Focal therapy for localized prostate cancer: Is there a 'middle ground' between active surveillance and definitive treatment? / 亚洲男科学杂志(英文版)

In recent years, it has come a long way in the diagnosis, treatment, and follow-up of prostate cancer. Beside this, it was argued that definitive treatments could cause overtreatment, particularly in the very low, low, and favorable risk group. When alternative treatment and follow-up methods are being considered for this group of patients, active surveillance is seen as a good alternative for patients with very low and low-risk groups in this era. However, it has become necessary to find other alternatives for patients in the favorable risk group or patients who cannot adopt active follow-up. In the light of technological developments, the concept of focal therapy was introduced with the intensification of research to treat only the lesioned area instead of treating the entire organ for prostate lesions though there are not many publications about many of them yet. According to the initial results, it was understood that the results could be good if the appropriate focal therapy technique was applied to the appropriate patient. Thus, focal therapies have begun to find their 'middle ground' place between definitive therapies and active follow-up.

Focal therapy for localized prostate cancer: is there a "middle ground" between active surveillance and definitive treatment?

In recent years, it has come a long way in the diagnosis, treatment, and follow-up of prostate cancer. Beside this, it was argued that definitive treatments could cause overtreatment, particularly in the very low, low, and favorable risk group. When alternative treatment and follow-up methods are being considered for this group of patients, active surveillance is seen as a good alternative for patients with very low and low-risk groups in this era. However, it has become necessary to find other alternatives for patients in the favorable risk group or patients who cannot adopt active follow-up. In the light of technological developments, the concept of focal therapy was introduced with the intensification of research to treat only the lesioned area instead of treating the entire organ for prostate lesions though there are not many publications about many of them yet. According to the initial results, it was understood that the results could be good if the appropriate focal therapy technique was applied to the appropriate patient. Thus, focal therapies have begun to find their "middle ground" place between definitive therapies and active follow-up.

Plasma dispositions and concentrations of ivermectin in eggs following treatment of laying hens.

AIMS: To determine the plasma disposition and concentrations of ivermectin (IVM) in eggs produced by laying hens following S/C, oral and I/V administration. METHODS: Twenty-four laying hens, aged 37 weeks and weighing 1.73 (SD 0.12) kg were allocated to three groups of eight birds. The injectable formulation of IVM was administered either orally, S/C, or I/V, at a dose of 0.2 mg/kg liveweight, following dilution (1:5, v/v) with propylene glycol. Heparinised blood samples were collected at various times between 0.25 hours and 20 days after drug administration. Eggs produced by hens were also collected daily throughout the study period. Samples of plasma and homogenised egg were analysed using HPLC. RESULTS: Maximum concentrations of IVM in plasma and mean residence time of IVM were lower after oral (10.2 (SD 7.2) ng/mL and 0.38 (SD 0.14) days, respectively) than after S/C (82.9 (SD 12.4) ng/mL and 1.05 (SD 0.24) days, respectively) administration (p<0.01). The time to maximum concentration and elimination half-life were shorter following oral (0.14 (SD 0.04) and 0.23 (SD 0.11) days, respectively) than S/C (0.25 (SD 0.00) and 1.45 (SD 0.45) days, respectively) administration (p<0.01). IVM was first detected in eggs 2 days after treatment in all groups and was detected until 8 days after oral and I/V administration, and until 15 days after S/C administration. Peak concentrations of IVM were 15.7, 23.3 and 1.9 µg/kg, observed 2, 5 and 4 days after I/V, S/C and oral administration, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: The low plasma bioavailability of IVM observed after oral administration in laying hens could result in lower efficacy or subtherapeutic plasma concentrations, which may promote the development of parasitic drug resistance. Due to high IVM residues in eggs compared to the maximum residue limits for other food-producing animal species, a withdrawal period should be necessary for eggs after IVM treatment in laying hens.

Focal therapy for localized prostate cancer: is there a "middle ground" between active surveillance and definitive treatment? / 亚洲男科学杂志(英文版)

In recent years, it has come a long way in the diagnosis, treatment, and follow-up of prostate cancer. Beside this, it was argued that definitive treatments could cause overtreatment, particularly in the very low, low, and favorable risk group. When alternative treatment and follow-up methods are being considered for this group of patients, active surveillance is seen as a good alternative for patients with very low and low-risk groups in this era. However, it has become necessary to find other alternatives for patients in the favorable risk group or patients who cannot adopt active follow-up. In the light of technological developments, the concept of focal therapy was introduced with the intensification of research to treat only the lesioned area instead of treating the entire organ for prostate lesions though there are not many publications about many of them yet. According to the initial results, it was understood that the results could be good if the appropriate focal therapy technique was applied to the appropriate patient. Thus, focal therapies have begun to find their "middle ground" place between definitive therapies and active follow-up.

Effect of prednisolone and cetirizine on D. farinae and histamine-induced wheal and flare response in healthy dogs.

OBJECTIVE: Prednisolone and antihistamines are highly potent drugs in the treatment of atopic dermatitis and widely used in humans and dogs. In some atopic patients in which antihistamines, corticosteroids or other drugs have already been administered intradermal testing (IDT) may be necessary. The aim of the present study was to compare the effects of cetirizine and prednisolone on IDT results. MATERIAL AND METHODS: Thirty healthy dogs (average age 5.9 ± 0.6 years) were randomly assigned to three groups. Treatment groups were administered prednisolone (1 mg/kg BW daily, tapering dosage; group I), cetirizine (1mg/kg BW daily; group II) and placebo (group III) respectively for one week. In the second week, none of the dogs received any medications. IDT was performed prior to drug administration and results obtained were considered as the baseline response. Second and third IDTs were performed at the end of the first and second week, respectively. RESULTS: In groups I and II IDT reactivity was reduced at the end of first week (p<0.05). After drug discontinuation the reactivity almost returned to baseline at the end of the 2-week period, with the exception of the prednisolone group for D.farinae . CONCLUSION: Prednisolone and cetirizine have significant effects on IDT reactions and must be withdrawn by veterinary practitioners up to 2 weeks prior to IDT.

Pre-operative trans-thoracic doppler ultrasonography evaluation and intraoperative manual evaluation of the left internal thoracic artery in patients with type 2 diabetes with coronary artery disease.

Patients with coronary artery disease, with (n = 25) and without (n = 59) type 2 diabetes, who were scheduled to undergo coronary artery bypass grafting were enrolled in this prospective study. The left internal thoracic artery (LITA) was assessed for graft suitability before surgery by trans-thoracic Doppler ultra sonography and during surgery by manual measurement. Significant differences were seen between preoperative and intra-operative LITA blood flow rates and LITA diameters, and the values of each at the two time points showed significant correlation, suggesting that pre-operative measurements largely related to intra-operative conditions. The pre-operative and intra-operative LITA blood flow rates and LITA diameters were not significantly different between patients with and without type 2 diabetes. Pre-operative LITA blood flow was monophasic in three patients without diabetes and the LITA grafts of these patients were deemed unsuitable for implantation during surgery. It is concluded that type 2 diabetes does not seem to have a negative effect on the suitability of LITA grafts. In addition, trans-thoracic Doppler ultrasonography is an easy, cost-effective, reproducible and non-invasive examination method, which may help in the evaluation of LIMA function and contribute to graft selection.

On-pump coronary artery bypass surgery in high-risk patients aged over 65 years (EuroSCORE 6 or more): impact on early outcomes.

The results of on-pump coronary artery bypass graft (CABG) surgery in 166 high-risk elderly patients (EuroSCORE 6 or more; over age 65 years [mean 71.8 years]) were compared with 176 low-risk elderly patients (EuroSCORE below 6; over age 65 years [mean 68.8 years]). There was no significant difference in hospital mortality or number of grafts between the two groups. Rates of inotropic agent use, intra-aortic balloon pump insertion and atrial fibrillation, and the duration of intensive care unit and hospital stay were significantly higher in high-risk than low-risk patients. There were no significant differences in the incidence of major complications between the two groups. The results suggest that, in selected patients, on-pump CABG can be safely performed in high-risk patients over 65 years old with no effect on mortality.

Complete myocardial revascularization using arterial grafts only in patients with unstable angina: impact on early outcome.

OBJECTIVE: The aims of this study were 1) to assess early clinical outcomes for patients with unstable angina (UA) who undergo urgent/emergent coronary artery bypass grafting (CABG); and 2) to evaluate the feasibility and safety of complete revascularization using strictly arterial grafts in this patient group. PATIENTS AND METHODS: Between September 2001 and May 2005, a total of 961 patients underwent CABG at our center. One hundred and sixty-seven (17.4 %) of these individuals underwent urgent or emergent CABG because of UA, and 794 (82.6 %) underwent elective CABG for stable angina (SA). Of the 167 patients with UA, 59 (35.3 %) underwent complete revascularization using arterial grafts only (AO subgroup: internal thoracic arteries and radial arteries) and the other 108 received a combination of arterial and venous grafts (AV subgroup: 1 internal thoracic artery plus saphenous vein grafts). RESULTS: The UA group had a significantly higher proportion of women and a significantly higher rate of left main coronary artery disease than the SA group ( P = 0.016 and P = 0.0001, respectively). Cardiopulmonary bypass time was significantly longer in the UA group ( P = 0.01). Higher proportions of the UA group required inotropic support ( P = 0.001), intra-aortic balloon pump support ( P = 0.001), and re-exploration for bleeding or cardiac tamponade ( P = 0.005). This group also had a significantly longer mean time on mechanical ventilation ( P = 0.001) and a longer mean intensive care unit stay ( P = 0.01). The rates of operative mortality (first 30 days) in the SA and UA groups were 1.8 % and 6 %, respectively ( P = 0.001). There were no statistical differences between the AO and AV subgroups with respect to any of the preoperative or intraoperative findings. The AO group had a significantly shorter mean intensive care unit stay than the AV group ( P = 0.05). The AV group had a roughly fivefold higher operative mortality than the AO group (8.3 % vs. 1.7 %, respectively), but this difference was not statistically significant ( P = 0.17). CONCLUSION: Urgent or emergent CABG in the setting of UA is associated with increased but acceptable rates of mortality and morbidity. Complete myocardial revascularization using arterial grafts only (combinations of internal thoracic and radial arteries) is feasible and safe in this patient group.

Atrial fibrillation after coronary artery bypass grafting in elderly patients: incidence and risk factor analysis.

OBJECTIVE: New-onset atrial fibrillation (AF) is the most frequent arrhythmic complication after coronary artery bypass grafting (CABG). Elderly patients who undergo this operation may have a different risk profile from the general population. The aim of this study was to identify risk factors for post-CABG AF in the elderly population. METHODS: Between September 2001 and December 2005, 426 elderly patients (age >/= 65 years) underwent CABG at our center. Ninety-one developed post-CABG AF (AF group), and the other 335 (no-AF group) did not develop this complication. Multivariate analysis (odds ratio, +/- 95 % CI, P value) was used to identify independent clinical predictors of post-CABG AF. RESULTS: The incidence of post-CABG AF in elderly patients during the study period was 21.4 %. Multivariate analysis identified age (OR 1.07, P < 0.009), age >/= 75 years (OR 1.77, P < 0.042), preoperative renal insufficiency (OR 5.09, P < 0.035), EuroSCORE (OR 1.18, P < 0.038), and cross-clamping time (OR 1.02, P < 0.012) as predictors of AF occurrence. The AF group had a significantly longer mean intensive care unit (ICU) stay (3.8 +/- 4.7 vs. 2.5 +/- 1.3 days for AF vs. no-AF; P = 0.0001), and a significantly higher proportion of patients with prolonged (>/= 6 days) ICU stays (8.8 % vs. 3.2 %, respectively; P = 0.033). Hospital mortality was 3.2 % in the no-AF group and 2.2 % in the AF group ( P = 0.74). CONCLUSION: This study of elderly patients reveals some novel predictors of post-CABG AF, most notably preoperative renal insufficiency and EuroSCORE. It is important to identify risk factors for post-CABG AF in all patient groups as this knowledge might lead to better prevention of this problem and its potential consequences.

Outbreak of botulism in a dairy herd in Turkey.

In this study, the clinical findings and results of haematological and biochemical analyses of 26 cattle with botulism were evaluated. The most important clinical signs in the affected cattle included: decreased appetite, ataxia, difficulty to rise, loss of tongue tone, salivation and bradycardia. A definitive diagnosis of botulism was based on demonstration of the preformed toxin in ruminal and intestinal contents and feed materials including poultry litter, by mouse inoculation test. This study is the first confirmation, by direct toxin isolation, of Clostridium botulinum type C and Clostridium botulinum type D in cattle, in Turkey.

Early postoperative candida colonization in alimentary canal in patients undergoing open heart surgery.

AIM: To examine the frequency and factors predisposing to candidiasis in the digestive tract in the early postoperative period after open heart surgery. METHODS: One hundred patients undergoing open heart surgery were enrolled in this study. Patients were divided into 2 groups in regard to Candida spp. colonization. Group A means increased Candida spp. colonization after open heart surgery (31/100). Group B indicates unchanged Candida spp. colonization after open heart surgery (69/100). Samples were obtained from both oral and anal mucosa in 3 different periods of operation: 1) preoperatively (stage 1), 2) at the end of the first hour in the intensive care unit (stage 2), 3) 24 hours after operation (stage 3). Findings were compared with both preoperative and intraoperative parameters. For fungal isolation Sabourauds dextrose agar and blood agar were used. RESULTS: In Group A (31), there was a significant relationship between the samples in stage 1 and 2 (p=0.031), and also a significance between stage 1 and 3 (p=0.048). Comparison between Candida positive and negative groups (Group A and B) did not reflect any statistical significance (p>0.05). CONCLUSIONS: Candida colonization in the alimentary canal in the early postoperative period after open heart surgery is due to individual preoperative features. However, early postoperative Candida colonization in the digestive tract is not a risk factor for sepsis unless the patient has an additional risk factor leading to prolongation of length of stay in the intensive care unit.

An unusual cause of hemoptysis: ventriculopulmonary fistula.

A 55-year-old man presented with massive hemoptysis following coronary artery bypass grafting and repair of a left ventricular aneurysm. Radiological and bronchoscopic examinations revealed no bronchial cause. The findings of computed tomography (CT) of the chest and echocardiography showed a pseudoaneurysm of the left ventricle. Surgical exploration confirmed that the pseudoaneurysm communicated with the lung parenchyma.

[Peripheral vascular injuries]. / Periferik damar yaralanmalari.

Between 1994-2000, 60 peripheral vascular injuries were admitted to the Turgut Ozal Medical Center Thoracic and Cardiovascular Surgery Clinic. Forty eight (80%) of patients were male, twelve (20%) were female and their age ranged from 5 to 70 years (mean 28.9 years). The causes of injuries were related to penetrating device in 34 (56.6%), gun shots in 14 (23.3%), blunt trauma in seven (11.6%) and iatrogenic causes in five(8.3%). Total laceration, partial laceration and pseudoaneurysm were observed in 45 (75%), 14 (23.3%) and one (1.6%) respectively. The localization of injuries were the upper limbs in 34(56.6%) and the lower limbs in 26 (43.4%). The vascular injury localizations in order of frequency were femoral artery in 12 cases (20.75%), radial artery in ten cases (17%), popliteal artery in ten cases (15%), brachial artery in nine cases (15%), axillary artery in nine cases (13.2%), ulnar artery in six cases (11.3%) and tibial artery in four cases(7.4%). There were nearby venous injuries in nine patients (15%) and neural injuries in ten patients (16.6%). The patients' mean admission time to the hospital was 3 hours and 30 minutes and mean operation time for revascularization was within 95 minutes. The operative techniques were autogenous saphenous vein graft interposition in 27 cases (45%), resection and end-to-end anastomosis in 19 cases (31.6%), lateral repair in ten cases (16.6%), synthetic graft insertion in three cases (4.8%) and ligation in one case (1.6%). Our success rate was 98.2% in salvaging the limbs. Mean length of hospital stay was 14.4 days. Mortality was not observed during the hospital stay.

Intraoperative arrhythmias and tissue damage during transmyocardial laser revascularization.

BACKGROUND: Transmyocardial laser revascularization creates transmural channels to improve myocardial perfusion. Different laser sources and ablation modalities have been proposed for transmyocardial laser revascularization. We investigated the incidence of cardiac arrhythmias and laser-tissue interactions during transmyocardial laser revascularization of normal porcine myocardium with three different lasers. METHODS: We used a continuous-wave, chopped CO2 laser (20 J/pulse, 15 ms/pulse) synchronized with the R wave; a holmium:yttrium aluminum garnet (Ho:YAG) laser (2 J/pulse, 250 micros/pulse, 5 Hz); and a xenon-chloride (excimer, Xe:Cl) laser (35 mJ/pulse, 20 ns/pulse, 30 Hz). Each laser was used 30 times as the sole modality in four consecutive pigs, yielding 120 channels. RESULTS: The average number of pulses needed to create a channel was 1, 11 +/- 4, and 37 +/- 8 for the CO2, Ho:YAG, and Xe:Cl lasers, respectively. All Ho:YAG and Xe:Cl channels had premature ventricular contractions. Ventricular tachycardia occurred in 70% of the Xe:Cl and 60% of the Ho:YAG channels. Only 36% of the CO2 channels had premature ventricular contractions, and only 3% of the CO2 channels had ventricular tachycardia (p < 0.001 versus Ho:YAG and Xe:Cl). Ho:YAG channels were highly irregular: each had a 0.6-mm-wide central zone surrounded by a ring of coagulation necrosis (diameter, 1.84 +/- 0.67 mm) with effaced cellular architecture in a thin hemorrhagic zone. The Xe:Cl sections exhibited the same patterns on a smaller scale (diameter, 0.74 +/- 0.18 mm). The CO2 channels were straight and well demarcated. The zone of structural and thermal damage extended over half the channel's diameter, measuring 0.52 +/- 0.25 mm. CONCLUSIONS: During transmyocardial laser revascularization, the CO2 laser synchronized with the R wave is significantly less arrhythmogenic than the Ho:YAG and Xe:Cl lasers not synchronized with the R wave. In addition, the interaction of the CO2 laser with porcine cardiac tissue is significantly less traumatic than that of the Ho:YAG and the Xe:Cl lasers.

Transmyocardial laser revascularization in allograft coronary artery disease.

We used transmyocardial laser revascularization to treat accelerated cardiac allograft atherosclerosis in 2 patients. One patient received transmyocardial laser revascularization as sole therapy, the other as an adjunct to coronary artery bypass grafting. The systolic function improved in both patients, although the patient who had adjunctive transmyocardial laser revascularization died of systemic infection and renal failure on postoperative day 55. The second patient is alive and well 1 1/2 years after the laser procedure. We discuss 4 other patients who received transmyocardial laser revascularization treatment elsewhere in the United States. Transmyocardial laser revascularization has the potential to become important in the treatment of transplant atherosclerosis. Randomized clinical trials are warranted to assess the efficacy of transmyocardial laser revascularization in this setting.

Transmyocardial laser revascularization: histopathological findings.

Transmyocardial laser revascularization (TMLR) is a new surgical technique clinically tested in patients with advanced severe coronary arteriosclerosis when classic routine treatment by medicaments, percutaneous transluminal coronary angioplasty (PTCA), or aorto-coronary bypass surgery does not improve symptoms of ischemic heart disease. During the procedure high-energy CO 2 laser performs 35-40 transmyocardial channels via left-sided thoracotomy. Channels are drilled from the epicardial side of the heart through the myocardium into the left ventricle cavity. Impulses are synchronized with EKG (diastole), the channel diameter is about 1 mm. Transmural laser penetration is confirmed by intraoperative transesophageal echocardiography (TEE). This technique is based on a theory that channels allow blood supply from left ventricle directly into the intramyocardial vessels (possibly capillaries) and so improve oxygenation of ischemic myocardium. Presented are gross and microscopic findings in a 75-year-old woman who suffered from classic class IV angina with shortness of breath. She had a history of an inferior myocardial infarct, ventricular tachyarrhythmia, aorto-coronary bypass, and mitral valvuloplasty. Her ejection fraction by echocardiography was 25%. Angiographically, she had multiple occlusions of native coronary arteries and diffuse distal stenosis in the graft of the left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD). Thirty six of forty laser pulses were confirmed by TEE as transmural. The patient died suddenly of ventricular fibrillation 5 days after TMLR surgery. The autopsy was performed 6 hours after death. After cross-sectioning of the heart all the laser-bored channels were found partially or completely filled by fibrin and cell infiltrate composed mainly of polymorphonuclear leukocytes. Patent channels were found within myocardial scars, channels performed through viable myocardium appeared to be partially collapsed and occluded.