Bladder cancer (BC), the most frequent malignancy of the urinary system, is ranked the sixth most prevalent cancer worldwide. Of all newly diagnosed patients with BC, 70-75% will present disease confined to the mucosa or submucosa, the non-muscle-invasive BC (NMIBC) subtype. Of those, approximately 70% will recur after transurethral resection (TUR). Due to high rate of recurrence, patients are submitted to an intensive follow-up program maintained throughout many years, or even throughout life, resulting in an expensive follow-up, with cystoscopy being the most cost-effective procedure for NMIBC screening. Currently, the gold standard procedure for detection and follow-up of NMIBC is based on the association of cystoscopy and urine cytology. As cystoscopy is a very invasive approach, over the years, many different noninvasive assays (both based in serum and urine samples) have been developed in order to search genetic and protein alterations related to the development, progression, and recurrence of BC. TERT promoter mutations and FGFR3
Introduction. Renal transplantation is the best treatment for end-stage renal disease. In the last years, we have seen improvements in immunosuppressive treatment, which have allowed patients to experience a better quality of life and graft survival. Nevertheless, surgical complications remain important problems that increase morbidity, mortality, costs, and hospitalization. Our purpose was to evaluate surgical complications among a large series of 2000 renal transplantations. Patients and Methods. We retrospectively analyzed all surgical complications among 2000 renal transplants performed between June 1980 and March 2010 in our department. Results. Among 318 (15.9%) surgical complications, 4.8% of patients had urologic problems. Ureteral stenosis and fistula, stent obstruction, and ureteral necrosis occurred in 2.7%, 1.8%, 0.1%, and 0.2% of patients, respectively. Vascular complications reported in 2.7% of patients included arterial or venous thrombosis (1.0% or 0.4%), both arterial and venous thrombosis (0.1%), renal infarction (0.1%), renal artery aneurysm (0.1%) as well as arterial stenosis (0.5%), kinking (0.4%), or dissection (0.1%). Other complications, not specifically related with transplantation surgery, occurred in 4.4% of patients. Conclusion. Renal transplantation is a safe surgery by experienced teams. Our rates of surgical complications were within those reported by other series. A meticulous surgical technique is mandatory to prevent them. Prompt diagnosis and management are required to prevent graft damage and patient morbidity.
The purpose of this study was to compare the effects of sirolimus (SRL) vs cyclosporine (CsA) concerning the cardiovascular mechanisms hypothetically contributing to hypertension development. Three rat groups were studied: control (vehicle), CsA (5 mg/kg/d), and SRL (1 mg/kg/d). The following parameters were evaluated after 7 weeks of treatment: blood pressured (BP) and heart rate (HR; tail cuff), lipid profile, hematology, plasma and platelet 5-HT and catecholamines (HPLC-ECD), and oxidative equilibrium (serum malondialdehyde [MDA] and total antioxidant status [TAS]). Systolic (SBP) and diastolic blood pressure (DBP) values were higher (P Ͻ .001) in both the CsA (146.2 Ϯ 4.5 and 124.9 Ϯ 4.5 mm Hg) and SRL (148.9 Ϯ 4.8 and 126.4 Ϯ 6.0 mm Hg) groups vs the controls (115.9 Ϯ 3.3 and 99.1 Ϯ 2.0 mm Hg). However, HR values were elevated in CsA but not SRL animals. The dyslipidemic pattern of CsA was even more enhanced in the SRL group, with significantly higher low-density lipoprotein cholesterol (LDL-c) and triglyceride (TG) levels vs CsA (P Ͻ .05); red blood cells, hematocrit, hemoglobin concentration, mean platelet volume, and platelet distribution width were significantly (P Ͻ .05) higher in the SRL vs CsA group. The pro-oxidative profile (increased MDA/TAS) in the CsA group was not reproduced in the SRL cohort. While plasma and platelet 5-HT were elevated in SRL rats, catecholamine content was higher in CsA animals. In conclusion, this study demonstrated that CsA and SRL produce identical hypertensive effects. However, while CsA promotes oxidative stress and sympathetic activation, SRL mainly interferes with lipid profile and hematological parameters. Thus, the hypertensive effects of CsA, a calcineurin inhibitor, and of SRL, an mTOR inhibitor, are associated with impairment of distinct cardiovascular pathways.
Highlights
Iatrogenic injury of the superior mesenteric artery is rare.
This injury imparts a high risk of mortality due to visceral ischemia and death.
An anastomosis to the splenic artery may be an easier solution than an aorto-mesenteric bypass.
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