Marcin Życzkowski

Basic Parameters of Blood Count as Prognostic Factors for Renal Cell Carcinoma

Background. Renal cell carcinoma is the most common type of kidney cancer. Taking account of morbidity and mortality increase, it is evident that searching for independent prognostic factors is needed. Aim of the Study. The aim of the study was to analyze routinely performed blood parameters as potential prognostic factors for kidney cancer. Material and Methods. We have retrospectively reviewed the records of 230 patients treated for renal cell carcinoma in the years 2000–2006. Preoperative blood parameters, postoperative histopathological results, and staging and grading were performed. To estimate the risk of tumor recurrence and cancer specific mortality (CSM) within five years of follow-up, uni- and multivariate Cox and regression analyses were used. To assess the quality of classifiers and to search for the optimal cut-off point, the ROC curve was used. Results. T stage of the tumor metastasis is the most important risk factor for early recurrence and cancer specific mortality (p < 0.001). The preoperative platelet count (PLT) above 351 × 103/uL (95.3%; 55.1%) and AUC of 77% are negative prognostic factors and correlate with increased cancer specific mortality (CSM) during the five-year follow-up (p < 0.001). Increased risk of local recurrence was observed for PLT above 243.5 × 103/ul (59%; 88%) and AUC of 80% (p = 0.001). The opposite was observed in the mean platelets volume (MPV) for cancer specific mortality (CSM). The cut-off point for the MPV was 10.1 fl (75.4%; 55.1%) and for the AUC is of 68.1% (p = 0.047). Conclusions. Many analyzed parameters in univariate regressions reached statistical significance and could be considered as potential prognostic factors for ccRCC. In multivariate analysis, only T stage, platelet count (PLT), and mean platelet volume (MPV) correlated with CSM or recurrent ccRCC.

Ten-year treatment outcomes including blood cell count disturbances in patients with simple renal cysts

Background The simple renal cyst is the most common benign kidney disease. It may cause pain and hypertension, especially if significantly enlarged. As in polycystic kidney disease, blood cell count disturbances are frequently observed in simple renal cysts. The aim of our study was to assess such disturbances, changes in blood pressure, and complication rate in our patients undergoing surgery due to simple renal cyst in the last 10 years. Material/Methods 210 patients with simple renal cysts were underwent surgery between 2002 and 2012. Two different kinds of operation were conducted: aspiration of cyst fluid with injection of sclerosing agent, and laparoscopic/retroperitoneoscopic decortications of the cyst wall. A control group comprised 134 patients with benign prostate hyperplasia. The following data were obtained: cyst burden, hematocrit, hemoglobin, red blood cells, thrombocytes, occurrence of pain, and blood pressure before and after the operation. Complications were collected and presented in Clavien score. Results Hematocrit, hemoglobin, and red blood cells were significantly increased in the experimental group. A positive correlation was observed between cyst burden and the parameters mentioned above. Of 91 patients with hypertension, 56 (61.7%) had blood pressure reduction after the operation. Treatment relieved the loin pain in 132 (88%) patients. Complications occurred in 15 (7.4%) patients. Conclusions Patients with simple renal cysts have high values of red blood cells, hematocrit, and hemoglobin. Treatment decreases blood pressure in patients with hypertension. Complications after treatment are rare and mild.

Gangrene of the penis, scrotum, and perineum, occurred after radiotherapy of rectal cancer.

We present a case of a 58-year-old man hospitalized because of gangrene of the penis and scrotum, after radiochemotherapy for rectal cancer. At the time of the admission the patient presented with extensive gangrene with necrosis affecting the scrotum and the penis. During the first day of hospitalization the patient was operated. Due to the progress of the disease he had to be operated again. The status of the patient, which initially was very bad, was gradually improving. He was discharged from the hospital after 59 days in a good general state with good wound healing.

Sacrocolpopexy with Polypropylene Tape as Valuable Surgical Modification during Cystectomy with Orthotopic Ileal Bladder: Functional Results

Introduction. Urinary diversion is very often associated with urinary retention and urinary incontinence. In this study, a surgical modification during cystectomy with orthotopic ileal neobladder is presented. Material and Methods. Female patients enrolled in the study (n-24) were subjected to sacrocolpopexy during the operation. Apart from oncological control, the follow-up consisted of 1-hour inlay test and questionnaires (UDI-6 and IIQ-7) in the 3rd, 6th, and 12th month after the operation. In the 12th month after the surgery, the urodynamic pressure-flow test was performed. Outcomes were compared with the control group (n-18) in which sacrocolpopexy was not implemented. Results. The study group was characterised by reduced urinary retention and improved continence. Conclusion. Sacrocolpopexy during cystectomy with orthotopic ileal bladder is a valuable surgical method which provides patients with a better quality of life.

The comparison of laparoscopic and microsurgical varicocoelectomy in infertile men with varicocoele on paternity rate 12 months after surgery: a prospective randomized controlled trial

The best surgical approach for varicocoelectomy is still unknown, however more and more physicians favour subinguinal microsurgery. The aim of this study was to find whether microsurgical approach is superior to laparoscopic varicocoelectomy in terms of pregnancy rate, fertility potential, endocrinological function of the testis, erectile dysfunction and testicle volume increase. It was a prospective, non‐masked, parallel‐group randomized controlled trial with one to one allocation. It was conducted at authors’ institution and designed as per protocol study. From 2012 till 2015 84 patients were randomly allocated to two groups. First group consisted of 42 patients who underwent laparoscopic varicocoelectomy, whereas patients from the second group underwent microsurgical varicocoelectomy. The indications for varicocoelectomy consisted of infertility >1 year, palpable left‐sided varicocoele and at least one impaired semen parameter (sperm concentration <15 mln/mL; total motility<40%; progressive motility <32%, vitality <58% or normal morphology <4%). The primary goal was to show superiority of microsurgical varicocoelectomy over laparoscopic varicocoelectomy in terms of pregnancy rate. The secondary endpoints comprised assessment of sperm parameters in three‐month intervals after intervention until one year. Other points included, LH, FSH and testosterone levels as well as testicle volume and International Index of Erectile Function. From each group five patients were lost during the follow‐up period. The primary endpoint was not achieved – pregnancy rate in first and second group was 29.7% and 40.5% respectively (p = 0.34). Analysis of the sperm parameters after surgery revealed significant statistical difference in total motility, progressive motility and morphology in favour of microsurgical approach. Both methods showed improvement in all sperm parameters. There were no differences in hormonal levels as well as in erectile function and testicle volume between groups. Small number of patients in both groups are the main limitation of our study.

The Usefulness of Determining Neutrophil Gelatinase-Associated Lipocalin Concentration Excreted in the Urine in the Evaluation of Cyclosporine A Nephrotoxicity in Children with Nephrotic Syndrome

Introduction. The use of cyclosporine (CsA) in the treatment of nephrotic syndrome (NS) contributed to a significant reduction in the amount of corticosteroids used in therapy and its cumulative side effects. One of the major drawbacks of CsA therapy is its nephrotoxicity. Prolonged CsA treatment protocols require sensitive, easily available, and simple to measure biomarkers of nephrotoxicity. NGAL is an antibacterial peptide, excreted by cells of renal tubules in response to their toxic or inflammatory damage. Aim of the Study. The aim of this study was to assess the suitability of the NGAL concentration in the urine as a potential biomarker of the CsA nephrotoxicity. Material and Methods. The study was performed on a group of 31 children with NS treated with CsA. The control group consisted of 23 children diagnosed with monosyptomatic enuresis. The relationship between NGAL excreted in urine and the time of CsA treatment, concentration of CsA in blood serum, and other biochemical parameters was assessed. Results. The study showed a statistically significant positive correlation between urine NGAL concentration and serum triglycerides concentration and no correlation between C0 CsA concentration and other observed parameters of NS. The duration of treatment had a statistically significant influence on the NGAL to creatinine ratio. Conclusions. NGAL cannot be used alone as a simple CsA nephrotoxicity marker during NS therapy. Statistically significant correlation between NGAL urine concentration and the time of CsA therapy indicates potential benefits of using this biomarker in the monitoring of nephrotoxicity in case of prolonged CsA therapy.

Novel hematological biomarkers predict survival in renal cell carcinoma patients treated with nephrectomy

Introduction The association between novel blood-based inflammatory indices and patient survival has been reported with reference to various cancers. The aim of this study was to investigate the prognostic value of preoperative platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), derived neutrophil-lymphocyte ratio (dNLR) and lymphocyte-monocyte ratio (LMR) in patients with renal cell carcinoma (RCC) treated with nephrectomy. Material and methods From 2003 to 2012, 455 patients who underwent partial or radical nephrectomy for RCC were enrolled in the study. The study endpoints were overall survival (OS) and cancer-specific survival (CSS). Results The median follow-up was 70 months. Groups of patients with high levels of PLR, NLR and dNLR and a low level of LMR more often underwent radical nephrectomy, had a higher cancer stage in the TNM classification, and were more frequently diagnosed with tumor necrosis in histopathological examination. Both cancer-specific mortality and overall mortality were significantly higher in patients with high PLR, NLR and dNLR and low LMR. Multivariate analysis of CSS, adjusted for standard clinicopathological factors, identified only dNLR (p = 0.006) as an independent prognostic factor. PLR (p = 0.0002), dNLR (p = 0.0003) and NLR (p = 0.002), but not LMR (p = 0.1), achieved prognostic significance in multivariable analysis regarding OS. Conclusions Only dNLR was an independent prognostic factor for CSS and OS. Nevertheless, our study indicates that all examined complete blood count-based biomarkers may be useful tools in managing RCC patients treated with a surgical approach.

Percutaneous Nephrolithotomy with Amplatz and Alken Dilators: An Eight-Year Single Tertiary Care Centre Experience

Background Percutaneous nephrolithotomy (PNL) is the standard procedure for patients with renal stones over 2 cm in diameter. We analyzed complications after this procedure focusing on two different methods of tract dilation. Material/Methods Between August 2008 and April 2016 222 percutaneous nephrolithotomies were performed in a total of 208 patients. The Group I (n=123) comprised patients where Alken dilatators were used, while Group II (n=99) comprised patients where Amplatz dilators were used. Efficacy was examined based on ultrasound and x-ray examination one month after the procedure. Complications were recorded using Clavien Dindo classification. Results Efficacy was 85.3% and 86.8% in group I and II, respectively (p=0.77). Grade I complications were present in 14.6% and 3%, grade II were present in 9.7% and 8%, grade IIIa were present in 2.4% and 2%, grade IIIb were present in 1.6% and 2%, grade IVa were present in 1.6% and 7%, grade IVb were present in 3.2% and 1% in Group I and Group II, respectively. These differences were statistically significant (p=0.03). Conclusions Efficacy was comparable between Alken dilator and Amplatz dilator groups. In group I, there were more postoperative fevers >38.5 °C and a higher rate of urosepsis. On the other hand, in group II we observed more pleural injuries. All differences resulted from the type of access to the kidney (inter/infracostal), punctured calyx, and utilization (or not) of access sheath rather than type of dilators itself.

Influence of Orthodontic Rapid Maxillary Expansion on Nocturnal Enuresis in Children

Background. The etiology of nocturnal enuresis (NE) is multifactorial and has not been fully explained yet. New ways of treatment are constantly being investigated, including the rapid maxillary expansion (RME). Methods. A total of 41 patients diagnosed with NE were divided into two experimental groups: A and B. Group A included 16 children who have been treated with RME. Group B comprised 25 children who have not undertaken orthodontic treatment. Children from both groups have been monitored in monthly intervals, during a 12-month period, towards the intensification of NE. The comparative analysis of both groups has been conducted after 3 years of observation. Results. Statistical analysis has shown a 4.5 times increase of the probability of reduction of NE in the case of the treated group in comparison with the group of children who have not undergone orthodontic treatment. Unfortunately, the chance of obtaining total dryness diminished proportionally to the higher degree of intensification of enuresis at the beginning of the test. Conclusion. RME can constitute an alternative method of NE treatment in children, irrespective of the occurrence of upper jaw narrowing.