Should Targeted Biopsy be Performed in Patients Who Have Only Pi-rads 3 Lesions?

Objective: To determine whether clinical or radiological parameters can predict clinically significant prostate cancer (csPC) in patients with the Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions. Patients and Methods: Data were obtained from 247 patients with PI-RADS 3 lesions on mpMRI and who had received a software guided transperineal/transrectal MRI/transrectal ultrasonography (MRI/TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy following mpMRI in the prostate cancer and prostate biopsy database of Turkish Urooncology Association, between 2016 and 2020. The cut-off values of clinical parameters were determined using receiver operating characteristic (ROC) curve analysis. Simple and multiple logistic regression analyses were performed to determine the clinical parameters in predicting csPC. Results: A total of 56 patients (22.6%) had prostate cancer, 23 (9.3%) of whom had csPC. In the lesion- based analysis, cancer detection rates (CDRs) of each lesion in targeted biopsy were found to be 6% and 5% for ISUP GG 1 and ISUP GG ≥ 2, respectively. In the patient-based analysis, clinically insignificant CDRs were significantly higher in systematic biopsy compared with targeted biopsy, whereas no significant difference was found in terms of clinically significant CDRs (p = 0.020 and p=0.422, respectively). The cut-off values were determined as 48.3 mL (AUC [95% CI] = 0.68 [0.53–0.82]) for prostate volume, and 0.213 ng/mL/mL (AUC [95% CI] = 0.64 (0.51–0.77]) for PSAD in predicting csPC. In the multiple logistic regression analysis, only PSAD was found to be an independent risk factor in predicting csPC (OR [95% CI]: 3.56 [1.15–10.91], p = 0.024). Conclusion: Since PSAD > 0.20 ng/mL/mL was found to be positive independent risk factor in predicting csPC, in the absence of advanced radiological parameters, PSAD could be used for the biopsy decision in patients with PI-RADS 3 lesions (AU)

Neutrophil volume distribution width as a new marker in detecting inflammatory bowel disease activation.

INTRODUCTION: We sought to investigate the value of neutrophil volume distribution width in detecting inflammatory bowel disease activation. METHODS: Patients with infection and accompanying inflammatory disease were excluded. All the patients were diagnosed and classified according to Porto criteria and Paris classification, respectively. Physician global assessment, pediatric Crohn's disease and pediatric ulcerative colitis activity indexes and fecal calprotectin were used to define disease activation. RESULTS: A total of 34 pediatric patients with Inflammatory bowel diseases (IBD) and 29 controls were enrolled in the study. Neutrophil volume distribution width (NVDW) was significantly higher in patients with IBD compared to healthy controls (P < 0.001). An increased NVDW level was observed in IBD patients in activation (22.42 ± 2.13) compared to those in remission (19.22 ± 1.63) (P < 0.001). There was no statistically significant difference between IBD patients in remission and healthy controls. The best cutoff of NVDW for prediction of disease activation in Crohn's disease and ulcerative colitis in this series was 20.39 with a sensitivity of 90.9% and a specificity of 75% (AUC: 0.852 CI: 0.698-1.000 P < 0.001) and 19.74 with a sensitivity of 92.9% and a specificity of 90.9% (AUC: 0.961, CI: 0.889-1.000, P < 0.001), respectively. CONCLUSIONS: As a quantitative, objective, and sensitive parameter, we believe that the NVDW has a potential to be an additional test detecting disease activation in IBD.

Can p53, Ki-67 and bcl-2 predict biochemical failure after radical prostatectomy?

BACKGROUND AND OBJECTIVE: To analyze p53, Ki-67 and bcl-2 expressions immunohistochemically and their predictive role in biochemical recurrence after radical prostatectomy. MATERIALS AND METHODS: Seventy one patients who had undergone radical prostatectomy between 1992 and 2001 were randomly selected. Tissue microarrays were constructed from their radical prostatectomy specimens. They contained four cores from neoplastic and additional four cores from corresponding non-neoplastic regions. Gleason score ranged from 6-9, and pathological stage ranged from T2N0Mx to T3BN1. Staining for bcl-2 was scored visually taking percent negative, weak, moderate and strong positivity into consideration. Strong immunoreactivity was considered positive for p53. Ki-67 index was measured as the percentage of positive nuclei among tumor cells. Statistical analysis was performed to explore correlations between staining patterns and clinicopathological prognostic parameters. RESULTS: The follow-up period extended from 13 to 112 months with a mean 60 (48 ± 23, 2) months. Of all, 38.02% had no evidence of disease, 52.1% were alive with disease and 9.8% were died during follow-up. The expression of p53, Ki-67 and bcl-2 in tumors were 39%, 76% and 5% respectively. While the secretory layer showed negative or weak bcl-2 staining in most cases, expression in basal cells was often stronger. Statistical analysis revealed differences in staining between normal and carcinoma for all three markers. There was no correlation between staining patterns and time to biochemical relapse. On the other hand, cases with higher Gleason sum showed the tendency for over expression of p53, Ki-67 and bcl-2 although the differences were not statistically different. Multivariate analysis revealed CMS group and seminal vesicle invasion as the independent predictors of PSA failure (log rank P = 0.0039 and P = 0.001, respectively). CONCLUSION: The proteins bcl-2, p53 and Ki-67 were expressed at a different rate in normal and neoplastic prostate tissue. Bcl-2 was mainly expressed by basal cells in normal glands. p53 and Ki-67 expression were increased in most prostate carcinomas. However, overall expression levels did not correlate with biochemical recurrence in this study.

Pathological, biochemical and haematological investigations on the protective effect of alpha-lipoic acid in experimental aflatoxin toxicosis in chicks.

1. The purpose of this study was to investigate the protective effect of alpha-lipoic acid (LA) on aflatoxin (AF) toxicosis in chicks. 2. Groups of 10 Ross PM3 chicks were given, for 21 d, no AF (C), 60 mg/kg/bwt of alpha-lipoic acid (LA), 150 ppb of aflatoxin (AF1), 150 ppb of aflatoxin plus 60 mg/kg/bwt of alpha-lipoic acid (AF1 + LA), 300 ppb of aflatoxin (AF2), and 300 ppb of aflatoxin plus 60 mg/kg/bwt of alpha-lipoic acid (AF2 + LA). Before the animals were killed, blood samples were drawn for haematological analysis, and then tissue samples were collected for histopathological investigation. Immunohistochemical staining was performed against inducible nitric oxide synthase (iNOS) and nitrotyrosine on liver samples. Apoptotic cell death in liver was assessed by in situ TUNEL assay. The malondialdehyde (MDA) and reduced glutathione (GSH) concentrations in liver and kidney were also determined. 3. Hydropic degeneration and occasional necrosis, bile duct hyperplasia and periportal fibrosis were observed in the livers of AF-treated groups. The severity of these changes was reduced in LA-supplemented AF groups. Occasionally, thymic cortical atrophy, lymphoid depletion in spleen and bursa of Fabricius, and degeneration in the kidney tubule epitheliums were detected in AF groups. The severity of these degenerative changes was slightly reduced in LA supplemented groups. 4. There was moderate to strong iNOS and nitrotyrosine immunoreactivity in the livers of AF groups, while decreased immunoreactivity was observed against both antibodies in the LA supplemented groups. Apoptotic cells were numerous in the AF groups, while greatly reduced in LA supplemented groups. 5. In the liver and kidney of AF-treated groups given 300 ppb of aflatoxin, MDA concentrations were increased as GSH decreased, compared to the control group. LA supplementation of AF-treated birds improved the results compared to the AF only groups, however a statistical difference was observed only in liver tissues between AF2 + LA and AF2 groups. Haematological variables showed no differences among the groups. 6. In conclusion, supplementation of feed with the antioxidant LA, might ameliorate the degenerative effects caused by aflatoxin due to lipid peroxidation.

Caffeic acid phenethyl ester prevents ovary ischemia/reperfusion injury in rabbits.

Protective effect of caffeic acid phenethyl ester (CAPE) on ovary ischemia/reperfusion (IR) injury was investigated in this study. Twenty four New Zealand rabbits were divided into 4 groups as follows: group S served as sham. Group C was intraperitoneally injected with CAPE (8.5mg/kg). In groups E+IR and C+IR, 1% ethanol and CAPE was given intraperitoneally before torsion, respectively. Then, the ovaries were subjected to IR in both groups. Ovary reduced glutathione (GSH) level and glutathione peroxidase (GSH-Px) activity in group E+IR were significantly reduced compared to that of group S. GSH level and GSH-Px activity was significantly increased in group C+I/R. Thiobarbituric acid reactive substances (TBARS) and catalase (CAT) activity in group E+I/R was significantly higher than in group S. CAT activity was decreased to normal levels by CAPE treatment in group C+I/R, while TBARS in group C+IR was significantly reduced compared to that of E+IR. According to histopathological examination, severe congestion, hemorrhage, edema and leukocyte infiltration were observed in E+I/R group. CAPE prominently reduced degenerative effects of IR injury thus it alleviates free radical damage. In conclusion, CAPE which is able to prevent IR-induced injury in the ovaries may be of therapeutic value before the surgical correction.

Melatonin ameliorates cerebral vasospasm after experimental subarachnoidal haemorrhage correcting imbalance of nitric oxide levels in rats.

In the present study, we investigated the in vivo effects of melatonin on SAH-induced cerebral vasospasm and oxidative stress, resulting from SAH in an experimental rat model. Twenty-eight rats (225-250 g) were divided into four groups equally: group 1; control, group 2; SAH, group 3; SAH plus placebo, and group 4; SAH plus melatonin. We used double haemorrhage method for SAH groups. Beginning 6 h after SAH, 20 mg/kg melatonin or equal volume of 0.9% saline was administered intraperitoneally twice daily for 5 days to groups 3 and 4, respectively. Melatonin or 0.9% saline injections were continued up to fifth day after SAH and rats were sacrificed at the end of this period. Brain sections at the level of the pons were examined by light microscopy. The lumen diameter and the vessel wall thickness of basilar artery were measured using a micrometer. The serum levels of cerebral vasodilator nitric oxide (NO), the brain levels of an intrinsic antioxidant superoxide dismutase (SOD) and a NO regulator arginase activities were measured. The brain levels of inducible nitric oxide (iNOS) and nitrotyrosine, a nitrosative stress parameter immunohistochemiacally determined. In conclusion, melatonin administration ameliorated cerebral vasospasm by increasing serum NO level and decreasing the brain the levels of arginase and oxidative stress. It is therefore possible that increased brain arginase activity after SAH may also have a significant role in the pathogenesis of vasospasm by limiting the availability of arginine for NO production.

Effects of different concentrations of benzylaminopurine on shoot regeneration and hypericin content in Hypericum triquetrifolium Turra.

The current study was undertaken to determine the effects of different benzylaminopurine (BAP) concentrations on the accumulation of bioactive hypericin in Hypericum triquetrifolium Turra. via micropropagation. To achieve this objective, seeds of H. triquetrifolium Turra. were cultured on Murashige and Skoog (MS) medium supplemented with a BAP (0.5, 1.0 and 2.0), 3% sucrose and 5.5% agar. Apical tips of axenic germinated seeds were proliferated on a MS medium supplemented with BAP (0.0, 0.5, 1.0 and 2.0 mg L(-1)). The highest shoot number was obtained from a MS medium supplemented with a 2.0 mg L(-1) BAP. Hypericin percentages were found to be highest in a 1.0 mg L(-1) BAP supplemented medium. These results provide the indication that cytokinin BAP can change the chemical composition of H. triquetrifolium Turra.; thereby, seriously impacting the quality and the efficacy of natural plant products produced by an in vitro culture system for aseptic production of hypericin.

Hematopoietic stem cell transplantation in a CD3 gamma-deficient infant with inflammatory bowel disease.

Partial or total CD3 chain expression defects including CD3 gamma, epsilon, delta, and zeta chain are among the autosomally inherited SCID presenting with T-B+NK+ phenotype with lymphopenia. The clinical findings are generally severe in all except for CD3 gamma deficiency. Here we present a 10-month-old CD3 gamma deficient boy with IBD. The patient had suffered from intractable diarrhea, recurrent pulmonary infections and oral moniliasis since two months of age. Following the first allogeneic HSCT from his HLA-identical (6/6) sister after a reduced intensity regimen, a second transplantation was performed five months later. On day +19 after second transplantation, the CD3 TCR alpha/beta chain expression increased to 66% with development of full donor chimerism (98.6%). A significant improvement in diarrhea, perianal lesions, and rectal fistula was observed suggesting an improvement in inflammatory bowel disease. The patient died at home on day +50 with a sudden respiratory failure secondary to an undetermined infection. The case was interesting being the first reported case with SCID and inflammatory bowel disease who responded very well to HSCT by full recovery of intractable diarrhea, failure to thrive, laboratory findings, and improvement of fistula formation.

Nitrosative tissue damage and apoptotic cell death in kidneys and livers of naturally ethylene glycol (antifreeze)-poisoned geese.

Three naturally ethylene glycol (EG)-intoxicated geese were investigated for pathological changes, nitrosative tissue damage and apoptotic cell death. Severe degeneration of kidney tubular epithelium and congestion of kidney and liver tissues were observed. Immunohistochemical staining for inducible nitric oxide synthase and nitrotyrosine revealed strong immunoreactivity with both antibodies in kidney and liver tissues compared with the weak immunostaining in the control animals. In both tissues of the EG-intoxicated geese, erythrocytes were also highly immunoreactive with nitrotyrosine antibody. A high degree of apoptotic cell death was present in the kidney tubule epithelium of EG-intoxicated geese. Some apoptotic cells were also observed in the liver. These results show that nitrosative tissue damage and apoptotic cell death takes place in kidney and liver during EG intoxication in geese.

A cadaveric histological investigation of the prostate with three-dimensional reconstruction for better results in continence and erectile function after radical prostatectomy.

In this study our aim is to increase the understanding of the prostate and related organs anatomy for better continence and erectile function results after urological surgery. Prostate and related organs were dissected from seven cadavers. After dissection, 165 serial sections with 300 microm thickness were derived at a 100 microm interval. The histological images were examined and imported to the computer. Three-dimensional (3D) remodeling had been performed. The findings were evaluated into three categories: macroscopic, microscopic and 3D reconstruction. Striated muscle fibers had been detected at the anterior fibromuscular stroma in histological sections. In 3D remodeling, urethra seemed to be a complete functional unit, beginning from the trigone up to the membranous urethra. The neurovascular bundles run under the pelvic fascia on both sides and go through to the bladder neck at 5 and 7 o'clock. Computer remodeling demonstrated that neurovascular structures had a close association with the bladder neck and the seminal vesicle. Computer program made it possible to rotate all 3D-reconstructed figures by 360 degrees and examine them from all possible angles. All reconstructed structures can be examined together at the same time or one by one. Surgeons must pay special attention to the continence area described as a single unit, beginning from trigone to the membranous urethra, during the surgery. Meticulous dissection of the neurovascular bundles, especially close to the seminal vesicles and bladder neck, during the radical prostatectomy is necessary. These reconstructions can be used for the educational purpose of medical students as well as the urology surgeons.

Atypical cyclopia in a brown swiss cross calf: a case report.

In this report, an atypical form of cyclopia is described in a stillborn Brown Swiss cross male calf. The changes were confined to the head. The most significant malformation was the presence of a median orbita-like opening that did not contain an eyeball. Other defects included prosencephalic aplasia, brachygnathia superior and arrhinia. The possible cause of this congenital defect could not be ascertained.

A novel surveillance protocol for stage I nonseminomatous germ cell testicular tumours.

OBJECTIVES: To report the results of a novel surveillance policy for stage I nonseminomatous germ cell tumours (NSGCTs). PATIENTS AND METHODS: Between 1978 and 2000, 132 patients (median age 28 years, range 16-52) who were regularly followed were included in a new surveillance policy. All pathology specimens were studied retrospectively by the same pathologist for embryonal carcinoma, yolk sac tumour and lymphovascular invasion components. A loose surveillance protocol was designed in which computed tomography (CT) was used only for the first year. RESULTS: The median (range) follow-up was 38 (6-265) months; the relapse rate was 24% and all occurred before 23 months, with 87% diagnosed within the first year. Platinum-based chemotherapy was given to patients with relapse, and surgery used after chemotherapy in seven. Among all the risk factors, an embryonal carcinoma component was the only significant predictor of relapse. The overall survival rate was 99%. CONCLUSION: The presence of embryonal carcinoma in the primary pathology is the only risk factor determining the relapse rate of the present surveillance policy for stage I NSGCTs. The overall survival was no different from those reported for retroperitoneal lymph node dissection and primary chemotherapy. Decreasing the frequency of CT in the first year and totally eliminating it after 1 year reduces the cost of surveillance. The possible compliance problems of patients are also minimized, without changing the overall survival. This surveillance protocol for patients with stage I NSGCT has reduced costs and provided a better quality of life for the patients, without jeopardizing the final outcome.

Percutaneous nephrostomy in the management of malignant ureteral obstruction secondary to bladder cancer.

BACKGROUND AND PURPOSE: Malignant ureteral obstruction (MUO) is a common late manifestation of metastatic bladder cancer. We investigated the effectiveness of percutaneous nephrostomy (PN) in our patients with MUO associated with bladder cancer as judged by the serum creatinine concentration in the presence of unilateral or bilateral obstruction and in relation to the treatment results. PATIENTS AND METHODS: The records of 23 consecutive patients with a mean age of 55 years (21 men, 2 women) who underwent PN were retrospectively reviewed. Eleven had unilateral obstruction. We assessed normalization of creatinine concentration, survival, and quality of life after PN in patients with either unilateral or bilateral obstruction. RESULTS: The mean serum creatinine concentration before PN was 6 mg/dL (range 2.1-24.6 mg/dL). Percutaneous nephrostomy provided improvement to normal renal function in 19 patients (83%). The mean survival of patients after PN was 4.9 months (range 1-14 months). No independent factor playing a significant prognostic role was determined. The overall complication rate was 30% (7/23), namely kinking or dislodgment of nephrostomy tubes. After PN, all patients were able to undergo treatment for bladder cancer. CONCLUSIONS: Percutaneous nephrostomy, with a low morbidity rate, is a safe urinary diversion technique in bladder cancer-induced MUO. It relieves at least the devastating effects of uremia and allows appropriate treatment for the malignancy.

Repeated transurethral resection and intravesical BCG for extensive superficial bladder tumors.

PURPOSE: We report our experience with repeat transurethral resection (TUR) in a group of patients with superficial bladder tumors in whom complete resection in one session was impossible because of the extensive tumor burden. PATIENTS AND METHODS: Only the patients with such extensive (>10 g of resected tissue) tumors that we were unable to perform complete TUR initially were included in the present study. The patients underwent repeat TUR(s) 4 weeks after the previous one until complete resection of the tumor was achieved. After complete TUR, if the pathology examination confirmed superficial disease, the patients received intracavitery immunotherapy and were followed up thereafter. If pathology examination documented muscle-invasive disease, cystectomy was suggested. RESULTS: Of the 43 patients undergoing repeat TUR, 15 needed a second and 5 needed a third session to achieve complete resection. Of the patients, 28 (65%) had stage T1 and 15 (35%) has stage Ta tumor. Eight patients (19%) otherwise regarded as having superficial tumor were found to have muscle-invasive disease following repeat TURs. The mean follow-up of the remaining 35 patients with superficial disease was 34 months (range 1-126 months). Four of the patients with superficial disease progressed to T2 tumor. However, 16 patients achieved a state of complete response with no tumor recurrences during a mean of 38 months (range 4-126 month). The present protocol achieved bladder sparing in a total of 22 (63%) of the 35 patients with superficial disease. CONCLUSIONS: From the presented series, we suggest that one can use the combination of repeat TUR and intravesical immunotherapy in the management of bulky superficial bladder tumors in an effort to preserve the bladder.

Helicobacter pylori infection and recurrent abdominal pain in Turkish children.

BACKGROUND: Helicobacter pylori infection is primarily acquired in childhood. However, the association between H. pylori infection and recurrent abdominal pain (RAP) remains unclear. MATERIALS AND METHODS: One hundred and forty-one children with and 21 without RAP underwent upper gastrointestinal endoscopy. At least five antral gastric biopsies were obtained from each patient and the presence of H. pylori infection was accepted when at least two out of four tests (histology, direct antral smear, culture, and rapid urease test) were positive. Patients with H. pylori infection underwent triple therapy with omeprazole, clarithromycin, and metronidazole. RESULTS: Eighty-five out of 141 (60.3%) patients with RAP were H. pylori positive whereas 5 out of 21 (20.8%) patients without RAP were (p =.0037). Symptoms were disappeared in 87% of children whose H. pylori infection was eradicated compared with 41% of those in whom the infection was not eradicated (p =.0035). CONCLUSIONS: It was concluded that children with RAP and H. pylori infection appear to benefit from eradication therapy in Turkey.