tumours seemed to progress locally.

Aged↗