Renal Pelviceal Keratinizing Squamous Metaplasia with Sparing of Pyramidal Zones

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

The Future of Transplant Biology and Surgery

Although allograft organs remain the gold standard for transplantation, the availability of donor organs has forced us to search for alternatives. Regenerative medicine and tissue engineering offer a solution for this issue. Through the use of synthetic scaffolds and organic substrates, we have been able to generate neoorgans for a variety of different body systems. Although these neoorgans remain largely in the experimental phase, the results are promising, and recent technological developments have made production a realistic endeavor on the large scale. In this review, we highlight recent advances in the field of regenerative medicine and their application to the future of transplant surgery.  This review contains 6 figures, 2 tables and 42 references Key Words: bioengineering, biomaterial, bioreactor, decellularized organs, organ scaffolds, regenerative medicine, stem cell, three-dimensional printing</jats:p

The Future of Transplant Biology and Surgery

Although organ transplantation remains the mainstay of treatment for patients with severely compromised organ function, with the growing number of patients in need of treatment and the lack of organ supply, medical scientists have begun seeking out alternatives. In the last two decades, researchers have attempted to grow native and stem cells, engineer tissues, and design treatment modalities using regenerative medicine techniques for almost every tissue of the human body. This chapter discusses the basics of tissue engineering, including cell isolation and biomaterial selection. It then outlines specific advances and potential surgical uses. This review contains 9 figures, 2 tables, and 135 references.</jats:p

Daily Enema Regimen Is Superior to Traditional Therapies for Nonneurogenic Pediatric Overactive Bladder

Our objective was to evaluate the efficacy of daily enemas for the treatment of overactive bladder (OAB) in children. This study was a prospective, controlled trial of 60 children with nonneurogenic OAB. The control patients (40) were treated with standard therapies, including timed voiding, constipation treatment with osmotic laxatives, anticholinergics, and biofeedback physical therapy, whereas the treatment patients (20) received only daily enemas and osmotic laxatives. On assessment of improvement of OAB symptoms, only 30% of the traditionally treated patients’ parents reported resolution of symptoms at 3 months, whereas 85% of enema patients did. At the onset of the study, the average pediatric voiding dysfunction score of all patients was 14, whereas on follow-up, the average scores for traditionally treated patients and enema-treated patients were 12 and 4, respectively. This study demonstrated that daily enema therapy is superior to traditional methods for the treatment of OAB