Transverse testicular ectopia, a case report and review of literature

Crossed testicular ectopia (CTE)/transverse testicular ectopia (TTE) is a rare but well known congenital anomaly, in which both gonads migrate toward the same hemiscrotum. It is usually associated with other abnormalities such as persistent Mullerian duct syndrome, true hermaphroditism, inguinal hernia, hypospadias, pseudohermaphroditism, and scrotal anomalies. About 100 cases of transverse testicular ectopia have been reported in published studies. We report a case of transverse testicular ectopia in an 8-month-old boy who presented with right inguinal hernia and nonpalpable left testis. On exploration, both testes were present in the right inguinal region. Bilateral orchiopexy was performed by crossing the left testis in the extra-peritoneal space and ipsilateral scrotal orchiopexy. The diagnosis could not be made preoperatively in most of reported cases

Spontaneous kidney rupture in a patient with polyarteritis nodosa

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that affects the medium- and small-sized arteries. It involves the renal arterioles in approximately 80% of cases, but spontaneous retroperitoneal hemorrhage is a rare complication
 of PAN. We report a case of spontaneous kidney rupture in a patient with PAN.
 KEY WORDS: Polyarteritis nodosa, hematoma, kidney ruptur

MATERIAL SIGNATURE ORTHONORMAL MAPPING IN HYPERSPECTRAL UNMIXING TO ADDRESS ENDMEMBER VARIABILITY

A new hyperspectral unmixing algorithm which considers endmember variability is presented. In the proposed algorithm, the endmembers are represented by correlated random vectors using the stochastic mixing model. Currently, there is no published theory for selecting the appropriate distribution for endmembers. The proposed algorithm first uses a linear transformation called material signature orthonormal mapping (MSOM), which transforms the endmembers to correlated Gaussian random vectors. The MSOM transformation reduces computational requirements by reducing the dimension and improves discrimination of endmembers by orthonormalizing the endmember mean vectors. In the original spectral space, the automated endmember bundles (AEB) method extracts a set of spectra (endmember set) for each material. The mean vector and covariance matrix of each endmember estimated directly from endmember sets in the MSOM space. Second, a new maximum likelihood method, called NCM_ML, is proposed which estimates abundances in the MSOM space using the normal compositional model (NCM). The proposed algorithm is evaluated and compared with other state-of-the-art unmixing algorithms using simulated and real hyperspectral images. Experimental results demonstrate that the proposed unmixing algorithm can unmix pixels composed of similar endmembers in hyperspectral images in the presence of spectral variability more accurately than previous methods

Direct and indirect medical costs of bladder cancer in Iran

Abstract Background Bladder cancer is one of the most prevalent and costly cancers in the world. Estimating the economic burden of bladder cancer is essential for allocating resources to different sectors of health systems and determining the appropriate payment mechanisms. The present study aimed at estimating the economic burden of bladder cancer in Iran. Methods In this study, we used a prevalence-based approach for estimating the economic burden of bladder cancer. Direct and indirect costs of bladder cancer were calculated using the cost of illness and human capital approaches. Data were collected using a researcher-made checklist obtained from several sources including Iran bladder cancer clinical practice guideline, the Statistical Center of Iran, Iran’s Ministry of Cooperatives, Labor, and Social Welfare, Relative Value of Health Services (RVHS) book and Iranian Food and Drug Administration organization. The analyses were done by Microsoft Excel 2013 and Stata 13. Results The number of the cases of 5-year prevalence of bladder cancer in Iran was estimated as 21,807 people in 2018. The economic burden of bladder cancer in Iran was estimated at US$ 86,695,474. Indirect medical costs constituted about two-third of the economic burden of bladder cancer, and mostly related to productivity loss due to mortality. Most of the direct medical costs (29.7%) were related to the stage T2–T3 and transurethral resection of bladder (31.01%) and radical cystectomy (19.99%) procedures. Conclusion Our results showed that the costs of bladder cancer, imposed on the healthcare system, were significant and mostly related to lost production costs. The implementation of screening and diagnostic programs can improve the survival rate and quality of life of patients and reduce the cost of lost productivity due to mortality in these patients

Amplatz versus Balloon for Tract Dilation in Ultrasonographically Guided Percutaneous Nephrolithotomy: A Randomized Clinical Trial

Purpose. To compare balloon with Amplatz for tract dilation in totally ultrasonographically guided PCNL (UPCN). Methods. We randomized 66 patients candidate for sonographically guided PCNL in the flank position in two study groups. In the first group, we used single step Amplatz dilation (AG) technique in which the 28- or 30-French Amplatz dilator is used for tract dilation. In the other group, we dilated the tract using balloon dilator (BG). We compared procedure time, success rate of dilation, and postoperative clinical outcomes and cost between two groups. Results. The rate of short dilation was higher in the Amplatz group (57.6%) compared with Balloon group (36.4%) (P=0.08). When using Amplatz for lower pole access, short dilation occurred in 81% of cases compared with 44% in the BG (P=0.02). Overall operation was longer in the AG (80±21 versus 65±20 minutes P=0.02). Stone free rate was 87.9% in the AG compared with 72.7% in the BG (p=0.12). Mean cost of the surgery was 603±85 USD and 718±78 USD in the AG and BG, respectively (P=0.0001). Hemoglobin drop, transfusion rate, renal function alteration, duration of hospitalization, and complication rate based on Clavien classification were similar in both groups. Conclusions. AG showed a higher rate of short dilation compared with BG; consequently, overall operating time was significantly longer in the AG whereas BG was significantly more expensive than AG. Bleeding and other complications were similar in two groups. We observed an advantage for balloon dilation over Amplatz when approaching the lower pole calyxes