[Show abstract][Hide abstract] ABSTRACT: Epidemiological studies link obesity, as measured by increased body mass index (BMI) to the incidence of renal cell carcinoma (RCC) as well as to the cancer-related mortality of RCC patients. RCC is the third cancer most robustly associated with increased BMI. Understanding the role of the adipose tissue in renal carcinogenesis is therefore of major importance for the development of novel paradigms of RCC prevention and treatment. Here, we discuss the current knowledge on the impact of obesity on the development and progression of RCC as well as the role of adipose tissue-derived hormones (adipokines) in the conflict between growing tumors and the immune system.
[Show abstract][Hide abstract] ABSTRACT: Background: Primary testicular non-Hodgkin lymphoma (NHL) is an uncommon extra nodal presentation, accounting for 1% of all NHL and 1 to 9% of testicular neoplasms. Median age at time of presentation is 60 years old. Anthracycline based chemotherapies are most frequently used. aim: To analyze baseline characteristics, treatment modalities and survival of six cases of primary testicular non-Hodgkin lymphoma. methods: We screened 46 testicular neoplasm cases registered from January 1999 to January 2009 and found six primary testicular lymphoma patients. These six cases were analyzed for baseline clinical features, investigations, treatment and outcome variables. results: Median age was 50 years old and median duration of symptoms was 4 months. All patients had testicular swelling. Four patients had abdominal lymphadenopathy. Most patients had diffuse large B-cell histology. All patients underwent high inguinal orchidectomy and five were treated with anthracycline based chemotherapy. Four patients completed therapy and one of them relapsed two years later. Conclusion: Primary testicular NHL is an uncommon entity and with current combined modality treatment, the outcome may be as good as nodal NHL.
[Show abstract][Hide abstract] ABSTRACT: The impact of delayed graft function (DGF) on the outcome of renal transplantation remains controversial. We analyzed the risk factors for DGF and its impact on graft and patient survival. A total of 354 renal transplants performed between June 1986 and April 2000 were analyzed. Variables analyzed included donor and recipient age, method and duration of renal replacement therapy, HLA mismatch, cold and warm ischemia times, biopsy-confirmed acute rejection, length of stay in the hospital, serum creatinine at the end of first hospitalization as well as graft and patient survival at one, three, five and ten years. The study patients were divided into two groups: patients with DGF (G1) and those without DGF (G2). DGF occurred in 50 patients (14.1%), and it was seen more frequently in patients transplanted from deceased donors (60% vs. 40%, P <0.0001). The cause of DGF was acute tubular necrosis, seen in 98% of the cases. Univariate analysis showed a statistically significant difference between the two groups G1 and G2 in the following parameters: average duration on dialysis (52.3 vs. 36.4 months, P = 0.006), HLA mismatch (44.9% vs. 32.11% P = 0.015), donor age (35.9 vs. 40.2 years, P = 0.026), cold ischemia time (23 vs. 18.2 h, P = 0.0016), warm ischemia time (41.9 vs. 38.6 mn, P = 0.046), length of stay in the hospital during first hospitalization (54.7 vs. 33.2 days, P <0.0001), serum creatinine at the end of first hospitalization (140 vs. 112 μmol/L, P <0.0001) and at three months following transplantation (159 vs. 119 μmol/L, P = 0.0002). Multivariate analysis revealed the following independent risk factors for DGF: deceased donor (RR = 13.2, P <0.0001) and cold ischemia time (RR = 1.17, P = 0.008). The graft survival at one, three, five and ten years was 100%, 93%, 88.3% and 78.3% in G1 versus 100%, 95.9% 92.8% and 82.3% in G2; there was no statistically significant difference. The patient survival at one, three, five and ten years was 100%, 91.3%, 83.6% and 74.4% in G1 versus 100%, 95.9%, 94% and 82.6% in G2 with a statistically significant difference (P = 0.04). Prolonged cold ischemia time and transplantation of kidneys from deceased donors were the main risk factors for DGF in our study. Also, DGF significantly affected patient survival but had no influence on graft survival.
Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 01/2013; 24(2):243-6.
[Show abstract][Hide abstract] ABSTRACT: Background : Emphysematous pyelonephritis is an uncommon, necrotizing bacterial infection of the kidney. It is a severe, lifethreatening affection. Aims: To study the epidemiological, clinical, biological, bacteriological and radiological features of this affection, and to describe its therapeutic management and prognostic characteristics. Methods: We conducted a retrospective study including 30 patients who were treated for an emphysematous pyelonephritis, in Charles Nicolle hospital department of urology, from 1987 to 2009. Results: Emphysematous pyelonephritis generally affects adults. It is especially favored by diabetes and urinary tract obstruction. Escherichia coli is the main causative agent. Uroscan is the key of diagnosis. It is both medical and surgical emergency; the treatment combines intensive care with appropriate antibiotics and often drainage. Nephrectomy may be necessary from the outset, or after drainage failure. Prognosis is poor, with a high mortality rate (23 %), in our series. Conclusion: Management of emphysematous pyelonephritis poses real problems. This affection is still threatening, despite of advances in intensive care.
[Show abstract][Hide abstract] ABSTRACT: Kidney transplantation remains the best treatment option of end-stage renal disease. Kidney donations are of particular interest with the currently increasing practice of living-donor transplantation. The purpose of this study was to analyze retrospectively the general health status as well as renal and cardiovascular consequences of living-related kidney donation. A total of 549 living-related kidney donors had donated their kidneys between 1986 and 2007. We attempted to contact all donors to determine short- and long-term outcome following kidney donation. All kidney donors who responded underwent detailed clinical and biochemical evaluation. The data were compared with age-matched health tables of the Tunisian general population. In all, 284 donors (52%) had a complete evaluation. They included 117 men and 167 women with a mean age of 42 ± 12 years. The major peri-operative complications that occurred in these donors included four cases of pneumothorax, six cases of surgical site infection, one case of phlebitis and one case of pulmonary embolism. None of the study cases died. The median length of hospital stay after donor nephrectomy was 6.5 days (range: 3-28 days). The median follow-up period was eight years. The mean creatinine clearance after donation was 90.4 ± 25 mL/min in men and 81.5 ± 27.2 mL/min in women. Proteinuria was >300 mg/24 h in 17 cases (5.9%). Fifty-eight (20.4%) donors became hypertensive and 19.6% of the men and 37.2% of the women became obese. Diabetes mellitus developed in 24 (8.4%), and was more common in patients who had significant weight gain. Our study suggests that kidney donors have minimal adverse effects on overall health status. Regular follow-up identifies at-risk populations and potentially modifiable factors. Creation of a national registry of living donors and their monitoring are an absolute necessity.
Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 07/2012; 23(4):853-9.
[Show abstract][Hide abstract] ABSTRACT: Kidney cancer is generally asymptomatic and discovered incidentally at a late stage, which is a negative diagnosis because in most cases the disease is incurable at this stage. Some predisposing factors have been revealed by studies such high blood pressure, which is a frequent among the Tunisian population.
A study among the Tunisian population to determine if there is a link between the occurrence of kidney cancer and the hypertension.
Our work was conducted on 91 patients with confirmed renal cell carcinoma and 91 healthy subjects who consulted the Urology Department at the Charles Nicolle Hospital in Tunis. The study of clinical records has identified the clinical, pathological and therapeutic features of the 182 patients.
59% of individuals with hypertension have developed kidney cancer with a significant p-value equal to 0.03. The more the value of blood pressure increases the more the risk is (p = 0.03). Smoking in combination with hypertension is a factor favoring the occurrence of cancer with a value of p equal to 0.05.
In the Tunisian population hypertension is a risk factor for developing kidney cancer, a factor compounded by the high incidence of this disease. What prompts us to make explorations of kidney lodges of hypertensive patients.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the pre-existing renal lesions (PERL) found incidentally during evaluation for blunt renal trauma, determine their importance, and suggest guidelines for effective management, including conservative treatment, we reviewed 180 patients who were hospitalized with blunt renal trauma between 1992 and 2008. Thirty of the 180 (16.6%) patients had PERL, which had been undiagnosed. The mean follow-up was 5 years (range 1-9 years). There were 24 men and 6 women with a mean age of 30 years (range 14-80 years). The most common cause of blunt renal injuries was falls and sports. Renal stones were present in 14 patients, pelvi-ureteric junction obstruction in 12, ectopic kidney in two, and megaureter and renal cyst in one case each. Ureteral stenting was used in four cases, and early nephrectomy was required in the other four. Fourteen patients underwent surgery for the PERL and not trauma, with a pyeloplasty in eight cases, partial nephrectomy in three cases, percutaneous nephrololithotomy in two cases, and ureteroneocystostomy in one case. In our study, the conservative treatment was possible in 73% of cases. We believe the published data support increasing conservative attempts in the hemodynamically stable patient.
Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 11/2011; 22(6):1175-80.
[Show abstract][Hide abstract] ABSTRACT: Prostate cancer is the second leading cause of men cancer-related death. Cancer immunotherapy has been investigated as a treatment which might be instituted at the point of detection of androgen-independent metastatic disease.
to investigate the expression and humoral response against NYESO-1 in patients with prostate cancer (PC) and to analyze the relationship between expression of NY-ESO-1 and clinicopathological features. Methods: NY-ESO-1 mRNA in surgically resected PC and benign prostatic hyperplasia (BPH) were examined by reverse transcriptionpolymerase chain reaction. The antibody response to NY-ESO-1 was examined by enzyme-linked Elisa assay using recombinant NYESO-1 protein.
NY-ESO-1 mRNA was detected in 9 of 23 (39%) PC patients. Antibodies against NY-ESO-1 protein were detected in 12 of 23 (52%) sera of PC patients and in 5 of 9 (55%) of NY-ESO-1 expressing tumors. However, no mRNA copy or NY-ESO-1 antibodies were detected in all BPH patients tested. CONCLUSION : The present study has demonstrated the expression of NY-ESO-1mRNA in prostate Cancer patients and NY-ESO-1 antibody production. Our data suggest that NY-ESO-1 could be used as a tumor marker and constitute a good candidate for vaccine-based immunotherapy for hormonal resistant prostate cancer patients.
[Show abstract][Hide abstract] ABSTRACT: RéSUMé: Le carcinome épidermoïde de l'urètre masculin est une tumeur rare, les tumeurs de l'urètre tous types confondus représentant moins de 1 % des tumeurs de l'appareil urinaire. Le pronostic reste défavorable malgré un traitement chirurgical énergique. La radiochimiothérapie semble être un traitement prometteur, mais son rôle doit être défini par d'autres études.Nous rapportons un cas rare de carcinome épidermoïde de l'urètre bulbo-membraneux découvert à un stade localement avancé après observation d'une rupture urétrale transtumorale chez un homme âgé de 70 ans. Le patient a été traité, après drainage vésical, par une irradiation externe associée à une chimiothérapie par cisplatine, et est décédé après progression de la maladie sur un an.La rupture spontanée de l'urètre transtumorale est un mode de découverte exceptionnel témoignant d'une évolution locale défavorable, ce qui rend ces tumeurs difficilement opérables. Cependant, l'espoir actuel réside dans des protocoles thérapeutiques associant radiothérapie et chimiothérapie.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada 06/2011; 5(3):E36-9. · 1.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Infections following renal transplantation in children are a major cause of severe morbidity and mortality. Surgery is complex and performed in a subject whose immunological mechanisms are impaired by end stage renal failure and immunosuppressive drugs.
To evaluate the incidence and the risk factors of early infectious following renal transplantation in children. Methods: Infectious complications were retrospectively monitored in 37 children receiving renal transplantation at our center from 1992 to 2008.
Infectious complications identified were dominated by urinary tract infections occurred in 12 patients. The clinical symptomatology is dominated by fever and decrease in health. In 4 patients the urinary infection was asymptomatic. Three patients had pneumonia; the diagnosis was suspected clinically and confirmed by the chest radiography. Three other patients developed sepsis. In one of them, the etiology was a peritonitis related to dialysis catheter. Two transplant showed a herpetic cheilitis and one patient developed a parvovirus infection that evolved well after two transfusions. In all cases, the outcome was favourable with no deaths or impact on graft function.
After renal transplantation, the disturbance of inflammatory reactions explains the often latent or delayed infectious process making early diagnosis difficult. It is imperative to monitor infectious to minimize morbidity and mortality.
[Show abstract][Hide abstract] ABSTRACT: Background: Intravesical Bacille Calmette-Guérin (BCG) immunotherapy has been used for several decades as a prophylactic approach against recurrence of superficial bladder cancer. However, its effectiveness has been both variable and unpredictable. Typically, cancer BCG-immunotherapy aims to redirect or modulate both innate and adaptive immune responses. The consequences of gene polymorphisms in several key immuno-regulatory molecules on the heterogeneity of the response to BCG-immunotherapy have been investigated. Objective: The aim of this study was to evaluate the association of toll-like receptor (TLR) 2 polymorphisms (arginine to glutamine substitution at position 753 [Arg753Gln] and arginine to tryptophan substitution at position 677 [Arg677Trp]) and the outcome of BCG-immunotherapy. Methods: This prospective study was conducted during a 3-year period from June 2006 to July 2009. Consecutive patients were recruited during a 1-year period and followed for 2 years at the Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia. Patients with superficial bladder tumors at stage Ta (noninvasive papillary carcinoma) or T1 (where the tumor has grown from the layer of cells lining the bladder into the connective tissue below but has not grown into the muscle layer of the bladder) of any grade were eligible; carcinoma in situ cases were excluded. The TLR2 Arg753Gln and Arg677Trp polymorphisms were studied in peripheral blood DNA from patients treated with BCG-immunotherapy after transurethral resection. Results: A total of 112 consecutive patients were enrolled (101 men and 11 women; mean age, 63.9 years [range, 25-85 years]) and completed the 2-year followup. Polymerase chain reaction amplification followed by direct sequencing of the region containing the TLR2 single-nucleotide polymorphism (SNP) of interest did not detect Arg753Gln or Arg677Trp in any of the study participants belonging to either of 2 groups: responders (n = 67) and nonresponders (n = 45) to BCG-immunotherapy. Conclusions: No patients included in the study were found to have the 2 known TLR2 nonsynonymous SNPs, and the relative importance of these polymorphisms could not be definitely determined. However, a significant proportion of patients without these polymorphisms responded to BCG-immunotherapy, suggesting that these genetic variants are not critical in the effectiveness of this approach for preventing recurrence of the tumor.
Current Therapeutic Research 12/2010; 71(6):398-407. · 0.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Renal cell tumours are numerous and heterogeneous. Because of their clinicopathological heterogeneity, their accurate diagnosis may be challenging. In case of an equivocal diagnosis, immunohistochemistry may be a useful mean of diagnosis. Recently, alpha-methyl CoA racemase has been identified as a useful marker in kidney cancers.
Our objectives are to highlight the role of alpha-methyl CoA racemase (AMACR) as a diagnostic marker in papillary renal carcinoma and to assess its utility in the other tumour types.
Aretrospective review was performed on 62 patients who were treated for renal tumours between January 1994 and November 2005. Immunoreactivity was evaluated with a qualitative manner. Positive AMACR staining was defined as a coarse dense cytoplasmic granularity.
The 62 renal tumours were diagnosed as papillary tumours in 22 cases, clear cell tumours in 18 cases, chromophobe carcinoma in 12 cases and oncocytoma in 10 cases among the 22 cases of papillary tumours, all the cases (100%) showed cytoplasmic immunoreactivity staining. 4 cases between the 18 clear cell carcinomas (22%) showed positivity with AMACR. The 12 cases of chromophobe carcinoma didn't express AMACR by immunohistochemistry. Only one case between the oncocytomas (1%) expressed AMACR.
This study confirms the high sensitivity of AMACR for papillary renal cell carcinomas but we must keep in mind that weak focal AMACR staining could be present in other renal cell carcinomas.
[Show abstract][Hide abstract] ABSTRACT: Renal cell carcinoma (RCC) is the most common type of kidney cancer and recent developments in the molecular biology of RCC have identified multiple pathways associated with the development of this cancer. This study aimed at analyzing the expression pattern of cytokeratin 18 (CK18) in RCC patients and its prognostic relevance. We quantified CK18 mRNA expression and protein using real-time reverse transcription quantitative polymerase chain reaction (RT-QPCR) and immunohistochemistry, respectively, in paired tumor and non-tumor samples from 42 patients. Our data indicate that CK18 mRNA and proteins levels increased with advanced stage and grade of the disease. Using primary (RCC5) and metastatic renal cell carcinoma (RCC5 met) cell lines, we demonstrated that CK18 expression was 5-fold higher in the metastatic as compared to the primary RCC cell line and correlated with a migratory phenotype characterized by a distinct elongated morphology as revealed by Phalloidin staining. In addition, RCC5 met cells displayed an increased capacity to attach to fibronectin and collagen which was lost following CK18 knock-down. Our data also indicate that the expression of CK18 was associated with increased Snail expression which correlated positively with advanced disease in RCC patients. The present findings suggest that CK18 may play an important role in the progression of RCC and it may be used as a new predictor for RCC.
International Journal of Oncology 05/2010; 36(5):1145-54. · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Staghorn stone is considered as a dreadful type of renal stones. The choice of the best treatment is always difficult.
To evaluate the results of percutaneous nephrolithotomy in the treatment of staghorn stones.
We report 83 cases of staghorn stones that were treated by percutaneous nephrolithotomy during a period of 10 years from 1994 to 2004.
The mean age was 44 years and sex-ratio was 2,2. The right kidney was treated alone in 42% of cases, the left one in 56% of cases and both kidneys in only two cases. The mean area of stones was 6,6 cm2. One renal punction was necessary in 97% of cases. The rate of stone free after percutaneous nephrolithotomy only was about 54% and when combined with lithotripsy the rate was 64%.
Combined treatment using percutaneous nephrolithotomy and lithotripsy is considered as the best procedure for staghorn stones treatment.
[Show abstract][Hide abstract] ABSTRACT: To report the surgical complications among our pediatric and adolescent renal transplants and to compare these results with other reported series in the literature. A total of 50 pediatric and adolescent renal transplants were included in this study. There were 30 boys and 20 girls with a mean age of 13 years (range 6 - 18 years). 70% of patients received their kidneys from living donors. Two patients underwent renal re-transplantation. Among the 52 transplantations, 17 surgical complications were encountered in 15(30%) patients. The incidence of urological and vascular complications was respectively 13.2% and 18.9%. These complications included vesico-ureteral reflux (9.4%), urinary leakage (3.8%), lymphocele (5.8%), peri-renal hematoma (1.9%), renal artery stenosis (3.7%), and thrombosis of the allograft (7.5%). The patients with vesico-ureteral reflux were treated by antibiotic prophylaxis. In four recipients, thrombosis of the allo-graft with subsequent graft loss occurred. The graft survival rate was 90% in 1 year, 77% in 5 years and 40% in 10 years follow-up. The patient survival rate was 94.4% in 1 year and 84% after 8 years follow-up. We conclude that surgical complications can be minimized if basic principles of careful transplant techniques are used. Prompt identification and treatment of any complication are critical for graft and patient survival.
Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 01/2010; 21(2):251-7.
[Show abstract][Hide abstract] ABSTRACT: To describe our novel technique of laparoscopic pyeloplasty with an antegrade placement of a ureteral stent with a bridge operating-guide device (BOGD).
After completing the posterior suture line of the dismembered pyeloplasty, a guidewire is inserted through the BOGD and grasped within the renal pelvis. Then, the BOGD is removed and the ureteral stent advanced until it is positioned in the renal pelvis, and the lower end of the stent lies in the bladder. The anastomosis is completed. Fifteen patients underwent the laparoscopic placement of ureteral stents with this technique.
With this method, the ureteral stent insertion is very convenient and time saving (the mean time for inserting a stent was 5 minutes). The stents were successfully inserted in all patients.
This technique is reliable and effective in laparoscopic ureteral operations. It uses an endoscopic urological equipment, and costs are reduced.
Journal of endourology / Endourological Society 08/2009; 23(11):1871-4. · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Emphysematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadically in the literature. Our objective is to study the epidemiological, clinical and therapeutic characteristics of emphysematous pyelitis.
The data of six patients managed for emphysematous pyelitis were collected and analyzed.
The mean age was 55 years. Urinary lithiasis and diabetes were the most common co-morbidities. Febrile lumbar pain and general health impairment were the presenting symptoms in five patients; the remaining case presented with septic shock. Urine and blood culture grew E. Coli in 4 and 3 cases respectively. Computed tomography of the abdomen led to diagnosis by showing gas images in the collecting system. Treatment consisted of antibiotics associated with collecting system drainage. It avoided emergent nephrectomy in all cases. The treatment of the calculi was held at distance from the infection. Nephrectomy was done in one patient presenting a thinned -- dedifferentiated -- renal parenchyma. Outcome was good.
Emphysematous pyelonephritis is a rare upper urinary tract infection. Risk factors include diabetes and urinary obstruction. The diagnosis is made by computed tomography. Efficient antibiotics administration associated with collecting system drainage allow soon recovery and avoid nephrectomy.