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The aim of this review is to provide an up-to-date review of the available literature on photodynamic diagnosis (PDD) for nonmuscle-invasive bladder cancer, to present the technique in a comprehensive approach and, finally, to discuss the relevance of PDD in clinical practice in terms of indications, outcomes and its development trend. A literature search was conducted up to July 2012, using MEDLINE and EMBASE via Ovid databases to identify published studies on PDD for nonmuscle-invasive bladder cancer. Only English-language and human-based full manuscripts that reported on case series and studies with >40 participants, concerning clinical evidence of the technique, its efficacy and safety data were included. Evidence showed that PDD significantly improves detection of bladder cancer compared with standard white-light cystoscopy, having proven to be more effective for the diagnosis of carcinoma in situ. This condition seems to facilitate more complete resections, resulting in a lower residual tumor rate, which, in turn consecutively leads to higher recurrence-free survival rates. The literature search demonstrated that for mid- and long-term follow-up, PDD showed acceptable outcomes in terms of tumor detection, as well as lower residual tumor and lower recurrence rates compared with white-light cystoscopy. It has proven to be safe and well tolerated; the major limitations of PDD are its low specificity and elevated costs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the prevalence of cardiac autonomic neuropathy (CAN) in a cohort of patients with type 2 diabetes, truly asymptomatic for coronary artery disease (CAD), using heart rate variability (HRV) and 123I-metaiodobenzylguanidine (123I- mIBG) myocardial scintigraphy. The study group comprised 88 patients with type 2 diabetes prospectively recruited from an outpatient diabetes clinic. In all patients myocardial perfusion scintigraphy, CAN by HRV and 123I- mIBG myocardial scintigraphy were performed. Two or more abnormal tests were defined as CAN-positive (ECG-based CAN) and one or fewer as CAN-negative. CAN assessed by 123I- mIBG scintigraphy was defined as abnormal if the heart-to-mediastinum ratio was <1.8, the washout rate was >25%, or the total defect score was >13. The prevalence of CAN in patients asymptomatic for CAD with type 2 diabetes and normal myocardial perfusion assessed by HRV and 123I- mIBG scintigraphy was respectively, 27% and 58%. Furthermore, in almost half of patients with normal HRV, 123I- mIBG scintigraphy showed CAN. The current study revealed a high prevalence of CAN in patients with type 2 diabetes. Secondly, disagreement between HRV and 123I- mIBG scintigraphy for the assessment of CAN was observed. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the effects of a short-term very-low-calorie diet (VLCD) in type 2 diabetic patients with cardiac complications on myocardial triglyceride (TG) content and cardiac function. Based on the results, only three days of VLCD substantially increased plasma nonesterified fatty acid (NEFA) levels and myocardial TG content. The study was authorized by the Leiden University Medical Center medical ethics committee in the Netherlands.

Background: Cone beam computed tomography (CBCT) enables intraoperative cross-sectional and three-dimensional imaging of the urinary tract. CBCT in a hybrid operating room can be used for intraoperative detection of residual stones and potential additional stone extraction at the end of percutaneous nephrolithotomy (PCNL). This study describes our initial experience with intraoperative CBCT during PCNL and analyzes its role in potentially improving its outcomes. Methods: We conducted a single-center retrospective cohort study at a tertiary referral hospital between 2018 and 2021. The study aimed to evaluate the outcome of patients who underwent intraoperative noncontrast CBCT scan during PCNL. The CBCT scan was performed when the urologist determined the kidney to be endoscopically stone-free. In case any residual fragments were imaged, an additional effort was made to extract them. Patients were divided into three groups based on treatment outcome: stone-free upon CBCT, not stone-free with additional stone extraction after CBCT, and not stone-free without additional stone extraction. Procedure and patient characteristics were recorded to identify factors associated with additional stone extraction during CBCT-assisted PCNL. Results: A total of 102 procedures were included in this study. Intraoperative CBCT scans showed residual calcifications in 58 (57%) cases. In 39 cases, which is 38% of the total population and 61% of the cases with residual calcifications, one or more residual fragments imaged on the intraoperative CBCT-scan were extracted additionally within the same procedure. A higher Guy's Stone Score was associated with a higher likelihood of additionally extracting stones as a result of the CBCT. Conclusions: CBCT-assisted PCNL in a hybrid operating room can lead to additional stone extraction in the same procedure in 37% of all cases and in over 60% of the cases in which residual fragments are imaged. The value of CBCT-assisted PCNL appears to increase in the case of more complex stone surgery cases.

Purpose: Developments in optical diagnostics have potential for less invasive diagnosis of upper urinary tract urothelial carcinoma (UUT-UC). This systematic review provides an overview of technology, applications, and limitations of recently developed optical diagnostics in the upper urinary tract and outlines their potential for future clinical applications. In addition, current evidence was evaluated., Literature Search: A PubMed literature search was performed and articles on narrow band imaging (NBI), photodynamic diagnosis (PDD), Storz professional imaging enhancement system (SPIES), optical coherence tomography (OCT), and confocal laser endomicroscopy (CLE) regarding UUT-UC were reviewed for data extraction. Study quality was reviewed according to Quality Assessment of Diagnostic Accuracy Studies and Innovation, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) standards., Results: Four articles available for quality assessment, demonstrated high level of evidence, but low level of IDEAL stage. NBI and SPIES enhance contrast of mucosal surface and vascular structures, improving tumor detection rate. A first in vivo study showed promising results. PDD uses fluorescence to improve tumor detection rate. However, due to the acute angle of the ureterorenoscopes there is an increased risk of false positives. OCT produces cross-sectional high-resolution images, providing information on tumor grade and stage. A pilot study showed promising diagnostic accuracy. CLE allows ultrahigh-resolution microscopy of tissue resulting in images of the cellular structure. CLE cannot be applied in vivo in the upper urinary tract yet, due to technical limitations., Conclusions: NBI, SPIES, and PDD aim at improving visualization of UUT-UC through contrast enhancement. OCT and CLE aim at providing real-time predictions of histopathological diagnosis. For all techniques, more research has to be conducted before these techniques can be implemented in the routine management of UUT-UC. All techniques might be of value in specific clinical scenarios and allow for integration, for example, OCT with NBI, and could therefore improve tumor detection and staging and help in selecting the optimal treatment for the individual patient.

Ninety-five percent of all urothelial carcinomas are located in the bladder and 5% in the upper urinary tract. Therefore, upper urinary tract urothelial carcinoma is relatively rare, with an incidence of 2.1-2.4 per 100,000 persons per year. Diagnosis is based on imaging, endoscopy, urine cytology and histology. Histopathological diagnosis of upper urinary tract tumours is essential for choice of therapy and follow-up, as both tumour grade and stage are important prognostic factors. Radical nephroureterectomy is the standard treatment, but has a direct effect on kidney function. For this reason, an increasing number of patients with low-risk tumours undergo kidney-sparing surgery to maintain kidney function. After kidney-sparing surgery intensive follow-up of the ipsilateral upper urinary tract is mandatory because of a five-year recurrence-free survival rate of 17-63%, depending on tumour grade. Current diagnostics all have their limitations. Nowadays, research focuses on improving diagnosis in order to be able to offer better individual treatment.

Purpose: Knowledge of tumor stage and grade is paramount for treatment decision making in cases of upper urinary tract urothelial carcinoma but this condition cannot be accurately assessed by current techniques. Optical coherence tomography can hypothetically provide the urologist with real-time intraoperative information on tumor grade and stage. In this pilot study we report what are to our knowledge the first results of optical coherence tomography for grading and staging upper urinary tract urothelial carcinoma., Materials and Methods: Eight consecutive patients underwent ureterorenoscopy for suspicion or followup of upper urinary tract urothelial carcinoma. Optical coherence tomography data sets were intraoperatively obtained from the ureter and renal pelvis. All patients eventually underwent nephroureterectomy. Optical coherence tomography staging was done by visual inspection of lesions found on optical coherence tomography images. Optical coherence tomography grading was done by quantifying optical coherence tomography signal attenuation in mm(-1) on lesions and comparing results with the histopathological diagnosis. The Wilcoxon rank sum test was used for statistical analysis., Results: For 7 in vivo optical coherence tomography diagnoses staging was in accordance with histology. In patient 8 tumor thickness transcended optical coherence tomography imaging depth range and, therefore, invasiveness findings were inconclusive. For grading the median attenuation coefficient for grade 2 and 3 lesions was 1.97 (IQR 1.57-2.30) and 3.53 mm(-1) (IQR 2.74-3.94), respectively (p<0.001). Healthy urothelium was too thin to reliably determine the attenuation coefficient., Conclusions: Optical coherence tomography is a promising, minimally invasive tool for real-time intraoperative optical diagnosis of tumors in the upper urinary tract. Our results warrant future research in a larger sample size to determine the accuracy of grading and staging by optical coherence tomography, and its possible implementation in the diagnostic algorithm for upper urinary tract urothelial carcinoma., (Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)