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The comparison of the diagnostic and prognostic significance of histology, immunohistochemical parameters (PSA, PSP), and silver-stained nucleolar organizer regions (AgNORs) was estimated in paraffin sections taken of 63 prostatic carcinomas prior to therapy. AgNORs were visualized with a one-step silver staining technique with the appropiate staining time determined by preliminary staining-time series. The mean AgNOR number per cell (n) and the mean AgNOR area per silver-stained dot (A) were determined by means of an automatic image analysis system. Thereby prostatic carcinomas exhibited multiple small AgNORs within their nuclei (n = 4.7, A = 0.09 µm2), whereas benign prostatic epithelium showed few but large silver-stained particles (n = 1.8, A = 0.27 µm2; p < 0.001). This relationship was then calculated as a quotient of AgNOR number and area (NQ = n/A) which provided additional information for the diagnosis of malignancy as well as survival. Univariate survival analysis disclosed a set of four variables predicting death from prostatic cancer: cribriform growth pattern, AgNOR quotient, histological grade, and PSA immunoreactivity. Of these parameters, immunoreactivity of PSA failed to prove its prognostic significance in multivariate survival analysis (Cox model). No relation to prognosis was found for the number as well as the area of AgNORs alone. Therefore, image analysis proved to be a prerequisit for the feasibility of this promising technique by providing objective and reproducible results.

A clinical study was started in order to examine the suitability of Ihe Thrombostat (in vitro bleeding lesl) (lVBT) as a diagnostic tool to prevenl perioperative bleeding due to aspirin (ASA) and/or plalelet function disorders of other origins. This report is based on preliminary dala. Eighty three patients who had ingested ASA in the last Iwo weeks and/or with a history of bleeding and/or documented hemorrhagic disorders requiring distinct urological operations, were included in Ihe study, In all patients the IVUT with CaCI 2 , in addition 10 common coagulalion tests, were performed. Thirteen patients stopped ASA ingestion untillVBT became normal and did not show any increased bleeding lendency. The residual patients were classified by the various operations. The following operation groups were formed: Male genitals (n = 11), inguinal/suprapubic operations (n = 7), transurethral tumor reseclions of Ihe bladder (TURB) (n = 17), transurethral prostate resection (TURP) (n = 12), tumor nephreclomy (n = 8), radjcal prostateclomy (n = 9). Thirty six patients with a history of ASA use, bul normal rVBT, served as conIrol group (C). Thirty one patients with a history of ASA ingestion had normal in vivo bleeding times (BT) and abnormal IVBT with CaCl 2 (A). Seven patients had a bleeding history and/or documented hemorrhagic disorders (B). None of the patients (A) with From rhe UroloK;c C/i'lie, ami *abnormal IVUT but normal BT displayed clinically relevant bleeding. However, the blood loss was some· what higher compared to the controls (C), especially in patients with TURB and radical prostatectomy (nol significant). The only real bleeding complication occurred in an ASA palient (TURB), who was subjecled to surgery by error. Anesthesia had already started, when abnormaUty of BT (> 15 min) and IVBT ("infinite") were measured. Operative revision was neces· sary and revealed Ihallhe blood loss (>3 L) was based on diffuse microvascular bleeding. The majority of the patients with a bleeding history and/or documented hemorrhagic disorders (B) showed an increased bleeding tendency, which could be managed withoul relevant blood loss, except in two patients, one with factor XIII deficiency (25%) and ASA inlake, and the other with undetected mild congenital platelel disorder (storage pool disease?). The IVBT proved suitable as screening lest for platelet function disorders. Major bleeding complications could be prevented by ifs use. A hislory of low·dose ASA inges. tion without prolongation of BT, but abnormallVBT. also seemed to increase the bleeding tendency; however, the clinical relevance has 10 be demonstrated by an extended clinical study, There is a dose-related acetylsalicylic acid (aspirin) (ASA) effect on platelet function. This effect is enhanced in patients with von Willebrand's disease (frequency -1_3%)1 and may cause severe inlra-and post-52

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