Early detection of myocardial dysfunction in poorly treated pediatric thalassemia children and adolescents: Two Saudi centers experience.

BACKGROUND & OBJECTIVE: Cardiac complications are among the most serious complications in Beta Thalassemia Major Patients. Our aim was to evaluate the value of tissue Doppler imaging (TDI) for early detection of myocardial dysfunction in pediatric and adolescent patients with B-TM before development of overt heart failure or cardiomyopathy. PATIENTS AND METHODS: 100 thalassemic patients below 18 years old and 100 healthy, age & sex matched controls were enrolled in our case-control study. Cases were selected from those attending outpatient clinics and inpatient wards, King Abdulaziz University hospital and Alhada Armed Forces Hospital, Saudi Arabia, between January 2014 and January 2015. They were subjected to echo-Doppler examination for both septal and lateral walls of the basal mitral and tricuspid annuli assessing the systolic myocardial velocity (S wave), early diastolic myocardial velocity (Ea wave) and late diastolic myocardial velocity (Aa wave). RESULTS: Patients with thalassemia have RV and LV dysfunction on the basis of abnormal TDI derived myocardial velocities. There was a statistically significant differences between patients and controls regarding (Aa) and (S) of the septal wall of the basal mitral annulus and (Ea) of the lateral wall of the mitral annulus. Also patients with thalassemia have significantly higher (S) of the basal tricuspid annulus. These abnormalities were not detected by conventional echo-Doppler. CONCLUSION: Clinically asymptomatic thalassemic children and adolescents who had normal global functions by conventional echo-Doppler were found to have abnormal left ventricular and right ventricular dysfunctions detected by TDI. TDI is superior to Echo-Doppler in detection of early myocardial damage in asymptomatic thalassaemic patients.

The prognostic significance of p53, p63 and her2 expression in non-muscle-invasive bladder cancer in relation to treatment with bacille Calmette-Guerin.

OBJECTIVE: To investigate whether the immunohistochemical expression of p53, p63 and her2/neu is correlated with the prognosis of tumour recurrence and progression in patients with non-muscle invasive (NMI) bladder cancer. PATIENTS AND METHODS: In all, 88 patients diagnosed with NMI transitional cell carcinoma of the bladder in a Urology Department from May 2009 to April 2014 were included in the study. Paraffin-embedded specimens were obtained by transurethral resection of the bladder tumours. Sections on haematoxylin and eosin-stained slides were examined histologically and tumour grade was classified according to the World Health Organisation system (2004) Mostofi classification. The sections were evaluated using p63, p53 and her2/neu immunohistochemical staining before and after immunotherapy with bacille Calmette-Guerin (BCG), and patients were followed up for 36 months in the Urology Department. RESULTS: For tumour grade there was a significant relationship with the overexpression of p53 (P = 0.010), her2 (P = 0.025) and negativity of p63 (P = 0.025). There was no significant relationship between p53 or her2/neu overexpression and tumour stage. However, there was a significant correlation (P = 0.005) between p63 negativity and tumour stage. There was a significant relationship between p53 (P = 0.01), her2/neu (P = 0.025) overexpression and p63 negativity (P = 0.005) and tumour recurrence and progression. CONCLUSION: Patients with transitional cell carcinoma who are selected for BCG treatment should preferably be positively immunoreactive for p63, but negative for both p53 and her2/neu. These patients were less susceptible to recurrence and/or progression after BCG adjuvant therapy. Further studies are needed to investigate the relationship between these three markers and treatment with anti-her2/neu therapies.

Supine transgluteal vs prone position in extracorporeal shock wave lithotripsy of distal ureteric stones.

OBJECTIVE: To evaluate of efficacy of transgluteal (supine) approach for shock wave lithotripsy (SWL) in treatment of distal ureteric stones. PATIENTS AND METHODS: This prospective, randomized, comparative study was conducted on 98 patients. Patients were randomly assigned into 2 groups: group A (n = 49; prone position) and group B (n = 49; supine position, transgluteal). Inclusion criteria included patients with radiopaque lower ureteric stones ≤10 mm. Exclusion criteria included radiolucent stones, stones >10 mm, the need for any auxiliary procedure, and any contraindication for SWL. Post-SWL evaluation included plain x-ray of kidney, ureter, and bladder at 2 weeks after treatment and then at monthly intervals after treatment for 3 months. Stone-free status was defined as no residual stone fragments visible on plain x-ray. Treatment failure was defined as persistence of stone fragments at 3 months or the need for ureteroscopy. RESULTS: Stone-free rate after 1 treatment session was achieved in 44.9% and 75.5% for prone and supine positions, respectively. Proceeding to ureteroscopy, after failure of the second SWL session to clear the stones, was done in 34.7% and 8.2% for prone and supine positions, respectively. The overall success rate for SWL treatment in prone and supine groups was 65.3% and 91.8%, respectively (P <.001). CONCLUSION: Transgluteal SWL while patient in supine position proved efficacy for treatment of distal ureteric stones. Larger group studies comparing the results of SWL in supine position with those of prone position and also with those of ureteroscopy may enrich our data to reach a consensus for the ideal management of distal ureteric stones.

Flank free modified supine position: A new modification for supine percutaneous nephrolithotomy.

OBJECTIVES: Percutaneous nephrolithotomy (PCNL) is the standard management for large and/or complex urolithiasis, but the standard patient position for PCNL is undecided. With the patient prone PCNL has several drawbacks, while when supine, as described previously, PCNL has mechanical limitations. We describe a modification that aims to overcome these limitations and provide easy access comparable to that in the prone position. PATIENTS AND METHODS: This prospective study was carried out at the Urology Department, Zagazig University, Egypt, from October 2008 to March 2011, and included 78 patients (48 men and 30 women). First the patient was placed supine and then in the 'flank-free modified' supine position. The distance between the last rib and the iliac crest in the posterior axillary line was measured in both positions. RESULTS: The mean age of the patients was 40.8 years, the mean (SD) stone diameter was 3.4 (0.7) cm, the number of right/left stones was 34/44, and mean body mass index was 28.8 kg/m(2). The mean (SD) increase in the distance between the last rib and the iliac crest in the posterior axillary line in the flank free modified supine position vs. the previous supine position was 12 (0.8) mm. CONCLUSION: The flank-free modified supine position increases the distance between the last rib and the iliac crest, and, together with the absence of a cushion under the flank, provides ample space for puncture, dilatation, multiple tracts and manoeuvrability of the system with the nephroscope.

Single vs. double dartos layers for preventing fistula in a tubularised incised-plate repair of distal hypospadias.

OBJECTIVE: To compare the outcome of a single vs. a double-layer dartos interposition for preventing a fistula after tubularised incised-plate (TIP) distal hypospadias repair. PATIENTS AND METHODS: We retrospectively reviewed the records of patients with primary distal hypospadias who had the hypospadias repaired between February 2009 and June 2011, operated by one surgeon (S.A.K.). In all of the children a standard TIP urethroplasty was performed, which was covered by a dartos fascial flap fashioned using one of two techniques, i.e. in Group I (48 patients) double dartos preputial flaps were used, and in Group II (52 patients) a single dorsal dartos flap was used and transposed ventrally via a 'buttonhole'. The fistula rate and other complications related to each group were recorded. RESULTS: The mean (range) follow-up was 12 (6-22) months for Group I and 14 (6-24) months for Group II. The result was considered a success in 96% of Group I and 92% of Group II. In Group I there were no fistulae, while in Group II there were four fistulae (8%) detected; this difference was statistically insignificant (P = 0.1). Meatal stenosis was associated with a fistula in one patient in Group II but not in the other three. In Group I a meatal stenosis developed late after complete healing of the urethroplasty, with no associated fistula. The repair broke down in one patient in Group I (2%). CONCLUSION: A double-dartos neourethral cover in TIP hypospadias repair seems to be more effective than a single layer for preventing a fistula, despite there being no statistically significant difference between the groups. However, the protective effect of double-dartos flaps must be appropriately evaluated in a prospective, randomised and controlled study in more patients.