Background: Bladder cancer constitutes 30% of all cancer patients, for whom a non-invasive marker is, required for the follow-up and diagnosis and follow up. Aim: Evaluation of the potential prognostic significance of serum osteoprotegerin (OPG), and pS3 protein and urine telomerase in patients with bladder cancer. Methods: For all patients, serum levels of OPG and pS3 protein were determined using ELISA and urine telomerase by PCR ELISA technique. Patients were then assigned into group1 (cystectomy and adjuvant radiotherapy) and group2 (TUR and chemoradiation). Results: Serum OPG and p53 levels and urine telomerase were significantly higher in bladder cancer patients than in healthy individuals. (p 0.0001). High serum OPG was associated with significantly lower OAS and DFS rates (p=0.001), and was correlated with advanced T stages (p0.0001), high grades (p0.0001) and presence of disease relapse (p=0.001).Serum p53 and urine telomerase did not show prognostic significance. Conclusions: Serum OPG level may be used as a diagnostic tool and a prognostic variable in patients with muscle invasive bladder cancer. Future trials are needed to elucidate its therapeutic role in those patients.

Background: Bladder cancer constitutes 30% of all cancer patients, for whom a non-invasive marker is, required for the follow-up and diagnosis and follow up. Aim: Evaluation of the potential prognostic significance of serum osteoprotegerin (OPG), and pS3 protein and urine telomerase in patients with bladder cancer. Methods: For all patients, serum levels of OPG and pS3 protein were determined using ELISA and urine telomerase by PCR ELISA technique. Patients were then assigned into group1 (cystectomy and adjuvant radiotherapy) and group2 (TUR and chemoradiation). Results: Serum OPG and p53 levels and urine telomerase were significantly higher in bladder cancer patients than in healthy individuals. (p 0.0001). High serum OPG was associated with significantly lower OAS and DFS rates (p=0.001), and was correlated with advanced T stages (p0.0001), high grades (p0.0001) and presence of disease relapse (p=0.001).Serum p53 and urine telomerase did not show prognostic significance. Conclusions: Serum OPG level may be used as a diagnostic tool and a prognostic variable in patients with muscle invasive bladder cancer. Future trials are needed to elucidate its therapeutic role in those patients.

Background: Bladder cancer constitutes 30% of all cancer patients, for whom a non-invasive marker is, required for the follow-up and diagnosis and follow up. Aim: Evaluation of the potential prognostic significance of serum osteoprotegerin (OPG), and pS3 protein and urine telomerase in patients with bladder cancer. Methods: For all patients, serum levels of OPG and pS3 protein were determined using ELISA and urine telomerase by PCR ELISA technique. Patients were then assigned into group1 (cystectomy and adjuvant radiotherapy) and group2 (TUR and chemoradiation). Results: Serum OPG and p53 levels and urine telomerase were significantly higher in bladder cancer patients than in healthy individuals. (p 0.0001). High serum OPG was associated with significantly lower OAS and DFS rates (p=0.001), and was correlated with advanced T stages (p0.0001), high grades (p0.0001) and presence of disease relapse (p=0.001).Serum p53 and urine telomerase did not show prognostic significance. Conclusions: Serum OPG level may be used as a diagnostic tool and a prognostic variable in patients with muscle invasive bladder cancer. Future trials are needed to elucidate its therapeutic role in those patients.

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Intrathecal ketamine has been studied extensively in animals, but rarely in humans. Intrathecal dexmedetomidine prolongs the duration of spinal anesthesia. Objective: To investigate the efficacy and safety of intrathecal dexmedetomidine, ketamine, or both when added to bupivacaine for postoperative analgesia in major abdominal cancer surgery. Design: Double-blinded, randomized, controlled trial. Setting: Academic medical center. Methods: Ninety patients were randomly allocated to receive either intrathecal 10 mg of hyperbaric bupivacaine 0.5% and 5 μg of dexmedetomidine (group I, n = 30), 10 mg of hyperbaric bupivacaine 0.5% and 0.1 mg/kg ketamine (group II, n = 30), or 10 mg of hyperbaric bupivacaine 0.5% and 5 μg of dexmedetomidine plus 0.1 mg/kg of ketamine (group III, n = 30). Hemodynamics, pain score, time to first request of analgesia, total PCA morphine consumption, sedation score, and adverse effects in the first 24 hours postoperatively were recorded. Results: Time to first request of analgesia was longer in group II (7.42 ± 1.43 h) and group III (13.00 ± 7.31h) compared to group I (3.50 ± 1.57 h). PCA morphine consumption was less in group III (6.67 ± 2.8 mg) compared to group I (9.16 ± 3.63 mg) and group II (8.66 ± 3.49 mg). Group III showed lower postoperative pain scores, and a higher incidence of postoperative sedation (P 0.03). Limitations: This study is limited by its relatively small sample size. Conclusion: In conclusion, the combination of intrathecal dexmedetomidine and ketamine provided superior postoperative analgesia, prolonged the time to first request of rescue analgesia, and reduced the total consumption of PCA morphine, without serious side effects compared to either drug alone.

Intrathecal ketamine has been studied extensively in animals, but rarely in humans. Intrathecal dexmedetomidine prolongs the duration of spinal anesthesia. Objective: To investigate the efficacy and safety of intrathecal dexmedetomidine, ketamine, or both when added to bupivacaine for postoperative analgesia in major abdominal cancer surgery. Design: Double-blinded, randomized, controlled trial. Setting: Academic medical center. Methods: Ninety patients were randomly allocated to receive either intrathecal 10 mg of hyperbaric bupivacaine 0.5% and 5 μg of dexmedetomidine (group I, n = 30), 10 mg of hyperbaric bupivacaine 0.5% and 0.1 mg/kg ketamine (group II, n = 30), or 10 mg of hyperbaric bupivacaine 0.5% and 5 μg of dexmedetomidine plus 0.1 mg/kg of ketamine (group III, n = 30). Hemodynamics, pain score, time to first request of analgesia, total PCA morphine consumption, sedation score, and adverse effects in the first 24 hours postoperatively were recorded. Results: Time to first request of analgesia was longer in group II (7.42 ± 1.43 h) and group III (13.00 ± 7.31h) compared to group I (3.50 ± 1.57 h). PCA morphine consumption was less in group III (6.67 ± 2.8 mg) compared to group I (9.16 ± 3.63 mg) and group II (8.66 ± 3.49 mg). Group III showed lower postoperative pain scores, and a higher incidence of postoperative sedation (P 0.03). Limitations: This study is limited by its relatively small sample size. Conclusion: In conclusion, the combination of intrathecal dexmedetomidine and ketamine provided superior postoperative analgesia, prolonged the time to first request of rescue analgesia, and reduced the total consumption of PCA morphine, without serious side effects compared to either drug alone.

Intrathecal ketamine has been studied extensively in animals, but rarely in humans. Intrathecal dexmedetomidine prolongs the duration of spinal anesthesia. Objective: To investigate the efficacy and safety of intrathecal dexmedetomidine, ketamine, or both when added to bupivacaine for postoperative analgesia in major abdominal cancer surgery. Design: Double-blinded, randomized, controlled trial. Setting: Academic medical center. Methods: Ninety patients were randomly allocated to receive either intrathecal 10 mg of hyperbaric bupivacaine 0.5% and 5 μg of dexmedetomidine (group I, n = 30), 10 mg of hyperbaric bupivacaine 0.5% and 0.1 mg/kg ketamine (group II, n = 30), or 10 mg of hyperbaric bupivacaine 0.5% and 5 μg of dexmedetomidine plus 0.1 mg/kg of ketamine (group III, n = 30). Hemodynamics, pain score, time to first request of analgesia, total PCA morphine consumption, sedation score, and adverse effects in the first 24 hours postoperatively were recorded. Results: Time to first request of analgesia was longer in group II (7.42 ± 1.43 h) and group III (13.00 ± 7.31h) compared to group I (3.50 ± 1.57 h). PCA morphine consumption was less in group III (6.67 ± 2.8 mg) compared to group I (9.16 ± 3.63 mg) and group II (8.66 ± 3.49 mg). Group III showed lower postoperative pain scores, and a higher incidence of postoperative sedation (P 0.03). Limitations: This study is limited by its relatively small sample size. Conclusion: In conclusion, the combination of intrathecal dexmedetomidine and ketamine provided superior postoperative analgesia, prolonged the time to first request of rescue analgesia, and reduced the total consumption of PCA morphine, without serious side effects compared to either drug alone.