Currently available prognostic tools appear unable to adequately predict recurrence and progression in non muscle-invasive bladder carcinomas. We aimed to assess the prognostic value of immunohistochemical evaluation of the cell cycle markers p53, p16 and pRb. Paraffin blocks were obtained from 78 cases of pTa and pT1 transitional cell carcinomas, for which long-term follow-up was available. Representative sections were stained using antibodies against p53, p16 and pRb. Altered marker expression was found in 45, 17 and 30% of cases, respectively. Concurrent alteration of two or three markers occurred in 19% of cases, and was significantly associated with grade and stage. In univariate survival analysis, the concurrent alteration of any two markers was significantly associated with progression. The greatest risk was produced by alteration of both p53 and p16, which increased the risk of progression by 14.45 times (95% confidence interval (CI) 3.10 -67.35). After adjusting for grade and stage, this risk was 7.73 (CI 1.13 -52.70). The markers did not generally predict tumour recurrence, except in the 25 pT1 tumours. In these, p16 alteration was associated with a univariate risk of 2.83 (CI 1.01 -7.91), and concurrent p53 and p16 alteration with a risk of 9.29 (CI 1.24 -69.50). Overall, we conclude that the immunohistochemical evaluation of p53 and p16 may have independent prognostic value for disease progression, and may help guide management decisions in these tumours.
Chronic myeloid leukaemia is a chronic myeloproliferative disorder characterised by a reciprocal translocation between chromosomes 9 and 22 and thereby formation of the Philadelphia chromosome. Imatinib mesylate (STI-571) is a potent and selective inhibitor of BCR-ABL tyrosine kinase and has emerged as a treatment of choice in chronic myeloid leukaemia (CML) patients in chronic phase. It has shown activity in CML patients in the chronic phase or blastic phase. However there is poor penetration of the central nervous system (CNS) by the drug or its active metabolites. Therefore the CNS acts as a sanctuary site for malignant cells for CML patients treated with Imatinib. We report cases of two CML patients on Imatinib therapy, who were in haematological remission but developed CNS disease.
The supernumerary kidney especially on right side is a rare diagnosis. Only few case reports are documented in literature. We report a case of Right supernumerary kidney with partial fusion of right accessory kidney to upper kidney.
Introduction To compare the burn patients undergoing early excision and grafting (within 7 days of burn injury) with the patients undergoing late surgeries (more than 7 days after burn injury) to see if there was any difference in surgical and outcome parameters including length of stay, expenditure, and overall outcome of the patients. Material and Methods A retrospective analysis of the data collected from the burn care unit records over a period of one year was done. Fifty-eight patients who matched with our inclusion criteria were divided into two groups. An early excision group who underwent surgery within 7 days of sustaining burn injury ( n = 24) and a late excision group who underwent excision and grafting/debridement after 7 days of sustaining burn ( n = 34). Data recorded included demographic variables like age, sex, percentage total body surface area (TBSA) burn; nature of burn; date of sustaining burn; date of admission to the burn care unit; and treatment and outcome parameters like date of surgery, days from burn injury to first surgery, number of surgeries, type of surgery, percentage of TBSA resurfaced with skin graft, blood products used, length of stay, outcome, and total expenditure incurred by patients. Results There was no statistically significant difference in the number of surgeries done, the units of packed cell used, and the number of fresh frozen plasma (FFP) used between the early excision group and the late excision group. The length of stay was significantly low in the early excision group as compared with the late excision group. The expenditure incurred in the treatment of the early excision group was significantly lower than the cost of treatment of the late excision group. Conclusion Early excision and grafting in burn cases reduces the length of the stay of burn patients and, in turn, reduces the cost of treatment. However, having a dedicated burn care unit is important for the hospitals and both public and private hospitals should make a move in that direction.
Case presentation 45 years male with a history of a gunshot fired from the left side of the hip with a retained bullet in the penis. On evaluation no history of hematuria, no difficulty in walking. On examination, entry wound was found on the left side of buttock with no other injury mark except bruise at the base of the penis. The bullet was seen in the distal part of the penis on X-ray pelvis (Figure 1). No hematuria was seen. Retrograde urethrogram was normal. Pelvic X-ray was normal except the retained bullet was seen in the distal part of the penis (Figure 2). The bullet was removed from the penis under local anesthesia. Postoperative period was uneventful (Figure 3).
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