[Neuroendocrine bladder cancer: oncological emergency?].

Neuroendocrine bladder cancer is extremely rare, with an estimated incidence of 0.5%- 0.7%. In bladder cancers there is no evident connection between the neuroendocrine phenotypic expression and the clinical history. However, prognosis is usually poor and the survival rate at 5 years does not exceed 8%, if untreated. METHODS. We are here describing three case reports of bladder carcinoma with neuroendocrine differentiation, which is extremely aggressive and leads rapidly to death. At the present time, the local control of these tumors is achieved by radical cystectomy and radiotherapy; they can be both associated to chemotherapy. However, since these lesions are fairly rare, there is no gold standard therapy and there are no prospective studies on the management of these tumors. CONCLUSIONS. Considering the quick evolution and progression of any variant of the neuroendocrine tumors of the bladder, urologists and anesthetists should see them as real oncological emergencies. A prompt intervention through radical surgery with cystectomy and linfadenectomia, and the anathomo-pathologist's systematic investigation of the scraps could make the approach therapeutic and not only palliative. Prospective studies on neo-adjuvant chemotherapy as well as experimental studies about target therapies may yield new guidelines on the tumor management.

Effect of calcium antagonists on aortae isolated from normotensive and hypertensive rats: relaxation and calcium influx blockade.

Verapamil and diltiazem were equally potent (ie, similar EC50s) in relaxing potassium-contracted aortas of spontaneously hypertensive (SHR) and normotensive Wistar-Kyoto (WKY) rats. The mechanical EC50s produced approximately 50% calcium influx blockade, suggesting a causal link between relaxation and calcium influx blockade. Nitrendipine was about 250 times more potent in relaxing aortic smooth muscle in SHR than in WKY rats (EC50s in -log [M] were 14.10 +/- 0.30 and 11.70 +/- 0.54, respectively). This difference was not affected by endothelial denudation, and was present when nitrendipine was used by preincubation rather than during established potassium chloride contractions. In spite of the different relaxant potency of nitrendipine in SHR and WKY rats, both strains showed similar EC50s for calcium influx blockade for this compound (9.21 +/- 0.36 in SHR and 8.75 +/- 0.26 in WKY). The dissociation between aortic smooth muscle relaxation and calcium influx blockade after nitrendipine was more pronounced in the SHR strain. This suggests that mechanisms other than or in addition to calcium influx blockade play a role in the relaxation of potassium-contracted vascular smooth muscle with dihydropyridine compounds, but not with other calcium antagonists.

Increased sensitivity to nifedipine of smooth muscle from hypertensive rats.

The sensitivity of smooth muscle from aortas of spontaneously hypertensive rats (SHR), renal hypertensive rats: two kidney-one clip and one kidney-one clip (2K-1C, 1K-1C) and DOCA salt hypertensive rats to the relaxant effect of nifedipine (NIF) was studied. A parallel leftward shift of the concentration-relaxation curve was detected in the K-precontracted aortic smooth muscle from hypertensive rats. This increased sensitivity seems to be related to the degree of hypertension and independent of the experimental method used to produce the high blood pressure level. No change in sensitivity was detected either in SHR or in renal hypertensive rats when nitroglycerin was used as a vasodilator.

Botryomycosis: first report of human brain involvement.

A 57-year-old man, previously well except for dental caries and a history of Wolff-Parkinson-White syndrome, presented with marching right-sided motor seizures of sudden onset. Cerebral arteriography and scan demonstrated an avascular left frontal lobe mass. At operation, it was identified as an abscess and was totally excised. Histologically, granules resembling those seen in actinomycosis were demonstrated in the abscess wall, but special stains revealed gram-positive cocci in chains within and outside the granules. Fungal spores, mycelia, or branching filamentous structures were absent. Acid-fast stains were negative, and alpha-hemolytic streptococcus was recovered in pure culture from the abscess. While the patient was convalescing with penicillin therapy, a dental survey revealed the presence of periodontal abscesses which were drained by exodontia. Culture of the tooth sockets showed alpha-hemolytic streptococcus and Staphylococcus aureus. The literature on this relatively rare bacterial disease which histologically resembles actinomycosis is reviewed.