The ameliorative effect of various antioxidants on Adriamycin-induced fetal renal abnormalities.

OBJECTIVE: To examine the efficacy of nine antiapoptotic compounds in preventing the development of Adriamycin-induced fetal renal abnormalities or ameliorating the resultant renal damage in a rat model. METHODS: Thirty-three Sprague-Dawley rats were randomly divided into sham-control, Adriamycin and prevention groups. The prevention group was divided into 9 subgroups. The rats were time mated and experimental rats were injected with Adriamycin on gestational day 7-9. Sham-control rats were injected with saline on the same days. The preventive medications were administered to the prevention group from 7 days prior to mating to the end of pregnancy. Samples were prepared from fetuses for histological and biochemical analyses. RESULTS: A total of 331 fetuses were recovered. There were no resorptions in the Deferoxamine, Amifostine and sham-control groups. Significant decrease of antioxidant activities was noted in the Adriamycin group compared to the sham-control group. In all prevention groups, antioxidant activities were significantly increased compared to the Adriamycin group. The highest rate of hydronephrosis was observed in the Adriamycin group (82%). The lowest rates of renal abnormalities were noted with Deferoxamine and Amifostine: 8% and 11%. CONCLUSION: Oxidant injury plays a critical role in the development and progression of Adriamycin-induced fetal renal abnormalities. Some antiapoptotic medications, notably Deferoxamine and Amifostine, may have preventive and therapeutic potential in the management of fetal renal abnormalities.

Complex genitourinary duplication affecting neurourologic and urodynamic findings: report of a case and review of the literature.

BACKGROUND: Complete duplication of the bladder and urethra is a rare congenital anomaly and usually occurs in association with other organ anomalies. We report a case of complete bladder duplication associated with multiple non-genitourinary anomalies. CASE: A 10-year-old girl presented with urinary incontinence and recurrent episodes of febrile urinary tract infections. Simultaneous right and left bladder urodynamic study was performed and revealed bilateral decreased bladder compliance associated with hyperreflexia. The patient underwent reconstructive surgery with combination of the 2 bladders and closure of the right incompetent bladder neck. SUMMARY AND CONCLUSION: Management of bladder duplication is directed towards creating an unobstructed urinary tract, preventing infections, and achieving urinary continence. Neurourologic and urodynamic assessment is of utmost importance especially when concomitant spinal anomaly exists. Furthermore, these patients should be observed lifelong as alteration in bladder function may occur.

Wilms tumor and a duplex collecting system: a case report and review of literature.

Wilms tumor (WT) is described as a component of many different clinical conditions and genetic syndromes. However, the simultaneous occurrence of WT and a duplex collecting system is extremely rare. We report a case of a 4-year-old boy diagnosed with WT and a left duplex collecting system. The patient underwent a left radical nephrectomy. The histologic examination diagnosed it to be a case of WT with favorable histology. The patient received the chemotherapy regimen for stage 1 WT and was in complete remission during the follow-up period of 2 years. Further investigations are required for assessing the need for screening of WT in children with genitourinary malformations.

Determining the optimal decellularization and sterilization protocol for preparing a tissue scaffold of a human-sized liver tissue.

Attaining a well-qualified whole decellularized organ applicable for an enduring and successful transplantation, decellularization protocols should be organ specific in terms of decellularizing agents and time of tissue exposure. Since a bioscaffold resulting from a large solid organ should have the potential to preserve its three-dimensional architecture and consistency for at least several months in the site of transplantation, evaluating the mechanical properties of the bioscaffold is mandatory before transplantation. In the current study, we compared five different decellularization protocols and also two main decellularization techniques (perfusion vs. diffusion) to decellularize the sheep liver, which is similar to the human liver in terms of size and anatomy. Moreover, we assessed the retaining of vascular network by dye injection and angiography. We also determined the most proper sterilization method by comparing six different sterilization methods. The mechanical properties of the scaffolds were assessed by applying tensile strength, suture retention, and compressive strength tests. The perfusion technique showed better results compared to the diffusion technique. The protocol containing ammonium hydroxide and triton X-100 was the most proper decellularization protocol leading to completely decellularized livers along with intact vascular network. Furthermore, we noted that application of streptokinase in washing step facilitates decellularization. Our results also showed that a combination of two sterilization methods is necessary for complete sterilization of a sheep liver and peracetic acid or ethylene oxide+gamma irradiation was associated with the best outcome. Determining the most appropriate decellularization and sterilization method for each organ along with assessing the mechanical properties of the resulting bioscaffold are principal steps before fabricating efficient artificial organs in the foreseeable future.

Paratesticular metastasis from Wilms tumor: the possible routs of metastasis and literature review.

Testicular or paratesticular metastasis from Wilms tumor (WT) is extremely rare. We report a 5-year-old boy with WT of right kidney presented with metastasis to the ipsilateral spermatic cord. The patient underwent a high inguinal right orchiectomy. Histopathological examination revealed infiltration of WT to spermatic cord but the testis and epididymis were not involved. The patient received the standard chemotherapy regimen but the response to treatment was poor with 2 tumor recurrences within the follow-up period. Among the mechanisms of metastasis to scrotal region, retrograde venous and the patent processus vaginalis seem to be more common and also preventable.

Shunt-type and stop-type varicocele in adolescents: prognostic value of these two different hemodynamic patterns.

OBJECTIVE: To investigate different varicocele hemodynamic patterns (shunt type vs. stop type) as predictors of new-onset testicular hypotrophy or recurrence after varicocelectomy. DESIGN: Prospective clinical study. SETTING: Department of pediatric urology, children's hospital medical center. PATIENT(S): Seventy-four children and adolescents with varicocele. INTERVENTION(S): Based on ultrasound findings, patients were classified into shunt-type or stop-type varicocele groups. All patients with stop-type varicocele and testicular volume discrepancy of ≥20% underwent retroperitoneal varicocelectomy and internal spermatic vein ligation. Patients with shunt-type varicocele and ≥20% testicular asymmetry were randomly divided to undergo either retroperitoneal varicocelectomy (ligation of internal spermatic vein) or inguinal varicocelectomy with ligation of both internal and external spermatic veins. Patients with testicular volume discrepancy of <20% were put on conservative management. MAIN OUTCOME MEASURE(S): Occurrence of new-onset asymmetry among untreated patients and recurrence rate among operated patients. RESULT(S): Patients with shunt-type varicocele who did not undergo surgery revealed a higher risk of developing asymmetry during follow-up (odds ratio 10.5). Ligation of both internal and external spermatic veins in shunt-type patients was associated with significantly decreased rate of recurrence (6.3%) compared with retroperitoneal approach (30.8%). CONCLUSION(S): Shunt-type varicocele is associated with a higher risk of testicular hypotrophy among untreated patients. In addition, recurrence rate in shunt-type patients who underwent inguinal varicocelectomy was lower compared with retroperitoneal approach.

The optimal dose of Adriamycin to create a viable rat model potentially applicable to congenital obstructive uropathy.

PURPOSE: The Adriamycin rat model is an established model for different organ anomalies including congenital obstructive uropathy. In the current study, we carried out a dose-response analysis to find out the optimal dose of Adriamycin to create a viable rat model of obstructive uropathy. METHODS: Thirty time-mated Sprague-Dawley rats were divided into 5 groups including 1 control group and 4 different treatment groups. The 4 Adriamycin dosage regimens investigated in this study were 1.25, 1.5, 1.75, and 2 mg/(kg d). Experimental rats (n = 24) were injected intraperitoneally with different doses of Adriamycin on gestational days 7 to 9 (6 rats in each group). Control rats (n = 6) were injected with an equivalent volume of saline on the same days. Viable term fetuses were harvested on gestational day 21 by cesarean delivery and dissected under a dissecting microscope. Serial transverse sections from urinary tract system were obtained for histological examination. RESULTS: One hundred thirty-three viable fetuses were recovered from Adriamycin-treated rats, and 50 were from rats in the control group. There were no resorptions in the control group; however, 52 resorptions were recorded in Adriamycin groups. The rates of hydronephrosis and resorptions were 60% and 0%, 80.5% and 5.8%, 100% and 17.3%, and 100% and 76.9% at doses of 1.25, 1.50, 1.75, and 2 mg/(kg d), respectively. Histologic examination of the kidneys in the treated groups showed a significant decrease in renal parenchyma compared with the control group. CONCLUSIONS: The dosage of 1.5 mg/(kg d) of Adriamycin yielded the highest number of viable hydronephrotic fetuses. At this dose, urinary abnormalities are milder; but the highest number of viable fetuses is provided, which is necessary to create a reproducible and viable animal model.