Renal Autotransplantation in Lynch Syndrome: A Viable Option in a Patient With Contralateral Metachronous Ureteral Cancer

The success of human kidney allotransplantation was realized over six decades ago. First described 50 years ago, renal autotransplantation has been utilized sparingly as a salvage procedure for patients at risk of losing renal function, either from a benign or malignant condition. While classically associated with colorectal malignancies, Lynch syndrome also carries a small yet significant risk for the development of ureteral carcinoma. For these patients who develop chronic kidney disease, allotransplantation may not be an option due to the lifelong risk of several malignancies. We report the first known case of renal autotransplantation in a patient with metachronous ureteral cancer due to Lynch syndrome.

Retrograde flexible ureterorenoscopic holmium-YAG laser lithotripsy: the new gold standard

To demonstrate the efficacy of flexible retrograde ureterorenoscopic holmium-YAG intracorporeal laser lithotripsy for the treatment of renal calculi, a total of 86 patients presenting to our hospital with renal calculi underwent flexible retrograde ureterorenoscopic holmium-YAG intracorporeal laser lithotripsy of their stones, and the data were collected prospectively. As extracorporeal shock wave lithotripsy is not available at our institution, all patients with renal calculi in this study were treated in a retrograde fashion using the Richard Wolf 6.0F semirigid ureteroscope, the 7.5F flexible ureterorenoscope, and the holmium-YAG laser by Coherent Inc. Except for inhospital consults or patients requiring admission secondary to infection, all cases were performed on an ambulatory basis. All renal calculi 3 cm or smaller were approached in a retrograde fashion. Where possible, the stones were initially debulked using the semirigid ureteroscope and the 550-microm fiber followed by the flexible ureterorenoscope in combination with the 360- or 200-microm laser fiber depending on stone position. Stones were fragmented until they were small enough to be removed by hydrocleansing. Using this technique, stone-free success rates for calculi 2.5 cm or smaller after a single treatment, regardless of stone composition or location, are superior to those of extracorporeal shock wave lithotripsy. For calculi between 2.5 and 3 cm, the results also are noted to be superior. We conclude that for calculi larger than 3 cm or for partial staghorn calculi, the treatment of choice appears to be a percutaneous approach.

Holmium:YAG laser and its use in the treatment of urolithiasis: our first 160 cases

Over the course of 18 months, 160 patients underwent endoscopic holmium:YAG laser surgery at our institution for the treatment of urolithiasis. After appropriate consent had been obtained, 127 patients were treated for ureteral calculi, 18 for renal calculi, and 15 for large bladder stones. All procedures were performed using the VersaPulse combination holmium:YAG/Nd:YAG laser by Coherent Inc., and all were done endoscopically using video guidance. Of the 16 patients treated percutaneously for renal calculi, 5 were rendered stone free (mean stone size 3.5 cm). Two patients with renal calculi were treated in a retrograde fashion. One had a 1-cm stone in an upper-pole calix with a narrow infundibulum, while the other had a stone just proximal to the ureteropelvic junction. Both patients were rendered stone free. Of the 127 patients with ureteral calculi, 46 had stents placed after fragmentation of their stones. To date, 123 patients in this group (97%) are free of stones. All 15 patients with bladder calculi had complete fragmentation of their stones. The Ho:YAG laser is effective and versatile in the treatment of urolithiasis.

Visualization of glucocorticoid receptor translocation and intranuclear organization in living cells with a green fluorescent protein chimera

A highly fluorescent mutant form of the green fluorescent protein (GFP) has been fused to the rat glucocorticoid receptor (GR). When GFP-GR is expressed in living mouse cells, it is competent for normal transactivation of the GR-responsive mouse mammary tumor virus promoter. The unliganded GFP-GR resides in the cytoplasm and translocates to the nucleus in a hormone-dependent manner with ligand specificity similar to that of the native GR receptor. Due to the resistance of the mutant GFP to photobleaching, the translocation process can be studied by time-lapse video microscopy. Confocal laser scanning microscopy showed nuclear accumulation in a discrete series of foci, excluding nucleoli. Complete receptor translocation is induced with RU486 (a ligand with little agonist activity), although concentration into nuclear foci is not observed. This reproducible pattern of transactivation-competent GR reveals a previously undescribed intranuclear architecture of GR target sites.

Applied stapling technique in radical retropubic prostatectomy: efficient, effective and efficacious

PURPOSE

We demonstrated the efficiency, efficacy and effectiveness of the endoscopic gastrointestinal anastomosis (GIA) stapler in radical retropubic prostatectomy.

MATERIALS AND METHODS

A total of 21 patients with organ confined prostate cancer on preoperative staging underwent radical retropubic prostatectomy. During these procedures we analyzed the applicability and efficacy of the endoscopic GIA vascular stapler to effect ligation, division and stapling of the dorsal vein complex and lateral pedicles of the prostate. This group was compared to 7 controls in whom we performed surgery for organ confined disease, using the stapler solely for the lateral prostatic pedicles or not at all depending on availability. One patient with localized muscle invasive transitional cell carcinoma of the bladder underwent radical cystectomy using the endoscopic GIA stapler in a sequential fashion to ligate and divide all pedicles of the specimen.

RESULTS

Mean total operative time was 2 hours (range 1 hour 40 minutes to 2 hours 50 minutes) and average estimated blood loss was 400 cc. All patients were discharged from the hospital on postoperative day 3. To date 17 of the 21 patients are continent and 6 are potent.

CONCLUSIONS

Although not designed to replace the standard approach to radical retropubic prostatectomy, we believe that this technique makes the procedure easier and more approachable in the hands of the less experienced surgeon.

Cytometrically detected specific binding of interleukin 2 to cells

We have developed a new technique for detecting binding of interleukin 2 (IL-2) to cells. This technique involves incubating the cells with IL-2 and then analysing the cell surface with specific anti-IL-2 antibodies and flow cytometry. This binding was only detected on tumor cells that possessed the p55 subunit of the IL-2 receptor. The role of p55 was ascertained by inhibition of the binding with a monoclonal antibody to p55. Although p55 is necessary for cytometrically detected IL-2 binding, further studies demonstrated that p55 is not sufficient. Thus, cytometrically-detected binding is likely to involved the contribution of other IL-2 surface receptors. Interleukin-2 binding to peripheral blood T lymphocytes and to a non-transformed T-cell clone was also detected cytometrically and it was shown that this binding is regulated by the activation status of the cells. Whereas IL-2 binding to quiescent T cells could not be detected, upon activation abundant binding was seen. The functional consequences of this type of cellular binding were studied. Interleukin-2 binding to cells during a short pulse was shown to have significant long-term consequences both for T-cell proliferation and for the enhancement of major histocompatibility complex (MHC)-non-restricted cytotoxicity.