Positron emission tomography thyroid incidentaloma: Is it different in Indian subcontinent?

BACKGROUND

Positron emission tomography (PET) forms an integral part in work-up and follow-up of various malignancies. With the increased use of PET in oncology, finding of an incidental focal thyroid uptake (incidentaloma) is not unusual and presents a diagnostic challenge.

AIM

The aim of the following study is to evaluate the frequency and radio-pathologic correlation of focal 18-fluoro deoxyglucose uptake (FDG) on PET within the thyroid from a large series.

MATERIALS AND METHODS

Retrospective review of 37,000 consecutive patients who underwent FDG-PET at tertiary cancer center in India. Radiological, pathological, PET scan and follow-up details were evaluated. Statistical analyzes were carried out using Mann Whitney test and Pearson correlation.

RESULTS

Abnormal thyroid uptake was seen in 78 (0.2%) patients. Nearly 61 (0.16%) scans had focal and 17 (0.04%) had diffuse FDG uptake. A total of 57 patients with focal uptake were available for further evaluation. No further evaluation was done in 24 (42.1%) patients who had advanced index malignancy. Of the remaining 33 patients 26 were benign and seven were a cause for concern (four primary thyroid cancers, one follicular neoplasm with hurthle cell change and two metastatic cancers). There was no significant correlation in Standardized uptake value (SUV) max of benign and malignant lesion (P = 0.5 on Mann Whitney) or size (r = 0.087 Pearson correlation co-efficient P= 0.667).

CONCLUSION

Incidence of PET incidentaloma is low in this large cohort of Indian patients. Nearly 27% of focal incidentaloma were malignant. There was no correlation between the SUVmax, size and malignancy.

Concomitant Renal Cell Carcinoma and Hematologic Malignancy in Immunosuppressed Patients

OBJECTIVES

Treatment of a renal mass in patients with hematologic malignancy or on immunosuppression can be complex and is not well defined. Surgical excision or thermal ablation of renal mass is generally recommended in view of concern for tumor progression in immunosuppressed patients. We report our management decision experience in patients and literature review on concomitant renal and hematologic malignancy.

MATERIALS AND METHODS

A retrospective medical record review of patients with renal cell carcinoma (RCC) and a hematologic malignancy over 3 years at our University Hospital was performed. Data were collected including patient׳s demographics, renal tumor and hematologic malignancy characteristics (stage, pathologic subtype, time of diagnosis, treatment type and prognosis). Surgical and medical management of each malignancy was reviewed and perioperative and overall outcomes are reported.

RESULTS

In total, 6 patients were identified with RCC and a hematologic malignancy of which 4 were on immunosuppressive therapy. A total of 5 patients had leukemia and 1 patient had multiple myeloma. Most kidney tumors were stage I, 83%; and 80% were Fuhrman grade II. There was equal distribution of clear cell and papillary-type RCC. All but 1 patient had undergone nephron-sparing surgery. Overall, 50% of our patients died within 1 year after renal surgery for pT1a tumors from causes that are unrelated to renal cancer.

CONCLUSIONS

Our small cohort showed significant mortality in patients with hematologic malignancy on immunosuppression, who had their renal mass treated with surgical excision or thermal ablation. However, this mortality was not secondary to surgical procedure itself. The prognosis of the hematologic malignancy might dictate the management of RCC.

Effects of Alpha-Blockade on Ureteral Peristalsis and Intrapelvic Pressure in an In Vivo Stented Porcine Model

INTRODUCTION

Clinical studies have shown beneficial role of oral alpha-blockers for ureteral stent-related morbidity. However, the in vivo effects of oral alpha-blockers on a stented ureter are unclear. We evaluated the effects of alpha-blockade on ureteral dynamics in a stented porcine ureter.

METHODS

Twenty-seven female pigs were used in this study. Fourteen pigs received oral alpha-blocker medication (silodosin, 8 mg daily), and 13 pigs received no medication. Under cystoscopic guidance, a 5F ureteral catheter was positioned in the renal pelvis and attached to a pressure monitor. A Foley catheter was placed in the bladder along with a bladder pressure transducer. A lumbotomy was performed, and the ureter was identified. A magnetic sensor was placed on the extraluminal surface of the ureter to monitor ureteral peristalsis. We measured renal pelvic and bladder pressures, urine output, and ureteral peristalsis every hour for 10 minutes for a total of 5 hours. The pigs were then euthanized.

RESULTS

The mean weight was 42.5 kg in the drug group and 45.9 kg in the nondrug group (p = 0.008). Mean hourly urine output was 140 mL in the drug group and 144 mL in the nondrug group (p = 0.76). Mean baseline renal pressure was 13.2 and 13.8 mm Hg (p = 0.69) in the drug and nondrug groups, respectively. Mean peristaltic renal pelvic pressure was 19.1 mm Hg in the drug group and 19.2 mm Hg in the nondrug group (p = 0.97). Mean number of peristalsis was 11/10 and 14/10 minutes (p = 0.03) in the drug and nondrug groups, respectively.

CONCLUSIONS

Alpha-blockade in an in vivo stented porcine ureter resulted in no significant effect on renal pelvic pressure but a significant decrease in the number of ureteral peristalsis. Further investigation of the effects of alpha-blocker on ureteral dynamics is required to better understand its effects on stent-related symptoms.

Optic nerve head segmentation using fundus images and optical coherence tomography images for glaucoma detection

BACKGROUND

Glaucoma is a common causes of blindness. The associated elevation in intra ocular pressure leads to progressive degeneration of the optic nerve and resultant structural changes with functional failure of the visual field. Since, glaucoma is asymptomatic in the early stages and the associated vision loss is irreparable, its early detection and timely medical treatment is essential to prevent further visual damage.

OBJECTIVE

This paper presents a novel method for glaucoma detection using digital fundus image and optical coherence tomography (OCT) image.

METHOD

The first section focuses on the features such as cup to disc ratio (CDR) and the inferior superior nasal temporal (ISNT) ratio which were obtained from fundus images.The above features were used for classifying the normal and glaucoma condition using back propagation neural network (BPN) and Support Vector Machine (SVM) classifiers. In the second part of the article, features such as CDR and two novel features, cup depth and retinal thickness were obtained from the OCT image. These features were evaluated by the BPN and SVM classifier.

RESULTS AND CONCLUSION

The combined features from fundus and OCT images were analyzed. The system proposed here is able to classify glaucoma automatically. The accuracy of BPN and SVM Classifiers was 90.76% and 96.92% respectively.

Management of neglected sacral fracture with cauda equina syndrome: report of two cases with review of literature

STUDY DESIGN

A retrospective study was performed.

OBJECTIVES

To analyze the outcome of two neglected sacral fractures who presented late to us after 6 weeks of injury with main complaints of incontinence and numbness in sacral region. There are no guidelines for management of complex fractures of sacrum who present late, and available literature is equally perplexing.

METHODS

Patients were evaluated and radiological investigations were done. Anterior-displaced U-shaped fracture was found to be present between S2 and S3 with bony fragments encroaching the canal. Decompression with wide sacral laminectomies was done without any fixation.

RESULTS

Case 1 showed complete recovery of bladder and perineal sensations 6 months post surgery. Second patient (case 2) had partial recovery of bladder control but numbness persisted till last follow-up at 6 months.

CONCLUSION

Neglected fractures of sacrum that present later than 6 weeks post injury with cauda equina syndrome could be given a chance for decompression if imaging shows canal encroachment with bony fragments. Fixation of fracture may not be required in all unstable sacral fractures after 6 weeks.

Directed Assembly of Ultrathin Gold Nanowires over Large Area by Dielectrophoresis

Ultrathin Au nanowires (∼2 nm diameter) are interesting from a fundamental point of view to study structure and electronic transport and also hold promise in the field of nanoelectronics, particularly for sensing applications. Device fabrication by direct growth on various substrates has been useful in demonstrating some of the potential applications. However, the realization of practical devices requires device fabrication strategies that are fast, inexpensive, and efficient. Herein, we demonstrate directed assembly of ultrathin Au nanowires over large areas across electrodes using ac dielectrophoresis with a mechanistic understanding of the process. On the basis of the voltage and frequency, the wires either align in between or across the contact pads. We exploit this assembly to produce an array of contacting wires for statistical estimation of electrical transport with important implications for future nanoelectronic/sensor applications.

An ex vivo approach to complex renal artery aneurysm repair

Ex vivo repair technique for a complex renal artery aneurysm may have several advantages. Smaller incision size and use of minimally invasive techniques may decrease incisional morbidity and improve recovery time, especially in patients with a high body mass index. Improved visualization afforded by back-table methods may also be valuable when repair of aneurysms involving multiple branches is necessary. We report of a successful case of laparoscopic nephrectomy, followed by back-table aneurysmorrhaphy and autotransplant, in a patient with a renal artery aneurysm.

Self-cleaning and superhydrophobic CuO coating by jet-nebulizer spray pyrolysis technique

The pocket-sized nebulizer equipped jet-spray coating of a monoclinic CuO crystallite surface showed excellent superhydrophobic self-cleaning properties owing to its compact crystallite texture and high surface roughness.

Percutaneous nephrolithotomy for removal of encrusted ureteral stents: a multicenter study

PURPOSE

Encrusted ureteral stents are a challenging endourologic problem. We performed a multi-institutional review of percutaneous nephrolithotomy (PCNL) as primary treatment for encrusted stents.

MATERIALS AND METHODS

We identified 36 patients who underwent PCNL for treatment of an encrusted stent. A retrospective review was performed to compile details of procedures and outcomes for these patients.

RESULTS

In 36 patients, 38 renal units underwent PCNL for encrusted ureteral stents. The mean patient age was 47.1 years (±16.7), and the female:male ratio was 15:21. Mean stent indwelling time before removal was 28.2 months (±27.8). The reason for long indwelling time was reported in 25 cases; these reasons included "patient unaware stent needed to be removed" (17 cases), pregnancy (2 cases), other comorbidities (3 cases), and patient incarceration (3 cases). In 3 cases, the stent had become encrusted within 3 months of placement. Mean operative time was 162 minutes (±71). There were no major intraoperative complications, and no patients required blood transfusion. Litholapaxy was required for bladder coil encrustations in 22 cases (58%), and ureteroscopy with lithotripsy was required for encrustation of the ureteral portion of the stent in 13 cases (34.2%). Second look percutaneous procedures were required in 13 cases (34.2%). The stent was removed at the time of PCNL without need for concomitant or delayed ureteroscopy and/or cystolitholapaxy in 8 cases (21%). Ultimately, all stents were removed successfully. Patients were rendered stone free according to radiographs in 24 cases (63%).

CONCLUSIONS

In this multicenter review, PCNL is confirmed to be a safe and effective means of addressing the retained and encrusted ureteral stent. PCNL without ureteroscopy or litholapaxy was sufficient in a minority of cases (21%). Adjunctive endourologic modalities are often required, and the surgeon should anticipate the need for concomitant antegrade ureteroscopic laser lithotripsy and/or cystolitholapaxy. Although complete stent removal can be anticipated, residual fragments are not uncommon.

Association of clinical and radiographic features with perinephric "sticky" fat

BACKGROUND AND PURPOSE

The discovery of thick, adherent, perinephric sticky fat (PSF) is relatively common during open or laparoscopic retroperitoneal surgery. To our knowledge, however, there has been no previous analysis of clinical or radiographic features associated with the development of PSF or of perioperative outcomes for those patients in whom it is found. Our objective is to analyze potential predictive features and determine whether there is any effect on clinical or pathologic outcomes for patients with perinephric sticky fat.

PATIENTS AND METHODS

Patients undergoing partial nephrectomy or laparoscopic cryoablation with available preoperative imaging were identified from 2005 to 2011. Operative records were reviewed to identify patients with and without PSF. Preoperative images and medical records were examined to obtain patient data regarding potential predictors as well as clinical and pathologic outcomes.

RESULTS

A total of 29 patients were identified-16 with PSF and 13 controls. Statistically significant factors associated with PSF included sex, tumor size, presence of perinephric stranding, tumor >50% exophytic, and thickness of perinephric fat (P<0.05). Median total operative time for patients with sticky fat was nearly 40 minutes longer than the control group (228 min vs 190 min, P<0.05). All four (17%) patients with Fuhrman grade 3 or 4 renal-cell carcinoma were from the sticky fat group (P=0.09).

CONCLUSIONS

Despite the small sample size, multiple possible factors associated with perinephric sticky fat were identified and may provide guidance for future investigation of this phenomenon.

Prospective comparison of outcomes of percutaneous nephrolithotomy in elderly patients versus younger patients

PURPOSE

The purpose of the study was to prospectively compare operative and postoperative characteristics and outcomes in elderly patients undergoing percutaneous nephrolithotomy (PCNL) compared with younger patients.

PATIENTS AND METHODS

Prospectively collected data from the Clinical Research Office of the Endourological Society (CROES) Global PCNL Study database were used. Elderly patients were defined as those aged 70 years and above, while younger patients were those between 18 and 70 years of age. Matched and unmatched group comparisons were performed based on imaging modality used for assessing stone-free status. Patient characteristics, operative data, and postoperative outcomes were compared.

RESULTS

The median age of the elderly group vs the young group was 74 years (range 70-93 years) vs 49 years. In the unmatched analysis, staghorn stones were seen at higher rates in the elderly group (27.8% vs 21.8%, P=0.014); however, the mean stone size was not significantly different (465.0 vs 422.8, P=0.063). The length of hospitalization was significantly longer in the elderly group compared with the young group in the unmatched analysis (5 days vs 4.1 days, P<0.001). The same difference was not apparent in the matched analysis (5.0 days vs 4.4 days, P=0.288). Overall complication rates were not significantly different in the unmatched analysis. In the matched analysis, however, a statistically significant higher rate of overall complications was seen. Stone-free rates were similar among all groups.

CONCLUSION

PCNL in elderly patients over the age of 70 years produces results comparable to those seen in younger patients. With only a slightly higher-be it statistically significant-complication rate, the stone-free rate in older patients was the same as in the younger group.

Impact of statin therapy on PSA kinetics during active surveillance of prostate cancer

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Background: Statin therapy has been associated with decreased serum PSA levels in men undergoing prostate cancer screening, lower rate of adverse pathologic features in radical prostatectomy specimens and decreased risk of biochemical recurrence following prostatectomy. Here we evaluate the impact of statin therapy on PSA kinetics during active surveillance of prostate cancer.

Methods: A retrospective review of patients diagnosed with prostate cancer at our institution between the years 2000 and 2009 was performed. Patients undergoing at least 12 months of active surveillance were identified. PSA velocity and percentage change in PSA per year were compared between patients receiving and not receiving statin therapy during active surveillance. Subgroup analysis was performed on low risk patients (prebiopsy PSA <10, Gleason score <6, <cT2).

Results: We identified 81 patients meeting our inclusion criteria, 43% (35/81) were on statin therapy during active surveillance. Prebiopsy PSA was significantly lower in patients receiving statin therapy (6.0 ng/ml) compared to controls (8.3 ng/ml), p = 0.005. There was no difference in duration of active surveillance, PSA velocity, and percentage change in PSA per year based on statin use in all patients. When evaluating the 41 low risk patients, 54% (22/41) were on statin therapy. Prebiopsy PSA was lower in low risk patients receiving statin therapy (4.9 ng/ml) compared to controls (6.4 ng/ml), p= 0.055. PSA velocity was significantly lower in low risk patients (0.02 ng/ml/year) compared to low risk controls (0.89 ng/ml/year), p=0.024. Percentage change in PSA per year was significantly lower in low risk patients receiving statin therapy (-1.7%/year) compared to low risk controls (11.6%/year), p=0.05. The percentage of low risk patients receiving definitive therapy following a period of active surveillance on statin therapy was 9% (2/22)compared to 26% (5/19) in controls, p = 0.14.

Conclusions: PSA kinetics during active surveillance appear to be significantly altered by statin therapy in low risk patients. Further evaluation of the impact of statin therapy on PSA kinetics and clinical outcomes of men undergoing active surveillance for prostate cancer are warranted.