Observations of aggressive,small, flat,and depressed colon cancer

Three cases of small, flat, and depressed colon cancers are reported. One lesion is less than 1 cm in diameter with lymphatic invasion in the submucosa; the other measures 0.8 cm in the longest dimension and penetrates through the muscular layers to the subserosa. The third one, 1.2 cm in diameter, has had liver metastasis. The endoscopic appearances of two lesions with a resected specimen are presented in color to demonstrate some difficulties in visualizing these lesions for endoscopists. The biologic aggressiveness of these three lesions appears due to their rapid growth, which is expressed by a high mitotic rate of the cancer cells. Their histogenesis is considered to derive from (1) flat adenoma, from (2) serrated adenoma, and (3) from hyperplastic epithelium (or de novo in origin), respectively.     

Management of superficial recurrences in an irradiated bladder after combined-modality organ-preserving therapy: Weiss C,Wittlinger M,Engehausen DG,Krause FS,Ott OJ,Dunst J,Sauer R,Rödel C,Department of Radiation Therapy,University of Erlangen,Erlangen, Germany.

PURPOSE: Standard treatment for superficial bladder cancer is transurethral resection of the bladder tumor (TURBT) followed by intravesical therapy. Little is known about the biologic behavior and treatment response of superficial disease within an irradiated bladder. We specifically analyzed patients who developed superficial recurrence after TURBT and radiotherapy or radiochemotherapy. PATIENTS AND METHODS: Between 1982 and 2006, a total of 531 consecutive patients with invasive bladder cancer were treated by using various bladder-sparing protocols at our institution. Of these, 389 (76%) achieved a complete response after TURBT and radiotherapy/radiochemotherapy. During follow-up, 68 of 389 patients (17%) developed a superficial local relapse (相似文献   

Expression, roles, receptors, and regulation of osteopontin in the kidney.

Osteopontin (OPN) is a secreted glycoprotein in both phosphorylated and non-phosphorylated forms. It contains an Arg-Gly-Asp cell-binding sequence and a thrombin-cleavage site. OPN is mainly present in the loop of Henle and distal nephrons in normal kidneys in animals and humans. After renal damage, OPN expression may be significantly up-regulated in all tubule segments and glomeruli. Studies utilizing OPN gene-deficient mice, antisense-treated or anti-OPN-treated animals have demonstrated that OPN promotes accumulation of macrophages, and may play a role in macrophage-mediated renal injury, but that the effect may be mild and short-lived. On the other hand, OPN has some renoprotective actions in renal injury, such as increasing tolerance to acute ischemia, inhibiting inducible nitric oxide synthase and suppressing nitric oxide synthesis, reducing cell peroxide levels and promoting the survival of cells exposed to hypoxia, decreasing cell apoptosis and participating in the regeneration of cells. In addition, OPN is associated with renal stones, but whether it acts as a promoter or inhibitor of stone formation is controversial. It has been demonstrated that OPN receptors include two families: integrin and CD44. The OPN integrin receptors include alpha(v)beta(3), alpha(v)beta(1), alpha(v)beta(5) and alpha(9)beta(1), and alpha(4)beta(1). In normal human kidneys, standard CD44 is expressed most dominantly. Different OPN functions are mediated via distinct receptors. Parathyroid hormone, vitamin D(3), calcium, phosphate and some cytokines increase OPN expression in vitro or in vivo, whereas female sex hormones and angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists decrease OPN expression in some renal damage states.     

Evidence for dual modulation of pepsinogen secretion using isoproterenol, carbachol, CCK-8, forskolin, 8 bromo-cAMP, and A23187 probes

The cellular mechanisms by which pepsinogen (PNG) secretion is controlled are not understood. The aim of this study was to explore whether modulation of PNG secretion is mediated by cAMP or calcium-calmodulin (C-C). PNG secretion in isolated rabbit gastric fundic glands (IGG) was tested, using agents believed to act via cAMP or C-C. IGG were stimulated for 30 minutes with histamine (H) 10(-5) M, isoproterenol (I) 10(-5) M, carbachol (C) 10(-5) M, cholecystokinin-octapeptide (CCK-8) 10(-7) M, forskolin (F) 10(-5) M, 8 bromo-cAMP (8B) 10(-3) M, and A23187 (A) 10(-6) M. PNG levels were determined by spectrophotometric assay of hemoglobin digestion products. PNG amounts secreted were (mean per cent above basal levels of total IGG PNG units +/- SEM): H, -0.02 +/- 0.30%; I, 3.5 +/- 0.9%; C, 5.1 +/- 2.2%; CCK-8, 5.3 +/- 1.5%; F, 10.6 +/- 3.8%; 8B, 13.8 +/- 4.5%; A, 2.1 +/- 1.1%. All secretagogues except H stimulated PNG release significantly above basal levels (p less than 0.05). A primary histaminergic mechanism for pepsinogen secretion is unlikely. Since two other adenylate cyclase activators, isoproterenol and forskolin and the 3':5'-cyclic adenosine monophosphate analog 8-bromo cAMP stimulated pepsinogen secretion, cAMP-dependence is probable. Since carbachol, CCK-8, and A23187, which are believed to act via calcium-calmodulin, also stimulated pepsinogen secretion, this system, too, presumably plays a substantial role. Thus the data support a dual 3':5'-cyclic adenosine monophosphate/calcium-calmodulin modulation of pepsinogen secretion.     

Evaluation of clinico-radiological, bacteriological, serological, molecular and histological diagnosis of osteoarticular tuberculosis

Background:

The diagnosis of osteoarticular tuberculosis is clinico-radiological in endemic areas. However every patient does not have the classical picture. Osteoarticular tuberculosis is a paucibacillary disease hence bacteriological diagnosis is possible in 10-30% of the cases. The present study is undertaken to correlate clinico-radiological, bacteriological, serological, molecular and histological diagnosis.

Materials and Methods:

Fifty clinico-radiologically diagnosed patients of osteoarticular tuberculosis with involvement of dorsal spine (n = 35), knee (n = 8), shoulder (n = 1), elbow (n = 2) and lumbar spine lesion (n = 4), were analyzed. Tissue was obtained after decompression in 35 cases of dorsal spine and fine needle aspiration in the remaining 15 cases. Tissue obtained was subjected to AFB staining, AFB culture sensitivity, aerobic/anaerobic culture sensitivity histopathological examination and polymerase chain reaction (PCR) using 16srRNA as primer. Serology was performed by ELISA in 27 cases of dorsal spine at admission and one and three months postoperatively.

Results:

AFB staining (direct) and AFB culture sensitivity was positive in six (12%) cases. Aerobic/anaerobic culture sensitivity was negative in all cases. Histology was positive for TB in all the cases. The PCR was positive in 49 (98%) cases. All dorsal spine tuberculosis cases showed fall of IgM titer and rise of IgG titer at three months as compared to values at admission.

Conclusion:

Histopathology and PCR was diagnostic in all cases of osteoarticular tuberculosis. The serology alone is not diagnostic.     

Cholinergic stimulation of pancreatic polypeptide release by a meal,bombesin, neurotensin,tetragastrin, cholecystokinin,and cerulein

It has been demonstrated that pancreatic polypeptide (PP) release can be markedly impaired by vagotomy or anticholinergic drugs. The current studies examine the role of cholinomimetic stimulation on PP release in dogs. Eight conscious animals underwent a series of tests: (1) a test meal (10 g/kg Alpo); (2) tetragastrin infusion (4 μg/kg/hr); (3) bombesin infusion (1.0 μg/kg/hr); (4) cerulein infusion (100 ng/kg/hr); (5) cholecystokinin octapeptide (CCK-OP) infusion (100 ng/kg/hr); (6) neurotensin infusion (3 ng/kg/hr). All the studies were repeated individually with intravenous bethanecol (100 μg/ kg/hr) as the background stimulant. The mean increment of PP released by a meal (160 ± 32 fmol/ ml) was significantly increased by bethanecol infusion (316 ± 49 fmol/ml) (P < 0.05). Each individual peptide released a significant amount of PP; tetragastrin: 53 ± 11; neurotensin: 58 ± 14; CCK-OP: 42 ± 9; cerulein: 42 ± 12; bombesin: 118 ± 24 (P < 0.05). Bethanecol did not significantly augment PP release by any of the individual peptides (P > 0.05). This study indicates that PP release by a meal is sensitive to cholinomimetic stimulation and that the peptide involved is neither gastrin, neurotensin, CCK, bombesin, nor cerulein. These data support the possibility of the existence of a cholinergic stimulatable mechanism, possibly a peptide responsible for the release of PP.     

Distribution, elimination, and action of d-tubocurarine in neonates, infants, children, and adults

The relation of plasma concentration of d-tubocurarine (dTc) to neuromuscular blockade, and the distribution and urinary excretion of dTc was determined in neonates (n = 4), infants (n = 6), children (n = 8), and adults (n = 8). The plasma concentration-time course curves to 24 hr are best described for all groups by three-compartment models. Both neonates and infants exhibit decreased plasma clearance (CLP), 1.1 +/- 0.08 and 1.0 +/- 0.06 ml X kg-1 X min-1, and in addition a prolonged t1/2 terminal phase, 311 +/- 44 and 306 +/- 35 (mean +/- SEM, min). The neonates' 24-hr urinary excretion, 27 +/- 2 (mean +/- SEM, % total dose) is significantly less than the adult value, 45 +/- 4% total dose. There was no significant difference seen in the log plasma concentration-evoked compound electromyogram (ECEMG) response between 20-80% paralysis for adults, children, infants, and five of the seven neonates studied. Two of the neonates had a significant shift of their log concentration-response curve to the right. There was also no significant difference between any of the groups in the time for 50% return of ECEMG stimulus height or the time required for recovery of the ECEMG from 25 to 75% of control value. for recovery of the ECEMG from 25 to 75% of control value.     

Pharmacokinetics of desflurane, sevoflurane, isoflurane, and halothane in pigs

We tested the prediction that the alveolar washin and washout, tissue time constants, and pulmonary recovery (volume of agent recovered during washout relative to the volume taken up during washin) of desflurane, sevoflurane, isoflurane, and halothane would be defined primarily by their respective solubilities in blood, by their solubilities in tissues, and by their metabolism. We concurrently administered approximately one-third the MAC of each of these anesthetics to five young female swine and determined (separately) their solubilities in pig blood and tissues. The blood/gas partition coefficient of desflurane (0.35 +/- 0.02) was significantly smaller (P less than 0.01) than that of sevoflurane (0.45 +/- 0.02), isoflurane (0.94 +/- 0.05), and halothane (2.54 +/- 0.21). Tissue/blood partition coefficients of desflurane and halothane were smaller than those for the other two anesthetics (P less than 0.05) for all tissue groups. As predicted from their blood solubilities, the order of washin and washout was desflurane, sevoflurane, isoflurane, and halothane (most to least rapid). As predicted from tissue solubilities, the tissue time constants for desflurane were smaller than those for sevoflurane, isoflurane, and halothane. Recovery (normalized to that of isoflurane) of the volume of anesthetic taken up was significantly greater (P less than 0.05) for desflurane (93% +/- 7% [mean +/- SD]) than for halothane (77% +/- 6%), was not different from that of isoflurane (100%), but was less than that for sevoflurane (111% +/- 17%). The lower value for halothane is consistent with its known metabolism, but the lower (than sevoflurane) value for desflurane is at variance with other presently available data for their respective biodegradations.     

Comparison of TURP, TUVRP, and HoLEP

Since the first transurethral resection of the prostate (TURP) was performed by Guyon at the Necker Hospital in Paris in 1901, this treatment modality has replaced open prostatectomy as the procedure of choice for more than 95% of patients. TURP has been used in surgical treatment of benign prostatic hyperplasia (BPH) and remains the gold standard treatment. Transurethral vapor resection of the prostate (TUVRP) and holmium laser enucleation of the prostate (HoLEP) are new treatment modalities for the treatment of BPH. Each procedure has its own advantages and disadvantages. Availability of instruments, surgical expertise, and specific indications for a particular procedure are of utmost importance for successful outcome, with minimal morbidity. TURP can be either monopolar or bipolar, using thin or thick loop. Bipolar TURP is associated with less bleeding and less chances of dilutional hyponatremia. TUVRP, using a thick wedge loop, causes vaporization and resection of the prostate, and is associated with less bleeding and short operative time. HoLEP is another effective alternative for the surgical treatment of BPH. The holmium laser possesses the ideal combination of cutting and coagulation; however, it has a learning curve.     

Assessing the roles of demographic,social, economic,environmental, health-related,and political factors on risk of osteoporosis diagnosis among older adults

Summary

Until now, there have been only a few retrospective studies that focused on the outcomes of sandwich vertebral bodies (SVBs). This is a long-term retrospective cohort study to investigate the SVBs. We found that although patients with SVBs had a relatively high risk of developing new fractures after VA, the incidence rate of new fractures was not significantly different from that of the control group. However, the statistical power of this study was very limited. Therefore, and because the refracture rate in these patients is substantial, routine long-term monitoring of patients after VA for osteoporosis is strongly recommended.

Background

Sandwich vertebral bodies (SVBs) are intact unaugmented vertebral bodies between two previously augmented vertebrae. Until recently, only a few studies have reported the outcomes and strategies for SVBs. This retrospective cohort study aimed to describe the clinical features and incidence of new fractures in patients with SVBs.

Methods

The clinical data were collected from 179 patients with 237 symptomatic osteoporotic vertebral compression fractures who underwent vertebral augmentation (VA). Among them, 23 patients with 24 levels of SVBs were included. Spinal radiographs (X-ray and CT) of all patients were evaluated prior to surgery 1 day after primary VA and during follow-up.

Results

All patients successfully underwent PKP with an average follow-up period of 21.48 months. Asymptomatic cement leakage occurred in four patients (17.4%), and eight patients (34.8%) developed new fractures following primary PKP, including four sandwich, six adjacent, four remote vertebral fractures, and one re-collapse of cemented vertebrae. The incidence of new fractures in the SVB and control groups was 16.7% (4/24) and 13.0% (6/46), respectively, but there was no significant difference.

Conclusions

Although patients with SVBs had a relatively high risk of developing new fractures after VA, the incidence rate of new fractures was not significantly different from that of the control group. However, the statistical power of this study was very limited. Therefore, and because the refracture rate in these patients is substantial, routine long-term monitoring of patients after VA for osteoporosis is strongly recommended.

     

Classification,imaging, biopsy and staging of osteosarcoma

Osteosarcoma is the most common primary osseous malignancy excluding malignant neoplasms of marrow origin (myeloma, lymphoma and leukemia) and accounts for approximately 20% of bone cancers. It predominantly affects patients younger than 20 years and mainly occurs in the long bones of the extremities, the most common being the metaphyseal area around the knee. These are classified as primary (central or surface) and secondary osteosarcomas arising in preexisting conditions. The conventional plain radiograph is the best for probable diagnosis as it describes features like sun burst appearance, Codman''s triangle, new bone formation in soft tissues along with permeative pattern of destruction of the bone and other characteristics for specific subtypes of osteosarcomas. X-ray chest can detect metastasis in the lungs, but computerized tomography (CT) scan of the thorax is more helpful. Magnetic resonance imaging (MRI) of the lesion delineates its extent into the soft tissues, the medullary canal, the joint, skip lesions and the proximity of the tumor to the neurovascular structures. Tc99 bone scan detects the osseous metastases. Positron Emission Tomography (PET) is used for metastatic workup and/or local recurrence after resection. The role of biochemical markers like alkaline phosphatase and lactate dehydrogenase is pertinent for prognosis and treatment response. The biopsy confirms the diagnosis and reveals the grade of the tumor. Enneking system for staging malignant musculoskeletal tumors and American Joint Committee on Cancer (AJCC) staging systems are most commonly used for extremity sarcomas.     

A 6-week,multicentre, randomised,double-blind,double-dummy,active-controlled,clinical safety study of lumiracoxib and rofecoxib in osteoarthritis patients

Background  

Lumiracoxib is a selective cyclooxygenase-2 inhibitor effective in the treatment of osteoarthritis (OA) with a superior gastrointestinal (GI) safety profile as compared to traditional non-steroidal anti-inflammatory drugs (NSAIDs, ibuprofen and naproxen). This safety study compared the GI tolerability, the blood pressure (BP) profile and the incidence of oedema with lumiracoxib and rofecoxib in the treatment of OA. Rofecoxib was withdrawn worldwide due to an associated increased risk of CV events and lumiracoxib has been withdrawn from Australia, Canada, Europe and a few other countries following reports of suspected adverse liver reactions.     

Inducible FGFR-1 activation leads to irreversible prostate adenocarcinoma and an epithelial-to-mesenchymal transition Acevedo VD, Gangula RD, Freeman KW, Li R, Zhang Y, Wang F, Ayala GE, Peterson LE, Ittmann M, Spencer DM, Program in Cell and Molecular Biology, Baylor College of Medicine, Houston, TX

Fibroblast growth factor receptor-1 (FGFR1) is commonly overexpressed in advanced prostate cancer (PCa). To investigate causality, we utilized an inducible FGFR1 (iFGFR1) prostate mouse model. Activation of iFGFR1 with chemical inducers of dimerization (CID) led to highly synchronous, step-wise progression to adenocarcinoma that is linked to an epithelial-to-mesenchymal transition (EMT). iFGFR1 inactivation by CID withdrawal led to full reversion of prostatic intraepithelial neoplasia, whereas PCa lesions became iFGFR1-independent. Gene expression profiling at distinct stages of tumor progression revealed an increase in EMT-associated Sox9 and changes in the Wnt signaling pathway, including Fzd4, which was validated in human PCa. The iFGFR1 model clearly implicates FGFR1 in PCa progression and demonstrates how CID-inducible models can help evaluate candidate molecules in tumor progression and maintenance.     

Effect of castration, DES, flutamide, and the 5 alpha-reductase inhibitor, MK-906, on the growth of the Dunning rat prostatic carcinoma, R-3327.

Male rats bearing implants of the Dunning rat prostatic carcinoma, R-3327, were used in a 42-day study to determine the effect of castration or orally administered flutamide (FL), DES (diethylstilbestrol) or the 5 alpha-reductase inhibitor, MK-906, on the growth of this androgen-responsive cancer. The rate of growth and final weights of the tumor and the ventral prostate (VP) were all reduced (P less than 0.05) by castration. Flutamide (25 mg/kg/day) significantly decreased tumor and VP weights in intact rats and castrates given 100 micrograms/day (SC) of testosterone propionate (TP) or dihydrotestosterone propionate (DHTP). It also significantly retarded tumor growth rate in TP- or DHTP-treated castrates and was marginally effective in intact animals. DES (100 micrograms/kg/day) reduced (P less than 0.05) tumor and VP weights of intact rats but did not significantly affect tumor growth rate or weight in castrates given TP or DHTP. These results indicated that the effect of DES on tumor growth is caused by its inhibition of the secretion or release of the gonadotropins necessary for testicular androgen production. MK-906 (25 mg/kg/day) affected neither the gross nor the histomorphology of the tumor in intact rats or castrates given TP or DHTP. Further, it caused no histological changes in the testes of intact rats. It did, however, significantly reduce VP weight in intact animals and TP-treated castrates but not in those given DHTP. This illustrates that the anti-androgenicity of MK-906 stems from its inhibition of DHT formation. The failure of MK-906 to influence tumor growth in the TP-treated castrates strongly suggests that the R-3327 tumor can respond to testosterone directly. If that is true, then its growth is unlikely to be affected by a pure 5 alpha-reductase inhibitor such as MK-906. In ancillary experiments, tumors from MK-906-treated animals were found to have reduced levels of DHT and, when assayed in vitro, to have a reduced capacity to convert [3H]-T to [3H]-DHT.     

Congenital pseudarthrosis of the tibia: history, etiology, classification, and epidemiologic data

Congenital pseudarthrosis of the tibia is a rare disease with a variable history. The pseudarthrosis is usually not present at birth (and therefore is not truly congenital) but occurs during the first decade of life. Paget in 1891 was the first to describe a case. The etiology is unknown. Neurofibromatosis plays a role in approximately 50% of patients. In the others, hereditary and mechanical factors are debated. Various (morphologic) classification systems have been proposed (Andersen, Boyd, Crawford). Because the appearance changes during the course of the disease, all classification systems have limited value: the determining factor is the stage of the disease at which it was classified. Because of the rarity of the disease and the variability of its history, the European Pediatric Orthopaedic Society decided to carry out a multicenter study on this disease. This paper presents the epidemiologic data on the patients involved. Data have been gathered on 340 patients from 13 countries. Two hundred patients were male (58.8%), 140 were female (41.2%). The right side was affected in 165 patients (48.5%) and the left side in 172 (50.6%); 3 patients had bilateral disease. Symptoms of neurofibromatosis were present in 54.7%. Histologic examinations in 192 patients showed a nonspecific appearance in 45.3%; in 15.6% the ultrastructure resembled fibrous dysplasia, and in 39% there was histologic evidence of neurofibromatosis. Most of the lesions were initially localized in the middle or distal third of the tibia. In 29% the localization changed during the course of the disease.     

Anterolateral Ligament of the Knee: Diagnosis,Indications, Technique,Outcomes

In the context of anterior cruciate ligament reconstruction surgery, anterolateral ligament reconstruction is now recognized as a reliable option to control rotatory instability and should be considered in the knee surgeon's modern armamentarium. By highlighting its daily practical application, this infographic presents the indications for this specific additional lateral augmentation, the anatomic and biomechanical principles that underline its rationale, and the clinical outcomes from recent large series.In 2013, Claes et al. updated the anterolateral ligament (ALL) concept, and numerous subsequent studies detailed its precise anatomy. It is now accepted that the femoral insertion is located proximal and posterior to the epicondyle. The biomechanical behavior of the ALL during the knee flexion path has been reported to provide control of tibial internal rotation during the pivot shift and with increasing knee flexion angles (>35). Clinically, when a patient presents with an anterior cruciate ligament (ACL) injury, clinical examination (pivot shift test), radiography (Segond fracture), ultrasound, and 3-dimensional magnetic resonance imaging are useful to assess a combined ALL injury.The following indications for ALL reconstruction are now well established: ACL revision, high-grade pivot shift test, chronic ACL rupture, young patients, pivoting activities, and patients undergoing medial meniscus repair. It has been reported that anatomic and minimally invasive surgical techniques that control anterolateral rotatory instability can achieve successful outcomes without specific complications. Finally, the addition of ALL reconstruction does not delay postoperative rehabilitation, and no modification is required for an early rehabilitation protocol.     

Epidemiology,Pathogenesis, and Pathophysiology of Urolithiasis

ContextUrolithiasis (UL) is one of the most common diseases, with worldwide increasing incidence and prevalence. The pathogenesis of calcium oxalate (CaOx) UL, which accounts for >80% of all urinary stones, is only incompletely understood.ObjectiveOur aim was to review trends in epidemiology and current concepts for the pathogenesis and pathophysiology of urinary stone disease.Evidence acquisitionWe reviewed data from the literature and our own series.Evidence synthesisUrinary stone formation is a result of different mechanisms. Completely different pathomechanisms lead to CaOx stone formation, with Randall plaques playing a key role in the pathogenesis.ConclusionsThe lithogenesis of key stones is multifactorial. Lifestyle and dietary choices are important contributing factors. The pathogenesis and pathophysiology of CaOx stones is still incompletely understood. Recent evidence suggests a primary interstitial apatite crystal formation that secondarily leads to CaOx stone formation.     

Cancer of the lung: staging, radiology, surgery

Primary lung cancer is the leading cause of cancer-related deaths in industrialized countries. Despite advances in treatment, the overall 5-year survival remains poor due to the advanced stage of disease at presentation. Smoking remains the main risk factor being responsible for around 85% of all cases. The most important distinction is that between non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Surgeons primarily deal with NSCLC (SCLC is an aggressive tumour that usually presents with systemic disease). NSCLC has a number of histological subtypes.Patient evaluation aims to establish the cell type of the tumour, determine the stage of the disease, and to determine fitness for surgery. Staging of NSCLC is based on the tumour/node/metastasis (TNM) classification. Procedures used to diagnose or stage lung cancer can include chest X-ray, chest computed tomography (CT) scan, combined positron emission tomography/CT, CT or transbronchial guided needle biopsy, and mediastinoscopy amongst others. Surgery is the only established method for ‘curing’ NSCLC. However, only a quarter of patients have resectable disease at presentation. Surgical resection can be performed using a variety of procedures including lobectomy, pneumonectomy or wedge resections. The 5-year survival of patients with stage I lung cancer following surgical resection is 51-60%.     

Cost-effectiveness of prostate cancer chemoprevention: A quality of life-years analysis Svatek RS, Lee JJ, Roehrborn CG, Lippman SM, Lotan Y, Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX

BACKGROUND: The Prostate Cancer Prevention Trial (PCPT) demonstrated that finasteride reduces the prevalence of prostate cancer by 24.8% (risk reduction) but questions remain regarding the cost-effectiveness of widespread utilization. The purpose of the current analysis was to evaluate the cost-effectiveness of chemoprevention utilizing a quality-of-life adjustment. METHODS: A Markov decision analysis model with probabilistic sensitivity analysis was designed to determine the lifetime prostate health-related costs, beginning at age 50 years, for men treated with finasteride compared with placebo. Model assumptions were based on data from the PCPT; Surveillance, Epidemiology, and End-Results program; literature review of costs, utilities, and transition rates among various prostate cancer health states; and local institutional cost data. RESULTS: The quality-adjusted cost-effectiveness ratio for finasteride compared with men not receiving chemoprevention was $122,747 (in U.S. dollars) per quality-adjusted life-years saved (QALYs). If finasteride is assumed to not increase the incidence of high-grade tumors, the quality-adjusted cost-effectiveness ratio was $112,062 per QALYs. Sensitivity analysis found that chemoprevention of prostate cancer with an agent that has no effect on the prevalence of benign prostatic hyperplasia can render a cost-effectiveness ratio of <$50,000 per QALYs saved when applied to a high-risk population associated with a 25% risk reduction, and a cost of $30 per month. CONCLUSIONS: Finasteride is unlikely to be cost-effective when considering the impact on survival differences among treated vs. untreated groups. However, chemoprevention may be cost-effective in high-risk populations when taking into consideration adjustments for the impact on quality of life.     

A clinical, histological, and computer-based assessment of the Polaris LV, combination diode, and radiofrequency system, for leg vein treatment

BACKGROUND AND OBJECTIVES: Electro-optical synergy (ELOS) is a novel technology that combines radiofrequency (RF) with optical energy. This study investigated the safety and effectiveness of the Polaris LV system, which is based on combined RF and diode laser (915 nm), for the treatment of leg veins. STUDY DESIGN/MATERIALS AND METHODS: Fifty women (Fitzpatrick II-IV) with red or blue leg veins (1-4 mm in diameter) were treated with the Polaris LV, using a fluence of 60-80 J/cm(2) and conducted RF energy of 100 J/cm(3). Patients received up to three treatment sessions at 2- to 4-week intervals. Both patients and an independent physician graded the level of vessel clearance at 2 months following the last treatment, using pre- and post-treatment photographs. Also, a computer-generated assessment of vessel clearance was done in 40 patients. Twenty patients provided biopsy specimens for histologic assessment. RESULTS: Approximately three-quarters of patients demonstrated >/= 50% vessel clearance, and about 30% had 75%-100% vessel clearance. Computer-generated scores correlated closely with physician scores. Histologic assessment showed signs of coagulation and prominent endothelial degeneration in all treated vessels, but the epidermis remained normal. There were minimal complications. CONCLUSIONS: The Polaris LV is effective and safe in treating red and blue leg veins up to 4 mm in diameter.