Medium-term oncological and functional outcomes of hemi-gland brachytherapy using iodine-125 seeds for intermediate-risk unilateral prostate cancer

PURPOSETo examine medium-term outcomes of hemi-gland low-dose-rate brachytherapy as a primary treatment for intermediate-risk prostate cancer.METHODSWe recruited intermediate-risk unilateral prostate cancer patients for a prospective trial of hemi-gland brachytherapy. Twenty-four patients underwent hemi-gland iodine-125 seed implantation with a prescribed dose of 160 Gy. Serum prostate-specific antigen (PSA) was measured regularly and follow-up biopsy was scheduled after 2–3 years of treatment. When clinically needed afterward, for-cause biopsy was performed to confirm pathology. Treatment failure (TF)-free survival, which was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality, was assessed, as was biochemical failure (BF)-free survival. Urinary and sexual functions were also evaluated.RESULTSMedian follow-up duration was 61 months. Twenty-two patients (92%) exhibited a declining trend or decreased value of PSA for 12 months or longer after the treatment. Follow-up biopsy in the initial triennium and for-cause biopsy in the subsequent triennium were performed in 16 and four patients, respectively, and cancer was found from the treated lobe in one patient (4% of the cohort) and significant cancer was found from untreated lobes in four patients (17%) in total. Secondary treatments were performed in six patients successfully. Five-year freedom from BF, TF, and metastasis was 71%, 90%, and 100%, respectively. The International Prostate Symptom Score significantly deteriorated at 3 months and reversed itself afterward. The International Index of Erectile Function 5 had no significant decrease.CONCLUSIONSHemi-gland low-dose-rate brachytherapy provides favorable medium-term oncological outcomes with genito-urinary functional preservation for men with intermediate-risk unilateral prostate cancer.     

Mortality and morbidity after spinal surgery in patients with Parkinson's disease: a retrospective matched-pair cohort study

Background Context

There is a lack of information about postoperative outcomes and related risk factors associated with spinal surgery in patients with Parkinson's disease (PD).

Emergency Pylorus-Preserving Pancreatoduodenectomy Followed by Second-Stage Pancreatojejunostomy for a Gastrointestinal Stromal Tumor of the Duodenum with an Intratumoral Gas Figure: Report of a Case

We report a case of a duodenal gastrointestinal stromal tumor (GIST) necessitating urgent surgery because of a gas figure on computed tomography (CT). A 46-year-old woman, complaining chiefly of upper abdominal pain and tarry stools, consulted a local doctor. A gastrointestinal fiberscopy revealed an ulcer in the second part of the duodenum, and the patient was admitted to our hospital where a dynamic CT scan showed a hypervascular solid tumor in the pancreatic head. A repeat CT scan done 4 days later showed a gas figure in the tumor, necessitating an emergency pylorus-preserving pancreatoduodenectomy (PpPD). First, we performed a tube pancreatostomy for complete external drainage of the pancreatic juice, and planned a second-stage pancreatojejunostomy for the near future. Histopathologically, the tumor was diagnosed as a GIST originating in the duodenum. The patient was discharged on postoperative day 23 after an uneventful postoperative recovery. Her local doctor completed the second-stage pancreatojejunostomy.     

Hemiarch replacement during pregnancy (19 weeks) utilizing normothermic selective cerebral perfusion

A 20-year-old woman with Marfan syndrome in the 19 weeks of pregnancy was admitted for a dissecting aneurysm of the ascending aorta to the proximal arch. She wanted to continue with pregnancy. A cardiotocography and a trans-esophageal echo probe which allowed visualization of the fetal heart contraction were attached on the abdomen. A cardio-pulmonary bypass was established via the right axillar and femoral arteries with bicaval drainage. The aortic isthmus and arch branches were clamped. After opening the ascending aorta, selective cerebral perfusion was initiated by quick cannulation into the left carotid and left subclavian arteries. Peripheral pressure was maintained above 80 mmHg with the flow of the selective cerebral perfusion at 1.0 L/min and flow from the femoral artery at 3.5 L/min. Hemi-arch replacement was performed using a Dacron graft. The body temperature passively descended to 35 °C. She normally delivered a healthy female baby after 37 weeks’ of gestation.     

Successful one-stage operation for completely obstructive colorectal carcinoma

We describe herein a new and successful method of performing a safe and steady one-stage operation for completely obstructive colorectal carcinoma. First, a long ileus tube is utilized to decompress the dilated proximal bowel preoperatively and irrigate the feces-loaded colon intraoperatively. Following this procedure, a standard resection with radical lymph node dissection is carried out without a diverting colostomy. We performed this procedure successfully in seven patients, none of whom developed any anastomotic leakage.     

Comparison of surgical and conservative treatment outcomes for type a aortic dissection in elderly patients

Background

In recent years, surgical outcomes have improved, and positive reports on surgery for type A aortic dissection (AAD) in the elderly are increasing. However, the difference between surgical and conservative treatments in the elderly remains unclear. Therefore, we conducted this study to determine whether surgery should be performed for Stanford (AAD) in elderly patients.

Methods

Data of patients aged 80?years or older who were hospitalized for AAD from April 2014 to March 2016 were extracted from the Japanese national inpatient database. Outcome measures were all-cause in-hospital death, stroke, acute kidney injury and tracheotomy, and composite adverse events (consisting of all-cause in-hospital death, stroke, acute kidney injury, and tracheotomy), and we compared them between surgical and conservative treatments using propensity score matching.

Results

The study cohort included 3258 patients, with 845 matched pairs (1690 patients) in the propensity score matching. All-cause in-hospital death was significantly lower in the surgical treatment group than in the conservative treatment group before and after matching (15.6% vs. 51.1%, p?<?0.001; 16.7% vs. 31.6%, p?<?0.001, respectively); however, there was no significant difference in composite adverse events after matching (36.0%, conservative vs. 37.2%, surgical; p?=?0.65), and adjusted odds ratio was 1.06 and 95% confidence interval was 0.86–1.29 (p?=?0.61) with reference to conservative treatment.

Conclusions

All-cause in-hospital death among elderly patients with AAD was significantly lower in patients treated surgically than in those undergoing conservative treatment. However, there was no significant difference between the two groups in the event-free survival, which is important for the elderly. These findings may be used in the consideration of treatment course for elderly patients with AAD.

     

Angiospermic Changes of Coronary Aneurysms in Kawasaki Disease

The fate of coronary aneurysms in Kawasaki disease or MCLS was examined by follow-up studies on 9 patients with multiple bilateral aneurysms in the coronary arteries demonstrated by coronary arteriography. Their ages at the time if first examination ranged from 0.3 to 11 years (mean, 4.1 years). The mean interval between the onset of acute illness and the initial examination was 15.8 months, and the mean interval between the first and second examination was 17.9 months. Eight of the nine patients received anticoagulants between examinations. The second coronary arteriogram showed morphologic changes of the aneueysm from the time of the first examination: changes were seen in the right coronary artery area in 8 patients (89%) and in the left coronary artery area in 7 patients. These morphologuic changes seemed to be mainly secondary to thrombus formation, calcification, stenosis and/or obstruction of the aneuryms. Thus, coronary aneuryms in Kawasaki disease were transformed despite the use of anticoagulants. It is considered that multiple large coronary aneurysms will not healed or disappear, but are simply transformed as a result of their thrombosis and/or calcification.