Outcome of transplantation in renal allograft recipients from cadaveric donors with standard and expanded criteria: a single-center experience.

INTRODUCTION: The increasing number of patients requiring kidney transplantation and the lack of available organs has led to the utilization of kidneys from expanded criteria donors (ECD). AIM: The comparison of the clinical outcome of renal transplantation, performed in a single center, between allograft recipients from standard (SCD) and expanded criteria donors (ECD). PATIENTS AND METHODS: Data from 215 cadaveric renal transplantations performed during a 16 year period at the University Hospital of Patras were retrospectively studied. Donors' and recipients' characteristics (gender, age, history of hypertension and diabetes mellitus, cold ischemia time, post-transplant and long term graft function) were analyzed. RESULTS: Grafts from donors with expanded criteria (ECD, n = 53) were allocated to older recipients whereas grafts from donors with standard criteria (SCD, n = 162) were allocated to younger recipients. The mean cold ischemia time was 1,146 min and was similar between the two groups of patients. Patients' survival rates were similar between allograft recipients from SCD and ECD up to the 5(th) post-transplant year of follow-up. Graft survival was significantly better in allograft recipients from SCD during a 5-year follow-up period. A significantly lower eGFR was noted in allograft recipients from ECD in comparison to those from SCD throughout the observation period. Cold ischemia time was positively correlated to the development of DGF, while patients with DGF had significantly worse graft function throughout the observation period. CONCLUSION: Patient survival from ECD is comparable to that from SCD but graft survival is significantly lower. However, since renal function of recipients from ECD is adequate for long term period, grafts from ECD should be used in older patients.

Solitary fibrous tumor of the urinary bladder: report of a case with long-term follow-up and review of the literature.

Solitary fibrous tumor (SFT) is a neoplasm typically arising in the pleura. Yet, extrapleural cases have been described and are a common cause of diagnostic pitfalls, especially when met in unusual sites. We report the clinical and pathological features of a case of SFT arising in a rather unusual site, the urinary bladder, the seventh reported to date in the English literature and the first with long term follow-up. Differential diagnosis from other spindle cell neoplasms of the bladder can be problematic. Prognosis of this neoplasm is obscure and long-term follow-up is required for all cases of solitary fibrous tumor. Solitary fibrous tumor is a rare mesenchymal tumor of the urinary bladder, but should always be considered in the differential diagnosis of spindle cell neoplasms encountered in the lower genital tract.

Paranephric abscess during pregnancy: a case for a low-dose interventional CT.

A young pregnant woman hospitalized in our department with sepsis due to a paranephric abscess, and treated successfully with a nephrostomy under the guidance of low-dose CT, is presented. Based on this successful and safe treatment for the fetus, it is proposed that low-dose CT can be applied without any risk to pregnant women with special urological problems such as paranephric and splenic abscesses, dysmorphic and ectopic or horseshoe kidneys.

Experimental evaluation of free versus pedicled fascial flaps for sling surgery of urinary stress incontinence.

PURPOSE: Bladder neck suspension using an autologous fascial sling is an established surgical technique for treatment of urinary stress incontinence. However, the biological fate and physical properties of autologous fascial sling yet remain to be determined. MATERIALS AND METHODS: Our study was designed to evaluate in an animal model of twenty rabbits fascial slings from free and pedicled fascial flaps of two different widths (7 mm and 15 mm.) and uniform length (60 mm.) in respect to changes of length, width, tensile strength and histological criteria of vitality and integrity 3 months after surgery. RESULTS: The results 3 months after surgery revealed shrinkage in length by 37% (31%-46%) of the original length, shrinkage in width by 63% (60%-69%) of the original width and reduction of tensile strength of 53% (51%-55%) without consistent differences between free and pedicled flaps or 7 mm. and 15 mm. wide flaps. In the groups with 7 mm. wide flaps a total of two dystrophic slings (1 pedicled, 1 free) were seen; however, no dystrophies were seen in 15 mm. wide flaps. On microscopy, all slings were vital regardless of their surgical configuration. CONCLUSIONS: In summary, on macroscopic, microscopic and physical examination no gross differences between free and pedicled slings could be detected, so that preferences for use of free or pedicled fascial flaps could not be established for clinical applications in sling surgery. However, 15 mm. wide flaps had a lower incidence of dystrophy and retained greater absolute tensile strength than 7 mm. wide flaps.

Intravesical bacillus Calmette-Guérin versus epirubicin in the prophylaxis of recurrent and/or multiple superficial bladder tumours.

A prospective, randomized trial was conducted to evaluate and compare the effects of modified adjuvant intravesical bacillus Calmette-Guérin (BCG) and epirubicin regimens in patients with superficial bladder cancer. One hundred thirty-two individuals with recurrent and/or multiple neoplasms, i.e. at high risk for tumour recurrence and progression, were enrolled. After complete transurethral resection of their tumours, the patients received a 6-week course of BCG instillations or an early 4-week course of epirubicin instillations as their initial therapy. Those with stage Ta and grade 1 neoplasms who remained free of recurrences received maintenance therapy consisting of single quarterly instillations. However, for those with stage T1 cancer of any grade or stage Ta of grade 2 or 3 neoplasms who also remained free of recurrences, the treatment schedules were modified: they received, instead of single maintenance doses, 3 weekly instillations of epirubicin at months 3 and 6 of follow-up, or a 3-week course of BCG at month 6 of follow-up. The recurrence-free rates did not differ significantly between the two study groups (44% for epirubicin versus 55% for BCG), for an identical median follow-up of 43 months. However, in terms of relative risk of recurrences, disease-free intervals and recurrence rate per 100 patient-months, a significant benefit in favour of BCG when compared with epirubicin was demonstrated in patients who had stage T1 or grade 3 neoplasms.

Nonfunctional adrenal cortical carcinoma. Report of a case and review of the literature.

Nonfunctional carcinomas of the adrenal gland are quite rare. By presenting a 47-year-old woman with such a tumour, a review of the literature is made, with special emphasis on the epidemiology and histologic criteria in predicting malignant behaviour. In addition, the clinical, pathological and radiographic findings, as well as the treatment modalities of this neoplasm are discussed.

BCG versus epirubicin in the prophylaxis of multiple superficial bladder tumours: results of a prospective randomized study using modified treatment schemes.

A prospective randomized trial on 94 eligible patients evaluated and compared the efficacy of adjuvant intravesical epirubicin and bacillus Calmette-Guérin (BCG) after complete resection of multifocal superficial bladder cancer. BCG treatment schedule consisted of an induction 6-week course of instillations (150 mg Pasteur BCG per instillation) and single maintenance doses to patients who remained free of recurrences at follow-up examinations for a total treatment period of 2 years. These initial responders received additionally a separate 4-week course of therapy 6 months after the start of treatment. Chemoprophylaxis included an early (on the second postoperative day) instillation followed by 4 weekly treatments with epirubicin (50 mg per instillation) and then by 10 monthly treatments for the initial responders during the first year of follow-up and at every follow-up examination for a total treatment period of 2 years. The overall treatment results did not differ significantly between the 2 arms (54% of patients of the epirubicin group remained free of recurrences compared to 65% of those treated with BCG) for an identical mean follow-up of 35.1 months. However, a significant benefit in favour of BCG when compared with epirubicin was shown in patients who had stage T1 and grade 3 tumours and in terms of relative risk of recurrences, disease-free interval and recurrence rate per 100 patient-months. Both drugs were proved to be safe with manageable toxicity.

Intravesical bacillus Calmette-Guerin immunoprophylaxis of superficial bladder cancer: results of a controlled prospective trial with modified treatment schedule.

A controlled prospective trial on 94 patients evaluated the efficacy of intravesical Pasteur strain bacillus Calmette-Guerin (BCG) administration as prophylaxis against tumor recurrences after complete endoscopic resection of superficial bladder cancer. The treatment schedule, consisting of an initial 6-week course of instillations and a single quarterly maintenance dose to the responders, was modified to those of the latter who were at high risk for recurrence and who received an additional separate 4-week course of therapy. The percentage of the patients treated prophylactically with BCG and who remained free of recurrences (68%, mean followup 33.8 months) was significantly higher than that of the controls who underwent transurethral resection only (41%, mean followup 30.2 months). In terms of relative risk of recurrences, recurrence rate per 100 patient-months and disease-free interval, comparisons between the 2 groups of patients revealed a significant benefit for the BCG group overall as for those subjects having stages Ta and T1 tumors, multifocal tumors, a history of disease, and grades 2 and 3 carcinoma. Drug-induced toxicity was acceptable. Our study suggests that our modified treatment protocol is notably safe and effective against recurrent superficial bladder cancer.

Intravesical instillations of 4-epi-doxorubicin (epirubicin) in the prophylactic treatment of superficial bladder cancer: results of a controlled prospective study.

A controlled prospective study in 65 patients was done to evaluate the efficacy of intravesical epirubicin administration as prophylactic treatment in regard to the pattern of tumor recurrences after complete endoscopic resection of superficial transitional cell carcinoma of the bladder. Intravesical instillations of the drug were given weekly for 6 consecutive weeks and to the responders an intermittent maintenance therapy was administered for the first 2 years after each followup examination. Of the patients treated prophylactically with epirubicin 37% had recurrence within a total of 1,136 patient-months compared to 55% of the controls who were followed for a total of 436 months, a difference that was not statistically significant (p greater than 0.05). However, examining the results in another manner, the control patients demonstrated a significantly shorter mean interval to recurrence and higher recurrent tumor rate per 100 patient-months. To clarify further the efficacy of epirubicin therapy, comparisons of the treatment outcome according to several tumor factors were done. These comparisons revealed a significant benefit for those who received epirubicin with respect to history of tumor recurrences and multiplicity at presentation. Drug-induced toxicity was acceptable. Our study suggests that epirubicin is safe and effective against the recurrence of superficial bladder cancer.

Primary non-Hodgkin's lymphoma of the urinary bladder.

Primary non-Hodgkin's lymphoma of the bladder is a rare entity and when found in such an unusual location is often difficult to distinguish from other vesical or extravesical neoplasms. Understanding of the pathobiological characteristics of this malignancy has been hampered not only because of its rarity but also by the previous confusion in its nomenclature. Factors that influence survival most strongly are the stage and the bulk of disease at presentation and the histologic classification of the tumor. We report a case of primary non-Hodgkin's lymphoma of the bladder presenting as a large pelvic mass which dramatically regressed with systemic chemotherapy with simultaneous restoration of the upper dilated urinary tracts. In addition, the incidence, clinical picture, staging procedures, histologic classification and treatment modalities of this disease are reviewed.

Prostatectomy in the very aged.

The number of very aged men who demand prostatectomy for benign disease is increasing. We have assessed surgery results in 79 patients operated during the last four years. Sixty-two underwent endoscopic and 17 open procedure. Mortality rate was 3.7%. Two patients died in the first week and one patient three weeks after surgery. Morbidity rate was 61% but did not significantly affect the final operative outcome. Operative success rate six weeks postoperatively was 87%, satisfactory for this age group. After detailed preoperative evaluation and postoperative care by specialized age care team, prostatectomy is safe, effective and involves low-cost treatment.