Extracorporeal shockwave lithotripsy of ureteral stone in a patient with en bloc kidney transplantation: a case report.

We report a case of ureterolithiasis in a patient with an en bloc kidney transplantation, using extracorporeal shockwave lithotripsy (ESWL). The patient presented with asymptomatic macrohematuria. Computed tomography revealed a ureteral calculus just below the pyeloureteral junction with hydronephrosis of the medially positioned kidney. Took two sessions of ESWL were required for complete disintegration of the stone. At 3 years after successful treatment, the patient has an excellent functioning and stone-free graft.

Different perforin expression in peripheral blood and prostate tissue in patients with benign prostatic hyperplasia and prostate cancer.

Perforin (P) is a prototypical cytotoxic molecule involved in cell-mediated immunity against various pathogens, alloantigens and particularly different tumours. The purpose of this study was to determine P expression in different lymphocyte subpopulations isolated from peripheral blood and prostate tissue of patients with benign prostatic hyperplasia (BPH) and prostate cancer (PCa) and compare it with the P expression found in the control group. Twenty subjects were recruited in each of the groups. Prostate mononuclear cells of the BPH and PCa tissues were isolated by enzymatic digestion and gradient density centrifugation, whereas peripheral blood mononuclear cells were isolated by gradient density centrifugation alone. Cells and tissue samples were labelled using monoclonal antibodies against P and different surface antigens (CD3, CD4, CD8 and CD56) and analysed by immunofluorescence and flow cytometry. Total P expression in peripheral blood lymphocytes did not differ significantly between BPH/PCa patients and control group, although the BPH and PCa tissue showed lower P expression level. A negative correlation between prostate-specific antigen levels and the overall percentage of P(+), CD3(+) CD56(-) P(+) , and CD3(-) CD56(+) P(+) cells in the prostate tissue was observed only in patients with PCa. Our findings indicate that the low frequency of P(+) lymphocytes, including T, NKT and NK cells, in the prostate tissue of patients with BPH and, particularly, PCa could be the consequence of local tissue microenvironment and one of the mechanisms involved in the pathogenesis of prostate hyperplasia following malignant alteration.

Vascular complications after 725 kidney transplantations during 3 decades.

Among 725 renal transplantations, the most common vascular complication was arterial stenosis, which was observed in 23 patients (3.17%). The majority of 20 (6.49%) arterial stenoses appeared in our initial experiences when we routinely used end-to-end renal graft to internal iliac artery anastomoses. A significant reduction in this incidence (0.72%) was achieved by introducing end-to-side anastomoses of the renal graft artery to the external or common iliac arteries. Intractable hypertension or impaired renal function in 14 patients (60.87%) with arterial stenosis demanded treatment. Patch angioplasty was more successful than other methods. The limited possibilities of conservative treatment of arterial hypertension at that time were the main reason for this frequent surgical repair. Among other vascular complications, the most serious were 12 episodes of arterial bleeding in 10 patients. Five kidneys were lost because of ruptured arterial anastomoses. In 6 patients, the common or external iliac artery was ligated as to achieve hemostasis with acute arterial insufficiency of the lower extremity in 4 patients. One patient required leg amputation, whereas 2 underwent extra-anatomic bypass procedures and 1 died because of hepatic failure. The majority of vascular complications occurred in the initial period of our transplantation practice. However, in spite of progress in diagnostic and treatment options, vascular complications may cause considerable clinical problems.