Urinary schistosomiasis presented as bladder malignancy with pulmonary metastases: a case report.

Schistosoma haematobium is the species primarily responsible for the manifestation of schistosomiasis in the genitourinary tract. It is a parasitic disease caused by flukes (trematodes) of the genus Schistosoma, which can result in acute and chronic manifestation. We report a case of urinary schistosomiasis that initially presented as advanced bladder cancer with pulmonary metastasis on initial computed tomography scan. Further investigations revealed no cancer and pulmonary changes resolved with treatment. The involvement of bladder is the hallmark of S. haematobium infection and it is unusual to have pulmonary manifestation without concurrent hepatosplenic disease. Within the lungs, deposition of Schistosoma eggs causes a granulomatous reaction, typically producing miliary nodules on chest radiographs. In our case, this was interpreted initially as lung metastases. However, given the cystoscopic findings and subsequent resolution with praziquantel, this was proved otherwise. This case highlights the importance of urinary cytology in the initial investigation of haematuria. Clinicians should be aware of such a potential differential diagnosis, especially in patients with prior travel history to endemic areas.

A Prospective Evaluation of High-Resolution CT Parameters in Predicting Extracorporeal Shockwave Lithotripsy Success for Upper Urinary Tract Calculi.

OBJECTIVE: To evaluate the ability of noncontrast CT parameters (stone size, stone attenuation, and skin-to-stone distance [SSD]) to predict the outcome of extracorporeal shockwave lithotripsy (SWL) in a prospective cohort of patients with renal and upper ureteric stones. PATIENTS AND METHODS: Patients with stones 5 to 20 mm were prospectively enrolled from 2011 to 2014. Patients had NCCT with recording of stone size, stone mean attenuation, and SSD, as well as various stone and patient parameters. The numbers of needed sessions as well as the final outcome were determined, with SWL failure defined as residual fragments >3 mm. Predictors of SWL failure were assessed by multiple regression analysis. RESULTS: Two hundred twenty patients (mean ± standard deviation [SD] age 41.5 ± 12.4 years) underwent SWL. Mean ± SD stone size was 11.3 ± 4.1 mm, while mean ± SD stone attenuation was 795.1 ± 340.4 HU. Mean ± SD SSD was 9.4 ± 2.1 cm. The average number of sessions was 1.64. SWL was effective in 186 (84.5%) patients (group A), while 34 (15.5%) patients had significant residual fragments (>3 mm). On univariate analysis, predictors of SWL failure included stone attenuation >1000 HU, older age, higher body mass index, higher attenuation value, larger stone size, and longer SSD. Increased SSD and higher stone attenuation retained their significance as independent predictors of SWL failure (p < 0.05) on multiple regression analysis both after first session and as final SWL outcome. A positive correlation was found between number of SWL sessions and mean stone attenuation (r = 0.6, p < 0.001) and SSD (r = 4, p < 0.001). CONCLUSIONS: Stone mean attenuation and SSD on noncontrast CT are significant independent predictors of SWL outcome in patients with renal and ureteric stones. These parameters should be included in clinical decision algorithms for patients with urolithiasis. For patients with stones having mean attenuation of >1000 HU and/or large SSDs, alternatives to SWL should be considered.

Exploring Portal Vein Hemodynamic Velocities as a Promising, Attractive Horizon for Small-for-Size Syndrome Prediction After Living-Donor Liver Transplantation: An Egyptian Center Study.

BACKGROUND: Liver transplantation is the only definite treatment for patients with irreversible liver failure. This explored the impact of portal vein hemodynamic velocities on graft functions to determine the mean portal vein velocities that may increase small-for-size syndrome (SFSS) risk. METHODS: The study was conducted with 123 cirrhotic patients who underwent living-donor liver transplantation (LDLT) at Kasr Alainy Hospital, Cairo, Egypt. Patients were submitted to full history, examination, pre-transplantation labs, and imaging. Intra-operative Doppler studies were performed after graft reperfusion. Post-operative (PO) Doppler was performed once a day over the first 2 weeks. Complete graft functions were obtained daily for patients. RESULTS: PVV (portal vein velocities) declined gradually but significantly after LT (intra-operative), and PO PVV were significantly higher in the SFSS group. The best cut-off values for prediction of SFSS with the use of intra-operative (before, during, and after) post-anastomotic PVV were 55.5, 106, and 126.5 cm/s, respectively, and, for PO before and after anastomotic PVV, 48.6 and 71.1 cm/s, respectively. There was a significant positive correlation between PO mean PVV and mean alanine transferase, total bilirubin, and international normalized ratio. CONCLUSIONS: PVV is a significant hemodynamic factor that influences graft functions. SFSS, which has a negative impact after LDLT, could be predicted by cut-off values for PVV, and therefore preventive measures such as splenectomy may be considered for its prevention.

Intra-operative Ultrasound-guided Thrombectomy and Thrombolysis for Post-operative Portal Vein Thrombosis in Living Liver Donors.

There are few reports of portal vein thrombosis among living donor liver transplant donors and no published data on the management of this event. In this report, we present our experience in the diagnosis and management of this rare complication in two living donor liver transplantation donors who developed post-operative portal vein thrombosis. Both cases were successfully managed with intra-operative ultrasound-guided thrombectomy, vein patch venoplasty, and catheter-directed thrombolysis. The two donors are symptom-free two years after the event.

Repression of miR-17-5p with elevated expression of E2F-1 and c-MYC in non-metastatic hepatocellular carcinoma and enhancement of cell growth upon reversing this expression pattern.

E2F-1, c-MYC, and miR-17-5p is a triad of two regulatory loops: a negative and a positive loop, where c-MYC induces the expression of E2F-1 that induces the expression of miR-17-5p which in turn reverses the expression of E2F-1 to close the loop. In this study, we investigated this triad for the first time in hepatocellular carcinoma (HCC), where miR-17-5p showed a significant down-regulation in 23 non-metastatic HCC biopsies compared to 10 healthy tissues; however, E2F-1 and c-MYC transcripts were markedly elevated. Forced over-expression of miR-17-5p in HuH-7 cells resulted in enhanced cell proliferation, growth, migration and clonogenicity with concomitant inhibition of E2F-1 and c-MYC transcripts expressions, while antagomirs of miR-17-5p reversed these events. In conclusion, this study revealed a unique pattern of expression for miR-17-5p in non-metastatic HCC patients in contrast to metastatic HCC patients. In addition we show that miR-17-5p is the key player among the triad that tumor growth and spread.

miR-615-5p is restrictedly expressed in cirrhotic and cancerous liver tissues and its overexpression alleviates the tumorigenic effects in hepatocellular carcinoma.

microRNAs aberrant behavior in heptocellular carcinoma (HCC) plays a major role in HCC pathogenesis. miR-615-5p expression has never been evaluated in HCC. We showed that miR-615-5p was preferentially expressed in HCC, cirrhotic liver tissues and HCC cell lines, but undetected in normal livers. Forced miR-615-5p expression in HCC cell lines led to significant decrease in cell growth and migration. In-silico predication revealed insulin-like growth factor-II (IGF-II) as a potential downstream target for miR-615-5p. Forcing the expression of miR-615-5p showed downregulation of IGF-II mRNA, as well as inhibition of the luciferase activity in a luciferase reporter vector harboring the IGF-II-3'UTR target sequence. miR-615-5p acts as tumor-suppressor in HCC through targeting IGF-II.

Chitosan-based Floating Microspheres of Trimetazidin Dihydrochloride; Preparation and In vitro Characterization.

The aim of present study involves preparation and characterization of floating microspheres using trimetazidin dihydrochloride as a model drug to increase the residence time in the stomach without contact with the mucosa, Floating microspheres were prepared by the capillary extrusion technique using chitosan as polymer and sodium lauryl sulphate as cross linking agent. The surface morphology of the prepared microspheres was characterized by the optical microscopic method. The effect of the stirring rate during preparation, polymer concentration and cross linking concentration on the percent yield, in vitro floating behavior, physical state of the incorporated drug, drug loading and in vitro drug release were studied. The prepared microspheres exhibited prolonged drug release (12 h) and remained buoyant for more than 11 h. The microspheres were found to be regular in shape and highly porous. The trimetazidin dihydrochloride release rate was higher in the case of microspheres prepared at a higher agitation speed and decreased with increasing the polymer and cross linking agent concentration. All formulations demonstrated favorable in vitro floating characteristics. The drug entrapment increased from 65.13 to 85.3% with increasing polymer to drug ratio. Diffusion was found to be the main release mechanism. Thus, the prepared floating microspheres may prove to be potential candidates for multiple-unit delivery devices adaptable to any intragastric conditions.