Retroperitoneal "Triton" tumor.

Malignant Triton tumor is a malignant peripheral nerve sheat tumor with rhabdomioblastic differentiation. These tumors are frequently associated with Neurofibromatosis type 1, sporadic cases being exteremly rare. Retroperitoneal localization have the most unfavorable prognois due to delayed diagnosis but also due to relation to adjacant organs. Preoperative diagnosis is inaccurate, but core needle biopsy gives more promising results. Aggressive surgical management remains the most effective modality since adjuvant forms of treatment like irradiation or chemotherapy do not have reproducible results. We present a 60-year-old female patient in whom a retroperitoneal presacral mass was postoperatively diagnosed as Triton tumor. At time of diagnosis, no visible metastases were present. The posterior pelvic exenteresis was performed. Intended chemotherapy was never started since multiple pulmonary, hepatic and splenic metastases were diagnosed only a month after surgery, with rapid lethal outcome. This case demonstrates the bad prognosis of malignant retroperitoneal tumors. Diagnostic tools such as refined biopsy techniques or cytogenetic analysis might help in differentiating patients who will benefit from radical surgery.

Diagnosis of prostate cancer in Serbia.

PURPOSE: A rising incidence of prostate cancer is noticed in USA and Europe, which might be due to better diagnostic procedures and screening programs started in some countries. We still lack epidemiological studies confirming the same trend in our country, but the rising number of patients in whom radical prostatectomy is performed is an indirect proof of bigger recruitment of patients with prostate cancer. The purpose of this study was to establish the most appropriate diagnostic protocol for detection of prostate cancer in our unscreened population. MATERIALS AND METHODS: Transrectal ultrasound (TRUS) -guided biopsies of the prostate were performed in 229 patients. Biplanar transrectal probe with needle channel was used. Six to 10 tissue cores were obtained from each patient. RESULTS: The mean patients' age was 67.12 years (range 42-88). All patients had serum prostatic specific antigen (PSA) estimation before biopsy, which ranged from 0.41 to 1550 ng/ml (mean 50.83), with 146 (63.8%) patients having PSA level greater than 10 ng/ml. Free (F) PSA was performed in 120 (52.4%) patients; the range of F to total (T) PSA ratio was 0.02 to 0.74 (mean > 0.13). Digital rectal examination (DRE) was positive in 65% of the patients. The mean prostate volume was 40.5 ml (range 11-140). Cancer was diagnosed in 99 (43.2%) patients, prostate cancer in situ (PIN) alone was diagnosed in 37 (16.2%), chronic prostatitis in 73 (31.9%), while benign prostatic hyperplasia (BPH) was found in 20 (8.7%) patients. CONCLUSION: The cancer detection rate in our patients was high. In a lot of patients the biopsy was needed only for histological proof, not as a staging tool, the intention of which is the selection of patients with localized prostate cancer amenable to curative treatment. There is still reluctance to use PSA as a sole indication for biopsy, positive DRE still being mandatory. With such a policy we are missing a lot of curable prostate cancer cases, thus increasing the cost of treatment. A national policy including screening should be considered.

Mitogen-induced lymphoproliferative response and phagocytic-activity of monocytes in renal-cell carcinoma patients treated by interferon a alone or in combination with vinblastine.

The functions of T cells and monocytes were studied in relation to the clinical stage and clinical course of renal cell carcinoma (RCC) patients, treated by interferon alpha (LFN-alpha). Lymphoproliferative response (LPR) to phytohemagglutinin and phagocytic activity of peripheral blood monocytes were estimated before, immediately after, and six months after completion of therapy with IFN-alpha alone (applied in stage II RCC) or in combination with vinblastine (in stages III and IV). The number of total T cells and their mitogen-induced proliferative response were diminished in all patient groups before therapy, the decrease of LPR being more pronounced in advanced (III and IV) stages of the disease. The pretreatment number of monocytes and their phagocytic activity were increased in RCC patients regardless of clinical stage. The initial level of the lymphocyte and monocyte functions did not correlate with the clinical course of the disease. The pretreatment levels of LPR and phagocytic activity were not changed immediately after IFN treatment, irrespective of the clinical response to therapy. Similar results were obtained six months after therapy; the only exception was the increased LPR in stage III patients, which was unrelated to clinical response to the therapy, since it was seen in patients with progression of the disease. These findings suggest that the pretreatment level of LPR and monocyte phagocytic activity in RCC patients in different clinical stages of RCC were not predictive of the clinical response to IFN therapy. IFN-alpha, as used in this study, had no major influence on LPR and phagocytic activity of monocytes irrespective of the clinical stage or clinical course of the disease.

Immune reactive proteins in renal cell carcinoma patients treated by IFN alpha alone or in combination with vinblastine.

Immunoreactive proteins--serum immunoglobulins and immune complexes were evaluated in renal cell carcinoma (RCC) patients. The analyses were done after radical nephrectomy before, at the end, and six months after the therapy, with IFN alpha alone (in patients in Stage II) or IFN alpha in the combination with vinblastine (in patients in Stage III and IV of the disease). Data obtained before immuno- or immunochemotherapy show significant increase in IgG and IgA concentrations in RCC patients in all stages of the disease investigated--in comparison to controls, while circulating immune complexes were significantly elevated only in patients in the advanced Stages of the disease (III and IV). The unchanged IgM level was found in all untreated RCC patients regarding the controls. Immuno- or immunochemotherapy did not affect the immunoreactive proteins (Ig and CIC) in the investigated patients, without respect to their clinical response to the applied therapy.

Neurobiology of depression: an integrated view of key findings.

AIMS: The objectives of the present review were to summarise the key findings from the clinical literature regarding the neurobiology of major depressive disorder (MDD) and their implications for maximising treatment outcomes. Several neuroanatomical structures in the prefrontal and limbic areas of the brain are involved in affective regulation. In patients with MDD, alterations in the dynamic patterns of activity among these structures have profound implications for the pathogenesis of this illness. DISCUSSION: The present work reviews the evidence for the progressive nature of MDD along with associated changes in neuroanatomical structure and function, especially for the hippocampus. The role of glucocorticoids, inflammatory cytokines and brain-derived growth factors are discussed as mediators of these pathological alterations. From this integrated model, the role of antidepressant therapy in restoring normative processes is examined along with additional treatment guidelines. CONCLUSION: Major depressive disorder is an illness with significant neurobiological consequences involving structural, functional and molecular alterations in several areas of the brain. Antidepressant pharmacotherapy is associated with restoration of the underlying physiology. Clinicians are advised to intervene with MDD using an early, comprehensive treatment approach that has remission as the goal.

[Current knowledge on cryopreservation of spermatozoa, ovum cells and zygotes]. / Dosadasnja saznanja o kriokonzervaciji spermatozoida, jajnih celija i zigota.

CELL INJURIES DURING FREEZING AND THAWING: The aim of various cryopreservation procedures is to minimize cell injuries during the freeze-thaw cycle (cryoinjuries). Generally, the cell damage during freezing and thawing procedures may be the results of: (a) extensive cellular dehydration (solution effect) and/or (b) intracellular ice crystallization/recrystallization (mechanical cell damage). Two independent mechanisms are involved. They can act simultaneously, leading to cytolysis. The first one is expressed primarily during low rate freezing, and the second one during rapid freezing. Thus, determination and use of the optimal cooling velocity, specific for each type of isolated cells, should be considered. Finally, a higher degree of cell destruction has been documented when the transition period from liquid to solid phase (release of the fusion heat) is prolonged. CRYOPROTECTIVE AGENTS: For successful cell cryopreservation, cryoprotectants are needed. They decrease the osmotic gradient and the vapor pressure difference between the intra- and extracellular area. Adequate choice of the most suitable type and concentration of cryoprotective agent is important for the required cell recovery after thawing. There are several well known protocols for obtaining cryopreservation of isolated cells using different cryoprotectants. Glycerol, dimethyl sulfoxide (DMSO) and propanediol sucrose are commonly used as cryoprotectants, though in different concentrations. Glycerol, a trihydric alcohol, is a clear, colorless fluid. Pharmacologically, it is relatively inert. DMSO is a colorless liquid with a sulphur-like smell and has several medical uses. It is highly polar and dissolves many water- and lipid-soluble substances. DMSO given intravenously may cause nausea, vomiting, local vasospasm and an objectionable garlic-like odor and taste. HUMAN SPERM, OVA AND EMBRYOS CRYOPRESERVATION: Despite the fact that cryopreservation procedures of spermatozoa, ova and embryos are already in routine clinical use, some questions related to the optimal cooling velocity during controlled-rate freezing and the choice of the most effective, either penetrating (glycerol, dimethyl sulfoxide) and/or non-penetrating (hydroxyethyl starch) cryoprotective agent at the appropriate concentration are not resolved.

[Quality of life in patients with renal carcinoma]. / Kvalitet zivota kod bolesnika sa karcinomom bubrega.

First line treatment of renal cell carcinoma (RCC) is radical nephrectomy. In patients with metastasis or with local recurrence adjuvant immunohaemiotherapy is necessary. Interferon alpha is used with or without Interleukin 2 in combination with cytostatics. Immunotherapy induces some adverse effects which might compromise the treatment. The aim of this pilot study was to asses the effect of interferon on the quality of life in patients with RCC previously treated with radical nephrectomy. The originally made questionnaire was used to measure the impact of the treatment on quality of life of 15 patients. It was that Interferon did not alter significantly the quality of life in examined patients.