42 Egyptian evidence-based consensus recommendations for diagnosis and targeted management of juvenile dermatomyositis. An initiative by the Egyptian College of Pediatric Rheumatology

Background

Objective

Methods

Results

Conclusion

The implication to policy, practice, research and advocacy

Possible role of low level laser therapy on bone turnover in ovariectomized rats

OBJECTIVE

The aim of this study was to assess the effect of low level laser therapy (LLLT) on bone turnover markers in ovariectomized rats.

METHODS

Thirty adult female albino rats were divided into three groups; Group 1: 10 sham- operated control rats; Group 2: 10 bilaterally ovariectomized rats (OVX); Group 3: 10 OVX rats exposed to LLLT. LLLT was applied on the neck and shaft of femur, five times per week for 8 weeks. The dose applied on each point was 1000 Hertz, 5 Watts for 30 seconds with a total dose of 15 mJoule/cm². At the end of experiment, blood samples were collected and sera were separated for determination of serum calcium (Ca), inorganic phosphorus (Pi), osteocalcin and alkaline phosphatase (ALP). In addition, a 24 hour urine sample was also collected from each rat for the determination of urinary calcium, phosphorous and deoxypyridinoline (U-DPD)/creatinine.

RESULTS

Significant increase in serum Ca, Pi , ALP, osteocalcin and significant decrease in U-DPD/creatinine in LLLT exposed group was found as compared to the other two groups. Bone morphological findings revealed the increase in calcium deposition and alkaline phosphatase of femoral bones in LLLT exposed group as compared to sham-operated and OVX rats. The software image analysis showed increased osteoblast numbers, decreased osteoclast numbers and increased compact bone thickness in LLLT exposed group. Significant positive correlations was obtained between osteoblast numbers and serum Ca , Pi, ALP and osteocalcin in LLLT exposed group ,while a significant negative correlation was noticed with U-DPD.

CONCLUSION

The use of LLLT was found effective in enhancing bone formation and decreasing bone resorption in the osteoporotic OVX rats. Further studies are necessary to investigate the effect of different parameters of LLLT as wave length, duration and also numbers of sessions. The potential use of LLLT in postmenopausal women with osteoporosis is needed to be verified.

Detectable serum PSA after radical prostatectomy. Clinical and pathological relevance of perianastomotic biopsies

BACKGROUND

Few reports have detailed the histopathological results of biopsies of the vesicourethral anastomosis or prostatic bed in patients with a detectable postoperative PSA.

PATIENTS AND METHODS

Among a series of 153 patients who underwent radical retropubic prostatectomies, we analyzed the results of 64 perianastomotic biopsies performed in 17 men with a detectable PSA and no evidence of local recurrence or distant metastases.

RESULTS

Fourteen of the 17 patients had a relapse of prostatic carcinoma; the results of histology in the three pT2bN0M0 patients revealed the presence of benign prostatic hyperplasia in 2 patients and atypical cribriform proliferation in 1 patient. The first two patients are free from prostatic cancer recurrence 36 months after perianastomotic biopsies; a further biopsy performed 6 months after in the third patient showed the presence of prostatic carcinoma.

CONCLUSION

The present study raises the possibility that residual benign tissue, resulting from unintentional disruption of the prostatic capsule during surgery, may be responsible for a detectable postoperative PSA. These cases comprise a histopathological classification described as "intraprostatic surgical margin".

Pressure-flow studies in men with benign prostatic hypertrophy before and after treatment with transurethral needle ablation

BACKGROUND/AIMS

In this study we wanted to examine the effects that transurethral needle ablation (TUNA) might have on the urodynamic characteristics of bladder outlet obstruction and to evaluate the clinical changes and the safety profile in patients undergoing the TUNA procedure, including the effects on erectile and ejaculatory function.

MATERIALS AND METHODS

We evaluated 24 patients, aged between 66 and 81 (mean 73.4) years with a mean prostatic volume of 57 +/- 15 ml. Before treatment, the clinical history was collected, then prostate-specific antigen (PSA) analysis, digital rectal examinations, I-PSS and quality-of-life (QOL) tests, uroflowmetry with residual volume, and pressure-flow studies were performed in all patients. After treatment, all the patients were evaluated at 6, 12 and 24 months by the same parameters.

RESULTS

After treatment, the I-PSS and QOL scores were considerably improved, and the mean flow rate and the residual volume were also improved. The serum PSA level remained unchanged. The prostatic volume was almost unchanged, and pressure-flow studies showed a reduction in the mean opening pressure and detrusor pressure at maximum flow after treatment. None of the patients complained of alterations in sexual activity nor retrograde ejaculation.

CONCLUSIONS

Our study confirms that in patients with benign prostatic hyperplasia, the TUNA procedure results in no major complications and in significant clinical improvements. There was an improvement in the subjective and objective variables, such as symptom scores and frequency-volume charts and, in the majority of patients, subjective and objective improvements were sustained for the duration of this study, which included a 2-year follow-up with pressure-flow studies. From our experience we can say that the ideal candidate for TUNA treatment should be younger than 70 years, with a prostatic volume of <60 cm H(2)O, with a baseline detrusor pressure at maximum flow of <60 cm H(2)O, with a pretreatment residual volume of <100 ml and with a QOL score of <5.

[Ultrasound-guided cryosurgery of the prostate: short- and long-term experience]

We have assessed 24 patients consecutively treated with cryosurgery and chosen according to the guidelines of the European Study Group of Urologic Cryosurgeons. Of the 24 patients (average age about 70, range 61-79), all were not considered candidates for radical prostatectomy, 9 (37%) were clinical stage cT2 N0M0, 15 (63%) cT3 N0M0 who had not received any prior treatment, except 1 patient (61 years old) who was treated with TCT and successive recurrence of the disease (cT2). Of the 24 chosen patients, 13 (55%) were over the age of 71, 11 (45%) had important factors of co-morbidity and an elevated risk of surgery (ASA 3). The average PSA was of 19.3 ng/ml (range 2.2-61). Gleason score was 2-5 in 9 cases, 6-7 in 14 and 8-10 in 1 case. In the follow-up, we evaluated serum PSA every 3 months and transrectal ultrasound and the echoguided prostatic biopsies at 6, 12 and 24 months. Post-operative complications included: ecchymosis and edema of external genitals (16/24), fever > 38 degrees C (1/24), sloughing syndrome (6/24), urinary tract infections (10/24) acute urine retention (1/24). In 2 cases, 6 months after treatment, a transrectal resection was carried out. After a follow-up at 6 months, the PSA was 0.4 ng/ml (range 0.1-0.9), in 1 case. In positive core biopsy out of 6 showed neoplastic cells with fibrous tissue; the patient had a PSA of 0.58 ng/ml. At 12 months there were 11 assessable patients. The average PSA was 0.3 ng/ml (range 0.1-0.9). At 24 months there were 4 assessable patients, 1 of 4 showed serum PSA level of 4 ng/ml and cancer in apical biopsy. Erectile dysfunction was assessed on 8 patients affective before surgery: 1 referred to sufficient erections at penetration (1/8, 12.5%). After removal of the catheter, 4 of the 20 patients suffered stress and urge incontinence with the use of 1 pad a day. In 1 case, 18 months from surgery, slight stress incontinence was found (1 pad/day). Cryoablation is an efficient method and is given to slight post-operative morbidity and no intra-operative mortality, also in patients with high risk for open surgery. Indications may be found in patients with the following conditions: older than 72 years, severe co-morbidity and high risk for surgery, neoplasia at high risk of progression, and disease recurrence after radiotherapy. Our case history is at the moment encouraging and a larger number of cases as well as longer follow-up are needed.

[Intraprostatic spread of prostatic carcinoma: stereographic representation based on ultrasonography and biopsy findings]

The aim of this study is to identify and evaluate a scheme of graphic representation of the prostate, that allows the reconstruction of cancer diffusion based on ultrasound findings and on histological biopsy findings. A graphical representation of the prostate using transversal and longitudinal sections is represented by the US-operator, who write severy single performed biopsies (site, directions, and angle) and draws the US relieves. Biopsy specimens are separately prepared on a paper-support and marked at one extremity with china ink. The histopathological examination on every single specimen allows to identify the tumor extent, Gleason grading and the percentage occupied by the neoplasia. Were performed 50 transrectal echo-guided mapping biopsies. Comparing biopsy results with the pathological analysis on 13 whole-mount radical prostatectomy: pathological stage was predicted in 6 of 7 cases, Gleason grading was predicted in 85% of cases. In 5 cases in which the core biopsy histological analysis showed only atypical glands suspicious for cancer it has been possible to repeat new biopsies in the same site of the gland. Tumor was this time diagnosed in 3 of 5 cases (60%). The proposed approach can be useful to reduce variables linked to operator, technique, and single clinical situation, but it needs an employment on a higher number of cases and a verification on more surgical specimens. The scheme proposed has been of easy complication and immediate interpretation by clinicians and pathologists.

[Transurethral needle ablation (TUNA) in benign prostatic hypertrophy: 2-year follow-up]

In this study we have evaluated the effectiveness, safety and tolerability of TUNA in the long term follow-up. We have evaluated 24 patients, aged between 66 and 81 years (mean age 73, 4 yrs) with a mean prostatic volume of 57 ml (range 33-140 mls). Before treatment, urodynamic investigation (max flow rate), residual volume, PSA, IPSS and quality of life tests have been performed in all patients. After treatment, all the patient have been evaluated at 6, 12 and 24 months by the same parameters. Based on our experience, we can say that the results obtained after 24 months are similar to those observed 12 months after treatment, except a slight increase in IPSS and quality of life tests in patients older than 70 years, with a baseline maximal detrusorial pressure > 60 cm H2O, with a baseline residual urine > 100 cc and with a baseline quality of life = 5.

[Gene p53 mutation and prognosis in bladder tumors]

The choice of treatment for bladder tumors is based on pathological criteria, i.e. staging and grading mainly. It has recently been observed that genetic alterations that involve activation of oncogenes and inactivation of suppressor genes can occur during tumorigenesis. p53 protein is coded for by a genes on chromosome 17, and is able to suppress malignant transformation and proliferation; it can be important in maintaining the integrity of DNA, when damaged during neoplastic disease. We have analyzed samples of transitional cell carcinoma of the bladder of 60 patients managed by conservative treatment; all the specimens have been stained for p53 protein. We could observe that the presence of the protein p53 is correlated with staging and grading and is associated with an increased risk of relapse and progression. Patients with transitional-cell carcinoma confined to the bladder that demonstrates nuclear p53 reactivity should be considered for protocols of adjuvant treatment.