Neutrophil percentage-to-albumin ratio predicts mortality in bladder cancer patients treated with neoadjuvant chemotherapy followed by radical cystectomy.

AIM: To investigate the prognostic role of neutrophil percentage-to-albumin ratio (NPAR) in muscle-invasive bladder cancer (MIBC) patients treated with neoadjuvant chemotherapy (NAC) and radical cystectomy (RC). PATIENTS & METHODS: 213 patients were included. INCLUSION CRITERIA: Nonmetastatic, MIBC (cT2-T4aN0M0), at least three cycles of NAC, undergone RC and with blood count within 30 days before NAC. RESULTS: Five-years overall survival (OS) with NPAR >18 was 34.06% (95% CI: 18.3-50.5) and 65.37% (95% CI: 52.4-75.6) with NPAR <18. Five years cancer-specific survival (CSS) with NPAR >18 was 42.9% (95% CI: 23.9-60.7) and 74.5% (95% CI: 62.6-83.1) with NPAR <18 (p < 0.001). In multivariable analysis, NPAR increased OS of 1.3 points and CSS of 4.37 points. CONCLUSION: High NPAR prior to NAC seems to be a strong predictor of OS and CSS in MIBC patients treated with NAC and RC.

Radiofrequency energy in the arthroscopic treatment of knee chondral lesions: a systematic review.

INTRODUCTION: Cartilage debridement is one of the recommended procedures for the management of chondral defects. Radiofrequency probes allow to debride the cartilage, but may induce subchondral bone necrosis. SOURCES OF DATA: Medline, Cochrane and Google Scholar were searched to identify studies on arthroscopic debridement of the articular cartilage of the knee using radiofrequency chondroplasty. The methodological quality of the studies was assessed using the Coleman methodology score (CMS). AREAS OF AGREEMENT: Monopolar and bipolar radiofrequency devices provide significantly better clinical outcomes, especially for patients with high-grade chondral lesions, compared with mechanical shaver only. Despite the original concerns regarding subchondral bone necrosis, low complication rates are reported. AREAS OF CONTROVERSY: Heterogeneity in terms of type of device does not allow sound comparison of the published results. There is lack of evidence on the long-term effects of radiofrequency chondroplasty. GROWING POINTS: Study methodology should be improved: the average Coleman methodology score was 56.2 out of 100. RESEARCH: More comparative, well-designed and larger cohort trials are needed to ascertain whether radiofrequency chondroplasty offers long-term benefits over other simpler and more economical alternatives.

Laparoscopic ureterolithotomy: minimally invasive second line treatment.

PURPOSE: To describe our experience of 33 laparoscopic ureterolithotomies for large ureteral stones. METHODS: Since February 2004, in our department, 33 patients had undergone laparoscopic ureterolithotomy. Inclusion criteria were failure of SWL and\or ureteroscopic treatment. Stones were located in the lower ureter in 9 patients, in the mid ureter in 16 patients, and in the upper ureter in 8 patients. RESULTS: Mean age of the patients was 47 years (range 37-51). The mean stone size, at preoperative IVP, was 34 mm (range 18-55). All stones were impacted from 4 to 36 months before procedure. Successful rates were 100%. No conversion to open surgery occurred. No intraoperative and postoperative complications occurred. Mean operating time was 85 min (range 60-160). Mean intraoperative blood loss was 70 ml (range 30-120). Mean hospital stay was 3.4 days (range 2-7). Mean follow-up was 24 months (range 6-44). During follow-up, no major complications were observed in any patients. CONCLUSIONS: In our hand, first-line treatment after failure of SWL and\ or ureteroscopy is laparoscopic ureterolithotomy. Large stone size and previous open surgery did not affect the successful rates of laparoscopic ureterolithotomy.