Using of telomerase enzyme in urine as a non invasive marker for cancer bladder detection

Urinary bladder cancer is one of the major health problem all over the world. Cystoscopy remains the gold standard for identifying bladder cancer but it is invasive and expensive, therefore, a simple, non invasive test for detecting bladder cancer would be helpful. Several biomarkers for bladder cancer have been used, but no single marker has been accurate and conclusive. The current study aimed to measure telomerase enzyme in urine as a useful non invasive marker for detection of bladder cancer. Forty eight patients [39 males and 9 females] were included, They are complaining of urinary symptoms and undergo cystoscopy with biopsy of bladder lesions and histopathological examination. They were divided into groups: Group I: 16 patients [11 males and 5 females] have benign urologic conditions. Group II: 32 patients [28 males and 4 females] have proven bladder cancer patients underwent transurethral resection of bladder tumor or cystoscopy with biopsy of bladder lesions. Also, 15 apparently healthy volunteers with matched age and sex with patients were served as a control group. All subjects were submitted to laboratory estimation of the following in urine: urinary creatinine, urine cytology, telomerase enzyme in urine by telomerase PCR and complete urine examination. The results of this study revealed that a highly significant increase in the frequency of cytolological positive cases for tumor cells in malignant group than each of benign group and healthy subjects, while no' significant difference was detected between benign group and healthy subjects. The frequency of telomerase in urine was significantly higher in malignant group than each of benign group and healthy subjects, while no significant difference was detected between benign group and healthy subjects. The telomerase activity has sensitivity of 90.6% for diagnosis of cancer bladder with 93.7% for specificity and PPV was 96.6%, NPV was 83.3% and diagnostic accuracy of 91.6%. While, urine cytology gives a sensitivity of 68.8%, specificity of 87.5%, PPV of 91.6%, NPV 58.3% and diagnostic accuracy of 75%. When combined tests were used the sensitivity raised to 96,8%, and specificity reached to 100%, PPV was 96.6%, NPV was 94.1% and diagnostic accuracy increased to 97.9%. the urinary assay of telomerase could be used as non invasive test to identify the bladder cancer patients and distinguish them from normal subjects and patients with benign tumor of urinary bladder. The low cost of this test may help to be implicated as non invasive screening of bladder cancer

outcome of surgical interference in patients with acute obstructive renal failure

To evaluate some of the morphological, functional and clinical impacts of surgical management of acute obstructive renal failure. Thirty six clinically diagnosed patients as having acute obstructive renal failure [22 men 61.1% and 14 women 38.9% ranging in age between 28 and 62 years, mean 45 years] in the period from October 2005 to October 2008. All patients have been evaluated according to the protocol of obstructive uropathy. Clinically most patients presented by anuria 21[58.3%] patients, oliguria 12 [33.33%] patients, loin pain 16 [44.44%] patients, nausea and vomiting 23[63.9%] patients. 30 Patients underwent direct intervention and 6 patients were managed by temporary drainage until improvement of the general condition then definitive surgical procedure. There was a highly significant increase in the incidence of improvement among studied patients.100% [36 patients] out of 36 patients with acute obstructive renal failure showed improvement after surgical intervention. The syndrome of acute renal failure was reversed to a stable renal function that probably represents the preobstructive state of every patient. There was no morbidity or mortality rate in our series if compared with other series dealing with corrective surgery in obstructive renal failure. Surgical correction of acute obstructive renal failure show excellent results, so more efforts must be done for suspected obstruction in acute uremic patients to avoid the dialysis or kidney transplantation

outcome of surgical interference in patients with chronic obstructive renal failure

To evaluate some of the morphological, functional and clinical impacts of surgical management of chronic obstructive renal failure. We will try to assess some of the factors that may predict favorable outcomes. Sixty four clinically diagnosed patients as having chronic obstructive renal failure [41 men 64.1% and 23 women 35.9% ranging in age between 25 and 69 years, mean 47 years] in the period from October 2005 to October 2008. The patients on this study were divided according to past history of renal impairment and/or regular dialysis into two groups as follow: Group [A]: Patients with chronic renal failure with no regular dialysis [36 patients] Males: 26 [72.22%] Females: 10[27.78%]. Group [B]: Patients with chronic renal failure with regular dialysis [28 patients] Males: 18 [64.29%] Females: 10 [35.71%]. All patients have been evaluated according to the protocol of obstructive uropathy. Clinically most patients presented by anuria 17 [26.6%] patients [9 group A and 8 group B], oliguria 24 [37.5%] patients [14 group A and 10 group B], loin pain 42 [65.6%], patients [27 group A and 15 group B], nausea and vomiting 27 [42.2%] patients [8 group A and 19 group B]. 50 Patients underwent direct intervention and 14 patients were managed by temporary drainage until improvement of the general condition then definitive surgical procedure. In our series patients with chronic obstructive renal failure [group A], showed improvement in 31 patients [86.1%] and did not improve in 5 patients [13.9]. Out of the 5 patients who did not improve after management 1 patient [2.8%] remained unchanged and 4 patients [11.1%] continued to have progressive renal failure up to regular dialysis. In patients with chronic obstructive renal failure [group B], renal functions showed different degrees of improvement as follow: In 15 patients [53.6%] good improvement and subsequent complete weaning from dialysis occurred, while in 5 patients [17.8%] there was a decrease in weekly dialysis sessions from 3 to 2 sessions/week. In the remaining 8 patients [28.6%] there was no improvement and patients continued to have regular dialysis as preintervention. The overall complications in this series were [15.6%]. The incidence was much more in the chronic cases group B. The mortality rate in our series is [3.1%] which is not high if compared with other series dealing with corrective surgery in obstructive renal failure. The degree of improvement of renal function found to be correlated to preoperative residual parenchyma thickness, parenchymal echogenicity, corticomedullary differentiation, presenting hemoglobin value and radioisotope GFR. Finally there is evidence of reversibility of renal function after long standing obstruction which provides justification for efforts to identify and treat urinary tract obstruction even if a patient with an obstruction requires dialysis to avoid the dialysis or kidney transplantation or helping patients under dialysis for complete weaning form dialysis or decrease their number of weekly sessions