[Nephrotoxicity of tacrolimus and preventive effect of diltiazem: experiment with rats].

OBJECTIVE: To study the nephrotoxicity tacrolimus (FK506) at the therapeutic dose the preventive effect of diltiazem (Dil), a calcium antagonist against the FK506-induced pathological changes. METHODS: 24 Sprague-Dawley male rats were randomly divided into 4 equal groups: cyclosporine A (CsA) group, undergoing treatment of CsA at the therapeutic dose after kidney transplantation (25 mg x kg(-1) x d(-1)) for 4 weeks, FK506 group treated with FK506 (0.8 mg x kg(-1) x d(-1)), FK506 + Dil group treated with FK506 (0.8 mg x kg(-1) x d(-1)) and Dil at the dose of 8 mg x kg(-1) x d(-1), and control group. Four weeks later body weight was measured and 24 h urine sample was collected. Then the rats were killed. Their kidneys underwent light and transmission electron microscopy. RESULTS: The body weight ad weight gain, and the weights of both kidney of the CsA group were all significantly lower than those of the other 3 groups (all P < 0.05), and there were not significant differences in there parameters among the other 3 groups. The serum creatinine levels of the FK506 and CsA groups were (36.0 +/- 2.6) and (34.2 +/- 4.5) micromol/L respectively, both significantly higher than those of the FK506 + Dil and control groups [(28.5 +/- 2.1) and (29.2 +/- 3.428) micromol/L respectively, all P < 0.05], however, there was no significant difference between the FK506 + Dil and control groups. The creatinine clearance rate of the FK506 and CsA groups were (0.63 +/- 0.45) and (0.58 +/- 0.39) ml x min(-1) x 100 g(-1) respectively, significantly lower than those of the FK506 + Dil and control groups [(1.55 +/- 0.91) and (1.02 +/- 0.62) mlxmin(-1) x 100 g(-1) respectively, all P < 0.05]. Pathological examination showed epithelial cell cloudy swelling and vacuolization and interstitial fibrosis in the renal tubules, mitochondria swelling and vacuolization in renal tubular epithelial cells, renal arteriole hyalinization, and foot cell conjugation glomerulus, mitochondria swelling and vacuolization in the FK506 and CsA groups, and such changes were relatively mild in the FK506 + Dil group. CONCLUSION: FK506 at renal transplantation therapeutic dose, as well as CsA, induces pathological changes in renal tissues and ultrastructural organization. Dil is able to prevent FK506-induced these pathological changes.

[Clinical analysis of renal cell carcinoma: report of 271 cases].

OBJECTIVE: To study the diagnosis and treatment of renal cell carcinoma. METHOD: From January 1993 to December 2000 the data of 271 cases of renal cell carcinoma were reviewed. RESULTS: Ultrasonography and CT scanning were still the main diagnostic methods. Surgical operation was performed on 234 patients. Radical nephrectomy was performed on 197 patients (72.6%); Nephron sparing surgery was performed on 19 patients; Metastatic tumor resection was performed on 6 patients and other procedures for 12. The pathological results showed that 137 cases (61.4%) were clear cell carcinoma, 18 cases (8. 1%) of granular cell carcinoma, 32 cases (14. 3%) being combination of the above two varieties, 23 cases (10.3%) of renal papillary adenocarcinoma, 13 cases being renal cell of other types. And 210 cases (77.5%) had been successfully followed up. The 1, 3, 5 and 10 year survival rates were 95.3% (182/191), 88.7% (107/122), 74.7% (56/75) and 32.1% (10/31) respectively. CONCLUSIONS: Ultrasonography is the first select examination method of detecting of renal cell carcinoma, and CT scanning is the most valuable diagnostic mean. Early diagnosis and prompt radical nephrectomy or nephron sparing nephrectomy are the critical points for achieving long-term survivals of patients with renal cell carcinoma.

[Prevention of diltiazem in tacrolimus-induced nephrotoxicity: experiment with rats].

OBJECTIVE: To study the nephrotoxicity induced by first oral administration of tacrolimus (FK506) and the prevention of diltiazem (Dil). METHODS: 24 Sprague-Dawley male rats were randomly divided into 4 equal groups: control (n = 6), cyclosporine A (CsA) group (receiving CsA 25 mg.kg(-1).d(-1) so as to develop CsA-induced nephropathy model), FK506 group (receiving FK506 0.8 mg.kg(-1).d(-1), the common renal transplantation therapeutic dose, so as to develop FK506-induced nephropathy model), FK506 + Dil group (receiving CsA 0.8 mg.kg(-1).d(-1) and Dil 8 mg.kg(-1).d(-1)), and control group. Four weeks later body weight was measured, blood samples were collected to examine the creatinine, urea nitrogen, and uric acid, and urine samples were collected to examine the 24 h urine protein, uric acid, and creatinine. Then the rats were killed with their kidneys taken out to undergo histopathological examination. RESULTS: The urine creatinine levels of the CsA and FK506 groups were significantly lower than that of the control group (both P < 0.05), however, there was no significant difference in urine creatinine between the FK506 + Dil group and control group. The blood creatinine levels of both CsA and FK506 groups were significantly higher than those of the FK506 + Dil group and control group (all P < 0.05), however, there was no significant difference in blood creatinine between the FK506 + Dil group and control group. The urea nitrogen level of the CsA group was significantly higher than those of the other 3 groups (all P < 0.05). The creatinine clearance rates of the CsA and FK506 groups were both significantly lower than that of the control group (both P < 0.05), and the creatinine clearance rate of the FK506 + Dil group was between those of the FK506 group and control group, however, with significant differences with both of them. Histopathology examination showed cloudy swelling and vacuolization of the renal tubular epithelial cells in the CsA and FK506 groups. However, the pathological changes of the FK506 + Dil group were remarkably milder in comparison with these 2 groups. CONCLUSION: FK506 and CsA at the renal transplantation therapeutic dose induce nephrotoxicity. Diltiazem prevents FK506-induced nephrotoxicity.

[siRNA knocks down the expression of AR gene in PC3 cell lines].

OBJECTIVE: To observe the suppression of the expression of androgen receptor (AR) gene in PC3 cells after AR-specific siRNAs transfection, and to search for the siRNA (s) with the greatest suppressing efficiency. METHODS: Five AR-specific siRNAs were selected, RNAi expression vectors were constructed and transfected into PC3 cells, and the AR expression was detected by real time FQ-PCR and Western blot. A nonsense small RNA was set as negative control. RESULTS: Compared with the control group, the AR expression decreased in various degrees in the 5 experimental groups (P < 0.05), and siRNA1, siRNA4 and siRNA5 showed the greatest suppressing efficiency as compared with the other experimental groups, with statistically significant difference (P < 0.05). CONCLUSION: The AR-specific siRNAs could suppress the endogenous expression of target gene. Three siRNAs with great suppressing efficiency were identified and the expression vectors were constructed successfully. It can be applied in the future researches in vivo.

Persistent Muellerian duct syndrome with transverse testicular ectopia.

Persistent Muellerian duct syndrome (PMDS) is a rare form of male pseudohermaphrodism without the feature of ambiguous genitalia. We present a case of PMDS with transverse testicular ectopia (TTE).

[The detection of protein expression of clusterin and Ki-67 and the status of cell apoptosis in bladder transitional cell carcinoma].

OBJECTIVE: To investigate the expression of clusterin protein in bladder transitional cell carcinoma (BTCC) and it's association with tumor cell proliferation and apoptosis. METHODS: A tissue microarray (TMA) containing 87 informative cases of BTCCs was constructed firstly. The methods of immunohistochemistry and terminal deoxynucleotidyl transferase-mediated nick end-labeling were then used to examine the expression of clusterin and Ki-67 protein and the status of cell apoptosis in BTCC, respectively, and the correlations between different markers and the clusterin expression associated with patients' clinico-pathological features were evaluated. RESULTS: In TMA of 87 BTCCs, 37 (43%) cases were observed overexpression of clusterin. A significant association of clusterin expression with BTCC's pathological grade, as well as with tumors clinical stage was observed (P < 0.01), where the frequency of overexpression of clusterin in poor differentiated BTCCs (G(3), 71%) and tumors in more advanced stage (T(2-4), 62%) was significantly higher than that in well differentiated BTCCs (G(1-2), 29%) and tumors in early stage (T(a-1), 28%). In addition, a significant correlation between clusterin expression and tumors apoptotic index (AI) was evaluated (P < 0.01), in which 57% of BTCCs with overexpression of clusterin were observed a lower AI, while 72% of tumors with normal expression of this protein showed a higher AI, but no correlation between clusterin and Ki-67 expression. CONCLUSIONS: The overexpression of clusterin is associated positively with BTCC's malignant clinical phenotypes including tumor's differentiation and invasive depth, and it is correlated inversely with AI of tumor cells.

[Diagnostic value of urodynamic parameters multianalysis in the evaluation of bladder outlet obstruction resulting from benign prostatic hyperplasia].

OBJECTIVE: To construct a function model that can be used in the diagnosis bladder outlet obstruction (BOO) resulting from benign prostatic hyperplasia, and to develop a diagram allowing the judgement of bladder outlet for patients with different detrusor contractility, especially with impaired one. METHODS: Urodynamic and clinical data of 131 men were analyzed retrospectively. By Logistic analysis, a function model was constructed. Based on the model, a diagram allowing the evaluation of bladder outlet was drawn. The cutoff point for diagnosing BOO with the function model and the curve was confirmed by ROC curve analysis. RESULTS: The function model (BOOI) was obtained by the formula 5.03 x residual fraction + 0.04 x PdetatQmax - 0.20 x Qmax - 0.91 + alpha (alpha = 0 for those with low pressure-low flow on P-FS, alpha = 1.42 for high pressure-low flow, alpha = -7.30 for high pressure-high flow). The cutoff point for BOOI diagnosing BOO was 0.36. When validated, the sensitivity, specificity, positive predictive value, and negative predictive value were 85.7%, 91.7%, 96.0% and 73.3% respectively. CONCLUSION: The BOOI, with an easy calculation mode, could predict the probability of BOO. The sensitivity and specificity of the criterion for the diagnosis of BOO were satisfactory. The curve we drew could help to differentiate the obstructed men with low pressure-low flow and thus benefit them by surgical relief of their obstruction.

Endotoxins in the prostatic secretions of chronic prostatitis patients.

AIM: To evaluate the clinical significance of the quantitative determinations of endotoxins in the expressed prostatic secretions (EPS) of chronic prostatitis (CP) patients. METHODS: The EPS of 45 patients with CP and 15 normal volunteers were obtained for microscopic examination, bacterial culture and endotoxin determination. The level of endotoxins was determined by the Limulus-amebocyte-lysate test with chromogenic substrate. RESULTS: Patients with CP had higher mean levels of endotoxins in EPS than normal volunteers [52.06 +/- 32.83 EU/L vs. 4.77 +/- 4.14 EU/L (P <0.05)]. The levels of endotoxins in CP type II, type IIIa and type IIIb were 68.62 +/- 34.78 EU/L, 45.30 +/- 23.33 EU/L and 15.83 +/- 5.31 EU/L, respectively [type II vs. type IIIa (P >0.05), type IIIb vs. normal controls (P <0.05), type II/type IIIa vs. normal controls P >0.05)]. CONCLUSION: CP patients have elevated levels of endotoxins in the EPS, which suggests that inflammation is a feature of this disease. EPS endotoxin determination is not only helpful in diagnostic confirmation, but also in evaluating the response to treatment in CP patients.

[The influence of mycophenolate mofetil upon the maturation and allostimulatory activity of cultured dendritic cell progenitors and the effects of tolerance induction in allograft recipients].

OBJECTIVE: To investigate the influence of mycophenolate mofetil (MMF) on the maturation and allostimulatory activity of cultured dendritic cell progenitors (DCPs) and to evaluate the efficacy of pretreatment of donor dendritic cells (DCs) with MMF in tolerance induction in allograft recipients and its possible mechanism. METHODS: DCPs of Balb/c mice were cultured in culture fluid containing recombinant mouse granulocyte-macrophage colony stimulating factor (GM-CSF), and then divided into 4 groups: control group, MMF group, lipopolysaccharide (LPS) group, and MMF + LPS group. Seven days later, flow cytometry was used to analyze the phenotypes of the DCs. ELISA was used to examine the level of IL-12 in the supernatant. T cells from the spleens of C57/BL6 mice were cultured together with inactivated DCs from Balb/c mice, and added with [(3)H]-TdR. Mixed lymphocyte reaction (MLR) was analyzed. The DCs and MMF-DCs cultured for 5 days were co-cultured with T hybridoma cells of the line MF2.2D9 in culture fluid containing ovalbumin (OVA). Twenty-four hours later, the supernatant was collected and ELISA was used to measure the level of interleukin (IL)-12 so as to reflect the antigen-presenting ability of the DCs. OVA immunized C57/BL6 mice for 4 times. 21 days after T cells were collected from the spleens and co-incubated with DCs and MMF-DCs, [(3)H]-TdR was added and the values of counts per minute (cpm) were calculated so as to analyze the antigen-specific proliferation. Twenty-four Balb/c mice were randomly divided into 3 groups: group A (without treatment), group B (treatment with intravenous injection of untreated DCs of Balb/c mice), and group C (treatment with intravenous injection of DCs of Balb/c mice treated with MMF), and then transplanted with the hearts of C57/BL6 mice. The functions of the transplanted hearts were evaluated by touching the arterial pulse and histological examination. ELISA was used to detect the levels of Th1 cytokines, such as IL-12, IL-4, IL-10, IL-2, and IFN-gamma, in the cultured DCs and in the sera of the recipients 7 and 14 days after culture or transplantation. RESULTS: The immunophenotypic analysis showed that in comparison with those in the control group and the LPS group the expressions of the costimulatory molecules, Ia(d), CD80, and CD86, of the DCPs were significantly weaker in the MMF-group and MMP + LPS group. The IL-12 levels in the supernatant of the MMF and MMF + LPS groups of DCPs were significantly lower than those in the other groups (P < 0.01). The IL-12 level of the MF2.2D9 cells treated with MMF-treated DCs was significantly lower than control group (P < 0.01). The ability to stimulate proliferation of T cells of the same genotype in the MMF-DC group was significantly inhibited (P < 0.01). The survival time of the transplanted heart was 30.50 +/- 3.25 days in the C57/BL6 mice injected with untreated DCPs of Balb/c mice (21.25 +/- 2.12, P < 0.01) and that in the control C57/BL6 mice (8.63 +/- 1.06 days, P < 0.01) and with a significant difference between the latter 2 groups too (P < 0.01). The levels of, such as IL-2 and IFN-gamma, 7 and 14 days after heart transplantation of the group B were all significantly lower than those of the group A (both P < 0.05). The IL-2 and IFN-gamma levels 7 days after the heart transplantation were similar to those in the group B (both P > 0.05) and even lower than those of the group C (both P < 0.05). The IL-10 level in the groups B and C were all higher than those in the group A (all P < 0.05) with a significant difference between the group B and group C. The level of IL-4 was not significantly different among the 3 groups. CONCLUSION: MMF has a significant suppressive effect on the maturation and function of DCs, which leads to a donor-specific tolerance in transplant recipients.

[Effect of nitric oxide donor and alpha1-receptor antagonist on proliferation/apoptosis of hyperplastic prostatic stromal cells in vitro].

OBJECTIVE: To study the effect of nitric oxide donor and alpha(1)-receptor antagonist on proliferation/apoptosis of hyperplastic prostatic stromal cells in vitro. METHODS: Primary cultured prostatic stromal cells were treated by nitric oxide donor SNP and Terazosin, and the antiproliferative index and apoptosis index were determined by MTT assay and TUNEL respectively. RESULTS: There was a significant dose-effect relationship between SNP and the antiproliferative effects, while Terazosin showed no antiproliferative effects and the combination of SNP and Terazosin showed no strengthen effects. Terazosin significantly induced apoptosis, but SNP showed no effect on induction of apoptosis, while there were much more effects of inducing apoptosis in the combination of Terazosin and SNP than the Terazosin alone. CONCLUSIONS: Terazosin induces apoptosis in cultured BPH stromal SMCs with little effect on the cell proliferation. SNP inhibits the proliferation of the cells without affecting apoptosis. The apoptosis induction effect is enhanced when Terazosin is combined with SNP, but they do not have an additive antiproliferative effect.

[Effect of cytomegalovirus infection on long-term renal allograft function].

OBJECTIVE: To evaluate the effect of cytomegalovirus (CMV) infection following kidney transplantation on long-term renal function and its mechanism. METHODS: Ninety-six patients undergoing kidney transplantation between March 2000 and December 2005, who completed a 3-year follow-up investigation, were divided into 3 groups according CMV-pp65 antigenemia and clinical symptoms. Group A consisted of 33 recipients with symptomatic active CMV infection, group B included 33 with asymptomatic active CMV infection and group C included 30 with inactive infection. The relation of CMV infection, transforming growth factor-beta1 (TGF-beta1) mRNA in the peripheral blood mononuclear cells (PBMCs) and serum creatinine (Scr) were analyzed, and the grafts in 6 cases with renal dysfunction were biopsied. RESULTS: The expression of TGF-beta1 mRNA in PBMCs was significantly higher in group A than in the other two groups 6 months after the transplantation (P<0.01), while Scr levels showed no significant difference between the 3 groups (P>0.05). Three years later, Scr levels in group A were significantly increased as compared with those in the other two groups (P<0.01), and the rate of renal dysfunction in group A (10/33) was significantly higher than those in group B (3/33) and C(3/30) (P<0.05). In the 16 with renal dysfunction, the expression of TGF-beta1 mRNA in PBMCs significantly higher than that in the other 80 patients with normal renal function (P<0.01). Renal allograft biopsies demonstrated mild or severe interstitial fibrosis, tubular atrophy and mononuclear cell infiltration in the 6 patients with renal graft dysfunction, supporting the diagnosis of chronic allograft nephropathy (CAN). CONCLUSION: Symptomatic active CMV infection in renal allograft recipients is an important factor contributing to the occurrence of CAN. Monitoring of TGF-beta1 mRNA expression in PBMCs proves useful in identifying patients at risk of CAN.

[Diagnosis and therapy for penile cancer: a report of 46 cases with literature review].

BACKGROUND & OBJECTIVE: Penile cancer is an uncommon malignancy, which is mainly treated by surgery, radiation and chemotherapy. This study was to investigate reasonable curative methods for penile cancer. METHODS: Medical records of 46 patients with penile cancer in the Department of Urology, The First Affiliated Hospital of Sun Yat-sen University between Jan. 1996 to Jan. 2005 were analyzed retrospectively. Forty-four patients had squamous cell carcinoma, one had Paget disease, and one had verrucous carcinoma. RESULTS: Thirty-nine patients received partial penectomy, four received total penectomy and perineal urethrostomy, one Paget disease patient received lesion resection and skin grafting, two patients did not receive surgery. Nine out of 10 patients with positive lymph node received ilioinguinal lymphadenectomy, and five received pelvic lymphadenectomy. Forty-one cases were regularly followed up for one to 10 years. The 1-, 2-, 5- and 10- year survival rates were 95.1%, 95.1%, 82.9% and 31.7%, respectively. Prognosis of patients with pelvic lymph node metastasis was poor. Two patients who had pelvic lymph node metastasis died of lung metastasis within two years after surgery. CONCLUSIONS: Partial penectomy is an appropriate and effective management for penile cancer. Lymph node metastasis is an important prognostic factor for penile cancer. Patients with ilioinguinal lymph node metastasis should receive lymphadenectomy as early as possible to improve the therapeutic effect. The prognosis is poor for patients with pelvic lymph node metastases.

[Individualization of transrectal ultrasonography-guided prostate biopsy for prostate cancer detection].

BACKGROUND & OBJECTIVE: Transrectal ultrasonography (TRUS)-guided sextant biopsy technique was regarded as golden standard method for the diagnosis of prostate cancer. Recently, many reports show that the detection rate of prostate cancer by sextant biopsy is not high, and suggest to take more cores to improve the detection rate. But there is no ideal protocol now. This study was to explore an appropriate prostate biopsy protocol for the detection of prostate cancer. METHODS: Clinical data of 325 consecutive men with suspected prostate cancer were analyzed. All patients underwent 12-core biopsy protocol (first biopsy) with additional 1 or 2 cores at each suspicious area detected by TRUS. The sensitivity of different combinations of biopsy cores was analyzed. RESULTS: Of the 325 patients, 126 (38.8%) were positive for prostate cancer. The detection rate by 12-core protocol was significantly higher than maximal detection rate by 6-, 8-, and 10-core protocols (38.8% vs. 27.7%, 29.8%, and 35.4%, P<0.05). In the patients with prostate volume of <40 ml, there was no significant difference in detection rate of prostate cancer between 8-, 10-, and 12-core protocols. In the patients with prostate volume of 40-60 ml, the detection rate by 10-core protocol was significantly higher than that by 8-core protocol (36.2% vs. 26.9%, P=0.046). In the patients with prostate volume of >60 ml, the detection rate by 12-core protocol was significantly higher than that by 10-core protocol (37.9% vs. 25.8%, P=0.049). CONCLUSIONS: Individual prostate biopsy protocol should be taken for the detection of prostate cancer. We recommend 8-core protocol for the patients with small prostate (<40 ml), 10-core protocol for the patients with the prostate of 40-60 ml, and 12-core protocol for the patients with the prostate of >60 ml, and add 1 or 2 cores or take focus biopsy protocol at suspicious areas detected by TRUS.

[Therapeutic effect of sirolimus against chronic allograft nephropathy in kidney transplant recipients].

OBJECTIVE: To investigate the efficacy and safety of sirolimus in management of chronic allograft nephropathy (CAN). METHODS: A retrospective study was conducted involving 31 CAN patients followed up since March 2002, who experienced a change from a calcineurin inhibitor (CNI)-based regimen to a SRL-based regimen. Serum creatinine (Cr) in these patients was compared before and after the regimen change, and the adverse events associated with SRL were analyzed. RESULTS: Till March 2007 when the study closed, 15 patients reached the primary endpoint for resuming dialysis, 8 had improved and 8 had stable renal function. In patients with high Cr(0)(> or =3 mg/L, n=12), 9 resumed dialysis and 2 had improved renal function, but one of the patients with renal improvement eventually died due to infection; in the patients with low Cr(0)(<3 mg/L, n=19), 5 resumed dialysis, 8 had stable renal function and 6 had improved renal function, showing significant difference between the 2 groups (P=0.003). Altogether 14 patients reached the secondary endpoint for ceasing SRL for severe infection (5 patients, of whom 4 resumed dialysis and 1 died of infection) or adverse events associated with SRL (9 patients, of whom 4 resumed dialysis, 2 had stable and 3 had improved renal function). Hyperlipidemia (51.6%), leukocytopenia (41.9%), mouth ulcer (29.0%) and liver function lesion (16.1%) were the commonest adverse events in these patients, and totalling 13 severe adverse events were recorded, including 2 fatal cerebral hemorrhage, 3 fatal infection episodes, and 8 pulmonary and urinary infections that require hospitalization. CONCLUSION: Conversion from a CNI-based to SRL-based regimen can be effective for some CAN cases, especially for those with Cr(0) below 3 mg/L. Attention must be given to adverse events like hyperlipidemia and leukocytopenia, as well as the related cerebral vascular accidents and infections.

[Diagnosis and therapy of metastatic tumors in the adrenal gland--a report of 21 cases].

BACKGROUND & OBJECTIVE: Recently, the occurrence of metastasis to the adrenal gland is increasing, while the early and differentiated diagnosis still remains difficult. Whether metastasis to the adrenal gland needs to be resected and when and how the resection should be done are controversial. This study was to explore the surgical indications of metastasis to the adrenal gland and the role of laparoscopic adrenalectomy in the treatment of this disease. METHODS: Clinical data of 21 patients with metastatic tumors in the adrenal gland, treated in Cancer Center of Sun Yat-sen University from Mar. 1997 to Mar. 2004, were analyzed retrospectively. Literature of the diagnosis and therapy was reviewed. RESULTS: The diagnosis rates of ultrasonography and spiral or thin-cut computed tomography (CT) were 70.0% (7/10) and 84.6% (11/13). Ten patients received adrenalectomy with negative resection margins, 4 of them received laparoscopic adrenalectomy. The patients survived for 1-67 months, with a median of 18 months. One patient was still alive 67 months after the adrenalectomy, and 2 was lost. Eleven patients received palliative operation or no treatment, 10 of them survived for 5-28 months with a median of 13 months, while 1 was lost during follow-up. The difference in survival rates between the 2 groups was not significant (P=0.346). CONCLUSIONS: Ultrasonography and CT are important diagnosis methods for metastatic adrenal cancer. No evidence of tumor invasion revealed by preoperative imaging studies, no adjacent lymphadenopathy and no extraladrenal metastasis are indications of adrenalectomy. Laparoscopic adrenalectomy is safe and effective for those well-selected patients.

[Clinical analysis of 123 cases of transitional cell carcinoma (TCC) of upper urinary tract].

BACKGROUND & OBJECTIVE: With the development of diagnostic techniques of imaging, and application of endoscope, early diagnosis and treatment of transitional cell carcinoma (TCC) of upper urinary tract have been improved to a great extent in recent years, but still caused debates. In this article, we discussed the diagnostic and therapeutic methods of TCC of upper urinary tract. METHODS: Clinical data of 123 patients with TCC of upper urinary tract treated in our hospital from Mar. 1996 to Dec. 2003 were retrospectively analyzed. RESULTS: Ratios of final diagnosis of renal pelvic cancer (RPC) by B ultrasound, intravenous pyelogram (IVP), and computed tomography (CT) were 82.1% (46/56), 37.1% (20/54), and 88.1% (37/42), respectively; those of ureter cancer were 11.8% (4/34), 3.2% (1/31), and 93.8% (15/16), respectively. Successful retrograde pyelography could locate both kinds of carcinomas accurately. Of 123 patients, 116 underwent radical surgery, and 7 given up for metastasis or poor heart and lung function; 107(87.0%) were followed-up with a mean of 3.5 years. Three-year survival rates of patients with superficial RPC (stage T1), and invasive RPC (stages T2-T4, or N1, N2) were 94.1%, and 73.6%; 5-year survival rates were 88.2%, and 43.3%. Three-year survival rates of patients with superficial ureter cancer, and invasive ureter cancer were 100%, and 68.8%; 5-year survival rates were 80.0%, and 40.6%. Bladder tumor occurred in 29 (23.6%) patients. CONCLUSIONS: Combination of IVP and B ultrasound should be used as a routine examination for TCC of upper urinary tract. Retrograde pyelography may be used as an adjuvant examination when IVP showed negative results, CT may be used for further examination. Radical resection of kidney and ureter is the preferred treatment for this disease.

[Correlation of clusterin expression to prognosis of bladder carcinoma].

BACKGROUND & OBJECTIVE: Clinically, molecular prognostic markers for bladder carcinoma are still rare. Recently, up-regulation of clusterin protein has been suggested to relate with development and prognosis of several human cancers, but its relation with bladder cancer is unclear. This study was to analyze correlation of expression of clusterin protein to clinicopathologic parameters and prognosis of bladder cancer with tissue chip. METHODS: A tissue microarray containing 81 cases of bladder carcinoma was constructed. The expression of clusterin was detected by immunohistochemistry; its correlation with clinicophathologic parameters was analyzed. RESULTS: Of the 81 cases of bladder cancer, 69 were detectable by immunohistochemistry, 32 (46.4%) of which showed overexpression of clusterin protein. Overexpression rate of clusterin was significantly higher in poorly differentiated (G3 grade) tumors than in well differentiated (G1-G2 grades) tumors (75.0% vs. 34.7%, P=0.002), and was significantly higher in invasive (T2-T4 stages) tumors than in superficial (Ta-T1 stages) tumors (65.4% vs. 34.9%, P=0.014). Expression of clusterin was negatively correlated with prognosis of bladder cancer patients (log-rank=5.88, P=0.015); the recurrence-free survival time of patients with overexpression of clusterin was shorter than that of patients with normal expression of clusterin (37.3 months vs. 48.8 months). CONCLUSION: The overexpression of clusterin might be a molecular prognostic marker of bladder cancer.

[Characteristics of neoplasm occurrence of renal allograft recipients and their prognosis].

BACKGROUND & OBJECTIVE: Renal allograft recipients are more likely to develop neoplasm than general population because of long-term immunosuppressive treatment and concurrent infections. This study was designed to analyze the clinical features of neoplasm occurrence of renal allograft recipients, and the effect of radical surgery (RS) on their prognosis. METHODS: Records of 2 160 renal allograft recipients treated in our center from Oct. 1987 to Apr. 2003 were retrospectively studied. The time to neoplasm development, pathologic type of tumor, patients' survival time were analyzed to explore the clinical features of neoplasm developing after kidney transplantation. Recipients developed neoplasms were divided into RS group and non-RS group according to their treatment pattern. The effect of RS on patients' survival was estimated. RESULTS: A total of 33 patients developed neoplasms after transplantation. Among them,11(33.3%) developed neoplasms in digestive system. The median survival time of RS group (10 patients) was 41.5 months, that of non-RS group (23 patients) was 6.0 months. The 20-month survival rate of RS group was 70.0%, while that of non-RS group was 13.0%. CONCLUSIONS: Renal allograft recipients are more likely to develop neoplasm than general population. Moreover, their main malignancies are liver cancer, skin cancer, lymphoma and thyroid carcinoma, which differ from those observed in general population. Early diagnosis and treatment, especially feasible RS, will improve short-term outcome, while long-term therapeutic effect needs to be further observed.