Faculty Bibliography

PURPOSE/OBJECTIVE:To provide data of the incidence and management of common urological malignancies in renal transplant recipients. MATERIALS AND METHODS/METHODS:We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed. RESULTS:Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45% of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow up. CONCLUSIONS:The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.

PURPOSE OF REVIEW:With this review, we describe the most recent advances in active surveillance as well as diagnosis and management of small renal masses (SRMs). RECENT FINDINGS:We discuss diagnosis, differentiation of solid from cystic lesions, risk prediction and treatment of the SRM. A better understanding of the disease facilitates the use of more conservatory treatments, such as active surveillance. Active surveillance has been increasingly accepted not only for SRM, but also for larger tumors and even metastatic patients. Exiting advances in risk prediction will help us define which patients can be safely managed with active surveillance and which require immediate treatment. Meanwhile, the use of renal tumor biopsies is still an important tool for these cases. SUMMARY:Active surveillance is an option for many patients with renal masses. Noninvasive methods for diagnosis and risk prediction are being developed, but meanwhile, renal tumor biopsy is a useful tool. A better understanding of the disease increases the number of patients who can undergo active surveillance fully certain of the safety of their management.

INTRODUCTION/BACKGROUND:ED and LUTS affect a high proportion of male population. Although Hispanics are suspected to have a higher risk of experiencing LUTS, detailed information on its frequency and association with ED in this population is scarce. OBJECTIVE:To determine the frequency of LUTS and ED, and its correlation in Mexican males. METHODS:A cross-sectional analytical survey was answered by 1041 men. It included the International Prostate Symptom Score and the quality of life question (IPSS/QoL); International Index of Erectile Function (IIEF-5); the short form of the International Consultation of Incontinence Questionnaire (ICIQ-SF); and demographic data. For the analysis, we divided our population into 2 groups (18-39 and 40 and older), and then an exploratory correlation analysis was performed to search for significant differences among IPSS severity groups, and finally a multivariate regression model was applied. RESULTS:Mean age was 48.6 ± 14.5 years. One hundred twenty-three individuals (11.8 %) were asymptomatic, and 611 (58.7 %) had mild, 226 (21.7 %) had moderate, and 81 (7.8 %) had severe IPSS score. The most common symptoms were nocturia (72.4 %), increased urinary frequency (58.3 %), and slow urinary stream (42.6 %). Two hundred fifty-eight (24.7 %) complained of incontinence. Of 765 individuals, 484(63.2 %) reported some degree of ED. Severe LUTS, DM, and age were independent risk factors for ED severity. CONCLUSION/CONCLUSIONS:LUTS and ED may represent one of the largest sources of morbidity in our population, and their association was demonstrated. Awareness on these entities should be raised, and further research is required to determine the higher frequency of LUTS and ED in Hispanics.

Sepsis is a leading cause of death around the world, and 73-83% of all sepsis cases requiring attention in intensive care units are linked to intra-abdominal infection (IAI) or pneumonia. The activation of innate immunity is central to the manifestation of sepsis, and toll-like receptor (TLR) 4 plays an important role in this activation process. The 299G and 399I alleles of TLR4 have been linked with an increased risk of Gram-negative bacteria (GNB) infections and septic shock in some populations. This case-control study evaluated the prevalence of D299G/T399I polymorphisms in Mexican patients with IAI and/or pneumonia and in healthy controls. Genotyping revealed that 1 in 44 patients (2.3%; CI 95%: 0.05-12.0%) and 4 in 126 controls (3.2%; CI 95%: 0.9-7.9%) were heterozygous for both the D299G and T399l polymorphisms (OR: 0.71, CI 95%: 0.01-7.44, p = NS), confirming the co-segregation of these alleles in this population. Furthermore, the patients with a GNB infection and severe sepsis were not carriers of the risk alleles. In summary, this report shows that the frequency of the D299G and T399I polymorphisms in Mexican-Mestizos is lower than anticipated in comparison with other ethnic groups, emphasizing the variable distribution of TLR4 polymorphisms among different populations. Consequently, this study was not able to detect associations between TLR4 polymorphisms and sepsis in this population.

BACKGROUND AND AIMS/OBJECTIVE:The diagnosis of Clostridium difficile-associated disease (CDAD) is based on the detection of toxins from stool samples. There are several immunoassays for this purpose. The aim of this study was to determine the concordance between the two immunoassays and their performance in comparison to the toxigenic culture as part of the initial evaluation of a suspected case of CDAD. METHODS:All fecal samples submitted for detection of C. difficile toxins during a 5-month period to our laboratory were analyzed by two immunoassays, VIDAS Toxin CDA/B assay (BioMerieux) and ImmunoCard Toxins A/B (Meridian Bioscience). We cultured on cycloserine-cefoxitin-fructose agar and PCR was used for detection of toxigenic genes. Real-time PCR was performed directly from samples to detect the tcdC gene. RESULTS:At the end of the study we processed 230 samples, 13 were positive using VIDAS CDA/B (5.6%), and 14 using ImmunoCard A/B (6.0%); kappa coefficient was 0.857. With ImmunoCard A/B we obtained a sensitivity of 80%, a specificity of 99%, positive predictive value (PPV) 86% and negative predictive value (NPV) 98%, as compared to toxigenic culture. For VIDAS CDA/B we obtained a sensitivity of 90%, a specificity of 98%, PPV 69% and NPV 99%, compared to the same standard. There were seven undetermined results (3.0%) by VIDAS CDA/B. Five of these had a positive culture and all the patients had symptoms of CDAD. Considering these undetermined results as positive, we calculated a sensitivity of 93%, specificity of 97%, PPV 71% and NPV of 99% for this test, and a kappa of 0.856. Both immunoassays showed similar results and are suitable for the initial evaluation of patients with suspected CDAD. CONCLUSIONS:Our data suggest that an undetermined result of VIDAS CDA/B should be considered as positive if CDAD is suspected. Additionally, both immunoassays showed similar results and are suitable for the initial evaluation of patients with suspected CDAD.