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Computerized tomography has become the most widely applied staging technique in the assessment of retroperitoneal lymph nodes in patients with nonseminomatous testicular carcinoma. Errors in clinical staging of testicular carcinoma can have serious implications for the treatment afforded these patients. We describe a duplicated inferior vena cava that simulated retroperitoneal lymphadenopathy on abdominal computerized tomography in a patient with embryonal cell carcinoma of the testicle. The embryology and implications of anomalous lymphatic drainage of the testicle are discussed.

Mitomycin C is an active drug in the treatment of superficial bladder cancer. Although clinical safety of intravesical mitomycin C has been well accepted there are no data on absorption of this drug from the bladder in patients with damaged bladder mucosa. We studied 18 patients for evidence of absorption of mitomycin C after transurethral resection and/or radiation therapy. Mitomycin C is absorbed on intravesical instillation and the degree of absorption depends on the degree of damage to the bladder. Despite some evidence of absorption no systemic effect on bone marrow was observed and no evidence of deoxyribonucleic acid damage was found in any of these patients. Mitomycin C appears to be a safe drug but further studies are indicated to document its safety when used for maintenance therapy.

Three new assay methods for prostatic acid phosphatase are described relative to results of biochemical methods. Methods for total and isozymes of alkaline phosphatase are also described. Results of a field trial for acid phosphatase tests among multiple institutions in the United States revealed a marked increase in sensitivity for one assay (CIEP) over biochemical methods. which was positive with increasing frequency as the clinical and surgical stage advanced beyond B. Only for stage D did the biochemical method approach the sensitivity of the CIEP assay. The CIEP assay has potential value as a screen for prostate cancer. Another acid phosphatase assay (RIA) proved difficult to perform for many institutions in the field trial. A new solid phase immunofluorescent assay recently introduced may on further testing be more sensitive than the CIEP assay. Total alkaline phosphatase levels studied in patients with advanced disease were markedly elevated in over one-third of the cases. Higher levels were associated with poor survival or response to chemotherapy. Alkaline phosphatase isozyme levels were of added value in locating the site of the increased alkaline phosphatase activity in soft tissue, bone, or liver. Occasionally in the face of a normal total value, increased isozyme activity in one of the aforementioned compartments preceded clinical ability to detect the metastatic foci.

Estramustine has been shown previously to be an effective drug in the treatment of metastatic prostatic cancer, demonstrating significant objective and subjective responses in long-term non-randomized trials and in other randomized trials. In this study prednimustine alone has shown a minimal over-all objective response rate of 12.9 percent of the cases, although with marked subjective improvement of pain relief and patient performance status. The combination of prednimustine with estramustine did not result in improvement of objective or subjective response parameters. The effects in terms of responses or in terms of toxicity for either agent were not additive when they were given in combination. Cross-over for those patients whose disease progressed on prednimustine therapy to estramustine had some benefit in over-all survival. Prednimustine alone or in combination with estramustine may be used safely and could improve markedly the quality of life for irradiated patients with advanced prostatic cancer who failed on hormonal treatment and have too poor a bone marrow reserve to be treated by other currently available myelosuppressive agents.

Renal oncocytoma is an unusual tumor that has been identified with increasing frequency during the last decade, and more than 150 cases have been reported in the literature, including multifocal and bilateral tumors. We report a case of oncocytoma in a horseshoe kidney. Oncocytoma and tumors in horseshoe kidneys are discussed.

The potential difference in survival due to scheduling of cyclophosphamide treatment was examined in A/J mice inoculated with neuroblastoma C1-1300 cells. Treatment was started on the third day post tumor implantation. There were four groups of animals each consisting of 30 mice: Group A, a control group, was injected with 0.3 cc of normal saline for a week. Group B was injected with cyclophosphamide 50 mg/kg/day every other day for five doses. This cycle was repeated in the same fashion starting on day 17. Group C was injected with cyclophosphamide 250 mg/kg on day 3 and this was repeated on day 17. Group D was injected with cyclophosphamide 50 mg/kg/day for five consecutive days. This cycle was repeated on day 17-21. The median survival for group B was 26.2 days (the same as the control group), for group C 47.7 days (87% increased survival) and for group D 63.2 days (143% increased survival with 30% possible cures). Twenty-three percent of the mice in group B died of pneumonia and another 23% had minor evidence of lung infection. Only three mice in this group had tumor at the time of death. The study suggests that the response of murine neuroblastoma as well as the development of pneumonia in A/J mice treated with cyclophosphamide might be schedule dependent.

We assigned 49 patients with transitional cell carcinoma of the bladder to 1 of 3 groups: 21 patients (group 1) received cyclophosphamide alone, 10 patients (group 2) received adriamycin alone and 18 patients (group 3) received cyclophosphamide and adriamycin. The objective responses were 52.3 per cent in group 1, 10 per cent in group 2 and 50 per cent in group 3. These results suggest a significant activity of the drugs (especially in groups 1 and 3) tested in bladder cancer.

The alkaline phosphatase isoenzymes in 105 patients with stage D carcinoma of the prostate who entered the National Prostatic Cancer Study were analyzed and these values were correlated to clinical response. Only patients with at least 3 measurements of alkaline phosphatase were evaluated. In 91% of patients with metastatic bone disease, bone alkaline phosphatase was elevated. Those patients with higher pre-treatment levels of alkaline phosphatase generally showed a poorer response to therapy. The results of alkaline phosphatase isoenzyme estimation indicate that these biological markers may be used in the evaluation of patients with metastatic prostatic cancer to predict and monitor their response to chemotherapy. The evaluation of bone and liver alkaline phosphatase isoenzymes in earlier stages also may be valuable.

One hundred and fifteen patients with penile cancer were treated at Roswell Park Memorial Institute from 1952 to 1975. A full follow-up is reported and factors involving the prognosis are analyzed. Although the clinical error of staging was near 30%, the lymphography results suggest that this study may result in added improvement in preoperative staging. Early diagnosis, adequate surgical resection, and lymph node dissection will improve the survival significantly. When dealing with an individual patient the prognosis is poor when any one or more of the follow factors are present: the lesion involves the shaft; there is a positive margin at the surgical resection; total penectomy is necessary to obtain tumor-free margin; lymphography is positive for tumor involvement of lymph nodes; lymph node dissection has not been performed; positive lymph nodes are found on surgical exploration. The good prognostic factors include: a lesion confined to the glans and partial penectomy is sufficient to obtain a tumor-free margin of resection; no clinical evidence (including lymphography) of lymph node invovlement; performance of lymph node dissection. The histological grading of the tumor should not influence the clinical decision for treatment in our opinion at this time, based on our current results. Further prospective studies of different factors involved in etiology, diagnosis, and treatment of penile cancer are suggested.

Testosterone (T), dihydrostestosterone (DHT) and prolactin (HPr) levels were determined in normal males and females, in patients with benign prostatic hypertrophy (BPH) and in clinically stable patients with prostatic carcinoma (CAP), intact and orchiectomized. CAP patients were either untreated or on different modalities of therapy. The HPr levels were higher in prostatic cancer patients, in BPH patients, and in subjects on estrogen therapy. No significant differences were found between controls or patients treated with 5-Fu plus cytoxan. The T and DHT levels were decreased in all noncontrol subjects. The levels of DHT in intact, untreated CAP patients or those receiving 5-FU plus cytoxan were significantly higher than in BPH patients. Based on these observations, it appears that HPr could be involved with T and DHT in a feedback control role, especially in BPH. The alterations in these hormone levels in CAP treated or untreated patients are in marked contrast and must be evaluated further.

The relationship of prior hormonal therapy to subsequent response on estramustine phosphate (Estracyt) was examined in 107 patients with advanced prostatic cancer treated in two different Phase II chemotherapy trials. In both trials patients with the longest prior hormonal treatment were the least likely to respond to estramustine phosphate. Patients in the series from the National Prostatic Cancer Project with a response classification to prior hormonal therapy had only a 26 per cent response to subsequent estramustine phosphate therapy, whereas 40 per cent of those with no prior response to hormonal therapy responded to estramustine phosphate. This latter group had the shortest average disease duration from diagnosis. The sample of prostate cancers studied appeared to include groups that were sensitive to both hormones and cytotoxic activity as well as to either of these two alone. These data support the contention that estramustine phosphate may act both as an estrogenic and a cytotoxic agent.

The value of pedal lymphangiography as a staging procedure for carcinoma of the prostate and the bladder continues to be debated because of the fact that the obturator lymph nodes apparently are not visualized during this diagnostic technique. This study involves 25 patients who have undergone pedal lymphangiography followed by fine needle aspiration. Pelvic lymph node dissection was performed and pelvic x-rays were taken once the external iliac nodes had been excised, leaving the obturator nodes behind. The next step was the removal of the remaining nodes in the obturator fossa, after which another x-ray was obtained. With this technique we could prove whether these obturator lymph nodes opacified on routine pelvic x-ray. In a review of the radiography consistent filling of the obturator nodal chain was noted in all of the cases, as well as the consistent prediction of the location of these lymph nodes before fine needle aspiration.

Blood group distribution in 264 Stage D relapsing patients from the National Prostatic Cancer Project was analyzed. No significant differences were found in distribution of blood groups in prostatic cancer patients as compared to the control population. This study does not support the observation of others of a relationship between blood group A and susceptibility to carcinoma of the prostate. Other patient groups may, however, be of value in searching for this relationship.

Primary malignant melanoma of the male urethra is a rare disease, with only 24 cases previously reported in the literature, including 1 black patient. We describe 2 additional patients with primary malignant melanoma of the urethra, one of whom was a black man. The literature is reviewed briefly and treatment recommendations are discussed.

Radical cystectomy remains the gold standard in the treatment of patients with muscle invasive bladder cancer. However, the specter of high failure rates coupled with morbid treatment methods has caused urologists, oncologists, and radiotherapists to explore modifications in, and alternatives to, the traditional treatments for invasive bladder cancer. The identification of the active methotrexate-platinum-based combination chemotherapy regimens heralds a new era in our ability to treat advanced disease effectively. Patients with less extensive muscle invasive tumors may be efficiaciously treated using conservative surgical excision, either alone or in combination with adjunctive treatments. In addition, definitive radiation therapy, given via the interstitial route or in combination with radiosensitizers, may result in long-term survival and preservation of bladder function. Progress has been made on multiple fronts in our ability to improve overall survival rates while allowing for the preservation of bladder function. The ability of these new mixed multimodality treatment initiatives to produce viable statistics equal to that of radical exenteration is an important landmark on the route towards an ideal treatment for invasive bladder cancer.

Results of the first randomized trial of the National Prostatic Cancer Project (NPCP) revealed an advantage for cytoxan and 5-FU over standard therapy in hormonally resistant stage D prostate carcinoma. A subsequent trial for patients previously irradiated, receiving the less myelosuppressive agents estracyt or streptozotocin also revealed an advantage over standard therapy. Other completed randomized trials have revealed activity for prednimustine and DTIC. Trials underway for newly diagnosed stage D disease or for stage D disease clinically stable to diethylstilbestrol (DES) show promising activity for cytoxan and DES combined. Current randomized trials in advanced disease are comparing methyl CCNU and hydroxyurea wih cytoxan, and estracyt or vincristine alone or in combination. Chemotherapy in earlier staged patients as adjuvants to definitive surgery or irradiation is underway in two trials, comparing the effects of cytoxan or estracyt as long-term therapies with no additional treatment.

Serial histological sections were performed in 54 radical prostatectomy specimens in an attempt to identify prognostic factors responsible for dissemination of prostatic cancer. Factors considered in the study included clinical versus pathological staging, histological grading of the biopsy specimen compared to the final pathological result, intraprostatic tumor distribution and deoxyribonucleic acid analysis of the tumor by flow cytometry in the last 33 cases. In patients with clinical stages A2 and B1 disease pathological findings were in accord in 78 per cent (11 of 14). However, only 3 of 40 patients with clinical stage B2 tumor had pathological stage B2 disease. Histologically, 72 per cent of the tumors were bilateral. Microscopic involvement of the capsule per se did not appear to influence lymph node invasion, since only 1 of 27 patients with microscopic capsular involvement had pelvic lymph node metastasis. However, 9 of 13 patients with seminal vesicle involvement had pelvic lymph node metastasis. The addition of flow cytometry to the Gleason score improves the predictive value of histological grade in higher stage lesions.

Specific receptors for dihydrotestosterone and estradiol-17-beta have been identified in cytosols of the human and baboon prostate. Binding of radioactive estradiol-17-beta to the 0.4 M potassium chloride extractable component of human prostate nuclei also was demonstrated. Cyproterone acetate and diethylstilbestrol, agents of known high affinity for dihydrotestosterone and estradiol-17-beta receptors, respectively, did not bind significantly to sex hormone binding globulin and, therefore, were useful as competitors in distinguishing binding of dihydrotestosterone and estradiol-17-beta to sex hormone binding globulin and to their specific receptors. Displacement of [3H]-estradiol-17-beta binding by diethylstilbestrol in cytosols of 11 needle biopsy specimens (mean equals 16.8 mg.) from prostatic cancer patients was analyzed. These preliminary data indicated a trend towards greater competition by diethylstilbestrol for high affinity binding sites in differentiated tumor specimens from men who were not receiving estrogen therapy. Objective and subjective responses to hormone therapy were recorded in these patients, whereas the disease in those men with low displacement assay values progressed.

Percutaneous fine needle aspiration of retroperitoneal pelvic and abdominal lymph nodes was done in 100 patients with clinically localized bladder, prostatic, testis and penile cancer. A diagnosis of metastases to regional lymph nodes was detected by this method in 20 patients. Fine needle aspiration revealed evidence of regional lymph node involvement in 6 of 40 patients (15 per cent) with negative findings on lymphography and computerized tomography scan. Lymph node aspiration was followed by lymph node dissection in 50 patients. The correlation between aspiration and dissection was 68 per cent. The accuracy of obtaining representative material from the lymph node aspiration was 83 per cent. Negative results of lymph node aspiration cannot be used in clinical management. However, positive aspiration results provide the clinician with valuable information obtainable otherwise only by laparotomy or lymph node dissection. Positive aspiration results may spare patients with prostatic and bladder cancer an unnecessary radical operation, and may indicate early chemotherapy or surgery in patients with testis and penile cancer.

A 33-year-old man had a 1-year history of a painless testicular mass and a 2-month history of an enlarging left supraclavicular mass. Biopsy of the supraclavicular mass showed classical seminoma. Massive abdominal lymphadenopathy was demonstrated by computerized tomography. Radical orchiectomy was performed and examination of the specimen showed only fibrous scar tissue consistent with regression of a primary tumor in the testis. While complete regression of a primary testicular tumor with progressive growth of metastases is well recognized in cases of nonseminomatous germ cell tumors, this phenomenon is reported rarely with seminoma.

To evaluate the effect of prostaglandin inhibition on the renal blood flow of the ischemic kidney, we administered indomethacin to 10 anesthetized dogs with renal artery stenosis and contralateral nephrectomy. Following the operation to produce renal ischemia, there was an increase of blood pressure associated with an increase of renin and the prostaglandins F1 (PGF1), and E (PGE). The administration of indomethacin to the intact, normotensive animals caused the anticipated decrease of prostaglandin E, renin, and renal blood flow. However, in the hypertensive dogs, indomethacin caused a paradoxical 45 per cent increase in the renal blood flow, despite a 44 per cent decrease of prostaglandin E. PGF1, PGE, renin, and erythropoietin exhibited the anticipated decreased levels. The study suggests that prostaglandins may not be the sole important factor in the regulation of renal blood flow in the presence of ischemia. Other important factors likely include the renin-sensitive angiotensin, the adrenergic, and the kallikrein-kinin systems.

The value of immediate postoperative enteral hyperalimentation with an elemental diet (high nitrogen Vivonex, full strength) at 125 cc per hour for 4 days was assessed in patients after radical urological surgery. Of 32 patients studied 21 received an elemental diet using a Vivonex Moss tube, which is a 3-lumen tube with esophagogastric decompression and simultaneous duodenal feeding, and the remaining 11 had a nasogastric tube only without nutritional support. We have used a selected group of parameters, including serum albumin, serum transferrin, creatinine height index, weight loss, total lymphocyte count, nitrogen balance and plasma fibronectin. All patients in the Moss tube group approached or achieved positive nitrogen balance by 4 days postoperatively, whereas the nasogastric tube group remained in negative nitrogen balance. Postoperative paralytic ileus was prevented in the majority of patients in the Moss tube group while receiving full nutritional support. We have found that the use of the Moss tube is a reasonable approach for postoperative alimentation. The tube is relatively easy to insert and well tolerated, and its use is a less expensive alternative to parenteral hyperalimentation.

A case of hemangiopericytoma arising in the urinary bladder is presented. Initial symptoms included hematuria and frequency of urination. Hemangiopericytoma is a vascular tumor of pericyte origin which occurs primarily in several organs and can be benign or malignant. Reports in the literature of genitourinary system involvement are reviewed. It is concluded that genitourinary tumors of this type should be considered malignant and treated aggressively.

There were 22 patients with vertebral metastases and impending neurologic damage from prostatic, vesical and renal cell carcinoma treated by decompressive laminectomy combined with local radiotherapy and chemotherapy. The neurological recovery was complete in the prostatic carcinoma patients (10 of 10), partial in the vesical carcinoma patients (2 of 5) and unsatisfactory in the renal cell carcinoma patients (1 of 7).

Twenty-one patients with gram-negative urinary tract infections were treated with sisomicin, a new aminoglycoside antibiotic. Bacteriologic cure was achieved in 62 per cent of patients, and improvement in another 33 per cent. Mild transient elevation of serum creatinine occurred in 3 patients. No other toxicity was observed. Further clinical trials with more frequent dose administration and in combination with other antibiotics is suggested.

Twenty-five patients subjected to pelvic node dissection for urologic malignancies underwent bilateral pedal lymphangiography preoperatively. Postoperatively, 50 samples of the nodes selectively removed from the regions surrounding the obturator nerve were radiographed. All 50 samples revealed the presence of radiopaque dye. The lymph nodes surrounding the obturator nerve represent the first point of lymphatic metastases in carcinoma of the prostate and the bladder. Their visualization by lymphangiography emphasizes the importance of such a diagnostic study for the correct clinical staging of these diseases. The lymphatic anatomy of the pelvis is reviewed and compared to the radiological findings in lymphangiography.

The development and proliferation of modern radiotherapy techniques, and their application in the 1970s to the treatment of localized adenocarcinoma of the prostate have led to substantial improvement in therapy of this disease. However, treatment failures occur. Among these patients is a small subset who have local recurrence of disease confirmed by biopsy without evidence of metastatic disease, and who still are relatively young and healthy. We report on 7 patients who satisfy these criteria. All 7 patients underwent a salvage operation with removal of the prostate gland following attempted curative radiotherapy: 3 underwent cystoprostatectomy and urinary diversion, and 4 underwent radical prostatectomy. Operating times averaged 4.9 hours and average blood transfusion was 5.3 units. Postoperative hospital stay averaged 13 days. Significant morbidity included 2 patients with rectal lacerations (1 of whom suffered a rectourethroperineal fistula that closed spontaneously), 2 with temporary urinary incontinence, and 1 with idiopathic thrombocytopenia and pseudomembranous colitis. As illustrated by these patients salvage surgery is difficult and there is substantial morbidity. However, this treatment option with its potential for cure can be offered to patients as a reasonable and rational approach to the problem.

Seventeen patients with histologically proven adenocarcinoma of the prostate were selected for evaluation of their immunologic competence and therapy with bacillus Calmette-Guérin (BCG). All patients were in stage D. The immune response was explored in two main aspects: cell-mediated and humoral immunity. Delayed skin hypersensitivity reaction with purified protein derivative (PPD), streptokinase-streptodornase (varidase), Candida, mumps antigen, and Trichophyton were tested. Lymphocyte reactivity was measured by in vitro blastogenesis. Serum immunoglobulin levels and serum protein electrophoresis were also measured. The patients were then divided in two groups according to the skin test response to PPD. Group 1 (PPD-positive) consisted of seven patients. Group 2 (PPD-negative) consisted of ten patients. In group 1, two patients were treated with intraprostatic injection of BCG every week in the following doses: 1 cc the first week, 2 cc the second week, 4 cc the third week, and 6 cc the fourth week. The five remaining patients in this group received only 1 cc every week for 4 weeks. The group 2 patients (PPD-negative) were stimulated by oral intake of BCG in an attempt to convert their skin tests to positive. All patients revealed varying degrees of immunodepression. None of the patients in group 2 (stimulated by oral intake of BCG) converted to positive skin tests. Three patients in group 1 treated with BCG showed necrosis of the tumor. The different aspects of immunodepression in this disease are analyzed and correlated to the clinical staging, histologic grading, and response to therapy. The mechanism of BCG action in advanced prostatic carcinoma is discussed.

Our experience with the preoperative staging of bladder cancer by bilateral selective hypogastric arteriography has been accumulated since 1968. More than 150 patients have been studied by selective angiography before radical cystectomy. Our latest series of 52 patients (1972 to 1976) compares to our previous experience demonstrating angiographic staging accuracy to detect bladder invasion and occult metastases at a rate exceeding that of clinical staging alone. Arteriographic staging of D lesions, when supplemented with lymphography, approaches 100 per cent accuracy. Falsely negative lymphograms currently are extremely uncommon (1.9 per cent). In several illustrated instances angiographic staging was proved to be even more accurate than the pathologic staging of a limited cystectomy specimen. The over-all angiographic and lymphangiographic staging accuracy in our most recent series of cystectomy patients was 78.8 per cent. The techniques and reliability of the data are discussed in detail, including the factors that interfere with the exact arteriographic staging of bladder cancer. However, these factors are more troublesome in early stage lesions. These studies demonstrate the role and value as well as areas of limitation of preoperative arteriography and lymphography in the evaluation of invasive bladder cancer.

Modification in lymphatic drainage following retroperitoneal lymph node dissection, such as a collateral circulation or lymph node and lymphatic vessel regeneration, was observed in 2 patients in whom a second tumor developed in the remaining testicle. Such alterations of the lymphatic system are difficult to evaluate for the possible presence of metastatic disease. The presence of extensive collateral circulation rules out lymph node dissection or radiation therapy as an appropriate treatment in these patients. A short course of systemic chemotherapy, regardless of the histological type of the second malignancy, seems to be the safest adjunctive treatment in such cases.

Blood urea nitrogen and weight reduction can be accomplished in renal failure by doubling the surface area of the standard dialysis coils. This results in a reduction of time on the machine, drugs and personnel utilization.

A total of 25 patients with renal cell carcinoma underwent angioinfarction of the tumor using absolute ethanol. An average of 15 ml. absolute ethanol was injected into the main renal artery through a balloon occlusion catheter. Complete cessation of renal arterial flow could be demonstrated in all cases. The post-embolization syndrome of pain, nausea, vomiting, hypertension and fever was minimal compared to other methods of renal artery occlusion. Of the patients 21 underwent post-infarction transabdominal radical nephrectomy without intraoperative or postoperative complications attributable to the injection of absolute ethanol. No damage to extrarenal tissue was noted at operation. Subsequent surgical dissection was facilitated, particularly in cases of large tumors when control of the renal pedicle often is difficult. Median blood loss was 725 ml. In light of recent reports concerning the benefit of angioinfarction and nephrectomy in metastatic disease a similar approach may be applicable to localized disease. This pilot study shows the safety of preoperative angioinfarction with absolute ethanol and may be used as a reference for future randomized prospective studies comparing angioinfarction and nephrectomy to nephrectomy alone for localized renal cell carcinoma.

The treatment of patients with advanced seminomatous tumors represents a challenge for the medical and urological oncologists. In contrast to the reported excellent results of radiotherapy in the treatment of patients with clinical stages I and II disease the survival rate for those with advanced seminomatous disease is only around 40 per cent. Six consecutive patients with metastatic seminomas were treated with systemic chemotherapy and all achieved a complete response. The combination of vincristine, cis-platinum, bleomycin and prednisone was used in 4 patients and an excellent tolerance was observed even in patients with previous radiation therapy. Two other patients who had had radiation therapy to the mediastinum were treated with VP-16 and cis-platinum and again a complete response was observed. However, a significant potentiation of myelosuppressive effect of VP-16 was observed in the previously radiated patients. In view of the observed sensitivity of seminomatous tumors it appears that all patients who present initially with metastatic or bulky retroperitoneal disease should be treated with multiple drug chemotherapy and cytoreductive surgery similar to the treatment modalities used for nonseminomatous germ cell tumors. Radiation therapy for patients with this stage of the disease seems to be not only ineffective but also may compromise the benefits of aggressive chemotherapy.

This is the second case reported in the literature involving transitional cell carcinoma in an ileal loop. The case is described and the literature reviewed.

A rare case of a fifty-six-year-old female with neuroblastoma is presented. Possible implications as to etiology are discussed, and the radiographic similarities between renal cell carcinoma and neuroblastoma are presented.

The effects of high concentrations of CO2 on experimental murine neuroblastoma tumor were studied. Similar to the experience with the animal model of Wilms' tumor, the local growth of this neuroblastoma model was not affected by concentrations of 76% and 55% of CO2 applied for 10 and 30 minutes. The tumor bearing animals exposed to different CO2 concentrations tended to develop metastases more frequently than the control groups, although no change in survival was noted. Different animals and additional tumor models could be used by others to study the effects of different CO2 concentrations at different exposure times.

Twenty-five patients with disseminated renal cell carcinoma have been followed for eleven months. These patients have been treated with CCNU, bleomycin, methotrexate, and platinum in various combinations. The results have been discussed in light of other studies using chemotherapeutic agents against this disease process.

Most superficial bladder tumors are best treated by transurethral resection. However, because of their multifocal origin and high rate of recurrence they often present challenging therapeutic problems. Intravesical chemotherapy often is used in such cases in the treatment and prevention of recurrent transitional cell carcinoma of the bladder. Recently, mitomycin C intravesical chemotherapy was shown to be effective in the treatment of superficial bladder tumors. No systemic toxicities were described but bladder irritation and drug-related palmar desquamation were noted. We report a case of a severely contracted bladder requiring urinary diversion following intravesical chemotherapy with mitomycin C. A possible relationship of this complication to the mitomycin C treatment is suggested.

From 1984 to 1987, 49 patients with transitional cell carcinoma of the bladder underwent radical cystectomy during which intraoperative autotransfusion was used. Thirty-three patients were observed for a minimum of one year postoperatively; the mean and median follow-up periods in this group were 23.8 and 26.0 months. Twenty-nine of these 33 patients were alive at the time of reporting; 25 were alive with no evidence of disease, and seven had postoperative recurrence of disease, and seven had postoperative recurrence of tumor. Diffused metastatic disease compatible with intravascular dissemination of tumor during autotransfusion did not develop in any of the patients. Intraoperative loss of blood ranged from 400 to 4,000 milliliters; the mean was 1,497, and the median, 1,300 milliliters. The mean volume of autotransfused blood was 492 milliliters. Autotransfusion accounted for 40 per cent of the total transfusion requirements of the patients and proved to be cost effective for the entire study group. Fear of dissemination of tumor has limited the use of intraoperative autotransfusion during surgical procedures for carcinoma. Analysis of our data failed to define any evidence for dissemination of tumor caused by autotransfusion in patients who underwent radical cystectomy.