Prostate adenocarcinoma metastasis to the testis: A new case report.

Prostate cancer (PCa) in the second most common cancer in men worldwide. It commonly metastasizes to the bone, lymph nodes, liver and lungs. Synchronous or metachronous testicular metastasis is a rare finding, generally diagnosed incidentally after bilateral orchidectomy for hormonal management in patients with advanced PCa, or at autopsy. We report a case of a 55-year-old male, presenting a PCa and who developed a single testicular metastasis treated by radical orchidectomy, while he was under hormonotherapy.

Paratesticular leiomyoma: A case report of a rare entity.

Paratesticular leiomyoma is an extremely rare benign tumour. It is often asymptomatic. It is sometimes difficult to distinguish leiomyomas from malignant testicular tumours, which leads to radical orchidectomy, despite its benign nature. Magnetic resonance imaging can be helpful to make conservative management of this lesion.

Adult's Wilms tumor: A case report.

Nephroblastoma is the most frequent renal tumor in childhood population. Rarely, it can occur in adults. In this case, the diagnosis is frequently challenging for pathologists. No standard guidelines are available for this neoplasm in adults. It needs multidisciplinary collaboration for optimal management. Herein we report a 26-year-old man presenting with a non-metastatic right nephroblastoma. He underwent a radical nephrectomy. He is currently in complete remission after a follow-up of 18 months.

Upper urinary tract urothelial carcinoma diagnosis by biopsy of a vaginal metastasis.

Upper tract urothelial carcinoma presents 5% of urothelial cancers. The most frequent revealing symptom gross haematuria. Vaginal metastasis is rare revealing condition. The combination on these two symptoms should recall the diagnosis of this neoplasm. Biopsy of the vaginal mass can make the histologic diagnosis easily.

Dried blood spot versus venous blood sampling for phenylalanine and tyrosine.

BACKGROUND: This study investigated the agreement between various dried blood spot (DBS) and venous blood sample measurements of phenylalanine and tyrosine concentrations in Phenylketonuria (PKU) and Tyrosinemia type 1 (TT1) patients. STUDY DESIGN: Phenylalanine and tyrosine concentrations were studied in 45 PKU/TT1 patients in plasma from venous blood in lithium heparin (LH) and EDTA tubes; venous blood from LH and EDTA tubes on a DBS card; venous blood directly on a DBS card; and capillary blood on a DBS card. Plasma was analyzed with an amino acid analyzer and DBS were analyzed with liquid chromatography-mass spectrometry. Agreement between different methods was assessed using Passing and Bablok fit and Bland Altman analyses. RESULTS: In general, phenylalanine concentrations in LH plasma were comparable to capillary DBS, whereas tyrosine concentrations were slightly higher in LH plasma (constant bias of 6.4 µmol/L). However, in the low phenylalanine range, most samples had higher phenylalanine concentrations in DBS compared to LH plasma. Remarkably, phenylalanine and tyrosine in EDTA plasma were higher compared to all other samples (slopes ranging from 7 to 12%). No differences were observed when comparing capillary DBS to other DBS. CONCLUSIONS: Overall agreement between plasma and DBS is good. However, bias is specimen- (LH vs EDTA), and possibly concentration- (low phenylalanine) dependent. Because of the overall good agreement, we recommend the use of a DBS-plasma correction factor for DBS measurement. Each laboratory should determine their own factor dependent on filter card type, extraction and calibration protocols taking the LH plasma values as gold standard.

Multiple unusual urological locations of hydatic cysts including kidney, retrovesical and spermatic cord. A new case report.

Human hydatidosis is endemic in regions with temperate climate where pastoral farming is common. It is frequent in the southern shore of the Mediterranean, particularly in the Maghreb countries. It remains asymptomatic for long period, and the diagnosis is often delayed. The most affected organs are the liver and lungs. Hydatic disease of the urinary tract is an unusual entity. Our case concerns multiple unusual locations of hydatic disease in the urinary tract, including renal, retrovesical and spermatic cord, associated with splenic and intraperitoneal locations. Coexistence of hydatic cysts in such locations of urinary tract has not been previously reported.

Oxidative metabolism appears to be reduced in long-term hemodialysis patients.

BACKGROUND: As part of a study of whole-body protein metabolism in hemodialysis (HD) patients, we obtained values for whole-body bicarbonate production in control subjects and HD patients before and during dialysis by using stable isotopically labeled bicarbonate. Indirect calorimetry measurements have shown normal or increased energy expenditure in HD patients, which has been used to explain the malnutrition in many of these patients. However, this method becomes inaccurate when the dynamics of whole-body bicarbonate production change during measurement, as is the case with HD patients during dialysis. METHODS: Whole-body bicarbonate production was measured in 6 control subjects, 9 patients on a nondialysis day (HD-), and 8 patients during an HD session (HD+) by means of a primed constant infusion of carbon 13 (13C)-labeled sodium carbonate (NaH13CO3). 13C-abundance of expired carbon dioxide was measured by means of isotope ratio mass spectrometry. RESULTS: Carbon dioxide production was 141 +/- 12, 123 +/- 11*, and 148 +/- 19 micromol/kg/min for the control, HD-, and HD+ groups, respectively (*P < 0.05 compared with the control and HD+ groups). Values for energy expenditure were derived and were 29.1 +/- 2.4, 24.9 +/- 2.1*, and 32.6 +/- 2.0 kcal/kg/day, respectively (*P < 0.05 compared with the control and HD+ groups). CONCLUSION: Whole-body oxidation in HD patients is reduced compared with control subjects. During dialysis, bicarbonate turnover, as well as carbon dioxide expiration, increases because of the influx of bicarbonate from the dialyzer.

Membrane biocompatibility does not affect whole body protein metabolism during dialysis.

BACKGROUND: Protein-calorie malnutrition is present in 30-50% of dialysis patients. The lack of biocompatibility of the dialysis membrane, which results in low-grade inflammation, could be responsible for this malnutrition. We investigated whether protein-energy malnutrition could be partly due to incompatibility of the dialyzer during the dialysis session. METHODS: Five patients were dialyzed during 2 periods of 3 weeks (cross-over) with either a single-use low-flux polysulfone or cellulose triacetate (biocompatible) or a single-use cuprophan (bio-incompatible) membrane. As a measure of whole body protein metabolism, a primed constant infusion of L-[1-(13)C]-valine was used during a 4-hour dialysis session. RESULTS: Cuprophan was a more powerful activator of the complement system than other membranes. Protein metabolism parameters during both study protocols were not different and resulted in the same protein balance during polysulfone/cellulose triacetate (-15 +/- 3) and cuprophan (-13 +/- 2 micromol/kg/h) dialysis. CONCLUSION: In stable hemodialysis patients with no apparent complications, protein metabolism during dialysis is not affected by the compatibility of the dialysis membrane.

Comparison of amino acid oxidation and urea metabolism in haemodialysis patients during fasting and meal intake.

BACKGROUND: The PNA (protein equivalent of nitrogen appearance) is used to calculate protein intake from urea kinetics. One of the essential assumptions in the calculation of PNA is that urea accumulation in haemodialysis (HD) patients is equivalent to amino acid oxidation. However, urea is hydrolysed in the intestine and the resulting ammonia could be used metabolically. The magnitude and dependence on protein intake of this process are unknown in HD patients. METHODS: Seven HD patients were studied twice, 1 week apart, on a similar protocol. After an overnight fast, patients fasted in the morning and received meals in the afternoon. On one day, amino acid oxidation was measured by infusion of L-[1-(13)C]valine. Urea production, measured from the dilution of [(13)C]urea, and urea accumulation, calculated from the increase in plasma urea concentration multiplied by the urea dilution volume, were measured during the other day. PNA was calculated using standard equations. RESULTS: Amino acid oxidation and urea production were not significantly different during fasting. Urea accumulation during fasting was significantly lower than both amino acid oxidation and urea production. Urea accumulation during feeding remained significantly lower than amino acid oxidation. PNA was equal to the average of the urea accumulation values during fasting and feeding. CONCLUSION: We conclude that during fasting, urea accumulation is not associated with amino acid oxidation or urea production. During meal intake, amino acid oxidation, urea production and urea accumulation show acutely an almost identical increase. PNA represents the average of fasting and fed urea accumulation and is lower than average amino acid oxidation or urea production.

The metabolic response to ingested protein is normal in long-term hemodialysis patients.

BACKGROUND: Protein-energy malnutrition affects 30% to 50% of hemodialysis (HD) patients. This has been attributed to inadequate food intake, but may be caused by disturbances in utilization of ingested protein. METHODS: We studied protein kinetics during fasting and during ingestion of a protein-enriched meal to investigate possible metabolic differences between stable HD patients and control subjects. Whole-body protein kinetics was measured by means of a primed constant infusion of L[1-13C] valine. RESULTS: During fasting, whole-body protein balance was significantly less negative in HD patients compared with control subjects. During meal intake, protein balance was similar between HD patients and control subjects. Meal intake increased protein balance significantly in both groups, but not differently between the groups. Also, protein oxidation was decreased during fasting in HD patients compared with control subjects, but not during meal intake. CONCLUSION: We conclude that the rate of protein breakdown is lower in HD patients compared with control subjects, but the efficiency of protein utilization is normal in HD patients during a nondialysis day.

Protein intake during hemodialysis maintains a positive whole body protein balance in chronic hemodialysis patients.

Protein energy malnutrition is present in 18 to 56% of hemodialysis patients. Because hemodialysis has been regarded as a catabolic event, we studied whether consumption of a protein- and energy-enriched meal improves the whole body protein balance during dialysis in chronic hemodialysis (CHD) patients. Patients were studied on a single day between dialysis (HD- protocol) in the morning while fasting and in the afternoon while consuming six small test meals. Patients were also studied during two separate dialysis sessions (HD+ protocol). Patients were fasted during one and consumed the meals during the other. Whole body protein metabolism was studied by primed constant infusion of l-[1-(13)C]valine. During HD-, feeding changed the negative whole body protein balance observed during fasting to a positive protein balance. Dialysis deepened the negative balance during fasting, whereas feeding during dialysis induced a positive balance comparable to the HD- protocol while feeding. Plasma valine concentrations during the studies were correlated with whole body protein synthesis and inversely correlated with whole body protein breakdown. We conclude that the consumption of a protein- and energy-enriched meal by CHD patients while dialyzing can strongly improve whole body protein balance, probably because of the increased amino acid concentrations in blood.