Manejo urológico y procedimientos quirúrgicos en migrantes del África Subsahariana con esquistosomiasis urogenital / Urological management and surgical procedures in migrants from Sub-Saharan Africa with urogenital schistosomiasis

Introducción y objetivos: Tras el flujo migratorio procedente del África Subsahariana (ASS) en Europa, el número de diagnósticos de esquistosomiasis urogenital (EUG) es cada vez mayor. Este fenómeno representa un desafío para los urólogos que trabajan en zonas no endémicas. El objetivo de este estudio es describir el tratamiento urológico y los procedimientos quirúrgicos de los pacientes con EUG en un centro de referencia terciarioPacientesTodos los sujetos del ASS diagnosticados con EUG entre enero del 2011 y noviembre del 2018 fueron inscritos retrospectivamente. Se recogió y analizó la información detallada de los pacientes con EUG tratados mediante procedimientos urológicos.ResultadosTreinta pacientes fueron diagnosticados con EUG, 12 (42,8%) fueron tratados mediante cirugía. El procedimiento quirúrgico más común fue la resección transuretral de vejiga (RTUV) para las lesiones sospechosas persistentes después del tratamiento con praziquantel administrado en 7 casos (58%). Otros procedimientos quirúrgicos (realizados una vez) fueron RTUV combinada con ureteroscopia láser por sospecha de neoplasia de vejiga con cálculos renales, litotricia endoscópica y nefrolitotomía percutánea para cálculos vesicales y renales, nefrectomía laparoscópica para enfermedad renal terminal, colocación de nefrostomía bilateral para hidroureteronefrosis, cirugía testicular exploratoria por sospecha de torsión testicular. Cuatro pacientes (33%) se perdieron en el seguimiento.ConclusiónSe ha observado un número cada vez mayor de migrantes del ASS diagnosticados con EUG. Algunos pacientes requirieron intervención quirúrgica por sospecha de lesiones neoplásicas o daños en órganos en fase terminal. En varios pacientes fue particularmente difícil realizar un seguimiento regular. Se necesitan más estudios multicéntricos para lograr un manejo estándar en términos de diagnóstico, tratamiento y seguimiento de los sujetos con EUG. (AU)

Introduction and objectives: An increasing number of urogenital schistosomiasis (UGS) is being diagnosed in Europe following the unprecedented migratory flux from Sub-Saharan Africa (SSA). This phenomenon represent a challenge for urologists working in a non-endemic area. The aim of this study is to describe the urological management and the surgical procedures of patients with UGS in a tertiary referral centre.PatientsAll subjects from SAA diagnosed with UGS from January 2011 to November 2018 were enrolled retrospectively. Detailed data of patients with UGS undergoing to urological procedures were collected and analysed.ResultsThirty patients were diagnosed with UGS, among them 12 (42.8%) were submitted to surgery. The most common surgical procedure was trans urethral resection of bladder (TURB) for suspected lesions persisted after praziquantel treatment performed in 7cases (58%). Other surgical procedure were TURB and concomitant ureteroscopy with laser fragmentation for suspected bladder neoplasm with renal stone, endoscopic lithotripsy and percutaneous nephrolithotomy for bladder and renal stones, laparoscopic nephrectomy for end-stage kidney disease, placement of bilateral nephrostomy for hydroureteronephrosis, explorative testicular surgery for a suspected testicular torsion in one case each. Four patients (33%) were lost at the follow up.ConclusionAn increasing number of migrants from SSA diagnosed with UGS has been observed. Some patients required a surgical intervention for suspected neoplastic lesions or end-stage organ damage. It was particularly difficult to perform a regular follow-up in several patients. Further multicentric studies are needed to reach a proper standard in diagnosis, treatment and follow-up of subjects with UGS. (AU)

Urological management and surgical procedures in migrants from Sub-Saharan Africa with urogenital schistosomiasis. / Manejo urológico y procedimientos quirúrgicos en migrantes del África Subsahariana con esquistosomiasis urogenital.

INTRODUCTION AND OBJECTIVES: An increasing number of urogenital schistosomiasis (UGS) is being diagnosed in Europe following the unprecedented migratory flux from Sub-Saharan Africa (SSA). This phenomenon represent a challenge for urologists working in a non-endemic area. The aim of this study is to describe the urological management and the surgical procedures of patients with UGS in a tertiary referral centre. PATIENTS: All subjects from SAA diagnosed with UGS from January 2011 to November 2018 were enrolled retrospectively. Detailed data of patients with UGS undergoing to urological procedures were collected and analysed. RESULTS: Thirty patients were diagnosed with UGS, among them 12 (42.8%) were submitted to surgery. The most common surgical procedure was trans urethral resection of bladder (TURB) for suspected lesions persisted after praziquantel treatment performed in 7cases (58%). Other surgical procedure were TURB and concomitant ureteroscopy with laser fragmentation for suspected bladder neoplasm with renal stone, endoscopic lithotripsy and percutaneous nephrolithotomy for bladder and renal stones, laparoscopic nephrectomy for end-stage kidney disease, placement of bilateral nephrostomy for hydroureteronephrosis, explorative testicular surgery for a suspected testicular torsion in one case each. Four patients (33%) were lost at the follow up. CONCLUSION: An increasing number of migrants from SSA diagnosed with UGS has been observed. Some patients required a surgical intervention for suspected neoplastic lesions or end-stage organ damage. It was particularly difficult to perform a regular follow-up in several patients. Further multicentric studies are needed to reach a proper standard in diagnosis, treatment and follow-up of subjects with UGS.

Activation of estrogen signaling pathways collaborates with loss of Brca1 to promote development of ERalpha-negative and ERalpha-positive mammary preneoplasia and cancer.

BRCA1 can regulate estrogen receptor-alpha (ERalpha) activity. This study tested the hypotheses that Brca1 loss in mammary epithelium alters the estrogenic growth response and that exposure to increased estrogen or ERalpha collaborates with Brca1 deficiency to accelerate preneoplasia and cancer development. Longer ductal extension was found in mammary glands of Brca1(f/f;MMTV-Cre) mice during puberty as compared to wild-type mice. Terminal end bud differentiation was impaired in Brca1 mutant mice with preservation of prolactin-induced alveolar differentiation. Exogenous estrogen stimulated an abnormal sustained increase in mammary epithelial cell proliferation and the appearance of ERalpha-negative preneoplasia in postpubertal Brca1 mutant mice. Carcinogenesis was investigated using Brca1(f/f;MMTV-Cre) mice hemizygous for p53. Exogenous estrogen increased the percentage of mice with multiple hyperplastic alveolar nodules. Targeted conditional ERalpha overexpression in mammary epithelial cells of mice that were Brca1 mutant and hemizygous for p53 increased the percentage of mice exhibiting multiple hyperplastic nodules, invasive mammary cancers and cancer multiplicity. Significantly more than half of the preneoplasia and cancers were ERalpha negative even as their initiation was promoted by ERalpha overexpression.

Trans-arterial chemoembolization (TACE) of liver metastases from colorectal cancer using irinotecan-eluting beads: preliminary results.

PURPOSE: The purpose of the study was to evalutate the feasibility of irinotecan drug-eluting beads (DC Bead) administered as trans-arterial chemoembolization (TACE) in patients with liver metastases from colorectal cancer (CRC). PATIENTS AND METHODS: Ten patients with liver metastases from CRC were treated with TACE adopting irinotecan-eluting beads at a dose of 100 mg every 3 weeks. Computed Tomography (CT) was performed 24h before and after TACE. RESULTS: TACE with irinotecan eluting beads was found to be feasible and well-tolerated. Right upper quadrant pain (RUQP) lasting 4 days (range 2-7) was reported by all the patients. After 30 days, a reduction >50% of CEA levels and of the lesional contrast enhancement was observed in all the patients. CONCLUSION: Irinotecan drug-eluting beads administered as TACE were shown to be active and safe in patients with liver metastases from CRC.

Radiofrequency ablation of liver malignancies: MRI for evaluation of response.

The aim of this study was to investigate the role of magnetic resonance imaging (MRI) in the evaluation of response to radiofrequency ablation (RFA) and detect residual or recurrent tumor. After RFA, the target lesion shows a hyperintensive signal without increased T1-weighted, low on T2-weighted, non enhancing in gadolinium-enhanced MRI. In the long term follow-up the successfully treated lesions decrease in size. Signs of recurrence include new enhancement areas, the lesion's size increase, and development of T1-weighted hypointense and T2 weighted hyperintense areas. The MRI is a reliable method to evaluate the effectiveness of RFA and detect residual tumor.

Survey of genetic counselors and clinical geneticists regarding recurrence risks for families with nonsyndromic cleft lip with or without cleft palate.

Nonsyndromic cleft lip with or without cleft palate (CL/P) is a common congenital malformation affecting about 1/1,000 caucasian infants. Although the familial clustering of CL/P has been studied thoroughly, estimation of recurrence risk for genetic counseling purposes can be difficult. A survey was mailed to 912 board-certified genetic counselors, 542 non-board-certified genetic counselors, and 776 board-certified clinical geneticists to investigate the recurrence risks they would assign to three example families with CL/P. Responses were received from 155 (17%) board-certified genetic counselors, 36 (6.6%) non-board-certified genetic counselors, and 100 (18.5%) board-certified clinical geneticists. No major differences were found in their responses, suggesting that for these three families, geneticists would provide similar estimates of risk, regardless of their amount of experience with oral clefts patients, where they are currently employed, or their board certification status.