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21.
《Surgery (Oxford)》2022,40(11):731-737
Disorders of sex development (DSD) occur in 1–2/10,000 live births, with a specific molecular diagnosis only possible in 20% of cases. Presentation is usually at birth, and gender assignment must be avoided before review by an expert multidisciplinary team. Initial investigations allow a working diagnosis to be made within 48 hr. In 46,XY DSD, surgery may be necessary to correct hypospadias, reposition or remove undescended testes, and remove symptomatic Müllerian remnants. In 46,XX DSD, feminizing surgery is performed less frequently than in the past, but genitoplasty may still be indicated. Psychosocial support is required to promote positive adaptation as gender dissatisfaction can occur in certain conditions. Long-term outcome data are sparse. 相似文献
22.
Marco Maruzzo Umberto Basso Eugenio Borsatti Laura Evangelista Filippo Alongi Orazio Caffo Francesca Maines Sara Galuppo Rocco De Vivo Fable Zustovich Dario Palleschi Andrea Zivi Teodoro Sava Mariella Sorarù Roberto Iacovelli Maurizio Nicodemo Susanne Baier Lucia Fratino Vittorina Zagonel 《Clinical genitourinary cancer》2019,17(1):e187-e194
Background
Radium 223 was introduced for metastatic castration-resistant prostate cancer based on the results of a randomized controlled trial showing risk reduction for death and skeletal events. Our aim was to evaluate the outcome of patients receiving radium 223 in a real-world setting.Patients and Methods
We conducted a multicenter retrospective analysis in the Triveneto region of Italy.Results
One hundred fifty-eight patients received radium 223 in our region. After a median follow-up of 9.5 months, 75 patients died. The median overall survival (OS) was 14.2 months, and the median progression-free survival (PFS) was 6.2 months. Seventy-one (45%) patients achieved progression as best response. Thirty-seven (23%) patients stopped the treatment early because of progression. Eastern Cooperative Oncology Group performance status was prognostic for OS (18.4 vs. 12.3 vs. 7.5 months; 0 vs. 1, P = .0062; 0 vs. 2, P = .0002), whereas previous prostatectomy or docetaxel exposure were not. A neutrophil to lymphocytes ratio ≥ 3 significantly impacted OS (18.1 vs. 9.7 months; P < .001) and slightly impacted PFS (6.6 vs. 5.6 months; P = .05). Patients with a baseline alkaline phosphatase (ALP) value ≥ 220 U/L had worse OS and PFS (24.1 vs. 10.5 months; 7.2 vs. 5.5 months; P < .001). Patients with changes in ALP value achieved better OS (P = .029) and PFS (P = .002). There was no difference according to the line of therapy (0 vs. ≥ 1; P = .490). The main grade 3/4 toxicities were anemia, asthenia, and thrombocytopenia.Conclusion
This large real-world report confirms comparable OS and PFS data when compared with the pivotal study, as well as the predictive role of ALP and neutrophil to lymphocytes ratio. The definition of the optimal position of radium 223 in the treatment of metastatic castration-resistant prostate cancer has still to be defined. 相似文献23.
Giorgio Gandaglia Guillaume Ploussard Massimo Valerio Agostino Mattei Cristian Fiori Nicola Fossati Armando Stabile Jean-Baptiste Beauval Bernard Malavaud Mathieu Roumiguié Daniele Robesti Paolo Dell’Oglio Marco Moschini Stefania Zamboni Arnas Rakauskas Francesco De Cobelli Francesco Porpiglia Francesco Montorsi Alberto Briganti 《European urology》2019,75(3):506-514
Background
Available models for predicting lymph node invasion (LNI) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) might not be applicable to men diagnosed via magnetic resonance imaging (MRI)-targeted biopsies.Objective
To assess the accuracy of available tools to predict LNI and to develop a novel model for men diagnosed via MRI-targeted biopsies.Design, setting, and participants
A total of 497 patients diagnosed via MRI-targeted biopsies and treated with RP and extended pelvic lymph node dissection (ePLND) at five institutions were retrospectively identified.Outcome measurements and statistical analyses
Three available models predicting LNI were evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analyses. A nomogram predicting LNI was developed and internally validated.Results and limitations
Overall, 62 patients (12.5%) had LNI. The median number of nodes removed was 15. The AUC for the Briganti 2012, Briganti 2017, and MSKCC nomograms was 82%, 82%, and 81%, respectively, and their calibration characteristics were suboptimal. A model including PSA, clinical stage and maximum diameter of the index lesion on multiparametric MRI (mpMRI), grade group on targeted biopsy, and the presence of clinically significant PCa on concomitant systematic biopsy had an AUC of 86% and represented the basis for a coefficient-based nomogram. This tool exhibited a higher AUC and higher net benefit compared to available models developed using standard biopsies. Using a cutoff of 7%, 244 ePLNDs (57%) would be spared and a lower number of LNIs would be missed compared to available nomograms (1.6% vs 4.6% vs 4.5% vs 4.2% for the new nomogram vs Briganti 2012 vs Briganti 2017 vs MSKCC).Conclusions
Available models predicting LNI are characterized by suboptimal accuracy and clinical net benefit for patients diagnosed via MRI-targeted biopsies. A novel nomogram including mpMRI and MRI-targeted biopsy data should be used to identify candidates for ePLND in this setting.Patient summary
We developed the first nomogram to predict lymph node invasion (LNI) in prostate cancer patients diagnosed via magnetic resonance imaging-targeted biopsy undergoing radical prostatectomy. Adoption of this model to identify candidates for extended pelvic lymph node dissection could avoid up to 60% of these procedures at the cost of missing only 1.6% patients with LNI. 相似文献24.
《Journal of vascular and interventional radiology : JVIR》2020,31(4):635-643
PurposeThis study evaluated the factors affecting contralateral and ipsilateral recurrent deep vein thrombosis (DVT) after iliac vein stent placement in patients with iliac vein compression syndrome (IVCS).Materials and MethodsData from 130 patients (95 female patients) who underwent catheter-directed thrombolysis and stent placement for IVCS with left lower leg thrombosis at a single institution were retrospectively analyzed. Mean patient age was 69.0 ± 14.0 years old. Median follow-up was 14 months (range, 3–164 months). Anticoagulation therapy was prescribed for 6 months, followed by lifelong antiplatelet therapy. Multivariate logistic regression analysis was performed to evaluate the factors affecting the development of contralateral and ipsilateral recurrent DVT.ResultsSeven patients (5.4%) developed contralateral DVT (median, 26 months; range, 2–61 months), and 11 patients (8.5%) developed ipsilateral DVT (median, 1 month; range, 0–53 months). Stent location (odds ratio [OR], 11.564; 95% confidence interval [CI], 1.159–115.417) and in-stent thrombosis during follow-up (OR, 15.142; 95% CI, 1.406–163.119) were predictors of recurrent contralateral DVT. Thrombophilia (OR, 47.560; 95% CI, 2.369–954.711), remaining inferior vena cava filter (OR, 30.552; 95% CI, 3.495–267.122), and in-stent thrombosis during follow-up (OR, 82.057; 95% CI, 2.915–2309.848) were predictors of ipsilateral DVT.ConclusionsContralateral DVT occurs late and is associated with extension of the iliac vein stent to the inferior vena cava and in-stent thrombosis. Ipsilateral DVT occurs relatively early and is associated with thrombophilia, remaining inferior vena cava filter, and in-stent thrombosis. 相似文献
25.
目的探讨CT动态增强对鉴别肾上腺乏脂肪腺瘤与肾上腺结节样增生的价值。方法回顾性分析经手术病理证实的12例肾上腺乏脂肪腺瘤和27例肾上腺结节样增生患者的病例资料,统计两组病例各期增强CT值,利用公式灌注值P=CT静脉期-CT平扫期、廓清值C=CT静脉期-CT延迟期、绝对廓清灌注指数APC=(C/P)×100%及相对廓清灌注指数RAPC=(C/CT静脉期)×100%得到相关参数,并通过绘制受试者工作特征曲线,鉴别两者的最佳价值。结果肾上腺乏脂肪腺瘤直径较结节样增生更大;肾上腺乏脂肪腺瘤病灶各期CT值均明显高于结节样增生,且两者灌注值P、廓清值C、APC及RAPC有明显的统计学差异。年龄、性别、高血压、病灶位置、对侧肾上腺萎缩及动脉期CT值对鉴别两者无显著意义。结论CT动态增强扫描有助于鉴别肾上腺乏脂肪腺瘤和肾上腺结节样增生。 相似文献
26.
Elderly men with clinical and laboratory evidence of androgen deficiency are eligible for testosterone treatment.
With proper monitoring this is acceptably safe.
In the first year of testosterone treatment there should be a digital rectal examination of the prostate and measurement of prostate specific antigen every three months, thereafter yearly.
The rate of increase of prostate specific antigen (PSA) levels is more significant than its absolute values.
Levels of haemoglobin and the haematocrit should be monitored. 相似文献
27.
中老年男性下尿路症状的流行病学调查 总被引:8,自引:3,他引:5
为了了解下尿路症状在中、老年男性中的流行情况,用附加了二个症状问题的SL问卷对871名52~74岁的男子作回顾性调查,对调查结果作了年龄分组分析。结果发现:平均IPSS总分为4.93分,无症状者为12.2%,轻症者为64.7%,中度症状者为19.6%,重症者为3.5%。夜尿者占72.3%,尿终滴沥占54.4%,而症状中分值>3分者尿终滴沥占25.6%,夜尿占14.6%,平均QOL为1.74,QOL为0~2、3、4~6的比例分别为52.7%、46.0%、1.3%。QOL与IPSS的相关性较好(r=0.62),与梗阻症状群的相关性(r=0.57)优于与刺激症状的相关性(r=0.44)。中重度症状者中有72.0%的人未进行治疗。 相似文献
28.
诱导型一氧化氮合酶与移植血管平滑肌细胞增生的关系 总被引:2,自引:0,他引:2
目的 探讨诱导型一氧化氮合酶 (iNOS)与移植血管平滑肌细胞增生的关系。方法 新西兰大白兔 15只随机分成 3组 ,建立双侧颈动脉间置移植颈外静脉的动物模型。高剂量组每日喂食L 精氨酸 (L Arg) 2 5 0mg/kg ,低剂量组每日喂食L Arg 12 5mg/kg ;对照组不喂食L Arg ,持续 2周。检测血浆和组织匀浆一氧化氮(NO)水平 ,移植血管iNOSmRNA表达。观察术后 3和 6周移植血管平滑肌细胞增生。结果 1.iNOS活性 :(1)血浆NO水平 :实验组血浆NO水平显著高于对照组 ,高剂量组血浆NO水平高于低剂量组 ;(2 )组织匀浆一氧化氮合酶 (NOS)活性 :实验组组织匀浆NOS活性显著高于对照组 ;(3)组织匀浆iNOSmRNA表达 :术后 3周实验组iNOSmRNA表达 ,对照组无表达 ;术后 6周实验组iNOSmRNA表达高于对照组 ,高剂量组高于低剂量组。 2 .移植血管平滑肌细胞形态学变化 :(1)SMA免疫组化染色 :实验组移植血管平滑肌细胞厚度低于对照组 ;术后 6周低剂量组移植血管平滑肌细胞厚度低于高剂量组 ;(2 )PCNA免疫组化染色 :术后 3周实验组平滑肌细胞增殖低于对照组 ;术后 6周低剂量组平滑肌细胞增殖低于对照组和高剂量组。结论 iNOS表达致体内NO水平增高可抑制移植血管平滑肌细胞增生 ;NO浓度与平滑肌细胞增生关系密切 相似文献
29.
经尿道前列腺电切气化术治疗前列腺增生568例报告 总被引:13,自引:0,他引:13
目的 :进一步探讨前列腺增生 (BPH)的有效手术新方法。方法 :采用经尿道前列腺电切术和气化术治疗BPH患者 5 6 8例。结果 :疗效满意 ,术后 3~ 6个月随访 ,国际前列腺症状评分 (IPSS) 8.5± 1.5分 ;最大尿流率 (Q max) 2 0 .5± 4 .5ml s,剩余尿量 2 9.1± 14 .2ml,未出现严重并发症。结论 :将电切和气化相结合行经尿道前列腺切除术是一种安全性高、并发症少、疗效确切的新手术方法 ,具有操作易掌握、出血少、速度快、安全可靠等优点。 相似文献
30.
目的 评价总前列腺特异性抗原 (tPSA)、游离前列腺特异性抗原 (fPSA)及百分率 (f/tPSA % )检测前列腺癌 (PCa)的相关性及临床价值。方法 用酶免法测定 35例PCa及 73例良性前列腺增生 (BPH)患者血清tPSA水平 ,4tPSA <10ng/ml患者另测其fPSA ,计算f/tPSA(% )。 结果 血清tPSA <4、4~ 10、>10ng/ml者发现PCa的比例组间相比均有统计学意义。 4~ 10ng/ml组 ,PCa和BPH者f/tPSA(% )分别是 9.1± 4.8、16 .4± 6 .1,差别有显著意义 (P <0 .0 1)。结论 tPSA仍是PCa筛查的有效瘤标 ,tPSA低水平时 ,f/tPSA(% )检测PCa则更为灵敏精确。 相似文献