RESUMEN
Urothelial carcinoma is the most common urinary malignancy with a wide proportion of cancer morbidity and mortality. The aim of the present study is to evaluate Ki-67 and p63 immunoexpression and their correlation with grade and stage of bladder urothelial carcinoma. Fifty cases of bladder urothelial carcinoma were investigated and were submitted to immunohistochemical staining for p63 and Ki-67, which were assessed qualitatively and quantitatively. A high percentage of p63 immunoexpression showed a significant association with low-grade tumors (P < .05), while Ki-67 mean percentage of expression was higher in high-grade tumors, advanced stage and multiple tumors compared to low grade, early-stage and single tumors without statistical association. Furthermore, the mean percentage of p63 was higher in urothelial carcinoma with squamous differentiation compared to pure urothelial carcinoma with an absence of statistical significance. P63 could help in the identification of bladder tumors with squamous differentiation since identifying these cases is important regarding prognostic and therapeutic aspects. Ki 67 seems to be associated with features of bladder tumor progression as multiplicity, high grade and advanced stage.
Asunto(s)
Biomarcadores de Tumor/biosíntesis , Antígeno Ki-67/biosíntesis , Proteínas de la Membrana/biosíntesis , Neoplasias de la Vejiga Urinaria/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/análisis , Femenino , Humanos , Inmunohistoquímica , Antígeno Ki-67/análisis , Masculino , Proteínas de la Membrana/análisis , Persona de Mediana Edad , Estudios Prospectivos , Neoplasias de la Vejiga Urinaria/diagnósticoRESUMEN
OBJECTIVES: Successful kidney transplant depends partly on the normal physiologic functioning of the bladder, which involves effective urine storage and emptying. The bladder may become abnormal owing to various urologic and neuropathic disorders. Patients with abnormal bladders need careful management before and after transplant. In this study, we aimed to determine the outcomes of renal transplants in relation to various causes of abnormal bladder. MATERIALS AND METHODS: We conducted a retrospective review of 25 patients with abnormal bladder who received 30 renal transplants between 1990 and 2014. The patients were divided into neurologic and urologic groups based on the causes of abnormal bladder. Patient demographics, graft function, survival, and postoperative complications were compared. RESULTS: The most common urologic cause was posterior urethral valve (14 patients), while the most common neurologic cause was spina bifida (6 patients). There was no statistically significant difference in graft survival at 1, 3, and 5 years between patients with neurologic and urologic causes of abnormal bladder as well as at long-term follow-up. However, the mean estimated glomerular filtration rate at 1, 3, and 5 years was higher among patients with neurologic causes than in those with urologic causes, although the difference was statistically significant only at 1 year (61 ± 34 vs 37 ± 19 mL/min; P = .025). Stone formation was reported only in patients whose abnormal bladder had neurologic causes, and no incidence was reported in patients with urologic causes (20% vs 0%; P = .038). The incidence of other postoperative complications was not statistically significant between the 2 groups. CONCLUSIONS: With careful evaluation and proper preoperative correction of abnormal bladder dysfunction and optimization of the emptying and storage functions of the bladder, the causes of abnormal bladder did not appear to impact graft function and survival or overall rate of postoperative complications.
Asunto(s)
Supervivencia de Injerto , Trasplante de Riñón , Insuficiencia Renal Crónica/cirugía , Enfermedades de la Vejiga Urinaria/complicaciones , Vejiga Urinaria/fisiopatología , Adolescente , Adulto , Niño , Femenino , Tasa de Filtración Glomerular , Humanos , Estimación de Kaplan-Meier , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Enfermedades de la Vejiga Urinaria/diagnóstico , Enfermedades de la Vejiga Urinaria/fisiopatología , Enfermedades de la Vejiga Urinaria/terapia , Urodinámica , Adulto JovenRESUMEN
OBJECTIVE: To compare maternal and neonatal outcomes of fetal macrosomia in diabetic and nondiabetic women. METHODS: A retrospective case-control study was conducted at Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia from January 2004 to December 2006. A total of 766 macrosomic newborns met the inclusion criteria. We compared maternal and neonatal characteristics and outcomes between diabetic (group 1, n=207) and nondiabetic (group 2, n=559) women. RESULTS: There were significantly more macrosomic newborns in nondiabetic women; 73% versus 27% in diabetic women, p=0.0001. Cesarean deliveries were significantly higher in diabetic women compared to nondiabetic women (30.4% versus 19.5%, p=0.002). There were no significant differences between either group in total maternal morbidity (12.6% versus 14.1%, p=0.7). There were significantly more severe cases of shoulder dystocia occurring in newborns of diabetic women compared to nondiabetic women (1.9% versus 0.2%, p=0.03). CONCLUSION: Elective cesarean delivery for estimated fetal weight > or =4500g for nondiabetic women and > or =4250 g for diabetic women may avoid severe shoulder dystocia without increasing maternal morbidity rates.
Asunto(s)
Diabetes Gestacional , Macrosomía Fetal , Embarazo en Diabéticas , Adulto , Parto Obstétrico/métodos , Diabetes Gestacional/epidemiología , Distocia/epidemiología , Distocia/prevención & control , Femenino , Macrosomía Fetal/epidemiología , Humanos , Recién Nacido , Masculino , Embarazo , Resultado del Embarazo , Embarazo en Diabéticas/epidemiología , Estudios Retrospectivos , Arabia Saudita/epidemiologíaRESUMEN
OBJECTIVE: To assess maternal and fetal outcomes, in epileptic and non-epileptic pregnant women. METHODS: A retrospective case-control study was conducted from January 2005 - December 2006 at Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia. A total of 16508 live birth charts were reviewed. Maternal, obstetrical, and fetal outcomes were compared between women with epilepsy Group 1 (n = 53) and women who did not have epilepsy (controls) Group 2 (n = 60). RESULTS: There were no significant differences between either group in total length of labor, labor induction and oxytocin augmentation, need for labor analgesia, total blood loss and the need for blood transfusion, mode of delivery, and the length of hospital stay. There were no significant differences in all maternal complications between either group (p=0.8, 95% CI: 0.3-2.1). There was an increase in the mean dose of the antiepileptic medications needed during pregnancy. However, 4 women (7.5%) in the epileptic group had major seizures during pregnancy. All of these women needed addition of a second antiepileptic medication. Major congenital malformations occurred in 2 newborns (3.8%) of epileptic women, and none occurred in the control group. Both newborns were from women who received polytherapy. CONCLUSION: Women with epilepsy are not at increased risk for obstetric and neonatal complications, provided there is a combined team management approach by a neurologist and an obstetrician.
Asunto(s)
Epilepsia , Complicaciones del Embarazo , Resultado del Embarazo , Adulto , Anticonvulsivantes/uso terapéutico , Estudios de Casos y Controles , Epilepsia/tratamiento farmacológico , Femenino , Humanos , Recién Nacido , Paridad , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Estudios Retrospectivos , Arabia SauditaRESUMEN
OBJECTIVE: To determine the selectivity of 5-aminolevulinic acid (5-ALA) as a photosensitizer to malignant prostatic cells in men undergoing radical retropubic prostatectomy. PATIENTS AND METHODS: Nineteen patients with localized prostate cancer were included in the study. Eighteen patients received 5-ALA and one patient did not receive it and was used as a control. The dose was 20mg /kg body weight, 15 patients received 5-ALA 4 hours before radical prostatectomy, two patients received it 2 hours before prostatectomy through a Ryle tube, and one patient received 5-ALA 12 hours before the operation. The removed prostates were examined for protoporphyrin IX (PpIX) fluorescence macroscopically, by fluorescence microscopy and by light microscopy. RESULTS: All carcinomas showed a clear evidence of PpIX-enrichment except in the control case. The enrichments were strong (++) in 15 cases and weak (+) in 3 cases. Two of those three cases were given 5-ALA two hours through a Ryle tube before excision of the prostate as well as the patient who was given 5-ALA 12 hours preoperatively. No PpIX enrichment was observed in the stroma of the prostate gland or in the benign tissue sections in any case (0/19). CONCLUSION: Oral 5-ALA is selectively concentrated in malignant cells of the prostate. This may lead to the clinical application of photodynamic therapy for localized prostate cancer.