Balkan endemic nephropathy and papillary transitional cell tumors of the renal pelvis and ureters.

Papillary transitional cell tumors of the renal pelvis and ureters occur more frequently in the Balkan countries than in other areas in the world. The populations involved are the same as those who are at risk to develop Balkan endemic nephropathy (BEN). Seventy-seven patients were treated in the Urology Clinic for papillary cell tumors of the renal pelvis and ureters (UTT) from 1986 to 1988. Forty-four of the patients were from areas where BEN is endemic. The at-risk population is estimated to be less than 2% of the control population. Eleven of the 77 were on hemodialysis when UTT were detected, and all but one of those were from BEN areas. This finding emphasizes the need for continual monitoring of end-stage renal disease patients for evidence of these tumors. Comparing the frequency of the tumors from our study (1986 to 1988) with that of early studies indicates that the risk of developing the tumors remains very high in the BEN areas. We conclude that the causative agent(s) is still prevalent in the involved areas.

The changing pattern of renal tuberculosis.

The authors present a series of 2,173 patients with renal tuberculosis seen between 1950 and 1979. This is group 1, serving only to show the incidence of renal tuberculosis during the antibiotic era. The fact is that the incidence of renal tuberculosis is going down slightly but constantly in the last years because the resistance of patients is increasing and the virulence of the TB bacillus is decreasing. The second group consists of 128 patients completely examined and the conclusion is that certain forms of very active TB have disappeared; high fever, very active forms of renal TB with deep and limited ulcerations in the kidney do not occur anymore. The third group is formed of 208 patients reviewed in order to demonstrate the residues after long antituberculotic treatment. It has been found that certain residual changes in the parenchyma are minimal but present as the remnants of antibiotic treatment indicating that probably the bilateral forms of renal TB are more common than we supposed before, in full agreement with Cibert's claim.

[Treatment of impotence with implantation of penile prosthesis]. / Lecenje impotencije implantacijom penilnih proteza.

The authors have presented results and importance of the treatment of impotence by implantation of different types of penile prostheses in 46 patients. The aim of the study was to evaluate success in recovery of potency with modern types of prostheses. Problems related to characteristics of prostheses and risk groups of patients for this kind of treatment have been recognized. It has been concluded that penile prostheses are very good means for solving the problem of impotence which is exclusively or mainly of the organic origin when other methods are not suitable for a patient or have not given favourable results.

Xanthogranulomatous pyelonephritis.

Xanthogranulomatous pyelonephritis is a rare chronic form of pyelonephritis with a clinical presentation often suggestive of a renal mass. We present 51 patients with histologically proven xanthogranulomatous pyelonephritis who were treated by nephrectomy. The results are discussed and compared with those from the literature.

[Retrocaval ureter - diagnosis and surgical management]. / Retrokavaler Ureter - Diagnostik und chirurgische Behandlung.

There are presented 6 cases of retrocaval ureter treated by the reconstructive surgical intervention, with good results in 5 cases and bad results in 1 case. Characteristic statement on intravenous pyelography and retrograde ureteropyelography is enough for diagnosis of retrocaval ureter; if it is not characteristical, but the doubt exists on retrocaval ureter, the cavography is necessary. In the presence of hydronephrosis, the early operative reposition of ureter (pyeloureter, ureter-ureter, vena cava, vena cava anastomosis) is most important because it saves the residual function of kidney.

[Results of corrective surgery of hydronephrosis]. / Ergebnisse korrektiver Operationen bei Hydronephrosen.

The analysis of 120 cases of hydronephrosis and 124 of corrective operations of hydronephrosis (4 bilaterally) from the Urological Clinic in Belgrade, with 81.5% very good and good results, showed the endresult which is dependent from the correctness of the indication for surgical corrective treatment, adequacy of the performed type of the corrective operation, the correctness of its performance, lack of complications and its abolishment even more from anatomical resp. functional state of the kidney before the operation. Less damaged kidneys precede well, and developed damage has a bad prognosis of the corrective operation.

Destructive forms of renal tuberculosis.

The incidence of renal tuberculosis has declined slowly in recent years, but its development has also changed. There are silent forms with few symptoms of spread and without very great bladder pain; nevertheless these forms can be very destructive, and even on first presentation may show a destroyed kidney. Our Urological Clinic in Belgrade treated 1,890 patients during a period of 23 years. We cannot incriminate streptomycin or PAS as the only causes of a tendency to fibrosis or for the silent forms of ureteric stenosis. Yet it seems certain that the pathogenesis of the tubercle bacillus changed in different persons under treatment with streptomycin and other antibiotics. The following represents the renal tuberculosis cases we have seen in the Urological Clinic in Belgrade during 1950--1972.

[Penile angioscintigraphy in the study of vasculogenic impotence]. / Penilna angioscintigrafija u ispitivanju vaskulogene impotencije.

The development of diagnostical methods and evolution of multidisciplinary diagnostical approach contributed to frequent detection of vasculogenic impotence. The article deals with penile and iliac angioscintigraphy in order to determine the role of the vascular component in the onset of impotence. The investigation concerned 20 patients with marked impotence and a control group of healthy individuals. The vascular role of these disorders was determined according to Thouvenot, 1984 i. e. on the basic of the late penile perfusion represented by a deviated curve with maximum delay in comparison to the iliac curve. Vasculogenic impotence was found in 18 patients and non-vasculogenic in 2 subjects. Normal results were found in the control group. Angioscintigraphis results were compared with those of Doppler sonography and arteriography of the penile arteries. Contrary to the findings established by ultrasound method, radionuclide findings were not coordinated. The high agreement between angioscintigraphic and arteriographic findings in relation to the penile and iliac regions suggested the need of further clinical radionucleide studies in order to examine the possibility of its routine use in the selection or patients for invasive procedures in the diagnosis of vasculogenic impotence and the control of vascular surgical results.

[Duplex-Doppler sonography in the diagnosis of acute rejection in kidney transplantation]. / Primena sonografske analize dupleks-dopler u dijagnostici akutnog odbacivanja presadjenog bubrega.

Duplex Doppler sonography can be used in evaluation of renal allografts. Arterial Doppler signals were quantified with a pulsatility index. In this study 114 Duplex Doppler examinations were performed in 75 patients after renal transplantation. The mean PI in patients with acute rejection was statistically compared with the mean PI in normal allografts, and the mean PI in patients with CsA nephrotoxic effects and chronic rejection. The data shaw that there is statistically significant difference between the patients with acute rejection and other examined groups. The results of this study show that the use of quantitative Doppler US scanning may be valuable in differential diagnosis among the various forms of graft disfunction.

Solitary kidney stone treatment by extracorporeal shock wave lithotripsy.

OBJECTIVES: To determine if solitary kidney stones can be successfully treated with ESWL. METHODS: 38 patients were examined, 34 stones were treated on a Dornier lithotripter HM-3, and 4 on a Siemens Lithostar. 17 stones were larger than 400 mm2, 11 were incomplete and 6 complete staghorn calculi. In 26 patients a catheter was placed before lithotripsy, double-J and ureteral stents in 14 and 12, respectively. RESULTS: Successful outcome of lithotripsy was achieved in 34 patients (89%). Complete fragment elimination was recorded in 23 patients (60%), and in 11 (29%) a negligible residuum was noticed. Treatment failure was recorded in 4 patients. In 3 patients fragment elimination was poor, and in 1 patient 3 ESWL sessions were not sufficient to commence stone destruction and we decided to operate on this patient. Anuria occurred in 4 patients (10%). CONCLUSIONS: Our results suggest that ESWL can be successfully used in the treatment of urolithiasis in a solitary kidney. Even in cases of staghorn stones, the obligatory placement of a double-J catheter, and strategic lithotripsy in several sessions result in a high success rate with a tolerable risk of complications.

[Combined radio-chemotherapy in solid tumour treatment of advanced bladder cancer (preliminary report)]. / Kombinovana radioterapija i hemoterapija kod bolesnika sa solidnim tumorima (prethodni izvestaj o lecenju napredovalih carcinoma mokracne besike).

Radiotherapy combined with platinum compounds in widely used despite unclear biological basis and mechanism of their potentiation. We started a prospective nonrandom study on January 1, 1991 with the aim to ameliorate local tumour control and possibility of curative treatment, and treatment of toxicyty. PATIENTS CHARACTERISTICS: 82 patients with locally advanced bladder cancer (stage T3 and localizet T4) were treated with radiochemotherapy. Median age was 62 years, and male female radio was 3.5:1. The whole group had transitpy cell carcinoma, grade III, with primary tumour in 56 patients and solitary tumour in 51 patients. TREATMENT: External beam radiotherapy was performed on linear accelerator with locoregional technique, conventional fractionating and tumour dose of 65 Gy. On the lifth day of radiotherapy a 20 mg i.v. bolus Cisplatin 1 hour prior radiotherapy was administered to 49 patients. Total dose of Cisplatin was 120 mg per course. Carboplatin was given (75 mg i.v.) to 12 patients in the same way like Cisplatin, with total dose od 450 mg. In 21 patients Carboplatin was administered in a dose of 150 mg (fifth day) during radiotherapy, and total dose was 900 mg. TOLERANCE: The toxicity was mild in both groups of patients: 2/49 patients in Cisplatin group experienced nausea and 2/49 experienced haematological toxicity grade II as wel as 5/33 patients from Carboplatin group. RESPONSE: Tumours complete regression was observed in 69.4% of patients in Cisplatin group and in 84.6% in Carboplatin group. Mean follow-up was 14 months in Cisplatin group and overall survival was 77% at a 2-year interval, these results are not-suphicicent for the binal conclusion conserning the late complications and the clinical benefit, but the treatment was well tolerated. We intend to increase Carboplatin dose in our fur ther study.

[Carboplatin and radical radiotherapy in the treatment of locally advanced urinary bladder carcinoma]. / Carboplatin i radikalna radioterapija u lecenju lokalno uznapredovalog karcinoma mokracne besike.

Our prospective nonrandomized study included 46 patients with invasive urinary bladder carcinoma of the clinical T3a and b stages. The patients were treated by radical radiotherapy (65 Gy, conventional fractioning) and by Carboplatin (150 mg per week during radiotherapy; total 900 mg). Of 35 patients for whom the response was evaluated, the complete regression of tumor was reached in 85.71% and partial in 5.7% of patients. Hematological toxicity of I and II grade was seen in 36/46 of patients. The average follow-up time was 9 months (interval 4-15), overall one year survival rate was 85%, and disease-free survival was 87%. The results have shown that simultaneous application of radical radiotherapy and Carboplatine promises the improvement in the treatment of the invasive urinary bladder carcinoma, but the short follow-up time does not allow the definitive conclusions.

Concomitant radiotherapy and carboplatin in locally advanced bladder cancer.

OBJECTIVE: The aim of the study was to assess the efficacy and safety of concomitant radiotherapy (CRT) and carboplatin. PATIENTS AND METHODS: From 1992 until 1997, 67 patients with T3 invasive bladder cancer (IBC) were treated using CRT and carboplatin. X-Ray radiotherapy (10 MeV) was applied using LINAC in a locoregional technique, with a total tumor dose of 65 Gy in 32 fractions. Carboplatin was administered as a bolus infusion once a week, on day 5, up to a total dose of 900 mg. RESULTS: The most frequent toxicity was hematological. Of the 67 treated patients, 92.5% achieved a clinically complete response, and 7.5% developed progressive disease during therapy. The 5-year overall survival was 55% and disease-free survival was 35%. CONCLUSION: CRT and carboplatin appear to be safe and extremely active in the treatment of T3 IBC, but the results should be confirmed in a randomized study.

Living related kidney donors over 60 years old.

The lack of available cadaveric organs for transplantation has resulted in an increased number of kidney transplants from living donors. During a period of 6 years, 149 kidney transplantations were performed from living related donors in our institute, 33.5% of whom were older than 60 years of age. In this study we examined the survival of patients and grafts as well as the graft function in 50 patients with transplants from donors over 60 years (mean age 65 years) as compared with those of 99 patients with transplants from donors younger than 60 years (mean age 47 years). There were no significant differences in the course of donor nephrectomy, postoperative complications, or remnant kidney function. However, delayed graft function occurred more frequently in recipients of transplants from older donors. Improvement in graft function was also slower in recipients of kidneys from older donors, with significant differences in serum creatinine levels observed during the first 12 months after transplantation. More frequent acute complications and more progressive chronic graft failure, irrespective of the causes, occurred during the 1st post-transplant year in recipients with grafts from older donors. Five-year patient survival (77% vs 92%) and kidney graft survival differed significantly for the same period with worse results for patients receiving grafts from older donors. It may be concluded that kidney grafts from donors older than 60 years -- and especially those older than 70 years -- may be used for living related kidney transplantation, but with precautions.

[Kidney transplantation in high-risk patients]. / Transplantacija bubrega u bolesnika sa visokim rizikom.

Immunosuppression with Cyclosporine A in kidney transplantation, triple therapy (CyA + Imuran + corticosteroids) and plasmapheresis before and after kidney transplantation in high risk recipients (positive cytotoxic antibody, MLC at the level of non related persons), also in high risk patients (juvenile diabetes, patients over 50 years old). In 1988 we had done in our Centre, kidney transplantation in 52.8% (28: 53) in high and increased risk patients. Triple therapy with plasmapheresis before and after kidney transplantation (if the level of cytotoxic antibodies is over 15%) allows successful kidney transplantation in high risk kidney recipients. Patients with juvenile diabetes are also available kidney recipients with therapy and permanent regulation of blood sugar. The patients of the age group between 50-60 years should be considered as suitable for kidney transplantation.

[Mechanisms of the effect of interleukin-1 inhibitor activators]. / Mehanizam delovanja inhibitora aktivnosti interleukina-1.

Interleukin-1 (IL-1) has a broad range of effects on physiologic processes, including immunologic phenomena. In maintaining the tissue homeostasis the existence of feed-back mechanisms regulating down the IL-1 activity would be beneficial for the host. We and other investigators have provided evidence that such a regulatory circuit exists and may be altered by agents such as glucocorticoids and as well as by the UV irradiation. Here we provide evidence describing the mode of action of an accessory cell derived inhibitor of the IL-1 activity. This inhibitor is a product of radioresistant cells, it does not represent a nonspecific inhibitor of the DNA synthesis and appears to be specific for IL-1 since it does not interfere with the IL-2 dependent T cell proliferation. It affects both the IL-2 production and the induction of IL-2 receptor expression. As indicated in our previous work the immunoinhibitory factors affecting T cell proliferation are present in the sera of patients suffering from chronic renal and hepatic diseases. Further analyses have shown that these serum inhibitors have the same mode of action as macrophagederived glucocorticoid-induced inhibitors. Thus, it appears that the production of an IL-1 receptor antagonist may be enhanced in a pathological condition and during chronic inflammations in particular. Its significance for the disease pathogenesis remains to be elucidated.