Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma: magnifying endoscopy findings

Gastric mucosaâ associated lymphoid tissue lymphoma is uncommon and most patients have an indolent clinical course. The clinical presentation and endoscopic findings can be subtle and diagnosis can be missed on white light endoscopy. Magnifying endoscopy may help identify the abnormal microstructural and microvascular patterns, and target biopsies can be performed. We describe herein the case of a 64-year-old woman with Helicobacter pyloriâ negative gastric mucosaâ associated lymphoid tissue lymphoma diagnosed by screening magnification endoscopy. Helicobacter pyloriâ eradication therapy was given and she received biological therapy. She is in clinical remission after treatment. The use of magnification endoscopy in gastric mucosaâ associated lymphoid tissue lymphoma and its management are reviewed.published_or_final_versio

A report on a randomly sampled questionnaire survey about renal stone disease in Hong Kong

Objectives: To investigate the prevalence and characteristics of patients with renal stone in Hong Kong, and awareness of corresponding prevention strategies. Design: Telephone public survey. Setting: Hong Kong community. Participants: A public telephone survey concerning the occurrence of renal stone disease and the public awareness of the condition was performed. Respondents whose telephone numbers were randomly selected by computer and the family member of the household who had the closest birthday to that date was chosen for interview. Data collected were further adjusted for the gender and age distribution of the Hong Kong population in mid-2007. Results: A total of 1010 Hong Kong citizens aged 18 years or above were successfully interviewed in November 2007. Among them, 25 respondents themselves had a history of renal stones, yielding a point prevalence of 2.5%. In addition, 70 respondents had family members with a history of renal stones, yielding an estimated household point prevalence of 6.9%. Stone patients were mainly older, male, and imbibed less fluids than the average for all respondents. The public's concepts with regard to the diet necessary and the importance of taking more fluid to prevent stone formation was poor. Conclusion: Hong Kong has a relatively low prevalence of renal stone disease, compared to neighbouring areas. However, the local public and affected patients had little knowledge and awareness about this important health problem.published_or_final_versio

Use of the International Prostate Symptom Score (IPSS) in Chinese male patients with benign prostatic hyperplasia

Purpose: To test the psychometric properties of the International Prostate Symptom Score (Hong Kong Chinese version 2) (IPSS) in Chinese male patients with benign prostatic hyperplasia (BPH) under secondary care. Methods: A prospective longitudinal study was done by interviewing subjects at baseline, at 2 week after baseline for assessing test–retest reliability and at 26 week after baseline for assessing responsiveness. All subjects were interviewed to complete a structured questionnaire including IPSS, Short Form-12 Health Survey version 2 (SF-12v2) and Depression Anxiety Stress Scale (DASS). Results: The IPSS HRQOL score had weak correlations with SF-12v2 summary and DASS domain scores. For reliability analysis, Cronbach’s alpha coefficient was 0.90 for the seven symptom-related items. The intraclass correlation coefficients of the IPSS total symptom score and HRQOL score were 0.90 and 0.86, respectively. For sensitivity, statistically significant differences were detected between the subjects with BPH and those without for IPSS total symptom score (effect size=0.68) but not the IPSS HRQOL score. The areas under ROC curves for the IPSS total symptom and HRQOL scores were 0.67 and 0.60, respectively. Conclusions: The IPSS was valid, reliable instrument in Chinese patients with BPH. The IPSS total symptom score, but not the HRQOL score, is sensitive in differentiating subgroups

Simultaneous antegrade and retrograde and approach for upper ureteric and renal stones in modified supine valdivia position: initial experience

Poster MP29-35 fulltext on p. A218-A219Background: Management of large impacted proximal ureteric stone remains controversial. Stone free rate for ESWL is decreased in stones > 2 cm. URSL to impacted upper ureteric stones causes a back-pressure effect which flushes stone fragments to the kidney. Percutaneous antegrade ureteroscopy is an acceptable first-line treatment for (i) large impacted upper ureteric stones(ii) in combination with renal stone removal or (iii) in failure of retrograde access to the stone. Both approaches risk migration of stones to either the more distal ureter or into renal pelvis, resulting in residual stones that are difficult to be retrieved. Simultaneous antegrade and retrograde approach for upper ureteric stone and renal stone theoretically brings about the advantages of both approaches, while minimizing the risk of stone migration and residual stones. However, there is paucity of literature on simultaneous and retrograde approach for impacted upper tract stones. Purpose: To present early experience in management of complex upper ureteric and renal stones using a combined percutaneous and ureteroscopic approach in the supine position under local anaesthesia. Materials and methods: 10 patients who underwent simultaneous antegrade and retrograde approach for complex upper urinary tract stones from June 2009 to March 2010 were entered into the study. Demographics, stone characteristics, perioperative parameters, stone clearance rate were prospectively collected. Data was entered into a database, and analyzed. Results: 10 patients (M:F=7:3) underwent simultaneous antegrade and retrograde approach to upper urinary tract stones under local anaesthesia with sedoanalgesia. The mean age was 63 (range: 50 – 80 y.o.) 6 patients had impacted upper ureteric stones, of which two had previously failed URSL. 2 patients had obstructing PUJ stone. 1 patient had large lower pole stone. 1 patient had obstructing lower ureteric stone with multiple stones in upper, mid and lower poles. Mean stone size (maximum diameter) was 23.3 mm (range: 12 - 54 mm). 6 patients had PCN inserted pre-operatively due to sepsis, acute renal failure or pyonephrosis. 9 patients had hydronephrosis documented on pre-op imaging. Sheathless PCNL with Fr 16 nephroscope was performed in 3 patients with well-formed tract. 7 patients required the use of amplatz sheath, ranging from 18 – 30 Fr. All procedures were performed in the modified supine Valdivia position. 50% had ‘tubeless PCNL’with double J catheter inserted. OT time ranged from 64 to 125 min (mean 93.4 min). 7 patients achieved complete stone clearance on postop AP and KUB film. 1 patient with 8 mm residual stone underwent 2nd look PCNL, and was stone-free thereafter. 2 patients had residual stone of 2mm & 4 mm respectively, and preferred conservative management. Mean blood loss was 39ml and hemoglobin drop was 0.6 g. No patients required blood transfusion. Length of stay ranged from 0.5 days to 5 days (mean 2.65 days). 2 patients developed morbidities – post-op fever and hematuria, and were treated as urinary tract infection. Conclusion: Simultaneous antegrade and retrograde approach for complex upper ureteric stones and renal stones is feasible, with high stone-free rates and low morbidity.link_to_OA_fulltextThe 10th Asian Congress of Urology of the Urological Association of Asia, Taipei, Taiwan, 27-31 August 2010. In International Journal of Urology, 2010, v. 17 n. suppl. 1, poster no. MP29-35, p. A218-A21

A rare complication of transrectal ultrasound guided prostate biopsy: rectourethral fistula

Poster PP29-62 fulltext on p. A324Introduction: Transrectal ultrasound guided prostate biopsy (TRUS Bx) is the standard procedure for investigation of raised prostate specific antigen (PSA) levels or abnormal digital rectal examination (DRE) findings. It is considered a safe and effective diagnostic tool. However, TRUS Bx is not completely free from serious complications. We report a case of rectourethral fistula (RUF) post TRUS Bx, presenting with sepsis. Case report: A 84 gentleman with good past health presented with incidental finding of raised PSA level of 35 ug/L. DRE showed an enlarged, hard and fixed right lobe of prostate, with obliteration of median groove. TRUS Bx was arranged. Three days of oral ciprofloxacin 500mg bd as antibiotics prophylaxis and fleet enema were given before the procedure. Sextant TRUS Bx was performed by radiologist. The prostate gland was markedly enlarged, > 200ml in volume; with irregular outline and distorted internal anatomy. Pathology came back to be adenocarcinoma of prostate, GS 4 +4 over all six cores. Bone scan showed bone metastasis over sacro-coccygeal and bilateral acetabular regions. He was readmitted for post- TRUS Bx fever 2 days afterwards, which did not subside with intravenous antibiotics: Sulperazone (Cefoperazone/ sulbactam) and metronidazole. Urine culture yielded insignificant count, whereas blood C/St grew Bacteroides species. White cell count was persistently elevated at 24.5 ×10^9/L. He developed abdominal distension and DRE showed irregular mucosa over anterior rectal wall CT abdomen & pelvis with contrast showed prostate abscess, rectal perforation with intestinal obstruction, and enlarged prostate with lost of fat plane with seminal vesicles. Defunctioning transverse colostomy was performed due to overt sepsis and an attempt to allow the fistula to heal. Reassessment CT scan 2 months later showed no residual prostate abscess. Loopogram via rectum and transverse colostomy showed no leakage of contrast into urinary system. Closure of colostomy is pending. Concerning the treatment of CA prostate, he opted for hormonal treatment with LHRH agonist. The latest PSA is <0.1 ug/L. Discussion: The most common cause of RUF in modern series is post-radical prostatectomy. Other causes include cryotherapy, pelvic radiotherapy and anorectal surgery. It is rare for rectourethral fistula to occur post TRUS prostate biopsy. Patients with RUF present with urine per rectum, pneumaturia, recurrent urinary tract infections or fecularia, or rarely, as in our case – overt sepsis. There are two approaches in the management of RUF: conservative Vs surgical. Conservative management includes faecal diversion with colostomy and either suprapubic cystostomy or indwelling urethral catheter. The rationale behind conservative management is to allow symptomatic control and attempts to allow spontaneous healing of the fistula. However, conservative management is unpredictable and the time to allow healing is unknown. In our case, the RUF healed with a period of defunctioning colostomy. Conclusion: We have described a case of rectourethral fistula after TRUS Bx, which resolved with defunctioning colostomy and antibiotics. To our knowledge, this is the first reported case of post TRUS Bx rectourethral fistula.link_to_OA_fulltextThe 10th Asian Congress of Urology of the Urological Association of Asia, Taipei, Taiwan, 27-31 August 2010. In International Journal of Urology, 2010, v. 17 n. suppl 1, poster no. PP29-62, p. A32

Esophageal perforation: experience in 15 years

Poster Session - Esophageal, Gastric and Duodenal Disorders: no. P0721This journal suppl. entitled: Gastro 2013 APDW/WCOG Shanghai ...link_to_OA_fulltex

Synthesis and Characterization of Luminescent Cyclometalated Platinum(II) Complexes of 1,3-Bis-Hetero-Azolylbenzenes with Tunable Color for Applications in Organic Light-Emitting Devices through Extension of π Conjugation by Variation of the Heteroatom

A series of luminescent cyclometalated platinum(II) complexes of N^C^N ligands [N^C^N=2,6-bis(benzoxazol-2′-yl)benzene (bzoxb), 2,6-bis(benzothiazol-2′-yl)benzene (bzthb), and 2,6-bis(N-alkylnaphthoimidazol-2′-yl)benzene (naphimb)] has been synthesized and characterized. Two of the platinum(II) complexes have been structurally characterized by X-ray crystallography. Their electrochemical, electronic absorption, and luminescence properties have been investigated. In dichloromethane solution at room temperature, the cyclometalated N^C^N platinum(II) complexes exhibited rich luminescence with well-resolved vibronic-structured emission bands. The emission energies of the complexes are found to be closely related to the electronic properties of the N^C^N ligands. By varying the electronic properties of the cyclometalated ligands, a fine-tuning of the emission energies can be achieved, as supported by computational studies. Multilayer organic light-emitting devices have been prepared by utilizing two of these platinum(II) complexes as phosphorescent dopants, in which a saturated yellow emission with Commission International de I′Eclairage coordinates of (0.50, 0.49) was achieved