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Raza SJ, Xu P, Barnes J, Fisher R, May A, Darwish O, Dang B, Adsul P, Freeman CA, Siddiqui SA. Outcomes of renal salvage for penetrating renal trauma: a single institution experience. Can J Urol 2018; 25:9323-9327. [PMID: 29900820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Conservative management of penetrating renal trauma is emerging, with data originating from centers with variable level of trauma care. This study reviews the outcomes of renal salvage after penetrating trauma at a level I trauma center. MATERIALS AND METHODS An institutional review board approved trauma registry at Saint Louis University Hospital was retrospectively analyzed, for patients with penetrating renal trauma from 2009 to 2014. Patients were divided into nephrectomy group (NG) or non-nephrectomy group (non-NG), and compared. A multi-variable analysis was performed to determine predictors of nephrectomy, with cross validation to evaluate the performance of the multi-variable model. Data was analyzed using R version 3.3.2. A p value of < 0.05 was considered as significant. RESULTS A total of 121 patients were identified with penetrating renal trauma. Gunshot injury was the leading cause of injury (87%). Eighteen (15%) patients required nephrectomy. The overall mean injury severity score (ISS). was 20. High grade (grade 4-5) renal injuries were noted in 41 patients (34%). Among these, 14 patients (34%) underwent a nephrectomy, while 27 patients (66%) were managed conservatively to salvage renal units. CT grade of renal injury was the only predictor of nephrectomy, on multi-variable analysis (OR 17.09 CI 2.75-105.99, p = 0.002). CT grade of injury and injury severity score were predictors of endoscopic intervention on a sub group analysis of non-NG. CONCLUSIONS CT grade of injury predicts nephrectomy after penetrating renal trauma. Conservative management is a feasible option in penetrating renal trauma even with a higher grade of injury.
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Affiliation(s)
- S Johar Raza
- Division of Urology, Department of Surgery, Saint Louis University Hospital, St. Louis, Missouri, USA
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Haddad AQ, Luo JH, Krabbe LM, Darwish O, Gayed B, Youssef R, Kapur P, Rakheja D, Lotan Y, Sagalowsky A, Margulis V. Prognostic value of tissue-based biomarker signature in clear cell renal cell carcinoma. BJU Int 2017; 119:741-747. [PMID: 28075543 DOI: 10.1111/bju.13776] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To improve risk stratification for recurrence prognostication in patients with localised clear cell renal cell carcinoma (ccRCC). PATIENTS AND METHODS In all, 367 patients with non-metastatic ccRCC were included. The cohort was divided into a training and validation set. Using tissue microarrays, immunostaining was performed for 24 biomarkers representative of key pathways in ccRCC. Using Least Absolute Shrinkage and Selection Operator (LASSO) Cox regression, we identified several markers that were used to construct a risk classifier for risk of disease recurrence. RESULTS The median (interquartile range) follow-up was 63.5 (24.0-85.3) months. Five out of 24 markers were selected by LASSO Cox regression for the risk classifier: N-cadherin, E-cadherin, Ki67, cyclin D1 and phosphorylated eukaryotic initiation factor 4E binding protein-1 (p-4EBP1). Patients were classified as either low, intermediate or high risk of disease recurrence by tertiles of risk score. The 5-year recurrence-free survival (RFS) was 93.8%, 87.7% and 70% for patients with low-, intermediate- and high-risk scores, respectively (P < 0.001). Patients with a high marker score had worse RFS on multivariate analysis adjusted for age, gender, race and the Mayo Clinic Stage, Size, Grade, and Necrosis (SSIGN) score (hazard ratio 3.66, 95% confidence interval 1.58-8.49, P = 0.003 for high vs low marker score in the overall cohort). The five-marker classifier increased the concordance index of the clinical model in both the training and validation sets. CONCLUSION We developed a five-marker-based prognostic tool that can effectively classify patients with ccRCC according to risk of disease recurrence after surgery. This tool, if prospectively validated, could provide individualised risk estimation for patients with ccRCC.
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Affiliation(s)
- Ahmed Q Haddad
- Department of Urology, University of Louisville, Louisville, TX, USA
| | - Jun-Hang Luo
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Oussama Darwish
- Department of Urology, University of California, Irivine, CA, USA
| | - Bishoy Gayed
- Department of Urology, University of California, Irivine, CA, USA
| | - Ramy Youssef
- Department of Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Payal Kapur
- Department of Urology, University of California, Irivine, CA, USA
| | - Dinesh Rakheja
- Department of Urology, University of California, Irivine, CA, USA
| | - Yair Lotan
- Department of Urology, University of California, Irivine, CA, USA
| | | | - Vitaly Margulis
- Department of Urology, University of California, Irivine, CA, USA
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Gayed BA, Youssef R, Darwish O, Kapur P, Bagrodia A, Brugarolas J, Raj G, DiMaio JM, Sagalowsky A, Margulis V. Multi-disciplinary surgical approach to the management of patients with renal cell carcinoma with venous tumor thrombus: 15 year experience and lessons learned. BMC Urol 2016; 16:43. [PMID: 27435269 PMCID: PMC4952069 DOI: 10.1186/s12894-016-0157-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 06/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management of patients with renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is challenging. We report our 15 year experience in the management of patients with RCC with VTT utilizing a multidisciplinary team approach, highlighting improved total and specifically Clavien III-V complication rates. METHODS We reviewed the records of 146 consecutive patients who underwent radical nephrectomy with venous thrombectomy between 1998 and 2012. Data on patient history, staging, surgical techniques, morbidity, and survival were analyzed. Additionally, complication rates between two surgical eras, 1998-2006 and 2006-2012, were assessed. RESULTS The study included 146 patients, 97 males (66 %), and a median age of 61 years (range, 24-83). Overall complications rate was 53 %, high grade complications (Clavien III -V) occurred in 10 % of patients. Most importantly, there was a lower incidence of overall and high grade complications (45 % and 8 %, respectively) in the last 6 years compared to the earlier surgeries included in the study (67 % and 13 % respectively) [p = .008 and .03, respectively). 30 day postoperative mortality was 2.7 %. 5 year overall survival (5Y- OS) and 5 year cancer specific survival (5Y- CSS) were 51 % and 40 %, respectively. Metastasis was the only independent predictor factor for CSS (HR 3.8, CI 1.9-7.6 and p < .001) and OS (HR 2.6, CI 1.5-4.7 and p = .001) in all patients. CONCLUSIONS Our data suggest that patients with RCC and VTT can be treated safely utilizing a multidisciplinary team approach leading to a decrease in complication rates.
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Affiliation(s)
- Bishoy A Gayed
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA
| | - Ramy Youssef
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA
| | - Oussama Darwish
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA
| | - Payal Kapur
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA
| | - James Brugarolas
- Departments of Medicine and Developmental Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ganesh Raj
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA
| | - J Michael DiMaio
- Departments of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Arthur Sagalowsky
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA.
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Haddad A, Luo JH, Krabbe LM, Darwish O, Gayed B, Youssef R, Kapur P, Rakheja D, Lotan Y, Sagalowsky A, Margulis V. MP78-17 PROGNOSTIC VALUE OF TISSUE BASED BIOMARKER SIGNATURE IN CLEAR CELL RENAL CELL CARCINOMA. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Adsul P, Wray R, Spradling K, Darwish O, Weaver N, Siddiqui S. Systematic Review of Decision Aids for Newly Diagnosed Patients with Prostate Cancer Making Treatment Decisions. J Urol 2015; 194:1247-52. [PMID: 26055824 DOI: 10.1016/j.juro.2015.05.093] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Despite established evidence for using patient decision aids, use with newly diagnosed patients with prostate cancer remains limited partly due to variability in aid characteristics. We systematically reviewed decision aids for newly diagnosed patients with prostate cancer. MATERIALS AND METHODS Published peer reviewed journal articles, unpublished literature on the Internet and the Ottawa decision aids web repository were searched to identify decision aids designed for patients with prostate cancer facing treatment decisions. A total of 14 aids were included in study. Supplementary materials on aid development and published studies evaluating the aids were also included. We studied aids designed to help patients make specific choices among options and outcomes relevant to health status that were specific to prostate cancer treatment and in English only. Aids were reviewed for IPDAS (International Patient Decision Aid Standards) and additional standards deemed relevant to prostate cancer treatment decisions. They were also reviewed for novel criteria on the potential for implementation. Acceptable interrater reliability was achieved at Krippendorff α = 0.82. RESULTS Eight of the 14 decision aids (57.1%) were developed in the United States, 6 (42.8%) were print based, 5 (35.7%) were web or print based and only 4 (28.5%) had been updated since 2013. Ten aids (71.4%) were targeted to prostate cancer stage. All discussed radiation and surgery, 10 (71.4%) discussed active surveillance and/or watchful waiting and 8 (57.1%) discussed hormonal therapy. Of the aids 64.2% presented balanced perspectives on treatment benefits and risks, and/or outcome probabilities associated with each option. Ten aids (71.4%) presented value clarification prompts for patients and steps to make treatment decisions. No aid was tested with physicians and only 4 (28.6%) were tested with patients. Nine aids (64.2%) provided details on data appraisal and 4 (28.6%) commented on the quality of evidence used. Seven of the 8 web or computer based aids (87.5%) provided patients with the opportunity to interact with the aid. All except 1 aid scored above the 9th grade reading level. No evidence on aid implementation in routine practice was available. CONCLUSIONS As physicians look to adopt decision aids in practice, they may base the choice of aid on characteristics that correlate with patient socioeconomic and educational status, personal practice style and practice setting.
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Affiliation(s)
- Prajakta Adsul
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice and Division of Urologic Surgery, School of Medicine (KS, OD, SS), Saint Louis University, Saint Louis, Missouri.
| | - Ricardo Wray
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice and Division of Urologic Surgery, School of Medicine (KS, OD, SS), Saint Louis University, Saint Louis, Missouri
| | - Kyle Spradling
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice and Division of Urologic Surgery, School of Medicine (KS, OD, SS), Saint Louis University, Saint Louis, Missouri
| | - Oussama Darwish
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice and Division of Urologic Surgery, School of Medicine (KS, OD, SS), Saint Louis University, Saint Louis, Missouri
| | - Nancy Weaver
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice and Division of Urologic Surgery, School of Medicine (KS, OD, SS), Saint Louis University, Saint Louis, Missouri
| | - Sameer Siddiqui
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice and Division of Urologic Surgery, School of Medicine (KS, OD, SS), Saint Louis University, Saint Louis, Missouri
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Darwish O, Dang B, Adsul P, Siddiqui S. MP18-15 PENETRATING RENAL INJURIES: FEASIBILITY OF NON-OPERATIVE MANAGEMENT. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bagrodia A, Krabbe L, Gayed B, Kapur P, Darwish O, Bernstein I, Xie XJ, Wood C, Zigeuner R, Weizer A, Raman J, Remzi M, Langner C, Roscigno M, Montorsi F, Bolenz C, Bensalah K, Karam J, Sagalowsky A, Shariat S, Lotan Y, Margulis V. MP77-04 MULTI-INSTITUTIONAL EVALUATION OF THE PROGNOSTIC SIGNIFICANCE OF ALTERED MAMMALIAN TARGET OF RAPAMYCIN (MTOR) PATHWAY BIOMARKERS IN UPPER TRACT UROTHELIAL CARCINOMA (UTUC). J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Youssef R, Gayed B, Darwish O, Kapur P, Raj G, DiMaio M, Sagalowsky A, Margulis V. MP57-15 MULTI-DISCIPLINARY MANAGEMENT OF RENAL CELL CARCINOMA WITH VENOUS TUMOR THROMBUS: ARE WE GETTING BETTER. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Singla N, Bagrodia A, Gayed B, Palazzi K, Mirheydar H, Harrow B, Jacobs C, Youssef R, Darwish O, Sagalowsky A, Lotan Y, Derweesh I, Margulis V. MP30-08 MULTI-INSTITUTIONAL ANALYSIS OF RENAL FUNCTION OUTCOMES FOLLOWING RADICAL NEPHROURETERECTOMY AND PARTIAL URETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chung P, Darwish O, Mehta S, Roehrborn C, Lotan Y. MP42-17 PATIENTS MEETING ACTIVE SURVEILLANCE CRITERIA ON SATURATION BIOPSY ARE AT HIGH RISK FOR HISTOLOGIC GRADE PROGRESSION ON PROSTATECTOMY. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Belsante M, Darwish O, Youssef R, Bagrodia A, Kapur P, Sagalowsky AI, Lotan Y, Margulis V. Lymphovascular invasion in clear cell renal cell carcinoma—Association with disease-free and cancer-specific survival. Urol Oncol 2014; 32:30.e23-8. [DOI: 10.1016/j.urolonc.2012.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/14/2012] [Accepted: 11/07/2012] [Indexed: 11/16/2022]
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Belsante M, Darwish O, Youssef R, Bagrodia A, Kapur P, Sagalowsky A, Lotan Y, Margulis V. 1075 LYMPHOVASCULAR INVASION IN CLEAR CELL RENAL CELL CARCINOMA - ASSOCIATION WITH DISEASE FREE AND CANCER SPECIFIC SURVIVAL. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bagrodia A, Youssef R, Darwish O, Cannon C, Belsante M, Kapur P, Lotan Y, Margulis V. 387 PROSPECTIVE EVALUATION OF CELL CYCLE BIOMARKERS FOR PREDICTION OF CANCER-SPECIFIC MORTALITY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Darwish O, Youssef R, Kapur P, Bagrodia A, Belsante M, Alhalabi F, Lotan Y, Margulis V. 1297 NUMBER OF ALTERED BIOMARKERS IN THE MAMMALIAN TARGET OF RAPAMYCIN INDEPENDENTLY CORRELATES WITH ONCOLOGIC OUTCOMES IN PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bulbul MA, El-Hout Y, Haddad M, Tawil A, Houjaij A, Bou Diab N, Darwish O. Pathological correlation between needle biopsy and radical prostatectomy specimen in patients with localized prostate cancer. Can Urol Assoc J 2011; 1:264-6. [PMID: 18542801 DOI: 10.5489/cuaj.80] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aims to evaluate the accuracy of transrectal ultrasound (TRUS) guided prostate biopsies in predicting pathological grading and tumour distribution in the final pathological specimen of patients who underwent radical prostatectomy for clinically localized prostate cancer. The study ultimately aims to gain more understanding of the pathological behaviour of prostate cancer and the limitations of the currently available diagnostic and prognostic tools. MATERIAL AND METHODS We reviewed the records of 100 patients with localized carcinoma of the prostate diagnosed by TRUS-guided prostate biopsy and treated with radical retropubic prostatectomy, comparing tumour laterality and Gleason score in core biopsies with tumour distribution and Gleason score of the surgical specimen. We then correlated both results to diagnostic and prognostic variables such as prostate specific antigen (PSA) values and surgical margins. RESULTS All 44 patients with bilateral disease on needle biopsy had bilateral disease on final pathology, with 15 of these patients (34%) having positive margins. Of the 56 patients with unilateral disease on biopsy, 37 (66%) had bilateral disease on final pathology; however, only 4 of them (7%) had positive margins (p < 0.001). Median Gleason score on final pathology was upgraded to 7, compared with a median score of 6 on biopsies. Stratifying patients to 2 groups based on their PSA level (group 1: PSA < 10 ng/mL, 72 patients; group 2: PSA > 10ng/mL, 28 patients), revealed that 57 patients (79%) in group 1 and 24 patients (85%) in group 2 had bilateral disease. In addition, 13 patients (18%) in group 1 and 6 patients (21%) in group 2 had positive margins. CONCLUSIONS Sixty-six percent of patients with unilateral disease on needle biopsy had bilateral disease on final pathology, but this does not increase their rate of having positive margins. Gleason score is upgraded from 6 to 7. PSA did not seem to affect laterality of disease in patients selected for radical prostatectomy.
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Affiliation(s)
- Muhammad A Bulbul
- Department of Surgery, Division of Urology, the Department of Diagnostic Radiology, and the Department of Pathology and Laboratory Medicine, American University of Beirut-Medical Center, Beirut, Lebanon
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Bulbul M, BouDiab N, Hout Y, Hujeij A, Darwish O, Tawil A, Geara F. UP-2.132: Hormonal and Radiation Therapy for Selected Patients with Positive Surgical Margins Following Radical Prostatectomy: Short Term Outcome. Urology 2009. [DOI: 10.1016/j.urology.2009.07.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khauli R, Kharrouby A, Bachir B, Darwish O. Nerve-Sparing Radical Retropubic Prostatectomy: What Are The Expectations of Potency Preservation in the PDE5 Era? Journal of Men's Health 2009. [DOI: 10.1016/j.jomh.2009.08.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bulbul M, Bou Diab N, Hout Y, Hujeij A, Darwish O, Tawil A, Geara F. MP-18.06: Immediate adjuvant radiation and hormonal therapy for positive surgical margins following radical prostatectomy: selection criteria and outcome. Urology 2007. [DOI: 10.1016/j.urology.2007.06.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kandil H, Darwish O, Hammad S, Zagloul N, Halliday D, Millward J. Nitrogen balance and protein turnover during the growth failure in newly born low-birth-weight infants. Am J Clin Nutr 1991; 53:1411-7. [PMID: 2035469 DOI: 10.1093/ajcn/53.6.1411] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Weight gain, nitrogen balance, protein turnover, and energy and protein intakes were measured during the first week of life of 14 low-birth-weight (LBW) infants, 5 small-for-gestational-age (SGA) infants and 9 appropriate-for-gestational-age (AGA) infants enterally fed at rates determined by the infants ability to assimilate feed. Mean gross intakes were 334 KJ and 1.75 g/kg protein; 4 infants were increasing and 10 were losing weight at rates proportional to gross energy and protein intakes and to nitrogen balance (0.031 g protein balance/g wt gain). Rates of protein synthesis and degradation measured by an intragastric infusion of [1-13C]leucine, averaged 14.5 and 15.9 g protein.kg-1.d-1, some 50% higher than previously reported in older preterm infants and not correlated with nitrogen balance. The growth failure of these infants was not associated with inadequate overall rates of protein turnover, but appeared to reflect an influence of the insufficient energy and protein intakes on the high rates of protein turnover, inducing changes in protein balance in either direction through relatively small changes in protein synthesis and/or degradation.
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Affiliation(s)
- H Kandil
- High Institute of Public Health, University of Alexandria, Egypt
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