Erik Havranek

First digital flexible ureterorenoscope: initial experience.

BACKGROUND Flexible ureterorenoscopy is a minimally invasive procedure that is rapidly gaining popularity as a treatment for patients with upper urinary tract lithiasis. One of the main drawbacks is the limited visualization imposed by fiberoptic technology in an endoscope, often only 7 to 8F and the fragility of fiber-based optics in a flexible endoscope. MATERIALS AND METHODS We report our initial experience with digital flexible URS and holmium laser lithotripsy using digital image capture in three patients. Two patients had upper tract calculi (1 cm lower pole calculus and 8 mm caliceal diverticular stone, respectively), and one patient underwent diagnostic URS. RESULTS After basket capture and intrarenal relocation of the lower pole stone, complete stone destruction was achieved. Similarly, the caliceal diverticular stone was destroyed after holmium laser incision of the caliceal diverticulum. Remarkable improvement in image quality was observed throughout the procedures in comparison with current fiberoptic image acquisition. Minor image interference was noted during fluoroscopic screening, which increased slightly during laser activation. CONCLUSIONS The first digital flexible ureterorenoscope provided excellent image quality and zoom capability, with a substantial improvement compared with fiberoptic technology. It does not require a separate light source and is an important step for the continued evolution of flexible URS as a therapeutic modality for upper urinary tract pathology.

Advances in prostate cancer immunotherapy

Metastatic prostate cancer remains incurable. Harnessing the bodys own immune system to control or eradicate tumours has long been an attractive concept. Only recently has the field of tumour immunology provided the basic science behind the mechanisms of tumour genesis, molecular basis of the recognition of tumour associated antigens and the interactions of the antigen-presenting cells with effector cells. This research has been translated into numerous clinical immunotherapy strategies, which have reached the oncology clinic and which should provide options for our patients.

Prognostic significance of erythropoietin expression in human renal cell carcinoma.

To investigate, in a retrospective study, the expression of erythropoietin (Epo) in human renal cell carcinoma (RCC) and its correlation with overall survival, as Epo (an haematopoietic cytokine that regulates the production of red blood cells), with its receptor, was recently localized in non‐haematopoietic tissues, e.g. liver, uterus, central nervous system, vascular endothelial cells and solid tumours.

Minimally invasive ablative techniques in renal cancer

Evidence for achieving cytotoxic freezing temperatures is derived from various experimental and clinical reports, and shows that temperatures as low as 40 ∞ C to 50 ∞ C are required to induce complete cell death [2]. An adequate margin of the cryogenic lesion (ice-ball) is important, and has influenced probe design and technical applications in the clinical setting. An ideal ‘rim of death’ of 1 cm beyond the tumour edge has been described to achieve temperatures in the target tissue of 40 ∞ C and complete cellular death [3]. Most investigators advocate repeating the freeze/ thaw cycle to ensure adequate cell death, although no direct comparison of single vs repeat freeze/thaw cycles in RCC has been published. The rationale for this is based on evidence for increased cytotoxicity in prostate and hepatocellular carcinoma [1].

A novel murine model of allogeneic vaccination against renal cancer

To develop a murine model for whole‐cell allogeneic vaccination in renal cancer, as such vaccines aim to direct immune responses against patient tumour cells, due to shared antigens between the vaccine and tumour cells.