[ unusual case of transitional cell carcinoma of renal pelvis presenting with brain metastases]

Transitional cell carcinoma of renal pelvis presenting with brain metastases is a very rare case which should be diagnosed and treated in order to prevent further damages. We report a rare case, who had presented with a constellation of neurological symptoms [due to multiple brain metastases], but without any urological symptoms. During evaluation of patient, we found transitional cell carcinoma [TCC] of left renal pelvis, for which palliative radical nephroureterectomy was performed. Although transitional cell carcinoma of renal pelvis presenting with brain metastases is a very rare case, but the patient was managed with gamma knife stereotactic radiosurgery for the metastatic lesions. Afterward he received four cycles of paclitaxel and carboplatin chemotherapy. The patient is alive with stable disease at 32-months' follow-up

Synchronous contra lateral transitional cell carcinoma [TCC] of the kidney and bladder

Synchronous upper urinary tract tumor and superficial bladder tumor are uncommon. This is a report of a 62- year- old man presented with episode of painless gross hematuria and flank pain. We worked him up and found a left renal mass and bladder lesion. He underwent nephrectomy and TUR-BT, and the pathology report of both showed a high grade urothelial transitional cell carcinoma. The patient was followed by surveillance protocol for ureter stump. Our report included an uncommon case of high grade synchronous upper urinary tract and bladder transitional cell carcinoma

comparative study on the effect of lidocaine and furosemide on urinary output and graft function after renal transplantation

Renal transplantation is an ideal treatment for patients with chronic renal failure. It was demonstrated that despite the adhesion to surgical and anesthetic principles, urinary output is not satisfactory after transplantation. It seems that microvascular spasm of renal vasculature is responsible for this phenomenon. We designed a study to investigate whether lidocaine injection into renal artery can relieve vasospasm and subsequently improve output and graft function better than furosemide. In a randomized clinical trial, from July 2002 to November 2003, 100 consecutive patients who were referred to our center for kidney transplantation were recruited in this study. After obtaining written informed consent, they were divided blindly into two groups. In group 1, lidocaine was injected into renal artery, before arterial anastomosis, and group 2 received furosemide as the conventional intervention. Urine volume within 1, 4, and 24 postoperative hours and serum creatinine levels in the first three weeks were recorded and compared between the two groups. Urine volumes at 1, 4, and 24 hours after transplantation were higher significantly in lidocaine group [P<0.001]. Serum creatinine levels were lower significantly in the first postoperative day and also 21 days after transplantation in group 1 [P<0.001]. Comparing to furosemide, it seems that lidocaine can cause a more effective vasodilation in renal arteries of kidney allograft, resulting in a better diuresis. This may have a role in the betterment of graft function

Neurofibromatosis presenting as scrotal elephantiasis

Neurofibromatosis being manifested as scrotal elephantiasis is a very rare condition and in review of the literature no such presentation was found. Here we report a 20 year old man who presented with scrotal elephantiasis and consequently, a pathological diagnosis of neurofibromatosis was reached