Effective radiation exposure in evaluation and follow-up of patients with urolithiasis.

OBJECTIVE: To quantify the effective radiation dose associated with the evaluation and follow-up of patients with urolithiasis. METHODS: Retrospective review was performed for consecutive patients presenting to a tertiary stone clinic with acute stone episodes between November 2007 and December 2008, and had at least 2 years of follow-up. Number and modality of imaging studies were collected. Effective radiation exposure (ERE) doses were calculated from the dose length product values reported with each computed tomography (CT) scan. RESULTS: There were 72 males and 32 females with a mean age of 49 years (range 21-78). Patients underwent an average 1.8 (range 0-5) and 0.7 (range 0-2) plain radiographs, 0.82 (range 0-4) and 0.15 (range 0-2) CTs, 0.09 (range 0-1) and 0.03 (range 0-1) intravenous urograms, and 0.3 (range 0-1) and 0.6 (range 0-2) ultrasounds (US) during the first and second years, respectively (all P<.05). The average calculated ERE dose per CT scan was 23.16 mSv (range 4.94-72.77). The calculated mean ERE dose per patient significantly decreased from 29.29 mSv (range 1.7-77.27) in the first year to 8.04 mSv (range 1.4-24.72) in the second year (P<.01). This was because of significantly fewer CT scans and significantly more US imaging during the second year (P<.05). Although 18 (17.3%) patients exceeded 50 mSv during the first year, none exceeded this threshold during the second year. The mean ERE dose did not correlate with stone location, patient age, and sex. CONCLUSION: The calculated mean ERE dose significantly decreased during the second year of follow-up in patients with urolithiasis because of significantly higher use of US.

Delay in the surgical treatment of bladder cancer and survival: systematic review of the literature.

OBJECTIVES: Eighty per cent of the newly diagnosed invasive bladder tumours are invasive from the outset. Half of these patients already have occult distant metastases reflecting the rapid nature of progression. The aim of the current study was to review the literature to determine if delay in cystectomy leads to worse prognosis and to determine if a possible cutoff point for delay exists, after which a worse outcome would be expected. METHODS: We performed a systematic review of publications indexed in Medline and other scientific databases by analyzing types and causes of delay in performing radical cystectomy. Information on the impact of such delays on tumour recurrence and survival was collected and summarized. Papers that described only delay without any outcome correlation were excluded from the study. RESULTS: A total of 13 papers published from 1965 to 2006 were included in this study. Three (23%) papers did not find any correlation between pretreatment delays and survival. Two (15%) papers reported a trend towards worse survival with delay. Eight (62%) papers documented significant association between delay and worse prognosis. Delay influenced survival as an independent variable in two (25%) of these eight papers. In the remaining six (75%) manuscripts, delay was significantly associated with a higher pathologic stage. CONCLUSIONS: Although studies on bladder cancer failed to show a linear relationship between delay and prognosis, the majority confirmed that delays are associated with worse outcome. Studies suggested a window of opportunity of less than 12 weeks from diagnosis of invasive disease to radical cystectomy.

Chemokine and receptor-gene expression during early and late acute rejection episodes in human cardiac allografts.

BACKGROUND: The expression levels of several chemokine genes in heart allografts correlate with histologic rejection grade. Potential molecular differences between early and late rejection (grade > or =2) episodes were examined by testing chemokine and receptor-gene expression. METHODS: Expression of inducible protein (IP)-10, monokine induced by IFN-gamma (Mig), interferon inducible-T cell alpha chemoattractant (I-TAC), regulated on activation normal T-cell expressed and secreted(RANTES), and their receptors CXCR3 and CCR5 was tested in 60 endomyocardial biopsies from 24 patients using quantitative (Taqman) real-time polymerase chain reaction (PCR). The biopsies were taken in the first 3 months or from the 9th to the 12th month following transplantation. RESULTS: IP-10, Mig, RANTES, CXCR3, and CCR5 expression levels were increased in the later versus earlier biopsies (P< or =0.01) despite no change in histologic rejection-grade status. CONCLUSION These results demonstrate significantly increased expression of T-cell chemoattractants in heart allografts during later rejection when compared with episodes occurring shortly after transplantation. The findings suggest increased intensity of inflammation in rejection occurring at later times posttransplant that are revealed by molecular analyses of the graft.

Chemokine and chemokine receptor gene expression indicates acute rejection of human cardiac transplants.

BACKGROUND: Factors directing T-cell infiltration into allografts during acute rejection remain poorly defined. Chemokines have been shown to mediate leukocyte recruitment into allografts in animal models of rejection. The goal of this study was to test the presence and levels of chemokine and receptor gene expression in serial endomyocardial biopsy specimens from heart transplant patients and to correlate the levels observed with histopathologic rejection grade. METHODS: Three hundred sixteen serial endomyocardial biopsy specimens from 30 heart transplant patients were obtained during the clinically scheduled surveillance heart biopsy program. The follow-up period was 1 year. The expression of interferon (IFN)-gamma inducible protein (IP)-10, monokine induced by IFN-gamma (Mig), interferon-inducible T-cell alpha chemoattractant (I-TAC), regulated on activation normal T-cell expressed and secreted (RANTES), monocyte chemotactic protein (MCP)-1, interleukin (IL)-8, and the receptors CXCR3 and CCR5 were tested using quantitative, real-time polymerase chain reaction. Biopsy samples were examined histologically to assign rejection grade. RESULTS: Expression of IP-10, Mig, I-TAC, RANTES, CXCR3, and CCR5, but not MCP-1 and IL-8, increased significantly in both grade 2 and grade 3 rejection (P

Chemokines: directing leukocyte infiltration into allografts.

Chemokines have been shown to play a critical role in the recruitment of leukocytes to transplanted organs. Animal models and clinical studies have demonstrated predictable temporal and spatial correlations between chemokine production and leukocyte infiltration into allografts. Antagonism of chemokines or chemokine receptors has been shown to delay leukocyte infiltration and prolong graft function, demonstrating an important role for chemokines in allograft rejection.