Bone metastases from renal cell carcinoma: patient survival after surgical treatment

<p>Abstract</p> <p>Background</p> <p>Surgery is the primary treatment of skeletal metastases from renal cell carcinoma, because radiation and chemotherapy frequently are not effecting the survival. We therefore explored factors potentially affecting the survival of patients after surgical treatment.</p> <p>Methods</p> <p>We retrospectively reviewed 101 patients operatively treated for skeletal metastases of renal cell carcinoma between 1980 and 2005. Overall survival was calculated using the Kaplan-Meier method. The effects of different variables were evaluated using a log-rank test.</p> <p>Results</p> <p>27 patients had a solitary bone metastasis, 20 patients multiple bone metastases and 54 patients had concomitant visceral metastases. The overall survival was 58% at 1 year, 37% at 2 years and 12% at 5 years. Patients with solitary bone metastases had a better survival (p < 0.001) compared to patients with multiple metastases. Age younger than 65 years (p = 0.036), absence of pathologic fractures (p < 0.001) and tumor-free resection margins (p = 0.028) predicted higher survival. Gender, location of metastases, time between diagnosis of renal cell carcinoma and treatment of metastatic disease, incidence of local recurrence, radiation and chemotherapy did not influence survival.</p> <p>Conclusions</p> <p>The data suggest that patients with a solitary metastasis or a limited number of resectable metastases are candidates for wide resections. As radiation and chemotherapy are ineffective in most patients, surgery is a better option to achieve local tumor control and increase the survival.</p

Evaluation and management of recurrent urinary tract infections in children: state of the art

Urinary tract infections (UTIs) represent an important cause of febrile illness in young children and can lead to renal scarring and kidney failure. However, diagnosis and treatment of recurrent UTI in children is an area of some controversy. Guidelines from the American Academy of Pediatrics, National Institute for Health and Clinical Excellence and European Society of Paediatric Radiology differ from each other in terms of the diagnostic algorithm to be followed. Treatment of vesicoureteral reflux and antibiotic prophylaxis for prevention of recurrent UTI are also areas of considerable debate. In this review, we collate and appraise recently published literature in order to formulate evidence-based guidance for the diagnosis and treatment of recurrent UTI in children

Loss of Cadherin-Catenin Adhesion System in Invasive Cancer Cells

As described in the previous chapter, the loss of E-cadherin is the key event in epithelial–mesenchymal transition. While downregulation of E-cadherin could occur via aberrant Akt signaling, direct somatic mutations in E-cadherin are frequent in epithelial tumors such as diffuse-type gastric and lobular breast cancers, where they can be found in up to 50% of primary neoplasms (Berx et al. 1998). E-cadherin mutations were also observed in primary endometrial and ovarian carcinomas, albeit with a lower frequency (Risinger et al. 1994; Muta et al. 1996). The consequences of these mutations for EMT and tumor cell invasion are discussed below