A predictive model for prediction of heart surgery procedure

Coronary heart disease (CHD) is a disease in which plague in the form of waxy substance builds up inside the coronary arteries. Coronary artery bypass grafting (CABG) is used as treatment on CHD patients but the role of CABG has been challenged by percutaneous coronary intervention (PCI) when it was introduced in 1977. Drug eluting stents (DES) was introduced with the development of PCI. The purpose of this study was to find the potential risk factors that associated with the procedures (CABG and DES) and to model procedure (CABG vs DES) on coronary heart disease male patients aged 45 years old and below. The study sample was among male patients aged 45 years old and below who has undergone CABG or DES procedure at either IJN or HUKM from January 2007 until December 2010. Logistic regression was used to model treatment selection on coronary heart disease with 87.3% of the classification rate. Patient who i) smoke, ii) obese, or ii) had dyslipidemia was significantly associated with DES, and the other factors were prone to have CABG as their treatment

The current status of checkpoint inhibitors in metastatic bladder cancer

For many decades, no significant improvements could be achieved to prolong the survival in metastatic bladder cancer. Recently, systemic immunotherapy with checkpoint inhibitors (anti-PD-L1/anti-CTLA-4) has been introduced as a novel treatment modality for patients with metastatic bladder cancer. We conducted a systematic review according to the PRISMA statement for data published on the clinical efficacy of checkpoint inhibitors in metastatic bladder cancer. Clinical efficacy of anti PD-L1 therapy was investigated in prospective trials in a total of 155 patients. Patients with positive expression for PD-L1 tended towards better overall response rates (ORR) compared to those with negative expression (34/76 vs 10/73, 45 vs 14 %; p = 0.21). Among patients with PD-L1 positive tumors, those with non-visceral metastases exhibited significantly higher ORR compared to those with visceral metastases (82 vs 28 %; p = 0.001). For anti-CTLA4 therapy, there were no data retrievable on clinical efficacy. Although data on clinical efficacy of checkpoint inhibitors in metastatic bladder cancer are currently limited, the efficacy of these drugs might depend mainly on the metastatic volume and immune system integrity. Patients with PD-L1 positive tumors and non-visceral metastases seem to derive the highest benefit from therapy

Retrocaval ureter: report of 2 different clinical spectrums

Retrocaval ureter is a relatively rare anomaly where ureteric obstruction may occur as a result of ureter passes behind the inferior vena cava (IVC), hence, compressing it between the IVC and the vertebrae. We report 2 cases of retrocaval ureter with different presentations. One patient was managed surgically with minimally invasive approach and the other was managed conservatively

Role of laparoscopy in ureteropelvic junction obstruction with concomitant pathology: a case series study

INTRODUCTION: Laparoscopic pyeloplasty is considered a standard treatment for ureteropelvic junction obstruction (UPJO). However, the presence of another pathology makes it a more challenging operation and guides the surgeon towards open conversion. In this study, we present our experience in difficult pyeloplasty cases managed by laparoscopy. MATERIAL AND METHODS: Six patients (4 females and 2 males) with an average age of 44 and a range of 27 to 60 years old, were diagnosed for UPJO. Three were on the left side and 3 on the right side. In addition to UPJO, 2 patients had renal stones, one patient had both renal ptosis and an umbilical hernia, 3 patients had a para-pelvic cyst, hepatomegaly and malrotated kidney, respectively. All patients had a preoperative ultrasound, CT or IVU, and a renal isotope scan. Laparoscopic pyeloplasty was performed according to the dismembered Anderson-Hynes technique with auxiliary maneuver, according to the pathology. RESULTS: All patients were treated successfully for UPJO and the concomitant pathologies, except hepatomegaly and malrotation. Mean operative time was 125 minutes and estimated blood loss was <50 ml. CONCLUSIONS: Laparoscopic pyeloplasty can be performed in difficult situations provided that the surgeon has enough experience with laparoscopy

Urethral recurrence after radical cystectomy for urothelial carcinoma: a systematic review and meta-analysis

Purpose: Currently, identified factors for urethral recurrence (UR) are based on individual reporting which has displayed controversy. In addition, risk of UR is one of the limiting factors to offer neobladder diversion during radical cystectomy (RC). We aim to systematically evaluate the incidence and risk factors of UR post-RC and its effect on survival. Materials and methods: A systematic online search was conducted according to PRISMA statement for publications reporting on UR after RC. From initial 802 results, 14 articles including 6169 patients were included finally after exclusion of ineligible studies. Results: The incidence rate of UR was 4.4% (1.3%–13.7%). It was significantly lower with neobladder diversion (odds ratio = 0.44, 95% CI: 0.24–0.79, P = 0.006). Muscle invasion (hazard ratio = 1.18, 95% CI: 0.86–1.62, P = 0.31), carcinoma in situ (hazard ratio 0.97, 95% CI: 0.64–1.47, P = 0.88), prostatic stromal involvement (hazard ratio = 2.26, 95% CI: 0.01–627.75, P = 0.78), and prostatic urethral involvement (hazard ratio = 2.04, 95% CI: 0.20–20.80, P = 0.55) have no significant effect on UR. Men displayed tendency toward higher incidence of UR (odds ratio = 2.21, 95% CI: 0.96–5.06, P = 0.06). Absence of recurrence displayed tendency toward better disease specific survival, yet not significant (hazard ratio = 0.84, 95% CI: 0.66–1.08, P = 0.17). These results are limited by the retrospective nature of the included studies. Conclusion: Muscle invasion, carcinoma in situ and prostatic stromal or urethral involvement at time of RC have no significant effect on UR. Orthotopic neobladder is associated with a significant lower risk of UR after RC

Thyrotoxic goiter and asymptomatic thyroid nodule as an initial presentation of clear cell renal cell carcinoma: a report of two cases

Thyroid nodule as a metastasis to renal cell carcinoma (RCC) is rarely found. We present two cases – presented with thyroid nodules and diagnosed as metastatic RCC; one patient had thyrotoxic goiter, whereas the second patient presented with asymptomatic thyroid nodule. Subsequently, hemithyroidectomy and total thyroidectomy were performed, respectively. Then, both patients underwent radical nephrectomy for the primary tumor. At present, patients are under regular oncology follow-up, with no evidence of disease recurrence

Clinicopathological features and prognostic value of incidental prostatic adenocarcinoma in radical cystoprostatectomy specimens: a systematic review and meta-analysis of 13,140 patients

Purpose: There is controversy in the literature about the oncologic significance of incidental prostate cancer detected at radical cystoprostatectomy for bladder cancer. Materials and Methods: An online search was done for studies reporting incidental prostate cancer in cystoprostatectomy specimens. After following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines we identified a total of 34 reports containing 13,140 patients who underwent radical cystoprostatectomy for bladder cancer with no previous history of prostate cancer. A cumulative analysis was performed on the available data regarding prevalence, clinicopathological features and oncologic outcomes. RevMan, version 5.3 was used for data meta-analysis. Results: Of the 13,140 patients incidental prostate cancer was detected in 3,335 (24.4%). Incidental prostate cancer was significantly associated with greater age (Z = 3.81, p = 0.0001, d = 0.27, 95% CI −0.14–0.68), lymphovascular invasion of bladder cancer (Z = 2.07, p = 0.04, r = 0.14, 95% CI 0.09–0.18) and lower 5-year overall survival (Z = 2.2, p = 0.03). Among patients with clinically significant and insignificant prostate cancer those with clinically significant prostate cancer significantly more frequently showed a positive finding on digital rectal examination (Z = 3.12, p = 0.002, r = 0.10, 95% CI 0–0.19) and lower 5-year overall survival (Z = 2.49, p = 0.01) whereas no effect of age was observed (p = 0.15). Of 1,320 patients monitored for biochemical recurrence prostate specific antigen recurrence, defined as prostate specific antigen greater than 0.02 ng/ml, developed in 25 (1.9%) at between 3 and 102 months. Conclusions: This meta-analysis suggests that incidental prostate cancer detected during histopathological examination of radical cystoprostatectomy specimens might be linked with adverse characteristics and outcomes in patients with invasive bladder cancer

A review of studies examining the association between genetic biomarkers (short tandem repeats and single-nucleotide polymorphisms) and risk of prostate cancer: the need for valid predictive biomarkers

Prostate cancer (PCa) is a challenging polygenic disease because the genes that cause PCa remain largely elusive and are affected by several causal factors. Consequently, research continuously strives to identify a genetic marker which could be used as an indicator to predict the most vulnerable (i.e., predisposed) segments of the population to the disease or for the gene which may be directly responsible for PCa. To enhance the genetic etiology of PCa, this research sought to discover the key studies conducted in this field using data from the main journal publication search engines, as it was hoped that this could shed light on the main research findings from these studies, which in turn could assist in determining these genes or markers. From the research highlighted, the studies primarily used two kinds of markers: short tandem repeats or single-nucleotide polymorphisms. These markers were found to be quite prevalent in all the chromosomes within the research carried out. It also became apparent that the studies differed in both quantity and quality, as well as being conducted in a variety of societies. Links were also determined between the degree and strength of the relationship between these markers and the occurrence of the disease. From the studies identified, most recommended a larger and more diverse survey for the parameters which had not been studied before, as well as an increase in the size of the community (i.e., the population) being studied. This is an indication that work in this field is far from complete, and thus, current research remains committed toward finding genetic markers that can be used clinically for the diagnosis and screening of patients with PCa