Clinical study of prostate cancer: statistical analysis of 107 cases in the past 12 years

One hundred and seven patients with prostate cancer were treated at Mie University Hospital during the past 12 years between 1988 and 1999. They were between 53 and 83 years old, with an average age of 70.8 years old. The clinical stage was defined as A, B, C and D in 3 (2.8%), 19 (17.8%), 50 (46.7%) and 35 (32.7%) patients, respectively. At initial diagnosis, the tumor was well, moderately and poorly differentiated adenocarcinoma in 26 (24.3%), 47 (43.9%) and 34 (31.8%) patients, respectively. The median follow-up period was 52.3 months. The overall 1, 3 and 5-year survival rates were 98.0%, 86.8% and 75.2%, respectively. The 5-year survival rates for stage A, B, C and D were 100%, 93.8%, 82.1% and 56.9%, respectively. A significant difference (p = 0.017) in 5-year survival rate was noted between stage C and D. The 5-year survival rate was 100% for well differentiated, 78.0% for moderately differentiated, and 53.2% for poorly differentiated adenocarcinoma. A significant difference (p = 0.0016) in the 5-year survival rate was noted between well differentiated and poorly differentiated adenocarcinoma. According to the therapy, the 5-year survival rate in stage C was 86.2% for the radical prostatectomy group and 84.0% for the endocrine therapy group. There was no significant difference between these 2 treatment groups. Endocrine therapies, classified into maximum androgen blockade (MAB) and endocrine therapy other than MAB were performed for stage D as an initial therapy. Although the prognosis in the patients treated with MAB was better than that with other endocrine therapies, there was no significant difference between these 2 endocrine treatment groups.     

10年胆道再手术的临床分析

目的：对胆道再手术的原因，治疗方法及疗效进行综合评价。以避免或减少再手术的发生和次数。方法：总结南开医院1990－1999年收治的外科病人中各类胆道病人治疗后的再次胆道手术病例，从胆道疾病手术后再次手术的原因，处理方法及治疗效果等方面进行系统的分析比较，结果：10年间胆道再手术病人828例，胆道再手术原因以残余和（或）再生结石为多，占73．43％，其它依次为Oddi括约肌狭窄，胆管炎性狭窄，胆肠吻合口狭窄，损伤性狭窄和肿瘤等。多次再手术的主要原因是胆管和胆肠吻合口良性狭窄，再手术方式以不同形式的胆道成形及内引流为主，38．77％的病人因胆总管结石和（或）Oddi括约肌狭窄行单纯EST及网篮取石术，胆道再手术病死率3．87％。结论：（1）胆道再手术主要原因是胆管结石。（2）多次胆道再手术的原因则以胆管和胆肠吻合口狭窄为主。（3）胆道再手术以清除结石，纠正胆管狭窄和建立通畅引流为原则。     

Changes in the clinical and anatomo-pathological presentation of prostate cancer in Oviedo in the last 10 years (part I)

ObjectivesTo describe the clinical and pathological factors of prostate adenocarcinomas diagnosed in our department in the years 1995 and 2004Material and methodWe review the 216 patients diagnosed in both years, recording several featuresResultsThe mean age was significatively lower in the year 2004. In that year, the increments of the PSA levels was the main reason for the diagnosis of the prostate cancer, followed by low urinary tract symptons (LUTS), while the LUTS was the main reason in 1995. There was a greater proportion of high grade tumors in 1995 and also in this year, high risk tumors were the most frequently found, while in 2004 low risk and low grade tumors were predominantConclusionsDue to the general determinations of PSA levels in asymptomatic patients in 2004, we found a greater proportion of high grade tumors in 1995 and lower grade tumors in 2004     

The top 10 arthroplasty articles published in last 10 years by Indian authors

Joint replacement surgery is becoming increasingly popular globally and recently,?in India. The phenomenon of medical tourism has also contributed to increasing number of arthroplasty surgeries being done every year in our country. The surgeons who work in this highly specialized field of orthopedic surgery, have been publishing their research work in reputed journals. In this paper, we have discussed the most cited Indian papers in the field of arthroplasty. It was observed that publications in high impact and reputed journals attract more citations and therefore it is recommended that the ‘good’ scientific research work should preferably be submitted to these journals to create greater impact and awareness about ones’ research.     

Changes in the presentation pattern of the prostate cancer in Oviedo in the last 10 years: diagnostic and treatment (part II)

ObjectivesTo describe and compare the diagnostic and treatment factors of prostate adenocarcinomas diagnosed in our department in the years 1995 and 2004.Material and methodWe review the 216 patients diagnosed in both years, recording several features.ResultsSignificant differences were found in the mean of cylinders taken in the biopsies, being higher in 20041,6 than in 19952,3. Hormonal deprivation was the predominant treatment in 1995 followed by radical prostatectomy, while in 2004 radiotherapy (external beam or braquitherapy) was the most frequent therapy used followed by hormonal deprivation and radical prostatectomy. Independent factors to apply the treatment was the age (OR=5,6) and the risk groups (OR=2,8) in the year 2004 and only the age (>70 years vs ≤70) in the year 1995.ConclusionsThe evolution held in treatment therapies for prostate adenocarcinomas, made this disease in terms of treatment a multidisciplinary disease obtaining better results.     

The last 10 years in a burn centre in Ankara, Turkey: an analysis of 5264 cases

This is a retrospective study analysing 5264 patients treated in the burn centre at Gülhane Military Medical Academy from 1 January 1986 to 31 December 1995. Our burn centre is not only the firs, but one of the best established and supported in Turkey. Our present study has the largest patient group of other previously published studies from Turkey. Of the total patients studied, 4464 patients had minor burns and were treated on an outpatient basis and 800 patients had moderate to major burns. Although our centre is in a military area in Ankara, only 1047 (20 per cent) patients were military personnel and the military-related burn causes comprised only 6 per cent of the total. The remaining 4217 (80 per cent of the total patients) were civilians. Flame injuries were also more frequent in military patients than civilians. Minor burns were most common in the age group 0–10 years old (40 per cent) and moderate to major burns in the age group 21–30 years (54 per cent). Scalds were the main cause of paediatric burns. Male patients were dominant. The overall mortality among inpatients was 18.2 per cent and mean total body surface area (TBSA) was 57.6 per cent in patients who died. 134 patients demonstrated inhalation injury and 82 per cent of these patients died. The epidemiological pattern of our patients is similar to that in other studies from developed countries, although some ethnic causative factors could be found. Our study indicates that emergency measures should be taken to prevent flame injuries at military barracks and industrial workplaces and scalding accidents to children at home and throughout the country.     

Spontaneous retroperitoneal hemorrhage: our experience at last 10 years

Introduction and Objectives: Etiology, clinical features, diagnostic methods and treatment of spontaneous retroperitoneal hemorrhage were analyzed.Methods:We report 27 cases with diagnosis of spontaneous retroperitoneal hemorrhage treated in our hospital between January 1996 and December 2005. The imaging techniques were abdominal ultrasonography, abdominal CT scan and MRI.Results:The most common cause of retroperitoneal hemorrhage was renal angiomyolipoma rupture in 7 patients. Continuous flank or abdominal pain were the primary symptoms. Abdominal ultrasonography showed hematoma in 81.8% patients, but the actual etiologic diagnosis was ascertained in only 40.9% of them. Retroperitoneal hemorrhage was demonstrated by means of abdominal CT scan in all cases and bleeding origin was established in 92.6% of cases. Ten patients underwent urgent surgery while conservative treatment was attempted in the remaining 17.Conclusions:In our experience, in cases of spontaneous retroperitoneal hemorrhage, CT scan is the best imaging method to establish the diagnosis and the management of such entity although it will need to be individualized for every case because it depends on the hemodinamic situation and etiologic diagnosis.     

Clinical observations on urethritis over the last eight years in Gifu City Hospital

Clinical observations were made on patients with urethritis, syphilis, chancroid, genital herpes and venereal warts for the last eight years at Gifu City Hospital. The patients with urethritis, genital herpes and venereal warts tended to increase yearly, and the number of the cases with urethritis increased about 2.5 times in the eight years. Slightly more patients had nongonococcal urethritis than gonococcal urethritis excluding 1981. Of the patients with gonococcal urethritis seen between 1977 and 1979, 58% were treated with benzylpenicillin intramuscularly, and 43% of the patients seen between 1980 and 1984 were treated with a concomitant therapy of spectinomycin intramuscularly and minocycline or doxycycline orally. The cure rate for each treatment was 94% and 97%, respectively. Of the patients with nongonococcal urethritis seen between 1980 and 1984, 89% were treated with minocycline or doxycycline orally, and the cure rate was 97%. On the other hand, the cure rate was 43% for the treatment between 1977 and 1979, only 10% of whom had received treatment with minocycline or doxycycline.     

Gleason10分前列腺癌患者的临床特点分析

目的 观察Gleason 10分前列腺癌患者的临床诊疗及疾病变化过程,总结该类前列腺癌患者的临床特点及预后影响因素. 方法 2005年1月至2010年5月,21例初诊为前列腺癌、Gleason 10分、行手术去势加抗雄激素治疗的患者纳入本研究.初诊年龄56～85岁,平均73岁.PSA 8.9～261.0 ng/ml,平均60.8 ng/ml,其中6例PSA≤20 ng/ml.行核素骨扫描发现骨转移16例.予双侧睾丸切除术加氟他胺或比卡鲁胺全雄激素阻断治疗.术后1个月复查PSA,以后每3个月随访PSA.治疗后6个月为单纯内分泌治疗观察终点.6个月内PSA未降至＜4 ng/ml且无远处转移者加用局部外放射治疗,伴骨转移者使用基于多西他赛与泼尼松的全身化疗.患者死亡为研究终点.结果 15例初诊PSA＞ 20 ng/ml患者中,5例治疗后6个月内血清PSA未降至正常水平,其中4例伴骨转移.该4例子全身化疗后PSA均未降至正常水平,3例1年内死亡,1例诊断后19个月死亡,1例疾病局限患者予外放射治疗,PSA下降至正常水平8个月后出现肿瘤进展,诊断后11个月死亡.10例治疗后6个月内血清PSA降至正常水平,其中3例分别于诊断后第19、28、36个月死于肿瘤,7例存活.6例初诊时PSA≤20 ng/ml患者中3例治疗后6个月内PSA未降至正常水平,其中2例伴骨转移予化疗后于1年内死亡;1例PSA下降至正常水平但仍出现肿瘤进展,全身多发骨转移,化疗无效,1年内死亡;1例4年后因前列腺癌死亡;1例随访6个月,PSA降至0.07 ng/ml. 结论 Gleason 10分前列腺癌肿瘤进展迅速,抗雄激素治疗疗效不佳,行伞雄激素阻断后6个月内PSA无法下降至正常水平患者病情进展凶险.初诊PSA≤20 ng/ml且病理证实Gleason 10分者可能预示预后不佳.     

Diagnosis of localized prostate cancer: 10 years of progress

Advances in the diagnosis of early stage disease, and particularly the introduction of prostate-specific antigen (PSA) testing, have had a dramatic effect on the presentation and clinical management of prostate cancer during the past ten years. As a result, there have been significant epidemiological changes in countries where early diagnosis is recommended. The importance of PSA testing for the diagnosis of localized prostate cancer has become well established in clinical practice and this is reflected by improved outcomes from definitive treatment. The contribution of PSA-related parameters and molecular forms of PSA both to cancer detection and prediction of pathological stage continue to be explored. Concerns about the reliability of the standard sextant biopsy technique for cancer detection relate to the need for re-biopsy in a growing number of patients with negative biopsies and an increasing proportion of patients with low volume, multifocal disease. In men with cancer, additional prognostic information can be derived from biopsy findings, with important therapeutic implications. This relates also to the need for reliable markers indicating pathological stage and risk of progression. The opportunities for the prevention of prostate cancer have grown with improved understanding of its biology and the genetic basis of the early steps associated with malignant transformation. In the future, the need for therapeutic intervention is likely to be most influenced by successful prevention strategies.     

A narrative review of the role of glucocorticoid receptors in prostate cancer: developments in last 5 years

Background and ObjectiveGlucocorticoids, secreted from the adrenal gland, are commonly used in the treatment of castration-resistant prostate cancer (CRPC) because of their anti-inflammatory and anti-toxic effects. However, glucocorticoids have been reported to have the opposite effects within the course of treatment. Many studies have shown that glucocorticoid receptors (GRs) are involved in the establishment of a dominant population of androgen-independent malignant cells, which may result in CRPC. In this review, we summarized the mechanisms of GRs in CRPC and the clinical application of glucocorticoids based on the present evidence.MethodsWe summarized the isoforms of GRs and the mechanisms involved in CRPC. An updated literature search was performed from the ClinicalTrials database, the National Center for Biotechnology Information database and European Union Drug Regulating Authorities Clinical Trials database. The focus was on the timeframe from 2017 to 2022. At least one primary or secondary outcome [prostate-specific antigen (PSA) response rate, progression-free survival (PFS) or overall survival (OS) and median time to PSA progression] according to studies should be included.Key Content and FindingsThe molecular structures and applications of the isoforms of GR have been intensively researched in the past 60 years. In recent years, researchers have pointed out that GRs may be involved in the development of CRPC via genomic and non-genomic effects. Clinical trials in the past 5 years have focused on the efficacy of drugs regarding CRPC. The use of glucocorticoids during treatments of CRPC follows the guidelines (e.g., NCCN Guidelines^®, guidelines of CSCO, etc.). Based on the collected data, prednisone appears to be the most widely used steroid hormone, followed by dexamethasone. Comparisons of the PSA response rate and the median time to PSA progression revealed that the efficacy of the 2 hormones is similar; however, further research on the effect of steroid hormone in CRPC is still required.ConclusionsVarious GR isoforms may play an important part in the development of CRPC, whose mechanism remains unclear. Most clinical trials have focused on the use of prednisone in the last 5 years. The efficacy of prednisone and dexamethasone is similar.