Caval migration of a ureteral J-stent after simultaneous ureter and iliac vein perforation during its placement for obstructive pyelonephritis.

A variety of indications have made the use of double pigtail ureteral catheters routine in urological practice. Although side effects are frequent they are usually mild. We report a case of intravenous stent migration after simultaneous perforation of the left ureter and left common iliac vein during retrograde J-stent placement. To the authors' knowledge such a potentially severe complication of a J-stent has not been previously described. A postprocedural plain abdominal radiograph is a helpful tool which may suggest possible misplacement of the pigtail stent especially if urine fails to return from the distal opening and, if verified, advocate immediate intervention in order to avoid any further devastating complications.

Intraureteral metallic endoprosthesis in the treatment of ureteral strictures.

OBJECTIVE: We report our experience on intraureteral metallic stents placement for the treatment of malignant and benign ureteral strictures. METHODS: Eight patients (six men and two women) with inoperable malignant or benign ureteral strictures, underwent insertion of metallic stents through percutaneous tracts. Six lesions (three malignant, three benign) involved ureterointestinal anastomoses after cystectomy for bladder cancer and ureteroileal urinary diversion or bladder substitution, and two malignant lesions involved the midureter. Self-expandable stents were used in seven cases and a balloon-expandable stent in the remaining one case. One stent was sufficient in seven ureters, and in one ureter, two overlapping stents were placed. RESULTS: Metallic stents were inserted without technical difficulties in all obstructed ureters and patency was achieved in all patients. Ultrasonography revealed resolution of pre-existing hydronephrosis. The duration of follow-up was 6-17 months (mean, 9 months). One ureter was occluded 8 months after stent placement because of ingrowth of tumor and granulation tissue. The other ureters showed no signs of obstruction during follow-up. No major complications directly attributable to the metallic stent occurred. CONCLUSIONS: Our results suggest that insertion of a metallic stent in the ureter is feasible and safe for the treatment of benign or malignant ureteral strictures. However, more work needs to be done to establish the use of these stents for the treatment of ureteral obstruction.

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.

MRI and CT features in two unusual cases of xanthogranulomatous pyelonephritis.

Two unusual cases of xanthogranulomatous pyelonephritis studied by both magnetic resonance imaging and computed tomography, are presented. Extension of the disease depicted by both computed tomography and magnetic resonance imaging was compatible with the findings at surgery. Computed tomography seems to be sufficient for xanthogranulomatous pyelonephritis imaging evaluation, while magnetic resonance imaging is not recommended on a routine basis, since no additional valuable information is yielded.

Metastasis induced by overexpression of p185neu-T after orthotopic injection into a prostatic epithelial cell line (NbE).

Overexpression of p185erbB2/neu has been detected in many adenocarcinomas, including prostatic cancer. In this study, a nontumorigenic cell line isolated from the rat prostatic epithelium (NbE) transfected with the activated oncogene p185neu-T was used to investigate the role of this oncogene in tumor progression. When clones overexpressing p185neu-T were injected orthotopically (1.5 to 2 x 10(6) cells) into the dorsal-lateral prostates of nude mice, prostatic tumors were detected in all mice injected and metastasis to the skeletal muscle in the rib area in 60-80% of the mice injected. Tumor and metastasis origin was confirmed by reselection with G418 and reverse transcriptase-polymerase chain reaction. Control cell lines produced no prostatic tumors or metastases. Incubation at low density (12500 cells/2 cm2) in serum-free medium revealed that clones overexpressing p185neu-T had a higher rate of [3H]thymidine incorporation than did control clones on 3, 5, and 7 d after plating (P < or = 0.0001) and constitutively overexpressed the 2.6-kb ornithine decarboxylase transcript. Additionally, clones overexpressing p185neu-T demonstrated an increased expression of epidermal growth factor receptor and p180erbB4, as judged by RNA blot analysis. Together these data support the hypothesis that overexpression of p185neu-T fosters tumor progression by several pathways, including induction of the metastatic cascade, increased proliferative capabilities, and increased expression of other members of the erbB2 gene family.

Concurrent platinum and docetaxel chemotherapy and external radical radiotherapy in patients with invasive transitional cell bladder carcinoma. A preliminary report of tolerance and local control.

PURPOSE: The present study aims to evaluate the feasibility, toxicity, and efficacy of concurrent chemotherapy with cisplatinum and docetaxel, and external radical radiotherapy for transitional cell carcinoma of urinary bladder. MATERIALS AND METHODS: 42 patients (34 men, 8 females) with invasive bladder carcinoma (clinical stages T1-4) were treated after transurethral biopsy with chemotherapy and concomitant external radiotherapy. Chemotherapy consisting of cisplatin infusion (30 mg/m2) and Docetaxel (40 mg/m2) was given twice a week simultaneously with-irradiation during the whole treatment period (6-8 weeks) as follows: Cisplatin (D1,D8,D15,D22, D25,D36,D43,D50) and Docetaxel (D4, D11, D18, D25, D32, D39, D46, D53). An external irradiation scheme 1.8 to 2.0 Gy per fraction, 5 days a week was used up to 68-74 Gy (6MeV photons) total tumor dose. RESULTS: All but S patients completed the planned chemoradiation protocol. The complete response rate (CR-rate) assessed at 3 months after completion of combined treatment was 100%, 63.6%, 46.15% and 95% for clinical stage (c) cT1 (9/9), cT2 (7/11), cT3 (6/13) and cT4 (1/4) cases respectively. None of 9 patients with T1 tumors had any local failure at 36.1 months mean follow-up time. In total, 9 of 37 patients (24.32%) relapsed locally and/or distantly and were followed for 25.04 months (mean time), 50% of the relapses occurred at a mean time of 7.25 months. The mortality rate was 10.81% (4/37). All these patients died with a mean time of 11 months. 32 cases remain alive 19-46 months after treatment; 27 of those are with no evidence of disease with a mean follow-up time of 32.24 months. In total, there was a 78.50% (30/37) and a 75.67%, (28/37) rate of overall survival and pelvic control respectively at 25.04 months mean follow-up time. Chemotherapy was discontinued in 2 cases due to acute gastrointestinal toxicity and in 3 more, due to patient compliance. There was 1 toxic death 2 months after treatment completion due to ureteral obstruction and impaired renal function. The acute toxicity was estimated as moderate to severe and caused the interruption of treatment for 5 to 10 days in 8 of 37 patients (21.62%). Myelotoxicity appeared in 22/37 patients but febrile grade III and IV neutropenia was observed in 3 patients (8.10%) and thrombocytopenia (Grade I-III) in 8 (21.62%). Concerning late effects a sigmoid stricture, a transient small bowel obstruction, 4 patients with contracted bladder and 1 case with renal failure were found. Grade I to III hypersensitivity reactions appeared in 8/37 patients (21.62%) while stomatitis (grade I-II) and grade II skin toxicity appeared in 3 and 4 patients respectively. These and other symptoms (Grade I to II peripheral edema, transient myalgias and arthralgias in 7/37 cases), paresthesias or numbness (3/37) and peripheral motor dysfunction (1/37) were responsible for early reduction of docetaxel dose from 40 mg/m2 to 20 mg/m2. CONCLUSION: This preliminary analysis suggest that the radiosensitizing effect of cisplatin and docetaxel to megavoltage irradiation yielded a high CR-rate in transitional cell bladder carcinoma patients with medium to severe early and late side effects. The value of such a combined treatment as far as the tumor eradication is concerned requires further evaluation, because of the small number of patients, the short follow-up, and the absence of other studies using docetaxel as a radiosensitizer in urothelial cell cancer.

Transcriptional activation of H-ras, K-ras and N-ras proto-oncogenes in human bladder tumors.

In this study we demonstrate the involvement of ras oncogenes in bladder cancer at the level of RNA overexpression. We examined 26 bladder specimens, consisting of paired tumor and adjacent normal tissue and found that H-ras transcripts were overexpressed in 39% of the specimens while K-ras and N-ras in 58% of total specimens. Each tumor specimen had a unique pattern of overexpression for the three ras genes. A competitive-RT-PCR was employed for H-ras and a beta-actin control gene was co-amplified with K-ras or N-ras genes. These results indicate that the involvement of ras oncogenes in bladder cancer could be relative to overexpression of these genes.

Cystine stones: the efficacy of percutaneous and shock wave lithotripsy.

Cystinuria is a rare cause of renal calculi, whose management presents a complex problem mainly due to the hardness and high recurrence rate of cystine stones. During the period 1987-1991, 28 established cases of cystine calculi were treated by extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotripsy (PCNL). These cases were divided into 5 groups, according to the position and size of the stones, and each group then followed a specific regimen, either ESWL monotherapy or a combined treatment comprising an initial ESWL treatment followed by PCNL or vice versa. ESWL monotherapy provided satisfactory results only in the group with pelvic stones (54.5% success rate), with 2.16 stone treatments/renal unit, and only with calculi smaller than 2.5 cm. The groups with multiple stones or staghorn calculi were treated with a combined treatment of ESWL and PCNL and had success rates of 50 and 67%, respectively. However, the group in which PCNL was followed by ESWL showed a clear advantage over the group in which ESWL was administered before PCNL, since it required a smaller number of ESWL treatments (1,5 stone treatments/renal unit as compared to 4.3 stone treatments/renal unit). Finally, attempts for ESWL in situ in the few cases of ureteral stones proved unsuccessful.

Suprapubic versus transrectal ultrasonography in assessing the volume of the prostate and the transition zone in patients with benign prostatic hyperplasia.

The reliability of suprapubic ultrasonography (SU) in assessing the size of the prostate was examined in 95 patients with benign prostatic hyperplasia (BPH). Volumetric measurements of the prostate and the transition zone of the prostate (TZP) performed by SU were compared with corresponding measurements obtained by transrectal ultrasonography measurements obtained by transrectal ultrasonography (TU). A very strong correlation was found between suprapubically and transrectally performed measurements for both the total prostate gland (r = 0.948, p < 0.001) and the TZP volume (r = 0.953, p < 0.001). According to the results of this study, SU appears to be reliable as TU in assessing the size of the prostate and the TZP and may be used effectively in the evaluation of patients with BPH, as it is less cumbersome, better tolerated, and a widely available examination technique.

Growth inhibition of human prostatic carcinoma cell lines by serotonin antagonists.

Neuroendocrine (NE) differentiation within the primary prostate tumor has been correlated with tumor progression and shortened patient survival. Serotonin (5-hydroxytryptamine, 5-HT), a known mitogen, is found in most neuroendocrine cells of the human prostate. We have previously found that human prostatic carcinoma cell lines, PC-3, DU-145 and LNCaP, display certain NE characteristics. In this study, we have examined the effects of several subtype-selective 5-HT receptor antagonists on the growth of the three lines. Of these, the 5-HT1A antagonist pindobind had the most marked antiproliferative effect in vitro. Pindobind also had marked growth-inhibitory effects on the aggressive PC-3 cell line in vivo, in athymic nude mice. Radioligand binding studies indicated the presence of 5-HT binding sites on all three cell lines. Our results suggest that 5-HT is involved in the growth of prostate tumor cells and may serve as a target for treatment.

Androgen-independent cancer progression and bone metastasis in the LNCaP model of human prostate cancer.

Our laboratory has previously reported on the derivation of LNCaP cell sublines from LNCaP tumors maintained in castrated and intact athymic male mice. These LNCaP sublines differ from the parental line in tumorigenicity and androgen dependence. This paper demonstrates that one of these sublines acquired metastatic potential. When inoculated either s.c. or orthotopically, the C4-2 subline metastasized to the lymph node and bone with an incidence of 11-50%. Interestingly, the incidence of osseous metastasis was higher in castrated than in intact male hosts. We evaluated the chromosomal, immunohistochemical, and biochemical characteristics of the LNCaP sublines derived from C4-2 tumors that metastasized to the lymph node and bone. Cytogenetic analysis showed that all sublines were human and shared common marker chromosomes with the parental LNCaP cells. This experimental human prostate cancer model may permit, for the first time, the study of the molecular mechanisms underlying human prostate cancer metastasis.

Genomic instability and loh at 2 polymorphic sites in the h-ras1 gene.

Several repetitive elements have been associated with and identified in the surrounding region and within the human c-H-ras1 gene. The polymorphism exhibited by these sites provides valuable information regarding the function and structure of the H-ras gene. We have investigated two such polymorphic sites: i) a hexanucleotide microsatellite region (HRMS) within intron 1 of H-ras and ii) the VTR region at the 3' end of the gene. Comparison between normal and tumor tissues from 25 samples of bladder cancer revealed that 5 samples (20%) exhibited LOH at these polymorphic sites indicating that an allelic loss had occured at the H-ras locus. Furthermore, instability was detected in 4 cases at the hexanucleotide locus, while the VTR region was found unaffected. The two polymorphic sites are in a strong linkage disequilibrium in normal tissues, while in tumor tissues with genomic instability this linkage is altered, possibly leading to differential regulation of the H-ras. Also a previously reported allele at the HRMS locus was found to behave in a manner that preserves the linkage between the two polymorphic sites in normal tissues.

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.