Postoperative radiotherapy of renal adenocarcinoma

125 patients with renal adenocarcinoma treated at two departments of radiotherapy in Finland are presented. 82 (66%) of the patients had localized disease and 43 (34%) had distant metastases. The five year survival for all stages was 38% and for cases with local disease 56%. There were no essential differences among Stage I, II and III patients treated with surgery alone or treated with combined operation and postoperative radiotherapy. For tumours with infiltration to adjacent organs or metastases in the lymph nodes the survival was slightly higher after combined surgery and radiotherapy than after surgery alone. For patients with P4 tumours or regional lymph node dissemination postoperative radiotherapy is recommended.     

Vascular calcification in chronic renal failure

The prevalence and extent of vascular calcification (VC) increases rapidly with time on dialysis. There is increasing evidence that medial calcification of conduit arteries, without intimal disease, is associated with important abnormalities of vascular compliance and increased risk of cardiovascular death. Coronary artery calcification is also common in end-stage renal disease, but further research is required to determine how much of this calcification is in the form of calcified intimal atherosclerotic plaque and how much in the tunica media. Calcific uraemic arteriolopathy causes a syndrome of ischaemic necrosis of the skin and subcutaneous tissue and appears to be increasing in incidence. At all sites, arterial calcification is a biologically controlled process, with expression in vascular smooth muscle cells of genes usually expressed in osteoblasts and the formation of hydroxyapatite. High extracellular phosphate concentration induces these phenotypic changes in vitro, and much of the clinical evidence supports hyperphosphataemia as the major driver of VC. Whether warfarin treatment plays a role, by inhibiting production of vitamin-K-dependent inhibitors of calcification in humans, remains uncertain but possible. High doses of prescribed calcium-based phosphate binders are associated with VC, whereas use of sevelamer to achieve the same serum phosphate level greatly retards progression of coronary and aortic calcification. The biological mechanism by which positive calcium balance and/or episodes of hypercalcaemia promotes VC remains unclear. Treatment of established calcific uraemic arteriolopathy consists of aggressive reduction of serum calcium x phosphate product; the roles of hyperbaric oxygen, steroid therapy, and non-warfarin anticoagulation remain uncertain.     

鼻腔鼻窦肾细胞样腺癌临床病理观察

目的 探讨鼻腔鼻窦肾细胞样腺癌(SNRCLA)的临床病理学特征.方法 分析1例SNRCLA的病理诊断及鉴别诊断,并结合文献进行复习.结果 患者男性,64岁,右鼻腔肿物.组织学示肿瘤相似于透明细胞型肾细胞癌,由胞质透亮的瘤细胞组成,间质富于毛细血管.免疫组化示肿瘤细胞CK7、CK、vimentin、S100、CAⅨ、SO...     

Vascular involvement in pancreatic adenocarcinoma:reassessment by thin-section CT

We defined computed tomographic (CT) criteria of vascular involvement by pancreatic carcinoma and used these criteria to assess vascular involvement in 56 patients with pancreatic adenocarcinoma. CT of the pancreas was performed at 1.5-mm section thickness and 5-mm section intervals during a bolus phase of intravenous contrast enhancement. The type of vascular involvement was correlated with surgical and pathologic findings. When there was fat-plane (type A) or normal pancreatic parenchyma (type B) separating the tumor from adjacent vessels, the tumor could be resected without venous resection in 21 of 22 patients (95%). When the tumor was inseparable from the vessels but the points of contact formed a convexity against the vessel (type C), CT was not reliable in predicting whether or not the tumor was fixed against the vessel. When the tumor was partially encircling (type D) the vessel, the tumor was fixed against the vessels in most cases. The resectable rate was 47%, but resection would also require venous resection. When the tumor was completely encircling (type E) or occluding (type F<+>) the vessel, all tumors were not resectable with a negative margin. Thin-section CT with bolus intravenous contrast enhancement improved the ability to assess vascular involvement in pancreatic adenocarcinoma. Received: 14 April 1995/Accepted: 12 June 1995     

The role of imaging in staging renal adenocarcinoma

Numerous surgical options are available to physicians treating patients with renal adenocarcinoma. In the current clinical setting, imaging plays a key role in determining which options are selected. Newer imaging techniques such as helical CT with CT angiography, MRI, and ultrasound (US) have improved staging capabilities in this patient population. However, to approach staging accuracies recently reported, attention must be paid to proper imaging parameters. This article describes the strengths, limitations, and proper techniques used for staging renal adenocarcinoma with CT, MRI, and US.     

Primary mucus-secreting adenocarcinoma of the renal pelvis.

Mucus-secreting adenocarcinoma of the renal pelvis is an extremely rare tumor. It arises from multipotential transitional epithelium which is capable of undergoing metaplastic transformation when subjected to chronic irritation from calculi, hydronephrosis, or pyelonephritis. Women are affected slightly more often than men. Tumor invasion implies a poor prognosis. Long-term survival occurs but is infrequent. In the case reported, preoperative angiography yielded useful diagnostic information.     

Are mineralocorticoid receptors present in human renal adenocarcinoma?

1. The presence of high-affinity sites for [3H]-aldosterone was shown in the normal human renal tissue. 2. [3H]Aldosterone and [3H]dexamethasone binding were studied in human renal adenocarcinoma and in uninvolved external cortex, in 22 patients undergoing nephrectomy for renal adenocarcinoma. Tissue incubations were performed with either [3H]aldosterone (5 x 10(-10) mol/l; 5 x 10(-9) mol/l in the presence of unlabelled glucocorticoids) or [3H]dexamethasone (5 x 10(-9) mol/l). 3. Cytosol [3H]aldosterone binding was six- to seven-fold lower (P less than 0.001) in neoplastic than normal tissue. [3H]Dexamethasone binding was about twofold higher in neoplastic than in normal tissue. This difference was not significant. 4. Nuclear uptake experiments showed that, both in cytosol fractions and nuclei, [3H]aldosterone binding was lower in adenocarcinoma than in normal cortex. 5. The very low binding of [3H]aldosterone suggests that mineralocorticoid receptors are absent in renal adenocarcinoma, an hypothesis in line with the proximal origin of these tumours.     

Superoxide anions and other components of human renal adenocarcinoma.

The levels of superoxide anion production, cytochrome P450, ornithine decarboxylase(E.C.4.1.1.17), catalase(E.C.1.11.1.6), deoxyribonucleic acid, ribonucleic acid and protein have been studied in human kidney and renal clear-cell adenocarcinoma tissues. The levels of superoxide anion production, ornithine decarboxylase, catalase and ribonucleic acid in the tumor tissue are very different from those in the kidney.     

具有实体结构的嗜酸细胞性乳头状肾细胞癌3例临床病理分析

目的 探讨具有实体结构的嗜酸细胞性乳头状肾细胞癌(OPRCC)的临床病理特点、免疫表型及鉴别诊断.方法 对3例具有实体结构的OPRCC进行临床、组织形态学和免疫组化分析,并复习文献.另外选取10例经典型乳头状肾细胞癌和10例嗜酸细胞瘤作为对照.结果 3例OPRCC均为老年女性,年龄78～79岁.临床上均因体检发现.巨检:瘤组织边界清楚,2例可见包膜,切面灰褐色或棕色.镜检:瘤组织主要呈弥漫实性生长,局部可见管状、裂隙样结构和发育不全的乳头状结构;瘤细胞体积较大,圆形或多边形,胞质丰富,强嗜酸性颗粒状,核圆形或不规则,核分裂象罕见或无.2例可见局灶性坏死,1例可见泡沫状巨噬细胞,2例可见砂砾体.免疫组化:瘤细胞均呈vimentin和AMACR弥漫强(+);表达CD10和CK18不同程度(+),CK7、RCC和E-cadherin各有1例(+);所有肿瘤CD117和EMA均(-).结论 具有实体结构的OPRCC是一种非常罕见的肾细胞癌,形态学上与嗜酸细胞瘤有重叠,免疫组化染色有助于诊断和鉴别诊断.     

Vascular hyporesponsiveness of the renal circulation during endotoxemia in anesthetized pigs

OBJECTIVE: To compare the vascular reactivity of the renal circulation in control and septic conditions. DESIGN: Prospective, randomized, controlled animal study. SETTING: University research laboratory. SUBJECTS: Anesthetized pigs (n = 17). INTERVENTIONS: Ten pigs received a continuous intravenous infusion of endotoxin from Escherichia coli (160 ng x kg(-1) x hr(-1)) during 18 hrs, whereas seven control animals received a saline infusion. To test the vascular reactivity, norepinephrine (NE) (1 microg x kg(-1)), acetylcholine (10 microg x kg(-1)), and sodium nitroprusside (10 microg x kg(-1)) were intravenously injected for 20 secs and changes of mean arterial pressure and renal blood flow were observed during the 200 secs after the drug administration. To compare the evolution of the vascular reactivity over time, three tests were performed 5 hrs, 11 hrs, and 17 hrs after initial endotoxin or saline administration. MEASUREMENTS AND MAIN RESULTS: Endotoxin infusion induced a hypotensive and hypokinetic syndrome with renal hypoperfusion. The mean arterial pressure increase after NE injection and the mean arterial pressure decrease after acetylcholine and nitroprusside were lower in endotoxin than in control pigs. In the renal circulation, the increase of resistance after NE injection and the decrease of renal resistance after acetylcholine and nitroprusside injections were lower in endotoxin than in control pigs. CONCLUSIONS: This study shows a hyporesponsiveness of the renal circulation to vasoactive agents during endotoxemia. Vasoconstriction to NE, endothelium-dependent as well as endothelium-independent relaxations are altered during endotoxemia but not abolished, and despite the continuous infusion of endotoxin for 18 hrs, no recovery was observed over time.     

Vascular disruption in combination with mTOR inhibition in renal cell carcinoma

Renal cell carcinoma (RCC) is an angiogenesis-dependent and hypoxia-driven malignancy. As a result, there has been an increased interest in the use of antiangiogenic agents for the management of RCC in patients. However, the activity of tumor-vascular disrupting agents (tumor-VDA) has not been extensively examined against RCC. In this study, we investigated the therapeutic efficacy of the tumor-VDA ASA404 (DMXAA, 5,6-dimethylxanthenone-4-acetic acid, or vadimezan) in combination with the mTOR inhibitor everolimus (RAD001) against RCC. In vitro studies were carried out using human umbilical vein endothelial cells and in vivo studies using orthotopic RENCA tumors and immunohistochemical patient tumor-derived RCC xenografts. MRI was used to characterize the vascular response of orthotopic RENCA xenografts to combination treatment. Therapeutic efficacy was determined by tumor growth measurements and histopathologic evaluation. ASA404/everolimus combination resulted in enhanced inhibition of endothelial cell sprouting in the 3-dimensional spheroid assay. MRI of orthotopic RENCA xenografts revealed an early increase in permeability 4 hours posttreatment with ASA404, but not with everolimus. Twenty-four hours after treatment, a significant reduction in blood volume was observed with combination treatment. Correlative CD31/NG2 staining of tumor sections confirmed marked vascular damage following combination therapy. Histologic sections showed extensive necrosis and a reduction in the viable rim following combination treatment compared with VDA treatment alone. These results show the potential of combining tumor-VDAs with mTOR inhibitors in RCC. Further investigation into this novel combination strategy is warranted.     

The renal lesions of electrolyte imbalance. II. The combined effect on renal architecture of phosphate loading and potassium depletion

Potassium depletion in rats augments the specific renal lesions of phosphate loading. Since it has been shown that phosphate loading increases the specific cardiac lesions of potassium deficiency (12), it is concluded that the similar types of electrolyte imbalance (potassium depletion-phosphate load) act conversely in the two organs.     

Vascular and renal actions of brain natriuretic peptide in man: physiology and pharmacology

During the last decade brain natriuretic peptide (BNP) has received increasing attention as a potential marker of cardiovascular disease. BNP may act as a compensating mechanism in cardiovascular diseases in order to reduce preload. However, the increase in endogenous BNP is often not sufficient to compensate for volume overload in diseases like established hypertension and heart failure. The reported hemodynamic and renal effects of BNP in man differ largely between studies, because of differences in design and doses of BNP employed. In the pharmacological range, BNP has clear blood pressure and afterload lowering effects, and in the kidney blood flow and filtration is increased with concomitant natriuresis and diuresis. While in the physiological range BNP does not affect blood pressure and reduces preload only, and induces natriuresis/diuresis without changes in renal blood flow and filtration. There is increasing evidence from vascular studies that BNP preferentially acts on the venous system resulting in preload reduction, in contrast to atrial natriuretic peptide which acts preferentially on the arterial system to reduce afterload. This review summarizes our current understanding of BNP, and discuss its regulation and mechanisms of action on the vasculature and the kidneys.     

Vascular permeability and microcirculation in patients with hemorrhagic fever associated with renal syndrome

Vascular permeability and microcirculation (MC) were studied in 25 patients with hemorrhagic fever associated with the renal syndrome (HFRS). A considerable increase in vascular permeability for liquid and protein was recorded during oligoanuria and polyuria. These parameters slowly returned to normal with recovery. Investigation of MC identified the presence of changes mainly occurring in the intra- and extravascular parts of MC: turbidity of the angioscopic background, hemorrhages, spread sludge, atonia of the venules, winding of all groups of the vessels, aneurysms of the venules, and so forth. The increased vascular permeability and MC impairment are important components of the pathogenesis of HFRS which should be taken into consideration during institution of the pathogenetic treatment.