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Purpose: This study aims to evaluate the demographic, clinical, and pathologic characteristics and response to immunosuppressive therapy, particularly corticosteroids, in adult patients with primary focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD), which are classified as podocytopathies. Materials and Methods: Between January 1998 and December 2014, this study included 44 patients (27 with primary FSGS and 17 with MCD) aged older than 18 years with a histopathologic diagnosis, symptoms of nephrotic syndrome, and a minimum follow-up of six months. Patients were divided into two groups according to the treatment they received and three groups according to their response to treatment. Patients diagnosed with primary FSGS and MCD were evaluated based on clinical, demographic, and laboratory findings, as well as response to treatment, and a comparison was conducted between the two groups. Results: 59.1% of the patients were male with a mean age of 44.8±17.7 years. At the time of diagnosis, there were no statistically significant differences in clinical and demographic characteristics between MCD and primary FSGS patients. However, in patients with MCD, the mean creatinine clearance (118.0±46.7 ml/min) was higher and the rate of microscopic hematuria (11.8%) was lower at the time of diagnosis. There was an increased need for alternative immunosuppressive treatments besides corticosteroids in patients with primary FSGS to achieve partial or complete remission. At both the third and sixthmonth follow-ups, MCD patients achieved a higher rate of complete remission (proteinuria <0.3 g/day) than FSGS patients. Conclusion: Compared to MCD, primary FSGS is more likely to progress, requires more immunosuppressive therapy beyond corticosteroids to achieve partial or complete remission, and has a lower treatment response rate. [ABSTRACT FROM AUTHOR]

Aim: Nephrotic syndrome (NS) is the most common childhood glomerular disease manifested by proteinuria, edema and hypoalbuminemia. The aim of this study was to examine children with primary NS in terms of their clinical laboratory and histopathological features, and to evaluate their treatment responses. Materials and Methods: Thirty-eight (21 boys/17 girls) patients followed up with primary NS were included in this study. Results: The mean age at diagnosis was 6.4 years. The histopathological diagnoses were focal segmental glomerulosclerosis (FSGS) in 17 patients, minimal change disease (MCD) in 8, membranoproliferative glomerulonephritis (MPGN) in 3, and membranous glomerulonephritis in 1 patient. Those patients with MPGN were older than those with MCD and FSGS (p=0.035). Twenty-four patients were steroid sensitive. Steroid response rates were 88% in those patients with MCD, 41% in patients with FSGS and 33% in those with MPGN. At their last visit, three patients (7.9%) were diagnosed with chronic kidney disease. Conclusion: NS is the most common glomerular disease of childhood. Early diagnosis and the histopathological features of this disease have an important place in its prognosis. Knowing the demographic, clinical and pathological features of the disease is helpful in monitoring its progress and its prognosis. [ABSTRACT FROM AUTHOR]

Objective: Renal involvement is a common manifestation of systemic amyloidosis. Amyloid load can be predicted by histopathological grading of amyloid deposits in renal biopsy specimens. This study aimed to determine the relationship of renal amyloid deposition grade with clinical manifestations and outcomes in patients with biopsy-proven renal non-AA amyloidosis. Methods: This retrospective cohort study included 74 subjects with renal non-AA amyloidosis (52 light chain amyloidosis and 22 unclassified amyloidosis). Baseline characteristics and follow-up data were recorded. Pattern and quantity of amyloid deposition in glomeruli, interstitium, vessels, and tubulointerstitial changes were scored. Renal Amyloid Prognostic Score was obtained by addition of all scores and divided into 3 grades (Renal Amyloid Prognostic Score grades I, II, III). Results: In light chain amyloidosis group, the median follow-up was 11 (4-45) months. The baseline estimated glomerular filtration rate was significantly lower among patients with Renal Amyloid Prognostic Score grade III. Death-censored Renal survival was significantly lower among patients with Renal Amyloid Prognostic Score grade III. Renal Amyloid Prognostic Score grade III was a significant predictor of lower renal survival. Patient survival was not significantly different according to Renal Amyloid Prognostic Score grade. Receiving autologous stem cell transplantation treatment was associated with better patient survival. The type of amyloid could not be determined in 22 patients. In this group, baseline estimated glomerular filtration rate was significantly lower in patients with Renal Amyloid Prognostic Score grade III. Conclusions: In patients with light chain amyloidosis, baseline renal function is associated with Renal Amyloid Prognostic Score grade. Renal survival is significantly lower in patients with the highest Renal Amyloid Prognostic Score grade. However, patient survival is not significantly different according to Renal Amyloid Prognostic Score grade. [ABSTRACT FROM AUTHOR]

Objective: Chronic kidney disease is common, irreversible, and associated with high mortality and morbidity. In this study, we aimed to investigate the effects of calcitriol and paricalcitol on chronic kidney disease progression in an adenine induced uremic rat model. Methods: Male Wistar-albino rats were fed a diet containing 0.75% adenine + 1.2% phosphorus for 3 weeks to induce chronic kidney disease. The rats were randomly divided into 6 groups: control group (n = 12), chronic kidney disease group (n = 12), chronic kidney disease+ calcitriol group (n = 12), chronic kidney disease +paricalcitol group (n = 12), calcitriol group (n = 6), paricalcitol group (n = 6). Animals were monitored for weight and systolic blood pressure. The kidney function parameters, parathyroid hormone, monocyte chemoattractant protein-1, and kidney histology were investigated. This research was supported by the Scientific Research Projects Unit (11-TIP-062). Results: Kidney histology proved that the adenine-induced uremic rat model was successfully established. Serum urea, creatinine, and phosphorus were significantly higher in chronic kidney disease, chronic kidney disease + calcitriol, chronic kidney disease +paricalcitol groups compared with the control group (P < .05). Calcitriol and paricalcitol provide effective parathyroid hormone suppression and decrease serum monocyte chemoattractant protein-1 levels in uremic rats. All uremic rats, including the paricalcitol and calcitriol treatment groups, lost weight. Paricalcitol significantly lowered systolic blood pressure in uremic rats (P = .006). Serum calcium was higher in calcitriol group compared with chronic kidney disease group. Paricalcitol caused less hyperphosphatemia in non-uremic rats than calcitriol. Conclusion: Paricalcitol and calcitriol therapy may prevent chronic kidney disease progression in uremic rats as they restore vitamin D metabolism during the disease. [ABSTRACT FROM AUTHOR]

Objective: Urotensin-II is a potent vasoconstrictor peptide and has fibrotic effects in the heart and kidneys and palosuran is a selective urotensin-II receptor antagonist. This study aimed to investigate the effects of palosuran, which has antifibrotic effects, in an acute kidney injury model formed with gentamicin and to reveal new treatment options for acute kidney injury cases. Methods: A total of 24 Wistar albino rats were randomly divided into 3 groups of 8 animals as the control group, the gentamicin group, and the gentamicin+palosuran group. The rats in the control group received a 1 × 1 mL intramuscular injection of saline for 8 days. To create acute kidney injury in the rats in the gentamicin group, an intramuscular injection of 100 mg/kg/day gentamycine was applied for 8 days. In the gentamicin+palosuran group, an intramuscular injection of 100 mg/kg/day gentamycine was applied for 8 days, together with 300 mg/kg palosuran dissolved in distilled water and administered by oral gavage twice a day for the same period. Serum urea, creatinine, calcium, albumin, total protein levels, and urine gamma-glutamyl transferase and protein levels were evaluated for all the groups. In addition, tubular degeneration, tubular necrosis, tubular regeneration, tubulointerstitial nephritis, microcalcification, and total histological scores of these groups were also examined histopathologically. Results: The urine gamma-glutamyl transferase levels of the gentamicin and gentamicin+palosuran groups were significantly higher than those of the control group (311 ± 60.5 and 140 ± 39.5 vs. 0.33 ± 0.22, P < .05). On the eighth day, the gamma-glutamyl transferase levels of the gentamicin+palosuran group were significantly lower than the gentamicin group (311 ± 60.5 vs. 140 ± 39.5, P < .05). A significant decrease was obtained in tubular necrosis in the gentamicin+palosuran group compared to the gentamicin group (2.5 ± 0.3 vs. 1.3 ± 0.4, P< .05). A statistically significant decrease was determined in the total histological score in the gentamicin+palosuran group compared to the gentamicin group (6.4 ± 0.7 vs. 4.7 ± 0.7, P < .05). Our results showed that the urotensin-II receptor antagonist, palosuran, had positive effects on tubular necrosis, tubular degeneration, tubular regeneration, and the total histological score in an experimental acute kidney injury model formed with gentamicin. Conclusion: The study results suggest that urotensin-II may play a role in the physiopathology of acute renal failure associated with gentamicin. These results are promising for the use of palosuran in the treatment of acute kidney injury. [ABSTRACT FROM AUTHOR]

Hemolytic Uremic Syndrome (HUS) is characterized by the clinical triad of microangiopathic non-immune hemolytic anemia, thrombocytopenia, and acute renal failure. There are infections, genetic causes, malignancies, autoimmune diseases, drugs, and many unexplained causes in the etiology of HUS. The most common cause of HUS in children is Shiga toxin-producing Escherichia coli (STEC). In the literature, few influenza A (H1N1) pdm09 virus-related HUS cases are reported. In this case report, a case with hemolytic uremic syndrome associated with influenza A (H1N1) pdm09 virus infection is presented. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the relationship between prognostic factors and cancer-specific survival (CSS) in renal tumors larger than ten centimeters. Materials and Methods: We evaluated the data of 126 patients who underwent open radical nephrectomy due to a renal mass larger than 10 cm between January 2010 and June 2016. Kaplan-Meier analysis or Cox regression was used to analyze the relationship between CSS and variables. Pairwise group comparisons were also evaluated with the Log-Rank test. A p-value <0.05 was considered statistically significant. Results: Mean follow-up was 68.5 months and mean survival was 39.2 months. The relationships between tumor histopathology, stage and CSS were significant. Tumor size negatively affected CSS, but the relationship was not significant. Tumor stage (T2b, T3b), tumor thrombus, lymph node metastasis and adjuvant therapy were the most effective independent factors affecting CSS according to Cox regression analysis results. Conclusion: Although tumor size is an important prognostic factor for T2b and lower stage kidney tumors, this effect is less in larger tumors and other clinicopathological features should be considered further to predict prognosis. [ABSTRACT FROM AUTHOR]

Intraductal carcinoma of prostate has been previously described in radical prostatectomies. It’s rarely encountered in needle biopsies in the absence of infiltrative carcinoma. But, both histogenesis and nomenclature of the lesion is still controversial. Among the pure intraductal carcinoma of prostate cases, a different solid patern was described with smaller nuclei at the center of the ducts. However, there is a lack of information about the association of those cases with acinar prostate adenocarcinoma. Herein, we describe a case of acinar adenocarcinoma with predominant non-neuroendocrine TTF-1 positive small cell intraductal component. [ABSTRACT FROM AUTHOR]

Aim Lupus nephritis (LN) is an important complication of systemic lupus erythematosus (SLE). The aim is to use indication and protocol biopsies to determine clinicopathological findings and outcomes of patients with LN undergoing kidney transplantation (KTx). Methods Patients who underwent KTx due to LN were retrospectively analyzed. Recurrent LN (RLN) was diagnosed by transplant kidney biopsy. Results Among 955 KTx patients, 12 patients with LN as the cause of end-stage renal disease were enrolled. Five patients were male. Mean follow-up time was 63 ± 34 months. At the last follow-up visit, mean levels of serum creatinine and proteinuria were 137.0 ± 69.0 µmol/L and 0.26 ± 0.26 g/day, respectively. Eighteen indication and 22 protocol biopsies were performed; 27 biopsies were additionally evaluated by immunofluorescence. In two recipients, subclinical RLN was confirmed by protocol biopsies. Clinical recurrence occurred in four patients. Among patients with RLN, time from diagnosis of LN to KTx was significantly shorter and use of ATG as induction treatment was significantly lower. Graft loss occurred in two recipients who had clinical RLN. Five-year overall graft survival was 85.7%. Conclusion Kidney transplantation is a reasonable option for patients with ESRD secondary to SLE. However, recurrence of LN is common if protocol biopsies are included in post-transplantation surveillance. [ABSTRACT FROM AUTHOR]

Persistent Müllerian duct syndrome is the result of either anti-Müllerian hormone (AMH) deficiency or AMH receptor resistance. A long tubular structure was palpated during the physical examination of a 13-month-old male patient who had presented with bilateral undescended testes. At physical examination, the testes were not palpable. The patient's karyotype was XY, SRY (+), and his AMH level was 22 ng/mol. Structures suggestive of ovaries, a uterus, and fallopian tubes were observed during the laparoscopic examination of the ectopic testis. AMHR2 gene sequence analysis performed with a preliminary diagnosis of AMH receptor resistance revealed a previously unreported homozygous c.24G>A (p.W8X) mutation. The patient was assessed as a case of AMH receptor resistance. Orchiopexy was performed. [ABSTRACT FROM AUTHOR]

Objective: Systemic amyloidosis is a rare disorder, characterized by extracellular accumulation of Congo red positive fibrillar amyloid protein deposits that have an amorphous, eosinophilic appearance on hematoxylin-eosin stained preparations. The kidney is the most commonly affected organ by systemic amyloidosis. Congo red staining increases the positive birefringence of the weakly birefringent unstained amyloid. In this study, we investigated the potential diagnostic power of digitally reinforced birefringence of routine hematoxylin-eosin stained slides from renal biopsies. Material and Method: We reviewed 130 hematoxylin-eosin stained slides for polarization. Sixty-five new amyloidosis cases were diagnosed by renal biopsy. All renal biopsies were evaluated by light microscopy and immunofluorescence. Slides were reevaluated blindly using a microscope (Olympus BX51) that was attached polarization filters and connected to a digital camera (Olympus DP21, SAL). Deposits that showed green birefringence on hematoxylin-eosin preparations with digitalized microscopy were considered positive and the results were confirmed using Congo red. Results: Of the 65 Congo red confirmed amyloid positive biopsies, 61 showed green birefringence with hematoxylin-eosin. Of the 65 Congo-red confirmed amyloid negative biopsies, two were considered to be false positive. The sensitivity, specificity, and positive and negative predictive values were estimated as 94%, 97%, 97% and 94% respectively. Conclusion: We concluded that polarized hematoxylin-eosin sections can be used digitally as a fast and first step diagnostic method for renal amyloidosis. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Pathology is the property of Turkish Journal of Pathology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Geriatrics / Türk Geriatri Dergisi is the property of Turkish Geriatrics Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Pathology is the property of Turkish Journal of Pathology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context.—A disease associated with amyloid deposits, called amyloidosis, is associated with characteristic electron microscopic appearance, typical x-ray pattern, and specific staining. Renal involvement mainly occurs in AA amyloidosis and AL amyloidosis and usually progresses to renal failure. Objective.—The renal histopathologic changes with amyloidosis comprise a spectrum. Clear relationships between the extent of amyloid deposition and the severity of clinical manifestations have not been demonstrated. Whether there is a lack of clinicopathologic correlation is not clear, but studies have revealed the need for standardization of the renal amyloid biopsy report. With these objectives in mind, we proposed a histopathologic classification, scoring, and grading system. Renal amyloidosis was divided into 6 classes, similar to the classification of systemic lupus erythematosus.Amyloid depositions and other histopathologic lesions were scored. The sum of these scores was termed the renal amyloid prognostic score and was divided into 3 grades. Data Sources.—AA amyloidosis was detected in 90% of cases, mostly related to familial Mediterranean fever. Positive correlations between class I and grade I, class VI and grade III, and class III and grade II were observed. Also, a positive correlation was identified between severity of glomerular amyloid depositions, interstitial fibrosis, and inflammation. Because of the inadequacy of the patients' records and outcomes, different therapy regimes, and etiologies, clinical validation of this study has not been completed. Conclusions.—Standardization of the renal amyloid pathology report might be critical for patients' medication and comparison of outcome and therapeutic trials between different clinics. Because of our AA to AL amyloidosis ratio and the predisposition of familial Mediterranean fever-related AA amyloidosis, there is a need for further international collaborative studies. [ABSTRACT FROM AUTHOR]

Objective: Amyloidosis represents extracellular deposition of congophilic fibrils of similar morphology but different chemical composition. The types frequently involving the kidney are AA (serum amyloid A) and AL (light chain amyloid). Hereditary amyloidoses, which can also affect the kidney, are being described with increasing frequency. Distinguishing the type of amyloid is important because of the different treatments and outcomes. Typing of amyloidosis by immunohistochemistry (IHC) is believed to be unreliable, except for AA amyloid. We reevaluated our cases in this study to draw attention to the nonAA amyloid deposits in renal biopsies with amyloidosis. Material and Method: Renal biopsies diagnosed as amyloidosis between 1997 and 2008 were stained for amyloid A with IHC. Cases with negative amyloid A staining were included in the study. Results: We found 190 cases of renal amyloidosis (198 biopsies) during the study period. Thirty cases (33 biopsies) with negative antiAA staining were studied. Among those 30 cases with nonAA amyloidosis, secondary AL amyloidosis was due to multiple myeloma in 8 cases and plasma cell dyscrasia in 2 cases. Hereditary renal amyloidosis was suspected in some cases. Conclusion: Using amyloid A IHC on a routine basis and the clinical history are essential to diagnose AA amyloidosis. The differential diagnosis of nonAA amyloidosis may be inconclusive on IHC. The diagnostic approach should be multidisciplinary and requires careful clinical and pathological evaluation. The limitation of IHC may necessitate direct typing of the amyloid protein extracted from paraffin-embedded specimens in some cases. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "A proposed histopathologic classification, scoring, and grading system for renal amyloidosis: standardization of renal amyloid biopsy report" by S. Sen and B. Sarsık in the April 2010 issue.

Objective: Bone metastasis is common in advanced prostate cancer (PCa). Recently, there has been a growing interest in the potential role of inflammatory markers, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and neutrophil-to-monocyte ratio (NMR), in predicting advanced disease in patients with solid tumors. In the current study, we aimed to assess the relationship of bone metastasis detected on bone scintigraphy (BS) with NLR, PLR, and NMR in patients with Pca. Materials and Methods: The study group included 85 PCa patients. Patient characteristics, prostate-specific antigen (PSA) values, Gleason score, histopathological features, presence of metastatic focus on BS and complete blood count values were retrospectively evaluated. The relationship of the presence of bone metastasis on BS with clinicopathological features such as PSA, Gleason score, histopathological findings and NLR, PLR and NMR values were investigated. Results: Median NLR, PLR and NMR were 2.90, 125.69 and 8.38, respectively. Thirty-six patients had metastatic disease on BS. Our findings showed a statistically significant relationship between high NLR value and the presence of bone metastasis (p=0.018) and high Gleason score (p=0.034). However, no significant statistical relationship was found between clinicopathological features and PLR and NMR values (p>0.05). Conclusion: Despite the limited number of patients, a significant relationship between high NLR and metastatic bone disease was found. While high NLR has been generally considered an independent risk factor for poor PCa prognosis, we assume that larger scale studies are warranted to assess its value as a prognostic indicator in PCa patients. [ABSTRACT FROM AUTHOR]

Significant improvements in patient and graft survival and reductions in the frequency of acute rejection were obtained in the early period after renal transplantation, but this success was not sufficiently reflected in the long term. Allograft kidney losses in the long term remain a significant problem. In this study, we investigated the specific causes of graft losses in patients who had a good clinical course in the first year but developed graft loss in the long term. A total of 118 patients who underwent kidney transplantation in 2005 and 2006 in the Organ Transplantation Center of Ege University Medical Faculty Hospital were evaluated. The inclusion criteria were to be older than 18 years and have a serum creatinine value of <2 mg/dL at the 12th month after transplantation. Sixty-one percent of the recipients were male, and the mean age at the time of transplantation was 34 ± 11 years (18 to 61). We observed 29 graft losses during the mean follow-up period of 129 ± 35 months (27 to 162). Three of the graft losses were death by functional graft. Of the 26 patients with graft loss, 16 had chronic rejection, and 8 had recurrent glomerulonephritis. The relationship between nonimmune causes and graft loss was not detected. In conclusion, nonimmune factors may not be as important as we think in relatively young and healthier recipients. Chronic rejection and recurrent glomerulonephritis are the main causes of long-term graft loss of patients with good graft function at the end of the first year. Improvement of long-term survival will be possible with the prevention and effective treatment of these 2 problems. • The effect of nonimmunologic events on allograft kidney survey should not be ignored, but these factors may not be as important as we think in young and relatively healthier recipients. • Chronic rejection and recurrent glomerulonephritis are the main causes of long-term graft loss of patients with good graft function at the end of the first year. Improvement of long-term survival will be possible with the prevention and effective treatment of these 2 problems. [ABSTRACT FROM AUTHOR]

BK virus nephropathy is a serious complication that can lead to allograft kidney loss. Excessive immunosuppression increases the risk. We aimed to evaluate whether there is an increased risk of BK viremia and nephropathy in patients who underwent high-dose immunosuppression because of the development of acute rejection in the early period after kidney transplantation. This retrospective cohort study was performed between April 2015 and March 2016. Twenty-nine patients who had biopsy-proven acute rejection in the first 3 months were evaluated for BK viremia and nephropathy. Thirty patients who had transplantations at the same period were the control group. Plasma BK-DNA values were examined at 1, 2, 3, 6, 9, and 12 months after the rejection treatment and at 3, 6, 9, and 12 months in the control group. Presence of polyoma nephropathy was examined with surveillance biopsies at the 6 and 12 months. Acute rejection treatment was started on the 12th day after transplantation (2–37 days). Seventeen cellular rejections and 12 humoral rejections were reported by biopsy. Two of the 12 humoral rejections were suspicious. Only pulse steroid (PS) (n = 18); PS, plasmapheresis, and intravenous immunoglobulin (n = 8); PS and intravenous immunoglobulin (n = 2); and PS and plasmapheresis (n = 1) treatments were performed. In 21 patients in the rejection group and 25 patients in the control group, BK-DNA was not positive at all. Two patients had graft loss at 11 and 36 months in the rejection group. Graft losses were secondary to rejection. Treatment with antithymocyte globulin-free regimens after acute rejection episodes did not lead to an increase in BK viremia. • Treatment with antithymocyte globulin–free regimens after acute rejection episodes does not lead to an increase in BK viremia in renal transplant recpients. • With BK-DNA monitoring and appropriate treatment changes, it is possible to deal with BK viremia. [ABSTRACT FROM AUTHOR]

Introduction: Bladder cancer is responsible for more than 130,000 deaths annually worldwide. Intravesical delivery of chemotherapeutic agents provides effective drug localization to the target area to reduce toxicity and increase efficacy. This study aimed to develop an intravesical delivery system of gemcitabine HCl (Gem-HCl) to provide a sustained-release profile, to prolong residence time, and to enhance its efficiency in the treatment of bladder cancer., Materials and Methods: For this purpose, bioadhesive microspheres were successfully prepared with average particle size, encapsulation efficiency, and loading capacity of 98.4 µm, 82.657%±5.817%, and 12.501±0.881 mg, respectively. For intravesical administration, bioadhesive microspheres were dispersed in mucoadhesive chitosan or in situ poloxamer gels and characterized in terms of gelation temperature, viscosity, mechanical, syringeability, and bioadhesive and rheological properties. The cytotoxic effects of Gem-HCl solution, Gem-HCl microspheres, and Gem-HCl microsphere-loaded gel formulations were evaluated in two different bladder cancer cell lines: T24 (ATCC HTB4TM) and RT4 (ATCC HTB2TM)., Results: According to cell-culture studies, Gem-HCl microsphere-loaded poloxamer gel was more cytotoxic than Gem-HCl microsphere-loaded chitosan gel. Antitumor efficacy of newly developed formulations were investigated by in vivo studies using bladder-tumor-induced rats., Conclusion: According to in vivo studies, Gem-HCl microsphere-loaded poloxamer gel was found to be an effective and promising alternative for current intravesical delivery-system therapies., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Intraductal carcinoma of prostate has been previously described in radical prostatectomies. It's rarely encountered in needle biopsies in the absence of infiltrative carcinoma. But, both histogenesis and nomenclature of the lesion is still controversial. Among the pure intraductal carcinoma of prostate cases, a different solid patern was described with smaller nuclei at the center of the ducts. However, there is a lack of information about the association of those cases with acinar prostate adenocarcinoma. Herein, we describe a case of acinar adenocarcinoma with predominant non-neuroendocrine TTF-1 positive small cell intraductal component.

Small cell carcinoma (SmCC) is a rare and aggressive neuroendocrine carcinoma of the bladder. Neuroendocrine carcinomas expressing somatostatin receptors (SSTR) in other viscera such as lung, pancreas, and gastrointestinal system respond to therapy with somatostatin analogs. In the present study, expressions of SSTRs 1 to 5 including type 2A are investigated by immunohistochemistry (IHC) and their relationship with clinicopathologic factors was evaluated. Hundred primary bladder SmCC cases were collected from 12 centers in Turkey. Forty-three cases were pure SmCC. Other cases had mostly papillary urothelial carcinoma as a second component. The percentage of the SmCC component ranged from 5% to 100%. SSTR-2A expression was membranous, whereas the other receptors showed cytoplasmic staining. The percentages of positive cases for SSTR-1, SSTR-2A, SSTR-3, SSTR-4, and SSTR-5 were 4% (3/75), 61.4% (54/88), 2.4% (2/84), 24.4% (20/82), and 6.25% (5/80), respectively. The percentage of SmCC component was positively correlated with the percentage of SSTR-2A expression (P=0.003) while negatively correlated with patient age (P=0.032). SSTR-2A expression was correlated with survival as a bad prognostic factor (P=0.018). SSTR-1, SSTR-3, SSTR-4, and SSTR-5 expressions did not show any statistical significance with any parameter. In conclusion, although the limited number of cases with adequate term follow-up, SSTR-2A expression could be a prognostic factor and somatostatin analogs therapeutic candidate for SmCCs of the bladder as these tumors show high percentage of SSTR-2A expression.

This study aimed to develop an intravesical delivery system of gemcitabine HCl for superficial bladder cancer in order to provide a controlled release profile, to prolong the residence time, and to avoid drug elimination via urination. For this aim, bioadhesive nanoparticles were prepared with thiolated chitosan (chitosan-thioglycolic acid conjugate) and were dispersed in bioadhesive chitosan gel or in an in situ gelling poloxamer formulation in order to improve intravesical residence time. In addition, nanoparticle-loaded gels were diluted with artificial urine to mimic in vivo conditions in the bladder and were characterized regarding changes in gel structure. The obtained results showed that chitosanthioglycolic acid nanoparticles with a mean diameter of 174.5±3.762 nm and zeta potential of 32.100±0.575 mV were successfully developed via ionotropic gelation and that the encapsulation efficiency of gemcitabine HCl was nearly 20%. In vitro/ex vivo characterization studies demonstrated that both nanoparticles and nanoparticle-loaded chitosan and poloxamer gels might be alternative carriers for intravesical administration of gemcitabine HCl, prolonging its residence time in the bladder and hence improving treatment efficacy. However, when the gel formulations were diluted with artificial urine, poloxamer gels lost their in situ gelling properties at body temperature, which is in conflict with the aimed formulation property. Therefore, 2% chitosan gel formulation was found to be a more promising carrier system for intravesical administration of nanoparticles.

Autoimmune hemolytic anemia with giant cell hepatitis is a distinct entity in children. It is usually fatal with progressive liver disease. Immunosuppressive treatment with conventional drugs offers some response; however, it is usually only temporary. Alternative therapeutic options with monoclonals have been reported with promising remission of the disease. We report a case with autoimmune hemolytic anemia+giant cell hepatitis after varicella infection. She was resistant to standard immunosuppressive combinations, and rescue therapy with rituximab was used. Remission was not achieved with the drug and the child died with septic complication.