High frequency of alteration in PTEN expression in Egyptian patients with urinary bladder cancer

PTEN is a tumor suppressor gene which is involved in the pathogenesis of multiple cancers including urinary bladder cancer. Recent experimental evidence suggests that PTEN could be utilized as an effective targeted therapy. The aim of this study was to determine the frequency of PTEN alteration in Egyptian patients with urinary bladder cancer and to investigate potential role of PTEN in the pathogenesis of this tumor. We examined PTEN expression using immunohistochemistry in 19 unselected sporadic primary urinary bladder cancers from Egyptian patients. Of the 19 tumors, 6 [32%] showed no PTEN immunostaining, 9 [47%] showed weak or partial staining and the remaining 4 [21%] showed staining similar to the normal internal controls. The strength of immunostaining correlated with tumor grade with higher grade tumors showing more prominent PTEN loss. This study indicates the high frequency of PTEN alteration in urinary bladder cancer from Egyptian patients. The results of this study also suggest that PTEN is involved in the progression of these tumors. Finally these results may suggest the utility of PTEN as a potential target for therapy of urinary bladder cancers in Egyptian patients

Emergency ureteroscopic management of acute calcular anuria

To study the outcome and complications of emergency ureteroscopy in management of acute calcular anuria. 35 patients with calcular anuria were included in the study. The mean age was 45 +/- 18 years with 30 male and 5 females. The diagnosis was based upon anuria associated with high serum creatinine and hydronephrosis detected by ultrasonography. KUB was done to detect radio-opaque stones and its location and size. Emergency ureteroscopy was done to all cases. Bilateral ureteric calculi were detected in 31 patients and unilateral ureteric calculus in 4 patients in whom the other kidney was surgically removed. The stones were localized in the distal ureter in 50 units and in the proximal ureter in 16 units. 60 stones were radio-opaque and 6 stones were radiolucent. The mean stone size was 9 +/- 3mm. The mean serum creatinine was 7.3 +/- 2.5 mg/100 ml. The stone free rate in the proximal ureteric stones was 50% and for the distal ureteric stones was 90%. The overall stone free rate was 80%. No complications were discovered after ureteroscopy to any case. The urine output increased dramatically immediately after treatment in all cases. The serum creatinine dropped to the normal level in all cases [1.2 +/- 0.4 mg/100 ml] in 6.9 +/- 1.8 days after treatment. The mean hospital stay was 2.8 +/- 1.3 days. Emergency ureteroscopy is a safe and an appropriate therapeutic option in the management of acute calcular anuria. It can save patients from a second procedure

Tubeless percutaneous nephrolithotomy in the management of renal calculi

To evaluate the status of tubeless percutaneous nephrolithotomy [PCNL] after managing uncomplicated renal calculi in selected patients. From August 2006 to May 2007, 28 patients with single renal stones were selected for tubeless PCNL. At the end of the procedure, a 6 Fr ureteral catheter was left in place and a nephrostomy tube was avoided. The outcomes measured were the operative time, change in the haematocrit value, urinary leak, blood transfusion requirement, hospital stay and the success rate. The mean age was 48 +/- 11 years. There were 25 male and 3 females. The mean stone size in these patients was 35 +/- 10 mm. The operative time was 56 +/- 20 minutes. 25 [89.3%] patients were stone free and three patients [10.7%] had residual fragments less than 5 mm. Two patients had prolonged urine leakage for more than three days and managed by DJ insertion. No patient required blood transfusion or had postoperative urinoma. The mean hospital stay was 2.6 +/- 1.1 days. Tubeless percutaneous nephrolithotomy is an option in selected patients when there is no bleeding, perforation, or repeat PCNL required

Acute renal obstruction: evaluation with intrarenal duplex doppler ultrasound

To assess the value of duplex Doppler ultrasound [DU] in diagnosis of acute renal obstruction, 50 patients with symptoms suggestive of renal colic were studied. Intravenous urography was done as a standard technique for diagnosis of renal colic. DU was done during the attack, with determination of the intrarenal resistive index [RI], and the difference between the resistive index of the affected kidney and the asymptomatic kidney [dRI] was calculated. 12 to 24 hours after treatment with non steroidal anti-inflammatory drugs [NSAIDs], DU was repeated determining the RI and the dRI. An RI >/- 0.70 and or dRI >/- 0.06 considered reliable cut-off values to diagnose acute renal obstruction. The results of DU were compared with the IVU findings. 13 patients were shown to be normal by IVU and 37 proved by IVU to have a unilateral renal obstruction with a normal opposite kidney. The mean RI in the affected kidneys during the attack of renal colic [0.72 +/- 0.06] was significantly higher than that in normal kidneys [0.60 +/- 0.05] [P < 0.001]. The mean dRI in patients with unilateral renal obstruction [0.08 +/- 0.03] was significantly higher than that in patients without obstruction [0.02 +/- 0.02] [P < 0.001]. 12 to 24 hours after treatment with NSAIDs, the mean RI of normal kidneys remains constant, while, the mean RI of the obstructed kidneys decreased to 0.65 +/- 0.04 and it remained significantly higher than that of normal kidneys [P < 0.001]. The mean dRI in patients with acute renal obstruction decreased to 0.06 ' 0.03 and again it was significantly higher than the mean dRI in normal patients. The sensitivity of the RI was 76% and the specificity was 79% with +ve predictive value of 68% and -ve predictive value of 85% during the attack of renal colic.The sensitivity of dRI was 81% and the specificity was 92% with +ve predictive value of 97% and -ve predictive value of 63%. 12 to 24 after the relive of pain, the sensitivity of the RI and of dRI decreased to 49% and 70% respectively while the specificity remained stable at 79% and 92% respectively. The +ve predictive value of RI was 58% and the -ve predictive value was 72%. The +ve predictive value of dRI was 96% and the -ve predictive value was 52%