Surgery for pre-macular fibrosis

We review 12 consecutive cases of pre-macular fibrosis (PMF) treated by vitreous surgical techniques. The causes of PMF included retinal detachment surgery in four patients, idiopathic in three patients, laser treatment in three patients, pars planitis in one patient and diabetic retinopathy in one patient. The membrane was successfully removed in all the patients. One patient developed a retinal detachment that was repaired successfully. All patients had improved visual acuity (VA) of two Snellen lines or more and six patients achieved VA of 6/12 or better. Patients with PMF following retinal detachment had poorer final VA.     

A new look at pituitary adenomas: structure elucidating function.

Cases of seven different types of surgically resected pituitary adenoma are described. Included are tumours secreting prolactin or growth hormone or both, and nonfunctioning tumours--undifferentiated and oncocytic tumours, and one tumour with cells of the adrenocorticotropin-melanocyte-stimulating hormone type. The final interpretation of a case of pituitary adenoma should include an assessment of thorough morphologic studies, using not only routine staining and light microscopy but also immunostaining and electron microscopy, to complement the biochemical, radiologic and clinical evaluation.     

High intensity focused ultrasound for prostate cancer: a review of the scientific foundation, technology and clinical outcomes

High Intensity Focused Ultrasound (HIFU) is a definitive treatment for localized prostate cancer that is currently utilized most in Europe and Japan but it not yet approved by the FDA for this indication. Within the armamentarium of definitive prostate cancer therapies it is unique as it is truly non-invasive and does not involve incision or excision. The purpose of this paper is to review the scientific foundation of the technology as well as the clinical outcomes of commercially available devices. The scientific foundation of HIFU is reviewed in terms of how it has resulted in the development of commercially available equipment. MEDLINE was used to search the medical literature for publications pertaining to HIFU for prostate cancer as a primary therapy in terms of clinical outcomes. Biochemical disease free rates as well as negative biopsy rates are reviewed. Different engineering optimization strategies in the face of technicalities inherent to HIFU for prostate cancer have led to the development of two distinct commercially available devices. Each has their own merits and limitations. HIFU provides excellent biochemical and local control and results appear to be durable. Clinical outcomes are similar for the two technologies developed but are difficult to compare due to different lengths of follow-up and varying patient populations. HIFU is a technically advanced definitive local therapy for prostate cancer. Short and medium term results are encouraging and its role as a primary therapy for prostate cancer continues to be defined as more results become available.     

Tomographic abnormalities simulating pituitary microadenomas

False-positive and false-negative interpretations of sellar tomography were found in about one-fifth of cases in a recent autopsy study correlating the presence of pituitary microadenomas with abnormal sellar tomograms. An analysis of minor variations in the bony configuration of the sella disclosed variations due to posterior lobe asymmetry, intercavernous venous channels, bony asymmetry, and an empty sella in 27 of the 120 sellas examined. In some instances, the asymmetry resulted from a combination of these causes. A further study of 50 pituitary glands in situ showed posterior lobe asymmetry to be a common anomaly (76%) that can produce an obvious disparity between the two halves of the sella. Thus, the minor radiologic criteria of local thinning of the anterior wall or floor, slant of the floor, or asymmetry of the two halves of the sella must be interpreted with caution as being indicative of the presence of pituitary microadenoma. In the absence of clinical or biochemical dysfunction, the changes more likely result from explainable anatomic causes.     

Focal prostate cryoablation: initial results show cancer control and potency preservation

BACKGROUND: Focal prostate cryoablation is the less-than-complete ablation of the gland with ice. Known tumor is ablated aggressively, whereas contralateral prostate tissue and surrounding structures are spared. This method offers targeted local cancer control aiming at sexual potency and urinary continence preservation in patients whose prostate cancer is believed to be unilateral. PATIENTS AND METHODS: Patients who had a strong desire for preservation of sexual function and continence were informed of focal prostate cryoablation as an investigational treatment option for clinically organ-confined, unilateral tumor identified by color Doppler ultrasonography and confirmed by targeted and systematic biopsy. Only stage, not preoperative serum prostate specific antigen concentration (PSA) or tumor differentiation, was considered a potential contraindication. Thirty-one men with a mean age of 63 years underwent the procedure. Follow-up consisted of PSA measurement every 3 months for 1 year and every 6 months thereafter, with biopsies at 6 months and 1, 2, and 5 years and following any three consecutive PSA rises. Potency was determined with a patient questionnaire filled in without the physician present. RESULTS: At a mean follow-up of 70 months, biochemical disease-free status, according to the ASTRO definition, was maintained by 92.8% of patients (26/28) and a 96.0% negative-biopsy rate (24/25) was observed. The one biopsy-positive patient was subsequently treated with full-gland cryoablation and remains disease free. Potency was maintained by 48.1% of patients (13/27) and another 40.7% (11/27) were potent with oral pharmaceutical assistance, yielding a total potency-preservation rate of 88.9%. No complications were observed. CONCLUSION: Focal cryoablation can provide biochemical and local control of prostate cancer while preserving potency and continence. Further investigation is needed.     

Obstructive jaundice secondary to benign hepatic cyst

A case of hepatic cyst causing obstructive jaundice is presented. Following percutaneous aspiration of the cyst, the jaundice was relieved. Modern interventional radiologic techniques can provide prompt diagnosis and treatment, thus avoiding major surgery and prolonged hospitalization.