Xanthogranulomatous pyelonephritis: report of four cases

We report 4 patients with xanthogranulomatous pyelonephritis (diagnosed and treated between 1992 and 1996), aged 16 to 55 years (mean age 37 years). All had urolithiasis, pyonephrosis and nonfunctioning kidneys prior to surgical intervention, and underwent total nephrectomy. Clinical, laboratory and radiologic findings are discussed in the light of the cases reported in the literature.

Association between Abdominal Free Fluid and Postoperative Complications and Mortality in Patients with Small-Bowel Obstruction

BACKGROUND AND AIMS:

Small-bowel obstruction is a frequent cause of hospitalization. The condition is potentially life-threatening, causing many admission days and is a heavy burden socioeconomically. Patients with small-bowel obstruction may develop abdominal free fluid and the quality of this fluid may be predictive of worse outcomes. Our aim was to examine whether the presence of free fluid and its density, measured on computed tomography scans, was associated with severe complications and mortality postoperatively.

MATERIALS AND METHODS:

Patients admitted to the Department of Surgery, Zealand University Hospital with a diagnosis of small-bowel obstruction between January 2010 and December 2015 were included. Medical records were reviewed and preoperative computed tomography scans were examined. A radiologist blinded to the outcomes reviewed all Hounsfield unit values of the free fluid. The primary outcomes evaluated were odds ratios of the severity of complications and hazard ratios of 30- and 90-day mortality postoperatively.

RESULTS:

A total of 289 patients were included. Analyses revealed an adjusted odds ratio of 1.03 (95%confidence interval = 0.93-1.15) between the presence of free fluid and postoperative complications and an adjusted hazard ratio of 1.28 (95% confidence interval =  0.80-2.05, p = 0.30) of the 30-day mortality in this patient group. Furthermore, the analyses revealed an adjusted odds ratio of 1.22 (95% confidence interval 0.98-1.52) between the density of the free fluid > 20 Hounsfield unit and postoperative complications and an adjusted hazard ratio of 0.85 (95% confidence interval =  0.28-2.63, p = 0.78) of the 30-day mortality.

CONCLUSION:

No significant correlation was found between the presence of free fluid nor its density in regard to postoperative complications or mortality in patients with small-bowel obstruction.

Red Cell Distribution Width at Diagnosis Reflects Advanced Disease While Dynamic Changes Predict Survival at Relapse in Multiple Myeloma: A Retrospective Study

Introduction Multiple myeloma (MM) is a complex plasma cell malignancy characterized by clonal proliferation and monoclonal immunoglobulin production. Despite the availability of several prognostic markers for MM, many are challenging to implement routine clinical practice due to cost, complexity, or lack of standardization. Red cell distribution width (RDW), a cost-effective and routinely measured parameter in complete blood counts, has gained increasing attention as a prognostic marker due to its association with disease severity and outcomes in MM. This study investigates the prognostic utility of RDW in MM, focusing on its relationship with patient outcomes, particularly in those undergoing autologous stem cell transplantation (ASCT). Methods This retrospective study included 218 patients diagnosed with MM between 2010 and 2018. Demographic, clinical, and laboratory data, including RDW levels at ASCT and first relapse, were collected. Patients were stratified into high (>16.5%) and low (≤16.5%) RDW groups. The impact of RDW levels and their changes on progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier and log-rank tests. Results Higher RDW levels at diagnosis were significantly associated with advanced disease stages, notably R-ISS stage 3 (p=0.022). While no significant survival differences were observed based on baseline RDW levels, dynamic changes in RDW from diagnosis to first relapse were strongly prognostic. Patients maintaining low RDW had the longest PFS (37 months) and OS (88.8 months), whereas those transitioning from low to high RDW experienced the shortest PFS (nine months) and OS (40.6 months). At relapse, patients with low RDW demonstrated superior outcomes (PFS: 34 vs. 14 months, OS: 81.2 vs. 40.6 months; p<0.001). ASCT markedly improved survival outcomes, with longer PFS (p=0.028) and OS (p<0.001). Higher hemoglobin levels (>10 g/dL) were also associated with extended PFS (p=0.038). Reassessing RDW prior to ASCT did not yield significant differences, suggesting that the prognostic value of RDW lies in its dynamic changes, particularly around relapse events. Conclusions RDW levels at diagnosis reflect advanced disease stages in MM but are not independent predictors of survival. However, dynamic changes in RDW, particularly from diagnosis to relapse, highlight its potential as a robust marker for monitoring disease progression and relapse risk. ASCT remains a cornerstone of MM management, significantly improving survival outcomes and complementing RDW trends in prognosis. Standardizing RDW thresholds and integrating its dynamic trends into clinical workflows could enhance risk stratification and personalized treatment strategies. Prospective, multi-center trials are essential to validate these findings and establish RDW's role in comprehensive prognostic frameworks for MM.

The Effect of Helicobacter pylori Density on Serum Vitamin B12 and Folate Levels in Patients With Non-atrophic Gastritis

Introduction Chronic infection with Helicobacter pylori (Hp) is an essential cause of gastrointestinal pathologies in adults. Despite being a microorganism proven to play a role in vitamin B12 deficiency by causing gastric atrophy, Hp's role in patients with non-atrophic gastritis has not been fully explained. Our study investigated whether the presence and density of Hp is related to vitamin B12 and folate deficiencies in patients with non-atrophic gastritis. Methods This retrospective cohort study analyzed the following parameters, vitamin B12, folate, and mean red blood cell volume (MCV) in the hemogram; these were measured simultaneously in patients diagnosed with non-atrophic gastritis who had undergone gastroscopy to investigate Hp levels. Patients with conditions that could have caused vitamin B12 and folate deficiencies were excluded from the study. The study included 244 patients who met the criteria. The Sydney classification was used for histopathologic grading and staging of gastric biopsies of patients with gastritis. Results There was no relationship between the presence and density of Hp with vitamin B12 levels. However, folate levels were significantly lower in Hp-positive patients than in Hp-negative patients (p = 0.017). Folate levels were substantially lower in patients with chronic pan-mucosal gastritis than in patients with chronic inactive gastritis (p = 0.034). Statistically, a significant difference was found between folate levels on the basis of neutrophil activity and inflammation score (p = 0.011 and p <0.001, respectively). Conclusions Although there was no statistically significant relationship between the presence and density of Hp and vitamin B12, our study found an association between folate levels and Hp density. This may be associated with the time for the depletion of vitamin B12 and folate stores and the relatively early stage of gastritis. In cases with vitamin B12 and folate deficiencies, appropriate studies should be performed for specific epidemiological reasons in respective fields.