Urinary tract tumors

The 1978 Guidelines for Canadian Drinking Water Quality included phenols (for organoleptic reasons), biocides, and THMs. Nitrilotriacetic acid (NTA) was included because of its use as a constituent ofdaundry detergents, most of which are disposed into surface waters. Studies with rodents have shown that very large doses of NTA can result in an increased incidence of urinary tract tumors. THMs were included because of their production during the process of chlorine disinfection. 

There are two major forms of hereditary susceptibility to colon cancer.00 Familial adenomatous polyposis is caused by defects in the APC gene (see Chapter 32). The more common hereditary nonpolyposis colorectal cancer (HNPCC), which includes many endometrial, stomach, and urinary tract tumors, results from defects in DNA mismatch repair. -)) The proteins hMSH2 and hMSLl are homologs of the E.coli MutS and MutL (main text). 

T Petkova-Bocharova, M Castegnaro, J Michelon, V Mara. Ochratoxin A and other mycotoxins in cereals from an area of Balkan endemic nephropathy and urinary tract tumors in Bulgaria. In M Castegnaro, R Plestina, G Dirheimer, IN Chernozemskj, H Bartsch, eds. Mycotoxins, Endemic Nephropathy and Urinary Tract Tumors. Lyon IARC Scientific Publications, 1991, pp 83-87. 

Urinary tract tumors Renal carcinoma has been associated with analgesic abuse an order of magnitude greater than in non-abusers (52-54), and the causal association has been recognized since 1965 (SEDA-6,81) and repeatedly confirmed. In 1984 an authoritative consensus conference in the USA pointed to the evidence that very heavy and sustained use of some analgesic mixtures without phenacetin can also predispose to cancer of the urinary tract, particularly transitional cell carcinoma of the renal pelvis (55). 

MUiatsch MJ, Manz T, Knusli C, Hofer HO, Rist M, Guetg R, Rutishauser G, Zollinger HU. [Phenacetin abuse III. Malignant urinary tract tumors in phenacetin abuse in Basle... 

There have been reports of increased incidence of urinary tract tumors and thyroid tumors in rats exposed chronically to trifluralin. Trifluralin is structurally similar to ethalfluralin, which is a known carcinogen in rats, and formulations contain N-nit-roso-di- -propylamine, an omnipresent contaminant, also a known carcinogen. Trifluralin has been classified as a group C (possible carcinogen) due to evidence of increased combined malignant and benign urinary bladder tumors in female rats and renal pelvis carcinomas in male rats. There is also evidence for an increased incidence of thyroid and follicular cell tumors in male rats. 

In the clinical laboratory, enzymes are used in two ways. First the activity of certain enzymes may be measured directly. For example, the measurement of blood levels of acid phosphatase activity is used to diagnose prostatic carcinoma (a urinary tract tumor that occurs in males). Second, several enzymes are used as reagents. Because purified enzymes are available, detecting certain metabolites is more accurate and cost-effective. For example, the enzyme urate oxidase is used to measure blood levels of uric acid, a metabolite whose concentration is usually high in patients suffering from gout. 

Pfohl-Leszkowicz A, Tozlovanu M, Manderville R, Peraica M, Castegnaro M, Stefanovic V. 2007. New molecular and field evidences for the imphcation of mycotoxins but not aristolochic acid in human nephropathy and urinary tract tumor. Mol Nutr Food Res 51(9) 1131-1146. 

MDCT is a well-established method to delineate and stage TCC. With the introduction of multislice CT scanners, single-breath coverage with thin-slice reconstruction of the whole urinary tract is possible (Figs. 32.1, 32.2). The detection rate for upper and lower urinary tract tumors is comparable to RP and cystoscopy, with sensitivity for the upper urinary tract of up to 92%, and similar sensitivity for the lower tract (Park et al. 2007 Fig. 32.3). With a better detection rate and the multifocal nature of TCC, CTU replaces EU for detection of TCC (Albani et al. 2007). In this study, the usefulness of CT for evaluation of patients with hematuria was evaluated. 

Tnmorigenicity The possible association of artificial sweeteners and urinary tract tumors is controversial. In a case-control study in Argentina in 197 patients with histologically confirmed transitional urinary tract tumors and 397 controls with acute, non-neoplastic, and non-urinary tract diseases between 1999 and 2006, 51 of the former (26%) and 87 of the latter (22%) had used artificial sweeteners [8. The risk of urinary tract tumors was significantly increased in long-term users (10 years or more). The odds ratio for long-term consumers was 2.18 (95% Cl = 1.22, 3.89) and for short-term users 1.10 (0.61, 2.00) after adjustment for age, sex, BMI, social status, and years of tobacco use. 

Andreatta MM, Munoz SE, Lantieri Ml, Eynard AR, Navarro A. Artificial sweetener consumption and urinary tract tumors in Cordoba, Argentina. Prev Med 2008 47(1) 136-9. 

Roth, J., Brada, D., Blaha, I., Ghielmini, C., Bitter-Suermann, D., Komminoth, P., and Heitz, P. U., 1988b, Evaluation of polysialic acid in the diagnosis of Wilms tumor. A comparative study on urinary tract tumors and non-neuroendocrine tumors, Virchows Arch B 56 95-102. 

There was a statistically significant compound-related increase in incidence of several other tumors in female mice hemangiosarcoma of the abdominal retropehtoneum, particularly involving the area of the ovaries, uterus, kidneys, and adrenal subcutaneous fibrosarcomas and mammary adenocarcinoma (NTP 1982). A limitation of the study was poor survival in male mice from ascending suppurative urinary tract infections. 

Mexico. Decoction of the bark and dried branches is taken orally as an abortive and for diabetes. Decoction of the dried root is taken orally by pregnant humans as an abortive and for diabetes . Infusion of the shade-dried entire plant is taken orally to treat infectious diseases ". Decoction of the dried leaf is taken orally for treatment of diabetes. Hot water extract of the dried leaf is taken orally as a blood purifier to treat kidney problems, urinary tract infections, and frigidity for gallstones, rheumatism and arthritis, diabetes, wounds, and skin injuries, displacement of the womb, and paralysis and to dissolve tumors 5 United States. Hot water extract of the dried leaf is taken orally as a stimulating expectorant and tonic, for tuberculosis, and is drank by Indians of the Southwest for bowel cramps, as a diuretic, and for venereal disease. Hot water extract of the dried leaf is used externally for wound healing . Hot water extract of the dried plant is taken orally for cancer. Effects described are from multicomponent reaction ". 

From our investigation it is evident that abnormal excretion of tryptophan metabolites is not a typical feature of bladder tumor subjects, since human beings with neoplastic and nonneoplastic extrabladder urinary diseases have also been found to excrete spontaneously elevated amounts of tryptophan derivatives. It seems that the metabolic abnormality is not restricted to bladder tumors, but is rather more specific for patients with tumors of the upper urinary tracts and of the renal parenchyma. Actually 59% of these patients (Fig. 4) excreted abnormal amounts of kynurenine, 3-hydroxykynurenine, and 3-hydroxyanthranilic acid. 

Of 422 inhabitants of Basel with malignant tumors of the lower urinary tract, 18.5% were users of phenacetin-containing analgesics, which means that carcinomas and sarcomas of the lower urinary tract were nearly 13 times as common in abusers as in non-abusers (54). Carcinoma of the renal pelvis was increased 77-fold, carcinoma of the ureter 89-fold, and carcinoma of the urinary bladder 7-fold. In Australia, in 274 urological patients who had abused phenacetin-containing products, renal symptoms appeared after an average latent period of 10 years within the last decade of the period studied, 8% of this group (22 patients) had tumors of the urothelium. 

A clinical algorithm for the management of hematuria, for example in patients taking penicillamine or NSAIDs, has been published (238). It should be borne in mind that in such patients hematuria may be symptomatic of underlying pathology (for example a tumor of the urinary tract). 

First attempts to experimentally reproduce CHN failed two groups of seven Wistar rats were orally administered either pure aristolochic adds (10 mg/kg for 5 days a week during 3 months) or herbs powders (containing AA) mixed with fenfluramine. At sacrifice animals in both groups had developed the expected tumors but not fibrosis of the renal interstitium [61]. However, when 12 female New Zeeland whife rabbits were injected intraperitoneaUy with 0.1 mg aristolochic acids per kg, 5 days a week, for 17 to 21 months, they developed a severe hypocellular interstitial fibrosis, urothelial atypias and, in 3 of them, tumors of the urinary tract [62]. 

Balkan nephropathy is a chronic tuhulointerstitial disease with occult, insidious onset, usually progressing slowly with no apparent signs of symptoms. After a long asymptomatic period, the disease is manifested as chronic renal failure. Less commonly hlunt lumbar pain or renal colic may develop or, occasionally, dysuric symptoms induced by urinary tract infechon. If hematuria exists, urothelial tumor should be suspected. In an advanced case polyuria and nocturia are present due to impaired concentrating ability of the kidneys. The disease is tolerated well and the patients preserve their working ability until advanced stages of renal failure [18, 76, 88, 89]. 

Appearance and urine color are unchanged in most patients with Balkan nephropathy. Urine sediment is usually scarce, while microhematuria or leukocyturia are usually associated with the occurrence of tumors or urinary tract infection [88, 89]. 

Soloway MS, Briggman JV, Carpinito GA, et al. Use of a new tumor marker, Urinary NMP22, in the detection of occult or rapidly recurring transitional ceU carcinoma of the urinary tract following surgical treatment. J Urol 1996 156 363-67. 

Antiandrogens are coadministered during initial therapy to decrease symptoms of tumor flare (bone pain, urinary tract obstruction, or spinal cord compression) associated with the initial increase in serum testosterone levels Administered as a subcutaneous injection of implanted pellets every 1-3 months... 

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