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PubMedDate not supplied

[The treatment of inguinal hernia in a one-day surgery protocol. Our experience].

BACKGROUND: Personal experience in the treatment of inguinal hernia in "One day Surgery" is reported. METHODS DESIGN: retrospective evaluation of cases treated in a twelve months period. The follow-up has been programmed at 1, 3, 6 and 12 months after the treatment. SETTING: general, thoracic and oncological surgery, Department of Surgical and Anatomical Disciplines. Polyclinic, University of Palermo. SUBJECTS: 54 patients aged between 17 and 86 years (middle age 51.9), 48 male have been treated; in 3 cases recurrent hernias were found. INTERVENTIONS: in every case Trabucco's procedure with local anaesthesia has been performed. Premedication with Midazolam 10 mg i.v. has been associated. MAIN OUTCOME MEASURES: postoperative course and morbidity have been valued. RESULTS: Twice general anaesthesia has been necessary. No case of allergic reactions has been found. All the patients but three have been discharged before the sixth hour. Wound infections, seromas, deep hematomas, neuralgias and short-time recurrences have not been observed. CONCLUSIONS: Tension-free procedures and local anaesthesia, in personal experience, are mandatory to perform the treatment of inguinal hernia in "One Day Surgery".

Adolescent↗
PubMed1998

Surgical management of acquired rectourethral fistula, emphasizing the posterior approach.

Rectourethral fistula is an uncommon surgical entity having a variety of congenital and acquired causes. Although several surgical approaches have been proposed in the literature, successful repair is often difficult. The 2 patients described had rectourethral fistulas after radical prostatectomy. One patient failed previous transabdominal and perineal repairs. The authors propose a 3-step approach to management of acquired rectourethral fistulas. A diverting transverse colostomy with insertion of a suprapubic or indwelling silicone rubber Foley catheter for 3 to 6 months will allow for a decrease in the inflammatory response surrounding the involved area and possible spontaneous closure. If spontaneous closure does not occur within this time, the fistula should be closed operatively through a posterior approach (modified York-Mason procedure). This approach provides excellent exposure and allows the suture lines to be offset, which in turn allows for better healing, present a minimal risk of impotence or incontinence and allows for complete separation of urinary and fecal streams. The third step involves closure of the colostomy followed by removal of the Foley or suprapubic catheter if there is no recurrence. Timing of this step is crucial and should be individualized according to the postoperative course.

Aged↗
PubMed1987

Instillation of mitomycin C and doxorubicin in the prevention of recurrent superficial (Ta-T1) bladder cancer.

Both Mitomycin C (MMC) and doxorubicin (Adriamycin) (ADM) prevent the recurrence of superficial papillary (Ta-T1) urinary bladder cancers and also reduce the rate of progression. MMC appears to be more effective than ADM in buffered instillations. The number of recurrent tumours (RI/m) and the number of recurrence times (RR) before prophylactic instillation were of significant prognostic importance but the prognostic value of the grade was questionable. The buffer solution, together with methyl prednisolone, reduced the incidence of chemical cystitis.

Administration, Intravesical↗
PubMed1980

Tumour thickness and the site and time of first recurrence in cutaneous malignant melanoma (stage I).

A study was made of 326 patients first treated for clinical stage I cutaneous malignant melanoma by a wide excision (with or without split-skin graft) but no nodal dissection and who subsequently developed recurrence of their disease. Thick lesions recurred far more frequently than very thin lesions, although evidence of partial regression in very thin lesions conferred upon the latter a liability to metastasize. Thicker lesions first recurred predominantly in the vicinity of the scar of primary lesion excision whilst very thin lesions first recurred either at regional lymph nodes or at remote sites. The disease-free interval fell with increasing tumour thickness. As a result of this, local first recurrences developed more rapidly than remote first recurrences. The cumulative 10-year survival rate for patients with local first recurrences was, however, significantly higher than for patients with remote first recurrences, as the survival period after local first recurrence was considerably longer than after remote first recurrence. We conclude that tumour thickness is an easily measured, objective predictor of the site and time of first recurrence from melanoma. Thus, by facilitating early detection of first metastases, it may be possible to prolong survival time.

Humans↗
PubMed1998

[Mortality, recurrent angina pectoris and late myocardial infarction in patients surgically treated for coronary heart disease].

This cohort study includes 1,025 patients operated between 1982 and 1986 at Rikshospitalet, the National Hospital of Norway, 912 men and 113 women. The closing date was 1 January 1993. A total of 31 patients (3%) died within 30 days of operation. Independent risk factors were atrial fibrillation, previous heart surgery, mitral insufficiency, left main stem stenosis, unstable angina pectoris and elevated end-diastolic pressure. Among the 164 patients (16%) who died more than 30 days after operation, the independent risk factors of total mortality were atrial fibrillation, concomitant resection of left ventricular aneurysm, left main stem stenosis, NYHA functional class IV on admission, elevated end-diastolic pressure and prolonged cross-clamping time. Recurrent angina pectoris was experienced by 146 patients (14.2%) while 102 patients had non-fatal myocardial infarction. The cumulative incidence of these conditions was initially low, but began to increase four year after operation. The independent risk factor for these two end-points was hypertension. The study suggests that stratification of independent risk factors facilitates comparison of mortality in different centres and permits improved quality control.

Angina Pectoris↗
PubMed2004

[Analysis of the results of gamma knife radiosurgery for hemangioblastomas of the brain and the factors related to the tumor recurrence].

OBJECTIVE: To assess the 5-year-result of leksell gamma knife (LGK) in controlling hemangioblastomas of the brain (HB) and to analyze the factors related to tumor recurrence or development of new tumors. METHODS: From November 1993 to September 2001, 35 patients, 28 males and 7 females, aged 36 (16 approximately 61), 18 with multiple tumors and 17 with solitary tumor, the number of tumors being 93 in total, were treated by LGK. Twenty-one patients with HBs were associated with von Hippel-Lindau disease (VHLD). The tumor size ranged 5 approximately 55 mm with a mean size of 13 mm. The mean maximum irradiation dose was 35.6 Gy (20.0 approximately 50.0 Gy) at tumor center and the mean minimum dose was 17.2 Gy (12.0 approximately 24.0 Gy) at tumor periphery. Fisher exact test, independent T test and Wilcoxon rank sum W test were used to analyze the results of LGK on solitary and multiple HBs, the recurrent time of the HBs, and the relation between minimum irradiation dose and tumor control. RESULTS: 35 patients had been followed for 24 - 114 months with a mean value of 66 months. 29 patients were alive and 6 died. Of the 29 patients 21 achieved satisfying tumor control, and 8 patients underwent open surgery because of tumor-associated cysts enlarging or development of new tumors after LGK. 21 patients had improvement or remained stable in neurological status. Of the 8 reopened patients, 2 had deteriorated symptoms and the other 6 remained neurologically stable. Of the 35 patients, 7 developed new tumor during the follow-up period, and 5 had second LGK. Tumor control: Of the 29 cases, solitary or multiple tumors in 23 patients decreased in volume or remained the same, although two developed new tumors. The result of LGK in controlling HBs showed no significant difference between the solitary and multiple HBs (P > 0.05), but the dose of long-term tumor control was significantly higher than that of uncontrolled tumors (W = 98, P < 0.01). The tumor control rate was 94% 1 year after; 85% 2 years after; 82% 3 years after; 79% 4 years after; and 71% 5 years after. For the patients with solitary tumor, the mean time of development of new tumor was 63 months, but for the patients with multiple HBs, the time was 25 months. There was a significant difference between the two groups (t = 3.987, P < 0.001). With margin dose of 18 Gy, histopathology showed that no tumor cell was found and there were coagulation necrosis, hyaline degeneration and fibrosis tissues in the tumor nodule 48 months after LGK. CONCLUSION: LGK is a good choice for small- or medium-sized, solid HB in long term, especially when tumor margin dose is 16 - 20 Gy. Although LGK can treat multiple tumors in one single treatment session, for HB in patients associated with VHLD, LGK faces the problem of tumor recurrence or development of new tumor.

Adolescent↗
PubMed1989

Characteristics of inflammatory cells in urethral smears from men with non-gonococcal urethritis.

Differential cell counts in inflammatory exudates were undertaken in urethral smears from men with non-gonococcal urethritis (NGU) for the first time, recurrent NGU (presumably reinfection) after a new sexual contact, or persistent NGU (in patients with no recent history of sexual exposure). Patients experiencing first episodes of NGU had significantly higher macrophage counts, both in relative and absolute terms, than the other two groups, regardless of the presence or absence of Chlamydia trachomatis in the urethral culture. The estimated total inflammatory cell count (ETICC) in the urethral exudate was assessed by counting the number of inflammatory cells in the first voided urine. The ETICC was significantly lower in patients with persistent NGU but no recent history of sexual exposure than in patients with NGU for the first time or with NGU presumably caused by a new infection. The ETICC in all three groups of patients was significantly higher than in controls. A more precise definition of NGU or more reproducible methods of diagnosis may possibly differentiate patients without an infective cause.

Adolescent↗
PubMed1990

[Radiotherapy of epidemic Kaposi's sarcoma in patients with AIDS. Analysis of 149 cases treated by extended and/or localized cutaneous irradiation].

Between June 1986 and December 1988, 149 patients with AIDS-related Kaposi's sarcoma were treated by cutaneous irradiation in our department. According to Mitsuyasu's staging, 34 patients (23 p. 100) were stage I, 82 (55 p. 100) stage II and 33 (22 p. 100) stage IV; no stage III was reported. Fifty eight patients (39 p. 100) had previously presented with one or several opportunistic infections. Ninety four patients (63 p. 100) had previously received treatment with interferon in 85 (57 p. 100) and/or Velbe in 43 (29 p. 100). 319 cutaneous localisations were treated, 59 p. 100 by extended cutaneous irradiation, using 4 and/or 8 MeV electron beam energy, and 41 p. 100 by localized irradiation, using 45 kVX-ray energy, 2.5 Gy/fraction, 4 times a week by split course 20 Gy then 10 Gy two weeks later. Twenty patients (13 p. 100) with oedema of the lower limbs were treated, using 4 MV photon therapy with bolus, and 3 (2 p. 100) were treated for lesions in the ENT regions. Only 131 patients were evaluable (257 localisations); 62 p. 100 obtained complete remission and 31 p. 100 partial remission after a mean period of 1.5 months (0.5-3 months). The overall tolerance was acceptable. The complications were epidermitis with some necrosis (8 p. 100), exudative epidermitis (26 p. 100), moderate epidermitis (63 p. 100) and slight reactions in 4 p. 100. The mean recurrence time was 5 1/2 months.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Pseudomyxoma peritonei. Long-term patient survival with an aggressive regional approach.

OBJECTIVE: The aims of this study were to analyze the natural history of patients with pseudomyxoma peritonei (PMP), evaluate clinical and pathologic variables as prognostic indicators, and review the authors' experience with different treatments. SUMMARY BACKGROUND DATA: PMP is an unusual form of intra-abdominal neoplasm that presents with large amounts of extracellular mucin. Diffuse peritoneal spread occurs in most patients with PMP, and distant metastasis is infrequent. Debulking surgery, radiation therapy (radioisotope and external beam), and chemotherapy (both intraperitoneal and systemic) have all been advocated for optional patient management, but the variability of patients studied, the small patient numbers, and the prolonged course of this disease make the evaluation of results difficult. METHODS: Fifty-six patients were treated for PMP at the Mayo Clinic between 1957 and 1983. The data were collected retrospectively. Univariate (log-rank test) and multivariate (Cox regression model) analyses were performed for disease recurrence and patient survival. RESULTS: Most patients with PMP had carcinomas of the appendix (52%) or ovary (34%). All gross tumor could be removed only in the 34% of patients with limited disease. Although tumor progression occurred in 76% of patients, the 1-, 5-, and 10-year survival rates were 98%, 53%, and 32%, respectively. Adverse predictors of patient survival included weight loss (p = 0.001), abdominal distention (p = 0.004), use of systemic chemotherapy (p = 0.005), diffuse disease (p = 0.038), and invasion of other organs (p = 0.04). Intraperitoneal chemotherapy (p = 0.009) and radioisotopes (p = 0.0043) both were effective in prolonging the recurrence time of symptomatic PMP. CONCLUSIONS: Although PMP is an indolent disease, aggressive surgical debulking followed by intraperitoneal radioisotopes and/or chemotherapy should be considered because of the diffuse peritoneal involvement.

Adolescent↗
PubMedDate not supplied

Percutaneous ureteral clipping: long-term results and complications.

PURPOSE: The authors present their experience with ureteral clipping in patients with urinary fistulas. MATERIALS AND METHODS: The authors retrospectively reviewed records from eight patients in whom 14 ureters were ligated with use of a percutaneously applied stainless steel clip as treatment for urinary fistulas. All patients were female and had undergone pelvic radiation for treatment of cervical carcinoma (n = 7) or endometrial carcinoma (n = 1). Permanent urinary diversion was via percutaneous nephrostomy, which required routine change, at which time recurrence of symptoms and ureteral leakage were determined. Duration of follow-up (patient survival) ranged from 2 weeks to 17 months (mean, 7.1 months). RESULTS: All patients had significant improvement in their symptoms, with seven patients achieving complete perineal dryness. Two patients had recurrence of perineal symptoms due to nephrostomy tube blockage, which was successfully managed by means of interventional techniques. CONCLUSIONS: The authors believe that ureteral clipping is a safe and effective technique in the management of ureteral fistulas due to pelvic neoplasm and its treatment, despite the short life expectancy of these patients.

Female↗
PubMed2003

Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies.

BACKGROUND: Current approaches to adjuvant treatment after resection of gallbladder carcinoma (GBCA) and hilar cholangiocarcinoma (HCCA) are based on an incomplete understanding of the recurrence patterns of these diseases. Through an in-depth analysis of the sites of initial recurrence after resection of GBCA and HCCA, the current study aimed to highlight differences in the biology of these tumors and to provide further insight for adjuvant therapeutic strategies. METHODS: Patients with either GBCA or HCCA who underwent a potentially curative resection were identified prospectively from a maintained database. Specific sites of initial disease recurrence were identified retrospectively and categorized as locoregional (resection margin, porta hepatis, or retroperitoneal lymph nodes) or distant (peritoneal, extraabdominal, or discontiguous liver metastases). Differences in disease recurrence patterns, time to disease recurrence, and overall and site-specific survival were analyzed. RESULTS: Between May 1990 and August 2001, 177 patients underwent potentially curative resection, 97 for GBCA and 80 for HCCA. Disease recurrence and follow-up data were available for 156 patients (80 with GBCA and 76 with HCCA). The median time to disease recurrence was shorter for patients with GBCA compared with patients with HCCA (11.5 vs. 20.3 months; P = 0.007). Overall, 52 (68%) patients with HCCA and 53 (66%) patients with GBCA had disease recurrene at a median follow-up of 24 months. Of those who developed disease recurrence, isolated locoregional disease as the first site of failure occurred in 15% of patients with GBCA compared with 59% of patients with HCCA (P < 0.001). By contrast, an initial GBCA recurrence involving a distant site, with or without concomitant locoregional recurrence, occurred in 85% of patients compared with 41% of patients with HCCA (P < 0.001). This pattern of disease recurrence was diagnosis specific and did not change significantly when patients were stratified by several clinicopathologic factors, including disease stage and its component variables. Using multivariate analysis, diagnosis was an independent predictor of the site of disease recurrence. Among patients who experienced disease recurrence, survival was greater among the patients with HCCA compared with patients with GBCA (29 months vs. 20.6 months, respectively; P = 0.037). For both tumors, the site of initial disease recurrence had no apparent impact on survival time. CONCLUSIONS: After resection, recurrent GBCA is much more likely than recurrent HCCA to involve a distant site. GBCA is also associated with a much shorter time to recurrence and a shorter survival period after recurrence. The results demonstrated significant differences in the clinical behavior of these tumors and suggested that an adjuvant therapeutic strategy targeting locoregional disease, such as radiotherapy, is unlikely to have a significant impact in the overall management of GBCA. Conversely, there is at least some rationale for such an approach in patients with HCCA based on the pattern of initial recurrence.

Adult↗
PubMed1999

Medulloblastoma.

OBJECTIVE: To elucidate the diagnosis, treatment and prognosis of medulloblastoma in both children and adults. METHODS: A retrospective review was conducted in 80 patients with medulloblastoma confirmed pathologically during the period of 1984 and 1995. Multivariate analysis and comparison were made of the therapeutic effects of operation, radiotherapy and chemotherapy as well as the survival period. RESULTS: There were 42 males and 38 females with average age at diagnosis being 9.1 years in children and 25.1 years in adults. All patients were operated on to remove the tumour. Cerebral aqueduct re-opening was got through in 54 cases (67.5%), and Torkilsen's shunt was carried out at the same time for the rest patients. Seventeen patients had ventriculoperitoneal shunt, and 13 of them were performed after surgical excision of the tumour. Complete follow-up information was obtained in 61 patients (76%) for a period of 6 months to 14 years. During the follow-up, 27 patients received postoperative craniospinal irradiation, and 27 local radiation. Fourteen patients were subjected to adjuvant chemotherapy. The overall 5-year and 10-year survival rates were 50.5% and 27.89% respectively. The 5-year survival rate was higher in adults than in children (P < 0.05), whereas the 10-year survival rate was similar. Thirty-two patients died of relapse or metastasis between 6 months and 10 years after initial surgical therapy, and the mean recurrence time was 3.5 years. CONCLUSIONS: Operation and postoperative regular radiotherapy were important therapeutic modalities for medulloblastoma. Total or subtotal removal of the tumour combined with craniospinal radiotherapy can improve patients' survival rate. The survival period of medulloblastoma patients is consistent with Collins' law, that is, the period of risk for survival is the age at initial diagnosis plus 9 months. Only few patients can gain long-term survival.

Adolescent↗
PubMed2000

Pituitary adenomas: results of 684 surgically treated patients and review of the literature.

BACKGROUND: The outcome of patients with pituitary adenomas who were treated surgically with or without postoperative radiotherapy was analyzed. The purpose of this study was to determine the factors that strongly influence (A) tumor control, (B) the efficacy of surgery, and (C) radiotherapy based on the hormonal activity of adenomas and its invasion characteristics. METHODS: Between 1982-1996, 684 patients with the diagnosis of pituitary adenoma were operated on. The mean age was 38 years and the mean follow-up time was 40.5 months. A total of 516 patients who were followed for more than 1 year were studied to analyze the effect of treatment modalities and invasion characteristics on tumor control. There were 297 patients with prolactinomas, 118 patients with somatotropinomas, 45 with corticotropinomas, 17 with mixed adenomas, two with thyrotropinomas, and 205 with null cell adenomas. All patients were classified according to Hardy's modified radiological classification scheme and analyzed in invasive and noninvasive groups individually based on this classification system. In the early postoperative period, 230 of these patients were given conventional radiotherapy with a mean dose of 4400 cGy. The following factors were analyzed for prognostic significance in tumor control: the effects of surgery and radiotherapy based on tumor types and invasion characteristics, the existence of histologically proven invasion of the dura mater overlying the sellar floor, and the early results of topical bromocriptine application in macroprolactinoma patients. RESULTS: Overall surgical complications and mortality rate were similar to those of large series reported in the literature. Except for the invasive somatotropinomas and null cell adenomas, statistical analysis demonstrated the ineffectiveness of radiotherapy on tumor control. We did not detect any positive correlation between the recurrence rate and mean recurrence time or dural invasion of the sellar floor. Topical bromocriptine application seemed to improve tumor control in 21 selected macroprolactinoma patients. CONCLUSION: Conventional radiotherapy is not as effective as expected, considering its adverse effects. The increased side effects of radiotherapy in cases with supra-parasellar extension, especially to the optic pathway and hypothalamus, limit its benefits, which could be demonstrated only in invasive somatotropinomas and null cell adenomas. In contrast with our current beliefs, tumoral infiltration of the sellar dura mater is not a prognostic factor for recurrence and therefore should not be a criterion for radiotherapy after surgery. Topical application of bromocriptine into the sellar cavity after tumor removal seems to provide superior results compared with the conventional treatment modalities.

Adenoma↗
PubMed1988

Time course of night sleep EEG in the first year of life: a description based on automatic analysis.

The aim of this study is to describe the time course of night sleep in the first year of life. Forty-eight infants aged between 1 and 54 weeks were polygraphically recorded for 1 night. The central occipital EEG derivation was processed with a lab computer in order to obtain every 30 sec an EEG parameter value. The parameter is based on the joint frequency-amplitude distribution of the EEG and displays fluctuations between 2 extreme levels, high voltage low frequency (HVLF) and low voltage high frequency (LVHF). The range of the fluctuations between HVLF and LVHF increases from the period of 1-6 weeks to the period of 7-14 weeks. A further increase of the parameter range occurs after 24 weeks, which remains restricted to the first half of the night. The recurrence time of LVHF and HVLF episodes (possibly corresponding to quiet sleep paradoxical sleep cycles) is about 56 min and does not change with age in the first year of life.

Brain↗
PubMed2006

Time course of brain activity during change blindness and change awareness: performance is predicted by neural events before change onset.

People often remain "blind" to visual changes occurring during a brief interruption of the display. The processing stages responsible for such failure remain unresolved. We used event-related potentials to determine the time course of brain activity during conscious change detection versus change blindness. Participants saw two successive visual displays, each with two faces, and reported whether one of the faces changed between the first and second displays. Relative to blindness, change detection was associated with a distinct pattern of neural activity at several successive processing stages, including an enhanced occipital P1 response and a sustained frontal activity (CNV-like potential) after the first display, before the change itself. The amplitude of the N170 and P3 responses after the second visual display were also modulated by awareness of the face change. Furthermore, a unique topography of event-related potential activity was observed during correct change and correct no-change reports, but not during blindness, with a recurrent time course in the stimulus sequence and simultaneous sources in the parietal and temporo-occipital cortex. These results indicate that awareness of visual changes may depend on the attentional state subserved by coordinated neural activity in a distributed network, before the onset of the change itself.

Adult↗
PubMed1997

Antituberculosis drug-resistance surveillance as a tool for tuberculosis control programmes: a retrospective study.

The aim of this study was to verify the suitability of antituberculosis (antiTB) drug-resistance surveillance as a tool for tuberculosis (TB) control programmes at local level. A retrospective study reviewing laboratory records and medical records of TB patients referred to Udine Hospital between 1981 and 1995 was analysed. The initial susceptibility pattern for each Mycobacterium tuberculosis isolate was recorded. It was found that between 1981 and 1995, 899 M. tuberculosis strains underwent susceptibility testing for four first-line drugs. Over a period of 15 yrs the annual number of M. tuberculosis strains initially decreased and then stabilized. Overall, 15.3% of the 899 strains showed initial resistance to at least one first-line drug, and 2.8% to two or more first-line drugs. Streptomycin-resistant strains were the most commonly observed (10.8%), with resistance to isoniazid, rifampicin and ethambutal shown to be 6.4, 1.0 and 0.4%, respectively. Multidrug resistant (MDR)-TB was observed in only five cases. An additional four cases eventually developed secondary MDR-TB during the follow-up. The proportion of resistant strains did not vary significantly over time. Recurrent TB disease was significantly associated with resistant strains (odds ratio = 3.59, p < 0.01). Only one patient had a documented human immunodeficiency virus (HIV)-positive serology. All six patients who developed MDR-TB during or after treatment, were suffering either from chronic alcoholism or from a psychotic disorder. In the study it was shown that recurrent tuberculosis cases, tuberculosis patients with behavioural problems (i.e. alcoholism, psychiatric disorder) and patients presenting with primary resistant Mycobacterium tuberculosis strains are at risk of multidrug-resistant tuberculosis and may thus benefit from the directly observed treatment approach, which has been proposed as a mainstay in tuberculosis control programme strategy.

Antitubercular Agents↗
PubMed2005

Mild hypothermia for acute liver failure: a review of mechanisms of action.

Brain edema with intracranial hypertension is a major complication in patients with acute liver failure. Current therapies for this complication include a variety of pharmacologic and interventional measures, some of which are frequently associated with adverse effects or contraindications. Even though these measures usually allow the control of intracranial hypertension for a certain period of time, recurrence is common. New therapies are therefore needed. Increasing clinical and experimental evidence suggests that induction of mild hypothermia (32 degrees C-35 degrees C) may be a therapeutic alternative. Similar to traumatic brain injury or brain stroke, induction of mild hypothermia seems highly effective to reduce intracranial pressure in patients with acute liver failure. Several mechanisms by which mild hypothermia may prevent brain edema and intracranial hypertension in this condition have been disclosed and may include beneficial effects on ammonia metabolism, as well as on the disturbances of brain osmolarity, cerebrovascular hemodynamics, brain glucose metabolism, inflammation, and others. Improvement of systemic hemodynamics and amelioration of liver injury may be other benefits of the systemic induction of mild hypothermia, but the impact of potential adverse events, such as infection, should also be taken into account. At a time when mild hypothermia is increasingly used in several specialized centers, performance of a randomized controlled trial seems critical to confirm the benefits of mild hypothermia in acute liver failure and to provide adequate guidelines for its use.

Ammonia↗
PubMed2002

Risk of positive margins and biochemical recurrence in relation to nerve-sparing radical prostatectomy.

PURPOSE: To assess the effect of nerve-sparing (NS) radical retropubic prostatectomy (RRP) on surgical margins and biochemical recurrence. PATIENTS AND METHODS: Location and incidence of positive surgical margins, recurrence, and time to recurrence were assessed in a consecutive series of 734 men who underwent RRP for localized prostate cancer from 1992 through February 2000. NS procedures were used in 33% (n = 240) of 734 patients studied. RESULTS: Surgical margins were positive for 24% (n = 58) and 31% (n = 152) of NS and non-NS patients, respectively (P =.06). No significant difference between the groups was found in location of positive margins (P =.92). Prostate-specific antigen level greater than 10 ng/mL, extraprostatic extension, tumor volume more than 20%, capsular penetration, Gleason score > or = 7, positive margins, and seminal vesicle invasion were associated with significantly increased risk of recurrence. However, NS patients were not at increased risk of recurrence compared with non-NS patients (hazard ratio, 0.96; 95% confidence interval, 0.53 to 1.72). The cumulative risk of recurrence within 3 and 5 years of surgery in NS patients was 9.7% and 14.4%, respectively, as compared with 17.1% and 21.1% for non-NS patients. CONCLUSION: In patients with localized prostate cancer, neither margin status nor biochemical-free survival within 5 years of surgery were altered by the nerve preservation technique. Given our experience, we recommend preservation of neurovascular bundles in these patients whenever the procedure is technically feasible.

Aged↗