Staged treatment for substantial bilateral calcium carbonate nephrolithiasis in vegan patient.

Calcium carbonate (CaCO3), or calcite, stones average 0.15% of annual nephrolithiasis cases. The authors report a 53 year old female, following a 15 year vegan diet, presenting with left flank pain and later found to have bilateral extensive staghorn renal calculi requiring multiple procedures over the course of months. Calcite stone formation is likely attributed to the patient's vegan diet and vitamin supplements. This stone's formation increases with neutral or alkaline urinary pH in the presence of high levels of magnesium. The authors discuss staged surgical treatment plans and non-surgical management prophylaxis with surgery as another possible route for treatment.

Sclerosing lipogranuloma of the testis.

Sclerosing lipogranuloma is an uncommon, benign condition that can affect several organs, particularly of the genitourinary system in males. We describe a patient who presented with an intratesticular mass on physical examination. Pathologic evaluation confirmed the diagnosis of testicular sclerosing lipogranuloma. Most case reports involve self-injection with a foreign substance that is pathognomonic. Treatment is often conservative after establishing the diagnosis.

Clinical predictors of androgen-independent prostate cancer and survival in the prostate-specific antigen era.

OBJECTIVES: To further characterize and identify novel predictors of androgen-independent prostate cancer (AIPC) and survival in the prostate-specific antigen (PSA) era. METHODS: A total of 184 consecutive patients with prostate cancer receiving chronic androgen suppression were assessed for the development of AIPC and overall survival. RESULTS: The median time to development of AIPC was 44 months (Stage M+ = 24 months; Stage M0 = 63 months, P = 0.000001). The 10-year overall survival rate for Stage M0 or M+ disease was 89% and 55%, respectively. AIPC developed significantly more commonly in patients with a higher nadir PSA level (greater than 1 ng/dL), a longer time to reach nadir PSA (greater than 3 months), a larger body mass index (greater than 27 kg/m2), greater pretherapy PSA level, and when evidence of metastatic disease was identified (logistic regression analysis). Overall survival was significantly associated with advanced stage (skeletal metastases), pretreatment PSA level, and history of skeletal fracture (multivariate Cox regression analysis). CONCLUSIONS: In the PSA era, longer intervals of androgen suppression therapy in nonmetastatic, biochemically recurrent prostate cancer have translated into a change in the duration of androgen-dependent prostate cancer. Although the duration of androgen dependence remains variable, prolonged--possibly "curative"--control exists in a subset of patients. Obese men developed AIPC significantly sooner than did slender men. A skeletal fracture was a significant negative predictor of overall survival. These observations form the basis for nomogram predictions of AIPC in the PSA era.