Biomedical subjects
Publications and source records attributed to V Hvidt.
A patient passed 11 urate calculi after palliative orchidectomy for advanced prostatic cancer, and there was a simultaneous rise in urinary urate excretion. We believe that this rise could be the result of increased purine metabolism from lysis of tumour cells. To our knowledge this has not previously been reported.
In a multicenter Phase III trial 264 patients with advanced prostatic cancer were randomized to either bilateral orchiectomy or treatment with zoladex supplemented by flutamide. Presently, median follow-up time is 30 months. A small difference in objective response was recorded in favor of the combination therapy, whereas no statistically significant difference was found in subjective response to therapy, time to progression, and overall survival. Adverse effects were more commonly encountered in the pharmacologically treated patients. It is concluded that the combination of zoladex plus flutamide is not clinically superior to orchiectomy in the treatment of patients with advanced carcinoma of the prostate.
Early experience of extracorporeal shock wave lithotripsy (ESWL) using a second generation lithotriptor (Siemens Lithostar) is reported. Two hundred and seven patients underwent 272 treatments for 291 stones. There were 259 renal calculi, including three staghorn calculi and 32 ureteric calculi. Treatments were performed under local analgesia (78%) or epidural or general anaesthesia (22%) when invasive procedures had to be done in connection with the treatment. Stone fragmentation was achieved with 2,487 +/- 1,262 shocks. The first month stone clearance rate was 43%, 24% had fragments less than 6 mm and 33% had residual stones. The same figures after three and six months were 57%, 23% and 20% and 71%, 23% and 6%, respectively. Septicaemia occurred in four patients and cardiac arrhythmia in 24 patients (12%); no serious intra- or perirenal heamatomas were registered. In 7% additional procedures were required, seven patients had residual stones removed at an open operation. The Lithostar is an effective second generation lithotriptor which can be used for renal, staghorn and ureteric calculi in situ in all three segments without stone manipulation prior to ESWL.
Cystic lesions of the seminal vesicle are rare. We report on a new technique of transprostatic incision of a seminal vesicle cyst, which was used successfully in a patient with recurrent cyst 7 years after transrectal aspiration.
An LHRH agonist, Zoladex, was employed as a monthly depot in 56 previously untreated patients with advanced carcinoma of the prostate. Of 53 evaluable patients, 27 achieved partial remission and 7 were stable. Median duration of response was 10 months. A favorable subjective response was attained in 68% of the patients. During treatment, serum testosterone was in the castrate range in all patients except five. Possible explanations for this escape phenomenon are discussed. No toxicity was observed and treatment was well tolerated in all patients. Thirty-two patients underwent bilateral orchiectomy following treatment failure of Zoladex. In one patient partial remission according to protocol criteria was recorded. Treatment with LHRH agonists seems safe and may serve as an alternative to conventional hormonal treatment of advanced carcinoma of the prostate.
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Between 1979 and 1984 the Copenhagen Renal Cancer Study Group randomized 72 patients nephrectomized for stages II and III renal adenocarcinoma in a prospective study of postoperative radiotherapy versus observation. Radiotherapy was 50 Gy in 20 fractions to the kidney bed, ipsi- and contralateral lymph nodes. 7/72 were excluded from further analysis because of major protocol violations. 33/65 were in stage II, 32/65 in stage III. Relapse was found in 31/65 = 48% during the follow-up period without any difference between the two groups. 12/27 = 44% had significant complications from stomach, duodenum or liver, median 5 mo., range 1-44 mo. after radiotherapy. In 5/27 = 19% did the postirradiatory complications contribute to the death of the patients. Patients with stage II tumours survived significantly better than those with stage III tumours (p less than 0.05), but no significant differences in survival could be demonstrated between patients randomized to postoperative radiotherapy or observation. It is concluded that postoperative radiotherapy as given in the present study is without any beneficial effect on relapse rate and survival. Moreover, the treatment is associated with an unacceptable complication rate.
A material of 746 consecutive patients with tumours of the bladder from three hospitals in Greater Copenhagen for the period 1968-1974 is presented. This is the result of The Copenhagen Bladder Cancer Project. Some of the aims of the project were to describe the manifestations of bladder cancer by means of a number of examination parameters. The material may be regarded as representative for the region. About 80 percent of the patients are men, and the mean age is 66 years, but higher for patients with deeply invasive tumours and tumours of low degree of differentiation. Haematuria was the presenting symptom in 84 percent of the patients, and only 3.4 percent had urinary tract infection as sole first symptom. The interval from first symptom to hospitalisation was an average of 7.6 months, but less for cases of deeply invasive tumours and tumours of low degree of differentiation. About 60 percent of all bladder tumours are evaluated as being without invasion of the bladder nusculature, and 59 percent of the tumours are of a high degree of differentiation (Grade 0+I+II). Squamous cell carcinomas are found in about three percent and adenocarcinomas in about one percent of the cases. Benign papillomas, corresponding to Grade 0 tumours, are found in only one percent of the cases. About 50 percent of all transitional cell tumours are both superficial and show a high degree of differentiation. Grade II tumours show invasive growth in at least 25 percent of the cases and Grade III tumours in at least 77 percent. The bladder tumours are papillomatous in 66 percent of the cases, and 24 percent of the patients have more than one tumour in the bladder. Intravenous urography showed a pathological condition in 70 percent of the patients.
The aim of this study has been, on the basis of 746 cases of cancer of the bladder from The Copenhagen Bladder Cancer Project, to assess the prognosis in relation to the tumour classification employed. The following five-year survival rates were found: T1, 59.8 percent, T2, 39.0 percent, T3, 19.7 percent, T4, 5.7 percent. There are significant differences in survival between the different T categories. The survival rates were also calculated for the different histological grades, and significant differences were also found here. Both the T classification and the histological grading are, therefore, relevant prognostic criteria. Papillomatous tumours have the same survival, whether solitary or multiple, but solid tumours have a poorer prognosis than papillomatous tumours. Tumour size is likewise a significant prognostic criterion. Of special interest has been the results of radiotherapy related to the same parameters. Neither the T classification nor the histological grading can be used as prognostic criteria for patients in the present material who were treated by radiotherapy. The overall five-year survival for patients treated by radiotherapy was 22 percent. With the investigative parameters employed, it is not possible in advance to select the group of patients with radiosensitive tumours.
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A small percentage of patients with infra-vesical obstruction cannot tolerate open or transurethral prostatectomy. In these cases cryoprostatectomy is a possibility, we have, however, used another method based on heat destruction of the tissue. The results in 24 poor-risk patients were satisfactory, without any serious postoperative complications, and with excellent long-term results in 80% of the cases. The only complication is a high rate of incontinence. Until this problem has been solved the procedure should be reserved for poor-risk patients.
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