Nuck canal endometriosis: MR imaging findings and clinical features

Objective  

The purpose of this study was to describe the MR imaging findings of Nuck canal endometriosis (NCE).     

Transoral CO2 laser microsurgery for Tis-T3 supraglottic squamous cell carcinomas

Eighty patients affected by supraglottic cancer were treated by transoral carbon dioxide laser surgery between 1989 and 2006 in two Italian institutions. Patient staging was as follows: 2 pTis, 20 pT1, 38 pT2, and 20 pT3. Simultaneous or 1-month delayed neck dissection (ND) was performed on 27 (34%) patients, unilaterally in 10 and bilaterally in 17. The pN category was as follows: 9 pN0, 6 pN1, 8 pN2b, and 4 pN2c. A total of 16 (20%) patients received complementary radiotherapy (RT) and 5 (6%) were subjected to chemo-RT for persistent tumor after re-excision due to positive margins, multiple lymph nodes, and/or extracapsular spread after ND. The last follow-up was in December 2008. The 5-year overall, disease-specific and disease-free survivals, local control with laser alone, and organ preservation rates calculated by Kaplan–Meier analysis were 84.4, 97.4, 88.3, 96, and 97.2%, respectively. Univariate analysis showed a statistically significant impact on disease-free survival, local control with laser alone, and organ preservation of pT category (p = 0.009, p = 0.01, and p = 0.03, respectively), while pN category and tumor stage negatively influenced disease-free survival (p = 0.007 and p = 0.01, respectively). This series confirms the good overall oncologic outcomes obtained by transoral laser surgery for Tis, T1, T2, and selected T3 supraglottic cancer with minimal pre-epiglottic space involvement.     

Pathology of the prostate in radical cystectomy specimens: a critical review

Our aim was to critically review clinico-pathological features of incidental prostate tumors in cystoprostatectomy specimens and to evaluate implications for patients' management. Data were identified by a structured MEDLINE search. Studies addressing incidence, pathological characteristics, and/or clinical significance of prostate tumors or related pre-malignant lesions from cystoprostatectomy series were reviewed in detail. The reported incidence of prostate adenocarcinoma in cystectomy specimens is highly variable and mostly depending on the histopathology technique of sampling. The clinical significance of these incidentally discovered cancers remains questionable, as the outcome of patients depends on the prognosis of the bladder tumor. For those candidates for prostate sparing surgery, it seems reasonable to include a routine prostate biopsy in the standard preoperative work-up as relevant PSA values to exclude cancer are lacking. Reports of prostatic urethral involvement at the time of radical cystectomy are mostly retrospective. Thus, it is likely that the true incidence of involvement with urothelial carcinoma is underreported. It has been suggested that multifocal bladder tumors, CIS in the bladder and bladder tumor location in the bladder neck are independent risk factors for prostatic urothelial carcinoma. Prostatic stromal involvement, which reflects the depth of invasion, is the most important prognostic factor. Poorly differentiated prostate adenocarcinoma and urothelial carcinoma often share overlapping morphologic features and it can be sometimes difficult to differentiate between these two entities.     

No-glucose strategy influences posterior cranial fossa tumors' postoperative course: introducing the Glycemic Stress Index

In a selected patient population, we evaluated the glycemic response to different infusional policies in the management of posterior cranial fossa tumor (PFT) removal. We analyzed the perioperative course, prospectically collected, of 137 children undergoing 150 surgical procedures. Patients were divided in two groups according to different intraoperative fluids (group A, 2.5% glucose; group B, crystalloids). In group B glycemia remained below 125 mg dl⁻¹, while group A showed persistently supranormal glycemic plasma values, reaching statistical significance at the end of surgery (P < 0.018). As no perioperative mortality occurred and no differences were found between groups regarding PICU respiratory or infectious complications, PICU length of stay (LOS) was assumed as the main outcome indicator. LOS was not influenced by group A or B inclusion, while a new indicator, namely the Glycemic Stress Index (GSI), representing both glycemic intraoperative change and procedure length, showed significantly different results in the study groups (P = 0.004). Our clinical experience suggests that both intraoperative glucose-free solutions are safe, and GSI can be a useful tool to identify prolonged PICU stay patients.