Prognostic influence of the third Gleason grade in prostatectomy specimens

BackgroundGleason grading of prostatic specimens remains as one of the most powerful factors predicting prognosis in patients with prostate cancer. This grading system was created by Donald Gleason about 49 years ago and it takes into account the 2 most prevalent grades in the tumor sample, but it does not consider the presence of a third high grade pattern when it represents less than 5% of the whole radical prostatectomy specimen.ObjectiveThe objective of the present study is to determine whether the existence of a third pattern of growth in the radical prostatectomy samples correlates with a shorter recurrence free survival.Material and methodsWe have reviewed 85 consecutive specimens of radical prostatectomy from patients with clinical localized disease. Those who received previous hormonal or radiation therapy were excluded. We have determined the Gleason grade and also the presence of a third higher grade pattern, surgical margins status, capsular, vascular, and lymphatic invasion. We have analyzed whether the existence of this high grade third pattern areas influences prognosis. Recurrence was defined with PSA levels (biochemical recurrence).ResultsWe have shown that the presence of a Gleason's grade 5 pattern of growth worsens prognosis in patients with tumors grade 7 (both 3 + 4 and 4 + 3), with a shorter time to recurrence. The latter group of patients behaves more like patients with Gleason 8 tumors. This worse prognosis should be taken into account for patient surveillance and future adjuvant therapies. We feel this information is relevant and should be reported in the pathology reports.     

Estudio ultrasonográfico e histológico de la evolución de un modelo canino de hiperplasia benigna de próstata inducida por hormonas

IntroductionDespite exhibiting histological differences from the human process, canine hormone-induced benign prostatic hyperplasia (BPH) is still the most widely used animal model for evaluating treatment strategies.ObjectivesThe aim of this study is to determine the optimal moment for starting a therapeutic trial in this animal model.Material and methodsSix male beagle dogs over one year of age were used in this study. All animals received a combination of steroid hormones, namely 17β-estradiol and 5α-androstene 3α 17β-diol, every other day during three (Group 1, n=3) or five months (Group 2, n=3). Transrectal ultrasonographic examinations to measure prostate volume were performed monthly. Animals were euthanized after five months for histological study of their prostates.ResultsAll animals developed BPH, with prostate volume increasing over time as hormones were administered (r=0,910). All ultrasonographic studies performed up to the third month evidenced a significant increase in prostate volume when compared to the prior ultrasound measurement. A significant decrease in prostate volume was seen in Group 1 once hormone administration was interrupted, whereas Group 2 animals showed a continuing increase in prostate size. Histological examination showed almost no evidence of BPH in Group 1 animals, while Group 2 animals clearly exhibited moderate epithelial hyperplasia.ConclusionsThe administration of a combination of steroid hormones is effective in inducing benign prostatic hyperplasia in canines, but this hyperplasia disappears when hormone treatment is interrupted. In order to be useful for experimental studies, hormones should be administered for at least three months before commencing any treatment, and they should be continued throughout the length of the study..     

Vein and artery growth after anastomosis with vascular closure staple clips vs interrupted polypropylene suture: application in pediatric vascular surgery

Background/Purpose

Alternatives are still being sought in vascular surgery to address the problem of arrested growth after anastomosis in growing vessels, and opinions differ widely regarding the most suitable technique. This study compared vascular growth and permeability after anastomosis using the latest-generation vascular closure staple (VCS) system and the conventional suture technique to ascertain which approach yielded better results.

Methods

Thirty 55-day-old lambs underwent end-to-end anastomosis of the carotid artery and jugular vein. Serial ultrasonography and angiography were carried out over the ensuing 6-month growth period, after which lambs were euthanized.

Results

Both VCS clips and polypropylene suture allowed longitudinal and transverse vessel growth; however, longitudinal growth was significantly greater in clip-closed vessels than in either sutured or untreated vessels.

Conclusions

The results obtained for vascular growth and permeability suggest that VCS clips may provide a suitable alternative to conventional suture in pediatric vascular surgery.     

Clinical outcomes in patients with Chiari I malformation: a review of 27 cases

BACKGROUND: Chiari I malformation is a congenital maldevelopment defined as downward herniation of the cerebellar tonsils through the foramen magnum. It has been treated using a variety of surgical procedures. Surgical outcomes have been reported with varying results throughout the literature. METHODS:We retrospectively reviewed 27 patients with Chiari I malformation operated at the University Hospital during a 9-year period from 1988 to 1997. We assessed preoperative and postoperative signs and symptoms in all the patients including headache, neck pain, nystagmus, vertigo, weakness, spasticity, atrophy, numbness, pain and temperature dissociation, diplopia, dysphagia, and sphincter dysfunction. Each patient was analyzed to determine if there was an arrest in the progression of the disease after surgical intervention. RESULTS: Syringomyelia was present in 59% of the patients. Only 1 patient who presented with neck pain improved. One patient reported new onset headache, and one patient described his headache resolved. Vertigo resolved in three patients; two patients stated mild improvement, and one patient reported worsening. Nystagmus improved or resolved in six patients. Weakness improved in only two patients who did not have syringomyelia. Dysphagia improved in two patients, and in the others it remained unchanged. Diplopia, spasticity, atrophy, and numbness remained unchanged. CONCLUSIONS: Our study provides evidence that the main benefit of the surgical management in patients with Chiari I malformation with or without syringomyelia is to arrest the progression of the disease.     

Intra-observer and inter-observer agreement of the manual examination of the lumbar spine in chronic low-back pain

Examination is a cornerstone in the manual procedures leading to mobilisation/manipulation of the low back. The observer variation of the more specific segmental tests remains to be investigated. Two skilled specialists in manual medicine examined the segmental changes in the lumbar spine. The patients were unknown to the examiners and no information of the case history was given. All test results were recorded by an observer present in the room who ensured that no conversation was allowed during the examination. The primary outcome measures were the kappa values for each test. The matching was defined as acceptable (acc) within two neighbouring levels and perfect (per) on the same level. Intra-observer variation (tested in 33 patients and 10 subjects without low-back pain): The agreement between first and second segmental diagnosis examination was 70% (per) and 82% (per + acc). Kappa values were: segmental diagnosis 0.60 (per) and 0.70 (per + acc), multifidus test 0.51 (per) and 0.60 (per + acc), sideflexion 0.57 (per) and 0.69 (per + acc), and ventral flexion 0.31 (per) and 0.45 (per + acc). Inter-observer variation (tested in 60 patients): The agreement for segmental diagnosis between the examiner A and B was 42% (per) and 75% (per + acc). Kappa values were: segmental diagnosis 0.21 (per) and 0.57 (acc), multifidus test 0.12 (per) and 0.48 (acc), sideflexion 0.22 (per) and 0.45 (acc), and ventralflexion 0.22 (per) and 0.44 (acc). By manual tests, skilled examiners seem to be able to diagnose segmental dysfunctions in the low back. The clinical implication of these dysfunctions remains to be clarified.     

Prevalence and Distribution of Asbestos Lung Residue in a Spanish Urban Population

IntroductionThe purpose of the present study is to analyse the prevalence and distribution of asbestos lung residue in the Barcelona urban population.Material and methodsLung autopsy samples were obtained from 35 individuals who had lived in Barcelona. The close family was interviewed in order to rule out asbestos exposure. Samples were obtained from three areas of the right lung during the autopsy: upper lobe apex, lower lobe apex, and lower lobe base. The samples were treated to remove organic material. The inorganic residue was analysed using a light microscope. The results were expressed as asbestos bodies (AB) per gram of dry tissue. Levels greater than 1000AB/g of dry tissue were considered as potentially causing disease.ResultsAB were detected in 29(83%) of the subjects, of which 86% had levels less than 300AB/g. Only one individual (3%) had values greater than 1000AB/g dry tissue. The asbestos residue was higher in the lower lung lobe in 17 individuals (48%) than in the rest, although no significant differences were seen as regards AB residue in the three lung areas studied.ConclusionsThe results of this study show that the urban population of Barcelona has asbestos levels in the lung that vary between 0 and 300AB/g dry tissue. No differences in the asbestos residues were detected in the lung areas studied in this population.