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Kumar A, Joshi P, K SC, Singh B, Deori A, Sharda P, Ravi B, Syed A. Pectoralis major muscle sarcoma masquerading breast lesion: A rare case report with review of literature. Radiol Case Rep 2023; 18:1282-1285. [PMID: 36691414 PMCID: PMC9860174 DOI: 10.1016/j.radcr.2022.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Pectoralis major muscle sarcomas are extremely rare and can mimic breast lesion clinically. We report a case of poorly differentiated sarcoma of the pectoralis major muscle in a 63-year-old woman of south east Asian ethnicity presenting with a progressively increasing right breast lump. Mammography, ultrasonography (US), contrast-enhanced computed tomography, and biopsy were done to make the final diagnosis. Complete surgical excision was planned but deferred due to pulmonary metastasis, and the patient was treated with palliative chemotherapy. Clinical examination may be confusing but radiological and pathological investigations provide detailed information about the location and the extent of the disease and a definitive tissue diagnosis can only be made on histopathology which will be helpful in preoperative planning and further treatment of the patient.
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Affiliation(s)
- Anamika Kumar
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
- Corresponding author.
| | - Pranjali Joshi
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
| | - Satish Chaitanya K
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
| | - Bhagyashree Singh
- Department of Pathology, Government Medical College, Haldwani, Uttarakhand, India
| | - Ananya Deori
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
| | - Prateek Sharda
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
| | - Bina Ravi
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
| | - Anjum Syed
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
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Tsukamoto H, Kijima H, Saito K, Saito H, Miyakoshi N. Diagnostic accuracy of ultrasonography for occult femoral neck fracture. J Clin Orthop Trauma 2023; 36:102087. [PMID: 36570856 DOI: 10.1016/j.jcot.2022.102087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/08/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A delay in the diagnosis and treatment of an occult femoral neck fracture (OFNF) can negatively affect the subsequent quality of life. We investigated the diagnostic accuracy of ultrasonography for OFNF in patients confirmed with this condition by magnetic resonance imaging (MRI), and compared these results with other clinical findings. METHODS Ninety-four outpatients aged above 70 years with acute hip pain but without radiographic abnormal findings who were suspected of having an occult femoral neck fracture (11 men and 83 women with a mean age of 81.8 ± 6.0 years) were enrolled. Both ultrasonography and MRI were performed in all cases within 24 h. The ultrasonographic distance between the anterior aspect of the femoral neck and the anterior joint capsule (ultrasound joint swelling) was measured. RESULTS By MRI findings, 27 patients were assigned to an occult femoral neck fracture (OFNF) group (1 man, 26 women) and 67 patients to a non-OFNF group (10 men, 57 women). The mean ultrasound joint swelling in both groups was 7.53 ± 1.52 mm and 3.45 ± 0.89 mm, respectively (p = 0.006, 95% CI, 3.58-4.59). A cut-off value of 5.3 mm showed a sensitivity of 0.96 (0.89-0.96) and a specificity of 0.98 (0.92-1.00). CONCLUSIONS Ultrasonography shows very high diagnostic accuracy for occult femoral neck fracture. This modality can thus contribute to initial bed-side examinations for this condition in patients over 70 years with acute hip pain.
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Key Words
- BHA, bipolar hip arthroplasty
- CT, computed tomography
- Diagnostic accuracy
- Femoral neck fracture
- MRI, magnetic resonance imaging
- NPV, negative predictive value
- OFNF, occult femoral neck fracture
- Occult fracture
- PPV, positive predictive value
- ROC, Receiver operating characteristic ROC
- STIR, short TI inversion recovery
- UJS, ultrasonographic joint swelling
- US, ultrasonography
- Ultrasonography
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Mitoma T, Oba H, Mishima S, Ohira A, Kirino S, Tani K, Maki J, Eto E, Hayata K, Masuyama H. Postpartum pyomyoma due to Mycoplasma hominis: A case report. Case Rep Womens Health 2022; 36:e00456. [PMID: 36281242 PMCID: PMC9587518 DOI: 10.1016/j.crwh.2022.e00456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/18/2022] Open
Abstract
Pyomyoma is a rare condition that causes fever and abdominal pain associated with pregnancy, especially in the postpartum period. An appropriate diagnosis and early medical intervention are required to prevent serious complications. A 38-year-old primigravida with uterine fibroids had fever from the 11th day after cesarean section. The fever did not resolve despite repeated daily administration of broad-spectrum β-lactam antibiotics for 2 weeks. Although the physical examination did not show any lower abdominal pain, a pelvic magnetic resonance scan revealed degenerative fibroids, and myomectomy was performed. Yellow-greenish odorless pus inside the uterus was detected, and Mycoplasma hominis was detected in the pus culture. Mycoplasma species are resistant to broad-spectrum penicillin antibiotics and can cause pyomyoma. Pyomyomas may not cause uterine tenderness, and the causative organism may be difficult to identify; therefore, additional imaging studies should be considered.
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Rimeika G, Saba L, Arthimulam G, Della Gatta L, Davidovic K, Bonetti M, Franco D, Russo C, Muto M. Metanalysis on the effectiveness of low back pain treatment with oxygen-ozone mixture: Comparison between image-guided and non-image-guided injection techniques. Eur J Radiol Open 2021; 8:100389. [PMID: 34934778 PMCID: PMC8654796 DOI: 10.1016/j.ejro.2021.100389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 10/28/2022] Open
Abstract
Low back pain (LBP) is a common disorder affecting an increasing number of people worldwide, whose diagnosis is focused on the identification of triggering causes. First line therapy usually starts from conservative approaches, whereas second line treatments include a spectrum of minimally invasive techniques, before resorting to more invasive surgical approaches. Among minimally invasive techniques, percutaneous oxygen-ozone injections represent one of the most common and cost-effective procedures. Aim of this study is to provide a metanalysis on literature evidences on percutaneous oxygen-ozone injections, comparing image-guided to non-image-guided techniques for LBP treatment. Imaging-guided procedures showed better performances compared to non-image-guided techniques based only on anatomical landmarks, with higher therapeutic efficacy and lower age-related variability in clinical results.
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Key Words
- BPI, Brief Pain Inventory
- CT, Computed Tomography
- Chemodiscolysis
- DSA, Digital Subtraction Angiography
- IF, Impact Factor
- LBP, Low back pain
- LDH, Lumbar Disc Hernia
- Low back pain
- Lumbar disc herniation
- MRI, Magnetic Resonance Imaging
- Meta-analysis
- ODI, Oswestry Disability Index
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines
- Pain
- Percutaneous oxygen-ozone injection
- RMDQ, Roland Morris Disability Questionnaire
- Sciatica
- US, ultrasonography
- VAS, Visual Analogue Scale for pain
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Affiliation(s)
- Gustas Rimeika
- Department of Radiology, Nuclear Medicine and Medical Physics, Vilnius University, Vilnius, Lithuania
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliera Universitaria di Cagliari-Polo di Monserrato, Cagliari, Italy
| | - Ganesan Arthimulam
- Interventional Radiology Unit, Department of Diagnostic Imaging, Kuala Lumpur General Hospital, Malaysia
| | | | - Kristina Davidovic
- Clinical Centre of Serbia, Institute for Radiology, Emergency Room Department, Serbia
| | - Matteo Bonetti
- Department of Neuroradiology, Istituto Clinico Città di Brescia, Italy
| | - Donatella Franco
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Camilla Russo
- Department of Neuroradiology, A.O.R.N. Cardarelli, Naples, Italy
| | - Mario Muto
- Department of Neuroradiology, A.O.R.N. Cardarelli, Naples, Italy
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Xu Z, Wang X, Zeng S, Ren X, Yan Y, Gong Z. Applying artificial intelligence for cancer immunotherapy. Acta Pharm Sin B 2021; 11:3393-3405. [PMID: 34900525 PMCID: PMC8642413 DOI: 10.1016/j.apsb.2021.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/07/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023] Open
Abstract
Artificial intelligence (AI) is a general term that refers to the use of a machine to imitate intelligent behavior for performing complex tasks with minimal human intervention, such as machine learning; this technology is revolutionizing and reshaping medicine. AI has considerable potential to perfect health-care systems in areas such as diagnostics, risk analysis, health information administration, lifestyle supervision, and virtual health assistance. In terms of immunotherapy, AI has been applied to the prediction of immunotherapy responses based on immune signatures, medical imaging and histological analysis. These features could also be highly useful in the management of cancer immunotherapy given their ever-increasing performance in improving diagnostic accuracy, optimizing treatment planning, predicting outcomes of care and reducing human resource costs. In this review, we present the details of AI and the current progression and state of the art in employing AI for cancer immunotherapy. Furthermore, we discuss the challenges, opportunities and corresponding strategies in applying the technology for widespread clinical deployment. Finally, we summarize the impact of AI on cancer immunotherapy and provide our perspectives about underlying applications of AI in the future.
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Key Words
- AI, artificial intelligence
- Artificial intelligence
- CT, computed tomography
- CTLA-4, cytotoxic T lymphocyte-associated antigen 4
- Cancer immunotherapy
- DL, deep learning
- Diagnostics
- ICB, immune checkpoint blockade
- MHC-I, major histocompatibility complex class I
- ML, machine learning
- MMR, mismatch repair
- MRI, magnetic resonance imaging
- Machine learning
- PD-1, programmed cell death protein 1
- PD-L1, PD-1 ligand1
- TNBC, triple-negative breast cancer
- US, ultrasonography
- irAEs, immune-related adverse events
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Affiliation(s)
- Zhijie Xu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiang Wang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Shuangshuang Zeng
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xinxin Ren
- Center for Molecular Medicine, Xiangya Hospital, Key Laboratory of Molecular Radiation Oncology of Hunan Province, Central South University, Changsha 410008, China
| | - Yuanliang Yan
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
- Corresponding authors.
| | - Zhicheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
- Corresponding authors.
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Sha T, Yin T, Zheng R. Contrast-enhanced ultrasound of intrahepatic portal vein gas: Case report and review of literature. Radiol Case Rep 2021; 16:2151-2153. [PMID: 34168715 PMCID: PMC8207170 DOI: 10.1016/j.radcr.2021.04.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 11/24/2022] Open
Abstract
Portal vein gas is a rare imaging finding and a concomitant sign of abdominal disease. Here, we report a 64-year-old man with an emphasis on contrast-enhanced ultrasound for describing the findings for portal vein gas and evaluating liver blood perfusion. Ultrasonography is a favorable imaging modality for the rapid bedside evaluation and monitoring of portal vein gas in the emergency room.
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Falcetta P, Cetani F, Tonacchera M. Remission of Primary Hyperparathyroidism Following Fine-Needle Aspiration Biopsy: A Case Report and Review of the Literature. AACE Clin Case Rep 2021; 7:75-9. [PMID: 33851026 DOI: 10.1016/j.aace.2020.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Spontaneous or fine-needle aspiration biopsy (FNAB)-induced remission of primary hyperparathyroidism (PHPT) is an extremely rare and generally transient phenomenon. Methods A 40-year-old woman with a history of recurrent kidney stones was diagnosed with PHPT (serum calcium, 14.2 mg/dL; parathyroid hormone [PTH], 380 pg/mL). Ultrasonography and scintigraphy findings were consistent with a left enlarged parathyroid. Ultrasound-guided-FNAB cytology of the lesion did not confirm a parathyroid nature. However, levels of PTH within the needle-washing fluid were elevated. Results After few days, there was evidence of biochemical remission of the hypercalcemia (calcium, 8.1 mg/dL), and at subsequent follow-up visits, the enlarged parathyroid showed progressive shrinkage with eucalcemia and normalized PTH levels throughout 12 months of follow-up. Conclusions Rarely, remission of PHPT may occur after ultrasound-guided-FNAB performed on a hyperfunctioning parathyroid lesion.
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Thuluvath AJ, Ahn JC, Rattan P, Kurdi AT, Peeraphatdit TB, Kamath MJ, Lennon RJ, Poterucha JJ, Petersen BT, Kamath PS. Evaluation of Charcot Triad, Reynolds Pentad, and Tokyo Guidelines for Diagnosis of Cholangitis Secondary to Choledocholithiasis Across Patient Age Groups. Mayo Clin Proc Innov Qual Outcomes 2021; 5:377-387. [PMID: 33997636 PMCID: PMC8105521 DOI: 10.1016/j.mayocpiqo.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To determine the prevalence of Charcot triad, Reynolds pentad, and Tokyo Guidelines criteria and clinical outcomes among patients with cholangitis across different age groups. Patients and Methods We conducted a retrospective analysis of 257 consecutive hospitalized adult patients with acute cholangitis due to endoscopic retrograde cholangiopancreatography–confirmed choledocholithiasis between January 1, 2015, and December 31, 2019. Patients were divided into 3 age groups: less than 65 years, 65 to 79 years, and 80 years or older. Symptoms, vital signs, and laboratory data on admission were collected. Outcomes included length of hospitalization, intensive care unit stay, and 3-month mortality. Nominal variables were tested with the Pearson χ2 test, and continuous variables were tested with the Wilcoxon rank sum test. Results Charcot triad decreased with older ages. In the group that was age 80 years or older, malaise was the most common symptom; 33.6% (37 of 110) presented with altered sensorium, 9.1% (10 of 110) had no pain, fever, or jaundice, and positive blood culture results were more frequent. Tokyo cholestasis criterion was present in 96.0% (247 of 257), while inflammation (considered essential for diagnosis) was present in 75.9% (195 of 257). Patients 80 years or older had significantly higher mean length of hospital stay (P<.001) and mean length of intensive care unit stay (P=.021). Conclusion Compared with patients in younger age groups, patients with cholangitis who are 80 years or older are less likely to have Charcot triad, are more likely to have features of Reynolds pentad, or present with unexplained malaise. Within the Tokyo Guidelines, cholestasis should replace inflammation as an essential diagnostic criterion.
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Key Words
- ALT, alanine aminotransferase
- AP, alkaline phosphatase
- AST, aspartate aminotransferase
- CBD, common bile duct
- CRP, C-reactive protein
- CT, computed tomography
- ERCP, endoscopic retrograde cholangiopancreatography
- ICU, intensive care unit
- US, ultrasonography
- WBC, white blood cell
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Affiliation(s)
- Avesh J. Thuluvath
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joseph C. Ahn
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Puru Rattan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Ahmed T. Kurdi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | | | - Ryan J. Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - John J. Poterucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Bret T. Petersen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Patrick S. Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
- Correspondence: Address to Patrick S. Kamath, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
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Brown RS, Imawari M, Izumi N, Osaki Y, Bentley R, Ochiai T, Kano T, Peck-Radosavljevic M. Assessing the periprocedural magnitude of platelet count change in response to lusutrombopag. JHEP Rep 2021; 3:100228. [PMID: 33644726 PMCID: PMC7887643 DOI: 10.1016/j.jhepr.2021.100228] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/20/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Despite limitations, platelet transfusion has been used to minimise bleeding risk in patients with thrombocytopaenia. Lusutrombopag is an oral, thrombopoietin receptor agonist approved for treatment of thrombocytopaenia associated with chronic liver disease in patients undergoing planned invasive procedures. This post-hoc analysis assessed the magnitude of platelet count change based on the integrated per-protocol population from 2 similar phase III multicentre, randomised, double-blind, placebo-controlled trials. METHODS Adults with chronic liver disease-induced thrombocytopaenia and platelet count <50 (× 109/L) received lusutrombopag 3 mg or placebo ≤7 days before invasive procedure scheduled 9-14 days after randomisation. Platelet transfusion was required per protocol if the platelet count remained <50 no more than 2 days before the planned invasive procedure. Post-hoc analysis included: proportion of patients with platelet count ≥50, ≥1.5-fold increase, and a doubling of platelet count; maximum and maximum change in platelet count; and platelet count time course. RESULTS Platelet count ≥50, a platelet count increase ≥1.5-fold, and at least a doubling in platelet count were achieved in 88.3%, 86.9%, and 52.6% of patients in the lusutrombopag group (n = 137) vs. 58.6%, 32.3%, and 6.0% of patients in the placebo group (n = 133), respectively. In the lusutrombopag group, median maximum platelet count across baseline platelet counts of <30, ≥30 to <40, and ≥40 was 46, 76, and 87, respectively. Median maximum change in platelet count by baseline platelet count was +24, +42, and +40, respectively. Patients who received lusutrombopag without platelet transfusion achieved a median platelet count ≥50 for 3 weeks. CONCLUSIONS Patients treated with lusutrombopag experienced a clinically relevant response in platelet count for a substantial duration of time. LAY SUMMARY Patients with low platelet counts caused by chronic liver disease may not receive planned invasive procedures or surgeries because of an increased risk of bleeding. Lusutrombopag has previously demonstrated efficacy in raising platelet counts and is approved to treat chronic liver disease patients with low platelet counts in advance of a planned surgery. Physicians need to understand more clearly what to expect in terms of platelet count change when using lusutrombopag; this integrated analysis provides data to help guide its clinical application.
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Key Words
- AE, adverse event
- CLD, chronic liver disease
- CT, computerised tomography
- GCP, Good Clinical Practice
- HR, hazard ratio
- ICF, informed consent form
- ICH, International Conference on Harmonisation
- ITT, intention-to-treat
- LUSU, lusutrombopag
- Lusutrombopag
- MRI, magnetic resonance imaging
- Magnitude
- PBO, placebo
- PP, per protocol
- PT, platelet transfusion
- Platelet
- Procedural
- TCP, thrombocytopaenia
- TEAE, treatment-emergent adverse event
- Thrombocytopaenia
- US, ultrasonography
- WHO, World Health Organization
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Affiliation(s)
- Robert S. Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
| | - Michio Imawari
- Institute for Gastrointestinal and Liver Disease, Shin-Yurigaoka General Hospital, Kawasaki, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | | | - Roy Bentley
- Global Market Access, Shionogi Inc., Florham Park, NJ, USA
| | | | - Takeshi Kano
- Global Project Management Department, Shionogi & Co., Ltd., Osaka, Japan
| | - Markus Peck-Radosavljevic
- Abteilung Innere Medizin & Gastroenterologie (IMuG), mit Zentrale Aufnahme & Erstversorgung (ZAE), Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
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Albrecht N, Arora A, Shah CC. Protrusion of brain stem into oropharynx in newborn: Unusual severe case of Chiari 1 malformation and Clival hypoplasia. Radiol Case Rep 2021; 16:262-267. [PMID: 33299506 PMCID: PMC7708654 DOI: 10.1016/j.radcr.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 11/22/2022] Open
Abstract
Chiari 1 Malformation in children is defined as 6 mm or more caudal extension of cerebellar tonsils below the foramen magnum. It is one of the deformities in the spectrum of craniovertebral junction anomalies. We report an unusual case of newborn girl with hypoplasia of bassiocciput of the clivus and extension of brainstem into the oropharynx, in addition to extension of cerebellar tonsils below the foramen magnum. Right anterior arch and right posterior arch of C1 vertebra are absent. Dens of C2 vertebra is asymmetric. Laryngoscope showed a membrane covering the brainstem in the oropharynx. Endotracheal and orogastric tubes were placed. A ventriculo-peritoneal shunt was placed for hydrocephalus. The patient was discharged home at 4.5 months of age with home Hospice care. To the best of our knowledge, this has not been described in the literature. The case illustrates a rare defect in the clivus and unusual protrusion of brainstem into oropharynx.
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Affiliation(s)
- Nathan Albrecht
- University of Florida College of Medicine, Jacksonville, Florida
| | - Anurag Arora
- Nemours Children's Specialty Care, Jacksonville, Florida
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Molina-Molina E, Shanmugam H, Di Ciaula A, Grattagliano I, Di Palo DM, Palmieri VO, Portincasa P. ( 13C)-Methacetin breath test provides evidence of subclinical liver dysfunction linked to fat storage but not lifestyle. JHEP Rep 2021; 3:100203. [PMID: 33490935 PMCID: PMC7806794 DOI: 10.1016/j.jhepr.2020.100203] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/24/2020] [Accepted: 10/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) is characterised by the presence of hepatic steatosis in the absence of other causes of secondary hepatic fat accumulation, and is usually associated with visceral, metabolically active obesity. However, the subclinical effects of body and liver fat accumulation on liver function are still unclear. METHODS We used orally administered (13C)-methacetin and breath test to quantify the efficiency of hepatic extraction from portal blood flow and liver microsomal function in 81 participants, in relation to presence/absence of ultrasonographic NAFLD, extent of body fat accumulation, insulin resistance, dietary models, and lifestyle. RESULTS NAFLD was present in 23% of participants with normal weight, and prevalence increased with body fat and insulin resistance. Fat accumulation, NAFLD, and insulin resistance were associated with decreased hepatic extraction efficiency, and liver microsomal function was impaired in moderate-to-severe NAFLD. Caloric intake, dietary models, and lifestyles had a minor role in promoting functional changes. CONCLUSIONS The interplay between body fat accumulation, insulin resistance, and NAFLD is linked with altered hepatic extraction efficiency from blood flow and deranged microsomal function. Non-invasive diagnosis of subclinical alterations of liver function is relevant for primary and secondary prevention measures. Furthermore, the occurrence of NAFLD in lean individuals and the evidence that caloric intake, dietary models, and lifestyle played a minor role require further studies exploring the role of environmental factors in the natural history of these diseases. LAY SUMMARY Obesity is progressively increasing worldwide and is paralleled by fat accumulation in the liver (non-alcoholic fatty liver disease [NAFLD]), the most common chronic liver disease worldwide. NAFLD can alter liver structure and function, with a variety of consequences ranging from asymptomatic and subclinical alterations to cirrhosis and cancer. (13C)-Methacetin breath test, a non-invasive diagnostic tool, can reveal early subclinical alterations of liver dynamic function in individuals with obesity and in patients with NAFLD.
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Key Words
- (13C), carbon-13
- ALT, alanine aminotransferase
- ARFI, acoustic radiation force impulse
- AST, aspartate aminotransferase
- BT, breath test
- Body mass index
- DOB, delta over baseline
- FLI, fatty liver index
- GGT, gamma-glutamyl transferase
- HOMA, Homeostatic Model Assessment for Insulin Resistance
- HRQoL, health-related quality of life
- IDF, International Diabetes Federation
- KICA, ketoisocaproic acid
- Liver function
- MBT, methacetin breath test
- MD, Mediterranean diet
- MET, metabolic equivalent task
- Microsomal function
- NAFL, non-alcoholic fatty liver
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- Non-alcoholic fatty liver disease
- OR, odds ratio
- Portal blood flow
- R-ATPIII, Revised National Cholesterol Education Programme-Adult Treatment Panel III
- SF-36, 36-Item Short Form Health Survey Questionnaire
- US, ultrasonography
- cPDR, cumulative per cent dose recovery
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Affiliation(s)
- Emilio Molina-Molina
- Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Harshitha Shanmugam
- Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Agostino Di Ciaula
- Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | | | - Domenica Maria Di Palo
- Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo O. Palmieri
- Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Piero Portincasa
- Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
- Corresponding author. Address: Clinica Medica ‘Augusto Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy. Tel.: +39 80 5478 227; fax: +39 80 5478 232.
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Nam JY, Sinn DH, Bae J, Jang ES, Kim JW, Jeong SH. Deep learning model for prediction of hepatocellular carcinoma in patients with HBV-related cirrhosis on antiviral therapy. JHEP Rep 2020; 2:100175. [PMID: 33117971 PMCID: PMC7581930 DOI: 10.1016/j.jhepr.2020.100175] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & AIMS Personalised risk prediction of the development of hepatocellular carcinoma (HCC) among patients with liver cirrhosis on potent antiviral therapy is important for targeted screening and individualised intervention. This study aimed to develop and validate a new model for risk prediction of HCC development based on deep learning, and to compare it with previously reported risk models. METHODS A novel deep-learning-based model was developed from a cohort of 424 patients with HBV-related cirrhosis on entecavir therapy with 2 residual blocks, including 7 layers of a neural network, and it was validated using an independent external cohort (n = 316). The deep-learning-based model was compared to 6 previously reported models (platelet, age, and gender-hepatitis B score [PAGE-B], Chinese University HCC score [CU-HCC], HCC-Risk Estimating Score in CHB patients Under Entecavir [HCC-RESCUE], age, diabetes, race, etiology of cirrhosis, sex, and severity HCC score [ADRESS-HCC], modified PAGE-B score [mPAGE], and Toronto HCC risk index [THRI]) using Harrell's concordance (c)-index. RESULTS During a median 5.2 yr of follow-up (inter-quartile range 2.8-6.9 yr), 86 patients (20.3%) developed HCC. The deep-learning-based model had a Harrell's c-index of 0.719 in the derivation cohort and 0.782 in the validation cohort. Goodness of fit was confirmed by the Hosmer-Lemeshow test (p >0.05). Moreover, this model in the validation cohort had the highest c-index among the 6 previously reported models: PAGE-B (0.570), CU-HCC (0.548), HCC-RESCUE (0.577), ADRESS-HCC (0.551), mPAGE (0.598), and THRI (0.587) (all p <0.001). The misclassification rate of this model was 23.7% (model accuracy: 76.3%) in the validation group. CONCLUSIONS The deep-learning-based model had better performance than the previous models for predicting the HCC risk in patients with HBV-related cirrhosis on potent antivirals. LAY SUMMARY For early detection of hepatocellular carcinoma, it is important to maintain regular surveillance. However, there is currently no standard prediction model for risk stratification that can be used to establish a personalised surveillance strategy. We develop and validate a deep-learning-based model that showed better performance than previous models.
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Key Words
- ADRESS-HCC, age, diabetes, race, etiology of cirrhosis, sex, and severity HCC score
- CU-HCC, Chinese University HCC score
- Cirrhosis
- Convolutional neural network
- HCC, hepatocellular carcinoma
- HCC-RESCUE, HCC-Risk Estimating Score in CHB patients Under Entecavir
- Hepatitis B virus
- Hepatocellular carcinoma
- PAGE-B, platelet, age, and gender-hepatitis B score
- Prediction model
- SMC, Samsung Medical Center
- SNUBH, Seoul National University Bundang Hospital
- THRI, Toronto HCC risk index
- US, ultrasonography
- c-index, concordance index
- mPAGE-B, modified platelet, age, and gender-hepatitis B score
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Affiliation(s)
- Joon Yeul Nam
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junho Bae
- DEEPNOID Inc., Seoul, Republic of Korea
| | - Eun Sun Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Buus TW, Sivesgaard K, Fris TL, Christiansen PM, Jensen AB, Pedersen EM. Fat fractions from high-resolution 3D radial Dixon MRI for predicting metastatic axillary lymph nodes in breast cancer patients. Eur J Radiol Open 2020; 7:100284. [PMID: 33204769 PMCID: PMC7653281 DOI: 10.1016/j.ejro.2020.100284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/21/2020] [Accepted: 10/25/2020] [Indexed: 12/24/2022] Open
Abstract
High-Resolution 3D radial Dixon MRI allows for the creation of quantitative fat fraction images. Lymph node fat fractions improves diagnostic performance of MRI to detect axillary lymph node metastases. Lymph node fat fractions are a promising quantitative indicator of metastases in axillary lymph nodes.
Purpose To assess diagnostic performance of fat fractions (FF) from high-resolution 3D radial Dixon MRI for differentiating metastatic and non-metastatic axillary lymph nodes in breast cancer patients. Method High-resolution 3D radial Dixon MRI was prospectively performed on 1.5 T in 70 biopsy-verified breast cancer patients. 35 patients were available for analysis with histopathologic and imaging data. FF images were calculated as fat / in-phase. Two radiologists measured lymph node FF and assessed morphological features in one ipsilateral and one contralateral lymph node in consensus. Diagnostic performance of lymph node FF and morphological criteria were compared using histopathology as reference. Results 22 patients had metastatic axillary lymph nodes. Mean lymph node FF were 0.20 ± 0.073, 0.31 ± 0.079, and 0.34 ± 0.15 (metastatic, non-metastatic ipsi- and non-metastatic contralateral lymph nodes, respectively). Metastatic lymph node FF were significantly lower than non-metastatic ipsi- (p < 0.001) and contralateral lymph nodes (p < 0.001). Area under the receiver operating characteristics curve for lymph node FF was 0.80 compared to 0.76 for morphological criteria (p = 0.29). Lymph node FF yielded sensitivity 0.91, specificity 0.69, positive predictive value (PPV) 0.83, and negative predictive value (NPV) 0.82, while morphological criteria yielded sensitivity 0.91, specificity 0.62, PPV 0.80, and NPV 0.80 (p = 0.71). Combining lymph node FF and morphological criteria increased diagnostic performance with sensitivity 1.00, specificity 0.67, PPV 0.86, NPV 1.00, and AUC 0.83. Conclusions Lymph node FF from high-resolution 3D Dixon images are a promising quantitative indicator of metastases in axillary lymph nodes.
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Key Words
- ADC, apparent diffusion coefficient
- ALND, axillary lymph node dissection
- AUC, area under the ROC curve
- Axilla
- Breast neoplasms
- DWI, diffusion-weighted imaging
- F, fat
- FF, fat fraction
- IDC, invasive ductal carcinoma
- ILC, invasive lobular carcinoma
- IP, in-phase
- LN, lymph node
- Lymphatic metastasis
- Magnetic resonance imaging
- NPV, negative predictive value
- OP, opposed-phase
- PPV, positive predictive value
- ROC, receiver operating characteristics
- ROI, region of interest
- SLNB, sentinel lymph node biopsy
- SPAIR, spectral attenuated inversion recovery
- STIR, short tau inversion recovery
- TE, echo time
- TR, repetition time
- US, ultrasonography
- W, water
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Affiliation(s)
- Thomas Winther Buus
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Kim Sivesgaard
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Tanja Linde Fris
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200, Aarhus N, Denmark
| | - Peer Michael Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200, Aarhus N, Denmark
| | - Anders Bonde Jensen
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Erik Morre Pedersen
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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14
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Kroner PT, Mareth K, Raimondo M, Lee DD, Alsaad A, Aslam N, Abader P, Wadei HM. Acute Pancreatitis in Advanced Chronic Kidney Disease and Kidney Transplant Recipients: Results of a US Nationwide Analysis. Mayo Clin Proc Innov Qual Outcomes 2019; 3:160-168. [PMID: 31193877 PMCID: PMC6543454 DOI: 10.1016/j.mayocpiqo.2019.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To study the prevalence, etiology, and outcome of acute pancreatitis (AP) in kidney transplant and stage 5 chronic kidney disease (CKD) populations in comparison to a non-CKD cohort. Patients and Methods Using the Nationwide Inpatient Sample database, we identified patients with acute pancreatitis as the primary discharge diagnosis, after which propensity scores were used to create 2 cohorts of patients: 1 with CKD (n=13,425) and 1 without CKD (n=13,425). The CKD group was subsequently subdivided into dialysis-independent stage 5 CKD (n=690), dialysis-dependent stage 5 CKD (n=11,415), and kidney transplant recipients (n=1320). Patients younger than 18 years old, those who received a kidney transplant during the incident admission, and pancreas transplant recipients were excluded. Results The adjusted odds ratios (ORs) of AP were comparable between the no CKD, stage 5 CKD, and kidney transplant populations. Adjusted inpatient mortality was highest in patients with dialysis-dependent stage 5 CKD (OR, 2.72; 95% CI, 2.2-3.3; P<.01), followed by kidney transplant recipients (OR, 2.29; 95% CI, 1.12-4.51; P=.02), compared to the non-CKD group. Patients with stage 5 CKD experienced higher rates of shock and intensive care unit admission and had more prolonged and costly hospitalizations than the non-CKD group (P<.01 for all). Hypercalcemia was the most common cause of AP in both dialysis-dependent and dialysis-independent patients with stage 5 CKD, while viral and drug-induced pancreatitis were more prevalent in the transplant recipients. Conclusion Despite comparable adjusted prevalence of AP among the stage 5 CKD, transplant, and non-CKD populations, mortality, morbidity, and resource utilization were higher in the patients with stage 5 CKD and transplant recipients. Hypercalcemia is the most common cause of AP in the stage 5 CKD population irrespective of dialysis requirement.
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Key Words
- AP, acute pancreatitis
- CCI, Charlson Comorbidity Index
- CKD, chronic kidney disease
- CKD5, stage 5 CKD
- ERCP, endoscopic retrograde cholangiopancreatography
- ESRD, end-stage renal disease
- ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification
- ICU, intensive care unit
- NIS, Nationwide Inpatient Sample
- OR, odds ratio
- US, ultrasonography
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Affiliation(s)
- Paul T Kroner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| | - Karl Mareth
- Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Massimo Raimondo
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| | - David D Lee
- Department of Transplantation, Mayo Clinic, Jacksonville, FL
| | - Ali Alsaad
- Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Nabeel Aslam
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL
| | - Peter Abader
- Department of Transplantation, Mayo Clinic, Jacksonville, FL
| | - Hani M Wadei
- Department of Transplantation, Mayo Clinic, Jacksonville, FL.,Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL
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Mohey A, Gharib TM, Alazaby H, Khalil M, Abou-Taleb A, Noureldin YA. Efficacy of silodosin on the outcome of semi-rigid ureteroscopy for the management of large distal ureteric stones: blinded randomised trial. Arab J Urol 2018; 16:422-428. [PMID: 30534442 PMCID: PMC6277265 DOI: 10.1016/j.aju.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/24/2018] [Accepted: 07/04/2018] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the efficacy of silodosin therapy, as a new α-adrenergic receptor (α-AR) blocker, on the success rate of semi-rigid ureteroscopy (URS) for the management of large distal ureteric stones. Patients and methods This prospective study recruited 127 adult patients with single distal ureteric stone of ≥1 cm. The patients were randomly allocated to two groups: the first group included 62 patients who received silodosin (8 mg) for 10 days before URS (Silodosin group), whilst the second group included 65 patients who received placebo, in the form of multivitamins, for 10 days before URS (Placebo group). All patients underwent URS and a pneumatic lithoclast was used for stone fragmentation. Results The mean (SD) operative time was shorter in the Silodosin group compared with the Placebo group, at 41.61 (4.67) vs 46.85 (4.6) min, respectively. Furthermore, advancing the ureteroscope to access the stone failed in a statistically significant number of patients in the Placebo group compared with the Silodosin group (13 vs two, respectively). The complication rate was significantly higher in the Placebo group compared with the Silodosin group (20% vs 6.4%, P = 0.036). Additionally, the need for postoperative analgesia was significantly lower in the Silodosin group compared with the Placebo group (8.1% vs 26.2%, P = 0.009). Conclusion Silodosin therapy prior to URS management of large distal ureteric stones seems to be associated with better advancing of the ureteroscope to access the stone, shorter procedure time, higher stone-free rate, lower incidence of complications, and lesser need for postoperative analgesia.
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Affiliation(s)
- Ahmed Mohey
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Tarek M Gharib
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Hisham Alazaby
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Mostafa Khalil
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Abou-Taleb
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt.,Uropro Medical Center, Cairo, Egypt
| | - Yasser A Noureldin
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
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16
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Yamaga I, Kawaguchi-Sakita N, Asao Y, Matsumoto Y, Yoshikawa A, Fukui T, Takada M, Kataoka M, Kawashima M, Fakhrejahani E, Kanao S, Nakayama Y, Tokiwa M, Torii M, Yagi T, Sakurai T, Haga H, Togashi K, Shiina T, Toi M. Vascular branching point counts using photoacoustic imaging in the superficial layer of the breast: A potential biomarker for breast cancer. Photoacoustics 2018; 11:6-13. [PMID: 30003041 PMCID: PMC6039965 DOI: 10.1016/j.pacs.2018.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/27/2018] [Accepted: 06/11/2018] [Indexed: 05/07/2023]
Abstract
This study aimed to identify the characteristics of the vascular network in the superficial subcutaneous layer of the breast and to analyze differences between breasts with cancer and contralateral unaffected breasts using vessel branching points (VBPs) detected by three-dimensional photoacoustic imaging with a hemispherical detector array. In 22 patients with unilateral breast cancer, the average VBP counts to a depth of 7 mm below the skin surface were significantly greater in breasts with cancer than in the contralateral unaffected breasts (p < 0.01). The ratio of the VBP count in the breasts with cancer to that in the contralateral breasts was significantly increased in patients with a high histologic grade (p = 0.03), those with estrogen receptor-negative disease (p < 0.01), and those with highly proliferative disease (p < 0.01). These preliminary findings indicate that a higher number of VBPs in the superficial subcutaneous layer of the breast might be a biomarker for primary breast cancer.
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Affiliation(s)
- Iku Yamaga
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Japan
| | | | | | - Yoshiaki Matsumoto
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Aya Yoshikawa
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Toshifumi Fukui
- Medical Imaging System Development Center, Canon Inc., Japan
| | - Masahiro Takada
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Masahiro Kawashima
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Japan
| | | | - Shotaro Kanao
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Yoshie Nakayama
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Mariko Tokiwa
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Masae Torii
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Japan
| | | | - Takaki Sakurai
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Tsuyoshi Shiina
- Department of Human Health Science, Graduate School of Medicine, Kyoto University, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Japan
- Corresponding author.
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17
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Talreja D, Salunke V, Pande S, Gupta C. Successful management of ureteric endometriosis by laparoscopic ureterolysis - A review and report of three further cases. Arab J Urol 2018; 16:342-9. [PMID: 30147960 DOI: 10.1016/j.aju.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/18/2018] [Accepted: 03/28/2018] [Indexed: 11/23/2022] Open
Abstract
Objective To review articles highlighting the effectiveness of conservative laparoscopic ureterolysis as a primary treatment option in patients with ureteric endometriosis and to report on a further three cases. Patients and methods PubMed, EMBASE, Cochrane database were searched to identify articles reporting cases of laparoscopic management of ureteric endometriosis and, in particular management by ureterolysis. We further described three new cases of ureteric endometriosis managed at our institute. Results The present study illustrates the significance of laparoscopic ureterolysis in the management of patients with ureteric endometriosis. In our cases, a systematic surgical approach was followed in order to perform complete but careful excision of the all visible endometriotic implants. During follow-up successful treatment was established by relief of hydroureteronephrosis by ultrasonographic evaluation. Conclusion Considering the risk of loss of renal function and due to the nonspecific symptoms, a prompt clinical suspicion and thorough preoperative assessment can potentially help in the diagnosis. We conclude that laparoscopic ureterolysis is a minimally invasive technique with low complication and recurrence rates. It is a suitable option as a primary approach for selected patients with ureteric endometriosis, if done in a systematic step-by-step approach.
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18
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Correia JG, Moreira N, Costa Almeida CE, Reis LS. Partial Splenectomy in the treatment of an adult with β thalassemia intermedia: A case report. Int J Surg Case Rep 2018; 41:446-449. [PMID: 29546013 PMCID: PMC5702856 DOI: 10.1016/j.ijscr.2017.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Thalassemia is a common disease which treatment is often based on splenectomy. The risks associated with total splenectomy stimulated partial splenectomy as a potentially alternative therapy. Case presentation A 45 year-old female patient with long term follow-up for β thalassemia intermedia started to develop signs of hypersplenism and iron overload. A partial splenectomy was performed and was observed a marked hematologic improvement while preserving the desired splenic function. Discussion Partial splenectomy proved to provide a persistent decrease in hemolytic rate while preserving the integrity of splenic phagocytic function, presenting itself as an effective alternative to total splenectomy. After being subjected to partial splenectomy, our patient experienced a sustained control of hemolysis and showed no signs of hypersplenism or iron overload. No splenic regrowth or infectious complications were observed. The major drawbacks of partial splenectomy are the increased risk of intra- and postoperative bleeding, splenic remnant torsion and splenic regrowth. Conclusion Partial splenectomy is an alternative to total splenectomy for the treatment of adult β Thalassemia intermedia patients avoiding the risks associated with total splenectomy.
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Affiliation(s)
- João Guardado Correia
- Instituto Português de Oncologia de Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075 Coimbra, Portugal.
| | - Nídia Moreira
- Centro Hospitalar e Universitário de Coimbra (Hospital Geral - Covões), S. Martinho de Bispo, 3041-853 Coimbra, Portugal.
| | - Carlos Eduardo Costa Almeida
- Centro Hospitalar e Universitário de Coimbra (Hospital Geral - Covões), S. Martinho de Bispo, 3041-853 Coimbra, Portugal.
| | - Luís Simões Reis
- Centro Hospitalar e Universitário de Coimbra (Hospital Geral - Covões), S. Martinho de Bispo, 3041-853 Coimbra, Portugal.
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Lundy SD, Sabanegh ES. Varicocele management for infertility and pain: A systematic review. Arab J Urol 2018; 16:157-170. [PMID: 29713547 PMCID: PMC5922006 DOI: 10.1016/j.aju.2017.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 12/18/2022] Open
Abstract
Despite being first described two thousand years ago, the varicocele remains a controversial multifaceted disease process with numerous biological consequences including infertility, hypogonadism, and chronic orchidalgia. The underlying mechanisms remain poorly understood and likely include hypoxia, oxidative stress, hyperthermia, anatomical aberrations, and genetics as primary components. Despite a high prevalence amongst asymptomatic fertile men, varicoceles paradoxically also represent the most common correctable cause for male infertility. In this systematic review we discuss the rich historical aspects of the varicocele and the contemporary data regarding its clinical manifestations. We performed a systematic literature review with the goal of comparing outcomes and complication rates of each of the major surgical approaches as they relate to infertility and pain. We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-compliant systematic literature review for manuscripts focused on varicocele and its biological consequences. We identified 112 studies suitable for qualitative analysis and included 56 of these for quantitative analysis, with an emphasis on infertility and chronic pain outcomes. Taken together, the clinical work to date suggests that the highest fertility rates and the lowest complication rates are associated with the microsurgical subinguinal surgical approach to varicocelectomy. In all, 26-40% of patients undergoing varicocelectomy will successfully achieve short-term spontaneous pregnancy, and up to 90% of all patients undergoing varicocelectomy for pain will have improvement and/or resolution of their symptoms. Taken together, the data support an ongoing role for varicocelectomy in both of these clinical arenas.
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Affiliation(s)
- Scott D. Lundy
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Hodhod A, Noureldin YA, El-Sherbiny M. Is transurethral incision better than upper pole partial nephrectomy for management of duplex system ureterocoele diagnosed in the first year of life? Arab J Urol 2017; 15:319-325. [PMID: 29234535 PMCID: PMC5717465 DOI: 10.1016/j.aju.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/15/2017] [Accepted: 08/10/2017] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the outcomes of transurethral incision (TUI) and upper pole partial nephrectomy (PN) in patients with duplex system ureterocoele (DSU). Patients and methods We retrospectively reviewed the medical charts of patients who presented with DSU in the first-year of life and were managed with either TUI or PN. Patients’ demographics, ultrasonography examinations, voiding cystourethrogram studies, and dimercaptosuccinic acid scans were reviewed. Also, the postoperative vesico-ureteric reflux status and febrile urinary tract infection occurrences, and subsequent surgical interventions were identified. The outcomes for the DSU location (intravesical vs extravesical) were compared. Results Between January 1995 and September 2015, 44 patients underwent TUI (31 patients) or PN (13). The TUI patients presented at a median age of 1.1 months and were followed-up for a median of 47.4 months, whilst those who underwent PN presented at a median age of 1.06 months and were followed-up for a median of 44.23 months. Postoperatively, in the TUI group, four of 15 units had improved renal function and 11 units had stable function. In the PN group, five of nine units had stable renal function and the remaining four had worsened function (P = 0.019). Furthermore, 15 of the 31 patients (48%) in the TUI group required second interventions compared with one of 13 patients in the PN group (P = 0.01). There was no significant difference between the outcomes of intravesical and extravesical DSUs after TUI and PN. Conclusion This study shows significant renal function preservation with TUI compared to PN. However, secondary surgical interventions were higher with TUI.
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Affiliation(s)
- Amr Hodhod
- Division of Urology, McGill University, Montréal, Québec, Canada.,Department of Urology, Faculty of Medicine, Menoufia University, Al Minufya, Egypt
| | - Yasser A Noureldin
- Division of Urology, McGill University, Montréal, Québec, Canada.,Department of Urology, Benha Faculty of medicine, Benha University, Al Qalyubia, Egypt
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Etafy M, Gudeloglu A, Brahmbhatt JV, Parekattil SJ. Review of the role of robotic surgery in male infertility. Arab J Urol 2017; 16:148-156. [PMID: 29713546 PMCID: PMC5922003 DOI: 10.1016/j.aju.2017.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/27/2017] [Accepted: 11/04/2017] [Indexed: 02/07/2023] Open
Abstract
Objectives To present the current state of the art in various robot-assisted microsurgical procedures in male infertility and review the latest literature, as the technology in infertility procedures has substantially developed since the incorporation of the Vinci® robotic platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA). Materials and methods The search strategy in this review was conducted in accordance with Cochrane guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search strategy was conducted in MEDLINE, PubMed and the Cochrane electronic databases (from 2000 to present) to identify studies that included both robotic and male infertility. Results In all, 23 studies were found, 12 of which met our inclusion criteria. Articles were excluded if the study did not include both male infertility and robotics. Conclusions Robotic assistance for microsurgical procedures in male infertility appears to be safe and feasible. It has several advantages including elimination of tremor, multi-view magnification, additional instrument arms, and enhanced dexterity with articulating instrument arms. It also has a short learning curve with a small skin incision. However, larger, prospective studies are needed to establish the clinical benefits over standard microsurgery.
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Key Words
- 3D, three-dimensional
- ART, assisted reproductive technology
- FDA, USA Food and Drug Administration
- MeSH, Medical Subject Heading
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- RAVE, robot-assisted microsurgical vasoepididymostomy
- RAVV, robot-assisted vasovasostomy
- RAVx, robot-assisted microsurgical varicocelectomy
- RCT, randomised controlled trial
- Robotic testicular sperm extraction
- Robotic varicocelectomy
- Robotic vasectomy reversal
- Robotic vasoepididymostomy (RAVE)
- Robotic vasovasostomy
- TESE, testicular sperm extraction
- US, ultrasonography
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Affiliation(s)
- Mohamed Etafy
- The Personalized Urology and Robotics (PUR) Clinic, South Lake Hospital, Clermont, FL, USA.,Department of Urology, AlAzhar University Hospital, Assiut, Egypt
| | - Ahmet Gudeloglu
- Department of Urology, Hacettepe University Hospital, Ankara, Turkey
| | - Jamin V Brahmbhatt
- The Personalized Urology and Robotics (PUR) Clinic, South Lake Hospital, Clermont, FL, USA
| | - Sijo J Parekattil
- The Personalized Urology and Robotics (PUR) Clinic, South Lake Hospital, Clermont, FL, USA
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Hodhod A, Capolicchio JP, Jednak R, El-Sherif E, El-Doray AE, El-Sherbiny M. Influence of postnatal hydroureter in determining the need for voiding cystourethrogram in children with high-grade hydronephrosis. Arab J Urol 2018; 16:238-44. [PMID: 29892489 DOI: 10.1016/j.aju.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/26/2017] [Accepted: 11/07/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the utility of hydroureter (HU) to identify high-grade vesico-ureteric reflux (VUR) in patients with high-grade postnatal hydronephrosis (PH). Patients and methods We retrospectively reviewed patients’ charts that had antenatal hydronephrosis from 2008 to 2014. Patients were excluded if they presented with febrile urinary tract infection (fUTI), neurogenic bladder, posterior urethral valve, multi-cystic dysplastic kidney, and multiple congenital malformations. We reviewed postnatal ultrasonography images and patients with Society of Fetal Urology (SFU) Grades 3 and 4 hydronephrosis with a renal pelvic antero-posterior diameter of ≥10 mm were included. The ureter was assessed and considered dilated if the ureteric diameter was ≥4 mm. The voiding cystourethrogram (VCUG) studies, fUTI incidence, and surgical reports were reviewed. Results Of the 654 patients reviewed, we included 148 patients (164 renal units) of whom 113 (76.4%) were male and 35 (23.6%) female. SFU Grade 3 PH was identified in 49% of the renal units, with the remaining 51% being SFU Grade 4. HU was found in 50/164 renal units and was not detected in the remaining 114 units. VUR was diagnosed in four units (3.5%) without HU (low-grade VUR); whilst it was detected in 19 units (38%) with HU (72.7% were high-grade VUR) (P < 0.001). VUR was diagnosed on the contralateral side in four/105 patients with PH without HU and diagnosed in 10/43 patients with PH with HU (P < 0.001). During a median follow-up of 25.9 months, none of the renal units that had VUR without HU developed UTI or had surgeries. Conclusion Low-grade uncomplicated VUR was diagnosed in 3.5% of renal units without HU. Our results support limiting the use of VCUG to renal units with PH if associated with HU.
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Key Words
- (N)(P)PV, (negative) (positive) predictive value
- APD, antero-posterior diameter
- CI, confidence interval
- Congenital hydronephrosis
- HGH, high-grade postnatal hydronephrosis
- HU, hydroureter
- NU, normal ureter
- OR, odds ratio
- PH, postnatal hydronephrosis
- PUJO, PUJ obstruction
- Pelvi-ureteric junction obstruction
- SFU, Society for Fetal Urology
- US, ultrasonography
- VCUG, voiding cysto-urethrogram
- Vesico-ureteric reflux
- Voiding cystourethrography
- fUTI, febrile UTI
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El-Shaer W, Abou-Taleb A, Kandeel W. Transurethral bipolar plasmakinetic vapo-enucleation of the prostate: Is it safe for patients on chronic oral anticoagulants and/or platelet aggregation inhibitors? Arab J Urol 2017; 15:347-354. [PMID: 29234539 PMCID: PMC5717451 DOI: 10.1016/j.aju.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/20/2017] [Accepted: 09/16/2017] [Indexed: 02/02/2023] Open
Abstract
Objectives To assess the safety and efficacy of bipolar plasmakinetic enucleation and resection of the prostate (PKERP) for the management of benign prostatic hyperplasia (BPH) in patients on oral anticoagulant (OAC) therapy and/or platelet aggregation inhibitors (PAIs). Patients and methods In all, 91 patients were recruited and underwent PKERP whilst they were receiving PAIs (aspirin, 56 patients; clopidogrel, three; aspirin and clopidogrel, 11). In all, 15 patients were receiving an OAC drug perioperatively, whilst another six patients were on dual PAIs and OACs. The primary outcomes were the perioperative morbidity and mortality rates. The secondary outcomes were functional outcomes including maximum urinary flow rate (Qmax), International Prostate Symptoms Score (IPSS), and post-void residual urine volume (PVR). Results The mean (SD) age of the patients was 65 (5.9) years, preoperative adenoma volume was 80.9 (30.4) mL, and the operative time was 67 (23) min. No patient developed serious perioperative cardiovascular complications. The mean (SD) duration of hospital stay was 1.79 (1) days and the postoperative catheterisation time was 1.14 (0.76) days. The mean (SD) haemoglobin drop was 0.74 (0.61) g/dL, blood transfusion rate was 2.2%, and the clot retention rate was 2.2%. The mean (SD) postoperative Qmax was 18.6 (4.37) mL/s as compared to 7.2 (3.2) mL/s preoperatively (P < 0.001), and the preoperative IPSS was reduced from 24.3 (6.1) to 5.7 (2.3) postoperatively (P < 0.05). Prostate volume measured by transrectal ultrasonography was significantly reduced from a mean (SD) of 80.9 (30.4) mL preoperatively to 29.5 (10.6) mL postoperatively (P < 0.001). Conclusion Minimally invasive PKERP may be considered as a safe and effective treatment option for managing patients with BPH receiving OAC/PAI drugs.
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Key Words
- Anticoagulant
- BPH
- Hb, haemoglobin
- HoLEP, holmium laser enucleation of the prostate
- INR, international normalised ratio
- LUTS
- M-TURP, monopolar TURP
- OA, oral anticoagulant
- PAI, platelet aggregation inhibitor
- PKERP
- PKERP, plasmakinetic enucleation and resection of the prostate
- PVR, post-void residual urine volume
- Qmax, maximum urinary flow rate
- ThuVARP, thulium vaporesection of the prostate
- ThuVEP, thulium vapoenucleation of the prostate
- UI, urinary incontinence
- US, ultrasonography
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Affiliation(s)
- Waleed El-Shaer
- Department of Urology, Banha University Hospital, Banha, Egypt
| | | | - Wael Kandeel
- Department of Urology, Banha University Hospital, Banha, Egypt
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Jairath A, Singh A, Sabnis R, Ganpule A, Desai M. Minimally invasive basilic vein transposition in the arm or forearm for autogenous haemodialysis access: A less morbid alternative to the conventional technique. Arab J Urol 2017; 15:170-176. [PMID: 29071148 PMCID: PMC5653617 DOI: 10.1016/j.aju.2017.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/12/2016] [Accepted: 01/31/2017] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To devise a minimally invasive, less morbid yet effective alternative technique for basilic vein transposition (BVT) in the arm/forearm and to compare perioperative outcomes with the conventional technique. PATIENTS AND METHODS Patients undergoing BVT in the last two years (June 2013 to June 2015) were included in the study and the results were analysed. All patients were preoperatively evaluated using colour Doppler ultrasonography performed by the operating surgeon himself. For minimally invasive BVT, two or three small 1-2 cm incisions were made to completely mobilise the basilic vein, transposed in an anterolateral arm/forearm tunnel, and then anastomosed to the brachial or radial artery in the forearm and arm, respectively. The incision in the conventional technique was along the full length of the basilic vein, with the rest of the procedure remaining the same. Complications, pain, analgesic use, maturation and primary patency rates were compared between the techniques. RESULTS In all, 30 patients underwent minimally invasive BVT and 34 patients underwent conventional BVT, with mean age of 52 and 55 years, respectively. The complications of wound haematoma (one vs four) and wound infection/dehiscence (two vs six) were less common in the minimally invasive BVT group compared to the conventional group. The analgesic requirement and visual analogue scale pain score was significantly less in the minimally invasive BVT group. All other variables assessed, such as maturation and primary patency rate at 1 year, were not significantly different between the groups. CONCLUSION Minimally invasive dissection of the basilic vein for vascular access transposition is a safe, reliable procedure with patency and functional outcomes comparable with those of conventional BVT.
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Affiliation(s)
- Ankush Jairath
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Abhishek Singh
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | | | - Arvind Ganpule
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Mahesh Desai
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Sarhan OM. Posterior urethral valves: Impact of low birth weight and preterm delivery on the final renal outcome. Arab J Urol 2017; 15:159-165. [PMID: 29071146 PMCID: PMC5653607 DOI: 10.1016/j.aju.2017.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/08/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the relationship between low birth weight (LBW; <2.5 kg) and preterm delivery (<37 weeks gestational age) and final renal outcome in infants with posterior urethral valves (PUVs), emphasising the risk factors for the development of chronic kidney disease (CKD). Patients and methods A retrospective review was performed for all infants with PUVs who were treated between 1990 and 2010. In all, 52 infants were identified to have LBW and/or delivered preterm (Group 1). Infants in Group 1 were compared with a matching group (Group 2) of 60 full-term normal birth weight (NBW) infants with PUVs managed during the same period. The outcome of both groups was analysed. Results During follow-up, CKD developed in 17 (32.5%) and 22 patients (36.5%) in Groups 1 and 2, respectively (P = 0.812). Patients with LBW or delivered preterm had significantly higher incidence of oligohydramnios (P = 0.009), increased risk of vesicostomy (P < 0.001), longer hospital stay (P < 0.001), and higher incidence of vesico-ureteric reflux (VUR, P = 0.024). In the LBW patients, initial serum creatinine, nadir serum creatinine, oligohydramnios and Neonatal Intensive Care Unit (NICU) length of stay were significant predictors of final renal outcome (P < 0.001, P = 0.002, P = 0.004 and P = 0.012, respectively). Conclusion In our cohort of LBW and preterm delivery infants with PUVs, outcomes were similar to those of NBW full-term infants with PUVs but with an increased risk of vesicostomy, longer hospital stay, and higher incidence of VUR. LBW was associated with oligohydramnios, longer NICU admission, high initial and nadir serum creatinine, which were associated with a poor prognosis.
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Affiliation(s)
- Osama M Sarhan
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Singla A, Khattar N, Nayyar R, Mehra S, Goel H, Sood R. How practical is the application of percutaneous nephrolithotomy scoring systems? Prospective study comparing Guy's Stone Score, S.T.O.N.E. score and the Clinical Research Office of the Endourological Society (CROES) nomogram. Arab J Urol 2017; 15:7-16. [PMID: 28275512 PMCID: PMC5329720 DOI: 10.1016/j.aju.2016.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/13/2016] [Accepted: 11/27/2016] [Indexed: 12/03/2022] Open
Abstract
Objective To prospectively compare the Guy’s Stone Score (GSS), S.T.O.N.E. [stone size (S), tract length (T), obstruction (O), number of involved calices (N), and essence or stone density (E)] score and the Clinical Research Office of the Endourological Society (CROES) nephrolithometric nomogram to predict percutaneous nephrolithotomy (PCNL) success rate and assess the correlation with perioperative complications. Patients and methods We prospectively evaluated all consecutive PCNL patients at our institute between 1 November 2013 and 31 May 2015. The above scoring systems were applied to preoperative non-contrast computed tomography and the practical difficulties in such applications were noted. Perioperative complications and the stone-free rate (SFR) were also recorded. Receiver operating characteristic curves were drawn and the areas under curves were compared and appropriate statistical analysis done. Results In all, 48 renal units were included in the study. The overall SFR was 62.2%. The presence of staghorn stones (β = 27.285, 95% confidence interval 1.19–625.35; P = 0.039) was the only significant variable associated with the residual stones on multivariate analysis. Stone-free patients had significantly lower median GSS (2 vs 4) and S.T.O.N.E. scores (6 vs 10) and higher median CROES scores (83% vs 63%) (all P < 0.001) compared to residual-stone patients. All scoring systems were significantly associated with SFR (all P < 0.001). There was no significant difference in the areas under curves of the scoring systems (0.858, 0.923, and 0.931, respectively). Furthermore, all scoring systems had weak correlations with Clavien–Dindo classified complications (r = 0.29, P = 0.045; r = 0.40, P = 0.005 and r = −0.295, P = 0.04, respectively). We found no standardisation for the measurement of stone dimensions, tract length, Hounsfield units, and staghorn definition. Conclusions All scoring systems equally predicted SFR and had a weak correlation with Clavien–Dindo complications. Standardisation is needed for the variables in which they have been found deficient.
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Key Words
- 3D, three-dimensional
- ACS, acute angle, complicated calyx and stone size
- AUC, area under curve
- BMI, body mass index
- CCI, Charlson Comorbidity Index
- CROES, Clinical Research Office of the Endourological Society
- Clinical Research Office of the Endourological Society (CROES)
- GSS, Guy’s Stone Score
- Guy’s Stone Score
- HU, Hounsfield unit
- IQR, interquartile range
- KUB, plain abdominal radiograph of the kidneys, ureters and bladder
- NCCT, non-contrast CT
- PCNL, percutaneous nephrolithotomy
- Percutaneous nephrolithotomy (PCNL)
- ROC, receiver operating characteristic
- Renal stone
- S.O.N., stone size, obstruction and number of involved calyces
- S.T.O.N.E. score
- S.T.O.N.E., stone size (S), tract length (T), obstruction (O), number of involved calices (N), and essence or stone density (E)
- SFR, stone-free rate
- SFS, stone-free status
- SPSS, Statistical Package for the Social Sciences
- SSD, skin-to-stone distance
- SWL, shockwave lithotripsy
- US, ultrasonography
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Affiliation(s)
- Anurag Singla
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, Delhi, India
| | - Nikhil Khattar
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, Delhi, India
| | - Rishi Nayyar
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, Delhi, India
| | - Shibani Mehra
- Department of Radio-diagnosis, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, Delhi, India
| | - Hemant Goel
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, Delhi, India
| | - Rajeev Sood
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, Delhi, India
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Said SHA, Al Kadum Hassan MA, Ali RHG, Aghaways I, Kakamad FH, Mohammad KQ. Percutaneous nephrolithotomy; alarming variables for postoperative bleeding. Arab J Urol 2017; 15:24-29. [PMID: 28275514 PMCID: PMC5329700 DOI: 10.1016/j.aju.2016.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 11/11/2016] [Accepted: 12/04/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To evaluate factors contributing to bleeding after percutaneous nephrolithotomy (PCNL) and ways of managing this complication, as bleeding is a serious sequela that requires prompt management. PATIENTS AND METHODS The demographic and procedural data of 200 patients, who underwent unilateral PCNL during a 20-month period, were prospectively collected. Preoperative, operative, and postoperative details were recorded. The preoperative variables analysed included: age, sex, body mass index (BMI), the presence of hypertension, diabetes mellitus, serum creatinine, degree of hydronephrosis, previous ipsilateral open renal surgery, stone size and complexity. The operative variables analysed included: number of tracts, operative time, size of Amplatz sheath, type of anaesthesia, and complications such as calyceal and pelvic perforation. RESULTS The variables of age, sex, BMI, diabetes, hypertension, and a preoperative creatinine level of >1.4 mg/dL had no significant effect on blood loss (all P > 0.05). However, the rate of bleeding was significantly higher (P ⩽ 0.05) in patients who had a history of previous open renal surgery, intraoperative pelvicalyceal perforations, and Guy's Stone Score (GSS) grade 3 and 4 complex stones; however, absence of hydronephrosis, larger stone size, operative time (>83 min), more than one puncture, and size of the Amplatz sheath (26-30 F) did not maintain their significance in multivariate analysis. CONCLUSION According to our present results stone complexity (GSS grade 3 and 4), history of ipsilateral renal stone surgery, and occurrence of intraoperative pelvicalyceal perforation are alarming variables for post-PCNL bleeding.
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Affiliation(s)
- Shakhawan H A Said
- Department of Urology, Sulaymaniyah Surgical Teaching Hospital, Sulaymaniyah, Iraq
| | | | - Rawa H G Ali
- Department of Urology, Sulaymaniyah Surgical Teaching Hospital, Sulaymaniyah, Iraq
| | - Ismaeel Aghaways
- Department of Surgery, University of Sulaymaniyah, Faculty of Medical Sciences, School of Medicine, Iraq
| | - Fahmi H Kakamad
- Department of Cardiothoracic Surgery, Sulaymaniyah Surgical Teaching Hospital, Sulaymaniyah, Iraq
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Desoky EAE, Fawzi AM, Sakr A, Eliwa A, El Sayed ER, El Sayed D, Shahin AMS, Salem EA, Kamel HM, Shabana W, Kamel M. Immediate versus delayed shockwave lithotripsy for inaccessible stones after uncomplicated percutaneous nephrolithotomy. Arab J Urol 2016; 15:30-35. [PMID: 28275515 PMCID: PMC5329696 DOI: 10.1016/j.aju.2016.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/31/2016] [Accepted: 11/23/2016] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the efficacy and safety of immediate versus delayed shockwave lithotripsy (SWL) for inaccessible stones after uncomplicated percutaneous nephrolithotomy (PCNL). Patients and methods Between December 2011 and June 2014, patients with residual inaccessible stones after uncomplicated PCNL were prospectively randomised into two treatment groups; Group I, immediate SWL and Group II, delayed SWL at 1 week after PCNL. Patients with residual stones of ⩾1.5 cm, a stone density of >1000 Hounsfield units and body mass index of >40 kg/m2 were excluded from the study. The following data were reported: patients’ demographics, stone characteristics after PCNL, hospital stay, perioperative complications, stent duration, and stone-free rate (SFR). Results In all, 84 patients (51 males and 33 females) with mean (SD) age of 39 (8.5) years were included in the study. Group I included 44 patients, whilst Group II included 40 patients. There was no statistically significant difference amongst the groups for patients’ demographics, stone characteristics, and perioperative complications. The hospital stay was significantly shorter in Group I, at a mean (SD) of 34 (3.7) vs 45 (2.9) h (P < 0.001). The duration of ureteric stenting was significantly lower in Group I as compared to Group II, at a mean (SD) of 12 (4.2) vs 25 (3.5) days (P < 0.001). The SFR was 93.2% and 95% in Groups I and II, respectively (P = 0.9). Conclusions Immediate SWL after PCNL is as effective and safe as delayed SWL with a lesser hospital stay and duration of ureteric stenting.
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Affiliation(s)
- Esam A E Desoky
- Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Amr M Fawzi
- Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Ahmed Sakr
- Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Ahmed Eliwa
- Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Ehab R El Sayed
- Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Diab El Sayed
- Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Asharf M S Shahin
- Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Emad A Salem
- Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Hussien M Kamel
- Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Waleed Shabana
- Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Mostafa Kamel
- Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
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Gözen AS, Badawy H, Teber D, Assem A, Rassweiler J. Outcome of laparoscopic upper pole heminephroureterectomy in children: A two-centre experience. Arab J Urol 2016; 14:287-291. [PMID: 27900219 PMCID: PMC5122799 DOI: 10.1016/j.aju.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/07/2016] [Accepted: 08/09/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To report our multicentre experience and outcomes with laparoscopic transperitoneal and retroperitoneal upper pole heminephroureterectomy (HNU) in children with renal duplex systems and impaired upper pole. PATIENTS AND METHODS Laparoscopic HNU was performed in 22 children (15 girls, seven boys) with a mean age of 5.9 years. A retroperitoneal approach was used in 17 patients and a transperitoneal approach in the remaining five, between 2005 and 2010. Urinary tract infection was the initial presenting symptom in all children except for one with urinary retention caused by a large ureterocele. Voiding cystourethrography and renal scintigraphy revealed dual collecting systems on the right side in 11 and on the left in 11 cases. The upper pole collecting system was non-functioning in all cases. Postoperative ultrasonography was done at 1 and 3 months, with renal scintigraphy at 3 months, to check the remaining function of the lower moiety. RESULTS Overall, the mean operation time was 152 min (144 min for retroperitoneal and 160 min for transperitoneal). Blood loss was 10-50 mL and there were no intraoperative complications. The mean (SD) hospitalisation and postoperative follow-up were 3.5 (1.25) days and 22 (9.83) months, respectively. Postoperative recovery was uneventful and at the 3-month follow-up renal scintigraphy revealed no parenchymal loss of the remaining renal moiety. CONCLUSION Laparoscopic HNU in children can be performed via transperitoneal or retroperitoneal approach, both with low morbidity and with the typical benefits of laparoscopic surgery.
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Affiliation(s)
- Ali Serdar Gözen
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Haytham Badawy
- Unit of Pediatric Urology, Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Dogu Teber
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Akram Assem
- Unit of Pediatric Urology, Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Jens Rassweiler
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
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Rajadoss MP, Berry CJ, Rebekah GJ, Moses V, Keshava SN, Jacob KS, Kumar S, Kekre N, Devasia A. Predictors of renal recovery in renal failure secondary to bilateral obstructive urolithiasis. Arab J Urol 2016; 14:269-274. [PMID: 27900216 PMCID: PMC5122748 DOI: 10.1016/j.aju.2016.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/24/2016] [Accepted: 08/10/2016] [Indexed: 12/04/2022] Open
Abstract
Objectives To identify factors predicting renal recovery in patients presenting with renal failure secondary to bilateral obstructing urolithiasis. Patients and methods Data from electronic records of consecutive adult patients presenting with bilateral obstructing urolithiasis between January 2007 and April 2011 were retrieved. Ultrasonography of the abdomen, and kidney, ureter, bladder (KUB study) X-ray or abdominal non-contrast computed tomography confirmed the diagnosis. Interventional radiologists placed bilateral nephrostomies. Definitive intervention was planned after reaching nadir creatinine. Renal recovery was defined as nadir creatinine of ⩽2 mg/dL. Results In all, 53 patients were assessed, 50 (94.3%) were male, and 18 (33.9%) were aged ⩽40 years. Renal recovery was achieved in 20 patients (37.7%). A symptom duration of ⩽25 days (P < 0.01), absence of hypertension (P = 0.018), maximum renal parenchymal thickness of >16.5 mm (P = 0.001), and haemoglobin >9.85 g/dL (P < 0.01) were significant on unadjusted analysis. Symptom duration of ⩽25 days alone remained significant after adjusted analysis. Symptom duration of ⩽25 days (hazard ratio (HR) 13.83, 95% confidence interval (CI) 4.52–42.26; P < 0.01), parenchymal thickness of ⩾16.5 mm (HR 5.91, 95% CI 1.94–17.99; P = 0.002), and absence of hypertension (HR 9.99, CI 95% 1.32–75.37; P = 0.026) were significantly related to time to nadir creatinine. Symptom duration of ⩽25 days (HR 17.44, 95% CI 2.48–122.79; P = 0.004) alone remained significant after adjusted analysis. A symptom duration of ⩽25 days (P = 0.007) was 22-times more likely to indicate renal recovery. Conclusions Shorter symptom duration (⩽25 days) is predictive of renal recovery in renal failure secondary to bilateral obstructive urolithiasis.
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Affiliation(s)
| | | | - Grace J Rebekah
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Vinu Moses
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Shyamkumar N Keshava
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | | | - Santosh Kumar
- Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Nitin Kekre
- Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Antony Devasia
- Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Shariff MI, Kim JU, Ladep NG, Crossey MM, Koomson LK, Zabron A, Reeves H, Cramp M, Ryder S, Greer S, Cox IJ, Williams R, Holmes E, Nash K, Taylor-Robinson SD. Urinary Metabotyping of Hepatocellular Carcinoma in a UK Cohort Using Proton Nuclear Magnetic Resonance Spectroscopy. J Clin Exp Hepatol 2016; 6:186-194. [PMID: 27746614 PMCID: PMC5052404 DOI: 10.1016/j.jceh.2016.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/20/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Discriminatory metabolic profiles have been described in urinary 1H nuclear magnetic resonance (NMR) spectroscopy studies of African patients with hepatocellular carcinoma (HCC). This study aimed to assess similarities in a UK cohort, where there is a greater etiological diversity. METHODS Urine from cirrhosis and HCC patients was analyzed using a 600 MHz 1H NMR system. Multivariate analysis and median group MR spectra comparison identified metabolite alterations between groups. Metabolite identification was achieved through literature reference and statistical total correlation spectroscopy. Diagnostic accuracy was compared to serum alpha-fetoprotein (AFP). RESULTS Of the 52 patients recruited, 13 samples from HCC and 25 from cirrhosis patients were selected. At 200 IU mL-1, diagnostic sensitivity of AFP was 27%. Multivariate analysis of urinary spectra generated diagnostic models with a sensitivity/specificity of 53.6%/96%. p-Cresol sulfate (P = 0.04), creatinine (P = 0.03), citrate (P = 0.21) and hippurate (P = 0.52) were reduced in the HCC patients. Carnitine (P = 0.31) and formate (P = 0.44) were elevated. CONCLUSION Diagnostic sensitivity was lower than previous African studies, but still outperformed serum AFP. Reduced creatinine, citrate and hippurate and elevated carnitine are comparable with the African studies. p-Cresol sulfate alteration is a novel finding and may indicate an altered sulfonation capacity of the liver in patients with HCC.
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Key Words
- 1H NMR
- 1H NMR, proton nuclear magnetic resonance
- AFP, alpha-fetoprotein
- ALT, alanine transaminase
- BCLC, Barcelona Clinic Liver Cancer
- BMI, body mass index
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- INR, International Normalized Ratio
- NASH, non-alcoholic steatohepatitis
- PCA, principal component analysis
- PLS-DA, partial least squares discriminant analysis
- SEER, surveillance Epidemiology and End Results
- STOCSY, statistical total correlation spectroscopy
- TSP, trimethyl-silyl phosphate
- US, ultrasonography
- biomarkers
- hepatocellular carcinoma
- metabonomics
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Affiliation(s)
- Mohamed I.F. Shariff
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom
| | - Jin U. Kim
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom,Address for correspondence: Jin Un Kim, Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom.Division of Digestive Health, Department of Surgery and Cancer, Imperial College LondonSt Mary's Campus, South Wharf RoadLondonW2 1NYUnited Kingdom
| | - Nimzing G. Ladep
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom
| | - Mary M.E. Crossey
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom,Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, United Kingdom
| | - Larry K. Koomson
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom
| | - Abigail Zabron
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom
| | - Helen Reeves
- Northern Institute for Cancer Research, Paul O’Gorman Building, Medical School, University of Newcastle, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Matthew Cramp
- Liver Unit, Derriford Hospital, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, United Kingdom
| | - Stephen Ryder
- Nottingham Digestive Diseases Centre, University of Nottingham and NIHR Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Shaun Greer
- Department of Gastroenterology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom
| | - I. Jane Cox
- The Foundation for Liver Research, Institute of Hepatology, 69-75 Chenies Mews, London WC1E 6HX, United Kingdom
| | - Roger Williams
- The Foundation for Liver Research, Institute of Hepatology, 69-75 Chenies Mews, London WC1E 6HX, United Kingdom
| | - Elaine Holmes
- Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, United Kingdom
| | - Kathryn Nash
- Liver Unit, Southampton General Hospital, Tremona Rd, Southampton, Hampshire SO16 6YD, United Kingdom
| | - Simon D. Taylor-Robinson
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom
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Mohamed ER, Hammady AR, Eldahshoury MZ, Elsharkawi AM, Riad AM, Elmogazy HM, Hussien MM, Gamal WM. Surgical outcomes and complications of Tube® (Promedon) malleable penile prostheses in diabetic versus non-diabetic patients with erectile dysfunction. Arab J Urol 2016; 14:305-311. [PMID: 27900222 PMCID: PMC5122751 DOI: 10.1016/j.aju.2016.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate surgical outcome, complications, and patients satisfaction with the Tube® (Promedon, Cordoba, Argentina) malleable penile prosthesis in diabetic and non-diabetic patients with refractory erectile dysfunction (ED). PATIENTS AND METHODS The records of 128 eligible patients who received Tube malleable penile prostheses at our institute between September 2008 and October 2015 were reviewed. RESULTS Of the 128 patients, who received Tube penile prostheses at our institute, 53 were diabetics and 75 were non-diabetics. Both groups of patients were comparable for mean age, education level, marital status, hospital stay, time to commencing sexual intercourse, and median follow-up. Complications included: inter-corporeal septal perforation (2.3%), glanular urethral injury (1.5%), acute urinary retention (3.9%), superficial wound infection (7%), penile discomfort (9.4%), and penile prostheses infection (5.5%). Moreover, 3.9% developed atrophy of the cavernosal tissue, 5.5% experienced bad cosmesis, 6.3% experienced ejaculatory disorders, and 2.3% developed bladder calculi. In all, 13 prostheses (9.4%) were removed, seven of them due to infection, three on the patients' demand and three due to mechanical failure. The satisfaction rates with the prostheses were 77.3% and 79.4% in the diabetic and non-diabetic patients, respectively; with an overall satisfaction rate of 78.5%. There was no significant difference in the complication rate or prostheses infection between diabetic and non-diabetic patients. CONCLUSION Tube malleable penile prostheses are associated with low complication and high satisfaction rates. There was no significant difference in the complication rate or prostheses infection between diabetic and non-diabetic patients. A prospective comparative study with a large number of patients is recommended.
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Affiliation(s)
| | | | | | | | - Ahmed Mahmoud Riad
- Urology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | | | - Wael Mohamed Gamal
- Urology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
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D'Souza N, Verma A. Holmium laser cystolithotripsy under local anaesthesia: Our experience. Arab J Urol 2016; 14:203-6. [PMID: 27547461 PMCID: PMC4983162 DOI: 10.1016/j.aju.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/31/2016] [Accepted: 06/09/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the feasibility and effectiveness of transurethral holmium laser cystolithotripsy (HLC) under local anaesthesia using a flexible cystoscope. PATIENTS AND METHODS A prospective study was undertaken from January 2013 to June 2015. In all, 37 men with bladder calculi underwent HLC under local anaesthesia, preferably in a lithotomy position using a flexible cystoscope, followed by per urethral Foley catheter placement postoperatively. RESULTS The mean (SD; range) patient age was 46.6 (5.6; 32-76) years. All patients were rendered stone-free, regardless of stone size. The mean (SD; range) stone size was 2.1 (1.2; 1.4-4.1) cm and operative time was 35 (6; 26-52) min. The whole procedure was well tolerated and there were no major intraoperative complications. The mean (SD; range) hospital stay was 2.4 (1.5; 1-5) days. After a mean follow-up of 6 months, no recurrent stones, urinary retention or urethral strictures had developed. CONCLUSIONS Transurethral HLC using a flexible cystoscope under local anaesthesia is a safe and effective technique for the treatment of bladder calculi and can be used as an alternative treatment option.
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Affiliation(s)
- Nischith D'Souza
- Department of Urology, Yenepoya Medical College and Hospital, Derlakatte, Mangalore, Karnataka, India
| | - Ashish Verma
- Department of Urology, Yenepoya Medical College and Hospital, Derlakatte, Mangalore, Karnataka, India
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Abdel Hakim MA, Abdalla AA, Saad IR, ElSheemy MS, El Feel AS, Salem HK, Abdel Hakim AM. Internal versus external ureteric stents for uretero-ileal anastomosis after laparoscopic radical cystectomy with orthotopic neobladder: A prospective comparative study. Arab J Urol 2016; 14:136-42. [PMID: 27493809 DOI: 10.1016/j.aju.2016.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/01/2016] [Accepted: 03/29/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To prospectively compare the use of external ureteric stents with internal JJ stenting of the uretero-ileal anastomosis in patients undergoing laparoscopic radical cystectomy (LRC) with a Y-shaped ileal orthotopic neobladder (ON). PATIENTS AND METHODS The study included 69 patients undergoing LRC with ON. Patients were grouped according to the type of uretero-ileal stents used. An external ureteric stent was used in Group A (33 patients) and a JJ stent was used in Group B (36). We prospectively compared the duration of hospital stay, the incidence of short- and intermediate-term complications in the two study groups. RESULTS The mean (SD) follow-up periods were 29.18 (3.94) and 28.19 (3.37) months for patients in Groups A and B, respectively. Perioperative patient characteristics were comparable in the two study groups. The use of JJ stenting was associated with a shorter hospital stay compared with external stenting, at a mean (SD) of 14.63 (3.74) and 6.8 (3.03) days in Groups A and B, respectively (P < 0.001). The incidence of urinary leakage was comparable in the two study groups, at 6.1% in Group A vs 8.3% in Group B (P = 1.0). Strictures of the uretero-ileal anastomosis occurred in two patients (6%) in Group A and confirmed by intravenous urography. All strictures were treated with antegrade JJ fixation. CONCLUSION JJ stents could be used as an effective alternative to external ureteric stents to support the uretero-ileal anastomosis. JJ stenting is associated with a shorter hospital stay and similar complication rates compared with external stenting in patients undergoing LRC with ON.
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El-Assmy A, Harraz AM, Eldemerdash Y, Elkhamesy M, El-Nahas AR, Elshal AM, Sheir KZ. Does lithotripsy increase stone recurrence? A comparative study between extracorporeal shockwave lithotripsy and non-fragmenting percutaneous nephrolithotomy. Arab J Urol 2016; 14:108-14. [PMID: 27489737 DOI: 10.1016/j.aju.2016.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/30/2016] [Accepted: 02/21/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives To investigate the effect of stone fragmentation on late stone recurrence by comparing the outcome of extracorporeal shockwave lithotripsy (ESWL) and non-fragmenting percutaneous nephrolithotomy (PCNL), and to investigate factors contributing to recurrent calculi. Patients and methods We evaluated stone recurrence in 647 patients who initially achieved a stone-free status after ESWL and compared the outcomes to 137 stone-free patients treated with PCNL without stone fragmentation. Patients were evaluated every 3 months during the first year and every 6 months thereafter to censorship or time of first new stone formation. Stone recurrence rates were calculated using the Kaplan–Meier method. The effects of demographics, stone characteristics, and intervention on the recurrence rate were studied using the log-rank test and the Cox-regression analysis. Results For ESWL the recurrence rates were 0.8%, 35.8% and 60.1% after 1, 5 and 10 years, which were comparable to the 1.5%, 35.5% and 74.9%, respectively found in the PCNL group (P = 0.57). Stone burden (>8 mm) and a previous history of stone disease were significantly associated with higher recurrence rates regardless of the method of stone intervention (P = 0.02 and P = 0.01, respectively). In the ESWL group, a stone length of >8 mm showed a higher recurrence rate (P = 0.007). In both the ESWL and PCNL groups, there was a significant shift from baseline stone location, with an increased tendency for most new stones to recur in the calyces as opposed to the pelvis. Conclusions In comparison with PCNL, ESWL does not increase long-term stone recurrence in patients who become stone-free. The stone burden appears to be the primary factor in predicting stone recurrence after ESWL.
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Soomro HU, Hammad Ather M, Salam B. Comparison of ureteric stone size, on bone window versus standard soft-tissue window settings, on multi-detector non-contrast computed tomography. Arab J Urol 2016; 14:198-202. [PMID: 27547460 PMCID: PMC4983159 DOI: 10.1016/j.aju.2016.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/14/2016] [Accepted: 06/25/2016] [Indexed: 01/04/2023] Open
Abstract
Objective To compare the difference in mean stone size, as measured on bone window vs standard soft-tissue window setting using multi-detector computed tomography (MDCT) in patients with a solitary ureteric stone. Patients and methods In all, 60 patients presenting to the emergency and outpatient departments of a University Hospital from May 2015 to October 2015 and fulfilling the inclusion criteria were included in the study. A 64-slice MDCT was used to assess the locations and size of the ureteric stones. A consultant radiologist independently analysed the MDCT scans of all the patients. The mean difference in stone size was calculated between both window settings in axial and coronal planes. Results The mean (SD) age of the patients was 37.13 (11.9) years. Males constituted ∼68% of the cohort and 32% were female. In all, 85% of the patients had left ureteric stones and 15% had right ureteric stones. The mean (SD) stone size, as measured on the soft-tissue window setting was 6.68 (2.01) mm, and on the bone window setting was 4.8 (1.9) mm. The mean (SD) difference in stone size between the two window settings was +1.85 (0.55) mm. The two means were compared using Student’s t-test, and the difference was found to be statistically significant (P < 0.05). Conclusion The stone size measured using the soft-tissue window setting on a MDCT is significantly different from the measurement on the bone window setting.
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Affiliation(s)
- Hussam Uddin Soomro
- Section of Urology, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - M Hammad Ather
- Section of Urology, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Basit Salam
- Department of Radiology, Aga Khan University, Karachi, Pakistan
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Telha KA, Alkohlany K, Alnono I. Extracorporeal shockwave lithotripsy monotherapy for treating patients with bladder stones. Arab J Urol 2016; 14:207-10. [PMID: 27547462 PMCID: PMC4983163 DOI: 10.1016/j.aju.2016.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/28/2016] [Accepted: 06/05/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To describe our experience with extracorporeal shockwave lithotripsy (ESWL) for the treatment of bladder stones of <20 mm. PATIENTS AND METHODS This study was prospectively performed in two hospitals (Althawrah Modern General Hospital, and Ibn Sina Specialized Hospital) between November 2012 and November 2015. In all, 44 patients presented with urethral or bladder stones. The location and size of the stones was assessed by abdominal ultrasonography and plain abdominal radiography of the kidneys, ureters and bladder. All patients with radiopaque stones of <20 mm underwent ESWL monotherapy after fixation of a Foley catheter in a supine position under intravenous analgesia. RESULTS The mean size of the stones was 15.8 mm and spontaneous evacuation occurred after removal of the Foley catheter without the need for adjuvant procedures in 40 patients (90.9%). Four patients (9%) developed acute urinary retention due to urethral impaction of large stone fragments. In two of them, the urethral catheter was successfully re-inserted pushing the fragments back to the bladder and a complementary session of ESWL resulted in more fragmentation of the stones, with spontaneous passage after catheter removal. In the other two patients (4.5%), the catheter could not be re-inserted and urgent endoscopic intervention was required. CONCLUSIONS ESWL monotherapy is safe and effective method for treatment of bladder stones with no other causes of infra-vesical obstruction. Several indications can be met including patients with high anaesthetic risk, patients fearing anaesthesia or endoscopic procedures, and patients who have difficulty in positioning.
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Metwally AH, Sherief MH, Elkoushy MA. Safety and efficacy of cystoscopically guided percutaneous suprapubic cystolitholapaxy without fluoroscopic guidance. Arab J Urol 2016; 14:211-5. [PMID: 27547463 PMCID: PMC4983157 DOI: 10.1016/j.aju.2016.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 04/14/2016] [Accepted: 05/07/2016] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the safety and efficacy of percutaneous cystolitholapaxy (PCCL) under cystoscopic guidance and without fluoroscopy for the management of large or multiple bladder stones. Patients and methods Prospectively collected data were reviewed for patients undergoing PCCL with cystoscopic guidance and without fluoroscopy. Patients with a bladder stone burden of ⩾30 mm were included. Stone fragmentation was achieved using a pneumatic lithotripter through a rigid nephroscope and the fragments were removed with peanut forceps. Patients with concomitant bladder malignancy, previous pelvic radiotherapy, previous pelvic–abdominal surgery, or benign prostate enlargement of >80 mL were excluded from the study. Results In all, 40 male patients were included between July 2011 and June 2014 with a mean (SD) age of 36.9 (17.6) years. A single bladder stone was detected in 22 (55%) patients, whilst 18 (45%) had multiple bladder stones, with a mean (range) stone size of 35 (32–45) mm. The stone-free rate was 100% and the procedure was well tolerated by all patients. No intraoperative bladder perforation, bleeding or major perioperative adverse events were recorded. The mean (SD) hospital stay was 2.2 (0.41) days and the catheterisation time was 1.2 (0.6) days. At 4 weeks postoperatively, no significant stone fragments were found in any of the patients. Conclusion PCCL under cystoscopic control and without fluoroscopy seems to be an effective and safe technique to remove large or multiple bladder calculi. It represents an alternative treatment option, especially in situations where fluoroscopy is not available, and radiation hazards can be avoided.
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Affiliation(s)
- Adel H Metwally
- Department of Urology, Suez Canal University, Ismailia, Egypt
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Murray KM, Parker W, Stephany H, Redger K, Mirza M, Lopez-Corona E, Holzbeierlein JM, Lee EK. Venous thromboembolism after radical cystectomy: Experience with screening ultrasonography. Arab J Urol 2016; 14:37-43. [PMID: 26966592 DOI: 10.1016/j.aju.2015.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/13/2015] [Accepted: 11/24/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To detect the incidence of immediate postoperative deep vein thrombosis (DVT) using screening lower extremity ultrasonography (US) in patients undergoing radical cystectomy (RC) and to determine the rate of symptomatic pulmonary embolism (PE) after RC and identify risk factors for venous thromboembolic (VTE) events in a RC population. PATIENTS AND METHODS We performed a retrospective review of prospective data collected on patients who underwent RC between July 2008 and January 2012. These patients underwent screening US at 2/3 days after RC to determine the rate of asymptomatic DVT. A chart review was completed to identify those who had a symptomatic PE. Univariate and multivariable analysis was used to identify risk factors associated with DVT, PE and total VTE events. RESULTS In all, 221 patients underwent RC and asymptomatic DVT was identified in 21 (9.5%) on screening US. Nine (4.5%) developed symptomatic PE at a median of 9 days, of which no patients had positive lower extremity US postoperatively. Increased length of hospital stay, increased estimated blood loss, and lower body mass index were linked to risk of PE, and only a previous history of DVT was associated with postoperative DVT. CONCLUSION Patients who undergo RC are at high-risk for thromboembolic events and multimodal prophylaxis should be administered. Clinicians should be especially vigilant in those who demonstrate factors associated with higher risk for VTE events.
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El Abd AS, El-Abd SA, El-Enen MA, Tawfik AM, Soliman MG, Abo-Farha M, Gamasy AENE, El-Sharaby M, El-Gamal S. Immediate and late management of iatrogenic ureteric injuries: 28 years of experience. Arab J Urol 2015; 13:250-7. [PMID: 26609443 PMCID: PMC4656805 DOI: 10.1016/j.aju.2015.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/09/2015] [Accepted: 07/13/2015] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the long-term results after managing intraoperative and late-diagnosed cases of iatrogenic ureteric injury (IUI), treated endoscopically or by open surgery. Patients and methods Patients immediately diagnosed with IUI were managed under the same anaesthetic, while those referred late had a radiological assessment of the site of injury, and endoscopic management. Open surgical procedures were used only for the failed cases with previous diversion. Results In all, 98 patients who were followed had IUI after gynaecological, abdominopelvic and ureteroscopic procedures in 60.2%, 14.3% and 25.5%, respectively. The 27 patients diagnosed during surgery were managed immediately, while in the late-referred 71 patients ureteroscopic ureteric realignment with stenting was successful in 26 (36.6%). Complex open reconstruction with re-implantation or ureteric substitution, using bladder-tube or intestinal-loop procedures, was used in 27 (60%), 16 (35.5%) and two (4.5%) patients of the late group, respectively. A long-term radiological follow-up with a mean (range) of 46.6 (24.5–144) months showed recurrent obstruction in 16 (16.3%) patients managed endoscopically and reflux in six (8.3%) patients. Three renal units only (3%) were lost in the late-presenting patients. Conclusion Patients managed immediately had better long-term results. More than a third of the late-diagnosed patients were successfully managed endoscopically with minimal morbidity. Open reconstruction by an experienced urologist who can perform a complex substitutional procedure was mandatory to preserve renal units in the long-term.
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Affiliation(s)
- Ahmed S. El Abd
- Corresponding author at: 3 Mosafa Maher Street, Tanta, Egypt. Tel.: +20 1001833152.
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Abstract
OBJECTIVE To review paediatric posterior urethral injuries and the current potential management options; because urethral injury due to pelvic fracture in children is rare and has a low incidence, the management of this type of trauma and its complications remains controversial. METHODS We reviewed previous reports identified by searching the PubMed Medline electronic database for clinically relevant articles published in the past 25 years. The search was limited to the keywords 'pediatric', 'pelvic fracture', 'urethral injury', 'stricture', 'trauma' and 'reconstruction'. RESULTS Most paediatric urethral injuries are a result of pelvic fractures after high-impact blunt trauma. After the diagnosis, immediate bladder drainage via a suprapubic cystotomy, or urethral realignment, are the initial management options, except for a possible immediate primary repair in girls. The common complications of pelvic fracture-associated urethral injury include urethral stricture formation, incontinence and erectile dysfunction. Excellent results can be achieved with delayed urethroplasty for pelvic fracture-associated urethral injuries. CONCLUSION Traumatic injury to the paediatric urethra is rare and calls for an immediate diagnosis and management. These devastating injuries have a high complication rate and therefore a close follow-up is warranted to assure adequate delayed repair by a reconstructive urologist.
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Abdelwahab HA, Abdalla HM, Sherief MH, Ibrahim MB, Shamaa MA. The reliability and reproducibility of ultrasonography for measuring the residual urine volume in men with lower urinary tract symptoms. Arab J Urol 2014; 12:285-9. [PMID: 26019963 DOI: 10.1016/j.aju.2014.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/17/2014] [Accepted: 10/21/2014] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the reliability and reproducibility of abdominal ultrasonography (US) for measuring the postvoid residual urine volume (PVR), and to compare measurements by a radiologist and urologist, in men with lower urinary tract symptoms (LUTS), as a significant PVR is common in patients with LUTS and an assessment of the PVR could protect patients from unnecessary catheterisation. Patients and methods This was a prospective comparative study of 45 men aged ⩾45 years with LUTS attending a urological outpatient clinic from July 2011 to May 2012. A detailed history was taken, with an assessment of LUTS using the Arabic Validated International Prostate Symptom Score (IPSS) and complete general and local examination. The PVR was measured by US twice by a radiologist and urologist, and then repeated after 1 week. Within ⩽2 min after US a urethral catheter was used to measure the PVR. Results The mean (range) age of the patients was 63.8 (45–88) years and the mean IPSS was 16.18. Reliability testing between the PVR measured by US and the catheterised measure of PVR showed that US was not reliable (Cronbach’s α < 0.7). The US measurement was reproducible for both single examiner over two sessions, and with two examiners in one session. The PVR obtained by the urethral catheter was significantly higher than the US measurement (P < 0.05). Conclusions The measurement of PVR by US is reproducible by either a urologist or radiologist, but it is not reliable, as the urethral catheter estimate gives a significantly higher PVR.
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El-Wahab OA, El-Tabey MA, El-Barky E, El-Baky SA, El-Falah A, Refaat M. Multislice computed tomography vs. intravenous urography for planning supine percutaneous nephrolithotomy: A randomised clinical trial. Arab J Urol 2014; 12:162-7. [PMID: 26019942 DOI: 10.1016/j.aju.2013.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 11/10/2013] [Accepted: 11/14/2013] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the outcome of treatment planning using multislice computed tomography (CT) or intravenous urography (IVU) for supine percutaneous nephrolithotomy (PCNL). Patients and methods The study included 60 patients with renal stones, all treated by supine PCNL, between March 2011 and October 2012. The patients were divided randomly into two equal groups; in group 1 30 patients had the PCNL access planned based on IVU findings, and in group 2 the PCNL access was planned based on multislice CT images. All patients were suitable for PCNL, based on a plain abdominal film and ultrasonography, and with a body mass index of <30 kg/m2. The exclusion criteria were renal anomalies and bleeding diathesis. All data from both groups for the mean time taken to gain percutaneous access, operative duration, fluoroscopic time, access difficulty, stone-free rate and intraoperative morbidity were collected and analysed statistically. Results The mean (SD) time taken to gain percutaneous access was longer in group 1 than group 2, at 22.2 (1.76) vs. 13.1 (1.62) min (P < 0.001), as were the operative duration, at 81.9 (14.9) vs. 58.8 (7.6) min (P < 0.001), and fluoroscopic time, at 3.5 (1.7) vs. 2.2 (1.3) min (P = 0.002). In group 1 there were four cases (13%) in which there were difficulties in establishing percutaneous access, while in group 2 there were none (P = 0.003). There was intraoperative morbidity in three patients (10%) in group 1 and two (7%) in group 2. Conclusion Multislice CT is a safer, more accurate and noninvasive imaging technique than IVU for mapping the pelvicalyceal system. It saves time and is essential in choosing the optimal percutaneous access into the pelvicalyceal system for a safe and successful PCNL.
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Gordini L, Podda F, Medas F, Lai ML, Longheu A, Pisano G, Calò PG. Tall cell carcinoma arising in a thyroglossal duct cyst: A case report. Ann Med Surg (Lond) 2015; 4:129-32. [PMID: 25973192 DOI: 10.1016/j.amsu.2015.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Thyroglossal duct cyst carcinomas are extremely rare and their clinical presentation is similar to that of benign cysts. The diagnosis is based on physical examination, laboratory tests, and most importantly multiple imaging techniques (ultrasonography, computed tomography and magnetic resonance imaging), and fine needle aspiration cytology. Presentation of case We report a very unusual case of a tall cell variant of papillary carcinoma arising in a thyroglossal duct cyst in association with a follicular variant of papillary microcarcinoma and a tall cell variant of papillary carcinoma arising from the thyroid gland. Discussion Although rarely described in the medical literature, ectopic thyroid tissue present in the thyroglossal duct cyst could be involved in the development of a poorly differentiated carcinoma. The frequent observation of an associated primitive thyroid carcinoma makes surgical management of thyroid gland controversial. Conclusion For the optimal management of this rare pathological condition, a comprehensive preoperative evaluation and meticulous intra-operative appraisal are fundamental. TDCCs are uncommon but usually with a good prognosis. An association with thyroid primitive carcinoma is frequently observed. An extremely rare TDCC variant with a poor prognosis associated with two synchronous foci of thyroid carcinoma is reported. Surgical management of the thyroid gland within treatment plan is controversial. An accurate preoperative evaluation is mandatory for an optimal management.
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Aldaqadossi HA, Shaker H, Saifelnasr M, Gaber M. Efficacy and safety of tamsulosin as a medical expulsive therapy for stones in children. Arab J Urol 2015; 13:107-11. [PMID: 26413330 PMCID: PMC4561922 DOI: 10.1016/j.aju.2015.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/22/2015] [Accepted: 02/13/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy of tamsulosin for promoting ureteric stone expulsion in children, based on the confirmed efficacy of tamsulosin as a medical expulsive therapy in adults. PATIENTS AND METHODS From February 2010 to July 2013, 67 children presenting with a distal ureteric stone of <1 cm as assessed on unenhanced computed tomography were included in the study. The patients were randomised into two groups, with group 1 (33 patients) receiving tamsulosin 0.4 mg and ibuprofen, and group 2 (34) receiving ibuprofen only. They were followed up for 4 weeks. Endoscopic intervention was indicated for patients with uncontrolled pain, recurrent urinary tract infection, hypersensitivity to tamsulosin and failure of stone passage after 4 weeks of conservative treatment. RESULTS Sixty-three patients completed the study. There were no statistically significant differences between the groups in patient age, body weight and stone size, the mean (SD) of which was 6.52 (1.8) mm in group 1 vs. 6.47 (1.79) mm in group 2 (P = 0.9). The mean (SD) time to stone expulsion in group 1 was 7.7 (1.9) days, vs. 18 (1.73) days in group 2 (P < 0.001). The analgesic requirement (mean number of ketorolac injections) in group 1 was significantly less than in group 2, at 0.55 (0.8) vs. 1.8 (1.6) (P < 0.001). The stone-free rate was 87% in group 1 and 63% in group 2 (P = 0.025). CONCLUSIONS Tamsulosin used as a medical expulsive therapy for children with ureteric stones is safe and effective, as it facilitates spontaneous expulsion of the stone.
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Nagaya T, Tanaka N, Kimura T, Kitabatake H, Fujimori N, Komatsu M, Horiuchi A, Yamaura T, Umemura T, Sano K, Gonzalez FJ, Aoyama T, Tanaka E. Mechanism of the development of nonalcoholic steatohepatitis after pancreaticoduodenectomy. BBA Clin 2015; 3:168-74. [PMID: 26674248 PMCID: PMC4661550 DOI: 10.1016/j.bbacli.2015.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 02/05/2015] [Accepted: 02/10/2015] [Indexed: 02/08/2023]
Abstract
Background and aim It is recognized that nonalcoholic fatty liver disease (NAFLD), including nonalcoholic steatohepatitis (NASH), may develop after pancreaticoduodenectomy (PD). However, the mechanism of NASH development remains unclear. This study aimed to examine the changes in gene expression associated with NASH occurrence following PD. Methods The expression of genes related to fatty acid/triglyceride (FA/TG) metabolism and inflammatory signaling was examined using liver samples obtained from 7 post-PD NASH patients and compared with 6 healthy individuals and 32 conventional NASH patients. Results The livers of post-PD NASH patients demonstrated significant up-regulation of the genes encoding CD36, FA-binding proteins 1 and 4, acetyl-coenzyme A carboxylase α, diacylglycerol acyltransferase 2, and peroxisome proliferator-activated receptor (PPAR) γ compared with normal and conventional NASH livers. Although serum apolipoprotein B (ApoB) and TG were decreased in post-PD NASH patients, the mRNAs of ApoB and microsomal TG transfer protein were robustly increased, indicating impaired TG export from the liver as very-low-density lipoprotein (VLDL). Additionally, elevated mRNA levels of myeloid differentiation primary response 88 and superoxide dismutases in post-PD NASH livers suggested significant activation of innate immune response and augmentation of oxidative stress generation. Conclusions Enhanced FA uptake into hepatocytes and lipogenesis, up-regulation of PPARγ, and disruption of VLDL excretion into the circulation are possible mechanisms of steatogenesis after PD. General significance These results provide a basis for understanding the pathogenesis of NAFLD/NASH following PD. The mechanism of NASH development after pancreaticoduodenectomy (PD) was unclear. The gene expression involved in fatty acid uptake and lipogenesis was increased. PPARγ and its target genes were up-regulated in post-PD NASH livers. Impaired triglyceride excretion from the liver was suggested in post-PD NASH. This study proposes possible mechanisms of steatogenesis after PD.
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Key Words
- ACACA, acetyl-CoA carboxylase α
- ACACB, acetyl-CoA carboxylase β
- ACADM, medium-chain acyl-CoA dehydrogenase
- ACOX1, acyl-CoA oxidase 1
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- ApoB, apolipoprotein B
- BMI, body mass index
- CAT, catalase
- CPT1A, carnitine palmitoyl-CoA transferase 1α
- CT, computed tomography
- CYBB, cytochrome b-245 β polypeptide
- CYP, cytochrome P450
- CoA, coenzyme A
- DGAT, diacylglycerol acyltransferase
- FA, fatty acid
- FABP, fatty acid-binding protein
- FASN, fatty acid synthase
- Fatty acid
- HADHA, hydroxyacyl-CoA dehydrogenase/3-ketoacyl-CoA thiolase/enoyl-CoA hydratase α
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HOMA-IR, homeostasis model assessment for insulin resistance
- LPS, lipopolysaccharide
- LXR, liver X receptor
- MCD, methionine- and choline-deficient diet
- MTTP, microsomal triglyceride transfer protein
- MYD88, myeloid differentiation primary response 88
- MyD88
- NAFLD, nonalcoholic fatty liver disease
- NAS, NAFLD activity score
- NASH
- NASH, nonalcoholic steatohepatitis
- PD, pancreaticoduodenectomy
- PPAR, peroxisome proliferator-activated receptor
- PPARGC, PPARγ co-activator
- Pancreaticoduodenectomy
- ROS, reactive oxygen species
- RXR, retinoid X receptor
- SCD, stearoyl-CoA desaturase
- SOD, superoxide dismutase
- SREBF1, sterol regulatory element-binding transcription factor 1
- TG, triglyceride
- TGFB1, transforming growth factor β1
- TLR, Toll-like receptor
- TNF, tumor necrosis factor α
- US, ultrasonography
- VLDL
- VLDL, very-low-density lipoprotein
- qPCR, quantitative polymerase chain reaction
- γGT, gamma-glutamyltransferase
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Affiliation(s)
- Tadanobu Nagaya
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoki Tanaka
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan ; Department of Metabolic Regulation, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Takefumi Kimura
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Kitabatake
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoyuki Fujimori
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Michiharu Komatsu
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akira Horiuchi
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
| | - Takahiro Yamaura
- Department of Gastroenterology, Iida Municipal Hospital, Iida, Japan
| | - Takeji Umemura
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kenji Sano
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Frank J Gonzalez
- Laboratory of Metabolism, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, United States
| | - Toshifumi Aoyama
- Department of Metabolic Regulation, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Eiji Tanaka
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
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Abstract
Portal vein thrombosis (PVT) is being increasingly recognized in patients with advanced cirrhosis and in those undergoing liver transplantation. Reduced flow in the portal vein is probably responsible for clotting in the spleno-porto-mesenteric venous system. There is also increasing evidence that hypercoagulability occurs in advanced liver disease and contributes to the risk of PVT. Ultrasound based studies have reported a prevalence of PVT in 10-25% of cirrhotic patients without hepatocellular carcinoma. Partial thrombosis of the portal vein is more common and may not have pathophysiological consequences. However, there is high risk of progression of partial PVT to complete PVT that may cause exacerbation of portal hypertension and progression of liver insufficiency. It is thus, essential to accurately diagnose and stage PVT in patients waiting for transplantation and consider anticoagulation therapy. Therapy with low molecular weight heparin and vitamin K antagonists has been shown to achieve complete and partial recanalization in 33-45% and 15-35% of cases respectively. There are however, no guidelines to help determine the dose and therapeutic efficacy of anticoagulation in patients with cirrhosis. Anticoagulation therapy related bleeding is the most feared complication but it appears that the risk of variceal bleeding is more likely to be dependent on portal pressure rather than solely related to coagulation status. TIPS has also been reported to restore patency of the portal vein. Patients with complete PVT currently do not form an absolute contraindication for liver transplantation. Thrombectomy or thromboendovenectomy is possible in more than 75% of patients followed by anatomical end-to-end portal anastomosis. When patency of the portal vein and/or superior mesenteric vein is not achieved, only non-anatomical techniques (reno-portal anastomosis or cavo-portal hemitransposition) can be performed. These techniques, which do not fully reverse portal hypertension, are associated with higher morbidity and mortality risks in the short term.
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Key Words
- DVT, deep vein thrombosis
- EVL, endoscopic variceal ligation
- INR, international normalized ratio
- IVC, inferior vena cava
- LMWH, low molecular weight heparin
- MELD, model for end stage liver disease
- MTHFR, methylene-tetrahydrofolate reductase
- PE, pulmonary embolism
- PT, prothrombin time
- PVT, portal vein thrombosis
- SMV, superior mesenteric vein
- TEG, thromboelastography
- TIPS, transjugular intrahepatic portosystemic shunt
- US, ultrasonography
- VKA, vitamin K antagonists
- anticoagulation
- cirrhosis
- portal vein thrombosis
- portocaval hemitransposition
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Affiliation(s)
- Kaiser Raja
- Address for correspondence: Kaiser Raja, Department of Hepatology, Global Integrated Liver Care Program, BGS Global Hospitals, #67 Utarahalli Road, Kengeri, Bangalore 560 060, India.
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El-Kader OA, Mohyelden K, Metwally AH, Sherif MH, Elnasher A, Abdelhameed H, Azim AA. Ethanolamine oleate vs. absolute ethanol as sclerosing agents for treating symptomatic simple renal cysts. Arab J Urol 2014; 12:294-8. [PMID: 26019965 PMCID: PMC4435759 DOI: 10.1016/j.aju.2014.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/07/2014] [Accepted: 09/16/2014] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To compare the efficacy and safety of ethanolamine oleate (EO) as a sclerosing agent, vs. absolute ethanol (AE), in the treatment of symptomatic simple renal cysts. PATIENTS AND METHODS Between November 2009 and October 2012, 46 patients were prospectively randomised into two groups. All patients presented with a simple renal cyst underwent ultrasonographic aspiration and injection of a sclerosing agent. In group 1, 25 patients had the cyst injected with EO, and in group 2, 21 were treated with AE. One injection was used in cysts of <200 mL and two injections were used in larger cysts. Complete and partial success were defined as complete cyst ablation or a >50% reduction in cyst volume with symptomatic relief, respectively. Patients were followed up using semi-annual ultrasonography and computed tomography for 2 years. RESULTS Sclerotherapy was technically successful in all patients. There was no significant difference in cyst volume between the groups. After ≈2 years of follow-up there was complete symptomatic relief in both groups, and the overall radiological success rate was 100% of both groups, at 79% complete and 21% partial in group 1, and 83% complete and 17% partial in group 2. The frequency of transient complications in the form of microscopic haematuria was 7% and 13%, and of low-grade fever in 4% and 10% in groups 1 and 2, respectively. CONCLUSION EO can replace AE as a sclerosing agent for symptomatic simple renal cysts, as it has comparable efficacy with higher safety and tolerance.
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Affiliation(s)
| | | | | | | | - Ahmed Elnasher
- Department of Urology, Suez Canal University, Ismailia, Egypt
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Rifat UN, Hamadalla NY, Chiad Safi KC, Al Habash SS, Mohammed M. Urothelial bladder tumour in childhood: A report of two cases and a review. Arab J Urol 2014; 13:116-21. [PMID: 26413332 PMCID: PMC4561878 DOI: 10.1016/j.aju.2014.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 11/08/2014] [Accepted: 11/08/2014] [Indexed: 10/30/2022] Open
Abstract
Urothelial bladder tumour in childhood is extremely rare, and almost all the reported cases have been low-grade tumours with a favourable outcome. Here we review 57 reports comprising 127 cases, and we report two new cases.
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Teleb M, Ragab A, Dawod T, Elgalaly H, Elsayed E, Sakr A, Abdelhameed A, Maarouf A, Khalil S. Definitive ureteroscopy and intracorporeal lithotripsy in treatment of ureteral calculi during pregnancy. Arab J Urol 2014; 12:299-303. [PMID: 26019966 PMCID: PMC4435764 DOI: 10.1016/j.aju.2014.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 08/12/2014] [Accepted: 08/17/2014] [Indexed: 11/04/2022] Open
Abstract
Objective To evaluate the outcome of using semi-rigid ureteroscopy with or without intracorporeal pneumatic lithotripsy vs. temporary ureteric JJ stenting in the management of obstructing ureteric calculi in pregnant women. Patients and methods This prospective comparative study comprised 43 pregnant women with obstructing ureteric calculi. The diagnosis was based on the acute flank pain as the main symptom, microscopic haematuria, and unilateral hydronephrosis on abdominal ultrasonography (US). The patients were randomly divided into two groups; those in group 1 (22 patients) were treated by temporary ureteric JJ stenting until after delivery, and those in group 2 (21) were treated definitively by ureteroscopic stone extraction with intracorporeal pneumatic lithotripsy. Postoperative complications and the degree of patient satisfaction were reported. Results An obstructing ureteric stone was identified by US in 68% and 76% of groups 1 and 2, respectively. In group 1, nine patients had mid-ureteric stones and 13 had stones in the lower ureter. In group 2, seven patients had mid-ureteric stones, whilst the stones were in the distal ureter in 14. No perioperative foetal complications were detected in any group and all patients completed the full term of pregnancy. In group 1, four patients had a postoperative urinary tract infection (UTI), and the JJ stent was exchanged in seven. Two patients in group 2 had a postoperative UTI. Conclusions Definitive ureteroscopy, even with intracorporeal pneumatic lithotripsy, is an effective and safe treatment for pregnant women with obstructing ureteric calculi. It has a better outcome and is more satisfactory for the patients than a temporary JJ stent.
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Affiliation(s)
- Mohamed Teleb
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Ahmed Ragab
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Tamer Dawod
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Hazem Elgalaly
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Ehab Elsayed
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Ahmed Sakr
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Ahmed Abdelhameed
- Anesthesiology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Arif Maarouf
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Salem Khalil
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
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