Management of lower urinary tract fibroepithelial polyps in children

IntroductionFibroepithelial polyps (FEP) of the lower urinary tract are relatively common in adults but rare in children, with fewer than 250 cases reported in the literature to date.ObjectiveThe aim of this study was to address the experience of FEP management in children.Study designA retrospective multicenter review was undertaken in children with defined FEP of the lower urinary tract managed between 2008 and 2018. The data at 18 pediatric surgery centers were collected. Their demographic, radiological, surgical, and pathological information were reviewed.ResultsA total of 33 children (26 boys; 7 girls) were treated for FEP of the lower urinary tract at 13 centers. The most common presentation was urinary outflow as hematuria (41%), acute urinary retention (25%), dysuria (19%), or urinary infections (28%). A prenatal diagnosis was made for three patients with hydronephrosis. Almost all of the children (94%) underwent ultrasound imaging of the urinary tract as the first diagnostic examination, 23 (70%) of them also either had an MRI (15%), cystourethrography (25%), computerized tomography (6%), or cystoscopy (45%). Two of these children (6%) had a biopsy prior to the surgery. The median preoperative delay was 7.52 (range: 1–48) months. Most of the patients were treated endoscopically, although four (12.1%) had open surgery and two (6.1%) had an additional incision for specimen extraction. The median hospital stay was 1.5 (range: 1–10) days. There were no recurrences and no complications after a median follow-up of 13 (range: 1–34) months.DiscussionThe main limitation of our study is the retrospective design, although it is the largest one for this pathology.ConclusionThis series supports sonography as the most suitable diagnosis tool before endoscopy to confirm the diagnosis and to perform the resection for most FEP in children. This report confirms the recognized benign nature in the absence of recurrences.Level of EvidenceLevel V.     

MR-sequences for prostate cancer diagnostics: validation based on the PI-RADS scoring system and targeted MR-guided in-bore biopsy

Purpose

This study evaluated the accuracy of MR sequences [T2-, diffusion-weighted, and dynamic contrast-enhanced (T2WI, DWI, and DCE) imaging] at 3T, based on the European Society of Urogenital Radiology (ESUR) scoring system [Prostate Imaging Reporting and Data System (PI-RADS)] using MR-guided in-bore prostate biopsies as reference standard.

Methods

In 235 consecutive patients [aged 65.7?±?7.9 years; median prostate-specific antigen (PSA) 8 ng/ml] with multiparametric prostate MRI (mp-MRI), 566 lesions were scored according to PI-RADS. Histology of all lesions was obtained by targeted MR-guided in-bore biopsy.

Results

In 200 lesions, biopsy revealed prostate cancer (PCa). The area under the curve (AUC) for cancer detection was 0.70 (T2WI), 0.80 (DWI), and 0.74 (DCE). A combination of T2WI + DWI, T2WI + DCE, and DWI + DCE achieved an AUC of 0.81, 0.78, and 0.79. A summed PI-RADS score of T2WI + DWI + DCE achieved an AUC of 0.81. For higher grade PCa (primary Gleason pattern?≥?4), the AUC was 0.85 for T2WI + DWI, 0.84 for T2WI + DCE, 0.86 for DWI + DCE, and 0.87 for T2WI + DWI + DCE. The AUC for T2WI + DWI + DCE for transitional-zone PCa was 0.73, and for the peripheral zone 0.88. Regarding higher-grade PCa, AUC for transitional-zone PCa was 0.88, and for peripheral zone 0.96.

Conclusion

The combination of T2WI + DWI + DCE achieved the highest test accuracy, especially in patients with higher-grade PCa. The use of ≤2 MR sequences led to lower AUC in higher-grade and peripheral-zone cancers.

Key Points

? T2WI + DWI + DCE achieved the highest accuracy in patients with higher grade PCa ? T2WI + DWI + DCE was more accurate for peripheral- than for transitional-zone PCa ? DCE increased PCa detection accuracy in the peripheral zone ? DWI was the leading sequence in the transitional zone     

Drug-related problems in hospitalized patients with HIV infection.

PURPOSE: The type and number of drug-related problems that commonly occur in hospitalized patients with HIV were studied. METHODS: The medical records of HIV-infected patients who were receiving antiretroviral therapy at the time of hospital admission between January 1, 2005, and August 31, 2006, were reviewed. Patients age 18 years or older who had received at least one dose of an antiretroviral for an HIV-related indication during their hospitalization were included in the study. Patients' medical records were evaluated to identify drug-related problems and adverse drug events secondary to antiretroviral therapy. RESULTS: Eighty-three patients were eligible for study inclusion. A total of 176 drug-related problems were identified. The most common drug-related problem identified among medication orders reviewed was inappropriate dosing. Of the 251 orders for antiretroviral agents, 57 drugs were inappropriately dosed. The most common drug-related problems among patients were drug-drug interactions and incomplete antiretroviral regimens. There was no significant difference in the mean length of stay between patients with or without drug-related problems. Admission by physicians who were not infectious diseases specialists was an independent risk factor for having at least one drug-related problem during hospitalization (odds ratio, 3.83; 95% confidence interval, 1.08-13.54). CONCLUSION: A majority of HIV-infected patients at one institution had at least one drug-related problem at hospital admission. The most common problem observed among the medication orders reviewed was inappropriate dosing. The most common drug-related problems observed among patients were drug-drug interactions and incomplete antiretroviral regimens.     

Ergebnisse und Komplikationen nach tiefer Sklerektomie

BACKGROUND: As nonperforating glaucoma surgery, deep sclerectomy seems to offer the advantage of fewer complications than the classic trabeculectomy during the first weeks after surgery. PATIENTS AND METHODS: In this prospective study, 74 eyes of 56 patients received deep sclerectomy. The mean follow-up time was 9.5 +/- 5.8 months. Twelve eyes were treated intraoperatively with additional mitomycin C and 11 eyes had combined cataract procedures. The deep sclerectomies were performed without using material of high viscosity or a collagen implant. RESULTS: The mean preoperative pressure of 24.8 +/- 9 mmHg could be lowered to 16.1 +/- 5.9 mmHg (P < 0.0001). The number of glaucoma medications was reduced from 2.2 +/- 1.1 to 0.6 +/- 1.0 substances. Thirty-eight percent of the eyes needed glaucoma medication again. Complications included chorioidal detachment (n = 9), temporary hyphema (n = 6), and delayed pressure reduction (n = 2). CONCLUSIONS: Deep sclerectomy as nonpenetrating glaucoma surgery lowers the intraocular pressure as well as standard trabeculectomy. Its complication rate is very low during the early postoperative weeks. The number of patients who still need glaucoma medication seems to be higher than after trabeculectomy.     

Relief of buttock claudication by percutaneous recanalization of an occluded superior gluteal artery

We report a case of a woman presenting with right severe buttock claudication and normal neurological and osteoarticular examination, in whom a guidewire recanalization and percutaneous transluminal angioplasty (PTA) of an occluded right superior gluteal artery (SGA) has provided relief of her symptoms. To our knowledge, this is the first report of percutaneous recanalization of the SGA. PTA can be considered the treatment of choice for buttock claudication caused by SGA stenosis or occlusion.     

Progressive massive fibrosis in the absence of lung modulation

Progressive massive fibrosis is a well-recognized complication of long-term industrial dust exposure. Typically, it occurs in a setting of background parenchymal nodulation. We wish to report a case occurring in the absence of lung nodules.     

Prevalence of interstitial cystitis symptoms in a managed care population

PURPOSE: We calculated the prevalence of symptoms typically associated with interstitial cystitis (IC) in men and women in a managed care population in the Pacific Northwest. MATERIALS AND METHODS: International Classification of Diseases-9 based queries of the Kaiser Permanente Northwest, Portland, Oregon database were used to identify subjects with IC exclusion criteria, who were excluded from further analysis. A total of 10,000 questionnaires, including 5,000 for women and 5,000 for men, were mailed to subjects with codes indicating bladder symptoms and to those with none of the codes. The questionnaires included questions about the presence of IC symptoms and the O'Leary-Sant interstitial cystitis questionnaire. IC symptoms were defined in 2 ways, that is as 1) pelvic pain at least 3 months in duration plus urgency or frequency at least 3 months in duration and 2) the same criteria plus pain increasing as the bladder fills and/or pain relieved by urination. RESULTS: The prevalence of IC symptoms according to definitions 1 and 2 was 11.2% and 6.2% in women, and 4.6% and 2.3% in men, respectively. Symptoms were long-standing (duration greater than 1 year in 80% of cases) and bothersome (severity score 5 or greater in greater than 50%). Mean O'Leary-Sant interstitial cystitis questionnaire scores were 15.94 in subjects with definition 1 IC symptoms, 18.97 in those with definition 2 IC symptoms and 6.69 in those with no IC symptoms (p <0.001). Symptoms were most common and most severe in subjects previously diagnosed with IC. CONCLUSIONS: The prevalence of IC symptoms is 30 to 50-fold higher in women and 60 to 100-fold higher in men than the prevalence of a coded physician diagnosis of IC in the same population. Although these findings are not conclusive, they imply that IC may be significantly under diagnosed.