RESUMEN

We demonstrate that PdAu single-atom alloy model catalysts offer a heterogeneous route to selective Würtz-type C-C coupling. Specifically, when methyl iodide is exposed to an otherwise unreactive Au(111) surface, single Pd atoms in the surface layer promote C-I dissociation and C-C coupling, leading to the selective formation of ethane.

RESUMEN

INTRODUCTION: We previously showed that urological outreach clinics significantly increase access to urological clinical care in rural populations. How such clinics affect access to urological procedural care is unknown. In this study we analyzed the use of outreach facilities for outpatient hospital based urological procedural care in a rural state. METHODS: Using information from the Office of Statewide Clinical Education Programs and the Iowa Hospital Association database, we analyzed provider level data in Iowa from 2010 to 2013. Based on CPT codes all outpatient urological procedural care was categorized by procedure type and intent. Cities containing an Iowa Hospital Association hospital were characterized as primary vs outreach. Geographic data were used for analysis of travel metrics and proximity to urological procedural care sites. Outreach urological procedures were then compared to urological procedural care at primary centers. RESULTS: During the study period 11,464 outreach urological procedures were performed, accounting for 15.0% of all outpatient urological procedures in the state. The yearly number of outreach procedures remained relatively stable during the study period. The majority (51.7%) of outreach urological procedures were therapeutic and endoscopic (62.9%) in nature. Extracorporeal shock wave lithotripsy was significantly more common for treating stone disease in the outreach setting compared to ureteroscopy (p <0.0001). CONCLUSIONS: A large percentage of the total urological procedural care in our state was done at outreach clinics and, while the majority was of low acuity, it was therapeutic. Changes in health care are projected to affect rural hospitals, which rely heavily on procedural care, and this study is the first to our knowledge to demonstrate the role that urological procedural care can have in such locations.

RESUMEN

Malignant mesothelioma is an uncommon neoplasm that develops from serous surfaces, and rarely from the tunica vaginalis. Although atypical in any location, paratesticular presentation is exceedingly infrequent as only 0.3% to 1.4% of mesothelioma cases arise from the tunica vaginalis. Fewer than 300 cases have been reported with very few descriptions of long term follow up and multimodal therapy. Here we describe a patient with 2 years of follow up for metastatic mesothelioma treated with orchiectomy, chemotherapy and robot-assisted laparoscopic retroperitoneal lymph node dissection.

Asunto(s)

Adventicia/patología , Antineoplásicos/administración & dosificación , Neoplasias Pulmonares , Escisión del Ganglio Linfático/métodos , Mesotelioma , Orquiectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Hidrocele Testicular , Neoplasias Testiculares , Biopsia/métodos , Terapia Combinada/métodos , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Metástasis Linfática , Masculino , Mesotelioma/complicaciones , Mesotelioma/diagnóstico , Mesotelioma/patología , Mesotelioma/cirugía , Mesotelioma Maligno , Persona de Mediana Edad , Espacio Retroperitoneal , Hidrocele Testicular/diagnóstico , Hidrocele Testicular/etiología , Hidrocele Testicular/cirugía , Neoplasias Testiculares/complicaciones , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/patología , Neoplasias Testiculares/cirugía , Resultado del Tratamiento

RESUMEN

Urothelial carcinoma is the 2nd most common cancer of the urinary tract and accounts for the majority of cases of bladder cancer. Metastases are not infrequently encountered, increasing with disease stage and are most commonly seen in the bones and lungs. Many other sites have been described including the omentum, liver, and ovaries. An extremely rare site of metastatic disease however is within the vagina. Here we present a case of a probable vaginal 'drop metastasis' from previously treated urothelial carcinoma in the ureter and bladder.

Asunto(s)

Carcinoma de Células Transicionales , Procedimientos Quirúrgicos Ginecológicos/métodos , Neoplasias Ureterales , Neoplasias de la Vejiga Urinaria , Procedimientos Quirúrgicos Urológicos/métodos , Neoplasias Vaginales , Anciano de 80 o más Años , Carcinoma de Células Transicionales/patología , Carcinoma de Células Transicionales/cirugía , Femenino , Examen Ginecologíco/métodos , Humanos , Clasificación del Tumor , Metástasis de la Neoplasia , Estadificación de Neoplasias , Resultado del Tratamiento , Neoplasias Ureterales/patología , Neoplasias Ureterales/cirugía , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/cirugía , Hemorragia Uterina/diagnóstico , Hemorragia Uterina/etiología , Neoplasias Vaginales/patología , Neoplasias Vaginales/fisiopatología , Neoplasias Vaginales/secundario , Neoplasias Vaginales/cirugía

RESUMEN

OBJECTIVES: To determine whether the severity of haematuria (microscopic or gross) at diagnosis influences the disease stage at presentation in patients diagnosed with bladder cancer. PATIENTS AND METHODS: We conducted a multi-institutional observational cohort study of patients who were newly diagnosed with bladder cancer between August 1999 and May 2012. We reviewed the degree of haematuria, demographic information, clinical and social history, imaging, and pathology. The association of haematuria severity with incident tumour stage and grade was evaluated using logistic regression. RESULTS: Patients diagnosed with bladder cancer presented with gross haematuria (GH; 1 083, 78.3%), microscopic haematuria (MH; 189, 13.7%) or without haematuria (112, 8.1%). High-grade disease was found in 64% and 57.1% of patients presenting with GH and MH, respectively, and severity of haematuria was not associated with higher grade disease. Stage of disease at diagnosis for patients presenting with MH was Ta/carcinoma in situ (CIS) in 68.8%, T1 in 19.6%, and ≥T2 in 11.6%. Stage of disease at diagnosis for patients presenting with GH was Ta/CIS in 55.9%, T1 in 19.6%, and ≥T2 in 17.9%. On multivariate analyses, GH was independently associated with ≥T2 disease at diagnosis (odds ratio 1.69, 95% confidence interval 1.05-2.71, P = 0.03). CONCLUSIONS: Among patients with newly diagnosed bladder cancer, presentation with GH is associated with a more advanced pathological stage. Earlier detection of disease, before development of GH, could influence survival in patients with bladder cancer. Type of haematuria at presentation does not impact grade of disease.

Asunto(s)

Hematuria/etiología , Neoplasias de la Vejiga Urinaria/complicaciones , Neoplasias de la Vejiga Urinaria/patología , Anciano , Estudios de Cohortes , Detección Precoz del Cáncer , Femenino , Hematuria/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias

RESUMEN

Renal cell carcinoma (RCC) is the most common kidney malignancy, with many histologic subtypes. One of the rare forms of RCC is mucinous tubular and spindle cell carcinoma (MTSCC), which is newly described with limited information on clinical picture and outcome. Heterotopic bone formation (osseous metaplasia) is a rare finding within any renal mass. Here we report a case of a massive, bilateral MTSCC with histologic findings of heterotopic bone formation, which has not been described before.

RESUMEN

An 11-year-old female with spastic quadriplegia was seen in the emergency room with abdominal pain, vomiting and anorexia. Labs revealed possible pancreatitis and signs of a urinary tract infection. A CT scan was performed to assess her abdominal pain and demonstrated circumferential air within the bladder wall. Following cultures being drawn, she was started on broad spectrum antibiotics. Her urine eventually grew Klebsiella Pneumoniae. Follow up imaging 2 weeks later demonstrated resolution of the air. Emphysematous cystitis is an exceedingly rare condition in the pediatric population, with this report representing the second case within the literature.

Asunto(s)

Cistitis/microbiología , Enfisema/microbiología , Infecciones por Klebsiella/complicaciones , Infecciones Urinarias/complicaciones , Antibacterianos/uso terapéutico , Parálisis Cerebral/complicaciones , Niño , Cistitis/diagnóstico por imagen , Enfisema/diagnóstico por imagen , Femenino , Humanos , Infecciones por Klebsiella/tratamiento farmacológico , Klebsiella pneumoniae , Cuadriplejía/complicaciones , Enfermedades Raras/diagnóstico por imagen , Enfermedades Raras/microbiología , Tomografía Computarizada por Rayos X , Infecciones Urinarias/tratamiento farmacológico

RESUMEN

BACKGROUND: Urothelial carcinoma (UC) is a common cancer affecting many patients in the United States. Nephroureterectomy remains the gold standard for the treatment of high grade upper tract disease or low grade tumors that are not amenable to endoscopic management. Recent reports have shown a decrease in UC recurrence in patients who underwent nephroureterectomy and who had Mitomycin C (MMC) instilled into the bladder at the time of catheter removal. At our institution instillation of intravesical MMC at the time of nephroureterectomy has been common for more than 10 years. Given the recent data, we sought to formally describe our experience with and evaluate the safety of intravesical instillation of cytotoxic chemotherapy at the time of nephroureterectomy. METHODS: We retrospectively reviewed 51 patients who underwent intraoperative intravesical instillation of cytotoxic chemotherapy (MMC (n = 48) or adriamycin (n = 3)) at the time of nephroureterectomy (2000-2012). The procedure was performed in a similar fashion by 8 different surgeons from the same institution, with drainage of the bladder prior to management of the bladder cuff. Patient characteristics and perioperative data including complications out to 90 days after surgery were collected. Perioperative complications for all patients were graded using the modified Clavien-Dindo classification. RESULTS: Twenty-four men and 27 women underwent intraoperative intravesical instillation of cytotoxic chemotherapy at the time of nephroureterectomy. Median age at the time of operation was 74 years (range 48-88). Median dwell time was 60 min. Twenty three patients had a total of 45 perioperative complications. The majority (36/45) were Clavien grades I and II. No patients experienced any intraoperative or postoperative complications attributable to MMC or Adriamycin instillation. CONCLUSION: Intraoperative intravesical instillation of cytotoxic chemotherapy at the time of nephroureterectomy is safe and feasible. Multicenter trials to study the efficacy of early cytotoxic chemotherapy administration to prevent recurrence of bladder urothelial carcinoma following nephroureterectomy are warranted.

Asunto(s)

Carcinoma de Células Transicionales/terapia , Doxorrubicina/administración & dosificación , Neoplasias Renales/terapia , Nefrectomía/métodos , Uréter/cirugía , Neoplasias Ureterales/terapia , Administración Intravesical , Anciano , Anciano de 80 o más Años , Antineoplásicos/administración & dosificación , Carcinoma de Células Transicionales/mortalidad , Carcinoma de Células Transicionales/patología , Estudios de Cohortes , Terapia Combinada , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Cuidados Intraoperatorios/métodos , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Seguridad del Paciente , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento , Neoplasias Ureterales/mortalidad , Neoplasias Ureterales/patología

RESUMEN

Previously, we demonstrated that inhibition of proteasomal chymotrypsin-like (CT-like) activity in human prostate cancer (PCa) PC-3 cultures and PC-3 xenografts results in accumulation of ubiquitinated proteins, followed by induction of cell death. Studies have shown that plasma CT-like proteasomal activity may be a powerful biomarker for risk stratification in hematologic malignancies. We hypothesized that circulating proteasomes could also be used to stratify risk for patients with PCa. A total of 109 patients with suspected PCa underwent prostatic biopsies were enrolled. Subjects were divided into non-cancer, low-risk PCa, and high-risk PCa groups. Three different proteasomal activity markers (CT-like, caspase-like, and trypsin-like) were measured and compared among the three groups. The proteasomal target proteins, Ub-prs, Hsp70, Bax, and P27 in plasma and prostate tissues were also evaluated. Multivariate analysis was used to assess whether CT-like activity was a predictor of PCa progression. Only proteasomal CT-like activity in the high-risk group was statistically higher than in the non-cancer group (P < 0.05). The expression of Ub-prs, Hsp70, Bax, and P27 protein was decreased in both plasma and PCa tissue of high-risk patients. CT-like activity was found to be an independent predictor of high-risk PCa. Subjects with CT-like activity ≥55 had a 2.15-fold higher risk of having high-risk PCa as compared to those with a CT-like activity of <55 (P = 0.021). We found CT-like activity to be an independent predictor of high-risk PCa, and as such, it may be a good candidate as a biomarker for high-risk PCa detection and stratification.

Asunto(s)

Biomarcadores de Tumor/biosíntesis , Proteínas Sanguíneas/biosíntesis , Progresión de la Enfermedad , Neoplasias de la Próstata/genética , Anciano , Biomarcadores de Tumor/genética , Proteínas Sanguíneas/genética , Línea Celular Tumoral , Regulación Neoplásica de la Expresión Génica , Proteínas del Choque Térmico HSP72/biosíntesis , Humanos , Masculino , Neoplasias de la Próstata/patología , Complejo de la Endopetidasa Proteasomal/genética , Factores de Riesgo , Proteínas Ubiquitinadas/biosíntesis , Ensayos Antitumor por Modelo de Xenoinjerto , Proteína X Asociada a bcl-2/biosíntesis

RESUMEN

Chinese men should have a higher prostate-specific antigen (PSA) "gray zone" than the traditional value of 2.5-10.0 ng ml-1 since the incidence of prostate cancer (PCa) in Chinese men is relative low. We hypothesized that PSA density (PSAD) could improve the rate of PCa detection in Chinese men with a PSA higher than the traditional PSA "gray zone." A total of 461 men with a PSA between 2.5 and 20.0 ng ml-1 , who had undergone prostatic biopsy at two Chinese centers were included in the analysis. The men were then further divided into groups with a PSA between 2.5-10.0 ng ml-1 and 10.1-20.0 ng ml-1 . Receiver operating characteristic (ROC) curve was used to evaluate the efficacy of PSA and PSAD for the diagnosis of PCa. In men with a PSA of 2.5-10.0 ng ml-1 or 10.1-20.0 ng ml-1 , the areas under the ROC curve were higher for PSAD than for PSA. This was consistent across both centers and the cohort overall. When the entire cohort was considered, the optimal PSAD cut-off for predicting PCa in men with a PSA of 2.5-10.0 ng ml-1 was 0.15 ng ml-1 ml-1 , with a sensitivity of 64.4% and specificity of 64.6%. The optimal cut-off for PSAD in men with a PSA of 10.1-20.0 ng ml-1 was 0.33 ng ml-1 ml-1 , with a sensitivity of 60.3% and specificity of 82.7%. PSAD can improve the effectiveness for PCa detection in Chinese men with a PSA of 2.5-10.0 ng ml-1 (traditional Western PSA "gray zone") and 10.1-20.0 ng ml-1 (Chinese PSA "gray zone").

Asunto(s)

Pueblo Asiatico , Biomarcadores de Tumor/sangre , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/diagnóstico , Anciano , Biopsia , China/epidemiología , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Próstata/patología , Neoplasias de la Próstata/epidemiología , Curva ROC , Estándares de Referencia , Sensibilidad y Especificidad

RESUMEN

Basal cell carcinoma of the penis is an extremely rare entity, accounting for less than 0.03% of all basal cell carcinomas. Fortunately, wide local excision of such lesions is generally curative. Fewer than 25 cases have been reported in the literature describing penile basal cell carcinoma. Here we report a case of penile basal cell carcinoma cured with wide local excision.

RESUMEN

Immunotherapy has been investigated in both preclinical studies and clinical trials as a new therapy for prostate cancer. Vaccines, including those that utilize dendritic cells, viruses, or DNA, immunize against prostate-specific antigen and prostatic acid phosphatase. The vaccines have long been studied as monotherapy for the cancer, but increasingly more trials have been initiated in combination with other modalities. These include radiation, chemotherapy, and androgen deprivation therapy. This review describes and discusses the various combinations of vaccine immunotherapies.

Asunto(s)

Vacunas contra el Cáncer/uso terapéutico , Quimioradioterapia/métodos , Inmunoterapia/métodos , Neoplasias de la Próstata/terapia , Animales , Humanos , Masculino , Retratos como Asunto

RESUMEN

The prostate-specific antigen (PSA) "gray zone" in Chinese men is likely higher than the traditional value (2.5-10.0 ng/ml) since the incidence of prostate cancer in Chinese men is relative low. The utility of percent free PSA in predicting prostate cancer is based on Western populations and may introduce sizable bias when applied to a Chinese cohort. We assessed the efficacy of percent free PSA in predicting prostate cancer in Chinese men with a PSA of 2.5-10.0 and 10.1-20.0 ng/ml. A total of 558 men with a PSA of 2.5-20.0 ng/ml who had undergone prostatic biopsy to detect prostate cancer from two Chinese centers were included. The rates of prostate cancer in different percent free PSA ranges were evaluated. Receiver operating characteristic curve (ROC) was used to evaluate and compare the efficiency of PSA and percent free PSA in the diagnosis of prostate cancer. The areas under ROC (AUCs) for percent free PSA for predicting prostate cancer were not higher than those for PSA, although prostate cancer detection rates increased with decreased percent free PSA in men with a PSA of 2.5-10.0, 10.1-20.0, and 2.5-20.0 ng/ml. Similarly, for men aged <70 and ≥ 70 years and with prostate volume <40 and ≥ 40 ml, AUCs showed percent free PSA was not better than PSA in predicting prostate cancer. By analyzing multicenter data, we first found that percent free PSA does not improve detection of prostate cancer in Chinese men with a PSA of 2.5-10.0 or 10.1-20.0 ng/ml.

Asunto(s)

Antígeno Prostático Específico/sangre , Próstata/metabolismo , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/diagnóstico , Anciano , Área Bajo la Curva , Pueblo Asiatico , Biopsia , China , Estudios de Cohortes , Detección Precoz del Cáncer , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/etnología , Curva ROC , Sensibilidad y Especificidad , Resultado del Tratamiento

RESUMEN

The Bricker ileal conduit has been the most popular urinary diversion technique following a radical cystectomy since the 1950s. The procedure typically provides a high quality of life for patients. However, stomal complications occur in 16%-65% of ileal conduit cases. We describe an easy technique to aid in the intussusception of a Bricker ileal conduit. This technique produces stomas with a height of 2 cm-3 cm consistently. In our experience, we have had excellent results when using this technique.

Asunto(s)

Estomía/métodos , Derivación Urinaria/métodos , Cistectomía , Humanos , Estomía/efectos adversos , Calidad de Vida , Técnicas de Sutura

RESUMEN

OBJECTIVE: To examine variation in the open market cost of a radical prostatectomy (RP) procedure in the US hospitals for an uninsured patient, as many proposals for health care reform highlight the importance of individuals actively participating in selecting care. However, reports suggest that obtaining procedure prices remains challenging and highly variable. MATERIALS AND METHODS: We used 2011-2012 US News and World Report rankings to identify a cohort of 100 hospitals making an effort to include an equal distribution of both academic and private centers, city size, and geographic region. Each hospital was called and the essence of the script included a caller stating he was a healthy, uninsured 55-year-old man recently diagnosed with Gleason 3 + 4 prostatic adenocarcinoma with no metastases. Facility, surgeon, and anesthesia fees were solicited. RESULTS: Seventy hospitals provided facility prices. Facility estimates averaged $34,720 (±20,335; range, $10,100-$135,000), which was statistically higher at academics centers. No significant differences were seen by region, population, or hospital ranking. Surgeon and anesthesia fees were provided by 10%, averaging $8280 (±$4282; range, $4028-$18,720). Thirty-three hospitals provided discounted fees for prompt payment averaging 34% (±16%; range, 10%-80%). CONCLUSION: There is wide variation in pricing for RP, with higher rates found in academic centers. Wide variation in facility costs were observed, and nearly all were unable to provide surgeon and/or anesthesia fees. Currently, it appears to be unacceptably difficult for men with prostate cancer without insurance to obtain prices for an RP procedure.

Asunto(s)

Acceso a la Información , Economía Hospitalaria/estadística & datos numéricos , Honorarios Médicos/estadística & datos numéricos , Precios de Hospital/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Prostatectomía/economía , Centros Médicos Académicos/economía , Adenocarcinoma/economía , Adenocarcinoma/cirugía , Anestesia/economía , Hospitales con Fines de Lucro/economía , Hospitales Filantrópicos/economía , Humanos , Masculino , Neoplasias de la Próstata/economía , Neoplasias de la Próstata/cirugía , Estados Unidos

RESUMEN

OBJECTIVE: To determine the effect of outreach clinics on access to urologic care in a state with a large rural population. This is especially pertinent given the predicted shortage of urologists over the next decade and the trend toward practice in urban area. METHODS: We analyzed provider level data from urologic practices within the state of Iowa using information from 2 publicly available sources: (1) the Office of Statewide (Iowa) Clinical Education Programs, which collects detailed information on visiting consultant urologists (VCU), and (2) the Iowa Physician Information System, which tracks demographic and professional data on all active physicians in Iowa. Factors analyzed included percent of counties and Iowans served by urologists and travel distances/times for patients and physicians. RESULTS: Currently, 57% of Iowans are within 30 minutes of a urologist's primary office, increasing to 84% with VCU outreach clinics. Fifty-five urologists, including 40 of 69 (58%) of Iowa-based urologists, perform outreach within Iowa, accounting for 198 clinic days and 20,400 miles of travel per month. CONCLUSION: Within Iowa, the lack of rural urologists has been mitigated, in part, by an extensive VCU network. However, improved access has required significant effort from urologists in both time and miles traveled. This study is the first to show how a rural state can effectively use physician outreach clinics to provide specialized urologic care to underserved, rural communities.

Asunto(s)

Centros Comunitarios de Salud , Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Salud Rural/organización & administración , Centros Comunitarios de Salud/organización & administración , Relaciones Comunidad-Institución , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Derivación y Consulta , Servicios de Salud Rural/tendencias , Población Rural

Asunto(s)

Centros Comunitarios de Salud , Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Salud Rural/organización & administración , Humanos

RESUMEN

PURPOSE OF REVIEW: Male urinary incontinence affects a significant number of elderly men and the successful treatment has the potential to significantly improve their quality of life. RECENT FINDINGS: Stress urinary incontinence, overflow incontinence and detrusor overactivity are the major categories of urinary incontinence affecting men. Although the surgical standards of care have not changed significantly for urinary incontinence, there have been recent advances with minimally invasive techniques, which show promise. SUMMARY: The treatment of male urinary incontinence is constantly evolving, with recent advances in minimally invasive procedures.

Asunto(s)

Enfermedades Urogenitales Masculinas/terapia , Incontinencia Urinaria de Esfuerzo/terapia , Toxinas Botulínicas Tipo A/uso terapéutico , Manejo de la Enfermedad , Humanos , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos , Antagonistas Muscarínicos/uso terapéutico , Vejiga Urinaria Hiperactiva/terapia

RESUMEN

Bladder herniation within the inguinal canal is a relatively uncommon finding. We report an even less-common occurrence of transitional cell carcinoma located within a portion of inguinally herniated bladder. Fewer than 20 reports exist in the literature describing this scenario.