Robot-assisted laparoscopic radical prostatectomy after heart transplantation

Prostate cancer [CaP] is the leading visceral malignancy in males. Patients who undergo cardiac transplantation are immune compromised, thus presenting a therapeutic challenge. Immunosuppresion could accelerate tumor growth, while medical intervention may be associated with increased treatment mortality or morbidity. Due to paucity of such cases, there are no randomized trials that address the treatment algorithm for cardiac transplant patients with CaP, with only a few scattered reports in the literature. Treatment options range from hormonal manipulation to radiation therapy to radical prostatectomy. To our knowledge, we report the first successful robot-assisted laparoscopic radical prostatectomy in a heart transplant patient with CaP

Prospective randomized clinical trial comparing phytotherapy with potassium citrate in management of minimal burden [

To compare efficacy and tolerability of phytotherapy [PT] vs. potassium citrate [KC] in patients with minimal nephrolithiasis. To compare and assess changes in value of certain serum [Ca[2]+, PO[4][3-], uric acid [UA]] and urinary [24-hr Ca [2+], PO[4][3-], UA, citrate, oxalate, and urine pH] parameters in patients being treated with PT or KC. After clearance by the local institutional ethics committee, 60 patients of nephrolithiasis who had consented for the study, were enrolled [as per entry criteria] and randomized into citrate therapy [group-I] or PT [group-II]. PT was administered as a nutritional supplement, using a lupeol-based extract [Tablet Calcury[TM], two tablets twice a day]. They were monitored for the changes in the serum and urinary biochemical, radiological, and clinical parameters [efficacy and tolerability] as per protocol. Group-I patients demonstrated favorable changes in certain biochemical parameters [decreased serum calcium, urinary UA/oxalate, increased urinary citrate and pH] along with significant symptomatic improvement [decrease in visual analogue pain score with increased stone clearance/reduction in stone size]. Four [13.3%] patients of group-I had mild upper gastrointestinal discomfort which was controlled with antacids. Group-II patients had favorable changes in biochemical parameters [decreased serum UA and increased urinary citrate] along with significant symptomatic improvement [reduction/clearance in the stone size], but without any noticeable side effects. Medical therapies with both KC and PT [with lupeol extract using Calcury[TM]] were effective in reducing the stone size and symptoms of nephrolithiasis. It appeared that KC was biochemically efficacious in producing some favorable biochemical changes with some side effects, whereas PT was probably clinically efficacious in hastening stone expulsion [<8 mm] without any observed adverse events. Although both the medical therapies were not effective in all aspects, we believe that PT using lupeol-based extract [Calcury[TM]] may be used as an alternative form of medical therapy in select patients with minimal nephrolithiasis. Long-term randomized placebo-controlled trials are needed to better define the precise role of lupeol-based PT vs. citrate therapy in minimal nephrolithiasis

Capsular renal leiomyosarcoma with encasement of the inferior vena cava-diagnosed by immunostaining and review of literature

We report and describe the presentation, pathological diagnosis with immunostaining and management of a rare case of capsular renal leiomyosarcoma encasing the inferior vena cava [IVC]. We have reviewed and tabulated other such similar cases. The present case was successfully managed by radical nephrectomy and adjuvant radio-chemotherapy. Immunostaining should be freely used to define the histological type of renal sarcoma in order to accurately counsel and deliver a prognosis for patients with renal leiomyosarcomas with a poor prognosis