We report a rare mode of presentation of Crohn’s Disease (CD) in a 17-year-old boy, who was admitted at our hospital due to abdominal pain, dysuria, polyuria and fever. The ultrasound showed an increased wall thickne...We report a rare mode of presentation of Crohn’s Disease (CD) in a 17-year-old boy, who was admitted at our hospital due to abdominal pain, dysuria, polyuria and fever. The ultrasound showed an increased wall thickness of the small bowel and cecum and a vegetating lesion adjoined into the bladder. The histology was not suggestive of CD and it excluded the bladder neoplasm. Based on the biochemical assessment and the imaging, we started the treatment specific for CD (nutritional therapy by Modulen, short courses of steroids, azathioprine and mesalazine during the follow up), These treatments improved the gastrointestinal symptoms and the nutritional status of our patient but also induced the disappearance of the mass adjoined into the bladder. In spite of the severe onset, in this patient, the clinical course of CD was mild and responder to conventional therapy.展开更多
Extra-adrenal chromaffin cell-related tumours or paragangliomas are rare, especially in the bladder. In this article, we reported three different clinical cases of bladder paraganglioma, followed by a review of curren...Extra-adrenal chromaffin cell-related tumours or paragangliomas are rare, especially in the bladder. In this article, we reported three different clinical cases of bladder paraganglioma, followed by a review of current literature on the pathophysiology and management of bladder paraganglioma. Case 1 involved a 23 years old female patient who complained of a 10-year history of micturition-related headaches, palpitations and diaphoresis; while in case 2, a 58 years old female patient presented with history of painless haematuria and an incidentally diagnosis of a functioning paraganglioma during endoscopic transurethral resection of bladder tumour; and lastly in case 3, a 54 years old male renal transplant recipient was referred to the urology outpatient with a suspicious bladder mass found incidentally on routine transplant workshop.展开更多
AIM: To evaluate the perioperative and long term outcomes of cystectomy in obese patients.METHODS: This is a retrospective review of 580 patients for whom radical cystectomy(RC) was performed for primary urothelial bl...AIM: To evaluate the perioperative and long term outcomes of cystectomy in obese patients.METHODS: This is a retrospective review of 580 patients for whom radical cystectomy(RC) was performed for primary urothelial bladder cancer between November 1996-April 2013 at a single institution. Body mass index(BMI) was available for 424 patients who were categorized as underweight(< 18.5), normal(18.5-24.9), overweight(25.0-29.9), and obese(≥ 30). Baseline demographics, perioperative outcomes, and survival were assessed. Overall survival(OS) and disease specific survival(DSS) was estimated by Kaplan-Meier method. Medians were compared using the Mann-Whitney U Test. Categorical variables were compared using the χ2 test. A P-value of < 0.05 was considered statistically significant. Statistical analyses were performed using the Software Package for the Social Sciences(SPSS), Version 20(International Business Machines SPSS, Chicago, IL, United States). RESULTS: The median age of all patients was 69 years(inter-quartile range 60-75) and median followup was 23.4 mo(8.7-55.1). Patients were characterized as underweight [9,(2.1%)], normal [113,(26.7%)],overweight [160,(37.8%)], or obese [142,(33.5%)]. Estimated blood loss during RC was higher in the obese group(800 m L) as compared to the normal weight group(500 m L). However, need for transfusion(47.7% vs 52.1%), number of lymph nodes resected(32 vs 30), length of stay(9 d vs 8 d), and 30-d readmission(29.7% vs 25.2%) between obese and normal BMI patients were similar. Obese patients underwent ileal neobladder diversion in 42% of cases, compared to 24% of normal BMI patients(0.003). Normal BMI and obese patients had comparable urinary incontinence(21.4% vs 25.6%, P = 0.343), and need for intermittent catheterization(14.3% vs 5.2%, P = 0.685) at 2 years follow-up. Overall survival was better in obese compared to normal BMI patients on univariate analysis, with median survival of 67 mo vs 37 mo, respectively(P = 0.031). Disease specific survival in these populations followed the same Kaplan Meier curve, with the obese group having a significantly improved OS, P = 0.016. Underweight patients had a significantly worse prognosis, with a median overall survival of 19 mo(P = 0.018). Disease specific survival was significantly worse in the underweight group compared to the obese group, P = 0.007. On multivariate analysis underweight patients remained at increased risk for death(HR = 3.1, P = 0.006), as were older patients(HR = 1.6, P = 0.006), those with multiple nodal metastases(HR = 3.7, P = 0.007), and those who had received neoadjuvant chemotherapy(HR = 2.0, P = 0.015).CONCLUSION: Perioperative outcomes and survival following RC in obese patients is comparable with nonobese patients. Underweight patients have the worst OS and DSS.展开更多
Urinary retention in women is rare and is more frequently described as case reports or small case series. The female/male ratio is 1:13 with about 3 cases per 100,000 women every year We report a case of a 12-year old...Urinary retention in women is rare and is more frequently described as case reports or small case series. The female/male ratio is 1:13 with about 3 cases per 100,000 women every year We report a case of a 12-year old female student. She presented with progressive weight loss, worsening lower urinary tract symptoms with distended lower abdomen of 10 weeks duration. Physical examination revealed a mobile tender firm pelvic mass, 18 centimeters (cm) × 16 cm in size. Laboratory and imaging studies showed obstructive nephropathy and uropathy respectively. She was worked up and had uneventful exploratory laparotomy with right salpingo-oophorectomy, urinary bladder diverticulectomy and pelvic lymphadenectomy. Histopathology of the pelvic mass showed ovarian dysgerminoma with lymph node metastasis. She responded very well to chemotherapy and resumed her school activities. Bladder outlet obstruction is relatively rare in females and in the index patient, ovarian dysgerminoma is the cause leading to obstructive nephropathy and uropathy.展开更多
目的探讨单细胞质谱流式技术(single-cell mass cytometry,CyTOF)分析膀胱癌组织与癌旁组织浸润性免疫细胞亚群特征的效果,为膀胱癌异质性研究提供新的策略。方法收集4例膀胱癌患者新鲜癌组织及其癌旁组织,通过酶解法联合机械法解离制...目的探讨单细胞质谱流式技术(single-cell mass cytometry,CyTOF)分析膀胱癌组织与癌旁组织浸润性免疫细胞亚群特征的效果,为膀胱癌异质性研究提供新的策略。方法收集4例膀胱癌患者新鲜癌组织及其癌旁组织,通过酶解法联合机械法解离制备成单细胞悬液。采用CyTOF检测肿瘤浸润性免疫细胞中26种免疫相关标志物的表达情况。结果通过细胞相似性分析,将膀胱CD45^+免疫细胞分成25个亚群(CD4^+T细胞簇7个、CD8^+T细胞簇8个、巨噬细胞簇4个、B细胞簇2个、树突状细胞簇1个和其他类型的免疫细胞簇3个)。膀胱癌组织与癌旁组织浸润性免疫细胞亚群相对含量存在差异,膀胱癌组织中T细胞相对富集,占比为76.73%;癌旁组织中B细胞和巨噬细胞相对富集,占比分别为15.20%和23.82%。膀胱癌组织中CD4^+Treg细胞的平均占比高于癌旁组织(2.20%vs 0.81%,P=0.016)。结论CyTOF可有效区分膀胱肿瘤微环境中的免疫细胞亚群,实现对肿瘤异质性的检测,可为膀胱癌的精准治疗提供依据。展开更多
文摘We report a rare mode of presentation of Crohn’s Disease (CD) in a 17-year-old boy, who was admitted at our hospital due to abdominal pain, dysuria, polyuria and fever. The ultrasound showed an increased wall thickness of the small bowel and cecum and a vegetating lesion adjoined into the bladder. The histology was not suggestive of CD and it excluded the bladder neoplasm. Based on the biochemical assessment and the imaging, we started the treatment specific for CD (nutritional therapy by Modulen, short courses of steroids, azathioprine and mesalazine during the follow up), These treatments improved the gastrointestinal symptoms and the nutritional status of our patient but also induced the disappearance of the mass adjoined into the bladder. In spite of the severe onset, in this patient, the clinical course of CD was mild and responder to conventional therapy.
文摘Extra-adrenal chromaffin cell-related tumours or paragangliomas are rare, especially in the bladder. In this article, we reported three different clinical cases of bladder paraganglioma, followed by a review of current literature on the pathophysiology and management of bladder paraganglioma. Case 1 involved a 23 years old female patient who complained of a 10-year history of micturition-related headaches, palpitations and diaphoresis; while in case 2, a 58 years old female patient presented with history of painless haematuria and an incidentally diagnosis of a functioning paraganglioma during endoscopic transurethral resection of bladder tumour; and lastly in case 3, a 54 years old male renal transplant recipient was referred to the urology outpatient with a suspicious bladder mass found incidentally on routine transplant workshop.
文摘AIM: To evaluate the perioperative and long term outcomes of cystectomy in obese patients.METHODS: This is a retrospective review of 580 patients for whom radical cystectomy(RC) was performed for primary urothelial bladder cancer between November 1996-April 2013 at a single institution. Body mass index(BMI) was available for 424 patients who were categorized as underweight(< 18.5), normal(18.5-24.9), overweight(25.0-29.9), and obese(≥ 30). Baseline demographics, perioperative outcomes, and survival were assessed. Overall survival(OS) and disease specific survival(DSS) was estimated by Kaplan-Meier method. Medians were compared using the Mann-Whitney U Test. Categorical variables were compared using the χ2 test. A P-value of < 0.05 was considered statistically significant. Statistical analyses were performed using the Software Package for the Social Sciences(SPSS), Version 20(International Business Machines SPSS, Chicago, IL, United States). RESULTS: The median age of all patients was 69 years(inter-quartile range 60-75) and median followup was 23.4 mo(8.7-55.1). Patients were characterized as underweight [9,(2.1%)], normal [113,(26.7%)],overweight [160,(37.8%)], or obese [142,(33.5%)]. Estimated blood loss during RC was higher in the obese group(800 m L) as compared to the normal weight group(500 m L). However, need for transfusion(47.7% vs 52.1%), number of lymph nodes resected(32 vs 30), length of stay(9 d vs 8 d), and 30-d readmission(29.7% vs 25.2%) between obese and normal BMI patients were similar. Obese patients underwent ileal neobladder diversion in 42% of cases, compared to 24% of normal BMI patients(0.003). Normal BMI and obese patients had comparable urinary incontinence(21.4% vs 25.6%, P = 0.343), and need for intermittent catheterization(14.3% vs 5.2%, P = 0.685) at 2 years follow-up. Overall survival was better in obese compared to normal BMI patients on univariate analysis, with median survival of 67 mo vs 37 mo, respectively(P = 0.031). Disease specific survival in these populations followed the same Kaplan Meier curve, with the obese group having a significantly improved OS, P = 0.016. Underweight patients had a significantly worse prognosis, with a median overall survival of 19 mo(P = 0.018). Disease specific survival was significantly worse in the underweight group compared to the obese group, P = 0.007. On multivariate analysis underweight patients remained at increased risk for death(HR = 3.1, P = 0.006), as were older patients(HR = 1.6, P = 0.006), those with multiple nodal metastases(HR = 3.7, P = 0.007), and those who had received neoadjuvant chemotherapy(HR = 2.0, P = 0.015).CONCLUSION: Perioperative outcomes and survival following RC in obese patients is comparable with nonobese patients. Underweight patients have the worst OS and DSS.
文摘Urinary retention in women is rare and is more frequently described as case reports or small case series. The female/male ratio is 1:13 with about 3 cases per 100,000 women every year We report a case of a 12-year old female student. She presented with progressive weight loss, worsening lower urinary tract symptoms with distended lower abdomen of 10 weeks duration. Physical examination revealed a mobile tender firm pelvic mass, 18 centimeters (cm) × 16 cm in size. Laboratory and imaging studies showed obstructive nephropathy and uropathy respectively. She was worked up and had uneventful exploratory laparotomy with right salpingo-oophorectomy, urinary bladder diverticulectomy and pelvic lymphadenectomy. Histopathology of the pelvic mass showed ovarian dysgerminoma with lymph node metastasis. She responded very well to chemotherapy and resumed her school activities. Bladder outlet obstruction is relatively rare in females and in the index patient, ovarian dysgerminoma is the cause leading to obstructive nephropathy and uropathy.
文摘目的探讨单细胞质谱流式技术(single-cell mass cytometry,CyTOF)分析膀胱癌组织与癌旁组织浸润性免疫细胞亚群特征的效果,为膀胱癌异质性研究提供新的策略。方法收集4例膀胱癌患者新鲜癌组织及其癌旁组织,通过酶解法联合机械法解离制备成单细胞悬液。采用CyTOF检测肿瘤浸润性免疫细胞中26种免疫相关标志物的表达情况。结果通过细胞相似性分析,将膀胱CD45^+免疫细胞分成25个亚群(CD4^+T细胞簇7个、CD8^+T细胞簇8个、巨噬细胞簇4个、B细胞簇2个、树突状细胞簇1个和其他类型的免疫细胞簇3个)。膀胱癌组织与癌旁组织浸润性免疫细胞亚群相对含量存在差异,膀胱癌组织中T细胞相对富集,占比为76.73%;癌旁组织中B细胞和巨噬细胞相对富集,占比分别为15.20%和23.82%。膀胱癌组织中CD4^+Treg细胞的平均占比高于癌旁组织(2.20%vs 0.81%,P=0.016)。结论CyTOF可有效区分膀胱肿瘤微环境中的免疫细胞亚群,实现对肿瘤异质性的检测,可为膀胱癌的精准治疗提供依据。
