Sildenafil or vardenafil nonresponders' erectile response to tadalafil.

INTRODUCTION: Erectile dysfunction has usually been treated by a phosphodiesterase 5 inhibitor in men, especially in the past decade. Although sildenafil and vardenafil are widely used, there is a high percentage of people who do not respond to these drugs. This study was performed in order to evaluate the efficacy of the lastly presented phosphodiesterase 5 inhibitor, tadalafil, in nonresponder group of patients to sildenafil and vardenafil. MATERIALS AND METHODS: Forty married men with erectile dysfunction who had taken sildenafil or vardenafil at the maximum recommended doses and had not responded to the treatment were included. They were treated with tadalafil, 20 mg, at least 4 doses at different days. The effectiveness of the treatment was reviewed by different questionnaires, including the International Index of Erectile Function-5 (IIEF-5), Sexual Encounter Profile (SEP) questions 2 and 3, and the Global Assessment Question (GAQ), at the end of the 12th week. RESULTS: The IIEF-5 scores were 11.90 +/- 4.78 and 12.67+/-6.70, before and after at least 4 doses of tadalafil, respectively (P = .30). The rate of positive responses to SEP2, SEP3, and GAQ questions were also insignificantly different after the treatment. During this period, flushing was seen in 10 and headache was seen in 5 patients. CONCLUSION: The recommended maximum dose for tadalafil insignificantly improved the IIEF5, SEP2, SEP3, and GAQ scores in patients with erectile dysfunction who had not responded to sildenafil and vardenafil. The other treatment alternatives should be in mind after getting no response to the optimum doses and enough trials of sildenafil or vardenafil before trying a tadalafil regimen.

CD44 expression in renal ischemia-reperfusion injury in rats.

Renal ischemia-reperfusion injury (IRI) is an invariable consequence of transplantation. The tubuloepithelial expression of CD44 is markedly enhanced in autoimmune renal injuries. The aim of this experimental study was to evaluate the effect of IRI on the expression of CD44 in rat kidney. Thirty male Sprague-Dawley rats were used. The rats were divided into three groups. The rats in group 1 (n = 10) underwent laparotomy and left nephrectomy (Sham surgery). The rats in group 2 (n = 10) underwent laparotomy, 1 h renal ischemia, followed by 1 h of reperfusion and then left nephrectomy was performed. The rats in group 3 (n = 10) underwent laparotomy, 1 h renal ischemia, followed by 24 h of reperfusion and then left nephrectomy was performed. Histopathological findings and the immunohistochemical expression of CD44 in ischemic and reperfused rat kidneys were investigated. In histopathologic evaluation, non-specific changes were observed in group 2 and early phase of IRI were present in group 3. CD44 was expressed in both group 2 and 3 but not in group 1. The mean immunohistochemical staining percentages of rat kidneys in group 1, 2, and 3 were 0.00 +/- 0.00, 39.90 +/- 5.53, and 26.20 +/- 8.38, respectively. The immunohistochemical staining pattern was more dense in group 2 than in group 3 (P < 0.001). In conclusion, the expression of CD44 in renal tubuloepithelial cells was significantly increased after IRI. The increase in CD44 expression was more prominent during the early phase of IRI and started to decline after 24 h of reperfusion.

HLA class I and II antigens expression in patients with renal cell carcinoma.

An optimal antitumoral immune response requires the activation of both CD8(+) and CD4(+) T lymphocytes by the peptide antigen presentation via the human leukocyte antigen (HLA) class I and class II molecules, respectively. The frequency of A1, A26, DR11 alleles are significantly elevated and seem to be the predisposing alleles in RCC, while HLA A29 and DQ1 are the protective alleles and are found more frequently in the healthy group. To investigate the association between renal cell carcinoma (RCC) and the host's immune system, we immunohistochemically examined RCCs in 44 Turkish patients for the expression of class I and class II antigens. We found a significantly higher frequency of the alleles HLA-A1 (p= 0.001), HLA-A26 (p=0.047) and HLA-DR11 (p= 0.03) in RCC patients compared to the control group. The most frequent alleles in the control population were A29, DQ1 (p= 0.004 and 0.002 respectively). We observed no significant difference between patients and controls in HLA-B and HLA-C allele frequency. We conclude that our study found an association between HLA antigens and RCC in Turkish patients. We found a significantly higher frequency of the alleles HLA-A1, HLA-A26 and HLA-DR11in RCC patients compared to the control group. Larger studies are required to confirm these results.

Increased expression of CD44s in conventional renal cell carcinomas with renal vein or vena cava thrombosis. a retrospective evaluation of the expression of CD44s by immunohistochemical analysis in conventional RCC patients and in conventional RCC patients with renal vein or vena cava thrombosis.

OBJECTIVES: CD44 is thought to play an important role in the tumorigenesis of renal cell carcinoma (RCC). We retrospectively evaluated the expression of CD44s by immunohistochemical analysis in conventional RCC patients and in conventional RCC patients with renal vein or vena cava thrombus and investigated the differences in the pattern of expression of CD44s between the two groups. METHODS: Thirty RCC specimens and four RCC specimens with renal vein and five RCC specimens with vena cava thrombus were analyzed immunohistochemically using a CD44s-specific antibody. The expression of CD44s in RCC with renal vein or vena cava thrombus was compared with the expression of CD44s in RCC without renal vein or vena cava extention. RESULTS: Of the 30 tumor specimens without thrombus, 16 (53%) expressed CD44s. Staining was also positive in all of the nine specimens with thrombus. CD44s expression was weak in the tumour specimens without thrombus. RCC specimens with renal vein or vena cava thrombus exhibited strong positive staining for CD44s. CONCLUSIONS: The increased expression of CD44s seems to be correlated with tumor thrombus formation in renal vein or vena cava. CD44s may play a role in the formation of renal vein or vena cava extention.

Potential value of soluble intercellular adhesion molecule-1 in the serum of patients with bladder cancer.

INTRODUCTION: The potential value of serum levels of intercellular adhesion molecule-1 (ICAM-1) in the staging and pathological nature of bladder cancer was investigated in this study. MATERIALS AND METHODS: A total of 90 patients (mean age 64.5 +/- 7.1) having transitional cell carcinoma of the bladder and 30 control patients (mean age 64.0 +/- 5.5) were enrolled in the study. The serum samples of the patients were obtained on the day before surgery, at the same hour of the day. RESULTS: The preoperative sICAM-1 levels were found to be 46.2 +/- 14.7 and 28.0 +/- 7.8 ng/ml in the tumor group and the control group respectively, which is significantly higher (p = 0.00). The ICAM-1 levels were not different in the invasive tumor group (36 patients) and the superficial tumor group (54 patients; 47.3 +/- 13.8 ng/ml in the invasive group and 45.5 +/- 15.3 ng/ml in the superficial tumor group; p = 0.520). The serum levels of sICAM-1 were significantly higher in grade III tumors than grade I and II tumors (62.0 +/- 8.7, 38.4 +/- 11.9 and 42.2 +/- 8.2 ng/ml respectively; p = 0.000). The mean serum sICAM-1 levels in tumors >3 cm and <3 cm were found to be 52.6 +/- 15.8 and 40.7 +/- 11.0 ng/ml respectively which is statistically significant (p = 0.000). CONCLUSIONS: In this study, serum ICAM-1 levels were found to be related to tumor presence, grade and size. Larger series are needed for the thorough understanding of the role of ICAM-1 in bladder cancer.

A distal protruding ureteral polyp looking like a bladder mass.

A 34-year-old female patient with a right lumbar and back pain during micturition is presented. Ultrasonography and intravenous urogram both supported a possible bladder mass. Finally, a ureteral polyp was diagnosed on cystoscopy and resected by the ureteroscopic approach.

Value of urinary NMP-22 in patients with renal cell carcinoma.

OBJECTIVES: To investigate the preoperative and postoperative levels of urinary nuclear matrix protein-22 (NMP-22) in patients with renal cell carcinoma (RCC) and compare them with those of control patients. We also investigated and reported the relationship of NMP-22 with the pathologic grade and stage of RCC tumors. Urinary NMP-22 is currently used for monitoring patients with transitional cell carcinoma of the bladder. METHODS: The preoperative and postoperative urinary NMP-22 levels were measured in 23 patients with RCC and 20 control patients in whom solid renal masses were ruled out by either computed tomography or renal ultrasonography. The control group consisted of patients with benign conditions from the urology, gastroenterologic surgery, and cardiovascular surgery departments. Of the 23 patients with RCC, 21 underwent radical nephrectomy and 2 underwent partial nephrectomy. RESULTS: The preoperative urinary NMP-22 levels were significantly higher in the RCC group than in the control group (10.65 +/- 5.49 U/mL and 4.64 +/- 3.10 U/mL, respectively, P <0.001). Ten days postoperatively, the urinary NMP-22 levels had decreased from 10.65 +/- 5.49 U/mL to 5.98 +/- 3.86 U/mL in the RCC group, which was statistically significant (P <0.001). The postoperative urinary NMP-22 levels were not different from those of the control group (5.98 +/- 3.86 U/mL versus 4.64 +/- 3.10 U/mL, P = 0.176). CONCLUSIONS: The results of this study are promising for the use of urinary NMP-22 in the evaluation of patients who are at risk of RCC because the relationship between urinary NMP-22 and the presence of RCC has been shown.