Vasculitis of the bladder: An extremely rare case report

AbstractINTRODUCTIONIsolated vasculitis of the bladder is extremely rare. The main causes of which are auto-immune diseases and occasionally infections. Corticosteroid therapy plays a central role in treatment in the majority of cases.PRESENTATION OF CASEWe report a case of gross hematuria associated with irritative low urinary tract symptoms (LUTS) and an increase of biological parameters of inflammation. Radiologic studies suspected a pelvic tumor process. We performed a cystoscopy with multiple biopsies. The pathological findings of the chips were in favor of a thrombotic nongranulomatous vasculitis of small and medium caliber. In view of these findings, all systemic diseases and inflammatory diseases such as cryoglobulinemia, the anti-phospholipid syndrome, Crohn's disease were eliminated. The symptoms regressed completely under antibiotics and anticoagulants.DISCUSSIONOur treatment options were based on the extent of the acute phase reaction and the pelvic venous thrombosis. A few similar cases have been reported in the literature, particularly a case of isolated necrotizing vasculitis of the bladder involving small vessels with a mild laboratory acute phase reaction which was treated with corticosteroids and cyclophosphamide.CONCLUSIONIt is important to differentiate this rare pathological feature of the bladder from other bladder tumors as the treatment is medical rather than surgical

Study of signaling pathways involved in resistance to therapeuthic agents in human renal cell carcinoma

Le carcinome à cellules rénales (CCR) se caractérise par une résistance importante aux thérapies. Notre hypothèse était que des voies signalétiques prolifératives, anti-apoptotiques et/ou angiogéniques sont mises en jeu dans la résistance aux thérapies. Il s’agissait de mesurer la sensibilité de lignées cellulaires de CCR humain à différentes classes thérapeutiques in vitro et in vivo. Une étude pilote a été réalisée sur la base de xénogreffes de la lignée A498 chez la souris nude, puis exploitée pour des analyses sur biopuces à protéines afin d’identifier les voies de signalisation induites par le sunitinib. In vitro, les lignées cellulaires de CCR se sont révélées sensibles aux thérapies indépendamment du statut VHL. In vivo, la lignée A498 est apparue résistante au sunitinib. L’approche par biopuces a montré que plusieurs protéines de l’angiogenèse sont modulées sous l'effet du traitement, notamment l’angiogénine. Il n’y a pas de modification de l’expression des protéines de l’apoptose testées. Les formes phosphorylées d’Akt sont également augmentées dans les tumeurs traitées, de même que Lim1 alors que la forme phosphorylée de NFκB est diminuée. Ce travail a ainsi identifié de potentielles cibles impliquées dans les mécanismes de résistance et devraient permettre de définir de nouvelles options thérapeutiques dans le cancer du rein.The renal cell carcinoma is characterized by a high resistance to therapies. Our working hypothesis was that proliferative signaling pathways, anti-apoptotic and / or angiogenic are involved in resistance to therapies. Thus, as part of this thesis, we measured the sensitivity to chemotherapy and targeted therapies in kidney cancer cell lines in vitro as well in vivo.A pilot study was conducted on the basis of the A498 cell line xenografts in nude mice, and then used for analysis on proteome arrays to identify the signaling pathways induced by sunitinib. In vitro, the cell lines of RCC were sensitive to therapy regardless of the VHL status. In vivo, the line A498 appeared resistant to sunitinib. The approach using the proteome array has shown that several angiogenesis proteins are modulated as a result of treatment, including angiogenin. There was no change in the expression of proteins of apoptosis. Phosphorylated forms of Akt were also increased in the treated tumors, as well as Lim1 whereas the phosphorylated form of NFkB was reduced. This work has identified potential targets involved in resistance mechanisms and should define new therapeutic options in renal cancer

Study of signaling pathways involved in resistance to therapeuthic agents in human renal cell carcinoma

Le carcinome à cellules rénales (CCR) se caractérise par une résistance importante aux thérapies. Notre hypothèse était que des voies signalétiques prolifératives, anti-apoptotiques et/ou angiogéniques sont mises en jeu dans la résistance aux thérapies. Il s’agissait de mesurer la sensibilité de lignées cellulaires de CCR humain à différentes classes thérapeutiques in vitro et in vivo. Une étude pilote a été réalisée sur la base de xénogreffes de la lignée A498 chez la souris nude, puis exploitée pour des analyses sur biopuces à protéines afin d’identifier les voies de signalisation induites par le sunitinib. In vitro, les lignées cellulaires de CCR se sont révélées sensibles aux thérapies indépendamment du statut VHL. In vivo, la lignée A498 est apparue résistante au sunitinib. L’approche par biopuces a montré que plusieurs protéines de l’angiogenèse sont modulées sous l'effet du traitement, notamment l’angiogénine. Il n’y a pas de modification de l’expression des protéines de l’apoptose testées. Les formes phosphorylées d’Akt sont également augmentées dans les tumeurs traitées, de même que Lim1 alors que la forme phosphorylée de NFκB est diminuée. Ce travail a ainsi identifié de potentielles cibles impliquées dans les mécanismes de résistance et devraient permettre de définir de nouvelles options thérapeutiques dans le cancer du rein.The renal cell carcinoma is characterized by a high resistance to therapies. Our working hypothesis was that proliferative signaling pathways, anti-apoptotic and / or angiogenic are involved in resistance to therapies. Thus, as part of this thesis, we measured the sensitivity to chemotherapy and targeted therapies in kidney cancer cell lines in vitro as well in vivo.A pilot study was conducted on the basis of the A498 cell line xenografts in nude mice, and then used for analysis on proteome arrays to identify the signaling pathways induced by sunitinib. In vitro, the cell lines of RCC were sensitive to therapy regardless of the VHL status. In vivo, the line A498 appeared resistant to sunitinib. The approach using the proteome array has shown that several angiogenesis proteins are modulated as a result of treatment, including angiogenin. There was no change in the expression of proteins of apoptosis. Phosphorylated forms of Akt were also increased in the treated tumors, as well as Lim1 whereas the phosphorylated form of NFkB was reduced. This work has identified potential targets involved in resistance mechanisms and should define new therapeutic options in renal cancer

Etude des voies signalétiques impliquées dans la résistance aux agents thérapeuthiques dans le carcinome à cellules rénales humain

The renal cell carcinoma is characterized by a high resistance to therapies. Our working hypothesis was that proliferative signaling pathways, anti-apoptotic and / or angiogenic are involved in resistance to therapies. Thus, as part of this thesis, we measured the sensitivity to chemotherapy and targeted therapies in kidney cancer cell lines in vitro as well in vivo.A pilot study was conducted on the basis of the A498 cell line xenografts in nude mice, and then used for analysis on proteome arrays to identify the signaling pathways induced by sunitinib. In vitro, the cell lines of RCC were sensitive to therapy regardless of the VHL status. In vivo, the line A498 appeared resistant to sunitinib. The approach using the proteome array has shown that several angiogenesis proteins are modulated as a result of treatment, including angiogenin. There was no change in the expression of proteins of apoptosis. Phosphorylated forms of Akt were also increased in the treated tumors, as well as Lim1 whereas the phosphorylated form of NFkB was reduced. This work has identified potential targets involved in resistance mechanisms and should define new therapeutic options in renal cancer.Le carcinome à cellules rénales (CCR) se caractérise par une résistance importante aux thérapies. Notre hypothèse était que des voies signalétiques prolifératives, anti-apoptotiques et/ou angiogéniques sont mises en jeu dans la résistance aux thérapies. Il s’agissait de mesurer la sensibilité de lignées cellulaires de CCR humain à différentes classes thérapeutiques in vitro et in vivo. Une étude pilote a été réalisée sur la base de xénogreffes de la lignée A498 chez la souris nude, puis exploitée pour des analyses sur biopuces à protéines afin d’identifier les voies de signalisation induites par le sunitinib. In vitro, les lignées cellulaires de CCR se sont révélées sensibles aux thérapies indépendamment du statut VHL. In vivo, la lignée A498 est apparue résistante au sunitinib. L’approche par biopuces a montré que plusieurs protéines de l’angiogenèse sont modulées sous l'effet du traitement, notamment l’angiogénine. Il n’y a pas de modification de l’expression des protéines de l’apoptose testées. Les formes phosphorylées d’Akt sont également augmentées dans les tumeurs traitées, de même que Lim1 alors que la forme phosphorylée de NFκB est diminuée. Ce travail a ainsi identifié de potentielles cibles impliquées dans les mécanismes de résistance et devraient permettre de définir de nouvelles options thérapeutiques dans le cancer du rein

Hilar Parenchymal Oversew: a novel technique for robotic partial nephrectomy hilar tumor renorrhaphy

ABSTRACT Introduction A renorrhaphy technique which is effective for hemostasis but does not place undue tension on the branch vessels of the renal sinus remains one of the challenging steps after hilar tumor resection during robotic partial nephrectomy (RPN). The published V-hilar suture (VHS) technique is one option for reconstruction after an RPN involving the hilum. The objective of this video is to show a novel renorrhaphy technique, Hilar Parenchymal Oversew that has been effective for such cases. Materials and Methods We present two cases of RPN for renal hilar tumors. The first case depicts use of the VHS renorrhaphy technique for a tumor that abuts the renal hilum along 20% of its diameter. The second case demonstrates tumor resection and reconstruction for a tumor that has >50% involvement of the hilum along its diameter. After tumor resection, individual sinus vessels can be selectively oversewn with 2-0 Vicryl suture on SH needle. The remaining exposed parenchyma is controlled using the Hilar Parenchymal Oversew technique with a #0 Vicryl on CT-1 needle. Results For the Hilar Parenchymal Oversew surgery operative time was 225 min, estimated blood loss was 140 ml, warm ischemia time was 19 minutes, and there were no intraoperative complications. Pathology was consistent with clear cell renal cancer with negative margins. Conclusion Robotic partial nephrectomy with the Hilar Parenchymal Oversew technique is a good alternative to VHS renorrhaphy in the management of renal hilar tumors “bulging” into the renal sinus with >50% of the tumor diameter abutting the hilum

National prospective study on the use of local haemostatic agents during partial nephrectomy

International audienceOBJECTIVE:To assess the use of local haemostatic agents (HAs) in a prospective multicentre large series of partial nephrectomies (PNs).PATIENTS AND METHODS:Prospective National Observational Registry on the Practices of Haemostasis in Partial Nephrectomy (NEPHRON): the study was conducted in 54 French urological centres from 1 June to 31 December 2010. In all, 570 consecutive patients undergoing a PN were enrolled in this study in a prospective manner. The data was collected prospectively via an electronic case-report form: five different sheets were included for preoperative, perioperative, postoperative and follow-up data respectively. Information related to haemostasis was analysed.RESULTS:The median patient age was 60 years and the mean (range) tumour size was 3.68 (0.19-15) cm. An HA was primarily used in 71.4% of patients, with a statistically significant difference among surgical approaches (P = 0.024). In 91.8% of cases, a single use of a HA was sufficient for achieving haemostasis. The HA was used either alone (13.9%) or in association with sutures (80.3%). One or more additional haemostatic action(s) was needed in 12.3% of the cases. When comparing patients who received a HA with those who did not receive a HA, there was no statistical difference between the groups for tumour size (P = 0.542), collecting system drainage (P = 0.538), hospital stay (P = 0.508), operation time (P = 0.169), blood loss (P = 0.387) or transfusion rate (P = 0.713).CONCLUSION:HAs are widely used by urologists during PN. Progress is needed for standardising HA application, especially for the timing of application. For the time being, the role of the HA in nephron-sparing surgery is still to be evaluated