Shoulder Dysfunction After Radiotherapy in Surgically and Nonsurgically Treated Necks: A Prospective Study

Our goal was to evaluate the shoulder dysfunction after radiotherapy in surgically and nonsurgically treated necks.A prospective pair matched design was performed. A total of 96 patients from 3 groups were enrolled in the study. The patients were asked to complete the shoulder domain section of the University of Washington Quality of Life questionnaire on 2 occasions: preoperatively and 12 months postoperatively.None of the patients had a shoulder impairment before the operation. At the follow-up session, 4 patients who had received radiotherapy only reported mild shoulder dysfunction, the mean score was 96.3, the difference was significant compared with the preoperative score (P = 0.046). For patients who had received neck dissection, 7 patients reported that the impaired shoulder function caused them to change their work and 14 patients reported that their shoulder function was affected a little; the mean score was 71.6. For patients who had received both neck dissection and postoperative radiotherapy, 9 patients reported that they had changed their work due to shoulder dysfunction and 16 patients reported mild shoulder impairment; the mean score was 65.3 and the difference was not significant (P = 0.304).Radiotherapy does not increase shoulder dysfunction in surgically treated necks, but it could induce shoulder impairment in nonsurgically treated necks.     

Survival Prediction Model Using Clinico-Pathologic Characteristics for Nonsmall Cell Lung Cancer Patients After Curative Resection

The current TNM staging system did not provide disease relapse information. The aim of study was try to establish a predictive survival model for disease and overall survival in nonsmall cell lung cancer patients who presented as resectable disease and to develop a reference for follow-up imaging tool selection.From January 2005 to December 2011, 442 patients who initially presented as resectable disease (stages I–IIIa) and received anatomic resection and mediastinal lymph node dissection were included in the study.Medical charts were thoroughly reviewed and clinico-pathologic factors were collected and analyzed.Visceral pleural invasion, tumor size >5 cm, and postoperative adjuvant therapy were identified as risk factors for poorer disease-free survival. The 5-year disease-free survival from score 0 to 3 was 68.7%, 46.6%, 31.9%, and 26.1%, respectively. The disease relapse percentage for scores 0 to 3 were 26.49%, 50.61%, 65.05%, and 73.81%, respectively. For analysis of overall survival, age >60 years, tumor size >3 cm, and total metastatic lymph node ratio >0.05 were correlated to worse overall survival. Because greater age may be correlated with poor general condition, we re-scored risk factors that correlated to disease severity that ranging from 0 to 2. The 5-year overall survival range from score 0 to 2 was 56.3%, 43.1%, and 13.1%, respectively.Poor prognostic factors correlated to disease-free survival were tumor size >5 cm, visceral pleural invasion, and patients needing to receive postoperative adjuvant therapy. Disease-free survival of resectable nonsmall cell lung cancer patients and disease relapse can be stratified by these 3 factors. Chest tomography may be recommended for patients with 1 or more poor disease-free survival risk factors.     

The Tumor-immune Index is Correlated With the Prognosis of Patients After Curative Resection for Nonsmall Cell Lung Cancer

We developed a novel tumor-immune index (TII) based on carcinoembryonic antigen levels, lymphocyte counts, and platelet counts, and explored its prognostic value in nonsmall cell lung cancer (NSCLC).The prognostic value of the TII was evaluated based on a retrospective study of 205 patients with early NSCLC, who underwent resection in the whole year of 2006, and validated in another group of 228 patients enrolled in the next year of 2007.The optimal cut-off point for the TII was 578 × 10⁻⁹, and this value was used to stratify patients with NSCLC into low TII (≤578 × 10⁻⁹) and high TII (>578 × 10⁻⁹) groups. Univariate and multivariate analyses revealed that high TII was an independent predictor for overall survival and recurrence-free survival in both the training and validation cohorts. The areas under the curve of the TII for survival and recurrence were significantly larger than those for tumor, node, metastasis (TNM) stage and carcinoembryonic antigen. In the subgroup analysis, the TII was also significantly correlated with overall survival (P = 0.001, P = 0.009, and P = 0.007 in the TNM I, II, and IIIa subgroups, respectively) and recurrence-free survival (P < 0.001, P = 0.006, and P = 0.014 in the TNM I, II, and IIIa subgroups, respectively). Similarly, for patients with N2-positive tumors, the overall survival and recurrence-free survival rates for patients in the high TII group were also significantly lower than the respective values for patients in the low TII group (P = 0.026 and P = 0.007, respectively).The TII can be used to distinguish patients with similar pathologies and stages into high and low-risk categories based on the probability of recurrence according to a convenient blood-based test.     

Disseminated Cryptococcosis After Transurethral Resection of the Prostate

Abstract: Disseminated cryptococcosis after transurethral resection of the prostate. R. Allen, C. E. Barter, L. L. Chachoua, L. Cleeve, J. M. O'Connell and F. J. Daniel, Aust. N.Z. J. Med., 1982, 12, pp. 296–299.
A 63-year-old man presenting with acute retention and dysuria underwent transurethral resection of the prostate for suspected benign prostatic hypertrophy. Ten days postoperatively he developed disseminated cryptococcosis. Re-examination of the prostatic chips revealed cryptococcal prostatitis. Treatment consisted of amphotericin, flucytosine and transfer factor along with wedge resection of a pulmonary toruloma. He remains well 12 months after cessation of treatment. This appears to be the first case report in Australia of cryptococcal prostatitis with dissemination after transurethral resection of the prostate.     

The Change in Body Composition After Bilateral Lung Volume Reduction Surgery for Underweight Patients with Severe Emphysema

The aim of this study was to examine the short-term effect of lung volume reduction surgery (LVRS) on body composition and other nutritional indicators in 28 patients with emphysema underwent thoracoscopic LVRS. Functional tests, body weight (BW), and body composition were measured before and 6 months after surgery. Mean daily caloric intake (CI) was estimated by 3-day dietary record as well. Fat-free mass (FFM) and fat mass (FM) were assessed by bioelectrical impedance analysis (BIA). FEV_1.0 and Vo _2max have improved after LVRS by 35.2% and 23.8%, respectively. Preoperatively, 75% of patients were underweight (% ideal body weight (%IBW) <90) with the mean %IBW at 84.5%. BW, CI, and FFM increased significantly after LVRS, whereas FM was unchanged. The change in BW correlated significantly with the change in FEV_1.0, MVV, and Vo _2max (p < 0.01) but not with CI. Bilateral LVRS results in an increase in FFM and functional improvement for underweight patients with severe emphysema, and it may contribute to the improvement in maximal exercise capacity. Accepted for publication: 12 December 2000     

Male Sexual Dysfunction as Related to Alcohol Consumption: A Pilot Study

Personal interviews were conducted with 44 male volunteers consecutively admitted to outpatient treatment in a county alcoholism program. Fifty-three per cent of the subjects were still drinking minimally or in moderation at the time of the interview. Quantity, frequency, and duration of drinking, from onset of regular drinking to present, were related to sexual dysfunctions. During heavy drinking, 59% of patients experienced erection dysfunction, 48% repotted ejaculation incompetence, and 84.4% had experienced at least one kind of sexual dysfunction.     

Cerebral Dysfunction in Alcoholism Related to Mortality and Long Term Social Adjustment

All 1312 first-admitted alcoholics at the Department of Psychiatry, University Hospital, Lund (120 women) during 1949-1969 were followed until December 31, 1980. There were 537 deaths. All patients had been rated at discharge with a multidimensional rating scale including signs of cerebral dysfunction. Thirty-three per cent of the total patient group had signs of cerebral dysfunction, increasing with age up to 64% in those over 50 years. Men younger than 50 years with brain dysfunction had a higher mortality caused by alcohol-related physical disorders in relationship to violent deaths compared with the others. The main finding in those over the age of 50 was the increased number of deaths caused by circulatory disorder in the brain dysfunction group. The social prognosis was similar in all groups. It is suggested that a continuous and heavy drinking pattern in the young dysfunctional group and an accelerated aging in the old dysfunctional group could explain the differences found.