role of tri-modality treatment in bladder preservation of invasive bladder carcinoma: turt,concurrent irradiation and twice weekly gemcitabine

This study was conducted to evaluate the efficacy of transurethral resection plus chemo radiation in achieving bladder preservation, using conformal radiotherapy and twice weekly Gemcitabine. Thirty seven TCC patients with good performance status, and maximum possible transuretheral resection .They received. 46 GY/23 fractions with twice weekly Gemcitabine 30mg/m2. An evaluation was done after 2 weeks by cystoscopy and biopsy from the tumor bed. Patients who had a complete response continued in phase II, 20 GY/2 weeks, with twice weekly Gemcitabine 30 mg/m2. Patients who had invasive bladder cancer were subjected to radical cvsteclomy. Thirty two patients had complete response. Treatment schedule was tolerable. It was associated with moderate toxicity that was tolerable apart of patients who developed G3 wxicity [hat required treatment interruption till improvement .After 2 years of follow up, 29 patients achieved good local control and the 2 years LRFS was 79%. The 2 years over al survival and bladder intact survival was 70%, 69%, respectively. Trimodality bladder-sparing approach consists of inmsureihral resection, chemotherapy twice daily using gemcitabine and radiotherapy is well tolerated with high rate of bladder preservation. This approach can be considered a reasonable alternative to cystectomy in the proper selected group

Cardiovascular abnormalities associated with retino vascular accidents

Patients with thromboembolic disease and retinal artery occlusion are usually referred for cardiovascular assessment. Sixteen cases with branch retinal artery occlusion or complete retinal artery occlusion had been consecutively enrolled in our series. All patients had been subjected to careful history taking, systemic and cardiological clinical examination, resting 12 leads ECG, Transthoracic echocardiography, and bilateral carotid duplex. Transthoracic echocardiograph had revealed mitral valve prolapse without evidence Of intra cardiac masses nor thrombi in 68,75% of cases. We attributed this to the limitations of transthoracic echocardiography and to the dynamic nature of clotting pathology. Carotid Duplex was normal in all cases which were all relatively young population despite the relatively high association of retinal artery occlusion with mitral valve prolapse, the incidence would be still very low when compared with the high incidence of mitral valve prolapse in the general population. We recommend using transthoracic echocardiography as screening test in cases of retino vascular accidents and to use transesophageal echocardiography to assess false negative cases. We recommend using anti platelets as a prophylaxis to prevent recurrence in cases with retinal artery occlusion with mitral valve prolapse. To consider using oral anticoagulants to prevent recurrence in cases associated with evidence of intra cardiac thrombi

Treatment of stones in the lower ureter by ESWL

Fifty patients were included in this study and treated by ESWL under sedoanalgesia. Number of stones was [50], 78% were primary and 22% were recurrent. In two cases, an ureteric catheter was placed at the time of previous failed ureteroscopy and no post- ESWL stenting was done. The average stones mass was 9 mm, the average number of shock waves was 2945 and the average KV 22.8. The stone free rate was 94% at three-month follow up. It was concluded that ESWL is an easy, reliable and noninvasive technique for treatment of stones in the lower ureter

Transurethral resection of bilharzial bladder ulcers

This study aims at evaluation of the validity of transurethral resection as a line of treatment for Bilharzial bladder ulcers. Our study included 400 patients treated by transurethral resection. Follow up by clinical assessment was done monthly for 6 months. Cystoscopy was done 6 months after resection. We found that 325 patients [81.25%] were symptom free 47 patients [12.75%] had partial relief of their symptoms, and 28 patients [7%] had persistent symptoms.Transurethal resection proved to be a satisfactory, safe line of treatment for chronic bilharzial bladder ulcers

Urodynamic evaluation of bladder function in intravesical obstruction

The purpose of diagnostic evaluation in bladder outlet, obstruction is to identify precisely the pathophysiology underlying the patient's symptoms so that rational therapy directed at relieving the most related cause of the symptoms can be initiated. One hundred, patients diagnosed by clinical, radiological and endoscopic means as having bladder outflow obstruction were evaluated by 1] Detailed symptom score, 2] Uroflowmetry, 3] Cystometry 4] EMG of perianal muscles and 5] Pressure-Flow. The pressure-flow data were applied the pressure and flow diagram constructed by Schafer [1990]. Another twenty non obstructed controls were evaluated by the same procedures. Symptom score was higher in the OBS group, but no correlation was found between symptom score and urethral resistance in the OBS group. Detrusor instability [DI] was found in 43% of patients. Significantly higher opening pressure [56.83 +/- 40.01] and residual urine [170.26 +/- 129.94] were found in the OBS group versus those of controls, [3l.65 +/- 95.2] and [23.5 +/- 14.06] successively. We concluded that the pressure flow study remains to be the corner-stone for diagnosis of outflow obstruction, and that symptoms of prostatism are not totally related to simple outlet obstruction as they may be caused by weak detrusor and DI in addition

Fungus infection of the urinary tract

During an 18-month period 100 patients from our hospital [in-patients] underwent culture of urine for fungi. All patients had one or more of the factors predisposing to funguria, out of these cases 21 cases had positive culture for fungi, among them there were 12 males and nine females. The distribution of fungi was C. albicane 13 cases, other C. species five cases and T.glabrate three cases. Our work attracts the attention to the increasing incidence of funguria in hospitals nowadays, Candida fungal infections of the urinary tract is a significant part of the problem of nosocomial urinary tract infections, improvement in techniques of catheter care and insertion must continue and reduction of number and duration of antibiotic therapy should be done if possible

Urinary calculi in Minia governorate statistical study

The study included 3000 patients who attend the outpatient urology clinic and 500 patients who were admitted into urology department in one year duration from January 1990 to December 1990. Renal stones constitute 36.6 percent of all patients ham-urinary stones in the outpatient study and 27.3 percent in the inpatient study, the mean age of patients was 36.3 +/ -15.5 years, males constitute 81.3 percent and 63.3 percent of patients life in rural communities. The incidence of ureteric stones was 47.3 percent in the outpatient study and 38 4 percent in the admitted patients. The age incidence was 35.0 +/- 13.5 years; the male to female ratio was 5:1 in primary stone, 22:1 in stones formed above ureteric stricture. Stone bladder constitute 3.5 percent of hospital attendance, it affects male more than females. It constitutes 16.1 percent of all urinary tract stones. Age incidences is high from 1 to 5 years

Ultrasonic lithotripsy of bladder stones

Disintegration of vesical calculi using ultrasound energy was tried in 115 cases with different age and sex. Forty-eight out of these patients had bladder stones only, while sixty-seven patients had another pathology [SEP in thirty-two patients, tight urethra in sixteen patients, bladder diverticula in ten patients, neurogenic bladder in five patients, impacted urethral stone in three patients and post urethral valve in one patient]. The ultrasonic power was applied via nephroscope or lithotripsy [in 71 patients] and via ureteroscope [in 44 patients]. This method proved to be very superior and safe maneuver compared with operative surgery whenever litholapaxy is hazardous