Clodronate for treatment of bone metastases in hormone refractory prostate cancer

INTRODUCTION: Approximately 85 percent of patients who die from prostate cancer have bone metastases. Even though the radiological aspect of such metastases is osteoblastic, we currently know that these lesions are mixed, with coexisting blastic and lytic lesions, always beginning with bone lysis by osteoclast proliferation. Treatment options are palliative and have poor response, and when there is an improvement it is usually short-lived. This work intends to study the effect of clodronate in the treatment of skeletal complications of prostate cancer. MATERIALS AND METHODS: In an open prospective study 32 patients with hormone refractory prostate cancer with metastases to bones were assessed, in the period between November 2000 and September 2002. Mean age was 69 years (51 to 83 years). Patients were previously assessed by a pain scale and Karnofsky index. They underwent bone scintigraphy, X-ray, dosage of prostate specific antigen (PSA) and biochemical tests before and following treatment (administration of intravenous clodronate every 28 days). The Student's t-test was used for statistical analysis. RESULTS: Twenty-nine patients (90.6 percent) showed improvement after the first and the 2nd cycles, which persisted for at least 4 months. Average on the pain scale improved from 7.7 to 2.1 and Karnofsky index raised from 42 to 71. Radiological aspect of the metastases improved in 15 patients (46.8 percent) and side effects were low (only 2 patients - 6.2 percent). CONCLUSION: Bisphosphonate was effective in the treatment of skeletal complications of prostate cancer, presenting an objective response in 90.6 percent of treated patients, with a marked improvement in the pain scale, Karnofsky index and consequently in the quality of life of patients, and with low side effects.

Comparison of positivity frequency of bcl-2 expression in prostate adenocarcinoma with low and high Gleason score

CONTEXT: Multiple genetic and epigenetic factors have been implicated in the oncogenesis and progression of prostate cancer. The major difficulty is in that the clinical management stems from the reality that reliable and accurate prognostic biomarkers are not available and that effective treatment regimens forming hormone-resistant prostate cancers are yet to be developed. Among the most important regulators of apoptosis and programmed cell death is the bcl-2 gene and its related proteins. Elevated levels of bcl-2 protein may contribute to the progression of prostate cancers to a metastatic and hormone-insensitive state characterized by poor responses to chemotherapy. OBJECTIVE: To characterize the expression of bcl-2 proteins as a prognostic factor in humans. DESIGN: A retrospective approach. SETTING: Urology section, Federal University of Säo Paulo. DIAGNOSTIC TEST USED: Immunohistochemical analysis using bcl-2 protein antibody and normal staining by hematoxylin-eosin. MAIN MEASUREMENTS: Prognostic relations and protein expression were evaluated considering the total sample (28) divided into two groups, high (8 to 10) and low (2 to 4), separated according to the histological differentiation grade (Gleason score) with 10 and 18 samples, respectively. RESULTS: The differentiation of grade into two groups separated according to the Gleason score in low and high types presented different bcl-2 expression (P < 0.001). CONCLUSION: The higher frequency of bcl-2 immunostaining in tumor samples was observed in association with more advanced Gleason scores and suggests that an increase in the ratio of this anti-apoptotic protein often occurs during progression of prostate cancers

Duodenal damage complicating percutaneous access to kidney

CONTEXT: Since the first percutaneous nephrostomy performed by Goodwin in 1954, technical advances in accessing the kidneys via percutaneous puncture have increased the use of this procedure and thus the complications too. Among these complications, digestive tract damage is not common. DESIGN: Case report. CASE REPORT: We report a duodenal lesion that was corrected using surgical exploration and we touch on the therapeutic options, which may be conservative or interventionist. We chose conservative treatment, which has been approached in diverse manners in the literature

Lymphocele: a possible relationship with acute cellular rejection in kidney transplantation

CONTEXT: The incidence of lymphocele after renal transplantation varies between 0.6 and 18 percent of cases, and many factors have been associated to its etiology. Cellular rejection of the kidney allograft has been described as a possible causal factor of lymphocele. OBJECTIVE: To analyze the possible relationship between lymphocele and acute cellular rejection. DESIGN: A retrospective study. SETTING: A referral hospital center. SAMPLE: 170 patients submitted to kidney transplantation from March 1992 to January 1997. A standard technique for renal transplantation was used. RESULTS: Of the 19 patients that developed lymphocele, 16 presented at least one episode of acute cell rejection (84 percent), and were treated with methylprednisolone. The relation between lymphocele and rejection was statistically significant (p = 0.04). Treatment of lymphocele consisted of peritoneal marsupialization in 3 patients (15.3 percent), percutaneous drainage in 7 (36.8 percent), laparascopic marsupialization in 2 (10.5 percent), and conservative treatment in 7 patients (36.8percent. Evolution was favorable in 15 patients (78.9 percent), 1 patient (5.3 percent) died due to a cause unrelated to lymphocele, and 3 (15.8 percent) lost the graft due to immunological factors. The average follow-up period was 24.5 months. CONCLUSION: The high incidence of acute cell rejection in patients with lymphocele suggests a possible causal relationship between both conditions

Estudo da expressäo da glicoproteína CD44 padräo, por técnica imunohistoquímica, como fator prognóstico na neoplasia urotelial da bexiga / Immunohistochemical study of expression CD44 standard as a prognostic factor in human bladder cancer

A glicoproteína CD44 tem sido estudada e associada à progressão de tumores, além de apresentar uma relação com a capacidade de invasão tecidual e metástase. A determinação específica do papel da CD44 no comportamento clínico dos diferentes tipos de câncer humano ainda não foi definida completamente. O objetivo do presente trabalho foi estudar por métodos imunohistoquímico, a expressão da CD44 padrão como fator prognóstico em pacientes portadores de urotelioma vesical superficial no momento do diagnóstico. A expressão da glicoproteína CD44 foi estudada em 49 pacientes portadores de urotelioma vesical. As amostras foram analisadas por meio de lâminas de cortes histológicos de material fixado em blocos parafinados, obtidos pelo ato cirúrgico. Foram excluídos os pacientes com urotelioma que acometia a lâmina própria (pT1) e os portadores de carcinoma in situ (pTis). Dos 49 pacientes selecionados, 31 (63,2 por cento) apresentaram uroteliomas superficiais (pTa), dos quais 14 (45,2 por cento) evoluíram com invasão da camada muscular da bexiga no decorrer do acompanhamento, os quais foram considerados como grupo de interesse. Dezoito pacientes (36,8 por cento) apresentavam tumor invasivo (pT2-pT4) no momento do diagnóstico e 11 das amostras de tecido vesical eram livres de neoplasias, sendo utilizadas como grupo controle. O estudo revelou uma perda progressiva da expressão da CD44 relacionada ao estádio tumoral. A proteína estava expressa em 94,1 por cento dos casos de urotelioma superficiais e ausente em 61,1 por cento dos tumores invasivos. A especificidade do método imunohistoquímico em detectar alterações na expressão da CD44 em uroteliomas superficiais (Ta) no momento do diagnóstico e sua relação com a progressão tumoral foi de 28,5 por cento. Os resultados apresentados no presente trabalho indicam que a expressão da CD44 padrão, por método imunohistoquímico, pode ser utilizada como um poderoso marcador metástatico e deve ser considerada com ressalvas quando da determinação do prognóstico para uroteliomas superficiais (pTa) no momento do diagnóstico

Complicaçöes cirúrgicas pós-transplantes renais: análise de 356 casos / Surgical complications of renal post-transplantations: analysis of the 356 cases

No período de dezembro de 1977 a setembro de 1995 foram realizados 400 transplantes renais (Tx-r), dos quais 356 foram analisados retrospectivamente, com a finalidade de avaliar a incidência de complicaçöes cirúrgicas, classificadas em urológicas, vascularese e gerais (hematomas, abscessos perienxerto, ferida operatória). Para verificar possíveis modificaçöes no perfil de incidência dessas complicaçöes no decorrer do programa de Tx-r, dois grupos de pacientes foram analisados e comparados: G1 (os primeiros 200 Tx-r) G2 (de 201 a 400 Tx-r). Na análise global, observou-se que a complicaçäo mais frequente foi a urológica (10,7 por cento), seguida de hematoma ou abscesso perienxerto (5 por cento), complicaçöes de ferida operatória (5 por cento) e vasculares (4,5 por cento). As complicaçöes urológicas e vasculares mais incidentes foram: fístula ureteral (8,1 por cento) e estenose arterial (1,7 por cento). Analisando-se separadamente os grupos, foi encontrada reduçäo estatisticamente significativa do índice de fístula urinária e estenose arterial (G1 = 11,7 por cento, G2 = 4,5 por cento - p = 0,012, G1 = 2,8 por cento, G2 = 0,6 por cento - p < 0,001, respectivamente). Nossos dados demonstram a importância da utilizaçäo de esteróides em baixas dosagens no protocolo de imunossupressäo e o aprimoramento da técnica operatória como redutores do índice de complicaçöes cirúrgicas dos Tx-r

Feocromocitoma: relato de caso e analise clinico-cirurgica / Pheochromocytoma: case report and clinical-surgical analysis

Os autores descrevem um caso de feocromocitoma diagnosticado ha um ano em uma paciente jovem que evoluiu com quadro clinico de hipertensao,taquicardia,sudorese,palidez e exames laboratoriais sugestivos de feocromocitoma.O tratamento foi exerese da massa tumoral com preservacao do rim.A evolucao transcorreu sem intercorrencia,estando a paciente em bom estado e sem uso de medicacao anti-hipertensiva