Ethnic variation of the histological subtypes of renal cell carcinoma in Singapore

Introduction: The purpose of this study is to determine how the histological subtypes of renal cell carcinoma (RCC) vary among the heterogeneous Singaporean population and how this affects the survival rate. Patients and methods: The data analyzed in this retrospective study of the histological subtypes of RCC cases treated in Singapore General Hospital over a ten year period (2001–2010) were obtained from the Cancer Registry of the hospital's department of urology. Statistical analysis was done using the Statistical Package Service Solution (SPSS) version 17.0 software. Chi Square and z-tests were used where appropriate; a p value <0.05 was considered significant. Results: The records of 676 patients studied showed that 80.8% of the patients were Chinese, while Malays, Indians and other minor groups accounted for 6.5%, 4.6% and 8.1%, respectively. The mean age (SD) at presentation was 58.1 (12.1), 57.6 (10) and 55.1 (9.6) years for the Chinese, Indians and Malays, respectively. The commonest histological variant in each of the ethnic groups, irrespective of sex, was clear cell carcinoma which accounted for 79.7% of all the histological subtypes found in Chinese, for 70.5% in Malaysian and 77.4% in Indian patients. The sarcomatoid histological subtype was found in 4.3% of the studied population with a high prevalence in the Indian ethnicity (9.7%). The worst survival rate (33.3%) was recorded among Malays with the papillary cell subtype, and also in the Chinese population the highest mortality rate was found in cases with the papillary cell subtype (16.9%). Conclusion: The commonest histological subtype of RCC in each of the studied ethnic groups in Singapore is clear cell carcinoma. However, most of the cancer deaths in Chinese (16.9%) and Malays (66.7%) were associated with the papillary cell type, while in Indians the sarcomatoid component prevailed (9.7%). Thus, the usual prognostic trend for RCC subtypes cannot be applied to all Singaporean ethnicities, necessitating individualization of prognosis for each group

Urethral catheterization:The need for adequate undergraduate exposure

Introduction: Urethral catheterization is one of the basic skills expected of any intern. This is an important procedure which if not properly learnt and done leads to various complications. Objectives: To assess the knowledge and practice of urethral catheterization among new interns in University of Benin Teaching Hospital as a measure of their undergraduate exposure to the procedure. Subjects and methods: The study was carried out by administering questionnaire to all newly recruited house officers in the hospital. The component of the questionnaire included questions on knowledge of urethral catheterization procedure and precautionary methods taken while carrying out the procedure. Also assessed was the need for the demonstration of this procedure to newly recruited house officers. Permission for this study was obtained from the hospitals ethical committee. The result of the study was analysed using SPSS package. Results: There were 60 respondents who all graduated from medical schools in Nigeria except 2 Nigerian European graduates. All were able to define urethral catheterization. Forty percent had formal demonstration of urethral catheterization procedure during their undergraduate years. All the respondents observed urethral catheterization as undergraduates. About 33.3% did not perform the procedure as undergraduates while only 6.7% passed more than 10 urethral catheters. A total of 65.8% were able to describe the steps involved in urethral catheterization while only 20% used appropriate lubricant. Of the respondents 91.7% could list the possible complications of catheterization while 83.3% indicated that there is need for practical demonstration of urethral catheterization procedure during internship period. Conclusion: Newly recruited interns have poor practical exposure to urethral catheterization. Efforts should be made to improve the quality of supervised training given to medical undergraduates so as to avoid complications that could arise if this procedure is not properly done when they qualify

Adult renal cell carcinoma in Lagos: Experience and challenges at the Lagos University Teaching Hospital

Introduction: Renal cell carcinoma (RCC), regarded as the most lethal of all urological tumors, is relatively uncommon. Recent reports from developed countries indicate a rising incidence, most likely from the increasing availability of imaging services leading to an increase in incidental diagnosis of early stage tumors, with consequently better prognosis. However, literature on RCC in sub-Saharan Africa is relatively sparse. Objectives: To determine the prevalence, presentation, pattern and outcome of RCC at the Lagos University Teaching Hospital. Methods: Information extracted from the records of 64 adult patients with RCC seen in our institution between January 2000 and December 2010 included the age and sex of the patient, clinical features, investigations, tumor stage, treatment, outcome of management and follow-up. Results: The mean patient age was 41.8 years (range 20–75 years) with a male:female ratio of 1:1.7. Flank mass, flank pain and hematuria were present in 90.6%, 86% and 40.6% of patients, respectively, while 36% of patients had the classical triad of loin pain, loin mass and hematuria. Only 1 patient (1.6%) had an incidental diagnosis. TNM tumor stages T3 and T4 accounted for 93.7% of patients, while the clear cell type accounted for 60% of histologically examined cases. Forty-five patients (70.3%) had surgical intervention. Of the T2 patients available for follow-up, 50% were alive at 48 months, while all inoperable T4 and M1 patients available for follow-up were dead within 1 year. Conclusion: RCC in our environment is characterized by a younger age at presentation, a female predominance and clinical presentation at an advanced clinical stage