[Right atrial appendage thrombosis during atrial fibrillation: an element to look for]. / La trombosi auricolare destra durante fibrillazione atriale: un reperto da ricercare.

Oral anticoagulant therapy (OAT) is a mainstay of atrial fibrillation (AF) pharmacological treatment. Left atrial appendage closure is a possible treatment, when feasible, in patients with intracerebral hemorrhage during OAT. We report a case of right atrial appendage thrombosis in a patient with chronic AF admitted for syncope due to diuretic-induced orthostatic hypotension. Two years previously, he had undergone left atrial appendage closure with the Amplatzer Cardiac Plug device because of intracerebral hemorrhage during OAT. After neurological consult, OAT was resumed with apixaban 5 mg twice daily, and transesophageal echocardiography performed two months later showed complete resolution of the right atrial appendage thrombosis. This particular case underlines the importance of searching for a possible right atrial appendage thrombosis in patients affected by AF, and suggests that left atrial appendage closure in AF patients not suitable for OAT does not fully eliminate the risk of thromboembolism.

Visceral obesity predicts adverse pathological features in urothelial bladder cancer patients undergoing radical cystectomy: a retrospective cohort study.

PURPOSE: To evaluate the pathological characteristics of patients with metabolic syndrome (MetS) undergoing radical cystectomy (RC) for urothelial bladder cancer (BCa). METHODS: We retrospectively analyzed 262 consecutive patients with muscle-invasive urothelial BCa or non-muscle-invasive urothelial BCa bacillus Calmette-Guerin refractory undergoing RC with standard pelvic lymphadenectomy. The patients were stratified into those with or without MetS, and a bivariate logistic regression analysis was done to assess MetS and, separately, each single MetS component as independent predictors of higher pathological stage as well as of the presence of lymph vascular invasion (LVI) and lymph node metastasis (LM). RESULTS: Metabolic syndrome was found in 36.3 % of patients. At logistic regression analysis, the presence of MetS did not predict the risk of both higher pathological stage and LVI and LM. Investigating the single components of MetS after adjusting for age, gender, and smoking, the risk of higher pathological stage increased with body mass index [BMI (OR 1.307, 95 % CI 1.098-1.555)], waist circumference (OR 1.414, 95 % CI 1.364-1.668), and blood hypertension (OR 2.326, 95 % CI 1.147-4.717). Higher BMI also predicted the presence of LVI (OR 1.432, 95 % CI 1.173-1.748) and LM (OR 1.202, 95 % CI 0.951-1.519), whereas HDL cholesterol was inversely associated with the risk of LVI and LM. CONCLUSIONS: Metabolic syndrome does not represent an independent risk factor for worse pathological findings in BCa. Conversely, individual components of MetS could increase the risk of higher stage as well as LM.

EGFR mutational status in penile cancer.

OBJECTIVE: No substantial improvement in overall survival has been obtained over the past two decades in penile cancer (PC). Clinical data are available on the role of epidermal growth factor receptors (EGFR) inhibitors in PC but no EGFR mutational analysis has been conducted. RESEARCH DESIGN AND METHODS: We reviewed formalin-fixed, paraffin-embedded blocks of PC at the Pathology Department of the National Cancer Institute since 2000 through 2012 to evaluate activating mutations in the tyrosine kinase domain of EGFR: EGFR E746 - A750 specific deletion in exon 19 and EGFR L858R specific point mutation in exon 21. RESULTS: Thirty tumor samples were available for our analysis. EGFR was expressed in all samples at immunohistochemistry. Tested mutations were not identified in any of the samples analyzed. CONCLUSIONS: The most frequent activating EGFR mutations detected in non-small setting lung cancer are absent in penile cancer (PC). Sequencing of the entire EGFR gene in patients with PC may provide useful insights, as its mechanism of overexpression and activation in PC remains unknown.

Prevention of recurrent urinary tract infections by intravesical administration of hyaluronic acid and chondroitin sulphate: a placebo-controlled randomised trial.

BACKGROUND: Urinary tract infection (UTI) is a prevalent condition in women during their lifetime with a high rate of recurrence within 3-6 mo. OBJECTIVES: Our aim was to investigate the efficacy and tolerability of the intravesical administration of combined hyaluronic acid (HA) and chondroitin sulphate (CS) in female patients with a history of recurrent UTI. DESIGN, SETTING, AND PARTICIPANTS: We conducted a prospective, randomised, double-blind, placebo-controlled study comparing the intravesical instillation of HA-CS with placebo in women with recurrent UTI. INTERVENTION: Participants were randomised to receive 50 ml of sterile sodium HA 1.6% and CS 2.0% solution (IALURIL(®)) weekly for 4 wk and then monthly for 5 mo. MEASUREMENTS: The primary end point of the study was defined as the mean number of UTI per patient per year. Participants were evaluated addressing UTI status/urinary symptoms and with a general health-related quality-of-life (QoL) questionnaire at baseline and after 3, 6, 9, and 12 mo. RESULTS AND LIMITATIONS: In the intention-to-treat analysis, 57 women were randomly allocated to HA-CS (n=28) or placebo (n=29). The UTI rate per patient per year at the end of the study (12 mo) (mean±SD: -86.6%±47.6 vs -9.6%±24.6; mean difference: 77%; 95% confidence interval, 72.3-80.8; p=0.0002) and the mean time to UTI recurrence (52.7±33.4 vs 185.2±78.7 d; p<0.001) were significantly reduced after treatment with HA-CS compared with placebo. Overall urinary symptoms and QoL measured by questionnaires significantly improved compared with placebo (Pelvic Pain and Urgency/Frequency questionnaire symptom score: 14.53±4.32 vs 9.88±6.77; p=0.004; SF-36 QoL score: 78.6±6.44 vs 53.1±4.72; p<0.001). No serious adverse event was reported. CONCLUSIONS: Compared with placebo, HA-CS intravesical instillations significantly reduced UTI rate without severe side effects while improving symptoms and QoL over a 12-mo period in patients with recurrent UTI. TRIAL REGISTRATION: ISRCTN 76354426.

What happens to the abstracts presented at the Societè Internationale d'Urologie meeting?

OBJECTIVES: To estimate the acceptance rate on peer-reviewed journals, describe the time-course of subsequent full publication, and identify those with characteristics associated with publication from the abstracts presented at the Societè Internationale d'Urologie (SIU) meeting. METHODS: All abstracts accepted for presentation at the annual 2002 and 2004 SIU meetings were identified from the published supplements in the BJU International. The subsequent publication rate for the corresponding studies by scanning Medline was evaluated. RESULTS: Overall, 1877 abstracts were presented, 415 of which (22.1%) were followed by publication in peer-reviewed journals. The mean time to publication was 13 months (range, 1 to 45 months). A total of 60.6% of the published articles were in print within 1 year of presentation "In most of the cases the reports were published in The Journal of Urology (76 reports) and in Urology (49 reports). Abstracts on kidney cancer, urinary diversion, incontinence, and urolithiasis had the highest publication rates (43.4%, 36.6%, 33.3%, and 29.2%, respectively). Studies from North America and from Oceania had the highest publication rate (26.8% and 26.6%, respectively). CONCLUSIONS: One fifth of the abstracts presented at the SIU meetings are ultimately published in indexed journals. Delegates attending these meetings should be aware of this issue when taking into account findings from meeting reports for their clinical practice. Factors influencing their publication are the abstract geographical area of origin, the study subject, and the research type. The Journal of Urology and Urology represented target journals for the publication more than other ones.

A new transportable shock-wave lithotripsy machine for managing urinary stones: a single-centre experience with a dual-focus lithotripter.

OBJECTIVE: To assess the efficacy and safety of a transportable extracorporeal shock wave lithotripsy (ESWL) machine, the Modulith SLX-F2(TM) (Storz Medical Italia, Rome, Italy), in the management of solitary urinary calculi. PATIENTS AND METHODS: The study included 233 patients (mean age 51 years; 172 male, 61 female) with symptomatic solitary renal (group A, 170, mean diameter 15.5 mm) or ureteric stones (group B, 63, mean diameter 9.5 mm) treated in a tertiary care institution. Exclusion criteria for the analysis were: pelvi-ureteric junction obstruction, multiple stones, stone diameter >2 cm, stones in a lower calyx with unfavourable anatomy, active infection, or impacted ureteric stones. Selected patients had ureteric stenting before treatment, and all patients were treated with no anaesthesia. Hospitalization, complications and subsequent auxiliary procedures were evaluated. Patients were assessed after a single ESWL session and after 3 months by a plain abdominal film and renal ultrasonography. Stone-free status was defined as no evidence of calculi, and clinical success as the presence of stone fragments of <4 mm. An efficiency quotient (EQ) was calculated for the ESWL treatment. Pain was assessed using a visual analogue scale. RESULTS: The mean number of shocks used was 3779 and the mean (range) treatment time was 35 (5-55) min. The overall clinical success rate after one ESWL session was 83.7% and 82.5% for renal and ureteric stones, respectively, and the overall 3-month stone-free rate was 77% and 74.6%, respectively; the overall EQ was 0.64. When risk factors for persistent calculi were analysed simultaneously in a logistic regression model, only stones of >1 cm were statistically significant (P < 0.05). Most patients reported that pain during ESWL was mild to moderate and easily tolerated. Only minor complications occurred, with an overall complication rate of 3.8%. CONCLUSIONS: This transportable lithotripter is a safe and effective device for managing solitary stones throughout the urinary tract. Its main advantage is represented by the dual-focus system. Moreover, it shares with other contemporary machines several important features such as outpatient setting, no need for anaesthesia, easy patient positioning, and the capability of ancillary procedures.

[Relation between left atrial spontaneous echocontrast and pulmonary venous flow in nonvalvular atrial fibrillation: implications for stratification of thromboembolic risk]. / Relazione tra ecocontrasto spontaneo in atrio sinistro e flusso venoso polmonare nella fibrillazione atriale non valvolare: implicazioni nella stratificazione del rischio tromboembolico.

BACKGROUND: The links between pulmonary venous flow (PVF) and left atrial stasis have not been adequately defined in nonvalvular atrial fibrillation. In this setting, we aimed to study the relationship between PVF and the occurrence of left atrial spontaneous echocontrast (SEC) in order to evaluate its clinical relevance in the assessment of the cardioembolic risk. METHODS: We studied by echocardiography 109 patients with nonvalvular atrial fibrillation (65 males, 44 females, mean age 66 +/- 9 years). The left ventricular end-diastolic and end-systolic diameters, the left ventricular fractional shortening, the left ventricular mass, and the left atrial volume were measured by transthoracic approach. The systolic and diastolic peak velocities of PVF, their ratio (pS/pD) and the velocity-time integrals were assessed by means of transesophageal investigation; furthermore, the presence of left atrial SEC or thrombi was recorded. Among clinical data, thromboembolic events occurring within 15 days before the echocardiographic study, history of hypertension and duration of atrial fibrillation were also collected. RESULTS: Left atrial SEC showed a significant correlation with left atrial volume (p < 0.001), detection of thrombi (p < 0.001), thromboembolic events (p = 0.002) and pS/pD ratio (p < 0.001). By multivariate analysis, pS/pD ratio was independently correlated with left atrial volume, age and left ventricular fractional shortening (r2 = 0.29, p < 0.001). The sensitivity and specificity of pS/pD ratio to predict the presence of severe SEC was 73.9 and 62.5%, respectively. CONCLUSIONS: In patients with nonvalvular atrial fibrillation, pS/pD ratio is significantly related to the occurrence of left atrial SEC and seems to be a useful parameter concurring to assess left atrial stasis and thromboembolic risk.