W. Rui

Intravesical Instillation of Hyaluronic Acid Prolonged the Effect of Bladder Hydrodistention in Patients With Severe Interstitial Cystitis

OBJECTIVES To evaluate the efficacy of intravesical instillation of hyaluronic acid (HA) after hydrodistention for the treatment of patients with interstitial cystitis (IC) having small bladder capacity. METHODS A total of 47 patients with IC (aged 27-76 years) whose functional bladder capacity was less than 200 mL received bladder hydrodistention. Thereafter, 20 patients received intravesical instillation of 40 mg HA weekly in the first month and then monthly in the following 2 months. Sixteen patients received intravesical heparin instead and 11 patients received hydrodistention alone as the control. Mean voids per day, visual analog scale for pain, and functional bladder capacity were measured before hydrodistention and 3 and 6 months after hydrodistention in all 3 groups and 9 months after hydrodistention in HA and heparin groups. RESULTS Two patients in the HA group and 1 in the heparin group failed to complete the treatment. Three months after hydrodistention, there was no improvement in the control group. Six and 9 months after hydrodistention, rate of improvement was significantly higher in the HA group than in the heparin group (77.8% vs 33.3%, P < .05; 50% vs 20%, P < .05). At 9 months, heparin treatment did not show any improvement. Improvement in voids per day (-1.8 +/- 2.5, P < .01), visual analog scale (-0.9 +/- 1.1, P < .01), and bladder capacity (16 +/- 18 mL, P < .01) was still significant in the HA group. CONCLUSIONS Intravesical instillation of HA may obviously prolong the effect of bladder hydrodistention in patients with severe IC. Its effect was better than heparin.

Preoperative alpha blockade for normotensive pheochromocytoma: is it necessary?

Objective To compare the intraoperative hemodynamics in normotensive pheochromocytoma patients undergoing tumor resection between those with &agr;-blockade preparation, preoperatively, and those without it. Methods From January 2003 to July 2011, patients with adrenal incidentaloma, which was highly suspected as normotensive pheochromocytoma, were divided into two groups. Group 1 recieved &agr;1-blockade doxazosin before adrenalectomy. Group 2 received no &agr;-adrenoceptor, preoperatively. Data regarding the intraoperative hemodynamics was collected. These include peak/nadir blood pressure (BP) and heart rate, vasoactive medication and fluid infusion. Results Fifty-nine cases of pheochromocytoma were confirmed by histopathology examination: 38 in group 1 and 21 in group 2. No differences were found in the preoperative demographics, comorbidities, BP and anesthesia. Intraoperative BP and heart rate showed no difference between these two groups. Intraoperative use of nitroglycerin (P < 0.001), norepinephrine (P < 0.001), phentolamine (P < 0.001) and colloid fluid (P = 0.008) was significantly greater in group 1 with doxazosin. Conclusion Preoperative &agr;1-adrenoceptor antagonist has no benefit in maintaining intraoperative hemodynamic stability in patients with normotensive pheochromocytoma. It may increase the use of vasoactive drugs and colloid infusion.

Retroperitoneoscopic partial adrenalectomy for small adrenal tumours (≤1 cm): the Ruijin clinical experience in 88 patients

Study Type – Therapy (case series)
Level of Evidence 4

Heparanase-1 and Cyclooxygenase-2: prognostic indicators of malignancy in pheochromocytomas

The objective of this article is to evaluate Heparanase-1 and Cyclooxygenase-2 as tissue-based markers of pheochromocytoma prognosis. Ninety-two sporadic pheochromocytoma patients with a minimum of 8-year follow-up post-diagnosis were enrolled. Slides of normal adrenal glands in nephrectomy specimens from 20 patients with benign renal tumors were as control. Heparanase-1 and Cyclooxygenase-2 expression as well as microvessel density were examined using immunohistochemistry in tissues from these patients. Positive staining for Heparanase-1 was observed in 23.68% of the benign and 77.78% of the malignant cases, whereas none of the normal adrenal controls showed positive staining. Similarly, Cyclooxygenase-2 staining was seen in 23.68% of the benign versus 83.33% of the malignant cases, and none of the normal controls appeared positive for Cyclooxygenase-2. Using both HPA-1 and Cox-2 combined, the positive predictive value of malignancy was significantly increased to 0.72, compared to about 0.45 by their own. Malignant cases showed higher microvessel density compared to benign tumors and normal controls (36.41, 21.43, and 13.36%, respectively). Heparanase-1 and Cyclooxygenase-2 may contribute to the invasive characteristics of malignant pheochromocytomas. Heparanase-1 and Cyclooxygenase-2 combined is better than their own to be used as a marker to distinguish malignant from benign pheochromocytoma.

Expression of kallikrein-related peptidase 7 is decreased in prostate cancer

Recent evidence suggests that the human kallikrein 7 (KLK7) is differentially regulated in a variety of tumors. The aim of this study was to determine the expression of kallikrein-related peptidase 7 and KLK7 in our large collection of prostate samples. Between August 2000 and December 2012, 116 patients with histologically confirmed prostate cancer (PCa) and 92 with benign prostate hyperplasia (BPH) were recruited into the study. Using immunohistochemistry, quantitative reverse transcription polymerase chain reaction (RT-PCR) and western blot, kallikrein-related peptidase 7 expression in BPH and PCa tissues was determined at the mRNA and protein levels. The relationships between kallikrein-related peptidase 7 mRNA expression and clinicopathological features were analyzed. A total of 64 of 92 (69.57%) benign cases showed positive staining for KLK7 and 23 of 116 (19.83%) malignant cases showed positive, the difference of KLK7 expression between PCa and BPH was statistically significant (P < 0.001). The expression level of kallikrein-related peptidase 7 mRNA was significantly decreased in PCa tissues compared with that in BPH tissues and normal prostate tissue. Kallikrein-related peptidase 7 mRNA exhibited different expression patterns in terms of localization depending on pathological category of PCa. Similarly, our western immunoblot analyses demonstrated that the protein expression levels of KLK7 was lower in PCa than in BPH tissues and normal prostate tissue. Kallikrein-related peptidase 7 and KLK7 expression are down-regulated in PCa and lower expression of kallikrein-related peptidase 7 closely correlates with higher Gleason score and higher prostate-specific antigen level.

Expression and diagnostic relevance of heat shock protein 90 and signal transducer and activator of transcription 3 in malignant pheochromocytoma.

Background Malignant pheochromocytoma (PCC) is a rare catecholamine producing tumour with a poor prognosis. For many years predicting PCC behaviour has remained a highly difficult task. The aim of this study was to evaluate heat shock protein 90 (HSP90) and signal transducer and activator of transcription 3 (STAT3) as tissue-based markers to predict malignant PCC. Methods Ninety-two sporadic PCC patients were enrolled. We compared the expression of HSP90 and STAT3 by immunohistochemistry of benign versus malignant PCCs. In addition, in 17 snap frozen PCC and in 7 healthy adrenal tissues, we investigated the expression of HSP90 and STAT3 by means of western immunoblot. Results Positive staining for HSP90 was observed in 22.37% (95% CI 13.00% to 31.74%) of the benign and 66.67% (95% CI 44.89% to 88.45%) of the malignant cases. Similarly, STAT3 staining was seen in 26.32% (95% CI 16.42% to 36.22%) of the benign versus 83.33% (95% CI 66.11% to 100.55%) of the malignant cases. Using HSP90 and STAT3 combined, the positive predictive value of malignancy was significantly increased to 0.70 (95% CI 0.45 to 0.86). Besides, logistic regression analysis showed that HSP90 (OR=3.667, p=0.039) and STAT3 (OR=9.474, p=0.002) were independently associated with malignant PCC. Conclusions This study has confirmed that malignant PCC overexpress HSP90 and STAT3, and the combination of HSP90 and STAT3 can be used as helpful diagnostic markers to distinguish malignant from benign PCCs.

Predictors of hypertension urgency in primary aldosteronism patients during the first 24 hours after surgery

Study about blood pressure variation in the first 24 hours post-operation is limited in patients with adrenal aldosterone-producing adenoma. We aim to evaluate the potential predictors for postoperative hypertension urgency during the first 24 hours after laparoscopic adrenalectomy in patients with aldosterone-producing adenoma. Clinical data of 177 patients with aldosterone-producing adenoma were retrospectively collected from January 2009 to December 2015 and the potential factors that may influence postoperative blood pressure during the first 24 hours after surgery were analyzed. The factors included gender, age, body mass index, preoperative maximum systolic blood pressure, number of antihypertensive medicines, preoperative spironolactone treatment, duration of hypertension, surgical method and approach, adenoma diameter, preoperative proteinuria, estimated glomerular filtration rate, serum potassium and serum aldosterone. Univariate and multivariate regression analyses were used to evaluate the relationship between the above variables and postoperative hypertension urgency. We found that the proportion of patients with a higher systolic blood pressure ≥ 160 mmHg and ≥ 180 mmHg were significantly increased post-operation (both p < 0.001). In multivariate analysis, the maximum systolic blood pressure was an independent predictor of postoperative hypertension urgency, and the cut-off point was 157 mmHg with the sensitivity of 66% and specificity of 82%. Multivariable analysis also showed that preoperative maximum systolic blood pressure and number of antihypertensive medicines were independent risk factors for higher postoperative systolic blood pressure. This study was derived from a high volume adrenal tumor center, and these data may provide a potential tool to guide preoperative counseling.