Is there a role for the development of a supra-regional network for the management of penile cancer in the Republic of Ireland?

INTRODUCTION: There is an average of 25 cases of penile cancer in the Republic of Ireland each year. Due to the low volume of cases, the National Institute for Clinical Excellence recommends that treatment is centralised to allow the best standardised treatment for primary tumours and nodal disease. OBJECTIVES: To determine whether outcomes for patients with penile cancer differed significantly between secondary and tertiary referral centres in the Republic of Ireland. METHODS: Between 2001 and 2014, 36 patients were treated in the Mercy University Hospital (MUH) with penile cancer. Twenty patients were treated primarily in MUH and 16 patients underwent initial management in a secondary referral centre (SRC) with subsequent referral to the MUH. A retrospective matched case-control study was performed on this patient cohort. RESULTS: There were no significant differences in length of follow-up or risk factors for the development of penile cancer between both groups (p = 0.6 and p = 0.5 respectively) Ultimately, the incidence of high risk disease, nodal metasases, high grade disease and pelvic lymph node dissection were significantly greater in patients that were initially managed in a SRC (p = 0.02, p = 0.03, p = 0.004 and p = 0.028 respectively). Patients undergoing initial treatment in a SRC had a non-significantly reduced rate of cancer specific survival (88 Vs 66%, MUH Vs SRCs, p = 0.495) and recurrence free survival (85 Vs 46%, MUH Vs SRCs, p = 0.24). CONCLUSION: Our findings suggest that managing penile cancer in special interest centres may improve oncological outcome.

Development of UK recommendations on treatment for post-surgical erectile dysfunction.

AIM: To develop a management strategy (rehabilitation programme) for postsurgical erectile dysfunction (ED) among men experiencing ED associated with treatment of prostate, bladder or rectal cancer that is suitable for use in a UK NHS healthcare context. METHODS: PubMed literature searches of ED management together with a survey of 13 experts in the management of ED from across the UK were conducted. RESULTS: Data from 37 articles and completed questionnaires were collated. The results discussed in this study demonstrate improved objective and subjective clinical outcomes for physical parameters, sexual satisfaction, and rates of both spontaneous erections and those associated with ED treatment strategies. CONCLUSION: Based on the literature and survey analysis, recommendations are proposed for the standardisation of management strategies employed for postsurgical ED.

Eating quality of the longissimus thoracis muscle in beef cattle - Contributing factors to the underlying variability and associations with performance traits.

The objective was to determine the factors associated with meat tenderness, juiciness, flavour and chewiness in 4791 growing crossbred cattle. Meat quality of bulls was inferior to that of both steers and heifers with little difference between the latter two genders. Angus, Hereford and Belgian Blues had the most tender meat with the Simmental being the toughest albeit the difference was, on average, only 5%. Moderate to strong correlations (r ≥ |0.43|) existed among tenderness, juiciness and flavour although some of the correlations differed by animal gender. Correlations between chewiness and tenderness in the different genders varied from -0.81 to -0.74 while the correlations between chewiness and the other sensory traits varied from -0.54 to -0.09. The (partial) correlations between each of the four sensory metrics and all of carcass weight, carcass conformation and carcass fat score were ≤|0.09| with most not being different from zero. Correlations between the sensory traits with growth rate, muscle depth, feed intake and efficiency were all ≤|0.08| and mostly not different from zero.

Inter-animal genetic variability exist in organoleptic properties of prime beef meat.

The objective of the present study was to estimate genetic parameters for four organoleptic traits in beef meat, namely tenderness, juiciness, flavour and chewiness using data from 5380 young crossbred progeny of 748 different sires. As well as using the mean animal sensory score across all panellists for a given trait, other aggregate functions such as the median and modal values were also investigated. The heritability (SE) of mean tenderness, juiciness, flavour and chewiness was 0.16 (0.04), 0.14 (0.04), 0.11 (0.03) and 0.21 (0.06), respectively; heritability estimates for the other aggregate values of these traits were generally lower. All genetic correlations between tenderness, juiciness and flavour were positive (0.52 to 0.68) while the genetic correlations between these three traits with chewiness were all negative varying from -0.95 to -0.48. Weak genetic correlations (≤|0.16|) were evident between the sensory traits and all of carcass weight, conformation and subcutaneous fat cover.

Potential exists to change, through breeding, the yield of individual primal carcass cuts in cattle without increasing overall carcass weight1.

The ability to alter the morphology of cattle towards greater yields of higher value primal cuts has the potential to increase the value of animals at slaughter. Using weight records of 14 primal cuts from 31,827 cattle, the objective of the present study was to quantify the extent of genetic variability in these primal cuts; also of interest was the degree of genetic variability in the primal cuts adjusted to a common carcass weight. Variance components were estimated for each primal cut using animal linear mixed models. The coefficient of genetic variation in the different primal cuts ranged from 0.05 (bavette) to 0.10 (eye of round) with a mean coefficient of genetic variation of 0.07. When phenotypically adjusted to a common carcass weight, the coefficient of genetic variation of the primal cuts was lesser ranging from 0.02 to 0.07 with a mean of 0.04. The heritability of the 14 primal cuts ranged from 0.14 (bavette) to 0.75 (topside) with a mean heritability across all cuts of 0.48; the heritability estimates reduced, and ranged from 0.12 (bavette) to 0.56 (topside), when differences in carcass weight were accounted for in the statistical model. Genetic correlations between each primal cut and carcass weight were all ≥0.77; genetic correlations between each primal cut and carcass conformation score were, on average, 0.59 but when adjusted to a common carcass weight, the correlations weakened to, on average, 0.27. The genetic correlations among all 14 primal cut weights was, on average, strong (mean correlation of 0.72 with all correlations being ≥0.37); when adjusted to a common carcass weight, the mean of the genetic correlations among all primal cuts was 0.10. The ability of estimated breeding values for a selection of primal cuts to stratify animals phenotypically on the respective cut weight was demonstrated; the weight of the rump, striploin, and fillet of animals estimated to be in the top 25% genetically for the respective cut, were 10 to 24%, 12 to 24%, and 7 to 17% heavier than the weight of cuts from animals predicted to be in the worst 25% genetically for that cut. Significant exploitable genetic variability in primal carcass cuts was clearly evident even when adjusted to a common carcass weight. The high heritability of many of the primal cuts infers that large datasets are not actually required to achieve high accuracy of selection once the structure of the data and the number of progeny per sire is adequate.

Management of bladder cancer.

Bladder cancer is the fourth most common cancer in men and is increasing in incidence in women as well. Bladder cancer has a broad range of behavior and presentations, with different prognoses and treatments. Laboratory research has made strides in elucidating pathways of this cancer, and identifying novel therapeutic targets. This short review provides a summary of the current knowledge of the management of bladder cancer.

A prospective 10 year audit of a single Irish centre's experience of retroperitoneal lymph node dissection for metastatic testis cancer.

BACKGROUND: Retro-peritoneal lymph node dissection (RPLND) following chemotherapy is critical in advanced germ cell tumours with residual retro-peritoneal masses. Post-chemotherapy RPLND is more extensive, may require adjacent organ resection and has higher morbidity. The study aim was to analyse patient demographics, clinical stage, surgical procedures and cure rates following RPLND. METHODS: An RPLND database (1994-2005) was analysed prospectively for demographics, pre/post-RPLND staging, chemotherapy regimen, cure, follow-up and early/late morbidity and mortality. RESULTS: 73 patients were identified (range 17-49 median 25.7). The mean hospital stay was 14.3 days (range 6-50). Clinical stage at presentation was; IV (16), III (19), II (27), I (11) and prior to RPLND was IV (12), III (6), II (55), I (0). Eleven patients with stage I disease progressed prior to RPLND. Seventy-one patients received cisplatin-based chemotherapy with partial response (49), minimal response (14), no response (7), disease progression (3) and 13 patients required salvage chemotherapy. RPLND was bilateral (26), unilateral (36) and suprahilar (11) with nerve sparing in 10. Other major procedures included nephrectomy (22), aortic graft (1), ureterectomy (1) and caval dissection (1). RPLND histology was mature teratoma (MT) (37), fibrosis/necrosis (26), NSGCT (6), seminoma (1), mixed NSGCT/teratoma (1), sarcoma (1) and mixed seminoma/teratoma (1). Early (n = 26) and late (n = 13) morbidity was significant but expected. There was no mortality. Ninety-five per cent had complete remission following RPLND (mean follow-up 30 months). One patient is deceased following relapse. CONCLUSIONS: The decision to perform post-chemotherapy RPLND depends on the possibility of viable tumour or teratoma and surgical morbidity. Appropriate case selection and timely intervention in an experienced centre permits optimum outcome.

Dynamic sentinel node biopsy for penile cancer: an initial experience in an Irish Hospital.

BACKGROUND: The presence of nodal metastases is the single most important prognostic factor in penile cancer. However, reliable assessment of nodal status in clinically node-negative (cN0) patients poses a challenge. Approximately 20% of these patients harbour occult nodal metastases. Currently available non-invasive radiological investigations are unreliable in excluding micrometastatic disease. AIM: Dynamic sentinel node biopsy (DSNB) is a minimally invasive procedure for assessing lymph node involvement. We report our initial experience with DSNB in assessing the status of regional lymph nodes in cN0 penile cancer patients. METHODS: DSNB was performed in penile cancer patients with at least one cN0 groin. All patients undergoing DSNB at our institution were included. Lymphoscintigraphic images were obtained from all patients, after intradermal, peritumoral injection of a Technetium-99m nanocolloid. The sentinel nodes were defined as the nodes identified on lymphoscintigraphy, which were also radioactive intraoperatively using a gamma probe. RESULTS: In total, 18 groins from 11 patients underwent DSNB. Of these, 11 patients underwent bilateral DSNB and 4 had unilateral DSNB. The mean (range) age of patients at the time of presentation of their primary tumour was 63 (39-78) years. A mean of 1.2 nodes per groin was retrieved. One lymph node was positive in one patient, who subsequently underwent a bilateral inguinal lymph node dissection. Overall, the median (range) follow-up was 12.8 (2.7-31.3) months with no local or regional recurrences. CONCLUSION: Further cases and longer follow-up will define the accuracy of this technique in the Irish population.

Effect of autonomic nervous system dysfunction on the circadian pattern of myocardial ischemia in diabetes mellitus.

OBJECTIVES: The aim of this study was to determine the prevalence and characteristics of ambulatory myocardial ischemia in patients with diabetes mellitus and to delineate the relation between the presence and severity of autonomic nervous system dysfunction and the incidence and time of onset of myocardial ischemia. BACKGROUND: Conflicting data exist with regard to the circadian pattern of myocardial infarction and other cardiovascular events, such as ambulatory ischemia, in diabetes. METHODS: We performed ambulatory electrocardiographic monitoring in 60 patients with diabetes and coronary artery disease. Autonomic nervous system testing was performed in a subgroup of 25 patients with myocardial ischemia after discontinuation of all antianginal medications. RESULTS: Thirty-eight of 60 patients had evidence of ambulatory ischemia; 91% of all ischemic episodes were asymptomatic. The 25 patients with ambulatory ischemia who underwent autonomic nervous system testing had a peak incidence of ischemia between 6 AM and noon (46 of 133 ischemic episodes, p < 0.007), compared with the other three 6-h periods. Fifteen of the 25 patients had no or mild autonomic nervous system dysfunction and demonstrated a similar peak incidence of ischemia between 6 AM and noon (p = 0.0009). However, the 10 patients with moderate to severe autonomic nervous system dysfunction did not experience a morning peak of ischemia, and the number of ischemic episodes was distributed evenly throughout the day (p = 0.4). CONCLUSIONS: Silent ischemia is highly prevalent among patients with diabetes and coronary artery disease. Time of onset of ischemia in diabetic patients follows a circadian distribution, with a peak incidence in the morning hours. However, patients with significant autonomic nervous system dysfunction did not demonstrate such a peak, suggesting that alterations in sympathovagal balance may have an effect on the circadian pattern of cardiovascular events.

Mineralization of different bones in streptozotocin-diabetic rats: study on the concentration of eight minerals.

Streptozotocin-induced diabetes was studied in male and female rats weighing 188 and 145 g, respectively, at the start of the experiment. After 79 days in the diabetic condition the weights and lengths of different bones were less in the diabetic rats than in two nondiabetic control groups, i.e., ad libitum fed and a group restricted in food intake to achieve the same body weight as the diabetic rats. The concentrations of calcium, phosphorus, and sodium were similar in the diabetic and nondiabetic groups, whereas the concentrations of iron and zinc were higher in the diabetic rats. Results for the concentration of potassium, magnesium, and chromium showed a less uniform pattern between groups and between males and females. It is concluded that the length and weight of bones in diabetic rats are less than nondiabetic rats of the same body weight. This results in a lower total amount of calcium, phosphorus, sodium, potassium, magnesium, and chromium. This observation was similar in all three bones studied. Therefore, prolonged streptozotocin-induced diabetes does interfere with the normal pattern of bone mineralization.

Hair zinc levels in rural Costa Rican infants and preschool children.

Correlations between hair zinc and age, sex, weight, and length were determined on 138 boys and girls aged 6 months to 4 years from a low socioeconomic region of rural Costa Rica. Zinc deficiency, as assessed by hair zinc concentrations of less than 70 microgram/g, was observed in only a few of these children. A negative correlation between hair zinc and growth parameters was obtained, which may reflect increased zinc needs during rapid growth. Females had significantly more zinc in hair than males of similar age. This study confirms previous findings that normally growing infants and preschool children have normal hair zinc levels.

Rehabilitating effect of vitamin E therapy on the ultrastructural changes in skeletal muscles of vitamin E-deficient rabbits.

Ultrastructural repair of the morphological damages produced in nutritional muscular dystrophy was studied by refeeding dystrophic rabbits with vitamin E. Weanling (1.2 kg body weight) rabbits were fed a vitamin E-deficient diet for 24 days. Half of this group was then sacrificed and the remainder was given an initial oral dose of 50 mg of DL-alpha-tocopherol acetate and a vitamin E supplemented diet for 28 days. Control animals were fed a vitamin E supplemented diet with 50 mg of DL-alpha-tocopherol acetate per kilogram of diet. Abnormalities of dystrophic muscles included streaming Z-disk, degenerated mitochondria, fragmented sacroplasmic reticulum and development and aggregation of myelin figures. The effect of vitamin E therapy resulted in significant repair of the dystrophic muscle. Small localized sections of rehabilitated muscle revealed abnormal mitochondria and residual myelin figures.

Effect of nifedipine on total ischemic activity and circadian distribution of myocardial ischemic episodes in angina pectoris.

A randomized, double-blind, crossover study was conducted in 10 patients to assess the effect of nifedipine versus placebo on total ischemic activity and circadian distribution of ischemic episodes. After baseline exercise treadmill testing and 48-hour ambulatory electrocardiographic ST-segment monitoring, patients received either nifedipine (mean dose, 80 mg/day) or placebo administered 4 times per day, with the initial dose taken immediately upon arising in the morning. Patients were maintained on a stable dose of each study drug for 7 days, after which they underwent repeat exercise treadmill testing and 48-hour ambulatory electrocardiography. During exercise treadmill testing, greater exercise duration was achieved by patients receiving nifedipine than by those receiving placebo (421 +/- 121 vs 353 +/- 155 seconds, respectively; p less than 0.05). Time to greater than or equal to 1 mm ST depression was significantly greater with nifedipine (282 +/- 146 seconds) than at baseline (130 +/- 72 seconds, p less than 0.003) and with placebo (150 +/- 98 seconds, p less than 0.0005). During ambulatory electrocardiographic monitoring, nifedipine reduced both the total number of ischemic episodes (18 vs 54 at baseline and 63 with placebo; p less than 0.02 for both) and the total duration of ischemia (260 vs 874 at baseline and 927 minutes with placebo; p less than 0.02 for both). The surge of ischemia between 06:00 and 12:00 noted at baseline and during placebo therapy was nearly abolished during nifedipine treatment. Nifedipine at this dosage, administered in this manner, is effective in reducing total ischemic activity and may prevent morning surges of ischemic episodes.

Prevention of postsplenectomy sepsis: how much do patients know?

INTRODUCTION: Asplenia causes a deficiency in immunity with a long-term risk of fulminant infection, associated with significant mortality. Patient compliance requires an understanding of risks of infection and its prevention. The impact of patient education has been little studied. MATERIALS AND METHODS: To ascertain the degree of knowledge held by patients who have undergone splenectomy, a comprehensive survey was designed. This also aimed to determine which group of health professionals was most successful in conveying information to patients. Patients who had undergone total splenectomy were interviewed by telephone, using a standardised list of questions to assess their understanding of the post-operation risks. RESULTS: Of 40 consecutive patients, 32.5% had a good knowledge of the risks of asplenia and their prevention, 52.5% had a fair knowledge and 15% a poor knowledge. Haematologists were most successful in initially conveying information to patients, and general practitioners also played a critical role in patient education. In this survey, it appears that surgeons were not effective at educating patients. CONCLUSION: Patient education postsplenectomy is poor. Measures to prevent infection in the asplenic patient are not being adequately implemented.

The effects of social category norms and stereotypes on explanations for intergroup differences.

A 2-stage model of the construction of explanations for differences between groups is presented. Category norms affect which of 2 groups becomes "the effect to be explained," and stereotypes shape attributions about that group. In 3 experiments, 288 participants wrote explanations for differences between gay and straight men. Explanations focused on gay men who were also judged to have more mutable attributes. However, these effects were not correlated. Participants focused explanations on straight men when explicitly instructed to do so (Experiment 1). Explanations focused on both groups equally when the gay men constituted the numerically larger sample, when gay men were more typical of the overarching category (i.e., people with AIDS) than straight men, or when more straight men were described as performing the behavior (Experiment 2). Stereotype-consistent information prompted more essentialist references and fewer reconstructive references to gay men than did stereotype-inconsistent information (Experiment 3). The relevance of this model for theories of norms, stereotypes, and for the conduct of social science is discussed.

Total fat and fatty acid composition of commercially available chocolate candies.

Forty different brands of chocolate candies were purchased in a supermarket. The wrappers were removed and coded, and the candy was re-wrapped in aluminum foil until analyzed. More than 60 percent of the samples had a polyunsaturated/saturated (P/S) ratio of less than 0.10. Although the candies examined had a higher carbohydrate than fat content, fat frequently contributed more calories in the candies containing more than 25 percent fat (15 of the 40 brands studied).

Exploration of the acute scrotum: a retrospective analysis of 100 consecutive cases.

BACKGROUND: Acute scrotal pain is a common urological emergency. Urgent exploration is the standard means of management, as no investigation can confidently exclude torsion of testis from the differential diagnoses. In our department, all patients up to the age of 40 years, presenting with acute scrotal pain undergo emergency scrotal exploration. AIM: This study assesses the outcome of such a policy in one unit. METHODS: The notes of 100 consecutive males who underwent exploration of scrotum have been reviewed. RESULTS: Testicular torsion was diagnosed in 33% of patients, with torsion of the appendix testis being the next most common entity. In the group with testicular torsion 12% required orchidectomy, and all had presented at least 24 hours after the onset of pain. The perioperative morbidity of scrotal exploration was very low. CONCLUSION: These data justify the policy of emergency exploration for all cases of acute scrotal pain up to the age of 40 years.

One-stage Fowler-Stephens orchidopexy for impalpable undescended testis.

BACKGROUND: The Fowler-Stephens orchidopexy (FSO) is a well-described treatment for high maldescended testes where the limiting factor for successful placement in the scrotum is short testicular vessels. The operation involves division of these vessels. The testicular blood supply is then dependent on collaterals from the vasal artery. AIMS: To assess the long-term outcome of patients who underwent this procedure in our institution. METHODS: The medical records of 20 patients who underwent 22 FSO from 1978 to 1999 by one urologist (HB) were reviewed. Outcome was assessed in terms of testicular position and size. RESULTS: Age at operation ranged from 2 to 14 years (mean 5.8 years). All patients had a one-stage FSO and in two of them the procedure was bilateral. In five patients, FSO was preceded by a diagnostic laparoscopy. Mean follow up was 22 months (range 0-121 months). Overall, results were considered good in 18 of 22 testes (82%). CONCLUSION: Our results for the one-stage FSO are comparable with other procedures for the management of high maldescended testis.

Sexual orientation beliefs: their relationship to anti-gay attitudes and biological determinist arguments.

Previous studies which have measured beliefs about sexual orientation with either a single item, or a one-dimensional scale are discussed. In the present study beliefs were observed to vary along two dimensions: the "immutability" of sexual orientation and the "fundamentality" of a categorization of persons as heterosexuals and homosexuals. While conceptually related, these two dimensions were empirically distinct on several counts. They were negatively correlated with each other. Condemning attitudes toward lesbians and gay men were correlated positively with fundamentality but negatively with immutability. Immutability, but not fundamentality, affected the assimilation of a biological determinist argument. The relationship between sexual orientation beliefs and anti-gay prejudice is discussed and suggestions for empirical studies of sexual orientation beliefs are presented.