Plasmacytoid urothelial carcinoma with duodenal metastasis-A rare tumor with unusual site of metastasis with grim outcome.

Plasmacytoid urothelial carcinoma (PUC) is a newly recognized rare variant of urothelial carcinoma, which is now being increasingly diagnosed prospectively as well as by retrospective analysis of cases with a poor prognosis. Morphologically, these tumors simulate plasma cell neoplasms and pose a diagnostic challenge. Identifying this variant is essential in two aspects: therapy and prognosis. Here, we present a case who underwent multiple transurethral resection of bladder tumor (TURBT) procedures, each with a diagnosis of urothelial carcinoma, the plasmacytoid type which was confirmed on radical cystectomy, and after 1 year, the patient presented with duodenal metastasis. We discuss the morphological aspects of differentiating this tumor from variants of urothelial carcinoma and other tumors with a plasmacytoid appearance. Despite the recognition and aggressive treatment, the patient expires within 2 years of the first diagnosis of bladder carcinoma.

Relationship of interleukin-23 with matrix metalloproteinase-9, pentraxin-3, sleep quality and prostate size in benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is known to be associated with sleep disturbance and inflammation. The objective of the study was to assess the levels of serum MMP-9 and its inhibitor (TIMP-1), interleukin-23 and pentraxin-3 and their association with sleep quality index and prostate size in BPH patients. Eighty-eight BPH patients were recruited based on clinical and ultrasound findings. MMP-9 and its inhibitor (TIMP-1), interleukin-23 and pentraxin-3 were estimated in all the subjects. Sleep quality was assessed using Pittsburgh Sleep Quality Index (PQSI). Interleukin-23 was significantly correlated with prostate size (p = 0.031), TIMP-1 (p = 0.035), MMP-9 (p = 0.004) and PSQI score (p = 0.020). TIMP-1 was significantly correlated with MMP-9 (p = 0.006) and prostate size (p = 0.016). Pentraxin-3 was positively correlated with PSQI score (p = 0.047). Multivariate analysis shows that interleukin -23 (p = 0.006) predicts prostate enlargement in BPH patients. Interleukin-23 was significantly increased in BPH patients with PSQI score >9 compared to those with PSQI <9. We conclude that poor sleep quality contributes to inflammation in BPH. Inflammation leads to prostate enlargement in patients with BPH.

Impact of Therapeutic Drug Monitoring on Once-Daily Regimen of Amikacin in Patients With Urinary Tract Infection: A Prospective Observational Study.

BACKGROUND: Amikacin is a semisynthetic antibiotic used in the treatment of gram-negative bacterial infections and has a narrow therapeutic index. Although therapeutic drug monitoring is recommended for amikacin, it is not routinely performed because of the use of a less toxic once-daily regimen. Only few studies have evaluated the role of therapeutic drug monitoring in patients treated with amikacin. The objective of our study was to find an association between the pharmacokinetic parameters of amikacin and the time required for a clinical cure, creatinine clearance, and frequency of ototoxicity in patients with urinary tract infection treated for 7 or more days. METHODS: A prospective study was conducted on patients with urinary tract infections who were administered amikacin for 7 or more days. Blood samples were obtained from the patients to measure the maximum drug concentration (Cmax) and trough concentration (Ctrough). Minimum inhibitory concentration (MIC) values were determined for patients with positive urine cultures. Serum creatinine levels were estimated every 3 days. The auditory assessment was performed using pure tone audiometry at baseline and weekly until the patients were discharged. Levels of amikacin were analyzed using a validated liquid chromatography-tandem mass spectrometry method. RESULTS: Of 125 patients analyzed, the median time required for a clinical cure was less in the group of patients who achieved a Cmax/MIC ratio ≥8 than it was in those who did not achieve this level [7 versus 8 days (P = 0.02)]. The Ctrough of amikacin was associated with the change in serum creatinine level (P = 0.01) and the incidence of nephrotoxicity (P = 0.004). CONCLUSIONS: In patients receiving short-term amikacin therapy, Cmax/MIC value can be used to predict the time required for a clinical cure. Ctrough can be used to predict the occurrence of nephrotoxicity in patients receiving amikacin therapy.

Case Report: Partial nephrectomy in primary renal sarcoma presenting as Wunderlich syndrome; a rare tumour with rare presentation managed atypically.

Spontaneous retroperitoneal haemorrhage also called Wunderlich Syndrome (WS) may be caused by various aetiologies. One of the most common causes is renal tumour. Renal sarcoma is a rare cause of WS, and renal sarcoma in itself is a rare entity. In the era of nephron-sparing surgery, optimum management of primary renal sarcoma remains a dilemma as there are limited number of cases available in the literature. Nevertheless, radical nephrectomy remains the recommended treatment, keeping in mind the aggressiveness of the tumour. We report a case of primary undifferentiated renal sarcoma, which presented as WS, and which was managed by partial nephrectomy.