Anthony Y. Smith

Cystic Renal Cell Carcinoma and Acquired Renal Cystic Disease Associated with Consumption of Chaparral Tea: A Case Report

Nordihydroguaiaretic acid is an antioxidant used experimentally to induce cystic renal disease in rats. It may be extracted from the leaves of the creosote bush, which are consumed as chaparral tea in the southwestern United States. We report a case of cystic renal disease and cystic adenocarcinoma of the kidney associated with a history of protracted consumption of chaparral tea.

Short-term and long-term function of cadaveric kidneys from pediatric donors in recipients treated with cyclosporine

Short and long-term renal function of 67 cyclosporine-prednisone (CsA-Pred)-treated recipients of pediatric cadaveric donor kidneys followed for up to 68 months (mean 16 months) were compared with 67 recipients of adult kidneys (group 3), who were demographically matched for recipient age, sex, race, cause of disease, HLA compatibility, ABO blood type, and re-transplant status. Thirty-seven of the pediatric kidneys came from donors <10 years old (group 1) and 30 from donors 11–16 years old (group 2). Group 1 displayed impaired short-term graft function: a significantly higher mean value of the nadir serum creatinine (SCr; 2.35 versus 1.63 mg/dl), a lower maximal creatinine clearance during the first 30 days (50.3 versus 65.7 ng/dl/1.73 m2), and a longer time to achieve the nadir creatinine (22.1 versus 17.2 days). Group 1 transplants also had a higher mean nadir creatinine at 3 months and a lower mean creatinine clearance (CC1) at 3 and 6 months. By 12 months the values in the group 1 pediatric kidneys were similar to those using the group 3 adult grafts. Therefore, CsA therapy did not preclude compensatory graft function. Group 2 grafts showed intermediate short-term function relative to groups 1 and 3. Mean SCr and CC1 showed progressive improvement over time, significantly better than adult kidneys at two years. Graft loss was significantly greater at two years in pediatric compared with adult grafts, but significantly better than our historical controls using azathioprine-prednisone immunosuppression.

IPSILATERAL URETEROURETEROSTOMY FOR SINGLE URETERAL REFLUX OR OBSTRUCTION IN A DUPLICATE SYSTEM

PURPOSE The traditional treatment for obstruction or reflux involving a single ureter in a duplicated system has been common sheath reimplantation. More recently, ipsilateral ureteroureterostomy has been suggested as an alternative treatment. We reviewed cases with duplicate systems that were treated with ipsilateral ureteroureterostomy at our institution to determine the acceptability of this operation as an alternative to common sheath reimplantation. MATERIALS AND METHODS A total of 22 patients with 24 duplicate systems underwent ipsilateral ureteroureterostomy between March 1986 and December 1996. Patient charts were reviewed and analyzed for patient age, sex, ureteral and renal anatomy, initial presentation, the clinical situation necessitating operation, and the occurrence of early and late complications. Patients were followed for a mean period of 41.4 months. RESULTS Two adults and 20 children 10 years old or younger presented with urinary tract infection (13), hydronephrosis on maternal ultrasound (5), dribbling (2), ureteral calculus (1) and hydronephrosis on neonatal abdominal ultrasound (1). Mean hospital stay was 3 days. There was 1 early and 1 late complication. CONCLUSIONS Ipsilateral ureteroureterostomy is an acceptable alternative to common sheath reimplantation in select patients with single ureteral disease in a duplicate system.

Primary Psoas Abscess

Infectious processes in the retroperitoneal space often involve the psoas muscle. These infections usually are secondary to other intra-abdominal or intrapelvic inflammatory processes but rarely they will arise primarily within the retroperitoneum. These primary infections occur most often in younger patients and usually will demonstrate a chronic illness in which the diagnosis often is missed. We describe a 22-year-old man with a 2-year history of symptoms before the diagnosis was confirmed. The clinical presentation of the process and pathophysiology are discussed briefly.

Randomized Evaluation of a Web Based Interview Process for Urology Resident Selection

PURPOSE We determined whether a web based interview process for resident selection could effectively replace the traditional on-site interview. MATERIALS AND METHODS For the 2010 to 2011 match cycle, applicants to the University of New Mexico urology residency program were randomized to participate in a web based interview process via Skype or a traditional on-site interview process. Both methods included interviews with the faculty, a tour of facilities and the opportunity to ask current residents any questions. To maintain fairness the applicants were then reinterviewed via the opposite process several weeks later. We assessed comparative effectiveness, cost, convenience and satisfaction using anonymous surveys largely scored on a 5-point Likert scale. RESULTS Of 39 total participants (33 applicants and 6 faculty) 95% completed the surveys. The web based interview was less costly to applicants (mean

SEER Coding Standards Result in Underestimation of Positive Surgical Margin Incidence at Radical Prostatectomy: Results of a Systematic Audit

171 vs

Telomere DNA content in prostate biopsies predicts early rise in prostate-specific antigen after radical prostatectomy for prostate cancer.

364, p=0.05) and required less time away from school (10% missing 1 or more days vs 30%, p=0.04) compared to traditional on-site interview. However, applicants perceived the web based interview process as less effective than traditional on-site interview, with a mean 6-item summative effectiveness score of 21.3 vs 25.6 (p=0.003). Applicants and faculty favored continuing the web based interview process in the future as an adjunct to on-site interviews. CONCLUSIONS Residency interviews can be successfully conducted via the Internet. The web based interview process reduced costs and improved convenience. The findings of this study support the use of videoconferencing as an adjunct to traditional interview methods rather than as a replacement.

Early growth response 1 and fatty acid synthase expression is altered in tumor adjacent prostate tissue and indicates field cancerization

PURPOSE SEER (Surveillance, Epidemiology and End Results) is the leading source of population level data on prostate cancer, including the positive surgical margin incidence at radical prostatectomy. Recently studies showed wide ranges in positive surgical margin rates among individual registries, which we hypothesized was the result of coding inaccuracies. Thus, we systematically audited SEER prostate cancer data. MATERIALS AND METHODS The New Mexico Tumor Registry, a SEER core registry, was queried for incident prostate cancer cases in 2007 that met certain criteria, including 1) adenocarcinoma histology, 2) malignant behavior and 3) radical prostatectomy as the first course of therapy. Pathological stage codes were audited by examining original radical prostatectomy pathology reports in accordance with SEER coding guidelines. The incidence and sites of positive surgical margins were critically analyzed. RESULTS Of the 305 cases that met all study inclusion criteria with complete source documents available 92 (30%) were coded incorrectly. The most common error was failure to properly account for surgical margin status (46 of 92 cases or 50%). The incidence of positive surgical margins in organ confined disease cases was 13% by SEER coding rules but 28% by a more clinical definition of positive surgical margins (p<0.001). In organ confined cases positive surgical margins occurred principally at the apex but in nonorgan confined cases most were multifocal. CONCLUSIONS In this SEER registry 30% of radical prostatectomy cases in 2007 were coded inaccurately. SEER coding guidelines result in underestimating the positive surgical margin incidence. Clinicians and investigators should recognize the limitations of tumor registry data on positive surgical margins.

Signet ring cell adenocarcinoma of prostate

OBJECTIVE To determine whether measurement of telomere DNA content (TC) in prostate biopsy tissue predicts prostate-specific antigen (PSA) recurrence in men after undergoing radical prostatectomy for prostate cancer. METHODS Slot blot titration assay was used to quantitate TC in archived diagnostic prostate needle biopsy specimens for subjects (n = 103) diagnosed with prostate cancer and who subsequently underwent radical prostatectomy between 1993 and 1997. TC was compared to the clinical outcome measure; PSA recurrence, defined as an increase in PSA > or = 0.2 ng/mL on 2 or more consecutive measurements post-prostatectomy, was observed retrospectively, for a mean follow-up period of 114 months (range, 1-165). RESULTS In the cohort, 46 subjects had a PSA recurrence. In a univariate Cox proportional hazards model, low TC (< 0.3 of standard) demonstrated a significant risk for PSA recurrence (HR = 1.94; 95% CI: 1.02-3.69, P = .04). In a subset analysis of men with biopsy Gleason sum < or = 6 (n = 63; 25 recurrences), a univariate Cox proportional hazards model demonstrated that low TC had a greater risk of PSA recurrence (HR = 4.53; 95% CI: 2.00-10.2, P < .01). In a multivariate Cox proportional hazards model, low TC was also significantly associated with PSA recurrence in this subset after controlling for preoperative PSA levels (HR = 6.62; 95% CI: 2.69-16.3, P < .01). CONCLUSIONS Low TC measured in prostate biopsy tissue predicts early likelihood of post-prostatectomy PSA recurrence in a retrospective analysis, and in men with biopsy Gleason sum < or = 6 disease it is also independent of preoperative PSA level.

Urodynamic evaluation of patients with spinal stenosis

Field cancerization denotes the occurrence of molecular alterations in histologically normal tissues adjacent to tumors. In prostate cancer, identification of field cancerization has several potential clinical applications. However, prostate field cancerization remains ill defined. Our previous work has shown up‐regulated mRNA of the transcription factor early growth response 1 (EGR‐1) and the lipogenic enzyme fatty acid synthase (FAS) in tissues adjacent to prostate cancer.