The value of surgical therapy in the treatment of urogenital tuberculosis

A series of 94 patients treated over a period of 22 years for genitourinary tuberculosis is reviewed. The group was made up of 72 patients with isolated urinary tuberculosis, 12 with isolated tuberculosis of the genitalia and 12 with combined disease. In 70 patients surgery was performed in addition to the standardized chemotherapy. Of the 72 patients with urinary tuberculosis, 21 received exclusively conservative treatment, while 16 underwent conservative surgery and the remaining 35, ablational surgery. The high nephrectomy and overall operation rate is explained by the high percentage of advanced state of disease and a large number of patients referred to us for nephrectomy following long-term conservative treatment. A retrospective justification for this procedure is found in the fact that 52% of the surgical specimens showed florid tuberculosis though the patients had been receiving standardized chemotherapy for an average of 9 months.     

Behavioral monitoring and urine toxicology testing in patients receiving long-term opioid therapy

No study has examined the role of urine toxicology in addition to behavioral monitoring in patients receiving opioid therapy for chronic pain. All patients maintained on chronic opioid therapy by the two senior authors at two university pain management centers were monitored for 3 yr with urine toxicology testing and for behaviors suggestive of inappropriate medication use. We retrospectively extracted demographic information, aberrant drug-taking behaviors, and urine toxicology information from the medical record. For 122 patients maintained on chronic opioid therapy, 43% (n = 53) had a "problem" (either positive urine toxicology or one or more aberrant drug-taking behaviors). Of patients with no behavioral issues, 21% (n = 26) had a positive urine screen for either an illicit drug or a nonprescribed controlled medication. Of patients with a negative urine screen, 14% (n = 17) had one or more behavioral issues. Monitoring both urine toxicology and behavioral issues captured more patients with inappropriate drug-taking behavior than either alone. Requiring a report of behavioral issues and urine toxicology screens for patients receiving chronic opioids creates a more comprehensive monitoring system than either alone. IMPLICATIONS: Monitoring both urine toxicology and aberrant behavior in chronic-pain patients treated with opioids identified more problem patients than by monitoring either alone. The authors recommend routine urine testing on all patients prescribed opioids for noncancer pain and as a required element in all opioid analgesic studies.     

Characterization of inflammasome-related genes in urine sediments of patients receiving intravesical BCG therapy

Background

Nowadays, the intravesical Bacillus Calmette-Guérin (BCG) instillation is the method of choice for the postsurgical treatment of high-grade nonmuscle-invasive bladder cancer , to reduce both recurrence rate and risk of progression. BCG is hypothesized to correct the immune system disequilibrium occurring during carcinogenesis, through an immunostimulation with detrimental effects for tumoral cells. Inflammation plays a crucial role in tumor progression. The deregulation of inflammasomes upon carcinogenesis underlines its importance both in physiologic and pathologic human conditions. Nucleotide oligomerization domain-like receptors (NLRs) are key components of this molecular platform and the increase in expression of some members of nucleotide oligomerization domain-like receptors family (NLRP3, NLRP4, NLRP9, and NLR family apoptosis inhibitory protein [NAIP]) in urothelial carcinoma was already demonstrated in our previous work.The first aim of the present work was to estimate whether these inflammasome-related genes show alterations during BCG instillations. The expression levels of NLRP3, NLRP4, NLRP9, and NAIP were assessed in the urine sediments from patients, which underwent surgery for superficial high-grade bladder cancer and further subjected to serial BCG instillations. The eventual association between NLR expression and recurrence was also evaluated. The expression of CK20 mRNA as confirmed marker of bladder cancer was also assayed.

t细胞斑点试验对菌阴肺结核的诊断价值

结核病是全球严重的公共卫生问题之一,据who估计,全球约有20亿人感染结核分枝杆菌,每年约有200万人死于结核病[1-2].传统的结核分枝杆菌检测方法因检测的敏感性、特异性等缺陷限制了其推广应用.酶联免疫斑点试验( enzyme-linkedimmunospot,elispot)是一种体外检测单细胞水平特异性抗体分泌细胞功能的免疫学技术,由lalvani等[3 ]首先将其应用于结核病的快速诊断,为结核病的实验室检测提供了一条新途径.本文就t细胞斑点试验在菌阴肺结核中的诊断价值进行初步探讨.     

Systemic therapy approaches in patients with bone metastases of urogenital malignancies

Bone metastases develop commonly in patients with a variety of urogenital malignancies and are a major cause of morbidity and diminished quality of life in a significant proportion of urogenital carcinoma patients. For example, bone metastases occur in approximately 80% of patients with hormone-refractory prostate cancer and in approximately 25% of patients with renal cell carcinoma. A sufficient and early therapy is crucial since adequate therapy can lead to significant improvements in pain control and function and maintain skeletal integrity. The effective treatment of bone metastases requires multidisciplinary cooperation between urologists, oncologists, surgeons, nuclear medicine physicians and radiation oncologists. Analgesic measures, bisphosphonates, radionuclides, radiation therapy as well as surgical procedures are available. This review will focus mainly on the role of analgetics, bisphosphonates, radionuclides and radiolabelled bisphosphonates in the treatment of bone metastases.     

Immunological and virological studies of patients with tumours of the urogenital system

The possible connections between the oncogenic viruses and the various tumours of the urogenital system were investigated. Examining the patients' cellular immune response by the lymphocyte transformation test, it was found that the non-specific immune response was considerably diminished in almost all cases, while response to adeno- and herpesvirus antigens was enhanced. Structural and functional impairment of T-lymphocytes frequently occurred. Antiviral humoral antibodies were present more rarely in cancer patients than in the controls. However, type 12 markedly oncogenic anti-adenovirus antibody was frequently found. Using the immunofluorescent method, adeno- and herpesviruses were found in more than 50% of the patients' malignant tumour cells. Electron microscopically, in some cases adeno-, herpes- and type C virus particles, too, were isolated in the tumour cells. According to these results besides other factors also adenoviruses may play a role in urogenital tumours.     

The osmolarity of the blood and urine in patients with tuberculosis of the urinary system and chronic kidney failure

Osmolarity and its constituents were followed up during the treatment course in 43 patients with tuberculosis of the urinary system and in 14 controls. The authors confirmed the relation of the blood and urinary osmolarity to the stage of chronic renal failure (CRF). CRF aggravation was evidenced by the development of hypo-osmolarity in the urine and a progressing decrease in the ratio coefficient between the osmolarity in the urine and in the plasma. Stability of plasma hyperosmolarity continued to be more than 340 mosmol/kg H2O and a decrease in the aforementioned coefficient to less than 1 despite the treatment evidenced the terminal stage of CRF and unfavourable outcome of surgical intervention.     

Study of antibodies to adenoviruses in patients with tumors of the urogenital system

The presumable relationship between viruses and malignant disease has been studied. Approximately 4000 assays for antibodies to adenovirus were carried out with sera of patients with malignant and nonmalignant diseases of the urogenital organs and other organic diseases. The search was directed in the first place at antibodies to the early non-virion antigens of adenovirus-12 of oncogenic properties. On the evidence of the complement fixation reaction antibodies to adenoviruses were found to be less frequent in malignant tumors and in hypertrophy of the prostate than in the control group. Antibody to the non-virion antigen of adenoviruses was found in 53 per cent of patients with neoplastic diseases and prostatic hypertrophy, in 18 per cent of those with urogenital diseases other than tumors and in 4 per cent of those with other organic diseases. The results point to a possible role of adenoviruses in tumors of the urogenital organs.     

The diagnostic value of the phosphate levels in serum and 24-hour urine samples in patients with recurrent renal stone disease

OBJECTIVE: The aim of this study is to investigate the value of phosphate levels in serum and urine in patients with recurrent renal stone disease. MATERIALS AND METHODS: The patients (n:60) were divided into two groups as first-time stone disease (group 1) and recurrent renal stone disease (group 2). The demographical datas and their historical information were recorded and physical examination was done. The sera and urine for 24 hr were obtained from patients to measure electrolyte levels especially phosphorus. In addition, based on presenting serum phosphate levels, patients were divided into the hypophosphatemia group, less than 2.5 mg/dl; normophosphatemia group, between 2.5-5.2 mg/dl; and hyperphosphatemia group greater than 5.2 mg/dl. RESULTS: The mean age of study group was 45 (21-70) years. Thirty-six patients (60%) were in group 1 and 24 patients (40%) were in group 2. No statistically correlation was found between stone recurrence and phosphate levels both in serum and urine. There was only a statistical association of K levels in 24-hour urine samples between group 1 and 2. CONCLUSION: There was no significant association between stone recurrence and initial phosphate levels in the serum or in urine. We do not propose to determine phosphate levels routinely in management of patients with stone disease.