Methylation of tumor suppressor genes in a novel panel predicts clinical outcome in paraffin-embedded bladder tumors.

DNA methylation of tumor suppressor genes (TSGs) represents a frequent and early epigenetic event with potential applications for cancer detection and disease evolution. Our aim was to examine the stratification and prognostic biomarker role of the methylation of a novel panel of TSGs in bladder cancer. The methylation status of 18 TSGs was evaluated in bladder cancer cells (n=14) and paraffin-embedded primary bladder tumors (n=61), using a methylation-specific multiplex ligation-dependent probe amplification assay (MS-MLPA). Recurrence, progression, and disease-specific survival were analyzed using univariate and multivariate Cox models. PRDM2, HLTF, ID4, DLC1, BNIP3, H2AFX, CACNA1G, TGIF, and CACNA1A were discovered methylated in bladder cancer. The methylation of RUNX3 (p=0.026), TWIST1 (p=0.009), SFRP4 (p=0.002), and CCND2 (p=0.027) correlated to tumor stage. Univariate analyses indicated prognostic associations for recurrence (DLC1, SFRP5, H2AFX, CACNA1G), progression (DLC1, SFRP5, CACNA1G), disease-specific (PRDM2, DLC1, SFRP5, CACNA1G, and TIMP3), and overall survival (SFRP5 and TIMP3). In multivariate analyses, several TSGs remained as independent prognosticators for recurrence (SFRP5, H2AFX), progression (CACNA1G), and disease-specific survival (SFRP5). Thus, a novel set of TSGs was identified, frequently methylated in bladder cancer cells and tumors. TSG methylation allowed histopathologic and outcome stratification using paraffin-embedded tumors. This is clinically relevant by offering a strategy for the management of patients affected with uroepithelial neoplasias in pathology routine laboratories.

[The treatment of urinary incontinence by injectables. Analysis of our series]. / "Tratamiento de la incontinencia urinaria mediante sustancias inyectables. Análisis de nuestra serie".

OBJECTIVES: To determine the efficacy of endoscopical injections for the treatment of stress urinary incontinence (SUI), evaluating its low invasiveness and positive impact on quality of life. METHODS/RESULTS: Belween 1997--2003 30 procedures of periurethral injection of various substances for urinary incontinence were performed at our department in women between 47-80 years. All patients were evaluated before surgery, clinically and urodynamically, in accordance to international standardized parameters (filling pressure/flow studies, maximum urethral closure pressure, LPP-leak point pressure). The kind of material employed for injection, surgical technique and satisfaction degree were also evaluated. RESULTS: The indication for surgery was SUI in 17 cases (56.6%), and mixed urinary incontinence in 73 cases (43.3%). 16 cases (53.3%) had history of previous surgery for SUI. Regarding urodynamic parameters, 19 patients (63.3%) have a maximum urethral closure pressure below 25 H2O cm, and 22 patients (73.3%) had a leak point pressure below 60 H2O cm. Collagen was employed in six cases (20%) and macroplastic in 24 (80%) (14 of them with the MIS system). 22 patients had three injection sites (73.3%). Mean follow-up was 38 months. Continence outcomes were evaluated in relation to complete continence (12 cases, 40%), mild incontinence and patient satisfaction (11 cases, 36.6%), and severe incontinence (7 cases, 23.3%). CONCLUSIONS: 1-To achieve acceptable results it is mandatory to do the best possible indication (Mc Guire type III SUI). 2.-There is an excellent relationship between minimal invasiveness and good results.

Tratamiento de la incontinencia urinaria mediante sustancias inyectables. Análisis de nuestra serie / The treatment of urinary incontinence by injectables. Analysis of our series

OBJETIVO: Determinar la efectividad delas inyecciones endoscópicas en la corrección de laIUE, valorando su escasa agresividad y su impactopositivo en la calidad de vida.MÉTODOS/RESULTADOS: Entre 1997-2003 se realizaronen nuestro servicio 30 intervenciones por incontinenciaurinaria con inyección periuretral de diversassustancias, en mujeres con edades comprendidas entre47-80 años. Todas las pacientes fueron valoradas previaintervención clínica y urodinámicamente atendiendoa los parámetros internacionalmente reconocidos (cistomanometríade llenado, presión uretral máxima, LPP(Leak point presure o presión abdominal de escape).También se valoró el tipo de material utilizado para lainyección, técnica quirúrgica y grado de satisfacción.RESULTADOS: En 17 casos (56.6%) la indicación quirúrgicafue por IUE pura mientras que en 13 casos(43.3%) fue mixta. En 16 casos (53.3%) existían anteÓscarRodríguez FabaC/ Amsterdam, 4 - 7ºA33011 Oviedo.Asturias. (España)e-mail: oscar.rodriguez@sespa.princast.esTrabajo recibido: 8 de junio 2004CorrespondenciaPalabras clave: Sustancias periuretrales.Incontinencia tipo III.Summary.- OBJECTIVES: To determine the efficacyof endoscopical injections for the treatment of stressurinary incontinence (SUI), evaluating its low invasivenessand positive impact on quality of life.METHODS/RESULTS: Between 1997-2003 30 proceduresof periurethral injection of various substances for urinaryincontinence were performed at our department inwomen between 47-80 years. All patients wereevaluated before surgery, clinically and urodynamically,cedentes de intervenciones previas por IUE. En cuantoa parámetros urodinámicos en 19 pacientes( 63.3%) lapresión máxima de cierre uretral fue menor de 25 cmde agua y en 22 pacientes ( 73.3%) , el leak point presurefue menor de 60 cm de agua. En 6 pacientes(20%) se utilizó colageno y en 24 pacientes (80%)macroplastique ( 14 de ellos con sistema M.I.S). En 22casos (73.3%) se realizaron 3 habones. El tiempomedio de seguimiento fue de 38 meses. El resultado encuanto a continencia se valoró en relación a que lapaciente estuviese totalmente seca ( 12 casos 40%),incontinencia leve pero satisfecha (11 casos 36.6%) eincontinencia grave ( 7 casos, 23.3%).CONCLUSIONES: 1.-Resulta imprescindible para obtenerresultados aceptables la mejor de las posibles indicaciones( IUE tipo III de Mc Guire). 2.- Existe una relaciónexcelente entre la mínima agresividad y los buenosresultados

OBJECTIVES: To determine the efficacyof endoscopical injections for the treatment of stressurinary incontinence (SUI), evaluating its low invasivenessand positive impact on quality of life.METHODS/RESULTS: Between 1997-2003 30 proceduresof periurethral injection of various substances for urinaryincontinence were performed at our department inwomen between 47-80 years. All patients wereevaluated before surgery, clinically and urodynamically,in accordance to international standardized parameters(filling pressure/flow studies, maximum urethral closurepressure, LPP-leak point pressure). The kind of materialemployed for injection, surgical technique and satisfactiondegree were also evaluated.RESULTS: The indication for surgery was SUI in 17cases (56.6%), and mixed urinary incontinence in 13cases (43.3%). 16 cases (53.3%) had history ofprevious surgery for SUI. Regarding urodynamicparameters,19 patients (63.3%) have a maximum urethralclosure pressure below 25 H2O cm, and 22 patients(73.3%) had a leak point pressure below 60 H2O cm.Collagen was employed in six cases (20%) andmacroplastic in 24 (80%) (14 of them with the MISsystem). 22 patients had three injection sites (73.3%).Mean follow-up was 38 months. Continence outcomeswere evaluated in relation to complete continence (12cases, 40%), mild incontinence and patient satisfaction(11 cases, 36.6%), and severe incontinence (7 cases,23.3%).CONCLUSIONS: 1-To achieve acceptable results it ismandatory to do the best possible indication (Mc Guiretype III SUI). 2.-There is an excellent relationship betweenminimal invasiveness and good results

Regresión espontánea de trombosis venosa en un caso de carcinoma renal / Spontaneous regression of venous thrombus in a case of renal carcinoma

OBJETIVO: Describir el primer caso deregresión espontánea de trombosis de vena renal y cavainferior en un paciente con carcinoma de células renales.MÉTODO/RESULTADO: Se describe el caso de una mujerdiagnosticada de masa renal con trombosis de venasrenal y cava. En los estudios de extensión previos a lanefrectomía radical se constata la regresión de dicho tromboque se confirma posteriormente tras la nefrectomía.CONCLUSIÓN: La regresión espontánea de metástasisde carcinoma de células renales se estima menor al 1%.Este es el primer caso descrito en la literatura que afectaa una trombosis tumoral de venas renal y cava inferior

OBJECTIVES: To report the first case of spontaneous regression of renal vein and inferior vena cava thrombus in a patient with renal clear cell carcinoma. METHODS/RESULTS: We describe the case of a woman with the diagnosis of renal mass with venous thrombus of the renal vein and inferior vena cava. Extension studies before radical nephrectomy showed regression of the thrombus which was confirmed during nephrectomy. CONCLUSIONS: Spontaneous regression of clear cell renal carcinoma metastases is estimated below 1% of the cases. This is the first case report of regression of a tumoral thrombus of the renal vein and inferior vena cava

Relación entre síntomas del tracto urinario inferior y calidad de vida / Relationship between LUTS (lower urinary tract symptoms) and quality of life

OBJETIVOS: Evaluar el impacto de los síntomasdel tracto urinario inferior (STUI) referidos en elcuestionario IPSS sobre la calidad de vida y determinarla relación entre calidad de vida o puntuación total delIPSS con el tratamiento.MÉTODOS: Revisión retrospectiva del cuestionario IPSSde 125 hombres que habían consultado por STUI entreenero del 2001 y diciembre de 2003. La mediana deseguimiento fue de 24 meses. Los resultados fueronrecogidos en una base de datos Access. Para la evaluaciónestadística se utilizó la versión 11.0 del SPSS.RESULTADOS: Según la puntuación del IPSS total el17% de los pacientes presentaba síntomas severos. Enla evaluación de la calidad agrupada en 2 categorías,el 88% referían buena o indiferente calidad. Al evaluarla asociación entre los resultados del IPSS de cada preguntay la calidad, existió asociación significativa paratodas las preguntas. Los pacientes con STUI importantetenían un riesgo 6 veces mayor de mala calidad. Lospacientes que respondieron con peor calidad presentabanun riesgo 6 veces mayor de recibir tratamiento.Con un tiempo de evolución de más de 2 años demedia, el 91% de los que no tenían tratamiento seguíansin él.CONCLUSIONES: Cuanto más graves sean los síntomaspeor es la calidad de vida. Los parámetros independientesque más influyeron en la toma de decisiónpara iniciar un tratamiento fueron la calidad de vida yla puntuación total del IPSS. La polaquiuria, el chorrodébil y la vacilación inicial pueden explicar la calidadde vida de cada paciente

OBJECTIVES: To evaluate the impact ofthe lower urinary tract symptoms (LUTS) included in theIPSS on the quality of life and to determine therelationship between quality of life or total IPSS scoreand treatment.METHODS: Retrospective review of the IPSS questionnairein 125 male patients who had consulted for LUTSbetween January 2001 and December 2003. Resultswere included in an Access database. Statistical analyseswere done with the SPSS 11.0 software.RESULTS: 17% of the patients showed severe symptomsin accordance to the IPSS score. In the quality of lifeevaluation grouped into two categories, 88% referredgood or indifferent quality of life. In the evaluation ofthe association between IPSS individual questions andquality of life there was a significant association for allquestions. Patients reporting worse quality of life had a6 times higher risk of receiving treatment. With a meanfollow-up of two years, 91% of patients who were noton treatment continued without it.CONCLUSIONS: The most severe symptoms are, theworse the quality of life. The independent parametersthat most influenced decision to start treatment werequality of life and total IPSS. Frequency, weak streamand hesitation may explain quality of life on eachpatient