Clinicopathologic features and treatment outcome of urinary bladder neoplasm.

More than ninety percent of bladder neoplasm is Transitional Cell Carcinoma (TCC). About 85% of patients present with symptom of painless haematuria. However haematuria is quite often intermittent so that a negative result has little meaning in ruling out the presence of bladder cancer. The present study was conducted to observe the natural history of different clinicopathologic stages of bladder cancer after transurethral resection bladder tumor (TURBT), either intravescical chemotherapy (IVC) or immunotherapy with BCG and of other forms of therapy like radio-chemotherapy (RCT) and radical surgery in few cases. A consecutive series of 52 cases with different grades and stages of bladder cancer patients were studied. Those who were noncompliant with surgery were sent for RCT. The age range of the patients was 34 to 75 with mean 53 year. Macroscopic haematuria, flank pain, microscopic haematuria, bladder irritability was found in 43(82.7%), 06(11.5%), 03(5.8%), 32(61.5%) cases respectively and coincidental ureteral TCC with hydronephrosis was found in 04(7.7%) cases for whom radical nephreureterectomy and cystectomy with ileal conduit was done. Amongst the other muscle invasive tumor only three cases were compliant to do radical surgery; rest were advised to consult with oncologist for possible RCT. Superficial bladder cancer was 19(36.5%) and invasive bladder cancer was 33(63.5%). TURBT and IVT were offered for all superficial bladder tumors. Of them 06(31.5%) patients showed recurrence during the study period. More recurrences occur in IVC group (35.7%) than immunotherapy with BCG group (20%) Re-TURBT and stage wise treatment was offered to them. All recurrent cases were G-3 tumor and were multifocal. Recurrence rate is about 30%. Screening program and structured referral system should be developed to have early diagnosis for prompt treatment and best prognosis.

Relation between insulin secretory capacity and microangiopathy in young diabetic patients in Bangladesh.

The pathogenesis of diabetic retinopathy is still unclear. The relative role of duration of diabetes, glycemic and insulinemic status in the etiopathogenesis of retinopathy is to be clearly understood. Hypertension, hyperlipidemia, pregnancy and age at diagnosis have been thought to be factors associated with diabetic retinopathy. Taking advantage of the availability of a group of young lean, normotensive and generally normolipidemic subjects in Bangladeshi population, the present study was undertaken to investigate the relationship between insulin secretory capacity and microvascular damage in the pathogenesis of diabetic retinopathy. A total number of 91 diabetic subjects, diabetes diagnosed before the age of 30 years, were recruited form the out-patient Department, BIRDEM Hospital. Diabetic subjects recruited were new- to previously diagnosed cases with duration of diabetes around 8 years. Insulin secretory capacity was assessed by C-peptide and C-peptide was estimated by ELISA method. Urinary albumin was measured by Immunoturbidetric methods. The subjects were grouped on the basis of duration of diabetes and presence (DR) and absence (NDR) of diabetic retinopathy. Subjects were also divided on the basis of albumin-creatinine ratio (ACR) level. ACR level was observed sharply increased with the duration of diabetes and showed a peak after 8 years. In the ACR positive cases 95.25% of diabetic patient had retinopathy. Both retinopathic and ACR positive subjects had low insulin secretory capacity as evident by absolute C-peptide level and C-peptide glucose ratio. Retinopathy was found increased with generalized vasculopathy. Both microvasculopathy and retinopathy seemed to occur at around 8 years. Insulin secretory capacity in particular seemed to have predominant determinant effect in the etiopathogenesis of diabetic retinopathy.

Sarcomatoid renal cell carcinoma with huge retroperitoneal metastasis.

Sarcomatoid Renal Cell Carcinoma (SRC) is a very rare form of renal neoplasm with very poor prognosis. A case of sarcomatoid renal cell carcinoma (SRC) is reported herein at the National Institute of Kidney Diseases and Urology (NIKDU), Dhaka. A 40 year old man presented with swelling in right loin with dragging abdominal pain and intermittent low grade fever. A huge, fleshy and highly vascular retroperitoneal mass was found peroperatively. Tumor affected the lower pole of right kidney invading the renal capsule, perinephric fat and continued to grow as a large tumor mass in the right retroperitoneal space Histologically, it revealed the features of sarcomatoid renal cell carcinoma.