Aged ; Carcinoma, Renal Cell ; diagnosis ; diagnostic imaging ; Female ; Humans ; Kidney Neoplasms ; diagnosis ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, Emission-Computed ; Ultrasonography

INTRODUCTIONThe incidence of lymphoceles - lymphatic collections around a transplanted kidney - can be as high as 20%. We aimed to review the presentation, treatment and outcome of patients with lymphoceles.

METHODSWe reviewed a prospective database of 154 patients who underwent renal transplantation at our hospital from January 2005 to November 2008.

RESULTSThe mean age of the patients in our cohort was 46 (range 34-58) years. The incidence of lymphoceles in our series was 5.8% (n = 9). The median onset was 19 (range 6-28) days post-transplantation, while the median size of the lymphoceles was 5 (range 1.5-8) cm. Lymphoceles were most commonly found at the lower pole of the transplanted kidney. Eight patients with lymphoceles had received cadaveric transplants. While a majority of these patients did not have hydronephrosis on presentation, four had markedly elevated creatinine. Of the nine patients with lymphoceles, six were on macrolides (tacrolimus, sirolimus or everolimus), two were successfully managed conservatively, three were managed percutaneously and four required surgical drainage via either laparoscopic marsupialisation (n = 1) or open drainage (n = 3). There was no graft loss.

CONCLUSIONIt remains unknown whether the choice of immunosuppressants increases the risk of lymphocele formation. Intervention is necessary in the case of impaired drainage of the pelvicalyceal system in these patients. Minimally invasive intervention, while effective in treating lymphoceles, does not provide definitive treatment. Surgical intervention should be considered early for the treatment of post-transplantation patients with lymphoceles, so as to shorten hospital stay and prevent further complications.

Adult ; Databases, Factual ; Drainage ; adverse effects ; Female ; Humans ; Immunosuppressive Agents ; therapeutic use ; Incidence ; Kidney Transplantation ; methods ; Laparoscopy ; Lymphocele ; complications ; diagnosis ; Male ; Middle Aged ; Postoperative Complications ; Prospective Studies ; Renal Insufficiency ; complications ; therapy ; Treatment Outcome

INTRODUCTIONCultural influences affect attitudes towards cancer screening, diagnosis, treatment and palliation. The objective of this study is to survey the prevailing attitudes towards cancer in a multicultural tertiary outpatient setting.

MATERIALS AND METHODSThis is a cross-sectional study of 300 respondents visiting the Singapore General Hospital (SGH) Urology Centre over a period of 1 month. A questionnaire was developed assessing responses to various facets of cancer management and administered in English, Chinese or Malay to every 10th person visiting the centre. Institutional review board approval was obtained.

RESULTSOf 300 respondents, 57% were Chinese, 17% Malay, 19% Indian, and 7% others. Mean age was 54.3 years. Most respondents were male (68%) and had up to secondary education (56%). Most Chinese were Taoist/Buddhist (42%) or Christian/ Catholic (36%) while Indians were largely Hindu (47%) or Muslim (27%). Thirty-seven percent of respondents had ever participated in cancer screening. Eighty-nine percent of respondents wanted to be the first to know if they had cancer, and 76% found it unacceptable if the diagnosis of cancer was withheld from them. These were irrespective of race, religion or other factors. Forty percent of respondents believed that being diagnosed with cancer was a matter of fate. Sixty percent of respondents would undergo treatment with 50% chance of cure, even if it involved major surgery and adjuvant therapy. Eighty-one percent believed in efficacy of at least 1 form of alternative treatment. Seventy-one percent of respondents preferred to die at home and this was most marked among Malay respondents (90.4%).

CONCLUSIONThis better understanding of patient attitudes will allow us to help patients balance wishes for autonomy versus family involvement in dealing with cancer. This will help us achieve a more holistic and patient-centred approach to cancer care.

Cross-Sectional Studies ; Health Knowledge, Attitudes, Practice ; Humans ; Neoplasms ; Outpatients ; Surveys and Questionnaires

This paper describes a liver elasticity and viscosity measurement system based on existing medical ultrasound platforms. This system relies on acoustic radiation force to invoke transient response on soft tissue, and employs displacement estimation algorithms to detect the propagation of shear wave. The research proves that the velocity of the shear wave may serve as a reliable estimation of the Young's modulus and viscosity coefficient of the liver tissue, and existing commercial products may be easily adapted to support this technique without extra hardware cost.
Algorithms ; Animals ; Elastic Modulus ; Elasticity Imaging Techniques ; instrumentation ; methods ; Liver Cirrhosis ; diagnostic imaging ; Viscosity

Androgen Antagonists ; therapeutic use ; Anilides ; therapeutic use ; Antineoplastic Agents, Hormonal ; therapeutic use ; Bone Neoplasms ; complications ; secondary ; Goserelin ; therapeutic use ; Humans ; Male ; Middle Aged ; Nitriles ; therapeutic use ; Prostatic Neoplasms ; complications ; drug therapy ; Purpura, Thrombotic Thrombocytopenic ; drug therapy ; etiology ; Tosyl Compounds ; therapeutic use

Cardiovascular disease is a major cause of death in Australia. The Tick Program by the National Heart Foundation was designed to assist consumers in making healthier food choices. The aim of our study was to evaluate the awareness of university students regarding the Tick Program as a sustainable approach in preventing the onset of cardiovascular disease (CVD) in youth. Following Ethics Committee approval, a cross-sectional study was undertaken in 2006 to measure university students’ level of awareness of the Tick Program using a self-administered survey form. Inclusion criteria were full-time university students who have lived in Australia for a minimum duration of twelve months and do their own shopping. Students of less than 18 years of age were excluded from the study. Of 110 university students surveyed, 97 questionnaires were successfully completed (response rate: 88%). Overall there was a high level of awareness (72.2%) of the Tick program, which was also considered trustworthy by a majority of participants, with a mean rating of 3.87 (on a scale of 1 to 5). Tick-approved products were also considered a healthier choice by participants (mean 4.06 out of 5). Participants were also asked to identify potential barriers limiting the use of the Tick in making purchase decisions. The most important barrier identified to the Tick program was the limited range of Tick-approved products. A significant proportion of respondents also believed there was limited publicity of the program. The Tick Program is considered to be trustworthy and the approved products were regarded as healthy, with the results showing that participants have confidence in the Tick Program. This research also highlighted the potential areas for improvement of the Tick Program.
Cardiovascular Diseases ; Food Preferences ; Students ; Universities ; Australia

Anesthesia ; Conscious Sedation ; Endoscopy, Gastrointestinal ; Humans

INTRODUCTIONTo review the perioperative and short-term outcome of all laparoscopic partial nephrectomies (LPN) performed in a single institution.

MATERIALS AND METHODSThirteen consecutive patients who underwent LPN since the beginning of the programme in March 2002 to January 2008 were enrolled. Demographic, perioperative and follow-up data were retrospectively collected. Transperitoneal approach was used in all cases, and vascular control was achieved with the use of a laparoscopic Satinsky clamp or vascular tape. The tumour was excised using cold scissors. Transected intrarenal vessels were suture ligated and the parenchymal defect was closed primarily with absorbable suture over a bolster.

RESULTSThirteen patients underwent a total of 14 LPN. The median age of patients was 60 years (range, 41 to 77). The mean tumour size was 24 +/- 11.4 (2SD) mm. The mean operative time was 228 +/- 129 (2SD) minutes and median warm ischaemia time was 35 minutes (range, 24 to 68). Postoperatively, serum haemoglobin level decreased by a mean of 1.4 +/- 2.5 (2SD) gm/dL and serum creatinine increased by a mean of 22.5 +/- 25.8 (2SD) micromol/L. Twelve out of 13 (92%) patients achieved their baseline serum creatinine level within 1 month postoperatively. There was 1 open conversion (7%), and 2 patients (14%) required blood transfusion perioperatively. Two patients (14%) had transient fever postoperatively due to basal atelectasis. No other complications were encountered. Median patient hospital stay was 4 days (range, 2 to 10). Eleven out of 14 (79%) of the tumours were renal cell carcinoma (RCC). At a median follow-up of 12 months (range, 6 to 53), all except 1 patient with RCC were disease-free.

CONCLUSIONSOur experience has shown that laparoscopic partial nephrectomy is a safe, feasible technique in our centre for patients with small exophytic renal tumours. Patients can be discharged early with preservation of renal function and good early cancer control.

Adult ; Aged ; Carcinoma, Renal Cell ; surgery ; Female ; Hospitals, General ; Humans ; Kidney Neoplasms ; surgery ; Laparoscopy ; methods ; Length of Stay ; Male ; Middle Aged ; Nephrectomy ; methods ; Retrospective Studies ; Singapore

INTRODUCTIONInfection-related complications after transrectal ultrasound guided prostatic biopsy (TRPB) could be life threatening. Our centre observed sepsis after TRPB despite prophylactic oral ciprofloxacin. We reviewed all cases of post-TRPB sepsis with their bacteriology and evaluated if the addition of intramuscular (I/M) gentamicin to standard prophylaxis before TRPB could reduce its incidence.

MATERIALS AND METHODSIn a single urological centre, we performed an interventional study that compared a prospective group with retrospective control. The latter is known as the "cipro-only" group included consecutive patients who underwent TRPB between 1 September 2003 and 31 August 2004. The addition of I/M gentamicin 80 mg half an hour before TRPB started on 1 September 2004. All subsequent patients who underwent TRPB until 31 August 2005 were included in the "cipro+genta" group. Patients who did not receive the studied antibiotics were excluded.

RESULTSThere were 374 patients in the "cipro+genta" group and 367 patients in the "cipro-only" group with comparable profiles. There were 12 cases of post-TRPB sepsis in the "cipro-only" group and 5 cases in the "cipro+genta" group. Ciprofloxacin-resistant Escherichia coli (E. coli) was the only pathogen isolated in both groups. In the "cipro-only" group, 9 patients had positive blood cultures and 8 were sensitive to gentamicin. In the "cipro+genta" group, the only positive E. coli was gentamicin-resistant. One patient in the "cipro+genta" group was admitted to the intensive care unit with septicaemia.

CONCLUSIONThe addition of I/M gentamicin to oral ciprofloxacin is a safe and effective prophylactic antibiotic regime in reducing the incidence of post-TRPB sepsis.

Administration, Oral ; Adult ; Aged ; Antibiotic Prophylaxis ; methods ; Biopsy ; Ciprofloxacin ; administration & dosage ; therapeutic use ; Drug Resistance, Bacterial ; Escherichia coli ; drug effects ; isolation & purification ; Gentamicins ; administration & dosage ; Humans ; Injections, Intramuscular ; Male ; Middle Aged ; Prospective Studies ; Prostate ; diagnostic imaging ; pathology ; Rectum ; Ultrasonography