Renal cell carcinoma associated with granulomatous reaction.

Granulomatous inflammation is a distinctive pattern of chronic inflammatory reaction characterized by accumulation of epithelioid histiocytes and multinucleate giant cells. The cause of granulomas can be infectious or non-infectious. Granulomas have been described within the stroma of malignancies like carcinomas of the breast and colon, seminoma and Hodgkin's lymphoma, where they represent T-cell-mediated reaction of the tumor stroma to antigens expressed by the tumor. Granulomatous reaction in association with renal cell carcinoma (RCC) is uncommon, with only few published reports in the literature. We describe three cases of conventional (clear cell) RCC associated with epithelioid granulomas within the tumor parenchyma.

Continuous ambulatory peritoneal dialysis catheter placement: Is omentectomy necessary?

CONTEXT: There are different methods of continuous ambulatory peritoneal dialysis (CAPD) catheter placement. Open surgical technique is a widely followed method. The complication rate following catheter placement varies and catheter blockage due to omental plugging is one of the main reasons. AIM: To analyze the need for routine omentectomy during CAPD catheter placement. MATERIALS AND METHODS: This was a retrospective analysis of 58 CAPD catheter placements performed between July 2002 and June 2007. Tenckhoff double cuffed catheter was used in all. The postoperative complications were analyzed. RESULTS: There were 44 males and 14 females. The mean age was 51 years ranging from 15 to 76 years. Of these, 40 (69%) patients underwent omentectomy (group A) and 18 (31%) did not (group B). Laparoscopic and open techniques were performed in 5 and 53 patients, respectively. Omentectomy was not performed in 13 patients with open technique and all the five in the laparoscopic group. One patient in group A developed hemoperitoneum which was treated conservatively. None from group A developed catheter blockage, whereas five (27.8%) from group B developed catheter blockage postoperatively. The median time interval between the primary procedure and development of catheter blockage was 45 days (ranged from 14 to 150 days). CONCLUSIONS: Omentectomy during CAPD catheter placement prevents catheter blockage and secondary interventions.

An in vitro study on human ureteric smooth muscle with the alpha1-adrenoceptor subtype blocker, tamsulosin.

OBJECTIVE: To study the effects of tamsulosin on ureteric contractions and its effects on the basal tone of human ureteric specimens, as clinical trials with tamsulosin have shown promising results in the spontaneous expulsion of lower ureteric calculus, but the mechanism of action of tamsulosin in the expulsion of ureteric calculus has not been elucidated in in-vitro studies on human ureters. MATERIALS AND METHODS: Human mid-ureteric specimens were obtained from live kidney donors. The specimen was transported in Krebs' solution and the isometric contraction of human ureteric smooth muscle was recorded in the presence of tamsulosin. Ureteric rings from 19 kidney donors were studied. RESULTS: At 100 microm tamsulosin the frequency of ureteric contraction was blocked completely, or the contraction frequency was reduced in 89% of specimens. There was no change in the frequency or in the amplitude of contraction in the remaining specimens. The basal tone of the ureter was reduced in 16% of the specimens. CONCLUSION: Our results suggest that peristaltic activity in human ureteric smooth muscle is inhibited by tamsulosin. The effect of tamsulosin on basal tone is marginal.

Emphysematous pyelonephritis: outcome of conservative management.

OBJECTIVES: To identify the prognostic factors, assess the outcome of conservative management, and modify the existing radiologic classification of emphysematous pyelonephritis. METHODS: Forty-one consecutive patients diagnosed with emphysematous pyelonephritis between January 2001 and February 2007 were studied retrospectively. On the basis of computerized tomographic scan they were grouped into four classes (1 to 4). The management was conservative with antibiotics alone or with a combination of percutaneous drainage and antibiotics. RESULTS: Thirty-eight (93%) of a total of 41 patients were diabetic. Escherichia coli (in 97%) was the predominant pathogen identified in pus culture. With antibiotics alone treatment was successful in 40%, and with a combination of percutaneous drainage and antibiotics the success rate was 80%. None underwent nephrectomy as a primary procedure. The risk factors for mortality were thrombocytopenia, shock, altered sensorium, and hemodialysis. In the absence of risk factors the success rate with conservative management was 100%. The mortality rate was 27%, 75%, and 100% in the presence of one, two, and three risk factors, respectively. The mortality rate in class 1, 2, 3, and 4 was 9%, 13%, 50%, and 33% respectively. The overall success rate was 78%. CONCLUSIONS: A combination of percutaneous drainage with antibiotics offers an effective therapy for emphysematous pyelonephritis.