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Xanthopoulou ET, Koukourakis IM, Kakouratos C, Nanos C, Kalaitzis C, Giatromanolaki A, Koukourakis MI. Irradiation-induced IFN-type-I pathway activation in prostate cancer cell lines. Cytokine 2023; 169:156252. [PMID: 37301190 DOI: 10.1016/j.cyto.2023.156252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/21/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
The Interferon (ΙFN) Type-I pathway has an important role in the activation of an anti-tumor immune response. We investigated the effects of two different dose fractionations of radiation (3 daily 8 Gy fractions vs. one fraction of 20 Gy) on the activation of the Type-I IFN-pathway in three hormone-dependent (22Rv1) and independent (DU145, PC3), prostate cancer (PC) cell lines. Regardless of the dose schedules, radiation-induced the expression of IFN-stimulated genes in all PC cell lines, with a strong up-regulation of the IFI6v2 and IFI44 genes. In addition, strong up-regulation of the MX1 and MX2 genes was noted in the PC3 cell line. This effect was independent of the expression of IFNβ, cGAS, or TREX1 levels. It is suggested that the RT-induced IFN type-I response could be exploited for the development of immuno-RT policies for localized and metastatic PC.
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Affiliation(s)
- Erasmia T Xanthopoulou
- Department of Radiotherapy / Oncology, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | | | - Christos Kakouratos
- Department of Radiotherapy / Oncology, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Christos Nanos
- Department of Radiotherapy / Oncology, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Christos Kalaitzis
- Department of Urology, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | | | - Michael I Koukourakis
- Department of Radiotherapy / Oncology, Democritus University of Thrace, Alexandroupolis 68100, Greece.
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Diamantidis D, Tsakaldimis G, Lailisidis S, Panagiotopoulos N, Kafalis C, Giannakopoulos S, Kalaitzis C. Severe Complications of Artificial Urinary Sphincter Placement in a Young Woman With Neurogenic Urinary Incontinence: A Case Report. Cureus 2023; 15:e41097. [PMID: 37519492 PMCID: PMC10381096 DOI: 10.7759/cureus.41097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
This article reports a case of a 40-year-old woman with a history of myelomeningocele and neurogenic urinary incontinence who developed erosion and fistula formation following the placement of an artificial urinary sphincter (AUS) when she was 18 years old. The patient had a long-standing history of urinary incontinence that was unresponsive to prior surgeries for meningomyelocele. She reported the loss of uro-fecal material from the vagina but did not seek further medical evaluation until the age of 40. Clinical examination revealed protruding tubes from the suprapubic region. The administration of a contrast agent through one of the two tubes led to the visualization of intestinal loops, and the administration of a contrast agent through the urethra confirmed the connection between the rectum, urinary bladder, and vagina. Due to the absence of reliable surgical history and in the absence of abdominal discomfort, bilateral nephrostomies were initially performed to prevent further uro-fecal material loss. The patient showed significant improvement, decided to not seek further evaluation and surgical treatment, and remained socially integrated during the follow-up period of 20 years. This case highlights the severe consequences of AUS placement in a young woman with neurogenic urinary incontinence and emphasizes the importance of proper patient selection and management in the presence of underlying neurological disorders.
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Affiliation(s)
- Dimitrios Diamantidis
- Department of Urology, University General Hospital of Alexandroupolis, Alexandroupolis, GRC
| | - Georgios Tsakaldimis
- Department of Urology, University General Hospital of Alexandroupolis, Alexandroupolis, GRC
| | - Stavros Lailisidis
- Department of Urology, University General Hospital of Alexandroupolis, Alexandroupolis, GRC
| | | | - Charalampos Kafalis
- Department of Urology, University General Hospital of Alexandroupolis, Alexandroupolis, GRC
| | | | - Christos Kalaitzis
- Department of Urology, University General Hospital of Alexandroupolis, Alexandroupolis, GRC
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3
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Xanthopoulou ET, Kakouratos C, Nanos C, Gkegka AG, Kalaitzis C, Giatromanolaki A, Koukourakis MI. HIF1α-dependent and independent pathways regulate the expression of PD-L1 in prostate cancer. Med Oncol 2023; 40:151. [PMID: 37067635 PMCID: PMC10110727 DOI: 10.1007/s12032-023-02017-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
PD-L1/PD-1 pathway is a major pathway exploited by human cancer types, which is a target for current immunotherapy. We investigated tumor microenvironmental factors involved in PD-L1 induction in prostate cancer (PC). We studied the expression of PD-L1 in a series of 66 PCs, in parallel with the expression of hypoxia- and acidity-related immunohistochemical markers (Hypoxia-inducible factor HIF1α, and lactate dehydrogenase LDHA) and tumor-infiltrating lymphocyte TIL density. Experiments with three PC cell lines, the 22Rv1, DU145, and PC3 were conducted focusing on the inducibility of PD-L1 by hypoxia, acidity, lymphocyte interactions, and radiation. In tissues, PD-L1 expression by cancer cells was directly related to PD-L1 expression by TILs and macrophages (p < 0.05), and the overexpression of HIF1α and LDH5 (p < 0.05). TIL density was inversely related to ΗΙF1α (p = 0.02). Exposure of PC cell lines to hypoxia strongly induced PD-L1 and protein and mRNA levels, directly controlled by HIF1α function (p < 0.001). Irradiation with 20 Gy had no apparent effect on PD-L1 expression. Culturing PC cell lines with culture medium (CM) from PBMCs strongly induced PD-L1 at protein and mRNA levels, independently from HIF1α, which was also confirmed when cells were incubated with Interferon-γ (p < 0.001). It is concluded that the combination of anti-PD-L1/PD-1 immunotherapy with hypoxia/HIF-targeting may be important in the treatment of specific subgroups of PC patients.
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Affiliation(s)
- Erasmia T Xanthopoulou
- Department of Radiotherapy/Oncology, Democritus University of Thrace, 68100, Alexandroupolis, Greece
| | - Christos Kakouratos
- Department of Radiotherapy/Oncology, Democritus University of Thrace, 68100, Alexandroupolis, Greece
| | - Christos Nanos
- Department of Radiotherapy/Oncology, Democritus University of Thrace, 68100, Alexandroupolis, Greece
| | - Anastasia G Gkegka
- Department of Pathology, Democritus University of Thrace, 68100, Alexandroupolis, Greece
| | - Christos Kalaitzis
- Department of Urology, Democritus University of Thrace, 68100, Alexandroupolis, Greece
| | | | - Michael I Koukourakis
- Department of Radiotherapy/Oncology, Democritus University of Thrace, 68100, Alexandroupolis, Greece.
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4
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Tsakaldimis G, Bousiou Z, Dimou-Besikli S, Karakasis N, Papalakis A, Giannakopoulos S, Sakellari I, Kalaitzis C. Pneumomediastinum as a rare complication in an immunosuppressed patient with emphysematous cystitis. Clin Case Rep 2022; 10:e05429. [PMID: 35154732 PMCID: PMC8822261 DOI: 10.1002/ccr3.5429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 11/09/2022] Open
Abstract
The extravesical spread of gas into the extraperitoneal space is an unusual complication of emphysematous cystitis and rarely, can reach remote areas of the body. Herein, we present the case of an immunosuppressed woman with emphysematous cystitis and extensive spread of extraperitoneal free gas up to the mediastinum.
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Affiliation(s)
| | - Zoi Bousiou
- BMT Unit Hematology Department G. Papanicolaou Hospital Thessaloniki Greece
| | | | - Nikolaos Karakasis
- Department of Urology General Hospital of Thessaloniki Thessaloniki Greece
| | | | | | - Ioanna Sakellari
- BMT Unit Hematology Department G. Papanicolaou Hospital Thessaloniki Greece
| | - Christos Kalaitzis
- Department of Urology Democritus University of Thrace Alexandroupolis Greece
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5
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Giannakopoulos S, Arif H, Nastos Z, Liapis A, Kalaitzis C, Touloupidis S. Laparoscopic transvesical vesicovaginal fistula repair with the least invasive way: Only three trocars and a limited posterior cystotomy. Asian J Urol 2020; 7:351-356. [PMID: 32995280 PMCID: PMC7498949 DOI: 10.1016/j.ajur.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/09/2019] [Accepted: 04/16/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Two conventional approaches for vesicovaginal fistula (VVF) repair are transabdominal repair for supratrigonal VVF and transvaginal approach for low lying fistulae. Laparoscopic surgery was introduced to duplicate the surgical steps of the transabdominal approach with reduction in morbidity. We report a series of patients treated with a modified laparoscopic technique which includes the use of only three trocars and a limited posterior cystotomy. Methods We retrospectively reviewed the data of eight patients who underwent laparoscopic VVF repair with our standardized technique from January 2015 to April 2018. Only cases with a supratrigonal fistula were included. We constantly used only three trocars. A limited 2 cm midline posterior cystotomy was performed using ultrasonic energy. A stay suture on a straight needle was passed percutaneously in the abdomen, then on either side of the cystotomy and finally was exteriorized to maintain countertraction. The cystotomy was extended downwards to include the fistula site. The fistula was dissected circumferentially to raise the bladder and vaginal flaps. The vaginal defect was closed in a transverse fashion and the cystotomy was closed vertically. Results Mean operative time was 178±31.6 min and estimated blood loss was 60±18.7 mL. Flap interposition was performed in six cases. No intraoperative complications were recorded. Mean hospital stay was 2.25±0.89 days. During hospitalization two patients experienced postoperative complications (Clavien grade I). Mean follow-up was 20.9±11.1 months (6.0–39.0 months). All patients remained continent during the follow-up period. Conclusions This minimally invasive laparoscopic approach with only three trocars and limited posterior cystotomy provides excellent results with minimum morbidity.
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Affiliation(s)
- Stilianos Giannakopoulos
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece.,Endoscopy Unit, Democritus University of Thrace, Alexandroupolis, Greece
| | - Halil Arif
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Zisis Nastos
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Apostolos Liapis
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christos Kalaitzis
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stavros Touloupidis
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
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6
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Argyriou C, Giannakopoulos S, Tasopoulou KM, Arif C, Kalaitzis C, Georgiadis GS. Neurologic Injury Resulting in Flank Bulge After Percutaneous Nephrolithotomy: a Case Series. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01918-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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7
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Vordos N, Giannakopoulos S, Vansant EF, Kalaitzis C, Nolan JW, Bandekas DV, Karavasilis I, Mitropoulos AC, Touloupidis S. Small-angle X-ray scattering (SAXS) and nitrogen porosimetry (NP): two novel techniques for the evaluation of urinary stone hardness. Int Urol Nephrol 2018; 50:1779-1785. [PMID: 30128922 DOI: 10.1007/s11255-018-1961-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/12/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate urinary stones using small-angle X-ray scattering (SAXS) and nitrogen porosimetry (NP). Traditionally, stones are categorized as hard or soft based on their chemical composition. We hypothesized that stone hardness is associated not only with its chemical composition but also with its internal architecture. SAXS and NP are well-known techniques in material sciences. We tested whether SAXS and NP are applicable for evaluating human urinary stones and whether they provide information at the nanoscale level that could be useful in clinical practice. METHODS Thirty endoscopically removed urinary stones were studied. Standard techniques for stone analysis were used to determine the stone composition. SAXS was used to evaluate the solid part of the stone by measuring the crystal thickness (T) and the fractal dimension (Dm/Ds), while NP was used to evaluate the porosity of the stone, i.e., the pore radius, pore volume, and specific surface area (SSA). RESULTS All stones were successfully analyzed with SAXS and NP. Each stone demonstrated unique characteristics regarding T, Dm/Ds, pore radius, pore volume, and SSA. Significant differences in those parameters were seen among the stones with almost identical chemical compositions. The combination of high T, high SSA, low Dm/Ds, low pore volume, and low pore radius is indicative of a hard material and vice versa. CONCLUSIONS SAXS and NP can be used to evaluate human urinary stones. They provide information on stone hardness based on their nanostructure characteristics, which may be different even among stones with similar compositions.
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Affiliation(s)
- Nick Vordos
- Hephaestus Advanced Laboratory, Eastern Macedonia and Thrace Institute of Technology, Kavala, Greece.,Department of Electrical Engineering, Eastern Macedonia and Thrace Institute of Technology, Kavala, Greece
| | - Stilianos Giannakopoulos
- Department of Urology, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece.
| | - Etienne F Vansant
- Hephaestus Advanced Laboratory, Eastern Macedonia and Thrace Institute of Technology, Kavala, Greece.,Laboratory of Adsorption and Catalysis, Department of Chemistry, University of Antwerpen, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Christos Kalaitzis
- Department of Urology, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - John W Nolan
- Hephaestus Advanced Laboratory, Eastern Macedonia and Thrace Institute of Technology, Kavala, Greece
| | - Dimitrios V Bandekas
- Department of Electrical Engineering, Eastern Macedonia and Thrace Institute of Technology, Kavala, Greece
| | - Ioannis Karavasilis
- Department of Urology, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Athanasios Ch Mitropoulos
- Hephaestus Advanced Laboratory, Eastern Macedonia and Thrace Institute of Technology, Kavala, Greece
| | - Stavros Touloupidis
- Department of Urology, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
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Bantis A, Zissimopoulos A, Sountoulides P, Kalaitzis C, Giannakopoulos S, Deftereos S, Tsakaldimis G, Thomaidis V, Touloupidis S. Bisphosphonate-induced osteonecrosis of the jaw in patients with bone metastatic, hormone-sensitive prostate cancer. Risk factors and prevention strategies. Tumori 2018; 97:479-83. [DOI: 10.1177/030089161109700411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Evidence from the literature suggests that osteonecrosis of the jaw is emerging as a serious complication of treatment with bisphosphonates for patients with advanced prostate cancer. Methods and study design This study is a series of 60 patients with osseous metastases from prostate cancer under complete androgen deprivation therapy. All patients also received bisphosphonates intravenously every 3 to 4 weeks. Over a period of 3 and a half years, we recorded the incidence, presenting signs and symptoms of osteonecrosis of the jaw among those patients and the diagnostic workup required. Results Nine of the 60 patients with metastatic prostate cancer were found to be affected with osteonecrosis of the jaw secondary to bisphosphonate administration at the Urology Department at the University Hospital of Alexandroupolis between January 2006 and August 2009. For diagnostic reasons, all 9 patients underwent computed tomography scan and magnetic resonance imaging of the maxillary region, as well as a three-phase whole body bone scan. Conclusions There is evidence that administration of bisphosphonates in patients with advanced prostate cancer may increase the risk of osteonecrosis of the jaw. Guidelines regarding the diagnosis and management of those patients are needed.
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Affiliation(s)
| | | | | | | | | | - Savas Deftereos
- Radiology Department, Democritus University of Thrace, Greece
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9
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Giannakopoulos S, Giannopoulos S, Gardikis S, Bantis A, Kalaitzis C, Zissimopoulos A, Touloupidis S. Second-look Flexible Nephroscopy Combined With Holmium: Yttrium-Aluminum-Garnet Laser Lithotripsy Under Local Anesthesia: A Prospective Study. Urology 2016; 99:27-32. [PMID: 27639795 DOI: 10.1016/j.urology.2016.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/26/2016] [Accepted: 06/30/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To present a prospectively studied series of patients who underwent second-look flexible nephroscopy combined with holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy under local anesthesia for residual stone removal after percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS Thirty consecutive eligible patients who underwent a PCNL procedure in the previous 48-96 hours were included. The inclusion criteria were the following: (1) 1 or 2 residual stones 0.8-1.5 cm in diameter and (2) age >18 years. Approximately 15 mL of a 2% solution of lidocaine hydrochloride was injected through the nephrostomy tube, which was then clamped for 15 minutes. Flexible nephroscopy was combined with Ho:YAG laser lithotripsy set at 0.8 Joules and 8 Hz. Patients were asked to rate their pain intensity using the numeric rating scale (NRS). RESULTS There were 14 (46.7%) men and 16 (53.3%) women in the study, with a mean age of 45.2 ± 17.5 years. Twenty-one (70%) patients had 1 stone and 9 (30%) had 2 stones needing fragmentation. Twenty-eight (93.3%) patients successfully underwent the procedure under local anesthesia. The mean NRS value was 1.39 ± 1.08 (range 0-5). For the entire group, there was a statistically significant difference between those patients with 1 stone vs 2 stones needing fragmentation (NRS scores of 1.1 ± 0.77 vs 2.1 ± 1.36, respectively, P = .033). Operative time >30 minutes was associated with higher NRS score. The stone-free rate under local anesthesia was 86.7%. CONCLUSION For patients with a minimal to moderate residual stone burden after PCNL, second-look flexible nephroscopy can be combined with Ho:YAG laser lithotripsy using only local anesthesia.
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Affiliation(s)
| | | | - Stefanos Gardikis
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasios Bantis
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christos Kalaitzis
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Stavros Touloupidis
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
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Kalaitzis C, Patris E, Deligeorgiou E, Sountoulides P, Bantis A, Giannakopoulos S, Touloupidis S. Radiological findings and the clinical importance of megacalycosis. Res Rep Urol 2015; 7:153-5. [PMID: 26528455 PMCID: PMC4621186 DOI: 10.2147/rru.s81519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To describe the radiological findings and the clinical importance of megacalycosis. Materials and methods On the basis of a case report and literature review, diagnostic criteria and clinical significance of megacalycosis are presented. Result Megacalycosis is mostly asymptomatic and is usually discovered either accidentally or as a result of its complications, such as stone formation, flank pain, hematuria, infection, and fever. The renal pelvis, infundibulum, and ureter are not dilated. Calyces have a semilunar configuration rather than the conventional triangular or conical form. The tip of each pyramid is flat, and the calyces possess neither fornix nor papillae impressions. The number of calyces is increased compared to the healthy condition, typically from 20–25. The renal parenchyma has a normal width but with a slight narrowing of the renal medulla. The kidney exhibits normal function, in particular with respect to its ability to concentrate the urine. Conclusion Megacalycosis is a rare, usually unilateral dilatation of the kidney calyces in the presence of a normal, undilated renal pelvis and ureter. Its pathological significance lies in the occurrence of complications.
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Affiliation(s)
- Christos Kalaitzis
- Department of Urology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Emmanuel Patris
- Department of Urology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Evangelia Deligeorgiou
- Department of Urology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | | | - Athanasios Bantis
- Department of Urology, General Hospital of Evros, Alexandroupolis, Greece
| | | | - Stavros Touloupidis
- Department of Urology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
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11
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Tsakaldimis G, Bantis A, Zissimopoulos A, Kalaitzis C, Gianakopoulos S, Pitiakoudis M, Polichronidis A, Touloupidis S. Tumor necrosis factor A and interleucin 6 serum values in patients undergoing extracorporeal shock wave lithotripsy for ureteral stones. Hell J Nucl Med 2015; 18 Suppl 1:103-108. [PMID: 26665219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/10/2013] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Extracorporeal shock wave lithotripsy (ESWL) is highly effective for the treatment of uretral lithiasis and remains the first treatment option for the majority of patients when ureteral lithiasis can not be treated otherwise for more than two decades. In the present study we aim to evaluate the levels of serum tumor necrosis factor a (TNF-a) and interleucin 6 (IL-6) in patients undergoing ESWL and investigate whether preESWL levels of serum TNF-a and IL-6 correllate with any possible infectious complications after ESWL. SUBJECTS AND METHODS Thirty patients (17 males and 13 females), with a mean age of 43 who underwent ESWL for ureteral stones and 10 healthy volunteers serving as the control group were enrolled in this study. Serum samples for TNF-a and IL-6 were obtained before ESWL and after ESWL, 1, 24, and 48 hours and 2, 24, and 48 hours, respectively. The preESWL and postESWL serum TNF-a levels and IL-6 were compared and correlated with possible tissue damage and infectious complications. RESULTS We found that serum TNF-a levels were significantly decreased one hour (P<0,001) and increased 24 hours (P=0.007) after ESWL. Furthermore IL-6 was also significantly increased 2 hours (P<0,001), 24 and 48 hours after ESWL (P=0,003 and 0,002 respectively). In 3 patients we observed fever (39 (o)C) postESWL procedure with negative urine culture and high serum values of TNF-a and IL6 preESWL. IN CONCLUSION A high specific markers such as serum TNF-a levels (15-25pg/ml) and IL-6 (25-35pg/ml) might be useful to identifying patients with possible infection following ESWL lithotripsy. However, further studies are needed to get more accurate results.
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Affiliation(s)
- Georgios Tsakaldimis
- Urology Department, University Hospital of Alexandroupolis, PC 68100, Alexandroupolis, Greece.
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12
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Bantis A, Tsakaldimis G, Zissimopoulos A, Kalaitzis C, Gianakopoulos S, Pitiakoudis M, Polichronidis A, Touloupidis S. Can tumor necrosis factor a (TNF-a) and interleukin 6 (IL-6) be used as prognostic markers of infection following ureteroscopic lithrotripsy and extracorporeal shock wave lithotripsy for ureteral stones? Hell J Nucl Med 2015; 18 Suppl 1:160. [PMID: 26672717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/01/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Ureteroscopic lithotripsy (URS) and Extracorporeal shock wave lithotripsy (ESWL) are highly effective for the treatment of uretral lithiasis and remain the treatment option for the majority of patients for more than two decades. In the present study we aimed to evaluate the levels of serum tumor necrosis factor A (TNFa) and interleucin 6 (IL6) in patients undergoing ESWL and URS. SUBJECTS AND METHODS A total number of seventy patients were involved in our study. Thirty patients (17 males, 13 females), with a mean age of 43 had underwent ESWL and thirty patients (19 males, 11 females), with a mean age of 47 (range: 26-68) underwent URS lithotripsy. Ten healthy volunteers serving as the control group were enrolled in this study. Serum samples for TNF-a and IL-6 were obtained before URS and ESWL and after the procedure at 1, 24, and 48 hours and at 2, 24, and 48 hours, respectively. The pre ESWL/URS and post ESWL/URS levels were compared and correlated with possible tissue damage. According to ESWL procedure we found that serumTNF-a levels were significantly increased after one hour (P<0,001) and after 24 hours (P=0.007). Furthermore, IL-6was significantly increased at 2 (P< 0,001), 24 and 48 hours post ESWL (P=0,003 and 0,002) respectively. For URS serum TNF-a levels were statistical significantly correlated preoperatively with one hour (P=0,0083) and 48 hours (P<0,001) after URS and IL-6 with 2 and 24 hours (P<0,001). In 3 patients for URS and 1 for ESWL we observed post procedure fever (>38.5C(o)). All those patients had preoperatively high values of TNF-a and Il-6 that increased at 1 and 2-hours respectively. In conclusion, high pre ESWL/URS levels of serum TNF-a and IL-6 may indicate a predisposition for post ESWL/URS inflammation and infection following URS lithotripsy or ESWL procedure.
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Affiliation(s)
- Athanasios Bantis
- Urology Department, University Hospital of Alexandroupolis, PC 68100, Alexandroupolis, Greece.
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Touloudi A, Valiakos G, Athanasiou LV, Birtsas P, Giannakopoulos A, Papaspyropoulos K, Kalaitzis C, Sokos C, Tsokana CN, Spyrou V, Petrovska L, Billinis C. A serosurvey for selected pathogens in Greek European wild boar. Vet Rec Open 2015; 2:e000077. [PMID: 26392908 PMCID: PMC4567164 DOI: 10.1136/vetreco-2014-000077] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 05/27/2015] [Accepted: 07/07/2015] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Serum samples, collected from 94 European wild boar (Sus scrofa) during the hunting seasons 2006 -2010 from different regions of Greece, were examined in order to estimate the role of these wildlife species as reservoir of pathogens important for livestock and/or public health. MATERIALS AND METHODS The assays used for this purpose were commercial indirect ELISA for the detection of antibodies against porcine circovirus type 2 (PCV-2), porcine reproductive and respiratory syndrome (virus) (PRRSV), Aujeszky's disease virus (ADV), influenza A (IA) virus, Actinobacillus pleuropneumoniae, Mycoplasma hyopneumoniae, Salmonella species, Trichinella species and indirect immunofluorescence antibody test for the detection of antibodies against Toxoplasma gondii and Neospora caninum. RESULTS Antibodies against PCV-2, PRRSV, ADV, IA virus,A. pleuropneumoniae, M. hyopneumoniae, Salmonella species, Trichinella species, T. gondii and N. caninum were detected in 19.1 per cent, 12.8 per cent, 35.1 per cent, 1.1 per cent, 57.4 per cent, 0 per cent, 4.3 per cent, 6.4 per cent, 5.2 per cent and 1.1 per cent of the samples, respectively. Cluster analysis revealed a hot spot of seropositivity near Bulgarian border; seropositivity to ADV was more common among female animals. CONCLUSIONS These results indicate exposure of wild boar to most of the above-mentioned pathogens, raising concern about the possibility that these species may pose a significant health risk for livestock and/or humans.
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Affiliation(s)
- A Touloudi
- Faculty of Veterinary Medicine , University of Thessaly , Karditsa , Greece ; Department of Biomedicine , Institute for Research and Technology Thessaly , Larissa , Greece
| | - G Valiakos
- Faculty of Veterinary Medicine , University of Thessaly , Karditsa , Greece ; Department of Biomedicine , Institute for Research and Technology Thessaly , Larissa , Greece
| | - L V Athanasiou
- Faculty of Veterinary Medicine , University of Thessaly , Karditsa , Greece
| | - P Birtsas
- Department of Forestry and Management of Natural Environment , Technological Education Institute of Thessaly , Karditsa , Greece ; Hunting Federation of Macedonia and Thrace , Thessaloniki , Greece
| | - A Giannakopoulos
- Faculty of Veterinary Medicine , University of Thessaly , Karditsa , Greece
| | | | - C Kalaitzis
- Hunting Federation of Macedonia and Thrace , Thessaloniki , Greece
| | - C Sokos
- Faculty of Veterinary Medicine , University of Thessaly , Karditsa , Greece ; Hunting Federation of Macedonia and Thrace , Thessaloniki , Greece
| | - C N Tsokana
- Faculty of Veterinary Medicine , University of Thessaly , Karditsa , Greece
| | - V Spyrou
- Department of Animal Production , Technological Education Institution of Thessaly , Larissa , Greece
| | - L Petrovska
- Department of Microbiology , Veterinary Laboratories Agency , Weybridge , UK
| | - C Billinis
- Faculty of Veterinary Medicine , University of Thessaly , Karditsa , Greece ; Department of Biomedicine , Institute for Research and Technology Thessaly , Larissa , Greece
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Patris E, Giakoumidakis K, Patris V, Kuduvalli M, Argiriou M, Charitos C, Kalaitzis C, Touloupidis S. Perioperative prostate specific antigen levels among coronary artery bypass grafting patients: Does extracorporeal circulation and body temperature induce prostate specific antigen levels alterations? Urol Ann 2015; 7:58-62. [PMID: 25657546 PMCID: PMC4310119 DOI: 10.4103/0974-7796.148619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 02/10/2014] [Indexed: 11/16/2022] Open
Abstract
Purpose: The purpose of this study is to compare the perioperative total prostate specific antigen (tPSA) levels among coronary artery bypass grafting (CABG) patients with and without extracorporeal circulation (ECC), to investigate the changes overtime of tPSA in each group separately and to determine the effect of body core temperature on tPSA levels. Materials and Methods: A prospective study was conducted. Our sample was allocated to: (a) Seven patients who underwent off pump CABG (Group I) and (b) 16 CABG patients with ECC (Group II). The levels of tPSA were measured preoperatively (baseline), intra-operatively and at the 4th postoperative day. We compared the two groups on their tPSA levels and we investigated the changes of tPSA overtime in each group separately. Results: Intra-operative serum samples were obtained in significantly lower body temperature in patients of Group II than in those of Group I (31°C vs. 36.9°C, P < 0.001). In each group separately, postoperative tPSA levels were increased significantly compared to the baseline values (2.55 ng/ml vs. 0.39 ng/ml for Group I, P = 0.005 and 4.36 ng/ml vs. 0.77 for Group II, P < 0.001). CABG patients with ECC had significantly lower intra-operative tPSA levels than the baseline values (0.67 ng/ml vs. 0.77 ng/ml, P = 0.008). We did not observe significant differences of tPSA levels between the two groups. Conclusions: CABG surgery affects similarly the perioperative tPSA independently the involvement of ECC. Although all patients had significantly higher early postoperative tPSA levels, only those who underwent CABG with ECC had exceeded normal values and significantly decreased intra-operative tPSA. Hypothermia seems to be the causal factor of tPSA reduction.
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Affiliation(s)
- Emmanuel Patris
- Department of Urology, School of Medicine, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece
| | | | - Vasileios Patris
- Department of Cardiac Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool L14 3 PE, United Kingdom
| | - Manoj Kuduvalli
- Department of Cardiac Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool L14 3 PE, United Kingdom
| | - Mihalis Argiriou
- Department of Cardiac Surgery, "Evangelismos" General Hospital of Athens, 10646 Athens, Greece
| | - Christos Charitos
- Department of Cardiac Surgery, "Evangelismos" General Hospital of Athens, 10646 Athens, Greece
| | - Christos Kalaitzis
- Department of Urology, School of Medicine, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece
| | - Stavros Touloupidis
- Department of Urology, School of Medicine, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece
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Bantis A, Sountoulides P, Kalaitzis C, Deftereos S. Conservative Management of Penile Trauma May Be Complicated by Abscess Formation. Clin Pract 2014; 4:648. [PMID: 25568766 PMCID: PMC4274484 DOI: 10.4081/cp.2014.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 09/02/2014] [Accepted: 09/10/2014] [Indexed: 11/22/2022] Open
Abstract
Blunt penile trauma during sexual activity, although highly underreported due to the associated patient embarrassment, constitutes a real urological emergency requiring immediate attention and possibly early surgical intervention. We report a case of a 58-year old man who presented with penile pain following excessive masturbation. Although there were no clinical signs of penile deformity or hematoma, magnetic resonance imaging revealed the presence of a rupture in the tunica albuginea. The patient opted for non-surgical management and his recovery period was complicated by the formation of an abscess at the site of the albugineal tear thus prolonging his hospital stay. The abscess was surgically drained and the patient reports to have normal erections at 3-month follow up.
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Gardikis S, Kambouri K, Giatromanolaki A, Agelidou M, Kalaitzis C, Giannakopoulos S, Touloupidis S, Vaos G. The use of a perimeatal-based penile skin flap to cover the repair of a tubularized incised plate urethroplasty: from experimental surgery to clinical practice. J Pediatr Urol 2014; 10:469-73. [PMID: 24444860 DOI: 10.1016/j.jpurol.2013.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 12/07/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To prospectively evaluate the efficacy and safety of a perimeatal-based penile skin flap for neourethral coverage after repair of distal hypospadias with tubularized incised plate urethroplasty (TIPU). METHODS In 12 New Zealand white rabbits a ventral urethral defect was created and reconstruction was accomplished with continuous suture. An epithelialized defect-based flap was harvested from the penile skin to cover the repaired defect. The animals were euthanized on the 28th postoperative day and their penises were processed for microscopic examination. In 32 children with distal hypospadias a TIPU was performed. A penile skin flap was created immediately below the distal end of the neourethra and used to cover the urethroplasty. RESULTS Histological examinations revealed complete restoration of continuity of the stratified squamous epithelium without evidence of inflammation or fistula formation with full consistency with the underlying papillary reticular and corium. There were no cases of fistula formation. One patient developed meatal stenosis. All patients had a satisfactory cosmetic appearance and excellent functional results. CONCLUSION The formation of a perimeatal-based skin flap is a simple and safe method of providing additional cover for the constructed neourethra after TIPU, minimizing the fistula rate.
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Affiliation(s)
- Stefanos Gardikis
- Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece.
| | - Katerina Kambouri
- Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
| | - Maria Agelidou
- Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
| | - Christos Kalaitzis
- Department of Urology, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
| | - Stilianos Giannakopoulos
- Department of Urology, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
| | - Stavros Touloupidis
- Department of Urology, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
| | - George Vaos
- Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
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Bantis A, Tsakaldimis G, Zissimopoulos A, Kalaitzis C, Gianakopoulos S, Pitiakoudis M, Polichronidis A, Touloupidis S. Serum cytocines values in patients after endoscopic surgery for ureteral lithiasis. Hell J Nucl Med 2014; 17 Suppl 1:20-23. [PMID: 24392463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/10/2013] [Indexed: 06/03/2023]
Abstract
Obstructive uropathy due to ureteral stones can cause renal infection and, if left untreated, can cause impairment of renal function. Endoscopic surgery such as ureteroscopy (URS) and laser lithotripsy are the primary therapeutic approach. Cytokines as non invasive markers may have a role to diagnose ureteral damage and infection. We aimed to evaluate serum cytokine levels of tumor necrosis factor-a (TNFa) and interleukin-6 (IL6) in patients undergoing URS and holmium laser lithotripsy. The study included 40 patients (male 25 and 15 female) with a mean age of 47 years and 10 healthy blood donors serving as the control group. None of them had any additional systemic diseases, previous insertion of a ureteral double "j" stent or of a nephrostomy tube, neoplasmatic disease ot renal insufficiency. Routine urine examination and urine culture were obtained to exclude urinary infection. Preoperatively and 1h, 2h, 24h and 48h postoperatively serum samples of TNF-a and IL-6 were collected and measured. Serum TNFa and IL-6 values were correlated with the other variables measured from blood samples after the URS using paired samples Students t-test with confidence interval 95%. A P value of less than 0.01 was considered statistically significant. Correlation between serum TNF-a and IL6 levels with healthy donors were statistically significant in 1h (0.004), 2h (0.001), 24h (0.001) and 48h (0.001 and 0.001) postoperatively, respectively. In conclusion, our study shows that cytokines could be helpful as markers of renal tissue damage. However, further studies are needed to get more accurate results.
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Affiliation(s)
- Athanasios Bantis
- Department of Urology, University General Hospital of Alexandroupolis, Dragana 68100, Alexandroupolis, Grecce.
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Ganas V, Kalaitzis C, Sountoulides P, Giannakopoulos S, Touloupidis S. Predictive values of urinary bladder tumor markers survivin and soluble-Fas comparison with cystoscopy and bladder tumor antigen. MINERVA UROL NEFROL 2012; 64:279-285. [PMID: 23288215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The aim of the study was to evaluate the predictive values of two novel urinary markers for bladder cancer: survivin and soluble-Fas (s-Fas). METHODS The study included 84 individuals divided in two groups. The first group contained 47 patients, who underwent transurethral bladder tumor resection and the second, control, group 20 patients with non-malignant conditions, who underwent cystoscopy and 17 health volunteers. Fresh, second morning voided urine was collected for measurement of s-Fas, survivin, BTA and for cytology. Sensitivity, specificity, positive and negative predictive values and accuracy were calculated. RESULTS Bladder tumor patients had significantly higher survivin urine levels in comparison to the controls. Survivin correlated also with the tumor stage. Combination of survivin with BTA had a sensitivity of 86.4% but still lower than that of cystoscopy (97.8%). Only the specificity of the combination between survivin and BTA was higher than that of cystoscopy (86.4% and 75.6%, respectively). CONCLUSION Survivin was a better marker for tumor detection than s-Fas and was better enough to discriminate cancer stage. Combination of survivin and BTA had a specificity of 86.4% to exclude bladder malignancy and the combination of s-Fas with survivin and BTA had a sensitivity of 93.6% to detect bladder cancer.
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Affiliation(s)
- V Ganas
- Department of Urology, University of Thrace, Alexandroupolis, Greece
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19
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Vageli DP, Giannopoulos S, Doukas SG, Kalaitzis C, Giannakopoulos S, Giatromanolaki A, Koukoulis GK, Touloupidis S. Mismatch repair hMSH2, hMLH1, hMSH6 and hPMS2 mRNA expression profiles in precancerous and cancerous urothelium. Oncol Lett 2012; 5:283-294. [PMID: 23255936 DOI: 10.3892/ol.2012.979] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 09/26/2012] [Indexed: 01/15/2023] Open
Abstract
Changes in the expression of the mismatch repair (MMR) genes hMSH2, hMLH1, hMSH6 and hPMS2 reflect dysfunction of the DNA repair system that may allow the malignant transformation of tissue cells. The aim of the present study was to address the mRNA expression profiles of the mismatch DNA repair system in cancerous and precancerous urothelium. This is the first study to quantify MMR mRNA expression by applying quantitative real-time PCR (qPCR) and translate the results to mRNA phenotypic profiles (r, reduced; R, regular or elevated) in bladder tumors [24 urothelial cell carcinomas (UCCs) and 1 papillary urothelial neoplasm of low malignant potential (PUNLMP)] paired with their adjacent normal tissues (ANTs). Genetic instability analysis was applied at polymorphic sites distal or close to the hMSH2 and hMLH1 locus. Presenting our data, reduced hMSH2, hMSH6 and hPMS2 mRNA expression profiles were observed in cancerous and precancerous urothelia. Significantly, the ANTs of UCCs revealed the highest percentages of reduced hMSH2 (r(2)), hMSH6 (r(6)) and hPMS2 (p(2)) mRNA phenotypes relative to their tumors (P<0.03). In particular, combined r(2)r(6) (P<0.02) presented a greater difference between ANTs of low-grade UCCs vs. their tumors compared with ANTs of high-grade UCCs (P= 0.000). Reduced hMLH1 (r(1)) phenotype was not expressed in precancerous or cancerous urothelia. The hMSH6 mRNA was the most changed in UCCs (47.8%), while hMSH2, hMLH1 and hPMS2 showed overexpression (47.8, 35 and 30%, respectively) that was associated with gender and histological tumor grading or staging. Genetic instability was rare in polymorphic regions distal to hMLH1. Our data reveal a previously unrecognized hMSH2 and hMSH6 mRNA combined phenotype (r(2)r(6)) correlated with a precancerous urothelium and show that hMLH1 is transcriptionally activated in precancerous or cancerous urothelium. In the present study, it is demonstrated that reduction of hMSH6 mRNA is a frequent event in bladder tumorigenesis and reflects a common mechanism of suppression with hMSH2, while alterations of hMSH2 or hMLH1 mRNA expression in UCCs does not correlate with the allelic imbalance of polymorphic regions harboring the genes.
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Affiliation(s)
- Dimitra P Vageli
- Department of Pathology, Medical School, University of Thessaly, Larissa, Thessaly 41110
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Giannakopoulos S, Toufas G, Dimitriadis C, Giannopoulos S, Kalaitzis C, Bantis A, Patris E, Touloupidis S. Laparoscopic transvesical resection of an en bloc bladder cuff and distal ureter during nephroureterectomy. ScientificWorldJournal 2012; 2012:658096. [PMID: 23049475 PMCID: PMC3463170 DOI: 10.1100/2012/658096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 09/12/2012] [Indexed: 11/26/2022] Open
Abstract
Objective. The most appropriate technique for excising the distal ureter and bladder cuff during laparoscopic nephroureterectomy is still debated. We report our experience with a pure laparoscopic transvesical method that duplicates the long-standing open transvesical approach. Materials and Methods. Seven men and three women diagnosed with upper tract transitional cell carcinoma were treated with this procedure. Three intravesical ports were inserted, and pneumovesicum was established at 12 mmHg. Transvesical laparoscopic circumferential detachment of the bladder cuff and en bloc mobilization of the last centimeters of the distal ureter were performed, followed by the closure of the bladder defect. Subsequently, a nephrectomy was performed either laparoscopically or using an open flank approach. Results. The median age was 68.5 years. The procedure was completed uneventfully in all cases. The median operating time for distal ureter excision was 82.5 minutes (range 55–120). No complications directly related to the pneumovesicum method were recorded. The median follow-up period was 31 months (range 12–55). During the follow-up period, two patients (20%) died from the disease, and a bladder tumor developed in three cases (30%). Conclusion. The laparoscopic transvesical resection of the en bloc bladder cuff and distal ureter is a reliable, effective, and oncologically safe technique, at least in the midterm.
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Bantis A, Sountoulides P, Kalaitzis C, Nikolaos B, Giannakopoulos S, Zissimopoulos A. Single inguinal node metastasis of stage I testicular seminoma shown by scrotal scintigraphy, 6 months following radical orchiectomy. Hell J Nucl Med 2012; 15:150-2. [PMID: 22741151 DOI: 10.1967/s002449910033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/30/2012] [Indexed: 11/18/2022]
Abstract
Lymphatic drainage of the testes is known to follow a predictable pathway that usually involves the retroperitoneal, paraaortic, paracaval and interaortocaval nodal chains. Herein we report the case of a 41 years old man with a stage I testicular seminoma, with an unexpected inguinal lymph node metastasis. During his routine follow-up visit, 6 months after radical orchiectomy, a spherical mass in the right inguinal region was palpated. Thoraco-abdominal CT did not reveal any evidence of retroperitoneal enlarged lymph nodes or distant metastases, but showed a 2cm right inguinal mass. Scrotal scintigraphy with technetium-99m pertechnetate was performed in order to evaluate the local vascularity of the right inguinal area. The angiographic phase (0-1min) and the blood pool images at 15, 30, 45 and 60min revealed high uptake in the right inguinal region, suggesting a hyperemic mass suspicious for tumor recurrence. The excised mass was found to be an enlarged lymph node infiltrated with seminoma. The patient received adjuvant radiotherapy to which he showed a complete response and has been disease free at 2 years follow-up. In conclusion, in the case presented scrotal scintigraphy showed a hyperemic mass at the right inguinal region that proved to be the sentinel node of a stage I testicular seminoma and was treated accordingly.
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Affiliation(s)
- Athanasios Bantis
- Department of Urology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece.
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Giannakopoulos S, Efthimiou I, Bantis A, Kalaitzis C, Touloupidis S. A Simplified Technique for Ureteral Spatulation in Laparoscopic Pyeloplasty. J Endourol 2012; 26:618-20. [DOI: 10.1089/end.2011.0354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Ioannis Efthimiou
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasios Bantis
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christos Kalaitzis
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stavros Touloupidis
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
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Bantis A, Zissimopoulos A, Sountoulides P, Kalaitzis C, Giannakopoulos S, Deftereos S, Tsakaldimis G, Thomaidis V, Touloupidis S. Bisphosphonate-induced osteonecrosis of the jaw in patients with bone metastatic, hormone-sensitive prostate cancer. Risk factors and prevention strategies. Tumori 2012. [PMID: 21989437 DOI: 10.1700/950.10401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND Evidence from the literature suggests that osteonecrosis of the jaw is emerging as a serious complication of treatment with bisphosphonates for patients with advanced prostate cancer. METHODS AND STUDY DESIGN This study is a series of 60 patients with osseous metastases from prostate cancer under complete androgen deprivation therapy. All patients also received bisphosphonates intravenously every 3 to 4 weeks. Over a period of 3 and a half years, we recorded the incidence, presenting signs and symptoms of osteonecrosis of the jaw among those patients and the diagnostic workup required. RESULTS Nine of the 60 patients with metastatic prostate cancer were found to be affected with osteonecrosis of the jaw secondary to bisphosphonate administration at the Urology Department at the University Hospital of Alexandroupolis between January 2006 and August 2009. For diagnostic reasons, all 9 patients underwent computed tomography scan and magnetic resonance imaging of the maxillary region, as well as a three-phase whole body bone scan. CONCLUSIONS; There is evidence that administration of bisphosphonates in patients with advanced prostate cancer may increase the risk of osteonecrosis of the jaw. Guidelines regarding the diagnosis and management of those patients are needed.
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Bantis A, Sountoulides P, Kalaitzis C, Boussios N, Giannakopoulos S, Zissimopoulos A. Positive lymphoscintigraphy (ILS) and negative computed tomography for metastatic penile cancer. Hell J Nucl Med 2011; 14:309-310. [PMID: 22087456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Penile carcinoma usually occurs in older than 40 years men with an incidence in western communities of 0.5 to 1.6 per 100,000 men per year while in developing countries the rate is much higher in men. Extensive lymph node dissection of lymphatic inguinal metastases evident by inguinal lymphoscintigraphy (ILS) induces improved overall survival. A 75 years old male with penile squamous cell carcinoma stage pT2N0M0 of less than 2cm diameter, with tumor invasion of the penis corpora underwent partial penectomy with a 2-cm disease-free margin. Three months postoperation, computed tomography (CT) was negative for local recurrence or distant metastases. A dynamic ILS was performed after local anaesthesia and intradermal injection of 80MBq of (99m)Tc-nanocolloid at the lower edge of the left and right inguinal ducts. The lymphatic chain and a hot spot suggestive of a first draining lymph node appeared after 15min on the right inguinal region in the second zone according to Daseler mapping. The left inguinal area was negative for sentinel node (SN). In view of this finding an exploratory laparotomy was performed and pathology showed that this lymph node that was probably a SN was infiltrated by the squamous cell carcinoma. The patient was upstaged to T2N1M0 and scheduled to receive adjuvant chemotherapy with two courses of cisplatin and 5-fluorouracil. While T1 and T2 tumours of diameters <2cm are best treated with penile-preserving methods such as circumciand/or local excision. Tumours of T2 >2cm, T3 tumours, and T4 tumours are treated with glans amputation and/or partial or total penile amputation. Imaging with magnetic resonance imaging (MRI) or computed tomography (CT) scan do not always give accurate staging information, because positive findings are usually found only in patients with clinically palpable, enlarged inguinal lymph nodes. Computed tomography and MRI have low sensitivity to identify occult metastases, because they present criteria for malignant involvement mainly based on the size of the lesions. The main pitfall of these diagnostic modalities is due to occult metastatic disease occurring within normal sized nodes. Approximatively 20% of the patients with non palpable lymph nodes harbour occult inguinal metastases, and there is evidence that this group of patients may benefit from early surgical dissection of the inguinal nodes, compared to a wait-and-see policy. It is understood that current imaging techniques cannot accurately detect occult metastases, while ILS is more reliable. In 80% of patients with penile cancer, after ILS, drainage to both groins is observed. Bilateral nodes are often visualized early, sometimes asynchronously with one of the lymph nodes filling late. This is why delayed images are recommended. Pitfalls of ILS are: a) Contamination of the skin with the tracer and b) radiopharmaceutical entering the blood. There are also several reasons that may account for absent or faint SN uptake: low dose of the tracer or low tracer quality, patient's age (better in young patients), tumor involvement of the sentinel node, and finally too short or too long interval between tracer injection and ILS. The ILS can be mapped according to Daseler's inguinal zones. Penile cancer drains directly to the nodes in the superior and central Daseler zones. According to others, the majority (73%) of SN was located in the medial superior, 8.7% in the lateral superior, and 18.3% in the central zone. No drainage was seen on the two inferior quadrants. The majority (62.1%) of higher-tier nodes was found in the external iliac zone. Inguinal LS can save us from watchful waiting in cases of otherwise occult metastases. In conclusion, ILS has shown lymph node metastases while clinical and CT examinations were negative. The false positive and false negative results of ILS are mentioned.
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Affiliation(s)
- Athanasios Bantis
- Department of Urology, Department of Nuclear Medicine, University Hospital of Alexandroupolis, Dragana 68100, Alexandroupolis, Greece.
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Kalaitzis C, Zissimopoulos A, Bantis A, Giannakopoulos S, Galazios G, Limperis V, Touloupidis S. Minimal invasive treatment options in pregnant women with ovarian vein syndrome. Arch Gynecol Obstet 2011; 285:83-5. [DOI: 10.1007/s00404-011-1926-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 05/04/2011] [Indexed: 11/29/2022]
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Giannakopoulos S, Bantis A, Kalaitzis C, Touloupidis S. Use of an angiographic catheter to facilitate fluoroscopy-guided percutaneous renal access in cases with diffuse contrast extravasation. J Endourol 2011; 24:1575-8. [PMID: 20818986 DOI: 10.1089/end.2010.0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Occasionally during percutaneous surgery, significant contrast extravasation obscures the field, making fluoroscopic access no longer feasible. Herein, we describe a salvage technique. MATERIALS AND METHODS The cystoscopically placed, open-end ureteral catheter is exchanged with an angled-tip angiographic catheter. With the aid of a guidewire and under fluoroscopic guidance, the tip of the catheter is placed in a posterior calix. The "bull's eye" technique is then applied to direct the needle into the tip of the catheter. This technique was used in four cases over a 7-year period. RESULTS Successful access was accomplished in all cases through a middle or upper calix. CONCLUSION The catheter serves as a target for providing access to the renal collecting system and facilitates final tract dilatation.
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Kalaitzis C, Pasadakis P, Bantis A, Giannakopoulos S, Touloupidis S. Sodium sensitivity and its role in the maintenance of high blood pressure in two-kidney, one-clip renovascular hypertension after removal of the clipped kidney in rats. MINERVA UROL NEFROL 2010; 62:225-229. [PMID: 20940692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM The aim of the present study was to define the role of sodium balance and sodium sensitivity in the maintenance of two-kidney, one-clip renovascular hypertension in rats. METHODS Six months after induction of hypertension, systolic blood pressure, sodium balance, water intake and urine excretion were measured under normal conditions, after nephrectomy of the clipped kidney, and under conditions of sodium load. RESULTS No difference between control rats and rats with or without post-Goldblatt hypertension emerged during the development of renovascular hypertension and after nephrectomy of the clipped kidney. Under conditions of high sodium intake, the contalateral kidney of the post-Goldblatt hypertensive rats was unable to excrete surplus sodium. Sodium retention was not correlated with water retention. In contrast to the controls, systolic blood pressure increased in the animals with post-Goldblatt hypertension and those with post-Goldblatt normotension during the sodium load period. No correlation was found between blood pressure increase and sodium retention. The animals were considered sodium sensitive in relation to blood pressure. CONCLUSION In the chronic phase of two kidney-one clip renovascular hypertension, the post-Goldblatt hypertensive and the post-Goldblatt normotensive animals showed sodium sensitivity of blood pressure. The contralateral kidney of the post-Goldblatt hypertensive animals was unable to excrete surplus sodium under conditions of high sodium intake. But this inability and the sodium sensitivity of blood pressure cannot be thought responsible for the maintenance of renovascular hypertension in this model.
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Affiliation(s)
- C Kalaitzis
- Department of Urology, University of Thrace, Alexandroupolis, Greece.
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Patris E, Patris V, Efthimiou I, Kalaitzis C, Giannopoulos S, Giannakopoulos S, Touloupidis S. UP-1.23: Evaluation of lower urinary tract symptoms in men with type II decompression sickness. Urology 2010. [DOI: 10.1016/j.urology.2010.07.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bantis A, Zissimopoulos A, Sountoulides P, Giannakopoulos S, Kalaitzis C, Athanassiadou P, Agelonidou E, Touloupidis S. Tissue polypeptide antigen in the follow-up of patients with urinary bladder cancer compared with conventional urine cytology. Hell J Nucl Med 2010; 13:213-217. [PMID: 21193872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 09/14/2010] [Indexed: 05/30/2023]
Abstract
The incidence of bladder cancer has demonstrated a rapid increase during the last decades. The aim of this study is to determine the clinical value of serum tissue polypeptide antigen (TPA) as a tumour marker for urinary bladder cancer in comparison with conventional urine cytology. Urine and blood samples were obtained from a total of 108 patients (group A) with a known history of bladder cancer, who presented for their routine 3 month follow-up. These 108 patients included 45 patients with high grade and 63 patients with low grade bladder cancer, and 30 patients with lower urinary tract symptoms (LUTS) and no history of bladder cancer (group B). Urine and blood samples from fifty healthy adults (group C) were also tested; this group served as the control group for estimating the normal range of serum TPA values. In all group A patients cystoscopy and/or bladder biopsies were performed. All blood and urine samples were tested for TPA and conventional urine cytology respectively. Results showed that the upper normal range for TPA was 1.0 ng/mL(0.9 ± 0.04) in the control group. For the subgroups of patients with high and low grade bladder cancer elevated serum TPA levels were found in 52% and 40% of the patients respectively. The overall serum TPA sensitivity and specificity were 50% and 85% respectively for patients with known bladder cancer (group A). We found the sensitivity of cytology for high grade bladder (GIII) carcinomas to be 72%; however when urine cytology was combined with serum TPA the overall sensitivity reached 80%. We conclude that serum TPA combined with urine cytology may be used as a prognostic marker for bladder cancer.
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Affiliation(s)
- Athanasios Bantis
- Urology Department, Medical School, Democritus University, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
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Panteliadou M, Touloupidis S, Giatromanolaki A, Pistevou K, Kyrgias G, Tsoutsou P, Kalaitzis C, Koukourakis MI. Concurrent administration of liposomal doxorubicin improves the survival of patients with invasive bladder cancer undergoing hypofractionated accelerated radiotherapy (HypoARC). Med Oncol 2010; 28:1356-62. [DOI: 10.1007/s12032-010-9544-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
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Laschos KA, Papazisis KT, Kontovinis LF, Kalaitzis C, Gianakopoulos S, Kortsaris AH, Touloupidis S. Targeted treatment for metastatic renal cell carcinoma and immune regulation. J BUON 2010; 15:235-240. [PMID: 20658715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
New targeted agents have become the mainstream of treatment in metastatic renal cell carcinoma (mRCC) and substituted the previous cytokine-based therapies. Vascular endothelial growth factor (VEGF) pathway is the principle target for drugs like sunitinib, sorafenib and bevacizumab. As VEGF is regulating dendritic cell (DC) function, inhibition of VEGF results in activation of DCs and a shift towards cellular (type 1) immunity, which is believed to favor cancer rejection. Recent studies have established the immune-stimulating effects of sunitinib that may as well be a marker for effectiveness. On the other hand, sorafenib not only inhibits VEGF receptor (VEGFR) but is also a B-Raf inhibitor (a component of the ras - MAPK pathway) and this leads to downregulation of immune responses. Sorafenib has not yet shown benefit in first-line treatment of mRCC when compared to interferon (IFN)-alpha and sorafenib-mediated immunosuppression may partially account for that. Mammalian target of rapamycin (mTOR), the target of temsirolimus, is an element of the DC activation pathway. There are no data for in vivo effects of temsirolimus in the immune system. The addition of IFN-alpha to temsirolimus resulted in inferior outcomes than temsirolimus alone. IFN-alpha has however still a place in mRCC treatment, as bevacizumab has been approved in combination with IFN-alpha. New clinical trials address the effects of the combination of cytokines with targeted agents. The immune-modulating effects of targeted treatments may be important in pharmacodynamic outcomes, effectiveness or the development of adverse events.
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Affiliation(s)
- K A Laschos
- Applied Molecular Oncology Laboratory, Theagenion Cancer Hospital, 2, Alexandrou Simeonidi Str, 540 07 Thessaloniki, Greece.
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Zissimopoulos A, Bantis A, Sountoulides P, Giannakopoulos S, Kalaitzis C, Agelonidou E, Touloupidis S. The prognostic value of serum chromogranin A and prostate specific antigen in prostate cancer patients for progression to the hormone resistance state. Hell J Nucl Med 2009; 12:234-237. [PMID: 19936334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 10/06/2009] [Indexed: 05/28/2023]
Abstract
Prostate adenocarcinomas (PAC) consist mainly of tumour cells of luminal immunophenotype and scattered neuroendocrine (NE) cells. NE cells are defined by chromogranin A (CgA) immunoreactivity. T he aim of this study is the evaluation of CgA serum levels in monitoring prostate cancer (PC) patients under complete androgen deprivation (CAD) in comparison with the prostate specific antigen (PSA) as a prognostic marker of androgen resistance and bone metastases. Ninety-two patients with newly diagnosed PAC and 30 healthy blood donors serving as the control group were enrolled in the study. Serum CgA and PSA values were measured. All patients had locally advanced or metastatic disease and received CAD treatment. In the group of PAC patients bone scanning with 925MBq (99m)Tc-MDP revealed the presence of bone metastatic lesions in 50 patients (29 with more than 3 lesions and 21 with less than 3 lesions). The other 42 patients had no bone metastases. The patients and the control group were re-evaluated after 1 year. Our results showed that serum CgA positively correlated with multiple bone metastases and higher Gleason score, serum levels of CgA and PSA. Levels of PSA were significantly higher in patients with PAC and bone metastases compared with those with no bone metastases (P<0.001). In patients with multiple bone metastases and Gleason Score >7 elevated serum levels of CgA higher than those of PSA were found. In conclusion, serum CgA levels is a valuable marker for predicting the presence of multiple bone metastases in PAC patients. Combined with PSA, CgA can predict disease progression in patients with advanced PAC under CAND treatment and is correlated with poor prognosis.
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Affiliation(s)
- Athanasios Zissimopoulos
- Nuclear Medicine Department, School of Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
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Kalaitzis C, Touloupidis S, Bantis E, Patris E, Triantafyllidis A. Effects of renal denervation of the contralateral kidney on blood pressure and sodium and eicosanoid excretion in the chronic phase of two-kidney, one-clip renovascular hypertension in rats. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/00365590410018774-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Evangelos Bantis
- Department of Urology, University of Thrace, Alexandroupolis, Greece
| | - Emmanuel Patris
- Department of Urology, University of Thrace, Alexandroupolis, Greece
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Giannakopoulos S, Pantazis T, Kalaitzis C, Bantis A, Antoniou DE, Touloupidis S. Outpatient Ureteral Stent Placement under Local Anesthesia Using a Flexible Cystoscope and Fluoroscopic Control. Curr Urol 2008. [DOI: 10.1159/000115414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Patris E, Pantazis T, Patris G, Giannacopoulos S, Kalaitzis C, Vudalikakis C, Koukourakis M, Touloupidis S. UP.52: Prostate Cancer and Sexual Function after External Beam Radiotherapy, with the Use of a Cytoprotective Agent (Amifostine): The Efficacy of Sildenafil. Urology 2008. [DOI: 10.1016/j.urology.2008.08.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bantis A, Sountoulides P, Zissimopoulos A, Kalaitzis C, Giannakopoulos S, Agelonidou E, Pantazis T, Touloupidis S. The Role of Chromogranin A (CgA) in Monitoring Patients with Prostate Cancer Under Androgen Deprivation Therapy: Comparison with Prostatic Specific Antigen (PSA). Curr Radiopharm 2008. [DOI: 10.2174/1874471010801020115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bantis A, Zissimopoulos A, Kalaitzis C, Giannakopoulos S, Sountoulides P, Parmenopoulou V, Agelonidou E, Touloupidis S. Four prognostic indices in advanced prostate cancer patients, under palliative androgen deprivation treatment. Hell J Nucl Med 2008; 11:21-25. [PMID: 18392222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 03/20/2008] [Indexed: 05/26/2023]
Abstract
Prostate cancer (PCa) is the second leading cause of death in men aged 40 years and older ]and prognostic indices are useful in suggesting its proper treatment. The aim of this study was to evaluate the prognostic value of Gleason score (GS), TNM staging system, initial serum prostate specific antigen (PSA) and bone scintigraphy (BS) in patients with PCa under hormonal palliative treatment, in the development and progression of recurrent PCa. Our methods were as follows: Between January 2005 and December 2007, we have studied at the University General Hospital of Alexandroupolis fourty patients of mean age 77+/-7.2 years with advanced PCa under palliative treatment with antiandrogens and luteinizing hormone-releasing hormone analogues. PCa was diagnosed histologically, based on the TNM system after transrectal ultrasonography guided biopsy. The Gleason score assessment was made as described by others. Metastases were confirmed by a positive bone scintigraphy with 925 MBq (99m)Tc-MDP using a tomographic gamma camera, computerized axial tomography or magnetic resonance imagining. Measurements of PSA were conducted by the radioimmunoassay method. We also examined 20 healthy blood donors (median age 45+/-6.1 years) as controls, in order to estimate the cut-off value of PSA. Our results show the following: Thirteen of our patients had 1-6 "hot" spots and 27 had more than 6 "hot" spots in the bone scan. The median Gleason score was 7 (modal Gleason score 3+4). Serum PSA levels were higher in patients with PCa and bone metastases in comparison to those with PCa without bone metastases. Very high values of PSA (more than 50 ng/ml) were found in patients with multiple bone metastases (>6 "hot" spots). In conclusion, our findings demonstrate that the prognostic value of GS (P=0.043), TNM staging (P=0.1410), serum PSA levels (P=0.002) and BS (P=0.0135) when used alone, not always improve the prognosis to hormone indepentent but when combined (P<0.001) increase the prognosis in patients with advanced PCa under hormonal palliative treatment.
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Triantafyllidis A, Kalaitzis C, Giannakopoulos S, Papatsoris AG, Pantazis T, Papathanasiou A, Touloupidis S. Holmium laser lithothripsy of ureteral calculi: our initial experience. Urol Int 2007; 79:24-7. [PMID: 17627163 DOI: 10.1159/000102908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 06/28/2006] [Indexed: 11/19/2022]
Abstract
AIM To evaluate effectiveness and safety of intracorporeal holmium:YAG (Ho:YAG) laser lithotripsy of ureteral calculi. PATIENTS AND METHODS Between October 2003 and September 2005, 45 patients (age range 27-74, mean age 51.5 years) with 49 ureteral stones (measuring 4-28 mm in size) were treated with Ho:YAG laser lithotripsy. The locations of the stones in the ureter were: 6 in the upper third, 7 in the middle third, and 36 in the lower third. Under general anaesthesia, we used semirigid 9- to 11-Fr ureteroscopes and a flexible 7.5-Fr ureteroscope. The Ho:YAG laser had a maximum power of 1.8 J at 8 Hz, and a 365-mum flexible quartz fibre was used. One month postoperatively the patients were followed up with imaging tests. RESULTS Stone disintegration was feasible in all cases. The mean hospital stay was 2.8 days. One month postoperatively, stone-free status was revealed in 93.3% of the cases. Only minor complications were noted in 4 patients (8.8%). No long-term complications were recorded. CONCLUSION Ho:YAG laser lithotripsy of ureteral calculi is a feasible, safe, and effective procedure.
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Affiliation(s)
- A Triantafyllidis
- Department of Urology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
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Kalaitzis C, Giannakopoulos S, Pantazis T, Pasadakis P, Touloupidis S. Role of eicosanoids of the contralateral kidney in maintenance of two-kidney, one-clip renovascular hypertension in rats. ACTA ACUST UNITED AC 2007; 41:362-6. [PMID: 17853043 DOI: 10.1080/00365590701365362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To elucidate the role of the eicosanoids prostaglandin E(2) (PGE(2)), 6-keto-prostaglandin F(1a) (PGF(1a)) and thromboxane B(2) (TXB(2)) in the maintenance of two-kidney, one-clip renovascular hypertension in rats. MATERIAL AND METHODS The right renal artery was constricted by a silver clip in 63 male Sprague-Dawley rats to induce hypertension, while a sham operation was performed in 17 control rats. Six months after the induction of hypertension, nephrectomy of the clipped kidney was performed. Nephrectomy was followed by a period of high sodium intake. Blood pressure and eicosanoid excretion were measured before and after nephrectomy of the clipped kidney, as well as during high sodium intake. RESULTS During the chronic phase of Goldblatt hypertension, the amount of vasoconstrictive TXB(2) excreted by the contralateral kidney increased compared to that in the controls, whereas PGE(2) excretion was unaffected. Eicosanoid excretion before and after removal of the clipped kidney did not differ between post-Goldblatt hypertensive and post-Goldblatt normotensive animals. During the period of high sodium intake, PGE(2) excretion increased only in control rats, being unaltered in Goldblatt hypertensive rats. CONCLUSIONS In the chronic phase of two-kidney, one-clip renovascular hypertension, the contralateral kidney of post-Goldblatt hypertensive and post-Goldblatt normotensive rats excretes more vasoconstrictive thromboxane in comparison to controls, whereas excretion of vasodilatory prostaglandin is not elevated. However, increased TXB(2) excretion and the absence of an increase in PGE(2) excretion from the contralateral kidney do not appear to be important for the maintenance of high blood pressure in this model of renovascular hypertension.
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Abstract
Ureterosciatic herniation is a rare cause of ureteral obstruction. Sciatic hernia is a well-defined anatomic defect that is the result of atrophy or abnormal development of piriform muscle. Patients with sciaitic hernias commonly present with symptoms of flank, abdominal, pelvic, lower back or thigh pain. The hernia sack can contain small bowel, ureter, ovary, colon or bladder. Ureterosciatic hernia causing ureteral obstruction should be surgical repaired.
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Affiliation(s)
- Stavros Touloupidis
- Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece.
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Patris E, Kalaitzis C, Gianacopoulos S, Bantis A, Sofikitis N, Koukourakis M, Touloupidis S. MP-08.06: Amifostine administration during radiotherapy for prostate cancer: a prospective study. Urology 2007. [DOI: 10.1016/j.urology.2007.06.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bantis A, Zissimopoulos A, Kalaitzis C, Sountoulides P, Giannakopoulos S, Patris E, Aggelonidou E, Voudalikakis C, Touloupidis S. MP-04.03: The value of tissue polypeptide antigen (TPA) in the after care patients with bladder cancer: relationship with conventional urine cytology. Urology 2007. [DOI: 10.1016/j.urology.2007.06.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Giannakopoulos S, Makris NE, Kalaitzis C, Papatsoris AG, Pantazis T, Touloupidis S. Two unusual cases of median raphe penile cysts. Eur J Dermatol 2007; 17:342-3. [PMID: 17540650 DOI: 10.1684/ejd.2007.0218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Aristotle (384-322bc) was one of the leading intellectual figures of all time. In his work he systematised a massive amount of knowledge on a diverse range of subjects, including medicine. This article discusses the observations and hypotheses of this great philosopher on semen and infertility, as they are presented in his work Generation of Animals. This is combined with an evaluation of his positions in relation to those of the Hippocratic Corpus on the same subject. An extensive review of Aristotle's work Generation of Animals was performed with particular focus on his perspectives about semen and infertility. Publications referring to this work were also reviewed. According to Aristotle, semen is that which contains the principles that come from both parents when they unite. He believed that semen was formed by the secretion of nutriments by the body, developing his theories of sterility on this basic principle. A lack of fertility is attributed to genetic or acquired causes. He proposed methods for diagnosing sterility, primarily the 'water test' for men and the 'pessary' method for women. Even if his observations contain clear mistakes, such as attributing only secondary functions to male testicles and the identification of menses as women's 'seed', Aristotle's views also contain keen observations and exceptional thinking, both on the characteristics of semen and the causes of sterility (infertility).
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Affiliation(s)
- C Trompoukis
- Department of History of Medicine, University of Crete, Heraklion, Greece.
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Touloupidis S, Zisimopoulos A, Giannakopoulos S, Papatsoris AG, Kalaitzis C, Thanos A. Clinical usage of the squamous cell carcinoma antigen in patients with penile cancer. Int J Urol 2007; 14:174-6. [PMID: 17302580 DOI: 10.1111/j.1442-2042.2007.01694.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We present our initial experience with the use of the squamous cell carcinoma (SCC) antigen (SCCAg) in 16 men with penile SCC (SCC group), in four men with condyloma acuminatum (benign group), and in 32 blood donors (control group). METHODS The SCCAg levels were measured at presentation and every 6 months (upper limit was 2 ng/mL). The mean follow-up time was 4 years. RESULTS All non-SCC patients had normal SSCAg serum levels in contrast with the SCC patients. The presence of nodal and/or distant metastases resulted in statistically significant higher SCCAg levels, both at presentation and during the follow-up. In patients undergoing lymph node dissection with elevated SCCAg levels prior to the procedure, there was a statistically significant decrease of the SCCAg levels after the operation. CONCLUSION The SCCAg level could be a serum marker that holds promise for clinical use in penile SCC. Sequential monitoring of SCCAg level might indicate developing of nodal and/or distant metastases and could be useful in following the response to treatment.
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Affiliation(s)
- Stavros Touloupidis
- Department of Urology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Kalaitzis C, Passadakis P, Giannakopoulos S, Panagoutsos S, Mpantis E, Triantafyllidis A, Touloupidis S, Vargemezis V. Urological management of indinavir-associated acute renal failure in HIV-positive patients. Int Urol Nephrol 2006; 39:743-6. [PMID: 17180736 DOI: 10.1007/s11255-006-9154-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 11/13/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Indinavir, a protease inhibitor that is commonly used to treat HIV infection, may cause crystal formation within the renal tubules when urine pH is above 3.5. Crystallization in the urine may lead to intrarenal crystal deposition and acute renal failure (ARF). AIM To establish the beneficial urological management of acute renal failure caused by indinavir treatment of HIV/AIDS patients. PATIENTS--METHODS Five HIV positive patients (four men, one woman) with a mean age of 32 years (range 28-36 years) were referred to our Department of Urology from an AIDS outpatient Clinic, because of the development of postrenal acute renal failure with continuously elevated creatinine and urea plasma levels after indinavir therapy. Among the initial therapeutic maneuvers, indinavir administration was interrupted for 1 week while bilateral double-J ureteral stents were inserted in all the HIV/AIDS patients, during the first 24-72 h to secure upper-tract drainage. Concurrently urine has been acidified by oral administration of the amino acid L: -methionine and oral fluid intake was increased. RESULTS All the patients responded well to the treatment and their renal function was effortlessly restored to normal within a few days. CONCLUSION HIV-positive patients receiving indinavir therapy might be complicated by acute renal failure, mainly due to intrarenal crystal deposition (tubules) or urolithiasis (postrenal obstruction). This adverse effect may simply manage by the discontinuation of indinavir administration, urine acidification, as well as the possible early insertion of bilateral double-J ureteral stents.
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Affiliation(s)
- C Kalaitzis
- Department of Urology, School of Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Touloupidis S, Papathanasiou A, Kalaitzis C, Fatles G, Manavis I, Rombis V. Renal cell carcinoma: The influence of new diagnostic imaging techniques on the size and stage of tumors diagnosed over the past 26 years. Int Urol Nephrol 2006; 38:193-7. [PMID: 16868681 DOI: 10.1007/s11255-005-4762-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We have analyzed data collected over a 26-year period for influences of new diagnostic imaging techniques (ultrasound, computed tomography, and magnetic resonance imaging) on the size, stage, and other parameters of renal cell carcinomas at the time of first diagnosis. We reviewed retrospectively the records of 203 patients who underwent operations at our institutions from 1973 to 1999. All the patients suffered from renal cell carcinoma. With this study we attempted to answer four questions regarding changes over this time span: (1) have new imaging techniques lead to a reduction in the median diameter of the tumor upon first diagnosis, (2) has the tumor stage decreased due to earlier diagnosis, (3) is there any correlation between tumor size and tumor stage, and (4) are the patient's early diagnoses at a younger age? Other parameters such as infiltration of the renal pelvis and the cell type were also examined. The tumor size and stage at the time of diagnosis and treatment are positively correlated, and both decrease significantly over the time span examined. There is also a strong association between tumor size and infiltration of the renal pelvis. The median age of the patients did not significantly change over time. The wider use of improved imaging techniques has significantly changed the clinical appearance of the renal cell carcinoma. The question is whether these techniques have also affected the prognosis of the disease.
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Affiliation(s)
- Stavros Touloupidis
- Department of Urology, Democritus University of Thrace, 68100, Dragana, Alexandroupolis, Greece.
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Touloupidis S, Fatles G, Kalaitzis C, Giatromanolaki A, Sivridis E, Simopoulos K, Rombis V. The significance of p53 and bcl-2 overexpression and other prognostic factors in transitional cell carcinoma of the bladder. Int Urol Nephrol 2006; 38:231-6. [PMID: 16868688 DOI: 10.1007/s11255-005-4763-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the expression of bcl-2 and p53 oncoproteins in a series of transitional cell bladder carcinomas and its relation to traditional prognostic indicators and patients' survival. Specimens from 59 patients who underwent transurethral resection from March 1992 to February 1997 were included in this study. Tumors were graded based on WHO grades 1-3 and staged according to the 1997 TNM classification. Three patients lost to follow-up were excluded from the analysis. We could not establish a statistically significant relation between bcl-2 and p53 and other parameters such as sex, age, stage and grade. Tumor grade and stage were the most important factors for predicting tumor recurrence and aggressiveness. Only sex seems to significantly affect the statistics of the risk of death (p<0.05). Women had quadruple risk of death compared to men.
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Affiliation(s)
- Stavros Touloupidis
- Department of Urology, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece.
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Papachristou F, Lialiaris T, Touloupidis S, Kalaitzis C, Simopoulos C, Sofikitis N. Evidence of increased chromosomal instability in infertile males after exposure to mitomycin C and caffeine. Asian J Androl 2006; 8:199-204. [PMID: 16491272 DOI: 10.1111/j.1745-7262.2006.00084.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM To evaluate the genetic instability of 11 fertile and 25 infertile men. METHODS The methodology of sister chromatid exchanges (SCEs) was applied to cultures of peripheral blood lymphocytes, and the levels of SCEss were analyzed as a quantitative index of genotoxicity, along with the values of the mitotic index (MI) and the proliferation rate index (PRI) as qualitative indices of cytotoxicity and cytostaticity, respectively. The genotoxic and antineoplastic agent, mitomycin C (MMC), and caffeine (CAF)--both well-known inhibitors of DNA repair mechanism--were used in an attempt to induce chromosomal instability in infertile men, so as to more easily detect the probable underlying damage on DNA. RESULTS Our experiments illustrated that infertile men, compared with fertile ones, demonstrated a statistically significant DNA instability in peripheral blood lymphocytes after being exposed simultaneously to MMC and CAF. CONCLUSION The current study showed vividly that there was genetic instability in infertile men which probably contributes to the development of an impaired reproductive capacity.
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Affiliation(s)
- Fotini Papachristou
- Laboratory of Genetics, Demokritus University of Thrace, Medical School, Alexandroupolis 68100, Greece
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Triantafyllidis A, Brouskelis N, Papathanasiou A, Fatles G, Kalaitzis C, Rombis V, Touloupidis S. Continent urinary diversion using Mainz II modified ureterosigmoidostomy. Folia Med (Plovdiv) 2006; 48:31-8. [PMID: 16918052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To assess the surgical technique of Mainz II urinary diversion and to discuss its simplicity, quickness of performance, short postoperative period, few postoperative complications, as well as its effectiveness allowing patients to have a very good quality of life. PATIENTS AND METHODS Over the last six and a half years, 47 patients aged between 65 and 76 years (mean age 69.9 +/- 2.5 years) underwent radical cystectomy and Mainz II ureterosigmoidostomy for invasive bladder cancer. All patients were followed according to a standard protocol including assessment of continence, renal function and acid-base balance. RESULTS Most of the patients retained normal renal function, complete continence and acid-base balance. There were no perioperative complications. In three patients there was urine leakage. Four patients presented with pyelonephritis and needed hospitalization. Mild hyperchloraemic acidosis was seen in nine patients. Most of them were pleased from their new quality of life. CONCLUSION The modified Mainz II ureterosigmoidostomy is a simple, quick, easy and safe procedure to achieve urinary diversion in invasive bladder cancer resulting in a very good quality of life for patients without altering their appearance and making them capable of performing all kinds of work.
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Affiliation(s)
- A Triantafyllidis
- Department of Urology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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