The role of thoracotomy in managing postchemotherapy residual thoracic masses in patients with nonseminomatous germ cell tumours.

OBJECTIVE: To evaluate the clinical outcome and identify prognostic variables in patients with nonseminomatous germ cell tumours undergoing postchemotherapy thoracotomy for residual masses, as the role of this procedure is controversial. PATIENTS AND METHODS: Of 385 patients who underwent postchemotherapy retroperitoneal lymph node dissections between 1988 and 1998, 105 also had 130 thoracotomies. The clinical presentation, chemotherapy regimens, marker status, primary tumour histology, pathology of all resected masses, and clinical outcome of these 105 patients were analysed. RESULTS: The overall discordance rate for synchronous thoracic and retroperitoneal masses was 28%; that for asynchronous thoracic and retroperitoneal masses was 57%. Independent prognostic factors for residual thoracic teratoma or cancer were teratoma (mature or immature) in the primary tumour or retroperitoneal teratoma or cancer. Although three of 12 patients with residual thoracic cancer remained with no evidence of disease, residual thoracic cancer is an independent prognostic factor (P < 0.001) against disease-free survival. CONCLUSION: Postchemotherapy thoracotomy yields important prognostic information, and is therapeutic for most patients with teratoma and a subset with residual viable cancer. The prognostic criteria predictive of fibrosis are not sufficiently accurate to omit resection of residual thoracic masses.

The efficacy of transurethral biopsy for predicting the long-term clinical impact of prostatic invasive bladder cancer.

PURPOSE: Involvement of the prostate by bladder cancer directly impacts survival, the risk of urethral recurrence, and treatment decisions concerning the timing of cystectomy and type of urinary diversion. Transurethral lateromontanal loop biopsies are proposed as the most accurate method for evaluating the prostatic urethra. Due to the potential clinical impact on individuals we assessed its accuracy in a large cohort. MATERIALS AND METHODS: Transurethral lateromontanal loop biopsies were performed in 246 of 416 male patients at our institution between 1989 and 1997. The predictive value and sensitivity of transurethral biopsy, patterns of recurrence, survival and clinical impact were assessed in a cohort with 10 years of followup. RESULTS: The sensitivity of transurethral biopsy for prostatic stromal invasion was 53%, specificity was 77%, positive predictive value was 45% and negative predictive value was 82%. At the 10-year followup 129 patients (52.4%) were dead, 85 (32%) had no evidence of disease, 16 (6.5%) had disease and 16 (6.5%) were lost to followup. Mean followup in patients at risk for urethral recurrence was 61.7 months (range 0.56 to 134.1, median 56.8). Delayed urethrectomy was performed in 15 of 235 cases (6.4%) at a mean of 15.2 months. Of the 246 patients 99 had prostatic disease at transurethral biopsy and/or cystectomy, including 11 (11%) with urethral recurrence. No patient required continent diversion takedown or died of urethral recurrence. CONCLUSIONS: Transurethral biopsy did not accurately determine prostatic involvement. Prostatic involvement at biopsy or cystectomy translated into a higher risk of urethral recurrence. However, it did not have significant clinical impact or affect survival and should not be an absolute contraindication to urethral diversion.

The type of urinary diversion after radical cystectomy significantly impacts on the patient's quality of life.

BACKGROUND: In this study, we used a previously well-validated survey to assess the impact of different forms of urinary diversion on overall quality of life in patients with bladder cancer. METHODS: A total of 92 patients, having three different forms of urinary diversion after radical cystectomy, completed by mail the SF-36, a validated quality-of-life survey. All patients had local/regional disease at the time of cystectomy and are currently without evidence of disease. Completed surveys were then analyzed into physical (PCS) and mental (MCS) component quality-of-life scores per published protocols. Results were then compared with published age-based norms. RESULTS: A total of 38 men who had cystectomy and ileal neobladder had a mean PCS (+/- SD) of 48.4 (7.8) and a mean MCS of 51.0 (7.4); 16 men and women who had cystectomy and Indiana Pouch had a mean PCS of 48.4 (8.9) and a mean MCS of 55.7 (3.8). None of these results is statistically different from published age- and sex-based population norms. Thirty-eight men who had cystectomy and ileal conduit had a mean PCS of 41.4 (8.5) and a mean MCS of 48.2 (10.7). The PCS is not statistically different from the population-based norm; however, the MCS is significantly decreased from the published norm (P = .01). CONCLUSIONS: Patients with ileal conduits have significantly decreased mental health quality of life whereas patients with continent urinary diversions do not. Therefore, when not medically contraindicated, patients should be offered a continent diversion as the diversion of choice after cystectomy.

Antimycobacterial crude plant extracts from South, Central, and North America.

Two-hundred and thirty crude organic extracts from 118 plant species distributed among 10 families were evaluated for anti-mycobacterial activity. Activity was determined against Mycobacterium tuberculosis H(37)Rv and Mycobacterium avium using the BACTEC 460 radiorespirometric assay. At 100 µg/ml, twenty-four and ten of the extracts caused more than 95% inhibition of growth of M. tuberculosis and M. avium, respectively. The most active plant species (100% inhibition) were Borrichia frutescens, Solidago arguta, and Inula helenium against M. tuberculosis, Euthamia leptocephala against M. avium, and Erigeron strigosus and Magnolia acuminata against both mycobacteria.

Staple leg profile influence on pullout strength: a biomechanical study.

Bone staples have widespread applicability in orthopaedic surgery. Their use, however, is limited by inconsistent quality of fixation. Prior studies have shown potential for improvement in the reliability of staple fixation through a change in the design of the staple legs. To identify a superior leg cross section profile, pullout strength of 5 different newly designed staple leg cross sections were evaluated in fresh frozen human cadaveric bones before and after toggle loading. The tests were repeated in a synthetic bone model with variable but consistent densities. The curvilinear square profile had the highest pullout strength in both the cadaveric and synthetic bone, followed in descending order by square, circular, and triangular profiles. Controlling for density, the pullout strength of the curvilinear square profile was 8% higher than the square profile and 34% higher than the circular profile. The triangular profiles had the least resistance to pullout force before and after cyclic loading. The curvilinear square may be the best profile for the cross section of the staple leg for maximum pullout strength and may expand the clinical use of staples in bone fixation.

Effects of the training dose on generalization of morphine stimulus to clonidine.

The relationship between the stimulus properties of morphine and clonidine was tested in rats trained to discriminate morphine sulfate (4, 2 or 1 mg/kg) from saline in a two-lever food-rewarded task. The response trained in the low dose group generalized to low doses of clonidine (0.125 to 0.5 mg/kg) whereas the response trained with the high dose of morphine generalized only to higher doses of clonidine (0.625 to 1.0 mg/kg). Naloxone blocked the generalization in the low dose group but only partially blocked it in the high dose group. Yohimbine blocked the generalization to clonidine in the high morphine dose group and reversed the response rate suppressant effect of clonidine in all groups.

Purification and properties of an endonuclease from nuclei of uninfected and polyoma-infected 3T3 cells.

An endonuclease activity has been purified approximately 800-fold from nuclei of 3T3 cells infected with polyoma virus. The purfied enzyme catalyzes an endonucleoytic cleavage of single- and double-stranded DNA and single-stranded RNA. Evidence that the activity towards these substrates resides in the same protein molecule is provided by the finding that they co-sediment in sucrose gradients and have identical rates of heat inactivation. Studies on the DNase activity shows that the rate of hydrolysis of single-stranded T7 DNA is 100-fold greater than that for double-stranded T7 DNA. Single-stranded DNA is extensively hydrolyzed to low molecular weight acid-insoluble products. With duplex DNA as substrate, only a limited number of single strand breaks are introduced. A limit digest with polyoma DNA (component I) as substrate results in the introduction of four breaks per strand. The phosphdiester bond interruptions can be repaired by polynucleotide ligase. Approximately 80% of the 5' termini present at the point of phosphodiester bond cleavage are purine nucleotides. Additional studies have demonstrated that a similar endonuclease is present in nuclei of uninfected cells and that this enzyme purified 400-fold has catalytic properties identical with those of the endonuclease from infected cells.