Outcome of post-TUR-BT combined chemo and immuno intravesical therapy in the management of papillary transitional cell carcinoma of the urinary bladder

To evaluate the outcome of post-TUR-BT combined chemo-and immune-intravesical therapy in papillary transitional cell carcinoma of the urinary bladder. From Sept 2001 to August 2007 in Alnoor specialist'hospital, Holly Makkah K.S,A and Urology Department, Benha Faculty of Medicine 158 patients of papillary transitional cell carcinoma Ta,T1,T2 were treated by TUR-BT plus combined intravesical chemotherapy and immunotherapy. TUR-BT was repeated and intravesical combined therapy if recurrence occurred on 3, 6 months cystoscopic follow up, percentage of the disease-free patient, recurrence, progression and survival with intact bladder were compared and analyzed. Follow up of the patients up to 5 years was done. At median follow up of about 24 months; 82 patients [53.6%] were disease free and recurrence was detected in 31 patients [20%] and progression was in 4 patients [2.6%]. The results of the follow up at the end of the 5 years revealed that the disease-free percentage was 64 patients [41.5%], recurrence was detected in 41 patients [26.8%] and progression was [14.4%] in 22 patients were shifted to cystectomy. Overall 5 year survival with intact bladder was 85.6% [131 patients], we did not follow cystectomy patients. Post TUR-BT combined intravesical chemo and immuno-therapy is an appropriate option for the management of papillary transitional cell carcinoma of the urinary bladder and could preserve the intact bladder for a long period and should be applied even in muscle invasive T2 tumor before shifting to cystectomy

Laparoscopic ureterolithotomy: is it an alternative technique replacing open surgery

To assess and evaluate the technique as a replacement to open surgical uretero-lithotomy. Fifteen patients with failed either ESWL or endoscopy and large calculi at the upper ureter were included in this study for performing transperitoneal laparoscopic uneterolithotomy Mean age was 47.2 7 +/- 9.32SD. 9 patients had right sided stones and 6 were left sided. Stone size range was 10-20 mm with mean 14.67 +/- 2.89 SD. 14 cases the stones were in the lumbar region and only 1 case at the iliac region. Successful laparoscopic stone removal were in 13 out of 15 [86.6%]. Two operative conversion to open surgery due to migration of stone in one case and in other conversion is due to injury of left common iliac artery. Operative times was 119.3 +/- 38.03 SD minutes [60-180min] estimated blood loss 62.3 +/- 11.6 [30-100] cc.. mean drain removal time was 3.4 days. mean post operative parentral analgesia was 150 mg of diclofenac sodium [75-300mg], mean hospital stay was 4.3 [3-8days] and mean resuming normal activity was 11.6[8-21 days]. Laparoscopic ureterolithotomy is a safe technique with a shorter hospital stay and rapid return to normal activity and offers an alternative modality than open surgery after treatment failure [ESWL, endoscopy] or for large size calculi. Open surgery has a role for managing laparoscopic converted cases

Comparative study for induction of painless labor between bupivacaine 0.25%, bupivacaine-fentanyl and clonidine-fentanyl

Labor analgesia is better provided by the epidural administration of local anesthetics with adjuvants e.g Opioids and alpha agonist to reduce local anesthetic requirements and side effects [e.g] systemic toxicity and motor blockade. 60 pregnant women subjected to: Action; Group I; Group II; Group III-Onset of analgesia; 20 Min; 17 Min; 26. Min-Duration of analgesia; 57 Min; 72 Min -; 57 Min-Motor Weakness; Sever; Moderate; Mild-Hemodynamic changes; Mild; Mild; Mild. From the previous study we concluded that the addition of adjuvants to local anesthetics in epidural labor analgesia is better than local anesthetics alone as regard complication and obstetric intervention

Comparative study of diffferent combination of total intravenous anesthesia in different-surgical procedures

Total intravenous anesthesia [TIVA] is a natural extension of balanced anesthesia. Propofol is considered to be the most suitable anesthetic drug for use in TIVA because of its pharmacokinetic properties suitable for this technique. Remifentanyl is the best analgesic component, remifentanyl has an ester linkage in its molecular structure, it has a very short duration of action because of rapid breakdown of the ester linkage by nonspecific plasma and tissue esterases. 30 patients aged between 20-40 years old undergoing surgical-procedures were included in this study. All patients premedicated with oral diazepam [0.2 mg/kg], 90 minutes preoperative patients were divided into three groups propofol fentanyl [P/F], propofol/ remifentanyl [P/R], and ketamine midazolam[K/M] group. We used these drugs in each group for induction and maintenance of anesthesia and we compared the three groups regarding: Hemodynamic changes, hormonal and metabolic changes, recovery pattern, side effect.-The result of this study showed that, remifentanyl in[P/R] group caused hemodynamic stability better than that of the other two groups. There is decrease in plasma cortisol level which was statistically significant during surgery and post operatively [P>0.05] in all patients in [P/R] group. While in [P/F] and [K/M] groups there was significant increase. All patients in the three group showed increase in blood sugar and B-endorphin levels during operation and in recovery room which was statistically significant only for B-endorphin in [K/M] group. There was no significant difference between [P/F] group and [P/R] group for the dose requirement of propofol. The small doses of fentanyl and ketarnin used in this study are not enough to suppress the hormonal and metabolic changes caused by stress response to surgary. Patients in [P/R] group showed shorter recovery period than in the other two group. We can concluded from this study that remifentanyl used with propofol was effective as the primary opioid in TiVA and provided better intra-operative hemodynamic stability during stressliall surgical events than that achieved with the recommended dose of fentanyl

Management of erectile dysfunction in patients with ischemic heart disease by intracavernous injection of vasoactive drugs because of failure, complications or contraindication of sildenafil

The aim of the present study was to evaluate the effectiveness of intracavemous injection [ICI] of vasoactive drugs combination in patients with ischemic heart disease [IHD] and erectile dysfunction [ED] who were not proper cadidatefor treatment with sildenafil citrate. The study population included 122 selected patients with IHD and ED in whom sildenafil was not an option because of its failure, side effects, or presence of contraindication for its use. The ICI program consisted of two combinations of vasoactive drugs. The first combination [A] included a mixture of papaverine, phen-tolamine, and verapamil The second combination [B] included a mixture of the former 3 drugs plus prostaglandin El. Patients who failed to respond with the first combination were switched to the second combination. A positive response was defined as an erection sufficient for vaginal penetration and maintained till ejaculation. A positive response was achieved with combination [A] in 67 [54.9%] of the 122 patients and with combination [B] in 24 [43.6%] of the remaining 55 patients. The total success rate was [74.6%]. Patients with positive response [91 pts.] were followed-up for one year with 80 [87.9%] patients reported successjid coitus during this period. The remaining 11 patients [12.1%] dropped out of the program, 2 [2.2%] because of treatment failure, and 9 [9.9%] because of marital and health reasons. Adverse effects of ICI therapy included prolonged erection in 10 [11%], painful erection in 9 [9.9%], subcutaneous hematoma in 7 [7.7%], and plaque formation in 3 [3.3%]. We conclude that ICI ofvasoactive drugs is a good alternative for the treatment of ED in patients with IHD in whom stidenafil is not anoption

Significance of total and lipid bound sialic acid in serum and urine as markers for bladder cancer

The reliability of serum total sialic acid [TSA], serum lipid bound sialic acid [LSA]. and urinary sialic acid / creatinine ratio [TSA / Cr. ratio] as markers for bladder cancer for grading, staging and follow-up purposes was evaluated in 10 healthy controls and 70 patients with bladder cancer, 25 of them with superficial tumors were evaluated after treatment with TUR for follow up. We found that TSA. LSA and TSA / Cr. ratio levels were significantly higher in patients with bladder cancer [56.9 +/- 8.9 mg /dl, 22.3 +/- 2.3 mg /dl and 37.2 +/- 16.1 ug/mg creatinine respectively] than controls [48.8 +/- 7.1 mg/dl, 16.9 +/- 0.6mg /dl and 11.9 +/- 5.1 ug /mg creatinine respectively]. There was no significant difference between grade 1,11 and III also between stage Ta, T1 and T2 and stage T3 and T4 bladder cancer patients regarding LSA and TSA, but there was a significant difference between these grades and stages regarding urinary TSA / Cr. ratio [20.1 +/- 16.1. 40.6 +/- 14.4 and 47.8 +/- 11.9 up / mg creatinine in grade I, II and III respectively and 32.1 +/- 12.1. 46.4 +/- 15.1 ug/mg creatinine in stage Ta. T1 and T2 and stage T3 and T4 respectively]. These findings suggest that TSA and LSA can't be used for grading and staging of bladder cancer patients. but urinary TSA / Cr. ratio can be used for grading and staging of these patients. On comparison of supeificial bladder cancer patients before and after treatment regarding the studied parameters, we found marked drop of urinary TSA/Cr. ratio in post-treatment patients [36.2 +/- 15.1 ug/mg creatinine before treatment versus 17.5 +/- 5.3 ug/mg creatinine after treatment] in contrary with serum TSA and LSA. We conclude that: urine can be used as easily available physiologic fluid for evaluation of TSA / Cr. ratio by an easy, inexpensive, photometeric method as a marker for bladder cancer for grading, staging and follow-up of treatment in patients with bladder cancer