In the cystoscopic follow-up of non-muscle-invasive transitional cell carcinoma, NMP-22 works for high grades, but unreliable in low grades and upper urinary tract tumors

Introduction and objectives

Two percent of the bladder non-muscle-invasive (NMI) transitional cell carcinomas (TCC) are associated with upper urinary tract (UUT) TCC. We evaluated the role of nuclear matrix protein-22 (NMP-22) (BladderChek^?) test in the diagnosis of lower urinary tract and UUT-TCC.

Methods

From March 2009 to June 2011, 122 patients with bladder NMI-TCC underwent 205 control cystoscopy. A total of 95 (78 men and 17 women, mean age 60.7?years, range, 27?C88) patients who were followed regularly with NMP-22 test and with follow-up cystoscopies (145 episodes; min. 1?Cmax. 5) were included in this study. For routine monitoring of the UUT, IVU or CT urography was used once a year for high grades (HG), and once in every other year for low grades (LG). The sensitivity and specificity of NMP-22 were evaluated by ROC curves, and sensitivity, specificity, and positive and negative predictive values were calculated. Chi-square test was used for the differences between the subgroups.

Results

Cystoscopy and NMP-22 results of the patients included in the study revealed the sensitivity (44.4%) of the test was very low and the specificity (98.4%) was quite high (p?Conclusions Nuclear matrix protein-22 cannot detect LG TCC. However, it detects overwhelming majority of HG TCC. For this reason, positive NMP-22 test largely indicates HG TCC. NMP-22 is also not reliable in UUT-TCC, even in HG tumors.     

Penile necrosis due to priapism developed after circumcision in a patient with protein S deficiency

IntroductionHypercoagulable state is a complex condition with an abnormal propensity for thrombosis. The consequences of it due to thrombosis of veins and arteries are the most common cause of sickness.AimThe present study is a report of a case describing penis necrosis after circumcision and evaluation of hypercoagulable state as a reason of it.MethodsNine‐year‐old boy referred from another hospital with the sequelae of the penile ischemia with discoloration of the penis after traditional circumcision.ResultsThe ischemic event developed 3 weeks after circumcision. Priapism that was treated with needed glandulocavernous shunt initially developed following circumcision. All values of routine blood count and blood biochemical analysis were within normal limits. Further, hematologic studies revealed that there might be a hypercoagulable state as a result of lower protein S level.ConclusionCircumcision is a common procedure frequently performed in many communities around the world. Although it is seen as an easy procedure and performed even by unauthorized medical stuff, it is not complication‐free. Severe penile necrosis after circumcision should be treated on an individual basis, necessitating different techniques. Hypercoagulable state should be concerned and evaluated in such a complication. In short, circumcision has to be done by specialists who can handle such serious complications. Canter HI and Coskuner ER. Penile necrosis due to priapism developed after circumcision in a patient with protein s deficiency. J Sex Med 2011;8:3236–3240.     

Protective effects of intravenous anesthetics on kidney tissue in obstructive jaundice

AIM:To evaluate the protective effects on kidney tissue of frequently used intravenous anesthetics(ketamine,propofol,thiopental,and fentanyl)in rats with obstructive jaundice.METHODS:There is an increased incidence of postoperative acute renal failure in patients with obstructive jaundice.Thirty-two Wistar-albino rats were randomly divided into four equal groups.Laparatomy was performed on each animal in the four groups and common bile ducts were ligated and severed on day 0.After 7 d,laparotomy was again performed using ketamine,propofol,thiopental,or fentanyl anesthesia whose antioxidative properties are well known in oxidative stress in a rat liver model of obstructive jaundice.After 2 h,the rats were sacrificed.Renal tissue specimens were analyzed for catalase,superoxide dismutase and malondialdehyde enzymes activities.All values are expressed as the mean±SD.P values less than 0.05 were considered statistically significant.RESULTS:All animals survived without complications until the end of the study.Enlargement in the bile duct and obstructive jaundice were observed in all rats.Catalase was found to be significantly lower in the fentanyl group than in the ketamine(P=0.039),propofol(P=0.012),and thiopental(P=0.001)groups.Superoxide dismutase activities were similar in all groups(P>0.05).Malondialdehyde was found to be significantly lower in the ketamine group than in the propofol(P=0.028),thiopental(P=0.002)and fentanyl(P=0.005)groups.Malondialdehyde was also lower in the fentanyl group than in the thiopental group(P=0.001).The results showed that obstructive jaundice sensitizes renal tissue to damage under the different anesthetics.CONCLUSION:Among the agents tested,ketamine and propofol generated the least amount of oxidative stres on renal tissues in this rat model of obstructive jaundice created by common bile duct ligation.The importance of free radical injury in renal tissue in obstructive jaundice under different intravenous anesthetics during hepatobiliary and liver transplant surgery should be considered for prevention of postoperative acute renal failure.     

Structures of the E46K Mutant-Type α-Synuclein Protein and Impact of E46K Mutation on the Structures of the Wild-Type α-Synuclein Protein

相似文献   

Structures and Free Energy Landscapes of the A53T Mutant-Type α-Synuclein Protein and Impact of A53T Mutation on the Structures of the Wild-Type α-Synuclein Protein with Dynamics

相似文献   

The role of the bipolar plasmakinetic TURP over 100 g prostate in the elderly patients

Background and purpose

Bipolar plasma kinetic (BP) transurethral resection of prostate (TURP) has been proved to be a safe and effective treatment for benign prostatic enlargement (BPE). However, the role of bipolar TURP on large prostates over 100 g compared with open suprapubic prostatectomy (SP) in elderly patients (>65 years) has not ever been studied before.

Patients and methods

A retrospective analysis of patients’ medical records between 2007 and 2012 was performed. A total of 102 patients who underwent SP (n = 44) or BP-TURP [Gyrus Plasma Kinetic? (Gyrus ACMI, USA)] (n = 58) for obstructive lower urinary tract symptoms due to BPE were included in this retrospective study. Inclusion criteria were age ≥65 years, prostate volume ≥100 g, International Prostate Symptom Score (IPSS) ≥18, and peak urinary flow rate (PFR) ≤15 ml/s. Exclusion criteria were urethral stricture, known history of neurogenic bladder due to neural disorders, previous prostate and/or urethral surgery, bladder stone, bladder cancer, and known prostate cancer. Operation time, hospitalization, and catheter removal times were noted. Patients were re-evaluated at postoperative 3rd and 12th months. Evaluated parameters were IPSS, quality of life (QoL), simplified International Index of Erectile Function-5 (IIEF-5), PFR, post-voiding residual urinary volume (PVR). Statistical significance was set at 0.05 and all tests were two-tailed.

Results

Preoperative IPSS, PVR, IIEF-5, QoL, and prostate volume were not statistically significantly different between two groups except for PFR. Mean follow-up for BP-TURP and SP groups were 15.0 ± 5.8 (R: 11–38), 22.1 ± 11.2 (R: 11–59) months, respectively (p < 0.001). When compared with SP, mean catheter removal time (p < 0.001) and median hospitalization time (p < 0.001) were significantly shorter in BP-TURP group. However, mean operative time was significantly (p < 0.001) longer than SP group and also median resected material weight was significantly lower in the BP-TURP group (p < 0.001). IPSS, QoL, PFR, PVR, and IIEF-5 scores at postoperative 3rd and 12th month were not significantly different between the two groups (p > 0.05). Thirty-three patients had perioperative complications according to the modified Clavien–Dindo system. Thirteen patients (22.4 %) in BP-TURP group and 20 patients (45.4 %) in SP group had complications. In 12th month follow-up visit, four patients presented with urethral stricture, three patients (5.1 %) were in BP-TURP group, and one patient (2.3 %) in SP group (p = 0.455). All strictures were treated with internal urethrotomy.

Conclusions

BP-TURP is a safe and highly effective treatment modality for BPE in the elderly patients with prostate glands over 100 g. Clinical efficacy and postoperative 12th month’s results were similar to SP. Larger studies with longer follow-up are needed in order to confirm our findings.     

Holmium laser ablation of recurrent strictures of urethra and bladder neck: preliminary results

BACKGROUND: The management of patients with recurrent urethral strictures represents a challenge for the practicing urologist. PATIENTS AND METHODS: We used holmium:yttrium-aluminum-garnet (Ho:YAG) laser in the management of recurrent urethral strictures in 13 patients. The energy level was set at 1.0 at a frequency of 10 pulses/sec. No treatment complications were observed. The mean preoperative maximum flow rate by uroflowmetric analysis was 3.8 mL/sec. RESULTS: Nine patients (69%) continue to do well with no symptoms at a median follow-up of 27 months with a mean maximum flow rate of 19 mL/sec. Of the four patients in whom treatment failed, three were retreated with the Ho:YAG laser. One of them was managed by insertion of a permanent urethral stent, another continues to do well without any further treatment, and the other is managed with dilation by self-catheterization. One of the four failures underwent open reconstructive urethroplasty after recurrence following his first treatment with the Ho:YAG laser. CONCLUSION: Our preliminary results suggest that Ho:YAG laser ablation of urethral strictures is safe and might be a reasonable alternative endoscopic treatment for recurrent urethral strictures.     

Modified tongue base suspension for multilevel or single level obstructions in sleep apnea: clinical and radiologic results

Objectives

To investigate the radiologic and polysomnographic success in opening the airway using a tongue base suspension procedure alone or in combination with uvulopalatal flap in obstructive sleep apnea syndrome (OSAS) patients.

Methods

This study was conducted in 20 patients with moderate or severe OSAS in a prospective manner. The tongue base suspension technique alone or with a uvulopalatal flap (UPF) technique was applied. Magnetic resonance imaging (MRI) scans of patients obtained during the preoperative period and at the 5th week of the postoperative period were compared. Changes in pain and swallowing difficulties were assessed. Polysomnography (PSG) was applied at the 12th postoperative month, and body mass index (BMI) and Epworth sleepiness scale (ESS) values were determined. The degree of satisfaction relative to the surgery was assessed with 4 questions.

Results

Preoperative apnea-hypopnea index (AHI) level was found to be 24.55 ± 9.87, whereas postoperative AHI level was 12.40 ± 9.87 (P < 0.01). The success rate was determined to be 60%. Preoperative ESS values were 13.90 ± 2.67 and were reduced to 6.55 ± 3.13 postoperatively (P < 0.01), and the preoperative posterior airway space (PAS) level was 10.08 ± 1.23, which was increased to 11.64 ± 1.46 postoperatively (P < 0.01). Visual analog scale (VAS) values for swallowing difficulty were 8.62 at day 1 and decreased to 3.98 at day 7. The VAS values for pain were 9.14 at day 1, but were reduced to 4.18 at day 7.

Conclusions

Patients with OSAS who have hypertrophy of the tongue base may safely receive a tongue base suspension procedure, which is a minimally invasive method. The postoperative hospital stay is short and the success rate is high, as shown with both PSG and MRI.     

Tooth color change due to different etching and debonding procedures

Objectives:To compare the effects of different etching techniques, 12–, 24–bladed tungsten carbide burs, and polishing discs on tooth color changes during orthodontic treatment.Materials and Methods:59 individuals (mean age: 15.20 ± 1.59 years) were divided into four groups: 37% phosphoric acid and adhesive primer was used in Groups I and II whereas self–etch primer was used in Groups III and IV for enamel preparation. After orthodontic treatment, residual adhesives were cleaned with 12–bladed tungsten carbide burs in Groups I and III, while 24–bladed tungsten carbide burs were used in Groups II and IV. All teeth were polished with medium and fine Sof–Lex XT discs (3M ESPE, St Paul, Minnesota). Color measurements were taken from upper incisors and canines at pretreatment (T0), after cleaning with tungsten carbide burs (T1) and polishing with discs (T2). Wilcoxon test was used for evaluation of L*, a*, b* changes and Kruskal–Wallis for intergroup comparison of color changes.Results:L*, a*, b* values, except a* at Groups I, II, IV, and b* at Group III, changed significantly (P < .05). Groups III and IV showed significantly different color alterations from T0 to T1 (P < .05). After polishing, tooth color alterations were not significantly different among the groups.Conclusions:In self–etch bonding groups, a 12–bladed tungsten carbide bur caused less color change than the 24–bladed tungsten carbide bur. Orthodontic treatment resulted with visible and clinically unacceptable tooth color alterations regardless of the enamel preparation and clean–up techniques. Polishing reduced the effect of tungsten carbide burs, but did not affect the total influence of orthodontic treatment on the tooth color.