Psoas Muscle Mass can Predict Postsurgical Outcomes in Patients Who Undergo Radical Cystectomy and Urinary Diversion Reconstruction.

OBJECTIVE: To morphometrically measure to muscle mass which may reflect physical components of frailty. Hence, we evaluated the association between L4 total psoas area (TPA) and operative outcome after radical cystectomy (RC) for bladder cancer. METHODS: In a retrospective single-center study, bladder cancer patients who underwent RC and urinary diversion between 2007 and 2012 were enrolled. TPA was evaluated in the cross-sectional imaging. The psoas muscles were normalized with the height. Male patients with a psoas mass index ≤7.4 cm2/m2 and female patients with a psoas mass index ≤5.2 cm2/m2 were classified as sarcopenic. Outcome measures were 30- and 90-day readmission and complications, and survival. Multivariable logistic and Cox proportional-hazards regression models were used to determine relevant predictors. RESULTS: The median age of the 441 participants and follow up time was 68 years (IQR 59-75) and 1.2 years (IQR 0.5-1.9), respectively. One hundred forty-three patients (32.4%) were sarcopenic. The 30-day readmission and the complication rates were 13.8% and 44.7%, respectively. The 90-day readmission and complication rates were 23.9% and 53.1%, respectively. The 1-year mortality rate was 11.6% (95%CI 8.7-15.4). Multivariable logistic regression analysis revealed an association between increased TPA and lower odds of 30-day complications after RC (OR 0.95, 95%CI 0.92-0.99, P = .02); similarly, an increase in TPA was of prognostic value, although not statistically significant in the multivariable model (P = .05) once adjusting for other patient factors. CONCLUSION: Sarcopenia predicted early complications and showed an informative trend for overall survival after RC, and thus may inform models predicting postsurgical outcomes.

The safety of the H1N1 influenza A vaccine in egg allergic individuals.

BACKGROUND: The safety of H1N1 vaccine is unknown in egg allergic (EA) recipients. OBJECTIVES: To establish the safety of administering H1N1 vaccine and to evaluate the predictability of H1N1 skin testing in EA patients. METHODS: In a controlled, prospective trial, H1N1 skin testing and vaccination was compared between EA patients (n = 105) and non-EA controls (n = 19). Those with negative H1N1 skin test results received a full H1N1 dose; those with a positive skin test result received a graded challenge (10%, 90%). Booster vaccine, if required, was given as a single dose from a different lot without prior testing. RESULTS: Prick and intradermal test results were positive in 3 (2.4%) of 124 and 41 (33.1%) of 124 study participants, respectively. Forty-one individuals received a 2-step graded vaccine challenge, including 13 of 25 with a history of egg anaphylaxis. No significant allergic reactions resulted from either method of vaccination or from subsequent booster doses. CONCLUSION: All study participants received the H1N1 vaccine without significant allergic reactions. Skin testing is unnecessary and does not predict vaccine tolerance. All study participants who received a graded challenge tolerated a single dose booster from a different, untested lot, including 7 individuals with a history of egg-induced anaphylaxis. We recommend administration of H1N1 vaccine to EA children without prior skin testing or graded challenge dosing.

Demographics and efficacy of head and neck cancer screening.

OBJECTIVE: This study was designed to 1) describe the demographics and 2) determine the efficacy of a head and neck cancer screening program to optimize future programs. STUDY DESIGN: Database analysis plus chart review. SETTING: Tertiary care academic medical center. SUBJECTS AND METHODS: After Institutional Review Board approval, we reviewed our 14-year experience (1996-2009) conducting a free annual head and neck cancer screening clinic. Available demographic and clinical data, as well as clinical outcomes, were analyzed for all participants (n = 761). The primary outcome was the presence of a finding suspicious for head and neck cancer on screening evaluation. RESULTS: Five percent of participants had findings suspicious for head and neck cancer on screening evaluation, and malignant or premalignant lesions were confirmed in one percent of participants. Lack of insurance (P = 0.05), tobacco use (P < 0.001), male gender (P = 0.03), separated marital status (P = 0.03), and younger age (P = 0.04) were the significant demographic predictors of a lesion suspicious for malignancy. Patients complaining of a neck mass (P < 0.001) or oral pain (P < 0.001) were significantly more likely to have findings suspicious of malignancy. A high percentage (40%) was diagnosed with benign otolaryngologic pathologies on screening evaluation. CONCLUSION: A minority of patients presenting to a head and neck cancer screening clinic will have a suspicious lesion identified. Given these findings, to achieve maximal potential benefit, future head and neck cancer screening clinics should target patients with identifiable risk factors and take full advantage of opportunities for education and prevention.