A comparison of the metabolic profiles of diabetic and non-diabetic uric acid stone formers.

INTRODUCTION: The aim of this study was to compare the metabolic profiles of diabetic and non-diabetic patients with uric acid stones to understand whether preventive strategies should be tailored to reflect different causative factors. METHODS: The results of the metabolic evaluation of patients with uric acid stones identified prospectively from the Metabolic Stone Clinic at St. Joseph's Hospital, London, Canada were reviewed. Information included patients' clinical histories, 24 hour urine collections, blood chemistry and stone analysis. RESULTS: Complete data were obtained from 68 patients with uric acid stones. Twenty-two patients had diabetes. There were no statistically significant differences in mean age, body mass index, or history of gout. Among diabetics, pure uric acid stones were identified in 14 patients (63%) and mixed uric acid in 8 (36%). Pure uric acid stones were more common in the diabetic cohort (63% vs. 46%, p = 0.16). Urine pH, serum and urine uric acid levels and 24-hour urine volumes were similar in both groups. The diabetic group had an increased average oxalate excretion (424 µmol/d vs. 324 µmol/d, p = 0.003). CONCLUSION: The exact etiological basis for the higher oxalate excretion in diabetic uric acid stone formers is unclear. Whether this is a metabolic feature of diabetes, due to dietary indiscretion or the iatrogenic consequence of dietary advice requires further investigation.

Dong Quai (angelica sinensis) in the treatment of hot flashes for men on androgen deprivation therapy: results of a randomized double-blind placebo controlled trial.

OBJECTIVE: To determine whether Dong Quai, a Chinese herbal compound purported to be efficacious in treating menopausal vasomotor symptoms, has a therapeutic benefit in treating hot flashes among prostate cancer patients receiving androgen deprivation therapy. METHODS: A randomized double-blind placebo controlled trial was conducted involving 22 men receiving luteinizing hormone-releasing hormone agonist therapy for prostate cancer with bothersome hot flashes. After recording a baseline log of the frequency, duration and severity of daily hot flashes, patients were randomly assigned in a 1:1 ratio to receive daily placebo or Dong Quai for 3 months. Vasomotor and adverse events were recorded daily. Blood work including serum prostate-specific antigen (PSA), international normalized ratio of prothrombin time and partial thromoboplastin time were recorded at baseline and at the termination of the study. RESULTS: Seventeen of the 22 patients enrolled completed the trial. Baseline vasomotor duration and severity were equivalent between the groups, however the number of hot flashes were significantly more in the Dong Quai group (p = 0.02). With respect to the change in number of hot flashes per day, there was a slight decrease in the mean number among the Dong Quai group which was insignificant. The absolute change and average percentage change in perceived hot flash severity was similar in both groups. There was no significant decrease in the duration of the hot flashes between the 2 groups. Disease progression based on either PSA increase or change in digital rectal exam was not observed in any patient. CONCLUSION: In this small pilot study, there were no significant differences in the severity, frequency or duration of hot flashes among men receiving placebo or Dong Quai.

Effect of prostate gland size on the learning curve for robot-assisted laparoscopic radical prostatectomy: does size matter initially?

BACKGROUND AND PURPOSE: Widespread introduction of robot-assisted laparoscopic radical prostatectomy (RALRP) has led to multiple surgeons going through the learning curve (LC). One of the recommendations for surgeons on the LC for RALRP is to choose patients with smaller glands. We evaluated our LCs to determine whether prostate size influenced intraoperative outcomes and positive surgical margin rates. PATIENTS AND METHODS: Data were obtained from a prospective database for the first 154 cases of RALRP performed by a single surgeon. Patients were divided into three groups based on prostate volume (PV): <40 cc (group 1), 40 to 60 cc (group 2), or >60 cc (group 3). PV was estimated by preoperative transrectal ultrasonography (TRUS) and correlated with pathologic weight (PW). Perioperative and immediate postoperative outcomes were evaluated. RESULTS: A statistically significant difference in total operative times between the groups (206 minutes vs 201 minutes vs 233 minutes for groups 1, 2, and 3, respectively) was noted. With regard to individual intraoperative steps, the bladder neck reconstruction and anastomosis time was longer in group 3. No other statistically significant differences were noted. The Pearson correlation coefficient between PV estimation by TRUS and PW was r = 0.785, and an additional analysis based on PW supports the results of our study. CONCLUSIONS: Prostate size influenced total operative times and the bladder neck reconstruction and anastomosis time. Our data support the use of preoperative TRUS to estimate PV and recommendations for surgeons starting on their LC to choose glands less than 60 cc.

Botulinum toxin for masseter hypertrophy.

BACKGROUND: Benign masseter muscle hypertrophy is an uncommon clinical phenomenon of uncertain aetiology which is characterised by a soft swelling near the angle of the mandible. The swelling may on occasion be associated with facial pain and can be prominent enough to be considered cosmetically disfiguring. Varying degrees of success have been reported for some of the treatment options for masseter hypertrophy, which range from simple pharmacotherapy to more invasive surgical reduction. Injection of botulinum toxin type A into the masseter muscle is generally considered a less invasive modality and has been advocated for cosmetic sculpting of the lower face. Botulinum toxin type A is a powerful neurotoxin which is produced by the anaerobic organism Clostridium botulinum and when injected into a muscle causes interference with the neurotransmitter mechanism producing selective paralysis and subsequent atrophy of the muscle. OBJECTIVES: To assess the effects of botulinum toxin type A in the management of benign bilateral masseter hypertrophy. SEARCH STRATEGY: We searched the following databases in August 2008: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, issue 3); MEDLINE (via PubMed) (1950 to August 2008); EMBASE (via embase.com) (1980 to August 2008); and LILACS via BIREME. We searched two bibliographic databases of regional journals which may be expected to contain relevant trials (IndMED and Iranmedex) using free text terms appropriate for this review. SELECTION CRITERIA: Randomised controlled clinical trials (RCTs) and controlled clinical trials (CCTs) comparing intra-masseteric injections of botulinum toxin versus placebo administered for cosmetic facial sculpting in individuals of any age with bilateral benign masseter hypertrophy, which had been self-evaluated and confirmed by clinical and radiological examination. We excluded participants with unilateral or compensatory contralateral masseter hypertrophy resulting from head and neck radiotherapy. DATA COLLECTION AND ANALYSIS: Two review authors conducted screening of studies in duplicate and independently, and although no eligible trials were identified, the two authors had planned to extract data independently and assess trial quality using standard Cochrane Collaboration methodologies. MAIN RESULTS: We retrieved 167 references to studies, none of which matched the inclusion criteria for this review and all of which were excluded. AUTHORS' CONCLUSIONS: We were unable to identify any randomised controlled trials on the efficacy of intra-masseteric injections of botulinum toxin for people with bilateral benign masseter hypertrophy. The absence of high level evidence for the effectiveness of this intervention emphasises the need for well-designed, adequately powered, randomised controlled clinical trials (RCTs) and controlled clinical trials (CCTs).

Simultaneous renal cell carcinoma of the kidney and transitional cell carcinoma of the bladder.

Herein we report a rare combination of two urological tumors simultaneously: renal cell carcinoma of the kidney and transitional cell carcinoma of the bladder. A 67 year old male presented with hematuria. He was diagnosed with left renal cell carcinoma and transitional cell carcinoma of the bladder. Subsequently this patient underwent left nephrectomy (palliative) to control the pain and transurethral resection of bladder tumor. The clinical picture, radiographic and histological finding are presented, as well as the treatment offered.