History of myocardial iron loading is a strong risk factor for diabetes mellitus and hypogonadism in adults with β thalassemia major

Endocrinopathies are common complications of transfusional hemosiderosis among patients with β thalassemia major (TM). Previous studies had shown associations between some endocrinopathies and iron overload of the myocardium, liver and/or endocrine organs as assessed by MRI techniques. This retrospective analysis of 92 patients with TM (median age 36 yr) from a tertiary adult thalassemia unit in UK aimed to determine independent risk factors associated with endocrinopathies among these patients. Unlike previous studies, longitudinal data on routine measurements of iron load [worst myocardial and liver T2* values since 1999, worst LIC by MRI‐R2 since 2008 and average 10‐yr serum ferritin (SF)] up to April 2010 together with demographic features and age of initiating chelation were analyzed for associations with endocrinopathies. The most common endocrinopathies in this cohort were hypogonadism (67%) and diabetes mellitus (DM) (41%), and these were independently associated with myocardial T2* <20 ms (P < 0.001 and P = 0.008, respectively) and increased age (P = 0.002 and P = 0.016, respectively). DM and hypogonadism were independently associated with average SF >1250 μg/L (P = 0.003) and >2000 μg/L (P = 0.047), respectively. DM was also associated with initial detection of abnormal myocardial T2* at an older age (30 yr vs. 24 yr, P = 0.039). An abnormal myocardial T2* may therefore portend the development of DM and hypogonadism in patients with TM.     

Assessment of patient effective radiation dose and associated radiogenic risk from extracorporeal shock-wave lithotripsy

The aim of the present study was to calculate patient effective dose and associated radiogenic risk from fluoroscopy guided extracorporeal shock-wave lithotripsy procedures. Fluoroscopy required during extracorporeal shock-wave lithotripsy was classified in two types identified by beam orientation: antero-posterior and 30 degrees anterior-oblique projected exposures. Duration of each exposure was monitored in 124 patients undergoing extracorporeal shock-wave lithotripsy treatment for ureteral stones. The dose from a kidney-ureter-bladder radiograph and the dose per min of fluoroscopy along antero-posterior and anterior-oblique projections were measured at 13 organs/tissues using an anthropomorphic phantom and thermoluminescence dosimetry. A radio-opaque object was placed in the phantom to simulate an ureteral stone at the proximal and distal ureter. The total effective dose in male and female patients with proximal ureteral stones was 1.71 mSv and 1.82 mSv, respectively. The corresponding values for male and female patients with distal ureteral stones was 0.76 mSv and 1.62 mSv, respectively. In the United States, the theoretical sex-averaged radiogenic excess of fatal cancers was estimated to be 140 per million and 85 per million of patients treated for proximal and distal ureteral stone, respectively. The average radiogenic risk for genetic defect associated to treatments of proximal and distal ureteral stones was found to be 2.5 and 24.4 per million of births, respectively. The radiation risk from a typical fluoroscopy guided extracorporeal shock-wave lithotripsy treatment of ureteral stones is low. Presented data may be used to determine patient effective dose from extracorporeal shock-wave lithotripsy procedures performed in any laboratory.     

Spontaneous perirenal hemorrhage: a 10-year experience at our institution

OBJECTIVE: To report our experience in patients with spontaneous perirenal hemorrhage (SPH) seen at our institution over a 10-year period. MATERIAL AND PATIENTS: Over the years from 1992 to 2002, 13 patients with SPH without a history of trauma, were treated at our hospital. There were 5 male and 8 female patients with a mean age of 55.7 years (range 36-79 years). The patients' records were reviewed retrospectively with respect to etiology, clinical presentation, radiologic findings and therapeutic management of SPH. RESULTS: All patients were presented with flank or abdominal pain. Radiological evaluation included ultrasonography (U/S) in 7 cases and computed tomography (CT) in 13 cases. An underlying renal mass was indentified employing U/S in 2 cases and using CT in 10 cases respectively. The etiology of SPH was determined in 12 cases. The most common causes were angiomyolipoma (5 patients) and renal cell carcinoma (4 patients). Out of the remaining 4 cases with SPH, one was associated with anticoagulant therapy; polyarteritis nodosa and Wegener angeitis were the underlying diseases in 2 cases respectively; finally, the etiology could not be determined in 1 case. All but two patients were managed surgically. Complete nephrectomy was performed in 6 cases, partial nephrectomy in 4 and simple evacuation of the haematoma was performed in 1 case. CONCLUSIONS: SPH presence should arouse suspicions concerning its etiology, since the most common cause is a renal tumor and approximately 50% of such tumors are malignant. CT scanning is a useful imaging modality for the initial evaluation of SPH, permitting identification of the underlying cause in most instances.     

Spontaneous perirenal hemorrhage: A 10-year experience at our institution

Objective: To report our experience in patients with spontaneous perirenal hemorrhage (SPH) seen at our institution over a 10-year period. Material and patients: Over the years from 1992 to 2002, 13 patients with SPH without a history of trauma, were treated at our hospital. There were 5 male and 8 female patients with a mean age of 55.7 years (range 36–79 years). The patients' records were reviewed retrospectively with respect to etiology, clinical presentation, radiologic findings and therapeutic management of SPH. Results: All patients were presented with flank or abdominal pain. Radiological evaluation included ultrasonography (U/S) in 7 cases and computed tomography (CT) in 13 cases. An underlying renal mass was indentified employing U/S in 2 cases and using CT in 10 cases respectively. The etiology of SPH was determined in 12 cases. The most common causes were angiomyolipoma (5 patients) and renal cell carcinoma (4 patients). Out of the remaining 4 cases with SPH, one was associated with anticoagulant therapy; polyarteritis nodosa and Wegener angeitis were the underlying diseases in 2 cases respectively; finally, the etiology could not be determined in 1 case. All but two patients were managed surgically. Complete nephrectomy was performed in 6 cases, partial nephrectomy in 4 and simple evacuation of the haematoma was performed in 1 case. Conclusions: SPH presence should arouse suspicions concerning its etiology, since the most common cause is a renal tumor and approximately 50% of such tumors are malignant. CT scanning is a useful imaging modality for the initial evaluation of SPH, permitting identification of the underlying cause in most instances. This revised version was published online in August 2006 with corrections to the Cover Date.     

Emergency ultrasound of the scrotum: a review of the commonest pathologic conditions

Ultrasound is the first imaging modality to be performed in emergency conditions of the scrotum. The commonest pathologic entities are divided into the 4 following groups: torsion, trauma, infection, and tumors. Sonographic examination should be performed as soon as possible to ensure fast diagnosis and treatment. Less acute conditions can also be noted while scanning on an emergency basis, such as anatomic variants, hydrocele, oscheocele, clinically evident varicocele, calcifications, etc. Although not threatening for scrotal integrity, they should be assessed during an emergency examination or later on. In this article, complex scrotal anatomy is reviewed and the basic examination technique is described. The commonest emergency conditions are analyzed, along with their pathophysiological basis. Nonemergent entities are also briefly mentioned. Ultrasound images of the commonest emergency conditions are demonstrated.     

Activation of membrane androgen receptors potentiates the antiproliferative effects of paclitaxel on human prostate cancer cells

Genomic signaling mechanisms require a relatively long time to get into action and represent the main way through which steroid hormones affect target cells. In addition, steroids may rapidly activate cellular functions by non-genomic signaling mechanisms involving membrane sites. Understanding in depth the molecular mechanisms of the non-genomic action represents an important frontier for developing new and more selective pharmacologic tools for endocrine therapies. In the present study, we report that membrane-impermeable testosterone-bovine serum albumin (BSA) acts synergistically with paclitaxel in modifying actin and tubulin cytoskeleton dynamics in LNCaP (androgen sensitive) and DU-145 (androgen insensitive) human prostate cancer cell lines. In addition, coincubation of either cell line with testosterone-BSA and paclitaxel induced inhibition of cell proliferation and apoptosis. Finally, in vivo experiments in LNCaP and DU-145 tumor xenografts in nude mice showed that both agents decrease tumor mass, whereas testosterone-BSA enhances the effect of paclitaxel. Our findings suggest that chronic activation of membrane androgen receptors in vitro and in vivo facilitates and sustains for a longer time the antitumoral action of cytoskeletal acting agents.     

Is magnetic resonance imaging insufficient in diagnosing preoperatively renal angiomyolipoma? A case report

A 33-year-old woman was admitted to our department with a palpable right flank mass of considerable size. Renal cell carcinoma was the diagnosis made by CT scan and MRI. When the tumor was excised, histology revealed an angiomyolipoma. The preoperative diagnostic error of MRI as well as CT scan is discussed.     

Membrane androgen receptor activation induces apoptotic regression of human prostate cancer cells in vitro and in vivo

Nongenomic androgen actions imply mechanisms different from the classical intracellular androgen receptor (iAR) activation. We have recently reported the identification of a membrane androgen receptor (mAR) on LNCaP human prostate cancer cells, mediating testosterone signal transduction within minutes. In the present study we provide evidence that activation of mAR by nonpermeable, BSA-coupled testosterone results in 1) inhibition of LNCaP cell growth (with a 50% inhibitory concentration of 5.08 nM, similar to the affinity of testosterone for membrane sites); 2) induction in LNCaP cells of both apoptosis and the proapoptotic Fas protein; and 3) a significant decrease in migration, adhesion, and invasion of iAR-negative DU145 human prostate cancer cells. These actions persisted in the presence of antiandrogen flutamide or after decreasing the content of iAR in LNCaP cells by iAR antisense oligonucleotides. Testosterone-BSA was also effective in inducing apoptosis of DU145 human prostate cancer cells, negative for iAR, but expressing mAR sites. In LNCaP cell-inoculated nude mice, treatment with testosterone-BSA (4.8 mg/kg body weight) for 1 month resulted in a 60% reduction of tumor size compared with that in control animals receiving only BSA, an effect that was not affected by the antiandrogen flutamide. Our findings suggest that activators of mAR may represent a new class of antitumoral agents of prostate cancer.     

Retroperitoneal fibrosis during the course of ulcerative colitis. A simple coincidence?

Retroperitoneal fibrosis has been described as a rare occurrence during the course of inflammatory bowel disease, mainly Crohn's disease. This is the third report on retroperitoneal fibrosis occurring during the course of ulcerative colitis. A 62-year-old male patient with a 5-year history of ulcerative colitis developed stenosis of the left ureter due to retroperitoneal fibrosis. Treatment consisted in surgically releasing the ureter from the mass and steroids. During a 2.5-year follow-up, renal function was stable and ulcerative colitis in remission. Important aspects of this case are the moderate course of ulcerative colitis, ultrasound confirmation of normal kidney structure before manifestation of fibrosis, hypertension diagnosed four years before retroperitoneal fibrosis, a non-functioning kidney at diagnosis, and reduction of retroperitoneal mass after steroid treatment. Retroperitoneal fibrosis, although a rare disease entity should be considered when a patient with ulcerative colitis develops otherwise unexplained renal insufficiency.