Primary synovial sarcoma of the kidney: use of PET/CT in diagnosis and follow-up

Primary renal synovial sarcoma is a rarely seen renal neoplasm. An experienced uropathologist is needed to make the pathological diagnosis. A patient, operated on with a prediagnosis of renal cell carcinoma, the pathology of which was reported as synovial sarcoma, is presented in this article. 18F-fluoro-deoxyglucose positron emission tomography and computed tomography were performed preoperatively and in the postoperative follow-up to detect the primary tumor and lymph node metastases.     

Verapamil prevents the apoptotic and hemodynamic changes in response to unilateral ureteral obstruction

Introduction: Obstruction of the urinary tract has marked effects on renal blood flow, glomerular filtration rate (GFR), and tubular function. Moreover, ureteral obstruction results in an injury response that can progress to irreversible renal fibrosis and tubular atrophy by apoptosis. Methods: We examined the effect of a calcium channel blocker (verapamil) on renal functions and the abundance of apoptotic (p53, Fas, proliferating cell nuclear antigen [PCNA]) markers 1 week after Unilateral Ureteral Obstruction (UUO). Results: Immunohistochemistry studies revealed that UUO was markedly associated with up-regulation in the expression of p53 (1550 ± 82 vs 100 ± 23%), Fas (657 ± 48 vs 100 ± 31%), and proliferating cell nuclear antigen (945 ± 70 vs 100 ± 17% of sham levels). Administration of verapamil normalized the up-regulation of apoptotic markers p53 (724 ± 116 vs 1550 ± 82%); Fas (162 ± 38 vs 657 ± 48%) and PCNA (353 ± 54 vs 945 ± 70%). Furthermore, tubular diameter, as an important marker for detecting tubular atrophy was significantly decreased compared to those in UUO rabbits. The percent area of interstitial fibrosis in UUO kidneys was significantly greater than that in Verapamil-treated kidneys. Importantly, Verapamil reduced the development of interstitial fibrosis in UUO rabbits. We measured the GFR and renal blood flow in UUO. Short-term Verapamil challenge partially prevented the decrease in GFR (non-treated UUO: 62 ± 14; Verapamil + UUO: 119 ± 7; Sham: 127 ± 23 μL·min⁻¹·kg body wt⁻¹, P < 0.05) and renal blood flow (non-treated UUO: 1.1 ± 0.4; Verapamil + UUO: 5.0 ± 0.2; sham: 6.3 ± 0.2 mL·min⁻¹·kg body wt⁻¹, P < 0.05). Conclusion: Verapamil significantly prevents impairment in renal function and also prevents the up-regulation of p53, Fas, and PCNA during UUO, demonstrating a marked renoprotective effect of Verapamil treatment in conditions with urinary tract obstruction.     

Can mycoplasma contribute to formation of prostate cancer?

Purpose

To reveal the possible role of mycoplasmas in the etiopathogenesis of prostate cancer.

Methods

In the study, prostate biopsy was performed on 62 patients with an abnormal digital rectal examination and/or elevated PSA. The patients’ age was between 62 and 77 (mean 65.4 years) years. Thirty-one patients had adenocarcinoma of the prostate histopathologically (group 1). From these patients, the specimens were divided into two subgroups as specimens with malignant findings (group 1A) and specimens with benign findings (group 1B). The control group consisted of 31 patients with benign prostatic hyperplasia (group 2). In the specimens, the presence of mycoplasma DNA was investigated by the polymerase chain reaction method.

Results

The mycoplasma DNA was found to be positive in 11 (35.4 %) patients in group 1A and in 4 (12.9 %) patients in group 1B. There was no mycoplasma DNA in the patients in group 2. The differences between group 1A and group 1B, and between group 1A and group 2 were statistically significant (p values, respectively, 0.006 and 0.0001).

Conclusions

Our data supported the thesis that mycoplasma infections play a role in the etiopathogenesis of the prostate cancer.     

Use of artificial neural networks in the management of antenatally diagnosed ureteropelvic junction obstruction

Background:

In this study, an artificial neural network (ANN) based system has been developed specifically to help in the management of antenatally diagnosed uretero-pelvic junction (UPJ) obstruction.

Methods:

A total of 53 infants with antenatally detected hydronephrosis caused by UPJ obstruction were included in this study. A neural network was developed with the help of a commercially available software package. The patients’ age and sex, renal pelvic diameter, laterality, split renal function and presence of renal scar on radionuclide scan, follow-up times, urine culture results and the presence of symptomatic infections were used as variables. These data were also entered into a statistical software package and linear regression analysis was done.

Results:

During the follow-up period, 36 children were observed, and the remaining 17 renal units underwent pyeloplasty. The average sensitivity of the ANN model in predicting the outcome was found to be 92% in the training group and 75% in the validation and test groups. In linear regression, none of the predictors were found to be statistically significant.

Interpretation:

In this study, we have demonstrated that the use of ANNs in antenatally diagnosed UPJ obstruction can help the clinician in making treatment decisions, and thus can be useful in daily clinical practice.     

Comparative analyses of percutaneous nephrolithotomy versus open surgery in pediatric urinary stone disease

Purpose

The aim of this study is to compare the efficiency and reliability of percutaneous nephrolithotomy (PCNL) and open surgery for pediatric urinary stone disease.

Methods

The retrospective analysis included 116 patients (69 PCNL, 47 open stone surgery). The stone surface area, stone-free rates, hospitalization time, blood transfusion rates, and the D-J implantation rates of patients in each group in whom PCNL and open surgery were performed were analyzed.

Results

The average age of the patients in the PCNL group was 10.01?±?0.51?years, and in the open surgery group 8.55?±?0.68?years. No statistically significant difference was observed between the two groups in average age, stone surface area or stone-free rates. However, hospitalization time (PCNL 2.31?±?0.46?days, open surgery 3.36?±?0.64?days), blood transfusion rate (PCNL 10.1?%, open surgery 42.5?%) and D-J catheter implantation rate (PNL 7.24?%, open surgery 42.5?%) of patients who underwent PCNL were determined to be statistically low.

Conclusion

In light of the results, it is concluded that PCNL supersedes open surgery in terms of the use of advanced instruments and technological developments for modern pediatric surgery.     

The effect of calcium channel blockers on stone regrowth and recurrence after shock wave lithotripsy

We evaluated the possible effects of a calcium entry blocking agent “verapamil” on new stone formation and/or regrowth of residual fragments after shock wave lithotripsy (SWL) during long-term follow-up (>30 months) and compared the results with the success rates of adequate fluid intake. A total of 70 patients treated with SWL were randomly divided into three different groups, in the first two of which the patients received different preventive measures with respect to stone recurrence and/or regrowth. While 25 patients received a calcium channel blocking agent, verapamil hydrochloride, beginning 3 days before SWL and continued 4 weeks after the procedure, an additional 25 patients were put in an enforced fluid intake program and the remaining 20 patients received no specific medication and/or measure apart from close follow-up. Patients were followed regularly with respect to the clearance/regrowth of the residual fragments and that of new stone formation during long-term follow-up (within a mean follow-up of 30.4 months). The overall stone recurrence rate was 14% (10/70). Of the patients who became stone free (12/25, 48%) in group I, only one patient (1/12, 8.3%) showed a new stone formation during long-term follow-up. The figure was 40% (4/10) in group II patients and 55% (5/9) in group III patients receiving no specific medication. Regarding the residual stone fragments (<5 mm) after SWL, again high fluid intake was found to be the most effective on stone regrowth rates (2/13, 15.3%). Patients treated with verapamil also had acceptable regrowth rates (3/15, 20%). Finally, verapamil treatment significantly improved the clearance of residual fragments; while 7 out of 15 patients with residual fragments passed these particles successfully, (46.5%) in this group; these figures were 46% (6/13) and 18% (2/13) in the remaining groups. Residual fragments located in lower calyces demonstrated a poor clearance rate with higher regrowth rates. Verapamil administration was found to be effective enough to limit the regrowth of residual fragments and also to facilitate residual fragment clearance after SWL. Patients receiving this medication seemed to pass the retained fragments easily in a shorter time than the others.