Laser desorption/ionization MS imaging of cancer kidney tissue on silver nanoparticle-enhanced target.

AIM: Renal cell carcinoma is a very aggressive and often fatal disease for which there are no specific biomarkers found to date. The purpose of work was to find substances that differentiate the cancerous and healthy tissue by using laser desorption/ionization MS imaging combined with silver nanoparticle-enhanced target. RESULTS: Ion images and comparative analysis of spectra revealed differences in intensities for several metabolites, for which their biochemical properties were discussed. Statistical analysis allowed to distinguish healthy and cancer tissue without the involvement of a pathologist. CONCLUSION: Laser desorption/ionization MS imaging technology combined with silver nanoparticle-enhanced target enabled rapid visualization of the differences between the clear cell renal cell carcinoma and the healthy part of the kidney tissue.

Surface-Transfer Mass Spectrometry Imaging of Renal Tissue on Gold Nanoparticle Enhanced Target.

Renal cell carcinoma (RCC) accounts for several percent of all adult malignant tumor cases and is directly associated with over 120 thousand death cases worldwide annually. Therefore, there is a need for cancer biomarker tests and methods capable of discriminating between normal and malignant tissue. It is demonstrated that gold nanoparticle enhanced target (AuNPET), a nanoparticle-based, surface-assisted laser desorption/ionization (SALDI)-type mass spectrometric method for analysis and imaging, can differentiate between normal and cancerous renal tissue. Diglyceride DG(18:1/20:0)-sodium adduct and protonated octadecanamide ions were found to have greatly elevated intensities in cancerous part of analyzed tissue specimen. Compounds responsible for mentioned ions formation were pointed out as a potential clear cell RCC biomarkers. Their biological properties and localization on the tissue surface are also discussed. Potential application of presented results may also facilitate clinical decision making during surgery for large renal masses.

Preliminary Analysis of the Expression of Selected Proangiogenic and Antioxidant Genes and MicroRNAs in Patients with Non-Muscle-Invasive Bladder Cancer.

Heme oxygenase-1 (HO-1) is an enzyme contributing to the development and progression of different cancer types. HO-1 plays a role in pathological angiogenesis in bladder cancer and contributes to the resistance of this cancer to therapy. It also regulates the expression of microRNAs in rhabdomyosarcoma and non-small cell lung cancer. The expression of HO-1 may be regulated by hypoxia inducible factors (HIFs) and Nrf2 transcription factor. The expression of HO-1 has not so far been examined in relation to Nrf2, HIF-1α, and potential mediators of angiogenesis in human bladder cancer. We measured the concentration of proinflammatory and proangiogenic cytokines and the expression of cytoprotective and proangiogenic mRNAs and miRNAs in healthy subjects and patients with bladder cancer. HO-1 expression was upregulated together with HIF-1α, HIF-2α, and Nrf2 in bladder cancer in comparison to healthy tissue. VEGF was elevated both at mRNA and protein level in the tumor and in sera, respectively. Additionally, IL-6 and IL-8 were increased in sera of patients affected with urothelial bladder cancer. Moreover, miR-155 was downregulated whereas miR-200c was elevated in cancer biopsies in comparison to healthy tissue. The results indicate that the increased expression of HO-1 in bladder cancer is paralleled by changes in the expression of other potentially interacting genes, like Nrf2, HIF-1α, HIF-2α, IL-6, IL-8, and VEGF. Further studies are necessary to also elucidate the potential links with miR-155 and miR-200c.

Role of marker lesion when applying intravesical instillations of IL-2 for non-muscle-invasive bladder cancer comparison of the therapeutic effects in two pilot studies.

AIM: Comparison of the therapeutic effect of treatment of non-muscle invasive bladder carcinoma (NMIBC) after intravesical Interleukin-2 (IL-2) instillations in the presence and absence of a marker tumour. MATERIALS AND METHODS: Two pilot studies were performed in patients with NMIBC. The first study (10 patients) was performed in Krakow (Poland), the second (26 patients) in Vilnius (Lithuania). In Krakow the tumours were treated with incomplete transurethral resection (TUR) leaving a marker tumour of 0.5-1.0-cm followed by IL-2 instillations (3 × 10(6) IU IL-2) on five consecutive days. In Vilnius the tumours were treated with complete TUR, followed by IL-2 instillations (9 × 10(6) IU IL-2) on five consecutive days. RESULTS: During 30 months follow-up, the recurrence-free survival was 5/10 (50%) and 6/26 (23%) after incomplete and complete TUR, respectively. So, the ratio of the recurrence-free survival after incomplete/complete TUR of 50/23=2.2. The median of the recurrence-free survival is >20.5 months and 7 months after incomplete and complete TUR, respectively. So, this ratio was >20.5/7= >2.9. The hazard ratio which combines both the chance of the disease recurrence and its timing for both censored and uncensored cases was 0.53, again confirming the better outcome after incomplete TUR. CONCLUSION: A possible explanation for the better therapeutic effects after incomplete TUR compared with complete TUR is that the marker tumour has tumour-associated antigens (TAA) that could lead to an immune reaction that is stimulated by local application of IL-2. After complete TUR, no TAA are available to initiate and to stimulate an immune reaction; consequently, local IL-2 therapy is less effective after complete TUR. The results of these two pilot studies have led to the recent start of a randomised prospective clinical trial in which therapeutic effects of local IL-2 therapy after complete and incomplete TUR are compared.

[Comparison of self-estimation of disuric disorders gauged IPSS scale and qualities of lives QoL with self-estimation of sexual life gauged by IIEF-5 scale]. / Porównanie samooceny dolegliwosci dysurycznych mierzonych przy uzyciu skali IPSS i jakosci zycia QoL z samoocena zycia plciowego mierzonego skala IIEF-5.

Evaluation of men with a point scale is a simple method that can be used both in primary care and specialist in-patient treatment. Although its use is not widespread. International scoring system for evaluation of symptoms of the prostate is common in Poland (IPSS). Responses to the questionnaire are the basis of IPSS scale. Quality of life form (QoL) is in addition to the scale of IPSS. It defines subjective assessment of patient well-being in case of symptoms of lower urinary tract at the same level as at the time of the study. 5-point questionnaire IIEF-5 has been used in Poland since 1999 to assess men's sexual life. The aim of the study is to compare the assessment of disuric disorders measured using the International Prostate System Score (IPSS) and Quality of Life scale versus scale of men's sexual self-esteem IIEF-5 in men at the age of 50-70. The study included 1746 randomly selected residents of the district Cracow-Downtown, at the age of 50-70. Medical interview was carried out (including complaints of lower urinary tract symptoms (IPSS), quality of life (QoL) and sexual dysfunction (IIEF-5); physical examination with assessment of individual systems with particular emphasis on genitourinary system, physical examination of the prostate (DRE), PSA level in total and free fractions, a biopsy of the prostate under ultrasound control if necessary. For the analysis qualified 1746 men. The men were divided into groups called groups of disease: a suspicion of prostate cancer, can not rule out prostate cancer, prostate cancer confirmed, probable benign prostatic hyperplasia (BPH), no lesions. The largest was the group with probable benign prostatic hyperplasia 64.89% of the total respondents, followed by a group of men without lesions, 26.29%, a group of probable prostate cancer was 6.41% of the respondents, a group with whom you can not rule out prostate cancer was 1.89%, the smallest was the group with confirmed prostate cancer, 0.52% of all male respondents. The age groups were: 498 respondents aged 50-54 years and 391 aged 55-59, 397 aged 60-64 and 460 aged 65-70. Mean age was 59.24 years. Ppicked up data were processed and analized by STATA- 5,0. Differences between groups relative to answers for the questions of scales: IPSS, QoL and IIEEF5 questionnaire were analized by Mann-Whitney, Kruskal- Wallis, Scheffe's and chi2 tests. Homogeneity of the IPSS were analised by a Cronbach coefficient test. Accordance of each questions of the scale to whole scale were analised by correlation and line regression tests. Based on the analysis of the total scale score by IPSS and QoL scale and quality of life questionnaire IIEF-5 showed that in the process of aging in the population more frequently in older than in younger men, there are complaints from the urinary tract and deteriorating quality of life of self-esteem and quality of life of sexual self-esteem. After analyzing the result of scale: IPSS, QoL, and IIEF-5 in the disease groups, it was found that the total score of IPSS differentiates men in the group with probable benign prostatic hyperplasia, from a group of men without lesions and men with suspected prostate cancer. Statistically significant reduction in quality of life (QoL) in patients with confirmed prostate cancer and in the group with probable benign prostatic hyperplasia compared with men without lesions. The highest self-esteem sex life (IIEF-5) was found in men without lesions and the lowest in the group with known prostate cancer. The scale of quality of life (QoL) was significantly positively correlated with the results of IPSS scale, as well as with each of its questions. Deterioration in the quality of life occurred as a crescendo pain of lower respiratory tract. With the increase in the incidence and severity of each symptom on a scale IPSS worsening of self-esteem was examined using a scale IIEF-5. U of men with the deterioration of the quality of life measured by the scale of QoL, worsening their sexual self-esteem scale IIEF-5. In the process of aging are growing complaints from the lower urinary tract, self-esteem deteriorates the quality of life, including sexual life, which is especially marked in men with enlarged prostate. The scale of quality of life (QoL) is significantly positively correlated with the results of IPSS scale. With the increase in the incidence and severity of symptoms on a scale IPSS had decreased self-test using the IIEF-5 scale. The deterioration of quality of life measured with QoL was associated with decreased sexual self-esteem scale IIEF-5.

[Strategy in preventing of uretero-intestinal anastomosis strictures in patients with low-pressure intestinal neobladder]. / Strategia postepowania w zapobieganiu zwezeniom zespolenia moczowodowo- jelitowego u chorych z niskocisnieniowym pecherzem jelitowym.

Ureteroileal stenoses occur in 1.2-20% patients with neobladders. They constitute a serious clinical complication since, as every obstruction of urine flow from the kidney. Ureteroileal stenoses develop usually within firs 6 to 12 months following the extended urological procedure such as radical cystectomy with the creation of ileal orthotopic neobladder. Ureteroileal stenosis belongs to the most difficult complications after creation of ileal neobladder. The experience of our clinic between 2001 and 2011 covers 3500 cases of patients with bladder cancer. 226 patients underwent cystectomy, 120 were treated with urinary diversion m. Bricker and 106 underwent low pressure ileal neobladder modo Studer. Ureters anastomosed with the intestine Michalowskis way of a flap. The authors performed 344 ureteroileal anastomoses, 212 ureteroileal anastomoses with the ileal neobladder modo Studer and 11 stenoses were detected, in 5 patients one-side, in 3 bilateral. In our practice there was altogether 11 detected stenoses which constitutes 5.18%. Based on our experience, in the course of radical removal of the bladder during the preparation of the least possible damage the blood supply ureter, ureter prior to implantation should be checked for leaks, catheter should be made of soft material. The performance of the left ureter to carry out the right side of the mesentery, be careful not without angulation. In the course of the uretero-intestinal anastomosis should not be stitched in place to destroy the vascular anastomosis of ureter to intestine anastomosis and the same should be done without tension. Protect the integrity of the anastomosis, aseptic oncology. Uretero-intestinal anastomosis performed without anti-reflux protection.

[Polish guidelines for the prevention and treatment of venous thromboembolism. 2012 update]. / Polskie wytyczne profilaktyki i leczenia zylnej choroby zakrzepowo-zatorowej. Aktualizacja 2012.

The overall objective of the Polish guidelines for the prevention and treatment of venous thromboembolism is to increase patient benefit and safety by appropriate prevention and treatment of deep vein thrombosis and pulmonary embolism as well as proper management of the complications associated with antithrombotic and thrombolytic therapy. These guidelines apply to adult trauma, cancer, surgical, and medical patients as well as those at increased risk of venous thromboembolism. Specific recommendations have been formulated for pregnant women, patients requiring surgery while receiving long-term oral anticoagulant treatment, and patients undergoing regional anesthesia and/or analgesia. We chose to update the existing Polish guidelines with the use of the most recent high-quality international guidelines that we identified and adjusted the final product to Polish cultural and organizational setting. We based our recommendations primarily on the 9th edition of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines on Antithrombotic Therapy and Prevention of Thrombosis, the European Society of Cardiology Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism, the 3rd edition of the American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines on Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy, the ACOG practice bulletin on thromboembolism in pregnancy (Number 123), and Guidance from the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis on the Duration of Anticoagulant Therapy after a First Episode of Unprovoked Pulmonary Embolus or Deep Vein Thrombosis, as well as two other Polish practice guidelines on the prophylaxis and treatment of venous thromboembolism and the management of patients treated with oral direct inhibitors of factor X or factor II. To make recommendations regarding specific management issues that had not been addressed in other guidelines, or whenever the panel members felt they needed additional information to reach the decision, we also consulted the authors of guidelines developed by other professional societies and organizations as well as additional sources of evidence. For each adapted recommendation, we explicitly assessed its relevance and applicability in the context of the healthcare system in Poland. When necessary, we explicitly stated the rationale for modification of the previously published recommendations and judgements about the values and preferences we assumed. The information regarding reimbursement of drugs mentioned in the recommendations was added in chapters 6-9 and 13 and approved by the National Health Fund. The final version of the practice guidelines was officially approved by the scientific societies and institutions listed at the beginning of the document.  

[Baloon dilatation of benign ureteroileal anastomotic strictures]. / Leczenie lagodnych zwezen zespolen moczowodowo-jelitowych (ZZMJ) za pomoca plastyki balonowej.

The study is presenting own experience with the use of percutaneous balloon angioplasty in the patients with the strictures of ureteroenteric anastomoses. A study group consisted of 11 patients with urinary bladder cancer in whom ureteroenteric anastomosis was performed. All patients developed in the postoperative period ureter strictures or the stenosis at the junction point of ureteroenterostomy resulting in retention of urea in the ureter and pyelocalyceal system requiring percutaneous nephrostomy. High-pressure balloon catheter inserted through the nephrostomy was placed centrally in the point of stenosis. The catheter was insufflated with physiological saline solution and contrast agent until ballon waisting disappeared. Subsequently temporary double-J catheter with diameter of 9 F or 12F was inserted and remained in place for the period of 1-6 months. All patients were followed-up for 2 years, and underwent control USG and CT examinations. Fourteen urethral dilatations of bilateral strictures were performed in 3 patients and in 9 patients with unilateral strictures. In 10 (71%) cases the symptoms of stenosis disappeared for the period of 1 year. Procedure of ballon dilatation follow by introduction of the double-J catheter should be method of first choice in all cases of benign ureteroileal anastomotic strictures.

[Bladder cancer biomarkers]. / Wyznaczniki procesu nowotworowego w raku pecherza moczowego.

Bladder cancer is one of the most prevalent cancers worldwide. Non-muscle invasive bladder cancer has a 70% rate of recurrence. Its biological tendency to recur and progress mandates close follow-up for the early detection of recurrent tumors. Urine cytology is the most widely used noninvasive test to detect urothelial tumors. However, it is limited by its low sensitivity. On the other hand, cystoscopy is the gold standard procedure to follow patients with a history of bladder cancer but this test is invasive and expensive. Therefore, there is a real need to develop new tests that can be used in bladder cancer surveillance. In recent years there is a constant effort to find a better non-invasive marker for bladder cancer. Many markers for the detection of bladder cancers have been tested and almost all urinary markers reported are better than cytology with regard to sensitivity, but they score lower in specificity. Our knowledge of molecular pathways in bladder cancer is growing and new methods of marker development emerge, but the perfect marker is still to be found. Currently, there are not clinically usable molecular markers that can guide us in diagnosis or surveillance, nor guide us in lowering the frequency of urethrocystoscopy in bladder cancer. This article reports some of the more prominent urine markers in use today.

Animal models of overactive bladder: cyclophosphamide (CYP)-induced cystitis in rats.

Cyclophosphamide (CYP) treatment induces chemical cystitis leading to bladder overactivity (OAB) in animals and humans. There is a great number of OAB models evaluations, which consider the bladder histology, as well as alterations in neurochemical, electrophysiological properties of bladder afferent neurons and reflex arcs activity in the spinal cord. However there are no data differentiating cystometrically acute and chronic models of OAB induced by CYP under urethane anaesthesia. The aim of this study was to investigate the influence of acute and chronic models of CYP-induced cystitis on urinary bladder motor activity in rats.

Immunophenotype and cytogenetics of mucinous tubular and spindle cell carcinoma of the kidney.

Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney is a rare, recently described entity. The authors present three new cases. The histological picture was that of classic MTSCC, with alternating small tubules located in a mucin-containing stroma, and spindle cell areas composed of bland, monomorphic cells. On immunohistochemistry, the tumors were positive for epithelial markers, including CK7 and CK18, vimentin, CD15, AMACR, and neuroendocrine markers, such as NSE and CD57. On FISH analysis we found losses on chromosomes 1 and 8, and gains of chromosomes 7 and 17. This is the first report of this rare entity in Polish medical literature.

Three in one kidney. report of a case.

The case of a 70-year old male in whom imaging studies revealed two separate tumors in the left kidney is presented. In the surgical nephrectomy material two tumors were seen, 4.5 and 4 cm in diameter; one of them was a clear cell carcinoma, and the other--a papillary carcinoma, respectively. In addition, a small, subcapsular nodule was detected, which was classified as an adrenal rest. According to current opinions, the above lesions have different pathogenesis and their coexistence may be regarded as accidental.

Adrenal rest presenting as a renal cyst. A case report.

The report presents a 42-year old female patient, in whom a cyst of the left kidney was diagnosed. The clinical presentation and gross picture suggested a simple cyst. The lesion was removed surgically; in the cyst wall, histology revealed structures identical to normal adrenal cortex. Based of this observation, the final diagnosis was established as the so-called adrenal rest. Such lesions are not uncommon in the kidney, but what was extraordinary in the described case was the macroscopic presentation. Thus, in differential diagnosis of cystic lesions of the kidney one should also take into consideration adrenal developmental abnormalities. This may be of particular importance in cystic clear cell renal carcinomas, the structure of which is well known to resemble the adrenal cortex.

Trace elements distribution in renal cell carcinoma depending on stage of disease.

OBJECTIVES: The aim of this study was to identify those trace elements which can be used to distinguish between normal and malignant tissue in renal cell cancer (RCC) kidney and to assess changes in trace elements concentration in tissue with progressing malignant disease. METHODS: In case control study, 36 cases of RCC were analyzed by Synchrotron Radiation Induced X-ray Emission (SRIXE) in order to establish the concentration of 19 elements. Patients with RCC were examined to obtain staging of disease after radical nephrectomy, which was performed in each case. Results were compared with 15 control kidney cortex tissue obtained during autopsy in which cause of death was trauma. RESULTS: The most relevant decrease was detected in Cd content: from 81 +/- 39.2 ppm in normal control samples to 16.6 +/- 22.2 ppm concentration in RCC. We found that the concentrations of Ti, Pb and Rb were also lower in RCC tissue. On the other hand, the RCC tissue was rich in iron and zirconium. With the progress of malignant disease, assessed by TNM (UICC 1997) scale, lower concentration of S and higher concentration of Ca in both RCC and neoplastic kidney cortex can be seen. The same tendency is observed in Zn and Se concentrations. Cadmium shows raising concentration with progress of RCC only in cortex of neoplastic kidney. In all cases it was shown that the relatively high tissue concentration of iron in both investigated tissues is decreasing with the progress of disease. The zirconium has shown raising tissue concentration in advanced disease. CONCLUSION: Trace elements concentration is different in malignant tissue and surrounding macroscopically unchanged kidney cortex. Progress of the disease is connected with changes in trace elements concentration. This may reflect different biology of compared tissue with potential practical implication.

Asynchronous collecting duct carcinoma of the kidney and pulmonary adenocarcinoma. A case report.

Collecting duct carcinoma (CDC) is a rare renal malignancy accounting for about 0.4-2.6% of cases. We report a case of CDC in a 61-year-old woman previously operated on for pulmonary adenocarcinoma. On histological examination and immunohistochemical research diagnosis of asynchronous primary bronchial carcinoma and renal CDC was made. The authors review the available literature on CDC and differential diagnosis of metastatic versus primary renal carcinomas.