The prognostic value of E-cadherin and Ki-67 compared to standard histopathologic examination in non-muscle invasive bladder cancer.

OBJECTIVES: The objectives of this study were to determine the prognostic value of expression levels of selected biomarkers and their statistical analysis in relation to survival and standard histopathologic examination and other clinicopathologic variables in non-muscle invasive bladder cancer (NMIBC). BACKGROUND: Worldwide, bladder cancer is a frequent malignant disease with rising incidence. Characteristic invasiveness and high recurrence rates call for more diagnostic methods to obtain more accurate information. Prognosis is affected by a significant interpersonal variability of the disease. For this reason, constant search for alternative and better diagnostic methods is essential. METHODS: We analysed cancer tissue from patients with Ta and T1 bladder cancer. E-cadherin and Ki-67 expression levels were analysed using immunohistochemical staining. The expression levels quantified to a percentual amount were statistically analysed in relation to survival and their frequency distribution in the study group. RESULTS: E-cadherin and Ki-67 expression levels show high association with tumor stage and grade         (p<0.001), in contrast, the association with recurrence has proven insignificant. Patients with non-aberrant biomarker expression levels have much higher survival rates than the cases with aberrant expression. CONCLUSION: Low expression levels of Ki-67 and high expression levels of E-cadherin positively affect survival of patients, whereas aberrant expressions pose poorer prognosis (Tab. 2, Fig. 2, Ref. 33).

Natural polyphenols improve erectile function and lipid profile in patients suffering from erectile dysfunction.

OBJECTIVES: Erectile dysfunction (ED) is characterised as the inability to achieve or maintain an erection to complete sexual intercourse. ED may be considered as an early complication of diabetes mellitus (DM). The aim of this study was to assess the effect of registered food supplement, natural polyphenolic extract from the French maritime pine bark, Pycnogenol (PYC) on erectile function and lipid profile in ED patients. METHODS: 53 patients with ED were divided into two groups (32 with DM, 21 non-DM) in randomised, blinded and placebo-controlled study. During 3-month intervention with PYC or placebo and one month after the end of the intervention patients were investigated for ED with validated questionnaire International Index of Erectile Function-5 (IIEF-5); lipid profile, glycaemia was analysed in each group. RESULTS: In a randomised, blinded and placebo-controlled study, we found that natural polyphenolic extract, Pycnogenol improved erectile function in DM group by 45 % compared to the NDM group, where the improvement was also significant, but only by 22 %. Total cholesterol, LDL-cholesterol and glucose level was lowered by PYC in patients with DM. Glucose level was not affected by PYC in non-DM. Placebo showed no effect on monitored parameters in both groups. CONCLUSION: Administration of Pycnogenol leads in improvement of erectile function in patients with ED and diabetes (DM group) by 45 %, in NDM group by 22 %, in lowering of total-, LDL-cholesterol by 20 % and 21 % and glycaemia by 22 % in DM (Tab. 2, Fig. 2, Ref. 19).

Urinary fluorescence analysis in diagnosis of bladder cancer.

Early diagnosis of bladder cancer is crucial for improvement of cancer specific survival and recurrence rate. We analyzed the possible role of fluorescence urine analysis in bladder cancer diagnosis. The cohort consisted of 20 healthy controls, 40 patients with hematuria and 75 patients with hematuria and histologically proven bladder tumor. Synchronous fluores- cence spectra with a 70 nm wavelength difference were recorded for (1:1-1:128) urine dilutions. Concentration matrices of synchronous spectra (CMSS) were used to classify samples into tested groups. CMSS analysis allowed us to distinguish patients with tumor from patients with hematuria with a sensitivity 55% and specificity 74.7%. This is comparable to the sensitivity and specificity of other non-invasive tests like BTA stat and nmP-22 (Bladder check®). Lower fluorescence inten- sity of Imax 280 nm and ratio of 280 nm to 450 nm was found to be associated with the presence of tumor. We have found an association of decreased fluorescence with the stage of the disease. Our data suggest that CMSS urine analysis has a potential role in the non-invasive diagnostic tests for bladder cancer, but it cannot replace the current diagnostic algorithm yet.

[Quality of nephrolithiasis surgical treatment - what is it influenced by?] / Kvalita operacnej liecby nefrolitiázy: co na nu vplýva?

INTRODUCTION: Identifying factors effecting the quality of nephrolithiasis surgical treatment could improve medical care for patients suffering from kidney stone disease. The objective of the article is to identify factors influencing reintervention rate after surgical treatment of kidney stone disease either by percutaneous nephrolitholapaxy or flexible ureterorenoscopy. METHOD: A retrospective study was conducted on 149 patients who underwent a surgery for a kidney stone disease at the Urological department of F.D. Roosevelt hospital Banská Bystrica from January 2015 till June 2015. The cohort included 60 women at average age of 57 (range 28-91) and 89 men at average age of 58 (range 30-92). Patients were treated by percutaneous litholapaxy (67 cases) and flexible ureterorenoscopy (82 cases, including 72 using dusting technique). Factors with potential influence on probability of repeated intervention during following 12 months have been studied and statistically analyzed. For the statistical analysis we used the generalized linear regression framework (GLM Generalized Linear Model) with the stepwise forward modeling approach. RESULTS: Using the significance level of 5% the statistically significant factors affecting the probability of the re-intervention for ipsilateral kidney stone disease are the stone size (p-value 0.0035) and the postoperative stone free status (p-value 0.0418). Other studied factors as demographical data (age, gender), surgical method (percutaneous nephrolitolapaxy or flexible ureterorenoscopy), stone count, postoperative draining system (nefrostomy or JJ stent) did not have any statistically significant impact. CONCLUSION: Patients could benefit from early diagnosis which could lead to earlier identification of smaller stones. Perfect operative technique with intraoperative achievement of stone free status is important to lower the need of repeated intervention.Key words: kidney stone disease - reintervention residual fragments.

Vascular complications after renal transplantation.

BACKGROUND: Vascular complications in renal transplant recipients are uncommon but important causes of graft dysfunction and graft loss after kidney transplantation. OBJECTIVES: To document vascular complications that occurred following kidney transplantations in order to assess the incidence of these complications at our center as well as to identify possible treatment approach. METHODS: 103 kidney transplantations were performed in the period from 1 January 2008 to 31 December 2009. All patients after kidney transplantation underwent ultrasound examination (included colour Doppler flow and duplex Doppler ultrasound) immediately after surgery--especially in condition of anuria, then regularly according to an internal schedule and always in patients with worsened graft function. RESULTS: We detected renal vein thrombosis in 3 cases (2.9%), artery thrombosis in 4 cases (3.9%), one time intrarenal pseudoaneurysm (1%) and renal artery stenosis in 10 patients (9.7%). There was no extrarenal pseudoaneurysm or arteriovenous fistula in our group of patients. CONCLUSION: The incidence of vascular complications in our department correlates with the incidence of these complications referred in literature. We confirmed the importance of established immediate diagnosis and fast intervention once the diagnosis of vascular complication is established (Fig. 8, Ref. 12). Full Text in free PDF www.bmj.sk.

Current issues of BPH treatment.

BPS is a disease with a negative impact on patient's quality not the quantity of life. Surgical treatment is still considered a gold standard, however, conservative treatment is an efficient and safe alternative with a positive impact on the quality of life.

[Acute conditions after kidney transplantation in patients with autosomal dominant polycystic kidney disease]. / Naliehavé situácie po transplantácii oblicky u pacientov s autozomálne dominantnou polycystózou obliciek.

There is a high risk of severe complications after kidney transplantation. In patients with autosomal dominant polycystic kidney disease (AD-PKD) the incidence of complications like ischaemic cardiac disease, acute myocardial infarction, pulmonary embolism, perforation of colonic diverticulosis is especially higher. The authors want to indicate another specific complication, rupture of the cyst of own polycystic kidney with retroperitoneal haemorrhage. Within the group of 658 patients who underwent kidney transplantation between January 1981 and January 2000 there were 54 (8.2%) patients with AD-PKD. Four patients with severe retroperitoneal haemorrhage due to rupture of the cyst of own polycystic kidney we present in a short case reports. All cases were fatal. Expect morphologic and functional follow up of the graft it is necessary to follow up polycystic kidney and indicate urgent nephrectomy in the case of any change.

[Laparoscopic fenestration of lymphoceles after kidney transplantation]. / Laparoskopická fenestrácia lymfokély po transplantácii oblicky.

Lymphocele is a relatively frequent complication after kidney transplantation, which impair the passage of urine from the kidney, cause emptying of bladder lymphoedemas of the lower limbs, etc. Percutaneous drainage of lymphocele is associated with a risk of infection and a high percentage of recurrence. Until recently, standard surgical treatment of this complication was open fenestration of the lymphocele into the peritoneal cavity. In their paper, the authors describe their first experience with laparoscopic fenestration of the lymphocele. From May 1998 till April 1999 the authors performed laparoscopic fenestration in 5 patients. In four patients the intervention was successful, in one female patient recurrence of lymphocele was observed, which was later resolved by an open operation. In none of the patients early or late surgical complications occurred, the use of analgetics during the postoperative period was minimal, the length of hospitalisation ranged from 2 to 4 days. The authors consider the discussed method a suitable alternative for treating lymphocele after renal transplantation thanks to its minimal invasivity. It involves practically no load of the sick patients after kidney transplantation.

The incidence of tumours in renal transplant recipients with long-term immunosuppressive therapy.

INTRODUCTION: The incidence of cancers after renal transplantation is significantly higher than in population that have not undergone transplantation. It is increased by a long-term survival of functional graft requiring long-term immunosuppressive therapy. MATERIAL AND METHODS: Since 1972, 620 renal transplantations have been performed for different causes of end stage renal disease. The authors report a group of 18 renal transplant patients (2.9%) who had cancer. Patients with malignancies are reviewed according to their age, sex, type of immunosuppression, interval between transplantation and the diagnosis of cancer, method of treatment and survival. RESULTS: All patients received cadaver kidneys, and secondary transplantation was performed in two patients. Five patients received conventional immunosuppression--azathioprine with prednisone, another 13 patients received cyclosporine with prednisone and/or azathioprine. In 13 males and 5 females (mean age 46.1 years) the malignant disease developed about 62.4 months after renal transplantation. Six patients had epithelial skin cancers (four of them had squamous cell carcinomas and two basal cell carcinomas). Two patients had breast cancer, colorectal carcinoma, renal cell carcinoma and bladder cancer, respectively, one patient had gastric cancer, thyroid carcinoma, carcinoma of tonsilla, and monocytic leukaemia with blastic transformation, respectively. The average survival of patients with malignancies was 20.3 months. Of 17 patients with cancer, 13 underwent surgical treatment, four patients with advanced disease received radiotherapy, hormonal treatment or only symptomatic therapy. In one patient the malignant disease was only discovered at autopsy. Five patients died of progressive malignant disease, four of intercurrent disease. Nine (50%) patients are alive, with no evidence of disease (NED), 31.9 months in average following the diagnosis of malignancy. Three patients returned to dialysis treatment, other 6 patients live with well functioning graft. CONCLUSIONS: In patients surviving long time after kidney transplantation the possibility of development of malignant disease should be considered. Preventive evaluation should guarantee early detection of cancer. Appropriate treatment, without cessation of immunosuppressive therapy, is indicated with the intention to prolong the patients' life with a functional graft and without dialysis treatment.