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PubMed2005

Heart failure care in a hospital unit: a comparison of standard 3-month and extended 6-month programs.

BACKGROUND: We have previously shown that a structured in-hospital and outpatient heart failure (HF) program reduces clinical events over a 3-month period following hospital discharge. AIMS: This prospective randomized controlled study examines the additional benefits of extending the standard 3-month HF program to 6 months on death and readmission over a 2-year follow-up period. METHODS: Of 161 patients admitted with NYHA class IV HF who completed the standard 3-month HF program, 130 consenting patients (mean age 69.9+/-12.2 years, 65% male) were randomized to the extended 6-month HF program (EP; n=62) or standard care (SP; n=68). The primary endpoint was death and/or unplanned rehospitalization for HF at 2 years postrandomization. RESULTS: In the 2-year follow-up period, there were eight people with unplanned hospitalizations for HF and 16 deaths in the EP group (event rate 38.7%) compared to seven people with unplanned HF readmissions and 14 deaths in the SP group (event rate 30.9%, p=0.348 versus EP). Kaplan-Meier survival analysis demonstrated no difference in outcome between standard and extended program (p=0.315). There were no differences between the groups in terms of unscheduled clinic visits or non-HF-related readmissions in the 2-year follow-up period. CONCLUSIONS: There is no measured clinical advantage in terms of death and/or HF readmission in extending a structured hospital-based disease management program for HF beyond 3 months postdischarge. However, it appears that patients continue to need access to the service to help abort clinical deteriorations, and this may have implication for the optimal organisation of such programs.

Aged↗

PubMed2005

Utilization and value addition of copper tailing as an extender for development of paints.

The present study deals with characterization of copper tailing waste, test for possibilities of hazards and its potential reuse as an extender in paints. The waste is a siliceous material containing aluminum oxide, iron oxide and sulphate in significant concentrations. In the primary stage waste is acidic in nature, which makes it unsuitable for paint. This acidity is removed from the waste by simple sieving and grinding. The prepared mass was characterized for basic properties of an extender like oil absorption, specific gravity, pH, etc. Toxicity studies were also conducted in term of leaching of heavy metals by standard techniques (USEPA using TCLP). Properties of the prepared paint's film in terms of hardness, adhesion, resistance to abrasion, resistance to impact, resistance to corrosion (under humidity and salt fog), etc. were evaluated and compared with a similar formulation of conventional extender and found satisfactory. Results from the experiments indicated that developed extender is environmentally clean and cost-effective.

Chemical Phenomena↗

PubMed2006

Independent extended supplementary nurse prescribers, their prescribing practice and confidence to educate and assess prescribing students.

BACKGROUND: No other country in the world has such extended prescribing rights for nurses as the United Kingdom. Concerns surround the move of nursing towards a medical model of care, and the level of medical practice support required by trainee prescribers. AIM: To provide an overview of the nurses adopting the role of independent extended supplementary prescriber, their prescribing practice and confidence to educate and assess prescribing students. METHODS: A convenience sample of 1187 independent extended supplementary nurse prescribers were sent a questionnaire. Eight hundred and sixty eight completed questionnaires were returned. RESULTS: The majority (82%) of nurses worked in primary care. Eighty seven percent used independent extended prescribing and 35% supplementary prescribing. Most were qualified to degree level or higher and had over 10 years nursing experience. Seventy four percent felt confident to act as a mentor during the prescribing programme. More highly qualified nurses and those who had undertaken, or had access to continuing professional development, were statistically more likely to feel confident to adopt this role. CONCLUSION: Appropriately qualified nurse prescribers might be best placed to support trainee prescribers. Exploration of the low uptake of supplementary prescribing and access to continuing professional development is required.

Adult↗

PubMed2004

The versatile extended pericranial flap for closure of skull base defects.

OBJECTIVE: We sought to demonstrate the technical aspects of the extended pericranial flap and its versatility in reconstruction of a variety of skull base defects. STUDY DESIGN: We conducted a retrospective chart review of 32 patients who underwent reconstruction of skull-base defects with an extended pericranial flap by the senior author (Y.D.) from September 1997 to July 2003. METHODS: Patients with skull base defects after trauma or extirpative surgery were reconstructed with either a lateral- or an anterior-based vascularized extended pericranial flap. Variables and outcomes measured included: the size and anatomical location of the defect, need for other flaps, preoperative and/or postoperative radiation therapy and/or chemotherapy, bone flap necrosis, hardware exposure, wound dehiscence, postoperative cerebrospinal fluid (CSF) leak, and meningitis. RESULTS: There was no evidence of flap failure, 2 cases of transient (3 to 4 days) CSF leak without resultant meningitis, 3 patients with hardware exposure, and 2 patients with hydroxyapatite infection. The 2 transient cases of CSF leak both resolved without further surgical intervention or the placement of a lumbar drain. CONCLUSION: Both the lateral and anteriorly based extended pericranial flaps are reliable and versatile flaps associated with minimal morbidity and a low rate of complications when used to reconstruct defects of the anterolateral skull base.

Adolescent↗

PubMed2004

Extended orbitozygomatic approach to the skull base to improve access to the cavernous sinus and optic chiasm.

BACKGROUND: The orbitozygomatic approach to the skull base has evolved over the past century, with a surge in development during the past 20 years. We describe an extension of this technique involving removal of the most inferior portion of the temporal bone to the level of the internal carotid artery as it enters the carotid canal, to further facilitate exposure of tumors in this region. METHODS AND MATERIALS: We performed the extended orbitozygomatic approach in a series of 17 patients with a variety of neoplastic lesions. Our case series was reviewed in a retrospective fashion, and our surgical approach is described. The approach is performed safely and effectively by using the spine of the sphenoid and middle meningeal artery as landmarks and then resecting the temporal bone from the temporal craniotomy site to the carotid canal. RESULTS: The extended orbitozygomatic approach has been performed at our institution over the past 6 years and has provided significantly improved access to this region of the skull base, facilitating tumor extirpation in our patient population without an increase in complications. CONCLUSIONS: The extended orbitozygomatic approach further improves exposure and facilitates surgical dissection in patients with neoplasms of the cavernous sinus, sellar region, interpeduncular region, and upper clivus. The improved access without an increase in complications supports the inclusion of the extended orbitozygomatic approach in the armamentarium of the skull base surgeon.

Cavernous Sinus↗

PubMed2004

Extended family's and women's roles in safeguarding orphans' education in AIDS-afflicted rural Zimbabwe.

The extended family forms the basis for orphan care and education in sub-Saharan Africa. Initial absence followed by emergence of differentials in primary school enrollment between orphans and non-orphans have been attributed to the strength and subsequent HIV/AIDS-induced breakdown of extended family orphan care arrangements. Yet, few attempts have been made to describe how these arrangements are affected by HIV/AIDS or how they relate to observed patterns of childhood outcomes by sex and orphan status. We use a combination of quantitative and qualitative data to show that maternal orphans but not paternal or double orphans have lower primary school completion rates than non-orphans in rural Zimbabwe, and that these patterns reflect adaptations and gaps in extended family orphan care arrangements. Sustained high levels of primary school completion amongst paternal and double orphans--particularly for girls--result from increased residence in female-headed households and greater access to external resources. Low primary school completion amongst maternal orphans results from lack of support from fathers and stepmothers and ineligibility for welfare assistance due to residence in higher socio-economic status households. These effects are partially offset by increased assistance from maternal relatives. These findings indicate that programmes should assist maternal orphans and support women's efforts by reinforcing the roles of extended families and local communities, and by facilitating greater self-sufficiency.

Adolescent↗

PubMed2004

Effects of in vitro storage time and semen-extender on membrane quality of boar sperm assessed by flow cytometry.

The Norwegian AI company Norsvin has used the short-term semen-extender BTS to extend and store boar semen since the late 1980s. Fertility results have been consistent when extended semen has been used for AI within 3 days after collection, however, from a production and economic point of view it is preferable that semen stored for up to 5 days can be used. The aim of this study was to compare membrane quality of sperm stored in BTS for 3 days with sperm stored in the long-term semen-extenders Androstar, Mulberry III and X-cell for 5 days. Using a split-sample design, plasma membrane- and acrosome-integrity were assessed flow cytometrically by use of Yo-Pro-1 and PNA-FITC, and fluidity and phospholipid asymmetry of the membrane were assessed by use of MC540 and Annexin V-FITC. Due to observed sperm fragmentation in Androstar after Day 1, the data for Androstar were excluded from the analyses. After 5 days of storage, the membrane quality of X-cell-stored sperm was not statistically different from that of sperm stored in BTS for 3 days, while membrane quality of sperm stored in Mulberry III was statistically better on Day 5 compared to BTS on Day 3. In conclusion, Mulberry III and X-cell preserve sperm quality, as well as that of BTS on Day 3, for up to 5 days after collection.

Acrosome↗

PubMed2006

Sperm DNA fragmentation in boars is delayed or abolished by using sperm extenders.

The semen quality of seven young adult boars was assessed for percentages of sperm motility, normal acrosomes, abnormal sperm, cells positive to sHOST (short Hipoosmotic Swelling Test), HPNA cells (sHOST Positive with Normal Acrosome cells) and the percentage of sperm heads, which exhibited DNA fragmentation using the Sperm Chromatin Dispersion test (SCD). These parameters were analysed in sperm samples both undiluted and diluted using a commercial extender and stored at 15 degrees C for 21 days. Results showed that semen quality decreases faster in the undiluted semen samples from day 0 to day 7 compared to diluted semen samples that remained with a high quality up to day 11. The undiluted semen exhibited a low DNA fragmentation index (DFI) during the first days and then a significant increase from day 7 up to day 21. This increase in the DFI coincided with the lowest levels of the other semen quality parameters. On the contrary, the samples diluted in the commercial extender showed very low levels of DNA fragmentation in all boars during the preservation period. When the evolution of DNA fragmentation was analysed in the undiluted samples, differences were found among boars. These differences were not shown in the samples diluted in the extender where the basal DFI remained stable during the 21 days. The main conclusion of this study was that some sperm extenders delay or partially prevent sperm DNA fragmentation.

Acrosome↗

PubMed2006

Extender osmolality and sugar supplementation exert a complex effect on the cryopreservation of Iberian red deer (Cervus elaphus hispanicus) epididymal spermatozoa.

We have carried out two experiments to study the cryobiology of red deer epididymal spermatozoa and to improve freezing extenders: (1) effect of extender (Tris-citrate-fructose) osmolality (300-600 mOsm/kg), and (2) effect of sugar (0.4M) supplementation to the extender (no sugar, glucose, fructose, mannose, sucrose, maltose, threalose and raffinose). Sperm quality was assessed pre-freezing, post-thawing, and after 2h at 37 degrees C post-thawing: sperm motility index (SMI), acrosome integrity and membrane integrity (HOS test) were assessed subjectively; mitochondrial activity (JC-1) and membrane stability (merocyanine 540) were assessed by flow cytometry. In experiment 2, DNA status was assessed using acridine orange and flow cytometry. To find an optimal osmolality, we fitted the data to a quadratic curve. Four hundred Osmolal per kilogram rendered better results pre-freezing and post-thawing. However, post-thawing viability and most parameters after 2h incubation fitted a linear model. Osmolalities above 425 mOsm/kg were deleterious (P<0.05). In experiment 2, fructose had a positive effect respect to control after 2h of incubation at 37 degrees C post-thawing. Di and trisaccharides were deleterious. Trehalose showed impaired DNA status after 2h incubation. In conclusion, the osmolality of the extenders should be around 400 mOsm/kg, although the change from quadratic to lineal may indicate a complex effect that must be further studied. Monosaccharides may enhance red deer epididymal sperm cryopreservation, especially fructose, whereas di and trisaccharides may not be adequate.

Animals↗

PubMed2005

Renal cell carcinoma with tumor thrombus extending above diaphragm: avoiding cardiopulmonary bypass.

OBJECTIVES: Renal cell carcinoma with a tumor thrombus extending into the supradiaphragmatic inferior vena cava (IVC) and right atrium represents a challenge to the surgical team. We describe a technique that can be used to resect these tumors safely through a transabdominal approach without recourse to cardiopulmonary bypass (CPB) or entry into the thoracic cavity. METHODS: Between May 1997 and August 2004, 59 patients (mean age 61 years) underwent surgical resection of a renal tumor extending into the IVC by techniques developed with the intention to avoid sternotomy and CPB. In 7 patients (12%), the tumor thrombus extended into the supradiaphragmatic IVC and right atrium. Complete surgical resection was successful through a transabdominal approach without CPB in all 7 of these patients. RESULTS: In the 7 patients who underwent the described technique, the median age was 71 years (range 51 to 80). The mean operative time was 7 hours, 47 minutes. The mean estimated blood loss was 2514 mL (range 500 to 6000). The mean number of blood units transfused was 4.7 (range 0 to 11). One patient died in the immediate postoperative period of cardiac arrhythmia. The median follow-up was 11.1 months, and 5 patients were disease free. CONCLUSIONS: In select cases, renal cell carcinoma extending into the supradiaphragmatic IVC and right atrium can be resected without the use of CPB. We describe our technique.

Aged↗

PubMed2005

Extended-field radiotherapy and high-dose-rate brachytherapy with concurrent and adjuvant cisplatin-based chemotherapy for locally advanced cervical cancer: a phase I/II study.

OBJECTIVE: The purpose of this prospective study was to investigate the toxicity and efficacy of integrating extended-field para-aortic and pelvic external radiation, high-dose-rate intracavity brachytherapy, and concurrent and adjuvant cisplatin-based chemotherapy for locally advanced cervical cancer. METHOD: A phase I/II study was performed from 1998 to 2003 including sixty-three patients with both clinical FIGO and MRI/CT-based TNM stage IIB-IVA cervical cancer. Patients were treated with extended-field external radiation to the para-aortic and pelvic regions with 45 Gy in 25 fractions, and an additional boost to the gross nodes to 50.4 Gy and the parametrium to 59.4 Gy. Patients also received a high-dose-rate (HDR) intracavity brachytherapy with doses of 22-31 Gy to point A in 4-6 fractions. Concurrently, two cycles of cisplatin (50-80 mg/m(2)) were administered in weeks 1 and 5 during radiotherapy, as well as two cycles of cisplatin (60-80 mg/m(2)) for 1 day and 5-fluorouracil (600-800 mg/m(2)) for 4 days at 1 and 2 months after completion of radiotherapy. The treatment-related acute and late side effects were evaluated using RTOG criteria, and the disease control and survival rate were calculated using the Kaplan-Meier method. The median follow-up interval was 36 months. RESULTS: All sixty-three patients completed the planned extended-field radiotherapy and high-dose-rate brachytherapy with 2 concurrent cycles of cisplatin. Fifty-eight (92%) patients received 2 cycles of the post-radiation adjuvant chemotherapy of cisplatin and 5-fluorouracil. RTOG grade III acute toxicity was gastrointestinal (2%) and hematological (10%). No patient had grade IV acute toxicity. Late grades III-IV morbidity actuarial risk of 6% at 6.5 years primarily involved the injuries to the bowels requiring surgical intervention for intestinal obstruction or fistula formation. Initial sites of recurrence were locoregional failure alone (pelvic and para-aortic regions within the radiation field), 3%; distant metastases only, 8%; and locoregional failure plus distant metastases, 8%. The observed rates at 3-year and 5-year of locoregional control, freedom from distant metastasis, and overall survival were 86% and 86%, 81% and 81%, and 81% and 77%, respectively. CONCLUSION: Incorporating HDR brachytherapy into a regimen including concurrent chemotherapy and extended radiation appears safe and effective.

Adult↗

PubMed1996

Comparison of standard- and extended-length participation in cardiac rehabilitation on body composition, functional capacity, and blood lipids.

Participation in a standard-length outpatient cardiac rehabilitation program (CRP) for 3 months is known to result in positive changes in body composition, functional capacity, and blood lipids in patients with coronary artery disease. However, there has been little attempt to compare patients who remain active in a formal CRP for an extended length of >1 year with patients who exit after a standard length of 3 months. Consequently, 50 patients underwent a series of tests including a maximal graded exercise treadmill test, assessment of body composition, and fasting blood lipid analysis, at entry to CRP and after a follow-up period that ranged from 1 to 5 years. All patients participated in a standard multidisciplinary cardiac rehabilitation program for 3 months. Twenty-five patients discontinued participation after 3 months and received no other contact from the program staff until follow-up, whereas 25 patients remained active in the program until follow-up. After statistically adjusting for baseline differences between the groups, significant differences were observed between the extended- and standard-length groups at follow-up for body weight (177 vs 183 lbs), percent fat (22% vs 24%), METS (10.5 vs 8.4), high-density lipoprotein level cholesterol (44 vs 39 mg/dl), total cholesterol/high-density lipoprotein ratio (5.2 vs 6.1), and triglycerides (134 vs 204 mg/dl), respectively. No significant differences in the adjusted means were observed between the groups at follow-up for total cholesterol (209 vs 219 mg/dl) and low-density lipoprotein cholesterol (136 vs 138 mg/dl). Data from this study demonstrate the efficacy of extended participation in CRP on body composition, functional capacity, and blood lipids. Greater efforts need to be directed at retaining patients in low-cost, center-based maintenance programs and at extending monitoring of patients exiting standard length CRPs.

Adult↗

PubMed2000

Long-term benefit of extended lymphadenectomy with gastrectomy in distally located early gastric carcinoma.

BACKGROUND: Extended lymphadenectomy performed with gastrectomy has been reported to prolong survival of patients with early gastric cancer. However, some authors question the value of extensive lymphadenectomy in these patients, especially since much recent discussion of patient quality of life after gastrectomy has favored less invasive operations. METHODS: We retrospectively analyzed 485 patients who had undergone gastrectomy for early cancer in order to evaluate the effect of extended versus limited lymphadenectomy on postoperative survival. Various prognostic factors were examined for patients whose tumors were located in the distal third of the stomach. RESULTS: Although extended radical lymphadenectomy did not prolong postoperative survival when early gastric cancer was located in the middle or proximal third of the stomach, it did when the tumor occupied the distal third. CONCLUSIONS: Performance of extended radical lymphadenectomy was a significant prognostic factor for early gastric cancer patients when tumors were located in the distal third of the stomach.

Female↗

PubMed1998

A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus.

BACKGROUND: Recurrence of thoracic esophageal carcinoma in the cervical and superior mediastinal lymph nodes occurs frequently and contributes to a poor prognosis. Extensive lymphadenectomy has been advocated. Findings in support of this to date, however, have been based on a comparison with historical controls. We herein report a prospective randomized trial of extended and conventional lymphadenectomy. METHODS: Cases of thoracic esophageal carcinoma meeting criteria predictive of complete resection were randomized into conventional and extended cervical and superior mediastinal lymphadenectomy groups. RESULTS: In the extended and conventional lymphadenectomy groups, respectively, mean operative time was 487 +/- 47 and 396 +/- 43 minutes, blood loss was 850 +/- 429 and 576 +/- 261 mL, node count was 82 +/- 22 and 43 +/- 15, hospital deaths occurred in 3% and 7%, 2-year survival was 83.3% and 64.8%, 5-year survival was 66.2% and 48.0%, and recurrence rate was 19.9% and 24.1%. CONCLUSION: Extended lymphadenectomy may prevent recurrence and prolong survival after resection of thoracic esophageal carcinoma.

Aged↗

PubMed2000

Day 3 morphology is a poor predictor of blastocyst quality in extended culture.

OBJECTIVE: To determine how the quality of blastocysts formed on day 5/6 of extended culture compares with their morphology on day 3. DESIGN: Retrospective observational study of IVF laboratory records. SETTING: Private assisted reproduction clinic. PATIENT(S): 101 IVF cycles in which 5 to 25 embryos were produced. The average maternal age was 33.1 years. INTERVENTION(S): Embryos were individually cultured in vitro in sequential media for an extended time to enable use of blastocysts for fresh transfer or cryopreservation. MAIN OUTCOME MEASURE(S): Comparison of embryo quality for putative ET or cryopreservation on day 3 with quality of embryos used for actual ET and cryopreservation on day 5/6. RESULT(S): Of 1,263 cleaving embryos, 559 were judged to have been suitable for use on day 3; 355 would have been used for ET (average per ET, 3.5) and 204 would have been frozen (equivalent to 44% utilization). In actuality, 471 blastocysts were used on day 5/6, of which 234 were transferred (average per ET, 2.3), and 237 were frozen (equivalent to 37% utilization). Only 48% embryos that would have been chosen for ET and/or cryopreservation on day 3 were eventually used in such a manner at the blastocyst stage. Historically, the rate of viable pregnancy from day 3 transfers was 30.5% per transfer; this rate increased to 45% with routine day 5/6 transfers. CONCLUSION(S): Extended culture of human embryos seems to increase discrimination of potential embryonic viability. Criteria for embryo selection on day 3 seem to be inadequate. Extended in vitro culture may therefore be an effective means of optimizing IVF clinical success.

Adult↗

PubMed2003

The extended multidomain solution structures of the complement protein Crry and its chimeric conjugate Crry-Ig by scattering, analytical ultracentrifugation and constrained modelling: implications for function and therapy.

Complement receptor-related gene/protein y (Crry) is a cell membrane-bound regulator of complement activation found in mouse and rat. Crry contains only short complement/consensus repeat (SCR) domains. X-ray and neutron scattering was performed on recombinant rat Crry containing the first five SCR domains (rCrry) and mouse Crry with five SCR domains conjugated to the Fc fragment of mouse IgG1 (mCrry-Ig) in order to determine their solution structures at medium resolution. The radius of gyration R(G) of rCrry was determined to be 4.9-5.0 nm, and the R(G) of the cross-section was 1.2-1.5 nm as determined by X-ray and neutron scattering. The R(G) of mCrry-Ig was 6.6-6.7 nm, and the R(G) of the cross-section were 2.3-2.4 nm and 1.3 nm. The maximum dimension of rCrry was 18 nm and that for mCrry-Ig was 26 nm. The neutron data indicated that rCrry and mCrry-Ig have molecular mass values of 45,000 Da and 140,000 Da, respectively, in agreement with their sequences, and sedimentation equilibrium data supported these determinations. Time-derivative velocity experiments gave sedimentation coefficients of 2.4S for rCrry and 5.4S for mCrry-Ig. A medium-resolution model of rCrry was determined using homology models that were constructed for the first five SCR domains of Crry from known crystal and NMR structures, and linked by randomly generated linker peptide conformations. These trial-and-error calculations revealed a small family of extended rCrry structures that best accounted for the scattering and ultracentrifugation data. These were shorter than the most extended rCrry models as the result of minor bends in the inter-SCR orientations. The mCrry-Ig solution data were modelled starting from a fixed structure for rCrry and the crystal structure of mouse IgG1, and was based on conformational searches of the hinge peptide joining the mCrry and Fc fragments. The best-fit models showed that the two mCrry antennae in mCrry-Ig were extended from the Fc fragment. No preferred orientation of the antennae was identified, and this indicated that the accessibility of the antennae for the molecular targets C4b and C3b was not affected by the covalent link to Fc. A structural comparison between Crry and complement receptor type 1 indicated that the domain arrangement of Crry SCR 1-3 is as extended as that of the CR1 SCR 15-17 NMR structure.

Amino Acid Sequence↗

PubMed2000

Extended left hepatectomy (left hepatic trisegmentectomy) in childhood.

BACKGROUND/PURPOSE: Extended left hepatectomy, also referred to as left hepatic trisegmentectomy, in which segments II, III, IV, V, and VIII are excised, is rarely performed in children. Experience with 7 such resections is reported to describe the anatomy, technique, indications, and outcomes of the operation. METHODS: The medical records of all pediatric patients treated at our institution over the last 15 years who underwent extended left hepatectomy were reviewed. Demographic information as well as operative, pathological, and follow-up data were analyzed. RESULTS: Seven patients underwent extended left hepatectomy over this period. There were 5 boys and 2 girls ranging in age between 4 months and 9 years with a median age of 3.1 years. Follow-up ranged from 8 months to 5 years with a median of 3.5 years. Diagnoses included hepatoblastoma (HB, n = 3), focal nodular hyperplasia (FNH, n = 1), leiomyosarcoma (LMS, n = 1), hepatocellularcarcinoma (HCC, n = 1), and metastatic neuroblastoma (NB, n = 1). All surgical margins were grossly negative. Median operative blood loss was 13 mL/kg (range, 5 to 32 mL/kg), and mean hospital stay was 9 days (range, 7 to 12 days). No major intra- or postoperative complications were encountered, and there was no perioperative mortality. The 3 HB patients, 1 FNH patient, 1 LMS patient, and 1 NB patient are without evidence of disease, whereas the 1 child with HCC died of recurrent and distant disease. The 6 surviving children have normal hepatic function. CONCLUSION: Although technically challenging and rarely performed, extended resection of the left hepatic lobe is feasible in children and can yield curative results with minimal morbidity.

Carcinoma, Hepatocellular↗

PubMed2003

Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study.

PURPOSE: We assessed the impact of age and prostate specific antigen (PSA) on extended systematic biopsy schemes for detecting prostate carcinoma and better characterized these tumors as a function of patient age and PSA. MATERIALS AND METHODS: We retrospectively reviewed the records of 2,299 consecutive patients who underwent initial systematic biopsy performed by 167 community based urologists. A total of 12 systematic biopsies of the peripheral zone were obtained in all patients. Various biopsy schemes were then created and cancer detection rates were calculated. Data analyses were stratified by patient age and PSA. RESULTS: On biopsy 1,020 patients (44.4%) had cancer. Detection rates increased with increasing patient age. Increasing age and PSA were associated with larger, higher grade tumors. Overall and unique site specific cancer detection rates were highest for laterally directed biopsies and the apical biopsy of the standard sextant scheme. The 12 site biopsy scheme outperformed all other schemes in patients with PSA 7 ng./ml. or less and in those 60 years or younger. The variation in age related and PSA related detection rates was greatest for the standard sextant scheme and this variability decreased for extended biopsy schemes. CONCLUSIONS: This multi-practice community based study confirms the inadequacy of sextant biopsies and emphasizes the need for extended peripheral zone sampling of the lateral aspect of the prostate. Generally increasing patient age and PSA were associated with larger, higher grade tumors. Extended biopsy schemes minimize PSA and age related detection rates.

Age Factors↗