The aim of the present study was to correlate tumor-infiltrating lymphocytes (TIL) with bladder cancer recurrence in patients with solitary low-grade non-muscle-invasive bladder cancer (NMIBC). We retrospectively identified from the institutional database 115 patients with solitary low-grade NMIBC after transurethral resection (TURBT) without adjuvant therapy and with complete follow-up, between 1996 and 2006. Tumor specimens were retrieved and tissue microarrays were constructed. Patients were divided in two groups: those who developed recurrent disease (n = 69) and those without recurrence (n = 46) during a follow-up period of a minimum of 5 years. Immunohistochemical staining for TIL with anti-CD3, CD4, CD8, CD20, CD56, CD68, and granzyme B (GrB) was performed. Student's t test, Mann-Whitney U test, as well as uni- and multivariate analyses were applied to compare the two patient groups. TIL were predominantly observed in cancer stroma. The number of CD3+ and CD8+ lymphocytes observed in the non-recurrent group of patients was lower than that in recurrent patients (p = 0.0001, p = 0.0002, respectively). Also, in uni- and multivariate analyses, levels of CD3+ TIL (OR = 5.4035; p = 0.0001 and OR = 5.8280; p = 0.0102) and CD8+ TIL (OR = 3.2857; p = 0.0036 and OR = 5.3257; p = 0.0092) showed prognostic value with regard to NMIBC recurrence. Our results suggest that CD3+ and CD8+ TIL are predictive of bladder cancer recurrence in patients with solitary low-grade NMIBC which might facilitate identification of patients with higher risk of recurrence. However, prospective validating studies have to confirm these results before immunohistochemical staining for CD3 and CD8 TIL can be included in the clinical workup of these patients.
Background: Peritoneal dialysis (PD) catheter placement is usually performed using general or local anesthesia. We present our PD catheter placement experience using an ultrasound-guided transversus abdominis plane (TAP) block, which is a regional anesthesia technique. Methods: In this study, we analyzed 33 patients from our center with ESRD who underwent PD catheter placement using a TAP block between June 2011 and April 2014. Results: The TAP block was successful for 29/33 (87.9%) patients. Four patients (12.1%) had pain at the incision site and required general anesthesia. There were no anesthesia-, surgery- or catheter-related complications. Conclusion: ESRD patients have a substantial number of comorbidities that can be negatively influenced by general anesthesia. Because regional anesthesia has no systemic effect, this procedure could be recommended for this group of patients. A TAP block is an effective, safe method and can be used as the principal anesthesia technique for PD catheter placement.
Wünderlich syndrome (WS) is a urological emergency characterized by retroperitoneal hemorrhage. In most cases, bleeding occurs from a renal angiomyolipoma (AML) and may be the first manifestation of the disease. We report a female patient with bilateral WS due to the metachronous rupture of renal AMLs. Because the patient was stable and the tumor was not malignant, treatment was conservative. Follow-up revealed the full recovery of kidney function and the resolution of the hematoma.
We report a case of a kidney-transplanted patient with urolithiasis treated with mini-percutaneous laser lithotripsy. The patient presented with renal dysfunction and graft hydronephrosis. Diagnostic procedures revealed ureterolithiasis as a cause of obstruction, and percutaneous nephrostomy was inserted as a temporary solution. Before surgery, the stone migrated to the renal pelvis. Mini-percutaneous laser lithotripsy was successfully performed, and during surgery, all stone fragments were removed. Six months after successful treatment, the patient has good functioning and stone-free graft.
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