Cake kidney drained though a single ureter in a patient with recurring urinary tract infection.

Cake kidney is a rare abnormality of the urinary tract. It is generally asymptomatic but can lead to renal and nonspecific systemic manifestations. This report describes a case of cake kidney drained through a single ureter diagnosed in a female patient with recurring urinary infection.

Incidental finding of retrocaval ureter in a patient without hydronephrosis.

Retrocaval or circuncaval ureters are rare congenital anomaly, in which the ureter is located posterior to the inferior vena cava (IVC). Usually, patients present symptoms in the 3rd or 4th decade of life due to compression of the ureter by the IVC, with obstruction of the urinary flow and consequent hydronephrosis. Herein we report the case of a 62-year-old patient who underwent ultrasonography to investigate abdominal pain. The patient had bilateral renal lithiasis associated with urinary tract dilation with no obvious obstruction. Computed tomography of the abdomen demonstrated a retrocaval ureter without hydronephrosis.

Inguinal hernia with ureter in patient with single kidney.

Inguinal hernias are a common disease in adults, but involvement of extraperitoneal structures is rare. This condition is usually asymptomatic and an incidental finding during the surgical correction of inguinal hernias, often resulting in iatrogenic damage. We present a rare case of left renal agenesis and right inguinal hernia, with the ureter being the only organ protruding as an inguinal hernia, diagnosed in the preoperative period.

Risk factors for acute renal failure in nephrectomized patients treated in a university hospital.

BACKGROUND: New surgical techniques for nephrectomy mainly related to early diagnosis made possible by advances in imaging studies have been developed in recent decades. However, postoperative renal dysfunction is a constant concern because of the major problems faced by healthcare services and by the patients themselves. To assess risk factors for developing acute renal failure (ARF) in patients submitted to nephrectomy in a university hospital. METHODS: Seventy-seven patients submitted to nephrectomy for benign and malignant diseases in a university hospital were evaluated in respect to preoperative and postoperative creatinine clearance. Demographic (gender, age), clinical (cancer, diabetes, high blood pressure, chronic kidney disease) and surgical (anesthesia time, open or laparoscopic surgery) variables were also analyzed. RESULTS: Of the 77 patients, 72 met the inclusion criteria. Of these, ten (13.8%) had a diagnosis of chronic renal failure (CRF), 30 (48%) had stage I ARF and one (16.1%) had stage II ARF. The anesthesia time, type of surgery (open or laparoscopy), total or partial nephrectomy, the side of the procedure, hypertension, diabetes, CRF, renal cancer, preoperative and postoperative creatinine concentrations were analyzed. Only the difference between preoperative and postoperative creatinine clearance was clinically significant (P<0.001). CONCLUSIONS: An altered preoperative renal function is a risk factor for the development of ARF in nephrectomized patients.

Association of Hypertension With Erectile Function in Chronic Peripheral Arterial Insufficiency Patients.

BACKGROUND: Risk factors may influence the improvement or worsening of erectile dysfunction (ED). The aim of the current study was to evaluate the effect of systemic hypertension on ED in patients with peripheral arterial disease. METHODS: The effect of hypertension on ED was assessed in 125 consecutive patients in a cross-sectional quantitative study. The ages of the patients ranged from 19 to 88 years old (mean: 59.82 ± 10.48 years). The only exclusion criterion was the amputation of one or both legs. The ankle-arm index was assessed and the international index of ED questionnaire was applied to all participants in the study. RESULTS: Of the 125 patients, 22 (17.6%) had mild (grade 1), 50 (40.0%) had moderate (grade 2) and 53 (42.4%) had severe (grade 3) ED. Hypertensive patients have more ED, with ED in hypertensive patients being associated to chronic arterial disease. However, in comparison with normotensive patients, hypertension exerts an immediate protective effect on erectile function. CONCLUSIONS: In conclusion, although erectile function is initially protected by systemic arterial hypertension in patients with chronic arterial disease, both chronic arterial disease and ED deteriorate over the long term in hypertensive patients.

Incidental Diagnosis of Nonfunctional Bladder Paraganglioma.

Nonfunctional bladder paragangliomas may present clinical, radiology and pathological features similar to bladder cancer, so knowledge of this generally benign neuroendocrine neoplasm is of great importance to avoid misdiagnosis. We present the case of a patient with no clinical symptoms of paraganglioma and with radiological and cystoscopy examination results suggestive of urothelial carcinoma but with pathological diagnosis of paraganglioma.

Familial mixed nephrocalcinosis as a cause of chronic kidney failure: two case reports.

INTRODUCTION: Nephrocalcinosis consists of the deposition of calcium salts in the renal parenchyma and is considered the mixed form when it involves the renal cortex and medulla. The main etiological agents of this condition are primary hyperparathyroidism, renal tubular acidosis, medullary sponge kidney, hyperoxaluria and taking certain drugs. These factors can lead to hypercalcemia and/or hypercalciuria, which can give rise to nephrocalcinosis. CASE PRESENTATIONS: Patient 1 was a 48-year-old Caucasian woman with a history of bilateral nephrocalcinosis causing chronic kidney failure. Imaging examinations (X-ray, ultrasound and computed tomography of the abdomen) revealed extensive calcium deposits in the renal parenchyma, indicating nephrocalcinosis as the causal factor of the disease. Patient 2 is the 45-year-old brother of patient 1. He exhibited an advanced stage of chronic kidney failure. As nephrocalcinosis is considered to have a genetic component, a family investigation revealed this condition in patient 2. CONCLUSION: Nephrocalcinosis may be detected incidentally through diagnostic imaging studies. Whenever possible, treatment should include the base disease that caused the appearance of the calcification, as the precise etiological determination is extremely important.

Prostatic paracoccidioidomycosis with a fatal outcome: a case report.

INTRODUCTION: Paracoccidioidomycosis is a systemic mycosis in Latin America that can affect various organs. Few case reports of paracoccidioidomycosis affecting the prostate are found in the literature. CASE PRESENTATION: We present the case of a 79-year-old Caucasian man with a six-month history of irritative symptoms of the prostate (urgency, frequency and nocturia) and difficulty initiating urination that progressed to urinary retention and the use of a urinary catheter. The anatomopathological analysis of the transurethral resection of the prostate revealed chronic granulomatous prostatitis of fungal etiology (paracoccidioidomycosis) with extensive necrosis. The patient began treatment with itraconazole at a dose of 100mg/day for six months. Radiography of the thorax revealed bilaterally diffuse nodular reticular interstitial lesions. The patient progressed to respiratory failure and was sent to the intensive care unit, but suffered a cardiopulmonary arrest and was pronounced dead. CONCLUSIONS: Due to the high incidence of paracoccidioidomycosis in countries like Brazil, urologists should suspect blastomycosis in all patients with symptoms of lower urinary obstruction with chronic abacterial prostatitis. Considering that paracoccidioidomycosis has the potential to affect various organs, following diagnosis, the treatment must be initiated as soon as possible.

Quantification of fractal dimension and Shannon's entropy in histological diagnosis of prostate cancer.

BACKGROUND: Prostate cancer is a serious public health problem that affects quality of life and has a significant mortality rate. The aim of the present study was to quantify the fractal dimension and Shannon's entropy in the histological diagnosis of prostate cancer. METHODS: Thirty-four patients with prostate cancer aged 50 to 75 years having been submitted to radical prostatectomy participated in the study. Histological slides of normal (N), hyperplastic (H) and tumor (T) areas of the prostate were digitally photographed with three different magnifications (40x, 100x and 400x) and analyzed. The fractal dimension (FD), Shannon's entropy (SE) and number of cell nuclei (NCN) in these areas were compared. RESULTS: FD analysis demonstrated the following significant differences between groups: T vs. N and H vs. N groups (p < 0.05) at a magnification of 40x; T vs. N (p < 0.01) at 100x and H vs. N (p < 0.01) at 400x. SE analysis revealed the following significant differences groups: T vs. H and T vs. N (p < 0.05) at 100x; and T vs. H and T vs. N (p < 0.001) at 400x. NCN analysis demonstrated the following significant differences between groups: T vs. H and T vs. N (p < 0.05) at 40x; T vs. H and T vs. N (p < 0.0001) at 100x; and T vs. H and T vs. N (p < 0.01) at 400x. CONCLUSIONS: The quantification of the FD and SE, together with the number of cell nuclei, has potential clinical applications in the histological diagnosis of prostate cancer.

Overexpression of ANXA1 in penile carcinomas positive for high-risk HPVs.

The incidence of penile cancer varies between populations but is rare in developed nations. Penile cancer is associated with a number of established risk factors and associated diseases including phimosis with chronic inflammation, human papillomavirus (HPV) infection, poor hygiene and smoking. The objective of this study was to identify genes related to this type of cancer. The detection of HPV was analyzed in 47 penile squamous cell carcinoma samples. HPV DNA was detected in 48.9% of penile squamous cell carcinoma cases. High-risk HPV were present in 42.5% of cases and low-risk HPV were detected in 10.6% of penile squamous cell carcinomas. The RaSH approach identified differential expression of Annexin A1 (ANXA1), p16, RPL6, PBEF1 and KIAA1033 in high-risk HPV positive penile carcinoma; ANXA1 and p16 were overexpressed in penile squamous cells positive for high-risk HPVs compared to normal penile samples by qPCR. ANXA1 and p16 proteins were significantly more expressed in the cells from high-risk HPV-positive penile carcinoma as compared to HPV-negative tumors (p<0.0001) independently of the subtype of the carcinoma. Overexpression of ANXA1 might be mediated by HPV E6 in penile squamous cell carcinoma of patients with high-risk HPVs, suggesting that this gene plays an important role in penile cancer.

High-risk human papillomaviruses in two different primary tumors in the same patient.

Two cases of patients with high-risk human papillomavirus-related squamous cell carcinomas of the penis are reported. In both patients, a second high-risk human papillomavirus-related squamous cell carcinoma, of the same type (genotype 16), was detected: a carcinoma of the oropharynx 2 years after treatment of the squamous cell carcinomas of the penis in the first patient, and a carcinoma of the esophagus 1 year after the treatment of the squamous cell carcinomas of the penis in the second patient. To the best of our knowledge, this is the first time that multiple human papillomavirus-related tumors in the same patient are reported. It is suggested that a careful clinical investigation is necessary in patients with tumors attributable to high-risk human papillomavirus for the early detection of a possible second neoplasm related to this virus in a different organ.

Effect of Sodium Cyclamate on the Rat Fetal Liver: A Karyometric and Stereological Study / Efectos del Ciclamato de Sodio en el Hígado Fetal de Ratas: Estudios Cariométrico y Estereológico

The cyclamate, a sweetner substance derived from N-cyclo-hexyl-sulfamic acid, is largely utilized as a non-caloric artificial edulcorant in foods and beverages as well as in the pharmaceutical industry. The objective of this study was to evaluate fetal hepatic karyometric and stereological alterations in the rat fetal liver resulting from the intraperitoneal administration of sodium cyclamate. The livers of ten rats were evaluated, five treated and five controls chosen at random, in which five rats that received from the 10th to 14th days of pregnancy an intraperitoneal daily injection of sodium cyclamate at 60 mg/Kg of body weight during 5 days. At the 20th day of gestation, the animals were removed and weighed, as were their placentas, on a precision balance; the length of the umbilical cords also were measured. After the laboratory processing, semi-seriated 6mm cuts stained with haematoxyline and eosine were performed. In seven karyometric parameters (major, minor, and medium diameters, volume, area, perimeter, and volume-area ratio), the increase was statistically significant in the treated group when compared with control group. Stereological parameters showed in the treated group a significant increase in the cytoplasmatic and cellular volume, and a significant reduction in the nucleus-cytoplasm ratio as well as in the numerical cellular density. These results showed that the sodium cyclamate in pregnant rats led to retardation of fetal development and hepatic-cellular hypertrophy in the offspring, suggesting toxicity in liver of rat fetuses.

El ciclamato, es una substancia derivada del ácido N-ciclo-hexil-sulfámico, bastante usada como edulcorante no calórica en alimentos y bebidas, así como en la industria farmacéutica. El objetivo del trabajo fue evaluar los efectos del ciclamato de sodio en hígados de fetos de ratas, considerándose las alteraciones cariométricas y estereológicas. Fueron utilizadas 10 ratas adultas (Rattus norvegicus) variedad Wistar, con peso medio de 240 g, siendo 5 el grupo control y 5 tratadas con ciclamato de sodio. Entre el 10 y 14 día de la preñez, 5 ratas recibieron una inyección diaria intraperitoneal de 60mg/Kg/día de ciclamato de sodio durante 5 días. En el 20 día, los animales fueron sacrificados y los fetos fijados en solución de Alfac, incluidos en parafina, cortados a 6 µm y teñidos com H-E. Hubo aumento estadísticamente significativo en siete parámetros cariométricos (diámetros mayor, menor y medio, volumen, área, perímetro y relación área/volumen) en el grupo tratado con ciclamato de sodio comparado con el grupo control. Parámetros estereológicos mostraron aumento significativo en los volúmenes citoplasmático y celular y disminución significativa en la relación núcleo/citoplasma y densidad numérica celular. Los resultados mostraron que el uso del ciclamato de sodio en las ratas preñadas causó retardo en el desarrollo fetal e hipertrofia celular hepática en los fetos, sugerente de toxicidad en el hígado fetal de las ratas.