Low-grade renal epithelial tumor originating from the distal nephron.

There are few published reports of low-grade renal epithelial tumor originating from the distal nephron. However, it should not be disregarded clinically, because the actual number of patients with such tumors may be higher than expected. We investigated the immunohistochemical profile of a histologically distinct subtype of such a tumor in detail, in addition to the clinical course and imaging studies. The present study demonstrated that both glandular and spindle cell components of this tumor have a persistent characteristic of an epithelial tumor arising from the distal tubule or collecting duct. This tumor is a benign complex neoplasm that can be treated successfully with radical surgery. Beta-catenin and E-cadherin are suggested to play a crucial role in tumorigenesis and the biphasic arrangement of this neoplasm, concerning the expression of epithelial membrane antigen and carbohydrate antigen 19-9. We suggest that the term 'distal nephron epithelioma' is appropriate for classifying such rare but clinicopathologically distinct tumors.

[The consequence after introduction of clean intermittent catheterization (CIC) in children with neurogenic bladder dysfunction secondary to spina bifida--the comparison of patients with and without upper urinary tract dilation at the time CIC was introduced].

PURPOSE: The aim of current study was to review the consequence after introduction of clean intermittent catheterization (CIC) in children with neurogenic bladder dysfunction secondary to spina bifida. PATIENTS AND METHODS: We retrospectively reviewed the records of 34 children (19 girls and 15 boys) presenting our clinic in a 18-year period. The patients were divided concentrating on the radiological upper urinary tract findings when CIC was introduced. 18 children had dilated upper urinary tract. In these patients, 10 children already had dilated upper urinary tract at first visiting to our clinic(group A). In remaining 8 patients, dilatation of upper urinary tract was found out in the course of followup (group B). 16 children had normal upper urinary tract when CIC was introduced. In 7 patients, CIC was applied for post-void residual and urinary tract infection (group C). In remaining 9 patients, CIC was introduced for urodynamically low compliance bladder (group D). RESULTS: In group A, 5 patients underwent enterocystoplasty and 3 patients underwent anti-reflux surgery consequently. Two patients, including 1 patient who underwent enterocystoplasty, have chronic renal dysfunction. In group B, 3 patients underwent enterocystoplasty and 2 patients underwent anti-reflux surgery. In group C, all patients have normal upper urinary tract. In group D, 8 patients have normal upper urinary tract. However, 1 patients underwent enterocystoplasty for low compliance bladder with vesicoureteral reflux (VUR). CONCLUSION: Some patients show the improvement of dilated upper urinary tract or VUR after introduction of CIC. However, enterocystoplasty or anti-reflux surgery was needed for many patients to prevent upper urinary tract deterioration. The patients whom CIC was introduced for postvoid residual and urinary tract infection have not shown any deterioration of upper urinary tract. The efficacy of CIC for incontinence was poor because many patients have urethral sphincter incompetence.

[Persistent müllerian duct Syndrome in brothers].

Persistent Müllerian duct syndrome is associated with cryptorchidism and transverse testicular ectopia. Such gonads are at an increased risk of malignant transformation. Furthermore, most patients have azoospermia. Here in we report about two brothers with persistent Müllerian duct syndrome. The diagnosis was made during surgical operation for testicular cancer in younger brother. In the other one, persistent Müllerian duct syndrome was diagnosed during examination for infertility.

[Gasless laparoscopy-assisted live donor nephrectomy].

PURPOSE: We evaluated both efficacy and feasibility of laparoscopy-assisted live donor nephrectomy. MATERIALS AND METHODS: Since September 2000, 11 living kidney donors (2 males and 9 females) underwent laparoscopy-assisted live donor nephrectomy. All of sides were left. Gasless surgery was performed with a 7 cm pararectal upper abdominal incision and three trocars via a retroperitoneal approach. After creating the working space using balloon dissection technique, the abdominal wall was lifted using a metal retractor attached to the margin of the abdominal incision. Additionally, a metal plate, which was attached to the abdominal wall inside, was raised. The surgeon dissected left kidney from the skin incision under both direct vision and magnificated view on the monitor. RESULTS: The operating time, estimated blood loss and warm ischemic time were a mean of 209 minutes, 219 g, and 4.2 minutes, respectively. The mean times for the return to a normal diet and unassisted ambulation were 1.3 and 1.8 days, respectively. One case required blood transfusion due to subcutaneous hematoma at trocar entry site on the second day after surgery, in the remaining 10 cases there were no complications. All of donated kidneys achieved immediate function after engraftment. CONCLUSIONS: Gasless laparoscopy-assisted donor nephrectomy is recommended and advantageous for healthy kidney donors as a minimally invasive method.

Immunohistochemical studies of caveolin-3 in germ cell tumors of the testis.

BACKGROUND/AIM: Caveolin, which is a major constructive component of the caveolar membranes, plays a key role in transcytosis of molecules into cells and regulation of several signal transductions. Caveolin has three isoforms, and recent studies suggest that in some malignant tumors an alteration of caveolin-1 expression correlates with oncogenetic changes. Caveolins have been reported to be negative regulators of inducible nitric oxide synthase (iNOS) which can provoke an antitumor response via infiltrating immune cells. The aim of this study was to examine the expressions of caveolin-1 and caveolin-3 (which is a caveolin-1 homologue localized predominantly in muscle tissue) in testicular cancer. METHODS: We evaluated the expressions of caveolin-1, caveolin-3, and iNOS in 16 seminoma and 10 non-seminoma testicular cancer specimens as well as normal testicular tissue, using a streptavidin-biotin bridge technique on cryostat sections. The expression of caveolin-3 was confirmed by slot-blot analysis. Tumor-infiltrating immune cells were also studied immunohistochemically, and the correlation between the number of immune cells and caveolin-3 concentrations was calculated. RESULTS: Immunohistochemistry revealed that caveolin-3, but not caveolin-1, was frequently expressed in seminomas (12 positive out of 16 specimens) without positive staining in their normal counterparts or in nonseminomatous germ cell tumors, except for muscle components in the teratoma. iNOS was not expressed in any tissues examined. Samples with high levels of caveolin-3 tended to have higher degrees of tumor-infiltrating immune cells, although this finding was not statistically significant. CONCLUSION: This is the first report demonstrating the involvement of caveolin-3 in germ cell tumors.