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The evidence on bladder cancer in the young population remains fragmented due to lack of literature and conflicting results from the existing studies. We aim to elucidate such conflicting data and define the clinicopathologic characteristics, management trends, and outcomes of urothelial bladder carcinoma in young adults as compared to their older counterparts. This was a retrospective, single-center study involving patients with primary urothelial bladder cancer who underwent treatment at our center from March 2017 to March 2022. For analysis, patients were stratified into three subgroups based on age: group A, 18–40 years; group B, > 40 years; and group C, > 60 years. Group A with younger patients was compared with groups B and C. A total of 471 eligible patients (422 males and 49 females) were included in the study with a median age of 44 years. Group A had significantly lower recurrence and progression rates as compared to group B (31% vs 57.1%, p = 0.002 and 9.5% vs 19.2%, p = 0.04, respectively). Group A had significantly more recurrence-free survival (RFS) than group B (5-year-RFS = 68.03% vs 32.58%, p = 0.01). Similarly, group A also had lower recurrence (31% vs 62.6%, p < 0.001) and progression (9.5% vs 28.6%, p = 0.015) rates as compared to group C as well as better RFS (5-year-RFS = 68.03% vs 19.00%, p = 0.04) and progression-free survival (5-year-PFS = 83.1% vs 62.8%, p = 0.03) in comparison to group C. Age and tumor grade were found to be independent predictors of recurrence-free and progression-free survival. We concluded that high-grade disease is more common than low-grade disease both in younger and older patients. Younger patients fare better in terms of recurrence and progression when compared to their older counterparts. [ABSTRACT FROM AUTHOR]

To describe a concept of ideal 'puncture zone' as against any single ideal 'puncture tract' for percutaneous nephro-lithotomy (PCNL) and present our results. Through this narrative, we aim to reduce the gaps in inter-understanding of an erstwhile description of ideal tract and real-life puncture making. The puncture zone principle was applied for our novel puncture making technique during PCNL. The largest imaginary cone that can fit into a respective calyx, with its tip in the pelvis defines the 'puncture zone' for that calyx. This concept allows fine-tuning of the ideal puncture tract based upon the desired corresponding manipulation zone and also shifts the focus of puncture making to infundibulum anatomy from the tip of calyx. The surgical technique and retrospective review of 136 cases done between 2015 and 2021 using this concept are presented. Primary outcome included stone-free rate, pseudo-aneurysm and blood transfusion at 3 months of follow-up. 33 cases had multiple (> 3) stones, 21 only calyceal/infundibular stones, eight partial staghorn and 12 were complete staghorn stones. Mean stone size was 29 ± 15 (Range: 5–53) mm. Complete clearance was achieved in 127 cases, four of which required two tracts. Blood transfusion was required in one case. No pseudo-aneurysms were encountered. The puncture zone concept has provided good results in our hands. It may help easier understanding of PCN puncture making and provides a background for reconciliation between description of an ideal tract and practical puncturing techniques used by different surgeons. [ABSTRACT FROM AUTHOR]

Horseshoe kidney is a rare congenital anomaly resulting from the fusion of the lower pole leading to medial and caudal deviation of kidneys that pose challenges to successful stone clearance. We evaluated the various patient- and treatment-related factors that can impact successful stone clearance. A total of 34 patients with 36 renal moieties with urolithiasis in horseshoe kidneys from 2015 to 2021 were included with a median age of 38 years (11–56 years). The mean calculus size was 39.27 mm (21–70 mm). Twenty-two patients had left, 10 had right, and 2 had bilateral disease. Twelve patients (33%) had previous interventions done. As per Guy stone score (GSS), 14 patients had grade IV, 16 patients had grade III, and 4 patients had grade II disease. Of these patients, 22 underwent unilateral percutaneous nephrolithotomy (PCNL), 2 underwent bilateral PCNL, 6 had pyelolithotomy, 2 had right nephrectomy, and 2 patients underwent shockwave lithotripsy (SWL). Six patients undergoing pyelolithotomy had complete clearance. In PCNL, infra-costal puncture was done uniformly. Complete clearance was seen in 12 out of 16 with superior calyceal access (75% stone-free rates, SFR), 2 out of 8 with middle calyceal puncture (25% SFR), and both the cases with inferior calyceal puncture (100% SFR). Factors affecting stone clearance are as follows: GSS, i.e., grade < IV vs ≥ IV (71.4 vs 50%, P = 0.42), STONE score < 12 vs ≥ 12 (83.3 vs 28.5%, P = 0.048), stone size < 40 vs ≥ 40 mm (50 vs 71.4%, P = 0.42). Our analysis showed that stone clearance was independent of mode of access, GSS, or stone size, although STONE score was a predictor of successful outcomes in PCNL. [ABSTRACT FROM AUTHOR]

Numerous studies have been done for markers of lung injury especially in animal models and it remains relatively unexplored whether these biomarkers clinically correlate with the outcome of patients or with the extent of lung parenchymal injury as deduced by MDCT. This prospective study was conducted to assess the serum level of Clara cell secretory protein (CC16) and volume of the uninvolved lung by MDCT and to ascertain the correlation between levels of CC16 with the volume of the injured lung in the clinical outcome of patients of blunt thoracic trauma. Serum CC16 levels and mean uninvolved lung volumes of both lungs were compared in between groups of eventless recovery, need for mechanical ventilation and mortality with p value < 0.05 considered to be significant. Sixty-two patients of blunt chest trauma, age range from 18 to 60 years, were evaluated in our study. Out of them, 43 (69%) were male. Higher level (more than 100 ng/mL) of serum Clara cell protein was associated with the requirement of ventilator and mortality. Total mean uninvolved lung volume of 1075.71 ± 327.5 and 2329.23 ± 776.01 was significantly associated with the requirement of mechanical ventilation and eventless recovery of patients respectively. A mild negative correlation (− 0.4) between the remaining volume of the lung after injury and serum Clara cell protein levels were also noted. Serum CC16 levels may obviate the need of MDCT in the selected group of patients and thereby avoiding its radiation hazards. [ABSTRACT FROM AUTHOR]

Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by intestinal hamartomatous polyps in association with skin and mucosal macular melanin deposition. There is a lifetime chance of 93% of cancers when all cancers are combined and the incidence of the disease is variable between 1 in 8300 and 1 in 280,000 live births (Daniell et al., Familial Cancer 17(3):421-427, 2018). Here, we present a 14-year-old Indian boy presenting to surgical emergency with intestinal obstruction secondary to jejunojejunal intussusception for which resection and anastomosis were done. Post-operative histopathological examination showed a single polyp leading to intussusception. He classically showed mucocutaneous pigmentation on general examination. Early identification of Peutz-Jeghers syndrome on a routine visit to healthcare can decrease complications like intestinal obstruction and help in starting early surveillance for cancers. [ABSTRACT FROM AUTHOR]