307 research outputs found
Radical Prostatectomy in Men with Oligometastatic Prostate Cancer: Results of a Single-institution Series with Long-term Follow-up
No full textIn the absence of data from randomized trials, the role of local treatment in metastatic prostate cancer (PCa) is gaining interest. Our study aimed to assess perioperative and long-term oncologic outcomes of radical prostatectomy (RP) in a selected cohort of 11 patients with oligometastatic disease treated with RP and extended pelvic lymph node dissection between 2006 and 2011. Oligometastatic disease was defined as the presence of five or fewer bone lesions at bone scan with or without suspicious pelvic or retroperitoneal nodal involvement at preoperative imaging. The minimum follow-up for survivors was 5 yr. Perioperative outcomes, clinical progression, and cancer-specific mortality (CSM) were evaluated. Median age was 72 yr. Median operative time, blood loss, and length of hospitalization were 170Â min, 750Â ml, and 13 d, respectively. Overall, two patients (18%) experienced grade 3 complications in the postoperative period, and eight (73%) received blood transfusions. Overall, 10 (91%) and 8 (73%) patients had lymph node invasion and positive surgical margins, respectively. Adjuvant androgen deprivation therapy was administered to 10 patients (91%). Median follow-up for survivors was 63 mo. The 7-yr clinical progression- and CSM-free survival rates were 45% and 82%, respectively. Our findings support the safety and effectiveness of RP in a highly selected cohort of PCa patients with bone metastases and long-term follow-up. Patient summary We evaluated the outcomes of patients with oligometastatic prostate cancer treated with radical prostatectomy with a minimum of 5-yr follow-up. This surgical procedure performed with a multimodal approach might represent a safe and feasible option in selected men and provide acceptable oncologic outcomes at long-term follow-up
Extended and saturation prostatic biopsy in the diagnosis and characterisation of prostate cancer: A critical analysis of the literature
No full textObjective: To review and critically analyse all the recent literature on the detection and characterisation of prostate cancer by means of extended and saturation protocols. Methods: A systematic review of the literature was performed by searching MedLine from January 1995 to April 2007. Electronic searches were limited to the English language, and the key words "prostate cancer," "diagnosis,". "transrectal ultrasound (TRUS)," "prostate biopsy," and "prognosis" were used. Results: The prostate biopsy technique has changed significantly since the original Hodge sextant biopsy protocol. Several types of local anaesthesia are now available, but periprostatic nerve block (PPNB) has proved to be the most effective method to reduce pain during TRUS biopsy. It remains controversial whether PPNB should be associated with other medications. The optimal extended protocol (sextant template with at least four additional cores) should include six standard sextant biopsies, with additional biopsies (up to 12 cores) taken more laterally (anterior horn) to the base and medially to the apex. Repeat biopsies should be based on saturation biopsies (number of cores >= 20) and should include the transition zone, especially in a patient with an initial negative biopsy. As a means of increasing accuracy of prostatic biopsy and reducing unnecessary prostate biopsy, colour and power Doppler imaging, with or without contrast enhancement, and elastography now can be successfully adopted, but their routine use is still controversial. Conclusion: Extended and saturation biopsy schemes should be performed at first and repeat biopsy, respectively. The widespread use of local anaesthesia makes the procedures more comfortable. (c) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved
Diagnosis of local recurrence after radical prostatectomy
No full textIn the long-term there is biochemical evidence of recurrent prostate carcinoma in approximate to 40% of patients after radical prostatectomy (RP). Detecting the site of recurrence (local vs distant) is critical for defining the optimum treatment. Pathological and clinical variables, e.g. Gleason score, involvement of seminal vesicles or lymph nodes, margin status at surgery, and especially the timing and pattern of prostate-specific antigen (PSA) recurrence, may help to predict the site of relapse. Transrectal ultrasonography (TRUS) of the prostatic fossa in association with TRUS-guided needle biopsy is considered more sensitive than a digital rectal examination for detecting local recurrence, especially if PSA levels are low. Although it cannot detect minimal tumour mass at very low PSA levels (<1 ng/mL) TRUS biopsy is presently the most sensitive method for detecting local recurrence. Nevertheless, the conclusive role of biopsy of the vesico-urethral anastomosis remains unclear. However, In-111-capromab pendetide scintigraphy and [C-11]-choline tomography (which are better than conventional imaging for detecting metastatic tumour), have low detection rates for local disease and are considered complementary to TRUS in this setting. Patients with a high PSA after RP may be managed with external beam salvage radiotherapy. An initial PSA of < 1 ng/mL, Gleason score < 8 and radiation dose of 66-70 Gy seem to be key factors in determining success. Although a positive TRUS anastomotic biopsy may predict a better outcome after radiation therapy, the need to take a biopsy in the event of PSA failure remains under investigation. The value of salvage radiation to the prostatic bed for PSA-only progression after RP remains in question
Anaesthesia in Transrectal Prostate Biopsy: Which Is the Most Effective Technique?
No full textBackground: Prostate biopsy (PBx) techniques have changed significantly since the original Hodge's scheme, with an increase in the number and location of cores. These improvements have been realized in part because of the introduction of different local anaesthesia techniques. We critically analysed the literature discussing the role of anaesthesia techniques for use during PBx to find which technique provides the best pain relief for the patient and safety for the urologist. Methods: We performed a literature review by searching the Medline database for articles published between January 2000 and March 2010. Electronic searches were limited to the keywords 'transrectal prostate biopsy' and 'anaesthesia'. Results: Pain and discomfort perceived during PBx are the result of different anatomic factors: the introduction to and movement of the transrectal ultrasound probe in the rectum and the needle piercing the rectum and the prostate capsule. The anaesthesia techniques currently available can be divided into two groups: local (i.e. intrarectal lubricant agents, periprostatic nerve blocks, caudal blocks, pudendal nerve blocks, and their different combinations) and systemic (i.e. oral/intravenous drug administration and sedoanalgesia). Conclusions: The most effective anaesthesia technique for transrectal PBx performed in outpatient settings is the periprostatic nerve blocks with 1 or 2% lidocaine 10 ml, which is associated with intrarectal lubricant agents, especially in younger people. Nevertheless, the current choice of the anaesthesia technique still depends both on patient characteristics (age, prostate size, number and location of cores, anxious personality, need for re-biopsy) and, above all, the urologist's experience and habits. Copyright (C) 2011 S. Karger AG, Base
The relationship between continence and perineal body tone before and after radical prostatectomy: a pilot study.
No full text"Introduction Recent preliminary studies showed that tonic-trophic characteristics of the pelvic muscles are related to postoperative male urinary incontinence. The aim of the current study was to test whether perineal body tone (PBT), evaluated using the Beco perineometer (Perineocaliper), is related to urinary continence recovery after robot-assisted laparoscopic prostatectomy (RALP). Materials and Methods: The study population consisted of 48 patients who underwent RALP between January and July 2009. Surgical interventions were performed by a single surgeon and patients were evaluated by a single physiotherapist. All patients were taught pelvic floor muscle exercises (PFME). PBT was evaluated in each patient preoperatively, as well 30 days and 3 months after surgery. In addition, patients were evaluated with a 24-hr pad-test and the International Consultation on Incontinence-questionnaire (ICI-Q). Results: Mean age at surgery was 65.5 years (range 46-63). Twenty-four patients underwent a bilateral nervesparing procedure (50%). One-month after surgery, 25 (52.1%) patients were continent while 23 (47.9%) patients were still incontinent. A statistically significant difference in preoperative perineometric measures was observed between continent and incontinent patients (mean 1.36 cm vs. 0.80 cm; P < 0.001). This difference was even more pronounced when comparing postoperative perineometric measures (mean 1.24 cm vs. 0.43 cm; P < 0.001). Evaluation of patients 3 months after surgery showed an increase in perineometric measures (mean increase 0.76 cm). The increase was significantly higher in patients who became continent after 3 months relative to patients who were still incontinent despite PFME (mean perineometric measures 1.45 cm vs. 1.00 cm; P 0.021). Conclusions: Our results demonstrate that urinary continence recovery is related to PBT recovery. Further studies are needed to confirm whether perineometric measures may be used as a predictive tool for the risk-stratification of postoperative UI. Neurourol. Urodynam. 31: 513-516, 2012. (C) 2012 Wiley Periodicals, Inc.
Les edats d’«In memoriam»
No full textRemarks on "In memoriam", the largest poem by Gabriel Ferrater, nn the occasion of the 100th birth anniversary of the author
Holmium laser enucleation versus transurethral resection of the prostate. Are histological findings comparable?
No full textPurpose: We investigated if an adequate histological diagnosis can be made from tissue after holmium laser enucleation of the prostate (HoLEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with benign prostatic hyperplasia. Materials and Methods: We analyzed 40 HoLEP and 40 age matched TURP tissue specimens from patients who underwent 1 of the 2 procedures between January 2001 and August 2002. Each histological specimen was reviewed by a single pathologist. Preoperative prostate ultrasound volume, total serum prostatic specific antigen and postoperative tissue weight were evaluated. Microscopic histological diagnosis was assessed by standard histological techniques and immunohistochemical evaluation. Results: Patients were comparable in terms of age and preoperative total serum prostate specific antigen. Tissue remaining following the procedure was estimated to be 36.3% of preoperative ultrasound volume after HoLEP and 52.8% after TURP (p <0.001). Incidental adenocarcinoma and high grade PIN of the prostate were diagnosed in a comparable percent of specimens in the 2 groups. Tissue thermal artifacts induced by the laser were mostly due to coagulation. Thus, the alterations were similar to those after TURP. Conclusions: Tissue quality is altered after HoLEP and TURP. General prostatic architecture was maintained in the majority of HoLEP histological specimens. A moderately higher percent of prostatic tissue obtained by the Ho laser is lost by vaporization and coagulation. Nevertheless, these differences do not seem to alter pathologist ability to detect incidental prostate cancer and PIN
Impact of photovoltaic technology and feeder voltage level on the efficiency of façade building-integrated photovoltaic systems
No full textsponsorship: This project receives the support of the European Union, the European Regional Development Fund ERDF, Flanders Innovation & Entrepreneurship and the Province of Limburg. This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No. 751159. Special thanks goes to C. Sheehan from Bourns for providing the required inductor specifications. Patrizio Manganiello was previously with IMEC, Kapeldreef 75, Leuven, Belgium. (European Union, European Regional Development Fund ERDF, Flanders Innovation & Entrepreneurship, Province of Limburg, European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie|751159, Marie Curie Actions (MSCA)|751159)status: Published onlin
Modulatory effects of transcranial direct current stimulation (tDCS) on words and non-words reading task
No full textTITLE:
Modulatory effects of transcranial direct current stimulation (tDCS) on words and non-words reading task
AUTHOR(S):
Margherita Forgioneb, Patrizio Tressoldi b, Daniela Mapelli b, Paulo Sergio Boggio a
a Centro de Ciências Biológicas e da Saúde, Universidade Presbiteriana Mackenzie, Sao Paulo
b Dipartimento di Psicologia Generale, Università degli Studi di Padova, Italia
INTRODUCTION:
In recent past tDCS has gained much attention for rehabilitation purposes. Moreover, few studies have been conducted to investigate its efficacy on reading process. The aim of these studies was to investigate the role of left and right posterior temporal cortex in words and non-words reading process, through tDCS. We focused on the online task to see if it can influence the subjects’ performance. We hypothesized that the anodal stimulation would facilitate the task execution compared to sham and cathodal, in terms of reaction times and accuracy.
METHOD:
Twenty good readers were tested in 3 sessions (sham, anodal, cathodal), with different online task (text reading or music listening). tDCS was applied bilaterally over posterior temporal lobe, with a current of 1,5 mA, lasting for 20 minutes. Participants had to read aloud words or non-words, before and after stimulation. We recorded reaction times and accuracy for words and non-words, before and after stimulation.
RESULTS:
Regarding reaction times, we found significant effect of cathodal tDCS in short words reading task. Similarly, we also found an improvement in reading accuracy for non-words after tDCS. The online task doesn’t seem to affect the performance.
CONCLUSIONS:
We found a modulatory effect of cathodal tDCS in words reading task, suggesting a compensatory mechanisms of the right hemisphere. To verify this hypothesis, we are investigating different montages, involving left or right hemisphere. Further studies are necessary to understand the modulation effects of this technique, in addition with other methodologies, such as eye tracker, and with clinical sample, in particular dyslexics
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