Tehran University Medical Journal

Background: Prostate cancer has been reported as a worldwide important kind of cancer and the second most common cause of cancer-related mortality among men. Prostate-specific antigen (PSA) serum level is one of the most important markers of prostate cancer diagnosis. While PSA level helps predict the risk of prostate cancer development, researchers still looking for ways to increase the accuracy of prognostic models. To increase the specificity of PSA and decrease of unnecessary biopsies and morbidity, PSA-related parameters such as PSA doubling time (PSADT) have been used. In this study, the relationship between this factor and the severity of prostate cancer was evaluated.
Methods: In this retrospective study, the data of patients who were subjected to transrectal ultrasound-guided (TRUS) biopsy of the prostate and referred to Imam Khomeini Hospital, Tehran, between 2009 and 2017 were reviewed. We enrolled the men with at least two consecutive elevated PSA level within three months to calculate PSADT. Based on the pathology report, primary and secondary Gleason score (GS) were determined. Correspondingly, considering GS, the patients were divided into two groups with high-grade and low-grade tumor (GS<7 considered as low-grade and GS>7 considered as high-grade tumor).
Results: Totally, 1712 cases of TRUS biopsy of the prostate were studied. Among them, 547 (32.3%) had prostate cancer, of whom 73 cases were eligible based on inclusion criteria and were consented to enroll in the study. According to the data obtained, we found a significant difference in PSADT between the two groups of patients with high-grade and low-grade malignancy (mean±SD PSADT, 9.8±14.2 vs. 16.1±14.9 respectively, P=0.004). Considering the seven months as the cut-off point for PSADT in determining malignancy, there was a significant difference between the two groups according to Fisher's exact test (P=0.01).
Conclusion: In our study, PSADT cut-off of 7 months provided the greatest accuracy for differentiation between low-grade and high-grade malignancy, and PSADT has acceptable accuracy for the diagnosis of high-grade tumors.

Methods: Our study was an interventional study from January 2015 to January 2018 on 16 lacrimal systems of 11 patients (5 males and 6 females) with congenital obstruction of the lacrimal duct (CNLDO) and a history of unsuccessful probing and stenting, in Farabi Hospital of Tehran (affiliated to Tehran University of Medical Sciences). Children who presented to our hospital and had previously been probed with or without intubation by another surgeon first underwent reprobing and re-intubation with a Crawford tube. Endoscopy of the nasolacrimal system was performed in suspected cases of false stent passage or in the presence of a history indicating nasal pathology. Crawford's Monoka tube was removed after two months. Balloon dacryoplasty with intubation was performed as the third surgery in cases who did not respond to probing and stenting after 3-6 months. The success after six months was evaluated using fluorescein dye disappearance test (FDDT) and also the resolution of the patients' symptoms.

Results: The age of the patients was 67±35.01 months (range: 26-121). The site of the canalicular stenosis in our patients was in the common canaliculi or within 2-3 mm from it. After 6 months, surgery was successfully performed in 13 lacrimal systems (81.25%). One patient with congenital lacrimal duct obstruction and Down syndrome and two other patients did not respond to balloon dacryoplasty and stenting and subsequently underwent dacryocystorhinostomy (DCR).

Conclusion: Balloon dacryoplasty combined with Monocrawford intubation is an effective surgical procedure that should be considered in cases of congenital nasolacrimal duct obstruction who have not responded to the probing and stenting of the lacrimal system.