W.H.A. HELMY, G.I. SELMY, M. HASSOUNA AND M. ELHILALI

Objectives To study ultrastructural changes in the neuronal component of the detrusor muscle during the spinal shock phase and following early electric neurostimulation in an animal model.

Material and Methods 12 dogs were decentralized at the levels from S1 to S3, while three animals were provided as normal controls. The decentralized animals were divided into four groups according to the method of bladder voiding: Group 1A: intermittent catheterization without neurostimulation, Group 1B: intermittent catheterization followed by neurostimulation, Group 2A: early prolonged neurostimulation and Group 2B: early neurostimulation followed by intermittent catheterization. From the different groups, bladder tissue blocks were dissected, fixed in glutaraldehyde and processed for electron microscopic study.

Results Early prolonged sacral root neurostimulation demonstrated a significant reduction of degenerated axons (mean = 28.9% ± 1.7), an increased frequency of cholinergic axons (mean = 16% ± 0.75) and an exhibited significant narrowing of the neuroeffector gap junctions (mean = 117.25 ± 22.6 nm) in comparison to non-stimulated animals (mean values were 80.5% ± 0.75, 5.4% ± 1.7, and 281 ± 62.6 nm, respectively) which were voided with intermittent catheterization. However, early sacral root stimulation followed by intermittent catheterization displayed a significant reduction of axonal degeneration (mean = 48.3% ± 1.8) in comparison to late stimulation following the intermittent catheterization (mean = 83.3% ± 2.8).

Conclusion Early sacral root electric stimulation decreased the incidence of neuronal degeneration in decentralized detrusor muscle, together with improving the regenerative potential of cholinergic axons.

A.K.G. VENYO, D.W. HERRING, H. GREENWOOD AND D.J.L. MALONEY

Objectives To study the expression of c-erb-B2 in human urothelial cancer using an immunohistological (ABC) method.

Material and Methods The staining characteristics of 86 tumors studied were analyzed with regards to grade, stage and outcome following treatment.

Results Twenty-two, 9 and 20 tumors, respectively, were positive for c-erb-B2 out of 45, 15 and 26 G1, G2 and G3 tumors. Twenty-nine out of 55 pTa and pT1 tumors and 22 out of 31 muscle invasive tumors were positive for c-erb-B2. C-erb-B2 negative pTa and pT2 tumors were more commonly associated with no recurrence. Recurrences of higher grade and higher stage were more commonly associated with c-erb-B2 positive pTa and pT1 tumors.

Conclusion Survival appeared to be more common in the c-erb-B2 negative muscle invasive tumors in comparison with the c-erb-B2 positive tumors.

A.A HASSAN, M.A. MORAD AND S.A. HAMMOUDA

Objectives To evaluate the role and prognostic value of the expression of epidermal growth factor receptors (EGFR) in serum and urine for the detection of human bladder cancer.

Patients and Methods The study comprised 30 patients with newly diagnosed transitional cell carcinoma of the bladder and 10 normal volunteers. The patients’ age ranged from 42 to 76 years. The serum and urinary EGFR levels were evaluated using the ELISA technique. An indirect haemoagglutination (IHA) test was used for the detection of bilharzial antibodies. Cystoscopy, tumor resection and bimanual examination under anaesthesia were carried out for every patient. The patients were divided into 4 groups: Group A: 10 healthy individuals serving as a control group, Group B: 7 patients with grade I bladder cancer, Group C: 10 patients with grade II bladder cancer and Group D: 13 patients with grade III bladder cancer.

Results Bilharziasis was recorded in 33 patients, 6 of them were in the control group. A comparison between the bilharzial and non-bilharzial patients did not reveal any significant difference in the serum EGFR expression (46.47 ± 32.23 and 36 ± 38.22 fmol/ml, respectively) nor in the urinary EGFR expression (45.42 ± 29.78 and 41 ± 31.16 fmol/ml, respectively). None of the patients with grade I bladder cancer was found to have stage T3 and T4 cancer, while all the patient with grade II and grade III cancer had invasive cancer (> Ta). The mean values of urinary and serum levels of EGFR in the control group were 12.37 ± 7.21 and 11.9 ± 8.17 fmol/ml, respectively, while the mean values of urinary and serum levels of EGFR in the cancer patients were 46.47 ± 32.23 fmol/ml and 45.4 ± 29.78 fmol/ml, respectively, which represents a significant increase in the serum and urinary EGFR in the cancer patients as compared to the control goup. In addition, a stepwise increase in the serum and urinary EGFR was noted with the cancer grade increasing from grade I to III. The best cut-off values for serum and urinary EGFR were 22 fmol/ml and 25 fmol/ml, respectively. The best cut-off point for the serum EGFR level had a sensitivity of 83.3%, a specificity of 90% and an accuracy of 85%, while the best cut-off point for the urinary EGFR level had a sensitivity of 80%, a specificity of 90% and an accuracy of 82.5%.

Conclusion The results of the present study suggest that high levels of EGFR in the serum and urine of patients with bladder cancer are related to various malignant histological features (tumor grade) and invasiveness of bladder cancer. In the future, the evaluation of urinary and serum EGFR might help in the prediction of recurrence rate, response to systemic treatment and in the screening of bladder tumors.

T. DRISS, A. AHMED, B. AMOUQRANE ET O. HAMMOU

Résultats Quarante patients ont été opérés, dont 35 en urgence, ces derniers ont tous évolué favorablement. Les interventions tardives (5 cas) ont été grevées de com-plications (2 cas de plaque fibrose, 1 cas de coudure de la verge). Les deux patients non opérés par refus de la chirurgie ont évolué vers une induration angulaire sévère.

Conclusion La RTCC est une affection de l’adulte jeune qui nécessite un traitement chirurgical précoce avec un abord adapté au type des lésions.

A.K.G. VENYO, D.W. HERRING AND G. SHIEL

Objectives To determine whether raised levels of serum Beta Human Chorionic Gonadotrophin (-HCG) are associated with higher grade and higher category tumors and whether in patients with raised levels of -HCG in their sera the rise (above normal range) and the fall (to normal) in -HCG levels would correspond with the presence or absence of tumors.

Patients and Methods Radioimmunoassay for -HCG was performed using the sera (blood samples) obtained from 120 patients (mean age 70 years, range 20 — 95 years) with urothelial carcinoma at the time of diagnosis of the tumors and at follow-up. For control purposes a radioimmunoassay for -HCG was performed in 2 groups of patients: Group A: 30 patients with benign conditions who came for operations like hernia repair, and Group B: 70 patients who previously had had resection of urothelial tumors but who repeatedly had no evidence of recurrent tumors at review cystoscopy.

Results Thirty-six of the 120 patients (30%) with urothelial carcinomas had raised serum levels (³ 4 IU/L) of -HCG. All 30 patients with benign conditions had normal levels ( £ 4 IU/L) of serum -HCG and 60 of the 70 patients who repeatedly did not have any evidence of recurrence at review had normal levels of serum -HCG. It was observed that raised serum levels of -HCG were more commonly associated with tumors of high grade and high stage. It was also observed that in patients with urothelial carcinoma and raised levels of serum -HCG the fall to normal levels ( £ 4 IU/L) corresponded with non recurrence of the tumor and the persistence of raised levels of -HCG or a further rise in serum levels of -HCG corresponded with persistence or recurrence of the tumor. Conclusion The results of this study may suggest that the serial measurement of serum -HCG may prove to be a useful adjunct to the follow-up of patients whose tumors are associated with raised serum levels of -HCG provided the elevation of serum -HCG is due to production by urothelial tumors.