Predictive Value of Positive Surgical Margins after Radical Prostatectomy for Lymph Node Metastasis in Locally Advanced Prostate Carcinoma

Introduction. Suspected locally advanced prostate carcinoma shows lymph node involvement in a high percentage of cases. For a long time, such patients were not radically prostatectomised. In recent years, however, this viewpoint has changed. Material and Methods. We analysed a single-centre series of 34 patients with suspected locally advanced prostate cancer to establish predictive parameters for lymph node metastasis. All patients underwent radical prostatectomy between 2007 and 2010. Results. Of the 34 patients, 26% showed pathological stage T3a, 59% pT3b, and 15% pT4. Median preoperative PSA level was 25 ng/mL, and five patients had had neoadjuvant antihormonal treatment. Positive margins were found in 76% of patients. Patients without neoadjuvant treatment showed it in 79%, and after preoperative antihormonal treatment the rate was 60%. Positive margins were associated with lymph node involvement in 85% of cases, complete resection was associated only in 50% of cases. Conclusions. Positive surgical margins play an important predictive role when estimating lymph node involvement in patients with locally advanced prostate carcinoma. Neoadjuvant antihormonal therapy is associated with a relevant reduction in the rate of positive margins but not with the rate of lymph node metastasis. As such, a combination of antihormonal and surgical treatment should be considered

Vacuum-assisted closure therapy in ureteroileal anastomotic leakage after surgical therapy of bladder cancer

BACKGROUND: Vacuum-assisted closure (VAC) is an acknowledged method of treating wound healing disorders, but has been viewed as a contraindication in therapy of intraabdominal fistulas. CASE PRESENTATION: We present the case of an 83-year old patient with ureteroileal anastomotic insufficiency following cystectomy and urinary diversion by Bricker ileal conduit due to urothelial bladder cancer. After developing an open abdomen on the 16(th )postoperative day a leakage of the ureteroileal anastomosis appeared that cannot be managed by surgical means. To stopp the continued leakage we tried a modified VAC therapy with a silicon covered polyurethane foam under a suction of 125 mmHg. After 32 days with regularly changes of the VAC foam under general anesthesia the fistula resolved without further problems of ureteroileal leakage. CONCLUSION: We present the first report of VAC therapy successfully performed in urinary tract leakage after surgical treatment of bladder cancer. VAC therapy of such disorders requires greater care than of superficial application to avoid mechanical alterations of internal organs but opens new opportunities in cases without surgical alternatives

Predictive Value of Positive Surgical Margins after Radical Prostatectomy for Lymph Node Metastasis in Locally Advanced Prostate Carcinoma

Introduction. Suspected locally advanced prostate carcinoma shows lymph node involvement in a high percentage of cases. For a long time, such patients were not radically prostatectomised. In recent years, however, this viewpoint has changed. Material and Methods. We analysed a single-centre series of 34 patients with suspected locally advanced prostate cancer to establish predictive parameters for lymph node metastasis. All patients underwent radical prostatectomy between 2007 and 2010. Results. Of the 34 patients, 26% showed pathological stage T3a, 59% pT3b, and 15% pT4. Median preoperative PSA level was 25 ng/mL, and five patients had had neoadjuvant antihormonal treatment. Positive margins were found in 76% of patients. Patients without neoadjuvant treatment showed it in 79%, and after preoperative antihormonal treatment the rate was 60%. Positive margins were associated with lymph node involvement in 85% of cases, complete resection was associated only in 50% of cases. Conclusions. Positive surgical margins play an important predictive role when estimating lymph node involvement in patients with locally advanced prostate carcinoma. Neoadjuvant antihormonal therapy is associated with a relevant reduction in the rate of positive margins but not with the rate of lymph node metastasis. As such, a combination of antihormonal and surgical treatment should be considered

Spontaneous ventral urethral fistula in a young diabetic man: a case report

We present the first case reported in the medical literature of a patient with a spontaneous ventral urethral fistula accompanied by severe infection due to diabetes mellitus. A 34-year-old man with poor controlled adult-onset diabetes mellitus was admitted to our hospital with a large subcutaneous abscess involving the complete penis, scrotum and perineum. The patient did not report any history of any penile trauma or local infection but has experienced transient swelling of the perineal region following urination. Initial surgical treatment consisted of surgical debridement of necrotic tissue. At this time reconstructive surgery was impossible and a suprapubic cystostomy was performed. After 4 months of suprapubic urinary diversion the urethral fistula resolved and function of external genitalia was reestablished. In a follow-up period of 40 months no recurrence occurred. Spontaneous diabetes-associated ventral urethral fistulas are extremely rare and we are not aware of any other published case report

Response of a Hexagonal Granular Packing under a Localized External Force: Exact Results

We study the response of a two-dimensional hexagonal packing of massless, rigid, frictionless spherical grains due to a vertically downward point force on a single grain at the top layer. We use a statistical approach, where each mechanically stable configuration of contact forces is equally likely. We show that this problem is equivalent to a correlated $q$-model. We find that the response is double-peaked, where the two peaks, sharp and single-grain diameter wide, lie on the two downward lattice directions emanating from the point of the application of the external force. For systems of finite size, the magnitude of these peaks decreases towards the bottom of the packing, while progressively a broader, central maximum appears between the peaks. The response behaviour displays a remarkable scaling behaviour with system size $N$: while the response in the bulk of the packing scales as $\frac{1}{N}$, on the boundary it is independent of $N$, so that in the thermodynamic limit only the peaks on the lattice directions persist. This qualitative behaviour is extremely robust, as demonstrated by our simulation results with different boundary conditions. We have obtained expressions of the response and higher correlations for any system size in terms of integers corresponding to an underlying discrete structure.Comment: Accepted for publication in JStat; 33 pages, 10 figures; Section 2.2 reorganized and rewritten; Details about the simulation procedure added in Sec.3.1. ; A new section, summarizing the final results and the calculation procedure adde

Neuroendocrine carcinoma of the seminal vesicles presenting with Lambert Eaton syndrome: a case report

Lambert Eaton syndrome may be the initial symptom of a seminal vesicle mass. Diagnosis needs to be obtained by transrectal biopsy and chemotherapy may delay progression of the tumor

Origin and Properties of the Gap in the Half-Ferromagnetic Heusler Alloys

We study the origin of the gap and the role of chemical composition in the half-ferromagnetic Heusler alloys using the full-potential screened KKR method. In the paramagnetic phase the C1_b compounds, like NiMnSb, present a gap. Systems with 18 valence electrons, Z_t, per unit cell, like CoTiSb, are semiconductors, but when Z_t > 18 antibonding states are also populated, thus the paramagnetic phase becomes unstable and the half-ferromagnetic one is stabilized. The minority occupied bands accommodate a total of nine electrons and the total magnetic moment per unit cell in mu_B is just the difference between Z_t and $2 \times 9$. While the substitution of the transition metal atoms may preserve the half-ferromagnetic character, substituting the $sp$ atom results in a practically rigid shift of the bands and the loss of half-metallicity. Finally we show that expanding or contracting the lattice parameter by 2% preserves the minority-spin gap.Comment: 11 pages, 7 figures New figures, revised tex

A systematic approach to mapping recessive disease genes in individuals from outbred populations

The identification of recessive disease-causing genes by homozygosity mapping is often restricted by lack of suitable consanguineous families. To overcome these limitations, we apply homozygosity mapping to single affected individuals from outbred populations. In 72 individuals of 54 kindred ascertained worldwide with known homozygous mutations in 13 different recessive disease genes, we performed total genome homozygosity mapping using 250,000 SNP arrays. Likelihood ratio Z-scores (ZLR) were plotted across the genome to detect ZLR peaks that reflect segments of homozygosity by descent, which may harbor the mutated gene. In 93% of cases, the causative gene was positioned within a consistent ZLR peak of homozygosity. The number of peaks reflected the degree of inbreeding. We demonstrate that disease-causing homozygous mutations can be detected in single cases from outbred populations within a single ZLR peak of homozygosity as short as 2 Mb, containing an average of only 16 candidate genes. As many specialty clinics have access to cohorts of individuals from outbred populations, and as our approach will result in smaller genetic candidate regions, the new strategy of homozygosity mapping in single outbred individuals will strongly accelerate the discovery of novel recessive disease genes

Leadership and the Australian Greens

This paper examines the inherent tension between a Green political party’s genesis and official ideology and the conventional forms and practices of party leadership enacted in the vast bulk of other parties, regardless of their place on the ideological spectrum. A rich picture is painted of this ongoing struggle through a case study of the Australian Greens with vivid descriptions presented on organisational leadership issues by Australian state and federal Green members of parliaments. What emerges from the data is the Australian Green MPs’ conundrum in retaining an egalitarian and participatory democracy ethos while seeking to expand their existing frame of leadership to being both more pragmatic and oriented towards active involvement in government