Effects of in utero antiretroviral exposure on mitochondrial DNA levels, mitochondrial function and oxidative stress.

OBJECTIVES: HIV and antiretroviral (ART) exposure in utero may have deleterious effects on the infant, but uncertainty still exists. The objective of this study was to evaluate aspects of mitochondrial DNA (mtDNA) content, mitochondrial function and oxidative stress simultaneously in placenta, umbilical cord blood and infant blood in HIV/ART-exposed infants compared with uninfected controls. METHODS: HIV-1-infected pregnant women and HIV-1-uninfected healthy pregnant controls were enrolled in the study prospectively. Placenta and umbilical cord blood were obtained at delivery and infant blood was obtained within 48 h of delivery. mtDNA content was determined for each specimen. Nuclear [subunit IV of cytochrome c-oxidase (COX IV)]- and mitochondrial (COX II)-encoded polypeptides of the oxidative phosphorylation enzyme cytochrome c-oxidase were quantified in cord and infant blood. Placental mitochondria malondialdehyde (MDA) concentrations were measured as a marker of oxidative stress. RESULTS: Twenty HIV-positive/HIV-exposed and 26 control mother-infant pairs were enrolled in the study. All HIV-infected women and their infants received ART. Placental MDA concentration and mtDNA content in placenta and cord blood were similar between groups. The cord blood COX II:IV ratio was lower in the HIV-positive group than in the controls, whereas the infant peripheral blood mtDNA content was higher in the HIV-exposed infants, but the infant peripheral blood COX II:IV ratio was similar. No infant had clinical evidence of mitochondrial disease or acquired HIV infection. In multivariable regression analyses, the significant findings in cord and infant blood were both most associated with HIV/ART exposure. CONCLUSIONS: HIV-exposed infants showed reduced umbilical cord blood mitochondrial enzyme expression with increased infant peripheral blood mitochondrial DNA levels, the latter possibly reflecting a compensatory mechanism to overcome HIV/ART-associated mitochondrial toxicity.

Diplopia - an unusual primary manifestation of metastatic renal cell carcinoma.

It is relatively unusual that initial symptoms of renal cell cancer begin with the metastatic involvement of other sites. Intracranial metastases especially in the paranasal sinuses may be unusual not only to surgeons but also to physicians. In this report, we present a case where a metastasis was first manifest as a sphenoid sinus secondary with ocular and visual disturbances prior to the demonstration of the primary tumor site. It turned out to be a case of diplopia masquerading as a metastatic renal cell cancer.

Primary non-Hodgkin's lymphoma of urinary bladder. Report of a case and review of the literature.

Primary extranodal lymphoma of the urinary bladder is a rare disorder that is diagnosed on the basis of histopathology and immunostaining. We report a case of diffuse B cell primary lymphoma of the urinary bladder and review the literature.

Current trends in the management of carcinoma penis--a review.

UNLABELLED: AIMS AND INTRODUCTION: To review the current literature, recent advances and recent trends in the management of squamous cell carcinoma of the penis so as to have a broad overview of penile cancer and its current management. The review was considered keeping in mind that squamous penile carcinoma is an infrequently encountered malignancy and that the etiology is still unclear though certain predisposing conditions are known to exist and also that controversy still exists as to the appropriate management of inguinal adenopathy. We also reviewed the etiological factors, clinical presentation, diagnosis, staging, prognostic factors in addition to management and prophylaxis. METHODS: A literature search was carried out from Pubmed for indexed articles published over the last 50 years using the key words 'Management penile carcinoma', 'Squamous cell carcinoma penis' and 'inguinal lymphadenectomy'. RESULTS: The search yielded over 1500 indexed published articles and reports. Important major reports and studies were reviewed, screened and tracked for recent changes and trends in the management of penile cancer. These were analyzed, tabulated and discussed. CONCLUSIONS: Newer approaches to the management of penile cancer include use of laser, photodynamic therapy, neoadjuvant therapy and sentinel node mapping by lympho-gamma-scintigraphy. The current approach towards managing inguinal adenopathy shows an increasing trend towards the use of these newer modalities as well as the use of certain modifications in lympadenectomy such as (the use of ligasure, modified dissection, saphenous vein sparing and lymphoscintigraphy, etc.) thereby making the procedure considerably less morbid than before.

Transurethral resection versus open surgery for leiomyoma of urinary bladder--a report of 2 cases.

The authors describe two patients with leiomyoma of the bladder who presented with bladder outlet obstruction. The results of magnetic resonance imaging are presented and their management discussed. Complete resection was curative in both patients, by enucleation in the first case and by transurethral resection in the second.

Ectopic prostate: an unusual bladder tumor.

A 25-year-old man presented with gross painless hematuria. Cystoscopy revealed a smooth surfaced mass in the supratrigonal region. Complete transurethral resection of the mass was done. Histopathological examination revealed benign prostatic tissue situated ectopically.

Monitoring of irrigation fluid absorption during percutaneous nephrolithotripsy: the use of 1% ethanol as a marker.

This study was performed in 32 ASA I patients undergoing percutaneous nephrolithotripsy under general anaesthesia, using absorption of 1% ethanol as a marker to monitor irrigation fluid absorption. Various parameters of fluid absorption were studied and compared, including irrigation fluid volume, irrigation time, total volume of irrigation fluid absorbed and the rate of irrigation. The amount of irrigant used vs. the volume absorbed and the volume absorbed vs. total irrigation time were observed. Fluid absorption occurred in 78% of patients, and 28% absorbed volumes in excess of 1 l. The mean volume of fluid absorbed was 696.7 ml. The maximum fluid absorption was observed when the irrigation fluid volume, total irrigation time and irrigation rate exceeded 10 l, 30 min and 200 ml.min(-1), respectively. In conclusion, this study has shown 1% ethanol to be a safe, simple and cost-effective marker of fluid absorption during percutaneous nephrolithotripsy associated with minimal adverse effects.

Management of renal angiomyolipoma in complex clinical situations.

Renal angiomyolipoma (AML) is associated with complex clinical situations such as tumour in a solitary kidney, bilateral, large or multicentric tumours or those associated with tuberous sclerosis (TS) or pregnancy. Management in these situations may be challenging. Fifteen patients (20 kidneys) were admitted with symptomatic AML over last 10 years. Eleven patients had one or the other complicating factor. Ten patients had a tumour of >10 cm, 4 had TS, 5 had multiple and bilateral tumours, 1 patient was pregnant and 1 had a solitary functioning kidney. With the newer imaging modalities correct diagnosis was possible in 12 cases and renal cell carcinoma (RCC) was suspected in 3 cases. Selective angioembolization (SAE) was done in 3 patients, which successfully controlled bleeding in all. Nephron-sparing surgery (NSS) was performed in 5 patients. Total nephrectomy was done in 4 cases, in 3 due to suspicion of RCC and in 1 due to extensive involvement of the kidney. Three patients with multiple and bilateral tumours were chosen for conservative treatment and none developed recurrence of bleeding on strict follow-up. In a pregnant patient, bleeding was successfully controlled with angioembolization. However, 1 patient with a solitary functioning kidney with large-sized tumour (20 x 18 cm) underwent NSS. In conclusion, the basis of management of AML is preservation of renal tissue, which can be effectively achieved with SAE or NSS. In a solitary functioning kidney, NSS or SAE is the ideal treatment, if feasible. The patients in the TS group are usually more complicated and require life-long follow-up after initial management with NSS or SAE. Pregnant AML patients can be safely managed with SAE. Conservative treatment without any intervention and regular follow-up may be more helpful in some patients with multiple, bilateral extensive tumours.

Retroperitoneoscopic ureterolysis and reconstruction of retrocaval ureter.

We report a case of circumcaval ureter in a symptomatic young man who was managed successfully by retroperitoneoscopic ureterolysis and ureteroureteral reconstruction using three-port technique.

Endoscopic management of an unusual foreign body in the urinary bladder leading to intractable symptoms.

A 70-year old female patient presented with intractable lower abdominal pain and recurrent urinary tract infection following an endoscopic bladder neck suspension. Investigations revealed it to be a case of suture and pledget migration leading to foreign body granuloma in urinary bladder. It is being reported as an uncommon complication of endoscopic bladder neck suspension. An early endoscopic evaluation should be carried out in cases of unexplained lower urinary tract symptoms following any surgical procedure for incontinence. It is also appropriate to retrieve these foreign bodies endourologically without resorting to open surgery and thus extending safe, comfortable, and short postoperative course with good long term results.

Urethral stone presenting as a stop valve--a rare complication of balanitis xerotica obliterans.

Balanitis xerotic obliterans (BXO) is the genital subcategory of lichen sclerosis et atrophicus. The association of BXO with urethral stone causing interruption of the urinary stream and voiding by manual displacement of the urethral stone has not been described before. We describe one such case of a young boy with BXO and urethral stone who voided by manually displacing the stone for over a year. The case is reported to emphasize the ingenuity of the patient in continuing to void for over a year despite the association of the impacted urethral stone with urethral stricture and BXO.

Renal cell carcinoma in cases of adult polycystic kidney disease: changing diagnostic and therapeutic implications.

Renal cell carcinoma in adult polycystic kidney disease is of rare occurrence and poses a diagnostic and therapeutic challenge. We have treated three such patients in our department. One was male and two were females ranging in age from 20 to 60 years. All were diagnosed preoperatively with ultrasonography or contrast-enhanced CT. Radical nephrectomy was performed in all patients. During the follow-up no patient had recurrence in the contralateral kidney. One patient had local recurrence in the renal fossa and was treated with local radiotherapy and immunotherapy. In the past due to difficulty in diagnosis, invasive investigations like angiography were recommended and prophylactic contralateral nephrectomy was often undertaken. With the availability of reliable noninvasive investigations these patients can be diagnosed accurately and the contralateral kidney saved in most cases.

Urethral hemangioma: laser treatment.

Urethral hemangioma is a rare cause of hematuria for which various modalities of treatment have been used. We report a young patient, who presented with hematuria and in whom urethrocystoscopy showed multiple hemangiomas in penile urethra. These were fulgurated successfully with Nd-YAG laser.

Retained surgical sponge: an unusual cause of malabsorption.

Retained surgical sponge is an unpleasant surprise in clinical practice. Intraluminal migration of the retained sponge, though rare, can lead to intestinal obstruction and other complications. We describe two cases of retained surgical sponge, both following gynaecological surgery, presenting several years after surgery with features of subacute intestinal obstruction, malabsorption and several years after surgery with features of subacute intestinal obstruction, malabsorption and sever hypoproteinemia which reverted after surgical removal.

Phospholipase A2 modification enhances lipoprotein(a) binding to the subendothelial matrix.

Lipoprotein(a), Lp(a), is found in the extracellular matrix in atherosclerotic plaques, but with a different localization than LDL. A two-compartment system, with a monolayer of endothelial cells forming a barrier, was used to compare the transport, cell binding, and retention of Lp(a) and LDL into the subendothelial matrix. Baseline values for transport and retention of Lp(a) and LDL were not significantly different. Incubation with lipoprotein lipase or sphingomyelinase caused modest and similar increases in transport and retention of the two lipoproteins. In contrast, incubation with phospholipase A2 (PLA2) resulted in a marked (4-fold) increase in retention of Lp(a) on the subendothelial matrix, but a lesser (2-fold) increase in LDL retention. Moreover, PLA2 treatment of Lp(a) enhanced its binding to individual matrix proteins (fibronectin, laminin, or collagen) by 4-10 times above that of LDL. The enzymatic activity of PLA2 was responsible for its effect on Lp(a) binding. The lysine binding sites of Lp(a) contributed to the increased binding of PLA2-modified Lp(a) to the matrix, and the enhanced lysine binding functions of PLA2-modified Lp(a) was demonstrated by two independent approaches. Thus, PLA2 modification leads to enhanced interactions of lipoproteins with the extracellular matrix, and this effect is more pronounced with Lp(a).