A rare case of successful percutaneous drainage of a methicillin-resistant Staphylococcus aureus prostatic abscess extending into the penis and revealing diabetes mellitus.

In the postantibiotic era, prostatic abscesses (PAs) are rare, affecting primarily immunocompromised men and/or caused by atypical drug-resistant pathogens, raising both diagnostic and management challenges. PA caused by methicillin-resistant Staphylococcus aureus (MRSA) is an uncommon condition and also a primary source of bacteremia. Nevertheless, the continued pattern of increase in reported cases, due especially to community-associated strains, is a growing concern regarding the significant morbidity and mortality. Besides proper antibiotics, drainage of a PA may be required, which is usually transrectal or transurethral. Herein, we describe the case of MRSA PA extending into the penis with concomitant MRSA bacteremia of unknown origin, whereupon diabetes mellitus was newly diagnosed in a previously healthy man residing in a community setting, and managed successfully by a transperineal drainage with good outcome. This case also highlights that individuals diagnosed with such rare deep-seated MRSA infections should be assessed for undiagnosed comorbidities. To the best of our knowledge, this is the first reported case of percutaneous drainage of a PA by using a double-lumen catheter.

A rare case of successful endoscopic management of a fibroepithelial polyp with intussusception of the ureter and periodic prolapse into bladder.

Fibroepithelial polyps of the ureter are rare non-epithelial benign tumours with a slight female predominance. They are primarily located in the upper left ureter, incidentally diagnosed in patients who are evaluated for gross haematuria or renal colic. Fibroepithelial polyps are traditionally managed by open surgery with resection of the polyp and its stalk or partial resection of the ureter. We describe the case of a fibroepithelial polyp located in the distal right ureter, which occurred in a 42-year-old man with lower urinary tract symptoms, haematuria and flank pain. To our knowledge, this is the first reported case of ureteral fibroepithelial polyp acting as a lead point for ureteral intussusception and to protruding periodically into the bladder cavity, which was successfully resected by ureteroscopic electrocauterisation with good outcome.

A rare case of pelviureteric junction obstruction in the uncrossed kidney of a crossed fused renal ectopia.

Crossed renal ectopia with fusion is an extremely rare congenital anomaly with few reported cases of pelviureteric junction obstruction, which often involves the crossed-over kidney. To our knowledge, we describe the second case in literature to report an uncrossed kidney with pelviureteric junction obstruction and giant hydronephrosis, which obstructs the pelviureteric junction of the crossed-over kidney. The grossly hydronephrotic kidney was found to be poorly functioning and an aberrant crossing vessel was considered to be potentially involved, raising both diagnostic and management challenges. By reporting this case, we aim to stress the importance of adequate mapping collecting systems, drainage patterns and vascular supply in such crossed fused anomalies.

Unusual variant of inverted Y ureteral duplication with an ipsilateral seminal vesicle cyst and renal dysgenesis.

Inverted Y malformation is a rare variant of ureteral duplication with a marked female predominance. We describe a case of inverted Y ureteral duplication with concurrent ectopic ureteral insertion into a seminal vesicle cyst, a ureterocoele and renal dysgenesis, which occurred in a 29-year-old man with lower urinary tract symptoms, haematospermia and postcoital discomfort. To our knowledge, this is the first reported case with this constellation of urogenital abnormalities.

Utilidad y valor predictivo de la densidad de PSA ajustada por el volumen de la zona de transición en hombres con niveles de PSA entre 2 y 4 ng/ml / Usefulness and Predictive Value of PSA Density, Adjusted by Transition Zone Volume, in Men With PSA Levels Between 2 and 4 ng/ml

Objetivo: Evaluar la significación diagnóstica del PSA, de su densidad (PSAD) y de la PSAD ajustada por el volumen de la zona de transición (PSATZD) en hombres con valores de PSA entre 2,0 y 4,0 ng/ml. Material y métodos: Entre los años 2000 y 2010, 138 hombres con niveles de PSA entre 2,0 y 4,0 ng/ml fueron sometidos a ultrasonografía transrectal (USTR) y biopsia prostática de 12 fragmentos. Se investigó la precisión diagnóstica de varios puntos de corte de la PSAD y de la PSATZD en rangos de PSA de 2,0 a 3,0ng/ml y de 3,1 a 4,0ng/ml. Resultados: La tasa de detección del cáncer de próstata fue del 23,9% (32/134). El porcentaje de pacientes con enfermedad extracapsular fue del 28,1% (10/32) y se obtuvieron primarios de grado Gleason 4 o 5 en 8 de 32 casos (25%). El volumen de la zona de transición y la PSATZD en los casos de cáncer fueron significativamente diferentes en comparación con los obtenidos en los casos sin cáncer. El área bajo la curva de la característica operativa del receptor (ROC) de la PSATZD fue significativamente mayor que la de la PSAD en los mismos rangos de subdivisión del PSA. La eficiencia diagnóstica de la PSATZD fue mayor que la de la PSAD. La eficiencia diagnóstica fue mayor en los niveles de corte de PSATZD de 0,23 y 0,28 en hombres con valores de PSA de 2,0 a 3,0ng/ml y de 3,1 a 4,0ng/ml, respectivamente. Conclusiones: El uso de puntos de corte de la PSATZD como indicación para biopsias evitaría muchas biopsias innecesarias sin pasar por alto la mayor parte de cánceres de próstata en el rango de PSA de 2,0 a 4,0ng/ml (AU)

Objective: To assess the diagnostic significance of prostate-specific antigen (PSA), density (PSAD) accuracy, and PSAD adjusted by transition zone volume (PSATZD) in men with PSA levels between 2.0 and 4.0ng/ml. Material and methods: Between 2000 and 2010, 138 men with PSA levels between 2 and 4.0ng/ml underwent transrectal ultrasonography (TRUS) and 12-core prostate biopsy. Diagnostic accuracies for various cut-offs of PSAD and PSATZD were investigated according to subdivided PSA levels of 2.0 to 3.0ng/ml and 3.1 to 4.0ng/ml. Results: The detection rate of prostate cancer was 23,8% (32/134). The percentage of patients with extracapsular disease was 28.1% (10/32) and primary Gleason grade 4 or 5 was obtained in 8/32 (25%) patients. The transition zone volume and PSATZD in cancer cases were significantly different in comparison with those in non-cancer cases. The area under the receiver operating characteristic curve for PSATZD was significantly higher in comparison with that for PSAD in the same subdivided PSA ranges. The diagnostic efficiency for PSATZD was higher than that for PSAD. The diagnostic efficiency showed the highest value at the cut-off level for PSATZD of 0.23 and 0.28 in men with PSA levels of 2.0 to 3.0ng/ml and 3.1 to 4.0ng/ml, respectively. Conclusions: The use of PSATZD cut-offs as a biopsy indication may reduce many unnecessary biopsies without missing most prostate cancer cases in the PSA range of 2.0 to 4.0ng/ml (AU)

[Usefulness and predictive value of PSA density, adjusted by transition zone volume, in men with PSA levels between 2 and 4 ng/ml]. / Utilidad y valor predictivo de la densidad de PSA ajustada por el volumen de la zona de transición en hombres con niveles de PSA entre 2 y 4 ng/ml.

OBJECTIVE: To assess the diagnostic significance of prostate-specific antigen (PSA), density (PSAD) accuracy, and PSAD adjusted by transition zone volume (PSATZD) in men with PSA levels between 2.0 and 4.0 ng/ml. MATERIAL AND METHODS: Between 2000 and 2010, 138 men with PSA levels between 2 and 4.0 ng/ml underwent transrectal ultrasonography (TRUS) and 12-core prostate biopsy. Diagnostic accuracies for various cut-offs of PSAD and PSATZD were investigated according to subdivided PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml. RESULTS: The detection rate of prostate cancer was 23,8% (32/134). The percentage of patients with extracapsular disease was 28.1% (10/32) and primary Gleason grade 4 or 5 was obtained in 8/32 (25%) patients. The transition zone volume and PSATZD in cancer cases were significantly different in comparison with those in non-cancer cases. The area under the receiver operating characteristic curve for PSATZD was significantly higher in comparison with that for PSAD in the same subdivided PSA ranges. The diagnostic efficiency for PSATZD was higher than that for PSAD. The diagnostic efficiency showed the highest value at the cut-off level for PSATZD of 0.23 and 0.28 in men with PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml, respectively. CONCLUSIONS: The use of PSATZD cut-offs as a biopsy indication may reduce many unnecessary biopsies without missing most prostate cancer cases in the PSA range of 2.0 to 4.0 ng/ml.

Resultados de gammagrafías óseas en individuos de etnia norteafricana y su relación con los niveles de APE y con la escala de Gleason obtenida en biopsia / Bone scan findings in a North African ethnic group and relation to PSA level and Gleason score of the biopsy

Objetivo: Numerosos estudios a gran escala realizados en países occidentales han demostrado una relación positiva entre el nivel sérico de antígeno prostático específico (APE) y la prevalencia de hallazgos positivos en la gammagrafía ósea en pacientes recientemente diagnosticados de cáncer de próstata. El objetivo de nuestro estudio es comprobar si esta tendencia aparece también en población norteafricana, así como determinar si se produce una relación entre los niveles de APE, los resultados de la gammagrafía ósea y la escala de Gleason. Material y método: Se revisaron de manera retrospectiva las historias clínicas de 348 pacientes diagnosticados de adenocarcinoma prostático, extrayendo los resultados de las gammagrafías óseas, los niveles de APE y la escala de Gleason. Se llevó a cabo un análisis estadístico mediante la prueba exacta de Fisher, utilizando el programa estadístico SPSS (Paquete Estadístico para las Ciencias Sociales, versión 11.5.1, Chicago), considerando significativa una p<0,05. Resultados: Mediante la gammagrafía ósea se demostró la existencia de metástasis óseas en 102 pacientes. Ninguno de estos pacientes tenía un nivel de APE menor de 10 ng/ml. Seis pacientes con metástasis tenían un nivel de APE entre 11 y 20 ng/ml. En 45 casos con metástasis se hallaron niveles de APE sérico entre 21 y 100. En relación con los niveles de APE superiores a 101 ng/ml, 51 hombres presentaban gammagrafía ósea positiva. Conclusión: Tomando como referencia los niveles de APE, se podría presuponer la probabilidad de un resultado positivo en la gammagrafía ósea. Según los niveles de APE, las investigaciones de estadificación pueden ser más selectivas en el caso de nuestros pacientes. En pacientes con un nivel de APE inferior a 10 ng/ml, el riesgo de presentar una gammagrafía ósea positiva es tan bajo que no sería necesario realizarla. Por otro lado, no se ha establecido una relación con significado estadístico entre la escala de Gleason y el nivel de APE o los resultados de la gammagrafía ósea(AU)

Objective: A number of large-scaled studies carried out in western countries have proven a positive relationship between serum prostate specific antigen (PSA) level and prevalence of positive bone scan findings, in newly diagnosed prostate cancer patients. The aim of our study is to verify that the tendency occurs as well in north-african population, as well as to establish a possible correlation between PSA level, bone scan result, and Gleason score. Material and methods: Records of 348 patients diagnosed to have prostatic adenocarcinoma were reviewed retrospectively for bone scan results, PSA levels, and Gleason score. Statistical analyses were performed using the Fisher exact test, by a statistical software (statistical package for the social sciences “SPSS”, version 11.5.1, Chicago, IL) with differences at P<0,05 considered significant. Results: Based on positive bone scintigraphy 102 patients were proven to have bone metastases. None of these patients had a PSA level of less than 10 ng/ml. Six metastatic patients had PSA level between 11 and 20 ng/ml. 45 metastatic cases had serum PSA between 21 and 100. Concerning PSA level over 101 ng/ml, 51 men had positive bone scan. Conclusion: Based on the PSA level, the likelihood of positive bone scan result can be postulated. According to PSA levels, staging investigations can be more selective for our patients. The risk of positive bone scan is so low that it is not required for patients with PSA level less than 10 ng/ml. On the other hand, on studying the correlation between Gleason score and PSA level or bone scan results, no statistically significant relationship was established (AU)

Cambios en la densidad mineral ósea: comparación entre pacientes de cáncer de próstata con o sin metástasis y varones sanos (grupo étnico norteafricano) / Bone Mineral Density Change: Comparison Between Prostate Cancer Patients with or Without Metastases and Healthy Men (a North African Ethnic Group)

Objetivo: Evaluar la densidad mineral ósea total y la densidad mineral ósea regional en pacientes de cáncer de próstata con y sin metástasis, estableciendo una relación con los resultados de la escintigrafía ósea. Pacientes y métodos: La investigación se realizó sobre un grupo de 135 pacientes con carcinoma prostático y 50 pacientes sanos empleando escintigrafía ósea y absorciometría de rayos X de doble energía. Los resultados de la escintigrafía ósea se clasificaron como normales (puntuación 0: n=55), anómalos pero no típicos de metástasis (puntuación 1: n=45) y patrón típico de metástasis (puntuación 2: n=35). Resultados: Los pacientes de cáncer de próstata con metástasis ósea presentaban una densidad mineral ósea total y regional muy superior en el tronco y la pelvis que los sujetos control sanos, y que los pacientes de cáncer de próstata sin metástasis óseas. Se encontró una relación positiva significativa entre la puntuación obtenida en la exploración ósea y la densidad mineral ósea total y regional de tronco y pelvis (r=0,328, p<0,05, r=0,60, p<0,001, r=0,480, p<0,001, respectivamente). Conclusión: La metástasis ósea es una de las causas principales de morbilidad en el cáncer de próstata, y la pérdida ósea en el transcurso del tratamiento hormonal tiene eficacia en la actualidad. Nuestros resultados muestran que los pacientes de cáncer de próstata con metástasis ósea presentan una mayor densidad mineral ósea (DMO) en la pelvis y el tronco, lo cual es probable que se deba al predominio de las metástasis osteoblásticas sobre las osteolíticas, como demuestra la exploración ósea 99mTc MDP (AU)

Aim: To evaluate total body bone mineral density and regional bone mineral density in patients with prostate cancer with and without metastases, and to correlate them with bone scintigraphy findings. Patients and Methods: 135 patients with prostatic carcinoma and 50 healthy subjects were investigated with bone scintigraphy and dual-energy X-ray absorptiometry. The bone scintigraphic findings were classified as normal (score 0: n=55), abnormal but not typical for metastases (score 1: n=45), and typical pattern of metastases (score 2: n=35). Results: The patients with bone metastases prostate cancer had significantly higher total bone minera1 density and regional bone mineral density of trunk and pelvis than healthy controls and prostate cancer patients without bone metastases. There was a significant positive correlation between bone scan score and total bone mineral density and regional bone mineral density of trunk and pelvis (r=0.328; P<0.05; r=0.60; P<0.001; r=0.480; P<0.001, respectively). Conclusion: Bone metastasis is a major cause of morbidity in prostatic cancer, bone loss during hormonal treatment is currently effective. Our results show that patients of prostate cancer with bone metastases have increased bone mineral density (BMD) in the pelvis and trunk, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by 99mTc MDP bone scan (AU)

[Bone scan findings in a North African ethnic group and relation to PSA level and Gleason score of the biopsy]. / Resultados de gammagrafías óseas en individuos de etnia norteafricana y su relación con los niveles de APE y con la escala de Gleason obtenida en biopsia.

OBJECTIVE: A number of large-scaled studies carried out in western countries have proven a positive relationship between serum prostate specific antigen (PSA) level and prevalence of positive bone scan findings, in newly diagnosed prostate cancer patients. The aim of our study is to verify that the tendency occurs as well in north-african population, as well as to establish a possible correlation between PSA level, bone scan result, and Gleason score. MATERIAL AND METHODS: Records of 348 patients diagnosed to have prostatic adenocarcinoma were reviewed retrospectively for bone scan results, PSA levels, and Gleason score. Statistical analyses were performed using the Fisher exact test, by a statistical software (statistical package for the social sciences "SPSS", version 11.5.1, Chicago, IL) with differences at P<0,05 considered significant. RESULTS: Based on positive bone scintigraphy 102 patients were proven to have bone metastases. None of these patients had a PSA level of less than 10 ng/ml. Six metastatic patients had PSA level between 11 and 20 ng/ml. 45 metastatic cases had serum PSA between 21 and 100. Concerning PSA level over 101 ng/ml, 51 men had positive bone scan. CONCLUSION: Based on the PSA level, the likelihood of positive bone scan result can be postulated. According to PSA levels, staging investigations can be more selective for our patients. The risk of positive bone scan is so low that it is not required for patients with PSA level less than 10 ng/ml. On the other hand, on studying the correlation between Gleason score and PSA level or bone scan results, no statistically significant relationship was established.

Terapia de oxígeno hiperbárico complementaria al desbridamiento en el control de la gangrena de Fournier: utilidad de la puntuación de un índice de severidad en la predicción de la gravedad de la enfermedad y la supervivencia del paciente / Hyperbaric oxygen therapy adjunctive to surgical debridement in management of Fournier’s gangrene: usefulness of a severity index score in predicting disease gravity and patient survival

Introducción: La terapia de oxígeno hiperbárico (TOHB) concomitante con la cirugía ha demostrado una mejora en la reducción de la mortalidad por gangrena de Fournier (GF) en comparación con la aplicación exclusiva de desbridamiento quirúrgico. La mayoría de los datos provienen de centros con un número relativamente reducido de pacientes, y en los que se emplea solamente un procedimiento quirúrgico. El objetivo planteado consistía en evaluar la eficiencia del desbridamiento agresivo con TOHB complementaria, así como evaluar el valor predictivo del índice de puntuación de gravedad de la gangrena de Fournier (IGGF). Material y métodos: 70 gangrenas de Fournier (GF) tratadas con desbridamiento quirúrgico y TOHB. Los datos evaluados fueron los resultados de las exploraciones físicas, los análisis de laboratorio tanto en el momento del ingreso como los finales, la extensión del desbridamiento quirúrgico y el antibiótico utilizado. Los pacientes recibieron TOHB complementaria. Se desarrolló un IGGF con el fin de adjudicar una puntuación que describiese la gravedad de la enfermedad. Este índice tiene en cuenta las constantes vitales de los pacientes, los parámetros metabólicos (niveles de sodio, potasio, creatinina y bicarbonato, así como recuento de linfocitos) y calcula una puntuación relativa a la gravedad de la enfermedad en ese momento. Se evaluaron los datos en función de la supervivencia o no del paciente. Todos los pacientes fueron sometidos a desbridamiento quirúrgico, realizándose el desbridamiento de la herida de forma periódica en el periodo postoperatorio. Resultados: De un total de 70 pacientes fallecieron 8 (el 11,4%) y sobrevivieron 62 (el 88,5%). La diferencia de edad entre los supervivientes (edad media 50,0 años) y no supervivientes (edad media 54,5 años) no fue significativa (p = 0,321). La extensión media del área del cuerpo afectada por el proceso de necrosis en los pacientes que sobrevivieron y en los que no sobrevivieron era del 2,4 y del 4,9%, respectivamente (p = 0,001). Excepto en lo referente a la albúmina, no se encontraron diferencias significativas entre supervivientes y no supervivientes. Las puntuaciones medias en el IGGF en el momento del ingreso de los supervivientes y de los no supervivientes fueron de 2,1±2,0 y de 4,2±3,8, (p = 0,331). Conclusión: La puntuación del IGGF no resultó ser un factor de predicción de la gravedad, de la enfermedad ni de la supervivencia del paciente. Sin embargo, tanto las alteraciones metabólicas como la extensión de la enfermedad aparecieron como factores significativos de riesgo en cuanto a predicción de la gravedad de la GF y la supervivencia del paciente (AU)

Introduction: Hyperbaric oxygen therapy (HBOT) concomitant to surgery has been reported to reduce Fournier’s gangrene (FG) mortality compared to exclusive surgical debridement. Most report from centers with relatively few patients using only surgical procedure. To assess efficiency of aggressive debridement with adjunctive HBOT. To evaluate Fournier’s gangrene severity score index (FGSI) predictive value. Material and methods: 70 Fournier’s gangrene (FG) treated by surgical debridement and HBOT. Data were evaluated physical examination findings, admission and final laboratory tests, surgical debridement extent, and antibiotic used. Patients had adjunctive (HBOT). FGSI, developed toa ssign a score describing the acuity of disease, was used. This index presents patients’ vital signs, metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, and white blood cell count) and computes a score relating to the severity of disease at that time. Data were assessed according to whether the patient survived or died. All patients underwent surgical debridement. Wound debridement was regularly performed in the post operative period. Results: Of 70 patients, 8 died (11.4%) and 62 survived (88.5%). Difference in age between survivors (median age, 50.0 yr) and non survivors (median age, 54.5 yr) was not significant (p = 0.321). Median extent of body surface area involved in necrotizing process in patients who survived and did not survive was 2.4% and 4.9%, respectively (p = 0.001). Except for albumin, no significant differences were found between survivors and non survivors. Median admission FGSI scores for survivors and non survivors were 2.1±2.0 and 4.2±3.8, (p = 0.331).Conclusion: FGSI score did not predict disease severity and the patient’s survival. Metabolic aberrations, extent of disease seemed to be important risk factors for predicting FG severity and patient survival (AU)

[Bone mineral density change: comparison between prostate cancer patients with or without metastases and healthy men (a North African ethnic group)]. / Cambios en la densidad mineral ósea: comparación entre pacientes de cáncer de próstata con o sin metástasis y varones sanos (grupo étnico norteafricano).

AIM: To evaluate total body bone mineral density and regional bone mineral density in patients with prostate cancer with and without metastases, and to correlate them with bone scintigraphy findings. PATIENTS AND METHODS: 135 patients with prostatic carcinoma and 50 healthy subjects were investigated with bone scintigraphy and dual-energy X-ray absorptiometry. The bone scintigraphic findings were classified as normal (score 0: n=55), abnormal but not typical for metastases (score 1: n=45), and typical pattern of metastases (score 2: n=35). RESULTS: : The patients with bone metastases prostate cancer had significantly higher total bone mineral density and regional bone mineral density of trunk and pelvis than healthy controls and prostate cancer patients without bone metastases. There was a significant positive correlation between bone scan score and total bone mineral density and regional bone mineral density of trunk and pelvis (r=0.328; P<0.05; r=0.60; P<0.001; r=0.480; P<0.001, respectively). CONCLUSION: Bone metastasis is a major cause of morbidity in prostatic cancer, bone loss during hormonal treatment is currently effective. Our results show that patients of prostate cancer with bone metastases have increased bone mineral density (BMD) in the pelvis and trunk, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by (99m)Tc MDP bone scan.

[Hyperbaric oxygen therapy adjunctive to surgical debridement in management of Fournier's gangrene: usefulness of a severity index score in predicting disease gravity and patient survival]. / Terapia de oxígeno hiperbárico complementaria al desbridamiento en el control de la gangrena de Fournier: utilidad de la puntuación de un índice de severidad en la predicción de la gravedad de la enfermedad y la supervivencia del paciente.

INTRODUCTION: Hyperbaric oxygen therapy (HBOT) concomitant to surgery has been reported to reduce Fournier's gangrene (FG) mortality compared to exclusive surgical debridement. Most report from centers with relatively few patients using only surgical procedure. To assess efficiency of aggressive debridement with adjunctive HBOT. To evaluate Fournier's gangrene severity score index (FGSI) predictive value. MATERIAL AND METHODS: 70 Fournier's gangrene (FG) treated by surgical debridement and HBOT. Data were evaluated physical examination findings, admission and final laboratory tests, surgical debridement extent, and antibiotic used. Patients had adjunctive (HBOT). FGSI, developed to assign a score describing the acuity of disease, was used. This index presents patients' vital signs, metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, and white blood cell count) and computes a score relating to the severity of disease at that time. Data were assessed according to whether the patient survived or died. All patients underwent surgical debridement. Wound debridement was regularly performed in the post operative period. RESULTS: Of 70 patients, 8 died (11.4%) and 62 survived (88.5%). Difference in age between survivors (median age, 50.0 yr) and non survivors (median age, 54.5 yr) was not significant (p=0.321). Median extent of body surface area involved in necrotizing process in patients who survived and did not survive was 2.4% and 4.9%, respectively (p=0.001). Except for albumin, no significant differences were found between survivors and nonsurvivors. Median admission FGSI scores for survivors and non survivors were 2.1±2.0 and 4.2±3.8, (p=0.331). CONCLUSION: FGSI score did not predict disease severity and the patient's survival. Metabolic aberrations, extent of disease seemed to be important risk factors for predicting FG severity and patient survival.

Evaluación de la sobreexpresión de proteína HER2 en cáncer vesical no músculo invasivo con énfasis en el grado tumoral y en la recurrencia / Evaluation of HER2 protein overexpression in non-muscle invasive bladder cancer with emphasis on tumour grade and recurrence

Objetivo: evaluar el valor pronóstico de la expresión de la HER2 en carcinoma vesical de células transicionales (CCT) no músculo invasivo, poniendo especial énfasis en la población con alto grado. Materiales y métodos (pacientes): se realizaron micromatrices de tejidos (TMA) con especímenes TUR-B representativos de 84 pacientes con CCT vesical no músculo invasivo (40 pT1GII y44 pT1GIII) a los que se trataba en nuestra institución. El mismo patólogo que había llevado a cabo la prueba ciega de análisis inmunohistoquímico con Hercep realizó el proceso de asignación de profundidades de invasión y grados de manera uniforme: se consideró el valor 3+ como signo altamente positivo de sobreexpresión de la HER2. También se evaluaron otras variables clínico-patológicas. Resultados: se detectó sobreexpresión de proteína HER2 en 30/ 44 (68,2%) lesiones pT1GIII, prediciendo recaídas en este subgrupo de CCT vesical (p < 0,01). Se detectó expresión negativa de la HER2 en 26/ 40 (65%) casos con CCT pT1GII, dándose esta situación con mayor frecuencia en tumores unifocales y sin angiogénesis, con baja tasa de recaída y sin evolución. La supervivencia libre de recidiva puede también preverse mediante la expresión de la HER 2 en los tumorespT1GII (p < 0,01). Conclusión: la expresión de la HER2 mediante test Hercep puede ser de utilidad en la predicción de recaídas en CCT vesical no músculo invasivo. El potencial de aplicación de este estudio, sobre todo en lo que se refiere a la predicción de la respuesta a BCG, debe confirmarse de forma prospectiva en ensayos multicéntricos (AU)

Objective: to evaluate the prognostic value of HER2 expression in non-muscle invasive bladder transitional cell carcinoma (TCC) with special emphasis in the high grade population. Materials and methods (patients): Tissue microarrays (TMA) were performed with representative TUR-B specimens from 84 patients with non-muscle invasive bladder TCC (40 pT1GII and 44 pT1GIII) treated in our institution. Depth of invasion and grade were uniformly assigned by the same pathologist who performed blind immunohistochemical analysis with Hercep test: 3+was considered strong positive HER2 over expression. Other clinico-pathological variables were also assessed. Results: HER2 protein over expression was detected in 30/44 (68.2%) pT1GIII lesions and predicted recurrence in this subgroup of bladder TCC (p < 0.01). Negative HER2 expression was detected in 26/40 (65%) cases with pT1GII TCC, and this condition was more frequent in unifocal tumours, without angiogenesis, with low recurrence rate and without progression. Recurrence-free survival can also be anticipated by HER 2 expression within pT1GII tumours (p < 0.01). Conclusion: HER2 expression using Hercep test may be useful to predict recurrence in non-muscle invasive bladder TCC. The potential application of this study, especially regarding prediction of response to BCG, should be prospectively confirmed in multi-institutional trials (AU)

[Evaluation of HER2 protein overexpression in non-muscle-invasive bladder cancer with emphasis on tumour grade and recurrence]. / Evaluación de la sobreexpresión de proteína HER2 en cáncer vesical no músculo invasivo con énfasis en el grado tumoral y en la recurrencia.

OBJECTIVE: To evaluate the prognostic value of HER2 expression in non-muscle invasive bladder transitional cell carcinoma (TCC) with special emphasis in the high grade population. MATERIALS AND METHODS (PATIENTS): Tissue microarrays (TMA) were performed with representative TUR-B specimens from 84 patients with non-muscle invasive bladder TCC (40 pT1GII and 44 pT1GIII) treated in our institution. Depth of invasion and grade were uniformly assigned by the same pathologist who performed blind immunohistochemical analysis with Hercep test: 3+ was considered strong positive HER2 overexpression. Other clinico-pathological variables were also assessed. RESULTS: HER2 protein overexpression was detected in 30/44 (68.2%) pT1GIII lesions and predicted recurrence in this subgroup of bladder TCC (p<0.01). Negative HER2 expression was detected in 26/40 (65%) cases with pT1GII TCC, and this condition was more frequent in unifocal tumours, without angiogenesis, with low recurrence rate and without progression. Recurrence-free survival can also be anticipated by HER 2 expression within pT1GII tumours (p<0.01). CONCLUSION: HER2 expression using Hercep test may be useful to predict recurrence in non-muscle invasive bladder TCC. The potential application of this study, especially regarding prediction of response to BCG, should be prospectively confirmed in multi-institutional trials.

[Renocolic fistula following abdominal trauma: a case study]. / Les fistules rénocoliques post-traumatiques : à propos d'une observation.

The renocolic fistula is a rare entity, which has occurred exceptionally in a traumatic not iatrogenic context, we report a case of renocolic fistula complicating penetrating abdominal trauma from a gunshot.

Synchronous Primary Tumors of the Kidney and Pancreas: Case Report

The simultaneous presence of primary carcinomas in the same patient is uncommon and synchronous primary tumors involving the kidney and pancreas are extremely rare. There are a few reports in the eng literature of synchronous primary malignancies of the kidney and pancreas. We present a 62-year-old man who had weight loss of 9 kg and epigastric pain. Findings showed a Furhman grade II renal papillary carcinoma confined to the kidney and a synchronous well differentiated pancreatic ductal adenocarcinoma

[Primitive neuroectodermal tumor (PNET) of the upper-urinary tract]. / Tumeur neuro-ectodermique primitive (TNEP) de la voie excrétrice supérieure.

Primitive neuroectodermal tumors (PNETs) are rare and aggressive malignant small round cell sarcomas. Primitive urogenital location of PNETs is rare and occurs most frequently in the kidney. PNETs of the upper-urinary tract are exceptional (only one case reported in the literature). Its diagnosis is almost postoperative within pathological study of the operatory specimen, supported by immunohistochemistry and cytogenetics. Treatment is similar in all to that of Ewing's sarcoma and involves surgery, chemotherapy and radiotherapy. We report a new case of upper-urinary tract PNET and discuss the diagnostic and therapeutic problems posed by this particular tumor.

[A case of hemoglobin D Punjab in Tunisia. Characterization and structural study]. / Un cas d'hémoglobine D punjab en Tunisie. Caractérisation et étude structurale.

Hb D Punjab is a hemoglobin abnormality due to the substitution of a glutamic acid by a glutamic on the hemoglobin beta chain: beta 121 Glu----Gln. Authors report here the first case of this rare variant in a tunisian family.