[Obstructive pyelonephritis caused by ureteral orifice catheterization with a bladder catheter]. / Pyélonéphrite obstructive par cathétérisation du méat urétéral par une sonde vésicale.

This article reports a rare case of acute pyelonephritis secondary to left ureteral obstruction by a bladder catheter. The patient was 93years old man hospitalized in the hospital emergency department with a 39°C fever and pyuria from an indwelling catheter. Blood test found hyperleukocytosis, inflammatory syndrome and acute renal failure. Diagnosis was confirmed by non-contrast abdominal CT scan showing distal part of the catheter inside left ureteral orifice with ureterohydronephrosis. Treatment consisted in replacing the catheter by a three-way catheter for irrigation and parenteral antibiotics therapy. Clinico-biological evolution was successful and a urinary tract CT scan could be realized at day 9. The left upper urinary tract function was recovered. With a short review of the literature we propose to describe the different procedures to manage those obstructions.

Kaposi's sarcoma confined to the colorectum: a case report.

Reported is a new case of a Kaposi's sarcoma involving only the colorectal area in an HIV-negative patient presenting with hemorrhagic rectocolitis. The colonoscopic examination and the radiological imaging showed the presence of multiple nodular pseudopolypoid formations in the rectum, which suggested, in the differential diagnosis, primarily a malignant non-Hodgkin lymphoma.

[Endovascular embolization of ophthalmic artery branches for control of refractory epistaxis: report of one case]. / Traitement endovasculaire d'un épistaxis réfractaire par embolisation dans le territoire ophtalmique: à propos d'un cas.

Embolization of the internal maxillary artery is an accepted method for control of severe or recurrent posterior epistaxis. Such endovascular treatment may fail if the vascular supply to the bleeding vessels originates in branches of the ophthalmic artery. We report one case in which embolization of the ophthalmic artery was performed to control epistaxis. Distal catheterisation at least beyond the second portion enables safe embolization.

Clinical impact of residual renal function on patients starting dialysis treatment.

We describe our clinical experience of monitoring residual renal function of patients on regular dialysis treatment as residual renal function can play an important role in the management of patients undergoing regular dialysis. With active residual renal function it is possible to delay the start of haemodialytic programmes. In managing dialysis treatments, it is important to maintain residual renal function by preventing hypotensive events. It is known that in acute renal failure intradialytic hypotension is able to reduce the recovery of renal function. Out patient follow-up plays an important role for these patients. This paper will also discuss the use of biocompatible membranes during dialysis. The outcome is that they are not associated with better maintenance of residual renal function.

Increased cyclin D1 expression is associated with features of malignancy and disease recurrence in ovarian tumors.

Alterations in the expression of cyclin D1 have been reported frequently in several human cancers, but their significance in the multistep model of carcinogenesis has been scantly described. To define the pattern of cyclin D1 expression in the development of ovarian cancer and clinical outcome, 55 cases of benign ovarian tumors, 12 borderline cases, and 37 ovarian carcinomas (32 primary and 5 recurrent carcinomas) were studied. Analyses were carried out on fresh tumor specimens by Western blotting and reverse transcription-PCR and provided significant superimposable results (P = 0.00001). Cyclin D1 abundance was classed according to the densitometric values as undetectable, detectable, well detectable, and highly detectable. A significant increase (P < 0.000001) in median cyclin D1 values was observed from benign (0.038; range, 0.001-0.705) to borderline (0.226; range, 0.001-0.623) to malignant (0.347; range, 0.027-2.330) to recurrent (0.887; range, 0.309-2.2260) tumors. In addition, higher median cyclin D1 values were reported in serous carcinomas (P = 0.058) and advanced-stage diseases (P = 0.003). Survival analyses carried out in the 32 primary carcinomas showed no significant difference in overall survival between detectable versus well/highly detectable cyclin D1 neoplasms. Conversely, a significant relationship between cyclin D1 expression and progression-free survival was found (P = 0.031). These results may elucidate the function of altered cyclin D1 expression in ovarian tumorigenesis and provide a basis for additional studies on its prognostic role.

Haemodialysis in acute renal failure.

Haemodialysis in acute renal failure differs from chronic uraemia. We describe our clinical experience comparing tolerance to dialysis and dialysis efficacy of bicarbonate haemodialysis in comparison to haemofiltration. Both provide adequate treatment for ARF, Kt/v 0.6 +/- 0.1, URR 56% in bicarbonate haemodialysis compared to Kt/v 0.4 +/- 0.06, URR 60% in haemofiltration. Clinical outcome was the same in both groups, in particular the overall survival was satisfactory at about 70%. These results are likely to reflect close control of these patients by nursing staff committed to haemodialysis in acute renal failure.

Clinical impact of residual function in haemodialysis.

The term residual renal function (RRF) refers to the small renal function activity persisting in patients affected by chronic renal failure in the uraemic phase. It is associated with better clinical features as well as better laboratory values (1). Nevertheless, RRF usually decreases with variable rates over time; in particular peritoneal dialysis is associated with a better preservation of RRF than haemodialysis.

Paclitaxel plus ifosfamide in advanced ovarian cancer: a multicenter phase II study.

BACKGROUND: While ovarian cancer is one of the most sensitive cancers to cytotoxic drugs, with objective response rates of 60-80% routinely being reported in previously untreated patients, the majority of individuals with advanced disease ultimately relapse. Paclitaxel, a new and novel antimicrotubule agent, has shown activity as a salvage therapy in epithelial ovarian cancer. More importantly, in a prior study, it has been shown to be active in tumors that have displayed resistance to platinum compounds, with a reported response rate of 20%. Ifosfamide has shown activity in the treatment of patients who previously demonstrated clinical resistance to a platinum-cyclophosphamide combination. Recently, a synergistic activity of Taxol combined with ifosfamide has been reported in ovarian cell lines. Based on these data, a phase I/II study of a combination treatment with paclitaxel and ifosfamide was performed. PATIENTS AND METHODS: Thirty-one patients with recurrent ovarian cancer or ovarian cancer refractory to cisplatin (CDDP)-containing regimens were treated with paclitaxel at a dose of 135 mg/m2 on day 1; ifosfamide was administered at 1 g/m2 on days 2 and 3 for the first cycle and 1.5 and 2 g/m2 with the same schedule in cycles 2 and 3, respectively. In the absence of toxicity, the dose of ifosfamide was maintained at 2 g/m2 for the last three cycles. Cytotoxic therapy was repeated every 3 weeks. RESULTS: A 30% overall objective response rate was achieved in the 30 patients assessable for response. Among 21 platinum-resistant patients, 4 partial responses (19%) were observed, while in the 9 platinum-sensitive patients 2 complete responses and 3 partial responses (55%) were observed. Myelosuppression was the predominant toxicity. Leukopenia (WHO grade 3-4) occurred in 10% of patients who received ifosfamide at a dose of 1 g/m2 and in 18% of patients treated with ifosfamide at 1.5 g/m2. CONCLUSION: Our results confirmed a low activity of paclitaxel in platinum-resistant patients. The results of this combination treatment with paclitaxel-ifosfamide in our platinum-sensitive patients support further investigations in a randomized study of the combination regimen against paclitaxel alone or retreatment with organoplatinum compounds.

Expression of cyclin D1 correlates with malignancy in human ovarian tumours.

Cyclin D1 is a cell cycle regulator of G1 progression that has been suggested to play a relevant role in the pathogenesis of several human cancer types. In the current study, the expression of cyclin D1 has been investigated in a series of 33 patients, with benign (10 patients), borderline (five patients) and malignant (18 patients) ovarian disease. Cyclin D1 protein and mRNA content were analysed by Western blotting and reverse transcriptase polymerase chain reaction respectively. The levels of cyclin D1 protein were undetectable in patients with benign disease, detectable in the majority of patients with borderline disease and elevated in those with ovarian carcinomas, being significantly related to the degree of malignancy (carcinoma vs benign, P = 0.0001; benign vs borderline, P = 0.0238). A significant relationship between cyclin D1 expression and tumour proliferative activity was also found (P = 0.000001). Moreover, eight benign lesions, two borderline tumours and 11 carcinomas proved to be suitable for the analysis of cyclin D1 transcript, and emerging data demonstrated significant agreement between protein abundance and mRNA expression. Results from the current study suggest that cyclin D1 expression is associated with the degree of transformation and most probably plays a role in the early development of ovarian malignancy.

Salvage chemotherapy with paclitaxel in platinum-resistant advanced ovarian cancer patients.

Encouraging results with Paclitaxel are reported in ovarian cancer patients relapsing and progressing after platinum-based chemotherapy; however, the two populations have different probabilities of a response to a second-line treatment. Here we report the results achieved in 39 patients with platinum-refractory ovarian cancer, treated with Paclitaxel 175 mg/qm2 (or 135 mg/m2 if heavily pretreated) using 3-hour intravenous infusion every 3 weeks, in an attempt to verify the activity of this drug in platinum-resistant patients. The toxicity was mild to moderate and primarily hematologic and neurologic. The objective response rate is 12.8% with no complete responses. The response duration was brief and the median survival 6 (range 1-17) months. An accurate cost-benefit balance is necessary before routinely use of Paclitaxel in platinum-refractory patients. Further research is needed to determine the optimal role of Paclitaxel in the whole therapeutic strategy for ovarian cancer.

Establishment and characterization of three new cell lines derived from the ascites of human ovarian carcinomas.

Three human cancer cell lines (OC 314, OC 315, and OC 316) were newly established in permanent culture from the ascites of patients with serous adenocarcinoma of the ovary. OC 314 was derived from an untreated tumor presenting with ascites at diagnosis; OC 315 was isolated from a neoplasm progressing after cisplatin-containing regimen; and OC 316 was collected from a patient with pleural metastasis at diagnosis, resistant to different chemotherapeutic treatments including Taxol. These cell lines were repetitively subcultured once to twice a week through 75-80 passage generations. Tumor cells grew as monolayers and displayed epithelial-like morphology, consistent with a feature of adenocarcinoma, which was then confirmed by the expressions of cytokeratins and vimentin. The cell lines proved highly tumorigenic when transplanted into nude mice, both subcutaneously and intraperitoneally. In addition, the mice inoculated with subcutaneous OC 316 developed extremely aggressive tumor, also invading the peritoneum, which correlated with the malignant behavior of the original tumor. Drug sensitivity, evaluated by the MTT assay, showed that the three cell lines expressed similar sensitivity to doxorubicin. Responses to cisplatin essentially reported low sensitivity of OC 314 and OC 315 and resistance of OC 316, thus reflecting the original sensitivity at the clinical level.

Treatment of FIGO stage Ib cervical carcinoma with nodal involvement.

One hundred and eighty one patients with stage Ib cervical cancer underwent hysterectomy with pelvic lymphadenectomy. The overall incidence of lymph node metastases was 20%. Twenty seven (71%) patients with nodal involvement were treated by external radiotherapy (TCT) and 11 (29%) by both chemotherapy and radiotherapy (Lin. Acc.). The overall survival at 5 years was 80%; it was 43% for patients with positive nodes and 89% for patients without metastatic nodal disease. The 3 year survival of patients with positive nodes who underwent radiation therapy by TCT was 58%, while it was 72% for those treated by chemotherapy plus radiotherapy. We observed a recurrence in 23% of the cases, 52% in patients with positive nodes and 15% in those with negative nodes. The association chemo-radiotherapy in patients with metastatic lymph nodes seems to improve the survival and reduce the recurrence rate.