35 research outputs found
Non-muscle invasive high grade urothelial carcinoma of the bladder. Which factors can influence understaging at the time of radical cystectomy?
No full textObjective: To evaluate the main factors which influence understaging in patients with T1G3 non-muscle invasive bladder cancer (NMIBC). Materials and methods: 109 patients with T1/G3 underwent transurethral resection of bladder tumor (TURBT) and then radical cystectomy (RC) with pelvic lymph nodes dissection. A number of variables were considered when evaluating the detection of understaging. We considered the patients age and gender, as well as the size, number, location and morphology of their tumor. We also considered coexistence of bladder carcinoma in situ (CIS), microscopic vascular invasion and deep lamina propria invasion. The level of experience of the surgeon was also analyzed. Results: in RC samples muscle invasion, that is understaging, was detected in 74 (67.9%) patients, while 35 (32.1%) patients were appropriately staged. In these cohort of patients with high grade tumors, understaging was associated with deep lamina propria and microscopic vascular invasion, multiple tumors, tumor size > 6 cm, tumor location (trigone and dome), presence of residual tumor; age, gender, tumor morphology, CIS associated, and experience of urological surgeon were not associated with clinical understaging. Conclusions: in our study, evaluating patients with high grade NMIBC at first TURBT, we identified some risk factors
that need to be considered and that are able to increase the risk of understaging: deep lamina propria and microscopic vascular invasion, multiple tumors, tumor size > 6 cm, tumor location (trigone and dome), presence of residual tumor. When these risk factors are present, performing an early cystectomy, and not a re-TURBT, could lower the risk of worse pathological finding due to rapid disease progression of the high grade tumors, and can prolong survival
The Economics of Scientific Misconduct
No full textThis article presents a model of the research and publication process that analyzes why scientists commit fraud and how fraud can be detected and prevented. In the model, authors are asymmetrically informed about the success of their projects and can fraudulently manipulate their results. We show, first, that the types of scientific frauds that are observed are unlikely to be representative of the overall amount of malfeasance; also, star scientists are more likely to misbehave but less likely to be caught than average scientists. Second, a reduction in fraud verification costs may not lead to a reduction of misconduct episodes but rather to a change in the type of research that is performed. Third, a strong "publish or perish" pressure may reduce, and not increase, scientific misconduct because it motivates more scrutiny. Finally, a more active role of editors in checking for misconduct does not always provide additional deterrence. The Author 2009. Published by Oxford University Press on behalf of Yale University. All rights reserved. For Permissions, please email: [email protected], Oxford University Press.
Perivascular epithelioid cell tumor (PEC-ome) of the prostate: ultrasound feature in case report
No full textINTRODUCTION: We describe a rare tumor arising from the prostate gland: Perivascular Epithelioid Cells tumor (PEC-ome). A 54-years old was treated for acute urinary retention with alpha-blockers at presentation due to benign prostate enlargement (65 cc) with asymmetric middle lobe and regular PSA (0.92 ng/ml). After 5 months, patient developed a second acute urinary retention episode and nodules in the left lung; he was treated with transurethral resection of the prostate and left lobectomy.
RESULTS: Histological examination of prostate and lung tissue gave the same diagnosis: leiomyosarcoma with atypical morphological features and patient was observed for 4 months. Considering the uncommon diagnosis, pathological review by the uro-pathologist at our Hospital was done. Additional immunohistochemistry was done and both tumors showed similar and typical features of metastatic PEC-ome (T1b N0 M1). Therefore a new staging showed local and distant progression with prostatic mass and small lung metastasis. Three cycles of Gemcitabine and Pazopanib were administered, but 2 months later a new urinary retention occurred, despite chemotherapy. Patient referred to our Hospital for salvage pelvic surgery with lymph node dissection. Final pathological diagnosis was PEC-ome of the prostate stage pT4 pN0 R0 M1.
CONCLUSIONS: PEC-ome is a rare but rapidly invasive mesothelial tumor with early metastatic potential. When this tumors originates from the fibromuscular stroma of the prostate it mimics benign prostatic enlargement and causes LUTS. Expert pathology aided by immunoisthochemistry is the cornerstone of diagnosis. There are no pathognomonic imaging on ultrasound or symptoms suggesting the presence of PEC-ome in early stage. A multidisciplinary approach is necessary and radical surgery should be done to treat this aggressive cancer
Repeated injection of botulinum toxin a in patients with neurogenic bladder: our experience.
No full textBackground: In literature, the majority of data about treatment with botulinum toxin A are based on the results of a single treatment. We evaluate the safety and effectiveness in the medium term of the use of botulinum toxin type A in patients with neurogenic bladder, taking into consideration the clinical and urodynamic parameters, particularly in cases with repeated injections. Methods: 25 patients were divided into 2 groups: a first group of patients with detrusor overactivity, and a second with overactive sphincter. We performed 20-30 injections (Dysport), at a dose ranging between 500 and 1000 U. The first group was treated with infiltration in the detrusor and in the detrusor and trigone. The second group received injections in the perisphinteric zone, and in the perisphinteric zone and bladder neck. Of the 25 patients, 12 received a retreatment: the first group of patients kept a daily voiding diary to record the number of bladder emptying, incontinence episodes, nycturia and urgency of urination. The urodynamic parameters and symptoms pre-treatment and 4 months after the treatment were compared in both groups. Results: In the first group there were significant changes in the cystometric capacity, maximum detrusor pressure, and in the post-void residual urine 4 months after treatment. These patients were satisfied with the treatment because of the improvement of incontinence and episodes of urgency. In 9 out of 15 retreated patients, the therapeutic results were similar to the first treatment. The second group reported significant improvements in maximum urinary flow rate, post-void residual urine and maximum detrusor pressure. 3 out of 10 patients were retreated even in this group; the new therapeutic results were similar to the first treatment. Conclusions: Our results in 25 patients with neurogenic bladder showed a concordance with the literature data. The treatment of detrusor and sphincter neurogenic overactivity with botulinum toxin A is effective and safe. Also in the 12 patients with repeated injection treatment, it has been proven safe and effective
Primary B-cell lymphoblastic lymphoma of the testis
No full textWe present a rare case of primary lymphoblastic B-cell lymphoma of the testis focusing on ultrasonographic and pathological features and clinical implications. Pathological examination revealed primary testicular lymphoblastic B-cell lymphoma which was treated with adjuvant chemotherapy, including rachicentesis with administration of chemotherapy and with radiotherapy of contralateral testis. Primary testicular lymphoblastic B cell lymphoma is an aggressive disease and it is necessary a multimodal therapy (surgery, chemotherapy and radiotherapy) to prevent metastasis
Neutrophil-to-lymphocyte ratio may be associated with the outcome in patients with prostate cancer
No full textPurpose: Evidences have shown that neutrophil-to-lymphocyte ratio (NLR) has a prognostic value in patients with
cancer. We wanted to test the prognostic significance of NLR in prostatic cancer of patients who are candidate to radical
prostatectomy.
Methods: We have considered 731 patients. Complete demographic data including age, tumor stage, Gleason score,
complete blood count and serum biochemical profile were collected. Pre-treatment percentage of neutrophils and
NLR were considered, and correlated with patients data and recurrence free survival.
Results: 389 patients were evaluated, mean age 65 years, mean follow-up 51.5 months, mean recurrence free survival
51.3 months. Total neutrophil count does not correlate with biochemical recurrence and disease free survival.
Patients with a value higher of 60% of neutrophils are more likely to have a recurrence. Patients with a total lymphocyte
count <1,500 have a higher rate of relapse. NLR was not correlated with baseline total PSA, with Gleason score
and with pathological stage; patients with a NLR >3 has a higher incidence of recurrence. In multivariate analysis
including age, total PSA and NLR, NLR is the most important factor able to predict recurrence. There are some limitations
to this study; first, this is a retrospective study, and the total number of patients analyzed is relatively small.
Conclusions: Our study suggests that pre-treatment NLR may be associated with disease free survival in patients
with prostate cancer, and could be introduced in clinical practice. NLR has the advantage of low economic cost and
wide availability
Biopsy follow-up in patients with isolated atypical small acinar proliferation (ASAP) in prostate biopsy
No full textThe incidence of prostate cancer (PCA) was evaluated in 155 patients with isolated Atypical Small Acinar Proliferation (ASAP) found on initial prostate biopsy, after a medium-term follow-up (40 months) with at least one re-biopsy. Clinical and histological data were analysed. Cancer was detected in 81 of 155 (52.3%). The cancer detection rate was 71.6%, 91.3%, 97.5%, 100% at the 1st re-biopsy, 2nd, 3rd, and 4th rebiopsy respectively. At the uni- and multivariate analyses, prostate volume (≤ 30 cc), transition zone volume (≤ 10 cc), small core length at the initial biopsy (≤ 10 mm) and few number of cores at initial biopsy (≤ 8) are predictive of cancer. Furthermore, tumour characteristics on the whole surgical specimens was assessed in 30 men: 13 of 30 (43 %) had clinically relevant cancer (volume > 0.5 ml or/and Gleason score ≥ 7, or pT3). Most of relevant cancers were detected in the distal apex, anterior gland and midline. These anatomical sites could be under-sampled at the initial biopsy using the transrectal approach. Our data suggest that follow-up biopsy is recommended in all cases of isolated ASAP detected after biopsy using endfire transrectal probe. The re-biopsy strategy should increase the number of cores (or a saturation biopsy), focusing on area of ASAP in the initial biopsy, but also including the under-sampled areas (anterior gland, distal apex and midline) to detect clinically relevant cancers
MVCT AND INTRAPROSTATIC MARKERS MAKE FEASIBLE THE TREATMENT OF PATIENTS WITH BILATERAL HIP PROSTHESIS
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