ABSTRACT
BACKGROUND: Accumulating evidence suggests that DNA methylation markers could serve as sensitive and specific cancer biomarkers. OBJECTIVE: To determine whether a panel of methylated genes would have the potential to identify primary bladder cancer (BCa) in voided urine samples. DESIGN, SETTING, AND PARTICIPANTS: A pharmacologic unmasking reexpression analysis in BCa cell lines was initially undertaken to unveil candidate methylated genes, which were then evaluated in methylation-specific polymerase chain reaction (MSP) assays performed on DNA extracted from noncancerous and cancerous bladder tissues. The most frequently methylated genes in cancerous tissues, with 100% specificity, were retained for subsequent MSP analysis in DNA extracted from urine samples to build and validate a panel of potential methylated gene markers. Urine samples were prospectively collected at three urologic centres from patients with histologically proven BCa and processed for use in real-time MSP and cytologic analysis. Patients with nonmalignant urologic disorders were included as controls. MEASUREMENTS: A urine sample was classified as valid when > or = 10 copies of the gene encoding ß-actin were measured in the urine sediment genomic DNA. Sensitivity, specificity, and predictive values of the MSP and cytology tests were assessed and compared. RESULTS AND LIMITATIONS: MSP assays performed on 466 of the 496 (94%) valid urine samples identified two genes, TWIST1 and NID2, that were frequently methylated in urine samples collected from BCa patients, including those with early-stage and low-grade disease. The sensitivity of this two-gene panel (90%) was significantly better than that of cytology (48%), with comparable specificity (93% and 96%, respectively). The positive predictive value and negative predictive value of the two-gene panel was 86% and 95%, respectively. CONCLUSIONS: Detection of the methylated TWIST1 and NID2 genes in urine sediments using MSP provides a highly (> or = 90%) sensitive and specific, noninvasive approach for detecting primary BCa. TRIAL REGISTRATION: BlCa-001 study - EudraCt 2006-003303-40.
Subject(s)
Biomarkers, Tumor/genetics , Cell Adhesion Molecules/genetics , DNA Methylation , DNA, Neoplasm/urine , Nuclear Proteins/genetics , Twist-Related Protein 1/genetics , Urinary Bladder Neoplasms/diagnosis , Actins/genetics , Actins/urine , Adult , Aged , Aged, 80 and over , Calcium-Binding Proteins , Cell Line, Tumor , Female , Humans , Male , Middle Aged , Neoplasm Staging , Polymerase Chain Reaction , Prospective Studies , Sensitivity and Specificity , Urinary Bladder Neoplasms/urineSubject(s)
Adrenal Cortex , Choristoma/diagnosis , Testicular Diseases/diagnosis , Diagnosis, Differential , Humans , Male , Middle AgedABSTRACT
Surgical injury to the ureter is an important problem that confronts the urologist, the gynaecologist and the general surgeon. We report 38 cases of iatrogenic ureteral injuries observed after gynaecological surgery between January 1972 and December 2004. Hysterectomy accounted for 22 injuries. Injuries were intra-operatively recognized in 3 cases and were treated immediately. In the case of lesions identified secondarily, a ureter-vesical implantation was performed in 66% of cases with a good result in 84% of them. Four patients required nephrectomy. We discuss the cicumstances of development, diagnosis approach and treatment of this lesion and review the literature about this subject.
Subject(s)
Gynecologic Surgical Procedures/adverse effects , Intraoperative Complications , Ureter/injuries , Adolescent , Adult , Aged , Cesarean Section/adverse effects , Child , Female , Humans , Hysterectomy/adverse effects , Iatrogenic Disease , Intraoperative Complications/diagnosis , Intraoperative Complications/surgery , Middle Aged , Nephrectomy , Ureter/surgeryABSTRACT
THE AIM: of this study is to evaluate the results of combined surgery of prostatic disease and inguinal hernia repair. METHODS: We report a retrospective study of 55 patients operated in the same operating time for benign prostatic hyperplasia and hernia inguinale, and present our criteria for patient selection, operative technique, and postoperative results. RESULTS: The mean age of our patient was 69 years with a range of 56 to 85 years. Open suprapubic prostatectomy was done in 53% of cases, transurethral prostatic resection in 47% of cases and prothetic hernioplasty in 60% of cases. The incidence of postoperative wound infection and recurrent hernia was 5,4 % and 6% respectively, witch compares favorably to results of herniorraphy and prostatectomy performed separately. Simultaneous repair of inguinal hernias and surgery of prostatic disease is effective and technically feasible.
