Management of Iatrogenic Urorectal Fistulae in Men with Pelvic Cancer

INTRODUCTION: Urorectal fistula (URF) is a devastating complication of pelvic cancer treatments and a surgical challenge for the reconstructive surgeon. We report a series of male patients with URF resulting from pelvic cancer treatments, specifically prostate (PCa), bladder (BCa), and rectal cancer (RCa), and explore the differences and impact on outcomes between purely surgical and non-surgical treatment modalities. METHODS: Between October 2008 and June 2015, 15 male patients, aged 59-78 years (mean 67), with URF induced by pelvic cancer treatments were identified in our institutions. Patients with a history of diverticulitis, inflammatory bowel disease, or other benign conditions were excluded. We reviewed the patients' medical records for symptoms, diagnostic tests performed, type and etiology of the fistula, type of surgical reconstruction, followup, and outcomes. RESULTS: Fourteen patients underwent surgical reconstruction. One patient developed metastatic disease before URF repair and, therefore, was excluded from this study. Mean followup (FU) was 32.7 months (14-79). All patients received diverting colostomy and temporary urinary diversion. An exclusively transperineal approach was used in nine (64.3%) patients and a combined abdominoperineal in five (35.7%). Overall successful URF closure was achieved in 12 (85.7%) patients, nine (64.3%) of whom at the first reconstructive attempt, two (14.3%) after two attempts (in our institution), and one (7.1%) after three attempts (two of which elsewhere). An interposition flap was used in seven (50%) patients. Surgical reconstruction failed ultimately in two (14.3%) patients who still have a colostomy and do not wish any further reconstruction. CONCLUSIONS: Our study has several limitations, including its retrospective nature and the heterogeneity of our small patient cohort. Nonetheless, although surgical reconstruction of URF may be extremely difficult and complex in the non-surgical/energy ablation patients, its successful reconstruction is possible in most through a transperineal, or a more aggressive abdominoperineal, approach with tissue interposition in selected patients.info:eu-repo/semantics/publishedVersio

Serum Lipids and Prostate Cancer

Background: Conflicting results are found in the literature relating serum lipids levels and prostate cancer. Some results imply a relationship between them; others contradict this association. The purpose of this study was to investigate a possible association between serum lipids levels and prostate cancer, at time of diagnosis. Methods: We measured serum levels of total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides in 237 patients submitted to a prostate biopsy, with PSA between 2 and 10 ng/ml. Patients without cancer at biopsy were used as controls, and the others were considered as cases. No information about lipid-lowering therapy, including statins, was available neither in cases nor in controls. Cases were divided into risk groups, according to the disease severity, based on staging. Lipids levels were compared between groups, using parametric and nonparametric tests. Logistic regression analysis and odds ratios were calculated. Results: LDL and total cholesterol levels were lower in patients with cancer, with the difference being statistically significant for LDL cholesterol (p = 0.010) and borderline for total cholesterol (p = 0.050). No significant differences were found between the several risk groups. Odds ratios for low LDL cholesterol (<130 mg/dl) and low total cholesterol (<200 mg/dl), with prostate cancer as the outcome, were 1.983 and 1.703, respectively. There were no significant differences between cases and controls for the other lipids. Conclusion: Lower LDL cholesterol (<130 mg/dl) and lower total cholesterol (<200 mg/dl) serum levels seem to associate with prostate cancer, at time of diagnosis.info:eu-repo/semantics/publishedVersio

Bladder Cancer New Biomarkers in Liquid Biopsies

Bladder cancer is one of the most common neoplasia in men in the developed countries. Diagnosis and surveillance are made by bladder examination through cystoscopy making this one of the most expensive on cost/patient. After tumor removal, clinical staging is important for prognosis and treatment decision as non-muscle invasive (Ta and T1) and invasive (T2+) are treated in a completely different way. Today no noninvasive method has enough sensitivity to substitute cystoscopy or histological examination for tumor clinical staging. Our aim is to identify and quantify in urine, proteins that can detect and classify bladder tumors. A biomarker study was conducted using urine samples from: individuals with bladder cancer; individuals with other genitourinary disorders and individuals without urological diseases. Several proteins were found to successfully help in the discrimination of the bladder cancer stages Ta, T1 and T2+. Two biomarkerpanels were developed, one capable of detecting bladder cancer presence and other able to distinguish Ta, T1 and T2+. Our results show a significant difference between urinary proteome in patients with different bladder cancer stages. This may allow through liquid biopsies predict patient’s cancer stage. A validation study is on progress to attest this biomarker panel’s accuracy.info:eu-repo/semantics/publishedVersio

The Role of Accessory Obturator Arteries in Prostatic Arterial Embolization

In 9 of 491 patients (1.8%) who underwent prostatic arterial embolization (PAE) for benign prostatic hyperplasia from March 2009-November 2013, prostatic arteries arose from the external iliac artery via an accessory obturator artery (AOA). Computed tomography angiography performed before the procedure identified the variant and allowed planning before the procedure. The nine AOAs were catheterized from a contralateral femoral approach. Bilateral PAE was technically successful in the nine patients. There was a mean decrease in international prostate symptom score of 6.5 points and a mean prostate volume reduction of 15.1% (mean follow-up, 4.8 mo) in the nine patients

Biogas production from dairy cattle manure, under organic and conventional production systems.

The purpose of this study was to evaluate the production of biogas, as well as the biogas production potential resulting from the anaerobic biodigestion of dairy cattle manure under organic (CMOS) and conventional (CMCS) production system. Also, the concentration of thermotolerant coliforms was evaluated after the biodigestion process. Therefore, bench biodigesters prototypes were supplied with CMOS and CMCS for 30 weeks. The experimental design was completely randomized with four repetitions for each treatment. Analysis of total solids (TS), volatile solids (VS), biogas production potential, most probable number (MPN) of thermotolerant coliforms were made. The cumulative biogas production was 6.18 L and 11.15 L, when using the CMOS and CMCS, respectively. Average biogas production potential of CMCS were 0.2; 2.6 and 2.9 L kg-1 substrate, ST and SV added, respectively and for CMOS 0.1; 1.4 and 1.9 L kg-1substrate, ST and SV added, respectively. After the anaerobic biodigestion process of CMOS and CMCS, it was observed that the concentrations of thermotolerant coliforms were well below than the limit established by law

Optimization of somatic embryogenesis and selection regimes for particle bombardment of friable embryogenic callus and somatic cotyledons of cassava (Manihot esculenta Crantz).

Made available in DSpace on 2018-05-24T00:41:20Z (GMT). No. of bitstreams: 1 SP19590ID30692.pdf: 933592 bytes, checksum: a6347a7911e489ae922ea4e39a116a55 (MD5) Previous issue date: 2009-01-1

Randomised Clinical Trial of Prostatic Artery Embolisation Versus a Sham Procedure for Benign Prostatic Hyperplasia

Background: Prostatic artery embolisation (PAE) has been associated with an improvement of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH), but conclusive evidence of efficacy from randomised controlled clinical trials has been lacking. Objective: To assess the safety and efficacy of PAE compared with a sham procedure in the treatment of LUTS/BPH. Design, setting, and participants: A randomised, single-blind, sham-controlled superiority clinical trial was conducted in 80 males ≥45yr with severe LUTS/BPH refractory to medical treatment from 2014 to 2019 in a private clinic, with efficacy assessments at 6 and 12 mo after randomisation. One patient in the PAE group and three in the sham group did not complete the study. Intervention: Patients were randomised 1:1 upon successful catheterisation of a prostatic artery to either PAE or a sham PAE procedure without embolisation. After 6 mo, all 38 patients randomised to the sham group who completed the single-blind period underwent PAE, and both groups completed a 6-mo open period. Outcome measurements and statistical analysis: An intention-to-treat analysis of all randomised patients was performed. The coprimary outcomes were the change from baseline to 6 mo in the International Prostate Symptom Score (IPSS) and the quality of life (QoL) score at 6 mo, analysed with analysis of covariance and t test, respectively. Results and limitations: Mean age was 63.8±6.0yr, baseline IPSS 26.4±3.87, and QoL score 4.43±0.52. At 6 mo, patients in the PAE arm had a greater improvement in IPSS, with a difference in the change from baseline of 13.2 (95% confidence interval [CI] 10.2-16.2, p<0.0001), and a better QoL score at 6 mo (difference: 2.13; 95% CI 1.57-2.68, p<0.0001) than the patients in the sham arm. The improvements in IPSS and QoL in the sham group 6 mo after they performed PAE were, respectively, 13.6±9.19 (p<0.0001) and 2.05 ± 1.71 (p<0.0001). Adverse events occurred in 14 (35.0%) patients after PAE and in 13 (32.5%) after sham, with one serious adverse event in the sham group during the open period. No treatment failures occurred. Limitations include a single-centre trial, only severe LUTS/BPH, and follow-up limited to 12 mo. Conclusions: The improvements in subjective and objective variables after PAE are far superior from those due to the placebo effect. Patient summary: Clearly superior efficacy of prostatic artery embolisation (PAE) compared with a sham procedure was found in this study, which supports the use of PAE in patients with typical symptoms associated with benign prostatic hyperplasia.info:eu-repo/semantics/publishedVersio