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Free radicals contribute to the pathogenesis of diabetic cardiomyopathy. We present a method forin vivoobservation of free radical events within murine diabetic cardiomyopathy. This study reports onin vivoimaging of protein/lipid radicals using molecular MRI (mMRI) and immuno-spin trapping (IST) in diabetic cardiac muscle. To detect free radicals in diabetic cardiomyopathy, streptozotocin (STZ)-exposed mice were given 5,5-dimethyl-pyrroline-N-oxide (DMPO) and administered an anti-DMPO probe (biotin–anti-DMPO antibody–albumin–Gd–DTPA). For controls, non-diabetic mice were given DMPO (non-disease control), and administered an anti-DMPO probe; or diabetic mice were given DMPO but administered a non-specific IgG contrast agent instead of the anti-DMPO probe. DMPO administration started at 7 weeks following STZ treatment for 5 days, and the anti-DMPO probe was administered at 8 weeks for MRI detection. MRI was used to detect a significant increase (p< 0.001) in MRI signal intensity (SI) from anti-DMPO nitrone adducts in diabetic murine left-ventricular (LV) cardiac tissue, compared to controls. Regional increases in MR SI in the LV were found in the apical and upper-left areas (p< 0.01 for both), compared to controls. The biotin moiety of the anti-DMPO probe was targeted with fluorescently-labeled streptavidin to locate the anti-DMPO probe in excised cardiac tissues, which indicated elevated fluorescence only in cardiac muscle of mice administered the anti-DMPO probe. Oxidized lipids and proteins were also found to be significantly elevated (p< 0.05 for both) in diabetic cardiac muscle compared to controls. It can be concluded that diabetic mice have more heterogeneously distributed radicals in cardiac tissue than non-diabetic mice. [ABSTRACT FROM AUTHOR]

Author(s): V. Compernolle; K. Brusselmans; T. Acker; P. Hoet; M. Tjwa; H. Beck; S. Plaisance; Y. Dor; E. Keshet; F. Lupu; B. Nemery; M. Dewerchin; P. Van Veldhoven; K. Plate; [...]

Introduction and objectives: Cumulative incidence of metacronous renal tumors is 0.8% at a 20 year follow-up, higher in younger patients (approximately 1.8% within 10 years). In the case of a solitary kidney, NSS is imperative in order to avoid dialysis. The difficulty of NSS is related to the position of the tumor rather than its dimensions. The objective of this paper is to present the usefulness of intraoperative ultrasonography in a case of centrally located solitary renal tumor. Materials and methods: We present the case of a 62 year old male patient with a history of a right renal tumor operated 10 years prior (radical nephrectomy), who came with an incidental diagnosis of central left renal tumor. The tumor had a diameter of 3.5 cm, and the CT scan found it to be closer to the posterior aspect of the renal sinus. Considering all the angles we decided a NSS was best suited, in order to preserve the renal function. The surgical technique involved a lombotomy and perirenal fat dissection. Because we were not able to identify the expression of the tumor on the renal surface (it did not bulge the renal cortex), we decided to perform an intraoperative ultrasound to distinguish the limits of the tumor (using a Siemens Acuson X300 with a 13 MHz linear array transducer), instead of going directly for a radical nephrectomy and dialysis. We then marked these limits on the surface of the kidney with an electrocautery. We afterwards performed an enucleoresection using ligasure sealing system on the main intrarenal vessels and tumor bed compression with a perirenal fat flap. Short term (5 minutes) renal artery clamping was needed, to reduce the blood loss while suturing the pyelocaliceal concomitant lesions and conducting the hemostasis. Results: A temporary rise of creatinine to 2 mg/dl was observed, which later subsided. Postoperative urine drainage was registered and consequently a double J stent was inserted. The histopathological report revealed a clear cell carcinoma Fuhrman grade 3, stage pT1a. 6 months after surgery the patient developed pulmonary nodes suggestive for metastasis and underwent Sunitinib treatment. At the 1 year follow-up the patient is alive, without oncologic progression and a normal renal function. Conclusions: NSS is the treatment of choice that avoids dialysis in cases of renal tumors with solitary kidney. Centrally located renal tumors are the most difficult cases for NSS. Intraoperative ultrasonography is mandatory for determining the borders of a tumor without an expression on the kidney surface. [ABSTRACT FROM AUTHOR]

Introduction: Renal cell carcinoma is one of the most common tumors in adults, accounting for approximately 3% of all cancers. Association of renal tumors and other neoplasia is a rare event. Surgical treatment strategy of synchronous bilateral renal tumors and the value of lymph node dissection are subjects of debate. Objective: To present the management of a complex case of synchronous bilateral kidney tumors associated with Hodgkin lymphoma. Materials and method: We present the case of a 64 years-old woman admitted for abdominal pain, loss of appetite and weight. Abdominal CT showed a massive left kidney tumor with lateroaortic, interaoticocaval and laterocaval lymph node enlargement and extension in the subhepatic inferior vena cava, and a 4 cm upper pole tumor of the right kidney. No distant metastases were revealed on the thoracic CT. The surgical strategy involved a left radical nephrectomy, caval thrombectomy and extensive lymph node dissection as the first step. We made an anterior transperitoneal triradiate incision with bilateral coloparietal dissection. First we went on the right side in order to approach the thrombosed inferior vena cava. The left renal artery is ligated near the aorta. We applied a tourniquet on the suprarenal caval vein just above the tumor thrombus, on the infrarenal cava vein and on the right renal vein. Next we incised the inferior vena cava at the ostium of the left renal vein with the extraction of the thrombus and caval wall suture. Then we moved to the left side and standard perifascial nephrectomy and en bloc thrombectomy was performed. After that we performed an extensive periaortocaval lymph node dissection. Considering that we had no restant tumor tissue, and there was a wide exposure of the right kidney, we decided to perform a right superior polar nephrectomy in the same intervention, with electrothermal bipolar sealing system and a fat flap compression of the tumor bed. Results: Postoperative creatinine rose to 2.5 mg/dl and then slowly decreased to a normal value. Histopathological examination sowed bilateral clear cell carcinoma Fuhrman II and III and Hodgkin lymphoma in the LND specimen. Consequently specific treatment for Hodgkin lymphoma (chemotherapy with an EVA protocol - etoposide, vinblastine and doxorubicin) was initiated. Favorable response and oncological outcome were registered at 1 year follow-up. Conclusions: Although synchronous bilateral renal tumors surgical strategy usually involves two consecutive operations, first addressed to the largest tumor, a concomitant operation is possible in selected cases. LND in RCC has a double role, diagnostic and therapeutic and must be performed. Proper treatment of two simultaneous neoplasia could provide healing or increase the patients' survival. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: TURB remains the standard in non muscle invasive bladder tumour treatment but sometimes the transurethral access is difficult or impossible because of long penile urethral strictures. In this paper we are trying to draw attention on perineal urethrostomy as an easy and fast access for TURB in patients with associated long penile urethral strictures. Materials and methods: Between 2008- 2013 we performed 36 perineal urethrostomies for different urethral pathology : penile or urethral carcinoma, recurrent long anterior urethral strictures associated with adverse conditions like periurethritis or lichen sclerosus . In 4 cases perineal urethrostomy was performed for allowing the access for TURB in cases with bladder tumors and long penile urethral strictures. With the patient in a lithotomy position, a vertical incision through the perineum is made, and after the fat tissue is being dissected, the bulbocavernous muscle is being incised. The bulbar urethra is being exposed and a 2-3 cm vertical incision on its ventral surface is made. When maturating the urethrostomy, 3 layers are being incorporated in the suture: the urethral mucosa, the adventitia of the spongiosus corpus and the skin, without suturing the muscle body of the spongiosum in order to preserve the lateral blood flow through the corpus spongiosus. After the maturation of the perineal urethrostomy a TURB is performed in a standard manner with a 26 Fr resectoscope. Results: Through the perineal urethrostomy a good access for TURB has been obtained. The operating time was 20 min. An uretral reconstruction with BMG and the closure of the urethrostomy can be attempted 6 months after two consecutive cystoscopic negative controls. Conclusions: Perineal urethrostomy is a fast and safe access for TURB in patients with non muscle invasive bladder tumour and associated recurrent long penile urethral strictures and it should be present in the standard armamentarium of any urologist. Through this approach an open surgery on the bladder tumor, with the consecutive risk of tumoral spread, is avoided and a second intervention for urethral reconstruction can be considered after the oncological control of the bladder tumour. [ABSTRACT FROM AUTHOR]

Oxidative stress plays a major role in diabetes. In vivo levels of membrane-bound radicals (MBRs) in a streptozotocin-induced diabetic mouse model were uniquely detected by combining molecular magnetic resonance imaging (mMRI) and immunotrapping techniques. An anti-DMPO (5,5-dimethyl-1-pyrroline N-oxide) antibody (Ab) covalently bound to an albumin (BSA)-Gd (gadolinium)-DTPA (diethylene triamine penta acetic acid)-biotin MRI contrast agent (anti-DMPO probe), and mMRI, were used to detect in vivo levels of DMPO-MBR adducts in kidneys, livers, and lungs of diabetic mice, after DMPO administration. Magnetic resonance signal intensities, which increase in the presence of a Gd-based molecular probe, were significantly higher within the livers, kidneys, and lungs of diabetic animals administered the anti-DMPO probe compared with controls. Fluorescence images validated the location of the anti-DMPO probe in excised tissues via conjugation of streptavidin-Cy3, which targeted the probe biotin moiety, and immunohistochemistry was used to validate the presence of DMPO adducts in diabetic mouse livers. This is the first report of noninvasively imaging in vivo levels of MBRs within any disease model. This method can be specifically applied toward diabetes models for in vivo assessment of free radical levels, providing an avenue to more fully understand the role of free radicals in diabetes. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Bleeding, urinary fistula and acute renal failure are the most frequent complications of nephron sparing surgery for renal tumors, and the ideal technique for reducing them is still to be found. [1-6] Our objective is to present the results in decreasing the complication rate by using a non-clamping open nephron sparing surgery (NSS) technique which combines the use of an electrothermal bipolar vessel sealing system and tumor bed compression with a perirenal fat flap. Material and Methods. Between 1975-2011 over 5000 cases of renal tumors were operated in our center of which 485 underwent different techniques of NSS. In this study we compare the results of two similar groups (GR) of 24 patients with non-clamping NSS operated between 2008-2010. In the first group we used the standard hemostasis technique by ligation of the main peritumoral vessels, sutured the identified urinary tract lesions and applied hemostatic materials on the tumor bed. In the second group we performed hemostasis of the main peritumoral vessels with and electrothermal bipolar sealing system, sutured the identified urinary tract lesions and applied a wide base perirenal fat flap on the tumor bed with approximation sutures of the superficial parenchyma and renal capsule. Mean age of the patients was 54 in the 1st group and 58 in the 2nd group. Mean tumor size was 3 cm (1.5-4.5 cm) in both groups. The procedures in the second group were more complicated, involving 1 versus. 3 polar nephrectomies, and 3 versus. 6 central or sinus tumors. Results. Median surgery time was 116 min (group 1, 80-200 min) versus 90 minutes (group 2, 65-140 min). The median intraoperative blood loss was 400 ml (100-1500 ml) in the first group versus 250 ml (100-600 ml) in the second group. Postoperative bleeding requiring reintervention and/or blood transfusion was encountered in 4 patients (16.7%) in the first group compared to no patients in the second group. Persistent urinary fistula requiring JJ stent was encountered in 5 patients (20.8%) and 1 case (4.2%) respectively, and nephrectomy was needed in 2 patients (8.3%) versus 0 cases. Septic complications were encountered in 3 (12.5%) versus 1 (4.2%) patients. Acute renal failure was observed in 3 (12.5%) versus 0 (with solitary kidney). Postoperative median hospital stay was 10 days (5-64 days) in the first group versus 6 days (5-15 days) in the second group. There was no postoperative mortality in any of the groups. Conclusions. Using an electrothermal bipolar vessel-sealing device on the main vessels of the tumor bed provides a fast and reliable intraoperative hemostasis control. Tumor bed compression with a perirenal fat flap under approximation sutures of the renal capsule provides a mechanical hemostasis of the small vessels and a trophic support for the healing of the suboptimal sutured or undetected urinary tract lesions, preventing urinary fistula, secondary bleeding and subsequent complications. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

An abstract of the article "Sepsis and Cellular Trauma Lead to Histone Mediated Organ Failure and Death," by J. Xu, F. Lupu, N.L. Esmon, M. Cohen, A. Tsung, C.T. Ammollo, F. Semeraro, and C. Esmon.

Presents a correction to an error made in the article 'Loss of HIF-2alpha and inhibition of VEGF fetal lung maturation, whereas treatment with VEGF prevents fatal respiratory distress in premature mice,' by V. Compernolle et al published in 'Nature Medicine' journal in 2002.