Office-based transurethral microwave thermotherapy using the TherMatrx TMx-2000

BACKGROUND AND PURPOSE: Transurethral microwave thermotherapy (TUMT) is an effective therapy for symptomatic benign prostatic hyperplasia (BPH), but the trade-off between the magnitude of clinical improvement and side effects and patient tolerance has limited its appeal to patients and urologists. This study, using the TherMatrx TMx-2000, a TUMT device that directly heats the transition zone to greater than 50 degrees C, has been focused on resolving these issues and developing a truly office-based therapy that is well tolerated with a benign post-treatment course. PATIENTS AND METHODS: This study was multi-institutional and designed as a blinded, randomized, and sham-controlled trial. A series of 200 patients with an AUA Symptom Index (AUASI) of >12, a peak flow rate of <12 mL/sec, and cystoscopic evidence of BPH were randomized 2:1 (active to sham) and treated in seven physician offices under a Food and Drug Administration-supervised and audited premarket approval protocol. No intravenous sedation was used in any patient. Follow-up for the sham-treatment group was 3 months, at which time, patients could cross over to an active treatment. A total of 119 patients have completed 1-year follow-up. RESULTS: The active and sham groups were statistically identical at baseline. The 1-hour total treatment was extremely well tolerated using urethral lidocaine and oral medications; not a single prostate block or parental dose of medication was required. The active-treatment group demonstrated a statistically significant reduction (p < 0.05) in AUASI at 3 months compared with sham treatment, with an AUASI decrease from 22.4 to 12.4 (n = 124) for active v 22.9 to 17 for sham (n = 62). For the 119 patients in the active arm who have reached 12 months, the AUASI has fallen to 10.6 points (47.1% decrease), and the peak flow rate has increased 5.0 mL/sec (58.1%). Postprocedure catheterization was typically 2 or 3 days, and the 16.8% of patients who failed their first voiding trial all voided within 1 week. No major adverse events such as stricture, rectal findings, or ejaculatory changes have been reported. CONCLUSIONS: This study demonstrates that the TherMatrx TMx-2000 TUMT effectively treats symptomatic BPH in the physician office with minimal morbidity.     

Synthesis,analgesic, anti-inflammatory and antibacterial activities of some novel 2-phenyl-3-substituted quinazolin-4(3H) ones

A series of novel 2-phenyl-3-substituted quinazolin-4(3H)-ones have been synthesized by treating methyl-N-(2-phenyl quinazolin-3-yl-4(3H)-one) dithiocarbamate with different amines, the starting material dithiocarbamate was synthesized from anthranilic acid. The title compounds were investigated for analgesic, anti-inflammatory and antibacterial activities. All the test compounds exhibited significant activity, the compounds A1, A2 and A3 shown more potent analgesic activity, and the compound A3 shown more potent anti-inflammatory activity than the reference standard diclofenac sodium.     

Transcutaneous cervical root stimulation in the diagnosis of multifocal motor neuropathy with conduction block

OBJECTIVES: To determine if transcutaneous electrical stimulation of the cervical roots can be used to diagnose proximal conduction block (CB) in multifocal motor neuropathy (MMN) and whether it can reliably distinguish MMN from amyotrophic lateral sclerosis (ALS). METHODS: Compound muscle action potentials (CMAPs) over the abductor digiti minimi (ADM) were evoked by supramaximal stimulation of the ulnar nerve at the wrist, below elbow, above elbow, axilla, Erb's point, and C8/T1 cervical roots in three groups of patients: 31 patients with ALS, nine patients with MMN, and 31 controls. Supramaximal stimulation at Erb's point and the C8/T1 roots was carried out using a transcutaneous high voltage electrical stimulator. The negative peak amplitude, area, and duration of the CMAP were measured and normalised to that from the wrist. The percentage change in each segment in these parameters was calculated and compared between the different groups. RESULTS: At stimulation sites proximal to the elbow, there were no significant differences in relative CMAP amplitude, area, or duration between controls, ALS patients, and MMN patients with clinically unaffected ulnar nerves. Similarly, the percentage segmental change between adjacent stimulation sites showed no significant differences. In six studies of MMN patients with weakness in ulnar hand muscles, the decrease in CMAP amplitude between the C8/T1 roots and Erb's point exceeded the mean + 2 SD of the control data. CONCLUSION: Cervical root stimulation can quantify CB in the most proximal segment of the ulnar nerve, a fall in CMAP amplitude if greater than 25%, indicating block, and should be used routinely in the evaluation of patients suspected of having MMN, especially when distal stimulation has proved unhelpful.     

Medulloepithelioma: a case report

Histological, immunohistochemical, and CT morphological features of medulloepithelioma, a rare embryonal tumor of primitive neuroepithelium, are described.     

Hydrophilic guide wire technique to facilitate organ entrapment using a laparoscopic sack during laparoscopy

PURPOSE: Morcellation of the kidney in a LapSac (Cook Surgical, Spencer, Indiana) is reportedly safe and effective during laparoscopic nephrectomy. However, organ entrapment in a LapSac can be difficult, especially during early surgeon experience. A technique to facilitate organ entrapment is described. MATERIALS AND METHODS: We have recently used a simple technique to facilitate deployment of the LapSac in the abdomen using a hydrophilic nitinol guide wire passed through the holes in the mouth of the sack beside its drawstring. The inherent elasticity of the guide wire helps to spring open the mouth of the sack, while facilitating appropriate orientation of the sack mouth. RESULTS: This technique appears to decrease the time needed for organ entrapment because it eliminates the need to triangulate the sack to achieve organ entrapment. An additional port is usually not required during the procedure. CONCLUSIONS: The hydrophilic guide wire technique is inexpensive and effective for LapSac deployment and organ entrapment.     

Hand assisted laparoscopic radical nephrectomy for renal cell carcinoma with inferior vena caval thrombus

PURPOSE: To our knowledge we present the initial clinical report of hand assisted laparoscopic radical nephrectomy for renal cell carcinoma with tumor thrombus extending into the inferior vena cava. MATERIALS AND METHODS: A 76-year-old man was referred to our medical center with a 12.5 x 10 cm. stage T3b right renal tumor extending into the inferior vena cava. The caval thrombus was limited and completely below the level of the hepatic veins. After preoperative renal embolization via the hand assisted transperitoneal approach the right kidney was completely dissected with the renal hilum. Proximal and distal control of the inferior vena cava was obtained with vessel loops and a single lumbar vein was divided between clips. An endoscopic Satinsky vascular clamp was placed on the inferior vena cava just beyond its juncture with the right renal vein, thereby, encompassing the caval thrombus. The inferior vena cava was opened above the Satinsky clamp and a cuff of the inferior vena cava was removed contiguous with the renal vein. The inferior vena cava was repaired with continuous 4-zero vascular polypropylene suture and the Satinsky clamp was then removed. A literature search failed to reveal any similar reports of laparoscopic radical nephrectomy for stage T3b renal cell cancer. RESULTS: Surgery was completed without complication with an estimated 500 cc blood loss. Pathological testing confirmed stage T3b grade 3 renal adenocarcinoma with negative inferior vena caval and soft tissue margins. CONCLUSIONS: The introduction of vascular laparoscopic instrumentation and the hand assisted approach enabled us to extend the indications for laparoscopic radical nephrectomy to patients with minimal inferior venal caval involvement.     

Metal-associated angiosarcoma of bone: report of two cases and review of the literature

Angiosarcoma is an extremely rare bone tumor. The authors report two cases of patients with angiosarcoma that developed adjacent to a stainless steel plate used for fixation of a femur fracture. In both patients, the interval between fracture treatment and the development of the neoplasm was more than 40 years. A review of the literature found 36 previously reported cases of malignancy arising adjacent to an orthopaedic implant. Despite any evidence directly linking these implants to the development of cancer, continued vigilance is warranted.