Bilateral emphysematous pyelitis: a rare encounter in urology.

Gas-forming infection of the kidneys can affect either the parenchyma or the collecting system. They are known as emphysematous pyelonephritis (EPN) and emphysematous pyelitis (EP) respectively. Bilateral EPN is a fairly established entity and numerous articles about this condition have been published. However, much less is known about bilateral EP. We report a rare case of bilateral EP and a literature review of this disease. A 66-year-old woman with long-standing bilateral staghorn calculi presented with bilateral EP and severe sepsis. She was treated with antibiotics and bilateral double-J stents to drain the upper urinary tracts. She recovered after 1 month of intensive care and medical therapy. Percutaneous nephrolithotomy (PCNL) had been scheduled to treat her staghorn calculi. A literature search on MEDLINE and Google Scholar with the terms "bilateral emphysematous pyelitis" only found 1 case report in English and another 2 reports in the Korean language that discussed bilateral EP. The collective experience of these few cases, including the present case, suggests that bilateral EP runs a more benign course than bilateral EPN. It should be diagnosed as soon as possible with computed tomography (CT) scans of the renal system. Current evidence shows that can be treated successfully with timely antibiotics. Drainage of the collecting system either percutaneously or with placement of double-J stents might facilitate recovery.

Reduced ADP-ribosylation by PARP1 natural polymorphism V762A and by PARP1 inhibitors enhance Hepatitis B virus replication.

HepG2 and Huh7 cell lines are frequently used as models to study viral hepatitis and hepatocellular carcinoma. However, they exhibit significantly different capacities in their ability to support hepatitis B virus (HBV) replication. To investigate the basis for this, transcription factor-binding motifs at the HBV core promoter (HBVCP) were tested in luciferase reporter constructs to identify the possible role of host factors. Among the transcription factors screened: PARP1, SP1, HNF4α, HNF3, hB1F and HNF1, deletion of the PARP1 binding motif abrogated transcriptional activity at the HBVCP in HepG2 but not Huh7 cells. Sequencing of the PARP1 gene revealed that HepG2 cells carried an Ala762 allele which has low ADP-ribosylation activity, which was shown to have increased PARP1 binding affinity to its cognate motif thus resulting in higher transcriptional activity. PARP1 inhibitors that are being developed as broad cancer therapeutics also target PARP1 ADP-ribosylation enzymatic function. Four PARP1 inhibitors: PJ-34, ABT888, AZD2281 and AG014699 were tested for their effect on HBV replication. All four small molecules effectively enhanced HBV replication in vitro, confirming the role of PARP1 in HBV replication and that alteration of ADP-ribosylation by mutation or drugs can affect HBV replication. Our data demonstrate that natural polymorphisms in the host affecting proteins such as PARP1 can have a significant effect on HBV replication. Hence, patients who are infected with HBV and are on clinical trials involving PARP1 inhibitors may be at risk from unintended side-effects such as exacerbation of HBV replication.

An unusual cause of a penetrating injury to the anterior urethra: a thorny situation.

Concurrent penetrating injury to the male external genitalia and the anterior urethra is uncommon. This case illustrates an unusual cause of such an injury, and its subsequent management and outcome. A 69-year-old man had his scrotum and anterior urethra pierced by a long thorn when he fell in his farm. He presented with urine leakage from the scrotal wound each time he micturated. Cystoscopic examination confirmed the cause and extent of the injury, and also facilitated the extraction of the thorn. The injury was allowed time to heal by urinary diversion with a urinary catheter. There were no stricture or fistula formations and the patient remained symptom-free at 3 months follow-up. Careful cystoscopic examination was both diagnostic and therapeutic in this case. A conservative approach is a feasible option in the management of selected cases of penetrating anterior urethral injury.

Evaluation of power Doppler ultrasonography for prostate biopsy in men with elevated serum prostate specific antigen levels.

OBJECTIVES: To evaluate power doppler ultrasonography (PDU)-directed prostate biopsy in patients with elevated serum prostate specific antigen (PSA) levels. MATERIALS AND METHODS: Men with serum total PSA levels of more than 4 ng/ml undergoing biopsy for the first time were included. Grey-scale transrectal ultrasound (TRUS) and PDU were performed. PDU signal on vascularity accumulation and perfusion characteristics were recorded and graded as normal or abnormal in the peripheral zone of the prostate. Abnormalities were defined on transverse image as radial or arc hypervascularities. A biopsy regime based on Vienna-normogram was performed in all patients. RESULTS: Overall, prostate adenocarcinoma detection rate was 21.4% and abnormal accumulation on PDU signal was identified in 96.7% of those patients (p = 0.01). PDU directed prostate biopsies were positive in 66.7% of the patients with prostate cancer. The sensitivity, specificity, positive predictive value and negative predictive value of PDU signal alone for prostate cancer detection was 96.7%, 24.5% and 96.4% respectively, and PDU guided biopsies were 66.7%, 24.5%, 19.4% and 73% respectively. CONCLUSIONS: The high sensitivity and negative predictive value of PDU makes it useful as an aid for TRUS biopsy in selected patient with previous negative biopsies at risk of harbouring prostate cancer.

Ureteric stone in the presence of existing backache: lessons to learn.

Incidence of urolithiasis is on the rise due to climatic changes especially global warming.The pain due to presence of ureteric stone is a well known identity but many times it may be asymptomatic or even masked by concurrent presence of backache. In the present article, we describe the case of a 43-year-old male who came to the clinic for treatment of backache persisting for more than two years. The patient complained of backache two years back for which he was treated with analgesics and physiotherapy which relieved his pain. No X-ray was taken earlier because the attending clinician thought the backache to be musculo-skeletal in origin. Recently, one day a sudden episode of backache in the midst of night compelled him to seek medical treatment. However, this time a X-ray was performed and it showed the presence of calculi in the right upper pelvis of ureter which measured 1.9 cm vertically. An ultrasound confirmed the diagnosis. The patient was treated with two episodes of shock wave therapy which failed to crush the stone. A Double-J stent was inserted under general anaesthesia. The stone was crushed using a ureteroscope guided laser. The present case report describes how backache in professionals cannot be lightly attended. Even the characteristic groin to loin pain may be absent. All cases of backache should be properly investigated with an X-ray to rule out renal or ureteric calculi.

Clinicopathological features and survival of testicular tumours in a Southeast Asian university hospital: a ten-year review.

INTRODUCTION: Testicular cancer mainly affects young men worldwide. There is lack of published data on patients with this malignant condition from the Southeast Asian region. The aim of this study was therefore to determine the clinicopathologic features of testicular cancer patients treated in a Southeast Asian university hospital and their overall survival rate. MATERIALS AND METHODS: This was a retrospective study of testicular cancer patients treated between January 2001 and February 2011. Their epidemiological data, clinical presentation, pathologic diagnosis, stage of disease and treatment were gathered and the overall survival rate of this cohort was analyzed. RESULTS: Thirty-one patients were included in this study. The majority of them were of Malay ethnicity. The average age at presentation was 33.7 years. The commonest testicular cancer was non-seminomatous germ cell tumour, followed by seminoma, lymphoma and rhabdomyosarcoma. More than half of all testicular germ cell tumour (GCT) patients had some form of metastasis at diagnosis. All the patients were treated with radical orchidectomy. Adjuvant chemotherapy was given to those with metastatic disease. Four seminoma patients received radiotherapy to the para-aortic lymph nodes. The 5-year survival rate for all testicular cancers in this cohort was 83.9%. The survival rate was 88.9% in 5 years when GCT were analyzed separately. CONCLUSION: GCT affects patients in their third and fourth decades of life while lymphoma patients are generally older. Most of the patients treated for GCT are of Malay ethnicity. The majority have late presentation for treatment. The survival rate of GCT patients treated here is comparable to other published series in other parts of the world.

Retrograde intrarenal surgery for renal stones smaller than 2 cm.

INTRODUCTION: Extracorporeal shock wave lithotripsy (ESWL) is accepted as the gold standard treatment for renal stones that are smaller than 2 cm. Recently, retrograde intrarenal surgery (RIRS) has been introduced as another form of treatment. We report our experience in dealing with renal stones smaller than 2 cm using RIRS as the primary treatment and following failed ESWL. METHODS: A retrospective analysis was conducted over a five-year period on patients with stone(s) measuring less than 2 cm each and who had undergone RIRS. The patients were divided into two groups: RIRS as the primary procedure and RIRS post-ESWL. RESULTS: A total of 46 patients underwent RIRS in our institute. The total stone clearance rate was 61 percent. The clearance rate was better for RIRS as the primary procedure when compared to RIRS as an adjunct procedure (70 percent versus 52 percent; p-value is 0.23). Patients with mid-pole stones achieved an 80 percent stone clearance rate as compared to 60 percent for those with lower pole stones. The clearance rate for upper pole stones was only 29 percent. When RIRS was the primary procedure for lower pole stones, the success rate was 75 percent, compared to 56 percent when it was used as an adjunct procedure post-ESWL. CONCLUSION: For renal stones measuring less than 2 cm, the stone clearance rate for RIRS was as good as that for EWSL as a primary procedure and achieved a good clearance rate following the failure of ESWL.

Proptosis: a rare presentation of metastatic renal cell carcinoma.

We present a case of a middle-aged man who was incidentally found to have right renal solid mass while investigating for his left eye proptosis. Computerised tomography (CT) scan confirmed the diagnosis of renal cell carcinoma and the tumour was successfully excised via open surgery. The histopathology examination revealed the 10x7x8 cm mass to be a clear cell type renal cell carcinoma. The rare presentation of this metastatic renal cell carcinoma, its diagnosis and management will be discussed.

Effect of maternal age, birth weight and infant sex on total nucleated cell (TNC) count and volume of umbilical cord blood (UCB) collected.

This study evaluates the effect of maternal age, birth weight and infant sex on two main UCB parameters for use and long-term cryopreservation: TNC and volume. Data from 1000 UCB units were collected and analyzed in this study. The results indicate that TNC is correlated to infant birth weight and sex but not maternal age at delivery. Volume is only correlated to birth weight but not maternal age and infant sex.

Amelanotic spitzoid melanoma in a prepubescent boy.

The diagnosis of malignant melanoma (MM) in children is difficult due to its uncommon occurrence as well histological similarities to Spitz nevus. A case of MM of the foot in an 11-year-old boy is reported illustrating the histological overlap between Spitz nevus and MM. In our patient, both the primary foot lesion and the regional inguinal metastases were amelanotic, further increasing the diagnostic difficulty. The literature on MM in children is limited and the documentation of such unusual cases is necessary to improve the knowledge on this disease.

Effects of fluoride on Xenopus embryo development.

Fluoride was first associated with fetal malformation shortly after water fluoridation was initiated in the 1940s. Since many chemicals can interact directly with the embryo to cause malformation, the effects of fluoride on embryonic and fetal development were investigated. The effects of sodium fluoride on the development of frog embryos were studied under conditions described by the Frog Embryo Teratogenesis Assay-Xenopus (FETAX), a screening assay for teratogens. The most prominent malformations caused by sodium fluoride are reduction in the head-tail lengths and dysfunction of the neuromuscular system of the tadpoles. The values for LC50, EC50, and minimal concentration to inhibit growth (MCIG) of sodium fluoride met the limits established for a teratogen in frog embryos, showing that sodium fluoride is a direct acting teratogen on developing embryos. Since FETAX has a high degree of success in identifying mammalian teratogens, the observed teratogenic action of sodium fluoride on frog embryos would indicate a strong possibility that sodium fluoride may also act directly on developing mammalian fetuses to cause malformation.

Analysis of cholesterol and desmosterol in cultured cells without organic solvent extraction.

Cultured cell sterols such as cholesterol and desmosterol are usually extracted into organic solvents before they are quantified with cholesterol esterase and oxidase. A method to quantify these cultured cell sterols using cholesterol enzymes without prior organic solvent extraction is described. In this method, a suspension or monolayer of cultured L-M, U-937, or PC-12 cells is digested with 0.1% sodium dodecyl sulfate (SDS), and the digest treated with microbial cholesterol enzymes. The quantity of oxidized sterols produced by the reaction can be measured easily with high-pressure liquid chromatography, when a mixture of sterols is present, or by the production of hydrogen peroxide when only one sterol is present. This method is easier and safer to use than solvent extraction and can greatly expedite the quantitation of cultured cell sterols. Preliminary data show that other lipids such as choline phospholipids, triglycerides, and fatty acids can also be directly quantified in SDS cell digest by using specific enzymes to transform these lipids into hydrogen peroxides.

HPLC analysis of desmosterol, 7-dehydrocholesterol, and cholesterol.

A simple and sensitive method to analyze mixtures of desmosterol, 7-dehydrocholesterol and cholesterol is described. The method involves the oxidative conversion of the sterols with cholesterol oxidase, followed by high performance liquid chromatographic (HPLC) analysis. A C18 reversed phase column (3 microns, 75 X 4.6 mm) and a mixture of methanol and acetonitrile (1:1, v/v) at a rate of 1 ml/min are used to separate the sterols. The eluted sterols are quantified by measuring UV absorption at 240 nm. As little as 10 pmoles of sterol can be quantified under these conditions.

Transfer of exogenous cholesterol to microsomes of hepatocytes investigated with [3H]desmosterol tracer.

The feasibility of using exogenous [3H]desmosterol as a mass metabolic tracer for exogenous non-esterified cholesterol in hepatocytes is investigated with albumin-bound non-esterified cholesterol containing [3H]desmosterol and [14C] cholesterol tracers. The amounts of uptake and metabolism of exogenous cholesterol monitored by either tracer are the same. In addition, the conversion of [3H]desmosterol into [3H]cholesterol by the delta 24-sterol reductase in the microsomes can be used as an estimate for the mass transfer of exogenous cholesterol to the microsomes. The results obtained indicate that only a small fraction of exogenous cholesterol that was transferred to the microsomes was metabolized into bile acids and steryl esters. The technique of estimating the mass transfer of exogenous cholesterol to the microsomes with [3H]desmosterol may be of importance in investigations dealing with the effect of exogenous plasma cholesterol on changes in the physiological functions of the endoplasmic reticulum in the cells.

Hydrolysis of guinea pig nascent very low density lipoproteins catalyzed by lipoprotein lipase: activation by hjman apolipoprotein C-II.

Very low density lipoproteins isolated from guinea pig liver perfusate (VLDLp) lack the equivalent of human apolipoprotein C-II (apoC-II), the activator of lipoprotein lipase (LpL). These lipoproteins are therefore ideal substrates with which to investigate the mechanism by which apoC-II activates the enzyme. VLDLp binds apoC-II, and apoC-II associated with VLDLp markedly increases the rate of lipoprotein lipase-catalyzed hydrolysis of VLDLp-triglycerides. The activator potency of apoC-II is independent of the method of enrichment of VLDLp with apoC-II: delipidated human apoC-II and apoC-II transferred from human high density lipoproteins activate lipoprotein lipase to equal extents. ApoC-II causes pH-dependent changes in both apparent Km and VmaX of LpL-catalyzed hydrolysis of VLDLp-triglycerides. At pH l7.4--7.5, the major effects of apoC-II is to decrease the apparent Km by 3.3--4.0 fold. The apparent Vmax is increased 1.3-fold. At pH 6.5 and 8.5, the decrease of apparent Km is less marked, 1.6-fold and 1.4-fold, respectively. At pH 6.5, apoC-II increases the apparent Vmax ty 1.3-fold, while at pH 8.5 the primary effect of apoC-II is a 1.6-fold increase of apparent Vmax. Based on a simple kinetic model, the data suggest that apoC-II favors direct interaction between enzyme and triglyceride within the lipoprotein particle, as well as subsequent catalytic turnover.

Selective area tuberculosis surveys in Singapore 1978.

A random population sample survey in Singapore 1975 revealed that a relatively high proportion of active pulmonary tuberculosis patients remained undiagnosed, mainly in the older age groups. Previous studies disclosed the cause to the lack of symptoms of concern in these patients. A new programme was devised to discover hidden elderly patients by mass chest X-ray screening of population aged 45 years and older living in areas with known high incidence of tuberculosis. The yield of cases was less than expected mainly due to the dislocation and dispersion of population from recent extensive urban re-development in Singapore. Nevertheless the results were comparable to the most productive case finding programme carried out in this department.

A dynamic model of tuberculosis epidemiology for Singapore.

An epidemiological model was used to estimate the size of the tuberculosis problem in Singapore from 1975 to 2025. It was shown that even without any control activities after 1979 there would be a reduction of the tuberculosis indices in the country. If the present control programme was pursued unchanged, a reduction of the tuberculosis problem by 10.0% and 14.5% would be expected in 2000 and 2025 respectively. Tuberculosis would be expected to remain a major public health problem over the next fifty years. In Singapore's context increased case finding and treatment of bacteriologically positive cases of tuberculosis would be the most effective ways of further reducing the tuberculosis problem over the next fifty years. Practical methods of implementing this were suggested. Reduced BCG coverage of infants was not expected to increase the tuberculosis problem to any significant extent over this period. Treatment relapse rates were shown not to be a sensitive variable that would affect the tuberculosis problem in Singapore.