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The relationship between the risk of prostate cancer and dietary intake of energy, fat, vitamin A, and other nutrients was investigated in a case-control study conducted in Montreal (Quebec), Canada. French Canadians aged 35 to 84 years with a recent, histologically confirmed diagnosis of adenocarcinoma of the prostate were identified through the admission offices of five major francophone teaching-hospitals in Montreal from 1989 to 1993. Population-based controls matched for age (+/- five years), language, and place of residence were selected by a modified random-digit dialing method. The study included 232 cases and 231 controls. Information on dietary intake was collected by means of a quantitative dietary history. No association was evident between energy intake and the risk of prostate cancer. In contrast, there was some evidence of an inverse association with intake of total fat, animal fat, monounsaturated fat, and particularly saturated fat (odds ratio = 0.69, 95 percent confidence interval = 0.40-1.18, P = 0.05), while a nonsignificant positive association was found with polyunsaturated fat. In addition, high intake of retinol and vegetable protein (highest cf lowest quartile) was associated with reduced risk, but was not statistically significant. No associations were established between intake of other nutrients and risk. These patterns persisted after adjustment for a number of potential confounding factors.

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OBJECTIVES: This study was designed to evaluate the safety and efficacy of the selective alpha 1-adrenoceptor blocker terazosin in the treatment of benign prostatic hyperplasia (BPH). METHODS: Two hundred twenty-four patients aged 50 to 80 years, who had a diagnosis of BPH based on medical history, physical examination, and digital palpation, were recruited from 11 different sites between January 1992 and January 1994. The study consisted of a screening phase, a placebo phase, a double-blind dose-titration phase, and a double-blind maintenance phase. RESULTS: Of the patients recruited, 164 entered the double-blind phase and of these 134 were evaluable. Only 11 patients withdrew because of an adverse event, 7 in the terazosin and 4 in the placebo group. Compared to placebo, terazosin significantly increased peak and mean urine flow rates without significantly affecting voided volume or postvoid residual volume. It significantly improved both the obstructive and irritative symptoms associated with BPH. Fifty-one patients from the terazosin group reported a total of 120 adverse events compared with 83 reported by 42 patients in the placebo group. The majority of these events were mild to moderate. Seventeen terazosin-treated patients reported hypotension-related adverse events and 4 withdrew from the study. However, concurrent treatment with antihypertensive agents did not affect the blood pressure response of the terazosin group. CONCLUSIONS: Overall, this study showed terazosin to be safe and effective in relieving the signs and symptoms of BPH and should be considered as a treatment alternative.

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A multicenter randomized, double-blind trial comparing total androgen blockade obtained by the use of castration with a pure anti-androgen (nilutamide) with simple castration was begun. One hundred and five patients received the combined treatment and 103 the orchiectomy plus placebo. Several features were used to evaluate the efficacy. Bone pain responded better to combined treatment at 6 months (P = 0.042). The number of favorable responses, as evaluated by the NPCP criteria, was 61% with simple castration and 78% with the combined treatment (P = 0.013). There was no statistically significant difference between the two groups in time to progression (logrank test P = 0.462) or survival (logrank test P = 0.137) despite an increase in median survival of 5.4 months. All other measures showed no difference between the two treatments. With total androgen blockade, 50% of the patients had disease progression at 1 year, and 45% were dead at 2 years. A review of the results of similar reported studies suggests no improvement or very modest improvement with total androgen blockade over testicular androgen ablation alone.

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A multicenter, randomized double-blind study was carried out in 203 patients with metastatic prostate cancer, in order to compare the efficacy of complete suppression of androgens achieved with surgical castration and nilutamide (Anandron), 100 mg t.i.d. The combined therapy was well-tolerated by patients, and they noted a better relief of bone pain after six months than those in the control group. There was a greater number of favorable responses in the combined treatment group. In addition, despite a similar median progression-free actuarial rate, the combined treatment (nilutamide plus orchiectomy) offered an improved survival time over orchiectomy alone.

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A randomized double-blind trial in patients with disseminated, previously untreated prostate cancer (Stage D2) was conducted in eight Canadian centers. All 203 patients enrolled in this study underwent bilateral orchiectomy and were randomized to receive either the nonsteroidal anti-androgen nilutamide or a placebo. Patient responses were graded according to the criteria of the National Prostatic Cancer Project (NPCP). Patients treated with nilutamide had a significantly greater number of positive objective responses (partial and complete regression) than did the patients treated with castration alone (46% versus 20%, P = 0.001). Progression-free survival was improved initially in the nilutamide group, but the median time to progression was 12 months for both groups. Despite an increase in the median length of survival from 18.9 to 24.3 months with the nilutamide, the survival time was not significantly longer in the nilutamide group (log = rank test, P = 0.048). Although minor side effects were frequent, adverse effects related to the medication and leading to discontinuation of treatment were observed in 9% of cases. These results suggest some benefit of the combined treatment (orchiectomy + nilutamide) over orchiectomy alone in the treatment of metastatic prostatic carcinoma.

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This randomized, double-blind study comparing orchiectomy plus placebo to orchiectomy plus a nonsteroid antiandrogen (Anandron) shows that total androgen blockade for metastatic cancer of the prostate provides a significantly better early objective response when compared to castration alone. This response, however, is less apparent at 18 months. The study also suggests a longer survival for the patients with total androgen blockade.

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Of 939 patients treated by radiotherapy for carcinoma of the cervix at the hôpital Notre-Dame in Montreal, between 1979 and 1981, 275 (29.3%) had digestive, urologic, gynecologic, vascular, osseous and cutaneous complications. Surgery was necessary to treat 73 complications in 55 patients (5.9%): 42 digestive (25 occlusions, 13 fistulas and 4 perforations); 22 urologic (16 occlusions, 5 fistulas, 1 hemorrhage); 6 gynecologic (3 hemorrhage and 3 uterine necrosis); 1 cutaneous, 1 vascular and 1 osseous necrosis. No direct correlation was found between the incidence of the complications and certain predisposing factors such as the type of radiotherapy, patients' age, stage of the disease and gynecologic surgery before radiotherapy. However, there was a strong correlation between the incidence of complications and the dose of radiotherapy and the need for gynecologic surgery after radiotherapy. High morbidity was observed in the 55 patients treated surgically: they had to undergo a mean of 2.36 operations each, 2.98 general anesthetics, 1.81 hospitalizations (mean duration 75.7 days); 21 had one or more definitive stomas. The death rate was 5.45%. Surgical treatment was individualized. Limited resections were performed for occlusions, fistulas and perforations whenever it was technically feasible to treat digestive and urologic complications. A bypass procedure was used when resection would have been too extensive or dangerous. The majority of rectal lesions were treated by colostomy and a Hartmann procedure.

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Iatrogenic ureteral injuries are not common but may occur whenever the retroperitoneum is opened. The best time to treat these injuries is when they occur. The abdominal surgeon is responsible for the immediate treatment of ureteral injuries that he causes and should be able to take care of most of them. The author describes methods for preventing and managing ureteral puncture, crushing injury, kinking and ligation of the ureter, partial and complete transection of ureters, excision of both short and long segments of the ureter and ureteral devascularization.

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A search for insect growth inhibitors in methanol extracts of soybean leaves resulted in isolation of pinitol. Pinitol caused a 50% reduction in weight gain (ED50) of Heliothis zea larvae at about 0.7% when added to a synthetic diet. Although myo-inositol is a normal component of the insect diet, it also caused growth inhibition at higher concentrations; ED50 4%.

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Six cases of avulsion of the upper ureter by blunt trauma are presented: 5 in children and one in an adult. One of these also involved the entire renal pedicle. A review of the literature shows that this type of trauma is rare, about 30 cases having been reported. They are seen mostly in children, and the right kidney is more prone to injury. Often, there is absence of hematuria which leads to considerable delay in diagnosis and surgical repair. On account of this delay, hydronephrosis, infection, and sometimes pseudocyst formation can complicate the initial pathologic condition. Despite these delays, successful repair can be accomplished and the kidney salvaged. In some instances, as we found out in our cases, a retrograde pyelogram was helpful in establishing the diagnosis and localizing the site of the lesion preoperatively.

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Five consecutive patients with 7 ureteral injuries found after gynecological operations were treated conservatively. The complications ensuing this type of management are reported briefly. Twenty more consecutive patients with 27 ureteral injuries were treated immediately after diagnosis and definitively. Important points of technique are 1) little attempt to stay extraperitoneally, 2) sacrifice of all abnormal ureter, 3) re-establishment of ureteral continuity between a normal ureter and the bladder by usual means, 4) peritoneal closure only when easy, 5) adequate drainage and 6) use of antibiotics. The results obtained were excellent. Early and definitive treatment of ureteral injuries found after gynecological operations seems to be the safest and easiest type of management in all cases.

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Cutaneous transureterostomy was done on 18 patients with chronically dilated upper tracts. The operation is simple with minimal immediate complications. Long-term results are good despite the frequent persistence of chronic urinary infection and dilatation of the ureters, which are attributable to their persistent damage. We believe that cutaneous transureterostomy represents a good type of urinary diversion for these children.

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