Preventing unnecessary invasive cancer-diagnostic tests: changing the cut-off points

To determine a cut-off point of tPSA and PSAD to prevent unnecessary invasive cancer-diagnosing tests in the community. This study was performed on 688 consecutive patients referred to our center due to prostatism, suspicious lesions on digital rectal examination and/or elevated serum PSA levels. All patients underwent transrectal ultrasound guided biopsies and obtained PSAD. Serum levels of tPSA and fPSA were measured by chemiluminescence. Comparisons were done using tests of accuracy [AUC-ROC]. Prostate cancer was detected in 334 patients, whereas the other 354 patients were suffering from benign prostate diseases. The mean tPSA in case and control groups were 28.32 +/- 63.62 ng/ml and 7.14 +/- 10.04 ng/ml; the mean f/tPSA ratios were 0.13 +/- 0.21 and 0.26 +/- 0.24 in PCa and benign prostate disease groups; the mean PSAD rates were 0.69 +/- 2.24, 0.12 +/- 0.11, respectively. Statistically significant differences were found [P<0.05]. Using ROC curve analysis, it was revealed that AUC was 0.78 for tPSA and 0.80 for f/tPSA. Sensitivity was 71% for the cut-off value of 7.85ng/ml. For f/tPSA ratio, the optimal cut-off value was 0.13 which produced the sensitivity of 81.4% and for PSAD, it was15%. As this trial is different from the European and American values, we should be more cautious in dealing with the prostate cancer upon the obtained sensitivity and specificity for PCa diagnosis [7.85ng/mL fortPSA, 15% for PSAD and 0.13 for f/tPSA ratio]

Should post kidney transplantation hyperlipidemia considered a risk factor for graft function?

Hyperlipidemia is a common problem after kidney transplantation.To uncover the real impact of post kidney transplantation hyperlipidemia on graft function and survival, and to determine whether it is just a biochemical phenomenon after using immunosuppressant or a part of disease pathology. 330 kidney transplants were managed in Sina Hospital Kidney Transplantation Unit affiliated to Tehran University of Medical Sciences, Tehran, Iran from September 1994 till February 2010. The demographic characteristics of the patients, causes of chronic kidney diseases, history of pretransplantation dialysis, pretransplantation comorbidities [e.g., hypertension, diabetes mellitus [DM], hyperlipidemia and coronary artery disease], rejection episodes, status of infection with cytomegalous virus [CMV], post-transplantation DM, hyperlipidemia, ischemic heart disease [IHD], and graft and patient survival were recorded. A serum creatinine level >2 mg/dL was considered as "graft deterioration," and return to dialysis as "graft loss." According to the presence or absence of post kidney transplantation hypercholesterolemia [>200 mg/dL] or hypertriglyceridemia [>200 mg/dL], the patients were classified into "hyperlipidemic" or "non-hyperlipidemic." The presence of clinical or paraclinical coronary artery disease was also determined in both groups.The incidence of hyperlipidemia elevated from 8% to 50% before and after transplantation. 2.7% developed clinical IHD. 13% of hyperlipidemics and 22% of non-hyperlipidemics developed graft deterioration. Among hyperlipidemics with deteriorated grafts 40% had premorbid diseases, 68% had CMV infection and 82% had hypertension. Only 22% had previous acute rejection and 27% received deceased kidney transplant.Post-kidney transplantation hyperlipidemia is just an associated phenomenon secondary to the use of immunosuppressant medications, which have no obvious impact on renal graft function and can be easily controlled by instituting dietary modifications and use of modern antilipid medications. Post kidney transplantation CMV infection and hypertension are considered as the main threatening risk for renal graft-even more dangerous than acute or chronic rejections

Risk factors and laboratory diagnostics for post renal transplant tuberculosis: a case-controlled, country-wide study on definitive cases

Tuberculosis [TB] is a common cause of morbidity and mortality in renal transplant recipients. It is usually misdiagnosed because of lack of medical awareness and its infrequency in renal transplant recipients. 44 cases [0.3%] with post-transplant TB out of 12820 patients who had renal transplants performed between 1984 to 2003 were found from the hospital records of 12 major kidney transplantation centers in Iran. These cases were compared with 184 healthy transplant subjects whose transplants were performed by the same surgical team as the controls. The mean age of cases and controls was 37.7 [13-63] and 35.6 [8-67] years [p=0.3], respectively. The mean duration of pre-transplantation hemodialysis was 30.3 [3-168] months in cases and 18.2[1-180] months in controls [p=0.03]. A past history of tuberculosis was detected in 2 cases and 1 control [p=0.3]. The mean doses of initial and maintenance immunosuppressive drugs in cases and controls were not significantly different. A total of 25 cases [56.8%] and 60[32.6%] controls had rejection prior to diagnosis of TB [p=0.004; OR=2.7, CI95%: 1. 3-5.6]. To our knowledge, this is the first study that demonstrated increasing risk of post-transplant TB by extending the duration of pre-transplant hemodialysis and the number of post-transplant rejection episodes. Further study is needed to clarify our new findings specifically in respect of different immunosuppressive regimens

Molecular detection of prostate specific antigen in patients with prostate cancer or benign prostae hyperplasia the first investigation from Iran

Prostate cancer is the second common form of cancer in men. Detection of circulating Prostate Specific Antigen [PSA] transcripts has effectively been used for early diagnosis of prostate cancer cells. This investigation employed a reverse transcriptase polymerase chain reaction [RT-PCR] technique to distinguish the patients with either localized or metastatic prostate cancer [CaP] vs. Benign Prostate Hyperplasia [BPH] and control subjects, as compared with clinical and pathological records. With reservation of ethical issues, blood samples were collected from 60 cases. Based on pathological and clinical findings, 25 patients [20 with localized cancer, 5 with metastatic], 22 with BPH, and 13 healthy [including 3 females] subjects as negative controls, were selected from Shariati, Mehrad, Sina,, Khatam and Atie Hospitals in Tehran, Iran. RT-PCR for a 260 bp PSA transcript was then performed. Clinical and pathological records were used for the assessment and comparison of PSA RT-PCR results. None of the control subjects and BPH [with 7 exceptions] were found positive by RT-PCR [Relative specificity= 72.7%]. In patients with prostate cancer, 21 out of 25 were found PSA positive [Relative sensitivity=83.4%] and the remaining 3 have been shown to be PSA negative [Positive predictive value= 83.4%]. All of 5 metastatic patients [100%] revealed PSA positive results. Our data reflects the clinical relevance and significance of RT-PCR results as assessed with clinical and pathological examinations. PSA RT-PCR might be used as a powerful means for diagnosis, even when either pathological or clinical findings are negative, and could be employed for further molecular epidemiology surveys

prevalence of infected stones in the urinary tract and their relationship to urease positive bacteria

To determine the prevalence of infected stones in the urinary tract and their relationship to urease positive bacteria and whether a positive urine culture signifies infected stone profile. This study was conducted on 168 patients [116 males and 52 females] with a mean age of 37 years. The analysis was performed on: [1] Urine specimen before operation, [2] Urine around the stone before stone retrieval and [3] Stones. Urine and stone culture was performed on blood agar [BA] and Eosin Methylene Blue [EMB] for gram staining, Brucella agar enriched with vitamin K and Thioglycolate medium for anaerobics and uroplasma urealyticum inside PPLO culture. Urease was determined on urea broth and urea agar media. Chemical analysis of the stone was done by Merck kit. Seven cases of culture were positive for infected stones [64%] while 6 cases of non-infected stones grew microorganisms [3.8%]. Infected stones comprised 6.5% of all the stones. Proteus mirabilis and Pseudomonas aeruginosa were the most commonly encountered bacteria [18%]. Urease positive bacteria were found to be 54.5% in the infected stones and 6% in the non-infected stones. Urine and stones samples showed that only 14.5% had the same type of bacteria. Other factors besides bacteria play a role in stone formation in the urinary tract and infected stones can be produced in non-infected urine also

Pheochromocytoma of the urinary bladder

One of the rarest tumors involving the urinary bladder is the pheochromocytoma. A case of pheochromocytoma of the urinary bladder in a young female suffering from headache and cystitis for many years is reported. Twenty-four hour urine VMA was normal. The patient was never hypertensive except during surgical manipulation of the tumor. Biopsy of the bladder resulted in massive hemorrhage