Genomic tests to guide prostate cancer management following diagnosis

Introduction: Prostate cancer (PCa) is a common cancer in men, but variable clinical behaviors make its management challenging. Risk stratification is a key issue in disease management. Patient-tailored strategies are strongly advocated to reduce unnecessary treatment while maximizing the oncological outcomes of patient who need active treatment in the primary, adjuvant or salvage setting. Recently, tissue-based biomarkers or genomic tests have become available to improve the clinical decision-making.

Areas covered: In this review, the authors present recent evidence about these tissue-based biomarkers, discussing the application of each of them in the clinical setting, focusing on the tests aimed to provide a better risk stratification and to guide decision-making after the diagnosis of PCa (i.e. OncotypeDX^?, Prolaris^?, ProMark^?, Ki-67, Decipher^?, PTEN, PORTOS, AR-V7 and DNA repair gene mutations).

Expert commentary: Even if the clinicopathologic features are still the most frequently-used predictors of disease progression, these tools can be helpful in decision-making at every stage of the PCa management. Actually, OncotypeDX^?, Prolaris^? and Decipher^? are recommended in the clinical setting by guidelines at different steps of PCa management. Consequently, further studies are indispensable to better tailor the right therapy for the right patient and at the right time.     

Burns: bone-anchored, extra-oral implantology.

Extra-oral implants represent a valid alternative technique in aesthetic reconstruction of the craniofacial district in oncology surgery. Two female patients were selected; they were treated from December 2001 to June 2007 by implanting auricular epithesis. The age range was 27 years. They shared the same diagnosis: burns of the auricle-temporal region. The deformity in the auricle region and the complete absence of the pinna convinced the authors to choose this reconstructive method. Most patients showed a good stability of fixtures, epithesis and perimplants soft tissue, in some cases there has been a delay in the time to healing soft tissue perimplant and only one patient has removed the plant after 5 years cancer recurrence. No complications were observed, including bleeding and infections, in the postsurgery period. No report was made in any case of lesion of the facial nerve having the fixtures being positioned in the back and above the point of emergency.     

Impact of Early Salvage Radiation Therapy in Patients with Persistently Elevated or Rising Prostate-specific Antigen After Radical Prostatectomy

Background

Salvage radiation therapy (SRT) is a recommended treatment option for biochemical recurrence after radical prostatectomy (RP). However, its effectiveness may be limited to specific categories of patients.

Asymptomatic Lacrimal Flow Abnormalities in Patients with Septal Deviations and Turbinate Hypertrophy

Background: This study aimed to investigate the lacrimal flow in patients affected by septal deviations and turbinate hypertrophy and to evaluate changes after rhinoseptoplasty with dacryocystography (DCT) and computed tomographic dacryocystography (CT-DCT). Methods: The study prospectively recruited patients having septal deviations with or without turbinate hypertrophy who underwent surgical evaluation for correction of their respiratory symptoms and were not referred for epiphora. Patients were excluded if they had undergone surgery for cranial vault defects or had experienced septal deviations after traumatic accidents. All patients were studied with DCT and CT-DCT preoperatively and postoperatively. Results: A total of 24 patients (10 men and 14 women) were recruited for the study. Of these patients, 11 (45.8%) had a reduced flow of the medium contrast due to a partial obstruction at the level of the internal ostium. All 11 patients had septal deviations and turbinate hypertrophy, whereas 8 patients had a unilateral obstruction (72.7%), and 3 patients had a bilateral obstruction (27.3%). All flows were corrected after surgery. Conclusions: The safe and well-tolerated radiologic techniques performed in this study provided detailed imaging of the lacrimal outflow system. A high incidence of partial obstruction to the internal ostium was found in patients with septal deviations, turbinate hypertrophy, and no lacrimal symptoms, suggesting a frequent presymptomatic condition.     

Orbital reconstruction: bone-anchored implants

The authors present their experience on reconstruction by extraoral bone-anchored implants technique, showing two patients from a total of 13, treated for orbital reconstruction. They were selected from 66 patients treated for reconstruction of orbit, ear and nose using this technique by the staff of the Department of Plastic and Reconstructive Surgery of the University of Tor Vergata, Rome, Italy. They underwent orbital emptying due to cancer pathology. Surgical technique is described in detail; its final purpose being positioning of titanium fixtures on the orbital borders, necessary to anchor the silicone epithesis. The advantages and potential limits of this technique are exposed, exposing the important role of patient's compliance. The importance of preliminary study on the patients is also emphasized and includes clinical evaluation and instrumental examination for surgical planning, completed by a photographic study in the three standard projections.Satisfactory aesthetic results were obtained by the use of this technique and the authors believe it may represent a valid option; complementary to more traditional ones, but is a first choice in patients who cannot endure major surgery or in case of failure of traditional techniques.     

Superficial circumflex iliac artery perforator flap in a case of Fournier’s gangrene

Fournier’s gangrene (FG) is a rare and acute form of necrotizing fasciitis involving the perineal region and genitalia with occasional extension up to the abdominal wall. The etiology of the FG is only partially understood, but in the majority of cases, aerobic and anaerobic bacteria are involved. FG is characterized by mortality rate ranging from 15 to 20 %, and for this reason, the disease must be treated aggressively. The key of management, after the emergency debridement of necrotic tissue, is a functional and esthetic reconstruction. We reported a case of FG in which the wide scrotal skin and fascia loss was managed with a propeller superficial artery perforator flap. Level of Evidence: Level V, therapeutic study.     

Cupremy values in women bearing IUD medicated with various Copper quantities (authors transl)

Long experience with the IUD shows it to be a safe, effective method, without influence on hormonal equilibrium, easy to insert, and completely reversible. IUDs containing copper are seen as a significant step forward in method efficiency, but there has been concern over whether the addition of metal has some systemic effect, especially since the quantities of copper in current models may be double those in the 1st models. A number of studies are cited which indicate no association of copper IUDs with levels of copper in patients using them. The present study at the Family Planning Center of Rome University involved 150 women using No-Gravid, Gravigard and Copper T IUDs. blood samples, drawn before and after insertion (3-13 months) showed no pathological relation between hematic rate of copper and insertion of the copper IUD.