Case report: percutaneous management of transitional-cell carcinoma of the upper urinary tract using the bipolar resectoscope

BACKGROUND: The traditional management of upper-tract urothelial tumors is radical nephroureterectomy. However, in recent years, minimally invasive nephron-sparing endoscopic approaches have been utilized. We present our initial experience using the bipolar resectoscope with saline irrigation in the management of renal transitional-cell carcinoma (TCC). CASE REPORT: A 74-year-old woman presented with a 3.5-cm filling defect in the collecting system on CT. Cystoscopy and retrograde ureterography demonstrated normal bladder mucosa and a normal contralateral ureter. Ureteroscopy revealed a papillary TCC in the renal pelvis. Ureteroscopic treatment was declined because of the lesion's size. We elected to proceed with percutaneous resection. Using the bipolar resectoscope, the lesion was removed completely. The procedure was accomplished in 90 minutes. The estimated blood loss was 50 mL. The hospital stay was 23 hours. Pathology examination revealed a low-grade TCC. Follow-up for 9 months has shown no recurrence. CONCLUSION: In our initial experience, percutaneous treatment of upper-tract urothelial tumors may be accomplished using the bipolar resectoscope with favorable results.     

Immediate recovery of renal function after orthotopic liver transplantation in a patient with hepatorenal syndrome requiring hemodialysis for more than 8 months

Severe liver dysfunction may lead to impairment of renal function without an underlying renal pathology. This phenomenon is called hepatorenal syndrome (HRS), which is associated with a poor prognosis showing a median survival of less than 2 months if renal replacement therapy is necessary. Liver transplantation is the best therapeutic option to regain renal function, but because of poor survival, these patients often die before transplantation. Herein we report a 37-year-old patient with ethyl-toxic liver cirrhosis who underwent hemodialysis due to HRS type I for more than 8 months. After living donor liver transplantation, diuresis immediately resumed, renal function soon recovered, and intermittent hemodialysis was stopped at 18 days after transplantation. Renal function was stable with a serum creatinine <2 mg/dL during the last 5 years posttransplantation. As far as we know, only a few cases of an anuric patient suffering from HRS have been reported with a survival beyond 8 months and full recovery of renal function after liver transplantation. This underlined that renal replacement therapy in HRS should be considered as a possible bridging method to liver transplantation even for longer periods.     

The assessment of postoperative pain by monitoring skin conductance: results of a prospective study

The number of fluctuations of skin conductance per second correlates with postoperative pain. The aim of this prospective study was to test the cut-off value for the number of fluctuations of skin conductance per second obtained from a previous study. Seventy-five patients were asked to quantify their level of pain on a numeric rating scale (0-10) in the recovery room. The number of fluctuations of skin conductance per second was recorded simultaneously. The number of fluctuations of skin conductance per second was different between patients with no (0.07), mild (0.16), moderate (0.28) and severe pain (0.33); p < 0.001. The tested cut-off value for the number of fluctuations of skin conductance per second (0.1) distinguished a numeric rating scale 3 with 88.5% sensitivity and 67.7% specificity. The number of fluctuations of skin conductance per second may be a useful means of assessing postoperative pain.     

Effect of cationic carriers on the pharmacokinetics and tumor localization of nucleic acids after intravenous administration

Nucleic acid based therapeutics are currently being studied for their application in cancer therapy. In this study, the effect of different cationic delivery systems on the circulation kinetics, tumor localization, and tissue distribution of short interfering RNA (siRNA) and plasmid DNA (pDNA) was examined, after intravenous administration in mice bearing a s.c. Neuro 2A tumor. Nanosized particles were formed upon complexation of siRNA with the cationic liposome formulation DOTAP/DOPE and the targeted, cationic polymer RGD-PEG-PEI. Both the circulation kinetics and the overall tumor localization of the siRNA complexes were similar to non-complexed siRNA. Importantly, the different carriers changed the intratumoral distribution of siRNA within the tumor. pDNA was effectively condensed with linear polyethylenimine (PEI), PEGylated linear PEI (PEG-PEI) or poly(2-dimethylamino ethylamino)phosphazene. Only PEG-PEI was able to improve the pDNA circulation kinetics. All pDNA complexes yielded similar pDNA tumor localization (1% of the injected dose, 60 min after administration). We conclude that the level of nucleic acid tumor localization is independent on the type of formulation used in this study. Therefore, the value of carrier systems for the intravenous delivery of nucleic acids cannot be solely attributed to benefits relevant during the transport towards the tumor. Rather, the benefits are arising from carrier-induced changes in the intratumoral fate of the nucleic acids.     

Locked volar plating for complex distal radius fractures: Patient reported outcomes and satisfaction

Background  

Distal radius fractures are common. The increasing prevalence of osteoporosis contributes to frequently complex articular injuries sustained even after low energy falls. The best method of treating complex type C distal radius fractures is debated. Locked volar plating and external fixation are both widely used with good reported results. Measures of success are traditionally based on technical measurements or the perception of the surgeon. Patient reported measures of outcome are increasingly recognised as important markers of surgical success. We report our experience using locked volar plating for complex type C distal radius fractures as well as patient reported measures of success and satisfaction.     

Targeting the retinal microcirculation to treat diabetic sight problems

Diabetic retinopathy is a secondary complication of hyperglycemia caused by diabetes mellitus. The damage to the retina can ultimately cause vision loss as a result of increased capillary permeability and angiogenesis. Recent progress in the understanding of the mediators that drive angiogenesis, as well as the phenotypes of cells that are involved in this process, has provided a multitude of targets for pharmacologic intervention. This review presents the inhibitors of the biochemical processes that are at the root of diabetic retinopathy (i.e., non-enzymatic glycosylation of biomolecules, oxidative stress, activation of aldose reductase and activation of protein kinase C by formation of diacylglycerol) in addition to the inhibitors of the mechanical damage (i.e., increased vascular permeability, capillary occlusion and neovascularization).     

Risk of second non-hematological malignancies among 376,825 breast cancer survivors

Breast cancer survivors are at increased risk of treatment-related second cancers. This study is the first to examine risk 30 or more years after diagnosis and to present absolute risks of second cancer which accounts for competing mortality. We identified 23,158 second non-hematological malignancies excluding breast in a population-based cohort of 376,825 one-year survivors of breast cancer diagnosed from 1943 to 2002 and reported to four Scandinavian cancer registries. We calculated standardized incidence ratios (SIR) and utilized a competing-risk model to calculate absolute risk of developing second cancers. The overall SIR for second cancers was 1.15 (95% confidence interval [CI] = 1.14–1.17). The SIR for potentially radiotherapy-associated cancers 30 or more years after breast cancer diagnosis was 2.19 (95% CI = 1.87–2.55). However, the largest SIRs were observed for women aged <40 years followed for 1–9 years. At 20 years after breast cancer diagnosis, the absolute risk of developing a second cancer ranged from 0.6 to 10.3%, depending on stage and age; the difference in the absolute risk compared to the background population was greatest for women aged <40 years with localized disease, 2.3%. At 30 years post breast cancer diagnosis, this difference reached 3.2%. These risks were small compared to the corresponding risk of dying from breast cancer. Although the absolute risks were small, we found persistent risks of second non-hematological malignancies excluding breast 30 or more years after breast cancer diagnosis, particularly for women diagnosed at young ages with localized disease.