PROSTATE CANCER AND DIET: FOOD FOR THOUGHT?

? There is now increasing evidence that diet plays a major role in prostate cancer biology and tumorigenesis. ? In a health conscious society, it is becoming increasingly common for Urologists to be asked about the impact of diet on prostate cancer. ? In the present review, we explore the current evidence for the role of different dietary components and its' effect on prostate cancer prevention and progression. ? A literature search was conducted using PubMed? to identify key studies. ? There was some evidence to suggest that green tea, isoflavones, lycopenes, cruciferous vegetables and omega 3 polyunsaturated fatty acid intake to be beneficial in the prevention and/or progression of prostate cancer. ? There was also evidence to suggest that a high total fat, meat (especially well cooked) and multivitamin intake may be associated with an increased risk of developing prostate cancer. ? To date publications have been highly heterogeneous and variable in quality and design. More robust, high quality research trials are needed to help us understand the complex relationship between diet and prostate cancer.     

FOCAL THERAPY FOR LOCALISED PROSTATE CANCER: ARE WE ASKING THE CORRECT RESEARCH QUESTIONS?

The goals of focal therapy are laudable, namely reducing morbidity of treatment while ensuring at least equivalent oncological outcomes when compared with established interventions for localised prostate cancer, e.g. RP and external beam radiotherapy. While progress has been made towards better identifying the index lesion in these patients, there is much yet to be done to establish the validity of the index lesion theory as the metastatic focus and to establish that current targeting and ablative platforms are adequate to deliver the goals outlined above. The correct research questions have not yet been asked to establish either of these key principles underpinning focal therapy for localised prostate cancer.     

FIXED AND DYNAMIC URETHRAL COMPRESSION FOR THE TREATMENT OF POST-PROSTATECTOMY URINARY INCONTINENCE: IS HISTORY REPEATING ITSELF?

PURPOSE: We reviewed the evolution of appliances and devices used for treating post-prostatectomy urinary incontinence. MATERIALS AND METHODS: We used the MEDLINE to search the literature from 1966 to March 2000 and then manually searched bibliographies to identify studies that our initial search may have missed. RESULTS: The evolution of treatment for post-prostatectomy urinary incontinence may be traced back to the 18th century. Two main schools of thoughts simultaneously evolved. The first fixed urethral compression devices were constructed to enable urethral obstruction by fixed resistance. This outlet resistance allows voiding after intra-abdominal and intravesical pressure is elevated but it is sufficient to prevent leakage between urinations. The other school of thought preferred creation of dynamic urethral compression in which outlet resistance is not fixed but may be decreased when voiding is desired or elevated between urinations. Therapeutic fixed and dynamic urethral compression interventions may be further divided into external or internal compressive devices or procedures. External fixed compression devices may be traced back to antiquity. A penile clamp, similar to the later Cunningham clamp, and a truss designed to compress the urethra by external perineal compression were presented in the Heister textbook of surgery, Institutiones Chirurgicae, as early as 1750. Dynamic compressive devices applied externally were developed much later, such as the first artificial urinary sphincter, described by Foley, in 1947 and the Vincent apparatus, described in 1960. The modern era of fixed urethral compression began in 1961 with Berry. Acrylic prostheses impregnated with bismuth to allow radiographic visualization were produced in various shapes and sizes, and used to compress the urethra against the urogenital diaphragm. In 1968 the University of California-Los Angeles group under the direction of Kaufman began to use cavernous crural crossover to compress the bulbous urethra (Kaufman I). Later 2 other modifications were described, including approximation of the crura in the midline using a polytetrafluoroethylene mesh tape (Kaufman II) and an implantable silicone gel prosthesis (Kaufman III). With the advent of the artificial urinary sphincter pioneered by Scott in 1973 interest in passive urethral compression disappeared in favor of the implantation of an inflatable circumferential prosthetic sphincter. Recently there has been a trend back to passive urethral compression. Synthetic bolsters have been described that passively compress the bulbar urethra to achieve urinary incontinence after radical prostatectomy. CONCLUSIONS: Much creativity has been dedicated to solve the complex and challenging problem of post-prostatectomy urinary incontinence. Devices used for treating this condition may be grouped according to the mechanism of action and how they are applied. Passive urethral compression, long abandoned in favor of dynamic implantable sphincters, has reemerged. Further research in this field may determine which school of thought may provide the best solution for treating post-prostatectomy urinary incontinence.     

SPINAL OR GENERAL ANAESTHESIA FOR SURGERY OF THE FRACTURED HIP?: A Prospective Study of Moratality in 578 Patients

The mortality following surgical correction of upper femoralfractures was investigated in 578 patients, over the age of50 yr, randomly allocated to receive spinal (bupivacaine) orgeneral (enflurane or neurolept) anaesthesia. Thirty days aftersurgery the mortality was 6% after spinal and 8% after generalanaesthesia (ns). Six months to 2 years after surgery the mortalitywas identical in the two groups. There were no differences withrespect to ambulation and discharge. The estimated blood losswas smaller (P < 0.05) in patients receiving spinal anaesthesia.Regardless of the anaesthetic technique, a high short-term mortalitywas related to age, male sex, and trochanteric fracture, whereasexcess long-term mortality was related to male sex and highASA scores. *Department of Anesthesia, Hvidovre Hospital, DK 2650 Hvidovre,Denmark. Department of Orthopedic surgery U, Rigsholpitalet, DK 2100Copenhagen Ø, Denmark.     

LONG-TERM ASSESSMENT OF EXTRADURAL ANALGESIA FOR THE RELIEF OF PAIN IN LABOUR. II: SENSE OF "DEPRIVATION" AFTER EXTRADURAL ANALGESIA IN LABOUR: RELEVANT OR NOT?

Ninety-nine mothers who received extradural analgesia, and 95who received conventional methods of analgesia for the reliefof pain in labour, were interviewed at 18–24 months followingdelivery. An increase of about 2% in the proportion of mothersexperiencing a sense of "deprivation" in the long term in comparisonwith the findings recorded immediately after delivery was noted.This was not accompanied by the need to seek psychiatric treatment