Re: NMP22 is a sensitive, cost-effective test in patients at risk for bladder cancer.
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Biomarkers, Tumor↗
Biomedical subjects
R Casella
Publications and source records attributed to R Casella.
Reasons for discontinuing intracavernous injection therapy with prostaglandin E1 (alprostadil).
OBJECTIVES: To clarify the reasons why experience with self-injection therapy for erectile dysfunction shows high dropout rates. METHODS: We studied 86 patients 36 to 76 years old who had been on home treatment for at least 3 months. Sixty-nine patients (80%) were continuing to use injections, and 17 (20%) had discontinued the treatment. Patients were evaluated by interview and clinical examination. RESULTS: Patients still in the program used one injection every 2 weeks, and those who had given up treatment had used one injection in 3 weeks (P = 0.31). They were in the program for 39+/-27 and 16+/-22 months (P = 0.002), respectively, and had used 50 (95% confidence interval [CI] 21 to 91) versus 12 (95% CI 4 to 20) injections, respectively (P<0.0001). Injections producing unsatisfactory penile rigidity, prolonged erections, hematoma at injection site, corporal fibrosis, secondary penile deviation, and mean estimated duration of a pharmacoinduced erection showed no significant differences. Patient satisfaction (P = 0.02), estimated partner satisfaction (P = 0.02), increase in self-esteem (P = 0.01), and negligible effort in performing injections (P = 0.001) all showed significantly better results for those still in the program. CONCLUSIONS: Reasons for dropout from self-injection therapy are not based on objective side effects and discomfort. Patients leaving the program are less motivated, less satisfied with the quality of pharmacoinduced sexuality, consider the effort to perform injections to be substantial, and have not achieved improved self-esteem.
Adult↗
Life-threatening spontaneous retroperitoneal bleeding: a rare complication of oral anticoagulation.
In a patient on oral anticogulation with sudden onset of loin pain, the possibility of spontaneous bleeding in the retroperitoneum must be considered in the differential diagnosis of renal colic. This rare pathology can be life-threatening, and rapid diagnosis with ultrasound and computerized tomography of the abdomen must be made. If the patient is hemodynamically stable, a conservative approach is justified. Otherwise, emergency nephrectomy may be needed. As patients become older and indications for anticoagulant therapy become more common, we will probably have to face more of these rare bleeding complications in the future. We report such a case.
Administration, Oral↗
[Tumor in the abdomen. II].
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Abdominal Neoplasms↗
Ki67 labeling index in core needle biopsies independently predicts tumor-specific survival in prostate cancer.
A better knowledge of the biological aggressiveness of individual tumors could facilitate the selection of treatment in prostate cancer patients. This study assesses the influence of histological and molecular features in core needle biopsy specimens of prostate cancer on tumor-specific survival. Formalin-fixed core needle biopsy specimens from 111 consecutive patients (mean follow-up, 5.0 years) were immunohistochemically examined for their proliferative activity (Ki67 labeling index [LI]) and expression of p53 and Bcl-2. Overexpression of p53 was found in 16% of the biopsy specimens and was mainly restricted to poorly differentiated tumors. Bcl-2 positivity was found in 20% of tumors. The median Ki67 LI was 7.5%. There was a strong relationship between Ki67 LI and Gleason grade, with a continuous increase in the proliferative activity from low-grade to high-grade tumors (P = .0006). Univariate tumor-specific survival analysis showed that high Gleason score (P = .0018), high percentage of biopsy tumor involvement (P = .0227), high Ki67 LI (P = .0007), and p53 positivity (P = .0024) were predictors of tumor-related death. A high Ki67 LI emerged as the only independent predictor of tumor-specific survival in multiparametric analysis. These results indicate that core needle biopsy specimens of the prostate not only are useful for diagnosis of malignancy but also can provide valuable prognostic information. Immunohistochemical examinations of molecular features may be a helpful adjunct for a better pretherapeutic assessment of prostate cancer aggressiveness and therefore contribute to an improved initial patient management.
Aged↗
Focal neuroendocrine differentiation lacks prognostic significance in prostate core needle biopsies.
PURPOSE: The biological behavior of prostate cancer is highly variable and cannot sufficiently be predicted by histological criteria alone. New prognostic factors are needed in core needle biopsies before initial treatment decisions. We investigate the prognostic significance of focal neuroendocrine differentiation in core needle biopsies of prostate cancer. MATERIALS AND METHODS: Core needle biopsies from 105 untreated patients (mean age 71 years) were immunohistochemically examined for focal neuroendocrine differentiation using an antibody against chromogranin A. Tumor cell proliferation was assessed with Ki-67 labeling index using MIB 1 antibody. The cause of death was determined by examination of records including autopsy reports. RESULTS: Focal neuroendocrine differentiation was found in 25% of the tumors. There was no association between the presence of focal neuroendocrine differentiation and Gleason score or Ki-67 labeling index. Tumor specific survival analysis revealed that high Gleason score and high Ki-67 labeling index were predictors of tumor specific death, whereas focal neuroendocrine differentiation failed to provide prognostic information. There was a significant increase in frequency and density of neuroendocrine differentiation between initial core needle biopsies and later specimens of secondary hormone resistant prostate cancer in 15 patients. CONCLUSIONS: In contrast to high Gleason score and high Ki-67 labeling index, focal neuroendocrine differentiation is not a prognostic factor in core needle biopsies of prostate cancer. Focal neuroendocrine differentiation seems to appear more frequently and intensively in hormone resistant prostate cancer, supporting a role of neuroendocrine cells in the development of hormone refractory disease.
Aged↗
[Results of microsurgical reconstruction after vasectomy].
Because of the increasing number of divorces surgical refertilisation by vasovasostomy has become increasingly important. Of 33 patients operated in the last decade, 32 could be reached for follow-up. The patency-rate was 86% and the pregnancy-rate 28%. Possible explanations for this discrepancy are discussed. The time lag between vasectomy and vasovasostomy was the most important prognostic factor. There was no difference in the results between one-layer and two-layer anastomosis. With an interdisciplinary approach the same patency rate as described in the literature was achieved.
Adult↗
Mumps orchitis: report of a mini-epidemic.
PURPOSE: The incidence of mumps orchitis has declined dramatically since the introduction of vaccination. While in the past cases of mumps have only been seen occasionally at our institution, recently there has been a sharp increase in the number of confirmed cases. MATERIALS AND METHODS: Between June 1995 and April 1996, 11 patients with severe mumps orchitis were hospitalized at our clinic. Medical history, therapeutic measures and clinical outcome were recorded for each patient. RESULTS: All patients showed marked scrotal swelling with a temperature above 38.5 C. Serum C-reactive protein was significantly elevated (mean 140 mg./l.). The vaccination status of 1 of the 11 patients (9%) was unknown. Medical records from the remaining 10 patients indicated that they had not been vaccinated. Nine patients (82%) had a typical mumps parotitis preceding the orchitis. In 2 patients the clinical diagnosis of parotitis was uncertain but mumps serology was positive. None of the patients showed other manifestations of mumps. Antibodies to the mumps virus (IgG and IgM) were determined in 6 patients and positive in all cases. The average interval between parotitis and onset of orchitis was 10 days. All patients were hospitalized for an average of 6 days. Treatment included bed rest with local cooling, scrotal support and systemic treatment with nonsteroidal anti-inflammatory drugs. Ciprofloxacin or clavulanic acid/amoxicillin was administered as bacterial orchitis could not be excluded at initial presentation. The mean time to cessation of fever was 3.6 days (range 3 to 5). Antibiotics were administered for an average of 8.8 days (range 7 to 13) and anti-inflammatory drugs were given an average of 8.6 days (range 7 to 11). One patient required scrotal exploration. CONCLUSIONS: Since the introduction of a vaccine against the mumps virus there is a diminished risk for mumps and its complications. However, in case of scrotal swelling mumps orchitis should still be considered. Despite vaccination mumps has not been erradicated. Therefore, continued vaccination should be considered an important step in minimizing clinical outbreaks and working towards a possible eradication of this disease in the future.
Adolescent↗
Complications of epidural infusions for analgesia in postoperative and trauma patients.
Few studies compare complications of continuous and bolus epidural analgesia. Ninety-eight postoperative and trauma patients receiving epidural infusions over 15 months were retrospectively studied. Continuous epidural analgesia was used for pain management in 60 patients (61%). Bolus epidural analgesia was administered to 38 patients (39%). Sixty patients reported 98 complications. Sixty-eight per cent of complications occurred in patients receiving continuous infusions. For the continuous infusions, motor blockade (18%), nausea/vomiting, (18%), and catheter leaks (12%) were the most common complications. For bolus infusions, nausea/vomiting (25%), mental status changes (21%), and erythema at placement site (13%) were encountered. Continuous infusions were associated with an increased incidence of complications compared with bolus infusions (P < 0.05). Patients undergoing abdominal surgery had an increased incidence of complications compared with other patients (P < 0.05). Epidural catheters are safe and effective for pain management, but they are not without risk. Hemodynamic stability and pulmonary status should be considered when evaluating patients.
Analgesia, Epidural↗
[Signet ring cell carcinoma of Vater's papilla: a very rare malignancy].
We describe a rare variant of carcinoma of the ampulla of Vater. A 70-year-old man with several illnesses and a newly appeared jaundice was investigated and a signet-ring cell carcinoma of the ampulla of Vater diagnosed. We performed a local transduodenal excision. One year after operation the patient is asymptomatic. This is the second case report in the literature.
Aged↗
An in vitro and in vivo study of toothbrush bristle splaying.
The extent to which a toothbrush is worn out, as evidenced by bristle splaying, is an important determinant of cleaning efficacy. In order for this aspect of oral hygiene to be studied, an accelerated means of producing a life-like pattern of bristle splaying was investigated and compared with splaying induced by a human test-panel. Porcelain denture teeth were brushed under a static applied load in a slurry of dentifrice, by means of a revolving "figure 8" motion, for up to 12,000 revolutions. This was found to induce an increase in the degree of splaying (as measured by "wear index") that was well-fitted (R2 = 0.96) by a second-order expression of the form: WI = WIi + Ritj - Ctj2 where WI = wear index, WIi = initial wear index, Ri = initial rate of increase in WI, tj = brushing time measured in either machine revolutions (tr) or weeks of human use (tw), and C = a separate constant for each brushing mode (machine or human panel). The rate of splaying was found to be strongly influenced by the quality of the bristle filament, but not by small differences in toothbrush design. The splaying pattern induced by the machine could not be distinguished visually from that in a set of brushes used at home by human volunteers. A strong correlation was found between the splaying produced by machine-brushing and by a panel who brushed free-style at home for 13 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Blastoma of the lung--a rare malignancy. Case report].
Pulmonary blastoma--so called because of its histological resemblance to fetal lung--is a rare malignant neoplasm, which tends to relapse locally and metastasize mainly in the first years, has a poor 5-year prognosis, and shows a potential radio-chemosensitivity. We report our findings and therapeutic approach in a case of a 64-year-old male.
Antineoplastic Combined Chemotherapy Protocols↗
[Gallstone ileus--still a current disease].
Two cases of gall-stone ileus during the past months have encouraged us to discuss the epidemiology, pathogenesis, diagnosis and therapy. This pathology is not as rare as one thinks and represents 23% of cases of mechanical ileus of the small intestine in patients over 65 years of age, thus being the third cause after stenosis due to carcinoma and incarcerated hernia. The importance of this illness is due to two factors: the diagnostic difficulties because of a periodic symptomatology with often a lack of typical radiologic signs and the still important mortality of 5 to 10% today. We present the casuistic of seven cases which have occurred over the last 15 years in our hospital and compare our experience with those of the literature. We discuss the therapeutic problem of enterolithotomy or one-stage repair. The main point for a reduction in mortality is an early diagnosis with the consequent reduction of the time from the appearance of the ileus to the operation.
Aged↗
The measurement of toothbrush wear.
Toothbrushes wear out and progressively lose their ability to clean as the bristles abrade and become curled and matted. To study the factors that influence this process, we developed a quantitative measure of bristle splaying (wear index) and a method for judging and ranking the overall state of brush deterioration (wear rating) and used these to determine the effects of the individual user, brush design, time in use, and bristle material. Wear index is the average increase in brush-head dimensions normalized for maximum bristle length, and is dimensionless. Wear rating is a subjective means of classifying the increasing severity of deterioration on a scale of 0 to 3. The wear characteristics of a variety of commercial and experimental brushes with different design features were determined. Test variables were time in use, brush design (e.g., geometry and size of the brush head), and bristle composition. Time of use, the individual user, and bristle composition were found to have the strongest influences on splaying, and brush design was found to have the least influence. The wear index offers a quantitative means of comparing brushes of different dimensions at various stages of splaying. The wear rating, although qualitative, is a quick means of ranking brushes in various stages of deterioration. The two methods correlate (R2 = 0.87), and both are sensitive to several factors that affect brush durability. Therefore, these methods appear to be suitable not only for research, but also for quality control, the setting of standards, and for substantiation of advertising claims.
Adult↗