Renal Pelviceal Keratinizing Squamous Metaplasia with Sparing of Pyramidal Zones

Metaplastic changes in the urothelium of the upper urinary tract are relatively infrequent. Metaplasia may present as either squamous or less often glandular differentiation. The process may be associated with chronic inflammation or associated chronic infections. There may be malignant transformation to either squamous cell carcinoma or adenocarcinoma. The demarcation of the metaplastic process in the minor calyces has not been well documented to date. We report the case of a 74-year-old female patient who presented with a history of chronic renal disease and acute pyohydronephrosis. The patient underwent a nephroureterectomy which revealed keratinizing desquamative squamous metaplasia throughout the renal pelvis and upper urinary tract with abrupt termination of metaplasia at the junction of the renal pelvis and the minor calyx (pyramidal zone). Immunohistochemical evaluation documents metaplastic urothelium stained positive for CK5, before converting sharply to simple cuboidal epithelium in the minor calyx (pyramidal zones) which stained positive CK7. At the junction of the metaplastic components and low cuboidal lined minor calyceal surfaces, the underlying stroma showed loss of ureteral muscularis mucosa with transition to renal parenchymal type stroma. We believe that this observation is unique and potentially relevant to the etiology and pathophysiology of pelviceal metaplasia

Altruism in the charnel ground: Śāntideva and Parfit on anātman, reductionism and benevolence

Political Philosophy and Ethic

‘Snakes and Ladders’ – ‘Therapy’ as Liberation in Nagarjuna and Wittgenstein’s Tractatus

This paper reconsiders the notion that Nagarjuna and Wittgenstein’s Tractatus may only be seen as comparable under a shared ineffability thesis, that is, the idea that reality is impossible to describe in sensible discourse. Historically, Nagarjuna and the early Wittgenstein have both been widely construed as offering either metaphysical theories or attempts to refute all such theories. Instead, by employing an interpretive framework based on a ‘resolute’ reading of the Tractatus, I suggest we see their philosophical affinity in terms of a shared conception of philosophical method without proposing theses. In doing so, this offers us a new way to understand Nagarjuna’s characteristic claims both to have ‘no views’ (Mūlamadhyamakakārikā 13.8 and 27.30) and refusal to accept that things exist ‘inherently’ or with ‘essence’ (svabhāva). Therefore, instead of either a view about the nature of a mind-independent ‘ultimate reality’ or a thesis concerning the rejection of such a domain, I propose that we understand Nagarjuna’s primary aim as ‘therapeutic’, that is, concerned with the dissolution of philosophical problems. However, this ‘therapy’ should neither be confined to the psychotherapeutic metaphor nor should it be taken to imply a private enlightenment only available to philosophers. Instead, for Nagarjuna and Wittgenstein, philosophical problems are cast as a source of disquiet for all of us; what their work offers is a soteriology, a means towards our salvation