We suggest that CML-Hb is increased in blood from patients on maintenance hemodialysis and is thus a potential biomarker of oxidative damage in these patients. Moreover, CML-modification of protein may play a pathogenic role in the development of dialysis related amyloidosis.
We report two cases of acute urinary retention in women with an impacted pelvic mass. In both cases, all urinary symptoms resolved completely after the surgical removal of the mass.
Objectives
To evaluate the clinical benefit of bone‐modifying agents and identify the risk factors of skeletal‐related events in patients with genitourinary cancer with newly diagnosed bone metastasis.
Methods
This was a multicenter retrospective study including a total of 650 patients with bone metastasis of the following cancer types: hormone‐sensitive prostate cancer (n = 443), castration‐resistant prostate cancer (n = 50), renal cell carcinoma (n = 80) and urothelial carcinoma (n = 77). Clinical factors at the time of diagnosis of bone metastasis were analyzed. Early treatment with bone‐modifying agents was defined as follows: administration of bone‐modifying agents before the development of skeletal‐related events and within 6 months from the diagnosis of bone metastasis.
Results
During the follow‐up period (median 19.0 months, interquartile range 6.0–43.8 months), skeletal‐related events were reported in 88 (20%) patients with hormone‐sensitive prostate cancer, 17 (34%) patients with castration‐resistant prostate cancer, 58 (73%) patients with renal cell carcinoma and 34 (44%) patients with urothelial carcinoma. Early treatment with bone‐modifying agents significantly prolonged the time to the first skeletal‐related event in castration‐resistant prostate cancer, renal cell carcinoma and urothelial carcinoma, but not in hormone‐sensitive prostate cancer. Bone pain and elevated alkaline phosphatase levels were independent predictive risk factors of the first skeletal‐related event. The subgroup analysis showed that early treatment with bone‐modifying agents was associated with prolonged time to the first skeletal‐related events in patients with bone pain or elevated alkaline phosphatase levels.
Conclusions
Early treatment with bone‐modifying agents should be considered, especially for patients with bone pain and elevated alkaline phosphatase levels, to prevent skeletal‐related events in patients with genitourinary cancer with bone metastasis.
Although further clinical evaluation is necessary, this novel curved balloon may be a reasonable alternative in angled lesions, providing better conformability and preventing excessive stress to the vessel wall adjacent to the stenosis.
To investigate the organ-specific response and clinical outcomes of mixed responses (MRs) to immune checkpoint inhibitors (ICIs) for unresectable or metastatic urothelial carcinoma (ur/mUC), we retrospectively analyzed 136 patients who received pembrolizumab. The total objective response rate (ORR) and organ-specific ORR were determined for each lesion according to the Response Evaluation Criteria in Solid Tumors version 1.1 as follows: (i) complete response (CR), (ii) partial response (PR), (iii) stable disease (SD), and (iv) progressive disease (PD). Most of the organ-specific ORR was 30–40%, but bone metastasis was only 5%. There was a significant difference in overall survival (OS) between responders and non-responders with locally advanced lesions and lymph node, lung, or liver metastases (HR 9.02 (3.63–22.4) p < 0.0001; HR 3.63 (1.97–6.69), p < 0.0001; HR 2.75 (1.35–5.59), p = 0.0053; and HR 3.17 (1.00–10.0), p = 0.049, respectively). MR was defined as occurring when PD happened in one lesion plus either CR or PR occurred in another lesion simultaneously, and 12 cases were applicable. MR was significantly associated with a poorer prognosis than that of the responder group (CR or PR; HR 0.09 (0.02–0.35), p = 0.004). Patients with bone metastases benefitted less. Care may be needed to treat patients with MR as well as patients with pure PD. Further studies should be conducted in the future.
To prevent inguinal hernia after retropubic radical prostatectomy, many urologists have utilized a prevention technique of inguinal hernia at the same time as retropubic radical prostatectomy. Here, we report the clinical benefit of the prevention technique of inguinal hernia as well as risk factors for the incidence of inguinal hernia. We investigated the medical records of 223 men who underwent retropubic radical prostatectomy for clinically localized prostate cancer between January 2007 and March 2013 at our medical center. We assessed the association between the postoperative inguinal hernia and variables such as age, body mass index, and previous abdominal surgery. Inguinal hernia-free survival was analyzed to verify risk factors of postoperative inguinal hernia. Of 223 patients, 67 (30 %) received prevention of inguinal hernia and 156 (70 %) did not. The median follow-up period after retropubic radical prostatectomy was 36 months (range, 3-58 months). Thirty one (14 %) patients developed unilateral or bilateral inguinal hernia after retropubic radical prostatectomy. The rate of postoperative inguinal hernia in prevented and non-prevented group was 3 % (2 of 67) and 19 % (29 of 156), respectively (P < 0.01, Mann-Whitney U test). Moreover, postoperative inguinal hernia-free survival in the prevention group was significantly longer than that in the nonprevented group (P < 0.01, log-rank test). In the prevention group, 1-, 2-, and 3-year inguinal hernia-free survival rates were 100 %, 96 %, and 96 %, respectively. Other clinical factors including age, body mass index, previous abdominal surgery, and previous inguinal hernia were not associated with the incidence of inguinal hernia in our cohort. The prevention technique was simple and safe to perform, and it could increase inguinal hernia-free survival rates after retropubic radical prostatectomy.
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