Ureteropelvic junction obstructions: Is side a prognostic factor?

Background: Ureteropelvic junction obstructions (UPJOs) occur more frequently on the left than on the right side. Among patients diagnosed during the neonatal period, those with left-side UPJO have a more severe course than those with right-side UPJO. Aim: This study examined clinical advances in the surgical management of right and left symptomatic UPJOs preoperatively and postoperatively, based on a retrospective analysis of cases. Patients and Methods: In this retrospective clinical trial, 650 patients were evaluated at the time of diagnosis and at surgery. Results: Left-side UPJO was diagnosed in 66.1% of patients (P = 0.017). The median age of the patients at surgery for left- and right-side UPJO was 1.5 and 4.2 years, respectively (P = 0.001). At the preoperative evaluation, the ratio of parenchymal thickness (RPT) on the UPJO side versus the contralateral side was 0.55 ± 0.3 and 0.7 ± 0.3 for patients with left-side and right-side UPJO, respectively (P = 0.029). RPT during the first postoperative year was 0.83 ± 0.2 for patients treated on the left side and 0.9 ± 0.3 for those treated on the right side (P = 0.25). The respective values at 3 years postoperatively were 0.8 ± 0.3 and 0.9 ± 0.2 (P = 0.09). The preoperative kidney function value in the left-side group was 42.5 ± 13.4, which declined to 39.52 ± 15.8 at the 3-year follow-up examination. In the right-side group, preoperative kidney function was 38.8 ± 16.1, which increased to 40.2 ± 13.2 at 3 years postoperatively. Both the decline and improvement were significant (both P = 0.006). Conclusions: Those with left-side UPJO had a more severe course than those with right-side UPJO.

¿Pueden contribuir los parámetros tumorales metabólicos, establecidos mediante 18F-FDG PET/TC para estadificación primaria, a la estratificación del riesgo de los linfomas del sistema nervioso central, para el tratamiento del paciente como modelo pronóstico? / Can metabolic tumor parameters on primary staging 18F-FDG PET/CT aid in risk stratification of primary central nervous system lymphomas for patient management as a prognostic model?

Objetivo. Los linfomas del sistema nervioso central (SNC) son linfomas no Hodgkin extranodales, agresivos y fatales, albergados en el SNC en el diagnóstico inicial. Su pronóstico es malo, teniendo la enfermedad un resultado fatal en comparación con el linfoma no Hodgkin sistémico. Se han indicado una serie de sistemas de estratificación del riesgo para estimar el pronóstico, basados principalmente en el nivel sérico de lactato deshidrogenasa, la edad, el índice de Karnofsky, el compromiso de las estructuras profundas del cerebro y la concentración proteica del líquido cefalorraquídeo. La PET/TC con 18F-FDG tiene un elevado valor pronóstico en cuanto a la supervivencia global y la supervivencia libre de enfermedad en muchos cánceres y linfomas. Nuestro objetivo fue investigar los índices tumorales metabólicos mediante 18F-FDG PET/TC para estadificación primaria, como marcadores pronósticos de los linfomas primarios del SNC. Material y métodos. Se incluyó en este estudio retrospectivo a una cohorte de 14 pacientes con linfoma primario de células B grandes del SNC (estadio i). Se realizó una PET/TC con 18F-FDG de estadificación primaria, calculándose en todos los pacientes, y con anterioridad al tratamiento, los parámetros cuantitativos tales como el valor estandarizado de captación máximo, el valor de captación medio, el volumen tumoral metabólico y la glucólisis tumoral total (TLG). Se realizaron modelos de regresión de Cox para determinar su relación con el tiempo de supervivencia. Resultados. En la evaluación de todos los factores de riesgo potencial con impacto sobre la recidiva/metástasis (edad, sexo, lactato deshidrogenasa sérico, compromiso de las estructuras profundas del cerebro, el valor estandarizado de captación máximo, el valor de captación medio, el volumen tumoral metabólico y la TLG), realizada mediante análisis univariante, el valor de TLG reflejó una significación estadística (p=0,02). Conclusión. Los parámetros tumorales metabólicos resultan de utilidad para la estimación pronóstica de los linfomas primarios del SNC. En especial, la TLG constituye el parámetro más importante, y puede desempeñar un papel en el tratamiento del paciente (AU)

Objective. Primary central nervous system (CNS) lymphoma is an aggressive and fatal extranodal non-Hodgkin lymphoma jailed in CNS at initial diagnosis. Its prognosis is poor and the disease has a fatal outcome when compared with systemic non-Hodgkin lymphoma. A few baseline risk stratification scoring systems have been suggested to estimate the prognosis mainly based on serum lactate dehydrogenase level,age, Karnofsky performance score, involvement of deep brain structures and cerebrospinal fluid protein concentration. 18F-FDG PET/CT has a high prognostic value with respect to overall survival and disease-free survival in many cancers and lymphomas. We aimed to investigate metabolic tumor indexes on primary staging 18F-FDG PET/CT as prognostic markers in primary CNS lymphoma. Material and methods. Fourteen patients with primary CNS diffuse large B-cell lymphoma (stage i) were enrolled in this retrospective cohort study. Primary staging 18F-FDG PET/CT was performed and quantitative parameters like maximum standardized uptake value, average standardized uptake value, metabolic tumor volume and total lesion glycolysis (TLG) were calculated for all patients before the treatment. Cox regression models were performed to determine their relation with survival time. Results. In the evaluation of all potential risk factors impacting recurrence/metastases (age, sex, serum lactate dehydrogenase, involvement of deep brain structures, maximum standardized uptake value, average standardized uptake value, metabolic tumor volume, and TLG) with univariate analysis, TLG remained statistically significant (P=.02). Conclusion. Metabolic tumor parameters are useful in prognosis estimation of primary CNS lymphomas, especially TLG, which is the most important one and may play a role in patient management (AU)

Can metabolic tumor parameters on primary staging 18F-FDG PET/CT aid in risk stratification of primary central nervous system lymphomas for patient management as a prognostic model? / ¿Pueden contribuir los parámetros tumorales metabólicos, establecidos mediante 18F-FDG PET/TC para estadificación primaria, a la estratificación del riesgo de los linfomas del sistema nervioso central, para el tratamiento del paciente como modelo pronóstico?

OBJECTIVE: Primary central nervous system (CNS) lymphoma is an aggressive and fatal extranodal non-Hodgkin lymphoma jailed in CNS at initial diagnosis. Its prognosis is poor and the disease has a fatal outcome when compared with systemic non-Hodgkin lymphoma. A few baseline risk stratification scoring systems have been suggested to estimate the prognosis mainly based on serum lactate dehydrogenase level,age, Karnofsky performance score, involvement of deep brain structures and cerebrospinal fluid protein concentration. 18F-FDG PET/CT has a high prognostic value with respect to overall survival and disease-free survival in many cancers and lymphomas. We aimed to investigate metabolic tumor indexes on primary staging 18F-FDG PET/CT as prognostic markers in primary CNS lymphoma. MATERIAL AND METHODS: Fourteen patients with primary CNS diffuse large B-cell lymphoma (stage i) were enrolled in this retrospective cohort study. Primary staging 18F-FDG PET/CT was performed and quantitative parameters like maximum standardized uptake value, average standardized uptake value, metabolic tumor volume and total lesion glycolysis (TLG) were calculated for all patients before the treatment. Cox regression models were performed to determine their relation with survival time. RESULTS: In the evaluation of all potential risk factors impacting recurrence/metastases (age, sex, serum lactate dehydrogenase, involvement of deep brain structures, maximum standardized uptake value, average standardized uptake value, metabolic tumor volume, and TLG) with univariate analysis, TLG remained statistically significant (P=.02). CONCLUSION: Metabolic tumor parameters are useful in prognosis estimation of primary CNS lymphomas, especially TLG, which is the most important one and may play a role in patient management.

Serum chitotriosidase levels in cancer patients undergoing high dose chemotherapy and stem cell transplantation.

OBJECTIVE: Human chitotriosidase (ChT) is an active chitinase expressed by activated phagocytes. Increased ChT activity has been reported in systemic Candida albicans infections and in Gram-negative and Gram-positive bacterial infections, indicating that an increase in ChT activity reflects phagocyte activation. The aim of this study was to determine the changes in serum ChT activity in patients who underwent high dose chemotherapy (HDC) and stem cell transplantation (SCT), who are at an increased risk for fungal and bacterial infections due to depression of the immune system during the neutropenic period. PATIENTS AND METHODS: A total of 55 SCT patients were included in the study. Serum ChT activity was determined before the initiation of HDC and during the neutropenic period after hematopoietic stem cell reinfusion on post-transplant first, fifth and tenth days. RESULTS: Chitotriosidase levels before transplantation were significantly lower than the results at first, fifth and tenth days post-hematopoietic stem cell reinfusion. CONCLUSIONS: Although the number of neutrophils was low, ChT enzyme activity was high in newly produced granules of neutrophils. Chitotriosidase may be supplemented as a drug for preventing and treating infections in the near future.

Current diagnosis and management of primary isolated bladder diverticula in children.

INTRODUCTION: Primary isolated bladder diverticula (PIBD) that are not correlated with the UVJ comprise approximately 10% of all primary bladder diverticulas (PBDs). No guidelines have been established for PIBD repair. It is unknown if infections or voiding dysfunction are impacted by the size of diverticula. PURPOSE: We evaluated the most effective approach to treating PIBD with respect to diverticula size and objective clinical and urodynamic findings. METHODS: We retrospectively evaluated age, sex, chief complaint, UTI diverticula size, clinical and urodynamic findings, and management of 14 consecutive patients diagnosed with PIBD from 1995 to 2013. Urodynamic studies were performed in all PIBD cases, Post micturition residue (PMR), maximum bladder capacity (MBC), voiding detrusor pressure (Pdet), and pressure flow (Qmax) were all measured. Among patients who underwent surgical repair, resected diverticula wall specimens were sent for pathological evaluation. RESULTS: Twelve boys and two girls ranging in age from 2 to 15 years (mean, 6.7 years) were included in this study. The mean follow-up duration was 54.2 months (range, 6-120 months). All diverticula were single, and most occurred in posterolateral locations (Figure). In eight patients with PIBD of <3 cm (range, 15-24 mm; mean, 18 mm), MBC, P det, and Qmax were within reference ranges. None of the patients had PMR, and most developed only one urinary tract infection (UTI) before admission. All patients underwent close follow-up without surgical intervention. Six patients had diverticula of >3 cm (range, 32-72 mm; median, 48 mm). Their MBC was lower (72% of predicted value) than the reference range. The P det was significantly higher than that of patients with diverticula of <3 cm and the Q max was lower in two patients. Four patients had PMR, and all patients developed at least three UTIs before admission to the hospital. This group of patients was treated surgically. All operated children reported improvement after in control urodynamic study over follow-up periods. DISCUSSION: The diverticula layer lacks the contractility that allows the diverticulum to appropriately void into the bladder. This accounts for the urinary retention and dysfunctional voiding. The patients with diverticula larger than 3 cm had PMR. Members of this group had more than three UTIs. In our series, diverticula of >3 cm exhibited an MBC that was lower than the predicted values. The detrusor contracts, but the urine enters the diverticula more easily than it enters the bladder neck. This could inhibit bladder enlargement and may explain the lower MBC in this group. This group also had higher Pdet, and their q max was low. Thus, probably simulating detrusor much higher pressure but undercontractility due to diverticulum. Another possible explanation could be that large PIBD creates a functional obstruction over the bladder neck during voiding. CONCLUSION: PIBD of >3 cm is characterized by UTI development, functional lower urinary tract symptoms, and disorders of bladder storage or emptying. Surgical repair of these diverticula is associated with improvement of voiding dysfunction and elimination of UTIs.