Intra‐arterial embolization of lumbar artery pseudoaneurysm following percutaneous nephrolithotomy

The management of a patient with haematuria following percutaneous nephrolithotomy is described. The patient underwent renal angiography to assess the cause of bleeding. A pseudoaneurysm arising from first left lumbar artery was incidentally discovered, which was then successfully embolized using an indigenously fabricated metallic coil and gel foam particles in the same sitting.     

Immune-complex disease in mice and humans given C. parvum

The present studies in mice and cancer-bearing patients, treated with C. parvum (CP) immunotherapy, were to determine the effects of CP on the production of immune complexes (IC) and associated disease. Using the Clq-binding assay, circulating immune complexes were detected in mice given a single high dose of CP (466 microgram) and repeated human-equivalent doses (70 microgram). All mice treated with CP developed proliferative glomerulonephritis, the severity of which was dose-related. The histological and immunofluorescent patterns of the nephritis were those attributed to immune-complex disease. The mice had haematuria but were not in renal failure. Fifty patients with inoperable lung cancer were studied. All received radiotherapy. Twenty-two had no other treatment (controls) and 28 were treated with infusions of CP. Using 2 immune-complex assays (Clq binding and monoclonal rheumatoid-factor binding) IC were found in 10/22 control patients but these did not develop haematuria or proteinuria. Twenty-four of the 28 patients treated with CP developed transient haematuria and/or proteinuria with red-cell and hyaline casts, the changes resolving over 5 days. Immune complexes were detected in 5 of these 28 patients before CP treatment. Although 16/28 had IC at the time of haematuria and proteinuria, these findings were difficult to interpret because IC may occur in response to the tumour, the radiotherapy, or the CP. Although no patient developed renal failure, we believe that those treated with CP should have regular assessment of their renal function.     

Renal metastasis from squamous cell carcinoma of the lung

Symptomatic renal metastases from primary malignancy elsewhere in the body is an uncommon feature in disseminated cancer. Postmortem diagnosis is more frequent. A case is reported here of a patient with renal metastasis from lung carcinoma who presented with haematuria.     

Heterotopic bone formation in renal cell carcinoma (a case report).

A case of renal cell carcinoma with heterotopic bone formation occurring in a female aged 55 years has been reported. There was no haematuria and the morphological picture showed only ossified stroma and no sarcomatoid appearance.     

Primary vascular tumours of the kidney

Primary vascular tumours of the kidney are rare and may pose diagnostic difficulties because of their similar clinical, morphological, and immunohistochemical features. This article summarizes the clinical and pathological features of primary renal angiosarcoma and anastomosing haemangioma of the kidney including epidemiology, genetics, and prognosis. Renal anastomosing haemangiomas are benign neoplasms characterized by anastomosing capillary-sized vascular channels. These tumours are rare, with about 75 cases reported in the literature. Most anastomosing haemangiomas are found incidentally on ultrasound, computed tomography, or magnetic resonance imaging. Common symptoms include abdominal pain, haematuria, and abdominal mass. Renal anastomosing haemangiomas are characterized by recurrent mutations in GNAQ and GNA14 genes. The prognosis of anastomosing haemangioma is excellent. Primary renal angiosarcomas are malignant tumours showing endothelial differentiation. To date, 76 cases have been described in the literature. Primary renal angiosarcomas are frequently symptomatic. The clinical features of renal angiosarcomas are similar to those of renal anastomosing haemangiomas, including abdominal pain, haematuria, and abdominal mass. Angiogenesis-related genes and vascular-specific receptor tyrosine kinases such as KDR, TIE1, SNRK, TEK, and FLT1 are upregulated in angiosarcomas. Primary renal angiosarcomas are highly aggressive neoplasms with a poor prognosis despite surgical treatment, chemotherapy, radiotherapy, or targeted therapy.     

Unusual clinical manifestations of the Nutcracker Syndrome

The Nutcracker Syndrome, caused by compression of the left renal vein as it passes in a tight angle between the aorta and the superior mesenteric artery, usually presents with unexplained haematuria localized to the left ureteric orifice. We report on a series of cases where compression of the left renal vein caused prominent left‐gonadal‐vein reflux, which in turn resulted in lower‐limb varices and varicocele formation.     

Congenital Renal Arterio-venous Fistula

In view of recent interest in renal vascular shunts (Elkin, 1971), a rare case of bilateral congenital renal arterio-venous fistulae is presented. The pyelographic and arteriographic appearances are described. Selective and free- flow arteriography weie performed, demon- strating the characteristic abnormal vasculature and rapid shunting of blood between the arterial and venous systems. The case demonstrates the common symptom of recurrent painless haematuria with such lesions, and the importance of angiography in the definitive diagnosis.     

Establishment of differential display mRNA and its application in the study on the mechanism of lung cancer induced by radiation

DifferentialdisplaymRNAwasdevelopedasameth0dt0identifyandanalyzealteredgeneexpressionatthemRNAlevelinanyeukaryoticcell.l1]Regardingthem0lecularmechanismofradiation-ass0ciatedcancer,thealterationandregulati0nofwellknownoncogenesandsuppressergenes,suchasras,myc,p53andRbhavebeeninvestigatedextensively.'='WeusedandmodifiedthedifferentialdisplaymRNAtostudythegenesrelatedtolungcancerinducedbyradiation.MATERIALSANDMETHODSCellandTissueSampleRNAIsolati0nThecellsusedintheexperimentwereSH…     

Autoradiographic evidence of estrogen binding sites in nuclei of diethylstilbesterol induced hamster renal carcinomas

Estrogen binding sites were demonstrated by autoradiography in one transplantable and five primary diethylstilbesterol induced renal carcinomas in three hamsters. Radiolabelling, following the in vivo injection of 3H-17 beta estradiol, was increased only over the nuclei of tumor cells; stereologic analysis revealed a 4.5- to 6.7-times higher concentration of reduced silver grains over nuclei than cytoplasm of these cells. Despite rapid tubular excretion of estradiol which peaked in less than 1 h, the normal cells did not appear to bind the ligand. This is the first published report documenting the preferential in vivo binding of estrogen to nuclei of cells in estrogen induced hamster renal carcinomas.     

肾血管平滑肌脂肪瘤21例

复习报告２１例肾血管平滑肌脂肪瘤（ＡＭＬ）的临床资料。年龄３１～７０岁（平均４４．５岁）。常见症状为腰、腹疼痛、包块、血尿、发热。２例有典型结节性硬化病的征象。临床上主要依据Ｂ超和ＣＴ检查诊断肾ＡＭＬ。资料表明，Ｂ超结合ＣＴ检查使术前诊断的准确性明显提高。肾ＡＭＬ常表现为Ｂ超强回声和ＣＴ低密度影团块。本组１１例行肾切除，但７例行保肾手术，３例随访，治疗效果同样良好。由于术前能诊断，肾ＡＭＬ的治疗趋向采用保肾手术或随访观察。     

Blockage of vascular endothelial growth factor (VEGF) reduces experimental pleurodesis

Background and objective

Chemical pleurodesis controls recurrent malignant pleural effusion. The mechanism that determines pleural symphysis involves the action of vascular endothelial growth factor (VEGF). We assessed the influence of the anti-VEGF antibody (bevacizumab) on pleurodesis induced by talc or silver nitrate and analyzed the temporal development of pleural angiogenesis.

Methods

Sixty New Zealand rabbits received intrapleural injection (2 mL) of talc (400 mg/kg) or 0.5% silver nitrate. In each group, half of the animals received an intravenous injection of bevacizumab 30 min before the sclerosing agent. Five animals from each group were euthanized 7, 14, or 28 days after the procedure. Adhesions and inflammation (scores: 0-4), thickness (μm), vascular density (vessels/field), and collagen fibers (μm²) were evaluated in the visceral pleura.

Results

Antibody anti-VEGF interferes in pleurodesis induced by talc or silver nitrate. Pleural inflammation was discreet with no difference between the groups, regardless the anti-VEGF treatment. Concerning the vascular density of the visceral pleura, a smaller number of neoformed vessels was noted in the animals that received bevacizumab. In the animals receiving silver nitrate, the decrement in adhesions and vascular density was associated with reduced thick and thin collagen fibers, resulting in less pleural thickness.

Conclusion

The anti-VEGF antibody inhibits adhesions between pleural layers. Despite being an experimental study in animals with normal pleura, the results call attention to a likely lack of success in pleurodesis when VEGF blockers are used.     

Clustering of the upper urothelial tumours in a family

In a Balkan nephropathy endemic area, 5 siblings developed haematuria over a period of 10 years. 4 of them were operated on and pathohystological examination revealed papillary transitional cell tumours of the renal pelvis and/or ureters. Both these tumours and the Balkan nephropathy affected only 1 generation of the family members. This fact, as well as the other relevant evidence, indicated that environmental factors played an important role in the process of carcinogenesis.     

Stratifying Patients with Haematuria into High or Low Risk Groups for Bladder Cancer: a Novel Clinical Scoring System

Haematuria is a common presentation of bladder cancer and requires a full urologic evaluation. This studyaimed to develop a scoring system capable of stratifying patients with haematuria into high or low risk groupsfor having bladder cancer to help clinicians decide which patients need more urgent assessment. This crosssectionalstudy included all adult patients referred for haematuria and subsequently undergoing full urologicalevaluation in the years 2001 to 2011. Risk factors with strong association with bladder cancer in the studypopulation were used to design the scoring system. Accuracy was determined by the area under the receiveroperating characteristic (ROC) curve. A total of 325 patients with haematuria were included, out of which 70(21.5%) were diagnosed to have bladder cancer. Significant risk factors associated with bladder cancer were malegender, a history of cigarette smoking and the presence of gross haematuria. A scoring system using 4 clinicalparameters as variables was created. The scores ranged between 6 to 14, and a score of 10 and above indicatedhigh risk for having bladder cancer. It was found to have good accuracy with an area under the ROC curve of80.4%, while the sensitivity and specificity were 90.0% and 55.7%, respectively. The scoring system designedin this study has the potential to help clinicians stratify patients who present with haematuria into high or lowr isk for having bladder cancer. This will enable high-risk patients to undergo urologic assessment earlier.     

A case of mixed adult Wilms’ tumour and angiosarcoma responsive to carboplatin, etoposide and vincristine (CEO)

Here we report an unusual case of mixed Wilms’ tumour and angiosarcoma in a 38-year-old female patient who presented with haematuria and right lower back pain. A computed tomographic (CT) scan confirmed a massive renal tumour associated with extensive retroperitoneal lymph node involvement, bony metastases and a right hip fracture. She was initially managed with palliative nephrectomy, which was followed by rapid postoperative deterioration. Histopathology revealed differentiated adult Wilms’ tumour with renal angiosarcoma, whereas the pathology of the para-aortic lymph node and bone metastasis revealed angiosarcoma only. In view of her cachexia and cytopaenia, emergency chemotherapy was initiated using a modified regimen of carboplatin, etoposide and vincristine (CEO) in preference to the more traditional but less well-tolerated VAC (vincristine, actinomycin D, cyclophosphamide). Four cycles of this protocol yielded a dramatic response on re-staging CT scan. This case suggests that highly angiogenic tumours such as angiosarcoma may be effectively palliated using agents usually reserved for refractory Wilms’ tumour, and supports the view that adult Wilms’ tumour is more sensitive to such agents.     

Can Reproductive Characteristics Predict Bladder Cancer in Women with Haematuria?

Background: Among women with haematuria, defining individuals under high risk for bladder cancer basedon reproductive factors prior to cystoscopy would be of great benefit in the management of this condition. Theaim of this study was to compare age and reproductive factors such as menopausal status, parity, age at firstdelivery and age at the last delivery between women who have haematuria with or without bladder cancer.Materials and Methods: A total of 463 patients underwent diagnostic cystoscopy in Düzce University Faculty ofMedicine between 1 June 2008 and 1 June 2013. Female patients who presented with persistent microscopic ormacroscopic haematuria and underwent standard evaluation for haematuria including urinalysis, urine culture,urine cytology, urinary tract imaging with excretory urography or computerized tomography with contrastenhancement and endoscopic evaluation of the urethra and bladder were included in this study. Exclusion criteriawere tobacco use and high risk occupations for bladder cancer such as textile, dry cleaning, painting and etc.Forteen women had hematuria due to benign conditions, and 18 due to bladder cancer. Data were retrospectivelyretrieved from the medical records of Duzce University Hospital. Results: Patients with haematuria due tobenign reasons did not significantly differ from patients who were found to have bladder cancer in terms of age(p=0.28), menopausal status (p=0.29), mean parity (p=0.38), being nulliparous (p=0.57), parity ≥3 (p=0.22), age≤18 years at first delivery (p=1.00), age ≥30 years at last delivery (p=0.26), age ≥35 years at last delivery (p=0.23)and percentage of the patients with advanced age (≥65 years) (p=0.18). Conclusions: It is difficult to predict ahigh risk for developing bladder cancer in women with haematuria based solely on reproductive factors.     

Pelvi-calyceal cast formation following silver nitrate treatment for chyluria

A case of chyluria is reported in which anuria followed instillation of 3% silver nitrate into the collecting system of both kidneys, with unusual radiographic features. Plain radiographic, ultrasound and computed tomographic findings are discussed. To the best of the authors’ knowledge this has not been previously described in the literature.     

Treating cancer-related hypercalcemia with gallium nitrate

Gallium nitrate is an approved therapy for symptomatic, cancer-related hypercalcemia unresponsive to adequate hydration, the most common life-threatening metabolic disorder of cancer. Initially developed because of its antineoplastic properties, gallium nitrate demonstrated the ability to reduce serum calcium levels in early trials. Although the mechanism by which gallium nitrate corrects hypercalcemia is not fully understood, it appears to involve multiple effects (inhibition of osteoclast-mediated bone resorption, stimulation of bone formation, and alteration of the mineral composition and properties of bone); however, gallium nitrate is not cytotoxic to bone cells. In randomized trials for moderate-to-severe cancer-related hypercalcemia, gallium nitrate was well tolerated and produced a higher rate and longer duration of normocalcemia relative to calcitonin and the bisphosphonates etidronate and pamidronate. Gallium nitrate induced normocalcemia in 72% to 82% of patients; in contrast to the comparator agents, it was effective regardless of epidermoid tumor status. Epidermoid tumors are associated with high levels of parathyroid hormone-related protein (PTHrP), the principal mediator of cancer-related hypercalcemia in solid tumors. High levels of PTHrP appear to adversely impact the calcium-lowering potential of bisphosphonates. The recommended schedule of gallium nitrate for the treatment of cancer-related hypercalcemia is 200 mg/m2 per day as a 5-day continuous intravenous infusion, administered with adequate hydration and close monitoring of renal function. Gallium nitrate is an effective treatment option for moderate-to-severe cancer-related hypercalcemia, a setting in which morbidity and mortality are high.     

Comprehensive evaluation of patients with haematuria on multi‐slice computed tomography scanner: Protocol design and preliminary observations

An imaging protocol with a multi‐slice CT scanner that allows comprehensive assessment of patients with haematuria is described. This protocol allows evaluation of the kidneys, ureters and bladder in a single examination using CT. This approach should streamline the diagnostic work‐up of patients with haematuria.     

Nitrate in public water supplies and the risk of renal cell carcinoma

Drinking water and dietary sources of nitrate and nitrite can react in vivo with amines and amides to form N-nitroso compounds (NOC), potent animal carcinogens. Nitrate is a widespread contaminant of drinking water supplies especially in agricultural areas. We conducted a population-based case–control study of renal cell carcinoma in 1986–1989 in Iowa, a state with elevated levels in many public water supplies. We collected a lifetime water source history, but due to limited monitoring data, most analyses focused on the subpopulation, who used Iowa public supplies with nitrate measurements (actual or imputed data) for ≥70% of their person-years since 1960 (201 cases, 1,244 controls). We computed the average nitrate level and years using a public supply with nitrate levels >5 and >10 mg/l. Dietary nitrate and nitrite were estimated from a 55-item food frequency questionnaire. There was no association of renal cell carcinoma with the average nitrate level and years using public supplies >5 and >10 mg/l nitrate-nitrogen (10+ years >5 mg/l odds ratio (OR) = 1.03, 95% confidence interval (CI) 0.66, 1.60). However, higher nitrate exposure was associated with an increased risk among subgroups with above the median red meat intake (10+ years >5 mg/l OR = 1.91, 95% CI 1.04–3.51) or below the median vitamin C intake (10+ years >5 mg/l OR = 1.90, 95% CI 1.01, 3.56), dietary factors that increase the endogenous formation of NOC. Exclusion of long-term Des Moines residents, a large proportion of the high exposure categories, attenuated the association. These findings deserve additional study in populations with high water nitrate intake and information on dietary intakes. The U.S. Government's right to retain a non-exclusive, royalty-free license in and to any copyright is acknowledged.     

Urinary tissue factor levels in patients with bladder and prostate cancer.

AIMS: Coagulation activation is a recognized complication of cancer in which increased tissue factor (TF) is implicated. TF can be detected in urine (uTF). This study assesses uTF levels in benign and malignant urological disease and correlates the results with conventional markers of tumour progression. METHODS: Using a simple and reproducible kinetic chromogenic assay, we determined uTF levels in controls (normal volunteers (n = 57) and patients with renal stones (n = 30)), benign and malignant bladder (n = 75) or prostate (n = 106) disease and in patients with or without recurrent bladder cancer (n=30). Each benign disease group was stratified as inflammatory (cystitis or prostatitis) or non-inflammatory (negative cystoscopy following haematuria or benign prostatic hypertrophy). RESULTS: The controls and the benign non-inflammatory results were indistinguishable. The malignant and inflammatory groups showed raised uTF levels over controls (P<0.001 bladder and P<0.01 prostate). The difference between malignant and benign inflammatory disease was only significant for the bladder group. uTF levels were significantly related to histological tumour grading, prostate serum specific antigen, static bone scan images and recurrence status. CONCLUSIONS: uTF levels can distinguish, statistically but not without overlap, patients with malignancy from normal controls and benign non-inflammatory conditions. Discrimination between inflammatory and malignant disease has only been demonstrated in the bladder. uTF levels showed a significant association with markers of tumour progression or metastasis and may be useful in predicting bladder tumour recurrence.