Effectiveness of a single immediate mitomycin C instillation in patients with low risk superficial bladder Cancer: short and long term follow up

We analyzed the impact of a single Mitomycin C instillation in patients with low risk superficial bladder cancer with short and long term follow up. This study was conducted on 63 patients with low risk superficial bladder transitional cell carcinoma [TCC], admitted to the Urology Department, Theodor Bilharz Research Institute [TBRI] during the period from January 2002 to August 2005. All patients had a 2 cm. or less single, papillary, primary or recurrent tumor and were disease-free for more than 1 year. Patients with muscular invasion, G III tumor or bladder carcinoma in situ on pathological examination were excluded from the study. The tumor was completely resected before patients were divided randomly into 2 arms: first group who have received no further treatment [control group] and a second group with a single immediate instillation of 30 mg. Mitomycin C [mitomycin C group]. Recurrences were considered early if they occurred within the first 2 years of follow-up. At 24-months follow-up, the recurrence-free interval was significantly increased and recurrence, recurrence per year and tumor per year rates were decreased in the mitomycin C group compared to the control group. Early recurrence was [16.1%] in the mitomycin C group versus [34.3%] in the control group. It was noted also that early recurrences were concentrated in the first year in the control group [18.7%] versus [3.2%] in the mitomycin C group. However, at long-term follow-up, these differences were not statistically significant [26.9%] in the mitomycin C group versus [28.6%] in the control group, and the recurrence-free interval curves-were parallel. A significant relationship between early and late recurrences was found in the mitomycin C, but not in the control group. Shorter hospital stay and catheterization periods were noted in the mitomycin C group compared to the control group, but the differences were not statistically significant. These data confirm the positive effect of a single immediate mitomycin C instillation in patients with low risk superficial bladder cancer. This benefit is limited to early recurrence and is not maintained with long-term follow-up. Thus, this approach is an alternative to observation or classic long-term intravesical chemotherapy. Our study also suggests that cell implantation as a mechanism of early recurrence can be controlled or minimized with a single mitomycin C instillation

Blood ammonia, S100B and neuron-specific enolase levels in patients with hepatic encephalopathy

To evaluate circulating blood ammonia [NH3], S 100B and neuron-specific enolase [NSE] levels in patients with liver cirrhosis with or without hepatic encephalopathy [HE] and to choose which of these parameters could be used as a useful marker for early diagnosis of HE. Subjects and The study included 20 patients with liver cirrhosis without HE, 20 patients with sub clinical HE [SHE], 24 patients with HE grades I-IV and 20 matched for age and sex healthy control subjects. Blood levels of NH3, S100B and NSE were determined by calorimetric method for the former and by enzyme immunometric assay [EIA] for the 2 latter. Blood levels of NH3 and S 100B were significantly elevated in patients with cirrhosis, SHE and HE with various grades compared to normal subjects. Serum NSE levels were significantly increased in patients with SHE and HE with various grades compared to normal subjects. These parameters were significantly greater in patients with SHE and HE grades I-IV in comparison to cirrhotic patients. Serum S100B and NSE levels were significantly higher in patients with HE grades I-IV in comparison to SHE cases. Plasma NH3 levels showed no significant difference among patients with different Child-Pugh classes or between patients with different HE grades and SHE. Meanwhile, serum S 100B and NSE showed significant increase in Child class C in comparison to Child class A and B and in patients with different HE grades compared to those in SHE cases. Plasma NH3 level was significantly correlated with serum S100B and NSE levels and significant correlation was found also between S 100B and NSE levels. The 3 parameters exhibited similar sensitivity of 79.50%, but plasma NH3 and serum S 100B showed 100% specificity meanwhile, serum NSE showed 80% specificity for predicting HE in comparison to cirrhotic patients. Serum S100B levels appeared to be a better marker predicting HE than plasma NH3 and serum NSE

double J ureteric stent, is it still a faithful friend to urologists?

To assess the side effects and long term complications of double-J ureteric stents .The records of all patients who were stented by using double-J-Ureteric stents to relieve ureteric obstruction or in the course of endourological management of urolithiasis - were reviewed 50 patients with morbidity and complication due to the D.J. Stents [35 Males, 15 Females] were followed up with plain x-ray, ultrasound. 20 patients were found to complain of fever, symptoms of bladder irritability and flank pain, treated with antibiotics, analgesics and antispasmodics. 8 patients had migration of the stent, 6 with proximal migration, 2 with distal migration, 2 with spontaneous fragmentation of the stent, 20 patients had encrustations and stones formed around the double J stents and treated accordingly. The double J ureteric stents are of great importance and helpful to urologists but may have side effects and complications that may add to the patient's morbidity. So follow up regularly and early interference is mandatory to prevent these complications

subserosal extramural tunnel for uretral implantation in the Ileal-W bladder: an ideal antireflux Technique for dilated ureters

Anti reflux in ileal pouches could be a real challenge when the ureters are considerably dilated. We adopted in this work the technique of subserosal extra lumenal tunnel 1st presented by Abol-Enein and Ghoneim, which we applied with some modifications to suit the dilated ureters, both in augmentation ileo cystoplasty and after radical cystectomy. The technique was applied in 19 patients in two groups. Group I was 11 patients for bladder substitution after radical cystectomy and group II was 8 patients for augmentation after supra trigonal cystectomy for neurogenic or contracted bladder. Patients were followed for 6 to 36 months by routine lab, ultrasound, intravenous pyelography [renogram for some] ascending and voiding pouchography and urodynamics. In the 38 renal units done by the technique, all with considerably dilated ureters, non was refluxing throughout the follow up period. 2 units in one patient were obstructed and managed primarily endoscopicaly, but later, one ureter needed open surgical correction. We found this technique ideal for dilated ureters even in the Bilharzial thick walled, with no incidence of reflux and assuming the original anatomical appearance of the uretrovesical junction with easy endoscopical manipulation if needed

Vesicoureteric reflux after ureteric dilatation: an experimental study

The present study was designed to evaluate the incidence of delayed [4-6 months] vesicoureteral reflux after dilating the terminal ureter of dogs to 2, 3 and 4 folds the normal calibre [4F]. It was found that 2-fold dilatation is harmless, with no incidence of vesicoureteral reflux, while the 3-fold dilatation carries an incidence of 28.5% of delayed reflux. Four-fold dilatation carries the hazards of 50-66.6% incidence of persistent vesicoureteral reflux using either balloon or teflon dilators, respectively. The implication of these findings for clinical practice are discussed

Long acting hormonal agents: applications of HPLC to the analysis and purification of steroid esters

Levonorgestrel, norethisterone and testosterone esters, synthesized for investigation as long-acting, injectable hormones, have been analyzed by HPLC using reverse phase and normal columns, monitored with a variable wave-length detector. Where necessary, purifications were accomplished with a laboratory assembled preparative HPLC which is capable of processing single injections of several hundreds of milligrams of steroid, providing sufficient quantities for biological evaluation

Long acting hormonal agents: analysis of thallium residues in steroid esters following thallium-mediated coupling

Thallium residues present in norethisterone esters synthesized for investigation as long acting, injectable hormones, have been analyzed by atomic absorption spectroscopy using a thallium-specific lamp. Residues were found to be in the ppm range