Introduction The aim of this study was to determine and quantify the mechanisms responsible for the delays in bladder cancer diagnosis and initial treatment. Material and methods Patients referred to two academic hospitals in Poland with a primary bladder tumor were prospectively identified and structurally interviewed. For all patients, time intervals between symptom onset, diagnostic and therapeutic interventions were assessed. Results A total of 144 patients diagnosed with bladder cancer were included in the analysis. The median time from symptom onset to treatment was 112 days. This comprised of the following median waiting times: 1) patient waiting time of 13 days, 2) assessment waiting time of 14 days and 3) treatment waiting time of 42 days. In the multivariate analysis, large city residence (OR 0.2, 95% CI 0.1–0.6) and comorbidity (OR 0.3, 95% CI 0.1–0.8) reduced the risk of delay, whereas medium-sized city residence (OR 1.4, 95% CI 0.4–5.1) and general practitioner as the first medical professional contact (OR 5.3, 95% CI 0.6–50.0) increased the risk of delay. Conclusions Diagnostic and treatment waiting times for bladder cancer in Poland are unsatisfactory. Potential solutions for shortening these delays include healthcare policy changes such as utilization of the oncological priority programs, primary care education and public health campaigns.
IntroductionThere is a need for a new biochemical marker of aggressive prostate cancer (PCa). Inosine monophosphate dehydrogenase 2 (IMPDH2) is a candidate for such a marker – its activity is increased in certain tumors and neoplastic cell lines, including PCa, and may correlate with cancer aggressiveness.Material and methodsIMPDH2 levels were measured in blood samples from 34 PCa patients. The results were analyzed and correlated with prostate-specific antigen (PSA), digital rectal examination (DRE), Gleason score, risk groups according to d'Amico and metastatic disease. Twenty healthy (non-PCa) patients served as the control group.ResultsThere was no significant difference in IMPDH2 level between the PCa and control group, and no significant correlation between PSA and IMPDH2. IMPDH2 levels were significantly higher in the DRE (+) patients (148.5 ±174.8 vs. 33.4 ±46.4, p <0.05), in patients with metastatic disease (100.1 ±139.0 vs. 25.3 ±25.9, p <0.05) and in the high-risk group according to d'Amico (93.4 ±129.2 vs. 18.8 ±10.4, p <0.05). There was a significant correlation between the Gleason score and IMPDH2.ConclusionsThese results suggest that IMPDH2 is a promising candidate as a biomarker for those with advanced PCa and those at high risk of progression towards advanced PCa.
Introduction Widespread use of scrotal ultrasonography has led to the detection of incidental, non-palpable small testicular masses (STMs). Historically, all intratesticular masses were treated radically, however more conservative strategies are now being applied with growing evidence that up to 80% of STMs are benign lesions. Testis-sparing surgery is deemed a gold standard in STMs. However, the high probability of the benign nature of STMs and the excellent cure rate of localized testicular cancer has led to emerging attempts to use an active surveillance (AS) strategy for selected groups of patients. Material and methods We conducted a non-systematic review of the literature in the PubMed and Embase databases for articles associated with AS strategy in STMs. Results The main inclusion criteria for AS in patients with STMs were lack of risk factors of testicular cancer, no features of disseminated disease, negative tumor markers, non-palpable lesion that did not exceed 10 mm. Mean follow-up time of AS across the studies ranged from 9.6 to 29.6 months. Surveillance protocols were based on regular physical examination, scrotal ultrasonography and measurement of tumor markers. The change rate to active treatment ranged from 0% to 8% without reported deterioration of oncological outcomes. Patients have proceeded to surgical treatment based on their preference, lesion growth, change in echogenicity, tumor marker growth and the need for testicular exploration for other reasons. Conclusions Active surveillance is a reasonable conservative strategy in the management of STMs in selected groups of patients with minimal risk of deteriorating impact on oncological outcomes.
in Poznań 3 Kierownik: prof. dr hab. W. Cichy Recent decades have seen a constant rise in the incidence of IBD in both adults and children. Despite considerable progress in the pharmacological treatment of this disease, surgery has become the more frequently used treatment modality in younger patients. In the presence of massive haemorrhage, free perforation, fulminate colitis or acute obstruction, only surgical intervention has a chance of saving the patient's life. The aim of the study was to present the results of surgical treatment of IBD in children and adolescents who were operated on in a department which copes with "adult surgery" in its everyday practice. Materials and methods. 235 patients were operated on for IBD in the years 1998-2005. There were 18 (7,66%) children in this group, 10 girls and 8 boys. 12 patients were diagnosed with ulcerative colitis (66.7 %) and (6) patients were diagnosed with Crohn's disease (33.3%). The age of the patients ranged from 12 to 17 years (mean 15.6). Among the 18 children, 10 (55.6%) were operated on for elective reasons and 8 (44.4%) of the interventions were emergencies (three perforations, two obstructions, one acute haemorrhage and one fulminate colitis). In all cases of ulcerative colitis, a two-step restorative proctocolectomy with J pouch anal anastomosis was performed. Patients with Crohn's disease were treated by limited (sparing)[it seems that either limited or sparing works here, pick one] bowel resection and/or strictureplasty. Results. There were no postoperative deaths in the study group. Postoperative complications were observed in 6 (33.3%) patients, the complications were ileus in 3 patients (1 patient demanded relaparotomy), pneumonia in 2 patients and wound suppuration with subsequent dehiscence in 1 patient. In one patient treated preoperatively with large doses of Imuran, the postoperative histology revealed a malignant lymphoma. Hospital stays ranged from 8 to 19 days (mean 12 days). Conclusions. Surgery for IBD in children and adolescents has become a widely accepted method, and it is often the only treatment modality that offers a chance of a cure. Restorative proctocolectomy should be considered earlier in many cases of younger patients with ulcerative colitis, prior to conservative treatment, as imunosupression and steroid therapy in particular produce undesired side effects. A consulting surgeon should be involved in the treatment of younger patients with IBD at a much earlier stage of therapy than is currently practiced.
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