PNET/Ewing's sarcoma of the kidney: imaging findings in two cases.

The CT-imaging findings of primary renal PNET/Ewing's sarcoma in two patients were retrospectively assessed. A large renal mass with heterogenous contrast enhancement and necrotic and hemorrhagic areas were the predominant characteristics. In adolescents or young adults presenting with a large renal mass, PNET/Ewing's sarcoma may be included in the differential diagnosis.

Effect of less invasive treatment modalities on handling urolithiasis in Belgium.

Recent developments in technology, such as extracorporeal shock wave lithotripsy and endoscopic tools for renoscopy and ureteroscopy, have dramatically changed the way supravesical urolithiasis is treated. In Belgium, all medical acts are recorded by the Belgian State Institute for Sickness and Invalidity Insurance. Data from 1978 until 1991 are given and compared with treatment data of the University Hospital of Ghent. The steady patterns, noted at the end of the 70s and during the early 80s, were disturbed when new endoscopic tools became available; these caused a slight increase in the number of treatments. When extracorporeal shock wave lithotriptors became commercially available, a dramatic change occurred: the overall number of stone treatment sessions tripled.

Evaluation of renal function before and after intravenous injection of non-cholangiographic water soluble contrast media in rats.

In the present study, normal laboratory rats (n = 22), were injected intravenously with water soluble contrast media (CM) or saline. Renal function was monitored before and followed after challenge. Seven animals were injected with saline, the others with 3 different types of contrast media. The absolute urinary creatinine output decreased significantly in the saline group, from 0.0247 mumol/min 100 g BW (IR: 0.0052) to 0.0167 mumol/min 100 g BW (IR: 0.0019) (p < 0.01), while in the CM groups only a significant decrease was seen after ioxaglate injection, from 0.0250 mumol/min 100 g BW (IR: 0.0014) to 0.0174 mumol/min 100 g BW (IR: 0.0027) (p < 0.01). ANOVA between the groups showed no difference. The median values for serum creatinine after injection of the test products did not differ from the control values. It seems therefore that the challenge of a normal laboratory rat with CM is not a suitable model for the detection of subtile nephrotoxic properties of CM.

Contrast media injection in the rat after multiple renal insults. No evidence of additional nephrotoxicity.

Experiments were performed to determine whether water-soluble contrast media (CM) show nephrotoxic properties when injected into rats after multiple renal insults. The latter consisted of combinations of prostaglandin synthesis inhibition (with indomethacin) and/or salt depletion and/or uninephrectomy. Renal function was evaluated by standard clinical methods to measure parameters such as urinary output, urinary osmolality, urinary creatinine excretion and serum creatinine. CM injected after prostaglandin synthesis inhibition alone did not influence urinary creatinine excretion or serum creatinine. After a combination of renal insults a significant increase in median serum creatinine values from 61.88 mumol/l [interquartile range (IR) 17.68] [0.70 mg% (IR 0.20)] to 97.24 mumol/l (IR 79.56) [1.10 mg% (IR 0.90)] was observed but CM or sham injections did not prevent a normalization of serum creatinine. The pattern of recovery of serum creatinine was not influenced by previous kidney mass reduction. It is concluded that the nephrotoxic properties of CM cannot be detected with standard clinical methods in rats after multiple renal insults.

Influence of feeding, blood sampling method and type of anaesthesia on renal function parameters in the normal laboratory rat.

With sophisticated experiments it is necessary to handle laboratory animals many times. To determine the effect of minor handling a series of experiments was performed to measure the impact of fasting, anaesthesia, blood collection method and serum creatinine analysis on renal function. Simple clinical methods to measure renal function parameters such as diuresis, urinary osmolality, urinary creatinine excretion and serum creatinine were used. During fasting a significant increase (P < 0.01) in diuresis and a significant decrease (P < 0.01) in urinary osmolality were noted. Fasting and anaesthesia have the additional effect of significantly decreasing (P < 0.05) urinary creatinine excretion. Blood sampling method also has a significant impact on serum creatinine: venous sampling causes false-positive differences compared with simultaneous arterial sampling.

Down-staging prostate cancer. Is it possible by androgen depletion and Mitomycin C therapy?

The study was carried out in order to investigate the possibility of tumor reduction in prostate cancer patients. As a reduction of the primary tumor was observed with hormonal treatment and complete response of soft tissue tumor markers with Mitomycin C, this combined treatment was given in seven patients to evaluate if it was able to down-stage those cases which were thought to be incurable (T3N1-2M0/T4N0-2M0). Although the clinical evaluation suggested a significant down-staging, the explorative lymphadenectomy was unable to confirm this. The proposed treatment is able to reduce the tumor bulk significantly of the primary cancer as well as of its metastases; progression during the treatment was not seen.

Absence of functional renal effects of uro-angiographic contrast media on post-ischemic rat kidneys.

Water soluble ionic contrast media (CM) and glucose 5% were administered to Sprague-Dawley rats 36 hours after bilateral warm renal ischemia for 45 min. In all animals (n = 28) the renal ischemia caused a decrease of the absolute urinary creatinine output. Intra-arterial injection of glucose 5% or CM did not produce different patterns of absolute urinary creatinine output. The serum creatinine increased after 36 hours of reflow. When compared by means of a Mann-Whitney U-test to a normal median serum creatinine obtained in a separate group of 22 normal rats, the increase was statistically significant (p less than or equal to 0.01). The serum creatinine medians returned to a normal level after 24 hours. It seems therefore that 45 min of warm renal ischemia and 36 hours of reflow is an insufficient challenge to the rat kidney for the detection of the nephrotoxic properties of CM as opposed to when CM are injected during ischemia.

Toxicity of litholytic ethylenediaminetetraacetic acid solutions to the urothelium of the rat and dog.

The toxicity to the urothelium of bipotassium ethylene-diaminetetraacetic acid (K2-EDTA) buffered with 0.2 M triethanolamine (TEA) at pH 8 and 8.5 was tested in rats and dogs. Even at a low concentration of 3.125 mM, K2-EDTA is very noxious to the bladder mucosa. This toxicity is not due to the buffer TEA, which is well tolerated. Although buffered K2-EDTA, at pH 8.5 is an excellent chemolytic agent for calcium-containing stones, its clinical use is limited by this toxicity.

Evaluation of renal function before and after intravenous injection of non-cholangiographic water soluble contrast media in rats: preliminary results.

In this preliminary study, water soluble contrast media (CM) were administrated to normal laboratory rats (n = 11) and renal function was monitored before and followed after this challenge. A significant decrease (p less than or equal to 0.001) of the absolute urinary creatinine output, was noted during 3 days after the injection of the CM: the median (M) control value was 0.0313 mumol/min. 100 g body weight (BW) (interquartile range (IR): 0.0014) while the M values the first, the second and the third day were 0.0209 mumol/min. 100 g BW (IR: 0.0141), 0.0198 mumol/min. 100 g BW (IR: 0.0044) and 0.0265 mumol/min. 100 g BW (IR: 0.0054) respectively. The serum creatinine 24 hours after injection was 59,8 mumol/l (IR: 7.92) which is significantly higher (p less than or equal to 0.002) compared to the M serum creatinine of 51.9 mumol/l (IR: 15.0) evaluated in a group of normal unchallenged laboratory rats. These changes are in contrast with the low frequency of renal failure episodes encountered in clinical circumstances. Further experiments with inclusion of a control group receiving a sham injection seem necessary.

Evaluation of renal function before and after intravenous injection of uroangiographic water soluble contrast media in men.

Nephrotoxicity due to injection of uro-angiographic water soluble contrast media is a wellknown hazard in patients with renal failure, diabetes mellitus, cardiovascular disease, multiple myeloma and old age. Cases of nephrotoxicity in other patient populations are extremely rare. In order to document the influence of water soluble contrast media in patient undergoing intravenous urography diuresis, osmolar changes, creatinine clearance, absolute urinary creatinine excretion and uric acid metabolism were evaluated before and after contrast medium injection. No adverse reaction could be evidenced as far as the renal function is concerned, as creatinine clearance and absolute urinary creatinine output values showed no significant differences. The significant raise (p less than or equal to 0.001) of uric acid excretion (absolute urinary uric acid excretion values before and after contrast injection were respectively 5.22 micrograms/min.kg (IR: 3.24) and 10.68 micrograms/min.kg (IR: 4.03] can be co-responsible for adverse reactions when the renal function is not normal.

[A study of the causes of staghorn calculi]. / La recherche des causes du calcul coralliforme.

A thorough metabolic evaluation of all staghorn stone patients seems justified, considering the results obtained by the study of 27 such cases. Pak's ambulatory screening test, slightly modified, was used. This allowed the finding of a hypercalciuria in more than 50% of the cases, a hyperuricosuria in 63% of the cases and a hyperoxaluria in one case out of five. A metabolic anomaly was not detected in two patients. Although urinary tract infection, present in 75% of the cases is essential to the genesis of a staghorn stone, the question raises whether metabolic anomalies are not the primary cause of the stone formation.