Correction to 'Multiple optimality criteria support Ornithoscelida'.

[This corrects the article DOI: 10.1098/rsos.170833.].

Sequential treatment with ProACT™ device implantation after male sling failure for male urinary incontinence.

OBJECTIVES: There is no strong evidence for second line therapy after male sling failure for post-prostatectomy urinary incontinence (PPUI). We report the outcomes after periurethral balloons implantation for persistence or recurrence of mild PPI symptoms after male sling implantation. METHODS: All patients implanted of a ProACT™ device (Uromedica, Inc., MN, USA) following I-STOP transobturator male sling (TOMS) failure, in a tertiary reference center between 2009 and 2016, were included. Patients were evaluated by 24-hour pad-test before and after implantation, and after each balloon repressurizing procedure. PGI-I and Likert scale patient satisfaction were estimated during a telephone interview conducted in 2016. Objective and subjective cure of urinary incontinence were defined by a 24-hour pad-test<8g and the use of zero or one pad per day, respectively. RESULTS: Fourteen patients were included. Median follow-up was 34months [4-89]. Objective and subjective cure were 29% (n=4) and 57% (n=8), respectively. Median pad-test decreased from 95g [IQR: 130] to 34g [IQR: 83] (P=0.022). ProACT™ significantly decreased median pad-test by a factor 2.73 [1.19-6.29]. Eighty-eight percent patients were feeling a little better, much better or very much better and 77% were satisfied or very satisfied at the end of follow-up. Reoperation rate was 28% (n=4): 3 balloons were changed for caudally migration (n=2) or deflation (n=1) and 1 had a urinary sphincter implanted for severe UI. CONCLUSIONS: ProACT™ is a safe and efficient treatment that can be used in second line therapy after TOMS failure for PPUI. LEVEL OF EVIDENCE: 4.

The cardiac silhouette.

The cardiac silhouette as seen on a routine chest film contains considerable information regarding the presence of heart disease, the nature and severity of the disease, and its prognosis. The changes that are seen directly reflect the altered anatomy and physiology of the heart. Appreciation of these factors allows for a reasonable, logical approach to interpretation of the cardiac silhouette.

Gemcitabine plus vinorelbine in nonsmall cell lung carcinoma patients age 70 years or older or patients who cannot receive cisplatin. Oncopaz Cooperative Group.

BACKGROUND: Although the prevalence of nonsmall cell lung carcinoma (NSCLC) is high among elderly patients, few data are available regarding the efficacy and toxicity of chemotherapy in this group of patients. Recent reports indicate that single agent therapy with vinorelbine (VNB) or gemcitabine (GEM) may obtain a response rate of 20-30% in elderly patients, with acceptable toxicity and improvement in symptoms and quality of life. In the current study the efficacy and toxicity of the combination of GEM and VNB in elderly patients with advanced NSCLC or those with some contraindication to receiving cisplatin were assessed. METHODS: Forty-nine patients with advanced NSCLC were included, 38 of whom were age >/= 70 years and 11 were age < 70 years but who had some contraindication to receiving cisplatin. All patients were evaluable for response and toxicity. Treatment was comprised of VNB, 25 mg/m(2), plus GEM, 1000 mg/m(2), both on Days 1, 8, and 15 every 28 days. Patients received a minimum of three courses unless progressive disease was detected. RESULTS: One hundred sixty-five courses were administered, with a median of 3. 6 courses per patient. The overall response rate was 26% (95% confidence interval, 15-41%). Two patients attained a complete response (4%) and 11 patients (22%) achieved a partial response. Eastern Cooperative Oncology Group performance status improved in 35% of those patients with an initial value > 0, whereas relief of at least 1 symptom without worsening of other symptoms was noted in 27 patients (55%). The median time to progression was 16 weeks and the 1-year survival rate was 33%. Toxicity was mild. Six patients (12%) had World Health Organization Grade 3-4 neutropenia, 2 patients (4%) had Grade 3-4 thrombocytopenia, and 2 patients (4%) had Grade 3 neurotoxicity. Three patients with severe neutropenia (6%) died of sepsis. The median age of those patients developing Grade 3-4 neutropenia was significantly higher than that of the remaining patients (75 years vs. 72 years; P = 0.047). CONCLUSIONS: The combination of GEM and VNB is moderately active and well tolerated except in patients age >/= 75 years. This age group had an increased risk of myelosuppression. Therefore the prophylactic use of granulocyte-colony stimulating factor should be considered with this treatment. New chemotherapy combinations with higher activity and lower toxicity are needed for elderly patients with advanced NSCLC.

Plain film diagnosis of common cardiac anomalies in the adult.

Congenital cardiac lesions in the adult have characteristic roentgen patterns that should be recognized by the radiologist. In other instances, abnormalities in the aorta or the position of the organs can indicate the likelihood of associated cardiac anomalies. An increasing number of congenital cardiac patients are surviving into adult life because of successful treatment. Some of the complications of these repairs can be recognized on routine chest films.

Role of interferon alfa-2b in the induction and maintenance treatment of low-grade non-Hodgkin's lymphoma: results from a prospective, multicenter trial with double randomization.

PURPOSE: To evaluate the effectiveness of adding interferon (IFN) alfa-2b to chemotherapy in the induction treatment of low-grade non-Hodgkin's lymphoma (NHL), and to assess the role of maintenance IFN. PATIENTS AND METHODS: A multicenter, two-phase controlled trial with double randomization was conducted in 155 patients with low-grade NHL. In the first randomization, 78 patients received cyclophosphamide, vincristine, and prednisone (CVP) and IFN, 3 MU/m2 three times a week for 3 months, and 77 patients received CVP alone. Responding patients were randomized to receive IFN for 1 year versus observation. RESULTS: Of 144 assessable patients, 73 received CVP + IFN and 71 received CVP. Responses were similar: CVP + IFN 79% versus CVP 76% (P = .62). The number of patients who did not complete the treatment was higher in the CVP + IFN group than in the CVP group (18% v 4%; P = .009), although the received dose-intensity of chemotherapy was comparable. Duration of response and progression-free survival (PFS) were significantly higher in the CVP + IFN group than in the CVP group (P = .0004). However, we observed no differences in overall survival (OS) (P = .30), with a median follow-up for the surviving patients of 3 years. Grade 3/4 granulocytopenia was the most frequent toxicity and was similar in both groups (33% v32%). Eighty-three (74%) of the 112 responding patients were randomized to maintenance IFN or observation. The duration of response was similar between 42 patients that received IFN compared with 41 control patients (P = .83), independently of treatment previously administered. CONCLUSION: Adding IFN alfa-2b to induction CVP in low-grade NHL did not induce a higher response rate, but it significantly increased the duration of the responses. We found significant differences in PFS that favored the patients who received CVP + IFN, but not in OS. To date, no additional benefit has been seen from the administration of IFN for maintenance.

Influence of tobacco on laryngeal carcinoma in Spain.

Spain is one of the countries with the highest incidence of laryngeal cancer in the world. Many risk factors have been linked to this neoplasm, such as tobacco, alcohol and occupation. In order to evaluate the effect of tobacco, a case-control study was performed. Cases included 85 patients with cancer of the larynx diagnosed in La Paz, Madrid, between 1983 and 1988, whereas a sample of 170 patients from the same hospital was used as control. Our study revealed that tobacco was significantly associated with laryngeal cancer. Filter-tipped cigarette was shown to be a risk factor as well as consumption of non-filtered cigarettes at first followed by consumption of filter-tipped cigarettes. An association was found between laryngeal cancer and smoking more than 15 cigarettes a day, as well as between cancer of the larynx and being in the habit of smoking for more than 15 years.

Bone metastases as the first manifestation of a tumour.

We have reviewed 29 patients whose first sign of a tumour was a bone metastasis. Two primaries were identified, lung adenocarcinoma and uterine adenocarcinoma and in 2 cases a presumptive diagnosis of tumours of the breast and prostate was made. The mean survival time was 3 months. When bone metastases are found in the absence of a primary tumour, investigation must include a clinical history, physical examination, routine laboratory tests and chest radiographs. Mammography should be done in women, particularly when there are palpable axillary nodes. Abdominal CT scanning and bronchoscopy should only be undertaken when there is a clinical indication.

Combination chemotherapy with ifosfamide, mitomycin, and cisplatin in advanced non-small cell lung cancer.

Thirty-two evaluable patients with stage III non-small cell lung cancer were treated with the combination of ifosfamide (4 g/m2), with uroprotective mesna, mitomycin (6 mg/m2), and cisplatin (100 mg/m2). The overall response rate was 68.8% (complete response rate, 21.9%; partial response rate, 46.9%). Toxicity was moderate and manageable. Based on the response rate observed, this three-drug combination could be considered for future randomized phase III trials against non-small cell lung cancer.

Circumflex retroesophageal right aortic arch simulating mediastinal tumor or dissecting aneurysm.

The authors present three cases of circumflex right aortic arch, a retroesophageal arch in which the aorta crosses from right to left behind the esophagus to descend on the left side. The findings on the frontal chest films resembled those of a left arch with mediastinal widening, simulating a mass. Aortography revealed four-vessel branching of the arch vessels, typical of right aortic arch with aberrant left subclavian artery. Computed tomography and barium studies of the esophagus demonstrated the retroesophageal course of the aorta. In two patients, obstruction of the thoracic portion of the left subclavian artery resulted in differences in blood pressure and pulse between the arms, supporting the clinical impression of dissecting aortic aneurysm.

Thoracic findings in gastrointestinal pathology.

A large variety of gastrointestinal and abdominal pathologic processes can be diagnosed or suspected by their direct effects on the chest. The chest radiograph, as often the first admission film, can aid the radiologist in recommending the appropriate follow-up examinations.

Oblique hilar tomography and mediastinoscopy. A correlative prospective study in 100 patients with bronchogenic carcinoma.

One hundred patients with bronchogenic carcinoma had oblique hilar tomography preoperatively to evaluate the pulmonary hila. Subsequently, all of these patients underwent mediastinoscopy or thoracotomy or both. Hilar and mediastinal nodes were evaluated for the presence of metastasis. These findings were then correlated with the radiographic findings of oblique hilar tomography. We found oblique hilar tomography to be a useful method of selecting patients for mediastinoscopy. The negative predictive value of oblique hilar tomography for mediastinal involvement was 95 percent, while the positive predictive value was 75 percent. Thus, patients with negative findings on oblique hilar tomography need not undergo mediastinoscopic examination prior to thoracotomy.