Significance of muscularis mucosae in metastasis involvement of urinary bladder transitional cell carcinoma.

OBJECTIVE: To assess the significance of muscularis mucosae involvement in metastasis of urinary bladder transitional cell carcinoma. MATERIAL AND METHOD: This was a retrospective cohort study of superficial urothelial carcinoma (transitional cell carcinoma). Histopathology and patient records of 192 patients were collected from 1990 to 2004. There were 115 males and 77 females, their age ranged from 43 to 83 years old with an average of 60 +/- 5 years. One hundred cases did not invade muscularis mucosae layer (group A) and 92 cases invaded the muscularis mucosae layer (group B). The histopathology of biopsy or cystectomy specimens for recurrence, progression of the disease and the number of vessels above and below the muscularis mucosae layer of bladder cancer specimens were compared by light microscopic examination with Hematoxylin and Eosin (H&E) and followed by immunoperoxidase desmin stain. RESULTS: The amount per high power field of the blood and lymphatic vessels below muscularis mucosae layer, 9 (6-12), was significantly higher than that above muscularis mucosae layer, 7 (5-10) (p < 0.05). The cancer high grade (grade 3) in group B had also significantly higher percentage than that in group A, 30.4:5.0 (p < 0.05). Moreover, the recurrent rate (recurrent > 2) in group B had also a significantly higher percentage than that in group A, 21.4:4.0 (p < 0.05). CONCLUSION: The present study has confirmed previous findings that not all muscularis mucosae layers (about 50%) were found in the biopsy specimens. The findings of superficial urothelial cancer (no invasion to muscularis propria) invading the muscularis mucosae are a warning sign for invasive tumor that needs more aggressive treatment.

Co-administration of diltiazem and cyclosporine for kidney transplant recipients: a four year follow-up study.

BACKGROUND: Diltiazem and cyclosporin A (CsA) share a similar metabolism and degradation via the hepatic cytochrome p 450 subfamily 3A4. Co-administration of diltiazem with CsA may lead to CsA dosage reduction, blood pressure control and renal protection. OBJECTIVES: To study the four year outcome of kidney transplant recipients who received diltiazem administration with CsA. This was compared to the outcomes of patients who received CsA without diltiazem and were matched for blood pressure control and other baseline characteristics. MATERIAL AND METHOD: Forty eight patients were included in the diltiazem group and seventy patients in the non-diltiazem group. CsA monitoring was done by using trough level (monoclonal fluorescent polarization immunoassay). RESULTS: The results showed that both groups has similar 4-year graft survival (92 and 95 %) with a similar mean final serum creatinine (1.3 mg/dl). Mean dose of CsA during the first month was 30 % lower in the diltiazem than non-diltiazem group. At one year CsA dose was 11% lower in the diltiazem than non-diltiazem group. However the diltiazem group was associated with significantly higher probability to have chronic allograft nephropathy than the non-diltiazem group (31% VS 19%) (RR 2.93; p = 0.03; Multivariate Cox regression). CONCLUSION: Co administration of diltiazem with trough level adjusted CsA is associated with benefits in terms of CsA dose reduction and good graft survival and function. However there appeared to be no protective effect of diltiazem on the progression to chronic allograft nephropathy.

Local anesthetic action of spilanthes acmella.

The local anesthetic action of ethanol extract of Spilanthes acmella was studied in guinea pigs and frogs’ sciatic nerves. Subcutaneous injection of 0.1 ml of 10% test solution into guinea pig’s back revealed that the onset of action occurred immediately after injection and lasted for 21 minutes. The duration of action was significantly shorter than that of 2% lidocaine (p<0.001,). The action potential of isolated frog’s sciatic nerve was completely abolished within 5 minutes after application of the test solution. The tissue apecimen obtained from guinea pig’s back muscle showed mild congestion of small blood vessels and mild intercellular edema. There was no significant difference as comparing to lidocaine injection. The results indicated that Spilanthes acmella possessed local anesthetic activity and further clinical trial should be investigated.