Glans resurfacing for the treatment of carcinoma in situ of the penis: surgical technique and outcomes

Background

The management of carcinoma in situ (CIS) of the penis is controversial, with relatively high local recurrence rates after minimally invasive therapies.

Objective

Report the surgical technique and outcome of partial glans resurfacing (PGR) and total glans resurfacing (TGR) as primary treatment modalities for CIS of the glans penis.

Design, setting, and participants

Between 2001 to 2010, 25 patients with biopsy-proven CIS underwent TGR (n = 10) or PGR (n = 15), defined as <50% of the glans requiring resurfacing. All patients were surveyed clinically every 3 mo for 2 yr and every 6 mo thereafter.

Surgical procedure

Excision of the glans epithelium and subepithelium of either the entire glans or the locally affected area, with a macroscopic clear margin. The penis was then reconstructed using a split skin graft.

Measurements

Positive surgical margin (PSM) rates and rates of recurrence and progression were collated. Complications, cosmesis, and patient satisfaction were evaluated.

Results and limitations

Mean follow-up was 29 mo (range: 2–120 mo). There were no postoperative complications, and 24 of 25 patients (96%) had complete graft take with excellent cosmesis. Overall, 12 of 25 patients (48%) had PSMs. Only 7 of 25 (28%) required further surgery, 2 of 25 (8%) for extensive CIS at the margin and 5 of 25 (20%) for unexpected invasive disease. Additional surgery consisted of further resurfacing in 4 of 25 cases (16%) or glansectomy in 3 of 25 cases (12%). Those undergoing further surgery had no further compromise to their oncologic outcome. The overall local recurrence rate was 4%. There were no cases of progression.

Conclusions

Glans resurfacing is a safe and effective primary treatment for CIS. The procedure maintains a functional penis without compromising oncologic control, while ensuring that definitive histopathlogy is obtained. Glans resurfacing has a low risk of recurrence and progression. Patients need to be warned that approximately 28% will require further surgery for PSM or understaging of their primary disease, although the need for further surgery does not compromise oncologic control.     

Evaluation of the vascular anatomy in potential living kidney donors with gadolinium‐enhanced magnetic resonance angiography: comparison with digital subtraction angiography and intraoperative findings

Asgari MA, Dadkhah F, Ghadian AR, Razzaghi MR, Noorbala MH, Amini E. Evaluation of the vascular anatomy in potential living kidney donors with gadolinium‐enhanced magnetic resonance angiography: comparison with digital subtraction angiography and intraoperative findings.
Clin Transplant 2011: 25: 481–485. © 2010 John Wiley & Sons A/S. Abstract: Background: X‐ray contrast arteriography has traditionally been used for pre‐operative evaluation in living kidney donors. However, magnetic resonance angiography (MRA) offers a non‐invasive alternative, which has been considered to be less accurate. This study was performed to determine whether MRA in the pre‐operative investigation of living kidney donors provides sufficient information. Methods: From December 2005 to December 2007, 173 potential live donors were evaluated in this study. Donors performed digital subtraction angiography (DSA) and those with one or more accessory arteries at least on one side recruited for further evaluation with three‐dimensional gadolinium‐enhanced MRA. Results: A total of 30 donors constituted the study population. When compared with DSA as the reference method, MRA detected 20 of 36 renal accessory arteries which indicates a sensitivity of 55.6%. The difference between MRA and DSA in identifying accessory renal arteries was significant (p‐value <0.001). Considering intraoperative findings as the standard of reference, MRA depicted correctly four of six (66.7%) accessory arteries on the transplanted kidneys. Conclusions: MRA has the advantage of avoiding exposure to ionizing radiation and is non‐invasive. These are important considerations in pre‐operative evaluation of a generally healthy donor population. However, MRA provides suboptimal accuracy in detecting small accessory arteries.     

Beta thalassemia major: the effect of age on glomerular filtration rate

Thalassemia is a common hereditary hemoglobinopathy disorder that affects many organs in the body. Estimation of kidney function is important, as it is the vital organ that plays the major role in the elimination of accumulated iron as well as the chelating drugs that have to be used as therapy. Sixty- three patients aged 1-29 years, with a mean ± SD of 14 ± 6.7 years, affected with beta- thalassemia major in Tabriz Children's Hospital were evaluated for their renal function on the basis of their age, serum iron, serum ferritin and serum creatinine levels along with two methods of estimating glomerular filtration rate (GFR); by Schwartz method for those under 18 years old and using Modification of Diet in Renal Disease (MDRD) formula for those who were 18 years and above. Elevation of serum creatinine denoting renal dysfunction was not seen in our patients, but hyperfiltration was a common finding. An increasing GFR was observed, which corresponded to age, but no relationships were seen between serum iron, serum ferritin, regular blood transfusion, chelating therapy to GFR.     

Comparison of venous and arterial blood sampling for the assessment of platelet aggregation with whole blood impedance aggregometry

Platelet monitoring is presently under evaluation in the clinic as a tool to improve antiplatelet treatment in patients with coronary artery disease (CAD). Measuring platelet function has, however, many inherent problems. It is important not only to evaluate the method used, but also to evaluate and standardize sampling and sample handling. As platelet monitoring is often performed in connection to coronary angiography and percutaneous coronary interventions, arterial sampling may be more convenient. However, in the outpatient follow-up setting venous sampling is, for obvious reasons, more practical and convenient. In the present study we compared platelet aggregation in blood collected from the arterial sheath to blood collected from the antecubital vein using multiple electrode aggregometry in whole blood in 28 patients with CAD. We found that sampling from artery and vein give similar data and that an identical number of patients with insufficient antiplatelet responses ('low responders' to aspirin and clopidogrel, respectively, according to predefined criteria) were detected with respect to adenosine diphosphate induced and arachidonic-acid induced aggregation. Thus both arterial and venous blood samples can be used in the monitoring of platelet function when multiple electrode aggregometry is applied to detect 'low responders'.     

Sequence analysis of cox1 and nad1 genes in Echinococcus granulosus G3 genotype in camels (Camelus dromedarius) from central Iran

Nineteen hydatid cyst isolates collected from camels in central Iran were subjected to sequences analysis of mitochondrial cytochrome c oxidase subunit 1 (cox1) and NADH dehydrogenase subunit 1 (nad1) genes. A consensus sequence obtained containing 366 nucleotides for cox1 and 471 nucleotides for nad1 genes. Overall, the camel isolates indicated five different sequences in cox1 and nine in nad1 genes. The sequences analysis indicated that 26.3%, 42.1%, and 31.6% of isolates belonging to G1, G3, and G6 genotypes of Echinococcus granulosus, respectively. The isolates with G3 genotype indicated one cox1 sequence having 100% homology with reference G3 sequence (AN: M84663) and two different nad1 sequences, one having100% homology with reference G3 sequence (AN: AJ237634) and the other with a silent mutation (G to A) in position 279. The presence of G3 genotype (buffalo strain) of E. granulosus as dominant genotype in camels is emphasized. As G3 genotype has formerly been reported in human, the epidemiological role of camels is warranted in future surveys.