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Current Opinion in Urology Nov 2017We review recent advancements in staging and imaging of penile cancer, including surveillance after therapy. (Review)
Review
PURPOSE OF REVIEW
We review recent advancements in staging and imaging of penile cancer, including surveillance after therapy.
RECENT FINDINGS
For cN0 patients, the sentinel lymph node biopsy is currently considered the preferred way for invasive staging. It has largely replaced other modalities such as staging inguinal lymphadenectomy. Its diagnostic value increases when combined with other staging modalities such as ultrasound with fine-needle aspiration cytology (US-FNAC) or fluorodeoxyglucose-PET with computed tomography (PET/CT). In patients with palpably suspicious nodes (cN+), imaging is more useful. PET/CT has shown good accuracy in a limited number of small studies. US-FNAC can confirm nodal metastatic disease. A staging inguinal lymphadenectomy is of therapeutic value but is associated with significant morbidity. Omitting staging inguinal lymphadenectomy was recently described; one study showed well tolerated use of sentinel lymph node biopsy combined with intraoperative ultrasound-guided resection of suspicious nodes in cN+ patients. Therapeutic inguinal lymphadenectomy was only performed in the 42% of groins with metastases confirmed by disorder. For M-staging, PET/CT has shown good sensitivity, and its role should be further evaluated. Follow-up and surveillance rely on physical examination and US-FNAC.
SUMMARY
Over the past decade, staging and treatment of penile cancer have become less invasive, while survival tends to improve.
Topics: Fluorodeoxyglucose F18; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Neoplasm Staging; Penile Neoplasms; Positron Emission Tomography Computed Tomography; Sentinel Lymph Node Biopsy
PubMed: 28937510
DOI: 10.1097/MOU.0000000000000447 -
Contributions To Nephrology 1979In neonates, thrombosis beginning in small renal veins and progressing to larger veins is best termed renal venous thrombosis (RVT) since the renal vein is not usually...
In neonates, thrombosis beginning in small renal veins and progressing to larger veins is best termed renal venous thrombosis (RVT) since the renal vein is not usually concerned. RVT occurs dominantly in the new-born and affects males more often than females (2:1). Hyperosmolality, maternal prediabetes and angiocardiography contribute to the occurrence or RVT. Early signs and symptoms are largely non-specific with the most reliable being the presence of haematuria (49%) or a palpably enlarged and hard kidney (60%). A falling platelet count, raised FDP level of falling plasminogen level support the diagnosis in 90% of cases. Radiology and nephrosonography are very useful in establishing the presence or absence and functional state of the kidneys. Therapy consists of the maintenance of homeostasis, minimization of spread, correction of uraemia and prevention of renal hypertension from a contracted functionless kidney by elective nephrectomy after 4--6 months. Heparin therapy and peritoneal dialysis have greatly improved the outlook in bilateral cases.
Topics: Diagnosis, Differential; Female; Heparin; Humans; Infant; Infant, Newborn; Kidney; Male; Nephrectomy; Osmolar Concentration; Prognosis; Renal Veins; Thrombosis; Ultrasonography; Urography; Venules; Water-Electrolyte Balance
PubMed: 428238
DOI: 10.1159/000402591 -
Annales de Dermatologie Et de... May 2016For many physicians, palpable purpura is synonymous with vasculitis. However, a skin biopsy is almost always performed in common clinical practice in order to confirm...
OBJECTIVE
For many physicians, palpable purpura is synonymous with vasculitis. However, a skin biopsy is almost always performed in common clinical practice in order to confirm the diagnosis. The aim of our study was to assess whether palpable purpura is always indicative of an inflammatory infiltrate in a vessel wall.
PATIENTS AND METHODS
Eighty-seven patients were included in this prospective monocentric study, 45 of whom were presenting a palpable purpura. Patients were classified in two categories: "leukocytoclastic vasculitis" or "other diagnosis". The clinical and histopathological features of patients with a palpable purpura were studied.
RESULTS
The mean age of patients presenting a palpable purpura was 69 years. There were 26 men and 19 women. Of the 43 patients biopsied, 37 were included in the vasculitis group. The sensitivity, specificity, positive predictive value and negative predictive value for a diagnosis of vasculitis in patients with palpable purpura were respectively 82, 65, 86 and 58 %. The Odds ratio was 8.48 (95 % CI, 2.52-31.80; P<0.05).
CONCLUSION
Most of the palpable purpuras examined were indeed related to leukocytoclastic vasculitis. In the remaining cases, biopsy did not contribute to the diagnosis since it only showed purpura without vessel wall inflammation. In our opinion, a skin biopsy is thus not essential where the clinical presentation is typical.
Topics: Aged; Biopsy; Female; Humans; IgA Vasculitis; Male; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Skin; Vasculitis
PubMed: 27083972
DOI: 10.1016/j.annder.2016.02.024 -
Clinical Techniques in Small Animal... Feb 2006The diagnosis of hyperthyroidism, one of the most common disorders affecting elderly cats, is usually straightforward and considered routine by most practitioners.... (Review)
Review
The diagnosis of hyperthyroidism, one of the most common disorders affecting elderly cats, is usually straightforward and considered routine by most practitioners. Nowadays, however, most cats suffering from hyperthyroidism tend to be diagnosed earlier and at a milder stage of the disease than those cats diagnosed 10 to 25 years ago. There are, in fact, a growing number of cats with clinical signs of hyperthyroidism and palpably large thyroid glands whose baseline serum total thyroid hormone concentrations are within the normal or borderline range, making diagnosis problematic. This paper reviews the available tests used to confirm a diagnosis of hyperthyroidism in cats and discusses their overall usefulness.
Topics: Animals; Cat Diseases; Cats; Hyperthyroidism; Thyroid Function Tests; Thyroid Gland; Thyrotropin; Thyroxine; Triiodothyronine
PubMed: 16584024
DOI: 10.1053/j.ctsap.2005.12.001 -
European Radiology 1999Varicocele can be very easily diagnosed by physical examination and subsequently treated when it is painful or associated with testicular hypotrophy. However,... (Comparative Study)
Comparative Study Review
Varicocele can be very easily diagnosed by physical examination and subsequently treated when it is painful or associated with testicular hypotrophy. However, palpability of the spermatic vein and reflux in low grade or even questionable varicoceles can be difficult to assess without imaging modalities. This can be a common problem for all physicians treating hypofertile men to decide whether the varicele needs to be treated or not. However, a gold standard that defines the presence of a subclinical varicocele has not yet been established. The different diagnostic tools based on ultrasonography investigated these past years to define a flow reversal in incontinent spermatic veins are presented in the first part of this review, with emphasis on subclinical varicocele. In the second part, we present our experience, together with a review of the literature concerning embolization of the spermatic veins as an alternative to surgery to treat varicoceles.
Topics: Blood Flow Velocity; Decision Making; Embolization, Therapeutic; Humans; Ligation; Male; Phlebography; Retrospective Studies; Scrotum; Ultrasonography, Doppler, Color; Varicocele; Veins
PubMed: 10087130
DOI: 10.1007/s003300050706 -
Problems in Veterinary Medicine Dec 1990As expertise among small animal practitioners grows, feline hyperthyroidism is being diagnosed earlier in the course of the disease. There are, in fact, a growing number... (Review)
Review
As expertise among small animal practitioners grows, feline hyperthyroidism is being diagnosed earlier in the course of the disease. There are, in fact, a growing number of cats with clinical signs of hyperthyroidism and palpably large thyroid glands whose serum total thyroxine (T4) and triiodothyronine (T3) concentrations are within the normal or borderline range. This condition can be referred to as "occult" hyperthyroidism. Early detection and treatment of feline hyperthyroidism presents an obvious advantage in avoiding some of the deleterious effects of chronic thyroid hormone excess (eg, cardiomyopathy). Recent advances have been made in the diagnosis of occult hyperthyroidism in cats. It has been found, for instance, that serum thyroid hormone concentrations can fluctuate in and out of the normal range in some cats with hyperthyroidism. Recent work also has laid the groundwork for use of a T3 suppression test as an aid in the diagnosis of early, mild, or occult hyperthyroidism in cats. The purpose of this chapter is to discuss these and other developments, as well as to discuss some of the problems confronted in diagnosing occult hyperthyroidism in cats.
Topics: Animals; Cat Diseases; Cats; Hyperthyroidism; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine; Triiodothyronine
PubMed: 2134081
DOI: No ID Found -
Journal of the National Cancer Institute Dec 2011Fine needle aspiration cytology (FNAC) is usually used to evaluate palpable nodes in patients with melanoma. The goal of our study is to review the sensitivity and... (Comparative Study)
Comparative Study
BACKGROUND
Fine needle aspiration cytology (FNAC) is usually used to evaluate palpable nodes in patients with melanoma. The goal of our study is to review the sensitivity and specificity of this technique when applied to palpable but also to nonpalpable nodes.
METHODS
FNAC was performed during 1984-2007 in 1279 patients with suspicious lesions and/or lymph nodes. Indications for biopsy included increased size and/or palpability of nodes or abnormal ultrasound findings such as increased perfusion or focal lesions within the lymph nodes. The sensitivity, specificity, and positive and negative predictive values of FNACs guided by palpation or ultrasound were calculated for all patients and for subgroups of patients with palpable nodes or nonpalpable but sonomorphologically suspicious nodes.
RESULTS
A total of 2446 FNACs were performed in 1279 melanoma patients, of which 2011 (82.2%) FNACs had clinically or histologically confirmed results. Increased size and/or palpability of nodes was observed in 376 (29.4%) of 1279 patients, and abnormal ultrasound findings occurred for 903 (70.6%), indicating that a biopsy was needed. FNACs guided by palpation had sensitivity, specificity, and positive and negative predictive values similar to that of FNACs guided by ultrasound (sensitivity = 98.4% vs 97.2%, specificity = 100% vs 99.8%, positive predictive value = 100% vs 99.9%, and negative predictive value = 95.2% vs 96.4%, for palpation-guided FNACs vs ultrasound-guided FNACs, respectively). Results did not differ between patients with the palpable nodes and patients with nonpalpable but sonomorphologically suspicious nodes.
CONCLUSIONS
Ultrasound-guided FNAC of suspicious lymph nodes and lesions in melanoma patients has a high sensitivity and specificity, and FNAC should not be limited to palpable nodes. FNAC of normal-sized nodes and/or lymph nodes with abnormal ultrasound findings can be used to identify early metastatic disease.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Child; Confounding Factors, Epidemiologic; Female; Humans; Lymph Nodes; Male; Melanoma; Middle Aged; Palpation; Predictive Value of Tests; Sensitivity and Specificity; Skin Neoplasms; Ultrasonography, Interventional
PubMed: 21940673
DOI: 10.1093/jnci/djr381 -
BMJ Case Reports Jul 2021Hepatoid adenocarcinoma (HAC) is a rare tumour that produces an alpha-fetoprotein (AFP) mimicking hepatocellular carcinoma (HCC). Adrenal HAC is exceedingly rare. Here...
Hepatoid adenocarcinoma (HAC) is a rare tumour that produces an alpha-fetoprotein (AFP) mimicking hepatocellular carcinoma (HCC). Adrenal HAC is exceedingly rare. Here we report extremely high AFP-producing adrenal HAC, the first case in Thailand. A 47-year-old man presented with left flank pain and weight loss for 2 months. A palpably huge left flank mass was observed on physical examination. CT revealed a 7 cm enhanced mass involving the left adrenal gland and multiple contrast-enhanced hypodense masses in both liver lobes. The largest was a 3.7 cm at liver segment-VII without cirrhotic background, with an AFP level of 321 495 ng/mL. Both adrenal and liver biopsies were performed. This patient received a diagnosis of advanced adrenal HAC. Unfortunately, the tumour progressed, causing massive upper gastrointestinal bleeding and death. Adrenal HAC is challenging to diagnose, which multifocal HCC, pheochromocytoma and adrenocortical carcinoma should be excluded. Surgical resection is preferred among resectable patients. However, no systemic therapy has been standardised.
Topics: Adenocarcinoma; Adrenal Cortex Neoplasms; Adrenocortical Carcinoma; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Male; Middle Aged; Thailand; alpha-Fetoproteins
PubMed: 34253511
DOI: 10.1136/bcr-2020-239830 -
Current Urology Reports Apr 2018To evaluate contemporary rationale and techniques for ectopic reservoir/balloon placement in complex urologic prosthetics patients. (Review)
Review
PURPOSE OF REVIEW
To evaluate contemporary rationale and techniques for ectopic reservoir/balloon placement in complex urologic prosthetics patients.
RECENT FINDINGS
Recent studies have demonstrated that ectopic reservoir placement is safe and durable when compared to traditional space of Retzius placement. Complex patients exist on a spectrum from those with a previously violated retropubic space, to those with bilaterally obscured external inguinal rings and/or multiple prior prosthetic reservoirs. Ectopic placement has become more commonplace and accepted as a viable alternative strategy over the past 7 years. Concerns relating to reservoir palpability and long-term outcomes have been allayed. The risk of deep pelvic complications appears to be negligible after both placement or removal of ectopic reservoirs when performed by experienced implanters even in the most complex patient. Ectopic placement of prosthetic balloons and reservoirs offers unique advantages and has become commonplace in contemporary prosthetic urology practice.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penile Prosthesis; Prosthesis Design
PubMed: 29654383
DOI: 10.1007/s11934-018-0789-9 -
Phytomedicine : International Journal... Aug 2023Phosphorylated Smad3 isoforms are reversible and antagonistic, and the tumour-suppressive pSmad3C can shift to an oncogenic pSmad3L signal. In addition, Nrf2 has a...
BACKGROUND
Phosphorylated Smad3 isoforms are reversible and antagonistic, and the tumour-suppressive pSmad3C can shift to an oncogenic pSmad3L signal. In addition, Nrf2 has a two-way regulatory effect on tumours, protecting normal cells from carcinogens and promoting tumour cell survival in chemotherapeutics. Accordingly, we hypothesised that the transformation of pSmad3C/3L is the basis for Nrf2 to produce both pro- and/or anti-tumourigenic effects in hepatocarcinogenesis. Astragaloside IV (AS-IV), the major component of Astragalus membranaceus, exerts anti-fibrogenic and carcinogenic actions. Lately, AS-IV administration could delay the occurrence of primary liver cancer by persistently inhibiting the fibrogenesis and regulating pSmad3C/3 L and Nrf2/HO-1 pathways synchronously. However, effect of AS-IV on hepatocarcinogenesis implicated in the bidirectional cross-talking of pSmad3C/3 L and Nrf2/HO-1 signalling, especially which one contributes palpably than the other still remains unclear.
PURPOSE
This study aims to settle the above questions by using in vivo (pSmad3C and Nrf2 mice) and in vitro (plasmid- or lentivirus- transfected HepG2 cells) models of HCC.
STUDY DESIGN AND METHODS
The correlation of Nrf2 to pSmad3C/pSmad3L in HepG2 cells was analysed by Co-immunoprecipitation and dual-luciferase reporter assay. Pathological changes of Nrf2, pSmad3C, and pSmad3L in human HCC patients, pSmad3C mice, and Nrf2 mice were gauged by immunohistochemical, haematoxylin and eosin staining, Masson, and immunofluorescence assays. Finally, western blot and qPCR were used to verify the bidirectional cross-talking of pSmad3C/3L and Nrf2/HO-1 signalling protein and mRNA in vivo and in vitro models of HCC.
RESULTS
Histopathological manifestations and biochemical indicators revealed that pSmad3C could abate the ameliorative effects of AS-IV on fibrogenic/carcinogenic mice with Nrf2/HO-1 deactivation and pSmad3C/p21 transform to pSmad3L/PAI-1//c-Myc. As expected, cell experiments confirmed that upregulating pSmad3C boosts the inhibitory activity of AS-IV on phenotypes (cell proliferation, migration and invasion), followed by a shift of pSmad3L to pSmad3C and activation of Nrf2/HO-1. Synchronously, experiments in Nrf2 mice and lentivirus-carried Nrf2shRNA cell echoed the results of pSmad3C knockdown. Complementarily, Nrf2 overexpression resulted in the opposite result. Furthermore, Nrf2/HO-1 contributes to AS-IV's anti-HCC effect palpably compared with pSmad3C/3L.
CONCLUSION
These studies highlight that harnessing the bidirectional crosstalk pSmad3C/3 L and Nrf2/HO-1, especially Nrf2/HO-1 signalling, acts more effectively in AS-IV's anti-hepatocarcinogenesis, which may provide an important theoretical foundation for the use of AS-IV against HCC.
Topics: Humans; Mice; Animals; Carcinoma, Hepatocellular; Liver Neoplasms; NF-E2-Related Factor 2; Cell Transformation, Neoplastic
PubMed: 37301185
DOI: 10.1016/j.phymed.2023.154903