Surveillance as an Option for the Treatment of Small Renal Masses

OBJECTIVES. To review the natural history and biological potential of small renal masses in order to evaluate surveillance as a treatment option. METHODS. Literature search of Medline and additional references from non-Medline-indexed publications concerning surveillance of small renal masses. RESULTS. The natural history and biological potential of small renal masses can still not be unambiguously predicted at present. There seems to be no clear correlation between tumour size and presence of benign histology. The majority of small renal masses grow and the majority are cancer, but one cannot safely assume that a lack of growth on serial CT scans is the confirmation of absence of malignancy. Needle core biopsies could be used to help in decision making. They show a high accuracy for histopathological tumour type but are less accurate in evaluating Fuhrman grade. CONCLUSIONS. At present, surveillance of small renal masses should only be considered in elderly and/or infirm patients with competing health risks, in those with a limited life expectancy, and in those for whom minimal invasive treatment or surgery is not an option. In all other patients, active surveillance should only be considered in the context of a study protocol. Long-term, prospective studies are needed to provide a more accurate assessment of the natural history and metastastic potential of small renal masses

Preclinical Evidence for the Benefits of Penile Rehabilitation Therapy following Nerve-Sparing Radical Prostatectomy

Erectile dysfunction following radical prostatectomy remains a frequent problem despite the development of nerve-sparing techniques. This erectile dysfunction is believed to be neurogenic, enhanced by hypoxia-induced structural changes which result in additional veno-occlusive dysfunction. Recently, daily use of intracavernous vasoactive substances and oral use of PDE5-inhibitors have been clinically studied for treatment of postprostatectomy erectile dysfunction. Since these studies showed benefits of “penile rehabilitation therapy,” these effects have been studied in a preclinical setting. We reviewed experimental literature on erectile tissue preserving and neuroregenerative treatment strategies, and found that preservation of the erectile tissue by the use of intracavernous nitric oxide donors or vasoactive substances, oral PDE5-inhibitors, and hyperbaric oxygen therapy improved erectile function by antifibrotic effects and preservation of smooth muscle. Furthermore, neuroregenerative strategies using neuroimmunophilin ligands, neurotrophins, growth factors, and stem cell therapy show improved erectile function by preservation of NOS-containing nerve fibers

Gains in Life Expectancy Associated with Higher Education in Men

Background: Many studies show large differences in life expectancy across the range of education, intelligence, and socio-economic status. As educational attainment, intelligence, and socio-economic status are highly interrelated, appropriate methods are required to disentangle their separate effects. The aim of this paper is to present a novel method to estimate gains in life expectancy specifically associated with increased education. Our analysis is based on a structural model in which education level, IQ at age 18 and mortality all depend on (latent) intelligence. The model allows for (selective) educational choices based on observed factors and on an unobserved factor capturing intelligence. Our estimates are based on information from health examinations of military conscripts born in 1944–1947 in The Netherlands and their vital status through age 66 (n = 39,798). Results: Our empirical results show that men with higher education have lower mortality. Using structural models to account for education choice, the estimated gain in life expectancy for men moving up one educational level ranges from 0.3 to 2 years. The estimated gain in months alive over the observational period ranges from -1.2 to 5.7 months. The selection effect is positive and amounts to a gain of one to two months. Decomposition of the selection effect shows that the gain from selection on (latent) intelligence is larger than the gain from selection on observed factors and amounts to 1.0 to 1.7 additional months alive. Conclusion: Our findings confirm the strong selection into education based on socio-economic status and intelligence. They also show significant higher life expectancy among individuals with higher education after the selectivity of education choice has been taken into account. Based on these estimates, it is plausible therefore that increases in education could lead to increases in life expectancy

War- and famine-related excess mortality among civilians in the Netherlands, 1944-1945

National estimates exist for war- and famine-related deaths in the Netherlands during the last stages of World War II, but no such estimates are available at the local level. To fill this information gap, this article aims at mapping and visualizing the timing of war- and famine-related excess mortality by municipality among the civilian population within the Netherlands. We use mortality statistics at the level of municipalities because these are the smallest administrative units for which this information is available. We use a seasonally adjusted mortality model combined with a difference-in-difference approach to estimate the number of excess deaths in the period between January 1944 and July 1945 separately for each Dutch municipality

The Effect of Star Formation History on the Inferred Initial Stellar Mass Function

Peaks and lulls in the star formation rate (SFR) over the history of the Galaxy produce plateaux and declines in the present day mass function (PDMF) where the main-sequence lifetime overlaps the age and duration of the SFR variation. These PDMF features can be misinterpreted as the form of the intrinsic stellar initial mass function (IMF) if the star formation rate is assumed to be constant or slowly varying with time. This effect applies to all regions that have formed stars for longer than the age of the most massive stars, including OB associations, star complexes, and especially galactic field stars. Related problems may apply to embedded clusters. Evidence is summarized for temporal SFR variations from parsec scales to entire galaxies, all of which should contribute to inferred IMF distortions. We give examples of various star formation histories to demonstrate the types of false IMF structures that might be seen. These include short-duration bursts, stochastic histories with log-normal amplitude distributions, and oscillating histories with various periods and phases. The inferred IMF should appear steeper than the intrinsic IMF over mass ranges where the stellar lifetimes correspond to times of decreasing SFRs; shallow portions of the inferred IMF correspond to times of increasing SFRs. If field regions are populated by dispersed clusters and defined by their low current SFRs, then they should have steeper inferred IMFs than the clusters. The SFRs required to give the steep field IMFs in the LMC and SMC are determined. Structure observed in several determinations of the Milky Way field star IMF can be accounted for by a stochastic and bursty star formation history.Comment: accepted by ApJ for 1 Jan 2006, Vol 636, 12 pages + 6 figure

Complications and Functional Results of Surgery for Locally Advanced Prostate Cancer

The role of surgery in clinical stage T3 prostate cancer (cT3 PCa) is still subject to debate. We reviewed the records of 139 consecutive patients who underwent a radical prostatectomy (RP) for cT3 PCa with a mean follow-up of 8 years. All data related to surgical and perioperative complications were collected. Continence and erectile function were assessed at 12 months postoperatively and long-term oncologic outcomes were analyzed. Rectal injury and injury of the obturator nerve occurred both in 0.7% of cases. No serious in-hospital complications were noted and no reintervention was needed. Lymphatic leakage was noted in 2.2% of patients and 1.4% experienced prolonged drainage of urine. In 7.2%, wound-related problems occurred. Anastomotic stricture occurred in 2.9%. These complication rates were not different compared to surgical series of RP in localized PCa. At 12 months, complete continence was 87.8% and erectile function had fully recovered in 6% and 10% of patients who underwent a non-nerve sparing or unilateral nerve-sparing procedure, respectively. 10-year estimated biochemical PFS, clinical PFS, CSS and OS were 51.8%, 85.6%, 94.6% and 85.9%, respectively. In cT3 PCa, RP is technically feasible with morbidity comparable to RP in clinically localized PCa. Long-term oncologic control was excellent

Клиническая значимость гене тической характеризации рака предстательной железы: обзор литературы

Molecular and genetic characterization of the prostate cancer seems to be a very relevant issue for clinical practice with regard to diagnostics, prognosis, treatment selection and assessment of therapy efficacy. A lot of fundamental studies assault the genetic basis of the disease and the differences in the phenotypic traits of prostate tumors. However, the significant gap is seen between the huge amount of studies to genetic characterization of prostate cancer, which often have a limited way to translation into the clinical practice or simply were not conceived to be so, and clinical practice. Substantial difficulties on the way are multifocality of the prostate carcinoma, inter- and intrafocal heterogeneity and abundance of recurrent genetic alterations, the role of which is understudied to date. In this review we have aimed at the providing an overview of the current studies, being the most close to translation in clinical practice. The common applications and problems are discussed.В последнее время предпринимаются многочисленные попытки выявления молекулярных генетических особенностей рака предстательной железы (РПЖ). Тем не менее, несмотря на большое количество исследовательских программ по молекулярной биологии и генетике, значение результатов этих работ остается неясным, а выводы имеют ограниченное применение в клинической практике. Во многом это связано с тем, что РПЖ характеризуется выраженной генетической гетерогенностью. Мы провели анализ литературы для выявления путей возможного клинического применения результатов фундаментальных генетических и молекулярно-биологических исследований в отношении РПЖ (трансляции в клинику), основных проблем, возникающих при этом, и перспектив развития данного направления