Tumor marker α-fetoprotein receptor does not discriminate between benign prostatic disease and prostate cancer.

BACKGROUND: The α-fetoprotein receptor (RECAF) is a proposed novel tumor marker for detecting several different types of tumors, including prostate cancer (PCa). OBJECTIVES: The aim of the study was to evaluate RECAF in discriminating benign prostatic conditions from PCa and to compare it with prostate-specific antigen (PSA). MATERIAL AND METHODS: A total of 64 patients with elevated serum PSA levels and/or abnormal digital rectal examination of the prostate referred to a tertiary center for transrectal ultrasound (TRUS) biopsy of the prostate were prospectively enrolled in the study from January 2009 to April 2010. Serum RECAF, total PSA (tPSA) and free PSA (fPSA) concentrations were measured. The results were correlated with histopathologic findings using the Mann-Whitney U test and Kruskal-Wallis χ2 test. RESULTS: The median RECAF concentration was 5.34 U/L in the benign pathology group of patients and 4.72 U/L in the malignant pathology group. The difference was not statistically significant. RECAF density, tPSA and fPSA concentrations and tPSA density were significantly different between the benign and malignant pathology groups (p = 0.033, p = 0.000, p = 0.002 and p = 0.000, respectively). RECAF concentration and RECAF density did not differ significantly in the subgroups of PCa patients stratified according to Gleason score, predominant primary Gleason grade or maximum primary Gleason grade, but in predominant secondary Gleason grade and maximum secondary Gleason grade, significant differences were found (p = 0.007 and p = 0.004, respectively). CONCLUSIONS: The results of the study did not confirm the RECAF tumor marker as an alternative way to discriminate between groups of patients with benign prostatic conditions and PCa, and its concentration and density do not differ among PCa histopathologic groups.

The influence of allogeneic platelet gel on the morphology of human long bones.

The aim of this study is to analyze the morphologic and functional change of human bone defect after its grafting with mixture of platelet gel and autologous cancellous bone. For one year, we have prospectively studied nine consecutive pa- tients, aged 25-73 y, with pseudoarthrosis of long bones, after unsuccessful initial surgeries. We have harvested can- cellous bone from patients' iliac crests and mixed with the ABO compatible allogeneic platelet rich plasma (PRP) gel. That mixture has been inserted in the bone defect, and surgically fixated. Radiologically, the defects achieved the bone morphology (the appearance of hazy callus) between 6th and 24th week. The time of functional recovery was varied, be- tween 12 and 40 weeks for partial weight bearing, and between 16 and 48 weeks for free limb mobility and full function of the limb. The overall healing of bone defect was 16 to 36 weeks. Two patients had complications of poor graft ingrowth and one with a reversible postsurgical nerve paresis. On the X-ray scans, solid and fast restoration of bone structure was notable, with excellent bone ingrowth, suitable for full weight bearing. The allogeneic platelet gel had no adverse effects. This method can be used for treating of long bone defects, because of its strong influence on restoration of normal bone morphology. Further investigation is required to establish efficiency relative to other methods.

An uncommon treatment of totally extruded and lost talus: a case report.

INTRODUCTION: Total extrusion and loss of the talus is a rare injury with a wide choice of appropriate treatment, but rarely resulting in a fully functional recovery. We report on an uncommon case, both for the severity of the injury and for the uncommon treatment due to the patient's rejection of secondary surgery. CASE PRESENTATION: We treated a 16-year-old Caucasian man with the most extreme variant of a totally extruded and lost talus, accompanied with complex injury of the soft tissues of the ankle and foot. The treatment included urgent microvascular foot reimplantation, microvascular muscle free flap transfer, and temporary fixation. This kind of injury should typically be treated by tibiocalcaneal arthrodesis. However, this was not performed, as after the successful early stages of the treatment he strongly objected to another surgery due to his fully functional status and the successful therapeutic results of our early treatment. CONCLUSIONS: The injury described in this case study would ordinarily be treated by amputation, but due to the well-executed treatment in the early stages after the injury, the outcome was satisfying. Surprisingly and against our expectations, the late results of the treatment were successful even without arthrodesis. He is now 37 years old and has a functional foot 21 years after the injury.

Metastatic prostate cancer proven by 18F-FCH PET/CT staging scan in patient with normal PSA but high PSA doubling time.

A 59-year-old man presented with frequent urination. Six months ago, his prostate-specific antigen (PSA) was 1.56 ng/mL; currently it is 3.5 ng/mL (PSA doubling time = 6 months; PSA velocity = 0.19 ng/mL/mo). Biopsy revealed aggressive prostate cancer (Gleason score 5 + 5). Staging with (18)F-fluorocholine PET/CT ((18)F-FCH PET/CT) demonstrated lymph node metastasis. After 6 months of hormonal therapy with goserelin, PSA decreased to 0.38 ng/mL. A (18)F-FCH PET/CT restaging scan demonstrated a global reduction of (18)F-FCH lesion uptake with disappearance of some mediastinal and iliac pelvic lymph node activity.

Allogeneic platelet gel with autologous cancellous bone graft for the treatment of a large bone defect.

BACKGROUND/AIMS: A 50-year-old type 2 diabetic male with a comminuted fracture of the tibia and delayed union after insufficient initial osteosynthesis with a resulting pseudoarthrosis was treated operatively by using a graft composed of platelet gel mixed with autologous cancellous bone. The essential idea of this therapy was to combine the healing capacities of platelet-derived growth factors and osteogenic stem cells and the modeling capacity of the gel. Due to a history of diabetes, allogeneic instead of autologous platelets were used. METHODS: The allogeneic platelet concentrate was ABO- and RhD-matched, leukocyte-depleted, irradiated and activated by human thrombin. The defect of 45 ml was filled with the graft mixture and fixed with an external fixator. RESULTS: Postoperative care was uneventful. After 6 months the graft was incorporated, the bone defect was fully bridged and full weight-bearing capacity was achieved. No side effects were observed and no platelet or HLA class I antibodies were detected. CONCLUSION: This case report shows that the clinical use of allogeneic platelet-derived growth factors is feasible and that a prospective study is necessary to prove the effectiveness and reproducibility of this therapeutic approach.