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Aims: To investigate the effect of combination endocrine treatment (CET) or luteinising hormone releasing hormone agonist and flutamide on non-neoplastic prostate, prostatic intraepithelial neoplasia, and prostatic adenocarcinoma., Methods: The morphology, including the mitotic activity, of 12 radical prostatectomies from patients with prostatic adenocarcinoma pretreated for three months with CET was evaluated in haematoxylin and eosin stained sections and compared with an untreated age and stage matched control group., Results: A differential effect on the non-neoplastic prostate was observed. In fact, the transition zone of the treated prostate showed simplification of the glandular lobules: the ducts and acini were small without undulations of the epithelial border and with a prominent basal cell layer. Within the peripheral zone there was inconspicuous branching of the ducts and acini which looked dilatated and lined by flattened atrophic epithelium. Prostatic intraepithelial neoplasia occurred in scattered ducts and acini in the peripheral zone of 10 of the 12 patients. The epithelial cell lining showed a prominent basal cell layer. A certain degree of secretory cell type stratification was always present. However, crowding was less evident than in the untreated prostate because of cytoplasmic clearing and enlargement as a result of coalescence of vacuoles. The treated adenocarcinomas had neoplastic acini which looked small and shrunken, and areas of individual infiltrating tumour cells separated by abundant interglandular connective tissue. The secretory cells of the nonneoplastic, prostatic intraepithelial neoplasia, and prostatic adenocarcinoma lesions had inconspicuous nucleoli, nuclear shrinkage, chromatin condensation, and cytoplasmic clearing. Apoptotic bodies were easily identifiable in all the cell layers. The lumina were rich in macrophages, sloughed secretory cells with degenerative features, and apoptotic bodies. Mitoses were not observed in any of the treated non-neoplastic prostate, prostatic intraepithelial neoplasia, or prostatic adenocarcinomas, whereas the mitotic frequency increased from non-neoplastic prostate through prostatic intraepithelial neoplasia up to prostatic adenocarcinomas in the untreated specimens., Conclusions: CET before radical prostatectomy causes regressive epithelial changes together with enhanced apoptosis and blocked mitotic activity.

Expression and location of Proliferating Cell Nuclear Antigen immunostaining in epithelial nuclei were assessed on histological sections from 32 cases of invasive adenocarcinoma of the prostate gland: 20 untreated and 12 treated with combination endocrine therapy or CET. The PCNA-positive nuclei showed homogeneous or granular types of staining or a mixture of both, and a gradation in the intensity of staining. Nuclei with homogeneous patterns appeared darker brown than the lighter granular and mixed patterns. Darker nuclei were more frequently noted, mainly among the epithelial cells adjacent to the stroma, in the untreated cases. In contrast, nuclei with pyknotic chromatin, unstained and corresponding to apoptotic bodies, were more frequently seen in the treated patients. For the untreated invasive adenocarcinomas, the mean proportion of PCNA-stained epithelial nuclei in the 10 cases with an acinar pattern (small and large) was 8.86% (SE 0.23%). The mean value in the 5 cases with a cribriform pattern was 11.76% (SE 0.52%), that is, greater than in the acinar pattern, and decreased from the nuclei in the basal position, or adjacent to the stroma, toward the lumen: 14.40% (SE 0.61%) in the basal position, 11.84% (SE 1.30%) in the intermediate and 9.26% (SE 0.66%) in the lumenal. In the 5 cases with a solid/trabecular pattern, the proportion of PCNA-positive nuclei was 15.74% (SE 2.30%), that is, higher than in all the other patterns, and decreased from the cell layer adjacent to the stroma (17.60%, SE 2.92%) toward the other layers (13.88%, SE 1.71%).(ABSTRACT TRUNCATED AT 250 WORDS)

The authors report a case of glans trauma with partial avulsion of the foreskin repaired by means of a foreskin pedicle flap. The cosmetic and functional result was very satisfactory with a follow-up of 36 months.

Our experience concerning 605 fine needle aspiration (FNA) biopsies performed between 1985 and 1988 is reported. FNA specimens of the prostate gland were compared to histological material in 101 cases: 37 patients underwent suprapubic prostatectomy, 15 radical prostatectomy, 28 transurethral resection, and 21 core needle biopsies. Adenocarcinoma was correctly diagnosed by using cytology in 39 out of 40 cases; benign prostatic hypertrophy was confirmed by histology in 54 out of 57 cytologically benign cases. The absolute sensitivity of the FNA biopsy was 98.2%; specificity was 98.1%; efficiency was 96%; and false negative rate was 6.6%. Our data support the value of transrectal aspiration biopsy as a precise and easy method for diagnosing prostatic cancer; the low false negative rate and the high number of correct diagnoses underline the great accuracy of the method.

The transforming activity of DNA extracted from one testicular cancer, one benign prostatic hyperplasia, two malignant prostatic adenocarcinomas, six renal cell carcinomas, two tumours of the renal pelvis, a specimen of normal urothelial tissue, two benign papillomas of the bladder and five malignant bladder carcinomas, was investigated using a DNA transfection assay on primary cultures of hamster kidney cells (HK cells) and mouse embryo fibroblasts (MEF cells). Transformation was scored under light microscope by the appearance of foci of morphologically transformed cells and by evaluating the ability of the transfected cells to from colonies in soft agar. Primary HK cells were unable to support transformation by human tumour DNA because of their very limited lifespan in vitro; MEF cultures, on the contrary, had a much more prolonged life: but were only abortively transformed by DNA from four out of six renal cell carcinomas and four out of seven malignant urothelial tumours, suggesting that transforming genes are present but not activated in the DNA from these urological malignancies.

The authors analyze diagnostic, prognostic and therapeutic influence of caval neoplastic thrombosis in management of renal cell carcinoma. They describe, for the first time, the utilization of De Weese caval clip to prevent intraoperative pulmonary embolism secondary to surgical manipulations.

The authors have observed with E.M. Philips 301 some biopsies obtained from testes of cryptorchid patients aged between 38 and 72 to study the ultrastructural aspects of seminiferous tubules in this age. Tissues were fixed in 2% phosphate-buffered solution of glutaraldehyde and then postfixed in 1% osmium tetroxide, processed for routine electron microscopy. The seminiferous tubules appear strongly damaged and we have observed numerous Sertoli cells and only few dark spermatogonia. The Sertoli cells appear either normal and mature or with a cytoplasm filled with big lipid droplets and large amounts of glycogen. The basal membrane of the seminiferous tubules is thickened. Leydig cells are characterized by dilated smooth endoplasmic reticulum and numerous nuclear bodies.

This work is aimed at demonstrating the validity of conventional radiological procedures, correlated with urodynamics, in the study of female urinary stress incontinence. In a study population of 110 patients with a clinical-urodynamic diagnosis of stress incontinence, radiological evaluation was performed by means of retrograde cystography, bead chain cystourethrography, and voiding cystourethrography. Radiographic findings were correlated with urodynamic data, and in particular with urethral pressure profile (functional length of the urethra, maximum closing pressure, maximum urethral pressure). In all patients the posterior urethro-vesical angle values were higher than 100 degrees; moreover, a correlation was proven to exist between an increase in the angle of front urethral inclination, the lowering and mobility of the urethrovesical junction, and the severity of urodynamic findings. Furthermore, in the different stages of urodynamic severity , urethral funneling was most frequent, and the flattening of the posterior vesical floor in voiding cystourethrography. The high reliability of the radiographic findings, although obtained by means of conventional techniques, and the variability of the morpho-dynamic results confirm the importance of a combined radiographic and urodynamic study in the evaluation of stress incontinence.