ABSTRACT

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We report the first case of a diagnosis of an asymptomatic primary renal angiosarcoma. The patient underwent laparoscopic nephrectomy and is alive after long-term follow up. We provide the preoperative imaging studies and the histologic features of this exceedingly rare tumor.

Peripheral blood samples from 61 patients (36 male, 25 female) with all stages of B-type chronic lymphocytic leukemia (CLL) were studied for MDR1 phenotype using monoclonal antibodies and rhodamine-123 dye exclusion, a functional assay of MDR1 expression. The duration of the disease varied from 1 month to 22 years at the time of initial study. Overall, 74% of the patients were positive for rhodamine-123 exclusion. When analyzed by gender, significantly more men than women were positive (89% versus 48%, p<0.001). There were more positive men than women for every stage of the disease. Female patients were found to be either MDR1 phenotype positive or negative at any stage of the disease. In contrast, all male patients with early (stages 0-II) disease were MDR1 phenotype positive. One early-stage (stage II) male patient converted from rhodamine-efflux positive to rhodamine-efflux negative as he progressed from stage-II to stage-IV disease. We suggest that some of the differences in disease biology of male versus female CLL patients (women having a more benign course) may be due to gender-dependent differences in drug-resistance gene activity, including MDR1. Our results also emphasize the need to take into account gender in evaluating the clinical course of patients with CLL.

Study Type – Diagnostic (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Although CT has become the gold standard for stone diagnosis, this study provides data suggesting that ultrasonography (US) is sufficient as primary diagnostic method for ureteral stones avoiding high costs, unnecessary radiation and long‐term risk of cancer. To our knowledge the identification of additional factors affecting diagnostic accuracy of US for ureteral stone diagnosis has not been established to date. OBJECTIVE • To identify additional factors that might improve the diagnosis of ureteric stones using ultrasonography (US) as the primary diagnostic method. PATIENTS AND METHODS • We performed a retrospective study of 228 patients who underwent rigid ureterorenoscopy (URS) for obstructive ureteric stones. • Patient age, sex, body mass index (BMI) and stone location and size were recorded. • All patients underwent US for stone detection before surgery. • If no cause of the flank pain was found by US, computer tomography (CT) was performed to confirm the absence of ureteric stones. RESULTS • In 57 (25%), 15 (6.6%) and 156 (68.4%) patients a stone was localized on the proximal, mid‐ and distal ureter, respectively. • In 96 (42.1%), 122 (53.5%) and 10 (4.4%) patients the stone measured 0–5, 6–10 and >10 mm, respectively. • The mean (range) BMI of the patients was 24.7 (17.3–37.2) kg/m2. • The overall stone detection rate using US was 86.4% overall, and 96.4% in adults ≤35 years. In 72/197 patients (36.5%) the stones found using US measured ≤5 mm and in 24/31 patients (77.4%) the stones found using CT measured ≤5 mm. • Age (P= 0.008), stone size (P < 0.001) and BMI (P= 0.013) were factors that independently affected ureteric stone diagnosis using US. CONCLUSION • Although CT has served as the ‘gold standard’ for stone detection, its high costs and radiation dose, together with the high detection rate of US in the hands of experienced radiologists, lead us to conclude that US should be the first choice for primary diagnostic purposes, especially in young slim adults as no patient ≤35 years with a BMI ≤24 kg/m2 needed unenhanced CT for ureteric stone diagnosis.

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We present the first case of a metastasizing renal cell carcinoma arising within a partially regressed multicystic dysplastic and ectopic left kidney in a 34-year-old patient. Despite nephrectomy and adjuvant immunotherapy, the patient died 4 months after diagnosis. Even though a recent systematic review found no evidence to support any of the different modalities for following up children with MCKD by ultrasound (Oxford Centre for Evidence-Based Medicine, Level of Evidence: 3a), our case supports the contrary and we emphasize that an annual control could be an important diagnostic choice (Level of Evidence: 4).

In Deutschland erfolgte innerhalb der vergangenen zwei Jahre die Einführung der Nackentransparenzmessung zur Risikoeinschätzung von chromosomalen Anomalien und/oder zur Erfassung von fetalen Fehlbildungen zwischen 11 und 14 SSW auf breiter Basis [1, 2, 6, 7]. Mit der Gründung der FETAL MEDICINE FOUNDATION (FMF)Deutschland im Jahr 2002 wurde ein DEGUM-assoziierter gemeinnütziger Verein etabliert, dessen Ziel es ist, die Qualität der Ultraschalluntersuchung im ersten Trimenon, insbesondere bei der Nackentransparenzmessung, entsprechend den DEGUMQualitätsansprüchen zu verbessern und zu sichern. Hierzu werden -in Anlehnung an die FMF UK -entsprechende Weiterbildungskurse mit definiertem Ausbildungsinhalt für Frauenärzte angeboten. In Deutschland haben in der Zwischenzeit über 2000 Frauenärzte einen solchen Kurs mit einer theoretischen und praktischen Prüfung abgeschlossen und führen ein NTScreening mit oder ohne Biochemie [3 -5] in Form einer individuellen Gesundheitsleistung (IGeL) durch.