Pre-medical dental evaluation and treatment of oral infection - a survey study among hospital-affiliated dentists in Sweden.

OBJECTIVE: To examine how hospital-affiliated dentists assess risk and evaluate oral foci of infection in patients facing certain medical treatments, and whether the nature of upcoming medical treatment affects the choice of dental intervention. MATERIALS AND METHODS: A survey comprising six clinical cases (50 teeth) was sent to hospital-affiliated dentists in Sweden. A treatment option for the affected tooth/teeth in each case was selected whether the patient was facing heart valve surgery, chemotherapy, radiation therapy, intravenous bisphosphonate treatment, solid organ transplantation or was diagnosed with endocarditis. RESULTS: Consensus in choice of dental treatment was high in 62%, moderate in 32% and low in 6% of the assessments. High variability of choice of treatment was seen for eight teeth whereas the remaining 42 teeth often received the same therapy regardless of medical issue. Chemotherapy and radiotherapy were thought to entail the highest risk for oral infectious sequelae with a risk ranging from 1% to 100%. CONCLUSION: Pre-medical dental evaluations and recommended treatments are often uniform with the exception of the management of asymptomatic root canal treated teeth with persisting apical radiolucency and heavily decayed molars. In many instances, dental diagnosis has a greater impact on choice of treatment than the underlying medical issue and associated implications thereof.

Systematic review of cytokines and growth factors for the management of oral mucositis in cancer patients.

PURPOSE: The aim of this project was to review the literature and define clinical practice guidelines for the use of cytokines and growth factor agents for the prevention or treatment of oral mucositis induced by cancer chemotherapy or radiotherapy. METHODS: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, No guideline possible. RESULTS: Sixty-four clinical studies across 11 interventions were evaluated. A recommendation was made for the use of recombinant human KGF-1 (palifermin) at a dose of 60 µg/kg per day for 3 days prior to conditioning treatment and for 3 days post-transplant for prevention of oral mucositis in patients receiving high-dose chemotherapy and total body irradiation followed by autologous stem cell transplantation for hematological malignancies. A suggestion was made against using granulocyte macrophage colony-stimulating factor mouthwash for the prevention of oral mucositis in the setting of high-dose chemotherapy followed by autologous or allogeneic stem cell transplantation. No guideline was possible for any other cytokine or growth factor agents due to inconclusive evidence. CONCLUSIONS: Of the cytokine and growth factor agents studied for oral mucositis, the evidence only supports use of palifermin in the specific population listed above. Additional well-designed research is needed on other cytokine and growth factor interventions and in other cancer treatment settings.

Complications of percutaneous nephrostomy in a district general hospital.

OBJECTIVE: Percutaneous nephrostomy (PCN) is one of the commonest procedures performed. There are currently no European recommendations on the accepted rate of complications. The aim of the present study is to report the complication rate of PCN with the specific emphasis on sepsis and septic shock, the causative organisms, sensitivities to antibiotics, and associated risk factors. MATERIAL AND METHODS: Retrospectively collected data on patients undergoing acute or elective PCN at the Department of Radiology, Countess of Chester Hospital (COCH), in the UK between January 2014 and December 2016 were analyzed after the study was approved by Local Audit Department at COCH. RESULTS: A total of 66 patients underwent 90 acute or elective PCNs. Three patients developed major post-PCN complication (two patients developed septic shock and the third suffered a hemorrhagic episode requiring blood transfusion). Nephrostomy tube complications (blockage, leaking, fracturing and kinking of the catheter) occurred in 4 patients. Complications were more common when the PCN was performed out of working hours (71.4% [10/14], and 17.3% [9/52] for PCNs performed within, and out of working hours, respectively: p<0.001). The age of the patients did not seem to correlate with the development of complications (p<0.001). Of all 25 patients, in whom septicemia was diagnosed prior to PCN tube insertion, 12 developed septic shock and 13 had signs of sepsis for longer than 24 h. Fifteen patients had positive urine cultures. The most common organism isolated was Escherichia coli. Blood culture isolates included: Escherichia coli, Eggerthella lenta, Enterococcus, Proteus mirabilis, Pseudomonas aeruginosa and Streptococcus pneumonia. CONCLUSION: Our complication rates were within United States proposed target ranges. Our data may help to serve as a baseline for outcome targets in the European centres.

Uretero-Arterial Fistula - Not So Rare?

The first uretero-arterial fistula (UAF) was reported in 1908 by Moschcowitz. In 2009, a systematic review identified 139 cases. Since then a further 23 cases were described with 19 cases originating from a single center. It has been recognized as a very rare condition in the past. However, more recently, the increasing incidence of UAF has led us to believe that this condition is more frequent than previously described. Aging population, improved cancer survival and extensive multimodal pelvic cancer treatments have been recognized as culprits for the increased incidence of UAFs. We have reviewed literature on UAFs, identified risk factors, patho-physiology and treatment options. Also, we present a case of fistulous communication between the internal iliac artery and ureter in a patient with a potential risk factor previously not described in the literature.

Is magnetic resonance imaging helpful in detecting significant prostate cancer in patients with haematospermia, normal prostate specific antigen level and digital rectal examination. A single institution, observational, and retrospective study in a United Kingdom hospital.

INTRODUCTION: Haematospermia is an uncommon clinical condition that may be associated with prostate cancer. The optimal investigation of haematospermia is unknown. The aim of this study was to investigate haematospermia as a presenting symptom of significant pathology and to assess the diagnostic value of magnetic resonance imaging (MRI). MATERIAL AND METHODS: Patient and treatment parameters were collected from a practice cohort of men referred to a urology center presenting with haematospermia. We used a multivariate logistic regression model to test the independent significance of MRI in detecting prostate cancer (PCa) after adjusting for other known predictors of PCa detection. RESULTS: A total of 125 men (median age 58 years) were evaluated between 2012-2015. In the univariate and multivariate logistic regression model MRI was a significant predictor of PCa diagnosis after adjusting for age, prostate specific antigen (PSA) and digital rectal examination (DRE) results (Odds Ratio (OR) 14.15, p = 0.001). Of 107 patients who underwent MRI prostate imaging, 31 (28.9%) had reports suspicious of PCa. In 26 patients, other benign conditions were detected on MRI. PCa was detected in 12 (25.5%) of the 47 men (median age 61 years; range 43 to 85) who underwent prostate biopsies. Eight (17%) of these patients had Gleason ≥7 grade cancer. The persistence of haematospermia was not an independent predictor of cancer diagnosis (OR 0.20, p = 0.15). CONCLUSIONS: PCa is not commonly associated with haematospermia. MRI seems to be improving detection rate of a significant PCa, particularly in patients presenting with haematospermia and normal PSA levels and DRE examination. Duration of haematospermia does not predict the presence of PCa.

Inspection of Ureteral Orifices: The Pearl of Flexible Cystoscopy.

Cystoscopy is most common diagnostic investigation. The examination technique and the findings, both normal and pathological, were well described described a hundred years ago. With technological advances, there has been over-emphasis on imaging modalities for diagnostic purposes. A basic maneuver of examining the ureteral orifices is sometimes rushed through when in fact careful examination can clinch the diagnosis. The importance is exemplified by two cases, one of which is a rare case of Xanthoma of the ureter.

An unusual case of chronic urinary retention and bladder diverticulum presenting with unilateral lower limb swelling.

A 64-year-old man presented with 1 month of gradual-onset left leg swelling and lower urinary tract symptoms including enuresis, frequency and poor stream. He was initially treated for suspected cellulitis, however, he returned 2 weeks later with persistence of his symptoms. Routine biochemical investigation revealed renal failure (Cr 623, Ur 29.9) and hyperkalaemia (K 7.2). Abdominal examination revealed a distended urinary bladder and an ultrasound scan revealed hydronephrosis, confirming the diagnosis of chronic high-pressure urinary retention. A urinary catheter was passed that initially drained 1.5 litre of clear urine. Shortly after insertion, this became heavily blood stained. A CT kidney ureter bladder (CTKUB) revealed a large mass behind the bladder thought to represent either an abscess or tumour. Cystoscopic correlation showed this to be a large, narrow-necked bladder diverticulum tensely distended with clot. Following successful clot evacuation and decompression of the bladder the leg swelling resolved and renal function improved.

Renal angiomyoadenomatoid tumor.

Renal angiomyoadenomatoid tumor is a distinct pathologic entity that can mimic clear cell renal adenocarcinoma in presentation. The nature and behavior of these tumors are not well understood, and they require long-term follow-up to clarify their neoplastic potential.