| BackgroundsNephron sparing surgery (NSS) has been proven to be an effective alternative for localized renal cell carcinoma. However, a major disadvantage of NSS is the risk of postoperative local recurrence, which is possiblly due to incomplete resection of the primary tumor as a result of extra-pseudocapsule cancer invasion, occult multicentric disease, or the development of a new primary or metastatic focus of renal cell carcinoma in the renal remnant. A series questions concerning NSS remain to be answered up to now. This pilot study was designed to investigate incidence, associated factors and pathogenesis of multicentricity, completeness of pseudocapsule of the primary tumors, extra-pseudocapsule invasion and to suggest optimal margin, patient select indication and surgical techniques in NSS for renal carcinoma.Renal vessel occlution on purpose is a frequent event to stop bleeding during a renal preserving procedure for renal cell carcinoma. It is well kown that transient ischemia and following reperfusion can cause injury, which is called ischemia-reperfusion injury. Studies show that a series of pathologic events may be involved in this process, including peroxidation injury to the plasmalemm lipid, reduction of Na+-K+-ATPase, cell apoptosis and disturbance of microcirculation, and etc. Puerarin, valid extracts from Chinese herbs radix purariae (Ge Gen), is a kind of flavone compounds. Studies demonstrate that puerarin can significantly improve the conditions of microcirculation in heart, liver and brain. Its important pharmacological features such as anti-peroxidation, removing O2 free radicals and inhibition of ischimia/reperfusion induced apoptosis can protect cells from ischemia/reperfusion injury.The pharmalogical action of puerarin in renal ischemia/reperfusion is still unclear.This study was also designed to investigate the role of puerarin in protecting the kidney from acute ischemia/reperfusion injury. Materials and Methods1. Study of the multicentricity, completeness of pseudocapsule, extra-pseudocapsule invasion: One hundred and two kidney samples from radical nephrectomy were included in the study. Tumors were staged according to UICC TNM classification and graded using Fuhrman's nuclear grade system. After fixed in 10% formalin solution, the kidney samples were step sectioned at 3 mm interval and examined under magnifying lens. All tissue of abnormalities was removed and stained with hematoxylin and eosin, and examined for multifocal cancer. Then on each slice of the samples, parenchyma margin of 15 mm beyond pseudocapsule and tissues around renal sinus were continuously sectioned and examined for completeness of pseudocapsule and extra-pseudocapsule invasion into parenchyma, vascular and lymph node. Oncogenes expression including P53, PCNA, c-erb B2, nm23H1, CD44v6, bcl-2 was measured using standurd SP immunohistochemical techniques, detected2. Study of the role of puerarin in protecting the kidney from acute ischemia/reperfusion injury: Forty-six male SD rats were devided into three subgroups: 1) control group (n=8), in which a pesudo operation was done without occlusion of renal artery. 2) Saline group, in which renal artery was occluded for 30 minutes to make artifitial acute ischemia and reperfused for 2 hours (n=8), 24 hours (n=8) and 48 hours (n=8). The rats were treated with normal saline only. 3) Treatment group (puerarin), in which renal artery was occluded for 30 minutes and reperfused for 2 hours (n=8), 24 hours (n=8) and 48 hours (n=8). The rats were treated with puerarin using dosage of 100 mg/kg 30 minutes before ischemia and every 6 hours after reperfusion. Kidney samples were harvested at different time intervals for measurement of activity of Na+-K+-ATPase and SOD, content of MDA, cell apoptosis and expression of oncogenes bcl-2 and Bax in the renal tissue.Results1. The incidence of multicentricity: Of the 102 renal cancer samples, 16 were found with setallite cancer, the incidence of multifocality... |
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