Predictors of prostate cancer after initial negative systematic 12 core biopsy

PURPOSE: We determined the cancer detection rate at initial systematic 12 core (S12C) biopsy and identified features associated with cancer at repeat S12C biopsy after an initial negative S12C biopsy in patients with prostate specific antigen (PSA) parameters associated with a higher risk of prostate cancer. MATERIALS AND METHODS: Between February 1999 and June 2002, 841 patients underwent initial S12C biopsy. Of these patients 99 underwent repeat S12C biopsy after initial negative S12C because of a percent free-to-total PSA of 15.0 or less and/or a yearly PSA velocity of 0.75 ng/ml or greater. The association between parameters revealed by initial biopsy and cancer at repeat biopsy was assessed. RESULTS: Of the 99 patients 21 (21.2%) had cancer at repeat biopsy. Age (p = 0.01), PSA transitional zone density (p = 0.05), and high grade PIN at initial biopsy (p = 0.01) were associated with cancer at repeat biopsy. CONCLUSIONS: In this select group of patients with PSA parameters associated with a higher risk of prostate cancer the cancer detection rate after initially negative S12C biopsy was 21%. Patients with high grade PIN on initial biopsy, advanced age and higher PSA transition zone density are at increased risk for cancer at repeat biopsy. Larger prospective studies are required to confirm these results and construct a nomogram that determines the probability of finding prostate cancer at subsequent biopsy.     

Switching elderly chronic psychotic patients to olanzapine

The purpose of this study was to examine whether elderly chronic schizophrenia or schizoaffective disorder patients would clinically improve if switched to olanzapine from previous neuroleptic treatment. Twenty-one hospitalized patients, aged 6088 yr, with a diagnosis of chronic schizophrenia or schizoaffective disorder who were being treated with typical neuroleptic medication were switched to olanzapine. The Positive and Negative Symptom Scale (PANSS), Geriatric Depression Scale (GDS) and Clinical Global Impression Severity (CGI-S) Scale were completed while patients were on their previous medication regimen and again 6 months after the last patient had been started on olanzapine. The mean duration of treatment was 289 d (S.D.=139). Three patients discontinued the medication. Mean end dose of olanzapine was 12.9 mg (S.D.=5.7). Paired sample t tests were used to test change on PANSS Positive, Negative and Total scales, CGI, GDS and body weight. PANSS (Positive, p=0.002; Negative, p=0.003; General, p=0.003; and Total, p=0.000) and CGI (p=0.000) but not the GDS (p=0.67) demonstrated statistically significant improvement. There was no significant change in body weight (p=0.61). Elderly patients with aggravation of chronic schizophrenia showed improvement after being switched to olanzapine with no weight gain. Clinically meaningful change was observed in positive and negative psychotic symptomatology but not in depressive symptoms.     

Photodynamic therapy of subfoveal choroidal neovascularization in high myopia in a clinical setting: visual outcome in relation to age at treatment

PURPOSE: To evaluate the visual outcome of patients with myopic subfoveal choroidal neovascularization (CNV) given photodynamic therapy (PDT) in a clinical setting, and to identify potential relation between the visual outcome and the age at treatment. DESIGN: Interventional case series. METHODS: Retrospective comparative study. SETTING: Outpatient ophthalmology clinic. PATIENTS: Twenty-nine consecutive patients (30 eyes) with subfoveal CNV caused by pathologic myopia who were treated with verteporfin PDT from January 2000 to May 2003. INTERVENTION: All the patients received verteporfin PDT and were followed clinically and with fluorescein angiography (FA). Review of the medical records and angiograms was performed. Patients were divided into two groups by age, using the median age (60 years) as the cutoff. MAIN OUTCOME MEASURES: Visual acuity (VA) at the end of follow-up in the older-patient group compared with the younger-patient group. RESULTS: The mean age was 63.1 years. Mean follow-up was 11.5 months. Patients received a mean of 3.48 treatments. Mean VA improved in the younger group from 0.63 to 0.39 logMAR (P = .02, paired t test) and deteriorated in the older group from 0.71 to 0.99 logMAR (P = .03, paired t test). In the whole cohort, 33% of eyes lost 3 or more lines of Snellen best-corrected VA; in the older age group, 50% of eyes lost 3 or more lines, whereas in the younger age group, only 8% of eyes did so (P = .024, Fisher's exact test). CONCLUSIONS: In our consecutive case series, visual prognosis of myopic CNV after PDT was found to be influenced by age at treatment.     

Local and non-local deficits in amblyopia: acuity and spatial interactions

Amblyopic vision is thought to be limited by abnormal long-range spatial interactions, but their exact mode of action and relationship to the main amblyopic deficit in visual acuity is largely unknown. We studied this relationship in a group (N=59) of anisometropic (N=21) and strabismic (or combined, N=38) subjects, using (1) a single and multi-pattern (crowded) computerized static Tumbling-E test with scaled spacing of two pattern widths (TeVA), in addition to an optotype (ETDRS chart) acuity test (VA) and (2) contrast detection of Gabor patches with lateral flankers (lateral masking) along the horizontal and vertical axes as well as in collinear and parallel configurations. By correlating the different measures of visual acuity and contrast suppression, we found that (1) the VA of the strabismic subjects could be decomposed into two uncorrelated components measured in TeVA: acuity for isolated patterns and acuity reduction due to flanking patterns. The latter comprised over 60% of the VA magnitude, on the average and accounted for over 50% of its variance. In contrast, a slight reduction in acuity was found in the anisometropic subjects, and the acuity for a single pattern could account for 70% of the VA variance. (2) The lateral suppression (contrast threshold elevation) in a parallel configuration along the horizontal axis was correlated with the VA (R2=0.7), as well as with the crowding effect (TeVA elevation, R2=0.5) for the strabismic group. Some correlation with the VA was also found for the collinear configuration in the anisometropic group, but less suppression and no correlation were found for all the vertical configurations in all the groups. The results indicate the existence of a specific non-local component of the strabismic deficit, in addition to the local acuity deficit in all amblyopia types. This deficit might reflect long-range lateral inhibition, or alternatively, an inaccurate and scattered top-down attentional selection mechanism.     

Perioperative factors for predicting successful hysteroscopic endometrial ablation

OBJECTIVE: To investigate factors affecting the success of hysteroscopic endometrial ablation in order to improve patient counseling. STUDY DESIGN: Preoperative patient characteristics (age, parity, uterine length, and presence and location of myomas) and intraoperative factors (intracavitary findings, ablation or resection, and operator) were analyzed. Forty-three women with a uterine size of < or = 10 weeks underwent hysteroscopic endometrial ablation or resection and had a median follow-up of 20 months. All were treated with depot triptorelin, 3.75 mg, 1 month prior to the procedure. Alleviation of menorrhagia and amenorrhea was classified as treatment success. Comparative analyses were made between patients with failed vs. successful procedures and with reduced bleeding vs. those with amenorrhea following surgery. RESULTS: Thirty-seven women (86%) reported a decrease in menstrual flow or amenorrhea. In 6 patients (14%), bleeding persisted or became more severe. There were no statistically significant differences between women who had successful vs. failed procedures with regard to all preoperative and intraoperative parameters analyzed. Patients with amenorrhea were significantly older as compared to women with reduced bleeding (47.5 +/- SD 5.0) vs. 44.0 +/- SD 4.1 years, P = .03. CONCLUSION: Most women with uterine size of < or = 10 weeks may expect alleviation of menorrhagia or amenorrhea after surgery. Apart from age, all other preoparative and intraoperative factors examined had no predictive value for a successful procedure. These data are valuable for proper patient counseling before hysteroscopic endometrial ablation.     

Intraoperative mitomycin C 0.02% for pterygium: effect of duration of application on recurrence rate

PURPOSE: To compare the effect of a 3- and 5-minute intraoperative application of topical mitomycin C 0.02% on the recurrence of pterygium. METHODS: A comparative, prospective clinical design was used. The study population consisted of 134 consecutive patients with unilateral primary advanced pterygium (growth of 3 mm or more horizontally from the limbus). All underwent excision of the lesion, leaving the sclera bare. At completion of surgery, topical mitomycin C 0.02% was applied for 3 minutes in the first 60 patients (group A) and for 5 minutes in the remaining 74 patients (group B). The patients were followed for 26 months by slit-lamp biomicroscopic examination of the anterior segment. Recurrent pterygium was defined as the postoperative appearance of a fibrovascular tissue crossing the limbus. RESULTS: After 12 months of follow-up, pterygium recurred in 20 patients (33.3%) in group A and in two patients (2.7%) in group B. After 15 months, the recurrence rates were 36.6% and 5.4%, respectively, and remained unchanged at 26 months. There were no cases of drug toxicity in either group. CONCLUSIONS: Five-minute intraoperative application of a single dose of 0.02% mitomycin C is safe and more effective than a 3-minute application in recurrence of pterygium.