196,270 research outputs found
Surgical Outcomes of Glansectomy and Split Thickness Skin Graft Reconstruction for Localized Penile Cancer
No full textIntroduction: The management of localized penile cancer is based on organ-sparing approaches. Our aim is to report surgical outcomes of glansectomy (GS) and split thickness skin graft (STSG) reconstruction in a consecutive series of penile cancers. Patients and Methods: Patients with a localized penile cancer underwent GS and STSG reconstruction in tertiary referral center. Data were extrapolated from a single center prospective database starting from May 2013 to August 2019. Two different techniques are presented in the video abstract: - a standard GS with dissection over the Bucks’ fascia. - a salvage GS with dissection under Bucks’ fascia. Results: A total of 34 patients were enrolled. 30 patients underwent a standard GS, whether a salvage GS was performed in the remainders. The apex of corpora cavernosa was transected in 5 cases due to suspicious of local invasion. Median follow-up was 12 (12-41) months. Operative time was 150 (105-180) minutes. Hospital stay was 2 (1-3) days. A modified TODGA compressive dressing and a catheter were applied and left in place for 5 days. After that a saline washing was used for 2 weeks. The incidence of intraoperative complications was minimal (2.9%). Positive surgical margins were detected in 2.9% of cases, requiring a salvage surgery. The incidence of postoperative complications was 29.4%: 11.7% were classified as Grade 1, 8.8% as Grade 2 and 8.8% as Grade 3a according to Clavien-Dindo classification. 1-year recurrence free-survival (RFS) was 88.2%. 1-y cancer-specific (CSS) and overall survival (OS) resulted 91.2% in both cases. Limitations of the study were the retrospective and single centre nature of the study, the lack of comparative group, the limited number of cases and of follow-up. Conclusions: GS and STSG reconstruction represents a safe procedure burden by a low incidence of postoperative complications providing a satisfactory cancer control, with a minimal risk of local recurrence
Eosinophilic oesophagitis in children: responders and non-responders to swallowed fluticasone
No full textEosinophilic Oesophagitis (EO) is characterised by large numbers of eosinophils in oesophageal mucosa in response to food or inhaled antigens. Treatment with elimination diet or corticosteroids lead to improvement in some children, but their efficacy is not optimal.
AIM:
of this study is to identify clinical, endoscopic and/or histological features associated with response to treatment with swallowed fluticasone propionate.
PATIENTS AND METHODS:
In the last 12 years 34 children (M/F 25/9) with EO were treated with fluticasone propionate spray 250 μg/puff by inhaler without spacer, three puffs three times a day for 6 weeks, and returned for a follow-up endoscopy. At histology 25 of them were found to be responders to therapy (73.5%) and 9 were non-responders. Anthropometric characteristics, symptoms at presentation, endoscopic and histological data at baseline between responders and non-responders were compared.
RESULTS:
Age, sex, height, duration and type of main symptom at presentation, type of allergy and number of allergens, peripheral eosinophil counts an serum IgE were similar in responders and non-responders. At baseline histology findings responders had a more severe inflammation: median peak eosinophils/high power field was higher (76 vs 44 in non responders p=0.04), eosinophilic microabscesses were present in a significantly higher number of responders (p=0.04) and peak mast cells/ high power field was significantly higher (p=0.001).
CONCLUSIONS:
Clinical characteristics of children with EO at baseline were similar in responders and non-responders, but a more severe inflammation in oesophageal mucosa was associated with a higher response rate to fluticasone treatment
Debulking surgery in the setting of very high-risk prostate cancer scenarios
No full textStudy Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Nowadays radical prostatectomy (RP) is considered an effective treatment in high-risk prostate cancer (PCa) and the indications for a surgical approach are expanding, even in cases of very high PSA or node-positive disease. We explored the outcomes of debulking surgery in the setting of these very high-risk PCa patients, in order to assess its feasibility. This review confirms the important role achieved by surgery in the complex setting of patients with very high-risk PCA. Excellent survival rates have been reported, even when PSA exceeds 100 ng/mL. The completion of RP with lymphadenectomy might give a survival benefit in patients who were found intraoperatively to be node-positive. Furthermore, salvage RP confirmed to be the most effective treatment option after RT failure. On the contrary, up-to-date surgery of isolated nodal recurrences has shown only little benefit. Finally, there is no evidence supporting the efficacy of debulking surgery in metastatic or in hormone-refractory tumours. An accurate selection of the patient is essential.
OBJECTIVE:
• To conduct a critical analysis of the available literature on the feasibility of debulking surgery in the setting of very high-risk prostate cancer (PCa) scenarios.
PATIENTS AND METHODS:
• We performed a systematic literature search of PubMed and Embase using combinations of the following keywords: radical prostatectomy, surgery, high-risk, high PSA (prostate-specific antigen), radiorecurrent, hormone-refractory, metastatic prostate cancer, salvage. • With the term 'very high-risk PCa' we indicated a clinical disease beyond the common definition of high-risk PCa, i.e. any clinical stage > T3, N0 or N+, any PSA level > 50 ng/mL and any recurrent disease after primary treatment.
RESULTS:
• Radical prostatectomy (RP) achieved excellent survival rates in high-risk PCa, even in patients with very high PSA level. The completion of RP with lymphadenectomy might give a survival benefit in patients who were found intraoperatively to be node-positive. • Salvage RP was confirmed to be the most effective treatment option after radiotherapy failure, with increased functional outcomes and decreased side-effects in the most recent series. • Surgery of isolated nodal recurrences after previous radical therapy has shown little benefit according to the few available series. • There is no evidence supporting the efficacy of debulking surgery in metastatic or hormone-refractory PCa.
CONCLUSION:
• Debulking surgery achieved an important role in several aggressive PCa scenarios. An accurate selection of the patient is essential
Dr. Duane M. Jackson, Morehouse College, July 2011
No full textThis video is a conversation with Dr. Duane M. Jackson. Dr. Jackson talks about his paper, "Recall and the Serial Position Effect: The Role of Primacy and Recency on Accounting Students' Performance." Jackie Daniel, AUC Woodruff Library, is the interviewer
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