Comparison of the clinical usefulness of different urinary tests for the initial detection of bladder cancer: a systematic review

Objectives: The standard initial approach in patients with hematuria or other symptoms suggestive of bladder cancer (BC) is a combination of cystoscopy and urine cytology (UC); however, UC has low sensitivity particularly in low-grade tumors. The aim of the present review was to critically analyze and compare results in the literature of promising molecular urinary tests for the initial diagnosis of BC. Methods: We searched in the Medline and Cochrane Library databases for literature from January 2009 to January 2019, following the PRISMAguidelines. Results: In terms of sensitivity, ImmunoCyt showed the highest mean and median value, higher than UC. All tests analyses showed higher mean and median sensitivity when compared with UC. In terms of specificity, only UroVysion and Microsatellite analyses showed mean and median values similar to those of UC, whereas for all other tests, the specificity was lower than UC. It is evident that the sensitivity of UC is particularly low in low grade BC. Urinary tests mainly had improved sensitivity when compared to UC, and ImmunoCyt and UroVysion had the highest improvement in low grade tumors. Conclusions: Most of the proposed molecular markers were able to improve the sensitivity with similar or lower specificity when compared to UC. However, variability of results among the different studies was strong. Thus, as of now, none of these markers presented evidences so as to be accepted by international guidelines for diagnosis of BC

Papiloma vírus humano e a relação com o câncer de colo uterino / Human papillomavirus and the relationship with cervical cancer

O papilomavírus humano causa uma infecção sexualmente transmissível caracterizada pelo surgimento de verrugas, também chamadas de papilomas, nas regiões urogenital e úmidas do corpo. Este estudo trata de uma revisão narrativa da literatura, realizada por meio de busca em livros e artigos científicos com conteúdos acerca da temática.  Como resultado destaca-se que há mais de 100 tipos de vírus, porém apenas 40 infectam o trato genital sendo que os tipos 16 e 18 são os que apresentam potencial oncogênico para o câncer uterino. Mundialmente o câncer de colo de útero é o terceiro tipo de câncer mais predominante nas mulheres, sendo que no Brasil a região norte é a mais afetada. O diagnóstico dessa neoplasia pode ser realizado por meio de exames histológicos que utilizam a colposcopia, curetagem endocervical e biópsia de cone. Há ainda os exames de imagens que geralmente são usados para o estadiamento da metástase, isto é, o seu espalhamento através do corpo. Sem tratamento efetivo para o vírus, apenas as verrugas podem ser tratadas. O câncer, dependendo da evolução do tumor, tem como opção tratamento pela quimioterapia, cirurgia ou radioterapia. Considera-se que a prevenção do HPV ocorre pelo uso de vacina, tomada em duas doses, e pelo uso de preservativos com a ressalva de que eles não são 100% eficientes em todas as situações

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Diagnosi di mucocele appendicolare gigante in corso di laparotomia per addome acuto. Caso clinico e revisione della letteratura

Gli Autori descrivono un caso clinico di mucocele appendicolare gigante secondario a tumore mucinoso dell’appendice, diagnosticato in corso di laparotomia per addome acuto. Con una revisione della letteratura evidenziano la singolare presentazione della neoplasia con complicanza acuta da rottura della parete appendicolare e le conseguenti difficoltà diagnostiche e gestionali dell’approccio in emergenza

Prospective trial comparing penoscrotal versus minimally invasive infrapubic approach for inflatable penile prosthesis placement: a single-centre matched paired analysis.

Introduction & objective: Currently, approximately 80% of inflatable penile prosthesis (IPP) are placed by penoscrotal approach (PSA), although no superiority of this technique compared to infrapubic approach has ever been demonstrated. The aim of this study was to compare perioperative results, safety and efficacy profile in patients receiving inflatable penile prosthesis(IPP) via PSA or minimally invasive infrapubic approach(MIIA) for erectile dysfunction. Methods: Data were prospectively collected in our password-secured institutional database of implanted patients. A matched-pair analysis was performed including 42 patients undergoing IPP implantation via PSA(n=21) or MIIA(n=21) between 2011 and 2016. Excluded from the study were those patients with urinary incontinence, simultaneous surgery for congenital or acquired recurvatum, previous urethral or penile surgery and lack of follow-up data. All patients were invited to fill in validated self-administered questionnaires to evaluate various aspects of post-prosthesis sexual life. Specifically, questionnaires included: the International Index of Erectile Function(IIEF), Erectile Dysfunction Inventory of Treatment Satisfaction(EDITS) and Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaires. Results Mean(SD) operative time was 128(40.6) min in group PSA and 91(43.0) min in group MIIA(p=0.041). Complications occurred in 3 (14%) and 2 (10%) patients in groups PSA and MIIA(p=0.832). Overall, no differences were observed concerning the device utilization (p=0.275). However, in group MIIA 4 (19%) patients were able to resume sexual activity prior to 4 postoperative weeks, while in group PSA no patient was (p=0.012). Mean(SD) scores for questionnaires were similar between groups PSA and MIIA: IIEF [20.9(7.3) vs 20.7(4.8); p=0.132], patient EDITS [76.0(25.6) vs 74.7(20.8); p=0.256] and partner EDITS [72.5(29.1) vs 73.1(21.4); p=0.114]. Similarly, QoLSPP showed comparable results among the groups PSA and MIIA: functional domain [3.9(1.4) vs 4.0(1.2); p=0.390], personal [4.0(1.2) vs 4.1(1.0); p=0.512], relational [3.7(1.5) vs 3.9(1.2); p=0.462] and social [4.0 (1.2) vs 3.9 (1.2); p=0.766]. Conclusions Penoscrotal and minimally invasive infrapubic approaches demonstrated to be safe and efficient techniques for IPP implantation, leading to high level of both patients and partners satisfaction. Additionally, the minimally invasive infrapubic approach showed a shorter operative time and a tendency for a faster return to sexual activity

Infected kidney stone progressing to perinephric abscess and thoracic empyema.

A case is presented that demonstrates unusual long-term evolution of an infected calculi, culminating in the formation of a retroperitoneal abscess that fistulised to the pleural space, leading to a right pleural empyema