Post-extracorporeal shockwave lithotripsy residual stone fragments: clinical significance and management.

Although extracorporeal shockwave lithotripsy (ESWL) is one of the primary treatments for urolithiasis, very often residual fragments of the calculi are still present for a long time after the ESWL session. These fragments are usually asymptomatic and can be managed expectantly, but sometimes they can cause symptoms and require intervention. Secondary procedures are not routinely applied to all patients with residual fragments, but only to those with significant symptoms. Medical therapy may play an important role in the management of residual fragments, by correcting an underlying metabolic disorder and by preventing the growth of residual calculi and the formation of new ones.

Expression profile of Rho kinases in urinary bladder cancer.

PURPOSE: To investigate the expression of RhoA, RhoB, RhoC, Rac1 and Cdc42 kinases in urothelial cell carcinoma (UCC) of the urinary bladder and determine the expression profile of 107 Rho-associated genes, including GTPases, GDIs, GAPs and GEFs. METHODS: Rho expression was investigated using microarrays, qPCR and Western blotting in 77 UCC specimens with paired normal urothelium. Computational analysis was also performed on Gene Expression Omnibus datasets. Further microarray analysis was carried out for the expression profiling of the Rho-associated genes. RESULTS: RhoB mRNA and protein levels were significantly lower in UCC, suggesting a tumour-suppressor role. On the contrary, mRNA of RhoC and protein levels of RhoA, RhoC and Cdc42, respectively, were significantly higher in UCC vs. normal tissue. High Cdc42 mRNA levels correlated with worse overall survival (p=0.027), whereas high RhoB mRNA levels correlated both with better overall (p=0.0258) and cancer-specific (p=0.0272) survival. Computational analysis verified the expression profile of Rho kinases among superficial UCCs, muscle-invasive UCCs and normal tissues. CONCLUSION: The majority of the Rho-related genes showed over-expression in UCC vs. normal tissue. Alterations in RhoA, RhoB, RhoC, Rac1 and Cdc42 expression play a significant role in the genesis and progression of UCC of the urinary bladder.

mRNA expression of G(1)-phase cell cycle regulatory molecules in bladder cancer.

PURPOSE: Cell cycle regulation, which is important for normal cellular proliferation, is controlled by a complex network of intracellular proteins, with cyclins, cyclin-dependent kinases (CDKs) and cyclin-dependent kinase inhibitors (CD-KIs) playing a central role. This equilibrium is interrupted in cancer cells, resulting in uncontrolled cellular proliferation. METHODS: In the present study we examined, by means of semi-quantitative RT-PCR, the expression of G(1)-phase cell cycle regulators MDM2, E2F1, Cyclin D1 (CCND1), CDK4, p19(INK4D), p21(WAF1/CIP1) and p27(KIP1) in a series of 32 bladder cancer specimens paired with adjacent normal tissues. RESULTS: Cyclin D1 was overexpressed in 10/32 (31.2%) and downregulated in 8/32 (25.0%) bladder cancer specimens. Additionally, p21 was overexpressed in 9/32 (28.1%) and downregulated in 10/32 (31.3%) cancer samples. On the contrary, MDM2, E2F1, CDK4, p19 and p27 expression was normal in the majority of malignant specimens. Further statistical analysis revealed significant associations between increased p21 levels and bladder cancer patients with no exposure to chemicals (p=0.048), as well as with patients with no artificial sweetener intake (p=0.012), and between increased Cyclin D1 levels and study subjects with no artificial sweetener intake (p=0.012). CONCLUSION: Based on these results, we conclude that Cyclin D1 and p21 mRNA deregulation seems to be an important event in bladder carcinogenesis. However, further studies are needed, in order to determine whether these two cell cycle regulators can be used as markers for the early detection of bladder cancer and to monitor its progression and recurrence.

Molecular mechanisms in urinary bladder carcinogenesis.

Urinary bladder cancer accounts for approximately 5% of all newly diagnosed malignancies in the developed world. Smoking, occupational exposure and dietary factors constitute the most important exogenous risk factors for bladder carcinogenesis. Yet, individuals with seemingly equal exposure to environmental carcinogens develop bladder cancer in an unpredictable manner. This is probably attributed to the fact that DNA repair capacity varies in human populations, pointing the role of genetic susceptibility in human cancer. Numerous studies demonstrated that certain genetic and epigenetic alterations are fairly constant. Loss of heterozygosity (LOH) at chromosome 9 is an aberration found in urothelial cell carcinoma (UCC) of all stages and grades as well as in dysplastic urothelium, possibly representing an early event in urinary bladder carcinogenesis. On the contrary, gains of 3p can only be found in tumors demonstrating highly malignant behavior. Microsatellite instability (MSI) is another frequent finding in urinary bladder cancer. This has led many investigator groups to employ the analysis for MSI for early diagnosis of UCC with promising results. The silencing of certain genes such as p16(INK4A) and DAPK by aberrant methylation of their promoter region also represents an important mechanism in carcinogenesis. Similarly, alterations in certain tumor suppressor genes and proto-oncogenes result in uncontrolled cell proliferation, reduced apoptosis and have been associated with more aggressive UCC phenotypes. Undoubtedly, the application of these observations in clinical practice will make a breakthrough in the management of bladder cancer.

Activation of RAS family genes in urothelial carcinoma.

PURPOSE: Bladder cancer is the fifth most common malignancy in men in Western society. We determined RAS codon 12 and 13 point mutations and evaluated mRNA expression levels in transitional cell carcinoma cases. MATERIALS AND METHODS: Samples from 30 human bladder cancers and 30 normal tissues were analyzed by polymerase chain reaction/restriction fragment length polymorphism and direct sequencing to determine the occurrence of mutations in codons 12 and 13 of RAS family genes. Moreover, we used real-time reverse transcriptase-polymerase chain reaction to evaluate the expression profile of RAS genes in bladder cancer specimens compared to that in adjacent normal tissues. RESULTS: Overall H-RAS mutations in codon 12 were observed in 9 tumor samples (30%). Two of the 9 patients (22%) had invasive bladder cancer and 7 (77%) had noninvasive bladder cancer. One H-RAS mutation (11%) was homozygous and the remaining 89% were heterozygous. All samples were WT for K and N-RAS oncogenes. Moreover, 23 of 30 samples (77%) showed over expression in at least 1 RAS family gene compared to adjacent normal tissue. K and N-RAS had the highest levels of over expression in bladder cancer specimens (50%), whereas 27% of transitional cell carcinomas demonstrated H-RAS over expression relative to paired normal tissues. CONCLUSIONS: Our results underline the importance of H-RAS activation in human bladder cancer by codon 12 mutations. Moreover, they provide evidence that increased expression of all 3 RAS genes is a common event in bladder cancer that is associated with disease development.

Pheochromocytoma of the urinary bladder: report of 2 cases and review of literature.

Pheochromocytoma of the urinary bladder is a rare neoplasm of the chromaffin tissue of the sympathetic nervous system within the layers of the bladder wall. Approximately 220 cases have been reported in literature. It accounts for less than 0.06% of all urinary bladder tumors and less than 1% of all pheochromocytomas. Females are affected more frequently and it is more common between the second to fourth decades of life. The diagnosis is strongly based on the clinical symptoms related to catecholamine hypersecretion. In some cases however, the tumor is hormonally inactive and may go undetected for years. The cytologic features of benign and malignant tumors overlap and thus there are no reliable features of malignancy. Nevertheless the prognosis seems to be better for patients with superficial tumors comparing to patients with invasive tumors, found in 5-10% of cases. In the majority of cases the treatment of choice is surgical resection. For metastatic tumors, chemotherapy and radiotherapy seem to be effective. The authors present two new cases of pheochromocytoma of the urinary bladder. The presenting symptom was painless hematuria. Both patients had well-controlled blood pressure and none of the characteristic symptoms of pheochromocytoma. The authors discuss the difficulties in diagnosis and treatment and briefly review literature.

Mediterranean diet, monounsaturated: saturated fat ratio and low prostate cancer risk. A myth or a reality?

Although the specific causes of prostate cancer initiation and progression are not yet known, evidence of a higher clinical incidence and mortality rates in Western societies than in Asian countries suggests that genetical, environmental and behavioural factors (such as diet) play an important role in the evolution of this disease. The nutritional etiology of prostate cancer has been evaluated in a large number of epidemiological studies and since traditional Asian diet is low in fatty components, it is not therefore surprising that dietary fat has been associated with prostate cancer risk in many of them. Experimental studies on the relationship between dietary patterns and increased prostate cancer risk supported further the idea that the risk of prostate cancer is increased as intake of fat rises. On the other hand, recent autopsy studies in Greece and Spain demonstrated that the incidence of histological prostate cancer in those Mediterranean Caucasian male populations is significantly lower than that of the other Caucasian males, while, epidemiological studies have reported a significant degree of adherence to the Mediterranean dietary pattern for Greek and Spanish males. Traditional Mediterranean dietary pattern has a relatively lower consumption of fat which consistency is characterized by a much higher monounsaturated:saturated fat ratio than in other places of the world. The purpose of the current article is to focus on the fatty components of the Mediterranean diet and elucidate their association with prostate cancer risk.

Management of ureteral stones in pediatric patients.

PURPOSE: We report our 5-year experience in the management of ureteral stones in pediatric patients using shockwave lithotripsy (SWL) in combination with ureteroscopy. PATIENTS AND METHODS: A total of 25 children (age range 12 months-14 years; mean 8.7 years) underwent SWL for ureteral lithiasis. Stones were located in the upper ureter in 6 children (24%), the middle ureter in 8 (32%), and the lower ureter in 11 (44%). Their size ranged from 5 to 14 mm (mean 10.9 mm). The children who failed SWL underwent ureteroscopic treatment. RESULTS: In the SWL-only group, the overall stone clearance rate at 3 months was 84% (21 of 25 children). Four children (16%) who failed SWL underwent successful ureteroscopic treatment. Complications were infrequent and generally minor in both groups. CONCLUSIONS: Shockwave lithotripsy is a safe and efficient treatment modality for ureteral stones in pediatric patients. In expert hands, ureteroscopy can be successfully applied in case of SWL failure.

Long-term results after percutaneous minimally invasive procedure treatment of symptomatic simple renal cysts.

OBJECTIVE: To assess the effectiveness and long-term results of two repeated ethanol injections in the treatment of symptomatic renal cysts. METHODS: Sixty-eight patients 47 to 75 years old with 77 large (6.3-14.8 cm; mean 8.62 cm) symptomatic cysts were included in this study. Of the 68 patients, in 4 cases there were renal cysts associated with renal calculi. An 8FR Pigtail catheter was inserted into the cyst under ultrasound guidance followed by aspiration of cystic fluid. Two repeated ethanol 95% injections were performed every 24 hours. Patients were followed-up by ultrasonography for a period of 12-48 months (mean 30). RESULTS: In two patients the cyst puncture was not feasible because of poor visualization of puncture site while in one patient there was communication of cystic cavity with the pelvocaliceal system. In these patients surgical resection of cysts was performed. Complete and partial regression rates were 57/68 (83.82%) and 8/68 (11.76%) respectively. In four patients with renal stones and renal cysts, extracorporeal shock wave lithotripsy (ESWL) was successfully executed I month after sclerotherapy. CONCLUSION: Our results suggest that percutaneous aspiration followed by two repeated ethanol injections is highly effective on reducing recurrence of simple renal cysts.

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.

Finasteride: a long-term follow-up in the treatment of recurrent hematuria associated with benign prostatic hyperplasia.

OBJECTIVES: To assess the effectiveness and long-term results after finasteride treatment of recurrent hematuria associated with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: The study comprised 80 patients, aged 62-86 (mean 74) years, of whom 50 received finasteride 5 mg once daily for 4 years and 30 were used as controls. Patients with malignancy, severe hepatic or renal failure and hematologic disorders were excluded. Patients were divided into 3 groups according to the severity of hematuria (minor, moderate, severe). All patients were followed up at 3, 12, 24 and 48 months. RESULTS: The follow-up ranged from 8 to 48 (mean 22) months in the finasteride group and 3-42 (mean 23) months in the control group. Hematuria recurrence rates were 6/50 (12%) and 23/30 (77%) in the finasteride and control groups, respectively. Surgical treatment was needed in 6 patients of the finasteride group and 19 of the control group. Patients with minor hematuria experienced no recurrence of symptoms in the finasteride group in contrast to 13 of 17 patients in the control group. For the patients with moderate hematuria, recurrence of symptoms was observed in 3 of 13 in the finasteride group and 3 of 5 in the control group. Three of six patients with severe hematuria had a recurrence of symptoms after finasteride treatment in contrast to 7 of 8 in the control group. CONCLUSION: Finasteride has proved to be a safe, well tolerable and effective medication in reducing or preventing recurrent hematuria related to BPH.

Genetic detection of bladder cancer by microsatellite analysis of p16, RB1 and p53 tumor suppressor genes.

PURPOSE: We investigated the incidence of genetic alterations in urine specimens from patients with bladder cancer. MATERIALS AND METHODS: A total of 28 cytological urine specimens were assessed for microsatellite alternations, and 15 microsatellite markers were located on p53, RB1 and p16 regions. In 15 patients DNA from tumor specimens was also available. RESULTS: Loss of heterozygosity was detected in 26 of 28 patients (93%) in at least 1 microsatellite marker. Allelic losses were found in 18 patients (64%) for the p16 locus, in 8 (29%) for the RB1 locus and in 17 (61%) for the p53 region. In contrast, no microsatellite alterations were found in the normal group without evidence of bladder cancer. In 11 cases genetic alterations in the cytological urine specimens were not detectable in the corresponding tumor specimen, suggesting heterogeneity of bladder cancer. CONCLUSIONS: The detection of loss of heterozygosity in cytological urine specimens may be a prognostic indicator of early detection of bladder cancer. Our results suggest that microsatellite analysis of urine specimens represents a novel, potentially useful, noninvasive clinical tool to detect bladder cancer.

Ureteral drainage by double-J-catheters during pregnancy.

PURPOSE: To access the safety and effectiveness of Double-J-stents in treating symptomatic hydronephrosis during pregnancy. MATERIAL AND METHODS: From 1994 to 1999, 21 women were hospitalized in the Urology Clinic at the University Hospital of Crete. Fourteen patients presented acute pyelonephritis, six painful hydronephrosis and one spontaneous renal rupture. In four cases the hydronephrosis was caused by calculus in the upper 3rd quadrant of the ureters. In 13 out of 14 cases of urinary febrile infection and one with spontaneous renal rupture, the dilatation resulted from direct compression of the ureters by the gravid uterus. Using ultrasound guidance, 21 ureteral stents were successfully placed under local ane- sthesia. RESULTS: In 14 out of 21 patients with urinary infection, we observed remission of fever during the first 24 hours after the placement of the ureteral stents. In the patient with spontaneous renal rupture the remission of symptoms was observed a few hours after the ureteral drainage. Complications were reported in six cases, such as, voiding symptoms and discomfort. CONCLUSION: Double-J-ureteral stenting is an effective, simple and safe method in treating symptomatic hydronephrosis during pregnancy.

Genetic instability in renal cell carcinoma.

OBJECTIVE: To investigate the incidence of loss of heterozygosity (LOH) and microsatellite instability (MI) in human renal cell carcinoma (RCC), and to determine a possible activation of H-ras oncogene in these tumours via implication of its polymorphic regions within the first intron and 3' ends. METHODS: In the present study, we investigated the incidence of MI and LOH in 22 RCCs, using a bank of 8 microsatellite markers located on chromosomes 2 (IL1A), 3 (D3S1234), 8 (MYC), 14 (D14S51) and 17 (THRA1, D17S250, D17S579). We also studied the microsatellite DNA of the H-ras oncogene within the first intron (HRM) and the minisatellite DNA of the variable tandem repeat (VTR), which is located 1,000 bp downstream of the H-ras gene and possesses enhancer activity, for genetic instability. Alterations of the 28-bp repetition core were studied employing restriction fragment length polymorphism analysis. RESULTS: MI and LOH were observed in 8 (4 MI and 4 LOH) out of 22 (18%) specimens at 3p21.1-p14.2 and 17q21, indicating the presence of putative tumour suppressor genes (TSGs) at these loci. Alterations of the 28-bp repetition core of H-ras VTR were found in 2 out of 22 cases (9%), while point mutations of the same repetition core were detected in only 1 case (5%). Additionally, 1 case (5%), showed LOH. CONCLUSIONS: Our results indicate that genetic instability is a detectable phenomenon in human RCC and it might be associated with the development of the disease. LOH at 3p21.1-p14.2 and 17q21 suggests that important TSGs may be located on these chromosomal regions involved in the tumorigenesis or progression of RCC. Considering the fact that the DNA sequence of this VTR region contains a target area for transcription and other regulation factors of H-ras gene expression, these findings could be of importance as regards the involvement of this gene in the process of carcinogenesis in RCC.

Bladder autoaugmentation in the rabbit using de-epithelialized segments of small intestine, stomach and lyophilized human dura mater.

OBJECTIVE: To develop an animal model of partial detrusorectomy (autoaugmentation) and thus avoid the consequences of the direct contact of intestinal mucosa with the urinary tract in bladder augmentation. MATERIALS AND METHODS: A diverticular urothelial bulge was created and patched with demucosalized segments of small bowel (group A), stomach (group B) and with lyophilized human dura mater (group C). The surgery was performed on 50 New Zealand rabbits which were compared with 10 control animals and killed at 2, 4 and 6 weeks after surgery. Urodynamic studies and cystography were performed before operation and at death, and the augmented bladders examined histologically. RESULTS: Six weeks after the procedure, the mean (SD) bladder compliance was 22.7 (5.7) in group A (intestinal patch. n = 6). 2.3 (0.5) in group B (stomach patch, n = 3). 3.1 (1.9) in group C (lyophilized human dura, n = 3) and 9.4 (0.4) in the control group (n = 4). Histological studies showed residual enteric and gastric mucosa but an intact urothelium under the intestinal patch. CONCLUSION: The results of this experimental study suggest that a demucosalized segment of small bowel is the best material to increase bladder compliance in detrusorectomy (autoaugmentation) as applied in this animal model.

Experience with the Dornier lithotriptor MPL 9000-X for the treatment of vesical lithiasis.

Between February 1994 and March 1995, 52 patients (48 men and 4 women) with vesical lithiasis were treated by extracorporeal shock wave lithotripsy (ESWL), using the MPL 9000-X Dornier lithotriptor. Twenty-five patients showed bladder outlet obstruction. In 9 patients, there was evidence of associated bladder neuropathy. In 6 patients, calculi presented idiopathically in normal bladders. Two patients had silent migration of ureteral calculi and increase in bladder volume, 8 were high risk and 2 others refused other methods of up to date treatment. Vesical stone sizes ranged from 10 to 22 mm in greatest diameter (mean 15 mm). The treatments were performed without the use of anaesthesia and on an outpatient basis. Complete fragmentation was achieved after a single session in 46 patients and 3 required 2 sessions. Postoperative adjunctive endourological procedures included cystoscopy in 9 patients and urethroscopy in 1 patient for evacuation of stone fragments. The overall stone-free rate was 94.2% (49 out of 52 patients) with ESWL and adjunctive measures as needed. No major complications were noted. We find ESWL with the MPL 9000-X lithotriptor to be a simple, effective and safe modality for the treatment of most patients with vesical lithiasis, especially in high risk patients.

Extracorporeal shockwave lithotripsy for urinary calculi in autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited systemic disorder. Renal stones have a high rate of occurrence among patients with ADPKD and are a significant cause of morbidity in this disorder. Thirteen patients with ADPKD and symptomatic or obstructive renal stones presented to our hospital for evaluation and treatment with extracorporeal shockwave lithotripsy (SWL). A total of 16 renal units were treated. The auxiliary procedures included placement of a double-J stent in nine kidneys when the stone was larger than 8 mm in diameter. Eleven patients (85%) were stone free 3 months after lithotripsy; a second treatment was necessary in two patients. We conclude that SWL can be used as a primary management tool for renal stones in patients with ADPKD.

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.

Coexisting non-functioning pheochromocytoma and renal oncocytoma: a case report and review of the literature.

We report a case of an oncocytoma, coexisting with a non-functioning pheochromocytoma in a patient who was operated on for suspicion of a renal tumor with metastases to the ipsilateral adrenal gland. As oncocytoma is a relatively rare lesion of the kidney, estimated to account for approximately 3-5% of renal neoplasms, its coexistence with non-functioning pheochromocytoma, to the best of our knowledge, has not hitherto been described in the medical literature.