Purpose of Review The prevalence of kidney stones is rising and historically carries a preponderance for males. However, recent evidence has questioned whether this gender gap is closing. The aim of this systematic review was to examine this further as well as evaluate possible underlying causes. Recent Findings Recent evidence confirms the disparity in kidney stone disease between genders is closing. In the modern era, the rise in prevalence among females has been greater, especially in adolescence. Quality of life is also more adversely affected by kidney stone events among females who are also more likely to develop sepsis after endourological surgery. Males, however, are more likely to present with stone events during periods of high ambient temperatures Summary Recent literature demonstrates a temporal change in the disease burden of KSD among men and women. The latter, especially adolescent females, are more likely to develop KSD in their lifetime compared to previous eras. Determining causation is complex and continued research is warranted.

Chyluria is secondary to the presence of chyle in the urine. The classical appearance on inspection is of milky white urine, which is caused by a fistulous communication between the lymphatic system and the urinary tract. Worldwide, it is most commonly associated with the parasite Wuchereria bancrofti, which is prevalent in Asia, most extensively in India but also China and Taiwan. However, in the United Kingdom, Europe and North America, where the condition is rare, non-parasitic aetiologies predominate. Chyluria is occasionally associated with other urinary tract symptoms including infection, loin pain and haematuria. It may also cause hypoproteinaemia, weight loss and cachexia. Management is based on identifying the aetiology and depends on the severity of the chyluria and presence of associated symptoms. Given its predominate symptom being urinary, cases in the West can fall under the care of the urologist. The aim of this article is to provide an overview and summary of the aetiology, assessment and management of chyluria based on the most up-to-date evidence available. This was achieved through a non-systematic review of world literature.

BackgroundSeveral recent studies provide evidence that D-dimer (DD) concentration in peripheral blood correlates negatively with overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC). Contrarily, there are recent evidence indicating that preoperative plasma fibrinogen, but not D-dimer might represent a prognostic factor in non-metastatic gastrointestinal cancers.MethodsIn a single-center prospective study, we enrolled 62 patients undergoing surgery for pathologically confirmed PDAC without detectable venous thrombosis. Intraoperatively, the sample of the blood from the portal vein was obtained. DD concentration in these samples was measured. Patients were followed postoperatively until time of death from any cause.ResultsWe found that OS for patients with portal blood DD values above 2700 (ng/mL) (n = 22 from 62 patients) was higher by 158% than that for the patients (n = 42) with DD values ≤ 2700 (416 days versus 161 days, p = 0.05). On the contrary to the studies investigating DD concentration in peripheral blood, we have found that patients with higher DD level in the portal vein had longer mean OS than patients with lower ones.ConclusionsFurther investigation is necessary both to confirm our results in a larger patient population and to elucidate the mechanism for the correlation between portal blood D-dimer concentrations and survival time. Along with other authors, we conclude that portal circulation is characterized by unique, biological environment that requires further evaluation.

Actinomycosis is an invasive and suppurative anaerobic infection, which can develop in the pelvis. This occurs most commonly as a result of prolonged use of an intrauterine device. The constellation of signs and symptoms associated with its typical clinical presentation include palpable mass, weight loss and malaise. It can be misdiagnosed as a result and often as a malignant process. Left unrecognised, pelvic actinomycosis can lead to sequelae such as severe abscess, fistula formation and even infertility. Removal of the intrauterine device and a prolonged course (6–12 months) of antibiotic treatment form the cornerstone of management. Surgery can be required in select cases. This article provides an overview of pelvic actinomycosis, including its background, presentation, investigations and management.

Background: Pancreatic cancer is a devastating disease, being the fourth cause of cancer-related death worldwide. Several studies have investigated the use of multiple cancer biomarkers, such as C 19-9, CA 125, and CEA, as prognostic factors for overall survival in pancreatic cancer. CA 125 seems to have superior predictive utility in selected groups of PDAC patients. Material and methods: We retrospectively analyzed data collected from 129 patients admitted to our Department due to diagnosis with pancreatic cancer. Prior to the survival analysis, the preliminary assessment of pre-treatment levels of biomarkers was carried out. The overall survival time was defined as that elapsing from the admission date to the date of death. Results: The patients mean age was 62 +/- 9.5 years, while the median overall survival (OS) was 7mo 12d. As for tumor localization, most of the patients had PDAC within the head of the pancreas (n=93), followed by PDAC of the pancreatic body (n=15), pancreatic tail (n=14) and both pancreatic body and tail (n=7). Ninety-five patients had an unresectable tumor and 34 were diagnosed with a resectable tumor (tab.1). The statistically significant correlation was found for CA 125 (ρ=-0.355 p<0.001) and CA 19-9 (ρ=-0.225 p=0.012). We chose the following cut-off points: CA 125>=20 IU/mL was considered as high, and CA 19-9>=200 IU/mL as significantly elevated. In the univariate analysis in the Kaplan-Meier survival model, adjusted for age, both elevated biomarkers were statistically significant prognostic factors of OS (CA 125<20 median OS- 10mo 3d vs. CA 125>=20- 4mo 17d p=0.001) and (CA19-9<200 median OS- 8mo 3d vs. CA 19-9>=200- 4mo 20d p=0.001). Patients’ gender and, PDAC resectability and its localization were not statistically significant prognostic factors (log rank test p=0.8; p=0.108 and p=0.578 respectively). In the age-adjusted multivariate analysis, both biomarkers remained significant- CA 125>=20 (HR: 1.73 95%CI 1.27-2.58 p=0.006) CA 19-9>=200 (HR: 1.78 95%CI 1.19-2.66 p=0.005) Conclusions: Our study proves the utility of the pretreatment assessment of CA 125 because its level is tightly correlated with OS. It may be hypothesized that the pretreatment measurement of both CA 19-9 and CA 125 can provide the valuable information about patients’ prognosis.