ABSTRACT
OBJECTIVES: In this study, our aim was to determine the role of Guy's stone scoring system (GSS) in the prediction of percutaneous nephrolithotomy (PNL) success and its ability to foresee potential complications in consideration of Clavien grading system (CGS). Material and Methodos: The data of 244 patients who underwent PNL between January 2009 and May 2014 were retrospectively examined. Renal stones were evaluated using GSS with the aid of the patients' preoperative radiological evaluations and their postoperative complications were assessed with CGS. Arch. Esp. Urol. 2015; 68 (9): 710-717 Keywords: Guy's Stone score. Percutaneous nephrolithotomy. Modified Clavien grading system. Stone-free rate. RESULTS: Mean age of the patients (men, n=166; 68% and women, n=78; 32%) was 46.50±13.12 years (range, 16-80yrs). Clinically significant residual stones were not detected in 195 (79.9%) patients, while they were found in 49 (20.1%) patients. Guy's stone scores of 1, 2, 3 and 4 points were estimated in 21.3, 37.7, 29.9, and 11.1% of the cases, respectively. Based on modified Clavien complication grading system, complications were categorized as Clavien grade 1, 2 and 3 in 81.9, 17.2, and 0.8% of the cases, respectively. Clavien Grade 4 and 5 complications were not encountered. A statistically significant correlation was found between Guy's Stone scores and Clavien grades (p < 0.05)- A statiscally and highly significant difference was detected between Guy's Stone scores of the cases with respect to residual stones (p = 0.001; p < 0.01). CONCLUSIONS: Our study findings have revealed that GSS is a successful and easily applicable method for the prediction of success and likelihood of complications of PN
OBJETIVOS: En este estudio nuestro objetivo era determinar el papel de la escala de puntuación STONE de Guy`s (GSS) en la predicción del éxito de la nefrolitotomía percutánea (NLP) y su capacidad de preveer potenciales complicaciones considerando el sistema de gradación de Clavien. MATERIAL Y MÉTODOS: Los datos de 244 pacientes sometidos a NLP entre enero del 2009 y mayo del 2014 fueron evaluados retrospectivamente. Las litiasis renales fueron evaluadas utilizando el GSS con la ayuda de las pruebas radiológicas preoperatorias y las complicaciones postoperatorias se evaluaron con la escala de Clavien. RESULTADOS: La edad media de los pacientes (varones n=166, 68%; y mujeres n=78, 32%) fue 46.50±13.12 años (rango, 16-80 años). En 195 pacientes (79.9%) no se detectaron litiasis residuales clínicamente significativas, mientras que en 49 pacientes (20.1%) sí se encontraron. Con la escala STONE de Guy`s se estimaron puntuaciones de 1,2,3 y 4 puntos en 21.3%, 37.7%, 29.9% y 11.1% de los casos respectivamente. En base a la escala de complicaciones de Clavien modificada las complicaciones fueron categorizadas como Clavien grados 1,2 y 3 en 81.9%, 17.2% y 0.8% de los casos respectivamente. No se encontraron complicaciones de Grado 4 y 5 de Clavien. Se encontró una correlación estadísticamente significativa entre las puntuaciones de la escala STONE de Guy`s y los grados de Clavien (p < 0.02). Se detectó una diferencia estadística y altamente significativa entre las puntuaciones del STONE de Guy`s de los casos con respecto a las de las litiasis residuales (p = 0.001; p < 0.01). CONCLUSIONES: Los hallazgos de nuestro estudio han revelado que la escala Stone de Guy`s es un método exitoso y fácilmente aplicable para la predicción del éxito y la probabilidad de complicaciones de la NLP
Subject(s)
Humans , Male , Female , Weights and Measures , Nephrostomy, Percutaneous/instrumentation , Nephrostomy, Percutaneous/methods , Nephrolithiasis/metabolism , Nephrolithiasis/pathology , Nephrostomy, Percutaneous/standards , Nephrostomy, Percutaneous , Nephrolithiasis/complications , Nephrolithiasis/diagnosis , Retrospective StudiesABSTRACT
The present article overviews the role of bisphosphonates for the treatment and prevention of bone metastases and their antiangiogenic effects and antitumoral activity. The skeleton is a frequent and clinically relevant site of metastasis in cancer patients. The major events related to bone metastases include bone pain, bone loss, hypercalcemia, spinal cord compression, and fractures. On the basis of their radiographic features, bone metastases are classified as osteoblastic, osteoclastic, or mixed. The primary goals of treatment of bone metastases are reduction of the risk of pathological fractures and other skeletal-related events, and pain control. Bisphosphonates are used to prevent pathological fractures by inhibition of osteoclasts. Recent studies suggest that bisphosphonates have some direct antitumoral activity, mainly mediated through the blockade of angiogenic pathways. Further clinical studies are needed to determine the optimal treatment duration, timing and schedule of bisphosphonates, assess their role as adjuvant therapy for the prevention of bone metastases, and establish their antiangiogenic activity in association with standard cytotoxic and hormonal drugs for treatment of patients with advanced disease.
Subject(s)
Antineoplastic Agents/therapeutic use , Bone Neoplasms/drug therapy , Bone Neoplasms/secondary , Diphosphonates/therapeutic use , Alkaline Phosphatase/analysis , Biomarkers, Tumor/analysis , Bone Resorption/metabolism , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Clinical Trials as Topic , Clodronic Acid/therapeutic use , Female , Humans , Ibandronic Acid , Imidazoles/therapeutic use , Male , Pamidronate , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/pathology , Zoledronic AcidABSTRACT
BACKGROUND: Skin tumours represent about 11% of all the malignant neoplasms and their frequency is increasing annually. Skin tumours (melanoma, basal and squamous cell carcinoma, etc.) can be used for a good screening activity, but in relation to breast or cervix uteri cancer needs to be better defined. A test on a population of selected patients against skin malignant neoplasms has been carried out in our Centre. All of them had skin lesions and further checks were necessary. METHODS: The diagnostic protocol used in our Centre for Oncological Prevention uses the collection of anamnestic data and an objective examination. Between 1996 and 2000, 222 patients between the ages of 18 and 80 have been selected. All of them had suspected skin lesions. The patients were selected by the oncologist, particularly for pigmentation, asymmetry, irregular borders and heterogeneous colour of their skin lesions. Subsequently, the patients were sent for a further examination to the dermatologist oncologist, who on the basis of the objective dermatological examination with possible dermatoscopy, made a clinical diagnosis of the skin injuries or suggested surgical removal for the histological control of the same. RESULTS: Requested consultations: 222. Exami-nations made: 195. Patients considered: 190. Skin injuries examined: 190. The following skin lesions were identified: melanoma: 4 (2.1%) [2: I Clark level; 2: II Clark level]; basal cell carcinoma: 14 (7.37%); dermatofibrosarcoma: 1 (0.53%); keratoacanthoma: 1 (0.53%); dysplastic nevus: 4 (2.1%); actinic keratosis: 7 (3.68%); benign lesions: 159 (83.68%). CONCLUSIONS: These data were obtained by a screening program and it is therefore not a random study. This study shows interesting results because tumoral skin lesions and in particular melanoma were recognised at early stages. This is more than enough for us to create a specific screening program for skin lesions to cut down the rate of morbidity and mortality.
