Accuracy of elastic fusion biopsy in daily practice: results of a multicenter study of 2115 patients

OBJECTIVES: To assess the accuracy of Koelis fusion biopsy for the detection of prostate cancer and clinically significant prostate cancer in the everyday practice. METHODS: We retrospectively enrolled 2115 patients from 15 institutions in four European countries undergoing transrectal Koelis fusion biopsy from 2010 to 2017. A variable number of target (usually 2-4) and random cores (usually 10-14) were carried out, depending on the clinical case and institution habits. The overall and clinically significant prostate cancer detection rates were assessed, evaluating the diagnostic role of additional random biopsies. The cancer detection rate was correlated to multiparametric magnetic resonance imaging features and clinical variables. RESULTS: The mean number of targeted and random cores taken were 3.9 (standard deviation 2.1) and 10.5 (standard deviation 5.0), respectively. The cancer detection rate of Koelis biopsies was 58% for all cancers and 43% for clinically significant prostate cancer. The performance of additional, random cores improved the cancer detection rate of 13% for all cancers (P < 0.001) and 9% for clinically significant prostate cancer (P < 0.001). Prostate cancer was detected in 31%, 66% and 89% of patients with lesions scored as Prostate Imaging Reporting and Data System 3, 4 and 5, respectively. Clinical stage and Prostate Imaging Reporting and Data System score were predictors of prostate cancer detection in multivariate analyses. Prostate-specific antigen was associated with prostate cancer detection only for clinically significant prostate cancer. CONCLUSIONS: Koelis fusion biopsy offers a good cancer detection rate, which is increased in patients with a high Prostate Imaging Reporting and Data System score and clinical stage. The performance of additional, random cores seems unavoidable for correct sampling. In our experience, the Prostate Imaging Reporting and Data System score and clinical stage are predictors of prostate cancer and clinically significant prostate cancer detection; prostate-specific antigen is associated only with clinically significant prostate cancer detection, and a higher number of biopsy cores are not associated with a higher cancer detection rate

On the Change of Substances of Strawberry Fruit

1. 水田裏作として栽培されたオランダイチゴ, ダナー種の完熟果実を室温中に貯蔵し, その含有成分の変化の過程を調査した。収穫当日に含まれていた80%エタノール可溶性N化合物, 糖類の含有量は次第に減少したが, 有機酸の量は殆んど変化がなかった。しかし, 収穫後の水分含有率の低下は収穫後の日数と共に著しく。従って各成分の濃度(含有率)は相対的に高くなり, その結果N化合物の含有率の低下は比較的緩慢となり, 糖類の含有率は殆んど変化なく, 有機酸は上昇した。糖の種類は, グルコース, フラクトース, キシロース及び蔗糖であるが, 収穫後次第にグルコース及び蔗糖が減少し, キシロースがやゝ増加した。有機酸は大部分がクエン酸で, リンゴ酸, コハク酸及び痕跡の酒石酸が認められたが, 減少したのはリンゴ酸のみであった。2. 排水良き砂壌土の圃場に於て, 栽培された4品種のオランダイチゴ(紅露・幸玉, アメリカ・ダナー)の果実について収穫後に於ける諸成分の含有率の変化を比較した。N化合物・糖類・有機酸についてみると, その含有率自体は品種の特性を示し, 夫々非常に異なっているが, 含有率の貯蔵中の変化は互に平行的に推移し同様の傾向を示した。この実験の果実成分のペーパークロマトグラフィーの結果は, 水田裏作のダナー種に比べて, 糖類の内, フラクトースが特に多く, 蔗糖が少かった。品種間差異は特にグルコースに認められた。有機酸では, 酒石酸がかなり多く, 紅露及び幸玉ではα-ケトグルタル酸を認めた。品種間の差異は, 大部分をクエン酸に, 次いで酒石酸によって影響された。 / 1. The studies were conducted to obtain the fundamental information on the change of the substances in the postharvest strawberry fruit, which was cultivated for the second crop on the rice field (heavy clay soil). The amounts of soluble total-N (in 80% ethanol), amino-N, total sugar and reducing sugar were decreased in the postharvest period. But the organic acid was constant. In the postharvest period, the water content of the strawberry fruit was decreased extremely. Therefore the percentage of the N-compounds and the sugars were not so low, and the organic acid became high percentage after the harvested. On the paperchromatography in the extracts of the strawberry fruit, glucose, fractose, xylose and sucrose were found. And the xylose was increased and the glucose and sucrose were decreased after the harvested. The most of organic acid was citric acid and there were also found succinic acid, malic acid and trace of tartaric acid. The malic acid was decreased after the harvested. 2. The differences of the contents in the fruit were studied among four varieties of the strawberry (Koro, Kogyoku, America and Danner) cultivated on the field of sandy loam soil. Each % of the substances in the fruit was very different among the four varieties, but the processes of the changing had parallel tendency during the postharvest period. The results of paperchromatographic study were compared with them of strawberry fruit cultivated on the rice field. Consequently, more fractose was recognized and the sucrose was slightly. There were much tartaric acid and the trace of α-keto gulutaric acid

Morbidity associated with anterior iliac crest bone graft

Objective. The aim of this retrospective study was to assess the morbidity of the harvest of the anterior iliac bone graft and the overall satisfaction rates in a group of patients who underwent harvesting of iliac crest bone graft.Patients and Methods. Patients who underwent iliac crest bone graft procedures from January 2002 to August 2009 were recalled and invited to answer a questionnaire about postoperative pain, sensory disturbance, functional limitations, and cosmetic appearance.Results. A total of 61 patients were included in this retrospective study. Seventeen patients (28%) reported postoperative pain. A patient reported an intraoperative hip fracture. Sensory disturbances were reported by 3 patients.Conclusions. Anterior iliac crest can still be considered a favorable donor site for preprosthetic and cleft surgery. Given its relatively low morbidity rate, early ambulation, and hospital discharge, anterior iliac crest still remains the donor site of choice according to the authors. (Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:586-591

Postoperative infections associated with microvascular free flaps in head and neck reconstruction: Analysis of risk factors and results with a standardized prophylaxis protocol

Currently, large defects of the head and neck regions are mainly reconstructed using microvascular free flap. Postoperative infections, including surgical site infections (SSIs) and medical postoperative infections (MPI), are important causes of morbidity and worsening of surgical outcomes. The authors aimed to analyze the results obtained using a standardized prophylaxis protocol in a series of 100 consecutive patients who underwent microvascular re- construction surgery between 2016 and 2021 at a single institution, to identify the risk factors, which could be overcome, to minimize the incidence of infectious complications. In this study, 24 patients developed infectious complications. Higher American Society of Anesthesiologists (ASA) score was statistically associated with higher risk of infectious com- plications (p = 0.01), need for postoperative transfusions (p = 0.01), and higher T and N stage (p = 0.03 and p = 0.02, respectively) in patients with cancer. We also found a correlation between the increase in surgery duration, hospitalization, and intensive care unit (ICU) stay with higher risk of infection (p = 0.03, p = 0.01, and p = 0.001, respectively). Nine patients reported partial or total flap necrosis and in this group of patients, a higher incidence of in- fectious complication was recorded (p = 0.001). Our experience shows that SSIs and MPIs affect the global and surgical outcomes of patients and both their incidences can be reduced by correcting potential risk factors preoperatively (e.g., anemia), intraoperatively (amount of blood loss and duration of surgery), and postoperatively (duration of hospitalization and ICU stay and early elimination of potential sources of infection). (c) 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd

Double consecutive retrobulbar hemorrhage in a high-risk patient in treatment with aspirin and warfarin

Retrobulbar hemorrhage is a vision-threatening emergency that may occur spontaneously or following facial trauma, orbital surgery, endoscopic sinus surgery, and retrobulbar injections. It may determine visual loss because of central retinal artery occlusion, optic neuropathy from direct compression, or compression of the circulation from mechanical tamponade. In addition to a deterioration in visual acuity with total blindness in the most severe cases, several symptoms and signs can be found, such as a sudden onset of severe pain, proptosis, and ophthalmoplegia.The knowledge of past medical history and underlying medical conditions is crucial in patients with retrobulbar hemorrhages. In fact, patients with blood dyscrasias have to be considered high-risk patients due to their increased propensity for uncontrolled bleeding.The aim of this article was to present and discuss the management of a case of double consecutive retrobulbar hemorrhage in a high-risk patient in treatment with aspirin and warfarin