Does true Gleason pattern 3 merit its cancer descriptor?

Nearly five decades following its conception, the Gleason grading system remains a cornerstone in the prognostication and management of patients with prostate cancer. In the past few years, a debate has been growing whether Gleason score 3 + 3 = 6 prostate cancer is a clinically significant disease. Clinical, molecular and genetic research is addressing the question whether well characterized Gleason score 3 + 3 = 6 disease has the ability to affect the morbidity and quality of life of an individual in whom it is diagnosed. The consequences of treatment of Gleason score 3 + 3 = 6 disease are considerable; few men get through their treatments without sustaining some harm. Further modification of the classification of prostate cancer and dropping the label cancer for Gleason score 3 + 3 = 6 disease might be warranted

Changing stone composition profile of children with nephrolithiasis

Objective: To determine if this trend toward calcium phosphate stone formation exists in children. Methods: This is a retrospective study of medical records of 179 children managed at our medical center from 1992-2010 for whom stone analysis and other pertinent laboratory data were available. A comparison of patients managed from 1992-2000 (P1) and 2001-2010 (P2) was undertaken. Statistical analysis included nonparametric tests. Results: There were no significant differences in the mean age of the 2 cohorts. During both periods, boys comprised a significantly higher proportion during the first decade of life, whereas girls comprised a significantly higher proportion during the second decade. A higher percentage of patients had calcium oxalate (CaOx) stones in P1 compared to P2 (60% vs 47%, P =.0019). There was a significant increase in the percentage of patients having calcium phosphate stones in P2 compared to P1 (27% vs 18.5%, P =.008). Twenty-seven patients had recurrent stones. A comparison of the compositions of the first and last stones of patients within this group demonstrated an increasing proportion of brushite stones (3.7% vs 11.1%, P =.04). Twenty-four hour urine testing results were similar for those with CaOx and calcium phosphate stones. Conclusion: An increasing proportion of children have calcium phosphate calculi. Brushite stones are more prevalent in children with recurrent stone events. The impetus of these shifts is not readily apparent. © 2013 Elsevier Inc. All Rights Reserved

Robotic Dismembered Pyeloplasty: A 6-Year, Multi-Institutional Experience

Purpose: The introduction of the da Vinci® Surgical System to perform complex reconstructive procedures, such as repair of ureteropelvic junction obstruction, has helped to overcome some of the technical challenges associated with laparoscopy. We review our large multi-institutional experience with long-term followup of robotic dismembered pyeloplasty. Materials and Methods: A total of 140 patients from 3 university medical centers underwent robotic dismembered pyeloplasty. An institutional review board approved retrospective chart review was performed to collect demographic, preoperative, operative and postoperative data. Patients were analyzed as an entire cohort and then divided into various subgroups. Results: Of the cases 117 (84.6%) were primary repairs and 23 (16.4%) were secondary repairs. There were 13 (9.3%) patients who underwent concomitant stone extraction and 5 (3.6%) procedures were performed on patients with solitary kidneys. A crossing vessel was found in 77 (55%) patients. Mean operative time was 217 minutes (range 80 to 510), estimated blood loss was 59.4 ml (range 10 to 600), mean length of hospital stay 2.1 days (range 0.75 to 7) and mean followup was 29 months (range 3 to 63). Radiographic resolution of obstruction on first postoperative diuretic renal scan or excretory urogram was noted in 134 patients (95.7%). There was a 7.1% major complication rate and a 2.9% minor complication rate. No statistically significant differences were found in any parameters among patients from the various cohorts. Conclusions: To our knowledge this review represents the largest multi-institutional experience of robotic dismembered pyeloplasty with long-term followup. Robotic pyeloplasty appears to be safe, durable and efficacious for primary and secondary ureteropelvic junction obstruction with or without concomitant stone extraction, and for patients with a solitary kidney. © 2008 American Urological Association

Amiloidose localizada laríngea: relato de caso e revisão de literatura Localized laryngeal amyloidosis: case report and literature review

A amiloidose localizada laríngea é uma doença rara, correspondendo a menos de 1% dos tumores benignos da laringe. No entanto, a amiloidose localizada acomete principalmente a laringe nas vias aéreas, sendo assim de grande importância para o otorrinolaringologista. Ela está relacionada à produção monoclonal de imunoglobulinas de cadeia leve, principalmente l e k. Este estudo tem como objetivo relatar um caso de amiloidose laríngea atendida no Ambulatório de Laringologia e Voz do Hospital das Clínicas da FMRP - USP, assim como discutir a revisão de literatura.<br>Localized laryngeal amyloidosis is a rare disease, corresponding to less than 1% of benign tumors in larynx. However, localized amyloidosis occurs mostly in larynx, being of great importance its diagnose by Otorhinolaryngologists. It is related to monoclonal production of light chain immunoglobulins, mainly l and k. This study has the purpose of relating a case of laryngeal amyloidosis assisted in Laryngology and Voice Clinics at Clinics Hospital FMRP - USP, and discussing literature as well