Voided urinary cytology in bladder cancer: is it time to review the indications?

OBJECTIVES: The sensitivity of voided urinary cytology has been reported as very low. In this study, we investigated the sensitivity and clinical utility of voided urinary cytology in the detection of various grades and stages of transitional cell carcinoma (TCC) of the bladder compared with the urinary nuclear matrix protein-22 (NMP-22) qualitative assay. METHODS: From March 2004 to April 2006, all patients with TCC of the bladder receiving follow-up care and those presenting with gross hematuria were enrolled in this prospective study. These patients underwent urinary cytologic examination and NMP-22 qualitative assay. The diagnosis, determined from the cystoscopy findings and biopsy findings of the suspicious lesion, was accepted as the reference standard. RESULTS: A total of 196 patients were enrolled in this study, of whom 127 patients had previously been diagnosed with bladder TCC and 69 were presenting for investigation of gross hematuria. A total of 52 cases of bladder TCC were diagnosed. The overall sensitivity of voided urine cytology and NMP-22 assay was 21.1% and 67.3%, respectively (P <0.001). The sensitivity of urinary cytology and urinary NMP-22 for well-differentiated tumors was 9.5% and 52.4%, respectively, and was 18.1% and 77.3%, respectively (P <0.001), in moderately differentiated tumors. The overall specificity of urinary cytology for TCC of the bladder was 98.6% and was greater than the specificity of NMP-22 (80.5%). CONCLUSIONS: The results of our study suggest that urinary cytology has a very low sensitivity and can be omitted in favor of NMP-22 in the follow-up of low-grade superficial bladder TCC.

Renal Transplantation - An Experience of 500 Patients.

BACKGROUND: Renal transplantation is the treatment modality of choice for patients with end stage kidney failure. We present our experience of graft and patient survival of initial 500 renal transplants performed between May 1991 and July 2006, at Army Hospital (R&R). MATERIAL AND METHODS: All patients received triple drug immunosuppression with cyclosporine/tacrolimus, azathioprine/ mycophenolate mofetil and steroids. Patients in high risk group received induction therapy with IL-2 receptor blockers/anti-thymocyte globulin. RESULTS: Majority of the recipients (79%) were males, whereas majority of the donors (59.4%) were females. In the donor profile, 385 (77%) transplants were live related, 108 (21.6 %) were spousal and 7 (1.4%) were cadaveric transplants. Mean age of the donors and recipients was 42.11 ± 11.53 years (range 19-72 years) and 33 ± 9.39 years (range 5-60 years) respectively. Eighty two patients (16.4%) were lost to follow up and the present data on rejections, patients and graft survival pertains to 418 patients. These patients have been followed up for a mean period of 2.63 years (SE, 0.122; median 1.8 years; range 0-13.36 years). Acute rejection episodes occurred in 115 (27.3%) patients and 95% of these could be reversed with steroids/ATG. Sixty eight patients (16%) have died on follow-up. Our one-year, 5 year and 10 year estimated graft survival is 95.4% (SE, 0.01), 80.5% (SE, 0.03) and 53.1% (SE, 0.09) respectively and patient survival at one year is 93.2% (SE, 0.01). The estimated graft and patient survival in our series is 9.83 (95% CI, 8.92-10.73) and 9.80 (8.93-10.67) years respectively. CONCLUSION: This centre's short-term graft survival of 95.4% is comparable to the best centres of the world.

Urological complications of live related donor renal transplantation: 13 years' experience at a single center.

BACKGROUND: This study is a retrospective analysis of urological complications and their treatment in our series of live-donor renal transplantation. MATERIAL AND METHODS: The series comprised of 500 patients. All underwent extravesical ureteroneocystostomy and all except a few initial patients were stented. RESULTS: There were 92 complications in 82 patients (18.4%). Urinary leakage occurred in 1.2%. There were no intrinsic ureteric obstructions. Extrinsic ureteric obstruction occurred in 0.8% of cases. The incidence of UTI was 15.4% and of urethral strictures 1%. CONCLUSION: The technique of stented extravesical ureteroneocystomy has led to an extremely low rate of urological complications in our series, over a long time and in a substantial number of patients.

Intravesical Explosion during Transurethral Resection of Prostate - a reminder.

Intravesical explosion during transurethral resection of the prostate (TURP) is an extremely rare but dreaded complication and results in rupture of the bladder. It is believed that intravesical explosion occurs due to formation of explosive gases in the bladder during TURP and its admixture with air. A case of intravesical explosion during TURP resulting in bladder rupture at our institution is described. Though the management of this catastrophe is relatively straightforward, it has the potential for dire consequences. We emphasize that, despite its rare occurrence, it is preventable and suggest measures to avoid it.

Dispelling inhibition for laparoscopic surgery in younger children with Cushing's syndrome. Case report and literature review.

Laparoscopic adrenalectomy (LA) is now the gold standard for the treatment of small, benign adrenal tumors in adults. In Cushing's syndrome (CS), LA is difficult and seldom done, especially in younger children. A 6-year-old girl was diagnosed with CS due to a juxtaadrenal tumor. She underwent LA and made an uneventful recovery. The histopathology was reported as paraganglioma which is a very rare cause of CS. LA is seldom done in younger children with CS owing to extreme obesity, abundant perinephric fat and a high incidence of pre- and postoperative complications.

Assessing the efficiency of extracorporeal shockwave lithotripsy for stones in renal units with impaired function: a prospective controlled study.

The objective was to determine the efficiency of extracorporeal shockwave lithotripsy (ESWL) in clearing stones from renal units with impaired function. Thirty-five patients with poorly functioning kidneys determined by intravenous urogram and 99mtechnetium diethylene triamine pentacetic acid renal dynamic scan underwent ESWL. Stone clearance was assessed at 3 months and compared with that in normally functioning kidneys. The study group was divided into two subgroups. Those with split glomerular filtration rate (GFR) of the concerned kidney between 10 and 20 ml/min were in group 1. Group 2 consisted of patients with split GFR between 20 and 30 ml/min. A control group (group 3) was formed from patients with urolithiasis and normally functioning kidneys. The overall retreatment rate was 84.4%. The overall stone clearance rate in the study group was 34.2% while it was 57.7% in the control group. The stone clearance rate in group 2 was 40%. The difference in stone clearance rate between the study and control groups was statistically significant (P=0.023) but that between group 2 and the control group was not (P=0.159). The incidence of steinstrasse between the study group 2 and control group was not statistically significant (P=0.408). The clearance rate for ureteral stones was comparable in all the three groups. The stone-free rate and rate of steinstrasse for renal stones in kidneys with moderately impaired function were comparable to normally functioning kidneys. However, kidneys with severely impaired function had poor results. The clearance rate for ureteral stones was not influenced by the impairment of renal function.

A Comparative Study of Laparoscopic with Conventional Open Donor Nephrectomy in Renal Transplantation.

BACKGROUND: Laparoscopic donor nephrectomy (LDN) has been gaining popularity among kidney donors. There have been concerns about the safety and efficacy of the procedure as compared to open donor nephrectomy (ODN). We compare our results on LDN with ODN. METHODS: We retrospectively analysed our data of LDN and ODN. Duration of surgery, blood loss, period of hospitalisation, per oral intake and analgesic requirements. RESULT: 22 LDNs were done, the operation time ranged from 220-300 minutes, and blood loss from 100-150ml. In the first 10 laparoscopic operations four cases required conversion to open surgical dissection. Only one case was converted to open surgery in the subsequent 12 laparoscopic cases. Oral intake was started on the first postoperative day. Analgesic requirement in laparoscopy cases was less. Patients were mobilised on the first day after surgery. Patients were discharged by seventh day. There was no significant difference in the functioning of the graft after revascularisation in the recipient. CONCLUSION: Laparoscopic donor nephrectomy is a safe and effective technique of donor nephrectomy.

Experience with marginal living related kidney donors: are they becoming routine or are there still any doubts?

OBJECTIVES: To analyze donor and recipient outcome of grafts from marginal kidney donors (ie, elderly or suffering from some anomaly). METHODS: We had 81 marginal donors from July 1996 to July 2004; 46 were older than 60 years, and 39 had renal or nonrenal anomaly. The donors and recipients were evaluated for morbidity, graft and recipient survival, and the number of rejection episodes. RESULTS: The mean (+/- standard deviation) age of elderly donors was 62.2 +/- 3.1 years. Follow-up ranged from 6 months to 50 months (mean 21.15 +/- 0.9 months). Actuarial 1-year and 3-year graft survival rates were 95% and 81%, respectively. Twenty-six percent of recipients maintained serum creatinine levels less than 1.4 mg/dL. The mean age of hypertensive donors was 46.2 years, and blood pressure was controlled with one drug. Serum creatinine levels in the recipients were less than 1.4 mg/dL in 10 and less than 2.5 mg/dL in the rest. Eleven percent of hypertensive donors required an increase in their antihypertensive medication. All donors showed a 15% to 20% increase in their glomerular filtration rate. Donors underwent simultaneous surgery when indicated. CONCLUSIONS: Criteria to reject donors need to be reviewed periodically. The elderly and donors with other anomalies are consistently showing acceptable results. Hypertensive donors require assessment with awake ambulatory blood pressure monitoring.

Genetic variability in triticale x bread wheat derivatives under normal and phosphorus stress regimes.

Twenty six hexaploid triticale (X Triticosecale Wittmack) X bread wheat (Triticum aestivum L. em Thell) derivatives, along with 2 bread wheat and 2 triticale checks, were grown in normal and P-stress environments. Spikes/plant and grain yield/plant, followed by peduncle length, Were the most sensitive to phosphorus deficiency, which also caused a delay in heading and maturity. The heritability and genetic advance for grain yield/plant were high in the stress environment, reflecting the effectiveness of direct selection. The 1000-grain weight, grains/spike and plant height were the important traits for phenotypic selections in both the environments.

Comparative performance of bread wheat and hexaploid triticale cytoplasms.

Thirteen wheat-like advanced-generation triticale x wheat derivatives, having tetraploid wheat cytoplasm from triticale, were reciprocally crossed with three improved bread wheats, and the resulting F1s were evaluated for determining the comparative performance of the bread wheat and triticale cytoplasms for different traits. Significant reciprocal differences in the mean performance were observed for days to heading, days to maturity, spikes/plant, flag-leaf area, peduncle length, plant height, spike length, grains/spike, 1,000-grain weight, grain yield and grain protein content, and most of them were in favour of hexaploid wheat cytoplasm. However, this superiority of the hexaploid cytoplasm was not universal for a particular trait, implying that the differences in the performance of the evaluated reciprocal crosses depended not solely on the cytoplasmic background, but also on the interplay of the specific genotype with the cytoplasm.

Transport of amino acids in gamma-glutamyl transpeptidase-implanted human erythrocytes.

gamma-Glutamyl transpeptidase purified from hog kidney cortex was implanted in the human erythrocyte membrane by incubation of erythrocytes at 37 degrees c with gamma-glutamyl transpeptidase-incorporated dipalmitoyl phosphatidylcholine vesicles. Membranes prepared from these implanted cells exhibited 4- to 5-fold increase in gamma-glutamyl transpeptidase activity. The association/insertion of gamma-glutamyl transpeptidase into erythrocyte membrane was further demonstrated by antibody to gamma-glutamyl transpeptidase. Implantation of gamma-glutamyl transpeptidase into erythrocyte membrane led to stimulation of uptake of glutamate and alanine, which are normally transported at a slow rate in human erythrocytes. The uptake of these amino acids in the implanted system was inhibited by inhibitors (serine-borate and azaserine) of transpeptidase activity as well as by antibody to gamma-glutamyl transpeptidase. These results in the implanted human erythrocytes demonstrate that gamma-glutamyl transpeptidase enzyme can mediate the translocation of amino acids and provide further evidence in support of its postulated role in the transport of amino acids in natural membranes.