Urinary tract infections in complicated kidney stones: Can they be correlated with Guy's stone score?

OBJECTIVE: To ascertain the existence of a connection between Guy's stone score and infectious complications after percutaneous nephrolitholapaxy. METHODS: The retrospective cohort, multi-centre study was conducted in the urology departments of Prof Dr Theodor Burghele Clinical Hospital and C.I. Parhon Clinical Hospital, Romania, and included data of patients who underwent percutaneous nephrolitholapaxy from January 1, 2017, to December 31, 2019. Based on urography, the subjects were assigned to four groups, from GSS1 to GSS4, in accordance with the Guy's stone score classification. The complication rate after percutaneous nephrolitholapaxy was classified using the modified Clavien staging classification. Demographics, preoperative urine cultures, and the rate of complications were compared. Data was analysed using SPSS 24. RESULTS: Of the 246 patients, 116(47.2%) were males and 130(52.8%) were females. The overall mean age was 53.06±13.04 years (range: 18-83). The mean Guy's stone score was 1.82±0.9. The rate of percutaneous nephrolitholapaxy success was 160(65.04%). There were 105(42.68%) patients in GSS1 group, 63(25.60%) in GSS2, 24(9.75%) in GSS3 and 54(21.95%) in GSS4. There were significantly more preoperative positive urine culture in GSS3 and GSS4 groups compared to GSS1 and GSS2 groups (p<0.05). The rates of complications were statistically different among the groups (p=0.019). CONCLUSIONS: Urinary tract infections were found more frequently in patients with higher Guy's stone scores compared to those with low scores. The Guy's stone score classification were found to be a useful tool in predicting the immediate success rate of percutaneous nephrolitholapaxy.

Preoperative C-reactive protein is related with renal cell tumor dimension? Preliminary results.

INTRODUCTION: Renal tumors do not benefit from an unanimously accepted tumor marker. We tried to evaluate the advantages of preoperative C-reactive protein (CRP) values and monitor the dynamic of CRP values from the perspective of the evolution of patients diagnosed with Grawitz tumors. PATIENTS, MATERIALS AND METHODS: We researched the medical records of patients with renal parenchymal tumors admitted to the Urological Clinic in Iasi, Romania, between 01.01.2018 and 01.08.2022. Data were collected regarding age, environment, comorbidities, paraclinical data, tumor characteristics, and treatment performed. Ninety-six patients were included. The data on the inflammatory syndrome pre- and postoperatively were evaluated comparatively. All patients were diagnosed with clear cell renal cell carcinoma (RCC). RESULTS: We found that the renal tumor dimension correlates with an increased preoperative CRP level. For other variables, the correlations regarding age, sex, tumor, node, metastasis (TNM) stage, and size in relation to the increase or decrease of CRP had no statistical significance. CONCLUSIONS: The analysis of preoperative CRP and CRP dynamics could predict the tumor's aggressiveness and the treatment's effectiveness. A clear association between CRP levels and RCC pathogenesis is not yet defined, thus, further studies are necessary.

Rectal Neuroendocrine Tumour with an Aggressive Behaviour.

Neuroendocrine tumors are rare epithelial neoplasms with the specific biological characteristics which can make the diagnosis and treatment questionable, and, which in general, have a good prognosis. In recent decades, the incidence of rectal neuroendocrine tumors has increased due to the accessibility of colonoscopy and the introduction of screening programs for colorectal tumors. We present the case of a 55-year-old patient who presented for rectal bleeding started 6 months before. At the moment of the hospital admission, the general state of the patient was good, and the clinical and paraclinical examination confirmed the diagnosis of stage IV rectal tumor. The pathology examination could not distinguish between a non-differentiated carcinoma and a neuroendocrine tumor. The diagnosis of Rectal neuroendocrine tumor with an aggressive behaviour was established via immunohistochemistry (ki 67 index of 75-80%, G3 grading). Due to the high aggressiveness of the tumor, the patient had a rapid evolution towards a severe state and the onset of liver failure did not allow the systemic anti-tumor treatment. In conclusion, we can state that in the case of rectal neuroendocrine tumors, the stage of the disease and the ki67 index have an important prognostic value, and it is crucial for both the diagnosis and tumor aggressiveness to have an immunohistochemical examination. Even though, in general, they are small well-differentiated tumors with a rather good prognosis, there are forms with tumors of greater dimensions and with metastases and severe prognosis.

Correlations between stones composition, dietary and comorbidities context of the lithiasic patient.

The incidence of nephrolithiasis is in full expansion, its etiology being frequently associated with lifestyle changes. The objective of this retrospective study, carried out between April and December 2019, was to identify the correlations of the known lithogenic factors with the chemical structure of the calculi in the patients from the North-Eastern region of Romania. The results obtained after the data analysis of our LAMPA questionnaire (L - liquids, A - antecedents, M - medication, P - associated pathologies, A - aliments) made in evidence a statistically relevant relationship between the heredocollateral history of lithiasis and calcium oxalate dihydrate (COD) calculi, hypertension and calcium oxalate monohydrate (COM) stones, uric lithiasis and diabetes, COD, and obesity, between predominantly uric lithiasis and meat or meat-derived products consumption, between frequent potato consumption and COD stones and the frequently consume of dairy products and predominantly COM calculi. The authors concluded that the use of a complex questionnaire, like LAMPA, together with Fourier-transform infrared (FTIR) spectroscopic and morphological analysis are essential steps for developing an efficient metaphylaxis.

A Rare Case of a Testicular Teratoma Associated with a Neuroendocrine Tumour.

Introduction: We report a rare case of testicular teratoma combined with a neuroendocrine tumour, emphasizing the difficulty of the following aspects: the clinical and laboratory diagnosis, the treatment options and the evolution of patients suffering from this disease. Case presentation: The patients with testicular neuroendocrine tumours represent a rarity, considering that as of 2017, only 22 cases had been reported in the literature. The case operated on in our clinic presents an association between a testicular teratoma and a neuroendocrine tumour. A 39-year-old patient was admitted in our Department for a non-painful abdominal tumour and concomitant testicular tumour. The serum tumour markers (-human chorionic gonadotropin, -phetoprotein and lactate dehydrogenase) were within normal limits. Lung and bone metastases were diagnosed CT scan. The histopathological diagnosis consisted of immunohistochemical study of the orchidectomy specimen as well as of the bioptic material from bone marrow puncture. Conclusions: The diagnosis of testicular carcinoids is based on immunohistochemistry study. Radical orchidectomy is the only potentially curative treatment for this type of malignancy. Adjuvant chemotherapy determined size reduction of the lung and bone metastases and the disappearance of the lymph node metastases.