Rosai-Dorfman disease of the genito-urinary tract: analysis of six cases from the testis and kidney.

AIMS: Rosai-Dorfman disease (RDD) commonly occurs in lymph nodes, but it can also affect the genitourinary (GU) system. In a search of GU RDD, we identified three cases involving the testis and three the kidney. METHODS AND RESULTS: The mean age was 52.4 (35-76) years. Tumour sizes were 3.6 cm on average (1.5-4.3) for testicular cases and 15.5 cm for the renal case treated by nephrectomy. All renal cases showed typical morphology similar to nodal RDD with scattered foci of lymphocytic aggregation. In contrast, all three testicular cases had an evenly distributed lymphocyte and plasma cell infiltration with entrapment of Sertoli-only seminiferous tubules. In all six cases, immunohistochemistry (IHC) for S100 showed strong reactivity in the lesional histiocytes and highlighted the hallmark emperipolesis. One testicular case had pleural and pericardial effusions but resolved after removal of the RDD lesion. Another renal case subsequently involved bone and then lung over a 3-year period. CONCLUSIONS: RDD involving the GU system is rare with it most commonly involving the kidney followed by testis. Our three renal cases were similar in morphology to typical nodal RDD. The testicular cases had a somewhat different histological picture and needed IHC for S100 to verify the diagnosis.

Greater volumes of static and dynamic stretching within a warm-up do not impair star excursion balance performance.

Based on the conflicting static stretching (SS) literature and lack of dynamic stretching (DS) literature regarding the effects of differing volumes of stretching on balance, the present study investigated the effects of 4, 8, and 12 sets of SS and DS following a 5 min aerobic running warm-up on the star excursion balance test (SEBT). The objective was to examine an optimal stretch modality and volume to enhance dynamic balance. A randomized, within-subjects experimental design with repeated measures for stretching (SS and DS) versus no-stretching treatment was used to examine the acute effects of 10 (4 sets), 20 (8 sets), and 30 (12 sets) min, of 15s repetitions per muscle of SS and/or DS following a 5 min aerobic warm-up on the performance of the SEBT. Results indicated that a warm-up employing either SS or DS of any volume generally improves SEBT by a "small" amount with effect sizes ranging from 0.06 to 0.50 (11 of 18 conditions>75% likely to exceed the 1.3-1.9% smallest worthwhile change). Secondly, the difference between static and dynamic warm-up on this observed improvement with warm-up improvement was "trivial" to "moderate" (d=0.04 to 0.57) and generally "unclear" (only two of nine conditions>75% likely to exceed the smallest worthwhile change). Finally, the effect of increasing the volume of warm-up on the observed improvement with a warm-up is "trivial" to "small" (d<0.40) and generally "unclear" (only three of 12 conditions>75% likely to exceed the smallest worthwhile change). In summary, an aerobic running warm-up with stretching that increases core and muscle temperature whether it involves SS or DS may be expected to provide small improvements in the SEBT.

Long-term histological and hemodynamic findings of repairing penile tunica albuginea defects with collagen fleece in dogs.

Clinically, collagen fleece patching of the penile tunica albuginea (TA) has been successful. However, the histopathological and hemodynamic outcomes are not known. We studied in vivo TachoSil® patching in two beagle dogs weighing 16.8 (16.7-16.9) Kg. Bilateral intracavernous pressures (ICP) response to 10 mg papaverine hydrochloride were measured. A full-thickness defect was created on the left side in TA 1 × 0.5 cm, and four transverse incisions 1 cm long were made on the right side, placed 0.5 cm apart, and covered with TachoSil®. Six months later, ICP measurements were repeated, and the penis was excised for histopathology. Grossly, the graft site was indistinguishable. The mean baseline ICP was 19.3 ± 2.98 mmHg and increased after papaverine injection to a mean peak ICP of 122 ± 26.1 mmHg. The ICP measurement before and after grafting did not show a significant difference in the baseline (p = 0.068) or the peak pressure (p = 0.465). Histologically, minimal foreign body reaction was seen, and the TA was completely regenerated. The underlying cavernous tissue did not show inflammation or necrosis. The study is the first to show the long-term histopathologic regeneration of TA after collagen fleece patching while maintaining the hemodynamic response to papaverine.

Molecular basis of urinary bladder cancer.

Bladder cancer is a relatively common and potentially life-threatening neoplasm. The diagnosis of urothelial carcinoma usually entails a lifelong surveillance to detect recurrent disease. In recent years, significant progress has been made in understanding the molecular mechanisms of carcinogenesis in urinary bladder. An early step in the process of carcinoma development is establishment of a premalignant abnormal urothelial patch that may give rise to various types of urothelial carcinoma and may provide a fertile ground for development of multifocal synchronous and metachronous tumors. Two distinct molecular pathways are involved. Low-grade papillary carcinoma is associated with mutation in the FGFR3 or in some cases mutations in RAS genes. High-grade in situ/muscle-invasive carcinoma on the other hand is characterized by alteration of p53 and pRB. Loss of function of these key genes, which play a crucial role in the control of cell cycle, leads to accumulation of additional mutations and deletions of genes resulting in an aggressive phenotype. It is hoped that a thorough understanding of the molecular basis of urothelial cancer will facilitate early diagnosis and will lead to development of new modalities for the management and treatment of these carcinomas.

Effect of Gender on Postoperative Outcome and Duration of Ventilation After Coronary Artery Bypass Grafting (CABG).

INTRODUCTION: The study assessed coronary artery bypass grafting (CABG) postoperative outcomes and associated factors in Saudi male and female patients. This was a retrospective cohort of patients who underwent CABG at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, from January 2015 to December 2022.  Results: We included 392 patients, of whom 63 (16.1%) were female. Female undergoing CABG were significantly older (p=0.0001), had a significantly higher incidence of diabetes (p=0.0001), obesity (p=0.001), hypertension (p=0.001), and congestive heart failure (p=0.005), with a smaller body surface area (BSA) (p=0.0001) than male. Though renal dysfunction, previous cerebrovascular accident/transient ischemic attack (CVA/TIA), and myocardial infarction (MI), incidences were similar in both genders. Females were at significantly higher risk of mortality (p=0.0001), longer hospital stay (p=0.0001), and prolonged ventilation (p=0.0001). Preoperative renal dysfunction was the only statistically significant predictor of postoperative complications (p=0.0001). Female gender and preoperative renal dysfunction, were significant independent predictors of postoperative mortality and prolonged ventilation (p=0.005). CONCLUSION: This study's findings indicated that females have worse CABG outcomes and a higher risk of morbidities and complications. Uniquely our study showed a higher incidence of prolonged ventilation in females postoperatively.

A Multicenter Cross-Sectional Study on Assessment of Depression in Cardiac Patients.

Introduction: Cardiovascular diseases (CVDs) are considered the primary cause of mortality in Saudi Arabia and it is one of the major health concerns in the country. Depression can complicate, halt or even exacerbate the process of managing CVDs, making it harder to optimize the patient's condition. The main aim of this study is to assess the depression in cardiac patients. Methods: A cross-sectional observational study was conducted in 257 patients diagnosed with cardiovascular diseases. The study was conducted in two governmental hospitals in Tabuk, Saudi Arabia, from December 2021 to April 2022. Depression was assessed using the Arabic version of the CESD-R questionnaire. Results: The mean age of the participants was 44.49 ± 12.99 years. Majority of patients were in the age group of 40-49 years (n = 92, 35.8%). More than half (53.3%) of the samples were female. The prevalence of depression among cardiac patients was 53.3%. Conclusion: The prevalence of depression was high among cardiac patients. It is strongly advised that routine examination and management of depression in cardiac patients be included in their regimens.

The Effect of Body Mass Index on the Degree of Renal Interstitial Fibrosis and Tubular Atrophy - A Retrospective Case-Control Study.

Introduction The degree of interstitial fibrosis and tubular atrophy (IFTA) seen on kidney biopsy has long been used to judge the chronicity of kidney disease to predict renal disease outcomes and prognosis. It is an essential component incorporated in many renal disease prognostic classification systems on the native and renal allograft. The impact of increased body mass index on the body metabolism, and the human vascular system, including the functional unit of the kidney, the nephron, is well-addressed in the literature. In this study, we focus on evaluating the degree of IFTA concerning the patient's body mass index (BMI). Method All the specimens of nephrectomies performed in King Abdulaziz University Hospital for adults from January 2010 to February 2021 were evaluated for this study. A total of 125 cases were selected for the study. The glass slides were pulled and assessed for the degree of IFTA. The demographic data, and the patient's BMI, were collected from the hospital records. Results Subjects with high BMI showed a 1.62 (OR: 1.62, 95% CI: 0.62, 4.22) and 1.52 (AOR: 1.52, 95% CI: 0.56, 4.13) increased risk of high IFTA score compared with those with normal BMI. This study has proved that only at a BMI of 25 or more will there be a measurable, independent effect on the degree of IFTA. Conclusion Although a small number of hospital-based populations limits this study, it could prove the increased severity of IFTA in patients with high BMI. Its result may act as a spark that will drive extensive population-based studies that more precisely delineate the relationship between BMI and the degree of IFTA on different levels.

Allometric growth and reproductive biology traits of pikeperch Sander lucioperca at the southern edge of its range.

This study describes some biological traits (allometric relationship, reproductive biology and condition factor) of pikeperch Sander lucioperca at the southern edge of its range. Data were compiled from field studies between January 1997 and January 2009 in three Tunisian reservoirs. Overall, 1497 fish were caught, from which 1308 specimens were sampled and dissected. Sexually undetermined, male and female fish from the different sites exhibited similar allometric growth, expressed through the equation M(T) = 5 × 10(-6) L(T) (3·06) , where M(T) is the total mass and L(T) is the total length. The exponent value is slightly but significantly greater than 3, indicating positive allometric growth. Sex ratio (males:females) was 47:53 but remained balanced only up to 55 cm L(T) and changed with increasing size towards female dominance. Spawning occurred in March and early April according to the changes in female size-adjusted gonad mass or corresponding gonado-somatic index (I(G) ) values. Thermal conditions seemed favourable in February, but March corresponded to the period of equal day and night lengths and the switch towards longer days in terms of photoperiod. Changes in both size-adjusted M(T) or Fulton's condition factor and size-adjusted liver mass or hepato-somatic index (I(H) ) were clearly associated with reproduction. Reserves were consumed during spring in association with spawning efforts. Nevertheless, the delay before the reconstitution of reserves seemed relatively long (from early spring to late summer) although both thermal and trophic conditions could be considered favourable for active feeding of the fish.

[Inverted Takotsubo Syndrome due to Severe Scorpion Envenomation: Report of one Case]. / Syndrome de Takotsubo dans sa forme Inversée Secondaire à une Envenimation Scorpionique Grave: À Propos D'un Cas.

Scorpion envenomation (SE) is common in tropical and subtropical regions. Cardio-respiratory manifestations, mainly cardiogenic shock and pulmonary oedema are the leading causes of death after scorpion envenomation. Cardiac failure can be due to massive release of catecholamines, myocardial damage induced by the venom or myocardial ischemia. Although it has been exceptionally reported, Takotsubo syndrome during SE can help to better elucidate the pathophysiology of this cardiomyopathy. We report a case of inverted Takotsubo following a SE in a 26-year-old patient admitted to the Intensive care unit department for severe scorpion envenomation. His evolution was favorable. We concluded that cardiac involvement in this case fulfills all clinical and paraclinical criteria of Takotsubo syndrome emphasizing the importance of catecholaminergic discharge during scorpion envenomation. We discuss again the management of this syndrome in this specific condition.

Recurrent C3 Glomerulonephritis with an ADAMTS 13 Gene Variant: A Case Report and Literature Review.

C3 glomerulonephritis (C3GN) is a recently described form of GN that mainly occurs in children and young adults. It results from dysregulation of the alternative complement pathway. Studies have shown that dense deposit disease has a high recurrence rate; however, since C3GN is a recently described disorder, its recurrence rate is still variable. A 28-year-old male with end-stage renal disease caused by C3GN underwent renal transplantation. After 19 months, the patient experienced recurrent C3GN (rC3GN) that involved a variant of unknown significance in the ADAMTS13 gene. Over a short span of time, the patient suffered from rapid deterioration of the graft function that required renal replacement therapy. This is the first case of rC3GN that possibly involved genetic alteration, a variant within the ADAMTS 13 gene.

Renal Stromal Expression of Oestrogen and Progesterone Receptors in Chronic Pyelonephritis as Compared to Normal Kidneys.

OBJECTIVE:  To determine and compare the distribution of oestrogen and progesterone receptors (ER and PR) expression between normal kidneys and chronic pyelonephritis. STUDY DESIGN: Comparative-descriptive study. PLACE AND DURATION OF STUDY: King Faisal Specialist Hospital and Research Centre, and Alfaisal University, Riyadh, Saudi Arabia, between January 2017 and December 2018.  Methodology: Renal specimens, including 41 chronic pyelonephritis, and 21 healthy specimens were examined. ER/PR expression was determined immunohistochemically, termed focal if <50% of nuclei stained positively, and diffuse when >50%. The intensity of staining was labelled weak (pale), moderate or strong. RESULTS: Majority of samples showed presence of diffuse ER (82.9% diseased; 71.4% healthy) and focal PR (53.7% diseased; 76.2% healthy), mostly with strong intensity. ER and PR distribution whether focal or diffuse, correlated with each other in 41.9%. All proportions comparisons showed p values greater than 0.05. CONCLUSION: There was a trend of diffuse renal stromal expression of ER and PR in chronic pyelonephritis as compared to healthy specimens. However, the difference did not reach statistical significance. Key Words: Oestrogen receptor, Progesterone receptor, Chronic pyelonephritis, Renal cancer, Renal stroma.

Tubulocystic renal cell carcinoma with poorly differentiated foci and loss of fumarate hydratase: A case report.

Tubulocystic renal cell carcinoma (RCC) is one of the newly recognized subtypes of RCC. It has a unique cystic morphology and indolent behavior. During the last decade, few studies have been published describing tubulocystic RCC with poorly differentiated foci. A subset of these cases are associated with loss of fumarate hydratase which is a characteristic feature of hereditary leiomyomatosis and renal cell carcinoma-associated RCC. However, these two entities represent two distinct subtypes of RCC in the recent WHO Classification of kidney tumors. Herein, we are describing a rare case of tubulocystic renal cell carcinoma with poorly differentiated foci and loss of fumarate hydratase.

The grasper-integrated disposable flexible cystoscope is comparable to the reusable, flexible cystoscope for the detection of bladder cancer.

Flexible cystoscopy under local anaesthesia is standard for the surveillance of bladder cancer. Frequently, several reusable cystoscopes fail to reprocess. With the new grasper incorporated single-use cystoscope for retrieval of ureteric stents, we explored the feasibility of using it off-label for diagnosis and the detection of bladder cancer. Consecutive diagnostic flexible cystoscopies between Mar 2016 and Nov 2018 were reviewed comparing the reusable versus the disposable cystoscopes. A total of 390 patients underwent 1211 cystoscopies. Median age was 61.5 years (SD 14.2, 18.8-91.4), males 331 (84.9%) and females 59 (15.1%). Indication for cystoscopy was prior malignancy in 1183 procedures (97.7%), haematuria 19 (1.6%) or bladder mass 7 (0.6%). There were 608 reusable and 603 disposable cystoscopies. There was no significant difference between groups at baseline in age, sex, BMI, smoking status, or prior tumor risk category. There was no significant difference in positive findings (123/608, 20.2% vs 111/603, 18.4%, p = 0.425) or cancer detection rates (95/608, 15.6% vs 88/603, 14.4%, p 0.574) among the two groups, respectively. We conclude that the disposable grasper integrated cystoscope is comparable to reusable cystoscope in the detection of bladder cancer.

Operative outcomes of robotic partial nephrectomy. A report of the first 101 cases from a single center in Saudi Arabia.

OBJECTIVES: To report robotic partial nephrectomy (RPN) outcomes from a single tertiary hospital in Saudi Arabia. Methods: We retrospectively reviewed consecutive cases of patients undergoing RPN at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of  Saudi Arabia, between January 2008 and January 2018. The study reports patient's demographics, tumor characteristics, operative details, and perioperative outcomes, using descriptive statistics of median and range values. Results: One hundred and one patients underwent RPN during the study period. Average tumor size was 3 (1.3-6.4) cm and average radius exophytic nearness anterior/posterior location (RENAL) score was 6 (4-10). Perioperative parameters were blood loss 200 (5-1500) ml and warm ischemia time 17 (8-40) minutes, excluding off-clamp surgery in 12 (11.9%); operative time was 166 (66-381) minutes. Conversion to open partial nephrectomy occurred in 9 (8.9%) patients, major complications in 3 (3%) patients, positive surgical margins in 5 (5%) patients, and the hospital stay was 4 (2-14) days. A total of 73 (73%) patients achieved a trifecta of freedom from any complication, negative surgical margins, and ischemia time ≤25 minutes. Study limitations included the retrospective design and small cohort size. Conclusions: The initial experience of robotic partial nephrectomy was associated with a surgical outcome comparable to that reported by higher-volume centers.

Clinical significance of IgM deposition in pediatric minimal change disease.

BACKGROUND: Idiopathic nephrotic syndrome (INS) is a common pediatric disease. Minimal change disease (MCD) is the most common histopathological subtype and usually has good prognosis. However, in less common presentations, INS may have an unusual course that makes renal biopsy a necessity to identify its etiology. Immunoglobulin M (IgM) occasionally deposits in the mesangium and can be seen under immunofluorescence (IF). The role of IgM is controversial in MCD. It is likely associated with less favorable outcomes for MCD. This study aims to investigate the clinical significance of mesangial IgM deposits on the outcome of MCD in a pediatric population. METHODS: In this retrospective cohort study, we obtained native kidney biopsy samples from 192 children who were diagnosed with MCD from 2003 to 2014. The samples were divided into groups according to the histopathological deposition of IgM in biopsies under IF. The group for which biopsies showed IgM was labeled as IgM + IF (n = 77), and the group for which biopsies were without IgM was labeled as IgM-IF (n = 115). We reviewed hypertension, hematuria, and estimated glomerular filtration rate (eGFR) at the time of presentation to our institute; response to steroid therapy (remission, dependence, frequent relapses, and resistance) and response after adjuvant immunosuppressive therapy (complete remission, partial remission, frequent relapses, and no response) when indicated; development of chronic kidney disease (CKD) and end-stage renal disease during the course of the disease (ESRD). RESULTS: Our results showed that mesangial IgM deposition in MCD showed significant statistical association with hypertension at the time of presentation (P = .05). There was statistically significant association between the presence of IgM deposition and the development of steroid dependence (P = .05) and CKD during the course of the disease (P = .05). CONCLUSIONS: Our study showed that IgM deposition in MCD showed statistical association with hypertension by the time the patient presented to our institute, development of steroid dependence, and CKD. IgM may play a role in MCD. However, we recommend a prospective study to verify the role of IgM in MCD outcomes.

[Posttraumatic thromboembolic complications: Incidence, risk factors, pathophysiology and prevention]. / Les complications thromboemboliques post-traumatique : incidence, facteurs de risques, physiopathologie et prévention.

Venous thromboembolism (VTE) remains a major challenge in critically ill patients. Subjects admitted in intensive care unit (ICU), in particular trauma patients, are at high-risk for both deep vein thrombosis (DVT) and pulmonary embolism (PE). The rate of symptomatic PE in injured patients has been reported previously ranging from 1 to 6%. The high incidence of posttraumatic venous thromboembolic events is well known. In fact, major trauma is a hypercoagulable state. Several factors placing the individual patient at a higher risk for the development of DVT and PE have been suggested: high ISS score, meningeal hemorrhage and spinal cord injuries have frequently been reported as a significant risk factor for VTEs after trauma. Posttraumatic pulmonary embolism traditionally occurs after a period of at least 5 days from trauma. The prevention can reduce the incidence and mortality associated with the pulmonary embolism if it is effective. There is no consensus is now available about the prevention of venous thromboembolism in trauma patients.

A rare complication of viper envenomation: cardiac failure. A case report.

Viper envenomation is common in North Africa. Cardiac complications are not common features of snakebites, the clinical picture of which is usually dominated by toxin-associated neurological, hematological, and vascular damage. There are rare reports of acute myocardial infarction and/or ischemia caused by snakebites, while myocarditis after envenomation has not yet been reported, to our knowledge. We report the case of a 43-year-old woman admitted to our intensive care unit after viper envenomation complicated by acute heart failure with acute pulmonary edema, in a state of cardiogenic shock, accompanied by multi-organ failure, intravascular disseminated coagulation, and neurological damage. Some of the mechanisms that may be involved in this heart failure are discussed, including the possibility of acute myocarditis.

[Bilateral proximal pulmonary embolism without associated hypoxemia. Case report]. / Embolie pulmonaire proximale bilatérale sans hypoxémie associée. À propos d'un cas.

INTRODUCTION: Pulmonary embolism is a classic complication in intensive care. It is characterized by hypoxemia secondary to perturbed ventilation/perfusion ratios. We report a case of proximal and bilateral pulmonary embolism that occurred without associated hypoxemia. A spiral computed tomography (CT) scan was performed to explore unexplained fever in a patient with a negative infectious investigation. We discuss the mechanisms underlying the absence of hypoxemia in this patient. CLINICAL CASE: A 43-year-old patient with no significant pathological history was admitted to intensive care for the management of multiple injuries following a road accident. During resuscitation, the patient developed a proximal and bilateral pulmonary embolism without signs of hypertension of the pulmonary artery or associated hypoxemia. The patient improved under treatment. DISCUSSION: This case shows that bilateral proximal pulmonary embolism may be associated with normal gas exchange. The absence of hypoxemia could be explained by the bilateral nature of the pulmonary embolism that led to balanced ventilation/perfusion ratios on both sides. Furthermore, bronchoconstriction was bilateral, explaining the maintenance of a stable ventilation/perfusion ratio on both sides. CONCLUSION: The presence of unexplained fever in a victim of multiple trauma, despite the absence of hypoxemia, suggests the diagnosis of pulmonary embolism.

[Up-to-date on the HELLP syndrome (Hemolysis, Elevated Liver enzymes and Low Platelets)]. / Actualité sur le syndrome HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets).

HELLP syndrome is an acronym for Hemolysis, Elevated Liver enzymes and Low Platelets. It is generally considered in the literature as a particular clinical form of pre-eclampsia, a severe complication of the second half of pregnancy. However, this syndrome can occur in isolation in the absence of pre-eclampsia symptoms. Its pathophysiology remains still unclear. The clinical picture is often incomplete and fruste at first. To date, its diagnosis and management is still the subject of much controversy. Associated or not with a vascular and renal manifestations, the HELLP syndrome is a high-risk maternal disorder. The objective of this article is to review the pathophysiological and clinical data and current treatment.

Chromophobe renal cell carcinoma occurring in the renal allograft of a transplant recipient presenting with weight loss.

The incidence of renal cell carcinomas (RCCs) in renal transplant recipients is reported as 1.1-1.5% in the native kidneys and 0.22-0.25% in the renal allograft. There are no data to support routine surveillance for tumors in transplant recipients. Most reported cases of RCCs occurring in renal allografts were incidental findings in asymptomatic patients. Herein, we report the second case of lone chromophobe RCC (ChRCC) of the renal allograft presenting with weight loss. Loss of weight is a presenting symptom in one-third of ChRCCs occurring in the native kidneys in the general population. Based on the age of the patient, R.E.N.A.L nephrometry score of the tumor and the lack of data on the prognosis of this histological subtype in a climate of long-term immunosuppression, we elected for radical nephrectomy. We suggest that RCCs should be considered in the differential diagnosis of a transplant recipient presenting with weight loss even in the absence of localizing symptoms or signs.