BACKGROUND Cutaneous metastasis of renal cell carcinoma is exceedingly rare, and there are few described cases of metastasis to the skin of the head and neck region. Most of these cases describe metastases to the scalp, but some cases of metastases to the face and neck have been reported. CASE REPORT A 72-year-old man presented to the Surgery Clinic with a chief complaint of a lesion that had grown on his left cheek over a period of about 3 months. A punch biopsy revealed the mass to be metastatic renal cell carcinoma, clear-cell subtype. The patient had already had a nephrectomy for primary tumor control. Due to the advanced disease process, the patient elected for palliative care. CONCLUSIONS Cutaneous presentations of renal cell carcinoma in the head and neck are exceptionally rare, and metastases to the face are less common than metastases to the scalp. When this disease process does occur, it often presents as a raised mass of between 1 and 3 cm with a red, red-purple, or red-blue color. Patient history often reveals a relatively rapid growth process of their facial lesion. This case highlights the fact that malignancies may manifest several years after initial primary resection.

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia (MP35)1 Sep 2021MP35-12 IS ANTIBIOTIC PROPHYLAXIS INDICATED FOR TRANSPERINEAL PROSTATE BIOPSY? LOCAL ANTIBIOGRAM FINDINGS TO INFORM ANTIBIOTIC SELECTION Ashley Davis, Mariela Martinez Rivera, Michael Silver, David Daniel, David Silver, Ervin Teper, Alejandro Zuretti, and Ariel Schulman Ashley DavisAshley Davis More articles by this author , Mariela Martinez RiveraMariela Martinez Rivera More articles by this author , Michael SilverMichael Silver More articles by this author , David DanielDavid Daniel More articles by this author , David SilverDavid Silver More articles by this author , Ervin TeperErvin Teper More articles by this author , Alejandro ZurettiAlejandro Zuretti More articles by this author , and Ariel SchulmanAriel Schulman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002044.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal (TP) prostate biopsy avoids rectal flora with less infectious risk than transrectal biopsy. The role of antibiotic prophylaxis remains undefined. We examined genitourinary and rectal colonization in men undergoing TP prostate biopsy to guide future antibiotic selection. METHODS: We evaluated patients undergoing TP biopsy at a single center from 2019 to 2020. Preoperative negative urinalysis was required, and procedural IV cefazolin and gentamicin prophylaxis was used. Catheterized urine, prostate tissue and rectal swab cultures were taken at the time of procedure. We examined culture positivity, resistant patterns and procedural complications. RESULTS: 146 TP biopsies were included. Median age was 65 (61-72), mean prostate volume was 60 (11-226) and mean PSA was 7.8 (0.84-60). 13 (8.9%) patients harbored positive genitourinary cultures including 7 (4.79%) positive urine, 4 (2.74%) positive prostate tissue, and 2 (1.37%) with bacteria in both. Escherichia coli was the most common bacteria on urine culture and staphylococcus epidermidis was the most common on prostate culture (Table 1). There were 8 unique bacteria isolated with variable resistance patterns (Table 2). Fluoroquinolone resistance was identified in 9/64 (14%) rectal swab isolates reflecting the overall community-level resistance. Despite culture findings, there was no post biopsy sepsis or infectious complications. One patient developed CAUTI-sepsis at day 10 secondary to prolonged catheterization. CONCLUSIONS: In this review of TP prostate biopsies using single-dose IV cefazolin and gentamicin prophylaxis, 8.9% (n=13) of men harbored occult positive urine and/or prostate tissue cultures at the time of biopsy despite negative urinalysis, although there were no immediate infectious complications. Thus, there seems to remain a risk of infectious complications and prophylaxis should be considered based on local resistance patterns. Source of Funding: Maimonides Research and Development Foundation © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e631-e632 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashley Davis More articles by this author Mariela Martinez Rivera More articles by this author Michael Silver More articles by this author David Daniel More articles by this author David Silver More articles by this author Ervin Teper More articles by this author Alejandro Zuretti More articles by this author Ariel Schulman More articles by this author Expand All Advertisement Loading ...

Early in the SARS-CoV-2 pandemic, convalescent plasma (CP) therapy was proposed as a treatment for severely ill patients. We conducted a CP treatment protocol under the Mayo Clinic Extended Access Program at University Hospital Brooklyn (UHB). Potential donors were screened with a lateral flow assay (LFA) for IgM and IgG antibodies against the SARS-CoV-2 S1 receptor-binding domain (RBD). Volunteers that were LFA positive were tested with an ELISA to measure IgG titers against the RBD. Subjects with titers of at least 1:1024 were selected to donate. Most donors with positive LFA had acceptable titers and were eligible to donate. Out of 171 volunteers, only 65 tested positive in the LFA (38.0%), and 55 (32.2%) had titers of at least 1:1024. Before our donation program started, 31 CP units were procured from the New York Blood Center (NYBC). Among the 31 CP units that were obtained from the NYBC, 25 units (80.6%) were positive in the LFA but only 12 units (38.7%) had titers of at least 1:1024. CP was administered to 28 hospitalized COVID-19 patients. Patients who received low titer CP, high titer CP and patients who did not receive CP were followed for 45 days after presentation. Severe adverse events were not associated with CP transfusion. Death was a less frequent outcome for patients that received high titer CP (>1:1024) 38.6% mortality, than patients that received low titer CP (≤1:1024) 77.8% mortality.

About 1 in 9 men will be diagnosed with prostate cancer in their lifetime. The traditional method of diagnosis is via a 12 core, trans-rectal biopsy. While this has been an appropriate method of investigation, a rectal approach to the prostate core made it difficult to differentiate prostatic bacterial infection from fecal contamination. Utilizing a sterile trans-perineal approach for biopsy, we were able to establish a true microbiome of the prostate, without contamination. This is a prospective, IRB approved study. Men who were required to have prostate biopsies were offered a trans-perineal or trans rectal method of biopsy. Those who opted for trans-perineal biopsy with a negative urine culture met the inclusion criteria. Urine culture was performed prior to scheduling for the procedure. At time of biopsy, sterile cultures were taken from the rectum and one randomly selected prostate core. Cultures were grown for 5 days, and the results were recorded. Of the 93 patients who met inclusion criteria, eight men contained various bacteria within the sterilely accessed prostate core. Of the eight prostate cores which grew positive cultures, five of those patients had an isolated prostatic infection, without rectal or urinary co-infection. The most common infections included E. coli (n=2) and Klebsiella species (n=3). New techniques in the performance of prostate biopsy provides the microbiology laboratory unique opportunities for investigation. This is the beginning of the study of the prostate microbiome, and future correlation with prostate cancer and isolated prostate infection are areas of future inquiry.

A 42-year-old female, with no past ocular history and no history of ocular trauma, presented for irritation from a left upper lid mass present for several years. The exam showed mechanical blepharo...

INTRODUCTION: Contraception is an important topic that is taught in medical school. The objective of this study is to assess contraceptive knowledge in incoming interns who have just graduated compared with students just entering medical school. METHODS: A cross-sectional study was performed using a survey regarding nine methods of contraception (natural family planning, condoms, Depo-Provera, patch, oral contraceptive pills, intrauterine device, diaphragm, NuvaRing, and Implanon). The survey was handed out during resident and student orientation with a response rate of 145 (54.1%) and 99 (52.6%). Results were analyzed using two-sided Mann–Whitney U tests, Spearman's rank correlation, Student's t tests, and a Bonferroni correction. RESULTS: Interns had a significantly higher overall score compared with students (P<.001). Additionally, interns had more knowledge regarding natural family planning (P<.001), Depo-Provera (P<.001), oral contraceptive pills (P<.001), intrauterine devices (P<.001), and diaphragms (P<.001). Women had a significantly higher overall score (P<.001). Respondents who regularly attended religious service had a lower overall score (P<.003). Age was positively correlated with a higher score (P<.001). Graduation from a U.S. medical school resulted in a higher overall score (P<.001). U.S. graduates were comprised of a younger population, yet still scored significantly higher than international graduates. CONCLUSION: Sex, religious attendance, age, and type of medical school all were related to contraception knowledge. However, specific knowledge regarding condoms, NuvaRing, Implanon, and the patch should be emphasized in medical school curricula. Although age correlated positively with score, this was not true for type of medical school. U.S. medical schools are more effective at teaching contraception than international schools.

A palladium-catalyzed microwave-assisted one-pot reaction for the synthesis of isoquinolines is developed. The reaction is carried out by sequential coupling-imination-annulation reactions of ortho-bromoarylaldehydes and terminal alkynes with ammonium acetate, and a variety of substituted isoquinolines, furopyridines, and thienopyridines is prepared in moderate to excellent yields (up to 86%).