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Scripps radiation therapist Ivette Martinez, left, and lead radiation therapist Lauren Mascia, prepare prostate cancer patient Larry Tritschler for a proton treatment at the new Scripps Proton Therapy Center in Mira Mesa Tuesday. What started as a proton therapy competition among two of the region’s largest health systems has ended in collaboration. Today, at a grand opening ceremony for a new proton therapy center that bears its name, Scripps Health will announce a new affiliation agreement with Rady Children’s Hospital and UC San Diego Health System. It was not long ago that the university was pursuing a $200 million proton plan of its own. Paul Viviano, chief executive of the university health system, said he met with Scripps CEO Chris Van Gorder a week after starting work in 2012. The center began treating its first patient, 81-year-old Larry Tritschler of San Marcos, for prostate cancer on Feb. Scripps is the 15th health system in the nation to offer proton therapy and the only one in California to offer the latest generation, which uses a sophisticated computer guidance system to more precisely control dose location and strength.
Van Gorder said a collaborative agreement with Rady and the university allows each operator to have its own radiation oncologists care for patients in the center’s five treatment rooms. Though the facility will bear the Scripps name and the health system will manage the operation, Van Gorder said steps will be taken to make sure that the public knows that this is a collaborative effort. With their focuses on children and research, Rady and UC San Diego have the ability to bring critical patient populations to the proton center. Because it irradiates less tissue than X-ray based treatments, protons are viewed as ideal for treating children.
The arrangement with Scripps and Advanced Particle Therapy allows Rady and UCSD radiation oncologists to see their own patients at the facility, rather than transferring them into the care of a Scripps doctor. This makes all the difference for Rady because treating children takes a special approach, Kearns said. The proton center will include a special entrance for Rady patients and a separate area with anesthesia beds. Rady also collaborates regularly with UCSD on medical research, another reason executives said they were excited about the new collaborative agreement.
Viviano of UCSD said that, as one of only 41 National Cancer Institute-designated comprehensive cancer centers, UCSD will be able to help advance research into the efficacy of proton therapy. He said it was critical for Scripps to allow UCSD oncologists free access to see their own patients in the center because Moores Cancer Center, the health system’s main cancer treatment group, relies on a team-based approach. Van Gorder said that the agreement allows doctors to do separate billing for the patients they treat at the center. The executive said he also approached other systems, including Kaiser and Sharp HealthCare, about participating in the proton center.
Materials and Methods: We retrospectively reviewed the medical records of 41 patients who underwent retroperitoneal laparoscopic total or partial nephrectomies performed in our center from 2004 to 2012. Conclusions: Laparoscopic retroperitoneoscopic renal surgery can be carried out safely and effectively in children. Subjects and Methods: The field work was conducted in Riyadh City, during the period February through July 2011.
Conclusion: Beliefs and attitudes have a great impact, at every stage of the cancer continuum, this attitudes depends mainly on level of knowledge and quantity of information provided to patients and their families. Factors effective on survival after radical prostatectomy: To what extent is pre-operative biopsy Gleason scoring is confident in predicting the prognosis? Statistical Analysis Used: Statistical analyses were performed by the Chi-square test and one-way analysis of variance. Conclusions: We think that the PE prevents kidney damage by decreasing oxidative stress in kidney. Materials and Methods: Twelve urology residents at McGill University were enrolled in the study between June 2008 and December 2011. Results: The kappa results demonstrated acceptable agreement between the two observers among all domains of the rating scale of performance except for confidence of movement and efficiency. Conclusions: Predictive validity was not demonstrated for the LapSim simulator in the context of a urology residency training program. Materials and Methods: A total of 3590 patients with bladder tumors operated in our clinic between September 1998 and May 2013 were retrospectively evaluated. Conclusion: Prognosis of urinary bladder tumors was directly related to histological type and stage of the tumor.
Materials and Methods: All patients who underwent laparoscopic management for previously failed dismembered pyeloplasty were analyzed in this study.
Results: A total of 16 patients were managed with laparoscopic approach for previously failed pyeloplasty. Conclusion: Laparoscopic redo pyeloplasty is a viable option with a satisfactory outcome and less morbidity. Settings and Design: This was a prospective randomized controlled study conducted at the Department of Urology, Regional Institute of Medical Sciences, Imphal. Subjects and Methods: One hundred and twenty-six patients requiring ureteroscopic lithotripsy for UVJ calculus were randomly assigned into two groups. Conclusions: Inflamed and or obliterated ureteric orifice is the major constraints for stone clearance at ureterovesical junction. Materials and Methods: We reviewed the results of 220 bone scintigraphies, which were done between January 1, 2011 and June 30, 2013 in patients with newly diagnosed prostate cancer.
Results: Bone metastases were seen in 44 patients of all 220 patients (20%, 95% confidence interval, 17-24%). Aim: To evaluate and compare accuracy of Dynamic contrast enhanced (DCE) and Diffusion weighted (DW) MRI for preoperative T staging of urinary bladder cancer and find correlation between apparent diffusion coefficient (ADC) and maximum enhancement with histological grade.
Conclusion: MRI is an effective tool for determining T stage and histological grade of urinary bladder cancers. Subjects and Methods: During the period of months between June 2010 and July 2012, 180 PE patients presented to outpatient clinic of our hospital.
Conclusion: Tramadol hydrochloride exhibits a significant dose-related efficacy and side-effects over placebo for treatment of PE. Materials and Methods: In 2013, a questionnaire regarding the students' perceptions of urology rotation was developed and E-mailed to all final (5 th ) year medical students and interns of KSU College of Medicine, Riyadh, Saudi Arabia. Conclusions: Knowledge of medical school graduates is insufficient in many urologic subjects, and there is a need for more urology exposure.
Objective: The aim was to describe the prevalence of LUTS in Saudi population and its relation to some other parameters.
Patients and Methods: A total of 81 patients underwent RPN between September 2009 and July 2013 for renal masses.

Results: Mean blood loss in the laparoscopic group (100 mls) was significantly less than open group (300 mls) and no difference between laparoscopic and robotic groups (150 mls).
Conclusions: Our study demonstrates that in obese patients, both laparoscopic and robotic partial nephrectomy are associated with less blood loss than open partial nephrectomy. The deal will allow doctors from both organizations to treat their own cancer patients in the new $220 million Mira Mesa facility.
It uses charged particles to kill tumors with less radiation exposure to surrounding tissue than other available technologies.
But, though Scripps and UC San Diego compete for patients every day, their executives said they decided that working together made better sense.
Scripps will manage the center, but it is owned by a private investment group, Advanced Particle Therapy. Donald Kearns, chief medical officer and acting president at Rady, said a handful of local patients are already traveling to proton facilities in Texas, Oklahoma City or even Boston for treatment of rare brain tumors because the therapy causes less radiation exposure to surrounding tissue. Though adult patients usually receive treatment while awake, many young children need to be sedated to keep them from moving when radiation is delivered.
Scripps will also receive a management fee from Advanced Particle Therapy for running the facility.
While no deals have yet been put together, Van Gorder said Scripps is still open to the idea.
We looked at the demographic data, age at surgery, indication, operative time, surgical complications, conversion to open surgery and operative complications. There were no intraoperative complications (surgical and anesthetic), and no significant blood loss was observed. Still, this procedure is more challenging and requires an excellent image of the retroperitoneal space, especially when partial nephrectomies are concerned. Such attitudes should rely on a solid background of proper information and motivation from physicians to enhance and empower attitudes toward PC screening behavior.
A total of 152 patients undergoing RP following biopsy were retrospectively investigated in an attempt to reveal the effect of discordance between needle biopsy Gleason score and RP Gleason score on prostate specific antigen relapse-free survival. We know that the pomegranate extract (PE) play a strong role on removal of free oxygen radicals and prevention of oxidative stress. The residents had weekly training on the LapSim that consisted of 3 tasks (cutting, clip-applying, and lifting and grasping). A total of 125 patients (107 men and 18 women) with nontransitional cell bladder cancer, confirmed by histopathology, were included in this study. Primary surgical approach for dismembered pyeloplasty was open in 11, laparoscopy in four patients and robotic assisted in one patient. The study group received tablet deflazacort 30 mg once a day for 10 days prior to the procedure, whereas the control group did not receive such treatment. The present study showed the administration of tablet deflazacort (a steroidal anti-inflammatory agent) significantly improves the outcome of URSL under local anesthesia. These parameters were evaluated together with standard clinicopathological data to determine the prediction ability of the bone scan by univariate and multivariate analyses.
In univariate analysis, PSA and biopsy GS were useful in predicting the bone scan result, but ALP and percentage of pathological cores was not.
Dynamic contrast-enhanced and diffusion-weighted MRI has been introduced in clinical MRI protocols of bladder cancer because of its accuracy in staging and grading. All patients underwent Magnetic Resonance Imaging (MRI) on a 1.5-T scanner with a phased-array pelvic coil.
Social reasons and lack of knowledge about urology hinder the choice of urology specialty as a future career. All participants were assessed for the serum level of prostate-specific antigen (PSA) and digital rectal examination. There was a weak, but significant correlation between the total IPSS and age, total prostate volume, and PSA.
Advanced skills are needed to accomplish tumor resection, hemostasis, and renorrhaphy within short ischemia time in RPN. Patients were divided into three groups according to intervention received: Open (n = 21), laparoscopic (n = 31) and robotic (n = 14). We observed a shorter median hospital stay in the laparoscopic group (two days) than open group (four days) and no difference between laparoscopic and robotic groups (three days). Second, the length of the hospital stay was not related to the type of utilized intervention. PUV continues to be a significant cause of morbidity and ongoing renal damage in infants and children. Ultimately it may be associated with substantial morbidity and even life-threatening events. Here, we present an atypical case where even in the absence of physical findings, a characteristic history led us to penile exploration and timely repair, highlighting the importance of careful history-taking in these cases.
Kearns said most proton centers do not have special areas for children, making the Scripps facility ideal. Furthermore, the Qur'ānic documentation of the role of practical demonstration on the individual's mind as well as the societies' collective mind is pointed out.
The Medline search used a strategy including medical subject headings and free-text protocols. Vesicoureteric reflux, pelviureteric junction obstruction, and multicystic dysplastic kidney disease were the main underlying pathologies.
Conversion to open surgery was necessary in two cases caused by failure to progress due to difficult anatomy during the partial nephrectomies.
In addition to socio-demographic data, history of the present and past medical illness, history of prostatic diseases and examination, family history of cancer prostate; participants were inquired about their knowledge and attitude toward prostate cancer (PC) and screening behavior using through two different Likert scales.
The respondents identified the physicians as the main sources of this information (62.4%), though they were not the main motives for a regular checkup.
In the current study study, we evaluated the effect of PE on kidney damage after unilateral ureteral obstruction (UUO). After 14 days, rats were killed and their kidneys were taken and blood analysis was performed. They underwent monthly assessment of their LapSim performance using total time, tissue damage and path length among other parameters as surrogates for their economy of movement and respect for tissue. The patients' characteristics, including age, gender, smoking history, tumor size, and localization, histological types, pathological tumor stages, treatment modalities, and survival rates were all recorded. Parameters with respect to the outcome of the procedure were recorded for all patients in both groups.

MR images were evaluated and assigned a stage which was compared with the histolopathological staging.
Results were more accurate when both ADC and DCE-MRI were used together and hence a combined approach is suggested.
All the respondents but 18 (8.9%) were enrolled in a urology rotation during undergraduate years.
Clearance of learning objectives, immediate and prompt feedback on performance and adequate emphasis of common problems and ambulatory care are some aspects that should be taken into account by curriculum planners as they consider improvements to urology rotation program. Participants were given a linguistically validated Arabic version of the International Prostate Symptom Score (IPSS). Off-clamp RPN with zero ischemia may decrease the risk of ischemic reperfusion injury to the kidney. The off-clamp technique was utilized for exophytic, nonhilar tumors that have a base of 2 cm or less. The outcome variables of blood loss, length of hospital stay, and complications were assessed. Three patients in the laparoscopic group had complications: Two grade II and one with grade III (based on Clavien-Dindo classification). Primitive neuroectodermal tumors occur preferentially in the soft-tissues of the paravertebral region and chest wall, less frequently in extremities, with a slight male predominance.
It can coexist with vesicoureteral reflux (VUR) in about 50% of cases and also with patent urachus in about one-third of cases.
Mixed NCS with renal vein duplication is an exceptional variety, have previously been reported to the best of our knowledge.
In addition, the study shows how the Qur'ān guides people to the proper use of reason within a scientific framework of mind.
PCNL is a well-established treatment option for patients with large and complex renal calculi. The last residents' LapSim performance was compared with their first performance of radical nephrectomy on anesthetized porcine models in their 4 th year of training. Intra-vaginal ejaculatory latency time (IELT) was recorded in seconds initially and for each arm. Multiple regression analysis reported that prostate volume and all individual items of IPSS except straining were significant predictors of QOL and patient satisfaction, where frequency and incomplete emptying had the heaviest impact on patient's QOL. We developed a novel technique to avoid ischemia reperfusion renal injury while minimizing blood loss in certain cases of RPN. We report a case of primitive neuroectodermal tumor of the kidney in a 17-year-old male with a pre-operative diagnosis of renal cell carcinoma-stage 4. It is a case of a 22-day-old full-term male child who presented with poor urinary stream and progressive abdominal distension of 5-day duration as well as leakage of clear fluid from umbilicus of 1-day duration.
We report a rare case of an 18-year-old boy who presented with a long history of abdominal, pelvic and left flank pain, fatigue and higher bilateral varicocele. In order to decrease morbidity associated with larger instruments like blood loss, postoperative pain and potential renal damage, a modification of the technique of standard PCNL has been developed.
Two independent urologic surgeons rated the resident performance on the porcine models, and kappa test with standardized weight function was used to assess for inter-observer bias. Operative and postoperative outcomes of laparoscopic redo pyeloplasty were compared with that of laparoscopic primary pyeloplasty. The purpose of this study was to evaluate the outcome of our modified off-clamp technique utilized in certain RPN cases. The patient underwent radical nephrectomy and histopathological examination revealed a highly aggressive tumor of monotonous sheets of round cells with focal areas of rosette formations and high mitotic rate with Ki67 index of 25-30%.
Computed tomographic angiography, Doppler ultrasonography and venography were performed revealed left renal vein duplication with dilated retroaortic and preaortic branchs, entrapped respectively between the aorta and the vertebral column and in the aortico-mesenteric space, with extensive and complex varices of the deep pelvic venous plexus; promoting the mixed renal NCS. This is performed with a miniature endoscope via a small percutaneous tract (11-20 F) and was named as minimally invasive or mini-PCNL. Also in this comparison, the difference in-between has been statically found significant (P = 0.041). Nonparametric spearman correlation test was used to compare each rater's cumulative score with the cumulative score obtained on the porcine models in order to test the predictive validity of the LapSim simulator. Tumor cells were positive for CD 99 confirming the diagnosis of primitive neuroectodermal tumor. Auto transplantation of the left kidney was suggested, but refused by the patient; and only the varicocele was managed.
This method was initially described as an alternative percutaneous approach to large renal stones in a pediatric patient population. Eventually, different grading, particularly determination of Gleason score higher than the RP specimen biopsy also bring about bad pathologic parameters and shortened survival periods. Primitive neuroectodermal tumor of the kidney needs to be kept in mind as a differential diagnosis in young adults presenting with a large kidney mass. In addition, a grade V left VUR and a fistulous tract between the dome of the urinary bladder and the umbilicus, which was consistent with a patent urachus was demonstrated.
Furthermore, it has become a treatment option for adults as well, and it is used as a treatment for calculi of various sizes and locations. In conclusion, this case demonstrates a rare combination of congenital urinary tract anomalies involving PUV, left VUR and patent urachus.
Diagnosis is difficult and should be considered in patients with inexplicable flank or abdominal pain. However, the terminology has not been standardized yet, and the procedure lacks a clear definition. Our purpose is to raise clinician's awareness for this condition so that they will be more likely to diagnose it. Nevertheless, mini-PCNL can achieve comparable stone-free rates to the conventional method, even for large stones. Although less invasiveness has not been clearly demonstrated so far, mini-PCNL is usually related to less blood loss and shorter hospital stay than the standard method.

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