Incidental Prostate Cancer Diagnosis Is Common After Holmium Laser Enucleation of the Prostate

OBJECTIVE

To determine the incidence of incidental prostate cancer detection (iPCa) after holmium laser enucleation of the prostate (HoLEP). The published rate of iPCa after HoLEP is widely variable from 7% to 23% and we aim to define preoperative risk factors for iPCa to inform risk-adjusted preoperative evaluation for PCa.

METHODS

Consecutive patients undergoing HoLEP from 2018 to 2022 were included and comprehensive clinical data abstracted from a prospectively maintained database. iPCa was defined as a diagnosis of PCa on pathologic examination of the HoLEP specimen. Patients with and without iPCa were compared with respect to preoperative clinical variables.

RESULTS

Of 913 HoLEP patients, 183 (20%) were diagnosed with iPCa. Most patients (95%) had a preoperative prostate-specific antigen (PSA), 9% had negative MRI, and 30% had negative prostate biopsy. On multivariable analysis, PSA density (OR 1.06; 95% CI 1.03, 1.10; P < .001), preoperative biopsy status (OR 0.47, CI 0.30, 0.75; P = .002), and current 5-alpha reductase inhibitor use (OR 0.64, CI 0.43, 0.97; P = .034), were associated with iPCa diagnosis.

CONCLUSION

In a significantly prescreened population, we identified a 20% rate of iPCa after HoLEP. Preoperative characteristics associated with iPCa diagnosis included increasing age, increasing PSA density, and current 5-alpha reductase inhibitor use. However, these factors alone may be of limited clinical utility to prospectively identify patients at high risk of iPCa diagnosis. We suggest and advocate for development of a standardized, risk-adapted evaluation focused on expanded use of imaging and selective biopsy to prioritize identification of clinically significant PCa prior to nononcologic surgery.

Refractory Complex Regional Pain Syndrome: A Case Report and Review of Literature

Introduction

Complex regional pain syndrome (CRPS) is characterized by extreme pain in a limb disproportional to the clinical history or physical findings accompanied by the signs of autonomic dysfunction. The pathophysiology of CRPS is obscure, making it challenging to treat. Treatment options include medications, physical therapy, and psychological support. In some cases, surgery or other minimally-invasive procedures such as nerve blocks may be recommended, while several novel treatments, such as ozone therapy, lack sufficient clinical evidence.

Case Presentation

A 40-year-old man with CRPS was referred to our clinic with pain in his right arm and left lower leg. The patient had a history of trauma to the ulnar nerve and had undergone a sural to ulnar nerve autograft surgery. After the surgery, the patient's symptoms began, primarily in the right arm. Despite receiving conventional drugs, multiple nerve blocks, and lidocaine patches, the patient's symptoms persisted. In addition, we tried medical ozone for 14 sessions along with ketamine infusion, but these treatments were also ineffective.

Conclusions

We emphasize the importance of studying and developing more effective treatments for CRPS and suggest that further randomized clinical trials are needed to determine whether ozone therapy is effective for patients with severe, intractable CRPS symptoms.

Erector Spinae Plane Block for the Treatment of Intractable Pain in a Patient with Pancoast Tumor: A Case Report

Introduction

The erector spinae plane (ESP) block is a regional anesthetic technique that involves injecting a local anesthetic below the erector spinae muscle in an interfascial plane.

Case Presentation

We report a case of a 66-year-old man with cervicothoracic junction pain caused by an advanced Pancoast tumor. The administration of ESP block at the T2-T3 level led to pain relief of more than 50% in this patient after two sessions.

Conclusions

Therefore, the application of this method of regional analgesia is both convenient and safe and reduces opioid consumption. Further studies are needed to evaluate the safety and effectiveness of continuous blocks in outpatient settings.

Robotic partial nephrectomy in the pediatric population: Cumulative experience at a large pediatric hospital

INTRODUCTION

Robotic partial nephrectomy is a complex minimally invasive procedure that addresses the intricate anatomy of renal masses while maximizing preservation of renal function. However, while common in adults, the evolution toward these minimally invasive procedures for children has been slow due to the anticipated technical difficulties in pediatric-sized working spaces. We present our technique and our experience with pediatric robotic partial nephrectomies that were performed with our adult urology colleagues at a large free-standing children's hospital.

METHODS

The video describes our technique for a robotic right-sided partial nephrectomy in a 14-month-old male patient. The video highlights several steps of the procedure including positioning and port placement, tumor resection, and renorrhaphy.

RESULTS

Six pediatric patients underwent robotic partial nephrectomy with our associated adult urologic surgeons from January 2019 to January 2021. The surgical pathology revealed both benign as well as malignant diagnoses.

CONCLUSION

Robotic partial nephrectomy is a feasible minimally invasive procedure in children. The collaboration with adult minimally invasive urologic surgeons with extensive adult procedural experience is recommended to avoid potential complications with this technically challenging procedure in pediatric patients. Pediatric strategies for robotic port placement are often needed to accommodate the smaller size of pediatric patients as well as tumor size.

Improving Gamma Ray Shielding Behaviors of Polypropylene Using PbO Nanoparticles: An Experimental Study

Recently, polymers have entered into many medical and industrial applications. This work aimed to intensively study polypropylene samples (PP) embedded with micro and nanoparticles of PbO for their application in radiation shielding. Samples were prepared by adding 10%, 30%, and 50% by weight of PbO microparticles (mPbO) and adding 10% and 50% PbO nanoparticles (nPbO), in addition to the control sample (pure polypropylene). The morphology of the prepared samples was tested; on the other hand, the shielding efficiency of gamma rays was tested for different sources with different energies. The experimental linear attenuation coefficient (LAC) was determined using a NaI scintillation detector, the experimental results were compared with NIST-XCOM results, and a good agreement was noticed. The LAC was 0.8005 cm⁻¹ for PP-10%nPbO and 0.6283 cm⁻¹ for PP-10%mPbO while was 5.8793 cm⁻¹ for PP-50%nPbO and 3.9268 cm⁻¹ for PP-50%mPbO at 0.060 MeV. The LAC values have been converted to some specific values, such as half value layer (HVL), mean free path (MFP), tenth value layer (TVL), and radiation protection efficiency (RPE) which are useful for discussing the shielding capabilities for gamma-rays. The results of shielding parameters reveal that the PP embedded with nPbO gives better attenuation than its counterpart pp embedded with mPbO at all studied energies.

Experimental Study of Polypropylene with Additives of Bi2O3 Nanoparticles as Radiation-Shielding Materials

This work aimed to intensively study polypropylene samples (PP) embedded with micro- and nanoparticles of Bi₂O₃ for their application in radiation shielding. Samples were prepared by adding 10%, 20%, 30%, 40%, and 50% of Bi₂O₃ microparticles (mBi₂O₃) by weight, and adding 10% and 50% of Bi₂O₃ nanoparticles (nBi₂O₃), in addition to the control sample (pure polypropylene). The morphology of the prepared samples was tested, and also, the shielding efficiency of gamma rays was tested for different sources with different energies. The experimental LAC were determined using a NaI scintillation detector, the experimental results were compared with NIST-XCOM results, and a good agreement was noticed. The LAC values have been used to calculate some specific parameters, such as half value layer (HVL), mean free path (MFP), tenth value layer (TVL), and radiation protection efficiency (RPE), which are useful for discussing the shielding capabilities of gamma rays. The results of the shielding parameters show that the PP embedded with nBi₂O₃ gives better attenuation than its counterpart, PP embedded with mBi₂O₃, at all studied energies.

Penile vascular abnormalities in young men with persistent side effects after finasteride use for the treatment of androgenic alopecia

Background

The constellation of persistent sexual, neurological, and physical adverse effects in patients who discontinue 5α-reductase inhibitors (5ARIs) has garnered recent concern. The objective of this study was to evaluate potential penile vascular changes and persistent adverse effects of 5ARIs in men treated for androgenic alopecia (AGA).

Methods

This was a prospective case-control study with 25 subjects with a history of 5ARI use for AGA and 28 controls. Patient self-reported questionnaires including the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), Patient Health Questionnaire-9 (PHQ-9), the Epworth Sleepiness Scale (ESS) and the Androgen Deficiency in the Aging Male (ADAM) were used. Penile duplex Doppler ultrasound (PDDU) results were evaluated in men with a history of 5ARI use.

Results

A significant difference in total IIEF score between the 5ARI (median: 35; IQR: 29–43) and control group (median: 29; IQR: 27–32) (P=0.035) was observed. Seventeen 5ARI subjects (68%) had a vascular abnormality on PDDU. The median (IQR) for total IPSS score for the 5ARI group was 10 [5–16] compared to 3 [2–8] for the controls (P<0.01). The 5ARI group had a higher median total PHQ-9 score than controls [10 (6.5–16) vs. 1 (0–2) (P<0.001)]. Two subjects (8%) committed suicide during or after the study.

Conclusions

While the sexual side effects of 5ARIs are well known, there may be persistent genitourinary, physical, psycho-cognitive, anti-androgenic and penile vascular changes after 5ARI discontinuation. Use of 5ARIs for treatment of AGA may lead to persistent sexual, genitourinary, physical, psycho-cognitive, and anti-androgenic sequelae even after cessation of 5ARI therapy.

Angiomyolipoma of the Adrenal Gland: A Case Presentation and a Review of Adrenal Lipomatous Tumors

Angiomyolipoma (AML) is a typically benign renal tumor derived from mesenchymal tissue. Extrarenal occurrences of AML are possible, but the adrenals are an exceedingly rare site. To date, a total of 4 cases of adrenal AML have been documented in the English literature.1-3 We present a case of right-sided adrenal AML found in a patient who initially presented with right-sided flank pain. Differential diagnosis of adrenal masses should include lipomatous tumors, as operative considerations and prognoses can be drastically altered.

Robotic Assisted Laparoscopic Partial Cystectomy as Treatment for Pseudosarcomatous Fibromyxoid Tumor of the Bladder

This case is of a 26 year old female evaluated for gross hematuria and suprapubic pain found to have a large bladder tumor. She subsequently underwent successful robotic assisted laparoscopic partial cystectomy. Pathology revealed pseudosarcomatous fibromyxoid tumor, an uncommon lesion that occurs most frequently among young females and must be distinguished from other malignant lesions, as treatment may differ. Partial cystectomy via robotic approach has never been described in the literature as a treatment option for this type of bladder lesion. In this case, the patient did exceptionally well upon follow-up. As such, robotic assisted laparoscopic partial cystectomy is presented a viable option for treatment of select patients with pseudosarcomatous fibromyxoid tumor.

Malignant melanoma in the pediatric population

Controversial pigmented lesions in children are a problem for pathologist, clinicians and families that are confronted with this dilemma. Some skin lesions in this population defy diagnosis with pathologists split between a benign diagnosis and a cancer diagnosis. Three cases of controversial pigmented lesions in the pediatric population are presented. Three patients underwent radical resection of the controversial pigmented lesion, intra-operative lymphatic mapping and sentinel lymph node (SLN) biopsy. Due to the low morbidity of the SLN procedure a case is made to perform lymphatic mapping in this clinical scenario. If the SLNs are negative, not much is lost except for the scar and this becomes another line of evidence that perhaps the original lesion was benign. If the SLN shows metastatic cells, then the original skin lesion must be malignant and the patient is offered stage III recommendations that would include complete node dissections and adjuvant Interferon therapy. This strategy provides for adequate treatment of the worse-case scenario, that the skin lesion is malignant. The cost to the patient is a low morbidity procedure, the SLN biopsy.

KIR genotype distribution among patients with multiple myeloma: Higher prevalence of KIR 2DS4 and KIR 2DS5 genes

Introduction

Natural killer (NK) cells possess an antitumor activity against multiple myeloma cells proven by the susceptibility of plasmocytes to NK lysis. In the early stage of MM, the killing of MM cells is mediated by natural cytotoxicity receptors (NRC) and NKG2D-dependent pathway, while in the late stage, NK cells lose their killing potential against MM cells due to the high expression of HLA class I molecules on MM cells.

Aim

The aim of this paper is to study KIR expression of NK cells in MM patients and in healthy controls, to check for any association between KIR genotypes and MM.

Methods

KIR genotype was analyzed in 120 healthy Lebanese individuals and 34 MM patients using the KIR Genotyping SSP kit.

Results

KIR 2DS4*001/002 and KIR 2DS5 were found to be significantly more prevalent among MM patients as compared to controls. For MM patients, the AA, AB, and BB genotype frequencies were, respectively, 38.23%, 47.06% and 14.71% with an A:B ratio of 1.62:1. As for the healthy controls, the AA, AB, and BB genotype frequencies were, respectively, 39.17%, 50%, and 10.83% with an A:B ratio of 1.80:1.

Conclusion

The interesting observation of the significant presence of KIR2DS4 and KIR2DS5 genes more among multiple myeloma patients than controls is worth further clinical, translational as well as survival research studies in these cases.

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KIR genotyping has been implicated in a variety of clinical and immunological disorders.

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This study is the first international research paper that describes the prevalence of KIR genes among Multiple Myeloma patients

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Results were compared to a large healthy control population sample