Influence of age on the prognosis of patients with renal cell carcinoma (RCC).

OBJECTIVE: Aim of this study was to analyze the prognostic value of age in patients with renal cell carcinoma (RCC). PATIENTS AND METHODS: A group of 15 patients (age < or = 40 years, group I) and a group of 103 patients (age > or = 50 years, group II) with sporadic RCC who underwent radical nephrectomy between 1985 and 1997 were compared. The two groups were analyzed with respect to histologic cell type, tumor grade, stage and outcome. RESULTS: In group I low-stage tumors (stage I and II) were diagnosed in 93% of patients and in group II in 65% of the patients (p = 0.017). High-grade tumors (stage III and IV) were diagnosed in 7% and 35% of patients in group I and group II, respectively (p < 0.01). In group I only one patient (7%) with stage II disease died of cancer. In group II the distribution of cancer-specific mortality was as follows: 6 patients (100%) with stage IV, 13 patients (42%) with stage III, and 12 patients (17%) with stage I and II died of disease. The 5-year-survival in group I was 93% and in group II was 77% (p = 0.05). CONCLUSION: According to our data we conclude that RCC is diagnosed at a lower stage in young patients than in the older patient group. RCC may exhibit a more favorable prognosis in young patients, possible due to the lower stage at time of diagnosis.

Leiomyoma of the genitourinary tract.

OBJECTIVE: To review our experience and the literature with respect to leiomyomas of the genitourinary tract with special emphasis on the role of the clinical presentation and imaging studies in the differential diagnosis. MATERIAL AND METHODS: During a period of 35 years in our department, five patients were treated with symptomatic leiomyomas, originating from the renal pelvis, bladder, urethra and epididymis. All the cases were diagnosed after exploration, excision and histological examination of the specimen. Following the presentation of the five cases of leiomyomas of the genitourinary tract, we reviewed the literature with special emphasis on the modern imaging techniques, differential diagnosis and treatment approach. CONCLUSION: Complete excision followed by histological examination is the most reliable means of distinguishing leiomyoma from other more common and usually malignant tumors of the genitourinary tract.

Semi-empirical AM1 calculation of the solvent effect on the fluorescence spectra of some dihydroquinolinones.

The COnductor-like Screening MOdel of solvent-solute interactions of Klamt and Schüürmann, COSMO, at the semiempirical AM1 level of MO calculations, augmented by limited singles and doubles configuration interaction, proves useful for the study of solvent induced shifts of fluorescence spectra. Optimization of geometry of ground S0 and excited S1 states for each solvent separately provides estimates of the changes of solvation energy accompanying the electron transition process and helps the understanding of the related solvent-solute reorganization and fluorescence mechanisms.

Interleukin-15, a leukocyte activator and growth factor, is produced by cortical tubular epithelial cells.

Many renal diseases, including transplant rejection, are mediated by mononuclear cells. Interleukin-15 (IL-15) has been recently described as a cytokine with IL-2-like activity. IL-15 is an effective leukocyte growth factor, activator, and chemoattractant. In rejected human kidney allografts, elevated IL-15, but not IL-2, mRNA is expressed, suggesting a role for IL-15 in the rejection process. The aim of this study was to investigate whether human cortical tubular epithelial cells (HTC) are able to produce IL-15 and whether IL-15 expression is regulated by inflammatory mediators. HTC were isolated and characterized, and IL-15 expression was analyzed by reverse transcription-PCR, enzyme-linked immunosorbent assay, and bioactivity. It was found that HTC constitutively express IL-15. Upon stimulation of HTC with interferon-gamma (IFN gamma), the levels of both mRNA and protein increased up to twofold. In contrast, lipopolysaccharide, IL-1, IL-2, and tumor necrosis factor-alpha had no detectable effect. IFN gamma action on HTC was dose-dependent from concentrations of 5 U/ml, reaching a plateau at 50 U/ml. HTC supernatants induced proliferation of the T cell line CTLD, which could be partially blocked (50%) by specific IL-15 antibodies. This study shows that IL-15 is secreted by HTC and that the Th1-cytokine IFN gamma upregulates IL-15 expression. This suggests that HTC play a role in cell-mediated renal diseases by releasing IL-15.

[Bacterial culture of chip tissue of enucleated prostates].

To assess the prevalence of infection and colonization of the prostate by bacteria, chip tissue samples from 166 patients undergoing retropubic prostatectomy were submitted for bacterial tissue culture. In 28 patients with an indwelling catheter before surgery, E. coli, Klebsiella, Pseudomonas and Enterobacter were the commonest species encountered, the first the most common. In only 7 patients (20%) who didn't have an indwelling catheter before operation was the culture positive. We confirmed that the longer the time the catheter was indwelling before surgery, the greater the likelihood of positive cultures. However, postoperative outcome and morbidity were not related to culture results. We conclude that even though it is worth trying to sterilize the urine and prostate before prostatectomy, the effect on the postoperative outcome is minimal when proper antimicrobial therapy is given perioperatively.

Deoxyribonucleic acid ploidy and the clinical pattern of grade 2 superficial bladder cancer.

PURPOSE: We attempted to find an objective and quantitative parameter that would enable us to differentiate between aggressive and nonaggressive grade 2 superficial transitional cell carcinoma of the bladder. This type of tumor belongs to a heterogeneous group, 30% of which behave aggressively by invading lamina propria and muscle tissue in the course of the evolution. The remaining 70% of tumors have less aggressive qualities, are nonprogressive and have a low recurrence rate. To date to our knowledge there is no way to differentiate between these 2 subpopulations of tumors. MATERIALS AND METHODS: We performed a retrospective flow cytometric analysis of deoxyribonucleic acid (DNA) ploidy and cell cycle phases on primary and solitary formalin fixed and paraffin embedded tumor tissue. RESULTS: Of the 41 specimens studied 16 were aneuploid and 25 were diploid. Aneuploidy was associated with progressive disease and high mortality rates, particularly in patients who did not receive postoperative adjuvant intravesical instillation. DNA diploidy was equated with lack of mortality and a low progression rate. The use of intravesical bacillus Calmette-Guerin as an adjuvant postoperative treatment was associated with low recurrence rates. In this group elevated G2M percent and S phase fractions correlated with higher recurrence rates. CONCLUSIONS: DNA ploidy was a prognostic factor in stage Ta grade 2 bladder transitional cell carcinoma and should be considered as a complementary test to histopathological analysis. Adjuvant instillation with bacillus Calmette-Guerin is advised after transurethral resection of primary solitary aneuploid stage Ta grade 2 bladder transitional cell carcinomas and of primary solitary diploid tumors with elevated G2M percent and S phase fraction.

Carcinoma of the bladder in patients under 25 years of age.

A review of our records between 1971 and 1995 identified 6 patients (4 male and 2 female) with transitional cell carcinoma of the bladder who were less than 25 years of age (mean age 18.6, range 10-22). Five patients presented with gross haematuria, one with microscopic haematuria, and two presented with recurrent urinary tract infection. All tumours were low grade and low stage and were associated with excellent prognosis. Transurethral resection or fulguration was the treatment of choice. This study supports the contention that transitional cell carcinoma of the bladder is a less aggressive disease in patients under 25 years of age.

Salvage of renal transplant allograft with complete duplication of collectory system by end-to-end and end-to-side pyelo-ureterostomy.

Secondary, ureteroneocystostomy is the procedure most commonly used for repair of ureteral stenosis or necrosis in renal transplant patient. However, when the transplant ureter, the viable part thereof, is too short, uretero-pyelostomy or ureteroureterostomy is the standard procedure. Another option is pyelopyelostomy which is used infrequently. We present a case of a patient with renal allograft with complete duplication of the collectory system, who required reintervention for urinary leak, due to extensive necrosis of both ureters of the allograft. End-to-end and end-to-side pyelo-ureterostomies were performed as rescue procedure for this particular case.

Amiodarone-induced epididymitis. Report of 2 cases.

Amiodarone-induced chemical, sterile epididymitis has previously been reported. We present 2 cases who were on amiodarone therapy for refractory cardiac arrhythmia. Recognition of this side effect and treatment by lower drug dosage can prevent unnecessary antibiotic therapy and invasive urological procedures.

Posterior urethral valves and vesicolithiasis in children.

Although posterior urethral valves is a well known and important entity in paediatric urology, its association with bladder calculi is not well documented and this condition is not discussed commonly in the literature. Association between posterior urethral valves and vesicolithiasis is presented in three children.

Spontaneous perinephric urinoma in pregnancy.

A rare case is presented of spontaneous urinary extravasation (urinary ascites) with left pleural effusion occurring during pregnancy. The clinical course, pathogenesis and treatment are described.

Gonadotropin-releasing hormone specific binding sites in normal and malignant renal tissue.

Renal cell carcinoma has been reported to contain estrogen and progesterone receptors. Thus, it has been suggested that these tumors are hormone dependent in a similar manner described for the breast and prostate cancers. It has been recently shown that mammary and prostate tumor cells contain gonadotropin-releasing hormone (GnRH) receptors and are growth inhibited directly by GnRH antagonists. In this study we examined for the presence of GnRH, estrogen and progesterone receptors in normal and malignant renal tissues. Estrogen receptors were found both in the normal and malignant kidney while progesterone receptors were present only in the normal tissue. Specific binding of [125I]buserelin, a GnRH agonist, was evident in renal carcinoma and in normal kidney and was displaced with equal efficiency by unlabeled buserelin and by D-Trp6-GnRH, but not by unrelated peptides such as thyrotropin releasing hormone and oxytocin. The non-linear scatchard curve obtained for buserelin binding, suggests the presence of at least two binding sites, one with high affinity in the nanomolar range and another in the micromolar range.

Post-herniorrhaphy paravesical granuloma simulating pelvic metastasis in a patient with bladder cancer.

We describe a rare case of bladder cancer associated with paravesical post-herniorrhaphy foreign body granuloma with abscess formation which simulated a lymph node metastasis. Management of this particular case is discussed and the literature is reviewed.