Inland Hospital

Strictures of the male urethra are common, often caused by trauma or occur idiopathically. The primary clinical symptoms include chronic obstructive voiding issues, and some patients may experience sexual dysfunction. Treatment choices mainly depend on the stricture's location and length. A 37-year-old man visited the urology department with lower urinary tract symptoms and recurrent urinary tract infections. He had a 5 cm urethral stricture previously treated with urethroplasty, which was unsuccessful. A retrograde urethrography revealed the stricture, an extra-anatomical bypass, and a diverticulum. A second urethroplasty was performed, using a combination of a buccal mucosa graft and a penile skin flap. Postoperative follow-up indicated improvement in the patient's voiding symptoms. A retrograde urethrography was done 3 months after the procedure showing a well-patent urethra with no complications. The key factors in deciding the treatment for urethral strictures are their location and length. Both grafts and flaps are effective for urethroplasties. However, complex long strictures with damaged urethral plates pose challenges for successful single-stage reconstruction. Combining a dorsal buccal mucosa graft to augment the urethral plate with a ventral onlay penile skin flap is a promising approach, leveraging the benefits of both tissue types. Combining grafts and flaps is advisable for reconstructing complicated urethral strictures with damaged urethral plates. Consulting a more experienced surgeon is recommended to minimize the risk of complications.

A man in his seventies underwent routine heart examinations as part of workup for kidney transplantation. Unexpected findings led to more extensive investigations and revealed two rare systemic diseases as causes of his heart failure.

Kidney extraction time has a detrimental effect on post-transplantation outcome. This study aims to improve the flush-out and potentially decrease ischemic injury by the addition of hydrogen sulphide (H2S) to the flush medium. Porcine kidneys (n = 22) were extracted during organ recovery surgery. Pigs underwent brain death induction or a Sham operation, resulting in four groups: donation after brain death (DBD) control, DBD H2S, non-DBD control, and non-DBD H2S. Directly after the abdominal flush, kidneys were extracted and flushed with or without H2S and stored for 13 h via static cold storage (SCS) +/− H2S before reperfusion on normothermic machine perfusion. Pro-inflammatory cytokines IL-1b and IL-8 were significantly lower in H2S treated DBD kidneys during NMP (p = 0.03). The non-DBD kidneys show superiority in renal function (creatinine clearance and FENa) compared to the DBD control group (p = 0.03 and p = 0.004). No differences were seen in perfusion parameters, injury markers and histological appearance. We found an overall trend of better renal function in the non-DBD kidneys compared to the DBD kidneys. The addition of H2S during the flush out and SCS resulted in a reduction in pro-inflammatory cytokines without affecting renal function or injury markers.

Som «skårunger» på vår første konferanse, vil vi gjerne dele noen inntrykk fra den europeiske GIM konferansen holdt i Fredericia 21.- 25. september 2022 (inkl. prekonferanse). Konferansen ble utsatt i to år på grunn av pandemien. «Skårunger» er en betegnelse I Norge for "førstereisgutter på fiske".

Background: Nigeria has the second highest case of multi-drug resistant tuberculosis (MDR TB) in Africa, estimated at 29,000 in 2015. The laboratory diagnosis of MDR TB in Nigeria is currently done using GeneXpert assay that generates results in less than two hours but can detect resistance to only rifampicin and has high-technology requirements. The objective of this study is to detect MDR TB using Microscopic Observation Drug Susceptibility (MODS) assay in Lagos State, Nigeria.
 Methodology: A total of 80 patients who were positive for TB by GeneXpert in three Directly Observed Treatment Short-course (DOTS) centres in Lagos were studied. Spot sputum samples were collected from each patient andtransported on ice-packs to Lagos University Teaching Hospital (LUTH) DOTS laboratory for decontamination. Culture and drug sensitivity test (DST) were performed on the pellets obtained by MODS assay in 24-well plates and examined with an inverted light microscope within 6 to 21 days of incubation at 35oC.
 Results: Of the 80 patients, males were 43 (53.8%) while females were 37 (46.2%), with mean age of 36.2±11.6years. Seventy-six (95.0%) of the patients had cough at presentation, 60 (75.0%) had not commenced anti-TB treatment, 15 (18.8%) were previously treated (PT) TB cases, and 14 (17.5%) were HIV positive. MODS assay detected Mycobacterium tuberculosis (MTB) in 52 (65.0%) patients across all the age groups but association between age groups and MTB detection by MODS assay was not significant (p=0.447). MODS assay detected MTB in 50 (83.3%) of 60 patients who had not commenced anti-TB drugs compared to 2 (10.0%) of 20 who had commenced anti-TB drugs at the time of sample collection (p<0.0001). Nine (60.0%) of 15 PT TB cases had MTB detected compared to 43 (66.2%) of 65 new cases of TB (p=0.7657). Nine of the 14 (64.3%) HIV positive patients were co-infected with MTB detected by MODS assay compared to 43 (65.2%) of 66 HIV negative patients (p=1.000). MDR TB was detected by MODS assay in 2 (2.5%) of the 80 patients (aged 30 and 38 years) who were previously identified as rifampicin resistant by GeneXpert assay (p=0.0003). The 2 MDR-TB cases were seen in the 15 PT (13.3%) cases, and in 1 of the 14 HIV (7.1%) positive patients.
 Conclusion: MODS assay detected MDR-TB among PT TB patients in Lagos, Nigeria at the rate of 2.5%. Hence, MODS assay is an effective, low-tech, liquid culture technique to accurately detect TB and MDR-TB simultaneously.
 
 French title: Détection de la tuberculose multirésistante (TB-MDR) à l'aide d'un test d'observation microscopique de sensibilité aux médicaments (MODS) dans l'État de Lagos, au sud-ouest du Nigeria
 Contexte: Le Nigéria compte le deuxième cas le plus élevé de tuberculose multirésistante (TB-MDR) en Afrique, estimé à 29 000 en 2015. Le diagnostic en laboratoire de la TB-MDR au Nigeria est actuellement effectué à l'aide du test GeneXpert qui génère des résultats en moins de deux heures, mais peut détecter la résistance à la seule rifampicine et a des exigences de haute technologie. L'objectif de cette étude est de détecter la tuberculose multirésistante à l'aide du test d'observation microscopique de la sensibilité aux médicaments (MODS) dans l'État de Lagos, au Nigeria.
 Méthodologie: Un total de 80 patients positifs pour la tuberculose par GeneXpert dans trois centres de traitement de courte durée sous surveillance directe (DOTS) à Lagos ont été étudiés. Des échantillons ponctuels d'expectorations ont été prélevés sur chaque patient et transportés sur des sacs de glace au laboratoire DOTS de l'hôpital universitaire de Lagos (LUTH) pour décontamination. La culture et le test de sensibilité aux médicaments (DST) ont été effectués sur les culots obtenus par dosage MODS dans des plaques à 24 puits et examinés au microscope optique inversé dans les 6 à 21 jours d'incubation à 35oC.
 Résultats: Sur les 80 patients, les hommes étaient au nombre de 43 (53,8%) tandis que les femmes étaient au nombre de 37 (46,2 %), avec un âge moyen de 36,2±11,6 ans. Soixante-seize (95,0%) des patients avaient toussé au moment de la présentation, 60 (75,0%) n'avaient pas commencé de traitement antituberculeux, 15 (18,8%) étaient des cas de tuberculose précédemment traités (PT) et 14 (17,5%) étaient infectés par le VIH. positif. Le test MODS a détecté Mycobacterium tuberculosis (MTB) chez 52 (65,0%) patients dans tous les groupes d'âge, mais l'association entre les groupes d'âge et la détection de MTB par le test MODS n'était pas significative (p=0,447). Le test MODS a détecté MTB chez 50 (83,3%) des 60 patients qui n'avaient pas commencé les médicaments antituberculeux par rapport à 2 (10,0%) des 20 qui avaient commencé les médicaments antituberculeux au moment du prélèvement de l'échantillon (p<0,0001). Neuf (60,0%) des 15 cas de TB PT avaient une MTB détectée contre 43 (66,2%) des 65 nouveaux cas de TB (p=0,7657). Neuf des 14 (64,3%) patients séropositifs pour le VIH étaient co-infectés par le MTB détecté par le test MODS, contre 43 (65,2%) des 66 patients séronégatifs pour le VIH (p=1 000). La tuberculose multirésistante a été détectée par le test MODS chez 2 (2,5%) des 80 patients (âgés de 30 et 38 ans) précédemment identifiés comme résistants à la rifampicine par le test GeneXpert (p=0,0003). Les 2 cas de TB-MR ont été observés chez les 15 cas PT (13,3%) et chez 1 des 14 patients séropositifs (7,1%).
 Conclusion: Le test MODS a détecté la TB-MR chez les patients PT TB à Lagos, au Nigeria, à un taux de 2,5 %. Par conséquent, le test MODS est une technique de culture liquide efficace et de faible technologie pour détecter simultanément avec précision la tuberculose et la tuberculose multirésistante.

The Hedgehog signaling pathway (Hh) probably plays a role in development and progression of pancreatic ductal adenocarcinoma (PDAC). In our study, 114 patients (83 with PDAC and 31 with chronic pancreatitis [CP]) after pancreatic surgery were enrolled. The immunoexpression of Sonic hedgehog (Shh), Smoothened (Smo), and Glioblastoma transcription factor 1 (Gli1) and Ki-67 were detected in tissue specimens. Mean (standard deviation) immunoexpression of all Hh pathway molecules was significantly higher in PDAC than in CP patients: Shh, 2.24 (0.57) versus 1.17 (0.25) (P < 0.01); Smo, 2.62 (0.34) versus 1.21 (0.23) (P < 0.01); and Gli1, 1.74 (0.74) versus 1.15 (0.72) (P < 0.01). Patients with a lower expression level (z score <0) of Shh and Ki-67 have longer overall survival when compared with z score >0 (15.97 vs 8.53 months [P = 0.0087] and 15.20 vs 5.53 months [P = 0.0004], respectively). In addition, Shh sensitivity in PDAC detection was 84.3%; specificity, 93.5%; positive predictive value, 97.2%; and negative predictive value, 69%. Our results suggest the prognostic role of the Hh pathway in PDAC and a role in the differential diagnosis with CP.

BackgroundIn South-Eastern Norway, genetic testing for BRCA1 and BRCA2 is offered to breast cancer patients by their treating surgeon or oncologist. Genetic counselling from a geneticist or a genetic counsellor is offered only to those who test positive for a pathogenic variant or have a family history of cancer. This practice is termed “mainstreamed genetic testing”. The aim of this study was to learn about patients’ experience of this healthcare service.MethodsQualitative in-depth interviews were conducted with 22 breast cancer patients who had been diagnosed during the first half of 2016 or 2017 at one regional and one university hospital and who had been offered testing by their treating physician. A six-phase thematic approach was used to analyse the data.ResultsThe participants had varied experiences of how and when testing was offered. Three main themes emerged from the analysis: 1. informational and communicational needs and challenges during a chaotic time, 2. the value of genetic testing and 3. the importance of standardised routines for mainstreamed genetic testing.ConclusionsDespite the shock of their diagnosis and the varying experiences they had in respect of how and when testing was offered, all of the participants emphasised that genetic testing had been an important part of their diagnosis and treatment. Our results indicate that there is a need for continuous collaboration between geneticists, surgeons, oncologists and laboratory specialists in order to establish simple and robust routines so as to ensure that all eligible breast cancer patients are offered testing at a point when the test result can have an impact on treatment.