Gossypiboma manifesting as urachal mass.

Gossypiboma (retained surgical sponge) occurs between 1 in 1000 and 1 in 1500 of all intra-abdominal operations. Patients with gossypibomas may present asymptomatically or with nonspecific symptoms, such as abdominal pain or bloating; identification frequently relies on imaging. Results of imaging alone, however, may appear nonspecific, and the gossypiboma may mimic other masses, such as neoplasms, hematomas, or abscesses. They require surgical removal for definitive diagnosis and treatment. Herein we present an unusual case of gossypiboma masquerading as an urachal mass in a 75-year-old woman. Diagnostic evaluation, natural history, and prevention of retained surgical materials are discussed.

Safety of the "drain and retain" option for defunctionalized urologic prosthetic balloons and reservoirs during artificial urinary sphincter and inflatable penile prosthesis revision surgery: 5-year experience.

OBJECTIVE: To present our 5-year experience using a "drain and retain" option, in which existing urologic prosthetic balloons and reservoirs (UPBR) were emptied but not removed during routine artificial urinary sphincter (AUS)/inflatable penile prosthesis (IPP) reoperation. METHODS: All genitourinary prosthetic surgeries by a single surgeon from July 2007 to September 2012 were reviewed. Patients were included in the study group if they underwent prosthetic replacement (with contralateral new UPBR placement) or subtotal device removal, although having their original UPBR drained and retained. Virgin cases, complete device removals for gross infection, and revision cases using the original UPBR were excluded. The "drain and retain" technique involved defunctionalizing the existing UPBR by aspirating all its fluid, placing the tubing on traction, and cutting proximally. Postoperative outcomes with specific attention to infection were reviewed and compared with patients receiving their first prosthesis (control group). RESULTS: A total of 551 urologic prostheses (251 AUS and 300 IPP) were inserted in 433 men during the 5-year study period. Among 120 reoperative prosthetic cases, UPBR were drained and retained in 55 (46%). The control group consisted of 352 patients undergoing initial AUS (154 cases) and/or IPP (236 cases) placement. No difference in infection rate was identified between the control group (6 of 390; 1.5%) and the "drain and retain" group (1 of 55; 1.8%; chi-square = 0.024; P = .88). CONCLUSION: Retention of defunctionalized uninfected genitourinary prosthetic balloons and reservoirs does not increase complication rate during reoperative AUS and/or IPP surgery.

High submuscular placement of urologic prosthetic balloons and reservoirs via transscrotal approach.

INTRODUCTION: Traditional placement of inflatable penile prosthesis (IPP) reservoirs and/or artificial urinary sphincter (AUS) balloons into the space of Retzius may be challenging following major pelvic surgery. AIM: The aim of this study is to report our 1-year experience using a novel technique for high balloon/reservoir placement beneath the rectus abdominus muscle, thus completely obviating deep pelvic dissection during prosthetic urologic surgery. METHODS: A retrospective review of all patients who underwent IPP and/or AUS placement between June 2011 and June 2012 was performed. All had AUS balloons and/or IPP reservoirs placed in a submuscular location by bluntly tunneling through the external inguinal ring into a potential space between the transversalis fascia and the rectus abdominus muscle using a long, angled, lung grasping clamp. MAIN OUTCOME MEASURES: Patient demographics, perioperative outcomes, and initial follow-up patient-reported outcomes were reviewed. RESULTS: During the study period, 120 submuscular balloons/reservoirs were inserted in 107 consecutive patients who underwent placement of an IPP (61 patients), AUS (33 patients), or both (13 patients). Among our 48 most recent patients, 41 (85%) reported they were totally unable to feel their balloon/reservoir, and all but two patients reported no bother from the submuscular balloon/reservoir placement. Of the 120 total submuscular balloons and reservoirs, surgical time and outcomes of the prosthetic procedures appeared similar to those placed using traditional methods; two reservoirs required revision surgery for repositioning. CONCLUSIONS: High submuscular placement of genitourinary prosthetic balloons and reservoirs via a transscrotal approach is both safely and effective, while avoiding deep retropubic dissection.

eIF4E-targeted suicide gene therapy in a minimal residual mouse model for metastatic soft-tissue head and neck squamous cell carcinoma improves disease-free survival.

BACKGROUND: Translation initiation factor eIF4E unwinds long 5'-untranslated regions of certain tightly regulated mRNAs and, thereby, facilitates their translation into proteins. eIF4E has been shown to be overexpressed in a majority of solid tumors, including head and neck cancers. To exploit this dysregulation, a long 5'-untranslated region was spliced upstream of a thymidine kinase (Tk) gene to enhance translation of this "suicide" gene within cells overexpressing eIF4E. We investigated the efficacy of therapy with an adenovirus incorporating this novel suicide gene (Ad-HSV-UTk) following cytoreductive tumor surgery in improving disease-free and overall survival in a mouse soft-tissue metastasis model for head and neck squamous cell carcinoma. MATERIALS AND METHODS: SCC-7 (orally-derived mouse SCCa) cells were treated with Ad-HSV-Tk, Ad-HSV-UTk, Ad-null, or saline and characterized for eIF4E and Tk levels by Western blot analysis. Cytotoxicities for cells treated with Ad-HSV-Tk, Ad-HSV-UTk, or Ad-null were quantified by MTS assay. Mice bearing SCC-7-induced tumors received cytoreduction followed by Ad-HSV-UTk + ganciclovir (GCV) or control treatment and were followed for disease-free and overall survival. RESULTS: SCC-7 cells showed uniformly high levels of eIF4E but elevated Tk for Ad-HSV-Tk- and Ad-HSV-UTk-treated cells over Ad-null-treated cells. Cytotoxicities for Ad-HSV-Tk- and Ad-HSV-UTk-treated cells were, correspondingly, observed to be 100-fold more sensitive than Ad-null-treated cells to GCV treatment. Cytoreduced mice receiving Ad-HSV-UTk + GCV treatment showed significantly longer disease-free survival (P = 0.0045) than control arm mice. CONCLUSIONS: Ad-HSV-UTk suicide gene therapy prolonged disease-free survival in a mouse minimal residual soft-tissue head and neck squamous cell carcinoma metastasis model.

GLUT1CBP(TIP2/GIPC1) interactions with GLUT1 and myosin VI: evidence supporting an adapter function for GLUT1CBP.

We identified a novel interaction between myosin VI and the GLUT1 transporter binding protein GLUT1CBP(GIPC1) and first proposed that as an adapter molecule it might function to couple vesicle-bound proteins to myosin VI movement. This study refines the model by identifying two myosin VI binding domains in the GIPC1 C terminus, assigning respective oligomerization and myosin VI binding functions to separate N- and C-terminal domains, and defining a central region in the myosin VI tail that binds GIPC1. Data further supporting the model demonstrate that 1) myosin VI and GIPC1 interactions do not require a mediating protein; 2) the myosin VI binding domain in GIPC1 is necessary for intracellular interactions of GIPC1 with myosin VI and recruitment of overexpressed myosin VI to membrane structures, but not for the association of GIPC1 with such structures; 3) GIPC1/myosin VI complexes coordinately move within cellular extensions of the cell in an actin-dependent and microtubule-independent manner; and 4) blocking either GIPC1 interactions with myosin VI or GLUT1 interactions with GIPC1 disrupts normal GLUT1 trafficking in polarized epithelial cells, leading to a reduction in the level of GLUT1 in the plasma membrane and concomitant accumulation in internal membrane structures.