The management of atherosclerotic renovascular disease

Atherosclerotic renovascular disease (ARVD) seems to be a common clinical condition. ARVD is clinically presented as: 'silent' renal artery stenosis, renovascular hypertension, ischemic nephropathy leading to deterioration of renal function and recurrent 'flash' pulmonary edema. Management of ARVD involves both revascularization and medical treatment. However, the impact of revascularization on kidney function and blood pressure control is a matter of great controversy in view of the results of recent randomized clinical trials. At present, concerted medical management (includes lifestyle modifications, such as smoking cessation) remains the main treatment option for patients with ARVD. However, there is a need to accurately identify individuals who may benefit from renal revascularization.     

Major complications following exenteration in cases of pelvic malignancy： A 10-year experience

AIM:To analyze the major complications after exentera-tion of gynecological and rectal malignancies.METHODS:Twenty-two patients with gynecologicalmalignancy and 6 with rectal malignancy underwentpelvic exenteration(PE)between 1996 and 2005.PE wasperformed for primary malignancy in 71.4% of cases(vulvar cancer in 13,cancer rectal in 5,cervical cancerin 1 and Bartholin's gland cancer in 1 cases respectivelyand recurrent malignancy in 28.6% of cases(cervicalcancer in 5,ovarian cancer in 1,uterine sarcoma in 1and rectal cancer in 1 cases respectively).Posterior PE,total PE and anterior PE were most often performed.RESULTS:Major complications in the operative fieldinvolving the urinary tract infection or the wounddehiscence occurred in 12 patients(42.9%).Earlycomplications included massive bleeding from the sacralplexus,adult respiratory distress syndrome(ARDS),thrombophlebitis,acute renal failure,urinary bladderdysfunction,ureter damage,re-operation and pulmonaryembolus.Urinary incontinence was observed in 2 womenas a late complication.In 1 patient a nephrostomy wasperformed in 1 patient due to extensive hydronephrosisand 1 patient had complications connected with thegastrointestinal tract.The mortality rate was 7%,ofwhich inter-operative mortality accounted for 3.5%.Major complications often occurred in advancedprimary vulvar cancer affecting those with recurrentmalignancies.CONCLUSION:PE is more beneficial to patientswith primary vulvar and rectal cancer than to thosewith recurrent cancer.Knowledge of the inherentcomplications and morbidity of PE is essential.     

Pheochromocytoma: presentation, diagnosis and treatment

Pheochromocytomas are rare, mostly benign catecholamine-producing tumors of chromaffin cells of the adrenal medulla or of a paraganglion. Typical clinical manifestations are sustained or paroxysmal hypertension, severe headaches, palpitations and sweating resulting from hormone excess. However, their presentation is highly variable and can mimic many other diseases. If remaining unrecognized or untreated, they can be a life-threatening condition. Therefore, the most important message of this review is to think of them. The diagnosis of pheochromocytomas depends mainly upon the demonstration of catecholamine excess by 24-h urinary catecholamines and metanephrines or plasma metanephrines. They are localized by a computed tomography scan and magnetic resonance imaging of the adrenal glands and abdomen; complementary 123I-metaiodobenzylguanidine scintigraphy and 18F-dihydroxyphenylalanine-positron emission tomography are available. Because approximately one out of four pheochromocytomas turn out to be hereditary entities, screening for genetic alterations is important. Laparoscopic and adrenal sparing surgical intervention following preoperative alpha-blockade is the treatment of choice and usually curative. In malignant pheochromocytomas, radiotherapy and chemotherapy are palliative treatment options. This review provides an update on identification and management of pheochromocytomas, emphasizing current developments in diagnosis, including genetic testing, pathophysiology and treatment of pheochromocytomas.     

Antitumor properties of diastereomeric and geometric analogs of vitamin D3

Analogs of 1,25-dihydroxyvitamin D3 with a reversed configuration at C-1 or C-24 and E or Z geometry of the double bond at C-22 in the side chain or at C-5 in the triene system were examined for their antiproliferative activity in vitro against a spectrum of various human cancer cell lines. The analogs coded PRI-2201 (calcipotriol), PRI-2202 and PRI-2205, such as calcitriol and tacalcitol (used as a referential agents), revealed antiproliferative activity against human HL-60, HL-60/MX2, MCF-7, T47D, SCC-25 and mouse WEHI-3 cancer cell lines. The toxicity studies in vivo showed that PRI-2202 and PRI-2205 are less toxic than referential agents. Even at total doses of 2.5-5.0 mg/kg distributed during 5 successive days, no changes in body weight were observed. Calcitriol and tacalcitol showed toxicity in the same protocol at 100 times lower doses. Calcipotriol was lethal to all mice after administration of a total dose of 5.0 mg/kg. The analog PRI-2205 appeared to be more active in mouse Levis lung cancer tumor growth inhibition than calcitriol, calcipotriol or PRI-2202. This analog did not reveal calcemic activity at doses which inhibit tumor growth in vivo nor at higher doses.