RESUMO
Background: The accuracy of multi-parametric MRI (mpMRI) in the pre-operative staging of prostate cancer (PCa) remains controversial. Objective: The purpose of this study was to evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan quality on diagnostic accuracy. Patients and Methods: We included 124 men who underwent robot-assisted RP (RARP) as part of the NeuroSAFE PROOF study at our centre. Three radiologists retrospectively reviewed mpMRI blinded to RP pathology and assigned a Likert score (1-5) for EPE on each side of the prostate. Each scan was also ascribed a Prostate Imaging Quality (PI-QUAL) score for assessing the quality of the mpMRI scan, where 1 represents the poorest and 5 represents the best diagnostic quality. Outcome measurements and statistical analyses: Diagnostic performance is presented for the binary classification of EPE, including 95% confidence intervals and the area under the receiver operating characteristic curve (AUC). Results: A total of 231 lobes from 121 men (mean age 56.9 years) were evaluated. Of these, 39 men (32.2%), or 43 lobes (18.6%), had EPE. A Likert score ≥3 had a sensitivity (SE), specificity (SP), NPV, and PPV of 90.4%, 52.3%, 96%, and 29.9%, respectively, and the AUC was 0.82 (95% CI: 0.77-0.86). The AUC was 0.76 (95% CI: 0.64-0.88), 0.78 (0.72-0.84), and 0.92 (0.88-0.96) for biparametric scans, PI-QUAL 1-3, and PI-QUAL 4-5 scans, respectively. Conclusions: MRI can be used effectively by genitourinary radiologists to rule out EPE and help inform surgical planning for men undergoing RARP. EPE prediction was more reliable when the MRI scan was (a) multi-parametric and (b) of a higher image quality according to the PI-QUAL scoring system.
RESUMO
AIM: To determine the prevalence of anemia and risk factors that can affect on it six months after kidney transplantation (TX) at the University Hospital Osijek (KBCO) in period from 2007 to March 2012. METHODS: The study included 55 patients, mean age 49 +/- 11 (27 - 70) years, after deceased donor kidney TX in KBCO from 2007 to March 2012. Two grafts did not survive a week (one for sudden death and another for the renal artery thrombosis, in the first 24 hours, respectively). The method of the survey comprised of taking data from the medical records and statistical analysis (SPSS). RESULTS: Posttransplantation anemia (PTA) and is defined by serum hemoglobin (Hb) concentration less than 110 g/l at 3 months after TX. The prevalence of PTA was 28.85%. PTA was more frequent among women (P=0,025). Patients with PTA were significantly longer hospitalized (P=0.002). PTA was more frequent in patients with sepsis after TX (P=0,03), in those with dehiscent postoperative wound (P=0,021) and in the patients with acute kidney transplant rejection (P=0.004). Although delayed graft function was not found significantly related to the PTA, decreased kidney function indicating feature, i.e. number of hemodialysis (HD) needed after TX (P=0.004) and after HD duration (P=0,008), were associated with the PTA significantly. Furthermore, serum creatinine concentration, at the time of hospital release, were significantly higher in those with PTA (P=0.035). There is statistically significant correlation between mean Hb and cratininemia at 3 months after TX. Immunosuppressive drugs and other studied medication, frequently used by kidney transplanted patients, were not related to the PTA. The anemia required crythropoietin substitution in 20 of 53 patients, while 20 patients received blood transfusions. CONCLUSION: PTA presents a great problem among the kidney transplanted patients with prevalence in our patients similar to that in previously published reports. This study had confirmed some of the well known risk factors for anemia in kidney transplant patients, like gender and graft function, but also there had been noticed few risk factors that can be prevented, like dehiscent postoperative wound and sepsis. PTA often requires erythropoietin substitution and blood transfusions, increasing the expenses of kidney transplantation and posttransplantation treatment. Therefore, prevention of PTA is, both medically and economically, justifide.
