Survival after primary and deferred cystectomy for stage T1 transitional cell carcinoma of the bladder

The optimal time of cystectomy for nonmuscle invasive bladder cancer [NMIBC] is controversial. This study aims at comparing cancer-specific survival in primary versus deferred cystectomy for T1 bladder cancer. Between 1990 and 2004, a retrospective cohort of 204 patients was studied. Primary cystectomy at the diagnosis of NMIBC was performed in 134 patients [group 1] and deferred cystectomy was done after failed conservative treatment in 70 [group 2] Both groups were compared regarding patient and tumor characteristics and cancer-specific survival. Cancer-specific survival was calculated using the Kaplan-Meier method. Mean follow-up was 79 and 66 months, respectively, in the two groups. Tumor multiplicity was more frequent in group 2; otherwise, both groups were comparable in all characteristics. The definitive stage was T1 in all patients. Although the 3-year [84% in group 1 vs. 79% in group 2], 5-year [78% vs. 71%] and 10-year [69% vs. 64%] cancer-specific survival rates were lower in the deferred cystectomy group, the difference was not statistically significant. In group 2, survival was significantly lower in cases undergoing more than three transurethral resections of bladder tumors [TURBT] than in cases with fewer TURBTs. Cancer-specific survival is statistically comparable for primary and deferred cystectomy in T1 bladder cancer, although there is a non-significant difference in favor of primary cystectomy. In the deferred cystectomy group, the number of TURBTs beyond three is associated with lower survival. Conservative treatment should be adopted for most cases in this category

Onset of treatment failure after radical cystectomy for bladder carcinoma

To correlate the patients and tumor characteristics to the onset of treatment failure after radical cystectomy, to see if there are risk factors associated with early failure within the first 2 years versus later recurrence. Between 1980 and 1995, 1450 patients were subjected to radical cystectomy and bilateral pelvic lymph node dissection for biopsy-proven invasive bladder carcinoma. 1116 were males and 334 were females with a mean age of 48.76 +/- 9.3 years. Mean follow up period was 5.9 +/- 3.5 years [range 1-17]. At last follow up, 885 [59%] patients were alive and free of disease and 460 [31.7%] were living with, or died from disease. Patients who died from unknown causes [8.6%] and those who died postoperatively [0.7%] were excluded to ensure cancer-specific treatment failure in this study. Among patients who had cancer-specific treatment failure [460], 86% failed within the first two years while the remaining 14% failed later. The relationship between the onset of treatment failure [2 years vs. > 2 years] and patients and tumor characteristics was assessed using Chi-Square test. Factors with significant association were further analyzed in a multivariate analysis. There was a significant relationship between the tumor histology and the onset of tumor recurrence as 30% of recurrence with aden-ocarcinoma occurred after the first 2 years while 12% and 13% of squamous cell carcinoma and transitional cell carcinoma failed during the same period respectively [P = 0.01]. There was a significant relationship between the stage of the tumor and onset of treatment failure as 93.8% of recurrence with non-organ confined tumor [P3 or more] occurred within first 2 years while 84% of organ confined tumor [P2 or less] failed during the same period [P = 0.01]. A highly significant correlation was also found with nodal involvement as 93% of relapse with positive nodes occurred within the first 2 years while 82% of negative nodes failed during the same period [P = 0.001]. The tumor grade, ploidy and lymphovascular invasion had no significant correlation with the onset of the treatment failure [P > 0.05]. The three significant factors by univariate analysis sustained their significance independently in multivariate analysis. Lymph node involvement and high stage tumors were associated significantly with early treatment failure. Although most of histological cell types relapsed within the first 2 years, adenocarcinoma has the tendency to relapse later. These results may help in planning the time, dose and type of adjuvant therapy

light and electron microscope study of the effect of sildenafil citrate on the kidney of cyclosporine-treated albino rats

The goal of the current study was to clarify the effects of the phosephodiesterse-5 inhibitor, sildenafil citrate [SC], on the kidney of cyclosporine A [CsA]-treated albino rats. Thirty adult male albino rats [200-250 gm] were used in the present investigation. They were allocated into three equal groups: control CsA- treated and both CsA and SC- treated. The animals were sacrificed after three weeks and blood samples were withdrawn by direct cardiac puncture to determine the levels of urea and creatinine in plasma. Also, small slices of the kidney were processed for histological histochemical and immunohistochemical study. The CsA-treated rats showed a significant increase in both blood urea nitrogen and plasma creatinine. Then, followed a significant decrease in their values in the CsA and SC- treated animals. Histological examination of the kidney of the CsA- treated group exhibited a degeneration in both the tubular epithelium and the glomerulus with a relative widening of the sub-capsular spaces. Areas of interstitial haemorrhage and cellular infiltration were encountered. There was a relative increase in the amount of interstitial fibrosis. Ultrastructurally, the minor foot processes of the podocytes were enlarged and fused around an apparently thickened basement membrane with an apparent reduction in the number of filtration slits. The cells of proximal convoluted tubules showed a marked reduction in their basal infoldings. The nucleus became irregular in outline and the cytoplasm housed degenerated mitochondria. Succinic dehydrogenase reaction got weak while the acid phosphatase one became strong. A moderate to strong immune reaction to caspase- 3 was detected in the renal tubules. On the other hand, albino rats receiving both CsA and SC showed an improvement in the histological architecture and in both the histochemical and immunohistochemical reactions. In conclusion, the present findings lend support to a lessening role of the phosphodiesterase-5 inhibitor, SC, on the CsA- induced renal effects

Accumulation of cadmium and iron in the hydrocele fluid of infertile men with primary varicocele: a possible role in male infertility

Varicoceles are a common cause of male infertility, but despite data from human studies some points of the pathophsiology remains unclear. Seminal plasma cadmium concentrations were found to be increased in infertile men. In addition, increases in blood plasma cadmium concentrations in infertile men have been associated with teratozoospermia. Cadmium contributes to infertility by induction of apoptosis in testicular tissue

Methods: An ejaculate and blood sample were collected immediately before surgery from 45 infertile men with varicocele classified into 3 groups [group 1 included 12 oligospermic, group 2 included 14 asthenospermic and group 3 included 19 oligoasthenospermic men] followed by aspiration of hydrocele fluid from the tunica vaginalis at the time of subinguinal varicocelectomy. Blood samples were collected from 10 healthy fertile men as control group. In each specimen, cadmium and iron levels were determined by atomic absorption spectrophotometer and the effect of hydrocele fluid on the sperm velocity was determined by examining aliquots of sperms suspended in hydrocele fluid compared to those suspended in seminal plasma

Results: The cadmium level was found to be significantly higher in the hydrocele fluid than peripheral blood, while the increase in the iron level was found to be non significant in the 3 patients groups with bilateral varicocele. Hydrocele fluid added to the sperms, initially increased the motility for 10 to 15 minutes then the velocity diminished gradually and eventually all the sperms became immotile in 30 minutes

Conclusions: 1- The hydrocele fluid in patients with varicocele has a deleterious effect on the sperm vitality. 2- The increased cadmium and iron concentrations in the hydrocele fluid are probably drived from the increased transvascular fluid exchange which occurs with varicocele. 3- These metal ions may diffuse from the hydrocele fluid to the sperms during their maturation in the epididymis and induce their acrosomal insufficiency effect

Effect of acute and chronic pain on reproductive functions in female rats

In this work, 30 adult female rats were used to study the effect of acute and chronic pain on the reproductive functions. Rats were divided into three equal groups, i.e. control group, acute pain group [exposed to pain once for one hour] and chronic pain group [exposed to pain one hour daily for two weeks]. In each group, gonadotropines and sex hormones were measured .The uterus and ovaries of each group were examined microscopically for histopathological changes. The results showed that acute pain led to an increase in gonadotropines and sex hormones levels as well as histological changes in the uterus [some dilatation in the uterine lumen, decreased uterine vascularity and increased polymorph-nuclear leucocytes [PNL] infiltration and stromal cellularity] and the ovaries [increased number and viability of corpora lutea] The chronic pain led to an increase in FSH, and decrease in LH and sex hormones with, histological changes in the uterus [dilated uterine lumen with increased vascularity, PNL infiltration and stromal cellularity] and the ovary [viable corpora lutea disappeared and only regressive ones were found]. The results of this study showed that pain as a physiological stressor has negative effects on reproductive functions as it causes disturbances in the harmony of gonadotropines and sex hormones and their effects on target tissues

Accumulation of cadmium and iron in the hydrocele fluid of infertile men with primary varicocele; a possible role in male infertility

Varicoceles are a common cause of male infertility, but despite data from human studies the pathophysiology remains unclear. Seminal plasma cadmium concentrations were found to be increased in infertile men. In addition, increases in blood plasma cadmium concentrations in infertile men have been associated with terat-ozoospermia. Cadmium contributes to infertility by induction of apoptosis in testicular tissue. An ejaculate and blood sample were collected immediately before surgery followed by aspiration of hydrocele fluid from the tunica vaginalis at the time of subinguinal varicocelectomy. In each specimen, cadmium and iron levels were determined by atomic absorption and the effect of hydrocele fluid on the sperm velocity was determined by examining aliquots of sperms suspended in hydrocele fluid compared to those suspended in seminal plasma. The cadmium and iron levels were higher in the hydrocele fluid than the peripheral blood in 72% and 46% of patients with bilateral varicocele respectively. Hydrocele fluid added to the sperms, initially increased the motility for 10 to 15 minutes then the velocity diminished gradually and eventually all the sperms became immotile in 30 minutes. 1-The hydrocele fluid in patients with varicocele has a deleterious effect on the sperm vitality. 2- The increased cadmium and iron concentrations in the hydrocele fluid are probably derived from the increased transvascular fluid exchange which occurs with vaticocele. 3- These metal ions may diffuse from the hydrocele fluid to the sperms during their maturation in the epididymis and induce their acrosmal insufficiency effect. 4- Impregnation rate was higher after surgical correction of varicocele and removal of hydrocele fluid in those patients who presented with high preoperative levels of cadmium and iron

Total and LDL combined vitamin E concentrations in plasma patient with non insulin dependent diabetes mellitus

Patients with diabetes mellitus are susceptible to oxidant-antioxidant imbalance. Diabetic complications such as nephropathy, neuropathy and retinopathy increase 'this susceptibility. Other traditional atherogenic risk factors such as hypertension, cigarette smoking and dyslipidemia can also induce oxidant stress. It is possible that the existence of two or more of the atherogenic risk factors may enhance oxidant-antioxidant imbalance. However, this proposal has not been fully studied. Aim: To determine plasma vitamin E concentrations, both total and the fraction within LDL particles in patients with sole noninsulin-dependent diabetes mellitus [N-1DDM] or N1DDM associated with one or more of the other risk factors of atherosclerosis. This study was conducted on 60 patients with NIDDM [32 males and 28 females]. They were classified into four groups: [1] sole diabetic [n=20], [2] diabetic-hypertensive [n=10], [3] cigarette smoking diabetic [n=10] and [4] diabetic with multiple atherogenic risk factors [n=20]. Also, twenty clinically healthy individuals were investigated as a control group. Vitamin E was measured by high performance liquid chromatography [HPLC] while a plasma thiobarbituric acid reactive substance [malondialde-hyde] was determined colorimetrically. Plasma total vitamin E [VE] and vitamin E in LDL [VE-LDL] concentrations were significantly decreased while plasma malondialdehyde [MDA] levels were significantly increased in sole N1DDM, diabetic hypertensive, smoking diabetic and diabetic with multiple atherogenic risk factors groups in comparison to the corresponding values of the control group. These changes were noted more frequently and more severely in patients with multiple risk factors than those with single DM or DM with another risk factor. In these groups, vitamin E content in HDL showed significant negative correlation with LDL-C concentrations and significant positive correlation with HDL-C concentrations. Multiple regression analysis showed that vitamin E in HDL particles was an independent risk factor for coronary heart disease. The subnormal vitamin E content in LDL panicles may be a result of enhanced LDL oxidation in patients

Evaluation of distal splenorenal shunt as an urgent surgical intervention in the management of acute variceal bleeding

The aim of the work was to evaluate distal splenorenal shunt as an urgent surgical intervention in management of acute variceal bleeding in Egyptian patients with portal hypertension. This study included 26 patients with acute variceal bleeding needing urgent surgery. All patients underwent distal splenorenal shunt, and patients were followed up for at least one year. Preoperatively and during the follow up period hepatic functions, portal homodynamic, and the state of varices were assessed. Control of bleeding was achieved in 88.46% of patients, re bleeding varices was reported in 3 patients [11.54%]. No infra-operative mortality, with a reasonable operative time of 148.00 +/- 50.05 minutes. The immediate post-operative mortality was 7.69%, and one patient died during follow up. Post operative morbidity was in the form of encephalopathy in 23.08% of patients, severe ascites in 15.38%, and partial wound dehiscence in 11.54% of patients. The mean follow up period was 21 +/- 4.34 months. Distal splenorenal shunt is a good surgical option for management of urgent variceal bleeding after failure of conservative measures, provided that there are available well trained personnel

Biochemical evaluation of some indices of oxidative stress in patients with hyperthyrodism before and after treatment

This study aimed to evaluate changes in plasma malondialdehyde, total thiol concentration and total antioxidant activity in newly diagnosed Graves' disease and toxic multinodular goiter patients prior to antithyroid treatment and after restoration of stable euthyroid state. Forty subjects were included in this study. Thirty patients with hyperthyroidism, which were classified into two groups, the first [group I] Comprised 15 patients with hyperthyroidism due to untreated Graves' disease, and the second [group II] Comprised 15 patients with hyperthyroidism due to untreated toxic multinodular goiter. Ten patients of each group were treated pharmacologically with antithyroid drug carbimazol [30 mg/day for 8 weeks]. Total thyroxin [T4], total triiodothyronine [T3], TSH, malondialdehyde, total thiol concentration and total antioxidant activity were estimated before initiation of treatment. After apparent attainment of euthyroid state, all tests were repeated for ten of the patients with Graves' disease and ten of the patients with toxic multinodular goiter. The results of this study revealed that there were a statistically highly significant increase in plasma malandialdehyde [MDA], a significant decrease in plasma thiol and very highly significant decrease in total antioxidant activity in both patient groups when compared to healthy controls. After treatment, plasma MDA levels were highly significantly decreased and total antioxidant activity was very highly significantly increased in both patient groups when compared to control one. As regard thiol, it was significantly increased in group I only. From this study it could be conclude that, intensification of lipid and protein peroxidation process and the impairment of plasma antioxidant activity in patients with hyperthyroidism due to Graves' disease or toxic multinodular goiter confirm the presence of oxidative stress and the disturbances in the antioxidant systems might be an indicator of patients' susceptibility to free radical damage. So, supplementation of antioxidants as an adjuvant to medical antithyroid treatment could help to prevent oxidative damage in hyperthyroid patients. Also, we suggest that measuring oxidative stress parameters could be a better way of follow up of thyroid state improvement both from the chemical and economic point of view

Evaluation of serum cytokeratin 19 as a tumor marker in patients with primary liver malignancy

The objective of this study was to evaluate the level of cytokeratin 19 related tumor marker CYFRA 21-1 in the sera of patients with chronic liver diseases [chronic viral hepatitis and liver cirrhosis] and primary hepatic malignancy and to find if it could be a significant tumor marker that can be used in the diagnosis of cholangiocarcinoma. The study was carried out on 69 patients attending Gastroenterology Centre, Mansoura University, in addition to 18 healthy controls. The selected subjects were divided into the following groups: Group I: included 18 patients with chronic viral C hepatitis. Group II: included 17 patients with liver cirrhosis. Group Il: included 14 patients with hepatocellular carcinoma Group IV: included 20 patients with cholangiocarcinoma. Group IV: included 20 patients with cholangiocarcinoma. Group V: The control group and included 18 apparently healthy volunteers. Blood samples were collected from all patients as well as healthy volunteers, and the separated serum was divided into aliquots. One part was used immediately for the determination of liver function tests [serum albumin, total serum bilirubin, ALT, AST, and alkaline phosphatase]. The rest of the aliquots were stored frozen at -20 degree C until assayed for serum levels of Cytokeratin 19 fragment [CYFRA 21-1] and levels of a fetoprotein [AFP] by electro chemiluminescent immunoassay. The results of the present study showed that there was a statistically significant increase in CYFRA 21-1 level in CC group when compared with viral hepatitis [P<0.001], liver cirrhosis group [P-0.001] and with HCC group [P-<0.001], but there was no significant difference in CYFRA 21-1 level in HCC group when compared with viral hepatitis group, liver cirrhosis group. A significant positive correlation was found between CYFRA 21-1 and total bilirubin and AST in CC [P=0.006; [tau]b= 0.442 and [P=0.005; [tau]b=0.453]. At the same time, there was non-significant correlation between CYFRA 21-1 and AFP in all studied groups. In the present study, serum CYFRA 21-1 levels exceeded 4 ng/ml [double the upper limit of normal controls] in 11.1% of patients with viral hepatitis, 29.4% of patients with liver cirrhosis, 21.4% of patients with HCC and 60% of patients with CC. To compare the ability of both AFP and CYFRA 21-1 in differentiating primary malignant liver tumors, we have performed Receiver operator characteristic [ROC] curves. From the data of ROC curve we can found that CYFRA 21-1 is superior to AFP in the diagnosis of CC from other primary liver malignancy as HCC. On the other hand, AFP was superior in differentiating HCC from CC. From the present study, we can conclude that the measurement of serum levels of CYFRA 21-1 can be utilized in the differential diagnosis of cholangiocarcinoma from other primary liver malignancies. So, we recommend the measurement of serum level of CYFRA 21-1 in all patients with hepatic mass to differentiate between hepatocellular carcinoma and cholangiocarcinoma, particularly the liver biopsy is not preferred. When the serum levels of CYFRA 21-1 increase in some patients with benign liver diseases, particularly liver cirrhosis on top of chronic viral hepatitis C infection, this may attract attention towards the possibility of malignant transformation

Assessment of propertide of type III procollagen in chronic liver diseases

Sixty-three hepatic patients [38 males and 25 females] with ages ranging between 25-75 years [mean 48.49 +/- 1.72] were included in this study. For comparison, 20 healthy age and sex matched volunteers were taken as controls. Patients with chronic liver diseases including hepatic cirrhosis [23 patients], bilharzial hepatic fibrosis [10 patients], hepatic malignancy [15 patients] and chronic viral hepatitis C [15 patients] were included in this study. All patients and healthy subjects were thoroughly clinically examined. Fasting blood sample was taken from each individual, divided into aliquots and analyzed for aminoterminal propeptide of type IIII procollagen and liver function tests [including prothrombin time, serum albumin, bilirubin, ALT and AST]. The severity of liver disease was graded by Pugh-Child scoring including the assessment of ascites, encephalopathy, bilirubin, albumin and prothrombin time. It was concluded that propeptide of type III procollagen [PIIINP] measurement is a good noninvasive marker of manifest fibrosis. Cirrhotic patients had the highest serum PIIINP levels of all studied patients

Trace elements in patients with acute cerebrovascular diseases

Free radical oxidation stress has been implicated in the pathogenesis of a variety of human diseases including stroke. Since trace elements act as cofactors for a variety of antioxidant enzymes, we decided to study the status of Copper. Zinc and Manganese in patients with acute cerebrovascular accidents. 45 patients [30 with cerebral infarction [CL] and 15 with cerebral haemorrhage [CH] and 44 control [C] were included in the study. Serum trace elements Cu. Zn and Mn were estimated using atomic absorption spectrophotometry. Routine liver and kidney function tests, pH, serum bicarbonate and random blood glucose were estimated for both patients and control CT scans were done for all patients. Patients with Cl and CH had significantly lower serum Cu, Zn and Mn than the control [P < 0.0001]. Patients with Cl tended to have higher serum Cu an Zn levels than those with CH, but the differences did not reach statistical significance [P > 0.05]. Serum Manganese concentrations were below detection Limit in either Cl or CH while in the control they ranged from 0.04-0.2 Ug/mI. Strong positive correlations were found between serum Cu and prothombin activity [r= 0.38. P < 0.009] and serum Zn and creatinine levels [r = 0.44, P < 0.002] in the whole cases with acute cerebrovascular accidents versus control. Trace elements involved in the antioxidant defense system are reduced in patients with acute cerebrovascular accidents. Replenishment of the deficient elements may help reduce the size of infarction and accordingly the functional disability in patients with strokes

Efficiency of FNAB in diagnosis of suspicious breast lumps

171 females and 9 males with palpable breast lumps were submitted to fine needle aspiration biopsy [FNAB] and the results were correlated to the final diagnosis of paraffin sections after surgical excision of the mass. the of accuracy of FNAB was 92.05% and the false negative results were 5.2% FNAB method is considered not only an efficient and economic screening diagnostic method but it also helps the surgeon to choose the best line of management

Diagnosis of diabetes mellitus among industrial workers

The aim of the present study is to test the validity of application of a questionnaire for diagnosis of diabetes mellitus among industrial workers. The study was carried out in the Department of Roads, the Arab Contractor Company. The sample of the study included 210 workers selected by simple random sample. The method adopted in the present study was an interviewing form designed to include simple questions about common symptoms, signs and complications of diabetes. In addition, urine was tested by test tape. The researchers recommend application of the studied questionnaire for diagnosis of diabetes among industrial workers