Efraim Serafetinides

Safety of ultrasound-guided transrectal extended prostate biopsy in patients receiving low-dose aspirin.

PURPOSE To determine whether the peri-procedural administration of low-dose aspirin increases the risk of bleeding complications for patients undergoing extended prostate biopsies. MATERIALS AND METHODS From February 2007 to September 2008, 530 men undergoing extended needle biopsies were divided in two groups; those receiving aspirin and those not receiving aspirin. The morbidity of the procedure, with emphasis on hemorrhagic complications, was assessed prospectively using two standardized questionnaires. RESULTS There were no significant differences between the two groups regarding the mean number of biopsy cores (12.9 +/- 1.6 vs. 13.1 +/- 1.2 cores, p = 0.09). No major biopsy-related complications were noted. Statistical analysis did not demonstrate significant differences in the rate of hematuria (64.5% vs. 60.6%, p = 0.46), rectal bleeding (33.6% vs. 25.9%, p = 0.09) or hemospermia (90.1% vs. 86.9%, p = 0.45). The mean duration of hematuria and rectal bleeding was significantly greater in the aspirin group compared to the control group (4.45 +/- 2.7 vs. 2.4 +/- 2.6, p = < 0.001 and 3.3 +/- 1.3 vs. 1.9 +/- 0.7, p < 0.001). Multivariate logistic regression analysis revealed that only younger patients (mean age 60.1 +/- 5.8 years) with a lower body mass index (< 25 kg/m2) receiving aspirin were at a higher risk (odds ratio = 3.46, p = 0.047) for developing hematuria and rectal bleeding after the procedure. CONCLUSIONS The continuing use of low-dose aspirin in patients undergoing extended prostatic biopsy is a relatively safe option since it does not increase the morbidity of the procedure.

Evaluation of Neutrophil Gelatinase–associated Lipocalin, Interleukin-18, and Cystatin C as Molecular Markers Before and After Unilateral Shock Wave Lithotripsy

OBJECTIVE To investigate the impact of shock wave lithotripsy (SWL) on renal tissues using neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and interleukin 18 (IL-18) levels in serum and urine and to examine the relationship of these biomarkers with patient and calculus characteristics as well as SWL treatment parameters. MATERIALS AND METHODS Thirty-seven patients with renal calculi were included in this study. Blood and urine samples were attained from each patient at 4 time points; immediately before SWL, 6 hours after, 3 days after, and 10 days after the SWL. A new generation lithotripter was used for all cases. Serum and urine NGAL concentrations were measured using commercially available enzyme-linked immunosorbent assay kits according to manufactures protocol. The concentration of cystatin C was measured in serum, whereas IL-18 concentration was assessed in urine. RESULTS There were no statistically significantly differences in the levels of NGAL in serum and urine before and after SWL. The mean levels of cystatin C in serum appeared significantly higher 3 and 10 days after SWL. No statistically significant differences were identified between levels of IL-18 before and after SWL. Patients with diabetes mellitus demonstrated significantly higher baseline cystatin C levels. There was no correlation between calculus characteristics or treatment parameters and the levels of all 3 biomarkers after SWL. CONCLUSION The results of this study indicate that SWL is associated with minimal acute injury to renal tissues. Our findings support the safety profile of new generation lithotripters, provided orthodox indications and treatment principles are followed.

The impact of body mass on managelent of patients with renal colic

Objective: To study the impact of bodymass on diagnosis and initial response tomedical treatment in patients presenting withrenal colic. Patients and methods: Onehundred and sixty-five consecutive patientspresenting with symptoms of renal colic havebeen examined. Patients were divided in 3groups according to their body mass index:normal-weight (BMI ≤ 24.9 kg/m2),overweight (BMI 25.0–29.9 kg/m2) and obese(BMI ≥ 30 kg/m2). Diagnosis of renal colicwas based on history, clinical examination,presence of hematuria in a urine sample,appearance of a stone on a plain radiograph,and/or presence of hydronephrosis inultrasonography. In addition, previous historyof renal colic, time to seek medical advice andtime to pain relief following administration ofmedications were examined. Results: Meanbody mass index did not differ between patientswith a history of ≤1, 1–5 and ≥5 renalcolics (P = 0.65). Prevalence rates of appearanceof either lithiasis or hydronephrosis vs normalfindings on the Kidney-Ureter-Bladder plainradiograph or ultrasonography were notdifferent between normal-weight, overweight andobese subjects (P = 0.38 and P = 0.90respectively). The time to seek for medicaladvice and the response to treatment were notdifferent between the study groups (P = 0.24 andP = 0.53 respectively). Conclusion: Bodymass does not have any impact on diagnosis,time to seek for medical advice or response totreatment in patients with renal colic.

Differential Expression of IGF-I Transcripts in Bladder Cancer

Background/Aim: A growing body of evidence shows that the differential expression of E domain-related insulin-like growth factor-I (IGF-I) transcripts (IFG-IEa, IGF-IEb and IGF-IEc) in normal and cancerous tissues, implicating specific biological roles for the putative Ea, Eb, and Ec peptides, beyond IGF-I. Herein, we investigated the expression profile of IGF-IEa, IGF-IEb and IGF-IEc transcripts in bladder cancer and compared them with samples from the normal adjacent bladder tissue. Materials and Methods: Biopsies from 46 patients (39 men and 7 women), aged 73.3±10.9 years, were analyzed for the expression of IGF-I transcripts using semi-quantitative real time-PCR (qRT-PCR). Results: The presence of all three IGF-I transcripts was detected in both normal urothelium and bladder carcinomas. The relative expression of the IGF-IEa and IFG-IEb was marginally increased in bladder cancer tissues compared to normal tissue (p>0.05). In contrast, the expression of the IGF-IEc was significantly decreased in bladder cancer as compared to normal adjacent urothelium (p<0.05). This specific suppression of IGF-IEc expression was evident and positively correlated with the histological and/or clinical characteristics of an advanced disease, referring to clinical stage, tumor grade and disease recurrence (p<0.05); however, in situ carcinomas exhibited an increased expression of all IGF-I transcripts. Conclusion: Our data confirm the differential expression of IGF-I transcripts in bladder cancer, revealing a distinct suppression of IGF-IEc. These findings suggest that IGF-IEc expression and putative Ec product may possess discrete biological role in disease progression beyond IGF-I.