Keon Cheol Lee

Idiopathic segmental ureteritis, misdiagnosed as ureteral cancer preoperatively : A case report with literature review

A 53‐year‐old man presented with right flank pain for 6 days. Computerized tomography revealed a 3 cm long segment of ureteral narrowing with wall thickening and hydronephrosis, suspicious for ureteral cancer. Under the clinical diagnosis of ureteral carcinoma a right nephroureterectomy was performed. The wall of the distal ureter, 2.5 cm from the bladder cuff, had a luminal‐narrowing, firm mass‐forming lesion with abrupt transition from the adjacent ureter. Histologically, the resected ureteral mass showed transmural fibrosing, chronic inflammation with numerous plasma cells, epithelioid granulomas, and obliterative phlebitis. Histological findings were consistent with idiopathic segmental ureteritis (ISU) with differential diagnoses of IgG4‐related sclerosing disease, including lymphoplasmacytic inflammatory pseudotumor (IPT) and idiopathic retroperitoneal fibrosis. IgG4 immunostaining in this case was barely positive, excluding the possibility of IgG4‐related IPT. Although the majority of luminal obliterated segmental lesions of the ureter are neoplastic in nature, non‐neoplastic inflammatory processes as seen in this case may occur in the ureter, causing diagnostic confusion with true neoplasms. Herein we report a rare case of ISU that was clinically misdiagnosed as malignancy preoperatively. ISU of the current case may be an IgG4‐unrelated subtype of IPT.

Does mirabegron relieve ureteric stent-related discomfort? A prospective, randomized, multicentre study

To evaluate the effects of 50 mg mirabegron once daily for ureteric stent‐related discomfort after ureteroscopic procedures by conducting a multicentre randomized study.

Cyclosporin A aggravates the Calcification of Vascular Smooth Muscle Cells under High Glucose conditions with a Calcifying Medium

Background Vascular calcification (VC) progresses substantially even in the case of stable kidney transplantation, and is a predictor of morbidity and mortality. However, the effect of cyclosporin A (CsA) on VC has not been reported in diabetic kidney transplant patients. In this study, we evaluated the effect of CsA on the VC of mouse vascular smooth muscle cells (VSMCs), in the diabetic milieu. Methods CsA of a concentration of 1.0 &mgr;mol/L was selected by the MTT assay for this study. To demonstrate the effect of CsA and high glucose (HG, 30mM) in the induction of the VC of the VSMCs, we determined alkaline phosphatase (ALP) activity, microscopic morphology of calcification, the expressions of the calcification and inflammation-related genes, and the intracellular calcium concentrations in VSMCs. Results Calcification was observed 14 days after exposure to a calcifying medium (sodium phosphate monobasic and dibasic mixture). On microscopic morphology, CsA alone did not induce calcification under HG conditions, but clearly increased calcification under HG with a calcifying medium. ALP activity increased under HG with CsA or a calcifying medium compared to HG conditions alone. CsA increased ALP activity under low glucose (LG, 5.5mM) with a calcifying medium, but markedly increased under HG with a calcifying medium. CsA significantly increased the mRNA expressions of the calcification markers (core binding factor-alpha 1, bone morphologic proteins 2) as well as those of the inflammatory marker (interleukin 6), under HG with a calcifying medium. Intracellular calcium concentrations was unchanged in CsA alone but significantly increased with the presence of a calcifying medium under both LG and HG conditions, Conclusion Considering the effect of CsA on VC, the vascular side effects of CsA need to be verified in diabetic transplant patients, in the future.