Aims: Peroxisome proliferator-activated receptor gamma (PPAR gamma) is a ligand-activated transcriptional factor that regulates the transcription of various target genes. Our purpose is to investigate the clinicopathologic and prognostic significance of PPARy expression in human urothelial bladder cancer (BUC).Methods: Immunohistochemistry was applied in 117 paraffin-embedded specimens of human BUC to detect the proteins PPARy and Ki67. The image analysis method was used for the evaluation of the immunohistochemical staining.Results: PPARy protein was localized in the nuclei of the malignant cells. Its expression was inversely associated with the stage of BUCs (p < 0.001), tumor grade (p = 0.007) and the expression of the proliferation marker Ki67 (p = 0.015) while it was found to exert a favorable effect on patients' overall survival (p = 0.001).Conclusion: The findings of the present study suggest that in BUC, PPARy expression can identify patients with a better prognosis who suffer front more differentiated, non-invasive tumors, of a low proliferative potential. (C) 2008 Elsevier Ltd. All rights reserved.

Hydatid disease constitutes an endemic zoonosis caused by different species of the cestode Echinococcus. The main organs affected are the liver and the lungs. Echinococcosis of the urinary tract is an extremely rare medical condition, met in 2-4% of cases. This pathologic entity has to be included in the differential diagnosis of occupying lesions of the urinary tract at any age, especially among patients in endemic areas. Meticulous laboratory and imaging control when taking into consideration the suspicion for the disease, can guarantee an accurate diagnosis and successful outcome.

Evaluation of therapeutic touch (TT) in the nursing of burn patients; post hoc evaluation of the research process in a non-academic nursing setting.38 burn patients received either TT or nursing presence. On admission, days 2, 5 and 10 of hospitalization, data were collected on anxiety for pain, salivary cortisol, and pain medication. Interviews with nurses were held concerning research in a non-academic setting.Anxiety for pain was more reduced on day 10 in the TT-group. The TT-group was prescribed less morphine on day 1 and 2. On day 2 cortisol level before dressing changes was higher in the TT-group. The situational challenges of this study led to inconsistencies in data collection and a high patient attrition rate, weakening its statistical power.Conducting an effect study within daily nursing practice should not be done with a nursing staff inexperienced in research. Analysis of the remaining data justifies further research on TT for burn patients with pain, anxiety for pain, and cortisol levels as outcomes.Administering and evaluating TT during daily care requires nurses experienced both in TT and research, thus leading to less attrition and missing data, increasing the power of future studies.

Mismatch repair (MMR) genes are involved in the recognition and repair of acquired DNA damage, which arises during cell division, thus playing an essential role in preserving genetic stability. Immunohistochemistry was applied to 130 specimens from urothelial carcinoma (UC) of the bladder to detect expression of MMR gene products hMSH2 and hMSH6, and to investigate its clinicopathological and prognostic value. hMSH2 and hMSH6 protein expression was exclusively detected in the nuclei of malignant cells. Of the 112 cases evaluable for hMSH2, 29 (25.9%) were negative and of the 130 UCs evaluable for hMSH6, 64 (49.2%) were negative, and were thus considered to depict MSI. Nuclear hMSH2 values were statistically lower in non‐invasive UCs (Ta‐T1) (p=0.013) and in carcinomas with decreased p53 staining (p=0.04). Lower hMSH6 values were more often met in well‐differentiated tumors (p<0.0001) and in tumors with low expression of p53 (p=0.016), topoIIα and caspase 3 (p=0.017 and p=0.018, respectively). Both hMSH2‐ and hMSH6‐negative immunoreactions were found to have a favorable impact on overall patient survival (p=0.041 and p=0.034, respectively), this finding being further verified in the multivariate analysis of hMSH2 (p=0.026). This is the first study to show that lack (and not reduction designated according to various cut‐off points) of hMSH2 and hMSH6 correlated with non‐invasive tumors of lower grade and is of favorable prognostic significance in patients suffering from bladder carcinoma.

BACKGROUND:General and spinal anesthesia are currently in widespread use during transurethral bladder tumor resection. However, local anesthetic methods are claimed to provide sufficient intra-operative analgesia and satisfactory post-operative pain management. We evaluated whether local levobupivacaine infiltration of the tumor would result in outcomes, in terms of intra-operative analgesia, similar to those for utilization of general anesthesia. Post-operative analgesia and patient satisfaction were also assessed. PATIENTS AND METHODS:Twenty patients with recurrent solitary bladder tumors were randomly allocated in two groups. Group A, underwent tumor resection under general anesthesia and group B was treated with resection after local levobupivacaine infiltration. Post-operative analgesia was evaluated with utilization of a visual analogue scale, ranging from 0 to 10, with higher scores indicating more intense pain perception. RESULTS:Group A patients demonstrated significantly lower visual analogue scale scores at t=0, which peaked at 4 h post-operatively. Group B scores were higher at t=0, declined over a 2 h interval and reached zero after t=4 h. Patients younger than 60 years and women benefitted more. Local anaesthesia was the method of pain control preferred by 90% of patients. CONCLUSION:Local levobupivacaine infiltration for transurethral bladder tumor resection seems feasible, providing intra and post-operative pain control. In this preliminary setting, general anesthesia provided a higher level of pain control in the immediate post-operative period (<4 h) while local levobupivacaine infiltration demonstrated excellent late post-operative analgesia (>4 h). Also, patients seem to prefer local to general anesthesia in future surgery.

The feasibility of peroral transgastric peritoneoscopy, liver biopsy, and tubal ligation has been demonstrated in prior animal studies. This approach has the potential to reduce postoperative morbidity.To explore the technical challenges and complications of performing a transgastric organ resection.Two-week animal survival study.Five female Yorkshire pigs underwent peroral transgastric partial hysterectomy. With the animals under general anesthesia, a sterile esophageal overtube was placed and a gastric antibiotic lavage was performed. Subsequently, a needle-knife and through-the-scope dilating balloon were used to make an anterior gastric wall incision through which a therapeutic gastroscope was advanced into the peritoneal cavity. Endoscopes and instruments previously had been disinfected in a 2.4% glutaraldehyde bath or were disposable. An endoloop and polypectomy snare were used to resect a portion of the uterus, which was removed through the mouth. Gastric incision closure was attempted with endoclips. After 2 weeks of observation, necropsy was performed.Transgastric partial hysterectomy was performed on all 5 animals. One animal became lethargic and febrile, so necropsy was performed on day 4. An incompletely closed gastric incision and suppurative peritonitis were found. A second animal developed a fever; necropsy performed on day 14 revealed a gastric abscess at the incision site and scattered abdominal pus. No complications were encountered in the 3 remaining animals, and necropsy revealed well-healed gastric incisions and no evidence of peritonitis.Endoscopic transgastric partial hysterectomy is technically feasible in a porcine model. Strict sterility seems mandatory but cannot always be assured. Incomplete closure of the gastric incision may lead to significant complications.

A1-blockers are widely used for symptomatic improvement of bladder outlet obstruction (BOO) although there is urodynamic evidence that their administration results in a small reduction of BOO. Since it is widely accepted that obstructed bladders are ischemic, in the present study we investigated the effect of a1-blockers in ischemia in human obstructed bladders.

The aim of this study was to investigate the patterns of renal function recovery during partial nephrectomy (PN) on an experimental solitary kidney rabbit model and establish the upper tolerable time limits of applied ischemia. Forty-eight New Zealand rabbits underwent an open right nephrectomy and after 30 days, the animals were clustered into five groups (A, B, C, D, E). The first four groups received an open left PN, under different types of ischemia. Groups A ( n = 8) and B ( n = 10) were subjected to 90 and 60 min of warm ischemia (WI), respectively, while groups C ( n = 10) and D ( n = 10) received 90 and 120 min of cold ischemia (CI) with ice-slush cooling. Group E ( n = 10) served as sham group. Serum determinations of creatinine (SCr) and BUN were recorded preoperatively and on postoperative days (POD) 1, 3, 6 and 15. The animals were euthanized and the remaining kidneys were harvested and evaluated microscopically. The type and duration of ischemia were statistically significant parameters ( P < 0.001). Groups B, C and D exhibited a similar pattern of recovery from trial initiation to the 15th POD ( P = 0.788 and P = 0.068, respectively). Group A was extremely differentiated, with 100% mortality caused by uremia. The microscopic findings were consistent to the serum biochemistry. In our solitary kidney rabbit model, the upper limits of tolerable WI seem to be set on 60 min. CI can safely preserve the model’s renal function—even up to 120 min.

Hypoxia in human obstructed detrusor was investigated through the expression of HIF-1a (hypoxia inducible factor 1a) and the results were correlated with clinical parameters of the patients.

Tumor marker Ca19-9 is a mucus glycoprotein that bears, in a repetitively manner, a carbohydrate the Sialyl Lea antigen that is related to the Lewis blood group system. The presence of Lea/b antigens correlates with the Lewis status of individuals. We have examined the relationship of the Ca19-9 antigen with the renal pelvis dilatation and its association with the patients Lewis status.

Preservation of normal renal function is a priority following a partial nephrectomy (PN) in a solitary kidney, especially when a prolonged period of ischemia is applied. Our aim was to investigate the patterns of renal function recovery after an ischemic insult and establish the upper tolerable limits of warm and cold ischemia in an experimental model undergoing PN.

Various techniques of the ileal neobladder have been proposed during the last 15 years. In this article, we present our 10-year experience of a personal modification of the ileal S-pouch, using a short, small bowel segment.

Hydatid disease mainly affects the liver and the lungs. Pelvic involvement have been rarely reported in the literature. Herein we present a rare case of isolated hydatid cyst of pelvis attached to the urinary bladder.

Seminal vesicle belongs to the unusual sites of the hydatid cyst presentation. Even though the patient had a history of surgically treated hydatid disease of the liver, however, solitary echinococcal cyst of the seminal vesicle is a rare condition. Surgical removal of the cyst intact is the treatment of choice.

BACKGROUND:Mismatch repair genes are possibly involved in the tumorigenesis and/or progression of bladder cancer, as has been reported in colorectal and other cancers.MATERIALS AND METHODS:The protein expression of one of these genes (MLH1) was examined in 121 patients with urothelial carcinoma (UC) of the bladder by an immunohistochemical technique.RESULTS:Reduced expression of MLH1 protein was detected in 56 cases (46%) and was significantly more frequent in pT2 UCs (p=0.039). In superficial disease (Ta-T1 tumors), preserved expression of the MLH1 protein was detected in tumors with high proliferation indices, as evidenced by Ki-67 immunostaining (p=0.046). Interestingly, low MLH1 levels were positively-associated with the possibly low apoptotic potential of the tumor cells, as evidenced by decreased caspase-3 (CPP32) immunoreactivity (p=0.050).CONCLUSION:A significant proportion of UCs revealed low positivity percentages for MLH1 expression, probably reflecting MLH1 gene dysfunction in the respective cases. Preserved MLH1 expression was associated with highly proliferating cells, which are more likely to need DNA repair systems. A reduced expression of MLH1 may exert an adverse influence on the apoptotic potential of cancer cells.