Success of targeted transperineal biopsy in patients on surveillance for grade group 1 prostate cancer

IntroductionWe aimed to determine the minimum cross-sectional ellipsoid area on magnetic resonance (MR) of intraprostatic nodules that best predicts for subsequent targeted biopsies revealing ≥ grade group (GG) 2 disease.MethodsForty-six patients previously diagnosed with GG 1 prostate adenocarcinoma who received cognitively fused, MR-guided, transperineal targeted biopsies in addition to six random biopsies were included in this analysis. A Youden cutpoint analysis was used to determine the ellipsoid area in the axial plane best predicting for ≥GG 2 disease within the targeted biopsy cores and logistic regression used to assess the result.ResultsMedian time from MR imaging to targeted biopsy was 2.4 (1.4–5.5) months. Forty of 46 (87%) patients had one nodule and 6/46 (13%) had two separate nodules on MR that received targeted biopsy. Of the 52 nodules, five (10%), 33 (63%), and 14 (27%) were Prostate Imaging-Reporting and Data System (PI-RADS) 3, 4, and 5, respectively. Thirteen (25%), six (12%), and 33 (64%) were in the anterior, medial, and posterior regions of the prostate, respectively. Median area was 0.72 (0.49–1.29) cm² (average diameter 9.5 mm). Fifteen of 46 (33%) patients had ≥1 random biopsy and 20/52 (38%) nodules had ≥1 targeted biopsy revealing ≥GG 2 disease. The optimal area cutpoint was ≥0.7 cm², with an area under the curve of 0.671 (0.510–0.832). On logistic regression, area ≥0.7 cm² was solely predictive of targeted biopsy revealing ≥GG 2 disease (odds ratio 6.5, 1.3–32.4, p=0.022).ConclusionsNodule area ≥0.7 cm² may predict for transperineal-based targeted biopsies being positive for ≥GG 2 disease when 1–2 cores are taken.     

Synchronous primary gastric cancer and renal cell carcinoma: A case report and literatures review

A 73-year-old woman was admitted and treated because of epigastric fullness, palpitation, and tarry stool for 2 days. Gastric cancer was found via panendoscopy. A preoperative abdominal computed tomographic scan revealed a hypervascular mass in the left kidney; renal cell carcinoma (RCC) was the initial impression. A concomitant surgery for subtotal gastrectomy and radical left nephrectomy was performed. The pathological examination confirmed gastric adenocarcinoma (T2a) and RCC (T2b). Convalescence was uneventful and she was discharged in stable condition. There was no evidence of tumor recurrence at a 20-month follow-up examination. Elderly people with early gastric cancers have a relative higher probability of developing a synchronous tumor than younger people. The incidence of synchronous gastric cancer and RCC is quite low, and concomitant surgery is rare. Surgeons need to be aware of the possibility of a synchronous second primary cancer when the initial gastric cancer is diagnosed. A concomitant surgery for gastrectomy and radical nephrectomy can be safely performed in selected patients, which can achieve feasible oncological control.     

Comparison of elderly patients with and without intertrochanteric fractures and the factors affecting fracture severity

BackgroundIntertrochanteric fractures in elderly patients are common and normally caused by low-energy injuries, such as falls. The favored treatment method is closed reduction with internal fixation using plate or nail systems. In general, the severity of an intertrochanteric fracture is one of key factors that affects the success rate of fixation. However, the factors that affect the severity of intertrochanteric fractures in elderly patients are rarely reported in the literature. In this prospective study, several possible factors were investigated.MethodsThe bone mineral densities (BMD) of 48 elderly patients (≥ 65 years) with intertrochanteric fractures due to low-energy injuries were compared with the BMDs of 48 elderly persons without hip fractures. Both groups were composed of people of similar ages and male-to-female ratios. Furthermore, in the patients with fractures, BMD, body mass index (BMI), body weight, and body height were compared between patients with nonsevere (intact lesser trochanter; 14 patients) and severe (displaced lesser trochanter or reverse obliquity fractures; 34 patients) intertrochanteric fractures.ResultsPatients with intertrochanteric fractures had significantly lower BMDs compared with persons without hip fractures to the lesser trochanter, total hip area, femoral neck, or greater trochanter (p = 0.001, <0.001, <0.001, and <0.001, respectively). There was no statistical difference in terms of BMD, BMI, body weight, or body height between patients with nonsevere and severe fractures.ConclusionElderly patients with intertrochanteric fractures have lower BMDs than persons without hip fractures. However, the severity of intertrochanteric fractures cannot be predicted by local BMD, BMI, body weight, or body height.     

End-stage periventricular leukomalacia: MR evaluation

A prospective study was performed to assess the capabilities of magnetic resonance (MR) imaging in evaluation of end-stage periventricular leukomalacia (PVL) in six children, aged 31-54 months, in whom PVL had been documented by neurologic ultrasonography during the neonatal period. Eight children of similar age (four premature infants and four full-term infants) with normal neurologic development served as controls. A characteristic triad of PVL abnormalities was seen on MR images: (a) abnormally increased periventricular white-matter signal intensity on the first and second echo images of a T2-weighted sequence (repetition time = 2,000-2,400 msec, echo times = 20 or 30 and 80 msec), most commonly observed in the trigone regions of the lateral ventricles bilaterally; (b) marked loss of periventricular white matter in these regions of abnormal signal intensity, predominantly in the periatrial regions; and (c) compensatory focal ventricular enlargement adjacent to regions of abnormal signal intensity. In patients with the classic periatrial distribution of PVL lesions, general correlation between the degree of neurologic impairment and the severity of MR abnormalities was demonstrated. MR imaging was useful in detecting subtle forms of PVL in cases in which neurologic damage was subclinical.