Hematuria grading scale: a new tool for gross hematuria.

OBJECTIVE: To develop a new tool for gross hematuria, the Hematuria Grading Scale (HGS), and evaluate its consistency in assessing hematuria samples. METHODS: The HGS was developed on the basis of an evaluation of sample brightness and saturation using a cyan, magenta, yellow, key (black) color model. Thirty hematuria samples were prepared from human blood by diluting with saline using a standard method. Twenty examiners (5 in each group, including laypeople, nurses, general practitioners, and urologists) participated. Each scored 30 hematuria samples using the HGS under the same conditions without communicating with one another. The intraclass correlation coefficient (ICC) was calculated to assess the reliability of the datasets. Questionnaires for usefulness (Q1) and simplicity (Q2) were obtained from all examiners using a 5-point Likert scale. RESULTS: The ICC for pooled examiner scores showed a high agreement rate (99.7%, 95% confidence interval [CI] 0.996-0.999). ICC values by group were 99.3% (95% CI 0.989-0.997) for laypeople, 98.8% (95% CI 0.980-0.994) for nurses, 99.1% (95% CI 0.984-0.995) for general practitioners, and 99.2% (95% CI 0.987-0.996) for urologists. Mean Q1 and Q2 scores were 4.70 ± 0.66 and 4.30 ± 1.03, respectively, indicating general satisfaction with the HGS among all examiners. CONCLUSION: Evaluations of gross hematuria using the HGS were in high agreement among examiners of all types, and all examiners found the HGS simple and easy to use. The HGS should be a helpful tool for assessment and communication of gross hematuria.

[Gastrointestinal metastasis from a primary adenocarcinoma of the lung presenting with acute abdominal pain].

Symptomatic gastro-intestinal metastasis in lung cancer is extremely rare and only a few case reports have been published. Here, we report a case with lung adenocarcinoma that presented with acute abdominal pain, nausea and vomiting due to duodenum, jejunum, and colon obstruction by the gastro-intestinal metastasis. The patient underwent colonoscopy and the pathologic report was adenocarcinoma. When there are similar histologic findings in both colon and pulmonary lesion, the question is whether both lesions are primary cancer or the colon lesions are metastases from lung cancer. Microscopic examination of a conventional pathologic section was not sufficient to make this determination. Immunohistochemistry was positive for thyroid transcription factor-1 (TTF-1) and cytokeratin 7 (CK7), and negative for cytokeratin 20 (CK20) and caudal-related homeobox transcription factor-2 (CDX-2) on colon mucosa specimen. Accordingly, we used immunohistochemical marker for differential diagnosis of primary adenocarcinoma of the lung with gastro-intestinal metastasis.

Prostate-Specific Antigen Density as a Powerful Predictor of Extracapsular Extension and Positive Surgical Margin in Radical Prostatectomy Patients with Prostate-Specific Antigen Levels of Less than 10 ng/ml.

PURPOSE: To assess the ability of preoperative variables to predict extracapsular extension (ECE) and positive surgical margin (PSM) in radical prostatectomy patients with prostate-specific antigen (PSA) levels of less than 10 ng/ml. MATERIALS AND METHODS: From January 2008 to December 2009, 121 patients with prostate cancer with PSA levels lower than 10 ng/ml who underwent radical prostatectomy were enrolled in the study. The differences in clinical factors (age, PSA, PSA density [PSAD], digital rectal examination [DRE] positivity, positive magnetic resonance imaging [MRI], Gleason sum, positive core number, and positive biopsy core percentage) with ECE and the presence of positive margins were determined and their independent predictive significances were analyzed. RESULTS: The ECE-positive patients had higher PSA, PSAD, and MRI-positive percentages, and PSM patients had higher PSA, PSAD, MRI-positive percentages, Gleason sum, and positive biopsy core percentages for prostate cancer. In the multivariate analysis, PSAD and MRI positivity were the best independent predictors for ECE, and PSA and PSAD were the best independent predictors of PSM. By receiver operating characteristic curve analysis, PSAD had better discriminative area under the curve value than did PSA for ECE (0.765 vs 0.661) and PSM (0.780 vs 0.624). The best predictive PSAD value was 0.29 ng/ml/cc for ECE and 0.27 ng/ml/cc for PSM. CONCLUSIONS: PSAD has relevance to ECE (plus MRI findings) and PSM (plus PSA). PSAD might be a powerful predictor of ECE and PSM preoperatively in patients undergoing a radical prostatectomy with PSA levels of less than 10 ng/ml.