Novel urine-based DNA methylation biomarkers for urothelial bladder carcinoma detection in patients with hematuria.

Background: Urothelial bladder carcinoma (UBC) is usually detected during work-up for hematuria. Cystoscopy and/or contrast-enhanced imaging are the gold standard tools for UBC diagnosis, despite limited by being invasive, expensive and low yield in small flat tumors. Objectives: To assess the diagnostic performance of urine-based DNA methylation of six genes (GATA4, P16, P14, APC, CDH1 and CD99) for UBC detection in patients with hematuria. Patients and methods: Voided urine was collected from consecutive patients presented with hematuria for urine cytology and DNA methylation assay of the assigned genes using methylation-specific Polymerase Chain Reaction (PCR). Further assessment by office cystoscopy and imaging with subsequent inpatient cystoscopic biopsy for positive findings was done. The diagnostic characteristics of DNA methylation and urine cytology were assessed based on its capability to predict UBC. Results: We included 246 patients in the study with identified macroscopic hematuria in 204 (82.9%) patients. Positive cytology was found in 78 (31.7%) patients. DNA methylation of GATA4, P16, P14, APC, CDH1 and CD99 genes was identified in 127 (51.6%), 52 (21.1%), 117 (47.6%), 106 (43.1%), 90 (36.6%) and 71 (28.9%) patients, respectively. The sensitivity of the assigned genes for UBC detection ranges from 35% (95%CI: 31-39) to 83% (95%CI: 79-87). Optimal specificity (SP) (100%) was noted for P16, APC and CDH1 genes. While for the other genes (GATA4, P14 and CD99), the SP was 95% (95%CI: 92-98), 96% (95%CI: 92-99) and 97% (95%CI: 93-99), respectively. On multivariate logistic regression analysis, all genes exclusively demonstrated independent prediction of UBC. On receiver operator characteristic (ROC) analysis, all tested genes methylation showed superior area under the curve (AUC) when compared to urine cytology. Conclusions: We have developed a novel urine-based DNA methylation assay for detection of UBC in patients with hematuria with superior diagnostic performance and independent predictive capacity over urine cytology.

[Central retinal occlusion in the course of idiopathic carotid-cavernous fistula]. / Zamkniecie zyly srodkowej siatkówki w przebiegu samoistnej przetoki szyjno-jamistej.

PURPOSE: This study presents the case history of a 58-year-old woman with a diagnosed spontaneous carotid-cavernous fistula on the left side and mild hypertension. THE FIRST SIGNS OF THIS DISEASE WERE: Headache, double vision, proptosis, ptosis of the left upper lid, paresis of the left abducens nerve, conjunctival edema, dilatation and tortuosity of the vessels in conjunctiva and episclera. In the course of this disease a massive central retinal vein occlusion occurred in the left eye. The angiography demonstrated carotid-cavernous fistula on the left side with pathological blood flow. Embolization of the fistula was attempted, but it was not successful. During 6 months of follow up, the signs of central retinal vein occlusion and other manifestations disappeared. CONCLUSIONS: A spontaneous carotid-cavernous fistula should be considered as one of the contributing factors of the central retinal vein occlusion, particularly in menopausal women with concomitant arterial hypertension. The significant reduction of neurological and ophthalmological symptoms and signs may suggest, that arteriovenous shunt is closed.

[Result of operations for hyper-mature cataract complicated with phacolytic glaucoma]. / Wyniki operacji zacmy przejrzalej powiklanej jaskra fakolityczna.

PURPOSE: The aim of this study was to describe the results of hypermature cataract surgery, complicated with phacolytic glaucoma. MATERIALS AND METHODS: Observations were done on 44 patients treated in the II Ophthalmic Clinic of Medical Academy in Lubling, during 1998-2000 years. The group consisted of 18 females and 26 males, with the age ranging from 50 to 84. In 40 patients extracapsular cataract extraction was performed, in 37 cases intraocular lens was implanted, in 7 cases no lens was implanted. Visual acuity and intraocular pressure were assessed before, and after the operation, possible complications were descripted. RESULTS: Before the operation visual acuity were: no light perception in 2 cases, unnormal light perception in 20 cases, normal light perception in 22 cases. Intraocular pressure was 21 mmHg to 75 mmHg, mean 33 mmHg. After the operation visual acuity were 5/50 in 3 cases, 5/30 in 2, 5/20 in 6, 5/15 in 6, 5/10 in 11, 5/6 in 7, 5/5 in 4 cases. Only in 5 cases visual acuity below 5/50 were achieved. There were cases of ischaemic neuropathy, absolute glaucoma, and age related macular degeneration. In all the patients after the operation intraocular pressure lowered, mean value was 15.5 mm Hg, and pain disappeared. CONCLUSIONS: Lens extraction and intraocular lens implantation may be a successful method to treat cataract complicated with phacolytic glaucoma. The procedure should be done as quickly as it is possible, after increase of intraocular pressure to obtain satisfactory results.

Linfonodo sentinela: protocolo de estudo anatomopatológico / Sentinel lymph node: pathologic study protocol

O linfonofo sentinela tem sido estudado como provável fator prognóstico de comprometimento axilar. Quando introduzida a técnica de sua exérese seletiva, estabelecemos protocolo de estudo adaptado à nossa realidade com o objetivo de incrementar a detecção de micrometástases