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- Burgu, Berk, et al.
(författare)
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When is it necessary to perform nuclear renogram in patients with a unilateral neonatal hydronephrosis?
- 2012
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Ingår i: World journal of urology. - : Springer Science and Business Media LLC. - 1433-8726 .- 0724-4983. ; 30:3, s. 347-52
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Tidskriftsartikel (refereegranskat)abstract
- To examine whether anteroposterior(AP) pelvic diameter on postnatal renal ultrasound scan (US) can predict both initial differential renal function (DRF) and deterioration in DRF in patients with prenatally diagnosed hydronephrosis.One hundred and thirty-three patients diagnosed with a unilateral prenatal hydronephrosis, confirmed postnatally, were evaluated. We tried to find the cutoff values for initial AP diameter and change in AP diameter based on initial DRF and renal outcome. Reduction of 5% or more was considered as deterioration in function. All patients had an initial US scan at a mean age of 1.62weeks (1-4) and nuclear renogram at 13.24weeks (7-21). All patients had a second US at a mean age of 10.58weeks (6-19). 119 patients had a second renogram.Initial mean pelvic diameter was 20.86 (11-49)mm. When AP pelvic diameter was less than 20mm, 98.6% of all renal units had a function of ≥40%. The cutoff point for AP pelvic diameter was 19.05 when DRF was ≥45% (P<0.001). When the reduction in hydronephrosis in pelvic diameter was analyzed to predict the initial renal function, a cutoff point of 1.3mm decrease was found when initial renal function was ≥40% (P<0.001). The reduction in AP pelvic diameter was 2.1mm when initial DRF was ≥45% (P=0.009). For all patients except 3 individuals, if there was a reduction in AP diameter or the AP diameter was stable, then no reduction in function was observed.When the AP pelvic diameter is less than 20mm at presentation, DRF is normal. If the AP diameter is stable or decreases, there is unlikely to be a significant deterioration in renal function. Consequently, in selected patients, congenital unilateral hydronephrosis can be followed with serial ultrasounds.
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- Grabe, Magnus, et al.
(författare)
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Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures.
- 2011
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Ingår i: World Journal of Urology. - : Springer Science and Business Media LLC. - 1433-8726 .- 0724-4983.
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To assess the patient and identify the risk factors for infectious complications in conjunction with urological procedures and suggest a model for classification of the procedures. METHOD: Review of literature, critical analysis of data and tentative model for reducing infectious complications. RESULTS: Risk factors are bound to the patient and to the procedure itself and are associated with the environment where the healthcare is provided. Assuming a clean environment and sterile operation field, a five-level assessment ladder related to the patient and type of surgery is useful, considering: (1) the ASA score, (2) the general risk factors, (3) the individual endogenous and exogenous risk factors, (4) the class of surgery and the potential bacterial contamination burden and (5) the level of severity and difficulty of the surgical intervention. A cumulative approach will identify the level of risk for each patient and define preventive measures, such as the type of antibiotic prophylaxis or therapeutic measures before surgery. There are data suggesting that the higher the ASA score, the higher is the risk of infectious complication. Age, dysfunction of the immune system, hypo-albuminaemia/malnutrition and overweight, uncontrolled blood glucose level and smoking are independent general risk factors, whilst bacteriuria, indwelling catheter treatment, urinary tract stone disease, urinary tract obstruction and a history of urogenital infection are specific urological risk factors. There is inconclusive evidence for most other reported risk factors. The level of contamination of the surgical field is of utmost importance as are the procedure-related factors, and the sum of these have to be reflected on for the subsequent perioperative management of the patient. CONCLUSIONS: It is essential to identify and control risk factors to minimize infectious complications in conjunction with urological procedures. Our knowledge is limited and clinical research and quality registries analysing risk factors must be undertaken. We propose a working basis for assessment of patients' risk factors and classification of urological procedures.
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- Hemminki, Kari
(författare)
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Familial risk and familial survival in prostate cancer
- 2012
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Ingår i: World Journal of Urology. - : Springer Science and Business Media LLC. - 1433-8726 .- 0724-4983. ; 30:2, s. 143-148
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Tidskriftsartikel (refereegranskat)abstract
- The Swedish Family-Cancer Database has been the major source of population-based prospective data on familial risks on most cancers, including prostate cancer. In the present review, I focus on three lines of family studies with novel results. The covered studies originate from the same database with publication dates spanning a period of somewhat over 3 years. Age-specific hazard ratios (HRs) of incident prostate cancer and fatal prostate cancer were determined according to the number of affected relatives. Cumulative risks for incidence and death were calculated for the various types of families. Finally, data on the familial association of prostate cancer with some other cancers were reviewed. If the father had prostate cancer, the HR for sons was 2.1 and it increased to 17.7 when three brothers were affected. The highest HR (23) was observed for men before age 60 years with three affected brothers. The patterns for fatal familial prostate cancer were similar. Other reviewed sets of data showed evidence for the familial concordance of good and poor survival in prostate cancer. Familial risks were somewhat higher for fatal than for incident prostate cancer, suggesting that fatal prostate cancers may be a genetic subgroup. Considering the high familial risks in fatal prostate cancer, family history remains an important prognostic piece of information useful for clinical genetic counseling. Obviously, preventive measures for at-risk men are needed but these are beyond the present paper. Starting screening before any prostate cancers are diagnosed in a family appears counterproductive.
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| 6. |
- Hemminki, Kari, et al.
(författare)
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Prostate cancer incidence and survival in immigrants to Sweden
- 2013
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Ingår i: World Journal of Urology. - : Springer Science and Business Media LLC. - 1433-8726 .- 0724-4983. ; 31:6, s. 1483-1488
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Tidskriftsartikel (refereegranskat)abstract
- The large international variation in the incidence of prostate cancer (PC) is well known but the underlying reasons are not understood. We want to compare PC incidence and survival among immigrants to Sweden in order to explain the international differences. Cancer data were obtained from the Swedish Cancer Registry. Standardized incidence ratios (SIRs) were calculated for PC in first-degree immigrants by country of birth. The immigrants were classified into four groups by SIR and area of origin. Survival in PC was assessed by hazard ratio (HR) in the four groups. In some analyses, clinical stage of PC was assessed by the tumor, node, and metastasis classification. The SIR was 0.47 (95 % confidence interval 0.43-0.51) for immigrants with the lowest risk, constituting men from Turkey, Middle East, Asia, and Chile. The HR was 0.60 (0.45-0.81) for these men and it was 0.49 if they had stayed 20+ years in Sweden. The SIR in screening detected PC, T1c, was 0.55. Among these men, screening detected PC constituted 34.5 % of all PC, compared to 29.0 % among Swedes (p = 0.10). The results showed that the non-European immigrants, of mainly Middle East, Asian, and Chilean origin, with the lowest risk of PC, also had the most favorable survival in PC. As the available clinical features of PC at diagnosis or the distribution of known risk factors could not explain the differences, a likely biological mechanism through a favorable androgenic hormonal host environment is suggested as an explanation of the observed effects.
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| 9. |
- Merseburger, Axel S, et al.
(författare)
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Hot topics in kidney cancer 2010
- 2010
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Ingår i: World journal of urology. - : Springer. - 0724-4983 .- 1433-8726. ; 28:3, s. 245-246
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Tidskriftsartikel (refereegranskat)
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