Bladder Cancer Enters the Targeted Immunotherapy Age

While other cancers have seen great improvements in outcomes due to new therapies and treatment paradigms over the last decades, advanced bladder cancer has been one of the few solid tumors for which no new major breakthrough have been seen in thirty years.

However, all that changed a few weeks ago with the US Food and Drug Administration (FDA) accelerated approval of atezolizumab (Tecentriq, Genentech, Inc), for the treatment of advanced urothelial carcinoma, the most common type of bladder cancer.

Atezolizumab is a targeted immunotherapy that acts as a programmed cell death ligand inhibitor (PD-L1), and is the third agent approved in cancer that targets the PD-1/PD-L1, PD-L2 checkpoint pathway (with nivolumab and pembrolizumab being the other two).

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Isolated Free Fluid without Pneumoperitoneum on Computed Tomography in Blunt Abdominal Trauma: Laparotomy Better Based on Imaging Finding and Clinical Presentation

This study examines the clinical assessment and management of patients sustaining blunt abdominal trauma (BAT) with unexplained intra-abdominal free fluid.All adult patients (age 18 years) presenting with BAT to our trauma center over a 7-year period were reviewed.

Those with abdominal computed tomography (CT) demonstrating intra-peritoneal free fluid but neither solid organ injury nor pneumoperitoneum were studied further. Demographic data, radiologic interpretation, operative findings, clinical management and outcome were analyzed.

115 patients met the inclusion criteria. Except 9 patients for non-operative management, 91 patients (86%) underwent therapeutic laparotomy, in whom 83 patients (78%) benefited from surgical intervention and 15 patients (14%) underwent non-therapeutic laparotomy, in whom 8 patients (8/15=53%) had retroperitoneal hematoma with associated pelvic fractures.

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Metastatic Renal Cell Carcinoma to Submandibular Gland: A Rare Occurrence

Approximately 20-30% of patients affected by renal cell carcinoma (RCC) present with metastatic disease, and 20% to 40% undergoing nephrectomy for clinically localized disease will develop metastases.

A 53 years old female patient developed a left submandibular swelling. Four years before she experienced a left radical nephrectomy for a clear cell tumor and two years later right kidney was removed for a cancer having the same histologic subtype. In that circumstance duodenal pancreasectomy was required for infiltration of pancreatic gland.

A sialoadenectomy has been performed and pathology demonstrated an intraglandular neoplasm with characteristics of a clear renal cell carcinoma. Although it is extremely rare, submandibular salivary gland may be a site of RCC metastasis. Diagnosis of metastatic disease for patients affected by submandibular swelling with a previous history of RCC should be always considered.

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Evaluation on the Effectiveness of the Different Modes of Publicity for Tissue Donation among Healthcare Professionals

There are two laws that governs organ and tissue donation in Singapore-the human organ transplant act (HOTA) and the medical (Therapy, Education and Research) act (MTERA).

Unlike HOTA, which allows for the three organs and one tissue (kidney, liver, heart and corneas) of Singapore citizens and permanent residents to be donated in the event of death for the transplantation purpose, the donation of skin and heart valves are governed by MTERA. The Act provides for voluntary donation of specified organs and tissues for the purposes of transplantation, treatment, education or research.

For the past years, the National Cardiovascular Homograft Bank and the Skin Bank, which are recently merged under Singhealth’s Transplant Tissue Centre in 2015, have engaged in various publicity methods. Many international studies have shown the importance of addressing the gaps in healthcare professionals’ knowledge, attitude and education needs with regards to organ/tissue donation

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Right Versus Left Laparoscopic Donor Nephrectomy: Initial 3 year Experience from a Single Centre Transplant Program

Laparoscopic living donor nephrectomy is the standard of care at high volume transplant centers. Despite this there is still reticence to harvest the right kidney laparoscopically because of concerns regarding the shorter renal vein, higher complexity of dissection and potentially higher complication rates and worse renal allograft outcomes. The aim of this single-center study of 72 consecutive laparoscopic donor nephrectomies was to compare left versus right-sided laparoscopic donors in terms of surgical difficulty, complication rates and outcomes.

There were 56 left-sided and 16 right-sided donors. There was no significant difference in surgical outcomes or complication rates. Similarly, the recipient surgery complication rates and allograft outcomes were no different between kidney sprocured laparoscopically from the left or the right. This single center study shows comparable donor operative parameters and recipient post-operative outcomes in left and right laparoscopic donor nephrectomies.