Percutaneous needle biopsy for indeterminate renal masses: a national survey of UK consultant urologists

<p>Abstract</p> <p>Background</p> <p>The use of percutaneous needle biopsy in the evaluation of indeterminate renal masses is controversial and its role in management remains largely unclear. We set to establish current practice on this issue in UK urology departments.</p> <p>Methods</p> <p>We conducted a national questionnaire survey of all consultant urologists in the UK, to establish current practice and attitudes towards percutaneous needle biopsy in the management of indeterminate renal masses.</p> <p>Results</p> <p>139 (43%) consultant urologists never use biopsy, whereas 111 (34%) always employ it for the diagnosis of indeterminate renal masses. 75 (23%) urologists use biopsy only for a selected patient group. Mass in a solitary kidney, bilateral renal masses and a past history of non-renal cancer were the main indications for use of percutaneous biopsy. The risk of false negative results and biopsy not changing the eventual management of their patients were the commonest reasons not to perform biopsy.</p> <p>Conclusion</p> <p>There is a wide and varied practice amongst UK Consultant Urologists in the use of percutaneous biopsy as part of the management of indeterminate renal masses. The majority of urologists believe biopsy confers no benefit. However there is a need to clarify this issue in the wake of recent published evidence as biopsy results may provide critical information for patients with renal masses in a significant majority. It not only differentiates benign from malignant tissue but can also help in deciding the management option for patients undergoing minimally invasive treatments.</p

Genetics of the thrombomodulin-endothelial cell protein C receptor system and the risk of early-onset ischemic stroke

Background and purpose Polymorphisms in coagulation genes have been associated with early-onset ischemic stroke. Here we pursue an a priori hypothesis that genetic variation in the endothelial-based receptors of the thrombomodulin-protein C system (THBD and PROCR) may similarly be associated with early-onset ischemic stroke. We explored this hypothesis utilizing a multi-tage design of discovery and replication. Methods Discovery was performed in the Genetics-of-Early-Onset Stroke (GEOS) Study, a biracial population-based case-control study of ischemic stroke among men and women aged 1549 including 829 cases of first ischemic stroke (42.2% African-American) and 850 age-comparable stroke-free controls (38.1% African-American). Twenty-four single-nucleotide-polymorphisms (SNPs) in THBD and 22 SNPs in PROCR were evaluated. Following LD pruning (r(2)>= 0.8), we advanced uncorrelated SNPs forward for association analyses. Associated SNPs were evaluated for replication in an early-onset ischemic stroke population (onset-ge Results Among GEOS Caucasians, PROCR rs9574, which was in strong LD with 8 other SNPs, and one additional independent SNP rs2069951, were significantly associated with ischemic stroke (rs9574, OR = 1.33, p = 0.003; rs2069951, OR = 1.80, p = 0.006) using an additive-model adjusting for age, gender and population-structure. Adjusting for risk factors did not change the associations; however, associations were strengthened among those without risk factors. PROCR rs9574 also associated with early-onset ischemic stroke in the replication sample (OR = 1.08, p = 0.015), but not older-onset stroke. There were no PROCR associations in African-Americans, nor were there any THBD associations in either ethnicity. Conclusion PROCR polymorphisms are associated with early-onset ischemic stroke in Caucasians.Peer reviewe

Diet and oral cancer - a case control study

Apart from strong genotoxic carcinogens, other environmental factors are implicated in both causes and prevention of cancers. A hospital based case control study was conducted to examine the role of diet in the aetiology of oral and oropharyngeal cancers. In this article, past dietary intake and nutrient estimates, obtained through diet history method and biochemical nutritional status at the onset of the disease are presented. The results of the study suggest that poor dietary intake of vegetables and fruits coupled with low estimated intake of betacarotene, thiamine, riboflavin, folate, vitamin C, iron and copper, modify the risk potential. The biological indicators of the nutritional status such as plasma vitamin A, E, red cell folate and plasma zinc were significantly reduced in cases and yielded moderate risk estimates. The risk estimates though of moderate magnitude are of importance in relatively homogeneous subjects with respect to diet and nutrition. The findings are in line with several other epidemiological observations. The combined effects of micro nutrients appears to be protective in countering the adverse effects of exogenous exposures to tobacco. The protective role of vegetables and fruits is of potential interest in terms of etiologic causes and prevention

Esophageal cancer and diet-a case-control study

It has been estimated that approximately 40% of human cancers may be associated with dietary factors. The relationship is more significant in esophageal cancers. Case-control studies involving 35 subjects of early-diagnosed esophageal cancers showed low mean blood levels of retinol, zinc (p &lt; 0.001), folk acid (p &lt; 0.01), and albumin (p &lt; 0.05). Relative risk was significantly higher for low levels of retinol and zinc. Diet, in general, in both groups reflected poor intake of several nutrients