UPPER TRACT RECURRENCES FOLLOWING RADICAL CYSTECTOMY: AN ANALYSIS OF PROGNOSTIC FACTORS, RECURRENCE PATTERN AND STAGE AT PRESENTATION

PURPOSE: We study the incidence and pattern of upper tract recurrences following radical cystectomy for bladder cancer, and analyze the prognostic factors. MATERIALS AND METHODS: A retrospective study was performed on 529 patients who underwent radical cystectomy and urinary diversion at Memorial Sloan-Kettering Cancer Center between July 1989 and June 1997. Data related to upper tract recurrence were analyzed. RESULTS: Of the 529 patients 16 (3%) had upper tract recurrence. Median followup was 16.9 months for the entire group and 49.1 months for patients with upper tract recurrence, with a median time to recurrence of 37.2 months. Of 12 upper tract recurrences 7 (58%) were locally advanced at surgery (p3a or greater with or without lymph node metastasis) and 5 of 16 patients with recurrence (31.3%) had bilateral tumors (2 synchronous and 3 metachronous). Overall survival from the time of diagnosis of upper tract recurrence after radical cystectomy was poor, with a median of 10 months (confidence interval 1 to 19). CONCLUSIONS: The incidence of upper tract recurrence following radical cystectomy is low (3%). However, the incidence of bilateral tumors (31.3%) and locally advanced stage at the time of operation (58%) is higher than expected for upper tract tumors in the general population. Survival of patients with upper tract recurrence is poor, with a median of 10 months.     

Good choices,great future: An applied theatre prevention program to reduce alcohol‐related risky behaviours during Schoolies

Introduction and Aims. The contextual and temporal factors of post‐school celebratory events (‘Schoolies’) place young people at elevated risk of excessive drinking compared with other social occasions. This study investigates the impact of an applied theatre prevention program ‘Choices’ in reducing the risk of drinking and other risk behaviours during Schoolies celebrations. Design and Methods. Choices was delivered in the last term of Year 12 across 28 North Queensland schools. A total of 352 school leavers (43.1% male, mean age = 17.14 years) completed a questionnaire at Whitsunday Schoolies, Queensland, Australia on 23–24 November 2010. Nearly 49% of respondents had attended Choices. The survey included measures of alcohol use, illicit drug use and associated problems during Schoolies and a month prior to Schoolies. Results. After controlling for gender and pre‐Schoolies drinking, school leavers who attended Choices were significantly less likely to report illicit drug use (OR = 0.51, P < 0.05) and problem behaviours (OR = 0.40, P < 0.01) than those who did not attend Choices. There was, however, no intervention effect in risky drinking (i.e. drank on 5 or more days, typical amount five or more standard drink and binge drank on 3 or more days) at Schoolies (OR = 0.92, P = 0.80). Discussion and Conclusions. Delivery of a youth‐specific applied theatre prevention program employing a harm minimisation framework may be effective in reducing high‐risk behaviours associated with alcohol consumption at celebratory events, even if young people expect to engage in excessive alcohol consumption. [Quek L‐H, White A, Low C, Brown J, Dalton N, Dow D, Connor JP. Good choices, great future: An applied theatre prevention program to reduce alcohol‐related risky behaviours during Schoolies. Drug Alcohol Rev 2012;31:897–902]     

The relationship of magnesium intake to serum and urinary calcium and magnesium levels in Trinidadian stone formers

BACKGROUND: The present study was undertaken to investigate the relationship between the dietary intake of magnesium and the serum and urinary levels of calcium and magnesium in a group of Trinidadian stone formers. METHODS: A group of 102 confirmed stone formers presenting to urological clinics were interviewed using a questionnaire designed to obtain a semi-quantitative estimate of their oral magnesium intake. Patients were invited to give blood samples for serum calcium and magnesium levels and to provide 24-h urine specimens for the measurement of urinary levels of these minerals, as well as total urinary volumes. A group of 102 controls was subjected to a similar interview and blood and urinary testing. Chi-square tests and Student's t-tests were used to examine group demographic differences. The Mann-Whitney test investigated differences in biochemical indices. Binary logistic regression was used to identify predictors of stone formation. RESULTS: Blood samples were obtained from 60 patients and 98 controls. Urine samples were returned by 34 patients and 97 controls. Only 10 stones were retrieved from patients. Patients had a significantly lower magnesium intake, but higher median serum and urinary calcium levels, and higher serum calcium to magnesium ratios than controls. Independent variables capable of predicting stone formation included total magnesium intake and serum and urinary calcium levels. CONCLUSIONS: Increased serum and urinary calcium levels, calcium to magnesium ratios, and a low magnesium intake were predictive of stone formation in this Trinidadian population.