RESUMO
OBJECTIVE: The Fas-Fas ligand (FasL) system has been recognized as a major pathway for the induction of apoptosis in cells and tissues. Fas-mediated apoptosis is deeply involved in cancer cell death brought about by the immune system. This study was performed to determine the Fas and FasL expression in human bladder cancer and the impact of schistosomiasis infection. MATERIAL AND METHODS: Of the 75 patients, 25 with chronic bilharzial cystitis and 50 with bladder cancer were included in this study. Ten control patients were included in the study, following their consent. Fas and FasL expressions in bladder tissue were determined by indirect immunohistochemistry using avidin-biotin-peroxidase complex (ABC) method. RESULTS: The association of bilharziasis with malignancy raised the incidence of Fas positive immunoreactivity to 100%. The number of malignant cases positive for Fas decreased with progress of tumour grade and stage. All control cases were negative for FasL expression. The percentage of positive FasL malignant cases increased with increasing tumour grade or stage. CONCLUSION: Malignant bladder lesions express high levels of Fas and decreased expression of Fas is associated with disease progression. Urinary bladder carcinoma acquires the functional FasL during tumour progression that may induce apoptosis of anti tumour T lymphocytes. Fas and FasL are recommended to be considered important tumour markers to define aggressive bladder cancer and may be included in defining the surveillance protocol for superficial bladder cancer.
RESUMO
PURPOSE: The effect of extracorporeal shock wave lithotripsy on the growing kidneys of young children has always been a concern. We determined whether shock wave lithotripsy causes renal parenchymal scarring or affects glomerular filtration rate in children. MATERIALS AND METHODS: This prospective study included 100 children with renal stones who presented to the shock wave lithotripsy unit at our institution between March 2005 and March 2008. A total of 28 children had multiple stones in the same kidney. All children with bilateral renal stones had 1 kidney cleared of stones by percutaneous nephrolithotomy before undergoing shock wave lithotripsy. A total of 138 stones were subjected to shock wave lithotripsy. All children underwent radionuclide scan of the renal parenchyma using dimercapto-succinic acid, and glomerular filtration rate was estimated using diethylenetriamine pentaacetic acid before extracorporeal shock wave lithotripsy and 6 months afterward. Children with renal scarring due to previous surgery or vesicoureteral reflux were excluded from the study. The number of shock wave lithotripsy sessions to achieve stone-free status and the dose of shock waves used were recorded for each patient. RESULTS: No patient demonstrated renal parenchymal scarring on dimercapto-succinic acid scan or any statistically significant change in glomerular filtration rate on diethylenetriamine pentaacetic acid scan up to 6 months after shock wave lithotripsy. CONCLUSIONS: Shock wave lithotripsy is a safe modality for treating renal calculous disease in children up to 16 years old, with no impact on long-term kidney function.
