Pathologically Node-Positive Prostate Carcinoma - Prevalence, Pattern of Care and Outcome From a Population-Based Study.

AIMS: To evaluate the prevalence, patterns of care and outcome of pathologically node-positive (pN+) prostate cancer (P-Ca) after radical prostatectomy from a provincial population database. PATIENTS AND METHODS: Patients were identified from a provincial cancer registry and a genitourinary cancer outcomes unit (2005-2014). Of a total of 4723 patients who underwent radical prostatectomy, 167 patients with pN+ P-Ca were identified (28/2181 from 2005-2007 and 139/2542 from 2010-2014). Persistently elevated postoperative prostate-specific antigen (PSA) ≥ 0.2 ng/ml was noted in 52 (31%) patients, 23 (44.2%) of whom had salvage androgen deprivation therapy plus radiotherapy (ADT + RT), 25 (48%) were managed with ADT alone and four (7.8%) had no treatment. Of 115 patients with postoperative PSA <0.2 ng/ml, 47 (41%) had ADT alone and 50 (43.5%) had ADT + RT. Survival estimation was carried out using the Kaplan-Meier method. The association of prognostic factors with survival was evaluated using univariate and multivariate analysis and was limited to the newer cohort (2010-2014). RESULTS: The median age was 64 years; the median baseline PSA was 12.5 ng/mL (range 2.5-108.4). After a median follow-up of 48 months, overall survival at 5 and 10 years for the entire cohort were 89% and 81%, respectively, and distant metastasis-free survival (DMFS) at the same time points were 77% and 58%, respectively. For the newer cohort, 5-year overall survival and DMFS were 91.5% and 76%, respectively. On univariate analysis, persistently elevated postoperative PSA ≥0.2 ng/ml (P = 0.0003), seminal vesicle involvement (P = 0.027), ≥2 nodes (P = 0.035) and ADT alone (P = 0.054) had a poor prognostic impact on DMFS, whereas margin involvement had a marginally negative influence on overall survival (P = 0.06). On multivariate analysis, postoperative PSA ≥0.2 ng/ml (hazard ratio 4.4, 95% confidence interval 1.7-11.4; P = 0.002) continued to have a significant association with DMFS. On a sensitivity analysis, postoperative PSA ≥0.1 also had a significant association with DMFS on univariate and multivariate analysis (hazard ratio 3.69, 95% confidence interval 1.32-10.29; P = 0.01). Similarly, postoperative PSA ≥0.4 ng/ml had a significant association with DMFS (hazard ratio 3.87, 95% confidence interval 1.58-9.46, P = 0.003). CONCLUSION: This study showed a notable difference in the proportion of pN+ P-Ca patients between two different time cohorts. A significant association of persistently elevated postoperative PSA with DMFS was noted in our study. This must be accounted for while tailoring postoperative treatment in pN+ P-Ca.

Non-Hodgkin's lymphoma of Waldeyer's ring in children: outcome using chemotherapy and involved field radiotherapy.

AIM: To evaluate the prognostic factors and treatment outcome of children with non-Hodgkin's lymphoma (NHL) of Waldeyer's ring treated at a single institution. MATERIALS AND METHODS: Thirty-two children with NHL of Waldeyer's ring treated at our institute between January 1990 and December 2001 were included in this analysis. The median age at presentation was 14 years, and most of the patients (87%) were boys. The most common histological subtype was diffuse large B-cell lymphoma (75%), 25% patients had stage I and 75% had stage II disease. Treatment comprised a combination of chemotherapy and radiotherapy in most of the patients (75%). Among these patients, 71% received a radiotherapy dose of > or = 45 Gy. RESULTS: After a median follow-up of 45 months, the 5-year disease-free and overall survival rates were 76.5 and 83.2%, respectively. Age > 10 years (P = 0.032), bulky tumours (P = 0.001) and the presence of B-symptoms (P = 0.004) had a negative influence on disease-free survival. Patients treated with a combination of chemotherapy and radiotherapy had a better outcome than patients treated with chemotherapy alone (disease-free survival: 87.1% vs 56.2%, P = 0.056). The complete response (P = 0.003), disease-free survival (P = 0.001) and overall survival (P = 0.001) rates were significantly better for patients receiving a radiotherapy dose > or = 45 Gy. CONCLUSION: The age at diagnosis, the size of the tumour, and the presence of B-symptoms significantly influenced the outcome of children with NHL of Waldeyer's ring in this study. A combined modality treatment, comprising chemotherapy and radiotherapy, resulted in a satisfactory outcome in patients with this rare neoplasm.

Phosphorus availability to maize as influenced by organic manures and fertilizer P associated phosphatase activity in soils.

Laboratory incubation and green house studies were conducted to compare the P availability of organic manures and P uptake from organic manures by maize. Various organic manures viz. Poultry manure (PM), Farmyard manure (FYM), Green manure (GM) and Crop residue (CR) and graded levels of fertilizer P were applied in Samana sandy loam and Ladhowal silt loam soils and incubated for 7, 15, 30, 60 and 90 days. Samples were analyzed for P availability, P uptake and alkaline phosphatase activity. The overall, phosphatase activity, Paranitrophenyl phosphate (PNP h(-1)g(-1)), in the Ladhowal silt loam soil was higher than in the Samana sandy loam soil. As the level of inorganic P increased, the release of PNP h(-1)g(-1) soil also increased. Among different organic manures, PM registered the highest enzyme activity followed by FYM, GM and CR. Compared to 7 days incubation a slightly higher increase in PNP was noticed in samples from 90 days incubation in both soils. The differential phosphatase activity in the organic manures was further reflected in dynamic P availability. The highest amount of Olsen extractable P was in PM-treated soil followed by FYM, GM and field pea crop residue. Organic manure addition along with inorganic P, irrespective of the source, increased the Olsen extractable P throughout the incubation period. Total P uptake by maize increased with the increasing level of inorganic P in both soils. The highest uptake was obtained in PM-treated soil and lowest in the CR-amended soil. We conclude that PM more readily supplies P to plants than other organic manure sources.

Changes in aqueductal CSF stroke volume and progression of symptoms in patients with unshunted idiopathic normal pressure hydrocephalus.

BACKGROUND AND PURPOSE: Idiopathic normal pressure hydrocephalus (iNPH) represents a diagnostic challenge, given its variable presentation and progression. Stroke volume (SV), defined as the mean volume of CSF passing through the aqueduct during both systole and diastole, greater than or equal to 42 muL, serves as a selection criterion for patients with good probabilities of improvement after ventriculoperitoneal shunt surgery (VPS). In this study, we evaluated the changes in SV during the progression of clinical symptoms in patients with suspected NPH. MATERIALS AND METHODS: Nine patients who presented with clinical and radiologic evidence of NPH, but refused treatment with VPS, were evaluated every 6 months for up to 2 years for progression in their clinical symptoms and changes in their SV, as measured by phase-contrast cine MR imaging (PCCMR). RESULTS: SV seems to increase between the onset of the symptoms and the following 18 to 20 months, then seems to plateau, followed in the next 18 to 20 months by a slight decline, and finally to a more precipitous drop in the next 12 months. During this time, however, the patient's clinical symptoms progressively worsen. CONCLUSION: Patients with a low SV have not necessarily had brain atrophy and can show, in the following months, a progressive increase in SV, which qualifies them as good candidates for VPS. The progressive reduction of the SV in untreated patients with worsening clinical symptoms may be a sign of a progressive cerebral ischemic injury, which renders the NPH irreversible.

Influence of poultry manure on phosphorus availability and the standard phosphate requirement of crop estimated from quantity-intensity relationships in different soils.

Twelve samples comprising of non-calcareous, calcareous and acidic soils were used to study P availability parameters and standard phosphate requirement (SPR) in the presence and absence of poultry manure (PM). Adsorption of P and phosphate potential decreased while Olsen extractable P increased by PM addition, the extent varying with the type of soil. The calculated SPR to attain soil solution concentration of 0.2 microg P ml(-1) was invariably higher in fine textured soils. Acid and calcareous soils registered higher SPR compared to non-calcareous soils. PM addition lowered the SPR in all the soils. The observed P supplementation through PM ranged from 11.6% to 100% signifying no fertilizer P need in the latter. Calibration curves were drawn for calculating the SPR for a given soil solution P concentration without and with the addition of PM.