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Sample records for cystectomy single-institution revision

  1. A Retrospective Analysis of Ventriculoperitoneal Shunt Revision Cases of a Single Institute

    PubMed Central

    Park, Man-Kyu; Kim, Myungsoo; Park, Ki-Su; Park, Seong-Hyun; Hwang, Jeong-Hyun

    2015-01-01

    Objective Ventriculoperitoneal (VP) shunt complication is a major obstacle in the management of hydrocephalus. To study the differences of VP shunt complications between children and adults, we analyzed shunt revision surgery performed at our hospital during the past 10 years. Methods Patients who had undergone shunt revision surgery from January 2001 to December 2010 were evaluated retrospectively by chart review about age distribution, etiology of hydrocephalus, and causes of revision. Patients were grouped into below and above 20 years old. Results Among 528 cases of VP shunt surgery performed in our hospital over 10 years, 146 (27.7%) were revision surgery. Infection and obstruction were the most common causes of revision. Fifty-one patients were operated on within 1 month after original VP shunt surgery. Thirty-six of 46 infection cases were operated before 6 months after the initial VP shunt. Incidence of shunt catheter fracture was higher in younger patients compared to older. Two of 8 fractured catheters in the younger group were due to calcification and degradation of shunt catheters with fibrous adhesion to surrounding tissue. Conclusion The complications of VP shunts were different between children and adults. The incidence of shunt catheter fracture was higher in younger patients. Degradation of shunt catheter associated with surrounding tissue calcification could be one of the reasons of the difference in facture rates. PMID:26113963

  2. Quality improvement of International Classification of Diseases, 9th revision, diagnosis coding in radiation oncology: single-institution prospective study at University of California, San Francisco.

    PubMed

    Chen, Chien P; Braunstein, Steve; Mourad, Michelle; Hsu, I-Chow J; Haas-Kogan, Daphne; Roach, Mack; Fogh, Shannon E

    2015-01-01

    Accurate International Classification of Diseases (ICD) diagnosis coding is critical for patient care, billing purposes, and research endeavors. In this single-institution study, we evaluated our baseline ICD-9 (9th revision) diagnosis coding accuracy, identified the most common errors contributing to inaccurate coding, and implemented a multimodality strategy to improve radiation oncology coding. We prospectively studied ICD-9 coding accuracy in our radiation therapy--specific electronic medical record system. Baseline ICD-9 coding accuracy was obtained from chart review targeting ICD-9 coding accuracy of all patients treated at our institution between March and June of 2010. To improve performance an educational session highlighted common coding errors, and a user-friendly software tool, RadOnc ICD Search, version 1.0, for coding radiation oncology specific diagnoses was implemented. We then prospectively analyzed ICD-9 coding accuracy for all patients treated from July 2010 to June 2011, with the goal of maintaining 80% or higher coding accuracy. Data on coding accuracy were analyzed and fed back monthly to individual providers. Baseline coding accuracy for physicians was 463 of 661 (70%) cases. Only 46% of physicians had coding accuracy above 80%. The most common errors involved metastatic cases, whereby primary or secondary site ICD-9 codes were either incorrect or missing, and special procedures such as stereotactic radiosurgery cases. After implementing our project, overall coding accuracy rose to 92% (range, 86%-96%). The median accuracy for all physicians was 93% (range, 77%-100%) with only 1 attending having accuracy below 80%. Incorrect primary and secondary ICD-9 codes in metastatic cases showed the most significant improvement (10% vs 2% after intervention). Identifying common coding errors and implementing both education and systems changes led to significantly improved coding accuracy. This quality assurance project highlights the potential problem

  3. International Robotic Radical Cystectomy Consortium: A way forward.

    PubMed

    Raza, Syed Johar; Field, Erinn; Kibel, Adam S; Mottrie, Alex; Weizer, Alon Z; Wagner, Andrew; Hemal, Ashok K; Scherr, Douglas S; Schanne, Francis; Gaboardi, Franco; Wu, Guan; Peabody, James O; Koauk, Jihad; Redorta, Joan Palou; Pattaras, John G; Rha, Koon-Ho; Richstone, Lee; Balbay, M Derya; Menon, Mani; Hayn, Mathew; Stoeckle, Micheal; Wiklund, Peter; Dasgupta, Prokar; Pruthi, Raj; Ghavamian, Reza; Khan, Shamim; Siemer, Stephan; Maatman, Thomas; Wilson, Timothy; Poulakis, Vassilis; Wilding, Greg; Guru, Khurshid A

    2014-07-01

    Robot-assisted radical cystectomy (RARC) is an emerging operative alternative to open surgery for the management of invasive bladder cancer. Studies from single institutions provide limited data due to the small number of patients. In order to better understand the related outcomes, a world-wide consortium was established in 2006 of patients undergoing RARC, called the International Robotic Cystectomy Consortium (IRCC). Thus far, the IRCC has reported its findings on various areas of operative interest and continues to expand its capacity to include other operative modalities and transform it into the International Radical Cystectomy Consortium. This article summarizes the findings of the IRCC and highlights the future direction of the consortium.

  4. Sacral nerve stimulation for fecal incontinence: causes of surgical revision from a series of 87 consecutive patients operated on in a single institution.

    PubMed

    Faucheron, Jean-Luc; Voirin, David; Badic, Bogdan

    2010-11-01

    Sacral nerve stimulation is offered to patients presenting with fecal incontinence of neurological or idiopathic etiology, when medical management has failed. The purpose of this study was to investigate the causes of surgical revision following sacral nerve stimulation in consecutive patients who had received implants. From September 2001 to August 2009, 123 patients (105 women) of mean age 56 years were operated on for neurological (n = 104) or idiopathic (n = 19) fecal incontinence. The mean preoperative Cleveland Clinic score was 13/20 (range 6/20 to 19/20). Eighty-seven patients of 123 had a positive test and underwent stimulator implantation. Any stimulator dysfunction was prospectively studied. Among the 87 patients, 36 had surgical revision of the device for the following reasons: device-related failure due to infection in 4 (successful reimplant in 4), electrode displacement in 2, electrode breakage in 2 (reimplantation of electrode in 4), and dysfunction owing to impedance increase of the system in 4; adverse stimulation with pain in 7 (stimulator repositioning in 4 and explantation in 3); battery depletion either spontaneously (n = 6) or owing to a MRI examination (n = 2); total or partial loss of clinical efficacy in 9 (removal of the generator and electrode). Sacral nerve stimulation is a recognized treatment for fecal incontinence. The stimulator reoperation rate is high and is caused by stimulator dysfunction in 24% of cases.

  5. Temporal trends in conduit urinary diversion with concomitant cystectomy for benign indications: a population-based analysis

    PubMed Central

    Brown, Elizabeth Timbrook; Osborn, David; Mock, Stephen; Ni, Shenghua; Graves, Amy J.; Milam, Laurel; Milam, Douglas; Kaufman, Melissa; Dmochowski, Roger; Reynolds, W. Stuart

    2016-01-01

    Objectives To describe national trends in cystectomy at the time of urinary diversion for benign indications. Multiple practice patterns exist regarding the necessity of concomitant cystectomy with urinary diversion for benign end-stage lower urinary tract dysfunction. Beyond single institution reports, limited data is available to describe how concurrent cystectomy is employed on a national level. Methods A representative sample of patients undergoing urinary diversion for benign indications with or without concurrent cystectomy was identified from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1998–2011. Using multivariate logistic regression models, we identified hospital and patient-level characteristics associated with concomitant cystectomy with urinary diversion. Results There was an increase in the proportion of concomitant cystectomy at the time of urinary diversion from 20% to 35% (p<0.001) between 1998 and 2011. The increase in simultaneous cystectomy over time occurred at teaching hospitals (vs. community hospitals), in older patients, in male patients, in the Medicare population (vs. private insurance and Medicaid), and in those with certain diagnoses. Conclusions There has been an overall increase in the use of cystectomy at the time of urinary diversion for benign indications on a national level, though the indications driving this clinical decision appear inconsistent. PMID:27374730

  6. [Laparoscopic radical cystectomy: initial experience].

    PubMed

    Núñez Mora, C; García Mediero, J Ma; Cáceres Jiménez, F; Cabrera Castillo, P M

    2007-09-01

    To review our initial experience with laparoscopic radical cystectomy. Between September 2004 and June 2006 we performed 16 laparoscopic radical cystectomies (14 males and 2 females) with a median age of 63.8 y.o. (51-85). 12 ileal neobladder (with laparoscopic ileal-urethra anastomosis), 3 cutaneous ureteroileostomies and 1 cutaneous ureterostomy were performed as derivation techniques. Median follow up was 12.4 months Mean operation time was 340 minutes. Estimated blood loss was 350 ml. and 3 cases required intra-op blood transfusion. Mean hospitalization discharged was at 7.6 days. Median linph node dissection was 22.9 finding node metastasis in 6 cases. Most frequent complication was ileo in two cases. No local recurrentes in trocar placement was achieved. Laparoscopic Radical cystectomy is a challenged long-lasting procedure but with the advantage of a less transfusion rate and short hospital stay. Oncologycal outcomes are similar as tose from open surgery.

  7. Laparoscopic radical and partial cystectomy

    PubMed Central

    Challacombe, Ben J.; Rose, Kristen; Dasgupta, Prokar

    2005-01-01

    Radical cystectomy remains the standard treatment for muscle invasive organ confined bladder carcinoma. Laparoscopic radical cystoprostatectomy (LRC) is an advanced laparoscopic procedure that places significant demands on the patient and the surgeon alike. It is a prolonged procedure which includes several technical steps and requires highly developed laparoscopic skills including intra-corporeal suturing. Here we review the development of the technique, the indications, complications and outcomes. We also examine the potential benefits of robotic-assisted LRC and explore the indications and technique of laparoscopic partial cystectomy. PMID:21206662

  8. Cost analysis of robotic versus open radical cystectomy for bladder cancer.

    PubMed

    Smith, Angela; Kurpad, Raj; Lal, Anjana; Nielsen, Matthew; Wallen, Eric M; Pruthi, Raj S

    2010-02-01

    Recently robotic approaches to cystectomy have been reported, and while clinical and oncological efficacy continues to be evaluated, potential financial costs have not been clearly evaluated. In this study we present a financial analysis using current cost structures and clinical outcomes for robotic and open cystectomy for bladder cancer. The financial costs of robotic and open radical cystectomy were categorized into operating room and hospital components, and further divided into fixed and variable costs for each. Fixed operating room costs for open cases involved base cost as well as disposable equipment costs while robotic fixed costs included the amortized machine cost as well as equipment and maintenance. Variable operating room costs were directly related to length of surgery. Variable hospital costs were directly related to transfusion requirement and length of stay. The means of the prior 20 cases of robotic and open cystectomy were used to perform a comparative cost analysis. Mean fixed operating room costs for robotic cases were $1,634 higher than for open cases. Operating room variable costs were also higher by a difference of $570, directly related to increased operating room time. Hospital costs were nearly identical for the fixed component while variable costs were $564 higher for the open approach secondary to higher transfusion costs and longer mean length of stay. Based on these findings robotic cystectomy is associated with an overall higher financial cost of $1,640 (robotic $16,248 vs open $14,608). Cost calculators were constructed based on these fixed and variable costs for each surgical approach to demonstrate the expected total costs based on varying operating room time and length of stay. Robotic assisted laparoscopic radical cystectomy is associated with a higher financial cost (+$1,640) than the open approach in the perioperative setting. However, this analysis is limited by its single institution design and a multicenter followup study

  9. Juvenile nasopharyngeal angiofibroma: a single institution study.

    PubMed

    Mistry, Rajesh C; Qureshi, Sajid S; Gupta, Shaikat; Gupta, Sameer

    2005-01-01

    Juvenile nasopharyngeal angiofibroma (JNA) is a rare tumor of adolescent males and there is a paucity of Indian studies on this subject. To present the experience of management of JNA at a single institution. This is a retrospective observational study of patients with JNA who presented at the Tata Memorial Hospital between May 1988 and August 2001. Thirty-two patients with JNA were treated in the study period. Since the time period was prolonged and diagnostic and therapeutic protocols had undergone many changes, the patients were divided into two groups, namely 1988-1996 and 1997-2001. The age distribution, disease patterns, management approaches and treatment outcomes of patients in the two groups were recorded. Statistical analyses were done using students 't' test and test for proportion. The mean age at presentation was 16 years and more than 90% of the patients had Stage III or IV disease. Preoperative embolization was carried out in 19 patients. The surgical approaches used were median maxillectomy, infratemporal fossa, transpalatal, maxillary swing and craniofacial approach. The recurrence rate, complete resection rate and cure rates were 12.5%, 41% and 63% respectively. Surgery is the mainstay of treatment of JNA. Preoperative embolization and newer surgical approaches result in less blood loss and complete resection. Aggressive re-resection should be done for resectable recurrences reserving radiotherapy for unresectable, recurrent/ residual disease.

  10. A Retrospective Analysis of the Effect on Survival of Time from Diagnosis to Neoadjuvant Chemotherapy to Cystectomy for Muscle Invasive Bladder Cancer.

    PubMed

    Park, Jong Chul; Gandhi, Nilay M; Carducci, Michael A; Eisenberger, Mario A; Baras, Alexander S; Netto, George J; Liu, Jen-Jane; Drake, Charles G; Schoenberg, Mark P; Bivalacqua, Trinity J; Hahn, Noah M

    2016-04-01

    We determine the impact of the timing of radical cystectomy from the diagnosis of muscle invasive bladder cancer on survival in patients also treated with neoadjuvant chemotherapy. We performed a retrospective chart review of consecutive patients with muscle invasive bladder cancer who received neoadjuvant chemotherapy followed by cystectomy between 1996 and 2014 at a single institution. Cox proportional hazards regression models were used to investigate the effect of treatment time intervals on overall survival. Three treatment intervals were analyzed for survival impact, from diagnosis of muscle invasive bladder cancer to initiation of neoadjuvant chemotherapy, from initiation of neoadjuvant chemotherapy to cystectomy and from diagnosis to cystectomy. Other pretreatment and posttreatment clinicopathological parameters were also analyzed. Median time from the diagnosis of muscle invasive bladder cancer to radical cystectomy was 28 weeks. Cystectomy performed less than 28 weeks from the diagnosis did not result in significant improvement in overall survival outcomes (HR 0.68, 95% CI 0.28-1.63, p=0.388). Neither the timing of neoadjuvant chemotherapy initiation from diagnosis (median 6 weeks) nor the timing of cystectomy from neoadjuvant chemotherapy initiation (median 22 weeks) was associated with survival. Patient age, variant histology, extravesical and/or lymph node involvement (T3-4 and/or N1 or greater) were significantly associated with survival. The timing of radical cystectomy in relation to muscle invasive bladder cancer diagnosis date does not significantly impact overall survival in patients with muscle invasive bladder cancer receiving neoadjuvant chemotherapy. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  11. Preoperative irradiation and cystectomy for bladder cancer.

    PubMed

    Smith, J A; Batata, M; Grabstald, H; Sogani, P C; Herr, H; Whitmore, W F

    1982-03-01

    Between 1971 and 1974, 101 patients at Memorial Sloan-Kettering Cancer Center underwent planned integrated treatment for bladder cancer with 2000 rads by megavoltage delivered to the whole pelvis over five consecutive days followed by radical cystectomy within a week. The overall five-year survival rate was 39%; the hospital mortality rate was 2%. In the pelvis alone tumor recurred in 9% of the patients. These results support other studies demonstrating the efficacy of this and other regimens of preoperative irradiation and cystectomy.

  12. MORTALITY INCREASES WHEN RADICAL CYSTECTOMY IS DELAYED MORE THAN 12 WEEKS: RESULTS FROM A SEER-MEDICARE ANALYSIS

    PubMed Central

    Gore, John L.; Lai, Julie; Setodji, Claude M.; Litwin, Mark S.; Saigal, Christopher S.

    2009-01-01

    Background: Single-institution series have documented the adverse impact of a 12-week delay between resection of muscle-invasive bladder cancer and radical cystectomy. These data are derived from tertiary centers, in which referral populations may confound outcomes. We sought to examine the survival impact of a delay in radical cystectomy using nationally representative data. Methods: From the linked SEER-Medicare dataset, we identified subjects with stage 2 transitional cell carcinoma (TCC) of the bladder who underwent radical cystectomy between 1992 and 2001. We examined delays of 8, 12, and 24 weeks and incorporated these delay cutoffs into multivariate Cox proportional hazards survival models. Covariates included age, race/ethnicity, marital status, Charlson comorbidity index, and cancer grade. Results: We identified 441 subjects with stage 2 TCC who underwent cystectomy during the study period. Compared with immediate surgery (i.e., within 4–8 weeks of transurethral resection), longer time to cystectomy increased the risk of both disease-specific and overall mortality (HR 2.0, p<0.01 and HR 1.6, p<0.01, respectively, for those delayed 12-24 weeks; HR 2.0, p<0.01 for disease-specific and overall death among those delayed beyond 24 weeks 1 year following diagnosis). Covariates associated with overall mortality included older age (HR 1.04, p<0.01) and comorbidity (HR 2.0 for Charlson ≥ 3 vs Charlson 0-1, p<0.01). Conclusions: Delay in definitive surgical treatment beyond 12 weeks conferred an increased risk of disease-specific and all-cause mortality among subjects with stage 2 bladder cancer. PMID:19142878

  13. Revising.

    ERIC Educational Resources Information Center

    Wyman, Linda, Ed.

    1983-01-01

    In focusing on recursive writing, the nine articles in this journal issue suggest that student writing should be taken seriously. The first article states that revision should occur throughout the writing process while the second discusses how to invite writers to become active readers of their own texts. The third article presents methods of…

  14. Natural History, Predictors and Management of Ureteroenteric Strictures after Robot Assisted Radical Cystectomy.

    PubMed

    Ahmed, Youssef E; Hussein, Ahmed A; May, Paul R; Ahmad, Basim; Ali, Taimoor; Durrani, Ayesha; Khan, Saira; Kumar, Prasanna; Guru, Khurshid A

    2017-09-01

    Ureteroenteric strictures represent the most common complication requiring reoperation after radical cystectomy. We investigated the prevalence, outcomes, predictors and management of ureteroenteric strictures. We retrospectively reviewed our quality assurance, robot assisted radical cystectomy database to identify patients in whom ureteroenteric strictures developed. Data were reviewed for demographics, perioperative outcomes and ureteroenteric stricture characteristics. The Kaplan-Meier method was used to calculate time to ureteroenteric stricture and multivariable stepwise regression was done to evaluate predictors of ureteroenteric strictures. Ureteroenteric strictures developed in 12%, 16% and 19% of 51 patients (13%) at 1, 3 and 5 years after robot assisted radical cystectomy, respectively. All patients were initially treated endoscopically or percutaneously, including 57% treated only endoscopically or percutaneously and 43% who required surgery, which was open repair in 6 and robot assisted repair in 16. At a median followup of 23 months 33 patients (65%) were free of disease, including 13 after endoscopic or percutaneous treatment, 15 after robot assisted repair and 5 after open revision. Open and robot assisted revisions showed comparable perioperative outcomes. On multivariable analysis the predictors of ureteroenteric anastomotic strictures were body mass index (OR 1.07, 95% CI 1.01-1.13, p = 0.02), intracorporeal urinary diversion (OR 3.28, 95% CI 1.41-7.61, p = 0.006), length of the right resected ureter (OR 0.66, 95% CI 0.50-0.88, p = 0.004), estimated glomerular filtration rate 30 days after assisted radical cystectomy (OR 0.85, 95% CI 0.74-0.98, p = 0.03), urinary tract infection (OR 2.68, 95% CI 1.31-5.49, p = 0.007) and leakage (OR 3.85, 95% CI 1.05-14.1, p = 0.04). Male gender (OR 0.19, 95% CI 0.04-0.96, p = 0.04) and higher body mass index (OR 0.85, 95% CI 0.72-0.996, p = 0.05) were associated with lower odds of successful endoscopic

  15. Single-session laparoscopic cystectomy and nephroureterectomy

    PubMed Central

    Chłosta, Piotr; Myślak, Marek; Herlinger, Grzegorz; Dobroński, Piotr; Kryst, Piotr; Drewa, Tomasz

    2012-01-01

    Patients with high grade and/or muscle invasive bladder cancer and with concomitant diseases of the upper urinary tract, e.g. urothelial tumors (transitional cell carcinoma – TCC) or afunctional hydronephrotic kidneys, may be candidates for simultaneous cystectomy and nephroureterectomy. Although the progress in laparoscopic techniques made these procedures feasible and safe, they are still technically demanding so only experienced surgeons can perform them. The aim of the study is to report our experience with laparoscopic simultaneous en bloc resection of the urinary bladder together with unilateral or bilateral nephroureterectomy in patients with TCC. Our material consists of three cases operated on in three centers between 2002 and 2011. After having completed bilateral (1 case) or unilateral (2 cases) nephroureterectomy, we performed radical cystectomy with pelvic lymph node dissection. All the specimens, including the kidneys, ureters, bladder, and reproductive organs in the female, were collected in endobags and were retrieved en bloc using hypogastric incision in the male patient and the vaginal route in the female patients. The demographic and perioperative information was collected and analyzed. All procedures were completed laparoscopically without the need of conversion to open surgery. No major intra- or postoperative complications were observed. Only 1 patient suffered from prolonged lymphatic leakage. From our experience we can conclude that single-session laparoscopic cystectomy and nephroureterectomy are technically feasible and safe, and may be offered for the treatment of selected cases of TCC of the urinary tract. PMID:23837100

  16. Carotid body tumours. A 20-year single-institution experience.

    PubMed

    Dalainas, Ilias; Nano, Giovanni; Casana, Renato; Bianchi, Paolo; Stegher, Silvia; Malacrida, Giovanni; Tealdi, Domenico Giuseppe

    2006-01-01

    The aim of this single-institution retrospective study was to review the surgical outcomes of resection of carotid body tumours over the last 20 years in our hospital. From January 1985 to December 2004, 17 patients were admitted to our institution with carotid body tumours. All patients were treated by surgical resection of the tumour. No perioperative deaths occurred. Perioperative comorbidities were more frequent in patients with large carotid body tumours intimately associated with the carotid vessels. Surgical excision of carotid body tumours is safe and effective even in the long term.

  17. Central airways stenoses management--a single institution experience.

    PubMed

    Pereszlenyi, A; Majer, I; Janik, M; Demian, J; Igaz, M; Knappkova, S; Eftimova, P; Benej, R; Harustiak, S

    2004-01-01

    Tracheal stenosis is a serious, life-threatening disease with an increasing tendency. The number of complicated tracheal lesions, where resection and anastomosis can not be performed, still increases and the situation requires solution by endoprosthesis. Consequent the management of such complicated obstructive tracheal lesions is individual and time-consuming. The main objective of this study is to review the single institution experience with central airways stenosis treatment and to define the role of endotracheal stenting in tracheal reconstruction surgery. This study presents the retrospective analysis of tracheal stenosis reconstruction by means of our own modification of Montgomery T-tube. (Tab. 3, Fig. 3, Ref. 12.)

  18. Nutritional Predictors of Complications Following Radical Cystectomy

    PubMed Central

    Johnson, David C.; Riggs, Stephen B.; Nielsen, Matthew E.; Matthews, Jonathan E.; Woods, Michael E.; Wallen, Eric M.; Pruthi, Raj S.; Smith, Angela B.

    2016-01-01

    Purpose To determine the impact of preoperative nutritional status on the development of surgical complications following cystectomy using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Methods We performed a retrospective review of the NSQIP 2005–2012 Participant Use Data Files. ACS-NSQIP collects data on 135 variables, including pre- and intraoperative data and 30-day post-operative complications and mortality on all major surgical procedures at participating institutions. Preoperative albumin (<3.5 or >3.5 g/dl), weight loss 6 months before surgery (>10%), and BMI were identified as nutritional variables within the database. The overall complication rate was calculated and predictors of complications were identified using multivariable logistic regression models. Results 1,213 patients underwent cystectomy for bladder cancer between 2005–2012. The overall 30-day complication rate was 55.1% (n=668). While 14.7% (n=102) had a preoperative albumin <3.5 g/dL, 3.4% had >10% weight loss in the 6 months prior to surgery, and the mean BMI was 28 kg/m2. After controlling for age, sex, medical comorbidities, medical resident involvement, operation year, operative time and prior operation, only albumin <3.5g/dl was a significant predictor of experiencing a postoperative complication (p=0.03). This remained significant when albumin was evaluated as a continuous variable (p=0.02) Conclusions Poor nutritional status measured by serum albumin is predictive of an increased rate of surgical complications following radical cystectomy. This finding supports the importance of preoperative nutritional status in this population and highlights the need for the development of effective nutritional interventions in the preoperative setting. PMID:25240535

  19. Panniculectomy and Cystectomy: An Approach to the Morbidly Obese Patient

    PubMed Central

    Turner, Robert M.; Gusenoff, Jeffrey A.; Correa, Andres F.; Jacobs, Bruce L.; Davies, Benjamin J.

    2016-01-01

    The obese patient undergoing radical cystectomy faces a unique set of challenges. We present the case of a 68-year-old gentleman who presented to our institution with Bacillus Calmette-Guerin refractory disease, a body mass index of 38.5, and a large pannus. The present paper describes our technique for performing radical cystectomy with ileal conduit urinary diversion and concomitant panniculectomy. We discuss the impact of obesity on patients undergoing radical cystectomy and how this may be mitigated by panniculectomy. PMID:27195168

  20. Incidence of Venous Thromboembolism in Patients Undergoing Major Hip Surgeries at a Single Institution: A Prospective Study

    PubMed Central

    Yamanaka, Yasuhiro; Ito, Hiroshi

    2016-01-01

    Background: Venous thoromboembolism (VTE) is one of the most significant complications after hip surgeries. Many studies have been reported about the incidence of VTE after THA, but a small number of reports were found concerning Periacetabular osteotomy, Revision THA and Surgery for hip fracture postoperatively. Furthermore, there exists no comparative study of the incidence of VTE among major hip surgeries at a single institution. We reported the incidence of VTE among hip surgeries performed at a single institution. Methods: A total of 820 Hip surgeries were performed at same institution. The procedures included 420 hips that underwent primary total hip arthroplasties (THA), 91 revision or removal of total hip arthroplasties (Revision THA), 144 periacetabular osteotomy (PAO) and 165 surgery for hip fracture (SHF) between 2006 and 2012. VTE was detected by Multidetector computed tomography (MDCT) that scanned 768 cases and by ultrasound that scanned 52cases postoperative 10-14 days. Results: The overall incidence of VTE was 12.2% (100 of 820). The incidence of VTE after THA was 13.1% (55 of 420), Revision THA was 13.2% (12 of 91), PAO was 2.1% (3 of 144) and SHF was 18.1% (30 of 165). The incidence of VTE was significantly higher in SHF than in PAO. Conclusion: This data indicates that the incidence of VTE after PAO is significantly lower than SHF and relatively lower than THA and Revision THA. A younger age and non-invasion of the bone marrow of the femur may have affected the result. Prophylaxis therapy was effective especially on SHF. PMID:27499823

  1. Management of the male urethra after cystectomy.

    PubMed

    White, Shawn E; Malkowicz, S Bruce

    2010-08-01

    Approximately 70,000 new cases of bladder cancer are diagnosed yearly, of which 52,000 are male patients. In 2009 there were approximately 14,000 deaths attributed to bladder cancer, 10,000 of which were men. Approximately 40% to 45% of all cases are high-grade tumors with half of these being muscle-invasive tumors at the time of diagnosis. With the preponderance of men in this population, there is a need for clear management strategies regarding the retained urethra in those men undergoing radical cystectomy. This article reviews the incidence of urothelial carcinoma in the retained urethra, risk factors for the development of urethral urothelial carcinoma, surveillance strategies, treatment modalities, and outcomes following intervention.

  2. Place of cystectomy in superficial bladder cancer.

    PubMed

    Chéchile, G; Sarroca, J; Zungri, E; Rosales, E; Martinez, E

    1988-01-01

    Between January 1978 and June 1985, 44 patients underwent cystectomy for clinically diagnosed superficial bladder cancer. Operative mortality was 13.6%. Early and late complications were observed in 34 and 55% patients, respectively. Clinical understaging was seen in 23%, and stage reduction in 18% of the patients. Clinical staging was correct in 59% of the patients. The mean follow-up was 40 months (range, 24-84 months). Five patients presented local recurrence (13%) of the tumor and 10 patients showed distant metastases (26%). Urethral and upper urinary tract recurrences were observed in 7 and 4 patients, respectively. Fourteen patients (39%) died of cancer after a mean follow-up of 24 months. The actuarial 5-year survival was achieved by 77% of the patients with PTo-PTa-PTis and by 67% of the patients with PT1 (p, not significant).

  3. Changes in Markers of Ovarian Reserve After Laparoscopic Ovarian Cystectomy.

    PubMed

    Ergun, Bulent; Ozsurmeli, Mehmet; Dundar, Ozgur; Comba, Cihan; Kuru, Oguzhan; Bodur, Serkan

    2015-01-01

    This study was conducted to determine the changes in ovarian reserve markers after laparoscopic ovarian cystectomy (LOC). Prospective cohort study (Canadian Task Force classification II-2). University teaching hospital. Fifty 50 patients who underwent LOC were prospectively examined to determine the changes in serum markers of ovarian reserve, starting from 1 month before and 3 months after consecutive operations. Changes in serum markers were compared between the following groups: endometrioma cysts (n = 26) versus nonendometrioma cysts (n = 24), unilateral cystectomy (n = 38) versus bilateral cystectomy (n = 12), and bilateral endometrioma extirpation (n = 10) versus other cystectomy operations (n = 40). A significant change was noticed between the preoperative and postoperative antimüllerian hormone (AMH) levels (2.67 ± 2.67 ng/mL vs 1.84 ± 1.72 ng/mL, p < .0001). Serum AMH levels were found to be significantly decreased in endometrioma (p = .002), nonendometrioma (p = .019), unilateral cystectomy (p = .001), bilateral cystectomy (p = .005), bilateral endometrioma (p = .011), and cysts other than bilateral endometrioma (p = .000) groups. The ovarian reserve was found to be diminished after LOC regardless of the presence of endometrioma that could be distinguishable by serum AMH levels. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  4. Current Status of Robot-Assisted Radical Cystectomy: What is the Real Benefit?

    PubMed

    Takenaka, Atsushi

    2015-09-01

    In recent years, robot-assisted radical cystectomy has received attention worldwide as a useful procedure that helps to overcome the limitations of open radical cystectomy. We compared the surgical technique, perioperative and oncological outcomes, and learning curve of robot-assisted radical cystectomy with those of open radical cystectomy. The indications for robot-assisted radical cystectomy are identical to those of open radical cystectomy. Relative contraindications are due to patient positioning in the Trendelenburg position for long periods. Urinary diversion is performed either extracorporeally with a small skin incision or intracorporeally with a totally robotic-assisted maneuver. Accordingly, robot-assisted radical cystectomy can be performed safely with an acceptable operative time, little blood loss, and low transfusion rates. The lymph node yield and positive surgical margin rate were not significantly different between robot-assisted radical cystectomy and open radical cystectomy. The survival rates after robot-assisted radical cystectomy are estimated to be similar to that after open radical cystectomy. However, the recurrence pattern is different between robot-assisted radical cystectomy and open radical cystectomy, i.e., extrapelvic lymph node recurrence and peritoneal carcinomatosis were more frequently found in patients who underwent robot-assisted radical cystectomy than in those who underwent open radical cystectomy. Further validation is necessary to prove the feasibility of oncological control. A steep learning curve is one of the benefits of the new technique. The experience of only 50 robot-assisted radical prostatectomies is a minimum requirement for performing feasible robot-assisted radical cystectomy, and surgeons who have performed only 30 surgeries can reach an acceptable level of quality for robot-assisted radical cystectomy.

  5. Barium appendicitis: A single institution review in Japan

    PubMed Central

    Katagiri, Hideki; Lefor, Alan Kawarai; Kubota, Tadao; Mizokami, Ken

    2016-01-01

    AIM To review clinical experience with barium appendicitis at a single institution. METHODS A retrospective review of patients admitted with a diagnosis of acute appendicitis, from January 1, 2013 to December 31, 2015 was performed. Age, gender, computed tomography (CT) scan findings if available, past history of barium studies, pathology, and the presence of perforation or the development of complications were reviewed. If the CT scan revealed high density material in the appendix, the maximum CT scan radiodensity of the material is measured in Hounsfield units (HU). Barium appendicitis is defined as: (1) patients diagnosed with acute appendicitis; (2) the patient has a history of a prior barium study; and (3) the CT scan shows high density material in the appendix. Patients who meet all three criteria are considered to have barium appendicitis. RESULTS In total, 396 patients were admitted with the diagnosis of acute appendicitis in the study period. Of these, 12 patients (3.0%) met the definition of barium appendicitis. Of these 12 patients, the median CT scan radiodensity of material in the appendix was 10000.8 HU, ranging from 3066 to 23423 HU (± 6288.2). In contrast, the median CT scan radiodensity of fecaliths in the appendix, excluding patients with barium appendicitis, was 393.1 HU, ranging from 98 to 2151 HU (± 382.0). The CT scan radiodensity of material in the appendices of patients with barium appendicitis was significantly higher than in patients with nonbarium fecaliths (P < 0.01). CONCLUSION Barium appendicitis is not rare in Japan. Measurement of the CT scan radiodensity of material in the appendix may differentiate barium appendicitis from routine appendicitis. PMID:27721929

  6. Ameloblastoma: 25 Year Experience at a Single Institution.

    PubMed

    Milman, Tatyana; Ying, Gui-Shuang; Pan, Wei; LiVolsi, Virginia

    2016-12-01

    Ameloblastoma is a rare, locally aggressive odontogenic neoplasm, accounting for fewer than 1 % of head and neck tumors. Recent literature suggests that the initial surgical approach and histologic growth patterns are the most important prognostic determinants in ameloblastoma. The aim of this study was to compare the clinical presentation, management, and outcomes of patients with ameloblastoma with data reported in the literature; the study spanned 2 decades at a single institution. The institution's database was searched for all patients with pathologically confirmed ameloblastoma, diagnosed between 1990 and 2015. The data collected included sex, age, clinical and imaging findings, management, histologic pattern, clearance of surgical margins, length of follow-up, time to recurrence, and disease-related mortality. The potential risk factors of recurrence were evaluated using log-rank test, proportional hazard model, and Fisher exact test. Review of the database yielded 54 patients with pathologically confirmed ameloblastoma and follow-up. Recurrence was noted in 13 (24 %) patients. Surgical approach was associated with the risk of recurrence (6.1 % following radical resection vs. 52 % following limited surgery, p = 0.002). There were trends toward higher recurrence rate in the group with pathologically documented positive margins (p = 0.054) and in follicular ameloblastoma (p = 0.35). Transformation into ameloblastic carcinoma was identified in two patients. There was no disease-related mortality. Our study confirms the recent data regarding the importance of radical surgical resection in management of ameloblastoma. Surgical approach appears to be the strongest predictor of tumor clearance.

  7. Cystoscopic-assisted partial cystectomy: description of technique and results

    PubMed Central

    Gofrit, Ofer N; Shapiro, Amos; Katz, Ran; Duvdevani, Mordechai; Yutkin, Vladimir; Landau, Ezekiel H; Zorn, Kevin C; Hidas, Guy; Pode, Dov

    2014-01-01

    Background Partial cystectomy provides oncological results comparable with those of radical cystectomy in selected patients with invasive bladder cancer without the morbidity associated with radical cystectomy and urinary diversion. We describe a novel technique of partial cystectomy that allows accurate identification of tumor margins while minimizing damage to the rest of the bladder. Methods During the study period, 30 patients underwent partial cystectomy for invasive high-grade cancer. In 19 patients, the traditional method of tumor identification was used, ie, identifying the tumor by palpation and cystotomy. In eleven patients, after mobilization of the bladder, flexible cystoscopy was done and the light of the cystoscope was pointed toward one edge of the planned resected ellipse around the tumor, thus avoiding cystotomy. Results Patients who underwent partial cystectomy using the novel method were similar in all characteristics to patients operated on using the traditional technique except for tumor diameter which was significantly larger in patients operated on using the novel method (4.3±1.5 cm versus 3.11±1.18 cm, P=0.032). Complications were rare in both types of surgery. The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088). Overall, disease-specific and disease-free survival rates were similar. Conclusion The use of a flexible cystoscope during partial cystectomy is a simple, low-cost maneuver that assists in planning the bladder incision and minimizes injury to the remaining bladder by avoiding the midline cystotomy. Initial oncological results show a trend toward a lower rate of local recurrence compared with the standard method. PMID:25368846

  8. What should be the patient’s preference regarding the choice of hospital in the case of radical cystectomy? Evaluation of early complications after open radical cystectomy in a medium and high volume setting in one hospital

    PubMed Central

    Mani, Jens; Vallo, Stefan; Brandt, Maximilian P; Gust, Kilian M; Bartsch, Claudia; Daechert, Johannes; Tsaur, Igor; Bartsch, Georg; Haferkamp, Axel

    2016-01-01

    Purpose This study compares early complications after cystectomy and urinary diversion (UD) stratified by the surgical focus and case load of two different department chairpersons in a single institution in two time periods. Creating clear data about complications that can affect the quality of life is an important tool for patients to decide whether and where to perform this extensive surgery. Hypothesis A team of surgeons with a clear focus on pelvic surgery leads to lower complication rates in radical cystectomy. Materials and methods Radical cystectomy was performed in two separate time periods under the patronage of two different chairmen in the same university hospital. The patient data were analyzed retrospectively and the complications 30 days after surgery were assessed using the Clavien–Dindo classification. Results Statistical analysis showed a significant difference in the severity of complications between the two time periods, A and B, in total (P<0.001). When placing patients into subgroups, significantly more complications in period A were also seen concerning sex (male, P<0.001; female, P=0.003), age (<70 years, P<0.001; >70 years, P≤50.001) tumor grade (low grade, P<0.001; high grade, P≤0.001), and UD (ileal conduit, P<0.001; neobladder, P<0.001). In a multivariable analysis, age (P=0.031) and type of UD (P=0.028) were determined as independent predictors for complications in period A. When joining the two periods together, the type of UD (P=0.0417), age (P=0.041), and the time periods (A/B) (P<0.001) show a significant association with the presence of complications. Conclusion This study compares for the first time surgical complications in two time periods with different case load and surgical focus in one department. Categorization shows that patients should prefer radical cystectomy in centers of excellence or a high-volume hospital in order to keep complications at the lowest possible level and thus have the highest benefit for oncologic

  9. Robotic-assisted laparoscopic radical cystectomy: history, techniques and outcomes.

    PubMed

    Liss, Michael A; Kader, A Karim

    2013-06-01

    Robotic-assisted radical cystectomy (RARC) is a less invasive means of performing the radical cystectomy operation, which holds promise for improved patient morbidity. We review the history, technique and current literature pertaining to RARC and place the current results in context with the open procedure. All articles regarding RARC found in PubMed after January 2000 were examined. We selected articles that appeared in high-impact journals, had large patient population size (>80 patients), or were novel in technique or findings. We chose key laparoscopic articles to give reference to the history in transition to robotic radical cystectomy. In addition, we chose classic articles from open radical cystectomy to give reference regarding the newer robotic perioperative outcomes. Studies suggest that a 20-patient learning curve is needed to reach an operative time of 6.5 h, with 30 surgeries performed to reach lymph node counts in excess of 20 (International Robotic Cystectomy Consortium). The only randomized surgical trial comparing open and robotic techniques showed equivalent lymph node yield, which may be surgeon and volume dependent. Literature demonstrates lower estimated blood loss, transfusion rates, early return of bowel function and decreased complications in early small series. RARC and urinary diversion are still early in development and limited to centers with extensive robotic experience and volume, although adoption of the robotic approach is becoming more common. Early studies have shown promise to reduce complications with equivalent oncologic results.

  10. Cost analysis of open radical cystectomy versus robot-assisted radical cystectomy.

    PubMed

    Mmeje, Chinedu O; Martin, Aaron D; Nunez-Nateras, Rafael; Parker, Alexander S; Thiel, David D; Castle, Erik P

    2013-02-01

    Bladder cancer is the fourth and ninth most common malignancy in males and females, respectively, in the U.S. and one of the most costly cancers to manage. With the current economic condition, physicians will need to become more aware of cost-effective therapies for the treatment of various malignancies. Robot-assisted radical cystectomy (RARC) is the latest minimally invasive surgical option for muscle-invasive bladder cancer. Current reports have shown less blood loss, a shorter hospital stay, and a lower morbidity with RARC, as compared with the traditional open radical cystectomy (ORC), although long-term oncologic results of RARC are still maturing. There are few studies that have assessed the cost outcomes of RARC as compared with ORC. Currently, ORC appears to offer a direct cost advantage due to the high purchase and maintenance cost of the robotic platform, although when the indirect costs of complications and extended hospital stay with ORC are considered, RARC may be less expensive than the traditional open procedure. In order to accurately evaluate the cost effectiveness of RARC versus ORC, prospective randomized trials between the two surgical techniques with long-term oncologic efficacy are needed.

  11. Safety of Live Robotic Surgery: Results from a Single Institution.

    PubMed

    Ogaya-Pinies, Gabriel; Abdul-Muhsin, Haidar; Palayapalayam-Ganapathi, Hariharan; Bonet, Xavier; Rogers, Travis; Rocco, Bernardo; Coelho, Rafael; Hernandez-Cardona, Eduardo; Jenson, Cathy; Patel, Vipul

    2017-08-28

    control group (p=0.7927). There was no significant difference in continence rates between the LS and control groups (97.22% vs 93.52%; p=0.7768). No differences in potency rate were evident by the end of the follow-up period (LS 69.44%, control group 70.37%; p=0.8432). The retrospective nature, the lack of randomization, and the single-institution experience are limitations of the study. In this series of live transmitted RARPs, perioperative results (oncological and functional outcomes and complications) were similar to those found in daily practice. After careful patient selection, LSEs are safe with minimal patient morbidity in the hands of an experienced surgeon working with a familiar surgical team. Further evaluation of the results from other surgeons at other centers is necessary. We investigated the safety of surgeries broadcast live from our institution. We found that outcomes were similar to those for patients undergoing surgery under regular circumstances in terms of the rate of complications and oncological and functional outcomes. We conclude that live transmitted surgery is safe in well-selected patients in the hands of an experienced surgeon. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  12. Risk of Fracture After Radical Cystectomy and Urinary Diversion for Bladder Cancer

    PubMed Central

    Gupta, Amit; Atoria, Coral L.; Ehdaie, Behfar; Shariat, Shahrokh F.; Rabbani, Farhang; Herr, Harry W.; Bochner, Bernard H.; Elkin, Elena B.

    2014-01-01

    Purpose Radical cystectomy and urinary diversion may cause chronic metabolic acidosis, leading to long-term bone loss in patients with bladder cancer. However, the risk of fractures after radical cystectomy has not been defined. We assessed whether radical cystectomy and intestinal urinary diversion are associated with increased risk of fracture. Patients and Methods Population-based study using SEER-Medicare–linked data from 2000 through 2007 for patients with stage 0-III bladder cancer. We evaluated the association between radical cystectomy and risk of fracture at any site, controlling for patient and disease characteristics. Results The cohort included 50,520 patients, of whom 4,878 had cystectomy and urinary diversion. The incidence of fracture in the cystectomy group was 6.55 fractures per 100 person-years, compared with 6.39 fractures per 100 person-years in those without cystectomy. Cystectomy was associated with a 21% greater risk of fracture (adjusted hazard ratio, 1.21; 95% CI, 1.10 to 1.32) compared with no cystectomy, controlling for patient and disease characteristics. There was no evidence of an interaction between radical cystectomy and age, sex, comorbidity score, or cancer stage. Conclusion Patients with bladder cancer who have radical cystectomy and urinary diversion are at increased risk of fracture. PMID:25185104

  13. Radical cystectomy for recurrent urothelial carcinoma after prior partial cystectomy: perioperative and oncologic outcomes.

    PubMed

    Mason, Ross J; Frank, Igor; Bhindi, Bimal; Tollefson, Matthew K; Thompson, R Houston; Karnes, R Jeffrey; Tarrell, Robert; Thapa, Prabin; Boorjian, Stephen A

    2017-09-14

    To evaluate perioperative and oncologic outcomes of patients undergoing radical cystectomy (RC) for recurrence of urothelial carcinoma (UC) after prior partial cystectomy (PC), and to compare these outcomes to patients undergoing primary RC. Patients who underwent RC for recurrence of UC after prior PC were matched 1:3 to patients undergoing primary RC based on age, pathologic stage, and decade of surgery. Perioperative and oncologic outcomes were compared using Wilcoxon sign-rank test, McNemars test, the Kaplan-Meier method, and Cox proportional hazards regression analyses. Overall, the cohorts were well matched on clinical and pathological characteristics. No difference was noted in operative time (median 322 versus 303 min; p = 0.41), estimated blood loss (median 800 versus 700 cc, p = 0.10) or length of stay (median 9 versus 10 days; p = 0.09). Similarly, there were no differences in minor (51.7 versus 44.3%; p = 0.32) or major (10.3 versus 12.6%; p = 0.66) perioperative complications. Median follow-up after RC was 5.0 years (IQR 1.5, 13.1 years). Notably, CSS was significantly worse for patients who underwent RC after PC (10 year-46.8 versus 65.9%; p = 0.03). On multivariable analysis, prior PC remained independently associated with an increased risk of bladder cancer death (HR 2.28; 95% CI 1.17, 4.42). RC after PC is feasible, without significantly adverse perioperative outcomes compared to patients undergoing primary RC. However, the risk of death from bladder cancer may be higher, suggesting the need for careful patient counseling prior to PC and the consideration of such patients for adjuvant therapy after RC.

  14. The economics of robotic cystectomy: cost comparison of open versus robotic cystectomy.

    PubMed

    Lee, Richard; Ng, Casey K; Shariat, Shahrokh F; Borkina, Anna; Guimento, Robert; Brumit, Kevin F; Scherr, Douglas S

    2011-12-01

    • To assess and compare the economic burden of open radical cystectomy (OC) vs robotic-assisted laparoscopic radical cystectomy (RC) with pelvic lymph node dissection and urinary diversion. • A series of 103 and 83 consecutive patients undergoing OC and RC, respectively, were prospectively studied at a tertiary care institution from April 2002 to February 2009. • Data were collected on patient demographics, perioperative parameters and length of stay (LOS) in hospital. Cohorts were subdivided into ileal conduit (IC), continent cutaneous diversion (CCD) and orthotopic neobladder (ON) subgroups. • A linear cost model was created to simulate treatment with OC vs RC. Procedural costs were derived from the Medicare Resource Based Relative Value Scale. Materials costs were obtained from the respective suppliers. The indirect costs of complications were considered. • Sensitivity analyses were performed. • Despite a higher cost of materials, RC was less expensive than OC for IC and CCD, although the cost advantage deteriorated for ON. • The per-case costs of RC with IC, CCD and ON were $20,659, $22,102 and $22,685, respectively, compared to $25,505, $22,697 and $20,719 for their OC counterparts. • The largest cost driver in the study was LOS in hospital. • RC showed a shorter LOS compared to OC, although this effect was insufficient to offset the higher cost of robotic surgery. • Complications materially affected cost performance. • Despite a higher cost of materials, RC can be more cost efficient than OC as a treatment for bladder cancer at a high-volume, tertiary care referral centre, particularly with IC. • Complications significantly impact cost performance. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  15. Laparoscopic Radical Cystectomy Versus Extraperitoneal Radical Cystectomy: Is the Extraperitoneal Technique Rewarding?

    PubMed

    Zhao, Junjie; Zeng, Shuxiong; Zhang, Zhensheng; Zhou, Tie; Yang, Bo; Song, Ruixiang; Sun, Yinghao; Xu, Chuanliang

    2015-08-01

    To study whether extraperitoneal radical cystectomy (EORC) accelerates the postoperative recovery of bowel function compared with laparoscopic radical cystectomy (LRC). All the patients with bladder cancer who underwent EORC or LRC with an ileal conduit by a single surgeon from January 2009 to June 2014 were investigated. The perioperative outcomes and follow-up data were analyzed, with a focus on postoperative ileus (POI). A total of 41 LRCs and 53 EORCs met the inclusion criteria. LRC was associated with a significant reduction in the estimated blood loss (278 vs. 356 mL, P = .017) and a shorter hospital stay (8.1 vs. 9.2 days, P = .003). However, LRC was also associated with longer operative times (349 vs. 316 minutes, P = .022). The incidence of paralytic POI was 7.3% (3 of 41) and 7.5% (4 of 53; P = .966) and the obstructive POI rate was 4.9% (2 of 41) and 3.8% (2 of 53; P = .792) for the LRC and EORC groups, respectively. No significant differences were noted in blood transfusion requirements, interval to flatus or liquid intake, or opioid dosage. No patient in either group had positive surgical margins, and no significant differences were observed in the lymph node count (P = .112). At a median follow-up period of 28.7 months (range, 3-62 months), no significant differences were seen between the LRC and EORC groups in the 3-year overall, cancer-specific, or cancer-free survival rates. EORC resulted in a POI rate similar to that of LRC, despite factors favoring LRC. Our results suggest that extraperitoneal LRC could improve the perioperative outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Robotic-assisted laparoscopic partial cystectomy for symptomatic urachal hamartoma

    PubMed Central

    Shepler, Richard; Zuckerman, Jack M.; Troyer, Dean; Malcolm, John B.

    2016-01-01

    We report a case of an urachal hamartoma in a 30-year-old African American woman. The urachal lesion was excised with a robotic-assisted laparoscopic partial cystectomy. Pathologic analysis revealed cysts, smooth muscle, and ciliated epithelium consistent with a hamartoma. The patient recovered without complication. This case highlights an unusual pathology that is infrequently reported following urachal remnant excision. PMID:27011882

  17. Urethral function after cystectomy: a canine in vivo experiment.

    PubMed

    Hübner, W A; Trigo-Rocha, F; Plas, E G; Tanagho, E A

    1993-01-01

    To study the function of the pelvic floor and the isolated urethra after removal of the bladder, 5 male and 5 female mongrel dogs were used in an acute in vivo experiment. Urethral pressure changes secondary to unilateral stimulation of the pelvic and pudendal nerves were recorded. After baseline data of the intact system were documented, the following procedures were carried out: separation of the urethra from the bladder neck (prostate), nerve-sparing cystectomy (cystoprostatectomy), and cold-knife incision through the entire length of the proximal urethra. Pressure recordings were repeated after each step of surgery. Pudendal nerve stimulation resulted in rapid and large pressure rises in the distal urethra (reaction typical of striated muscle). This response remained unchanged after all three surgical steps. Pelvic nerve stimulation provoked pressure rises within the urethra of a pattern typical of smooth muscle. The findings persisted after separation of the urethra from the bladder neck (prostate) and after cystectomy, but were not observed after urethrotomy. Contractions secondary to pudendal nerve stimulation were inhibited by curare, which did not affect the reaction to pelvic nerve stimulation. Our experiments demonstrate that in the dog the continuity of bladder and urethra is not required for the function of urethral closure mechanisms. The contractile potency of the urethral smooth muscles remains intact after nerve-sparing cystectomy. We believe that problems with the baseline continence of surrogate bladders should mainly be ascribed to a lack of surgical caution in preserving the autonomic nerves of cystectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Status of integrated irradiation and cystectomy for bladder cancer.

    PubMed

    Whitmore, W F; Batata, M

    1984-11-01

    The rationale and representative results of integrated irradiation and cystectomy for bladder cancer are reviewed and an hypothesis regarding the mechanism and benefits of such treatment formulated. The basis for uncertainty regarding the value of preoperative irradiation is outlined and a perspective on the resolution of this uncertainty provided.

  19. Laparoscopic Radical Cystectomy in the Elderly – Results of a Single Center LRC only Series

    PubMed Central

    Hermans, Tom J. N.; Fossion, Laurent M. C. L.; Verhoeven, Rob; Horenblas, Simon

    2016-01-01

    ABSTRACT Objective: To compare outcome of laparoscopic radical cystectomy (LRC) with ileal conduit in 22 elderly (≥75 years) versus 51 younger (<75 years) patients. Materials and Methods: Analysis of prospectively gathered data of a single institution LRC only series was performed. Selection bias for LRC versus non-surgical treatments was assessed with data retrieved from the Netherlands Cancer Registry. Results: Median age difference between LRC groups was 9.0 years. (77.0 versus 68.0 years). Both groups had similar surgical indications, body mass index and gender distribution. Charlson Comorbidity Index score was 3 versus 4 in ≥50% of younger and elderly patients. Median operative time (340 versus 341 min) and estimated blood loss (<500 versus >500mL) did not differ between groups. Median total hospital stay was 12.0 versus 14.0 days for younger and elderly patients. Grade I-II 90-d complication rate was higher for elderly patients (68 versus 43%, p=0.05). Grade III-V 90-d complication rate was equal for both groups (23 versus 29%, p=0.557). 90-d mortality rate was higher for elderly patients (14 versus 4%, p=0.157). Median follow-up was 40.0 months for younger and 57.0 months for elderly patients. Estimated overall and cancer-specific survival at 5years. was 46% versus 35% and 64% versus 64% for younger and elderly patients respectively. Conclusions: Our results suggest that LRC is feasible in elderly patients, where a non-surgical treatment is usually favoured. PMID:27532116

  20. Ileocolic neobladder post-cystectomy: continence and potency.

    PubMed

    Marshall, F F; Mostwin, J L; Radebaugh, L C; Walsh, P C; Brendler, C B

    1991-03-01

    Incontinence and impotence are 2 of the primary complications associated with total bladder reconstruction after cystectomy for carcinoma. These and other features are addressed in 25 patients who underwent total neobladder reconstruction following cystectomy for transitional cell carcinoma. Of these patients 20 had a urethral anastomosis. No patient had to wear a pad or device. Enuresis was rare. When the radical cystoprostatectomy population was contrasted with a radical prostatectomy patient population, continence was achieved more rapidly in the neobladder group. Potency was maintained in 15 of 21 (71%) evaluable patients. This ileocolic neobladder produces a large volume and low pressure, and provides excellent day and night continence. With preservation of the neurovascular bundle potency can be maintained in the majority of patients.

  1. Urinary Diversion and Morbidity After Radical Cystectomy for Bladder Cancer

    PubMed Central

    Gore, John L.; Yu, Hua-Yin; Setodji, Claude; Hanley, Jan M.; Litwin, Mark S.; Saigal, Christopher S.

    2011-01-01

    BACKGROUND The rate of continent urinary diversion after radical cystectomy for bladder cancer varies by patient and provider characteristics. Demonstration of equivalent complication rates, independent of diversion type, may decrease provider reluctance to perform continent reconstructions. The authors sought to determine whether continent reconstructions confer increased complication rates after radical cystectomy. METHODS From the Nationwide Inpatient Sample, the authors used International Classification of Disease (ICD-9) codes to identify subjects who underwent radical cystectomy for bladder cancer during 2001–2005. They determined acute postoperative medical and surgical complications from ICD-9 codes and compared complication rates by reconstruction type using the nearest neighbor propensity score matching method and multivariate logistic regression models. RESULTS Adjusting for case-mix differences between reconstructive groups, continent diversions conferred a lower risk of medical, surgical, and disposition-related complications that was statistically significant for bowel (3.1% lower risk; 95% confidence interval [95% CI], −6.8% to −0.1%), urinary (1.2% lower risk; 95% CI, −2.3%, to −0.4%), and other surgical complications (3.0% lower risk; 95% CI, −6.2% to −0.4%), and discharge other than home (8.2% lower risk; 95% CI, −12.1% to −4.6%) compared with ileal conduit subjects. Older age and certain comorbid conditions, including congestive heart failure and preoperative weight loss, were associated with significantly increased odds of postoperative medical and surgical complications in all subjects. CONCLUSIONS Mode of urinary diversion after radical cystectomy for bladder cancer is not associated with increased risk of immediate postoperative complications. These results may encourage broader consideration of continent urinary diversion without concern for increased complication rates. PMID:19924831

  2. Total Psoas Area Predicts Complications following Radical Cystectomy

    PubMed Central

    Lyon, Timothy D.; Farber, Nicholas J.; Chen, Leo C.; Fuller, Thomas W.; Davies, Benjamin J.; Gingrich, Jeffrey R.; Hrebinko, Ronald L.; Maranchie, Jodi K.; Taylor, Jennifer M.; Tarin, Tatum V.

    2015-01-01

    Purpose. To determine whether total psoas area (TPA), a simple estimate of muscle mass, is associated with complications after radical cystectomy. Materials and Methods. Patients who underwent radical cystectomy at our institution from 2011 to 2012 were retrospectively identified. Total psoas area was measured on preoperative CT scans and normalized for patient height. Multivariable logistic regression was used to determine whether TPA was a predictor of 90-day postoperative complications. Overall survival was compared between TPA quartiles. Results. 135 patients were identified for analysis. Median follow-up was 24 months (IQR: 6–37 months). Overall 90-day complication rate was 56% (75/135). TPA was significantly lower for patients who experienced any complication (7.8 cm2/m2 versus 8.8 cm2/m2, P = 0.023) and an infectious complication (7.0 cm2/m2 versus 8.7 cm2/m2, P = 0.032) than those who did not. On multivariable analysis, TPA (adjusted OR 0.70 (95% CI 0.56–0.89), P = 0.003) and Charlson comorbidity index (adjusted OR 1.34 (95% CI 1.01–1.79), P = 0.045) were independently associated with 90-day complications. TPA was not a predictor of overall survival. Conclusions. Low TPA is associated with infectious complications and is an independent predictor of experiencing a postoperative complication following radical cystectomy. PMID:26798336

  3. Extended partial cystectomy with augmentation cystoplasty in urachal adenocarcinoma: An oncologically favorable but underutilized alternative to radical cystectomy

    PubMed Central

    Valsangkar, Rohan Satish; Rizvi, Syed J.; Goyal, Niraj K.

    2016-01-01

    Partial/extended partial cystectomy (EPC) is the most common surgery done for localized urachal malignancies. However, sometimes, after EPC, patients may be left with small bladder remnant, reconstruction of which will result in very small capacity bladder with resultant severe storage voiding symptoms. We report a case of urachal adenocarcinoma, in which when a small bladder remnant was left post-EPC, instead of proceeding with radical cystectomy (RC) and neobladder (the standard alternative), bladder augmentation was done with good oncological and voiding outcome. Augmentation cystoplasty has many advantages over neobladder and we suggest it as an oncologically comparable alternative to RC with neobladder, which has been underutilized in urachal malignancies as we found on literature review. PMID:27453665

  4. Clinicopathologic characteristics of invasive lobular carcinoma of the breast: results of an analysis of 530 cases from a single institution.

    PubMed

    Orvieto, Enrico; Maiorano, Eugenio; Bottiglieri, Luca; Maisonneuve, Patrick; Rotmensz, Nicole; Galimberti, Viviana; Luini, Alberto; Brenelli, Fabricio; Gatti, Giovanna; Viale, Giuseppe

    2008-10-01

    Although invasive lobular carcinoma (ILC) is the second most common histotype of breast cancer, the prognostic implications of its clinicopathologic characteristics remain controversial. The authors undertook a retrospective analysis of a large series of cases treated and followed at a single institution, with the objective of assessing the prognostic/predictive value of distinct clinicopathologic features of the tumors, after revision of the original histopathologic preparations and statistical analyses. Overall, 530 patients with pure ILC (57% with the classic type; 19% with the alveolar type; 11% with the solid type; and the remaining 13% characterized by pleomorphic, signet ring cell, histiocytoid, or apocrine features) were included in the study. Tumor size, lymph node metastatic involvement, and hormonal status were confirmed to be significant prognostic factors. In addition, statistically significant correlations were demonstrated between the 'classic' histotype of ILC and a lower risk of axillary lymph node metastases (P = .0005), a reduced number of metastatic lymph nodes (P = .04), and lower tumor grade (P < .0001). Patients with ILC of the 'nonclassic' subtype demonstrated significantly increased breast-related events (hazards ratio of 1.80; 95% confidence interval, 1.04-3.10) and a trend toward reduced disease-free survival and overall survival. The results of the current study confirm the clinical usefulness of several traditional clinicopathologic features of ILC as prognostic parameters but also emphasize the prognostic role of the histopathologic subtyping of these tumors, documenting the more favorable outcome of the classic subtype of ILC.

  5. The MILLER banding procedure as a treatment alternative for dialysis access steal syndrome: a single institutional experience.

    PubMed

    Shukla, Pratik A; Kolber, Marcin K; Nwoke, Franklin; Kumar, Abhishek; Shams, Joseph N; Silberzweig, James E

    2016-01-01

    To describe a single institutional experience with minimally invasive limited ligation endoluminal-assisted revision (MILLER) for treatment of dialysis access steal syndrome (DASS). Twenty patients were retrospectively identified that underwent 30 MILLER band procedures for DASS at our institution from March 2010 to December 2014. Technical success was defined by successful creation of MILLER band with preservation of flow for hemodialysis. Clinical success was defined as complete resolution of signs and symptoms with preservation of dialysis access in a 1-month postprocedural period. Primary MILLER band patency, postintervention-assisted primary access patency, and postprocedure secondary access patency are reported. Technical success was achieved in all patients. Clinical success was achieved in 75% of patients after one banding procedure and in 95% of patients after two banding procedures. One patient experienced access thrombosis following the initial banding procedure which was subsequently treated and did not lead to loss of access. MILLER band patency was 83% at 1 month and 77% at 6 months. Postintervention-assisted primary patency was 95%, 93%, and 92% at 3 months, 6 months, and 1 year, respectively. Postintervention secondary patency was 86%, 68%, and 59% at 3 months, 6 months, and 1 year, respectively. MILLER banding offers a less-invasive alternative to surgical therapy that appears to be safe and permits preservation of dialysis access. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Refining Patient Selection for Neoadjuvant Chemotherapy before Radical Cystectomy

    PubMed Central

    Culp, Stephen H.; Dickstein, Rian J.; Grossman, H. Barton; Pretzsch, Shanna M.; Porten, Sima; Daneshmand, Siamak; Cai, Jie; Groshen, Susan; Siefker-Radtke, Arlene; Millikan, Randall E.; Czerniak, Bogdan; Navai, Neema; Wszolek, Matthew F.; Kamat, Ashish M.; Dinney, Colin P. N.

    2014-01-01

    Purpose We evaluated the survival of patients with muscle invasive bladder cancer undergoing radical cystectomy without neoadjuvant chemotherapy to confirm the utility of existing clinical tools to identify low risk patients who could be treated with radical cystectomy alone and a high risk group most likely to benefit from neoadjuvant chemotherapy. Materials and Methods We identified patients with muscle invasive bladder cancer who underwent radical cystectomy without neoadjuvant chemotherapy at our institution between 2000 and 2010. Patients were considered high risk based on the clinical presence of hydroureteronephrosis, cT3b-T4a disease, and/or histological evidence of lymphovascular invasion, micropapillary or neuroendocrine features on transurethral resection. We evaluated survival (disease specific, progression-free and overall) and rate of pathological up staging. An independent cohort of patients from another institution was used to confirm our findings. Results We identified 98 high risk and 199 low risk patients eligible for analysis. High risk patients exhibited decreased 5-year overall survival (47.0% vs 64.8%) and decreased disease specific (64.3% vs 83.5%) and progression-free (62.0% vs 84.1%) survival probabilities compared to low risk patients (p <0.001). Survival outcomes were confirmed in the validation subset. On final pathology 49.2% of low risk patients had disease up staged. Conclusions The 5-year disease specific survival of low risk patients was greater than 80%, supporting the distinction of high risk and low risk muscle invasive bladder cancer. The presence of high risk features identifies patients with a poor prognosis who are most likely to benefit from neoadjuvant chemotherapy, while many of those with low risk disease can undergo surgery up front with good expectations and avoid chemotherapy associated toxicity. PMID:23911605

  7. Which Should Be the Preferred Technique During Laparoscopic Ovarian Cystectomy.

    PubMed

    Sahin, Cagdas; Akdemir, Ali; Ergenoglu, Ahmet Mete; Ozgurel, Banu; Yeniel, Ahmet Ozgur; Taskiran, Dilek; Sendag, Fatih

    2017-03-01

    The aim of the present study was to determine the long-term effects of different laparoscopic hemostatic techniques on ovarian reserve after ovarian cystectomy. Ninety patients with unilateral ovarian cysts were recruited and randomly distributed into 2 groups. Laparoscopic stripping cystectomy was performed in all patients. Afterward, cystectomy hemostasis was achieved via hemostatic suture or bipolar electrocoagulation. Serum levels of anti-Müllerian hormone (AMH) were determined preoperatively and postoperatively at 1, 3, and 12 months, and patients were evaluated for residual ovarian volume, antral follicle count, and pregnancy. The statistical difference was determined between the 2 groups in terms of AMH levels at 3 months (hemostatic suture group = 3.17 ± 3.40 vs bipolar electrocoagulation group = 2.38 ± 2.57, P = .006) and 12 months (hemostatic suture group = 3.71 ± 3.09 vs bipolar electrocoagulation group = 2.78 ± 2.85, P = .005). In addition, in the hemostatic suture group, there was no statistically significant difference between preoperative and postoperative AMH levels ( P = .165) and between the postoperative antral follicle count ( P = .779) and the residual ovarian volume ( P = .248), whereas in the bipolar electrocoagulation group, postoperative AMH levels were lower than preoperative levels ( P = .028) and postoperative residual ovarian volumes at 3 and 12 months were lower than those at 1 month ( P = .001). Nonetheless, pregnancy rates were not significantly different ( P = .546). Bipolar electrocoagulation is more destructive compared with hemostatic suture. However, the ovarian reserve does not decrease further during the follow-up period.

  8. Refining patient selection for neoadjuvant chemotherapy before radical cystectomy.

    PubMed

    Culp, Stephen H; Dickstein, Rian J; Grossman, H Barton; Pretzsch, Shanna M; Porten, Sima; Daneshmand, Siamak; Cai, Jie; Groshen, Susan; Siefker-Radtke, Arlene; Millikan, Randall E; Czerniak, Bogdan; Navai, Neema; Wszolek, Matthew F; Kamat, Ashish M; Dinney, Colin P N

    2014-01-01

    We evaluated the survival of patients with muscle invasive bladder cancer undergoing radical cystectomy without neoadjuvant chemotherapy to confirm the utility of existing clinical tools to identify low risk patients who could be treated with radical cystectomy alone and a high risk group most likely to benefit from neoadjuvant chemotherapy. We identified patients with muscle invasive bladder cancer who underwent radical cystectomy without neoadjuvant chemotherapy at our institution between 2000 and 2010. Patients were considered high risk based on the clinical presence of hydroureteronephrosis, cT3b-T4a disease, and/or histological evidence of lymphovascular invasion, micropapillary or neuroendocrine features on transurethral resection. We evaluated survival (disease specific, progression-free and overall) and rate of pathological up staging. An independent cohort of patients from another institution was used to confirm our findings. We identified 98 high risk and 199 low risk patients eligible for analysis. High risk patients exhibited decreased 5-year overall survival (47.0% vs 64.8%) and decreased disease specific (64.3% vs 83.5%) and progression-free (62.0% vs 84.1%) survival probabilities compared to low risk patients (p <0.001). Survival outcomes were confirmed in the validation subset. On final pathology 49.2% of low risk patients had disease up staged. The 5-year disease specific survival of low risk patients was greater than 80%, supporting the distinction of high risk and low risk muscle invasive bladder cancer. The presence of high risk features identifies patients with a poor prognosis who are most likely to benefit from neoadjuvant chemotherapy, while many of those with low risk disease can undergo surgery up front with good expectations and avoid chemotherapy associated toxicity. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. Robotic cystectomy and the Internet: separating fact from fiction.

    PubMed

    Pruthi, Raj S; Belsante, Jim; Kurpad, Raj; Nielsen, Matthew E; Wallen, Eric M

    2011-01-01

    Patients commonly use the Internet to acquire health information. While a large amount of health-related information is available, the accuracy is highly variable. We sought to evaluate the current web-based information that exists with regard to robotic cystectomy. Two common search engines (Google and Yahoo) were used to search the term "robotic cystectomy" and obtain the top 50 websites for each. These 100 sites were analyzed with regard to type of site, presence and accuracy of information on bladder cancer, and of information related to robotic cystectomy outcomes (surgical/oncologic, functional, and recovery). In addition, information taken from Intuitive Corp website was identified, as was the presence (or absence) and literature-based references. Of the 100 sites, 61 were surgeon/provider sites, 23 links to articles, 8 news stories, 3 patient support sites, 3 meeting program, and 2 were the Intuitive site. Analysis of all 61 provider sites showed that 13% provided factually accurate information, 7% had both factual and erroneous information, and 80% had no information on bladder cancer. With regard to the purported benefits and outcomes of the robotic approach, a significant number of the sites had nonevidence-based claims with regard surgical/oncologic aspects (54%), functional recovery (26%), and surgical recovery (47%). Information taken directly from the Intuitive site was found on 33% sites, with 16% sites having a direct link. Only 4 provider sites (7%) had listed any references. These findings suggest that surgeons provide the majority of Internet information but do not often present evidence-based information and often over-state claims and outcomes of the robotic approach. This highlights the need for providers to deliver factual and evidence-based information to the public, and not suggest untrue/unproven claims that seem to presently occur. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Port site metastases after robot-assisted laparoscopic radical cystectomy.

    PubMed

    El-Tabey, Nasr A; Shoma, Ahmed M

    2005-11-01

    Laparoscopy has become a well-established alternative to open surgery for the management of many urologic tumors. Metastases at one of the port sites is not a common complication, though there are some reports of port site metastases after laparoscopic management for renal tumors and pelvicaliceal tumors, as well as after laparoscopic lymphadenectomy. Herein, we report a case of port site metastases after robot-assisted laparoscopic radical cystectomy for muscle-invasive bladder cancer. To the best of our knowledge this is the first case of such pathology to be reported. Although rare, the laparoscopic surgeon should be aware of such complications when dealing with malignant masses.

  11. Clinical experience with single-port access laparoscopic cystectomy and myomectomy.

    PubMed

    Jeong, Jae-Hyeok; Kim, Yu-Ri; Hong, Kil-Pyo; Ha, Jae-Eun; Kim, Eun-Jeong; Hong, Da-Kyo; Lee, Kyu-Sup

    2016-03-01

    This study was performed to assess our clinical experience with single-port access (SPA) laparoscopic cystectomy and myomectomy and the surgical outcomes of those procedures at our institution. The authors evaluated the surgical outcomes of SPA laparoscopic cystectomy in 293 patients and SPA laparoscopic myomectomy in 246 patients. The surgical outcomes comprised operation time, the amount of blood loss during the operation, the change in hemoglobin (before and after the operation), the change in hematocrit (before and after the operation), switching to the multi-port access method, complications, transfusions, and the duration of the postoperative hospital stay. The Pearson correlation coefficient and the Spearman correlation coefficient between the operation time and the amount of blood loss were 0.312 and 0.321 for SPA laparoscopic cystectomy, respectively, and 0.706 and 0.674 for SPA laparoscopic myomectomy, respectively. The drops in hemoglobin and hematocrit were 1.33±0.78 g/dL and 4.14%±2.45%, respectively, in SPA laparoscopic cystectomy, while the corresponding figures were 1.34±1.13 g/dL and 4.17%±3.24% in SPA laparoscopic myomectomy, respectively. This study reported the surgical outcomes of SPA laparoscopic cystectomy and myomectomy and compared them to previously published findings on traditional laparoscopic cystectomy and myomectomy. No significant differences were found in the surgical outcomes between SPA and traditional laparoscopic cystectomy and myomectomy.

  12. Clinical experience with single-port access laparoscopic cystectomy and myomectomy

    PubMed Central

    Jeong, Jae-Hyeok; Kim, Yu-Ri; Hong, Kil-Pyo; Ha, Jae-Eun; Kim, Eun-Jeong; Hong, Da-Kyo

    2016-01-01

    Objective This study was performed to assess our clinical experience with single-port access (SPA) laparoscopic cystectomy and myomectomy and the surgical outcomes of those procedures at our institution. Methods The authors evaluated the surgical outcomes of SPA laparoscopic cystectomy in 293 patients and SPA laparoscopic myomectomy in 246 patients. The surgical outcomes comprised operation time, the amount of blood loss during the operation, the change in hemoglobin (before and after the operation), the change in hematocrit (before and after the operation), switching to the multi-port access method, complications, transfusions, and the duration of the postoperative hospital stay. Results The Pearson correlation coefficient and the Spearman correlation coefficient between the operation time and the amount of blood loss were 0.312 and 0.321 for SPA laparoscopic cystectomy, respectively, and 0.706 and 0.674 for SPA laparoscopic myomectomy, respectively. The drops in hemoglobin and hematocrit were 1.33±0.78 g/dL and 4.14%±2.45%, respectively, in SPA laparoscopic cystectomy, while the corresponding figures were 1.34±1.13 g/dL and 4.17%±3.24% in SPA laparoscopic myomectomy, respectively. Conclusion This study reported the surgical outcomes of SPA laparoscopic cystectomy and myomectomy and compared them to previously published findings on traditional laparoscopic cystectomy and myomectomy. No significant differences were found in the surgical outcomes between SPA and traditional laparoscopic cystectomy and myomectomy. PMID:27104157

  13. Urethral recurrence after cystectomy: current preventative measures, diagnosis and management.

    PubMed

    Chan, Yvonne; Fisher, Patrick; Tilki, Derya; Evans, Christopher P

    2016-04-01

    To summarise the current literature on the diagnosis and management of urethral recurrence (UR) after radical cystectomy (RC), as UR after RC is rare but associated with high mortality. With the recently increased use of orthotopic bladder substitution and the questionable benefit of prophylactic urethrectomy, identification of patients at high risk of UR, management of the remnant urethra, and treatment of UR become critical questions. A review of the PubMed database from 1980 to 2014 was performed to identify studies evaluating recurrent urothelial cancer of the urethra after RC. The search terms used included 'urethral recurrence', 'cystectomy' or 'cystoprostatectomy'. Selected studies provided information on the type of urinary diversion performed, the incidence of UR, and the time to UR. Incidence of UR after RC ranges from 1% to 8% with most recurrences occurring within the first 2 years after surgery. Increased risk of UR is associated with involvement of the prostate, tumour multifocality, bladder neck involvement, and cutaneous diversion. The median overall survival after UR ranges from 6 to 54 months and the 5-year disease-specific survival after UR is reported to be between zero and 83%. UR remains a relatively rare event. Current literature suggests that urethral wash cytology may be useful in patients with intermediate- to high-risk of recurrence to enable early detection of non-invasive disease, which may be amenable to conservative therapy before urethrectomy.

  14. Radical cystectomy with or without prior irradiation in the treatment of bladder cancer.

    PubMed

    Whitmore, W F; Batata, M A; Ghoneim, M A; Grabstald, H; Unal, A

    1977-01-01

    This is a summary presentation on certain aspects of an experience with the use of radical cystectomy with or without prior irradiation in the treatment of selected patients with bladder cancer at the Memorial Sloan-Kettering Cancer Center.

  15. Bladder replacement after radical cystectomy using detubularized right colonic segment.

    PubMed

    Levy, O M; Phillips, M H; Aigen, A; Kwart, A M

    1988-12-01

    Bladder replacement after radical cystectomy offers the cancer patient the possibility of restoration to a functional level not possible with the standard means of urinary diversion. Herein we present our experience using a detubularized right colonic segment to create functional reservoirs in 2 male patients and a continent reservoir in a female patient. Cystometric analysis reveals capacious reservoirs, low basal pressures, and a tendency toward pressure spikes at higher filling volumes. All 3 patients are continent at volumes up to 400 cc with preservation of the upper urinary tracts and the absence of reflux. We believe the simplicity of this technique and the encouraging results will contribute to more widespread application of continent and functional reservoirs.

  16. Reoperations following Robot-Assisted Radical Cystectomy: A Decade of Experience.

    PubMed

    Hussein, Ahmed A; Hashmi, Zishan; Dibaj, Seyedeh; Altartir, Tareq; Fiorica, Thomas; Wing, Joseph; Durrani, Mohammad; Binkowski, John; Boateng, Lesley; Wilding, Gregory; Guru, Khurshid A

    2016-05-01

    There is a paucity of data regarding the operative management of complications after robot-assisted radical cystectomy. We reviewed operative management of robot-assisted radical cystectomy specific complications during our 10-year experience with this procedure and assessed the feasibility, safety and outcomes of robot-assisted reoperations. We retrospectively reviewed the records of all patients who underwent surgical interventions for robot-assisted radical cystectomy specific complications between 2005 and 2015. Univariable and multivariable logistic regression models were fit to evaluate predictors of surgical intervention after robot-assisted radical cystectomy. Kaplan-Meier curves were used to describe time to surgical interventions. A total of 92 patients (23%) underwent surgical intervention after robot-assisted radical cystectomy. Mean followup was 27 months. Average time to any surgical intervention after cystectomy was 14 months. The reoperation rate was 5%, 2% and 16% at 30, 31 to 90 and greater than 90 days, respectively. Using the Kaplan-Meier method surgical interventions occurred at a rate of 30% at 2 years and 46% at 5 years. Interventions for ureteroileal complications were the most common (48 cases) followed by interventions for bowel obstruction, fistulas and abdominal wall related complications (11 cases). Clavien 3 or greater complications and neoadjuvant chemotherapy were associated with surgical intervention. Even in experienced hands the long-term complications of robot-assisted radical cystectomy are notable. Of our patients 23% required surgical interventions after the procedure. Our initial experience with robot-assisted management of robot-assisted radical cystectomy complications appears safe and feasible, although the decision to proceed is determined primarily by surgeon experience. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  17. Management of Infected Mesh After Abdominal Hernia Repair: Systematic Review and Single-Institution Experience.

    PubMed

    Shubinets, Valeriy; Carney, Martin J; Colen, David L; Mirzabeigi, Michael N; Weissler, Jason M; Lanni, Michael A; Braslow, Benjamin M; Fischer, John P; Kovach, Stephen J

    2017-06-01

    Mesh infection after abdominal hernia repair is a devastating complication that affects general and plastic surgeons alike. The purpose of this study was 3-fold: (1) to determine current evidence for treatment of infected abdominal wall mesh via systematic review of literature, (2) to analyze our single-institution experience with treatment of infected mesh patients, and (3) to establish a framework for how to approach this complex clinical problem. Literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, followed by single-institution retrospective analysis of infected mesh patients. A total of 3565 abstracts and 92 full-text articles were reviewed. For qualitative and quantitative assessment, articles were subdivided on the basis of treatment approach: "conservative management," "excision of mesh with primary closure," "single-stage reconstruction," "immediate staged repair," and "repair in contaminated field." Evidence for each treatment approach is presented. At our institution, most patients (40/43) were treated by excision of infected mesh and single-stage reconstruction with biologic mesh. When the mesh was placed in a retrorectus or underlay fashion, 21.4% rate of hernia recurrence was achieved. Bridged repairs were highly prone to recurrence (88.9%; P = 0.001), but the bridging biologic mesh seemed to maintain domain and potentially contribute to a more effective repair in the future. Of the patients who underwent additional ("secondary") repairs after recurrence, 75% were eventually able to achieve "hernia-free" state. This study reviews the literature and our single-institution experience regarding treatment of infected abdominal wall mesh. Framework is developed for how to approach this complex clinical problem.

  18. The July Effect in Radical Cystectomy: Mortality, Morbidity, and Efficiency

    PubMed Central

    Zuk, Keegan; Jensen, Derek; Gills, Jessie; Wyre, Hadley; Holzbeierlein, Jeffrey M.; Lopez-Corona, Ernesto; Lee, Eugene K.

    2016-01-01

    Background: The “July effect” is the potential effect that new and recently promoted residents have on patient care during the first months of the academic year. Literature suggests that the July effect may worsen patient outcomes and lead to systemic inefficiencies. Objective: We evaluate the July effect on mortality, morbidity, and efficiency outcomes in patients undergoing radical cystectomy. Methods: A chart review was performed in patients who underwent radical cystectomy between January 2008 and April 2012. Demographic information was abstracted from patient charts and outcomes compared between operations performed in July, September, and November (first month of each resident’s university rotation) to the remainder of the year. Outcomes of interest included mortality, complications, and markers of efficiency (operative time, length of hospital stay, and estimated blood loss). Results: Two hundred and fifty one patients were included in the analysis. There were no major differences in mortality or morbidity between the July, September, November group and the rest of the year. Multivariable analysis demonstrates a trend for operations performed in the months of July, September, and November to be associated with longer OR times 2.06 (0.99–4.27), p = 0.053. Length of hospital stay and estimated blood loss were no different between the two groups. Conclusions: These data demonstrate no increase in mortality or morbidity during the early academic period. Additionally, while there is a trend for OR time to be longer in the early group, length of hospital stay and estimated blood loss were no different. These data may be used as an impetus to continue to investigate technical/clinical teaching practices, strategies to assess resident progression, and to initiate protocols to support residents early in the academic year in efforts to prevent inefficiencies. PMID:28035324

  19. The July Effect in Radical Cystectomy: Mortality, Morbidity, and Efficiency.

    PubMed

    Zuk, Keegan; Jensen, Derek; Gills, Jessie; Wyre, Hadley; Holzbeierlein, Jeffrey M; Lopez-Corona, Ernesto; Lee, Eugene K

    2016-10-27

    Background: The "July effect" is the potential effect that new and recently promoted residents have on patient care during the first months of the academic year. Literature suggests that the July effect may worsen patient outcomes and lead to systemic inefficiencies. Objective: We evaluate the July effect on mortality, morbidity, and efficiency outcomes in patients undergoing radical cystectomy. Methods: A chart review was performed in patients who underwent radical cystectomy between January 2008 and April 2012. Demographic information was abstracted from patient charts and outcomes compared between operations performed in July, September, and November (first month of each resident's university rotation) to the remainder of the year. Outcomes of interest included mortality, complications, and markers of efficiency (operative time, length of hospital stay, and estimated blood loss). Results: Two hundred and fifty one patients were included in the analysis. There were no major differences in mortality or morbidity between the July, September, November group and the rest of the year. Multivariable analysis demonstrates a trend for operations performed in the months of July, September, and November to be associated with longer OR times 2.06 (0.99-4.27), p = 0.053. Length of hospital stay and estimated blood loss were no different between the two groups. Conclusions: These data demonstrate no increase in mortality or morbidity during the early academic period. Additionally, while there is a trend for OR time to be longer in the early group, length of hospital stay and estimated blood loss were no different. These data may be used as an impetus to continue to investigate technical/clinical teaching practices, strategies to assess resident progression, and to initiate protocols to support residents early in the academic year in efforts to prevent inefficiencies.

  20. Age-Related Alterations in Regeneration of the Urinary Bladder after Subtotal Cystectomy

    PubMed Central

    Burmeister, David M.; AbouShwareb, Tamer; Bergman, Christopher R.; Andersson, Karl-Erik; Christ, George J.

    2014-01-01

    Prior work documented that surgical removal of approximately 70% of the bladder (subtotal cystectomy) in 12-week-old female rats induced complete functional regeneration of the bladder within 8 weeks. To determine whether animal age affects bladder regeneration, female F344 rats aged 12 weeks (young) and 12 months (old) underwent subtotal cystectomy, and then were evaluated from 1 to 26 weeks after subtotal cystectomy. At 26 weeks after subtotal cystectomy, bladder capacity in young animals was indistinguishable from that in age-matched controls, but bladder capacity in old animals was only approximately 56% of that in age-matched controls. There was no detectable difference in residual volume among treatment groups, but the diminished regeneration in old animals was associated with a corresponding increase in the ratio of residual volume to micturition volume. The majority of old animals exhibited evidence of chronic kidney damage after subtotal cystectomy. Maximal contraction of bladder strips to electrical field stimulation, as well as activation with carbachol, phenylephrine, and KCl, were lower in old than in young animals at 26 weeks after subtotal cystectomy. Immunostaining with proliferating cell nuclear antigen and Von Willebrand factor revealed delayed and/or diminished proliferative and angiogenic responses, respectively, in old animals. These results confirm prior work and suggest that multiple mechanisms may contribute to an age-related decline in the regenerative capacity of the bladder. PMID:24012523

  1. Seizure outcomes of lesionectomy in pediatric lesional epilepsy with brain tumor -- single institute experience.

    PubMed

    Jo, Kyung Il; Shin, Hyung Jin; Hong, Seung-Chyul

    2013-09-01

    To determine the clinical characteristics, surgical strategy, and outcome in pediatric lesional epilepsy patients younger than 5years of age undergoing surgery in a single institute. Retrospective data were collected and analyzed on patients younger than 5years of age who underwent lesionectomy for lesional epilepsy at single institute from January 2001 to August 2010. Fourteen pediatric lesional epilepsy patients were enrolled in this study. Engel classification was used to classify seizure outcome. Median preoperative seizure period was 1month (range, 1-21). Median post-operative follow up period was 35months (range 13-84). Ten patients who underwent gross total resection of tumor showed Engel class Ia seizure outcome without any antiepileptic drug (AED). Subtotal resection was performed in four patients to avoid eloquent area injury. Two of these four patients with subtotal removal became seizure-free (Engel class Ia) without AED, while two were in Engel class Ib with AED medication. There was no significant surgical morbidity or mortality. Lesionectomy in children younger than 5years of age is relatively safe and effective in controlling seizures. Short preoperative seizure periods and total removal of tumor might be associated with good outcome. Therefore, early and complete lesionectomy alone may help allow for seizure freedom and optimal brain development in pediatric patients. Copyright © 2013 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  2. The Use of Transanal Hemorrhoidal Dearterialization for Treatment of Hemorrhoid Disease at a Single Institution.

    PubMed

    Haskins, Ivy N; Holzmacher, Jeremy; Obias, Vincent; Agarwal, Samir

    2016-12-01

    Transanal hemorrhoidal dearterialization (THD) is a relatively new, minimally invasive approach for the treatment of hemorrhoid disease. Despite increasing use of this procedure, there remains scarce United States-based data on the perioperative variables affected by this surgical technique. This article details the experience with THD at a single institution. This is a single-institution study that includes consecutive patients that underwent THD at George Washington University from November 2011 to April 2014. After Institutional Review Board approval, retrospective chart review was performed. Patient demographic information, preoperative management of hemorrhoid disease, and quality of life indicators after THD were collected for all patients. A total of 96 patients underwent THD during the period of investigation. A majority of the patients were male and all patients had grade II or III hemorrhoids. Most patients who underwent THD presented with rectal bleeding. Four patients required postoperative admission to the hospital for pain control, eight patients experienced constipation postoperatively, and one patient had recurrence of their hemorrhoid disease at 30-day follow-up. No patients required admission to the hospital for postoperative hemorrhage and none experienced urinary retention or incontinence of flatus or stool. THD is a feasible alternative to Ferguson hemorrhoidectomy for the surgical treatment of grade II and III hemorrhoidal disease. Future prospective studies are needed to help improve patient selection for each respective surgical approach.

  3. Single port access laparoscopic surgery for large adnexal tumors: Initial 51 cases of a single institute

    PubMed Central

    Cho, Bo Ra; Han, Jae Won; Kim, Tae Hyun; Han, Ae Ra; Hur, Sung Eun; Lee, Sung Ki

    2017-01-01

    Objective Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. Methods We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. Results SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m2, respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. Conclusion Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery. PMID:28217669

  4. Does the presence of significant risk factors affect perioperative outcomes after robot-assisted radical cystectomy?

    PubMed

    Butt, Zubair M; Fazili, Anees; Tan, Wei; Wilding, Gregory E; Filadora, Victor; Kim, Hyung L; Mohler, James L; O'Leary, Kathleen A; Guru, Khurshid A

    2009-10-01

    To evaluate the effect of preoperative risk factors on perioperative outcomes up to 3 months after robot-assisted radical cystectomy (RARC), as RC continues to be associated with a high rate of morbidity and mortality. From 2005 to 2007, 66 consecutive patients had RARC at Roswell Park Cancer Institute. Patient demographics, preoperative risk factors and complications up to 3 months after RARC were reviewed from a prospective quality-assurance database. Patients were stratified into high- and low risk groups based on age, previous abdominal surgery, chronic obstructive pulmonary disease (COPD), body mass index (BMI), Revised Cardiac Risk Index (RCRI) and American Society of Anesthesiologists (ASA) score. Age, previous abdominal surgery, COPD, BMI, RCRI score and ASA score did not significantly influence complications during or up to 3 months following RARC (P > 0.05). Advanced age was associated with a higher RCRI score (P = 0.014) and an increased likelihood of admission to the Intensive Care Unit (P = 0.007). A higher ASA score was associated with an increased overall hospital stay (P = 0.039). Previous abdominal surgery was associated with more frequent unscheduled postoperative clinic visits (P = 0.014). Operative duration did not significantly influence complication rates (P > 0.05). Fifteen of 62 patients (24%) had a major complication, while 15 (24%) had minor complications within 3 months of surgery. The reoperation rate was 11% and the overall mortality rate was 1.6%. RARC appears to be well tolerated, independent of comorbid risk factors such as age, BMI, RCRI and ASA score.

  5. Subadventitial cystectomy in the management of biliary fistula with liver hydatid disease.

    PubMed

    Lv, Hailong; Jiang, Yufeng; Peng, Xinyu; Zhang, Shijie; Wu, Xiangwei; Yang, Hongqiang; Zhang, Hongwei

    2015-01-01

    Biliary fistulas are the most common morbidity (8.2-26%) following hydatid liver surgery. The aim of this study was to evaluate the results of subadventitial cystectomy in the treatment of liver hydatid cyst associated with a biliocystic fistula. The medical records of 153 patients who underwent subadventitial cystectomy for a liver hydatid cyst between January 2006 and December 2010 were retrospectively reviewed. Cysts were located in the right lobe anterior segment 37 (24.2%) patients, right lobe posterior segment 59 (38.6%) patients, the left lobe in 26 (17.0%) patients, and both lobes in 6 (3.9%) patients. The surgical procedures performed were closed (non-incised) subadventitial total cystectomy in 74 patients (48.4%), open (incised) subadventitial total cystectomy in 30 patients (19.6%), and subadventitial subtotal cystectomy in 49 patients (32.0%). Biliocystic communication was found in 52 patients (34.0%), and 21 patients (13.7%) were treated with T-tube drainage. Two patients had performed biliodigestive anastomosis. Biliary fistula was detected in 9 patients after subtotal subadventitial cystectomy. Biliary fistulas closed spontaneously within 10 days and 61 days respectively and the amount of drainage varying between 50 and 400ml after the procedure. Postoperative complication and recurrence rates were 19.0% and 0.7%, respectively. The mortality rate was 0%. Subadventitial cystectomy should be the surgical treatment of choice for this disease because of its feasibility and low rates of recurrence, complications of the residual cavity, and incidence of associated biliary fistula.

  6. Feasibility of radical cystectomy in exclusive spinal and/or epidural anaesthesia.

    PubMed

    Karl, A; Schneevoigt, B; Weninger, E; Grimm, T; Stief, C

    2013-10-01

    Muscle invasive bladder cancer can be found predominantly in elderly people with a high likelihood of suffering from concomitant diseases; especially in these patients, the risks associated with general anaesthesia during radical cystectomy can be the limiting factor of performing an otherwise indicated radical operation. To overcome this limitation, we analysed the feasibility of performing radical cystectomy in exclusive spinal and/or epidural anaesthesia. Between March and June 2010, nine patients underwent radical cystectomy in exclusive spinal and/or epidural anaesthesia. These patients were either not willing or unfit to undergo radical cystectomy in general anaesthesia. A continent urinary diversion (ileum neobladder) and an ileum-conduit were performed in five patients and four patients, respectively. The feasibility of radical cystectomy in regional anaesthesia was tested using a variety of parameters. All nine procedures could be performed under strict regional anaesthesia. Mean operation time was 206 min (range 146-265 min), mean intraoperative blood loss was 622 ml (range 200-1,500 ml), mean postoperative time at intermediate care was 1 day (range 0-3 days) and mean length of hospital stay was 21.8 days (range 17-26 days). Analgesics of the WHO class I, II and III were applied for 5.7, 1.2 and 2.8 days mean, respectively. Performance of radical cystectomy in exclusive spinal and/or epidural anaesthesia is feasible and can be considered particularly in those patients who would be otherwise unfit to undergo radical cystectomy in general anaesthesia. This new operative and anaesthesiological concept could also play an important role in new fast track regimens.

  7. Comparison of postoperative acute kidney injury between ileal conduit and neobladder urinary diversions after radical cystectomy

    PubMed Central

    Joung, Kyoung-Woon; Kong, Yu-Gyeong; Yoon, Syn-Hae; Kim, Yeon Ju; Hwang, Jai-Hyun; Hong, Bumsik; Kim, Young-Kug

    2016-01-01

    Abstract Ileal conduit and neobladder urinary diversions are frequently performed after radical cystectomy. However, complications after radical cystectomy may be different according to the type of urinary diversion. Acute kidney injury (AKI) is a common complication after surgery and increases costs, morbidity, and mortality of hospitalized patients. This study was performed to compare the incidence of postoperative AKI between ileal conduit and neobladder urinary diversions after radical cystectomy. All consecutive patients who underwent radical cystectomy in 2004 to 2014 in a single tertiary care center were identified. The patients were divided into the ileal conduit and ileal neobladder groups. Preoperative variables, including demographics, cancer-related data and laboratory values, as well as intraoperative data and postoperative outcomes, including AKI, intensive care unit admission rate, and the duration of hospital stay, were evaluated between the groups. Postoperative AKI was defined according to the Kidney Disease: Improving Global Outcome criteria. Propensity score matching analysis was performed to reduce the influence of possible confounding variables and adjust for intergroup differences. After performing 1:1 propensity score matching, the ileal conduit and ileal neobladder groups each included 101 patients. The overall incidence of AKI after radical cystectomy was 30.7% (62 out of 202) and the incidences did not significantly differ between the groups (27 [26.7%], ileal conduit group vs 35 [34.7%], ileal neobladder group, P = 0.268). Intraoperative data, intensive care unit admission rate, and the duration of hospital stay were not significantly different between the groups. Postoperative AKI did not significantly differ between ileal conduit and neobladder urinary diversions after radical cystectomy. This finding provides additional information useful for appropriate selection of the urinary diversion type in conjunction with radical cystectomy

  8. The role of cystectomy in elderly patients - a multicentre analysis.

    PubMed

    Izquierdo, Laura; Peri, Lluis; Leon, Priscila; Ramírez-Backhaus, Miguel; Manning, Thomas; Alcaraz, Antonio; Roupret, Morgan; Solsona, Eduardo; Rubio, Jose; Sengupta, Shomik; Chan, Yee; Liodakis, Peter; Gyomber, Dennis; Bolton, Damien; Lawrentschuk, Nathan

    2015-10-01

    Life expectancy in developed countries is continuously increasing. Hence elderly patients are becoming more common in our clinical practice. Currently, one of the greatest challenges of medicine is balancing the life expectancy of elderly patients against aggressive treatments that carry significant risks. To outline the complications and survival in surgical patients 80 years and over undergoing radical cystectomy for bladder cancer. A review of a radical cystectomy in elderly recorded in four different institutional prospective databases during the period between 1991 and 2014. Clinical and pathologic features, complications and survival were evaluated. A total of 111 patients were available. Median (range) age 82.2 (80-89) years. Seventeen women and 94 men. Regarding the ASA score, 6 patients were ASA I, 47 patients were ASA II, 49 patients ASA III and 9 ASA IV. Prior to surgery, 48 patients had hydronephrosis. The median (range) creatinine series was 1.1 (0.71-11.1) ng/dL. In 88 cases an ileal conduit was performed, 17 a cutaneous ureterostomy diversion, 5 neobladders and 1 ureterosigmoidostomy case. The median (range) operative time was 230 (120-420) min and a total of 97 patients required blood transfusion. The median (range) hospital stay was 14 (7-126) days. The early and late complication rates were 50.4% and 32%, respectively. A total of 14 patients (12.6%) required surgical reintervention. Eight patients (7.2%) died in the immediate postoperative period. The readmission rate of the series was 27.2%. The mean follow-up of the series was 18 (0.27-134.73) months. During this period 66 patients died, 52 of them due to the tumor. Twelve month tumour progression free survival was 83.9% for ≤pT1, 70.2% for pT2 and 36% for ≥pT3, respectively. Twelve month cancer specific survival was 85.6% for ≤pT1, 75.1% for pT2 and 42.5% for ≥pT3, respectively. Radical cystectomy in elderly population is an aggressive surgical treatment with a significant

  9. Helicobacter pylori infection and thrombocytopenia: a single-institution experience in Mexico.

    PubMed

    Estrada-Gómez, Roberto A; Parra-Ortega, Israel; Martínez-Barreda, Carlos; Ruiz-Argüelles, Guillermo J

    2007-01-01

    The association between gastrointestinal H. pylori infection and thrombocytopenia was studied in a single institution in Mexico, over a 5-year period. In 99 individuals with H. pylori infection, the prevalence of thrombocytopenia was 14%, whereas in 23 consecutive patients with chronic refractory thrombocytopenic purpura, the prevalence of H. pylori infection was 60%, this figure being similar to that informed in the general population of Mexico (66%); the association between thrombocytopenia and H. pylori infection was not significant. In 14 patients who were found to have both thrombocytopenia and H. pylori infection, eradication treatment was given and the platelet count recovered in three. It is not still clear if detection of H. pylori infection should be routinely included in the initial workup of chronic thrombocytopenia.

  10. Myeloablative therapy against high risk Ewing's sarcoma: A single institution experience and literature review

    PubMed Central

    Lopez, Jose Luis; Pérez, Concepcion; Marquez, Catalina; Cabrera, Patricia; Perez, Jose Maria; Ramirez, Gema Lucia; Ordoñez, Rafael; Praena-Fernandez, Juan Manuel; Ortiz, Maria Jose

    2011-01-01

    Background Attempts to improve survival outcomes of patients with high risk Ewing's sarcoma (ES) have focused on chemotherapy dose intensification strategies. Aim The objective of this study is to retrospectively evaluate clinical characteristics and outcome of pediatric patients with high risk ES treated at a single institution. Materials and methods From 1995 to 2008, seventeen patients (male:female, 14:3) were treated with dose-intensive therapy in our institution. Median age at diagnosis was 10 years (range: 2–15). Seven patients had metastases at diagnosis (lung in 6 cases and bone in one case). Eleven patients presented with unresectable disease. Fifteen (88.2%) received the Spanish Society of Pediatric Oncology protocol which includes six cycles of vincristine, doxorubicin, ifosfamide and etoposide. Two out of the six cases that were resectable received postoperative radiation. In addition, eleven patients received definitive radiation therapy. Finally, twelve (70.5%) out of 17 patients received myeloablative therapy with melphalan/etoposide. The rest of patients (N = 5) received busulfan/melphalan. Results Median follow-up was 78 months (range: 15–155 months). Initial responses were complete in all patients, but 9 of them developed progression disease. Seven patients became long-term event-free survivors. No patient died of toxicity after transplantation. The 2- and 5-year overall survival rates for all patients were 93% and 73%, respectively. Event-free survival rates were 74% and 54% at 2 and 5 years, respectively. Conclusion This single-institution experience suggests that myeloablative therapy against high risk ES is effective and safe. PMID:24376974

  11. Myeloablative therapy against high risk Ewing's sarcoma: A single institution experience and literature review.

    PubMed

    Lopez, Jose Luis; Pérez, Concepcion; Marquez, Catalina; Cabrera, Patricia; Perez, Jose Maria; Ramirez, Gema Lucia; Ordoñez, Rafael; Praena-Fernandez, Juan Manuel; Ortiz, Maria Jose

    2011-05-20

    Attempts to improve survival outcomes of patients with high risk Ewing's sarcoma (ES) have focused on chemotherapy dose intensification strategies. The objective of this study is to retrospectively evaluate clinical characteristics and outcome of pediatric patients with high risk ES treated at a single institution. From 1995 to 2008, seventeen patients (male:female, 14:3) were treated with dose-intensive therapy in our institution. Median age at diagnosis was 10 years (range: 2-15). Seven patients had metastases at diagnosis (lung in 6 cases and bone in one case). Eleven patients presented with unresectable disease. Fifteen (88.2%) received the Spanish Society of Pediatric Oncology protocol which includes six cycles of vincristine, doxorubicin, ifosfamide and etoposide. Two out of the six cases that were resectable received postoperative radiation. In addition, eleven patients received definitive radiation therapy. Finally, twelve (70.5%) out of 17 patients received myeloablative therapy with melphalan/etoposide. The rest of patients (N = 5) received busulfan/melphalan. Median follow-up was 78 months (range: 15-155 months). Initial responses were complete in all patients, but 9 of them developed progression disease. Seven patients became long-term event-free survivors. No patient died of toxicity after transplantation. The 2- and 5-year overall survival rates for all patients were 93% and 73%, respectively. Event-free survival rates were 74% and 54% at 2 and 5 years, respectively. This single-institution experience suggests that myeloablative therapy against high risk ES is effective and safe.

  12. [Radical cystectomy as a muscle-invasive bladder cancer treatment in elderly patients].

    PubMed

    March Villalba, J A; Martínez Jabaloyas, J M; Pastor Hernández, F; Günthner Stefan, F J; Rodríguez Navarro, R; Chuan Nuez, P

    2008-01-01

    Radical cystectomy in elderly is a controversial issue that increases importance overtime because average life span is growing. The purpose of our work was to analize the differences about perioperative and later outcomes between ages of patients with muscle-invasive bladder neoplasm treated with radical cystectomy. We retrospectively reviewed the records of patients who underwent radical cystectomy for muscle-invasive bladder cancer. Two age groups were compared: < 70-years-old at time of cystectomy (n = 55) and > or = 70 years (n = 57). There was no difference between both age groups about: time of surgery, intraoperative complications (< 70 = 21,8%, > or = 70 = 31,6%), postoperative mortality (< 70 = 3,6%, > or = 70 = 8,8%), minor (< 70 = 18,2%, > or = 70 = 26,3%) and major medical postoperative complications (< 70 = 7,3%, > or = 70 = 8,8%), late outcomes as cancer-specific morby-mortality and actuarial overall survival stratified by patient age. The rate of major postoperative complications (< 70 = 23,6%, > or = 70 = 43,9%) as well as the mean length of hospital stay (< 70 = 10,2, > or = 70 = 15,2 days) differed significantly between the two age groups. Age and cardiovascular risk factors were independient predictive factors of mayor postoperative complications. Radical cystectomy could be performed in carefully selected elderly patients.

  13. Venous thromboembolism after radical cystectomy: Experience with screening ultrasonography

    PubMed Central

    Murray, Katie M.; Parker, William; Stephany, Heidi; Redger, Kirk; Mirza, Moben; Lopez-Corona, Ernesto; Holzbeierlein, Jeffrey M.; Lee, Eugene K.

    2015-01-01

    Objectives To detect the incidence of immediate postoperative deep vein thrombosis (DVT) using screening lower extremity ultrasonography (US) in patients undergoing radical cystectomy (RC) and to determine the rate of symptomatic pulmonary embolism (PE) after RC and identify risk factors for venous thromboembolic (VTE) events in a RC population. Patients and methods We performed a retrospective review of prospective data collected on patients who underwent RC between July 2008 and January 2012. These patients underwent screening US at 2/3 days after RC to determine the rate of asymptomatic DVT. A chart review was completed to identify those who had a symptomatic PE. Univariate and multivariable analysis was used to identify risk factors associated with DVT, PE and total VTE events. Results In all, 221 patients underwent RC and asymptomatic DVT was identified in 21 (9.5%) on screening US. Nine (4.5%) developed symptomatic PE at a median of 9 days, of which no patients had positive lower extremity US postoperatively. Increased length of hospital stay, increased estimated blood loss, and lower body mass index were linked to risk of PE, and only a previous history of DVT was associated with postoperative DVT. Conclusion Patients who undergo RC are at high-risk for thromboembolic events and multimodal prophylaxis should be administered. Clinicians should be especially vigilant in those who demonstrate factors associated with higher risk for VTE events. PMID:26966592

  14. A comparative study of two preoperative radiation regimens with cystectomy for bladder cancer.

    PubMed

    Whitmore, W F; Batata, M A; Hilaris, B S; Reddy, G N; Unal, A; Ghoneim, M A; Grabstald, H; Chu, F

    1977-09-01

    This report surveys the results of two programs of preoperative irradiation with radical cystectomy for bladder cancer in 205 patients. Irradiating the true pelvis to 4000 rads in 4 weeks with radical cystectomy after 6 weeks was implemented in 119 patients (Group 1) from 1959 to 1965; 2000 rads given in 1 week to the true pelvis and radical cystectomy within the following week was implemented in 86 patients (Group 2) from 1966 to 1970. Determinate survival without evidence of recurrence at 5 years was 43% in Group 1 and 42% in Group 2. Mortality with recurrence of bladder cancer in 5 or more years was 44% in group 1 and 42% in group 2. Pelvic complications occurred in 13% of group 1 and 9% of group 2.

  15. The Impact of Health Literacy and Clinicodemographic Factors on Use of Discharge Services after Radical Cystectomy.

    PubMed

    Kappa, Stephen F; Scarpato, Kristen R; Goggins, Kathryn M; Kripalani, Sunil; Moses, Kelvin A

    2017-09-01

    There are few data on the relationship between health literacy and discharge disposition. We hypothesized that patient discharge needs after radical cystectomy are affected by health literacy. We identified 504 patients who underwent radical cystectomy and completed the validated BHLS (Brief Health Literacy Screen) after November 2010. Bivariate and logistic regression analyses were performed to determine whether health literacy is associated with the use of discharge resources after radical cystectomy. Of patients treated with radical cystectomy 50.6% required discharge services and had lower health literacy (BHLS 11.9 vs 12.5, p = 0.016) than patients discharged home without services. On multivariable analysis older age (OR 1.1, 95% CI 1.0-1.1, p = 0.002), female gender (OR 2.3, 95% CI 1.2-4.4, p = 0.019), body mass index (OR 1.1, 95% CI 1.0-1.1, p = 0.034), Charlson comorbidity index score (OR 1.1, 95% CI 1.0-1.2, p = 0.037) and length of stay (OR 1.1, 95% CI 1.0-1.2, p = 0.019) were significantly associated with the use of discharge resources. Patients with continent vs incontinent urinary diversion were less likely to require discharge services (OR 0.4, 95% CI 0.2-0.8, p = 0.013). Older age, female gender, body mass index, comorbidities, length of stay and incontinent diversion are associated with increased use of discharge resources after radical cystectomy. Low health literacy may affect patient discharge disposition but it was not significant on multivariable analysis. Factors that influence the complex self-care required of patients after cystectomy should be considered during discharge planning. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  16. Morbidity and mortality of octogenarians following open radical cystectomy using a standardized reporting system.

    PubMed

    Berneking, Adam D; Rosevear, Henry M; Askeland, Eric J; Newton, Mark R; O'Donnell, Michael A; Brown, James A

    2013-08-01

    Recent evidence suggests that radical cystectomy may be underutilized in elderly patients, despite literature supporting acceptable morbidity/mortality in this population. However, there is a paucity of literature reporting complications in a standardized manner. Therefore, we evaluated the morbidity and mortality of octogenarians treated with radical cystectomy using the modified Clavien complication reporting system. We retrospectively reviewed 443 consecutive patients undergoing radical cystectomy at our institution between January 2000 and April 2010. Patients who underwent cystectomy for benign conditions were excluded, leaving 359 for analysis. Baseline demographic and perioperative data were reviewed and all complications were graded. We compared the outcomes of our octogenarian population (n = 43) against our younger population (n = 316). There was no difference between octogenarians and the younger cohort for overall complication rates (86% versus 83%, p = 0.91), or major (33% versus 30%, p = 0.93) or minor (81% versus 80%, p = 0.91) complications. The younger group was more likely to encounter a late complication (41.5% versus 23.3%, p = 0.03). Those 80 years and older trended toward more intraoperative complications (21% versus 10%, p = 0.07). The older group also had a greater propensity for neurological complications (26% versus 11%, p = 0.02), but there was no difference in CVA (2% versus 3%, p = 0.22). There was no difference in mortality rates between the older and younger cohort (2.3% versus 0.9%, p = 0.95). Radical cystectomy is a morbid procedure regardless of patient age. Age alone should not preclude radical cystectomy in the elderly.

  17. QUALITY OF CARE IN BLADDER CANCER: TRENDS IN URINARY DIVERSION FOLLOWING RADICAL CYSTECTOMY

    PubMed Central

    Gore, John L.; Litwin, Mark S.

    2009-01-01

    Objective Quality-of-care indicators have not yet been defined for patients with bladder cancer. Nonetheless, certain aspects of bladder cancer care can be evaluated to quantify the quality of care delivered. We sought to determine trends in continent urinary diversion to evaluate the adoption of this more optimal reconstruction. Methods Subjects who underwent radical cystectomy for a primary diagnosis of bladder cancer were identified from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. We identified covariates independently associated with utilization of continent urinary diversion after radical cystectomy using multivariate logistic regression modeling. We then examined trends in diversion type based on patient and hospital characteristics and examined the impact of hospital volume on use of continent reconstruction. Results Our weighted sample included 5,075 subjects (14.3%) who underwent continent urinary diversion and 30,295 subjects (85.7%) who underwent an ileal conduit. Independent correlates of continent diversion included younger age, male gender, having private insurance, and undergoing surgery at an urban teaching hospital. Hospitals performing continent diversions on more than 40% of their cystectomies had a yearly cystectomy volume of 0.8 surgeries. Subjects treated at high-volume hospitals trended toward lower rates of comorbid conditions. Conclusions We identified substantial disparities in continent diversion which, based on yearly trends, are unlikely to improve in the near future. Continent reconstructions are not the exclusive domain of high-volume cystectomy centers. Yet efforts to increase rates of this complex reconstruction must concentrate on technique dissemination and better definition of the quality-of-life detriments incurred by cystectomy patients. PMID:19020881

  18. Readability of patient education materials in ophthalmology: a single-institution study and systematic review.

    PubMed

    Williams, Andrew M; Muir, Kelly W; Rosdahl, Jullia A

    2016-08-03

    Patient education materials should be written at a level that is understandable for patients with low health literacy. The aims of this study are (1) to review the literature on readability of ophthalmic patient education materials and (2) to evaluate and revise our institution's patient education materials about glaucoma using evidence-based guidelines on writing for patients with low health literacy. A systematic search was conducted on the PubMed/MEDLINE database for studies that have evaluated readability level of ophthalmic patient education materials, and the reported readability scores were assessed. Additionally, we collected evidence-based guidelines for writing easy-to-read patient education materials, and these recommendations were applied to revise 12 patient education handouts on various glaucoma topics at our institution. Readability measures, including Flesch-Kincaid Grade Level (FKGL), and word count were calculated for the original and revised documents. The original and revised versions of the handouts were then scored in random order by two glaucoma specialists using the Suitability Assessment of Materials (SAM) instrument, a grading scale used to evaluate suitability of health information materials for patients. Paired t test was used to analyze changes in readability measures, word count, and SAM score between original and revised handouts. Finally, five glaucoma patients were interviewed to discuss the revised materials, and patient feedback was analyzed qualitatively. Our literature search included 13 studies that evaluated a total of 950 educational materials. Among the mean FKGL readability scores reported in these studies, the median was 11 (representing an eleventh-grade reading level). At our institution, handouts' readability averaged a tenth-grade reading level (FKGL = 10.0 ± 1.6), but revising the handouts improved their readability to a sixth-grade reading level (FKGL = 6.4 ± 1.2) (p < 0.001). Additionally, the

  19. Effects of thyroid cystectomy for primary hyperparathyroidism on immune function

    PubMed Central

    Yin, Xiangdang; Hu, Liang; Wang, Xiaochun

    2016-01-01

    Objective: To evaluate the effects of thyroid cystectomy for primary hyperparathyroidism on immune function. Methods: Ninety-two patients with parathyroid cysts complicated with primary hyperparathyroidism were randomly divided into a treatment group and a control group (n=46). The treatment group received endoscopic thyroidectomy through the anterior chest wall via the areolar approach, and the control group was treated with conventional open thyroidectomy. Results: The two groups had similar immune function indices as well as thyroid hormone, serum calcium and phosphorus levels before surgery (P>0.05). After surgery, FT3 and FT4 levels significantly increased in both groups, whereas that of TSH significantly decreased (P<0.05). The levels of the two groups differed significantly on the postoperative 5th day (P<0.05). NK%, CD3+%, CD4+% and CD8+%, which significantly fluctuated on the postoperative 1st day in both groups (P<0.05), were basically recovered on the postoperative 5th day in the treatment group that had significantly different outcomes from those of the control group (P<0.05). On the postoperative 1st and 5th days, the treatment group had significantly lower serum calcium level and significantly higher serum phosphorus level than those of the control group (P<0.05). The surgeries were successfully performed for all patients. During three months of follow-up, the treatment group was significantly less prone to complications such as surgical site infection, recurrent laryngeal nerve injury, parathyroid crisis and hoarseness than the control group (P<0.05). Conclusion: For treatment of primary hyperparathyroidism, endoscopic thyroidectomy through the anterior chest wall via the areolar approach decreased the incidence rate of complications, as well as promoted the recovery of serum calcium and phosphorous levels, probably by only mildly affecting immune function and thyroid hormone levels. PMID:27022378

  20. Alvimopan in an Enhanced Recovery Program Following Radical Cystectomy

    PubMed Central

    Hamilton, Zach; Parker, Will; Griffin, Josh; Isaacson, Tanner; Mirza, Moben; Wyre, Hadley; Holzbeierlein, Jeffrey; Lee, Eugene K.

    2015-01-01

    Abstract Background: Radical cystectomy (RC) carries a high complication rate, including post-operative ileus. Alvimopan is an FDA approved peripherally acting μ-opioid receptor antagonist that has shown favorable results for improved recovery of gastro-intestinal function resulting in decreased hospital length of stay. Many enhanced recovery pathways (ERP) have been published demonstrating improved outcomes with decreased hospital stay and morbidity. Objective: We evaluated the addition of alvimopan to an ERP in patients undergoing RC. Methods: Patients undergoing RC at our institution during the implementation phase of alvimopan to our established ERP were retrospectively reviewed. Effect of alvimopan as it related to the use of nasogastric tubes, time to initiation of regular diet, and length of hospital stay was assessed using Chi-squared and Student’s T-tests. Linear regression was performed for univariate analysis and binary logistic regression was performed as a multivariate assessment of the effect of alvimopan. Results: Between July 2011 and January 2013, 80 patients were identified who underwent RC under the ERP (34 alvimopan and 46 standard care). Age, sex, neoadjuvant chemotherapy, surgical technique (open vs. robotic), and type of urinary diversion were not different between groups. Alvimopan was associated with a reduction in mean time to regular diet (5.3 vs 4.1 days, p <  0.01) and a reduction in mean length of hospital stay (6.9 vs 5.7 days, p = 0.01). After controlling for other variables, alvimopan usage predicted for shorter time to regular diet and total hospital stay. Conclusions: Alvimopan may help to improve time to regular diet and decrease hospital stay in patients on an enhanced recovery pathway. PMID:27398398

  1. Use of Cystoscopic Tattooing in Laparoscopic Partial Cystectomy

    PubMed Central

    Kim, Bong Ki; Song, Mi Ho; Yang, Hee Jo; Kim, Doo Sang; Lee, Nam Kyu

    2012-01-01

    Purpose During laparoscopic partial cystectomy (LPC), lesion identification is essential to help to determine the appropriate bladder incisions required to maintain adequate resection margins. The inability to use tactile senses makes it difficult for surgeons to locate lesions during laparoscopic surgery. Endoscopic India ink marking techniques are often used in laparoscopic gastroenterological surgery. We present our experience with performing LPC with India ink during the surgical resection of various bladder lesions. Materials and Methods LPC with cystoscopic fine needle tattooing was performed on 10 patients at our institute. Tattooing was performed at 1- to 2-cm intervals approximately 1 cm away from the outer margin of the lesion with enough depth (the deep muscle layer) under cystoscopic guidance. LPC was performed by the transperitoneal approach. The clinical courses and pathologic results were analyzed. Results All LPC with cystoscopic tattooing cases were performed successfully. The mean patient age was 39.1 years. The mean operative time was 130.5 minutes, and the mean estimated blood loss was 93 ml. The mean hospital stay was 13.1 days, and the mean duration of indwelling Foley catheterization was 10.7 days. There were no significant intraoperative or postoperative complications except 1 case of delayed urinary leak and 1 case of delayed wound healing. The pathological diagnosis included 1 urachal cancer, 1 urachal remnant, 4 urachal cysts, 2 pheochromocytomas, and 2 inflammatory masses. All specimens showed adequate surgical margins. Conclusions Cystoscopic tattooing in LPC is a simple and effective technique to assist in locating pathological bladder lesions intraoperatively. This technique can help to determine appropriate resection margins during LPC without incurring additional complicated procedures. PMID:22741048

  2. Tumors of the foot and ankle: a single-institution experience.

    PubMed

    Azevedo, Cristina P; Casanova, José M; Guerra, Marta G; Santos, António L; Portela, Maria I; Tavares, Paulo F

    2013-01-01

    Tumors of the foot and ankle are rare, and the particular clinicopathologic features, therapeutic approach, and outcomes in this setting are not well established. From January 2000 to December 2010, 72 patients with primary musculoskeletal tumors of the foot and ankle, both benign and malignant, were treated at a single institution. Of the 72 patients, 56% were female. The median age was 52 years. Of the 72 tumors, 62 (86.11%) were located in the foot and 10 were located in the ankle; 63 (87.5%) were soft tissue tumors and 9 (12.5%) were bone tumors. Overall, 56 (78%) were benign tumors and 16 (22%) were malignant tumors. The most frequent soft tissue and bone diagnosis was giant cell tumor. The median follow-up period was 49 months. The vast majority of the tumors were located in the foot. Benign tumors were dominant, outnumbering malignant tumors by more than 3 to 1. The diversity of the histologic benign types was evident, with giant cell tumor, angiomyoma, and lipoma the most frequent. Regarding the malignant tumors, a clear male predominance was present, the median age was 45 years, and the most frequent tumor was synoviosarcoma. The 9-year overall and disease-free survival rate was 65% and 40%, respectively.

  3. Surgical and endovascular treatment of visceral arteries aneurysms: single-institution experience.

    PubMed

    Dalainas, Ilias; Nano, Giovanni; Casana, Renato; Bianchi, Paolo; Stegher, Silvia; Malacrida, Giovanni; Tealdi, Domenico G

    2006-01-01

    Through a retrospective single-Institution study we report our experience on the treatment of the visceral arteries aneurysms, surgical or endovascular. Between February 1993 and February 2003, 17 patients were admitted to our Institution for treatment of an aneurysm of a visceral artery. In the pre-endovascular period for our Institution (1993-1998), 9 patients have been treated surgically. In the second period (1998-2003), 4 patients were treated surgically; and 4 with an endovascular procedure. Only 1 patient died in the operating room because of the advanced hypovolemic shock (rupture pancreatoduodenal artery aneurysm) that was admitted to the Institution. She was one of the surgically treated patients of the second period. No other complications occurred in the other patients. The endovascular procedures had favorable outcome. Actually, the treatment of choice in our Department is interventistic, preferring endovascular treatment when the clinical and anatomo-morphological conditions are favorable. When the morphologic conditions are not favorable, the surgical reconstruction should respect as much as possible the anatomic location of the lesion.

  4. Thyroid surgery at Children's Hospital Boston: a 35-year single-institution experience.

    PubMed

    Scholz, Stefan; Smith, Jessica R; Chaignaud, Beverly; Shamberger, Robert C; Huang, Stephen A

    2011-03-01

    Thyroidectomy is the primary therapy for thyroid cancer and an established treatment of hyperthyroidism. Because of the relative rarity of these conditions in childhood, few single-institution series exist in the pediatric literature. Here we analyze our institution's experience to assess patient demographics, operative risks, and the role of preoperative testing. This is a retrospective chart review of 175 consecutive patients not older than 18 years who underwent thyroid surgery at Children's Hospital Boston from 1970 to 2004. The most common indication for thyroidectomy was thyroid nodules (83%), followed by hyperthyroidism (7%) and goiter (7%). For children referred for nodules, we observed a peak incidence in adolescence and a female to male ratio of 3.7:1. Cancer was found in 36%, with papillary thyroid cancer the most common subtype (85%). Operative complications were rare, with permanent hypocalcemia in 2 (4.7%) of 43 patients who underwent bilateral resection for thyroid nodules (no cases of permanent hypocalcemia in other procedures). Permanent unilateral vocal cord paralysis was documented in 2 children after the resection of malignant nodules. Pediatric thyroidectomy can be performed with low operative risk. Because permanent hypocalcemia remains an obligate risk of bilateral thyroidectomy, we recommend the routine use of preoperative fine-needle aspiration to guide the extent of initial surgical resection, reserving near-total thyroidectomy for those cases where cytology is positive for malignancy. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Malignant tumors associated with ovarian mature teratoma: A single institution experience.

    PubMed

    Trabzonlu, Levent; Durmaz, Guray; Vural, Cigdem; Muezzinoglu, Bahar; Corakci, Aydin

    2017-05-01

    The aims of this study are to present demographical features of cases diagnosed with malignant tumor associated with ovarian mature teratoma and to analyze histopathological features and clinical follow up of these tumors. Single-institution retrospective charts were reviewed to identify all cases of ovarian mature teratoma diagnosed from 1998 to 2015. Clinicopathological parameters that were analyzed include age, tumor size, tumor stage, histological type, laterality, IOC diagnosis and whether or not patient has received adjuvant chemotherapy. A total of 218 ovarian mature teratoma cases were identified during the study period. Of the 218 ovarian mature teratoma specimens, eight (3.7%) exhibited malignant tumors. The average age for cases of malignancy associated with ovarian mature teratoma was 44.6 years. The average size of tumors was 10.36cm. On final pathology, histological types of tumors were as follows: two cases each of squamous cell carcinoma and papillary thyroid carcinoma; one case each of mucinous adenocarcinoma, metastatic adenocarcinoma, sebaceous carcinoma and oligodendroglioma. Only one patient with Stage IIB tumor died of disease. One patient was alive with metastatic disease two months after initial diagnosis. Mean and median follow-up times were 64.1 and 49 months, respectively. An ovarian mass that has characteristics of a teratoma in a postmenopausal patient should alert for malignancy -regardless of tumor size. IOC is a valuable tool for the detection of malignancy and should be requested to determine the modality of surgical approach. Copyright © 2017 Elsevier GmbH. All rights reserved.

  6. Nonintubated thoracoscopic lung resection: a 3-year experience with 285 cases in a single institution

    PubMed Central

    Chen, Ke-Cheng; Cheng, Ya-Jung; Hung, Ming-Hui; Tseng, Yu-Ding

    2012-01-01

    Objective Tracheal intubation with one-lung ventilation is considered mandatory for thoracoscopic surgery. This study reported the experience of thoracoscopic lung resection without endotracheal intubation in a single institution. Methods From August 2009 through July 2012, 285 consecutive patients were treated by nonintubated thoracoscopic surgery using epidural anesthesia, intrathoracic vagal blockade, and sedation for lobectomy, segmentectomy, or wedge resection in a tertiary medical center. The feasibility and safety of this technique were evaluated. Results The final diagnosis for surgery were primary lung cancer in 159 patients (55.8%), metastatic lung cancer in 17 (6.0%), benign lung tumor in 104 (36.5%), and pneumothorax in 5 (1.8%). The operative methods consisted of conventional (83.2%) and needlescopic (16.8%) thoracoscopic surgery. The operative procedures included lobectomy in 137 patients (48.1%), wedge resection in 132 (46.3%), and segmentectomy in 16 (5.6%). Collapse of the operative lung and inhibition of coughing were satisfactory in most of the patients. Fourteen (4.9%) patients required conversion to tracheal intubation because of significant mediastinal movement [5], persistent hypoxemia [2], dense pleural adhesions [2], ineffective epidural anesthesia [2], bleeding [2], and tachypnea [1]. One patient (0.4%) was converted to thoracotomy because of bleeding. No mortality was noted in our patients. Conclusions Nonintubated thoracoscopic lung resection is technically feasible and safe in selected patients. It can be a valid alternative in managing patients with pulmonary lesions. PMID:22934136

  7. Primary pulmonary carcinoid tumor: a long-term single institution experience/Primary pulmonary carcinoid tumor

    PubMed Central

    Herde, Ryan F.; Kokeny, Kristine E.; Reddy, Chakravarthy B.; Akerley, Wallace L.; Hu, Nan; Boltax, Jonathan P.; Hitchcock, Ying J.

    2015-01-01

    Objectives Primary carcinoid tumors of the lung are rare tumors which comprise approximately 0.5 to 5% of all lung malignancies in adults and roughly 20 to 30% of all carcinoid tumors. The purpose of this retrospective, descriptive study was to describe the incidence, characteristics, and outcomes of patients treated for primary pulmonary carcinoid tumor at a single institution. Methods All patients with a diagnosis of primary pulmonary carcinoid tumor treated from 1989 to 2009 were reviewed. Data collected included demographics, pathology, tobacco use, clinical presentation, tumor location, tumor spread, treatment and survival. Results There were 59 cases of pulmonary carcinoid tumors: 47 typical (80%) and 12 atypical (20%). All but 4 patients underwent surgery, including 54 (92%) lung-sparing resections and 1 pneumonectomy. Five out of 55 patients received concurrent adjuvant chemoradiation therapy; 4 patients with atypical and 1 with typical histology. Three additional patients with atypical carcinoid were treated only with adjuvant radiotherapy, palliative radiotherapy, or palliative chemotherapy, respectively. The Kaplan-Meier 5- and 10-year overall survivals were both 80% within the entire population. In the 88% of patients who achieved complete remission, disease-free survival was 98%. A review of a large series from the literature is also presented. Conclusions Surgical resection was primary and adequate therapy for most typical carcinoid tumors with high overall survival and disease-free survival. Adjuvant chemotherapy or radiotherapy might be considered for patients with atypical carcinoid tumors who present with adverse pathological findings. PMID:26270444

  8. Perineal pain secondary to tethered cord syndrome: retrospective review of single institution experience.

    PubMed

    Robbins, J Will; Lundy, Paige A; Gard, Andrew P; Puccioni, Mark J

    2015-11-01

    Tethered cord syndrome (TCS) encompasses a spectrum of neurological dysfunction related to excessive tension on the distal spinal cord resulting in anatomic deformation and metabolic disturbance. Symptoms typically manifest as back/leg pain, neurogenic bladder dysfunction, constipation, sphincter abnormalities, and scoliosis. To date, among the least well-described symptoms of TCS is pain or hypersensitivity in the perineal region. The authors reviewed their experience with spinal cord detethering to identify and further characterize those who present with perineal pain or hypersensitivity. Cases of spinal cord detethering at a single institution were retrospectively reviewed. Patients were initially identified by procedural codes. Cases were reviewed for presenting symptoms, specifically perineal pain or hypersensitivity. Magnetic resonance image (MRI) findings, clinical outcome, and length of follow-up were also noted. Of the 491 patients identified, seven patients (1.4%) were identified as having preoperative perineal pain or hypersensitivity. All of these patients had complete resolution of perineal pain/hypersensitivity at the time of last follow-up. Furthermore, five (71%) of these patients experienced resolution of all initial symptoms. Perineal pain or hypersensitivity can be an important symptom of spinal cord tethering. Spinal cord detethering may result in a good outcome and relief of perineal pain or hypersensitivity.

  9. In pursuit of the graft-versus-myeloma effect: a single institution experience.

    PubMed

    Galo-Hooker, Evelyn Gisella; Ruiz-Delgado, Guillermo José; Zamora-Ortiz, Gabriela; Velazquez-Sanchez-de-Cima, Sara; Ruiz-Arguelles, Guillermo José

    2013-03-01

    Partly because of a potential graft-versus-myeloma effect, allogeneic stem cell transplantation is a potentially curative treatment modality in patients with multiple myeloma (MM). Initial attempts have been hampered by the high transplant-related mortality in this setting. With a reduction of toxicity, allogeneic transplant approaches with reduced-intensity conditioning (RIC) have been utilized, although they are subjected to continued disease progression and relapse following transplantation. We analyze here the experience of allografting four patients with MM in a single institution, along a 16-year period in which a total of 152 individuals were allografted, using an RIC regimen; three of the patients have had previous autografts. All patients engrafted successfully and a graft-versus-myeloma effect was shown in all of them. One patient relapsed in the face of graft-versus-host disease (GVHD). Three patients have died (two as a result of GVHD) and one is alive with a limited form of chronic GVHD. The graft-versus-myeloma effect can be induced by means of allogeneic transplantation but the morbidity and mortality associated with the procedure leads into a relatively small proportion of MM patients being cured.

  10. A simplified method for stem cell autografting in multiple myeloma: a single institution experience.

    PubMed

    López-Otero, A; Ruiz-Delgado, G J; Ruiz-Argüelles, G J

    2009-12-01

    In a 14-year period in a single institution 31 autografts were performed in 26 patients with multiple myeloma (MM), using a simplified and affordable autografting procedure: conducting the grafts on an outpatient basis and avoiding stem cell freezing. Autografts were started on an outpatient basis in all instances, but four patients were admitted to the hospital. Median time to achieve more than 0.5 x 10(9)/l granulocytes was 27 days, whereas median time to recover above 20 x 10(9)/l plts was 37 days. CR was achieved in 19 cases and a very good partial response in 6 cases. The 100-day mortality was 9.6%. The overall median post-transplant survival has not been reached, being above 76 months, whereas the 76-month survival is 80%. The median cost of each procedure was US$ 15 000. Survival results were substantially better than those of historical control in a group of patients treated in the same institution with melphalan/prednisone. It is concluded that high-dose therapy rescued with a simplified autologous stem cell graft is a valid, useful and affordable therapeutic option for patients with MM, even with economical restraints.

  11. Traumatic brain injury due to gunshot wounds: a single institution's experience with 442 consecutive patients.

    PubMed

    Solmaz, Ilker; Kural, Cahit; Temiz, Cağlar; Seçer, Halil Ibrahim; Düz, Bülent; Gönül, Engin; Izci, Yusuf

    2009-07-01

    Traumatic brain injury (TBI) caused by a gunshot wound is a complex injury with a broad spectrum of symptoms and high rates of mortality and morbidity. This study presents an evaluation of TBI caused by gunshot wounds presenting at a single institution and discusses possible predictive factors for the outcome of surgical intervention. The study sample consisted of 442 patients who underwent surgery for TBI over a 16-year period. All injuries were caused by gunshot wounds, such as bullets and shrapnel. All patients underwent surgical intervention. Almost all patients (99.3%) were male, and the mean patient age was 22.3 years. Wounds were caused by shrapnel in 68 percent of patients. The Glasgow Coma Scale (GCS) score at admission was below 8 in 116 patients (26.2%) and above 8 in 326 patients (73.8%). In total, 47 patients (10.6%) died despite surgical management, with diffuse brain injury the most common cause of death. Low GCS scores, ventricular injuries and bihemispheric injuries are correlated with poor prognosis. Early and less invasive surgery in conjunction with short transportation time to the hospital could decrease mortality rates.

  12. Malignant salivary gland tumours of the larynx: a single institution review.

    PubMed

    Karatayli-Ozgursoy, S; Bishop, J A; Hillel, A T; Akst, L M; Best, S R

    2016-08-01

    Malignant salivary gland tumours of the larynx are very rare, with limited reports of clinical outcomes. We present the decade-long experience of a single institution. A 10-year retrospective chart review of a tertiary head and neck cancer centre was performed. Index patients were identified from a review of a pathology database, and reviewed by a head and neck pathologist. Patient demographics, presenting signs and symptoms, treatment modalities and clinical outcomes were extracted from electronic medical records. Six patients were included, with an age range of 44 to 69. All six had malignant laryngeal salivary gland tumours. Pathologies included: three adenoid cystic carcinoma (2 supraglottic, 1 subglottic), one mucoepidermoid carcinoma (supraglottic), one epithelial-myoepithelial carcinoma (supraglottic) and one adenocarcinoma (transglottic). All were treated with surgery (2 endolaryngeal, 4 open) and five of six with the addition of adjuvant therapy (4 radiotherapy, 1 concurrent chemoradiation). One patient had smoking history; no patients had significant alcohol history. With 4.5 years of median follow-up, none of the patients has had recurrence or local/distant metastasis. Salivary gland tumours of the larynx present in mid to late-age, and can be successfully managed with a multi-modality approach, resulting in excellent local and regional control rates. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

  13. Poor Hematopoietic Stem Cell Mobilizers in Multiple Myeloma: a Single Institution Experience.

    PubMed Central

    Ruiz-Delgado, Guillermo J.; López-Otero, Avril; Hernandez-Arizpe, Ana; Ramirez-Medina, Aura; Ruiz-Argüelles., Guillermo J.

    2010-01-01

    In a single institution, in a group of 28 myeloma patients deemed eligible for autologous transplant, stem cell mobilization was attempted using filgrastim: 26 individuals were given 31 autografts employing 1–4 (median three) apheresis sessions, to obtain a target stem cell dose of 1 x 106 CD34 +ve viable cells / Kg of the recipient. The median number of grafted CD34 cells was 7.56 x 106 / Kg of the recipient; the range being 0.92 to 14.8. By defining as poor mobilizers individuals in which a cell collection of < 1 x 106 CD34 viable cells / Kg was obtained, a subset of eight poor mobilizers was identified; in two patients the autograft was aborted because of an extremely poor CD34 +ve cell yield (< 0.2 x 106 CD34 +ve viable cells / Kg of the recipient) after four apheresis sessions. The long-term overall survival of the patients grafted with > 1 x 106 CD34 +ve viable cells / Kg was better (80% at 80 months) than those grafted with < 1 x 106 CD34 +ve viable cells / Kg (67% at 76 months). Methods to improve stem cell mobilization are needed and may result in obtaining better results when autografting multiple myeloma patients. PMID:21415967

  14. Adult Supratentorial Low-Grade Glioma: Long-Term Experience at a Single Institution

    SciTech Connect

    Bauman, Glenn; Fisher, Barbara; Watling, Christopher; Cairncross, J. Gregory; Macdonald, David

    2009-12-01

    Purpose: To report the long-term follow-up of a cohort of adult patients with supratentorial low-grade glioma treated at a single institution. Methods and Materials: A cohort of 145 adult patients treated at the London Regional Cancer Program between 1979 and 1995 was reviewed. Results: With a median follow-up of 105 months, the median progression-free survival was 61 months (95% confidence interval, 53-77), and the median overall survival was 118 months (95% confidence interval, 93-129). The 10- and 20-year progression-free and overall survival rate was 18% and 0% and 48% and 22%, respectively. Cox regression analysis confirmed the importance of age, histologic type, presence of seizures, Karnofsky performance status, and initial extent of surgery as prognostic variables for overall and cause-specific survival. Function among long-term survivors without tumor progression was good to excellent for most patients. Conclusion: Low-grade glioma is a chronic disease, with most patients dying of their disease. However, long-term survival with good function is possible. Survival is determined primarily by the disease factors with selection and timing of adjuvant treatments having less influence on outcome.

  15. A single institution report of 19 hepatocellular carcinoma patients with bile duct tumor thrombus

    PubMed Central

    Chotirosniramit, Anon; Liwattanakun, Akkaphod; Lapisatepun, Worakitti; Ko-iam, Wasana; Sandhu, Trichak; Junrungsee, Sunhawit

    2017-01-01

    Background Obstructive jaundice caused due to bile duct tumor thrombus (BDTT) in a hepatocellular carcinoma (HCC) patient is an uncommon event. This study reports our clinical experiences and evaluates the outcomes of HCC patients with BDTT in a single institution. Methods A retrospective review of 19 HCC patients with secondary obstructive jaundice caused due to BDTT during a 15-year period was conducted. Results At the time of diagnosis, 14 (73.7%) patients had obstructive jaundice. Eighteen (94.7%) patients were preoperatively suspected of “obstruction of the bile duct”. Sixteen patients (84.2%) underwent a hepatectomy with curative intent, while two patients underwent removal of BDTT combined with biliary decompression and another patient received only palliative care as his liver reserve and general condition could not tolerate the primary tumor resection. The overall early recurrence (within 1 year) after hepatectomy occurred in more than half (9/16, 56.3%) of our patients. The 1-year survival rate of patients was 75% (12/16). The longest disease-free survival time was >11 years. Conclusion Identification of HCC patients with obstructive jaundice is clinically important because proper treatment can offer an opportunity for a cure and favorable long-term survival. PMID:28331844

  16. Are Historically Black Colleges and Universities (HBCUs) in the United States a Single Institutional Group? Evidence from Educational Outcomes

    ERIC Educational Resources Information Center

    Simms, Kathryn; Bock, Sara

    2014-01-01

    Historically Black Colleges and Universities (HBCUs) have been studied consistently as a single institutional group. However, at least ostensibly, HBCUs are relatively heterogeneous. Consequently, we evaluated the homogeneity of three educational outcomes that have been recognized as potentially distinguishing features of HBCUs (i.e., STEM major,…

  17. Are Historically Black Colleges and Universities (HBCUs) in the United States a Single Institutional Group? Evidence from Educational Outcomes

    ERIC Educational Resources Information Center

    Simms, Kathryn; Bock, Sara

    2014-01-01

    Historically Black Colleges and Universities (HBCUs) have been studied consistently as a single institutional group. However, at least ostensibly, HBCUs are relatively heterogeneous. Consequently, we evaluated the homogeneity of three educational outcomes that have been recognized as potentially distinguishing features of HBCUs (i.e., STEM major,…

  18. Experimental supratrigonal cystectomy: II--Evaluation of urinary calculi, infection, and bladder dysfunction in the pathogenesis of renal failure.

    PubMed

    Barros, Milton; Martinelli, Reinaldo; Rocha, Heonir

    2008-01-01

    The objective of this study was to evaluate the role of urolithiasis, infection, and bladder dysfunction in the pathogenesis of renal failure in rats subjected to supratrigonal cystectomy. One group of Sprague-Dawley rats was submitted to supratrigonal cystectomy, a second to cystectomy during which a suspension of Proteus mirabilis was injected into the bladder stump, and a third to sham surgery (controls). The animals were sacrificed two months after surgery. Blood pressure and serum urea and creatinine were measured before surgery and at sacrifice when a careful inspection of the urinary tract was performed to determine the presence of hydronephrosis and calculi. Microbiological analyses were performed on urine aspirated from the bladder and on the kidneys. Significant differences were found between values of systolic blood pressure and serum urea and creatinine recorded prior to the surgical procedure and those recorded at sacrifice in each group except the control group. Renal failure was present in all animals subjected to cystectomy. Urinary calculi were documented in 5/10 animals subjected to cystectomy only and in all rats inoculated with P. mirabilis. Hypertension was documented in 43.75% of animals subjected to cystectomy. Pyelonephritis was diagnosed only in animals with urinary calculi, in each of which urine culture was also positive. No cases of renal failure, hypertension, calculi, and/or pyelonephritis were detected in the sham group. The findings of this study indicate that kidney failure in rats subjected to supratrigonal cystectomy is related to the severe bladder dysfunction induced by the surgical procedure.

  19. Outcome of Dupuytren Contractures After Collagenase Clostridium Histolyticum Injection: A Single-institution Experience.

    PubMed

    Hwee, Yin Kan; Park, Daniel; Vinas, Marisa; Litts, Christopher; Friedman, David

    2017-08-01

    Collagenase clostridium histolyticum (CCH) injection is an alternative to surgery for patients with Dupuytren disease (DD) of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. The success of surgical and nonsurgical treatment modalities for DD is reported to vary widely between 25% and 80% (J Bone Joint Surg Am. 1985;67:1439-1443; Plast Reconstr Surg. 2007;120:44e-54e; J Bone Joint Surg Am. 2007;89:189-198; J Hand Surg Am. 2011:36:936-942; J Hand Surg Am. 1990;15:755-761; J Hand Surg Br. 1996;21:797-800; J Bone Joint Surg Br. 2000;82:90-94; Plast Reconstr Surg. 2005;115:802-810; Ann Plast Surg. 2006;57:13-17). This study presents the outcomes of patients with DD contractures treated with CCH injections at a single institution. An institutional review board-approved retrospective study was conducted of patients with DD of the hand treated with CCH injections in a single institution from February 2010 to April 2015. All patients received the recommended dose of 0.58 mg of CCH and returned for joint manipulation the following day. Data for follow-up at 7 and 30 days postoperatively and up to 5 years for patients who returned seeking further therapy for recurrent symptoms were reviewed. One hundred thirteen patients with a total of 146 affected joints (72 MCP; 74 PIP) were treated with CCH injections (95 males; 18 females; age, 40-92 y). Successful CCH therapy occurred in 75% of injected joints (109/146 joints; 59 MCP; 50 PIP), as defined by less than 5 degrees of contracture after treatment. Twenty-three percent of treated joints had partial correction (34/146 joints; 13 MCP; 21 PIP), as defined by between 5 and 30 degrees of residual contracture after treatment. Three patients (2%) had a failure of treatment, as defined by unchanged or worsened contracture from pretreatment baseline measurements. Fifteen patients (13%) returned to the clinic seeking additional therapy for recurrent joint contracture symptoms in 17 joints over a span of 1

  20. Late-Presenting Congenital Diaphragmatic Hernia in Children: The Experience of Single Institution in Korea

    PubMed Central

    Kim, Dong Jin

    2013-01-01

    Purpose Late-presenting congenital diaphragmatic hernia (CDH) beyond the neonatal period is rare and often misdiagnosed, with delayed treatment. Materials and Methods We retrospectively reviewed our experience with late-presenting CDH over 30 years at a single institution to determine the characteristics of late-presenting CDH for early diagnosis. Results Seven patients had operations due to late-presenting CHD in our institution over 30 years. The patients' ages ranged from 2.5 months to 16 years. There were six boys and one girl. Five hernias were left-sided, one was right-sided and one was a retrosternal hernia. All patients had normal intestinal rotation. Non-specific gastrointestinal or respiratory symptoms and signs were usually presented. Intestinal malrotations were absent; therefore, only organs adjacent to the defect or relatively movable organs such as the small bowel and transverse colon were herniated. Two cases were accompanied by stomach herniation with the volvulus and liver, respectively. The duration from presentation to diagnosis varied from 5 days to 1 year. Diagnoses were made by chest X-ray, upper gastrointestinal series and chest computed tomography. All patients underwent primary repair with interrupted non-absorbable sutures by a transabdominal approach. None had postoperative complications. The follow-up period in six patients ranged from 4 months to 20 years (median 3.8 years). There was no recurrence in any of the patients on follow-up. Conclusion A high index of suspicion is important for the diagnosis of late-presenting CDH because it can be a life-threatening condition such as CDH with a gastric volvulus. Early diagnosis and appropriate treatment can lead to a good prognosis. PMID:23918563

  1. Acute pediatric encephalitis neuroimaging: single-institution series as part of the California encephalitis project.

    PubMed

    Bykowski, Julie; Kruk, Peter; Gold, Jeffrey J; Glaser, Carol A; Sheriff, Heather; Crawford, John R

    2015-06-01

    Diagnosing pediatric encephalitis is challenging because of varied clinical presentation, nonspecific neuroimaging features, and rare confirmation of causality. We reviewed acute neuroimaging of children with clinically suspected encephalitis to identify findings that may correlate with etiology and length of stay. Imaging of 141 children with clinically suspected encephalitis as part of The California Encephalitis Project from 2005 to 2012 at a single institution was reviewed to compare the extent of neuroimaging abnormalities to patient age, gender, length of stay, and unknown, possible, or confirmed pathogen. Scan review was blinded and categorized by extent and distribution of abnormal findings. Abnormal findings were evident on 23% (22/94) of computed tomography and 50% (67/134) of magnetic resonance imaging studies in the acute setting. Twenty children with normal admission computed tomography had abnormal findings on magnetic resonance imaging performed within 2 days. Length of stay was significantly longer among children with abnormal acute magnetic resonance imaging (P < 0.001) and correlated with increased complexity (Spearman rho = 0.4, P < 0.001) categorized as: no imaging abnormality, meningeal enhancement and/or focal nonenhancing lesion, multifocal lesions, confluent lesions, and lesions plus diffusion restriction, hemorrhage, or hydrocephalus. There was no correlation between neuroimaging findings and an identifiable pathogen (P = 0.8). Abnormal magnetic resonance imaging findings are more common than abnormal computed tomography findings in pediatric encephalitis. Increasing complexity of magnetic resonance imaging findings correlated with disease severity as evidenced by longer length of stay, but were not specific for an identifiable pathogen using a standardized diagnostic encephalitis panel. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Surgical management of Wilms tumor with intravascular extension: a single-institution experience.

    PubMed

    Aspiazu, Diego; Fernandez-Pineda, Israel; Cabello, Rosa; Ramirez, Gema; Alvarez-Madrid, Antonio; De Agustin, Juan Carlos

    2012-02-01

    The purpose of this study was to retrospectively analyze the clinical presentation, treatment, and outcomes of children with Wilms tumor (WT) and intravascular extension who were treated at a single institution. A retrospective review was conducted of medical records of all children with Wilms tumor and intravascular extension treated at Virgen del Rocio Children's Hospital between 1992 and 2010. Seven patients (median age 3.4 years, range 2-8.1 years) were identified. At diagnosis, 6 of the 7 patients (85.7%) presented with tumor thrombus that reached the right atrium (RA) and 1 patient with infrahepatic inferior vena cava (IVC) thrombus. All patients received neoadjuvant chemotherapy (SIOP 2001 protocol) with vincristine, doxorubicin, and actinomycin D. Regression of the intravascular extension of the tumor was documented in all patients. Postchemotherapy level of extension was suprahepatic IVC in 1 patient, infrahepatic IVC in 2 patients, renal vein (RV) in 1 patient, and RA in 3 patients. Nephrectomy and thrombectomy were performed in all cases, requiring cardiopulmonary bypass for the 4 patients who presented with suprahepatic IVC and RA thrombus. The other 3 patients with infrahepatic IVC and RV involvement underwent cavotomy and thrombus extraction. Computed tomography, ultrasonography, and echocardiography were used for diagnosis and follow-up. All patients remain disease-free with a median follow-up of 6.3 years (range, 2-19 years). Neoadjuvant chemotherapy for WT with intravascular extension may facilitate the resection by decreasing the extent of the tumor thrombus. Cardiopulmonary bypass is indicated for suprahepatic IVC and RA involvement. Accurate diagnostic imaging is necessary.

  3. Transfusion Related Acute Lung Injury (TRALI): A Single Institution Experience of 15 Years.

    PubMed

    Kumar, Ramesh; Sedky, Mohammed Jaber; Varghese, Sunny Joseph; Sharawy, Osama Ebrahim

    2016-09-01

    Transfusion related acute Lung injury (TRALI) though a serious blood transfusion reaction with a fatality rate of 5-25 % presents with acute respiratory distress with hypoxaemia and noncardiac pulmonary oedema within 6 h of transfusion. In non fatal cases, it may resolve within 72 h or earlier. Although reported with an incidence of 1:5000, its true occurrence is rather unknown. Pathogenesis is believed to be related to sequestration and adhesion of neutrophils to the pulmonary capillary endothelium and its activation leading to its destruction and leaks. The patient's underlying condition, anti-neutrophil antibody in the transfused donor plasma and certain lipids that accumulate in routinely stores blood and components are important in its aetiopathogenesis. Patient's predisposing conditions include haematological malignancy, major surgery (especially cardiac), trauma and infections. The more commonly incriminated products include fresh frozen plasma (FFP), platelets (whole blood derived and apheresis), whole blood and Packed RBC. Occasional cases involving cryoprecipitate and Intravenous immunoglobulin (IVig) have also been reported. We present a 15 year single institution experience of TRALI, during which we observed 9 cases among 170,871 transfusions, giving an incidence of 1:19,000. We did not encounter cases of haematological malignancy or cardiac surgery in our TRALI patients. Among the blood products, that could be related to TRALI in our patients included solitary cases receiving cryoprecipitate, IVIg, and recombinant Factor VII apart from platelets and FFP. All patients were treated with oxygen support. Six patients required mechanical ventilation. Off label hydrocortisone was given to all patients. There were no cases of fatality among our patients.

  4. Brachytherapy or Conformal External Radiotherapy for Prostate Cancer: A Single-Institution Matched-Pair Analysis

    SciTech Connect

    Pickles, Tom; Keyes, Mira; Morris, W. James

    2010-01-15

    Purpose: In the absence of randomized study data, institutional case series have shown brachytherapy (BT) to produce excellent biochemical control (bNED) in patients with localized prostate cancer compared with alternative curative treatments. This study was designed to overcome some of the limitations of case series studies by using a matched-pair design in patients treated contemporaneously with BT and external beam radiation therapy (EBRT) at a single institution. Methods and Materials: Six hundred one eligible patients treated between 1998 and 2001 were prospectively followed up in our institutional databases and matched on a 1:1 basis for the following known prognostic variables: prostate-specific antigen (PSA) level, Gleason score, T stage, the use and duration of neoadjuvant androgen deprivation therapy, and the percentage of positive tissue core samples. Two hundred seventy-eight perfect matches of patients (139 in each group) with low- and intermediate-risk cancer were further analyzed. bNED (Phoenix definition) was the primary endpoint. Other endpoints were toxicity, PSA kinetics, and the secondary use of androgen deprivation therapy. Results: The 5-year bNED rates were 95% (BT) and 85% (EBRT) (p < 0.001). After 7 years, the BT bNED result was unchanged, but the rate in EBRT patients had fallen to 75%. The median posttreatment PSA nadirs were 0.04 ng/mL (BT) and 0.62 ng/mL (EBRT, p < 0.001), which predicted a higher ongoing treatment failure rate in association with EBRT use than with BT use. Late urinary toxicity and rectal/bowel toxicity were worse in patients treated with BT and EBRT, respectively. Conclusions: BT for both low-risk and selected intermediate-risk cancers achieves exceptional cure rates. Even with dose escalation, it will be difficult for EBRT to match the proven track record of BT seen over the past decade.

  5. Single-incision laparoscopic cholecystectomy learning curve experience seen in a single institution.

    PubMed

    Feinberg, Elyssa J; Agaba, Emmanuel; Feinberg, Michelle L; Camacho, Diego; Vemulapalli, Pratibha

    2012-04-01

    Single-incision laparoscopic surgery (SILS) is laparoscopic surgery done by one incision through the umbilicus. Cholecystectomy lends itself well to a SILS approach. As these procedures have become more widely adapted, it is important to determine the approximate learning curve to decrease two surgical endpoints: (1) time to completion of the procedure; and (2) decreased incidence of conversion. We prospectively reviewed our series of 50 cholecystectomies done using the SILS approach between May 2008 to September 2008. All cases were performed by two advanced laparoscopic surgeons at a single institution. Data was collected immediately after the case and entered into an Excel database. Cases were performed by insufflating the abdomen with a Veress needle through the umbilicus followed by placement of 5-mm ports at the umbilicus. Patient ages ranged between 21 and 82 years with a median age of 45 years. Body mass index (BMI) range was 21 to 42 kg/m with a mean of 30 kg/m. Average length of time for cases was 1 hour 9 minutes with a range between 55 minutes and 120 minutes. The average length of time for the first 25 cases was 80 minutes. When compared with cases 26 to 50 the average length of time was 60 minutes (P<0.05). The conversion rate to conventional laparoscopic cholecystectomy was 10%. Conversion was accomplished through the addition of a 5-mm port elsewhere on the abdominal cavity. After the tenth case, the incidence of conversion went down to zero. When conversions were further stratified, they occurred within each individual surgeon's first ten cases. The learning curve for successful consistent completion of SILS cholecystectomy cases appears to be after 25 cases. In addition, conversion rates drop dramatically after the first ten cases.

  6. The natural history of tunneled hemodialysis catheters removed or exchanged: a single-institution experience.

    PubMed

    Alomari, Ahmad I; Falk, Abigail

    2007-02-01

    To track the natural history of tunneled hemodialysis catheters requiring removal or exchange at a single institution. Over a 2-year period, tunneled hemodialysis catheters that presented to interventional radiology for removal or exchange were entered into this retrospective study. Patient demographics, catheter location, dwell time, and indication for removal were recorded. Pull-back contrast venography was performed with imaging over the chest. Catheters were then removed or exchanged. Three hundred thirty-four tunneled dialysis catheters were removed or exchanged in 207 patients; 108 male, median age 53 years. Dwell time, available from 296 catheters, ranged from 1 to 114 days (median, 66 days) for a total of 32,847 catheter days. One hundred three catheters were removed for infection, yielding a rate of infection requiring catheter removal of 3.0 per 1,000 catheter days. One hundred catheters were removed for other working access, and 96 catheters were exchanged for poor function. Two hundred sixty-five were removed or exchanged from the internal jugular vein, 22 from the subclavian vein, and 24 from the femoral vein. One hundred seventy-two (76%) of the 226 catheters studied with contrast had fibrin sheaths; of which 42 had thrombus identified along the catheter tract. One hundred ninety-three catheters were removed, and 141 catheters were exchanged for new catheters with 82 catheters receiving balloon disruption of the fibrin sheath. Approximately one third of tunneled dialysis catheters are removed for infection, one third for other working access, and one third for poor function. Catheters usually remain in the patient for a median of 2 months. Fibrin sheaths associated with hemodialysis catheters are very common. Thrombus formation around the sheath is frequent.

  7. Nimotuzumab in combination with radiotherapy in high grade glioma patients: a single institution experience.

    PubMed

    Solomon, Maria Teresa; Miranda, Nederlay; Jorrín, Eugenia; Chon, Ivonne; Marinello, Jorge Juan; Alert, José; Lorenzo-Luaces, Patricia; Crombet, Tania

    2014-05-01

    Nimotuzumab, a humanized antibody targeting epidermal growth factor receptor, has potent anti-proliferative, anti-angiogenic, and pro-apoptotic effects in vitro and in vivo. It also reduces the number of radio-resistant CD133(+) glioma stem cells. The antibody has been extensively evaluated in patients with advanced head and neck, glioma, lung, esophageal, pancreatic, and gastric cancer. In this single institution experience, 35 patients with anaplastic astrocytoma (AA) or glioblastoma multiforme (GBM) were treated with irradiation and 200 mg doses of nimotuzumab. The first 6 doses were administered weekly, together with radiotherapy, and then treatment continued every 21 days until 1 year. The median number of doses was 12, and the median cumulative dose was thus 2400 mg of nimotuzumab. The most frequent treatment-related toxicities were increase in liver function tests, fever, nausea, anorexia, asthenia, dizziness, and tremors. These adverse reactions were classified as mild and moderate. The median survival time was 12.4 mo or 27.0 mo for patients with GBM or AA patients, respectively, who received curative-intent radiotherapy in combination with the antibody. The survival time of a matched population treated at the same hospital with irradiation alone was decreased (median 8.0 and 12.2 mo for GBM and AA patients, respectively) compared with that of the patients who received nimotuzumab and curative-intent radiotherapy. We have thus confirmed that nimotuzumab is a very well-tolerated drug, lacking cumulative toxicity after maintenance doses. This study, in a poor prognosis population, validates the previous data of survival gain after combining nimotuzumab and radiotherapy, in newly diagnosed high-grade glioma patients.

  8. Gestational trophoblastic disease in the western region of Saudi Arabia (single-institute experience).

    PubMed

    Anfinan, Nisrin; Sait, Khalid; Sait, Hesham

    2014-09-01

    To estimate the prevalence of gestational trophoblastic disease (GTD) in the western region of Saudi Arabia, and to evaluate the success of treatment and the effect of age and risk group on survival. Between January 2001 and December 2010, all patients treated for GTD were identified from the King Abdulaziz University Hospital database. Patients with persistent disease were evaluated according to their clinical treatment outcomes. In total, 122 cases of GTD were identified in the database. Of these, 77 (63%) cases were diagnosed and received initial treatment at the study centre, resulting in an incidence of 1.26 cases per 1000 deliveries. The mean (±standard deviation) age of the study participants was 31.52 ± 10.8 years, mean gestational age at diagnosis was 12.42 ± 3.2 weeks, and mean follow-up for each patient was 24 months. There were 20 cases (26%) of persistent GTD after treatment. The majority of patients with low-risk disease were treated with single-agent methotrexate, with an overall success rate of 83%. The overall 5-year survival rate for all patients was 98%. Using the Wilcoxon (Gehan) test, risk group and age (cut-off 40 years) were not found to be significantly associated with survival (p=0.69). This single-institute study reports the first survival data for GTD for Saudi Arabia. However, the overall incidence of GTD in Saudi Arabia will be defined by establishment of a GTD registry. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. Epithelioid trophoblastic tumor: A single institution case series at the New England Trophoblastic Disease Center.

    PubMed

    Davis, M R; Howitt, B E; Quade, B J; Crum, C P; Horowitz, N S; Goldstein, D P; Berkowitz, R S

    2015-06-01

    Epithelioid trophoblastic tumor (ETT) is a rare form of gestational trophoblastic neoplasm which is distinct based on its development from intermediate trophoblast cells and nodular growth pattern. The aim of this study is to describe a case series from a single institution with a review of the literature to better understand the clinical characteristics and outcomes for patients with ETT. A retrospective review was performed using the IRB approved New England Trophoblastic Disease Center (NETDC) database from 1998 to 2014. Eight patients were identified of which seven had complete records. Follow-up data was obtained from the longitudinal medical records. Four (57.1%) patients presented with vaginal bleeding and two (28.6%) patients were asymptomatic at presentation. Three (42.9%) patients had extrauterine disease. All three patients with extrauterine disease who received chemotherapy had stable or progressive disease at follow-up. Only two (29%) patients who presented with non-metastatic disease and underwent hysterectomy were alive with no evidence of disease. The mean interval following antecedent pregnancy was 104months. All patients with an interval >4years demonstrated stable or progressive disease despite intensive chemotherapy. Two patients with non-metastatic disease who declined hysterectomy developed stable or progressive disease despite chemotherapy. This series highlights several features of ETT including the potential for asymptomatic presentation of extrauterine disease. The series also demonstrates chemoresistance, even with multi-agent therapy and a poor prognosis with extrauterine disease and an interval greater than 4years following the antecedent pregnancy suggesting that surgery remains critical in disease control. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Pharyngocutaneous fistula after total laryngectomy: a single-institution experience, 2001-2012.

    PubMed

    Benson, Eleni M; Hirata, Richard M; Thompson, Carol B; Ha, Patrick K; Fakhry, Carole; Saunders, John R; Califano, Joseph A; Arnaoutakis, Demetri; Levine, Marshall; Tang, Mei; Neuner, Geoffrey; Messing, Barbara P; Blanco, Ray G F

    2015-01-01

    The purpose of this study was to determine the incidence of and risk factors for pharyngocutaneous fistula in patients undergoing total laryngectomy at a single institution. The records of 59 patients undergoing primary or salvage total laryngectomy at our institution from 2001 to 2012 were retrospectively reviewed. Data collected included patient, tumor and treatment characteristics, and surgical technique. Risk factors were analyzed for association with pharyngocutaneous fistula formation. Twenty patients (34%) developed fistulas. Preoperative tracheostomy (OR 4.1; 95% CI 1.3-13 [p=0.02]) and low postoperative hemoglobin (OR 9.1; 95% CI 1.1-78 [p=0.04]) were associated with fistula development. Regarding surgical technique, primary sutured closure of the total laryngectomy defect had the lowest fistula rate (11%). In comparison, primary stapled closure and pectoralis onlay flap over primary closure had nonsignificantly increased fistula rates (43%, OR 6.0; 95% CI 1.0-37.3 [p=0.06] and 25%, OR 2.7; 95% CI 0.4-23.9 [p=0.38], respectively). Pectoralis flap incorporated into the suture line had a significantly increased fistula rate (50%, OR 7.1; 95% CI 1.4-46 [p=0.02]). After stratification for salvage status, patient comorbidities were associated with fistula in non-salvage cases whereas disease-related characteristics were associated with fistula in salvage cases. Fistula development was associated with increased length of hospital stay (p<0.001) and increased time before oral diet initiation (p<0.001). Pharyngocutaneous fistula is a common complication of total laryngectomy. Preoperative tracheostomy, postoperative hemoglobin, and surgical technique are important in determining the risk of fistula. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Patterns of use of medical cannabis among Israeli cancer patients: a single institution experience.

    PubMed

    Waissengrin, Barliz; Urban, Damien; Leshem, Yasmin; Garty, Meital; Wolf, Ido

    2015-02-01

    The use of the cannabis plant (Cannabis sativa L.) for the palliative treatment of cancer patients has been legalized in multiple jurisdictions including Israel. Yet, not much is currently known regarding the efficacy and patterns of use of cannabis in this setting. To analyze the indications for the administration of cannabis among adult Israeli cancer patients and evaluate its efficacy. Efficacy and patterns of use of cannabis were evaluated using physician-completed application forms, medical files, and a detailed questionnaire in adult cancer patients treated at a single institution. Of approximately 17,000 cancer patients seen, 279 (<1.7%) received a permit for cannabis from an authorized institutional oncologist. The median age of cannabis users was 60 years (range 19-93 years), 160 (57%) were female, and 234 (84%) had metastatic disease. Of 151 (54%) patients alive at six months, 70 (46%) renewed their cannabis permit. Renewal was more common among younger patients and those with metastatic disease. Of 113 patients alive and using cannabis at one month, 69 (61%) responded to the detailed questionnaire. Improvement in pain, general well-being, appetite, and nausea were reported by 70%, 70%, 60%, and 50%, respectively. Side effects were mild and consisted mostly of fatigue and dizziness. Cannabis use is perceived as highly effective by some patients with advanced cancer and its administration can be regulated, even by local authorities. Additional studies are required to evaluate the efficacy of cannabis as part of the palliative treatment of cancer patients. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  12. Five-year survivors of brain metastases: A single-institution report of 32 patients

    SciTech Connect

    Chao, Samuel T.; Barnett, Gene H.; Liu, Stephanie W.; Reuther, Alwyn M.; Toms, Steven A.; Vogelbaum, Michael A.; Videtic, Gregory; Suh, John H. . E-mail: suhj@ccf.org

    2006-11-01

    Purpose: To report on 32 patients who survived {>=}5 years from brain metastases treated at a single institution. Methods and Materials: The records of 1288 patients diagnosed with brain metastases between 1973 and 1999 were reviewed. Patients were treated with whole-brain radiation therapy (WBRT), surgery, and/or stereotactic radiosurgery (SRS). Thirty-two (2.5%) {>=}5-year survivors were identified. Factors contributing to long-term survival were identified. Results: Median survival was 9.3 years for {>=}5-year survivors. Seven of these patients lived {>=}10 years. Female gender was the only patient characteristic that correlated with better survival (p = 0.0369). When these patients were compared with <5-year survivors, age <65 years (p = 0.0044), control of the primary at diagnosis (p = 0.0052), no systemic disease (p = 0.0012), recursive partitioning analysis (RPA) Class 1 (p = 0.0002 with Class 2; p = 0.0022 with Class 3), and single brain metastasis (p = 0.0018) were associated with long-term survival in the univariate logistic regression model. In the multivariate model, RPA Class 1 compared with Class 2 (OR = 0.39, p = 0.0196), surgery (OR = 0.16, p < 0.0001), and SRS (OR = 0.41, p = 0.0188) were associated with long-term survival. Conclusions: For patients with good prognostic factors such as young age, good RPA characteristics and single metastasis, treatment with surgery or SRS offers the best chance for long-term survival.

  13. Risk Factor Analysis for 30-Day Mortality After Primary THA in a Single Institution.

    PubMed

    Comba, Fernando; Alonso Hidalgo, Ignacio; Buttaro, Martín; Piccaluga, Francisco

    2012-07-01

    The purpose of this study was to determine the prevalence of, and associated risk factors for, 30-day perioperative death following primary total hip arthroplasty (THA). Data of all the patients were compiled from the computerized total joint registry at a single institution. Between May 1993 and May 2006, 3,232 consecutive primary THA (2,453 elective and 779 nonelective) were performed. Eleven deaths occurred during the first month after surgery (0.34 %). Thirty-day mortality rate after elective THA was 0.08 % (two of 2,453 IC 95 %(0-0.4)). The 30-day mortality rate after nonelective THA was 1.15 % (nine of 779 IC 95 %(0.7-2.4). To analyze the factors that could have contributed with death, we conducted a 4-to-1 nested case-control study. Control cases were strictly matched by sex, age, surgeon, prosthesis fixation mode, and date of surgery. Conditional logistic regression was used to evaluate the association of risk factors with mortality. Elective surgery was associated with a lower risk of mortality with an odds ratio (OR) of 0.07 (95 % CI 0.008-0.6);p = 0.015. American Society of Anesthesiologists (ASA) score III-IV increased the mortality risk 13 times (OR 13.7; 95 % CI 1.6-114.8). Cardiovascular disease increased the risk for mortality eight times (OR 8.83 (95 % CI 1.78-43.6). Time delay before surgery showed a trend towards significance (p = 0.06). Aggressive vs. nonaggressive thromboembolism prophylaxis and the amount of blood transfusions required were not associated with a higher risk of death. Patients undergoing a THA due to fractures, patients with high ASA score, and those with cardiovascular disease were the highest risk factors for 30-day mortality after primary THA.

  14. Ventricular conduction defects after transcatheter aortic valve implantation: a single-institute analysis.

    PubMed

    Kawaguchi, Akira T; D'Allessandro, Cosimo; Collet, Jean Philippe; Cluzel, Philippe; Makri, Ralouka; Leprince, Pascal

    2015-05-01

    Patients with aortic stenosis tend to develop ventricular conduction problems, which are known adverse events following transcatheter aortic valve implantation (TAVI). Changes in ventricular conduction status after TAVI were analyzed in 195 consecutive patients from a single institute registered in FRANCE2 between February 2010 and June 2012. Among the 195 patients, 29 had a prior pacemaker implantation (+PM) and 6 had acute catastrophic hemodynamics that made a full electrocardiogram (ECG) unavailable. Among the remaining 160, PM was newly required in 28 (17.5%, PM+) but not in 132 (PM-), which included 21 (13.1%) who developed new left bundle branch block (BBB), 12 (7.5%) had right BBB, and 99 (61.9%) had no change. While PM requirement had no correlation with preoperative factors, there was significant association with the development of right BBB with Edwards Sapien/XT (P = 0.003), and new left BBB (P = 0.012) and complete heart block requiring PM with CoreValve (22.6% vs. Edwards Sapien/XT, 7.4%, P = 0.016). Whereas postoperative survival regarding PM status (+PM, PM+, PM-), vascular access, valve size or type showed no difference, delayed heart block (n = 12, Day 2 or later) was associated with poor survival (P = 0.038) compared with the remaining PM+ patients with earlier onset (n = 16, Day 0 or 1). As a result, PM+ patients (n = 28) had significantly longer intensive care unit (ICU) stay and hospitalization than PM- or +PM patients. The results suggest that ventricular conduction problems requiring PM occurred more frequently after TAVI (17.5%) than with usual surgical replacement. Nonetheless, conduction problems failed to influence postoperative survival for up to 3 years on average with use of PM, but therefore did increase medical costs. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  15. Incidence, clinical features, and treatment of familial moyamoya in pediatric patients: a single-institution series.

    PubMed

    Gaillard, Jonathan; Klein, Jennifer; Duran, Daniel; Storey, Armide; Scott, R Michael; Kahle, Kristopher; Smith, Edward R

    2017-03-10

    OBJECTIVE Limited data exist on familial moyamoya in children. The purpose of this study was to characterize presentation and outcomes of pediatric moyamoya patients who have relatives diagnosed with moyamoya. METHODS The authors performed a single-institution retrospective analysis of a case series including all surgically treated children with moyamoya with first- or second-degree relatives with moyamoya. Clinical and radiographic characteristics were analyzed, along with surgical outcomes. RESULTS A total of 537 patients underwent surgery for moyamoya during the study period. Eighteen of those patients (3.4% of the total series) had moyamoya and a family history of moyamoya and were included in this study. Of these 18 patients, 14 were non-twin siblings, and the remaining 4 represented 2 pairs of identical (affected) twins. The presentation was predominantly ischemic (72%), but 4 patients (33%) were asymptomatic when they were found to have moyamoya. Bilateral disease was present in 13 patients (72%). Radiographic stroke prevalence (67%), Suzuki grade (3.3), and angiographic findings were comparable to findings in nonfamilial moyamoya patients. Thirty revascularization procedures were performed, with a 3.3% operative stroke rate per hemisphere and no new strokes in an average follow-up period of 4.5 years. CONCLUSIONS In a North American surgical series, familial moyamoya existed in 3.4% of cases, and was distinguished by manifesting in a broad range of ethnic groups, with a higher proportion of male patients and increased rates of asymptomatic and unilateral disease in comparison to nonfamilial moyamoya. Screening indications remain controversial and the current data are used to suggest guidelines. Surgical therapy is warranted, effective, and durable in these patients, but patients should be carefully selected.

  16. Adjuvant radiotherapy outcome of stage I testicular seminoma: a single institution study.

    PubMed

    Lee, Hayoon; Kim, Jun Won; Hong, Sung Joon; Yang, Seung Choul; Choi, Young Deuk; Rha, Koon Ho; Cho, Jaeho

    2015-01-01

    To analyze treatment outcome and side effects of adjuvant radiotherapy using radiotherapy fields and doses which have evolved over the last two decades in a single institution. Forty-one patients received radiotherapy after orchiectomy from 1996 to 2007. At our institution, the treatment field for stage I seminoma has changed from dog-leg (DL) field prior to 2003 to paraaortic (PA) field after 2003. Fifteen patients were treated with the classic fractionation scheme of 25.5 Gy at 1.5 Gy per fraction. Other patients had been treated with modified schedules of 25.05 Gy at 1.67 Gy per fraction (n=15) and 25.2 Gy at 1.8 Gy per fraction (n=11). With a median follow-up of 112 months, the 5-year and 10-year survival rates were 100% and 96%, respectively, and 5-year and 10-year relapse-free survival rates were both 97.1%. No in-field recurrence occurred. Contralateral seminoma occurred in one patient 5 years after treatment. No grade III-IV acute toxicity occurred. An increased rate of grade 1-2 acute hematologic toxicity was found in patients with longer overall treatment times due to 1.5 Gy per fraction. The rate of grade 2 acute gastrointestinal toxicity was significantly higher with DL field than with PA field and also higher in the 1.8-Gy group than in the 1.5-Gy and 1.67-Gy groups. Patients with stage I seminoma were safely treated with PA-only radiotherapy with no pelvic failure. Optimal fractionation schedule needs to be explored further in order to minimize treatment-related toxicity.

  17. Impact of preoperative imaging on surgical approach for primary hyperparathyroidism: Data from single institution in India

    PubMed Central

    Kaur, Parjeet; Gattani, Raghav; Singhal, Alka Ashmita; Sarin, Deepak; Arora, Sowrabh Kumar; Mithal, Ambrish

    2016-01-01

    Context: Preoperative localization of parathyroid adenoma is essential in deciding the surgical approach of parathyroidectomy. Aim: To describe clinical and biochemical profile, evaluate preoperative imaging modalities and surgical approach in patients with primary hyperparathyroidism (PHPT). Methodology: This was a retrospective study conducted at the single institution. All patients who underwent evaluation and surgery for PHPT from 2011 to 2015 were included in the study. Results: A total of 100 patients underwent surgery for PHPT. Mean (standard deviation) age was 51.6 (15.9) years with female to male ratio of 1.7:1. Forty patients had severe symptoms, and sixty had mild to moderate symptoms. The sensitivity of technetium-99m hexakis (2-methoxyisobutylisonitrile) (MIBI) scan and ultrasonography (USG) neck in identifying abnormal parathyroid gland was 93% (93/100) and 98% (98/100), respectively. The MIBI scan results of 90/93 (96.7%) patients corresponded with their surgical findings whereas preoperative USG findings of 96/98 patients (98%) showed correlation with operative findings. Intraoperative intact parathyroid hormone (IOPTH) levels at 10 min postexcision were measured in forty patients (minimally invasive parathyroidectomy = 38, bilateral neck exploration = 1, and unilateral neck exploration = 1). All patients except two had <50% fall in IOPTH. Adenoma weight was positively correlated with preoperative intact PTH. Conclusion: We found that USG has higher sensitivity (98%) than MIBI scan (93%) in localizing abnormal parathyroid gland. Moreover, USG had a higher preoperative localization accuracy (93%) than MIBI scan (90%), allowing to choose an appropriate surgical approach. A higher proportion of patients (60%) had mild/asymptomatic form of PHPT. PMID:27730071

  18. Diverticulectomy in the Management of Intradiverticular Bladder Tumors: A Twelve-Year Experience at a Single Institution.

    PubMed

    Bourgi, Ali; Ayoub, Elias; Merhej, Sleiman

    2016-01-01

    Purpose. In this retrospective case review we analyze the outcomes of patients treated for intradiverticular bladder tumors (IDT). Materials and Methods. A retrospective case review was done between January 2002 and May 2014 in Hotel-Dieu de France hospital. The series included 17 patients diagnosed with IDT, all males with a mean age of 49.8 years. Results. One patient was treated with tumor resection and adjuvant BCG instillation with no recurrence on follow-up cystoscopies and urine cytologies. 64% of patients were treated by diverticulectomy. Mean follow-up time was 38.7 months. At the end of the follow-up, 81% were disease-free. One patient had a radical cystectomy 6 months after diverticulectomy for recurrent high grade tumor; another one had a nodal metastasis 10 months after diverticulectomy and was managed with chemotherapy. 29% of patients were treated with radical cystectomy. Mean follow-up time was 28.4 months. No recurrence was documented on annual CT scans. Conclusions. Our data support a conservative approach for tumors confined to the bladder diverticulum, even in high grade or in the presence of CIS provided complete removal is feasible and close follow-up is ensured.

  19. Diverticulectomy in the Management of Intradiverticular Bladder Tumors: A Twelve-Year Experience at a Single Institution

    PubMed Central

    Bourgi, Ali; Ayoub, Elias; Merhej, Sleiman

    2016-01-01

    Purpose. In this retrospective case review we analyze the outcomes of patients treated for intradiverticular bladder tumors (IDT). Materials and Methods. A retrospective case review was done between January 2002 and May 2014 in Hotel-Dieu de France hospital. The series included 17 patients diagnosed with IDT, all males with a mean age of 49.8 years. Results. One patient was treated with tumor resection and adjuvant BCG instillation with no recurrence on follow-up cystoscopies and urine cytologies. 64% of patients were treated by diverticulectomy. Mean follow-up time was 38.7 months. At the end of the follow-up, 81% were disease-free. One patient had a radical cystectomy 6 months after diverticulectomy for recurrent high grade tumor; another one had a nodal metastasis 10 months after diverticulectomy and was managed with chemotherapy. 29% of patients were treated with radical cystectomy. Mean follow-up time was 28.4 months. No recurrence was documented on annual CT scans. Conclusions. Our data support a conservative approach for tumors confined to the bladder diverticulum, even in high grade or in the presence of CIS provided complete removal is feasible and close follow-up is ensured. PMID:27066072

  20. Age-Related Alterations in Regeneration of the Urinary Bladder after Subtotal Cystectomy

    DTIC Science & Technology

    2013-11-01

    approved by the Institutional Animal Care and Use Committee ofWake Forest University. Surgical Procedures Trigone-Sparing Cystectomies Rats were...intuition that char- acterizing the native regenerative process would provide the best blueprint for development of improved regenerative therapies for

  1. Systematic review of perioperative outcomes and complications after open, laparoscopic and robot-assisted radical cystectomy.

    PubMed

    Palazzetti, A; Sanchez-Salas, R; Capogrosso, P; Barret, E; Cathala, N; Mombet, A; Prapotnich, D; Galiano, M; Rozet, F; Cathelineau, X

    2017-09-01

    Radical cystectomy and regional lymph node dissection is the standard treatment for localized muscle-invasive and for high-risk non-muscle-invasive bladder cancer, and represents one of the main surgical urologic procedures. The open surgical approach is still widely adopted, even if in the last two decades efforts have been made in order to evaluate if minimally invasive procedures, either laparoscopic or robot-assisted, might show a benefit compared to the standard technique. Open radical cystectomy is associated with a high complication rate, but data from the laparoscopic and robotic surgical series failed to demonstrate a clear reduction in post-operative complication rates compared to the open surgical series. Laparoscopic and robotic radical cystectomy show a reduction in blood loss, in-hospital stay and transfusion rates but a longer operative time, while open radical cystectomy is typically associated with a shorter operative time but with a longer in-hospital admission and possibly a higher rate of high grade complications. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  2. Complications from robot-assisted radical cystectomy: Where do we stand?

    PubMed

    Guiote, I; Gaya, J M; Gausa, L; Rodríguez, O; Palou, J

    2016-03-01

    Radical cystectomy with extended lymphadenectomy is the surgical treatment of choice for muscle-invasive bladder cancer. The technical and technological improvements and the positive results from robot-assisted kidney and prostate surgery have led to the progressive development of robot-assisted radical cystectomy (RARC). We provide a global structured overview and an update on the complications of RARC, recorded according to the Clavien-Dindo classification system. We conducted a search on PubMed of all publications on RARC to date (2014). Of the 259 publications found, we excluded review articles and cost analyses, publications with less than 30 cases, updates of previous studies and those whose main objective was the study of other issues related to RARC other than complications, leaving a total of 38 articles for the final analysis. The most common complications associated with RARC are gastrointestinal, infectious and genitourinary system, mainly Clavien 1-2, followed by Clavien 3-4. RARC had lower overall complication rates than open radical cystectomy and laparoscopic radical cystectomy and had a lower incidence of severe complications, less intraoperative bleeding and better postoperative recovery. Although further scientific evidence is needed, RARC is an increasingly widespread technique that appears to reduce complications as well as the need for transfusion, and it improves recovery times. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Intraneobladder Hem-o-Lok Migration with Stone Formation after Orthotopic Neobladder Cystectomy.

    PubMed

    Shu-Xiong, Zeng; Zhen-Sheng, Zhang; Xiao-Wen, Yu; Hui-Zhen, Li; Xin, Lu; Ying-Hao, Sun; Chuan-Liang, Xu

    2014-01-01

    Introduction. Laparoscopic and robot-assisted laparoscopic surgery are widely performed in urology field, so Hem-o-Lok clips are thus extensively used in the laparoscopic procedures. We describe the first case of Hem-o-Lok clip which migrated into the neobladder with calculus formation 26 months after laparoscopic orthotopic neobladder cystectomy, which causes symptoms of gross hematuria and frequent urination. Case Presentation. A 57-year-old man with T2a muscle invasive bladder cancer underwent laparoscopic orthotopic sigmoid neobladder reconstruction after cystectomy which was complicated by intestinal anastomosis leak and peritoneal abscess requiring transverse colostomy and drainage 15 days postoperatively. Twenty-six months after cystectomy, he complained of gross hematuria and frequent urination. Computerized tomography and plain pelvic X-ray revealed a stone measuring approximately 2.8 cm in diameter in the neobladder. During cystoscopy, a closed whitish Hem-o-Lok clip was seen in the center of the calculi. No anastomotic leak or neoplasm was found during cystoscopy. Conclusion. Hem-o-Lok clip migration into the bladder after laparoscopic orthotopic neobladder cystectomy is a rare complication; the first reported case in the literature. To prevent Hem-o-Lok clip migration, it is recommended to avoid extensive use of Hem-o-Lok clip close to anastomosis site, and any loose Hem-o-Lok clip should be retrieved before closure.

  4. Does preoperative heparin increase the postoperative bleeding risk in women undergoing prosthetic breast implant surgery? A review of the data from a single institution.

    PubMed

    Monsivais, Sharon E; Roehl, Kendall R; Mahabir, Raman C

    2015-01-01

    In 2008, the authors' institution adopted a policy requiring that all patients, regardless of preoperative risk, receive both sequential compression devices and a single preoperative subcutaneous 5000 unit injection of heparin. A previously published 12-year review at this same institution before this policy demonstrated a 1.5% 30-day postoperative incidence of hematoma in primary augmentation or delayed tissue expander based breast reconstructions. To determine the incidence of postoperative bleeding complications associated with preoperative administration of 5000 units of subcutaneous heparin and compare that incidence with previously published data. Patient data were collected prospectively and maintained in a secure database at a single institution with institutional review board approval. Current procedural terminology and International Classification of Diseases, Ninth Revision, coding was then used to identify all patients who received either primary breast augmentation or delayed tissue expander based breast reconstruction during a five-year period. The primary outcome was the incidence of postoperative bleeding complication. A bleeding complication was defined as any hemorrhagic event that required a return to the operating room. The overall incidence of significant postoperative bleeding was 1.47% (five of 340 [1.16% augmentation, 2.50% expander]). Comparing the current results with the previously published data, demonstrated an OR of 0.98 (95% CI 0.38 to 2.55). In women undergoing primary breast augmentation or delayed tissue expander breast reconstruction, heparin prophylaxis did not increase the risk for significant postoperative bleeding compared with historical controls.

  5. Does preoperative heparin increase the postoperative bleeding risk in women undergoing prosthetic breast implant surgery? A review of the data from a single institution

    PubMed Central

    Monsivais, Sharon E; Roehl, Kendall R; Mahabir, Raman C

    2015-01-01

    BACKGROUND: In 2008, the authors’ institution adopted a policy requiring that all patients, regardless of preoperative risk, receive both sequential compression devices and a single preoperative subcutaneous 5000 unit injection of heparin. A previously published 12-year review at this same institution before this policy demonstrated a 1.5% 30-day postoperative incidence of hematoma in primary augmentation or delayed tissue expander based breast reconstructions. OBJECTIVE: To determine the incidence of postoperative bleeding complications associated with preoperative administration of 5000 units of subcutaneous heparin and compare that incidence with previously published data. METHODS: Patient data were collected prospectively and maintained in a secure database at a single institution with institutional review board approval. Current procedural terminology and International Classification of Diseases, Ninth Revision, coding was then used to identify all patients who received either primary breast augmentation or delayed tissue expander based breast reconstruction during a five-year period. The primary outcome was the incidence of postoperative bleeding complication. A bleeding complication was defined as any hemorrhagic event that required a return to the operating room. RESULTS: The overall incidence of significant postoperative bleeding was 1.47% (five of 340 [1.16% augmentation, 2.50% expander]). Comparing the current results with the previously published data, demonstrated an OR of 0.98 (95% CI 0.38 to 2.55). CONCLUSION: In women undergoing primary breast augmentation or delayed tissue expander breast reconstruction, heparin prophylaxis did not increase the risk for significant postoperative bleeding compared with historical controls. PMID:26361622

  6. Bladder cancer in men and women treated by radiation therapy and/or radical cystectomy.

    PubMed

    Batata, M A; Chu, F C; Hilaris, B S; Whitmore, W F; Kim, Y S; Lee, M Z

    1981-07-01

    Four-hundred fifty-one patients with bladder cancer, 348 men and 103 women, were treated by radiation therapy and/or radical cystectomy during the last two decades at Memorial Sloan-Kettering Cancer Center. Radical cystectomy alone was the treatment in 98 men and 39 women. Radical radiation therapy to an average tumor dose of 6,000 rad in six weeks was given to 79 men and 30 women +/- one year before salvage cystectomy was done for recurrent or persistent tumors. Planned preoperative irradiation was delivered to the true pelvis either 4,000 rad in four weeks in 95 men and 24 women or 2,000 rad in one week in 76 men and 10 women +/- six weeks and two days, respectively, before radical cystectomy. Over-all survival and recurrence results in both sexes were similar, 40 per cent of men and 36 per cent of women were alive at five years without recurrence, 45 per cent of men and 48 per cent of women died in five or more years with local and/or distant recurrences, and 21 per cent of men and 15 per cent of women died before five years from causes other than cancer recurrence. Higher five-year survival for high clinical stage B2 to D1 tumors was noted similarly in the irradiated men (30 per cent) and women (37 per cent) than in the cystectomy alone patients (19 per cent in men and 4 per cent in women). Similar survival rates (52 to 57 per cent) were observed in men and women with low clinical stage O to B1 tumors treated with or without irradiation.

  7. Preliminary Comparative Effectiveness of Robotic Versus Open Radical Cystectomy in Elderly Patients.

    PubMed

    Winters, Brian R; Bremjit, Prashoban J; Gore, John L; Lin, Daniel W; Ellis, William J; Dalkin, Bruce L; Porter, Michael P; Harper, Jonathan D; Wright, Jonathan L

    2016-02-01

    Treatment for muscle-invasive bladder cancer (MIBC) remains highly morbid despite improving surgical techniques. As the median age of diagnosis is 73, many patients are elderly at the time of cystectomy. We compare perioperative surgical outcomes in elderly patients undergoing robotic vs open radical cystectomy (RC). Patients >75 years at time of RC were identified. Demographic, clinicopathologic, and perioperative variables were examined. Estimated blood loss (EBL) and length of stay (LOS) data were collected with multivariate linear regression analysis performed to assess whether technique was independently associated with outcomes. Eighty-seven patients >75 years of age underwent cystectomy for MIBC (58 open, 29 robotic). Mean age was 79.6 (±3.2) and 79.2 (±3.5) for open and robotic groups, respectively (p = 0.64). There were no significant differences in baseline comorbidities, clinical or pathologic stage, or use of neoadjuvant chemotherapy. The mean number of lymph nodes removed was similar (p = 0.08). Robotic cystectomy had significantly longer mean OR times (p < 0.001). On multivariate analyses, robotic surgery was associated with -389cc less EBL (95% CI -547 to -230, p < 0.001) and a -1.5-day-shortened LOS (95%CI -2.9 to -0.2, p = 0.02) compared with open surgery. There were no significant differences in surgical complications or 90-day readmission rates between the two groups. Robotic cystectomy is safe and feasible in an elderly population. We observed longer OR times with robotic surgery, but with decreased EBL, shorter hospital stays, and comparable complication and readmission rates with open RC. Larger prospective studies are required to confirm these findings.

  8. Bladder preservation in non-metastatic muscle-invasive bladder cancer (MIBC): a single-institution experience.

    PubMed

    Gerardi, Marianna A; Jereczek-Fossa, Barbara A; Zerini, Dario; Surgo, Alessia; Dicuonzo, Samantha; Spoto, Ruggero; Fodor, Cristiana; Verri, Elena; Rocca, Maria Cossu; Nolè, Franco; Muto, Matteo; Ferro, Matteo; Musi, Gennaro; Bottero, Danilo; Matei, Deliu V; De Cobelli, Ottavio; Orecchia, Roberto

    2016-01-01

    The aim of this study is to access the feasibility, toxicity profile, and tumour outcome of an organ preservation curative approach in non-metastatic muscle-invasive bladder cancer. A retrospective analysis was conducted on patients affected by M0 bladder cancer, who refused cystectomy and were treated with a curative approach. The standard bladder preservation scheme included maximal transurethral resection of bladder tumour (TURBT) and combination of radiotherapy and platin-based chemotherapy, followed by endoscopic evaluation, urine cytology, and instrumental evaluation. Thirteen patients fulfilled the inclusion criteria. TNM stage was cT2cN0M0 and cT2cNxM0, in 12 and one patients, respectively. All patients had transitional cell cancer. Twelve patients completed the whole therapeutic programme (a bimodal treatment without chemotherapy for one patient). Median follow-up is 36 months. None of the patients developed severe urinary or intestinal acute toxicity. In 10 patients with a follow-up > 6 months, no cases of severe late toxicity were observed. Response evaluated in 12 patients included complete response and stable disease in 11 patients (92%), and one patient (8%), respectively. At the time of data analysis (March 2016), 10 patients (77%) are alive with no evidence of disease, two patients (15%) died for other reasons, and one patient has suspicious persistent local disease. The trimodality approach, including maximal TURBT, radiotherapy, and chemotherapy for muscle-invasive bladder cancer, is well-tolerated and might be considered a valid and feasible option in fit patients who refuse radical cystectomy.

  9. Metaplastic breast carcinoma: Analysis of 31 cases from a single institute.

    PubMed

    Fayaz, Salah; Demian, Gerges Attia; Eissa, Heba El-Sayed; Amanguno, Henney; Abuzalouf, Sadeq

    2017-09-01

    Metaplastic carcinoma of the breast (MBC) accounts for less than 1% of all mammary tumors. This study aimed at revision of the clinico-pathological features, treatment strategy and outcome for MBC patients presented to the Kuwait Cancer Control Center to define the clinical behavior and prognostic factors of these neoplasms in our population. Thirty-one patients were retrieved from our surgical pathology registry between January 2005 and December 2014. Medical records were revised regarding the clinico-pathological features and treatment outcome. MBC represented 1% of our breast cancer patients. The median age was 50years (32-70years). Two patients presented with metastatic disease. Mastectomy was done for 24 patients and 7 had conservative surgery. The median tumor size at the time of surgery was 5.5cm (1.5-12cm). Axillary nodes were negative in 21 patients (N0), 5 patients were N1, 4 patients were N2 and one Nx. Three histological subtypes were presented: carcinosarcoma (7 cases), squamous cell carcinoma/IDC with squamous differentiation (15 cases), high grade IDC with metaplastic differentiation (9 cases). Immunohistochemically, 26 were negative hormone receptors and all were negative for Her2/neu overexpression. Chemotherapy was used in 28 patients, and adjuvant radiotherapy in 24 patients. The median follow-up was 47months (7-126months), six patients lost follow-up. The 5-year OS was 69% and 5-year PFS was 50%. MBC is a rare entity among breast carcinoma in Kuwait. Most of the cases present with poor prognostic indicators and often show lack of expression of ER, PR and Her2/neu. Copyright © 2017 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. All rights reserved.

  10. Robotic radical cystectomy: where are we today, where will we be tomorrow?

    PubMed

    Richards, Kyle A; Kader, Karim; Hemal, Ashok K

    2010-11-16

    While open radical cystectomy remains the gold-standard treatment for muscle-invasive bladder cancer and high-risk non-muscle invasive disease, robotic assisted radical cystectomy (RARC) has been gaining popularity over the past decade. The robotic approach has the potential advantages of less intraoperative blood loss, shorter hospital stay, less post-operative narcotic requirement, quicker return of bowel function, and earlier convalescence with an acceptable surgical learning curve for surgeons adept at robotic radical prostatectomy. While short to intermediate term oncologic results from several small RARC series are promising, bladder cancer remains a potentially lethal malignancy necessitating long-term follow-up. This article aims to review the currently published literature, important technical aspects of the operation, oncologic and functional outcomes, and the future direction of RARC.

  11. Orthotopic ileal neobladder in female patients after radical cystectomy: 2-year experience.

    PubMed

    Cancrini, A; De Carli, P; Fattahi, H; Pompeo, V; Cantiani, R; Von Heland, M

    1995-03-01

    We describe a surgical technique to conserve urinary continence in 7 women who underwent radical cystectomy with construction of an orthotopic ileal neobladder for infiltrating bladder carcinoma. The selection of the patients and the surgical procedure to preserve the anatomical and functional integrity of the female urethra are described. Followup ranged from 7 to 28 months. There were no postoperative deaths or serious clinical complications. The urinary continence rate was 100% during the day and 71% at night with micturition at regular 3-hour intervals. The vesical capacity varied from 250 to 400 cc and pressure at maximum capacity from 10 to 25 cm. water. Urinary flow was satisfactory and the urethral pressure profile showed a normal sphincteric mechanism at rest. Two patients died of metastases at 14 and 8 months postoperatively, and 5 are alive and disease-free. We believe that these results confirm the possibility of obtaining micturition in women via the urethra following radical cystectomy.

  12. Endourologic Management of Upper Tract Transitional Cell Carcinoma following Cystectomy and Urinary Diversion

    PubMed Central

    Tomaszewski, Jeffrey John; Smaldone, Marc Christopher; Ost, Michael Cecil

    2009-01-01

    Traditionally, nephroureterectomy is the gold standard therapy for upper tract recurrence of transitional cell carcinoma (TCC) following cystectomy and urinary diversion. With advances in endoscopic equipment and improvements in technique, conservative endourologic management via a retrograde or antegrade approach is technically feasible with acceptable outcomes in patients with bilateral disease, solitary renal units, chronic renal insufficiency, or significant medical comorbidities. Contemporary studies have expanded the utility of these techniques to include low-grade, low-volume disease in patients with a normal contralateral kidney. The aim of this report is to review the current outcomes of conservative management for upper tract disease and discuss its application and relevance in patients following cystectomy with lower urinary tract reconstruction. PMID:19125199

  13. Health-Related Quality of Life after Cystectomy and Urinary Diversion for Bladder Cancer

    PubMed Central

    Shih, Cheryl; Porter, Michael P.

    2011-01-01

    With multiple options for urinary diversion after radical cystectomy for bladder cancer that have comparable cancer control and complication rates, health-related quality of life (HRQOL) has become an important consideration. This article reviews the methods for defining HRQOL, the challenges in measuring HRQOL in bladder cancer, and the literature comparing HRQOL after various methods of urinary diversion. Recent contributions include the validation of HRQOL instruments specific to bladder cancer and the publication of several prospective studies measuring HRQOL outcomes after cystectomy and urinary diversion. There is no convincing evidence from existing literature that any particular method of urinary diversion offers superior HRQOL outcomes. Rather, there is growing evidence that good HRQOL can be achieved with patient education and consideration of each patient's clinical and psychosocial situation. Future research should utilize the validated bladder cancer specific HRQOL instruments and perhaps explore the impact of preoperative counseling on postoperative HRQOL. PMID:21826139

  14. Pregnancy Outcome, and Adhesion Formation and Reformation after Laparoscopic Cystectomy of Ovarian Endmetriomas

    PubMed

    Gurgan; Yarali

    1996-08-01

    Unilateral or bilateral cystectomy for endometriomas was performed in 90 infertile women. Using a multipuncture technique, a cortical incision was made on the medial aspect of the ovary with sharp-tipped unipolar coagulation. Cystectomy was performed by stripping the cyst capsule from the normal ovarian cortex with the aid of atraumatic grasping forceps. If the capsule removal was incomplete due to technical difficulties, the remaining capsular fragments were vaporized with the carbon dioxide laser. Endometriosis implants elsewhere in the pelvis were vaporized and adhesions, if present, were lysed. The ovarian cortex was closed with a few interrupted 6-0 polyglactin sutures using extracorporeal knot technique. A second-look laparoscopy was performed in 25 patients to evaluate adhesion formation, reformation, postoperative crude pregnancy rates, and factors that would predict conception.

  15. The Cancer of the Bladder Risk Assessment (COBRA) score: Estimating mortality after radical cystectomy.

    PubMed

    Welty, Christopher J; Sanford, Thomas H; Wright, Jonathan L; Carroll, Peter R; Cooperberg, Matthew R; Meng, Maxwell V; Porten, Sima P

    2017-09-07

    Risk stratification of patients with urothelial carcinoma of the bladder (UCB) after cystectomy has important clinical and research implications. The authors assessed the relative effect of tumor stage and lymph node status on cancer-specific survival (CSS) after cystectomy and developed a simplified risk-assessment tool. In total, 14,828 patients who underwent cystectomy with lymph node dissection for UCB were identified from the Surveillance, Epidemiology, and End Results database (1988-2011). The relative importance of tumor stage and lymph node status with regard to CSS was assessed using stratified Kaplan-Meier and Cox proportional-hazards analyses. The patients were split randomly into development and validation cohorts. Additional validation using overall survival was performed on 19,362 patients from the National Cancer Data Base. The Cancer of Bladder Risk Assessment (COBRA) tool was created using a Cox model incorporating age, tumor stage, and lymph node density. Performance was validated using observed versus expected survival plots and the Harrell concordance index. Patients with muscle invasive (T2), lymph node-positive disease had a survival curve similar to that in patients with extravesical (T3 and T4), lymph node-negative disease (2-year CSS, 67% and 70%, respectively). Each point increase in the COBRA score (range, 0-7) was associated with a 1.61-fold increase (95% confidence interval, 1.56-fold to 1.65-fold increase) in the risk of bladder cancer death in the development cohort. The model accurately stratified patients across risk levels in the development cohort and the 2 validation cohorts (C-index, 0.712, 0.705, and 0.68, respectively). The COBRA score offers a straightforward, validated risk-stratification tool that incorporates the relative contribution of tumor stage and lymph node involvement to patient prognosis after cystectomy for UCB. Cancer 2017. © 2017 American Cancer Society. © 2017 American Cancer Society.

  16. Correlation between annual volume of cystectomy, professional staffing, and outcomes: a statewide, population-based study.

    PubMed

    Elting, Linda S; Pettaway, Curtis; Bekele, B Nebiyou; Grossman, H Barton; Cooksley, Catherine; Avritscher, Elenir B C; Saldin, Kamaldeen; Dinney, Colin P N

    2005-09-01

    The association between high procedure volume and lower perioperative mortality is well established among cancer patients who undergo cystectomy. However, to the authors' knowledge, the association between volume and perioperative complications has not been studied to date and hospital characteristics contributing to the volume-outcome correlation are unknown. In the current study, the authors studied these associations, emphasizing hospital factors that contribute to the volume-outcome correlation. Multiple-variable models of inpatient mortality and complications were developed among all 1302 bladder carcinoma patients who underwent cystectomy between January 1, 1999 and December 31, 2001 in all Texas hospitals. General estimating equations were used to adjust for clustering within the 133 hospitals. Data were obtained from hospital claims, the 2000 U.S. Census, and databases from the Center for Medicare and Medicaid Services and the American Hospital Association. Complications were reported to occur in 12% of patients, 2.2% of whom died. Mortality was higher in low-volume hospitals compared with high-volume hospitals (3.1% vs. 0.7%; P < 0.001); mortality in moderate-volume hospitals was reported to be intermediate (2.9%). After adjustment for advanced age and comorbid conditions, treatment in high-volume hospitals was associated with lower risks of mortality (odds ratio [OR] = 0.35; P = 0.02) and complications (OR = 0.53; P = 0.01). Hospitals with a high registered nurse-to-patient ratio also had a lower mortality risk (OR = 0.43; P = 0.04). Mortality after cystectomy was found to be significantly lower in high-volume hospitals, regardless of patient age. Referral to a hospital performing greater than 10 cystectomies annually is indicated for all patients. However, patients with poor access to a high-volume hospital may derive similar benefit from treatment at a hospital with a high-registered nurse-to-patient ratio. This finding requires further confirmation.

  17. [Extending the limits of lymphadenectomy during radical cystectomy: pitfalls in the interpretation of contemporary study results].

    PubMed

    Suttmann, H; Kamradt, J; Becker, F; Lehmann, J; Stöckle, M

    2009-02-01

    The optimal extent of lymphadenectomy performed during radical cystectomy for transitional cell carcinoma of the bladder is currently under intensive debate. Extending the limits of lymphadenectomy has been hypothesized to add further diagnostic and therapeutic benefit. However, our current knowledge is based exclusively on results from retrospective studies that are hampered by several statistical shortcomings. This article provides a critical analysis of the contemporary data on the subject and outlines typical statistical pitfalls that must be considered when interpreting such research results.

  18. Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort

    PubMed Central

    Corradi, Renato B.; Galvão, Gustavo Jaime Climaco; Oliveira, Gabriel M.; Carneiro, Vinicius F.; Miconi, Wadson Gomes; Salles, Paulo Guilherme Oliveira; Cabral, Walter Luiz Ribeiro; Corradi, Carlos; Salazar, Andre Lopes Lopes

    2016-01-01

    ABSTRACT Introduction and Objective Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control. Patients and Methods We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery. Results We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The medium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients. Conclusions In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity. PMID:27286104

  19. Enumerating pelvic recurrence following radical cystectomy for bladder cancer: A Canadian multi-institutional study

    PubMed Central

    Eapen, Libni J.; Jones, Edward; Kassouf, Wassim; Lambert, Carole; Morgan, Scott C.; Moussa, Madeleine; Nam, Robert; Parliament, Matthew; Russell, Laurie; Saad, Fred; Siemens, D. Robert; Souhami, Luis; Szumacher, Ewa; Tyldesley, Scott; Xu, Yan; Zbieranowski, Ingrid; Breau, Rodney H.; Belanger, Eric; Black, Peter; Estey, Eric; Bowan, Julie; Bora, Bishwajit; Brundage, Michael; Chung, Peter; Fleshner, Neil; Evans, Andrew; Bauman, Glenn; Izawa, Jonathan; Davidson, Chris; Brimo, Fadi

    2016-01-01

    Introduction: We aimed to enumerate the rate of pelvic recurrence following radical cystectomy at university-affiliated hospitals in Canada. Methods: Canadian, university-affiliated hospitals were invited to participate. They were asked to identify the first 10 consecutive patients undergoing radical cystectomy starting January 1, 2005, who had urothelial carcinoma stages pT3/T4 N0-2 M0. The first 10 consecutive cases starting January 1, 2005 who met these criteria were the patients submitted by that institution with information regarding tumour stage, age, number of nodes removed, and last known clinical status in regard to recurrence and patterns of failure. Results: Of the 111 patients, 80% had pT3 and 20% pT4 disease, with 62% being node-negative, 14% pN1, and 27% pN2; 57% had 10 or more nodes removed. Cumulative incidence of pelvic relapse was 40% among the entire group Conclusions: This review demonstrates a high rate of pelvic tumour recurrence following radical cystectomy for pT3/T4 urothelial cancer. PMID:27217852

  20. Orthotopic urinary diversion after radical cystectomy in treatment of muscle invasive bladder cancer.

    PubMed

    Jovan, Hadži-Djokić; Vladan, Andrejević; Tomislav, Pejčić; Miodrag, Aćimović; Uroš, Babić; Miodrag, Stanić; Zoran, Džamić

    2014-01-01

    Surgical treatment of invasive carcinoma of the bladder in males includes total cystectomy removal of the prostate, seminal vesicles, and the distal parts of the urethers and the pelvic lymph node dissection as well. At this moment it is not possible to recommend a particular type of urinary diversion, but today in clinical practice commonly used derivative are ileal orthotopic neobladder as the continent one and ileal conduit as non-continent urinary diversion. Continent urinary diversion after radical cystectomy are the result of the application of technological innovation in surgery, but also knowledge, imagination and skill of well trained urologist. This type of operation significantly improves the quality of life in patients who underwent radical cystectomy, and the proposal is to operate whenever there is a possibility for this type of procedure. Also it is very important, during surgery to respect oncological principles, of complete removal of tumorous tissue and that the functional principle of ensur- ing that the patients have daytime and also nighttime continence later on after the surgery.

  1. Tips and tricks to robot-assisted radical cystectomy and intracorporeal diversion.

    PubMed

    Poch, Michael A; Raza, Johar; Nyquist, John; Guru, Khurshid A

    2013-01-01

    To summarize the fundamental principles for technique of robot-assisted radical cystectomy (RARC) based on current peer reviewed literature. Also provide most recent evidence for the efficacy of RARC and Intracorporeal Ileal Conduit (ICIC). Technical tricks have increased the efficiency of RARC and ICIC diversion. Perioperative and short-term outcomes have demonstrated that RARC is an acceptable alternative to open radical cystectomy. Acceptable positive surgical margin rates, thorough extended lymph node dissection based on tenets of oncological principles and acceptable short-term oncologic outcomes have been reported. Learning curve towards safe incorporation of intracorporeal urinary diversion and its evolution are presented. The technical tips and tricks have led to evolution of technique translating into improved surgical outcomes. RARC is a well tolerated and effective alternative to open cystectomy and urinary diversion. Intracorporeal urinary diversion is the next challenge on the horizon with an acceptable learning curve and outcomes; this evolution will lead to improvement in quality of life after this morbid surgical procedure.

  2. Radiation therapy before cystectomy in the management of patients with bladder cancer.

    PubMed

    Batata, M A; Chu, F C; Hilaris, B S; Kim, Y; Lee, M; Chang, B; Whitmore, W F

    1982-01-01

    During the preceding two decades, 309 patients with bladder cancer were treated by irradiation before cystectomy at the Memorial Sloan-Kettering Cancer Center. A radical tumour dose averaging 6000 cGy (rad) in six weeks was given to 104 patients who underwent radical cystectomy +/- one year later for persistent or recurrent cancer. Pre-operative pelvic irradiation was planned in 205 patients who received either 4000 cGy in four weeks (119) or 2000 cGy in one week (86) and underwent radical cystectomy after +/- six weeks and two days, respectively. The determinate five-year survival rates (41-43%) were similar with the three irradiation regimes; mortality under five years was mainly due to cancer recurrence locally and/or distally. Incidence of recurrence with radiation-induced stage reduction (21%) was lower, especially within the pelvis, than with no stage reduction (51%). Treatment results with planned pre-operative irradiation, especially in high stage tumours, were more favourable with the shorter 2000 cGy regimen of high fractional doses than with the conventionally fractionated 4000 cGy regimen.

  3. [Negative prognostic impact of female gender on oncological outcomes following radical cystectomy].

    PubMed

    Dabi, Y; Rouscoff, Y; Delongchamps, N B; Sibony, M; Saighi, D; Zerbib, M; Peyraumore, M; Xylinas, E

    2016-02-01

    To confirm gender specific differences in pathologic factors and survival rates of urothelial bladder cancer patients treated with radical cystectomy. We conducted a retrospective monocentric study on 701 patients treated with radical cystectomy and pelvic lymphadenectomy for muscle invasive bladder cancer. Impact of gender on recurrence rate, specific and non-specific mortality rate were evaluated using Cox regression models in univariate and multivariate analysis. We collected data on 553 males (78.9%) and 148 females (21.1%) between 1998 and 2011. Both groups were comparable at inclusion regarding age, pathologic stage, nodal status and lymphovascular invasion. Mean follow-up time was 45 months (interquartile 23-73) and by that time, 163 patients (23.3%) had recurrence of their tumor and 127 (18.1%) died from their disease. In multivariable Cox regression analyses, female gender was independently associated with disease recurrence (RR: 1.73; 95% CI 1.22-2.47; P=0.02) and cancer-specific mortality (RR=2.50, 95% CI=1.71-3.68; P<0.001). We confirmed female gender to be an independent negative prognosis factor for patients following a radical cystectomy and lymphadenectomy for an invasive muscle bladder cancer. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  4. Clinical outcome of partial cystectomy for transitional cell carcinoma of the canine bladder.

    PubMed

    Marvel, S J; Séguin, B; Dailey, D D; Thamm, D H

    2017-02-20

    Canine transitional cell carcinoma (TCC) of the bladder has historically been treated with a combination of chemotherapy, cyclooxygenase inhibitors and radiation therapy. While surgery has been used to treat TCC of the bladder, its efficacy has yet to be established. Thirty-seven client owned dogs that underwent partial cystectomy +/- various nonsurgical treatments for TCC were retrospectively evaluated. The overall median progression-free interval (PFI) was 235 days and the median survival time (ST) was 348 days. Prognostic factors identified on univariate analysis significant for ST were age, tumor location, full thickness excision and frequency of piroxicam administration. Prognostic factors significant for PFI were full thickness excision and frequency of piroxicam administration. The median ST with partial cystectomy and daily piroxicam therapy, with or without chemotherapy, was 772 days. Dogs with non-trigonal bladder TCC treated with full thickness partial cystectomy and daily piroxicam (+/- chemotherapy) may have improved outcome compared to dogs treated with medical therapy. © 2017 John Wiley & Sons Ltd.

  5. Prediction of mortality after radical cystectomy for bladder cancer by machine learning techniques.

    PubMed

    Wang, Guanjin; Lam, Kin-Man; Deng, Zhaohong; Choi, Kup-Sze

    2015-08-01

    Bladder cancer is a common cancer in genitourinary malignancy. For muscle invasive bladder cancer, surgical removal of the bladder, i.e. radical cystectomy, is in general the definitive treatment which, unfortunately, carries significant morbidities and mortalities. Accurate prediction of the mortality of radical cystectomy is therefore needed. Statistical methods have conventionally been used for this purpose, despite the complex interactions of high-dimensional medical data. Machine learning has emerged as a promising technique for handling high-dimensional data, with increasing application in clinical decision support, e.g. cancer prediction and prognosis. Its ability to reveal the hidden nonlinear interactions and interpretable rules between dependent and independent variables is favorable for constructing models of effective generalization performance. In this paper, seven machine learning methods are utilized to predict the 5-year mortality of radical cystectomy, including back-propagation neural network (BPN), radial basis function (RBFN), extreme learning machine (ELM), regularized ELM (RELM), support vector machine (SVM), naive Bayes (NB) classifier and k-nearest neighbour (KNN), on a clinicopathological dataset of 117 patients of the urology unit of a hospital in Hong Kong. The experimental results indicate that RELM achieved the highest average prediction accuracy of 0.8 at a fast learning speed. The research findings demonstrate the potential of applying machine learning techniques to support clinical decision making.

  6. Hirschsprung's disease: 13 years' experience in 112 patients from a single institution.

    PubMed

    Pini Prato, Alessio; Gentilino, Valerio; Giunta, Camilla; Avanzini, Stefano; Parodi, Stefano; Mattioli, Girolamo; Martucciello, Giuseppe; Jasonni, Vincenzo

    2008-02-01

    Although Hirschsprung's disease is curable, a low mortality and a certain morbidity have been described by several authors. We will present our experience with the treatment of Hirschsprung's disease at Gaslini Children's Hospital. All patients who underwent a pull-through procedure since January 1993 were included. Data were obtained from a comprehensive questionnaire and from the revision of the notes. The results were subsequently described and compared with regard to age and length of aganglionosis. A total of 151 patients underwent a pull-through. One hundred and twelve of these patients completed the forms and were reviewed. Eighty patients had a classic form, 22 an ultralong. Complications occurred in 28 patients (25%). Postoperative enterocolitis was complained by 25 patients (13% colonic and 59% ultralong forms) and constipation by 15 (equally distributed). Excellent to good continence was experienced by 84% of patients with classic forms and by 68% of patients with ultralong forms. A clear improving trend during growth was evident for patients with ultralong forms. Psychological self-acceptance, patients' perspective and cosmetic results proved to be significantly better for patients with classic forms of the disease. Our study confirmed the complications and long-term sequelae that patients with Hirschsprung's can experience. Early diagnosis can minimise morbidity and mortality and prompt and adequate treatment can reduce the incidence of postoperative complications. The parents should be acknowledged regarding the progressive improvements of function that patients gain during growth, particularly in case of ultralong forms, thus strengthening the need for continuative care and close follow-up.

  7. Spanning the genomics era: the vital role of a single institution biorepository for childhood cancer research over a decade

    PubMed Central

    Zhou, Li

    2015-01-01

    The ‘genomics era’ is considered to have begun with the commencement of the Human Genome Project. As translational genomic studies can only be established when human tissue samples are available for analysis, biospecimens are now proven to be an essential element for their success. During the genomics era the necessity for more extensive biobanking infrastructure has been highlighted. With the increased number of genomic studies into cancer, it is considered that the availability of biospecimens will become the rate limiting step. Despite the efforts in international biobanking, translational genomics is hampered when there low numbers of biospecimens for a particular rare diseases and is most apparent for paediatric cancer. As there is a call for biobanking practice to be responsive to the current experimental needs of the time and for more expansive systems of tissue procurement to be established we have asked the question what role does a single institution biorepository play in the current highly networked world of translational genomics. Here we describe such a case. The Tumour Bank at The Children’s Hospital at Westmead (TB-CHW) in the western suburbs of Sydney was formally established in 1998 as a key resource for translational paediatric cancer research. During the genomics era, we show that the TB-CHW has developed into a key biospecimen repository for the cancer research community, during which time it has increasingly found itself having a vital role in the establishment of translational genomics for paediatric cancer. Here we detail metrics that demonstrate how as a single institution biorepository, the TB-CHW has been a strong participant in the advancement of translational genomics throughout the genomics era. This paper describes the significant contribution of a single institutional hospital embedded tumour biobank to the genomic research community. Despite the increased stringencies placed on biobanking practice, the TB-CHW has shown that a

  8. Contractual Revision.

    ERIC Educational Resources Information Center

    Engel, Mary F.; Sawyer, Thomas M.

    Contractual revision promotes cooperation between teachers and tutors and, being student initiated, provides a method to increase student control over the revision process and encourage students to communicate their strengths and weaknesses in writing to their teachers or tutors. The contractual revision process requires students to form contracts…

  9. Cystectomy and Urinary Diversion for the Management of a Devastated Lower Urinary Tract Following Prostatic Cryotherapy and/or Radiotherapy.

    PubMed

    Sack, Bryan S; Langenstroer, Peter; Guralnick, Michael L; Jacobsohn, Kenneth M; O'Connor, R Corey

    2016-04-01

    We investigated the outcomes and quality of life measures in men who underwent cystectomy and urinary diversion for devastating lower urinary tract toxicity after prostatic radiotherapy and/or cryotherapy for the treatment of prostate cancer. Records of patients who underwent cystectomy and urinary diversion for the management of a devastated lower urinary tract following prostatic radiotherapy or cryotherapy were reviewed retrospectively. A postoperative, retrospective quality of life (QOL) survey was designed specific to this patient subset and obtained by telephone interview. Extirpative surgery with urinary diversion for management of a devastated lower urinary tract was performed on 15 patients with a mean age of 72 years (range 63-82). Toxicities leading to bladder removal included bladder neck contractures, prostatic necrosis, incontinence, osteomyelitis, bladder calculi, fistulae, urethral strictures, abscesses, necrotizing fasciitis, and radiation/hemorrhagic cystitis. The mean number of failed conservative, minimally invasive interventions per patients prior to cystectomy was 3.7 (range 1-12). The average time period from major complication following radiotherapy/cryotherapy to cystectomy was 29.1 months (range 5-65). The QOL survey showed all of the patients who completed the survey (n = 13) would undergo the procedure again and 11 (85%) would have undergone the procedure an average of 13.2 months sooner (range 5-36). Toxicities secondary to prostatic radiotherapy or cryotherapy may be debilitating. Our results demonstrate that cystectomy with urinary diversion can improve QOL in patients with a devastated lower urinary tract.

  10. Enteric Duplication Cysts in Children: A Single-Institution Series with Forty Patients in Twenty-Six Years.

    PubMed

    Erginel, Basak; Soysal, Feryal Gun; Ozbey, Huseyin; Keskin, Erbug; Celik, Alaattin; Karadag, Aslıhan; Salman, Tansu

    2017-02-01

    The purpose of the study was to evaluate our experience with enteric duplication cysts in 40 children during the past 26 years, while assessing the variability of their presentations and to propose an algorithm for surgical management. We retrospectively analysed sex, age, clinical presentations, duplication site, surgical treatment, presence of ectopic tissue, complications, associated anomalies, and prognosis of 40 patients with gastrointestinal tract duplications who were surgically treated in our clinic. Overall, there was a predominance of boys (28 males, 70 %; 12 females, 30 %). The presenting symptom was vomiting in 23 patients, rectal bleeding in 11 patients, abdominal mass in 10 patients, abdominal pain in 9 patients, constipation in 6 patients, cough in 2 patients, and respiratory distress in 2 patients. In 30 patients, a complete excision of the cyst with additional segmental intestinal resection and anastomosis was performed. Cystectomy was performed in seven patients, while complete excision of the cyst with additional wedge resection was performed in two. A Wrenn procedure (mucosectomy) was performed in one patient. Due to the variability in the site of enteric duplications, a wide range of presenting symptoms can exist, which is challenging for diagnosis. In children with a diagnosis of acute abdomen, enteric duplication cysts should be considered, and these children should be further investigated for additional skeletal, urogenital, and gastrointestinal system pathologies. Surgical treatment depends on the site and type of the cyst.

  11. Robotic Assisted Radical Cystectomy with Extracorporeal Urinary Diversion Does Not Show a Benefit over Open Radical Cystectomy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

    PubMed

    Tan, Wei Shen; Khetrapal, Pramit; Tan, Wei Phin; Rodney, Simon; Chau, Marisa; Kelly, John D

    2016-01-01

    The number of robotic assisted radical cystectomy (RARC) procedures is increasing despite the lack of Level I evidence showing any advantages over open radical cystectomy (ORC). However, several systematic reviews with meta-analyses including non-randomised studies, suggest an overall benefit for RARC compared to ORC. We performed a systematic review with meta-analysis of randomised controlled trials (RCTs) to evaluate the perioperative morbidity and efficacy of RARC compared to ORC in patients with bladder cancer. Literature searches of Medline/Pubmed, Embase, Web of Science and clinicaltrials.gov databases up to 10th March 2016 were performed. The inclusion criteria for eligible studies were RCTs which compared perioperative outcomes of ORC and RARC for bladder cancer. Primary objective was perioperative and histopathological outcomes of RARC versus ORC while the secondary objective was quality of life assessment (QoL), oncological outcomes and cost analysis. Four RCTs (from 5 articles) met the inclusion criteria, with a total of 239 patients all with extracorporeal urinary diversion. Patient demographics and clinical characteristics of RARC and ORC patients were evenly matched. There was no significant difference between groups in perioperative morbidity, length of stay, positive surgical margin, lymph node yield and positive lymph node status. RARC group had significantly lower estimated blood loss (p<0.001) and wound complications (p = 0.03) but required significantly longer operating time (p<0.001). QoL was not measured uniformly across trials and cost analysis was reported in one RCTs. A test for heterogeneity did highlight differences across operating time of trials suggesting that surgeon experience may influence outcomes. This study does not provide evidence to support a benefit for RARC compared to ORC. These results may not have inference for RARC with intracorporeal urinary diversion. Well-designed trials with appropriate endpoints conducted by equally

  12. The natural history of symptoms and distress in patients and families following cystectomy for treatment of muscle invasive bladder cancer.

    PubMed

    Benner, Carly; Greenberg, Molly; Shepard, Nancy; Meng, Maxwell V; Rabow, Michael W

    2014-04-01

    We characterized the natural history of symptoms with time in patients with bladder cancer undergoing cystectomy. For 6 months we followed 33 participants treated with muscle invasive bladder cancer treatment with cystectomy in this prospective cohort study. Patients and family caregivers completed validated symptom assessment and satisfaction surveys at baseline, and 2, 4 and 6 months later. Primary outcomes were the change from baseline in pain, fatigue, depression, anxiety, quality of life and spiritual well-being. Secondary outcomes included posttraumatic growth, patient satisfaction and family caregiver burden. Pain increased after radical cystectomy and remained increased 6 months postoperatively based on Brief Pain Inventory scores (baseline and 6-month scores 4.0, 95% CI 0-8.0 and 9.8, 95% CI 1.9-17.6, respectively, p = 0.03). Posttraumatic growth showed a trend toward an increase at 2 months (p = 0.06). Fatigue peaked at 4 months but did not change significantly with time (p = 0.12). There was similarly no significant change with time in depression, anxiety, quality of life, spiritual well-being or satisfaction. Neither family caregiver burden nor satisfaction showed a statistically significant change with time postoperatively. Pain increased after radical cystectomy and remained increased 6 months postoperatively. There was a trend toward increased posttraumatic growth at 2 months. Otherwise, by 6 months cystectomy was associated with no improvement in preoperative symptoms of fatigue, quality of life, spiritual well-being, depression or anxiety. After cystectomy pain should be assessed and treated more aggressively in patients with bladder cancer and efforts should be made to improve postoperative symptoms. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Erection- and ejaculation-preserving cystectomy with orthotopic urinary diversion: is it feasible?

    PubMed

    Girgin, Cengiz; Oder, Mehmet; Sahin, M Oguz; Sezer, Akif; Berkmen, Serdar; Aydin, Rusen; Dincel, Cetin

    2006-01-01

    Nerve-sparing techniques to preserve sexual function in men undergoing cystoprostatectomy have been documented by different centers. We evaluated the results of the first 4 erection- and ejaculation-preserving cystectomies performed in our department. The ages of patients ranged between 36 and 43 years. In all cases, patients wished to maintain sexual function. Of the cases, 3 patients had pT1 G3 transitional cell carcinoma (TCC) refractory to treatment and one had pT2a adenocarcinoma of the bladder. Extirpation of the bladder and anterior proximal prostate en bloc with preservation of the vasa deferentia, seminal vesicles, posterior prostate, and neurovascular bundles was performed after pelvic lymphadenectomy. W-ileal neobladder was performed by using 40 cm of ileum. All patients had erections at the third month. Of the cases, 2 patients had antegrade ejaculation. The ejaculate volumes were 0.8 and 1.2 mL in patients with antegrade ejaculation. Patients in the other cases had retrograde ejaculation. All patients were continent day and night. We started clean intermittent catheterization in 1 case because of residual urine. There were no local recurrences. One patient with TCC died because of systemic disease in the postoperative 32nd month. The most important drawback of potent cases in cystectomy decision is erectile dysfunction after radical cystectomy. This drawback causes delay of the operation and sometimes mortality. As was the case in other reports, our limited number of cases in this study demonstrated that erection and ejaculation could be preserved in selected groups of patients.

  14. Robot-assisted radical cystectomy with intracorporeal neobladder diversion: The Karolinska experience

    PubMed Central

    Collins, Justin W.; Sooriakumaran, P.; Sanchez-Salas, R.; Ahonen, R.; Nyberg, T.; Wiklund, N. P.; Hosseini, A.

    2014-01-01

    Introduction: The aim of this report is to describe our surgical technique of totally intracorporeal robotic assisted radical cystectomy (RARC) with neobladder formation. Materials and Methods: Between December 2003 and March 2013, a total of 147 patients (118 male, 29 female) underwent totally intracorporeal RARC for urinary bladder cancer. We also performed a systematic search of Medline, Embase and PubMed databases using the terms RARC, robotic cystectomy, robot-assisted, totally intracorporeal RARC, intracorporeal neobladder, intracorporeal urinary diversion, oncological outcomes, functional outcomes, and complication rates. Results: The mean age of our patients was 64 years (range 37-87). On surgical pathology 47% had pT1 or less disease, 27% had pT2, 16% had pT3 and 10% had pT4. The mean number of lymph nodes removed was 21 (range 0-60). 24% of patients had lymph node positive dAQ1isease. Positive surgical margins occurred in 6 cases (4%). Mean follow-up was 31 months (range 4-115 months). Two patients (1.4%) died within 90 days of their operation. Using Kaplan-Meier analysis, overall survival and cancer specific survival at 60 months was 68% and 69.6%, respectively. 80 patients (54%) received a continent diversion with totally intracorporeal neobladder formation. In the neobladder subgroup median total operating time was 420 minutes (range 265-760). Daytime continence and satisfactory sexual function or potency at 12 months ranged between 70-90% in both men and women. Conclusions: Our experience with totally intracorporeal RARC demonstrates acceptable oncological and functional outcomes that suggest this is a viable alternative to open radical cystectomy. PMID:25097318

  15. Prognostic significance of lymphatic, vascular and perineural invasion for bladder cancer patients treated by radical cystectomy.

    PubMed

    Muppa, Prasuna; Gupta, Sounak; Frank, Igor; Boorjian, Stephen A; Karnes, R Jeffrey; Thompson, R Houston; Thapa, Prabin; Tarrell, Robert F; Herrera Hernandez, Loren P; Jimenez, Rafael E; Cheville, John C

    2017-04-01

    In radical cystectomy specimens with bladder cancer, lymphatic and vascular invasion are often reported as 'angiolymphatic' or 'lymphovascular' invasion, terms that combine the findings of tumour within simple endothelial-lined lymphatic spaces and tumour within muscle-lined blood vessels. It is unclear if these patterns of invasion have different prognostic significance. In addition, there are conflicting data regarding the significance of lymphatic, vascular and perineural invasion in patients with bladder cancer. Herein, we studied 1504 patients treated by radical cystectomy for bladder cancer at our institution and followed for a mean of 10.6 years. Cases were re-reviewed by a urological pathologist for lymphatic invasion defined as tumour within a non-muscle-lined endothelial-lined lymphatic space, vascular invasion defined as tumour in a muscle-lined blood vessel, and perineural invasion defined as tumour within the perineural sheath. Associations of clinical and pathological features with bladder cancer death were evaluated using Cox proportional hazards regression models and summarised with hazard ratios and 95% confidence intervals. Survival was estimated by the Kaplan-Meier method. Multivariate analysis showed that lymphatic and vascular invasion but not perineural invasion were significantly associated with cancer specific survival (p<0.0001 and p=0.02, respectively). There was a significant association of lymphatic and vascular invasion but not perineural invasion with involved regional lymph nodes (p<0.0001 and p=0.004, respectively). In patients with metastasis to regional lymph nodes, lymphatic invasion remained significantly associated with outcome (p=0.02). The frequency of lymphatic and vascular invasion varied amongst histological subtypes of bladder cancer. Vascular and lymphatic invasion should be clearly defined and reported for radical cystectomy specimens containing bladder cancer. Copyright © 2017 Royal College of Pathologists of

  16. Inflammatory Myofibroblastic Tumor of the Bladder: 2 Rare Cases Managed with Laparoscopic Partial Cystectomy

    PubMed Central

    Oliveira, Rita; Ferrito, Fernando; Gomes, Carrasquinho

    2016-01-01

    Two cases of inflammatory myofibroblastic tumor (IMT) of the bladder are reported here. Both patients were male and presented with macroscopic hematuria; in the first case terminal hematuria was associated with irritative voiding symptoms. The second case was a smoker with hematuria unresponsive to medical treatment and anemia. Clinical presentation, pathological features, treatment, and prognosis are discussed. Due to rarity of this pathological condition, there are no guidelines concerning treatment and follow-up. We present our follow-up scheme and highlight the use of laparoscopic partial cystectomy as a successful treatment approach. PMID:27974989

  17. Comparison of anesthetic management and outcomes of robot-assisted versus open radical cystectomy.

    PubMed

    Trentman, Terrence L; Fassett, Sharon L; McGirr, Dustin; Anderson, Brad; Chang, Yu-Hui H; Nateras, Rafael Nunez; Castle, Erik P; Rosenfeld, David M

    2013-09-01

    Robot-assisted cystectomy surgery may be advantageous for patients. The purpose of this study was to compare anesthetic management and outcomes in patients undergoing robot-assisted versus open radical cystectomy. In a retrospective review of 256 cystectomy procedures, procedure duration, blood loss, respiratory parameters, recovery room opiate consumption, pain scores and antiemetic use in the recovery room, and hospital length of stay were compared. After exclusions, 96 robot-assisted and 102 open procedures were analyzed. Anesthesia and surgery duration were significantly longer in the robot-assisted group, while the length of hospital stay was significantly shorter in the robot-assisted group: 7.1 ± 5.8 versus 9.8 ± 5.03 days, p = 0.0005. Estimated blood loss was 601.8 ± 491.4 ml in the open group versus 257.7 ± 164.3 ml in the robot-assisted group, p < 0.0001. Recovery room opiate consumption was significantly less in the robot-assisted group: 9.5 ± 8.9 versus 12.6 ± 9.9 mg (morphine equivalents), p = 0.02. The highest recorded respiratory rate was significantly higher in the robot-assisted group, as was the highest recorded peak airway pressure. Among patients with arterial blood gas data, the highest arterial partial pressure of CO2 was significantly greater in the robot-assisted group than in the open surgery group: 42.6 ± 5.6 versus 37.4 ± 4.8 mmHg CO2, p = 0.0001. Surgeons and anesthesia providers can expect robot-assisted radical cystectomy surgery to last longer than traditional open surgery, but to be associated with less pain and blood loss. Positioning and abdominal insufflation for robot-assisted surgery may contribute to ventilation challenges.

  18. Survival and prognostic factors in Chinese patients with osteosarcoma: 13-year experience in 365 patients treated at a single institution.

    PubMed

    Wang, Wei; Yang, Jing; Wang, Yun; Wang, Dianjun; Han, Gang; Jia, Jinpeng; Xu, Meng; Bi, Wenzhi

    2017-02-01

    This study was designed to retrospectively analyze the survival and prognostic factors in Chinese osteosarcoma patients received neoadjuvant chemotherapy or/and surgery in a single institution. A total of 365 patients with pathological proved osteosarcoma undergoing neoadjuvant chemotherapy or/and surgery in a single institution between December 1999 and December 2012 were retrospectively analyzed for the demographic, tumor-related, and treatment-related variables, prognostic factors for survival rate and chemotherapy response. There were 231 males and 134 females (ratio, 1.72:1). The average age was 21±10years, with peak age between 10 and 20 years old (62%, 226/365). Of 365 patients, 319 (87.4%) suffered from primary tumor only, and 46 (12.6%) had metastases upon initial presentation. The overall 5-year survival rate was 65%. Upon univariate analysis, tumor site (femur 60.3%; other long bone 70.2%; trunk 33.6%; P=0.012), primary metastases (yes 36.7%; no 68.9%; P=0.000), tumor response to preoperative chemotherapy (good 89.8%; poor 47.5%; P=0.001) and recurrence/metastases after treatment (yes 36.2%; no 63.8%; P=0.000) were associated with higher 5-year survival rate. All factors except tumor site maintained their significance in multivariate testing. Male sex and nonconventional subtype of tumor were related to a higher likelihood of poor chemotherapy response.The absence of metastases at initial presentation, negative local recurrence or metastases after treatment, and tumor response to chemotherapy are of independent prognostic value in osteosarcoma. The overall prognostic factors and survival in Chinese patients are similar to those patients reported in western countries. Copyright © 2016 Elsevier GmbH. All rights reserved.

  19. A novel clinicopathological analysis of early stage ovarian Sertoli-Leydig cell tumors at a single institution

    PubMed Central

    Nam, Seon Mi; Kim, Jee Whan; Eoh, Kyung Jin; Kim, Hye Min; Lee, Jung Yun; Nam, Eun Ji; Kim, Sunghoon; Kim, Sang Wun

    2017-01-01

    Objective To evaluate the clinical and pathologic characteristics of patients who were diagnosed with ovarian Sertoli-Leydig cell tumors (SLCTs) in a single institution. Methods The medical records of 11 patients who were pathologically diagnosed with SLCTs beginning in 1995 in a single institute was reviewed. Results The median patient age was 31 years (range, 16 to 70 years). Patient International Federation of Gynecology and Obstetrics stages were IA, IC, and IIB in 3 (27.3%), 6 (54.5%), and 2 (18.2%) patients, respectively. Six patients (54.5%) had grade 3 tumors, 3 patients (27.3%) had grade 2 tumors, and 1 patient (9.1%) had a grade 1 tumor. Four patients without children underwent fertility-sparing surgery, and 7 patients had full staging surgery, including a hysterectomy and bilateral salpingo-oophorectomy, with a laparoscopic approach used in 3. Eight patients underwent pelvic lymph node dissection, and 8 patients were administered adjuvant chemotherapy consisting of bleomycin, etoposide, and cisplatin in 6 cases, a modified bleomycin, etoposide, and cisplatin regimen in 1 case, and a combined paclitaxel and cisplatin regimen in 1 case. Two patients died of disease and were re-diagnosed with Sertoli form endometrioid carcinoma. The other patients remain alive without recurrence at the time of reporting. Conclusion Our findings suggest that regardless of tumor stage or grade, ovarian SLCT patients have a good prognosis. Close observation and unilateral salpingo-oophorectomy would be beneficial for women who still wish to have children, while hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy would be the optimal treatment in other cases. Furthermore, meticulous pathologic diagnosis is needed to develop a precise treatment strategy. PMID:28217670

  20. Scar revision

    MedlinePlus

    ... corrects skin changes (disfigurement) caused by an injury, wound, poor healing, or previous surgery. Description Scar tissue forms as ... stiffening of the joint, you may need physical therapy after surgery. Apply sunscreen to keep sunlight from permanently ... Keloid revision; Hypertrophic scar revision; ...

  1. America Revising.

    ERIC Educational Resources Information Center

    Marty, Myron

    1982-01-01

    Reviews Frances FitzGerald's book, "America Revised," and discusses FitzGerald's critique of recent revisions in secondary-level U.S. history textbooks. The author advocates the implementation of a core curriculum for U.S. history which emphasizes political and local history. (AM)

  2. Retrospective analysis of a concurrent series of microscopic versus endoscopic transsphenoidal surgeries for Knosp Grades 0-2 nonfunctioning pituitary macroadenomas at a single institution.

    PubMed

    Dallapiazza, Robert; Bond, Aaron E; Grober, Yuval; Louis, Robert G; Payne, Spencer C; Oldfield, Edward H; Jane, John A

    2014-09-01

    The object of this study was to compare surgical outcomes and complications in a contemporaneous series of patients undergoing either microscopic or endoscopic transsphenoidal surgery for nonfunctioning pituitary macroadenomas without imaging evidence of cavernous sinus invasion. This is a retrospective analysis of a prospectively collected database from a single institution. Data were collected from patients whose surgery had occurred in the period from June 2010 to January 2013. Patients who underwent microscopic or endoscopic surgery for Knosp Grade 0, 1, or 2 nonfunctioning pituitary macroadenomas were included in the study. Patients who had clinically secreting or Knosp Grade 3 or 4 tumors and patients who were undergoing revision surgery were excluded from analysis. Eligible patient records were analyzed for outcomes and complications. Statistical analyses were performed on tumor volume, intraoperative factors, postoperative complications, and degree of resection on 1-year postoperative MRI. The results were used to compare the outcomes after microscopic and endoscopic approaches. Forty-three patients underwent microscopic transsphenoidal surgery, and 56 underwent endoscopic transsphenoidal surgery. There were no statistical differences in the intraoperative extent of resection or endocrinological complications. There were significantly more intraoperative CSF leaks in the endoscopic group (58% vs 16%); however, there was no difference in the incidence of postoperative CSF rhinorrhea (12% microscopic vs 7% endoscopic). Length of hospitalization was significantly shorter in patients undergoing an endoscopic approach (3.0 days vs 2.4 days). Two-month follow-up imaging was available in 95% of patients, and 75% of patients had 1-year follow-up imaging. At 2 months postprocedure, there was no evidence of residual tumor in 79% (31 of 39) and 85% (47 of 55) of patients in the microscopic and endoscopic groups, respectively. At 1 year postprocedure, 83% (25 of 30) of

  3. A comprehensive guide to perioperative management and operative technique for robotic cystectomy with intracorporeal urinary diversion.

    PubMed

    Tan, Wei Shen; Lamb, Benjamin W; Sridhar, Ashwin; Briggs, Timothy P; Kelly, John D

    2017-02-27

    Robotic-assisted radical cystectomy (RARC) represents an evolution of open radical cystectomy (ORC) with the aim of reducing patient morbidity and improving return to normal function, whilst maintaining oncological equivalence. RARC is gaining popularity, especially in high-volume centres, although there remains a lack of level 1 evidence to demonstrate any superiority of RARC over ORC. All previously reported studies that randomised ORC and RARC have utilised a technique for RARC requiring a conversion to open surgery for urinary diversion. Conversion to open surgery invariably masks the benefits of a truly minimally invasive approach. Moreover, such studies tend to report a small sample size, likely reflecting early surgical experience that may contribute to the lack of observed benefit. Nonetheless, it is established that short-term oncological outcomes following RARC are comparable to those after ORC. It is likely that the benefits of RARC are only observed in cases wherein intracorporeal urinary diversion (iRARC) is performed by a surgical team with high volume experience, which will minimise morbidity and maximise early return to normal function. In this review, we will discuss a holistic approach to iRARC, including patient selection, perioperative optimisation, the surgical technique for iRARC with urinary diversion reconstruction, the use of enhanced recovery protocol, oncological outcomes and perioperative complications.

  4. Robot-assisted radical cystectomy and urinary diversion: technical recommendations from the Pasadena Consensus Panel.

    PubMed

    Chan, Kevin G; Guru, Khurshid; Wiklund, Peter; Catto, James; Yuh, Bertram; Novara, Giacomo; Murphy, Declan G; Al-Tartir, Tareq; Collins, Justin W; Zhumkhawala, Ali; Wilson, Timothy G

    2015-03-01

    The technique of robot-assisted radical cystectomy (RARC) has evolved significantly since its inception >10 yr ago. Several high-volume centers have reported standardized techniques with refinements and subsequent outcomes. To review all existing literature on RARC and urinary diversion techniques and summarize key points that may affect oncologic, surgical, and functional outcomes. The Pasadena Consensus Panel on RARC and urinary reconstruction convened May 3-4, 2014, to review the existing peer-reviewed literature and create recommendations for best practice. The panel consisted of experts in open radical cystectomy and RARC. No commercial support was received. The consensus panel extensively reviewed the surgical technique of RARC in men and women, extended pelvic lymph node dissection, extracorporeal urinary diversion, and intracorporeal urinary diversion. Critical aspects of the technique are described. Preoperative, operative, and postoperative parameters from the largest and most contemporary RARC series, stratified by urinary diversion technique, are presented. Preoperative, operative, and postoperative measures of RARC technique adhere closely to the standards established in open surgery. Refinement of techniques for RARC and urinary diversion over the past 10 yr has made it safe, reproducible, and oncologically sound. We summarize the critical aspects of surgical techniques reviewed at the Pasadena international consensus meeting on RARC and urinary reconstruction. Preoperative, operative, and postoperative measures of RARC technique adhere closely to the standards established in open surgery. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  5. Oncologic outcomes between open and robotic-assisted radical cystectomy: a propensity score matched analysis.

    PubMed

    Ahdoot, Michael; Almario, Leanne; Araya, Hiwot; Busch, Jonas; Conti, Simon; Gonzalgo, Mark L

    2014-12-01

    To compare oncologic outcomes between open radical cystectomy (ORC) and robotic-assisted radical cystectomy (RARC) using propensity score (PS) matching of preoperative variables. A group of 51 consecutive patients who underwent RARC between 2009 and 2012 were matched by propensity scoring with an equal number of patients who underwent ORC. Patient demographics, clinical staging, pathologic staging, pathologic grading, histology, positive margin status, lymph node yield, duration of hospital stay, and overall survival were examined. PS-matched ORC and RARC cohorts demonstrated no significant differences with respect to preoperative variables, pathologic stage, grade, histology, metastasis at preoperative staging, and postoperative positive margin status. There were statistically significant differences in nodal status (66.7 % N0 for ORC vs. 80.4 % N0 for RARC, p = 0.039) and median lymph node yield (6 for ORC vs. 18 for RARC, p < 0.0001). No positive soft tissue margins were observed in the RARC group compared to 5.9 % in the ORC group (p = 0.332). There were no significant differences in mean duration of hospital stay or mean overall survival between ORC and RARC. ORC and RARC represent effective surgical approaches for the treatment of bladder cancer. Histopathologic outcomes for RARC compare favorably to ORC with respect to soft tissue margin rates and lymph node yield. These data suggest that RARC is an acceptable surgical approach for treatment of bladder cancer that can achieve outcomes that are equal or superior to those of ORC.

  6. [Continent cutaneous urinary diversion after cystectomy for cancer: A reliable alternative? A monocentric retrospective study].

    PubMed

    Vuichoud, C; Perrouin-Verbe, M-A; Phe, V; Bitker, M-O; Parra, J; Chartier-Kastler, E

    Among available urinary diversion, continent cutaneous urinary diversion (CCUD) is not frequently used after cystectomy for malignancy. The aim of our work was to assess mid-term oncological and functional outcomes of CCUD in case of malignancies. We retrospectively included all patients who underwent CCUD after radical cystectomy for cancer (according Mitrofanoff or Monti's principle) between July 2001 and November 2015 in our department. Perioperative data, oncological and functional outcomes were reported. To measure disease specific quality of life, we used the French version of Bladder Cancer Index. Overall 12 patients were involved in the study. With a median follow-up of 32 months, we noticed one death due to cancer recurrence. Early postoperative complications occurred in 8 patients, with one requiring reoperation. The late postoperative complication rate was 66%, whose 4 patients (33%) presented cutaneous stenosis. Overall satisfaction rate was scored 8.9/10 and body image was preserved for 75% of patients. At last follow-up, continence (no urinary leakage) was achieved for 62.5% of patient. Sexual impairment was significant for 5 patients. The CCUD is a valid alternative to other urinary diversions with similar oncological results and with a similar rate of complications. The high satisfaction rate was related to the preservation of body image and the high rate of continence. 5. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  7. Laparoscopically assisted vaginal ovarian cystectomy for clinically diagnosed benign large ovarian masses.

    PubMed

    Wang, Chin-Jung; Chao, Angel; Lai, Chyong-Huey; Huang, Shang-Yu; Lee, Chyi-Long; Soong, Yung-Kuei

    2009-10-01

    The aim of this study was to present our experience with laparoscopically assisted vaginal ovarian cystectomy (LAVOC) in selected patients with various large ovarian masses. Among the medical records of 324 patients with ovarian masses, 10 consecutive women of reproductive age with prior sexual activity and with large ovarian masses (10-27 cm) were evaluated. A combined laparoscopic and vaginal ovarian cystectomy was done through the posterior cul-de-sac. All operations proceeded smoothly; the ovarian pathologies included 1 mucinous cystadenoma, 1 serous cystadenoma, 1 mucinous cystadenoma coexisting with mature cystic teratoma, and 7 mature cystic teratomas. The median (range) tumor size was 15.5 cm (range, 10-27), operative duration was 62 minutes (range, 31-110), the estimated blood loss 50 mL (range, 10-150), and the hospital stay was 2 days (range, 1-4). No open conversion and blood transfusion was required, and no patient had major perioperative complications. One patient suffered from postoperative low-grade fever (<38.5 degrees C) controlled by 3-day parenteral antibiotic therapy. LAVOC is safe and feasible and can be an alternative to traditional laparotomy and the pure laparoscopic approach in selected patients. The potential risk of postoperative infection has to be kept in mind.

  8. Laparoscopic radical cystectomy: neobladder or ileal conduit, debate still goes on

    PubMed Central

    Drewa, Tomasz; Olejniczak, Pawel; Chlosta, Piotr L.

    2014-01-01

    Objective To compare the pre, intra, and post–operative data between ileal conduit and neobladder urinary diversions during laparoscopic radical cystectomy(LRC). Material and methods Between 2006 and 2011, 63 patients who underwent LRC and urinary diversion had their data input prospectively into a database and said data used for the analysis. The outcome comparators were the patient demographics, operative time, conversion rate, blood loss, transfusion rate, morphine analgesic requirement, length of hospital stay, complication rates, follow up, and quality of life assessments. A Mantel–Haenszel test was used for dichotomous data and an inverse variance method was used for continuous data. P values less than 0.5 were considered significant Results Thirty–nine patients (60 ±7.11 years) had ileal conduits and 24 patients (57 ±8.68 years) had neobladder urinary diversion. No difference was found (P >0.05) regarding age, BMI, smoking history, TURBT pathology result, blood loss, blood transfusion requirement, conversion rates, length of hospital stay, morphine requirement, complications, or follow–up and quality of life. The neobladder groups did have more previous abdominal operations and had significantly longer operative time. Conclusions We found no difference between either types of diversion in all comparative aspects except that the neobladder had longer operative times. This is the first comparative study between ileal conduit and neobladder urinary diversion after laparoscopic radical cystectomy and can pose as a bench mark for future comparisons. PMID:24982773

  9. Heavy hematuria requiring cystectomy in a patient with hemophilia A: a case report and literature review.

    PubMed

    Washino, Satoshi; Hirai, Masaru; Kobayashi, Yutaka; Saito, Kimitoshi; Miyagawa, Tomoaki

    2015-08-13

    Hemophilia A is an X-linked recessive disorder caused by a deficiency in factor VIII. Hemophilia A affects 1 in 5,000-10,000 males. Hematuria is frequent in hemophilia. Hematuria in hemophilia is generally considered benign and manageable with conservative therapy; however, severe hematuria requiring surgical therapy has rarely been reported. A 60-year-old male with hemophilia A presented with persistent gross hematuria of unknown cause. He was treated with recombinant factor VIII products, followed by several conservative therapies as follows: clot evacuation by vesicoclysis, continuous bladder irrigation with normal saline, and intravesical instillation of aluminum hydroxide/magnesium hydroxide (Maalox); however, these failed to resolve the hemorrhaging. The patient was offered and consented to cystectomy with an ileal conduit. Intraoperative clotting was normal with the infusion of adequate recombinant factor VIII products and transfusion of fresh-frozen plasma, and the procedure was performed safely. After surgery, the patient had blood in his stool several times. No bleeding site was demonstrated in the colon by colonoscopy and (99m)Technetium-human serum albumin-diethylenetriaminepenta-acetic acid scintigraphy demonstrated that the extravasation of radioactive isotope was detected at the anal side of terminal ileum but not at the oral side. These findings were suspected to be bleeding from the ileoileal anastomosis. However, the bleeding was managed with recombinant factor VIII products. Cystectomy in hemophilia may be safe, if monitored appropriately. Urinary diversion using the intestine may be avoided because anastomotic hemorrhage may become a problem.

  10. AB047. Clinic therapeutic effect of sigmoid orthotopic neobladder after radical cystectomy

    PubMed Central

    Zhang, Jin; Li, Ranwei; Li, Shengwen

    2016-01-01

    Objective To investigate the clinic therapeutic effect of sigmoid orthotopic neobladder after radical cystectomy. Methods Sixteen patients with invasive bladder cancer (all males; age range from 53 to 75 years) were admitted and underwent radical cystectomy and sigmoid orthotopic neobladder. Results The 16 patients were hospitalized for 37 to 62 d, with an average of 51 d. All the 16 patients were followed up for a mean of 26 months (range from 5 months to 6 years). The serum creatinine and blood urea nitrogen levels were both in the normal range without acidosis in all the cases. No cases had unilateral ureteral urine reflux during cystography. Of the 16 patients 14 cases (87.5%) achieved continence during daytime; 6 cases (37.5%) were incontinent at night, but all of them could control urination by being woken up at night. The capacity of the neobladder was 245 to 380 mL with an average of 316 mL and the maximal pressure of the neobladder during filling was 28 to 57 cmH2O (1 cmH2O =0.098 kPa) with an average of 39 cmH2O. Conclusions As an operation the sigmoid orthotopic neobladder can be performed easily without serious postoperative complications and more reliable results. This operation may be generally applied in clinical practice.

  11. Robot-assisted radical cystectomy is a promising alternative to open surgery in the Japanese population with a high rate of octogenarians.

    PubMed

    Iwamoto, Hideto; Yumioka, Tetsuya; Yamaguchi, Noriya; Masago, Toshihiko; Morizane, Shuichi; Honda, Masashi; Sejima, Takehiro; Takenaka, Atsushi

    2016-08-01

    Japanese patients who undergo radical cystectomy have a unique feature, i.e., the ratio of octogenarians is higher than in Western patients because of the aging Japanese population. The purpose of this study was to compare perioperative outcomes, complications, and oncologic outcomes between robot-assisted radical cystectomy and open radical cystectomy. From 2010-2015, 20 (of which 8 were octogenarians) and 40 (of which 11 were octogenarians) patients underwent robot-assisted radical cystectomy and open radical cystectomy, respectively. There was no significant difference in terms of patient demographics between the two surgical cohorts, regardless of patient age. In the octogenarian patient cohort, the rates of previous abdominal surgery and the median age-adjusted Charlson comorbidity index were higher. The median estimated blood loss, transfusion rate and the days to resumption of a regular diet were significantly lower in the robot-assisted radical cystectomy cohort, regardless of patient age. Robot-assisted radical cystectomy significantly decreased grade II or higher complications, but there were no significant differences in terms of decreasing grade III or higher complications, regardless of patient age. Positive surgical margin and the mean number of lymph nodes removed were similar between the two surgical cohorts, regardless of patient age. Although robot-assisted radical cystectomy has a short history in Japan, the outcomes were generally comparable to those of previous studies. In a country that is aging rapidly like Japan, robot-assisted radical cystectomy could be a valid option for the management of muscle-invasive and high-risk superficial bladder cancer.

  12. Postoperative management of radical cystectomy. Review of the evidence on the prevention and treatment of urological complications.

    PubMed

    Rodríguez Faba, O; Parada Moreno, R; Malca, L; Palomino Martínez, A; Nervo, N; Breda, A; Esquinas, C; Palou, J

    2017-06-03

    This review article focuses on the prevention and management of the most common postoperative urological complications of radical cystectomy. We reviewed the current literature and conducted an analysis of frequency, prevention and treatment of complications. We conducted a search on Medline to identify original articles, literature reviews and editorials focusing on the urological complications of radical cystectomy during the first 90 days after surgery. We identified those series that included more than 100 patients. The literature regarding the prevention and treatment of complications after cystectomy is in general retrospective and nonstandardised. The level of evidence is generally low, and it is difficult to make evidence-based recommendations. Progress has been made in recent years in reducing mortality and preventing the complications of cystectomy. The most common complications are gastrointestinal, for which significant efforts have been made to implement ERAS and Fast Track protocols. The complications that can most significantly change patients' quality of life are urinary stoma. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Cystectomy and orthotopic ileal neobladder in a male patient 12 years after kidney transplantation; good preservation of the renal function.

    PubMed

    Selli, Cesare; Boggi, Ugo; Travaglini, Fabrizio; Vistoli, Fabio; Del Chiaro, Marco; Mosca, Franco

    2004-02-01

    In case of cystectomy, some forms of urinary diversion can impair the graft function of renal transplant patients. Here we present the case of a 70-year-old male with carcinoma of the bladder 12 years after renal transplantation. Immunosuppression was achieved with Cyclosporin A (200 mg/day) and Prednisone (5 mg/day). The patient's serum creatinine level was 1.4 mg/dl. Following cystectomy, an orthotopic ileal neobladder was constructed by means of Studer technique, and the afferent ileal loop was anastomosed to the graft ureter. Pathology revealed pT1 G3 N+ transitional cell carcinoma. Ten months later, periaortic nodal recurrences necessitated four cycles of chemotherapy with Epidoxorubicyn and Gemcytabine. To date, 20 months after cystectomy, the patient is stable, with day and night-time urinary continence. His serum creatinine level is 1.3 mg/dl, and there is no evidence of hydronephrosis or acidosis. We conclude that the orthotopic ileal neobladder is an effective form of urinary diversion in renal transplant patients requiring cystectomy, allowing good preservation of the renal function.

  14. Comparing long term impact on ovarian reserve between laparoscopic ovarian cystectomy and open laprotomy for ovarian endometrioma

    PubMed Central

    2013-01-01

    Objective To compare the long term impact on ovarian reserve between laparoscopic ovarian cystectomy with bipolar electrocoagulation and laparotomic cystectomy with suturing for ovarian endometrotic cyst. Patient and method(s) 121 patients with benign ovarian endometroitic cysts were randomised to either laparoscopic ovarian cystectomy using bipolar electrocoagulation (61 patients) or laparotomic ovarian cystectomy using sutures (60 patients). Serum follicle-stimulating hormone, Antimullerian hormon, Basal antral follicle Count, mean ovarian diameter, and ovarian stromal blood flow velocity were measured at 6, 12 and 18 months after surgery and compared in both groups. Result(s) A statistically significant increase of serum FSH was found in the laproscopic bipolar group at 6-, 12 and 18-month postoperativly compared to open laparotomy suture group. Also, a statistically significant decrease of the mean AMH value occurred in laproscopic bipolar group at 6-, 12 and 18-month follow- up compared to open laparotomy suture group. Basal antral follicle number, mean ovarian diameter and peak systolic velocity were significantly decreased during the 6-, 12,18 -month follow-up in laproscopic bipolar group compared to open laparotomy suture group. Conclusion(s) After laproscopic ovarian cystecomy for endometrioma all pareameter of ovarian reseve are significantly decreased on long term follow up as compared to open laprotomy. PMID:24180348

  15. Diabetes and elevated urea level predict for uretero-ileal stricture after radical cystectomy and ileal conduit formation

    PubMed Central

    Hoag, Nathan; Papa, Nathan; Beharry, Bhawanie Koonj; Lawrentschuk, Nathan; Chiu, Danny; Sengupta, Shomik; Bolton, Damien

    2017-01-01

    Introduction Benign uretero-ileal anastomotic stricture is a significant complication following radical cystectomy and ileal conduit urinary diversion after radical cystectomy. We examined risk factors for stricture formation to predict those at greatest stricture risk. Methods A retrospective chart review was conducted for patients undergoing radical cystectomy and ileal conduit diversion between 2002 and 2012. Demographic data and patient variables were analyzed to determine risk factors for uretero-ileal stricture using multivariate logistic regression. Results Over the study period, 133 patients underwent cystectomy and ileal conduit formation, with 14 (10.5%) developing uretero-ileal anastomotic stricture. Diabetes and elevated serum urea level (defined as >7.1 mmol/L) were associated with increased risk for development of uretero-ileal stricture (odds ratio 4.31 and 4.28, respectively; p<0.05 for each). Conclusions In this patient cohort, diabetes and elevated serum urea level were predictive for the development of uretero-ileal anastomotic stricture. Further prospective study with larger patient samples is required. PMID:28360953

  16. [Quality of life and overall survival in high risk patients after radical cystectomy with a simple urinary derivation].

    PubMed

    Mucciardi, Giuseppe; Macchione, Luciano; Galì, Alessandro; di Benedetto, Antonina; Subba, Enrica; Pappalardo, Rosa; Mucciardi, Massimo; Butticè, Salvatore; Inferrera, Antonino; Magno, Carlo

    2015-01-01

    To evaluate quality of life (QoL) and overall survival after radical cystectomy with cutaneous ureterostomies for locally advanced bladder cancer in elderly patients with high surgical risk. Fifty eight patients older than 74 years (mean age 80,6±4,3) with locally advanced bladder cancer (group A), underwent radical cystectomy and ureterocutaneous diversion. Patients completed the EORTC QLQC30 before and six months after surgery to assess functional, clinical and QoL outcomes. The same evaluation was carried out in a control group (group B) of 29 patients (mean age 82,3±3,8 years), who had refused cystectomy. Questionnaires were also administered to patients of both groups who survived at least 20 months and 5 years. All patients presented with an ASA score ≥3. Mean hospital stay was 15.1 days (±4.8) in group A and 23.5 days (±4.1) in Group B. No intraoperative complications occurred in group A. Postoperative overall survival evaluated within 6 months in group A was 97% versus 79% in group B (p<0.001). Radical cystectomy with cutaneous ureterostomy represents a valid alternative in elderly patients with invasive bladder cancer and high operative risk. Comparison between two groups showed a statistically significant difference for almost all the Qol related parameters and for short and medium term overall survival. Copyright © 2012 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. New retractor facilitates exposure of the vascular pedicles in Chinese men with complex pelvis during radical cystectomy.

    PubMed

    Zhang, Zhihong; Zhang, Changwen; Liu, Ranlu; Qiao, Baomin; Ma, Baojie; Yang, Kuo; Xu, Yong

    2013-02-01

    To evaluate the surgical instrument, the double-slice retractor of pelvis (DBR), for the division of the vascular pedicles from the bladder and prostate in male patients with complex pelvis during radical cystectomy. Radical cystectomy was performed on 140 male patients (all cases body mass index >28 kg/m(2), 29 cases having undergone partial cystectomy) with bladder cancer. With the aid of the double-slice retractor to expose vascular pedicles from the bladder and prostate, 80 radical cystectomies were performed. The others were treated as the control. The double-slice retractor provided excellent exposure for the division of vascular pedicles from the bladder and prostate. The handling of the vascular pedicles from the bladder and prostate became easier and safer without unnecessary bleeding and injury in the rectum. In double-slice retractor and control groups, the operative time to handle the vascular pedicles during radical cystectomy in the double-slice retractor group was 12.2 ± 1.4 min compared with 22.6 ± 3.4 min for the control group (P < 0.05), and the blood loss was 30.3 ± 2.2 ml compared with 50.2 ± 4.5 ml (P < 0.05). For the whole radical cystectomy procedure, the operative time lasted 72.1 ± 9.2 min in the double-slice retractor group compared with 85.7 ± 6.8 min for the control group (P < 0.05), the whole blood loss was reduced to 340.3 ± 12.7 ml from 410.1 ± 11.4 ml in the control group (P < 0.05). And the rate of transfusion was geared down to 10% in the double-slice retractor group from 25% in the control (P < 0.05). The use of the double-slice retractor for the exposure of vascular pedicles from the bladder and prostate is simple and effective in male patients with complex pelvis during radical cystectomy. We have devised a promising surgical instrument for the exposure of vascular pedicles.

  18. Is it necessary to insert nasogastric tube routinely after radical cystectomy with urinary diversion? A meta-analysis

    PubMed Central

    Zhao, Tao; Huang, Long; Tian, Yiyang; Wang, Haizhou; Wei, Qiang; Li, Xiang

    2014-01-01

    Background: To evaluate the necessity of using nasogastric tube (NGT) for patients undergoing radical cystectomy with urinary diversion. Methods: Literature was searched from PubMed, EMBASE, and Cochrane Library. We identified randomized controlled trials, Cohort study, and Case-control analysis that compared the individuals with or without nasogastric tube after radical cystectomy with urinary diversion. We performed the meta-analysis to evaluate the role of nasogastric tube in decompression after radical cystectomy with urinary diversion. Result: Two randomized controlled trial and four Cohort studies (780 patients) fulfilled the inclusion criteria. There was significant difference between the time (days) commencement of a liquid diet and the development of bowel sounds in patients without nasogastric tube than those with NGT (nasogastric tube) [P < 0.0001, standard mean difference (SMD) = -0.35, 95% CI -0.52 to -0.18; P < 0.00001, SMD = -0.43, 95% CI -0.60 to 0.26, respectively]. Additionally, there was no significant differences in pulmonary complications and wound complication [P = 0.25, odds ratio (OR) = 0.60 95% CI 0.25 to 1.43; P = 0.66 OR = 1.16 95% CI 0.60 to 2.25, respectively]. But the differences were significant in the paralytic ileus or bowel obstruction (P = 0.010, OR = 0.60, 95% CI 0.41 to 0.88) after surgery. Furthermore, the difference of the duration of hospital stay (days) between the NGT group and Without NGT group (P = 0.0005, SMD = -0.30, 95% CI -0.47 to -0.13). Conclusion: It cannot shorten the time of gastrointestinal function recovery or reduce the incidence of complications after radical cystectomy by using the nasogastric tube routinely. Routinely use of nasogastric tube after radical cystectomy with urinary diversion was not recommended. PMID:25663959

  19. Impact of complications and hospital-free days on health related quality of life 1 year after radical cystectomy.

    PubMed

    Ritch, Chad R; Cookson, Michael S; Chang, Sam S; Clark, Peter E; Resnick, Matthew J; Penson, David F; Smith, Joseph A; May, Alex T; Anderson, Christopher B; You, Chaochen; Lee, Haerin; Barocas, Daniel A

    2014-11-01

    We determined the extent to which complications as well as number of hospital-free days within 30 and 90 days of surgery predicted health related quality of life 1 year after radical cystectomy. We used data from a prospective health related quality of life study using a validated instrument, the Vanderbilt Cystectomy Index-15. Complications were graded by the Clavien system, and hospital length of stay and length of stay during readmissions were used to calculate 30 and 90-day hospital-free days, respectively. We compared the number of hospital-free days among patients with varying levels of complications. Multivariate analysis was performed to determine predictors of Vanderbilt Cystectomy Index-15 score 1 year after surgery adjusting for demographic (age, gender, comorbidities) and clinical variables (stage and diversion type). A total of 100 patients with complete baseline and 1-year followup health related quality of life data were included in the analysis. Median (IQR) 30 and 90-day hospital-free days were 24 (22-25) and 84 (82-85), respectively. Patients who experienced any complications had significantly fewer 30-day hospital-free days (22 vs 24 days, p <0.01) and 90-day hospital-free days (81 vs 84 days, p <0.01), and patients with higher grade complications had fewer hospital-free days than those with lower grade or no complications (p <0.01). On multivariate analysis female gender and baseline Vanderbilt Cystectomy Index-15 score independently predicted higher 1-year health related quality of life scores. Patients who experience complications after radical cystectomy have fewer 30 and 90-day hospital-free days. However, neither predicts health related quality of life at 1 year. Instead, long-term health related quality of life appears to be driven largely by baseline health related quality of life and gender. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  20. Emerging Impact of Malnutrition on Surgical Patients: Literature Review and Potential Implications for Cystectomy in Bladder Cancer.

    PubMed

    Tobert, Conrad M; Hamilton-Reeves, Jill M; Norian, Lyse A; Hung, Chermaine; Brooks, Nathan A; Holzbeierlein, Jeff M; Downs, Tracy M; Robertson, Douglas P; Grossman, Ruth; Nepple, Kenneth G

    2017-09-01

    Malnutrition is emerging as a significant factor in patient outcomes. A contemporary review of malnutrition has not been performed for the urologist. We review the available literature and current standards of care for malnutrition screening, assessment and intervention, focusing on patients with bladder cancer treated with cystectomy. Our multidisciplinary team searched PubMed® for available literature on malnutrition, focusing on definition and significance, importance to urologists, screening, assessment, diagnosis, immunological and economic impacts, and interventions. The prevalence of malnutrition in hospitalized patients is estimated to range from 15% to 60%, reaching upward of 71% in those with cancer. Malnutrition has been shown to increase inflammatory markers, further intensifying catabolism and weight loss. Bladder cancer is catabolic and patients undergoing cystectomy have increased resting energy expenditure postoperatively. Data are emerging on the impact of malnutrition in the cystectomy population. Recent studies have identified poor nutritional status based on low albumin or sarcopenia (loss of muscle) as having an adverse impact on length of hospitalization, complications and survival. The current standard of care malnutrition assessment tool, the 2012 consensus statement of the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition, has not been evaluated in the urological literature. Perioperative immunonutrition in patients undergoing colorectal surgery has been associated with significant decreases in postoperative complications, and recent pilot work has identified the potential for immunonutrition to positively impact the cystectomy population. Malnutrition has a significant impact on surgical patients, including those with bladder cancer. There are emerging data in the urological literature regarding how best to identify and improve the nutritional status of patients undergoing cystectomy

  1. Single-institutional experience of clinicopathological analysis and treatment for lung cancer patients with human immunodeficiency virus infection.

    PubMed

    Takahashi, Satoshi; Okuma, Yusuke; Watanabe, Kageaki; Hosomi, Yukio; Imamura, Akifumi; Okamura, Tatsuru; Gemma, Akihiko

    2017-05-01

    The advent of antiretroviral therapy has changed the disease spectrum constitution among patients living with human immunodeficiency virus (HIV), while the incidence of death due to non-AIDS-defining cancers, particularly lung cancer, continues to increase in the USA and Europe. However, the availability of detailed reports of the clinical characteristics of lung cancer among Asian populations is limited. The present study retrospectively analyzed the clinical characteristics, treatment regimens and outcomes of lung cancer patients with HIV who were treated in a single institution between 1988 and 2013. Of the 20 lung cancer patients living with HIV included in this study, 90% were diagnosed since 1996 in the post-antiretroviral era. The median CD4(+) cell count was 373.5/µl, whereas 65% of the patients were diagnosed with adenocarcinoma and 30% with squamous cell carcinoma. Epidermal growth factor receptor mutations were detected in 3 (27%) of the 11 specimens for which data were available, of which 65% had advanced-stage disease. Of the 20 patients, 9 underwent surgery, 6 received radiotherapy and 5 received chemotherapy as a first-line treatment. Treatment was generally well-tolerated. The median survival period was 35.8 months for all stages and 14.0 months for advanced stages. The treatment outcomes in our institution were favorable in comparison with previous studies from the USA and Europe, although these findings may be due to ethnic differences or the efficacy of treatment for HIV and lung cancer.

  2. A Comparison of the LigaSure and Harmonic Scalpel in Thyroid Surgery: A Single Institution Review

    PubMed Central

    Zarebczan, Barbara; Mohanty, Devi; Chen, Herbert

    2010-01-01

    Background Over the last few years many surgeons have begun to utilize the LigaSure device or Harmonic scalpel to perform thyroid surgery. Several papers have demonstrated the benefits of these devices over traditional hand-tying techniques. The purpose of this study was to examine our institution’s experience with the LigaSure device and Harmonic scalpel during thyroid surgery and to compare mean operative times and complications associated with each device. Methods A retrospective chart review was performed on all patients who underwent thyroid surgery using either the LigaSure device or Harmonic scalpel at a single institution between December 2005 and August 2009. Charts were reviewed for patient demographics, mean operative time, length of stay, and complications such as transient recurrent laryngeal nerve injury, hypocalcemia, and hematoma formation. Results Two hundred and thirty-one patients were included in the study, of whom 123 underwent total thyroidectomy and 108 underwent lobectomy. There was a significant decrease in the operative time for both thyroidectomies and lobectomies when the Harmonic scalpel was utilized. In regard to complications, there was no statistically significant difference in the number of transient and permanent recurrent laryngeal nerve injuries, percentage of patients developing hypocalcemia, or in the rate of hematoma development. Conclusion In this study, there was no difference in the rate of complications between the two devices. However, the use of the Harmonic scalpel significantly decreased operative time for both thyroidectomies and thyroid lobectomies when compared to the LigaSure device. PMID:20853030

  3. CyberKnife stereotactic radiosurgery for the treatment of symptomatic vertebral hemangiomas: a single-institution experience.

    PubMed

    Zhang, Michael; Chen, Yi-Ren; Chang, Steven D; Veeravagu, Anand

    2017-01-01

    OBJECTIVE Symptomatic vertebral hemangiomas (SVHs) are a very rare pathology that can present with persistent pain or neurological deficits that warrant surgical intervention. Given the relative rarity and difficulty in assessment, the authors sought to present a dedicated series of SVHs treated using stereotactic radiosurgery (SRS) to provide insight into clinical decision making. METHODS A retrospective review of a single institution's experience with hypofractionated radiosurgery for SVH from 2004 to 2011 was conducted to determine the clinical and radiographic outcomes following SRS treatment. The authors report and analyze the treatment course of 5 patients with 7 lesions, 2 of which were treated primarily by SRS. RESULTS Of the 5 patients studied, 4 presented with a chief complaint of pain refractory to conservative measures. Three patients reported dysesthesias, and 2 reported upper-extremity weakness. Following radiosurgery, 4 of 5 patients exhibited improvement in their primary symptoms (3 for pain and 1 for weakness), achieving a clinical response after a mean period of 1 year. In 2 cases there was 20%-40% reduction in lesion size in the most responsive dimension as noted on images. All treatments were well tolerated. CONCLUSIONS SRS for SVH is a safe and feasible treatment strategy, comparable to prior radiotherapy studies, and in select cases may successfully confer delayed decompressive effects. Additional investigation will determine future patient selection and how conformal SRS treatment can best be administered.

  4. Do iatrogenic factors bias the placement of external ventricular catheters?--a single institute experience and review of the literature.

    PubMed

    Woernle, Christoph M; Burkhardt, Jan-Karl; Bellut, David; Krayenbuehl, Niklaus; Bertalanffy, Helmut

    2011-01-01

    Placement of external ventricular drainage (EVD) catheters is the gold standard for managing acute hydrocephalus, but the range of complications varies in different studies. The objective of this present single institute study is to analyze iatrogenic factors, which may influence the EVD device placement and the patient's outcome. A total of 137 EVD placements in 120 patients at the University Hospital Zurich were analyzed retrospectively. Discriminative findings between the pre- and postoperative imaging were obtained and evaluated in detail with regards to the postoperative course, ventriculostomy-related infection, and acute neurological deterioration directly related to the EVD placement. These findings were correlated to iatrogenic factors including education level of the neurosurgeon and surgical setting. Overall EVD-related complication rate was 16.1%, including infection rate of 10.2%, catheter malplacement rate of 2.2%, and hemorrhage rate of 3.6%. Although not statistically significant, catheter-associated hemorrhages and malplacements were found mostly in primary EVD surgery, with a higher complication rate associated with junior residents as the performing surgeon. In contrast, ventriculostomy-related infection was most likely present in patients with more than one EVD placement and in patients treated by more experienced physicians. Complications related to EVD are common. The rate and character of the complication depends on the education level of the surgeon.

  5. Transumbilical multiport laparoscopic nephroureterectomy for congenital renal dysplasia in children: midterm follow-up from a single institution.

    PubMed

    Mei, Hong; Qi, Teng; Li, Shuai; Pu, Jiarui; Cao, Guoqing; Tang, Shaotao; Zheng, Liduan; Tong, Qiangsong

    2013-01-01

    To assess the clinical utility and efficiency of transumbilical multiport laparoscopic nephroureterectomy (TMLN) for the treatment of congenital renal dysplasia in children by analyzing consecutive cases from a single institution. Sixteen children underwent TMLN procedure due to dysplastic kidney between January 2010 and December 2011. The surgery was transperitoneally performed through three transumbilical incisions for two 5-mm and one 3-mm ports, which duplicated the standard laparoscopic steps with the usual laparoscopic instruments. Demographic, perioperative, and follow-up data were analyzed. TMLN was performed in all patients, without additional ports or conversion to open surgery. The mean operation time was 108.4 min (range 90-125), and the blood loss was minimal. There were no severe intraoperative or post-operative complications. The post-operative recovery was uneventful in all patients. No urinary incontinence or umbilical hernias occurred. The cosmetic result was excellent as the incision scar was hidden inside the belly button. TMLN is a safe and efficient procedure for the management of congenital renal dysplasia in children with good cosmesis. Future randomized studies with a larger number of cases and a longer follow-up are warranted to elucidate the benefits and limitations of TMLN in children.

  6. A Valid Approach in Refractory Glossodynia: A Single-Institution 5-Year Experience Treating with Japanese Traditional Herbal (Kampo) Medicine

    PubMed Central

    Chino, Atsushi; Hirasaki, Yoshiro; Ueda, Keigo; Raimura, Masaki; Namiki, Takao

    2013-01-01

    Glossodynia is often refractory to conventional medicine, and there is only limited evidence to guide clinicians in its management. Patients with refractory glossodynia are often introduced to Japanese traditional herbal (Kampo) medicine experts under such circumstances because Kampo medicine has become known in Japan to be effective in treating a wide variety of symptoms refractory to conventional medicine. Herein, we report our single-institution 5-year experience treating patients with Kampo medicine for primary glossodynia that was refractory to conventional medicine. We found that 69.2% of patients reported a beneficial effect of Kampo medicine on glossodynia, and the average onset of improvement was 8.0 ± 7.7 weeks after starting Kampo treatment. The top two frequently used Kampo medicines for glossodynia were seinetsuhokito and mibakuekkito among high responders who showed a decrease of severity by 50% or more. The top four most overlapped herbs among effective Kampo medicines for glossodynia were Glycyrrhiza Root, Ginseng Root, Hoelen, and Atractylodes (lancea) Rhizome, which compose an essential Kampo prescription called shikunshito. Although more research is required to further clarify the effectiveness of Kampo medicine, it has valid efficacy even in cases of glossodynia that remain incurable by conventional treatments. PMID:24223055

  7. t(8;21) (q22;q22) acute myelogenous leukemia in Mexico: a single institution experience.

    PubMed

    Ruiz-Argüelles, Guillermo J; Morales-Toquero, Amelia; Manzano, Carlos; Ruiz-Delgado, Guillermo J; Jaramillo, Patricia; Gonzalez-Carrillo, Martha L; Reyes-Núñez, Virginia

    2006-08-01

    We analyze the prevalence and clinical features of a group of patients with t(8;21) (q22;q22) acute myeloblastic leukemia, identified in a single institution in México over a 10-year period. Fifteen patients presented at the Centro de Hematología y Medicina Interna de Puebla from February 1995 to August 2005; only nine were treated and followed in the institution. Median age was 24 years, (range 7-49); there was only one male. According to the French-American-British (FAB) morphological classification of leukemia, the morphology was M2 in four cases, M4 in three cases, M3 in one case and M0 in one. In addition to the myeloid markers, lymphoid markers were identified in 6 patients. Patients were induced to remission with combined chemotherapy and three subsequently underwent bone marrow transplantation (BMT). The median overall and disease-free survival has not been reached, being above 3390 days, the probability of survival at this time was 73%. In this single-center experience in México, we found that the t(8;21) (q22;q22) variant of leukemia was more frequent than in Caucasian populations, that the co-expression of lymphoid markers in the blast cells is very frequent and that this malignancy is associated with a relatively good prognosis.

  8. National comparison of oncologic quality indicators between open and robotic-assisted radical cystectomy.

    PubMed

    Matulewicz, Richard S; DeLancey, John Oliver Lang; Manjunath, Adarsh; Tse, Jennifer; Kundu, Shilajit D; Meeks, Joshua J

    2016-10-01

    Despite increased adoption of robotic-assisted radical cystectomy (RARC), no national data have validated its oncologic efficacy compared to the "standard" open radical cystectomy (ORC). Positive surgical margins (PSM) and lymph node (LN) yield during radical cystectomy (RC) have an established relationship with bladder cancer outcomes. Here, we propose these 2 as quality indicators for RC and assess their differences to compare the oncologic efficacy between RARC and ORC. Using the National Cancer Data Base for the years 2010 to 2012, all patients who underwent ORC or RARC were analyzed. Baseline demographic and cancer stage information were compared as well as unadjusted rates of PSM and LN yield. Survival effect of each indicator was assessed. Using propensity score adjustment, rates of PSM and LN yield were compared between RARC and ORC. A total of 12,036 patients are included who underwent RC, 20% (2,397) of which were performed robotically. Percentage RARC of total RC increased from 16.2% to 23.3% over the 3 study years. Compared to ORC, patients who underwent RARC were no different in age but were more often men (78.4% vs. 73.6%, P<0.001), had less-advanced cancer stage, and were more likely to have received neoadjuvant chemotherapy (20.9% vs. 14.5%, P<0.001). Most RARC procedures were performed at academic medical centers (66.1%). Unadjusted rates of PSM were lower in the RARC group (10.8% vs. 13.2%, P = 0.002) whereas median LN yield was higher in RARC patients (16 [interquartile range 9, 25] vs. 11 [interquartile range 5, 19], P<0.001). After propensity score covariate adjustment, there was no significant difference in PSM rate between RARC and ORC (-1.12% difference, [95% CI:-2.8, 0.32%]. However, RARC was associated with a higher node yield (+3.32 LN, [95% CI: 2.61, 4.03]) than ORC (P<0.001). The RARC is becoming more prevalent. In a national cohort, RARC was performed more often on men, with lower stage cancer, who were more likely to receive

  9. Robotic and laparoscopic radical cystectomy for bladder cancer: long-term oncologic outcomes.

    PubMed

    Snow-Lisy, Devon C; Campbell, Steven C; Gill, Inderbir S; Hernandez, Adrian V; Fergany, Amr; Kaouk, Jihad; Haber, Georges-Pascal

    2014-01-01

    Extended oncologic outcomes after minimally invasive cystectomy have not been previously reported. To report outcomes of robot-assisted radical cystectomy (RARC) and laparoscopic radical cystectomy (LRC) for bladder cancer (BCa) at up to 12-yr follow-up. All 121 patients undergoing RARC or LRC for BCa between December 1999 and September 2008 at a tertiary referral center were retrospectively evaluated from a prospectively maintained database. RARC or LRC. Primary end points were overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) calculated using Kaplan-Meier curves. Secondary end points were survival analysis by number of lymph nodes (LNs) and type of procedure. Surgical outcomes, including complications, were analyzed. Most tumors were muscle invasive (≥ pT2; n=81; 67%) urothelial carcinomas (n=102; 84%). Extended LN dissection was performed in 98 patients (81%), with a median of 14 nodes removed (interquartile range [IQR]: 8-18). Twenty-four patients (20%) had node-positive disease (N1: 10 [8%]; N2: 14 [12%]). Eight patients (6.6%) had positive soft tissue margins. Median follow-up was 5.5 yr (mean: 5.9; IQR: 4.2-8.2; range: 0.13-12.1). At last follow-up, 58 patients (48%) had no evidence of disease, 3 (2%) were alive with recurrence, 59 (49%) had died, and status was unknown in 1. Twenty-eight patients (23%) died from cancer-specific causes, 20 (17%) from unrelated causes, and 11 (9%) from unknown causes. The 10-yr actuarial OS, CSS, and RFS rates were 35%, 63%, and 54%, respectively. At last follow-up, OS for pT0, pTis/a, pT1, pT2, and pT3 versus pT4 was 67%, 73%, 53%, 50%, and 16% versus 0%, respectively (p=0.02). At last follow-up, CSS for pT0, pTis/a, pT1, pT2, and pT3 versus pT4 was 100%, 91%, 74%, 77%, and 56% versus 0%, respectively (p=0.03). The longest oncologic outcomes following RARC and LRC for BCa reported demonstrates results similar to those reported for open RC. Continued analysis and direct randomized

  10. Carcinoma of the urinary bladder T/sub 3/N/sub x/M/sub o/ treated by preoperative irradiation followed by simple cystectomy

    SciTech Connect

    Van Der Werf-Messing, B.H.P.; Friedell, G.H.; Menon, R.S.; Hop, W.C.J.; Wassif, S.B.

    1982-11-01

    One hundred eighty-three patients with bladder cancer category, T/sub 3/N/sub x/M/sub o/ (the diameter of the primary exceeding 5 cm), were treated by preoperative 40 Gy and simple cystectomy. Using only pretreatment information, the group with the best prognosis was characterized by a T/sub 3A/-growth with a normal intravenous pyelography, with about a 75% cure rate. Before cystectomy, after irradiation the combination of a clinically assessed radiation-downstaged growth (T/sub 40GY/<3) with normal urography, predicted the best chance of cure at about 80%. After cystectomy was performed, the best prognostic group could be most correctly identified: those patients with both microscopic downstaging of the primary (''P''/sub <3/) and no vascular invasion in the cystectomy specimen (CV-) combined with normal urography had an 81% chance of cure. This most favorable group constitutes 45% of all patients.

  11. Carcinoma of the urinary bladder T/sub 3/N/sub X/M/sub O/ treated by preoperative irradiation followed by simple cystectomy

    SciTech Connect

    van der Werf-Messing, B.H.P.; Friedell, G.H.; Menon, R.S.; Hop, W.C.J.; Wassif, S.B.

    1982-11-01

    One hundred eighty-three patients with bladder cancer category, T/sub 3/N/sub X/M/sub O/ (the diameter of the primary exceeding 5 cm), were treated by preoperative 40 Gy and simple cystectomy. Using only pretreatment information, the group with the best prognosis was characterized by a T/sub 3A/-growth with a normal intravenous pyelography, with a 75% cure rate. Before cystectomy, after irradiation the combination of clinically assessed radiation-downstaged growth (T/sub 40GY/<3) with normal urography, predicted the best chance of cure at about 80%. After cystectomy was performed, the best prognostic group could be most correctly identified: those patients with both microscopic downstaging of the primary (''P''/sub <3/) and no vascular invasion in the cystectomy specimen (CV - ) combined with normal urography had an 81% chance of cure. This most favorable group constitutes 45% of all patients.

  12. Novel Closing Method Using Subcutaneous Continuous Drain for Preventing Surgical Site Infections in Radical Cystectomy

    PubMed Central

    Hirose, Yasuhiko; Ando, Ryosuke; Nakane, Akihiro; Etani, Toshiki; Iida, Keitaro; Akita, Hidetoshi; Okamura, Takehiko; Kohri, Kenjiro

    2014-01-01

    To reduce the incidence of surgical site infection (SSI) after radical cystectomy, a new closing method using subcutaneous continuous aspiration drain was developed and compared to the conventional closing method. The new method involved (a) closed aspiration with an indwelling aspiration drain without suture of the subcutaneous fat and (b) covering with hydrocolloid wound dressing after suture of the dermis with 4-0 absorbable thread and reinforcement using strips. The incidence of SSI was significantly improved by using the new method. Furthermore, univariate and multivariate analysis associated with SSI revealed that the new closing method was statistically correlated with 85% reduction of SSI (odds ratio: 0.15, 95% confidence interval: 0.03–0.69).Our new method using continuous aspiration with subcutaneous drain is useful for preventing SSI through removal of effusions and reduction of dead space by apposition of the subcutaneous fat. PMID:24734201

  13. Diagnostic accuracy of hexaminolevulinate in a cohort of patients undergoing radical cystectomy.

    PubMed

    Pagliarulo, Vincenzo; Stefano, Alba; Gallone, Maria Filomena; Di Stasi, Savino; Cormio, Luigi; Petitti, Tommasangelo; Buscarini, Maurizio; Minafra, Paolo; Carrieri, Giuseppe

    2017-02-01

    Purpose To compare the accuracy of white light cystoscopy (WLC) and blue light cystoscopy (BLC) in a cohort of patients undergoing radical cystectomy (RC) for previously resected urothelial bladder cancer (UCB). Patients and methods A cohort of patients undergoing RC received WLC and BLC prior radical surgery. To evaluate the residual tumor rate, the bladder was inspected after its removal and normal appearing mucosa sampled for histologic analysis. Lesions detected under WLC, BLC, or both, as well as biopsy samples from normal appearing mucosa, were all recorded separately. Results Starting 2011, 64 patients underwent WLC and BLC prior cystectomy. Overall, 540 tissue samples were collected during cystoscopy and from normal appearing mucosa. Residual disease was found in 31/64 (48.4%) patients, including 27 (42.1%) cases of CIS. The accuracy of BLC was much higher than WLC, both in the diagnosis of any residual disease (87.1% vs 32.3%, and 87.9% vs 51.5%, for sensitivity and specificity, respectively), as of CIS only (92.6% vs 29.6% and 83.8% vs 51.4%). We further evaluated the diagnostic accuracy as a result of the analysis on all specimens collected during the study. A total of 535 specimens were analyzed, and 58 specimens with residual disease were found, including 48 CIS foci. Again, detection rates and measures of accuracy were much better for BLC vs WLC, both overall (86.2% vs 31%, and 98.3% vs 93.3%, for sensitivity and specificity, respectively), and when CIS only was considered (89.6% vs 31.2% and 96.9% vs 92.8%). Conclusions Although BLC missed 12.9% of positive patients, and 7.4% of those with CIS, the agreement between BLC diagnostic accuracy and the definitive pathology was very robust.

  14. Quality assurance and benchmarking for radical cystectomy: monitoring early complications and mortality using cumulative summation charts.

    PubMed

    Chalasani, Venu; Abdelhady, Mazen; Stitt, Larry; Izawa, Jonathan I

    2009-04-01

    Cumulative summation is one method for quality assurance that has recently been adapted to the medical field to monitor any binary surgical outcomes on an ongoing basis. In this study we used cumulative summation charts for quality assurance in radical cystectomies. Cumulative summation charts were generated from prospectively collected data for the first 150 radical cystectomies performed by a single surgeon from 2001 to 2007. Overall and disease specific survival were estimated using the Kaplan-Meier actuarial methodology and stratified by pathological stage. Based on a literature review acceptable rates were identified as death 0.3% to 4%, ureterointestinal leak 0.3% to 1%, unplanned reoperation 2.3% to 17%, myocardial infarction 0.3% to 2% and pulmonary embolism 0.4% to 2%. Median followup was 16 months. There were 12, 12, 41, 26, 25 and 34 patients with pTis, pT1, pT2, pT3, pT4 and pN+ disease, respectively. The 5-year disease specific survival for less than pT2, pT2, pT3, pT4 and pN+ was 92%, 90%, 60%, 51% and 30%, respectively. The occurrence of postoperative death, rectal injury, ureterointestinal anastomotic leak, immediate reoperation, myocardial infarction and pulmonary embolus for the 150 patients was 1, 0, 3, 2, 2 and 3, respectively. Cumulative summation graphs allowed a visual guide to the key performance indicators. Using cumulative summation surgeons can continuously identify if their morbidity or mortality rates are approaching benchmark limits. This approach may provide more timely information when alterations in surgical technique, patient selection and perioperative care should be considered if benchmark limits are being approached for a variety of surgical outcomes.

  15. A comparison of early complications between open and robot-assisted radical cystectomy.

    PubMed

    Sung, Hyun Hwan; Ahn, Joong-Seo; Seo, Seong Il; Jeon, Seong Soo; Choi, Han Yong; Lee, Hyun Moo; Jeong, Byong Chang

    2012-06-01

    The aim of our study was to compare early complication rates between the robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using a standardized reporting system. From September 2008 to March 2011, 35 and 104 patients underwent ORC and RARC, respectively. Demographics and perioperative and complication data on all patients were reviewed retrospectively and compared between the two groups. All complications were categorized using a modified Clavien reporting system. We also sought to identify independent predictive factors of grade II or greater complications. There were no significant differences between the ORC and RARC groups with regard to age, body mass index, American Society of Anesthesiologists score, clinical stage, surgical procedure history, or sex. The RARC group had more cases of ileal neobladder urinary diversion (P<0.001). We did not find any differences in terms of pathologic stage or length of stay. The ORC group had more grade II or greater complications (P=0.001), wound problems (P=0.043), multiple complications (P=0.014), greater estimated blood loss (EBL) (P<0.001), and needed more transfusions (P<0.001). A longer operative time was needed in the RARC group, however. Multivariate logistic regression analysis demonstrated that the ORC (P=0.045, odds ratio [95% confidence interval]=2.44 [1.02-5.85]), EBL (>500 mL, P=0.013, 2.75 [1.24-6.10]), and female sex (P=0.028, 4.06 [1.12-14.11]) were independent predictors of grade II or greater complications. Our results showed that the RARC group was comparable to the ORC group with respect to complications using the Clavien reporting system. Further long-term and randomized trials are needed, however, because RARC is still not considered the standard therapy for bladder cancer.

  16. Risk Factors for Developing Metabolic Acidosis after Radical Cystectomy and Ileal Neobladder.

    PubMed

    Kim, Kwang Hyun; Yoon, Hyun Suk; Yoon, Hana; Chung, Woo Sik; Sim, Bong Suk; Ryu, Dong-Ryeol; Lee, Dong Hyeon

    2016-01-01

    To investigate the serial changes of metabolic acidosis and identify associated risk factors in patients who underwent radical cystectomy and ileal neobladder. From January 2010 to August 2014, 123 patients who underwent radical cystectomy and ileal neobladder reconstruction for bladder cancer were included in this study. Metabolic acidosis was defined as a serum bicarbonate level less than 22 mEq/L and impaired renal function was defined as a GFR <50ml/min. The presence of metabolic acidosis was evaluated at 1 month, 1 year, and 2 years after surgery. Multivariate logistic regression analysis was conducted to identify risk factors associated with development of metabolic acidosis. Metabolic acidosis was observed in 52%, 19.5%, and 7.3% of patients at 1 month, 1 year, and 2 years after surgery, respectively. At 1 month after surgery, impaired renal function was the only independent risk factor associated with metabolic acidosis (OR 3.87, P = 0.046). At 1 year after surgery, diabetes was the only independent risk factor associated with metabolic acidosis (OR 5.68, P = 0.002). At 2 years post-surgery, both age and diabetes were significant risk factors associated with metabolic acidosis. Approximately, half of patients experienced metabolic acidosis one month after ileal neobladder reconstruction. Preoperative impaired renal function was the most significant risk factor for developing metabolic acidosis in the early postoperative period. However, the incidence of metabolic acidosis decreased to less than 20% 1 year after surgery, and diabetes was an independent risk factor during this period.

  17. Extraperitoneal versus transperitoneal laparoscopic radical cystectomy for selected elderly bladder cancer patients: a single center experience

    PubMed Central

    Feng, Lang; Song, Jian; Wu, Menghua; Tian, Ye; Zhang, Daoxin

    2016-01-01

    ABSTRACT Objective: This study reports the initial experience of extraperitoneal laparoscopic radical cystectomy (ELRC) and compared with transperitoneal laparoscopic radical cystectomy (TLRC) in the treatment of selected elderly bladder cancer patients. Patients and Methods: A total of forty male bladder cancer patients who underwent ELRC (n=19) or TLRC (n=21) with ureterocutaneostomy were investigated. Demographic parameters, perioperative variables, oncological outcomes and follow-up data were retrospectively analyzed. Results: A significantly shorter time to exsufflation (1.5±0.7 vs 2.1±1.1 d; p=0.026) and liquid intake (1.8±0.9 vs 2.8±1.9 d; p=0.035) were observed in the ELRC group compared with the TLRC group. The incidence of postoperative ileus in the ELRC group was lower than the TLRC group (0 vs 9.5%). However, the difference had no statistical significance (p>0.05). The removed lymph node number in the ELRC group was significantly lower than the TLRC group (p<0.001). No significant differences were observed between the two groups in the overall and cancer-free survival rates (p>0.05). Conclusions: ELRC seems to be a safe and feasible surgical strategy for the selected elderly bladder cancer patients with ≤ T2 disease. The surgical and oncological efficacy of the ELRC is similar to that of the TLRC, but with faster intestinal function recovery. Further studies with a large series including different urinary diversions are needed to confirm our results and to better evaluate the benefit of ELRC in bladder cancer patients. PMID:27564274

  18. Cost-analysis comparison of robot-assisted laparoscopic radical cystectomy (RC) vs open RC.

    PubMed

    Lee, Richard; Chughtai, Bilal; Herman, Michael; Shariat, Shahrokh F; Scherr, Douglas S

    2011-09-01

    • To systematically review and compare the economic burden of open radical cystectomy (ORC) vs robot-assisted laparoscopic radical cystectomy (RALRC) with pelvic lymph node dissection and urinary diversion. • A Medline search was conducted to identify English language articles regarding RC with urinary diversion. The resulting articles were then further restricted by the terms 'laparoscopic', 'robotic', or 'robotic-assisted'.In all, three articles were identified. • Data from each of these articles were then collected on cost performance in addition to relevant clinical variables, such as length of stay (LOS), operative duration, and complication rates. • When possible, data were subdivided by ileal conduit (IC), continent cutaneous diversion (CCD), and orthotopic neobladder (ON) subgroups. • Direct costs resulting from ORC or RALRC with accompanying hospitalization were identified. The indirect costs of complications were considered. • Despite an increased materials cost, RALRC was less expensive than ORC when the cost of complications was considered. • RALRC was less expensive than ORC for IC and CCD, but the cost advantage deteriorated for ON. • The largest cost drivers cited in the published data were LOS, operative durations, and daily hospitalizations costs. • RALRC demonstrated shorter LOS compared with ORC, although this effect was insufficient to offset the increased cost of robotic surgery. • Complications materially affected cost performance. • Despite an increased materials cost, RALRC can be more cost efficient than ORC as a treatment for bladder cancer when the impact of complications are considered. • This effect is most pronounced for patients undergoing IC. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  19. Introducing an enhanced recovery programme to an established totally intracorporeal robot-assisted radical cystectomy service.

    PubMed

    Collins, Justin W; Adding, Christofer; Hosseini, Abolfazl; Nyberg, Tommy; Pini, Giovannalberto; Dey, Linda; Wiklund, Peter N

    2016-01-01

    The aim of this study was to assess the effect of introducing an enhanced recovery programme (ERP) to an established robot-assisted radical cystectomy (RARC) service. Data were prospectively collected on 221 consecutive patients undergoing totally intracorporeal RARC between December 2003 and May 2014. The ERP was specifically designed to support an evolving RARC service, where increasing proportions of patients requiring radical cystectomy underwent RARC. Patient demographics and outcomes before and after implementation of the ERP were compared. The primary endpoint was length of stay (LOS). Secondary outcomes included age, American Society of Anesthesiologists (ASA) score, preoperative staging, operative time, complications and readmissions. Differences in outcomes between patients before and after implementation of ERP were tested with the Jonckheere-Terpstra trend test and quantile regression with backward selection. Following implementation of the ERP, the demographics of the patients (n = 135) changed, with median age increasing from 66 to 70 years (p < 0.01), higher ASA grade (p < 0.001), higher preoperative stage cancer (pT ≥ 2, p < 0.05) and increased likelihood of undergoing an ileal conduit diversion (p < 0.001). Median LOS before ERP was 9 days [interquartile range (IQR) 8-13 days] and after ERP was 8 days (IQR 6-10 days) (p < 0.001). ASA grade and neoadjuvant chemotherapy also affected LOS (p < 0.05 and p < 0.01, respectively). There was no significant difference in 30 day complication rates, readmission rates or 90 day mortality, with 59% experiencing complications before ERP implementation and 57% after implementation. The majority of complications were low grade. Patient demographics changed as the RARC service evolved from selected patients to a general service. Despite worsening demographics, LOS decreased following ERP implementation. This evidence-based ERP safely standardized perioperative care, resulting in decreased LOS and decreased

  20. Febrile Urinary Tract Infection after Radical Cystectomy and Ileal Neobladder in Patients with Bladder Cancer.

    PubMed

    Kim, Kwang Hyun; Yoon, Hyun Suk; Yoon, Hana; Chung, Woo Sik; Sim, Bong Suk; Lee, Dong Hyeon

    2016-07-01

    Urinary tract infection (UTI) is one of the most common complications after radical cystectomy and orthotopic neobladder reconstruction. This study investigated the incidence and implicated pathogen of febrile UTI after ileal neobladder reconstruction and identify clinical and urodynamic parameters associated with febrile UTI. From January 2001 to May 2015, 236 patients who underwent radical cystectomy and ileal neobladder were included in this study. Fifty-five episodes of febrile UTI were identified in 46 patients (19.4%). The probability of febrile UTI was 17.6% and 19.8% at 6 months and 24 months after surgery, respectively. While, Escherichia coli was the most common implicated pathogen (22/55, 40.0%), Enterococcus spp. were the most common pathogen during the first month after surgery (18/33, 54.5%). In multivariate logistic regression analysis, ureteral stricture was an independent risk factor associated with febrile UTI (OR 5.93, P = 0.023). However, ureteral stricture accounted for only 6 episodes (10.9%, 6/55) of febrile UTI. Most episodes of febrile UTI occurred within 6 months after surgery. Thus, to identify risk factors associated with febrile UTI in the initial postoperative period, we assessed videourodynamics within 6 months after surgery in 38 patients. On videourodyamic examination, vesicoureteral reflux (VUR) was identified in 16 patients (42.1%). The rate of VUR presence in patients who had febrile UTI was not significantly different from those in patients without febrile UTI (50% vs. 39.3%, P = 0.556). Patients with febrile UTI had significantly larger residual urine volume (212.0 ± 193.7 vs. 90.5 ± 148.2, P = 0.048) than those without. E. coli and Enterococcus spp. are common pathogens and ureteral stricture and residual urine are risk factors for UTI after ileal neobladder reconstruction.

  1. Immature teratoma of ovary--outcome following primary and secondary surgery: study of a single institution cohort.

    PubMed

    Reddihalli, Pallavi V; Subbian, Anbukkani; Umadevi, K; Rathod, Praveen S; Krishnappa, Shobha; Nanaiah, Shakuntala P; Bafna, Uttam D

    2015-09-01

    To analyse the clinical presentation, treatment - primary and secondary debulking and outcomes with focus on recurrences in ovarian immature teratoma. This is a single institution, retrospective analysis of 24 women who presented to a gynecologic oncology unit from 1999 to 2011 with ovarian immature teratoma. Patient's clinical presentation, operative and chemotherapy details were included in a database. Follow up details regarding recurrence and management and future outcomes were also noted. Overall survival was calculated from the date of registration to last follow up or date of death. Survival curve was constructed by Kaplan-Meier method. Immature teratoma accounted for 11% of 218 malignant germ cell tumors. Of the 24 patients, pain was the predominant symptom and abdominal mass was the commonest clinical presentation. Sixteen out of 24 patients presented in Stage I and grade 3 tumors were found in 43% of patients. Six patients had only unilateral salpingo oophorectomy and no staging procedure. Twelve patients underwent staging, with omentectomy being the commonest procedure. All but one, had cisplatin based combination chemotherapy. Six patients underwent secondary debulking of recurrence. Most recurrences were recorded in Stage III, higher grade tumors. With secondary cytoreduction and platinum based chemotherapy, it was possible to salvage most recurrences as well. Overall survival after a mean follow-up of 39 months was 91.6%. Majority of the patients did well with conservative surgery in terms of survival, menstrual and reproductive function. Platinum based chemotherapy was indicated in higher grade and higher stage tumors as recurrences commonly occurred in this subgroup of patients. Recurrences could be salvaged with selected secondary cytoreduction and platinum based chemotherapy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Single Fraction Versus Fractionated Linac-Based Stereotactic Radiotherapy for Vestibular Schwannoma: A Single-Institution Experience

    SciTech Connect

    Collen, Christine; Ampe, Ben; Gevaert, Thierry; Moens, Maarten; Linthout, Nadine; De Ridder, Mark; Verellen, Dirk; D'Haens, Jean; Storme, Guy

    2011-11-15

    Purpose: To evaluate and compare outcomes for patients with vestibular schwannoma (VS) treated in a single institution with linac-based stereotactic radiosurgery (SRS) or by fractionated stereotactic radiotherapy (SRT). Methods and Materials: One hundred and nineteen patients (SRS = 78, SRT = 41) were treated. For both SRS and SRT, beam shaping is performed by a mini-multileaf collimator. For SRS, a median single dose of 12.5 Gy (range, 11-14 Gy), prescribed to the 80% isodose line encompassing the target, was applied. Of the 42 SRT treatments, 32 treatments consisted of 10 fractions of 3-4 Gy, and 10 patients received 25 sessions of 2 Gy, prescribed to the 100% with the 95% isodose line encompassing the planning target volume. Mean largest tumor diameter was 16.6 mm in the SRS and 24.6 mm in the SRT group. Local tumor control, cranial nerve toxicity, and preservation of useful hearing were recorded. Any new treatment-induced cranial nerve neuropathy was scored as a complication. Results: Median follow-up was 62 months (range, 6-136 months), 5 patients progressed, resulting in an overall 5-year local tumor control of 95%. The overall 5-year facial nerve preservation probability was 88% and facial nerve neuropathy was statistically significantly higher after SRS, after prior surgery, for larger tumors, and in Koos Grade {>=}3. The overall 5-year trigeminal nerve preservation probability was 96%, not significantly influenced by any of the risk factors. The overall 4-year probability of preservation of useful hearing (Gardner-Robertson score 1 or 2) was 68%, not significantly different between SRS or SRT (59% vs. 82%, p = 0.089, log rank). Conclusion: Linac-based RT results in good local control and acceptable clinical outcome in small to medium-sized vestibular schwannomas (VSs). Radiosurgery for large VSs (Koos Grade {>=}3) remains a challenge because of increased facial nerve neuropathy.

  3. Histopathology of ameloblastoma of the jaws; some critical observations based on a 40 years single institution experience

    PubMed Central

    Hertog, Doenja; Bloemena, Elisabeth; H A Aartman, Irene

    2012-01-01

    The aim of the present study is to examine all cases of intraosseous benign ameloblastomas treated between 1970 and 2010 in a single institution and to look for a possible correlation between the histopathological aspects and the demographical and clinical parameters, as well as the treatment outcome. The data of a total number of 44 patients were retrieved from the records. Nine patients were excluded because of doubt about the correct diagnosis (8 patients) or because of an extra-osseous presentation (1 patient). No statistically significant differences were found between the histopathological (sub)types of ameloblastomas and the demographical and clinical parameters, nor between the histopathological (sub)types and treatment outcome. Of the 28 patients treated by enucleation, in 17 patients one or more recurrences occurred, with no significant predilection for any histopathological (sub)type, including the unicystic type. There were no significant differences in the recurrence rate after enucleation in patients below and above the age of 20 years either. In six out of 17 patients with a recurrence, the recurrent lesion showed a different histopathological subtype than was encountered in the primary. In two cases a change from solid/multicystic to desmoplastic ameloblastomas was noticed. In conclusion, the current histopathological classification of benign intraosseous ameloblastoma does not seem to have clinical relevance with the possible exception of the luminal unicystic ameloblastoma that has been removed in toto, unfragmented. Since no primary desmoplastic ameloblastomas were encountered in the present study no further comments can be made on this apparently rare entity. Key words: Odontogenic tumours, ameloblastoma, histopathology. PMID:22157674

  4. Adaptive Planning in Intensity-Modulated Radiation Therapy for Head and Neck Cancers: Single-Institution Experience and Clinical Implications

    SciTech Connect

    Ahn, Peter H.; Chen, Chin-Cheng; Ahn, Andrew I.; Hong, Linda; Scripes, Paola G.; Shen Jin; Lee, Chen-Chiao; Miller, Ekeni; Kalnicki, Shalom; Garg, Madhur K.

    2011-07-01

    Purpose: Anatomic changes and positional variability during intensity-modulated radiation therapy (IMRT) for head and neck cancer can lead to clinically significant dosimetric changes. We report our single-institution experience using an adaptive protocol and correlate these changes with anatomic and positional changes during treatment. Methods and Materials: Twenty-three sequential head and neck IMRT patients underwent serial computed tomography (CT) scans during their radiation course. After undergoing the planning CT scan, patients underwent planned rescans at 11, 22, and 33 fractions; a total of 89 scans with 129 unique CT plan combinations were thus analyzed. Positional variability and anatomic changes during treatment were correlated with changes in dosimetric parameters to target and avoidance structures between planning CT and subsequent scans. Results: A total of 15/23 patients (65%) benefited from adaptive planning, either due to inadequate dose to gross disease or to increased dose to organs at risk. Significant differences in primary and nodal targets (planning target volume, gross tumor volume, and clinical tumor volume), parotid, and spinal cord dosimetric parameters were noted throughout the treatment. Correlations were established between these dosimetric changes and weight loss, fraction number, multiple skin separations, and change in position of the skull, mandible, and cervical spine. Conclusions: Variations in patient positioning and anatomy changes during IMRT for head and neck cancer can affect dosimetric parameters and have wide-ranging clinical implications. The interplay between random positional variability and gradual anatomic changes requires careful clinical monitoring and frequent use of CT- based image-guided radiation therapy, which should determine variations necessitating new plans.

  5. Perioperative Outcomes, Complications, and Efficacy of Robotic-Assisted Prolapse Repair: A Single Institution Study of 196 Patients.

    PubMed

    Gupta, Priyanka; Ehlert, Michael; Bartley, Jamie; Gilleran, Jason; Killinger, Kim A; Boura, Judith A; Nagaraju, Pradeep; Fischer, Melissa

    2017-09-15

    Abdominal pelvic organ prolapse repair is efficacious for uterovaginal and apical prolapse. We describe the safety and efficacy of robotic prolapse repair in a large teaching institution. Consecutive robotic-assisted prolapse repairs at a single institution between 2006 and 2014 were retrospectively reviewed for patient characteristics, operative information, and outcomes. A total of 196 women (mean age, 61 ± 9 years) underwent robotic prolapse repair (189 sacrocolpopexy, 6 sacrohysteropexy, 1 enterocele repair). Concomitant procedures included hysterectomy (88), midurethral sling (84), and/or Burch colposuspension (7). Mean odds ratio time was 242 ± 69.9 minutes, and median length of stay was 1 day. Intraoperative complications were as follows: cystotomy (4), vaginotomy (4), conversion to open (2), bowel injury/aborted (1), adhesions/aborted (1), and ureteral injury (1). Women with complications had greater blood loss than those without complications (P = 0.0015). Immediate (<30 days) postoperative complications were rare: port-site hernia (2), discitis (1), ileus (1), and ulnar neuropraxia (3). At median follow-up of 9 months (range, 0-85 months), 14 women had recurrent grade 3 prolapse, and 4 had grade 2 apical prolapse. Nine of 14 women had additional prolapse repair at a mean of 9.5 ± 6.3 months. Vaginal mesh exposure was detected in 12 (6.3%) of 192 women. There were 6 procedures for mesh exposure and 2 procedures for exposed sutures. One mesh erosion into the bladder required open excision. In this large series of robotic prolapse repair, complications are infrequent. Short-term apical outcomes are excellent. Few women required additional compartment repairs within 1 year with 6% rate of mesh exposure.

  6. Deferasirox treatment for myelodysplastic syndromes: "real-life" efficacy and safety in a single-institution patient population.

    PubMed

    Breccia, Massimo; Finsinger, Paola; Loglisci, Giuseppina; Federico, Vincenzo; Santopietro, Michelina; Colafigli, Gioia; Petrucci, Luigi; Salaroli, Adriano; Serrao, Alessandra; Latagliata, Roberto; Alimena, Giuliana

    2012-09-01

    We here describe a single-institution experience on 40 patients with myelodysplastic syndromes (MDS) consecutively treated with deferasirox at the dose of 10-30 mg/kg/day according to Consensus Guidelines on Iron Chelation Therapy, outside of clinical trials. Serum ferritin (SF) was measured monthly, and safety assessment included monitoring of adverse events during treatment and of liver and renal parameters. Median SF at baseline of the 40 patients was 2,878 ng/ml. Median dose of deferasirox was 1,125 mg/day. At a median follow-up of 12 months of treatment, there was a significant reduction in SF from baseline, the median value being 1,400 ng/ml (p = 0.001). Interruptions due to toxicity were recorded in 40 % of patients: most common adverse events were diarrhoea (five patients, 12.5 %) and skin rash (four patients, 10 %). Seven patients had increased serum creatinine values >33 % above baseline, but there were no progressive increases. Four patients (three refractory anaemia and one refractory anaemia with excess blasts type 1) had a reduction of transfusion requirement (from a median of 5 to 1 unit/month) according to International Working Group 2006 criteria, with mean Hb value increasing from 8.5 to 10.5 g/dl, and mean Hb improvement being 2 g/dl (p = 0.02). No increased toxicity was noted when deferasirox was used concomitantly with azacitidine (eight patients who were intermediate 2 International Prognostic Scoring System risk) or lenalidomide (two patients with del(5q)). In conclusion, the oral iron chelator deferasirox is effective and safe when used in MDS patients with transfusion requirement, also if administered concomitantly with other drugs.

  7. Relationship between minimally invasive hysterectomy, pelvic cytology, and lymph vascular space invasion: a single institution study of 458 patients.

    PubMed

    Zhang, Chelsea; Havrilesky, Laura J; Broadwater, Gloria; Di Santo, Nicola; Ehrisman, Jessie A; Lee, Paula S; Berchuck, Andrew; Alvarez Secord, Angeles; Bean, Sarah; Bentley, Rex C; Valea, Fidel A

    2014-05-01

    The aim of this study is to determine whether a minimally invasive approach to hysterectomy is associated with an increased rate of lymph vascular space invasion (LVSI) and/or malignant pelvic peritoneal cytology in endometrial cancer. We performed a single institution analysis of 458 women with endometrial cancer who underwent either total abdominal hysterectomy (TAH) or minimally invasive hysterectomy (MIH) with use of a disposable uterine manipulator. All patients had endometrial cancer diagnosed by endometrial biopsy at a single academic institution between 2002 and 2012. Exclusion criteria were pre-operative D&C and/or hysteroscopy, uterine perforation or morcellation, and conversion to laparotomy. Multivariate logistic regression models to determine if type of hysterectomy predicts either LVSI or presence of abnormal cytology were controlled for grade, stage, depth of invasion, tumor size, cervical and adnexal involvement. LVSI was identified in 39/214 (18%) MIH and 44/242 (18%) TAH (p=0.99). Pelvic washings were malignant in 14/203 (7%) MIH and 16/241 (7%) TAH (p=1.0). Washings were atypical or inconclusive in 16/203 (8%) MIH and 6/241 (2.5%) TAH (p=0.014). In multivariate analyses, type of hysterectomy was not a significant predictor of either LVSI (p=0.29) or presence of malignant washings (p=0.66), but was a predictor of atypical or inconclusive washings (p=0.03). Minimally invasive hysterectomy with use of a uterine manipulator for endometrial cancer is not associated with LVSI or malignant cytology. Algorithms that better determine the etiology and implications of inconclusive or atypical pelvic cytology are needed to inform the possible additional risk associated with a minimally invasive approach to endometrial cancer. Copyright © 2014. Published by Elsevier Inc.

  8. Klebsiella pneumoniae Carbapenemase (KPC)-Producing K. pneumoniae at a Single Institution: Insights into Endemicity from Whole-Genome Sequencing

    PubMed Central

    Stoesser, Nicole; Sheppard, Anna E.; Pankhurst, Louise; Giess, Adam; Yeh, Anthony J.; Didelot, Xavier; Turner, Stephen D.; Sebra, Robert; Kasarskis, Andrew; Peto, Tim; Crook, Derrick; Sifri, Costi D.

    2015-01-01

    The global emergence of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) multilocus sequence type ST258 is widely recognized. Less is known about the molecular and epidemiological details of non-ST258 K. pneumoniae in the setting of an outbreak mediated by an endemic plasmid. We describe the interplay of blaKPC plasmids and K. pneumoniae strains and their relationship to the location of acquisition in a U.S. health care institution. Whole-genome sequencing (WGS) analysis was applied to KPC-Kp clinical isolates collected from a single institution over 5 years following the introduction of blaKPC in August 2007, as well as two plasmid transformants. KPC-Kp from 37 patients yielded 16 distinct sequence types (STs). Two novel conjugative blaKPC plasmids (pKPC_UVA01 and pKPC_UVA02), carried by the hospital index case, accounted for the presence of blaKPC in 21/37 (57%) subsequent cases. Thirteen (35%) isolates represented an emergent lineage, ST941, which contained pKPC_UVA01 in 5/13 (38%) and pKPC_UVA02 in 6/13 (46%) cases. Seven (19%) isolates were the epidemic KPC-Kp strain, ST258, mostly imported from elsewhere and not carrying pKPC_UVA01 or pKPC_UVA02. Using WGS-based analysis of clinical isolates and plasmid transformants, we demonstrate the unexpected dispersal of blaKPC to many non-ST258 lineages in a hospital through spread of at least two novel blaKPC plasmids. In contrast, ST258 KPC-Kp was imported into the institution on numerous occasions, with other blaKPC plasmid vectors and without sustained transmission. Instead, a newly recognized KPC-Kp strain, ST941, became associated with both novel blaKPC plasmids and spread locally, making it a future candidate for clinical persistence and dissemination. PMID:25561339

  9. Radiotherapy in late elderly (aged 75 or older) patients with paranasal sinus carcinoma: a single institution experience.

    PubMed

    Doi, Hiroshi; Kitajima, Kazuhiro; Tanooka, Masao; Terada, Tomonori; Noguchi, Kazuma; Takada, Yasuhiro; Fujiwara, Masayuki; Ishikura, Reiichi; Kamikonya, Norihiko; Hirota, Shozo

    2016-12-01

    The purpose of our study was to assess the feasibility of radiotherapy (RT) for locally advanced paranasal sinus carcinomas in late elderly patients (aged ≥75 years) from a single institution in Japan. From 2000 to 2015, we retrospectively analyzed 14 patients (11 maxillary and 3 ethmoid sinus carcinoma patients) who underwent RT for pathologically confirmed paranasal sinus carcinomas. RT was performed without unexpected cessations. Two patients, however, developed Grade 3 mucositis. The median follow-up duration was 13 months (range 2-54 months). The 1- and 2-year overall survival (OS) rates were 81.8 and 54.5 %, respectively. The local response rate after the initial treatment was 85.7 %. The 1- and 2-year progression-free survival (PFS) rates were 46.2 and 24.8 %, respectively. Univariate analysis of different clinicopathological parameters was conducted to identify associations with OS and PFS. We demonstrated that intensity modulated radiation therapy (IMRT) of >60 Gy with concomitant intra-arterial (cisplatin-based) infusion chemoradiotherapy led to improved OS and PFS rates, although no statistical significance was observed. Moreover, none of the squamous cell carcinoma (SCC) patients who received 33 fractions of 66 Gy in IMRT died during the median follow-up period of 13 months (range 12-25 months). In conclusion, RT with concomitant intra-arterial (cisplatin-based) infusion chemoradiotherapy can be considered an effective, well-tolerated, and feasible treatment option for late elderly patients with paranasal sinus carcinomas. In addition, >60 Gy of RT in IMRT led to improved survival outcomes in elderly paranasal sinus carcinoma patients.

  10. Pharyngocutaneous fistula after total laryngectomy: A single-institution experience, 2001–2012☆,☆☆

    PubMed Central

    Benson, Eleni M.; Hirata, Richard M.; Thompson, Carol B.; Ha, Patrick K.; Fakhry, Carole; Saunders, John R.; Califano, Joseph A.; Arnaoutakis, Demetri; Levine, Marshall; Tang, Mei; Neuner, Geoffrey; Messing, Barbara P.; Blanco, Ray G.F.

    2015-01-01

    Purpose The purpose of this study was to determine the incidence of and risk factors for pharyngocutaneous fistula in patients undergoing total laryngectomy at a single institution. Materials and methods The records of 59 patients undergoing primary or salvage total laryngectomy at our institution from 2001 to 2012 were retrospectively reviewed. Data collected included patient, tumor and treatment characteristics, and surgical technique. Risk factors were analyzed for association with pharyngocutaneous fistula formation. Results Twenty patients (34%) developed fistulas. Preoperative tracheostomy (OR 4.1; 95% CI 1.3–13 [p = 0.02]) and low postoperative hemoglobin (OR 9.1; 95% CI 1.1–78 [p = 0.04]) were associated with fistula development. Regarding surgical technique, primary sutured closure of the total laryngectomy defect had the lowest fistula rate (11%). In comparison, primary stapled closure and pectoralis onlay flap over primary closure had nonsignificantly increased fistula rates (43%, OR 6.0; 95% CI 1.0–37.3 [p = 0.06] and 25%, OR 2.7; 95% CI 0.4–23.9 [p = 0.38], respectively). Pectoralis flap incorporated into the suture line had a significantly increased fistula rate (50%, OR 7.1; 95% CI 1.4–46 [p = 0.02]). After stratification for salvage status, patient comorbidities were associated with fistula in non-salvage cases whereas disease-related characteristics were associated with fistula in salvage cases. Fistula development was associated with increased length of hospital stay (p < 0.001) and increased time before oral diet initiation (p < 0.001). Conclusions Pharyngocutaneous fistula is a common complication of total laryngectomy. Preoperative tracheostomy, postoperative hemoglobin, and surgical technique are important in determining the risk of fistula. PMID:25245411

  11. Allogenic stem cell transplantation as salvage therapy for patients relapsing after autologous transplantation: experience from a single institution.

    PubMed

    Martínez, C; Carreras, E; Rovira, M; Urbano-Ispizua, A; Esteve, J; Fernández-Avilés, F; Perales, M; Rives, S; Gómez, M; Montserrat, E

    2001-05-01

    The prognosis of patients relapsing after an autologous transplant (autoSCT) is very poor. Allogenic stem cell transplantation (alloSCT) offers the possibility of curing some of these patients, at the cost, however, of a high transplant related mortality (TRM). The aim of this study was to analyze the outcome of 14 consecutive patients with hematologic malignancies, from a single institution, who underwent alloSCT for progressive disease after autoSCT. Patients had relapsed at a median of 11.5 months (range 2-72) after autoSCT and they underwent alloSCT at a median of 25.5 months (range 7-73) from the first transplant. Ten patients received HLA-identical related peripheral blood progenitor cells, three patients underwent matched-unrelated donor marrow transplants, and one patient received a mismatched related transplant. Conditioning regimens consisted of total body irradiation plus cyclophosphamide (n=5) or melphalan (n=1), or high-dose combination chemotherapy (n=8). Cyclosporin A and methotrexate were administered as graft-versus-host disease (GVHD) prophylaxis. Eight patients (57%) developed grade II-IV acute GVHD. All evaluable patients (n=6) presented extensive chronic GVHD. Overall survival at 1 year was 16% (median 3.5 months, 95% CI 0.7-10.3). Ten patients (71%) died from transplant related complications at a median of 3.5 months (range 0.7-11). Only one patient died of recurrent disease. Three patients remain alive and in complete remission at the time of this report (4, 20 and 20 months, respectively). In conclusion, alloSCT offers the possibility of a sustained control of the disease in some patients who relapse after an autoSCT. However, the procedure is associated with a high transplant-related mortality. Better results might be obtained by carefully selecting patients and by reducing the intensity of the preparative regimen.

  12. Women's fertility after laparoscopic cystectomy of endometrioma and other benign ovarian tumors - a 24-month follow-up retrospective study.

    PubMed

    Kostrzewa, Marta; Stachowiak, Grzegorz; Zyła, Monika; Kolasa-Zwierzchowska, Dorota; Szpakowski, Artur; Nowak, Marek; Wilczynski, Jacek R

    2016-09-01

    The golden standard in treatment benign ovarian cysts is laparoscopic cystectomy, but it may also influence women's fertility. The aim of the study was to compare women's fertility after laparoscopic cystectomy of endometrioma versus other benign ovarian tumors. Out of the 123 patients operated because of benign ovarian tumor (OT), 66 underwent laparoscopic cystectomy of endometrioma (endometrioma group) and 57 underwent laparoscopic cystectomy of other benign ovarian tumor like: functional cyst, hemorrhagic cyst, yellow body cyst or mature teratoma (reference group). OT-related data were obtained from medical documentation (diagnostic tests, medical reproductive and surgical history, clinical status during OT surgery). Follow-up data were collected by means of a telephone interview. The survey included questions focused on women's fertility during a 24-month period following the surgical treatment of OT (conception, subsequent pregnancies, recurrence of OT). A 24-month follow-up period revealed that the cumulative pregnancy rate was significantly higher in reference group (RG) as compared to endometrioma group (EG), i.e. 52.6% vs. 32.3%. Lower pregnancy risk was demonstrated in a EG group vs. other benign ovarian tumors, HR=0.57 (CI 0.33-0.99; p=0.049), log-rank test p=0.045. Benign OT returned in 19.3% vs. EG 36.3%, HR= 2.5 (CI 1.16-5.55 ; p=0.019) log-rank test: p=0.0136. The EG was divided on two subgroups: women with solitary endometrioma and women with endometrioma and coexistent peritoneal endometriosis. The study showed insignificantly lower risk of pregnancy in a group of advanced endometriosis vs. solitary endometrioma group (HR= 0.79 (CI 0.34-1.83; log-rank test p=0.57; pregnancy rate 29.3% vs. 40.0%). Statistically nonsignificant higher pregnancy rate occurred in a group of women with tumor ≤50mm in size among patients with benign ovarian tumor and solitary endometrioma vs. group of women with tumor >50mm (30% vs. 61%; p=0.09). There is a low

  13. Revision Rhinoplasty.

    PubMed

    Loyo, Myriam; Wang, Tom D

    2016-01-01

    Revision rhinoplasty is one of the most challenging operations the facial plastic surgeon performs given the complex 3-dimensional anatomy of the nose and the psychological impact it has on patients. The intricate interplay of cartilages, bone, and soft tissue in the nose gives it its aesthetic and function. Facial harmony and attractiveness depends greatly on the nose given its central position in the face. In the following article, the authors review common motivations and anatomic findings for patients seeking revision rhinoplasty based on the senior author's 30-year experience with rhinoplasty and a review of the literature.

  14. Development of a patient and institutional-based model for estimation of operative times for robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium.

    PubMed

    Hussein, Ahmed A; May, Paul R; Ahmed, Youssef E; Saar, Matthias; Wijburg, Carl J; Richstone, Lee; Wagner, Andrew; Wilson, Timothy; Yuh, Bertram; Redorta, Joan P; Dasgupta, Prokar; Kawa, Omar; Khan, Mohammad S; Menon, Mani; Peabody, James O; Hosseini, Abolfazl; Gaboardi, Franco; Pini, Giovannalberto; Schanne, Francis; Mottrie, Alexandre; Rha, Koon-Ho; Hemal, Ashok; Stockle, Michael; Kelly, John; Tan, Wei S; Maatman, Thomas J; Poulakis, Vassilis; Kaouk, Jihad; Canda, Abdullah E; Balbay, Mevlana D; Wiklund, Peter; Guru, Khurshid A

    2017-06-16

    To design a methodology to predict operative times for robot-assisted radical cystectomy (RARC) based on variation in institutional, patient, and disease characteristics to help in operating room scheduling and quality control. The model included preoperative variables and therefore can be used for prediction of surgical times: institutional volume, age, gender, body mass index, American Society of Anesthesiologists score, history of prior surgery and radiation, clinical stage, neoadjuvant chemotherapy, type, technique of diversion, and the extent of lymph node dissection. A conditional inference tree method was used to fit a binary decision tree predicting operative time. Permutation tests were performed to determine the variables having the strongest association with surgical time. The data were split at the value of this variable resulting in the largest difference in means for the surgical time across the split. This process was repeated recursively on the resultant data sets until the permutation tests showed no significant association with operative time. In all, 2 134 procedures were included. The variable most strongly associated with surgical time was type of diversion, with ileal conduits being 70 min shorter (P < 0.001). Amongst patients who received neobladders, the type of lymph node dissection was also strongly associated with surgical time. Amongst ileal conduit patients, institutional surgeon volume (>66 RARCs) was important, with those with a higher volume being 55 min shorter (P < 0.001). The regression tree output was in the form of box plots that show the median and ranges of surgical times according to the patient, disease, and institutional characteristics. We developed a method to estimate operative times for RARC based on patient, disease, and institutional metrics that can help operating room scheduling for RARC. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

  15. Radical Cystectomy and Cutaneous Ureterostomy in 4 Dogs with Trigonal Transitional Cell Carcinoma: Description of Technique and Case Series.

    PubMed

    Ricardo Huppes, Rafael; Crivellenti, Leandro Z; Barboza De Nardi, Andrigo; Roque Lima, Bruno; Alves Cintra, Cristiane; Luiz Costa Castro, Jorge; Adin, Christopher A

    2017-01-01

    To describe radical cystectomy followed by cutaneous ureterostomy as a treatment of invasive bladder neoplasia in dogs. Retrospective study. Client-owned dogs with transitional cell carcinoma of the bladder trigone (n=4). Perioperative complications and long-term outcomes of dogs that underwent cutaneous ureterostomy following radical cystectomy and lymphadenectomy for transitional cell carcinoma of the urinary bladder trigone were reviewed. Both ureters were transected and anastomosed to the ventral abdominal skin. Polyvinyl chloride catheters were placed in the ureteral stomas and maintained for 5 days. After catheter removal, dogs were managed with an absorbent diaper over the stomas. Long-term outcome and survival were documented by follow-up visits or phone contact. Median age at the time of surgery was 10.3 years (range, 8-12). Average procedural time was ∼4.7 hours (range, 3.8-6.1). Minor complications occurred in all dogs, including bleeding and edema of the ureterostomy site during the first 2-3 days after surgery. One dog developed urine scald that resolved with improved stoma care and hygiene. Median survival time after surgery was 278.6 days (range, 47-498). Distant metastases were documented in 2 dogs at 47 days (bone) and 369 days (lung) after surgery. Radical cystectomy with cutaneous ureterostomy is a viable salvage procedure for urinary diversion after cystectomy in dogs with invasive bladder neoplasia. Postoperative management and quality of life were considered acceptable by most owners. Future studies are warranted to evaluate survival time in a larger number of animals. © 2016 The American College of Veterinary Surgeons.

  16. Radical cystectomy in patients with disseminated disease: An assessment of perioperative outcomes using the National Surgical Quality Improvement Program database

    PubMed Central

    Wallis, Christopher; Khana, Suneil; Hajiha, Mohammad; Nam, Robert K.; Satkunasivam, Raj

    2017-01-01

    Introduction We sought to determine the effect of the presence of disseminated disease on perioperative outcomes following radical cystectomy for bladder cancer. Methods We identified 4108 eligible patients who underwent radical cystectomy for bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We matched patients with disseminated cancer at the time of surgery to those without disseminated cancer using propensity scores. The primary outcome of interest was major complications (death, reoperation, cardiac or neurological event). Secondary outcomes included pulmonary, infectious thromboembolic, and bleeding complications, in addition to prolonged length of stay. Generalized estimating equations were used to examine the association between disseminated cancer and the development of complications. Results Following propensity score matching and adjusting for the type of urinary diversion, radical cystectomy in patients with disseminated disease was associated with a significant increase in major complications (8.6% vs. 4.0%; odds ratio [OR] 2.50; 95% confidence interval [CI] 1.02–6.11; p=0.045). The presence of disseminated disease was associated with an increase in pulmonary complications (5.8% vs. 1.2%; OR 5.17. 95% CI 1.00–26.66. p=0.049), but not infectious complications, venous thromboembolism, bleeding requiring transfusion, and prolonged length of stay (p values 0.07–0.79). Conclusions Patients with disseminated cancer undergoing cystectomy are more likely to experience major and pulmonary complications. The strength of these conclusions is limited by sample size, selection bias inherent in observational data, and a lack of specific oncological detail in the database. PMID:28798823

  17. Radical cystectomy in patients with disseminated disease: An assessment of perioperative outcomes using the National Surgical Quality Improvement Program database.

    PubMed

    Wallis, Christopher; Khana, Suneil; Hajiha, Mohammad; Nam, Robert K; Satkunasivam, Raj

    2017-08-01

    We sought to determine the effect of the presence of disseminated disease on perioperative outcomes following radical cystectomy for bladder cancer. We identified 4108 eligible patients who underwent radical cystectomy for bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We matched patients with disseminated cancer at the time of surgery to those without disseminated cancer using propensity scores. The primary outcome of interest was major complications (death, reoperation, cardiac or neurological event). Secondary outcomes included pulmonary, infectious thromboembolic, and bleeding complications, in addition to prolonged length of stay. Generalized estimating equations were used to examine the association between disseminated cancer and the development of complications. Following propensity score matching and adjusting for the type of urinary diversion, radical cystectomy in patients with disseminated disease was associated with a significant increase in major complications (8.6% vs. 4.0%; odds ratio [OR] 2.50; 95% confidence interval [CI] 1.02-6.11; p=0.045). The presence of disseminated disease was associated with an increase in pulmonary complications (5.8% vs. 1.2%; OR 5.17. 95% CI 1.00-26.66. p=0.049), but not infectious complications, venous thromboembolism, bleeding requiring transfusion, and prolonged length of stay (p values 0.07-0.79). Patients with disseminated cancer undergoing cystectomy are more likely to experience major and pulmonary complications. The strength of these conclusions is limited by sample size, selection bias inherent in observational data, and a lack of specific oncological detail in the database.

  18. Impact of stage and comorbidities on five-year survival after radical cystectomy in Poland: single centre experience.

    PubMed

    Dybowski, Bartosz; Ossoliński, Krzysztof; Ossolińska, Anna; Peller, Michał; Bres-Niewada, Ewa; Radziszewski, Piotr

    2015-01-01

    Long-term outcomes of patients treated for invasive bladder cancer in Poland are poorly documented in the literature. Impact of various clinical parameters on their survival is even less well studied. Radical cystectomy is a major surgery, so the patients' condition can be equally important as cancer stage. The aim of the study was to assess 5-year overall survival (OS) after cystectomy and impact of comorbidity on OS in a single Polish academic centre. Clinical data of all patients who underwent cystectomy in years 2004-2006 for urothelial cancer were retrospectively reviewed. Survival status was determined at least 5 years after surgery. Pathological variables, comorbidities, surgery delay and complications were evaluated as potential predictors of OS. Kaplan-Meier estimates of the survival function as well as Cox proportional hazards models were utilized. Thirty-day, 1-year and 5-year OS for 63 patients was 98.4%, 58.7% and 31.7%, respectively. None of the investigated parameters were significantly related to five-year OS. However, a composite parameter consisting of stage, diabetes status and postoperative course was found as a significant predictor. Five-year OS in 16 patients with pT1-2 and without diabetes and without post-operative complications was higher than in the remaining 47 patients (56% vs. 23%; P = 0.02). Five-year OS in our group was lower than in most published international series but concordant with a previous Polish report. Improvement in survival after radical cystectomy may be expected when early diagnosis will be accompanied by optimal care of patients with diabetes mellitus and avoidance of postoperative complications.

  19. A Single-centre Early Phase Randomised Controlled Three-arm Trial of Open, Robotic, and Laparoscopic Radical Cystectomy (CORAL).

    PubMed

    Khan, Muhammad Shamim; Gan, Christine; Ahmed, Kamran; Ismail, Ahmad Fahim; Watkins, Jane; Summers, Jennifer A; Peacock, Janet L; Rimington, Peter; Dasgupta, Prokar

    2016-04-01

    Laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are increasingly popular, but high-level evidence for these techniques remains lacking. To compare the outcomes of patients undergoing open radical cystectomy (ORC), RARC, and LRC. From March 2009 to July 2012, 164 patients requiring radical cystectomy for muscle-invasive bladder cancer or high-risk non-muscle-invasive bladder cancer were invited to participate, with an aim of recruiting 47 patients into each arm. Overall, 93 were suitable for trial inclusion; 60 (65%) agreed and 33 (35%) declined. ORC, RARC, or LRC with extracorporeal urinary diversion. Primary end points were 30- and 90-d complication rates. Secondary end points were perioperative clinical, pathologic, and oncologic outcomes, and quality of life (QoL). The Fisher exact test and analysis of variance were used for statistical analyses. The 30-d complication rates (classified by the Clavien-Dindo system) varied significantly between the three arms (ORC: 70%; RARC: 55%; LRC: 26%; p=0.024). ORC complication rates were significantly higher than LRC (p<0.01). The 90-d complication rates did not differ significantly between the three arms (ORC: 70%; RARC: 55%; LRC 32%; p=0.068). Mean operative time was significantly longer in RARC compared with ORC or LRC. ORC resulted in a slower return to oral solids than RARC or LRC. There were no significant differences in QoL measures. Major limitations are the small sample size and potential surgeon bias. The 30-d complication rates varied by type of surgery and were significantly higher in the ORC arm than the LRC arm. There was no significant difference in 90-d Clavien-graded complication rates between the three arms. We compared patients having open, robotic, or laparoscopic bladder removal surgery for bladder cancer and found no difference in Clavien-graded complication rates at 90 d. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights

  20. Impact of stage and comorbidities on five-year survival after radical cystectomy in Poland: single centre experience

    PubMed Central

    Dybowski, Bartosz; Ossoliński, Krzysztof; Ossolińska, Anna; Peller, Michał; Radziszewski, Piotr

    2015-01-01

    Introduction Long-term outcomes of patients treated for invasive bladder cancer in Poland are poorly documented in the literature. Impact of various clinical parameters on their survival is even less well studied. Radical cystectomy is a major surgery, so the patients’ condition can be equally important as cancer stage. The aim of the study was to assess 5-year overall survival (OS) after cystectomy and impact of comorbidity on OS in a single Polish academic centre. Material and methods Clinical data of all patients who underwent cystectomy in years 2004-2006 for urothelial cancer were retrospectively reviewed. Survival status was determined at least 5 years after surgery. Pathological variables, comorbidities, surgery delay and complications were evaluated as potential predictors of OS. Kaplan-Meier estimates of the survival function as well as Cox proportional hazards models were utilized. Results Thirty-day, 1-year and 5-year OS for 63 patients was 98.4%, 58.7% and 31.7%, respectively. None of the investigated parameters were significantly related to five-year OS. However, a composite parameter consisting of stage, diabetes status and postoperative course was found as a significant predictor. Five-year OS in 16 patients with pT1-2 and without diabetes and without post-operative complications was higher than in the remaining 47 patients (56% vs. 23%; P = 0.02). Conclusions Five-year OS in our group was lower than in most published international series but concordant with a previous Polish report. Improvement in survival after radical cystectomy may be expected when early diagnosis will be accompanied by optimal care of patients with diabetes mellitus and avoidance of postoperative complications. PMID:26568866

  1. Core binding factor acute myeloid leukemia (CBF-AML) in México: a single institution experience.

    PubMed

    Ruiz-Delgado, Guillermo J; Macías-Gallardo, Julio; Lutz-Presno, Julia; Garcés-Eisele, Javier; Hernández-Arizpe, Ana; Montes-Montiel, Maryel; Ruiz-Argüelles, Guillermo J

    2011-01-01

    Twenty one patients with CBF-AML presented prospectively in the Centro de Hematología y Medicina Interna de Puebla (Puebla, México) between February 1995 and March 2010, 14 with the t(8;21)(q22;q22) and 7 with the inv(16)(p13;q22)/t(16;16)(p13;q22); they represent 13% of all cases of AML. The median age of the patients was 24 years (range 1 to 61). Seven of 14 patients with t(8;21)(q22;q22) had an M2 morphology whereas 3/7 with the inv(16) had an M4 morphology; in addition to the myeloid markers identified by flow-cytometry (surface CD13, surface CD33, and cytoplasmic myeloperoxidase) lymphoid markers were identified in the blast cells of 8/14 cases of the t(8;21) patients, but in no patient with the inv(16). Nineteen patients were treated with combined chemotherapy and 16 (84%) achieved a complete molecular remission. Seven patients were auto or allografted. Relapses presented in 10/16 patients. The median probability of overall survival (OS) has not been reached being above 165 months, whereas the 165-month probability of OS and leukemia-free survival was 52%; despite a tendency for a better outcome of patients with the t(8;21), there were no significant differences in survival of patients with either the t(8;21) or the inv(16). In this single institution experience in México, we found that the CBF variants of AML have a similar prevalence as compared with Caucasian populations, that the co-expression of lymphoid markers in the blast cells was frequent in the t(8;21) and that these two AML subtypes were associated with a relatively good long-term prognosis. Further studies are needed to describe with more detail the precise biological features of these molecular subtypes of acute leukemia.

  2. Clinical significance of the laparoscopic bariatric surgeries for morbid obesity: initial 30 cases at a single institution in Japan.

    PubMed

    Ikeda, Tetsuo; Akahoshi, Tomohiko; Tomikawa, Morimasa; Souzaki, Ryouta; Nomura, Masatoshi; Sonoda, Noriyuki; Nakayama, Rinko; Morita, Chihiro; Yamaguchi, Sadako; Hashimoto, Kenkichi; Maehara, Yoshihiko; Hashizume, Makoto

    2015-02-01

    Bariatric surgical procedures are becoming a standard treatment for morbid obesity in many western countries and in some Asian countries. The aim of the current study was to evaluate the efficacy and safety of the initial 30 cases of bariatric surgical procedures performed for morbid obesity at a single institution in Japan. From March 2012 until September 2014, 30 bariatric surgical procedures were performed for morbid obesity at a single medical center (Kyushu University Hospital) in Japan. All of the operations procedures were planned laparoscopic procedures, and none required conversion to laparotomy. There were no perioperative or postoperative mortalities. Postoperative complications occurred in 3 patients: 1 patient developed an intra-abdominal abscess, 1 patient experienced temporary food intolerance, and 1 patient developed small bowel obstruction. The excessive body weight reduction rates after surgery at 1 month, 3 months, 6 months, and 1 year post-surgery were 26.1%, 39.2%, 41.7%, and 51.2%, respectively. The mean body mass index (BMI) at the same time points were 38.3%, 36.4%, 35.5%, and 31.4%, respectively. Eighteen patients had type II diabetes mellitus (T2DM). The mean preoperative fasting blood glucose levels were 169 ± 37 mg/dL. Following surgery, the blood glucose levels at 3, 6 and 12 months were 113 ± 12, 115 ± 22, and 110 ± 19, mg/dL, respectively. The preoperative HbA1c percentage was 7.9 ± 0.5. Following surgery, the HbA1c percentages at 3, 6, and 12 months were 6.9 ± 0.5, 6.2 ± 0.9, and 5.9 ± 0.6, respectively. Bariatric surgical procedures are effective and safe for the treatment of morbid obesity. Our results indicate that the mechanism of improvement of diabetes and related diseases following bariatric surgical procedures is not simply as a result of calorie restriction and weight reduction.

  3. Laparoscopic Cystectomy In-a-Bag of an Intact Cyst: Is It Feasible and Spillage-Free After All?

    PubMed Central

    Detorakis, Stelios; Vlachos, Dimitrios; Athanasiou, Stavros; Grigoriadis, Themistoklis; Domali, Aikaterini; Chatzipapas, Ioannis; Stamatakis, Emmanuel; Mousiolis, Athanasios; Patrikios, Apostolos; Antsaklis, Aris; Loutradis, Dimitrios; Protopapas, Athanasios

    2016-01-01

    This prospective study was conducted to assess the feasibility of laparoscopic cystectomy of an intact adnexal cyst performed inside a water proof endoscopic bag, aiming to avoid intraperitoneal spillage in case of cyst rupture. 102 patients were recruited. Two of them were pregnant. In 8 of the patients the lesions were bilateral, adding up to a total of 110 cysts involved in our study. The endoscopic sac did not rupture in any case. Mean diameter of the cysts was 5.7 cm (range: 2.3–10.5 cm). In 75/110 (68.2%) cases, cystectomy was completed without rupture, whereas in the remaining 35/110 (31.8%) cases the cyst ruptured. Minimal small spillage occurred despite every effort only in 8/110 (7.2%) cases with large (>8 cm) cystic teratomas. There were no intraoperative or postoperative complications. We concluded that laparoscopic cystectomy in-a-bag of an intact cyst is feasible and oncologically safe for cystic tumors with a diameter < 8 cm. Manipulation of larger tumors with the adnexa into the sac may be more difficult, and in such cases previous puncture and evacuation of the cyst contents should be considered. PMID:27099793

  4. Performance status as a significant prognostic predictor in patients with urothelial carcinoma of the bladder who underwent radical cystectomy.

    PubMed

    Hinata, Nobuyuki; Miyake, Hideaki; Miyazaki, Akira; Nishikawa, Masatomo; Tei, Hiromoto; Fujisawa, Masato

    2015-08-01

    To assess the significance of performance status as a prognostic factor after radical cystectomy for urothelial carcinoma of the bladder. The present study included 730 consecutive patients with urothelial carcinoma of the bladder who underwent radical cystectomy. Clinicopathological outcomes in these patients were analyzed focusing on the impact of performance status, which was assessed using the Karnofsky Performance Status scale before surgery. Patients were classified into groups with Karnofsky Performance Status ≥90 and ≤80. A total of 561 (76.8%) and 169 (23.2%) patients were judged to have Karnofsky Performance Status ≥90 and ≤80, respectively. During a mean of 52.0 months, disease recurrence and mortality occurred in 257 (35.2%) and 249 (34.1%) patients, respectively, and the 5-year recurrence-free and overall survival rates were 64.1 and 65.3%, respectively. There were significant differences in age, hemoglobin, albumin, estimated glomerular filtration rate, pathological T stage and nodal involvement between the Karnofsky Performance Status ≥90 and ≤80 groups. Multivariate analysis showed independent impacts of Karnofsky Performance Status, pathological T stage, nodal involvement and lymphovascular invasion on recurrence-free survival, as well as independent impacts of Karnofsky Performance Status, age, body mass index, hemoglobin, pathological T stage, nodal involvement and lymphovascular invasion on overall survival. The results suggest a significant association between impaired performance status and unfavorable prognosis in patients with urothelial carcinoma of the bladder undergoing radical cystectomy. © 2015 The Japanese Urological Association.

  5. Long-term urodynamic evaluation of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer

    PubMed Central

    WANG, DONG; LI, LI-JUN; LIU, JING; QIU, MING-XING

    2014-01-01

    The long-term urodynamics of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer remain unclear in the clinical setting. The present prospective observational study was conducted between January 2010 and December 2012 to evaluate the 6-month and 12-month follow-up data of urodynamic changes of bladder cancer patients who were initially treated by laparoscopic radical cystectomy with orthotopic ileal neobladder. A total of 53 eligible patients were included, and all patients were followed up for at least 12 months, with a median time of 18 months. During the follow-up period, no patients reported difficulty urinating, and the daily frequency of urination and the urine output were gradually improved with time. Dynamic urodynamic examinations showed that the maximum flow rate (11.4±1.1 vs. 7.3±1.4 ml/sec; P<0.001), residual urine content (22.8±10.5 vs. 40.7±12.7 ml; P<0.001), maximum bladder capacity (373.8±62.2 vs. 229.7±56.3 ml; P<0.001) and maximum bladder pressure during filling (35.8±6.7 vs. 26.4±7.0 cm H2O; P<0.001) at 12 months were all improved significantly compared with that at 6 months after the initial surgical treatment. However, there were no significant differences in maximum bladder pressure during voiding (75.7±24.7 vs. 73.1±24.7 cm H2O; P=0.618) and bladder compliance (26.9±13 vs. 27.4±13.1 cm H2O; P=0.848) at 12 and 6 months after initial surgical treatment. In conclusion, the urodynamics of this orthotopic ileal neobladder gradually improve, and its long-term urine storage and voiding functions are acceptable. PMID:25120652

  6. Perioperative complications and oncological safety of robot-assisted (RARC) vs. open radical cystectomy (ORC).

    PubMed

    Niegisch, Günter; Albers, Peter; Rabenalt, Robert

    2014-10-01

    To assess the surgical and oncological outcome of robot-assisted radical cystectomy (RARC) compared with open radical cystectomy (ORC). Clinical data of 64 patients undergoing RARC between August 2010 and August 2013 were prospectively documented and retrospectively compared with 79 patients undergoing ORC between August 2008 and August 2013 at a single academic institution. Perioperative results, surgical margins status, and nodal yield after RARC and ORC were compared using Mann-Whitney U test (continuous variables) and chi-square test (categorical variables). Additional age-stratified analysis was performed in elderly patients (≥75 y). To avoid inference errors by multiple testing, P-values were adjusted using Bonferroni׳s correction. Baseline characteristics of both cohorts were balanced. RARC patients had significantly less blood loss (RARC: 300 [interquartile range {IQR}: 200-500]ml; perioperative transfusion rate: 0 [IQR: 0-2] red packed blood cells [RPBCs]; ORC: 800 [IQR: 500-1200]ml, P<0.01; transfusion rate: 3 [IQR: 2-4] RPBCs, P<0.01), and hospital stay of RARC patients was reduced by 20% (RARC: 13 [IQR: 9-17]d, ORC: 16 [IQR: 13-21]d, P< 0.01). A total of 55 patients who underwent RARC and 59 patients who underwent ORC were eligible for analysis of oncological surrogates "surgical margin status" and "lymph-node yield" as well as for survival data. No differences between patients undergoing RARC or ORC were observed. In elderly patients (≥75 y; RARC: 17 patients, ORC: 28 patients), decreased intraoperative blood loss (RARC: 300 [IQR: 100-475]ml; ORC: 800 [IQR: 400-1300]ml, P<0.01) and lower transfusion rate (RARC: 0 [IQR: 0-1] RPBCs; ORC: 4 [IQR: 2-5] RPBCs, P<0.01) were observed in the robotic group. Major limitations of this study are the retrospective study design and a potential selection bias. RARC provides significant advantages compared with ORC regarding blood loss and postoperative recovery, whereas surgical and oncological outcomes are not

  7. Adjuvant radiotherapy after radical cystectomy for muscle-invasive bladder cancer: A retrospective multicenter study

    PubMed Central

    Orré, Mathieu; Latorzeff, Igor; Fléchon, Aude; Roubaud, Guilhem; Brouste, Véronique; Gaston, Richard; Piéchaud, Thierry; Richaud, Pierre; Chapet, Olivier

    2017-01-01

    Objectives Radical cystectomy (RC) and pelvic lymph-node dissection (LND) is standard treatment for non-metastatic muscle-invasive urothelial bladder cancer (MIBC). However, loco-regional recurrence (LRR) is a common early event associated with poor prognosis. We evaluate 3-year LRR-free (LRRFS), metastasis-free (MFS) and overall survivals (OS) after adjuvant radiotherapy (RT) for pathological high-risk MIBC. Material and methods We retrospectively reviewed data from patients in 3 institutions. Inclusion criteria were MIBC, histologically-proven urothelial carcinoma treated by RC and adjuvant RT. Patients with conservative surgery were excluded. Outcomes were evaluated by Kaplan-Meier method. Acute toxicities were recorded according to CTCAE V4.0 scale. Results Between 2000 and 2013, 57 patients [median age 66.3 years (45–84)] were included. Post-operative pathological staging was ≤pT2, pT3 and pT4 in 16%, 44%, and 39%, respectively. PLND revealed 28% pN0, 26% pN1 and 42% pN2. Median number of lymph-nodes retrieved was 10 (2–33). Forty-eight patients (84%) received platin-based chemotherapy. For RT, clinical target volume 1 (CTV 1) encompassed pelvic lymph nodes for all patients. CTV 1 also included cystectomy bed for 37 patients (65%). CTV 1 median dose was 45 Gy (4–50). A boost of 16 Gy (5–22), corresponding to CTV 2, was administered for 30 patients, depending on pathological features. One third of patients received intensity-modulated RT. With median follow-up of 40.4 months, 8 patients (14%) had LRR. Three-year LRRFS, MFS and OS were 45% (95%CI 30–60), 37% (95%CI 24–51) and 49% (95%CI 33–63), respectively. Five (9%) patients had acute grade ≥3 toxicities (gastro-intestinal, genito-urinary and biological parameters). One patient died with intestinal fistula in a septic context. Conclusions Because of poor prognosis, an effective post-operative standard of care is needed for pathological high-risk MIBC. Adjuvant RT is feasible and may have

  8. Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-term single institution experience.

    PubMed

    Reddy, G Kesava; Bollam, Papireddy; Caldito, Gloria

    2012-07-01

    Infection remains the most significant complication of ventriculoperitoneal shunt surgery and the reported rates of cerebrospinal fluid shunt infection vary widely across studies in patients with hydrocephalus. The objective of this study is to review and evaluate the infections complicating ventriculoperitoneal shunt surgery in patients with hydrocephalus. Patients who underwent ventriculoperitoneal shunt surgery for hydrocephalus between 1961 and 2010 were included. Medical charts, operative reports, imaging studies, and clinical follow-up evaluations were reviewed and analyzed retrospectively. A total of 1015 patients with hydrocephalus who underwent ventriculoperitoneal shunt surgery were included. The mean and median follow-up was 9.2 and 6.5 years, respectively. The median age of the patients at the time of ventriculoperitoneal shunt placement was 41.6 years. Pediatric patients (<17 years) accounted for 30.0% of the patients. A total 1224 shunt revisions occurred in 1015 patients. Of the 1224 shunt revisions, 162 were due to infection, which occurred in a total of 107 patients. Single infection episodes occurred in 67 patients (6.6%), and multiple infection episodes occurred in 40 patients (3.9%). The overall infection rate was 7.2% per procedure and 10.5% per patient. The overall infection rate was 9.5% in pediatric patients and 5.1% in adult patients per procedure. Gender, age, and etiology of hydrocephalus were significantly associated with shunt infection. Pediatric patients had significantly lower infection-free survival than adults (79.9% vs. 94.4%, P<0.01). Infection remains the most serious complication of ventriculoperitoneal shunt surgery. The findings of this retrospective study show that gender, age, and etiology of hydrocephalus significantly correlated independently with the incidence of infection. Prospective studies are needed to assess the observed associations between the risk factors and incidence of infection in hydrocephalus patients

  9. Systematic methods for measuring outcomes: How they may be used to improve outcomes after Radical cystectomy

    PubMed Central

    Siddiqui, Khurram M.; Izawa, Jonathan I.

    2015-01-01

    In the era of managed healthcare, the measuring and reporting of surgical outcomes is a universal mandate. The outcomes should be monitored and reported in a timely manner. Methods for measuring surgical outcomes should be continuous, free of bias and accommodate variations in patient factors. The traditional methods of surgical audits are periodic, resource-intensive and have a potential for bias. These audits are typically annual and therefore there is a long time lag before any effective remedial action could be taken. To reduce this delay the manufacturing industry has long used statistical control-chart monitoring systems, as they offer continuous monitoring and are better suited to monitoring outcomes systematically and promptly. The healthcare industry is now embracing such systematic methods. Radical cystectomy (RC) is one of the most complex surgical procedures. Systematic methods for measuring outcomes after RC can identify areas of improvements on an ongoing basis, which can be used to initiate timely corrective measures. We review the available methods to improve the outcomes. Cumulative summation charts have the potential to be a robust method which can prompt early warnings and thus initiate an analysis of root causes. This early-warning system might help to resolve the issue promptly with no need to wait for the report of annual audits. This system can also be helpful for monitoring learning curves for individuals, both in training or when learning a new technology. PMID:26413333

  10. Prognostic value of vascular mimicry in patients with urothelial carcinoma of the bladder after radical cystectomy

    PubMed Central

    Hoang, Son Tung Nguyen; Liu, Zheng; Fu, Qiang; Lin, Zongming; Xu, Jiejie

    2016-01-01

    Vascular mimicry (VM) refers to the plasticity of aggressive cancer cells forming de novo vascular networks, which promoted tumor metastasis. The aim of this study was evaluate the impact of VM on recurrence-free survival (RFS) in urothelial carcinoma of the bladder (UCB). Records from 202 patients treated with radical cystectomy (RC) for UCB at Zhongshan Hospital between 2002 and 2014 were reviewed. The presence of VM was identified by CD31-PAS double staining. Positive VM staining occurred in 19.3% (39 of 202) UCB cases, and it was associated with increased risks of recurrence (Log-Rank p<0.001). VM was identified as an independent prognostic factor (p=0.002). In the cohort with MIBC, patients with VM negative got CSS benefit from the use of ACT (p = 0.048). As for lung metastasis, the combination of VM and TNM stage (AUC 0.792) showed a better prognostic value than TNM stage alone (AUC 0.748, p = 0.008) or VM alone (AUC 0.714, p = 0.023). Vascular mimicry could be a potential prognosticator for recurrence-free survival in patients with UCB after RC. Vascular mimicry seems to predict risk of developing lung metastases after RC. The presence of VM identified a subgroup of patients with MIBC who appeared to benefit from adjuvant chemotherapy. PMID:27776348

  11. [Compartment syndrome in bilateral lower legs after total cystectomy: a case report].

    PubMed

    Sumiyoshi, Takayuki; Utsunomiya, Noriaki; Segawa, Takehiko; Muguruma, Koei; Ichikawa, Koichi; Kawakita, Mutsushi

    2011-02-01

    We report a case of compartment syndrome in bilateral lower legs after total cystectomy with urethrectomy and ileal conduit diversion. A 64-year-old man who had diabetes mellitus for 20 years underwent an operation for invasive bladder cancer. He was placed in the lithotomy position and both lower legs were protected with an elastic stocking and intermittent pneumatic compression for prevention of deep vein thrombosis during the operation. Seven hours postoperatively, he complained of bilateral calf pain. Eleven hours postoperatively, skin redness, swelling, movement and sensory disorder of bilateral lower legs were found. Contrasting computed tomography (CT) of lower legs showed the swelling of bilateral soleus muscles and gastrocnemius muscles without any contrasting effect. Creatinine phosphokinase (CPK) increased to 46, 740 IU/l and the intramuscular pressure was 50 mmHg. He was diagnosed with compartment syndrome, in bilateral lower legs and emergent fasciotomy was performed. Bilateral calf pain was improved immediately after fasciotomy and could walk on his own after rehabilitation. Lower leg compartment syndrome is an uncommon disease but may require lower leg amputation or result in death if the treatment is delayed. Urologists should recognize this disease as a complication after prolonged operation in the lithotomy position.

  12. Prognostic value of vascular mimicry in patients with urothelial carcinoma of the bladder after radical cystectomy.

    PubMed

    Zhou, Lin; Chang, Yuan; Xu, Le; Hoang, Son Tung Nguyen; Liu, Zheng; Fu, Qiang; Lin, Zongming; Xu, Jiejie

    2016-11-15

    Vascular mimicry (VM) refers to the plasticity of aggressive cancer cells forming de novo vascular networks, which promoted tumor metastasis. The aim of this study was evaluate the impact of VM on recurrence-free survival (RFS) in urothelial carcinoma of the bladder (UCB). Records from 202 patients treated with radical cystectomy (RC) for UCB at Zhongshan Hospital between 2002 and 2014 were reviewed. The presence of VM was identified by CD31-PAS double staining. Positive VM staining occurred in 19.3% (39 of 202) UCB cases, and it was associated with increased risks of recurrence (Log-Rank p<0.001). VM was identified as an independent prognostic factor (p=0.002). In the cohort with MIBC, patients with VM negative got CSS benefit from the use of ACT (p = 0.048). As for lung metastasis, the combination of VM and TNM stage (AUC 0.792) showed a better prognostic value than TNM stage alone (AUC 0.748, p = 0.008) or VM alone (AUC 0.714, p = 0.023). Vascular mimicry could be a potential prognosticator for recurrence-free survival in patients with UCB after RC. Vascular mimicry seems to predict risk of developing lung metastases after RC. The presence of VM identified a subgroup of patients with MIBC who appeared to benefit from adjuvant chemotherapy.

  13. The role of adjuvant chemotherapy following cystectomy for invasive bladder cancer: a prospective comparative trial.

    PubMed

    Skinner, D G; Daniels, J R; Russell, C A; Lieskovsky, G; Boyd, S D; Nichols, P; Kern, W; Sakamoto, J; Krailo, M; Groshen, S

    1991-03-01

    We assigned 91 patients with deeply invasive, pathological stage P3, P4 or N+ and Mo transitional cell carcinoma of the bladder (with or without squamous or glandular differentiation) to adjuvant chemotherapy or to observation after radical cystectomy and pelvic lymph node dissection. For most patients chemotherapy was planned as 4 courses at 28-day intervals of 100 mg./M.2 cisplatin, 60 mg./M.2 doxorubicin and 600 mg./M.2 cyclophosphamide. A significant delay was shown in the time to progression (p = 0.0010) with 70% of the patients assigned to chemotherapy free of disease at 3 years compared to 46% in the observation group. Median survival time for patients in the chemotherapy group was 4.3 years compared to 2.4 years in the observation group (p = 0.0062). In addition to treatment groups, important prognostic factors included age, gender and lymph node status. The number of involved lymph nodes was the single most important variable. We recommend adjuvant chemotherapy for patients with invasive transitional cell carcinoma after definitive surgical resection.

  14. Commentary on "Robot-assisted laparoscopic vs open radical cystectomy: Comparison of complications and perioperative oncological outcomes in 200 patients." Kader AK, Richards KA, Krane LS, Pettus JA, Smith JJ, Hemal AK, Division of Urology, UC San Diego Health System, San Diego, CA.: BJU Int 2013; 112(4):E290-4. doi:10.1111/bju.12167. [Epub 2013 Jul 1].

    PubMed

    See, William A

    2014-11-01

    To compare perioperative morbidity and oncological outcomes of robot-assisted laparoscopic radical cystectomy (RARC) to open RC (ORC) at a single institution. A retrospective analysis was performed on a consecutive series of patients undergoing RC (100 RARC and 100 ORC) at Wake Forest University with curative intent from 2006 until 2010. Complication data using the Clavien system were collected for 90 days postoperatively. Complications and other perioperative outcomes were compared between patient groups. Patients in both groups had comparable preoperative characteristics. The overall and major complication (Clavien ≥ 3) rates were lower for RARC patients at 35 vs 57% (P = 0.001) and 10 vs 22% (P = 0.019), respectively. There were no significant differences between groups for pathological outcomes, including stage, number of nodes harvested or positive margin rates. Our data suggest that patients undergoing RARC have perioperative oncological outcomes comparable with ORC, with fewer overall or major complications. Definitive claims about comparative outcomes with RARC require results from larger, randomised controlled trials. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. ACL Revision

    PubMed Central

    Costa-Paz, Matias; Dubois, Julieta Puig; Zicaro, Juan Pablo; Rasumoff, Alejandro; Yacuzzi, Carlos

    2017-01-01

    Objectives: The purpose of this study was to evaluate a series of patients one year after an ACL revision with clinical evaluation and MRI, to consider their condition before returning to sports activities. Methods: A descriptive, prospective and longitudinal study was performed. A series of patients who underwent an ACL revision between March 2014 and March 2015 were evaluated after one year post surgery. They were evaluated using the Lysholm score, IKDC, Tegner, artrometry and MRI (3.0 t). A signal pattern and osteointegration was determined in the MRI. Graft signal intensity of the ACL graft using the signal/noise quotient value (SNQ) was also determined to evaluate the ligamentatization process state. Results: A total of 18 male patients were evaluated with a mean age of 31 years old.Average scores were: Lysholm 88 points, IKDC 80 points, Pre-surgical Tegner 9 points and postoperative 4 points. Artrhometry (KT1000) at 20 newtons showed a side to side difference of less than 3 mm in 88%. Only 44% of patients returned to their previous sport activity one year after revision.The MRI showed a heterogeneous signal in neoligaments in 34% of patients. SNQ showed graft integration in only 28%. Synovial fluid was found in bone-graft interphase in 44% of tunnels, inferring partial osteointegration. The heterogeneous signal was present in 50% of patients who did not return to the previous sport level activity. (Fisher statistics: p = 0.043) There were no meaningful differences in patients with auto or allografts. Conclusion: Although the clinical evaluation was satisfactory, only 44% of patients returned to the previous level of sport activity one year after the ACL surgery. The ligamentatization process was found in 28% of knees evaluated with MRI one year later. Partial osteointegration is inferred in 44%. Results showed a meaningful relation between the signal of neoligaments in the MRI and the return to sport activity in said series of patients. MRI is a useful tool

  16. Minimally Invasive Versus Open Approach for Cystectomy: Trends in the Utilization and Demographic or Clinical Predictors Using the National Cancer Database.

    PubMed

    Bachman, Andrew G; Parker, Alexander A; Shaw, Marshall D; Cross, Brian W; Stratton, Kelly L; Cookson, Michael S; Patel, Sanjay G

    2017-05-01

    To examine temporal national trends of operative approach for cystectomy and identify demographic or clinical predictive factors that influence choice of approach. We performed a retrospective cohort study of patients who underwent cystectomy for bladder cancer between 2010 and 2013 using the National Cancer Database. Approach was stratified by open vs minimally invasive (robotic or laparoscopic). Univariate Pearson chi-square and multivariate logistic regression analysis were used to assess the relationships between demographic and hospital factors and the receipt of minimally invasive or open surgical approach. A total of 9439 patients met our inclusion criteria, of which 34.1% received a minimally invasive approach (MIA). Frequency of MIA increased from 26.3% in 2010 to 39.4% in 2013 (P < .0001). Univariate analysis identified statistically significant associations between year of diagnosis, sex, age, race, clinical T stage, insurance status, income, education, distance from hospital, facility type, geographic location, and facility cystectomy volume, and the choice of approach (all P < .01). On multivariate analysis, independent predictors of MIA included increasing year of diagnosis, male gender, lower clinical T stage, private insurance vs Medicaid, nonacademic vs academic program, northeastern geographic region, receipt of neoadjuvant chemotherapy, and lower cystectomy volume. Utilization of MIA for cystectomy has increased nationally over the last several years likely due to increased surgeon familiarity with robotic laparoscopic pelvic surgery. Factors associated with MIA included male sex, locally confined disease, receipt of neoadjuvant chemotherapy, lower cystectomy volume centers, and nonacademic centers. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Novel Simulation Model of Non-Muscle Invasive Bladder Cancer: A Platform for a Virtual Randomized Trial of Conservative Therapy vs. Cystectomy in BCG Refractory Patients.

    PubMed

    Patel, Sanjay; Dinh, Tuan; Noah-Vanhoucke, Joyce; Rengarajan, Badri; Mayo, Kevin; Clark, Peter E; Kamat, Ashish M; Lee, Cheryl T; Sexton, Wade J; Steinberg, Gary D

    2015-10-26

    Introduction: There have been no randomized controlled trials (RCTs) evaluating the clinical or economic benefit of mitomycin C intravesical therapy vs. radical cystectomy in patients with high-risk non-muscle invasive bladder cancer (NMIBC). We used the Archimedes computational model to simulate RCT comparing radical cystectomy versus intravesical mitomycin C (MMC) therapy to evaluate the clinical and economic outcomes for BCG-refractory NMIBC as well demonstrate the utility of computer based models to simulate a clinical trial. Methods: The Archimedes model was developed to generate a virtual population using the Surveillance Epidemiology and End Results database, other clinical trials, and expert opinions. Patients selected were diagnosed with NMIBC (cystectomy vs. 2) MMC induction intravesical therapy. Clinical (progression, overall survival, and disease specific survival) and economic outcomes were reported. Results: A total of 1300 virtual patients were evaluation. Progression to MIBC in the MMC treatment arm was 30% over the lifetime. Disease specific death at 5 years was 1.6% and 8.7% for the immediate cystectomy and MMC treatment arms respectively; while, overall death was 17.8% and 23.8% at 5 years. Over a 5-year period the average cost of immediate cystectomy was $64,675 vs $68,517 in the MMC arm. Conclusion: Immediate radical cystectomy after BCG failure for NMIBC has improved survival and is more cost-effective when compared to those undergoing MMC. Simulation of clinical trials using computational models similar to the Archimedes model can overcome shortcomings of real-world clinical trials and may prove useful in the face of current medical cost-conscious era.

  18. Novel Simulation Model of Non-Muscle Invasive Bladder Cancer: A Platform for a Virtual Randomized Trial of Conservative Therapy vs. Cystectomy in BCG Refractory Patients

    PubMed Central

    Patel, Sanjay; Dinh, Tuan; Noah-Vanhoucke, Joyce; Rengarajan, Badri; Mayo, Kevin; Clark, Peter E.; Kamat, Ashish M.; Lee, Cheryl T.; Sexton, Wade J.; Steinberg, Gary D.

    2015-01-01

    Abstract Introduction: There have been no randomized controlled trials (RCTs) evaluating the clinical or economic benefit of mitomycin C intravesical therapy vs. radical cystectomy in patients with high-risk non-muscle invasive bladder cancer (NMIBC). We used the Archimedes computational model to simulate RCT comparing radical cystectomy versus intravesical mitomycin C (MMC) therapy to evaluate the clinical and economic outcomes for BCG-refractory NMIBC as well demonstrate the utility of computer based models to simulate a clinical trial. Methods: The Archimedes model was developed to generate a virtual population using the Surveillance Epidemiology and End Results database, other clinical trials, and expert opinions. Patients selected were diagnosed with NMIBC (cystectomy vs. 2) MMC induction intravesical therapy. Clinical (progression, overall survival, and disease specific survival) and economic outcomes were reported. Results: A total of 1300 virtual patients were evaluation. Progression to MIBC in the MMC treatment arm was 30% over the lifetime. Disease specific death at 5 years was 1.6% and 8.7% for the immediate cystectomy and MMC treatment arms respectively; while, overall death was 17.8% and 23.8% at 5 years. Over a 5-year period the average cost of immediate cystectomy was $64,675 vs $68,517 in the MMC arm. Conclusion: Immediate radical cystectomy after BCG failure for NMIBC has improved survival and is more cost-effective when compared to those undergoing MMC. Simulation of clinical trials using computational models similar to the Archimedes model can overcome shortcomings of real-world clinical trials and may prove useful in the face of current medical cost-conscious era. PMID:27376114

  19. Age and body mass index are independent risk factors for the development of postoperative paralytic ileus after radical cystectomy.

    PubMed

    Svatek, Robert S; Fisher, Mark B; Williams, Michael B; Matin, Surena F; Kamat, Ashish M; Grossman, H Barton; Nogueras-González, Graciela M; Urbauer, Diana L; Dinney, Colin P

    2010-12-01

    To identify the risk factors that would aid in the identification of patients at the greatest risk of developing postoperative paralytic ileus (POI). POI is a common complication after radical cystectomy and can result in a prolonged hospital stay and delayed recovery. A retrospective cohort study design was used to analyze data from consecutive patients presenting to our institution for radical cystectomy with pelvic nodal dissection. POI was declared if patients were without evidence of bowel function beyond the anticipated discharge goal of 6 days. The association between several clinical features and the occurrence of POI was examined. Of 283 patients, 43 (15.2%) developed POI. Of the 43 patients, 38 (88.4%) were given total parenteral nutrition for nutritional supplementation. No difference in the incidence of POI was observed between the sexes, previous abdominal operations, estimated blood loss, transfusion requirement, operative time, neoadjuvant chemotherapy, or previous radiotherapy. POI was observed in 11.3% of normal and overweight patients (body mass index [BMI] <30.0 kg/m(2)) compared with 25.6% of obese patients (BMI ≥30.0 kg/m(2); P = .005). On multivariate analysis adjusted for the influence of competing variables, increasing age (hazard ratio 1.09, 95% confidence interval 1.02-1.16, P = .008) and BMI (hazard ratio 1.09, 95% confidence interval 1.03-1.17, P = .007) were significantly associated with the presence of POI. Our results showed that increasing age and BMI were significantly associated with the presence of POI in patients undergoing radical cystectomy for bladder cancer. Published by Elsevier Inc.

  20. Risk Prediction Models of Locoregional Failure After Radical Cystectomy for Urothelial Carcinoma: External Validation in a Cohort of Korean Patients

    SciTech Connect

    Ku, Ja Hyeon; Kim, Myong; Jeong, Chang Wook; Kwak, Cheol; Kim, Hyeon Hoe

    2014-08-01

    Purpose: To evaluate the predictive accuracy and general applicability of the locoregional failure model in a different cohort of patients treated with radical cystectomy. Methods and Materials: A total of 398 patients were included in the analysis. Death and isolated distant metastasis were considered competing events, and patients without any events were censored at the time of last follow-up. The model included the 3 variables pT classification, the number of lymph nodes identified, and margin status, as follows: low risk (≤pT2), intermediate risk (≥pT3 with ≥10 nodes removed and negative margins), and high risk (≥pT3 with <10 nodes removed or positive margins). Results: The bootstrap-corrected concordance index of the model 5 years after radical cystectomy was 66.2%. When the risk stratification was applied to the validation cohort, the 5-year locoregional failure estimates were 8.3%, 21.2%, and 46.3% for the low-risk, intermediate-risk, and high-risk groups, respectively. The risk of locoregional failure differed significantly between the low-risk and intermediate-risk groups (subhazard ratio [SHR], 2.63; 95% confidence interval [CI], 1.35-5.11; P<.001) and between the low-risk and high-risk groups (SHR, 4.28; 95% CI, 2.17-8.45; P<.001). Although decision curves were appropriately affected by the incidence of the competing risk, decisions about the value of the models are not likely to be affected because the model remains of value over a wide range of threshold probabilities. Conclusions: The model is not completely accurate, but it demonstrates a modest level of discrimination, adequate calibration, and meaningful net benefit gain for prediction of locoregional failure after radical cystectomy.

  1. Symplastic glomus tumor of the urinary bladder treated by robot-assisted partial cystectomy: a case report and literature review.

    PubMed

    Palmisano, Franco; Gadda, Franco; Spinelli, Matteo G; Maggioni, Marco; Rocco, Bernardo; Montanari, Emanuele

    2017-01-16

    Glomus tumors arising in the urinary bladder are extremely rare, and only two cases have been reported in the English Literature. We present a case of a 58-year-old man with an asymptomatic mass of the anterior wall of the bladder that measured 2.5 × 2.5 cm. Endoscopic excision was performed, and the tumor was diagnosed as symplastic glomus tumor. The patient finally underwent robotic-assisted partial cystectomy, and he remains healthy without any recurrence to date.After reviewing this case and previous reports, we analyzed the clinicopathologic features and treatment options for this rare neoplasm.

  2. Analysis of open and intracorporeal robotic assisted radical cystectomy shows no significant difference in recurrence patterns and oncological outcomes.

    PubMed

    Tan, Wei Shen; Sridhar, Ashwin; Ellis, Gidon; Lamb, Benjamin; Goldstraw, Miles; Nathan, Senthil; Hines, John; Cathcart, Paul; Briggs, Tim; Kelly, John

    2016-06-01

    To report and compare early oncological outcomes and cancer recurrence sites among patients undergoing open radical cystectomy (ORC) and robotic-assisted radical cystectomy with intracorporeal urinary diversion (iRARC). A total of 184 patients underwent radical cystectomy for bladder cancer. ORC cases (n = 94) were performed between June 2005 and July 2014 while iRARC cases (n = 90) were performed between June 2011 and July 2014. Primary outcome was recurrence free survival (RFS). Secondary outcomes were sites of local and metastatic recurrence, cancer specific survival (CSS) and overall survival (OS). Median follow-up for patients without recurrence was 33.8 months (interquartile range [IQR]: 20.5-45.4) for ORC; and 16.1 months (IQR: 11.2-27.0) for iRARC. No significant difference in age, sex, precystectomy T stage, precystectomy grade, or lymph node yield between ORC and iRARC was observed. The ORC cohort included more patients with≥pT2 (64.8% ORC vs. 38.9% iRARC) but fewer pT0 status (8.5% ORC vs.vs. 22.2% iRARC) due to lower preoperative chemotherapy use (22.3% ORC vs. 34.4% iRARC). Positive surgical margin rate was significantly higher in the ORC cohort (19.3% vs. 8.2%; P = 0.042). Kaplan-Meir analysis showed no significant difference in RFS (69.5% ORC vs. 78.8% iRARC), cancer specific survival (80.9% ORC vs. 84.4% iRARC), or OS (73.5% ORC vs.vs. iRARC 83.8%) at 24 months. Cox regression analysis showed RFS, cancer specific survival and OS were not influenced by cystectomy technique. No significant difference between local and metastatic RFS between ORC and iRARC was observed. This study has found no difference in recurrence patterns or oncological outcomes between ORC and iRARC. Recurrent metastatic sites vary, but are not related to surgical technique. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Are we doing "better"? The discrepancy between perception and practice of enhanced recovery after cystectomy principles among urologic oncologists.

    PubMed

    Baack Kukreja, Janet E; Messing, Edward M; Shah, Jay B

    2016-03-01

    The concept of enhanced recovery after surgery has been around since the 1990s when it was first introduced as a means to improve postoperative recovery of general surgical patients. In the field of urology, the uptake of enhanced recovery pathways has been slow for unclear reasons. Recently, interest in enhanced recovery after cystectomy (ERAC) has been increasing, but the current urologic oncology practice patterns remain unclear. In this study, we investigate modern perioperative patterns of care and rates of application of ERAC principles by cystectomy surgeons. ERAC principles were identified by reviewing urology and general surgery literature. An adapted version of The Royal College of Surgeons of England fast-track surgical principles survey was used. Preoperative education, bowel preparation avoidance, nasogastric tubes avoidance, normothermia, opioid avoidance, early ambulation, and early feeding were all practices queried with the survey. Surveys were distributed electronically to faculty of Society of Urologic Oncology fellowships with bladder cancer as a special area of interest. Additional participants were identified by recent publications on cystectomies for bladder cancer. In total, 128 surveys were e-mailed to the previously identified experts. Of these, 61 (48%) completed the survey. Responses were classified as congruent with commonly accepted ERAC principles (ERAC group) or noncongruent (non-ERAC group). Chi-square test was used for categorical variables and Wilcoxon-Mann-Whitney for ordinal variables. Of the urologists who classified themselves in the ERAC group (64%), the average length of stay was reported to be 6.1 days and 7.2 days in the non-ERAC group (P = 0.02). Only 20% were practicing all interventions. Among the ERAC surgeons 1, 2 or 3 of the interventions were omitted by 13%, 25%, and 23% of the respondents, respectively. Significant differences were found between the self-reported ERAC adopters and nonadopters in the use of bowel

  4. Enhanced Recovery Pathways Versus Standard Care After Cystectomy: A Meta-analysis of the Effect on Perioperative Outcomes.

    PubMed

    Tyson, Mark D; Chang, Sam S

    2016-12-01

    Enhanced recovery after surgery (ERAS) protocols aim to improve surgical outcomes by reducing variation in perioperative best practices. However, among published studies, results show a striking variation in the effect of ERAS pathways on perioperative outcomes after cystectomy. To perform a systematic review of the literature and a meta-analysis comparing the effectiveness of ERAS versus standard care on perioperative outcomes after cystectomy. We performed a literature search of PubMed, EMBASE, Web of Science, Google Scholar, the Cochrane Library, and the health-related grey literature in February 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis and the Cochrane Handbook. Studies were reviewed according to criteria from the Oxford Centre for Evidence-Based Medicine. Thirteen studies (1493 total patients) met the inclusion criteria (ERAS: 801, standard care: 692). A pooled meta-analysis of all comparative studies was performed using inverse-weighted, fixed-effects models, and random-effects models. Publication bias was graphically assessed using contour-enhanced funnel plots and was formally tested using the Harbord modification of the Egger test. Pooled data showed a lower overall complication rate (risk ratio [RR]: 0.85, 95% confidence interval [CI]: 0.74-0.97, p = 0.017, I(2)=35.6%), a shorter length of stay (standardized mean difference:-0.87, 95% CI: -1.31 to -0.42, p=0.001, I(2)=92.8%), and a faster return of bowel function (standardized mean difference: -1.02, 95% CI: -1.69 to -0.34, p=0.003, I(2)=92.2%) in the ERAS group. No difference was noted for the overall readmission rates (RR: 0.74, 95% CI: 0.39-1.41, p=0.36, I(2)=51.4%), although a stratified analysis showed a lower 30-d readmission rate in the ERAS group (RR: 0.39, 95% CI: 0.19-0.83, p=0.015, I(2)=0%). ERAS protocols reduce the length of stay, time-to-bowel function, and rate of complications after cystectomy. Enhanced recovery after surgery pathways for

  5. Redefining the implications of nasogastric tube placement following radical cystectomy in the alvimopan era.

    PubMed

    Packiam, Vignesh T; Agrawal, Vijay A; Pariser, Joseph J; Cohen, Andrew J; Nottingham, Charles U; Pearce, Shane M; Smith, Norm D; Steinberg, Gary D

    2017-04-01

    Alvimopan has decreased ileus and need for nasogastric tube (NGT) after radical cystectomy (RC). However, the natural history of ileus versus intestinal obstruction in patients receiving alvimopan is not well defined. We sought to examine the implications of NGT placement before and after the introduction of alvimopan for RC patients. Retrospective review identified 278 and 293 consecutive patients who underwent RC before and after instituting alvimopan between June 2009 and May 2014. Baseline characteristics and postoperative outcomes were compared by alvimopan status. Multivariate logistic regression was performed to assess the impact of alvimopan on rates of NGT placement and reoperation for bowel complications. The cohorts had similar age, stage, approach, and BMI. Patients receiving alvimopan had decreased ileus (16 vs 32 %, p < 0.01) but similar rates of reoperation for bowel complications (2.8 vs 2.7 %). On multivariate analysis, alvimopan was associated with lower risk of NGT placement (OR 0.30, p < 0.01). For patients requiring NGT placement, there was an increased rate of reoperation among patients receiving alvimopan compared with those who did not (28 vs 11 %, p = 0.03). Patients receiving alvimopan who needed NGT had significantly increased median length of stay (22 vs 7 days), need for TPN (66 vs 5.3 %), and readmission for ileus (10.3 vs 2.3 %) compared with those who did not require NGT. Alvimopan significantly reduced the incidence of ileus and NGT placement following RC. NGT placement was associated with an increased need for reoperation for bowel complications in the setting of alvimopan.

  6. Risk Factors for the Development of Parastomal Hernia after Radical Cystectomy

    PubMed Central

    Donahue, Timothy F.; Bochner, Bernard H.; Sfakianos, John P.; Kent, Matthew; Bernstein, Melanie; Hilton, William M.; Cha, Eugene K.; Yee, Alyssa M.; Dalbagni, Guido; Vargas, Hebert A.

    2014-01-01

    Purpose Parastomal hernia (PH) is a frequent complication from stoma formation after radical cystectomy (RC). We sought to determine the prevalence and risk factors for developing PH following RC. Material and Methods Retrospective study of 433 consecutive patients who underwent open RC and ileal conduit between 2006-2010. Postoperative cross-sectional imaging studies performed for routine oncologic follow-up (n=1736) were evaluated for PH, defined as radiographic evidence of protrusion of abdominal contents through the abdominal wall defect created by forming the stoma. Univariable and multivariable Cox regression analyses were used to determine clinical and surgical factors associated with PH. Results Complete data were available for 386 patients with radiographic PH occurring in 136. The risk of developing a PH was 27% (95% CI 22-33%) and 48% (95% CI 42-55%) at 1 and 2 years. Clinical diagnosis of PH was documented in 93 patients and 37 were symptomatic. Of 16 patients with clinical PH referred for repair, 8 had surgery. On multivariable analysis, female gender (HR=2.25, 95%CI 1.58-3.21; p<0.0001), higher BMI (HR=1.08 per unit increase 95%CI 1.05-1.12; p<0.0001), and lower preoperative albumin (HR=0.43 per g/dl, 95%CI 0.25-0.75; p=0.003) were significantly associated with PH. Conclusions The overall risk of radiographic evidence of PH approached 50% at 2 years. Female gender, higher BMI, and lower preoperative albumin were most associated with developing PH. Identifying those at greatest risk may allow for prospective surgical maneuvers at the time of initial surgery, such as placement of prophylactic mesh in selected patients, to prevent the occurrence of PH. PMID:24384155

  7. Factors influencing the length of stay after radical cystectomy: implications for cancer care and perioperative management.

    PubMed

    Pietzak, Eugene J; Hwang, Wei-Ting; Malkowicz, S Bruce; Guzzo, Thomas J

    2014-12-01

    Although radical cystectomy (RC) is the gold standard treatment for muscle invasive bladder cancer it is associated with perioperative complications, readmissions, and a prolonged length of hospital stay (PLOS). We explored the perioperative factors associated with a PLOS after RC and subsequent long-term outcomes. Consecutive patients with urothelial bladder cancer undergoing RC with curative intent at our institution were classified into two groups: LOS <12 days and PLOS ≥12 days. Clinicopathological variables were compared on univariate and multivariable analysis. Complications, re-admissions, adjuvant chemotherapy use, recurrence free survival (RFS), and overall survival (OS) were compared between the two groups. Competing risk analysis was performed for bladder cancer specific mortality (BCSM). 330 patients were included in the analysis (median LOS = 9 days [IQR = 8-11]) of which, 274 patients (83 %) had a LOS <12 days (median = 8 days [IQR = 7-10]) and 56 patients (17 %) had a PLOS ≥12 days (median = 16 days [IQR = 13-21.5]). Only female gender, older age, and perioperative complications were associated with a PLOS. 90 day readmission rates were similar (p = 0.75). No difference was seen for BCSM, RFS, or adjuvant chemotherapy usage between the two groups. However, OS was significantly worse for PLOS (median OS = 27.7 vs. 45.6 months [p = 0.046]; HR = 1.53 [95 % CI = 1.01-2.33]). Both female and elderly patients should receive preoperative counseling about their increased risk of a PLOS after RC. Patients who experience a PLOS are at greater risk for subsequent all-cause mortality. These patient groups may benefit from proactive interventions.

  8. Femtosecond laser ablation of porcine intestinal mucosa: potential autologous transplant for segmental cystectomy

    NASA Astrophysics Data System (ADS)

    Higbee, Russell G.; Irwin, Bryan S.; Nguyen, Michael N.; Zhang, Yuanyuan; Warren, William L.

    2005-04-01

    Nearly 80% of patients with newly diagnosed bladder cancer present with superficial bladder tumors (confined to the bladder lining such as transitional cell carcinoma [90%], squamous cell carcinoma [6-8%], and adenocarcinoma[2%]) in stages Ta, Tis, or T1. Segmental cystectomy is one surgical treatment for patients who have a low-grade invasive tumor. Transposition of small intestine is a viable surgical treatment option. Success of the transplantation is also dependent upon removal of the entire SI mucosal layer. A Clark Spitfire Ti:Sapphire laser operating at 775 nm and 1 kHz repetition rate, was used to investigate the damage induced to fresh cadaveric porcine small intestinal mucosal epithelium. The laser was held constant at a focal spot diameter of 100 μm using a 200 mm focal point lens, with a power output maximum of 257 mW. A high resolution motorized X-Y-Z stage translated the SI tissue through the beam at 500 μm/sec with a line spacing of 50 μm. This produced a 50% overlap in the laser etching for each pass over a 1 cm x 1.5 cm grid. To determine if the mucosal lining of the SI was adequately removed, the targeted area was covered with 1% fluorescein solution for 30 seconds and then rinsed with phosphate buffered saline. Fluorescein staining was examined under UV illumination, to determine the initial degree of mucosal removal. Tissues were fixed and processed for light and scanning electron microscopy by standard protocols. Brightfield light microscopy of hematoxylin and eosin stained 4 μm thick cross sections, scanning electron microscopy were examined to determine the degree of mucosal tissue removal. Clear delineation of the submucosal layer by fluorescein staining was also observed. The Ti:Sapphire laser demonstrated precise, efficient removal of the mucosal epithelium with minimal submucosal damage.

  9. Peri-operative allogeneic blood transfusion and outcomes after radical cystectomy: a population-based study.

    PubMed

    Siemens, D Robert; Jaeger, Melanie T; Wei, Xuejiao; Vera-Badillo, Francisco; Booth, Christopher M

    2017-02-17

    To describe factors associated with peri-operative blood transfusion (PBT) at radical cystectomy (RC) for patients with bladder cancer and evaluate its association on both early and late outcomes. Electronic records of treatment and surgical pathology reports were linked to the population-based Ontario Cancer Registry to identify all patients who underwent RC between 2000 and 2008. Modified Poisson regression model was used to determine the factors associated with PBT. A Cox-proportional hazards regression model was used to explore the association between PBT and overall (OS) and cancer-specific (CSS) survival. Among 2593 patients identified, 62% received an allogeneic red blood cell transfusion. The frequency of PBT decreased over the study period (from 68 to 54%, p < 0.001). Factors associated with PBT included age, sex, greater co-morbidity, stage, and surgeon volume. PBT was associated with inferior outcomes, including median length of stay (11 vs. 9 days, p < 0.001), 90-day re-admission rate (38 vs. 29%, p < 0.001), and mortality (11 vs. 4%, p < 0.001). OS and CSS at 5 years were lower among patients with PBT on multivariate analysis (OS HR 1.33, 95% CI 1.20-1.48; CSS HR 1.39, 95% CI 1.23-1.56). Although rates are decreasing, these data suggest a very high utilization rate of PBT at time of RC in routine clinical practice. PBT is associated with substantially worse early outcomes and long-term survival. This association persists despite adjustment for disease-, patient-, and provider-related factors, suggesting that PBT is an important indicator of surgical care of RC.

  10. Pathologic nodal staging score for bladder cancer: a decision tool for adjuvant therapy after radical cystectomy.

    PubMed

    Shariat, Shahrokh F; Rink, Michael; Ehdaie, Behfar; Xylinas, Evanguelos; Babjuk, Marek; Merseburger, Axel S; Svatek, Robert S; Cha, Eugene K; Tagawa, Scott T; Fajkovic, Harun; Novara, Giacomo; Karakiewicz, Pierre I; Trinh, Quoc-Dien; Daneshmand, Siamak; Lotan, Yair; Kassouf, Wassim; Fritsche, Hans-Martin; Chun, Felix K; Sonpavde, Guru; Joual, Abdennabi; Scherr, Douglas S; Gonen, Mithat

    2013-02-01

    Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard of care for high-risk non-muscle-invasive and muscle-invasive bladder cancer (BCa). To develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes. We analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers. Patients underwent RC and PLND. We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative as a function of the number of examined nodes. Overall, the probability of missing a positive node decreases with the increasing number of nodes examined (52% if 3 nodes are examined, 40% if 5 are examined, and 26% if 10 are examined). The proportion of having a positive node increased proportionally with advancing pathologic T stage and lymphovascular invasion (LVI). Patients with LVI who had 25 examined nodes would have a pNSS of 80% (pT1), 88% (pT2), and 66% (pT3-T4), whereas 10 examined nodes were sufficient for pNSS exceeding 90% in patients without LVI and pT0-T2 tumors. This study is limited because of its retrospective design and multicenter nature. We developed a tool that estimates the likelihood of lymph node (LN) metastasis in BCa patients treated with RC by evaluating the number of examined nodes, the pathologic T stage, and LVI. The pNSS indicates the adequacy of nodal staging in LN-negative patients. This tool could help to refine clinical decision making regarding adjuvant chemotherapy, follow-up scheduling, and inclusion in clinical trials. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  11. Contemporary 90-day mortality rates after radical cystectomy in the elderly.

    PubMed

    Schiffmann, J; Gandaglia, G; Larcher, A; Sun, M; Tian, Z; Shariat, S F; McCormack, M; Valiquette, L; Montorsi, F; Graefen, M; Saad, F; Karakiewicz, P I

    2014-12-01

    Existing radical cystectomy (RC) perioperative mortality estimates may underestimate the contemporary rates due to more advanced age, more baseline comorbidities and potentially broader inclusion criteria for RC, relative to past criteria. Within the most recent Surveillance, Epidemiology, and End Results (SEER)-Medicare database we identified clinically non-metastatic, muscle-invasive (T2-T4a) urothelial carcinoma of the urinary bladder (UCUB) patients, who underwent RC between 1991 and 2009. Mortality at 30- and 90-day after RC was quantified. Multivariable logistic regression analyses tested predictors of 90-day mortality. Within 5207 assessable RC patients 30- and 90-day mortality rates were 5.2 and 10.6%, respectively. According to age 65-69, 70-79 and ≥ 80 years, 90-day mortality rates were 6.4, 10.1 and 14.8% (p < 0.001). Additionally, 90-day mortality rates increased with increasing Charlson Comorbidity Index (CCI, 0, 1, 2 and ≥ 3): 6.3, 10.3, 12.6 and 15.9% (p < 0.001). 90-day mortality rate in unmarried patients was 13.0 vs. 9.3% in married individuals (p < 0.001). In multivariable logistic regression analyses, advanced age, higher CCI, low socioeconomic status, unmarried status and non organ-confined stage were independent predictors of 90-day mortality (all p < 0.05). The contemporary SEER-Medicare derived 90-day mortality rates are substantially higher than previously reported estimates from centers of excellence, and even exceed previous SEER reports. More advanced age, higher CCI score, and other patient characteristics that distinguish the current population from others account for these differences. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Laparoscopic radical cystectomy with novel orthotopic neobladder with bilateral isoperistaltic afferent limbs: initial experience

    PubMed Central

    Xing, Nian-Zeng; Kang, Ning; Song, Li-Mming; Niu, Yi-Nong; Wang, Ming-Shuai; Zhang, Jun-Hui

    2017-01-01

    ABSTRACT Purpose To introduce a new method of constructing an orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs, and to describe its clinical outcomes. Materials and Methods From January 2012 to December 2013, 16 patients underwent a new method of orthotopic ileal neobladder after laparoscopic radical cystectomy for bladder cancer. To construct the neobladder, an ileal segment 60cm long was isolated approximately 25cm proximally to the ileocecum. The proximal 20cm of the ileal segment was divided into two parts for bilateral isoperistaltic afferent limbs. The proximal 10cm of the ileal segment was moved to the distal end of the ileal segment for the right isoperistaltic afferent limb, and the remaining proximal 10cm ileal segment was reserved for the left isoperistaltic afferent limb. The remaining length of the 40cm ileal segment was detubularized along its antimesenteric border to form a reservoir. The neobladder was sutured to achieve a spherical configuration. Results All procedures were carried out successfully. The mean operative time was 330 min, mean blood loss was 328mL, and mean hospital stay was 12.5 days. The mean neobladder capacity 6 and 12 months after surgery was 300mL and 401mL, respectively. With a mean follow-up of 22.8 months, all patients achieved daytime continence and 15 achieved nighttime continence. The mean peak urinary flow rate was 11.9mL/s and 12.8mL/s at 6 and 12 months postoperatively, respectively. Conclusions This novel procedure is feasible, safe, simple to perform, and provides encouraging functional outcomes. However, comparative studies with long-term follow-up are required to prove its superiority. PMID:28124527

  13. Scar revision

    PubMed Central

    Sharma, Mohit; Wakure, Abhijeet

    2013-01-01

    Most surgical patients end up with a scar and most of these would want at least some improvement in the appearance of the scar. Using sound techniques for wound closure surgeons can, to a certain extent, prevent suboptimal scars. This article reviews the principles of prevention and treatment of suboptimal scars. Surgical techniques of scar revision, i.e., Z plasty, W plasty, and geometrical broken line closure are described. Post-operative care and other adjuvant therapies of scars are described. A short description of dermabrasion and lasers for management of scars is given. It is hoped that this review helps the surgeon to formulate a comprehensive plan for management of scars of these patients. PMID:24516292

  14. Open surgical revision provides a more durable repair than endovascular treatment for unfavorable vein graft lesions

    PubMed Central

    McCallum, John C.; Bensley, Rodney P.; Darling, Jeremy D.; Hamdan, Allen D.; Wyers, Mark C.; Hile, Chantel; Guzman, Raul J.; Schermerhorn, Marc L.

    2015-01-01

    Objective Lower extremity bypass grafts that develop stenoses are commonly treated with either open surgical or endovascular revision. Vein graft stenoses with unfavorable lesions (multiple lesions, lesions greater than 2cm in length, lesions in grafts less than 3 months old, lesions in grafts less than 3mm in diameter) fare worse than those with favorable lesions when treated with endovascular therapy. However, it is not known if unfavorable lesions fare better with surgical revision than with endovascular treatment or than favorable lesions treated with surgery. Methods We performed a retrospective review of 175 vein graft revisions performed at a single institution from 2000 to 2010. Characteristics of lesions treated with surgical and endovascular revision were identified. Cox proportional hazard models were used to identify predictors of revision failure (restenosis >75%, revision, or amputation). Results 91 (52%) failing vein grafts were treated with surgical revision and 84 (48%) with endovascular treatment, with a median follow up of 30 months. Favorable lesions fared better than unfavorable lesions after endovascular treatment, with 12-month freedom from failure of 59% vs 34% (P <.01), but not after surgical revision (66% vs 62%, P =.90). Unfavorable lesions had better freedom from failure after surgery than endovascular treatment (62%vs 34%, P <.01), while results in favorable lesions were similar (66% versus 59%, P =.57). Conclusion For the treatment of failing vein grafts, endovascular therapy appears adequate for favorable lesions while surgical revision is more durable for unfavorable lesions. PMID:26483000

  15. Impact of surgeon volume on the morbidity and costs of radical cystectomy in the USA: a contemporary population-based analysis.

    PubMed

    Leow, Jeffrey J; Reese, Stephen; Trinh, Quoc-Dien; Bellmunt, Joaquim; Chung, Benjamin I; Kibel, Adam S; Chang, Steven L

    2015-05-01

    To evaluate the relationship between surgeon volume of radical cystectomy (RC) and postoperative morbidity, and to assess the economic burden of bladder cancer in the USA. We captured all patients who underwent RC (International Classification of Diseases, ninth revision, code 57.71) between 2003 and 2010, using a nationwide hospital discharge database. Patient, hospital and surgical characteristics were evaluated. The annual volume of RCs performed by the surgeons was divided into quintiles. Multivariable regression models were developed, adjusting for clustering and survey weighting, to evaluate the outcomes, including 90-day major complications (Clavien grade III-V) and direct patient costs. We adjusted for clustering and weighting to achieve a nationally representative analysis. The weighted cohort included 49,792 patients who underwent RC, with an overall 90-day major complication rate of 16.2%. Compared with surgeons performing one RC annually, surgeons performing ≥7 RCs each year had 45% lower odds of major complications (odds ratio [OR] 0.55; P < 0.001) and lower costs by $1690 (P = 0.02). Results were consistent when we analysed surgeon volume as a continuous variable and when we examined the surgeons with the highest volumes (≥28 cases annually), which showed markedly lower odds of major complications compared with the surgeons with the lowest volumes (OR 0.45, 95% CI 0.31-0.67; P < 0.001). Compared with patients who did not have any complications, those who had a major complication were associated with significantly higher 90-day median direct hospital costs ($43,965 vs $24,341; P < 0.001). We showed that there was an inverse relationship between surgeon volume and the development of postoperative 90-day major complication rates as well as direct hospital costs. Centralisation of RC to surgeons with higher volumes may reduce the development of postoperative major complications, thereby decreasing the burden of bladder cancer on the healthcare system

  16. Colonic seromuscular augmentation cystoplasty following subtotal cystectomy for treatment of bladder necrosis caused by bladder torsion in a dog.

    PubMed

    Pozzi, Antonio; Smeak, Daniel D; Aper, Rhonda

    2006-07-15

    A 5-year-old Labrador Retriever was evaluated because of a 3-day history of lethargy, anorexia, vomiting, stranguria, and anuria after routine ovariohysterectomy. On initial examination, signs of abdominal pain and enlargement of the urinary bladder were detected. Clinicopathologic abnormalities included leukocytosis, azotemia, and hyperkalemia. Radiography and surgical exploration of the abdomen revealed urinary bladder torsion at the level of the trigone; histologically, there was necrosis of 90% of the organ. After excision of the necrotic wall of the urinary bladder (approx 0.5 cm cranial to the ureteral orifices), the remaining bladder stump was closed with a colonic seromuscular patch. Eleven weeks later, cystoscopy revealed an intramural ureteral stricture, for which treatment included a mucosal apposition neoureterocystostomy. Thirteen months after the first surgery, the dog developed pyelonephritis, which was successfully treated. By 3 months after subtotal cystectomy, the dog's urinary bladder was almost normal in size. Frequency of urination decreased from 3 to 4 urinations/h immediately after surgery to once every 3 hours after 2 months; approximately 4 months after the subtotal cystectomy, urination frequency was considered close to normal. Urinary bladder torsion is a surgical emergency in dogs. Ischemia of the urinary bladder wall may result from strangulation of the arterial and venous blood supply and from overdistension. Subtotal resection of the urinary bladder, preserving only the trigone area and the ureteral openings, and colonic seromuscular augmentation can be used to successfully treat urinary bladder torsion in dogs.

  17. Korean version of the functional assessment of cancer therapy (FACT)-vanderbilt cystectomy index (VCI): translation and linguistic.

    PubMed

    Kim, Myong; Lee, Hahn Ey; Kim, Sung Han; Cho, Sung Yong; Jeong, Seong Jin; Oh, Seung June; Cookson, Michael S; Ku, Ja Hyeon

    2014-11-30

    To develop a Korean version of the Functional Assessment of Cancer Therapy (FACT)-Vanderbilt Cystectomy Index (VCI) from the original English version, with subsequent linguistic validation in Korean patients who underwent radical cystectomy with urinary diversion. Translation and linguistic validation were carried out between January and May of 2013, which consisted of the following stages:(1) permission for translation;(2) forward translation;(3) reconciliation;(4) backward translation;(5) cognitive debriefing and(6) final proof-reading. During the forward translation phases,word as such as "bother","spend time", "support", "coping" and "concern" were adjusted to be more comprehensible to the target population. There conciled Korean version was accepted without certain objections because the original version and the backward translation were almost congruent except for minor differences in a subset of questions. The translation was tested using 5 Korean-speaking subjects. The subjects took an average of 8.2 minutes to complete the questionnaire, without difficulty and found the questionnaire clear and easy to understand. The panel discussed each of the issues raised by subjects and most terms were judged by the panel as to not require further changes because the overall comprehension levels were relatively high and because the translated terms were accurately rendered in the target languages. This report has demonstrated that despite translation difficulties, the linguistic validation of the FACT-VCI in the Korean language was successful. The next step is to assess the psychometric properties of the Korean version of FACT-VCI.

  18. Impact of preoperative immunonutrition on morbidity following cystectomy for bladder cancer: a case-control pilot study.

    PubMed

    Bertrand, J; Siegler, N; Murez, T; Poinas, G; Segui, B; Ayuso, D; Gres, P; Wagner, L; Thuret, R; Costa, P; Droupy, S

    2014-02-01

    To compare postoperative complications in patients with or without preoperative immunonutrition before cystectomy. A prospective, multicenter, pilot, case-control study was conducted during 6 months. Patients with 7-day preoperative immunonutrition were prospectively included and compared with a retrospective, matched control group without immunonutrition. Early complication rates and the length of hospital stay were analyzed. The bilateral type I error was <0.05; the power was 90%. Thirty patients in each group were required. Thirty patients were included in each group, on a comparable basis. In the immunonutrition group, fewer postoperative complications (40 vs. 76.7%; p = 0.008), less paralytic ileus at D7 (6.6 vs. 33.3%; p = 0.02), fewer infections (23.3 vs. 60%; p = 0.008), and in particular less pyelonephritis (16.7 vs. 46.7%; p = 0.03) occurred. Clavien's grades for complications were higher in the control group (p = 0.04). Mortality, pulmonary embolism, anastomotic fistulae, and wound dehiscence were similar between two groups. The length of stay was reduced by 3 days in the immunonutrition group. In this pilot case-control study, immunonutrition is associated with a decrease in postoperative complications, urinary tract infections, Clavien's grade for complications, and paralytic ileus in patients undergoing cystectomy for bladder cancer. Prospective randomized placebo control studies are needed to confirm these promising results.

  19. Perineal herniation of an ileal neobladder following radical cystectomy and consecutive rectal resection for recurrent bladder carcinoma

    PubMed Central

    Neumann, PA; Mehdorn, AS; Puehse, G; Senninger, N; Rijcken, E

    2016-01-01

    Secondary perineal herniation of intraperitoneal contents represents a rare complication following procedures such as abdominoperineal rectal resection or cystectomy. We present a case of a perineal hernia formation with prolapse of an ileum neobladder following radical cystectomy and rectal resection for recurrent bladder cancer. Following consecutive resections in the anterior and posterior compartment of the lesser pelvis, the patient developed problems emptying his neobladder. Clinical examination and computed tomography revealed perineal herniation of his neobladder through the pelvic floor. Through a perineal approach, the hernial sac could be repositioned, and via a combination of absorbable and non-absorbable synthetic mesh grafts, the pelvic floor was stabilised. Follow-up review at one year after hernia fixation showed no signs of recurrence and no symptoms. In cases of extensive surgery in the lesser pelvis with associated weakness of the pelvic compartments, meshes should be considered for closure of the pelvic floor. Development of biological meshes with reduced risk of infection might be an interesting treatment option in these cases. PMID:26985818

  20. [A case of Crohn's disease developing bladder rupture 4 months after laparoscopic sigmoidectomy with partial cystectomy for vesicosigmoidal fistula].

    PubMed

    Masumori, Naoya; Tanaka, Toshiaki; Takeuchi, Motoi; Ichihara, Koji; Inoue, Ryuta; Shinkai, Nobuo; Maehana, Takeshi; Mizuno, Takahiro; Tabata, Hidetoshi; Hiyama, Yoshiki; Tsukamoto, Taiji

    2012-05-01

    A 32-year-old well-nourished man having a vesicosigmoidal fistula due to Crohn's disease received laparoscopic sigmoidectomy with partial cystectomy. The bladder wall was closed with an all-layer running suture and additional interrupted sutures using 2-0 Vicryl. Four months after surgery, the suture site on the bladder showed perforation to the abdominal cavity. Since the same event occurred again 6 months after surgery, open partial cystectomy was performed to repair the perforated site 8 months after the initial surgery. The perforated site showed a thinning bladder wall composed of normal urothelium, scar tissue and thin detrusor muscle. Non-caseating granuloma was not found in the specimen, even though it was slightly observed in the margin of the detrusor muscle resected in the initial surgery. Although it was possible that the persisting activity of Crohn's disease, subclinical impaired nutrition due to Crohn's disease or insufficient suturing of the bladder wall were involved in the bladder rupture, the definitive cause remains unknown.

  1. Early Recurrence Patterns Following Totally Intracorporeal Robot-assisted Radical Cystectomy: Results from the EAU Robotic Urology Section (ERUS) Scientific Working Group.

    PubMed

    Collins, Justin W; Hosseini, Abolfazl; Adding, Christofer; Nyberg, Tommy; Koupparis, Anthony; Rowe, Edward; Perry, Matthew; Issa, Rami; Schumacher, Martin C; Wijburg, Carl; Canda, Abdullah E; Balbay, Melvin D; Decaestecker, Karel; Schwentner, Christian; Stenzl, Arnulf; Edeling, Sebastian; Pokupić, Saša; D'Hondt, Fredrik; Mottrie, Alexander; Wiklund, Peter N

    2017-05-01

    Recurrence following radical cystectomy often occurs early, with >80% of recurrences occurring within the first 2 yr. Debate remains as to whether robot-assisted radical cystectomy (RARC) negatively impacts early recurrence patterns because of inadequate resection or pneumoperitoneum. We report early recurrence patterns among 717 patients who underwent RARC with intracorporeal urinary diversion at nine different institutions with a minimum follow-up of 12 mo. Clinical, pathologic, radiologic, and survival data at the latest follow-up were collected. Recurrence-free survival (RFS) estimates were generated using the Kaplan-Meier method, and Cox regression models were built to assess variables associated with recurrence. RFS at 3, 12, and 24 mo was 95.9%, 80.2%, and 74.6% respectively. Distant recurrences most frequently occurred in the bones, lungs, and liver, and pelvic lymph nodes were the commonest site of local recurrence. We identified five patients (0.7%) with peritoneal carcinomatosis and two patients (0.3%) with metastasis at the port site (wound site). We conclude that unusual recurrence patterns were not identified in this multi-institutional series and that recurrence patterns appear similar to those in open radical cystectomy series. In this multi-institutional study, bladder cancer recurrences following robotic surgery are described. Early recurrence rates and locations appear to be similar to those for open radical cystectomy series. Copyright © 2016. Published by Elsevier B.V.

  2. Total cystectomy and subsequent urinary diversion to the prepuce or vagina in dogs with transitional cell carcinoma of the trigone area: A report of 10 cases (2005–2011)

    PubMed Central

    Saeki, Kohei; Fujita, Atsushi; Fujita, Naoki; Nakagawa, Takayuki; Nishimura, Ryohei

    2015-01-01

    The cases of 10 dogs with transitional cell carcinoma of the urinary bladder that underwent total cystectomy were retrospectively reviewed to evaluate the feasibility and outcome of total cystectomy and ureteral transplantation to the prepuce or vagina. Dehiscence of ureterostomy (n = 2), pyelonephritis (n = 3), oliguria (n = 2), azotemia (n = 1), and ureteral obstruction (n = 1) were observed complications. The estimated median survival time was 385 days. This study demonstrates the feasibility of total cystectomy and subsequent urinary diversion to the prepuce or vagina in dogs. Compared to previous ureterocolonic anastomosis, this technique is associated with fewer gastrointestinal and neurologic complications. PMID:25565719

  3. Utility and significance of ureteric frozen section analysis during radical cystectomy.

    PubMed

    Satkunasivam, Raj; Hu, Brian; Metcalfe, Charles; Ghodoussipour, Saum B; Aron, Manju; Cai, Jie; Miranda, Gus; Gill, Inderbir; Daneshmand, Siamak

    2016-03-01

    To assess the utility of routine frozen section analysis of ureters at the time of radical cystectomy (RC) for urothelial cancer (UC), and the long-term outcomes of adverse ureteric pathology. Pathological data on 2 047 patients undergoing RC for UC with routine frozen section analysis of ureters (January 1971 to December 2009) were analysed. Univariate and multivariable logistic and Cox proportional hazards models were used to determine the risk of upper tract UC (UTUC) recurrence, local recurrence and overall survival in those identified as having adverse pathology (severe atypia/carcinoma in situ [CIS] or UC) at time of frozen section analysis. Adverse pathology was identified by frozen section analysis in 178 patients (8.6%). Frozen section analysis was found to have poor sensitivity in identifying adverse pathology (59.1%), which was improved in patients with preoperative CIS (68.0%). After a median (interquartile range) follow-up of 12.4 (1.9-10.1) years, 28 patients (1.4%) developed UTUC recurrence. There were no uretero-enteric anastomotic recurrences. Adverse pathology on frozen section analysis was associated with UTUC recurrence on univariate analysis (hazard ratio [HR] 6.2, 95% confidence interval [CI] 2.9-13.5), but 15/28 patients (54%) with UTUC recurrence had benign ureteric frozen section analysis on initial sectioning. Adverse pathology on frozen section analysis was not independently associated with the risk of local recurrence (HR 1.08, 95% CI 0.61-1.89) or overall survival (HR 1.12, 95% CI 0.94-1.35) in multivariate models. Ureteric frozen section analysis has poor sensitivity and may be marginally improved in pre-existing CIS. UTUC recurrence is rare and can occur despite negative frozen section analysis. Our data question the utility of routine frozen section analysis of the distal ureteric margin at the time of RC. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  4. Definition, incidence, risk factors, and prevention of paralytic ileus following radical cystectomy: a systematic review.

    PubMed

    Ramirez, Jorge A; McIntosh, Andrew G; Strehlow, Robert; Lawrence, Valerie A; Parekh, Dipen J; Svatek, Robert S

    2013-10-01

    Postoperative paralytic ileus (POI) has profound clinical consequences because it represents a substantial burden on both patients and health care resources. To determine the knowledge base regarding POI in the radical cystectomy (RC) population with an emphasis on preventive measures and risk factors. A systematic literature search of Medline (1966 to February 2011) and a study review were conducted. Eligible studies explicitly reported the incidence of POI and/or at least two quantitative measures of gastrointestinal recovery. The search identified 727 relevant articles; 77 met eligibility criteria, comprising 13 793 patients. Of these, 21 used explicit definitions of POI, and they varied widely. Across studies, the incidence of POI ranged from 1.58% to 23.5%. Possible risk factors for POI included increasing age and body mass index. Seventeen studies reported effects of an intervention on POI: 3 randomized controlled studies, 11 observational cohort studies with concurrent comparison, and 3 observational cohort studies with nonconcurrent comparison. Gum chewing was associated with shortened times to flatus (2.4 vs 2.9 d; p<0.0001) and bowel movement (BM) (3.2 vs 3.9 d; p<0.001) in one observational cohort study (n=102); omission of a postoperative nasogastric tube (NGT) was associated with shorter time to flatus (4.21 vs 5.33 d; p=0.0001) and shorter length of stay (14.4 vs 19.1 d; p=0.001) in one observational cohort study (n=430); and the routine use of bowel preparation was associated with an increased incidence of POI (5% vs 19%) in another series (n=86). Additionally, readaptation of the dorsolateral peritoneal layer was shown to shorten times to flatus (p=0.016) and times to BM (p=0.011) in one randomized controlled study (n=200). The incidence/definition of POI after RC is highly variable. An improved reporting strategy is needed to identify true incidence and risk factors, and to guide future research for both potential preventive and therapeutic

  5. Impact of body mass index on robot-assisted radical cystectomy with intracorporeal urinary diversion.

    PubMed

    Ahmadi, Nariman; Clifford, Thomas G; Miranda, Gus; Cai, Jie; Aron, Monish; Desai, Mihir M; Gill, Inderbir S

    2017-05-22

    To determine the impact of body mass index (BMI) on peri-operative and oncological outcomes after robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion. A total of 216 patients undergoing RARC, extended lymphadenectomy and intracorporeal urinary diversion, between July 2010 and December 2015, were categorized into four BMI groups according to the 2004 World Health Organization obesity classification groups: <25 kg/m(2) (normal); 25-29.9 kg/m(2) (pre-obese); 30-34.9 kg/m(2) (obese class I); and ≥35 kg/m(2) (obese class II). Pre-, intra- and postoperative characteristics, oncological outcomes, and 90-day complications were compared using sas statistical software. All 216 patients underwent intracorporeal urinary diversion, with 68 (32%) undergoing orthotopic neobladder construction. Demographics were similar among the BMI groups with regard to median (range) age (71.8 [35- 95] years), gender (80.6% men), Charlson comorbidity index (CCI) score (66.2% with CCI score 0-1), pathological stage (carcinoma in situ to T2: 55.1%, T3-T4/N0: 18.5%, Tx/N+: 26.4%), median (interquartile range) node count [41 (28, 53)] and positive soft tissue margin rate (4.2%). Obese patients had greater blood loss and longer operating time (P = 0.02 and P = 0.04, respectively). There were no significant differences in length of hospital stay, transfusion rates, readmission or 90-day overall and high-grade complication rates (P = 0.16, P = 0.96, P = 0.89, P = 0.22 and P = 0.51, respectively). At a median (range) follow-up of 13 months (15 days to 4.8 years), recurrence-free survival (P = 0.92) and overall survival (P = 0.68) were similar among the groups. The results of the present study show that RARC with intracorporeal urinary diversion is safe and feasible in obese patients with bladder cancer. BMI was not associated with significant differences in peri-operative, pathological or early oncological outcomes. © 2017 The Authors BJU International © 2017 BJU

  6. Lunar phases and zodiac signs do not influence quality of radical cystectomy--a statistical analysis of 452 patients with invasive bladder cancer.

    PubMed

    May, Matthias; Braun, Kay-Patrick; Helke, Christian; Richter, Willi; Vogler, Horst; Hoschke, Bernd; Siegsmund, Michael

    2007-01-01

    To determine the influence of the lunar phases and the position of the moon in the zodiac on the frequency of complications and the survival of bladder cancer patients after radical cystectomy. It has been postulated that radical cystectomy performed during the waxing moon, or particularly at full moon, or at the zodiac sign Libra is associated with a poorer outcome. We tested this hypothesis by evaluating the progression-free survival, the complication rate and the re-operation rate for 452 consecutive patients after radical cystectomy. In this retrospective review, the dates of surgery were allocated to the lunar phases and the zodiac signs. Based on these classifications, the patients were placed in groups which combined the lunar phase laws and differentiated between evidently unfavorable (full moon or waxing moon and/or the zodiac sign Libra; assigned to group 1) and favorable periods for surgery (new moon or waning moon and other signs of the zodiac apart from Libra; assigned to group 2). The mean follow-up was 49 months (range 0-158 months). A total of 244 patients (54%) were operated during an unfavorable period (group 1) and 208 (46%) patients during the auspicious period (group 2). The mean age, gender and kind of urinary derivation did not differ significantly in the two groups. Pathological tumor stages were evenly distributed according to the lunar phase groups (P = 0.713). We found no significant differences in the perioperative mortality rates, early re-operation rates, early complications, and late complications across the two groups. No significant differences in progression-free survival were observed when timing of cystectomy during the lunar cycle was considered (P = 0.231). Our analysis demonstrated no predictable influence of the lunar phase on survival or complications. Although this was not a prospective randomized trial, the statistical magnitude of the results do not support any recommendations for scheduling patients for radical

  7. Lymph node dissection during laparoscopic (LRC) and open (ORC) radical cystectomy due to muscle invasive bladder urothelial cancer (pT2-3, TCC).

    PubMed

    Chlosta, Piotr; Drewa, Tomasz; Siekiera, Jerzy; Jaskulski, Jarosław; Petrus, Andrzej; Kamecki, Krzysztof; Mikołajczak, Witold; Obarzanowski, Mateusz; Wronczewski, Andrzej; Krasnicki, Krzysztof; Jasinski, Milosz

    2011-09-01

    The aim of the study was to compare the number of nodes dissected during laparoscopic and open radical cystoprostatectomy in men or anterior exenteration in women due to muscle invasive bladder urothelial cancer (IBC). Fifty-one patients treated with laparoscopic radical cystectomy (LRC) and 63 with open radical cystectomy (ORC) were compared. The LRC group consisted of 47 pT2 tumours and 4 pT3, while the ORC group was composed of 27 pT2 tumours and 36 pT3. During ORC external, internal, common iliac and obturator lymph nodes were removed separately, but were added and analysed together for each side. Nodes dissected from one side during ORC were compared to en bloc dissected nodes in the LRC group. There were no complications associated with extended pelvic lymph node dissection during LRC or ORC. There were significant differences in the mean number of resected lymph nodes between LRC and ORC for pT2 tumours. The laparoscopic approach allowed about 8-9 more lymph nodes to be removed than open surgery in the pT2 group. In 15% of patients with pT2 disease treated with open radical cystectomy node metastases were observed. Active disease was detected in 18% of nodes resected laparoscopically due to pT2 disease. Fourty-seven percentage of patients with pT3 disease treated with open surgery were diagnosed as harbouring metastatic lymph nodes. The laparoscopic group with pT3 disease was too small to analyse. We have found that laparoscopic radical cystectomy can be performed without any compromise in lymph node dissection. The technique of lymph node dissection (LND) during laparoscopic cystectomy (LRC) resulted in sufficient resected lymphatic tissue, especially in patients with bladder-confined tumours with a low volume of lymph nodes.

  8. A six-month evaluation of the VivaSight™ video double-lumen endotracheal tube after introduction into thoracic anaesthetic practice at a single institution.

    PubMed

    Rapchuk, I L; Kunju, Sam; Smith, I J; Faulke, D J

    2017-03-01

    For a six-month period, all airway options used for non-emergent patients undergoing thoracic surgery requiring one-lung ventilation at a single institution were assessed after introduction of the VivaSight™ double-lumen endotracheal tube (VivaSight-DL), a novel double-lumen tube with an integrated camera. This device displays a continuous view of the position of the tube relative to the carina. A total of 72 patients had lung separation with the VivaSight-DL. Lung separation was achieved on first attempt without additional manipulation in 85% of cases. In only three cases (4%) was a fibreoptic bronchoscope required, in each instance to reposition the tube after intraoperative dislodgement. The VivaSight-DL represents a novel method of one-lung ventilation allowing rapid identification of intraoperative airway problems and reducing the need for fibreoptic bronchoscopy.

  9. Enhanced Recovery After Robot-assisted Radical Cystectomy: EAU Robotic Urology Section Scientific Working Group Consensus View.

    PubMed

    Collins, Justin W; Patel, Hiten; Adding, Christofer; Annerstedt, Magnus; Dasgupta, Prokar; Khan, Shamim M; Artibani, Walter; Gaston, Richard; Piechaud, Thierry; Catto, James W; Koupparis, Anthony; Rowe, Edward; Perry, Matthew; Issa, Rami; McGrath, John; Kelly, John; Schumacher, Martin; Wijburg, Carl; Canda, Abdullah E; Balbay, Meviana D; Decaestecker, Karel; Schwentner, Christian; Stenzl, Arnulf; Edeling, Sebastian; Pokupić, Sasa; Stockle, Michael; Siemer, Stefan; Sanchez-Salas, Rafael; Cathelineau, Xavier; Weston, Robin; Johnson, Mark; D'Hondt, Fredrik; Mottrie, Alexander; Hosseini, Abolfazl; Wiklund, Peter N

    2016-10-01

    Radical cystectomy (RC) is associated with frequent morbidity and prolonged length of stay (LOS) irrespective of surgical approach. Increasing evidence from colorectal surgery indicates that minimally invasive surgery and enhanced recovery programmes (ERPs) can reduce surgical morbidity and LOS. ERPs are now recognised as an important component of surgical management for RC. However, there is comparatively little evidence for ERPs after robot-assisted radical cystectomy (RARC). Due to the multimodal nature of ERPs, they are not easily validated through randomised controlled trials. To provide a European Association of Urology (EAU) Robotic Urology Section (ERUS) policy on ERPs to guide standardised perioperative management of RARC patients. The guidance was formulated in four phases: (1) systematic literature review of evidence for ERPs in robotic, laparoscopic, and open RC; (2) an online questionnaire survey formulated and sent to ERUS Scientific Working Group members; (3) achievement of consensus from an expert panel using the Delphi process; and (4) a standardised reporting template to audit compliance and outcome designed and approved by the committee. Consensus was reached in multiple areas of an ERP for RARC. The key principles include patient education, optimisation of nutrition, RARC approach, standardised anaesthetic, analgesic, and antiemetic regimens, and early mobilisation. This consensus represents the views of an expert panel established to advise ERUS on ERPs for RARC. The ERUS Scientific Working Group recognises the role of ERPs and endorses them as standardised perioperative care for patients undergoing RARC. ERPs in robotic surgery will continue to evolve with technological and pharmaceutical advances and increasing understanding of the role of surgery-specific ERPs. There is currently a lack of high-level evidence exploring the benefits of enhanced recovery programmes (ERPs) in patients undergoing robot-assisted radical cystectomy (RARC). We

  10. Comparative Outcomes of Pure Squamous Cell Carcinoma and Urothelial Carcinoma With Squamous Differentiation in Patients Treated With Radical Cystectomy

    PubMed Central

    Ehdaie, Behfar; Maschino, Alexandra; Shariat, Shahrokh F.; Rioja, Jorge; Hamilton, Robert J.; Lowrance, William T.; Poon, Stephen A.; Al-Ahmadie, Hikmat A.; Herr, Harry W.

    2013-01-01

    Purpose We compared clinical outcomes, and identified predictors of cancer specific and overall survival after radical cystectomy in patients with urothelial carcinoma with squamous differentiation and those with pure squamous cell carcinoma. Materials and Methods We reviewed data on 2,031 patients treated with radical cystectomy and pelvic lymph node dissection at a single high volume referral center. Of these patients 78 had squamous cell carcinoma and 67 had squamous differentiation. Survival estimates by histological subtype were described using Kaplan-Meier methods. Within histological subtypes pathological stage, nodal invasion, soft tissue margins, age and gender were evaluated as predictors of cancer specific survival and overall survival using univariate Cox regression. Results Median followup was 44 months. Of 104 patient deaths 60 died of their disease. We did not find a statistically significant difference between survival curves of patients with squamous cell carcinoma and squamous differentiation (log rank overall survival p = 0.6, cancer specific survival p = 0.17). Positive soft tissue margins were associated with worse cancer specific survival (HR 6.92, 95% CI 2.98–16.10, p ≤ 0.0005) and overall survival (HR 3.68, 95% CI 1.84–7.35, p ≤ 0.0005) in patients with pure squamous cell carcinoma. Among patients with squamous differentiation, pelvic lymphadenopathy was associated with decreased overall survival (HR 2.52, 95% CI 1.33–4.77, p = 0.004) and cancer specific survival (HR 3.23, 95% CI 1.57–6.67, p = 0.002). Conclusions There appears to be no evidence of a difference in cancer specific survival or overall survival between patients with squamous cell carcinoma and those with squamous differentiation treated with radical cystectomy and pelvic lymph node dissection. Patients with squamous differentiation and tumor metastases to pelvic lymph nodes should be followed more closely, and adjuvant treatment should be considered to improve

  11. [Does chewing gum improve postoperative results in patients undergoing radical cystectomy? A systematic review of literature and meta-analysis].

    PubMed

    Ziouziou, I; Ammani, A; Karmouni, T; El Khader, K; Koutani, A; Iben Attya Andaloussi, A

    2017-09-01

    Postoperative ileus occurs in different degrees, in the majority of patients undergoing radical cystectomy, which may increase the length of hospital stay. The use of chewing gum has demonstrated its effectiveness in reducing time-to-bowel function and the length of hospital stay in several surgical procedures. To evaluate the benefit of post-operative chewing gum use in patients undergoing radical cystectomy through a systematic review of the literature and meta-analysis. We performed a literature search of MedLine, Scopus, CochraneLibrary and ClinicalTrials.Gov in March 2017 according to the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. The studies were evaluated according to the "Oxford Center for Evidence-Based Medicine" criteria. The outcome measures evaluated were time-to-flatus, time-to-defecation, length of the hospital stay, and the rates of general and gastrointestinal postoperative complications. Continuous and dichotomous variables were compared respectively using weighted means differences and odds ratios with 95 % confidence intervals. The presence of publication bias was examined by funnel plots. Three studies (including 274 patients in total) met the inclusion criteria. The pooled results demonstrated a 11.82hour reduction in time-to-flatus (95 % CI : -15.43, -8.22h, P <0.00001), and 19.57hours in time-to-defecation (95 % CI : -29.33, -9.81h, P <0.0001), and a decreasing trend of 2.85 days in the length of the hospital stay (95 % CI : -6.13, -0.43, P=0.09), by the use of chewing gum. There was no significant difference between the "chewing gum" and "control" groups in terms of general and gastrointestinal complications (Peto Odds ratio 1.04 [0.60, 1.79], 95 % CI, P=0.89 and Peto Odds ratio 0.65 [0.26, 1.61], 95 % CI, P=0.35 respectively). Chewing gum may be recommended postoperatively in patients undergoing radical cystectomy to improve time-to-bowel function. Copyright © 2017 Elsevier

  12. [Recurrence of bladder cancer in remnant urethra and inguinal lymph node metastasis nine years after total cystectomy: a case report].

    PubMed

    Obata, Jun; Kikuchi, Eiji; Kaneko, Gou; Miyajima, Akira; Kameyama, Kaori; Jinzaki, Masahiro; Oya, Mototsugu

    2011-01-01

    A 68-year-old man underwent total cystectomy, urethrectomy preserving fossa navicularis, and an Indiana pouch urinary diversion in 1997. The histopathology was UC, G3, pT4 (prostate). Nine years after the operation, he had multiple metastases to the inguinal and paraaortic lymph nodes (LNs), and he complained of erosion around the glans. Histological diagnosis of the glans revealed recurrent UC to the urethra of the glans. We considered the possibility that the inguinal LN metastasis was due to lymphatic spread from a remnant urethral recurrence. Thus, a partial penectomy and inguinal LN dissection were undertaken. Systemic chemotherapy was administered. Remnant urethral recurrence after urethrectomy preserving the fossa navicularis and inguinal LN metastasis are rare.

  13. Association of hospital volume with conditional 90-day mortality after cystectomy: an analysis of the National Cancer Data Base.

    PubMed

    Nielsen, Matthew E; Mallin, Katherine; Weaver, Mark A; Palis, Bryan; Stewart, Andrew; Winchester, David P; Milowsky, Matthew I

    2014-07-01

    To examine the association of hospital volume and 90-day mortality after cystectomy, conditional on survival for 30 days. The National Cancer Data Base was used to evaluate 30- and 90-day mortality for 35,055 patients who underwent cystectomy for bladder cancer at one of 1118 hospitals. Patient data were aggregated into hospital volume categories based on the mean annual number of procedures (low-volume hospital: <10 procedures; intermediate-volume hospital: 10-19 procedures; high-volume hospital: ≥20 procedures). Associations between mortality and clinical, demographic and hospital characteristics were analysed using hierarchical logistic regression models. To assess the association between hospital volume and 90-day mortality independently of shorter-term mortality, 90-day mortality conditional on 30-day survival was assessed in the multivariate modelling. Unadjusted 30- and 90-day mortality rates were 2.7 and 7.2% overall, 1.9 and 5.7% among high-volume hospitals, and 3.2 and 8.0% among low-volume hospitals, respectively. Compared with high-volume hospitals, the adjusted risks among low-volume hospitals (odds ratio [95% CI]) of 30- and 90-day mortality, conditional on having survived for 30 days, from the hierarchical models were 1.5 (1.3-1.9), and 1.2 (1.0-1.4), respectively. A low hospital volume was associated with greater 30- and 90-day mortality. These data support the need for further research to better understand the relatively high mortality rates seen between 30 and 90 days, which are high and less variable across hospital volume strata. The stronger association between volume and 30-day mortality suggests that quality-reporting efforts should focus on shorter-term outcomes. © 2013 The Authors. BJU International © 2013 BJU International.

  14. Effect of Neoadjuvant Chemotherapy on Renal Function following Radical Cystectomy: Is there a Meaningful Impact?

    PubMed Central

    Chandrasekar, Thenappan; Pugashetti, Neil; Durbin-Johnson, Blythe; Dall’Era, Marc A.; Evans, Christopher P.; deVere White, Ralph W.; Yap, Stanley A.

    2016-01-01

    Objective: To evaluate the patterns of impact of neoadjuvant chemotherapy (NAC) on renal function across the initial year following treatment for muscle-invasive bladder cancer (MIBC) with radical cystectomy (RC). Methods: We reviewed the charts of 241 patients who underwent RC for urothelial carcinoma of the bladder between 2003-14 at our institution. Renal function was evaluated at multiple time points (pre-chemotherapy, pre-operatively, post-operatively, 6–12 months follow-up), and then classified by CKD staging. Univariable and multivariable logistic regression analyses were performed to determine relationship between NAC and change in CKD stage. Results: Of the 241 patients who underwent RC for urothelial carcinoma of the bladder, 66 (27%) received NAC and 175 (73%) did not. In multivariable analysis, NAC was significantly associated with a decrease of at least one CKD stage from baseline to post-op (p = 0.009), but not to the 6–12 months follow-up time point (p = 0.050). The loss of GFR in the NAC cohort occurs up-front with chemotherapy, but the peri-operative course is similar to those who underwent cystectomy alone. Of the 15 NAC patients (26.8%) who were Stage 3 CKD prior to chemotherapy, none progressed to a higher stage CKD. Conclusion: NAC is associated with an initial decline in GFR, which then remains stable through the first year following RC. Despite an initial insult, patients receiving NAC are not vulnerable to further deterioration. When appropriately selected, NAC does not appear to result in a clinically significant deterioration of renal function. PMID:28035325

  15. Transurethral partial cystectomy with 2 μm thulium continuous wave laser in the treatment of bladder pheochromocytoma.

    PubMed

    Yang, Yong; Wei, Zhi-tao; Lu, Jin-shan; Zu, Qiang; Wang, Haiyi; Zhang, Xu

    2012-06-01

    To introduce transurethal partial cystectomy with a 2013 nm thulium laser as a treatment for paraganglioma of the urinary bladder in adults. Three patients with pheochromocytomas were treated transurethrally with a 2013 nm thulium laser under general anesthesia. A 2013 nm thulium laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between the detrusor muscle layer and outer connective tissues. Tumors with full-thickness detrusor muscle layers at the base were removed together. Intraoperative fluctuation of blood pressure, preoperative values of 24-hour urine catecholamine (CA) and vanillylmandelic acid (VMA), and postoperative complications were observed, and postoperative followtwoups were performed. All operations were successful. Operative time was 25 to 32 minutes. Perioperative blood pressure was stable in two cases while blood pressure fluctuated in the third case. When the entire tumor and the full-thickness bladder wall at the base were freed, blood pressure reverted to stability. All values of 24-hour urine CA and VMA were within normal limits postoperatively. Patients were followed for 7 to 9 months postoperatively with no recurrence. This series included highly selected patients who were treated by a single senior surgeon who is rich in experience in performing 2013 nm thulium laser procedures. To our knowledge, this is the first report of a 2013 nm thulium laser used to treat bladder pheochromocytoma. It can be applied to precisely vaporize and incise the full-thickness bladder wall and cut down the blood supply of the tumor, then peel it while blood pressure remains stable, thus completing partial cystectomy for bladder pheochromocytoma safely.

  16. Robot-assisted partial cystectomy with intraoperative frozen section examination: Evolution and evaluation of a novel technique

    PubMed Central

    Klett, Dane E.; Abdollah, Firas; Sammon, Jesse D.; Pucheril, Dan; Menon, Mani; Jeong, Wooju; Peabody, James O.

    2016-01-01

    Purpose To describe a novel modification to robot-assisted partial cystectomy (RAPC) that allows for intraoperative surgical margin assessment by bimanual-examination and frozen-section analysis. Materials and Methods A total of 7 patients underwent RAPC at a single tertiary-care institution between 2008 and 2013. The technique evolved over the study-period and permitted real-time intraoperative surgical margin evaluation in the last 5 patients via bimanual-examination and frozen-section analysis, utilizing the GelPOINT platform (a hand-assist device). The GelPOINT platform was placed through a 4- to 5-cm vertical supraumbilical incision and allowed for rapid retrieval of the bladder specimen without compromising the pneumoperitoneum or prolonging the operative time. Perioperative, oncological and functional outcomes were evaluated; all patients had a minimum 12-month follow-up. At the time of last follow-up, a cross-sectional survey of patients was performed to evaluate regret/satisfaction utilizing validated questionnaires. Results The mean age was 72.5 years; 71.4% of the patients were men (n=5). All patients underwent RAPC for a malignant indication. The mean operative and console times were 291 and 217 minutes, respectively. No patient had a positive surgical margin. Mean length-of-stay was 1.7 days. At a median follow-up of 38.9 months, 1 patient experienced a local recurrence 6 months postsurgery. The only mortality was secondary to Lewy-body disease, in the same patient, 1 year postoperatively. Patient assessment of regret and satisfaction indicated 0% regret and 0% dissatisfaction. Conclusions The 'modified' technique of RAPC is technically feasible, safe, and reproducible; further, RAPC leads to favorable oncological, functional and quality-of-life outcomes in patients eligible for partial cystectomy. PMID:27195322

  17. A 10-Year Retrospective Review of a Nonrandomized Cohort of 458 Patients Undergoing Radical Radiotherapy or Cystectomy in Yorkshire, UK

    SciTech Connect

    Munro, Nicholas P.; Sundaram, Subramnian K.; Weston, Philip; Fairley, Lesley; Harrison, Simon C.W.; Forman, David; Chahal, Rohit

    2010-05-01

    Purpose: We have previously reported on the mortality, morbidity, and 5-year survival of 458 patients who underwent radical radiotherapy or surgery for invasive bladder cancer in Yorkshire from 1993 to 1996. We aim to present the 10-year outcomes of these patients and to reassess factors predicting survival. Methods and Materials: The Northern and Yorkshire Cancer Registry identified 458 patients whose cases were subjected to Kaplan-Meier all-cause survival analyses, and a retrospective casenote analysis was undertaken on 398 (87%) for univariate and multivariate Cox proportional hazards modeling. Additional proportional hazards regression modeling was used to assess the statistical significance of variables on overall survival. Results: The ratio of radiotherapy to cystectomy was 3:1. There was no significant difference in overall 10-year survival between those who underwent radiotherapy (22%) and radical cystectomy (24%). Univariate analyses suggested that female sex, performance status, hydronephrosis and clinical T stage, were associated with an inferior outcome at 10 years. Patient age, tumor grade, treatment delay, and caseload factors were not significant. Multivariate analysis models were created for 0-2 and 2-10 years after treatment. There were no significant differences in treatment for 0-2 years; however, after 2 years follow-up there was some evidence of increased survival for patients receiving surgery compared with radiotherapy (hazard ratio 0.66, 95% confidence interval: 0.44-1.01, p = 0.06). Conclusions: a 10-year minimum follow-up has rarely been reported after radical treatment for invasive bladder cancer. At 10 years, there was no statistical difference in all-cause survival between surgery and radiotherapy treatment modalities.

  18. Extent of lymphadenectomy in patients with bladder cancer undergoing radical cystectomy – a multi-institutional analysis

    PubMed Central

    Piotrowicz, Sebastian; Czarniecki, Stefan W.; Kowalski, Filip; Nowak, Grzegorz; Oszczudłowski, Maciej; Sochaj, Marta; Dobruch, Jakub; Radziszewski, Piotr

    2016-01-01

    Lymph node dissection (LND) performed at radical cystectomy (RC) has therapeutic and staging significance. However, the extent of LND remains controversial. The aim of this study was to analyze surgical patterns and results of LND in a contemporary series of patients with bladder cancer. This is a retrospective analysis of 113 consecutive patients subjected to RC in seven urological centres in the year 2013. The mean age of the cohort was 66.6 years. There were 49 cases of organ confined and 64 cases of locally advanced disease. Study endpoints were: status and extent of LND, number of LNs removed, and number of positive LNs. LND was performed in 102 patients (90.3%). Detailed data on the anatomical extent of LND was available in 82 patients (80.4%). Limited (lLND) and extended LND (eLND) was performed in 68.3% (n = 56) and 31.7% (n = 26) of patients, respectively. Obturator fossa LNs were removed in 84.1%, external iliac in 72.0%, internal iliac in 40.2%, common iliac in 31.7%, and presacral in 15.9% of cases. The median number of LNs removed in the whole study cohort, in patients who underwent lLND, and eLND, was 8.5, 5, and 16.5, respectively. In 28 patients (27.5%), LN metastases were diagnosed, including 6 cases (12.5%) in the organ-confined cohort and 22 cases (34.4%) in the locally advanced disease cohort. LND is an integral part of radical cystectomy in patients with bladder cancer. However, in the majority of patients, the extent of the procedure was suboptimal, potentially negatively affecting the survival and adequacy of pathological staging. PMID:28127445

  19. A comparison of preliminary oncologic outcome and postoperative complications between patients undergoing either open or robotic radical cystectomy.

    PubMed

    Cusano, Antonio; Haddock, Peter; Jackson, Max; Staff, Ilene; Wagner, Joseph; Meraney, Anoop

    2016-01-01

    To compare complications and outcomes in patients undergoing either open radical cystectomy (ORC) or robotic-assisted radical cystectomy (RRC). We retrospectively identified patients that underwent ORC or RRC between 2003- 2013. We statistically compared preliminary oncologic outcomes of patients for each surgical modality. 92 (43.2%) and 121 (56.8%) patients underwent ORC and RRC, respectively. While operative time was shorter for ORC patients (403 vs. 508 min; p<0.001), surgical blood loss and transfusion rates were significantly lower in RRC patients (p<0.001 and 0.006). Length of stay was not different between groups (p=0.221). There was no difference in the proportion of lymph node-positive patients between groups. However, RRC patients had a greater number of lymph nodes removed during surgery (18 vs. 11.5; p<0.001). There was no significant difference in the incidence of pre-existing comorbidities or in the Clavien distribution of complications between groups. ORC and RRC patients were followed for a median of 1.38 (0.55-2.7) and 1.40 (0.58-2.59) years, respectively (p=0.850). During this period, a lower proportion (22.3%) of RRC patients experienced disease recurrence vs. ORC patients (34.8%). However, there was no significant difference in time to recurrence between groups. While ORC was associated with a higher all-cause mortality rate (p=0.049), there was no significant difference in disease-free survival time between groups. ORC and RRC patients experience postoperative complications of similar rates and severity. However, RRC may offer indirect benefits via reduced surgical blood loss and need for transfusion. Copyright© by the International Brazilian Journal of Urology.

  20. Postoperative complications and short-term oncological outcomes of patients aged ≥80 years undergoing robot-assisted radical cystectomy.

    PubMed

    Nguyen, Daniel P; Al Hussein Al Awamlh, Bashir; Charles Osterberg, E; Chrystal, James; Flynn, Thomas; Lee, Daniel J; Scherr, Douglas S

    2015-09-01

    To assess complication rates and early oncological outcomes of patients aged ≥80 years who underwent robot-assisted radical cystectomy (RARC). A total of 368 consecutive patients underwent radical cystectomy from April 2001 to September 2013 in a tertiary referral center. Sixty-one patients aged ≥80 years underwent RARC and constitute the cohort of interest. Complications arising within 30 and 90 days of surgery were graded using the modified Clavien classification and were additionally categorized by organ system using a standardized complication reporting system. Recurrence-free survival, disease-specific survival and overall survival were calculated using Kaplan-Meier curves. Median age was 83 years (range 80-94). Twenty-nine (48 %) of all tumor specimens were stage ≥pT3. The median number of nodes removed was 19 (range 6-67). The soft tissue positive margin rate was 10 %. A total of 27 (44 %) patients had complications within 90 days, of which 9 had major complications. Two patients (3 %) died from surgical complications within 90 days. At a median follow-up of 13 months, 12 (20 %) patients had developed recurrent cancer and subsequently died from disease. An additional 13 (21 %) patients died from non-cancer-related causes. The median overall survival time was 36.0 months. At 2 years, recurrence-free, cancer-specific and overall survival rates were 73, 74 and 61 %, respectively. In patients aged ≥80 years, RARC is feasible with acceptable perioperative morbidity and favorable short-term oncological outcomes. Therefore, RARC should be considered a valid option for carefully selected patients aged ≥80 years with bladder cancer.

  1. Robot-assisted radical cystectomy with intracorporeal urinary diversion in patients with transitional cell carcinoma of the bladder.

    PubMed

    Jonsson, Martin N; Adding, L Christofer; Hosseini, Abolfazl; Schumacher, Martin C; Volz, Daniela; Nilsson, Andreas; Carlsson, Stefan; Wiklund, N Peter

    2011-11-01

    Robot-assisted radical cystectomy (RARC) may reduce morbidity after cystectomy. Descriptions of the surgical techniques of RARC with intracorporeal orthotopic neobladder or ileal conduit are sparse and oncologic and functional outcome data have not been reported. We present our technique with RARC and intracorporeal urinary diversion (neobladder or ileal conduit) and present oncologic and functional outcomes, as well as complication rates. Single-hospital institution case-series from 2004 to 2009 including 45 selected patients (38 male, 7 female) with high-grade and/or muscle-invasive urothelial cancer of the bladder. We performed RARC; pelvic lymph node dissection using three different templates; and a totally intracorporeal urinary diversion, either orthotopic neobladder (n=36) or ileal conduit (n=9). Perioperative variables, pathology data, early and late complication rates, urinary continence, potency, and cancer-specific survival were evaluated as outcome measures. Median patient age, operative time, estimated blood loss, and lymph node yield were 62 yr (range: 37-79), 477 min (range: 325-760), 550 ml (range: 200-2200), and 19 (range: 10-52), respectively. Nine patients were diagnosed with positive lymph nodes. Surgical margins were clear in all but one patient. Early complications occurred in 18 patients (40%). Median postoperative stay was 9 d (range: 4-78), and median postoperative follow-up time was 25 mo. Four patients died due to metastatic disease. The study is limited by a relative small sample size and no comparative group. RARC with totally intracorporeal urinary diversion is technically feasible with good intermediate-term oncologic results. This is a nonrandomised study including a limited number of patients with a restricted follow-up time, however, and so precautions must be considered when interpreting the outcomes. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  2. The Padua Inventory: Do Revisions Need Revision?

    ERIC Educational Resources Information Center

    Gonner, Sascha; Ecker, Willi; Leonhart, Rainer

    2010-01-01

    The purpose of the present study was to examine the psychometric properties, factorial structure, and validity of the Padua Inventory-Washington State University Revision and of the Padua Inventory-Revised in a large sample of patients with obsessive-compulsive disorder (n = 228) and with anxiety disorders and/or depression (n = 213). The…

  3. The Padua Inventory: Do Revisions Need Revision?

    ERIC Educational Resources Information Center

    Gonner, Sascha; Ecker, Willi; Leonhart, Rainer

    2010-01-01

    The purpose of the present study was to examine the psychometric properties, factorial structure, and validity of the Padua Inventory-Washington State University Revision and of the Padua Inventory-Revised in a large sample of patients with obsessive-compulsive disorder (n = 228) and with anxiety disorders and/or depression (n = 213). The…

  4. Efficacy and Safety of Stroke Volume Variation-Guided Fluid Therapy for Reducing Blood Loss and Transfusion Requirements During Radical Cystectomy: A Randomized Clinical Trial.

    PubMed

    Kong, Yu-Gyeong; Kim, Ji Yoon; Yu, Jihion; Lim, Jinwook; Hwang, Jai-Hyun; Kim, Young-Kug

    2016-05-01

    Radical cystectomy, which is performed to treat muscle-invasive bladder tumors, is among the most difficult urological surgical procedures and puts patients at risk of intraoperative blood loss and transfusion. Fluid management via stroke volume variation (SVV) is associated with reduced intraoperative blood loss. Therefore, we evaluated the efficacy and safety of SVV-guided fluid therapy for reducing blood loss and transfusion requirements in patients undergoing radical cystectomy.This study included 48 patients who underwent radical cystectomy, and these patients were randomly allocated to the control group and maintained at <10% SVV (n = 24) or allocated to the trial group and maintained at 10% to 20% SVV (n = 24). The primary endpoints were comparisons of the amounts of intraoperative blood loss and transfused red blood cells (RBCs) between the control and trial groups during radical cystectomy. Intraoperative blood loss was evaluated through the estimated blood loss and estimated red cell mass loss. The secondary endpoints were comparisons of the postoperative outcomes between groups.A total of 46 patients were included in the final analysis: 23 patients in the control group and 23 patients in the trial group. The SVV values in the trial group were significantly higher than in the control group. Estimated blood loss, estimated red cell mass loss, and RBC transfusion requirements in the trial group were significantly lower than in the control group (734.3 ± 321.5 mL vs 1096.5 ± 623.9 mL, P = 0.019; 274.1 ± 207.8 mL vs 553.1 ± 298.7 mL, P <0.001; 0.5 ± 0.8 units vs 1.9 ± 2.2 units, P = 0.005). There were no significant differences in postoperative outcomes between the two groups.SVV-guided fluid therapy (SVV maintained at 10%-20%) can reduce blood loss and transfusion requirements in patients undergoing radical cystectomy without resulting in adverse outcomes. These findings provide useful information for

  5. Rationale and early experience with prophylactic placement of mesh to prevent parastomal hernia formation after ileal conduit urinary diversion and cystectomy for bladder cancer

    PubMed Central

    Donahue, Timothy F.; Cha, Eugene K.; Bochner, Bernard H.

    2016-01-01

    Parastomal hernias represent a clinically significant problem for many patients after radical cystectomy and ileal conduit diversion. The prevalence may be as high as 60% and in some series, up to 30% of patients require surgical intervention due to the complications of pain, poor fit of an ostomy appliance, leakage, urinary obstruction, and bowel obstruction or strangulation. Due to the potential morbidity associated with PH repair, there have been efforts to prevent PH development at the time of the index surgery. Four randomized trials of prophylactic mesh placement at the time of colostomy and ileostomy stoma formation have demonstrated significant reductions in PH rates with acceptably low complication rates. In this review, we describe the clinical and radiographic definitions of PH, the clinical impact and risk factors behind its development, and the rationale behind prophylactic mesh placement for patients undergoing ileal conduit urinary diversion. Additionally, we report our experience with prophylactic mesh placed at radical cystectomy at our institution. PMID:26757903

  6. The role of surgical margins in treatment of Ewing's sarcoma family tumors: Experience of a single institution with 512 patients treated with adjuvant and neoadjuvant chemotherapy

    SciTech Connect

    Bacci, Gaetano . E-mail: gaetano.bacci@ior.it; Longhi, Alessandra; Briccoli, Antonio; Bertoni, Franco; Versari, Michela; Picci, Piero

    2006-07-01

    Purpose: To evaluate the importance of surgical margins for local and systemic control of Ewing's sarcoma family tumors (ESFT). Methods and Materials: Between 1979 and 1999, 512 patients with ESFTs entered 4 different adjuvant and neoadjuvant studies performed at a single institution. Of these patients, 335 were treated with surgery alone (196) or surgery followed by radiotherapy at doses of 44.8 Gy (139). We compared their outcome with that of the 177 patients who were locally treated by radiotherapy at 60 Gy. Results: Local control (88.8% vs. 80.2%, p < 0.009) and 5-year disease-free survival (63.8% vs. 47.6%, p < 0.0007) were significantly better in patients treated with surgery and, among them, in those with adequate surgical margins (96.6% vs. 71,7%, p < 0.0008, and 69.6% vs. 46.3%, p < 0.0002). Nonetheless, better results were observed only in extremity tumors. Conclusions: Surgery is better than radiotherapy in cases of extremity ESFT with achievable adequate surgical margins, and in cases of inadequate surgical margins, adjuvant reduced-dose radiotherapy is ineffective. Therefore, when inadequate margins are expected, patients are better treated with full-dose radiotherapy from the start.

  7. Semi-radical chemoradiotherapy for 53 esophageal squamous cell carcinomas with supraclavicular lymph node metastasis in a single institutional retrospective study.

    PubMed

    Yamashita, Mami; Takenaka, Hideomi Yamashita Ryousuke; Nakagawa, Keiichi

    2014-10-01

    Outcomes were examined for the cases that received radiotherapy (RT) for esophageal cancer with metastasis to supraclavicular lymph nodes (ScLN) in a single institutional retrospective study. Cases examined were 53 consecutive patients with pathologically confirmed esophageal cancer enrolled from our institution who received semi-radical RT from 2001 to 2013. Radiotherapy consisted of a total dose of from 50-50.4 Gy given in 25-28 fractions of 1.8-2.0 Gy with five fractions per week. The chemotherapy regimen included nedaplatin and 5-fluorouracil. All had ScLN metastasis, and all diseases were included in the RT field. The median follow up time was 42 months for survival patients. Overall survival (OS) and progression free survival (PFS) for 1-, 2-, and 3 years were 39%, 19%, and 12% and 14%, 9%, and 6%, respectively. Acute grade 3-5 esophagitis and neutropenia was seen in 11% and 81%, respectively. Late grade 3-5 toxicity in esophagus, lung, and heart was seen in 4%, 0%, and 0%. Five patients (9%) survived more than 4 year. Although the 2-year PFS was less than 10% and very poor, long term survival for over 4 year was seen in 9% cases. In other words, despite the poor results, the fact remains that some patients were cured with CRT.

  8. Factors Predictive of Improved Survival in Patients With Brain Metastases From Gynecologic Cancer: A Single Institution Retrospective Study of 47 Cases and Review of the Literature.

    PubMed

    Gressel, Gregory M; Lundsberg, Lisbet S; Altwerger, Gary; Katchi, Tasleem; Azodi, Masoud; Schwartz, Peter E; Ratner, Elena S; Damast, Shari

    2015-11-01

    The reported incidence of brain metastasis from epithelial ovarian cancer (EOC), endometrial cancer (EC), and cervical cancer (CC) is exceedingly rare. As the long-term survival for patients with gynecologic cancer increases, there has been a corresponding increase in the number of diagnosed intracranial metastases. We seek to report our experience with managing brain metastatic disease (BMD) in patients with gynecologic cancer. A retrospective review of all patients with EOC, EC, and CC at our institution revealed 47 patients with concurrent BMD between 2000 and 2013. Demographic data, risk factors, treatment modalities, progression-free data, and overall survival data were collected. Median survival time in patients with brain metastasis from EOC, EC, and CC was 9.0, 4.5, and 3.0 months, respectively. Two-year overall survival rates were 31.6%, 13.6%, and 0%, respectively. Patients received surgery, radiation therapy alone, palliative care, or radiation plus surgery. Radiation combined with surgical resection resulted in a significant hazards ratio of 0.36 (95% confidence interval, 0.15-0.86), compared with radiation alone. Our report provides a large single-institution experience of brain metastases from gynecologic cancer. Patients with BMD have poor prognoses; however, treatment with multimodal therapy including surgical resection and radiation may prolong overall survival.

  9. Reduction of infection-related mortality after allogeneic PBSCT from HLA-identical siblings: longitudinal analysis from 1994 to 2008 at a single institution.

    PubMed

    Martino, R; Kerguelen, A; Valcárcel, D; Sureda, A; Fachini, L; Piñana, J L; Briones, J; Delgado, J; Brunet, S; Sierra, J

    2011-05-01

    Infection-related mortality (IRM) is responsible for a major proportion of all cases of non-relapse mortality (NRM) after allogeneic PBSCT (alloPBSCT). We analyzed 580 consecutive adults who received a first alloPBSCT from an HLA-identical sibling from 1994 to 2008 at a single institution to describe the severe infections and report the incidence, causes and risk factors for IRM and NRM. Both IRM and NRM decreased with time; within the period of 1994-2000, the 2-year incidence of IRM and NRM was 22 and 31%, respectively, vs 11 and 16% within the period of 2001-2008 (P<0.05 for both comparisons). In multivariate analysis, the variables that increased IRM were within the earlier period of 1994-2000 (P<0.01), poor performance status (P<0.01), grade II-IV acute GVHD (P<0.001) and invasive fungal infection (IFI) (P<0.001) or CMV disease (P<0.001) after transplant. With respect to NRM, earlier time period was also identified as a risk factor (P<0.001), as well as IFIs (P<0.001) and CMV disease (P<0.001). The intensity of the conditioning regimen had no effect on IRM and NRM. These results showed a significant reduction in IRM and NRM over a period of 15 years. The development of IFIs and CMV disease continue to have an impact on NRM.

  10. Could ICG-aided robotic cholecystectomy reduce the rate of open conversion reported with laparoscopic approach? A head to head comparison of the largest single institution studies.

    PubMed

    Gangemi, A; Danilkowicz, R; Elli, F E; Bianco, F; Masrur, M; Giulianotti, P C

    2017-03-01

    Comparative studies between robotic and laparoscopic cholecystectomy (LC) focus heavily on economic considerations under the assumption of comparable clinical outcomes. Advancement of the robotic technique and the further widespread use of this approach suggest a need for newer comparison studies. 676 ICG-aided robotic cholecystectomies (ICG-aided RC) performed at the University of Illinois at Chicago (UIC) Division of General, Minimally Invasive and Robotic Surgery were compiled retrospectively. Additionally, 289 LC were similarly obtained. Data were compared to the largest single institution LC data sets from within the US and abroad. Statistically significant variations were found between UIC-RC and UIC-LC in minor biliary injuries (p = 0.049), overall open conversion (p ≤ 0.001), open conversion in the acute setting (p = 0.002), and mean blood loss (p < 0.001). UIC-RC open conversions were also significantly lower than Greenville Health System LC (p ≤ 0.001). Additionally, UIC ICG-RC resulted in the lowest percentages of major biliary injuries (0 %) and highest percentage of biliary anomalies identified (2.07 %). ICG-aided cholangiography and the technical advantages associated with the robotic platform may significantly decrease the rate of open conversion in both the acute and non-acute setting. The sample size discrepancy and the non-randomized nature of our study do not allow for drawing definitive conclusions.

  11. Validation of the Effectiveness and Safety of Temozolomide during and after Radiotherapy for Newly Diagnosed Glioblastomas: 10-year Experience of a Single Institution.

    PubMed

    Joo, Jin-Deok; Kim, Hansol; Kim, Young-Hoon; Han, Jung Ho; Kim, Chae-Yong

    2015-11-01

    This study was performed to validate the effectiveness and safety of concurrent chemoradiotherapy and adjuvant therapy with temozolomide for newly diagnosed glioblastoma multiforme as a standard treatment protocol. Between 2004 and 2011, patients newly diagnosed with glioblastoma who were treated with temozolomide during concurrent chemoradiotherapy and adjuvant chemotherapy were included from a single institution and analyzed retrospectively. The primary endpoint was overall survival, and the secondary endpoints were progression-free survival, response, and safety. A total of 71 patients were enrolled in this study. The response rate was 41% (29/71), and the tumor control rate was 80% (57/71). In the 67 patients who completed the concurrent chemoradiotherapy with temozolomide, the median overall survival was 19 months and the 1- and 2-yr overall survival rates were 78.3% and 41.7%, respectively. The median progression free survival was 9 months, and the 1- and 2-yr progression free survival rates were 33.8% and 14.3%, respectively. The mean duration of survival after progression of disease in salvage treatment group was 11.9 (1.3-53.2) months. Concurrent chemoradiotherapy with temozolomide resulted in grade 3 or 4 hematologic toxic effects in 2.8% of the patients. The current protocol of temozolomide during and after radiation therapy is both effective and safe and is still appropriate as the standard protocol for treatment of glioblastoma. An active salvage treatment might be required for a better prognosis.

  12. Single-Institution Financial Analysis of Biologic Versus Synthetic Mesh Hernia Repair: A Retrospective Analysis of Patients Readmitted for Hernia Repair.

    PubMed

    Otake, Leo R; Satterwhite, Thomas; Echo, Anthony; Chiou, Grace; Lee, Gordon K

    2013-07-11

    The advent and proliferation of commercially available biologic mesh material has expanded the repertoire of hernia repair materials available to the surgeon. Given the higher initial cost of these mesh materials relative to synthetic materials such as polypropylene, there has been debate regarding the purported benefit of the use of biologic mesh. This study is a single-institution review of complex hernia repairs using both biologic and synthetic mesh materials. The patients included in the analyses were admitted to the institution at least twice for management of hernia; this permitted specific evaluation of a given diagnosis, hernia, in the same patient, but at different points in time. In a subset of patients, hernia repair was performed upon the second admission with conversion from biologic or synthetic mesh, which had been placed at the initial repair. The objective of this study was to evaluate the financial implications of mesh choice. Specific parameters reviewed included type of mesh used, total costs of hospitalization, direct cost associated with the hernia repair, total collections, and percentage of collections relative to total charges. Through such analysis, our aim was to determine whether there were any variances in revenue and costs associated with the application of either mesh material or the associated clinical scenarios.

  13. EGFR mutation testing on cytological and histological samples in non-small cell lung cancer: a Polish, single institution study and systematic review of European incidence.

    PubMed

    Szumera-Ciećkiewicz, Anna; Olszewski, Włodzimierz T; Tysarowski, Andrzej; Kowalski, Dariusz M; Głogowski, Maciej; Krzakowski, Maciej; Siedlecki, Janusz A; Wągrodzki, Michał; Prochorec-Sobieszek, Monika

    2013-01-01

    The targeted treatment of advanced non-small-cell lung cancer (NSCLC) depends on confirmation of activating somatic EGFR mutation. The aim of the study was to evaluate the incidence of EGFR mutations in NSCLC detected in cytological and histological material and present literature review on European EGFR mutation incidence. 273 patients with confirmed NSCLC were entered into the study: 189 histological, paraffin-embedded materials, 12 fresh and 72 fixed cytological specimens. DNA was extracted from both types of material and the EGFR mutation in exons 18-21 was analyzed by direct sequencing. In addition the EGFR gene copy number in cases with sufficient histological material (110 patients) was evaluated by fluorescent in situ hybridization (FISH) technique. The percentage of EGFR somatic mutations was 10.62%. FISH positive results (amplification or high polysomy of EGFR gene) were identified in 33 patients (30.0%). The strongest clinicopathological correlation with the EGFR mutation was found for histological type (adenocarcinoma; p < 0.01), gender (females; p < 0.01) and FISH positive result (p < 0.05). This is the first, single institution study that estimates the EGFR mutation incidence in the Polish population. Cytological material recovered from fixed preparations and stained with hematoxylin and eosin showed DNA quality comparable to fresh tumor cells and histological samples.

  14. Antifungal susceptibility, serotyping, and genotyping of clinical Cryptococcus neoformans isolates collected during 18 years in a single institution in Madrid, Spain.

    PubMed

    Guinea, Jesús; Hagen, Ferry; Peláez, Teresa; Boekhout, Teun; Tahoune, Hicham; Torres-Narbona, Marta; Bouza, Emilio

    2010-11-01

    We studied the serotypes, mating-types, AFLP genotypes, and antifungal susceptibility of 58 Cryptococcus neoformans strains causing 56 episodes of cryptococcosis in 55 patients over an 18-year period in a single institution. The underlying conditions of the patients were classified as HIV infection (n = 48) or non-HIV-related immunodeficiency (n = 7). Serotype A (n = 34; 58.9%) predominated, but serotype AD was involved in 23.2% of episodes. Most of the episodes were caused by mating-type α (n = 41; 73.2%) or α/a strains (n = 12; 21.5%). The most common genotype was AFLP1 (n = 26; 44.8%), followed by AFLP3 (n = 21; 36.2%), and AFLP2 (n = 11; 19.0%). In two different patients, we showed the coexistence of different serotypes and/or genotypes in the same episode (AFLP1 and 3). The new triazoles voriconazole, posaconazole and isavuconazole showed high and similar antifungal activity (MICs ≤ 0.125 μg/ml). Fluconazole also had good antifungal activity, but two strains from patients with HIV-infections had an MIC of 16 μg/ml (3.4%). However, these two isolates remained very susceptible to the new triazoles (MICs ≤ 0.062 μg/ml). The remaining strains always showed MICs ≤ 8 μg/ml.

  15. Opioid prescribing patterns after Mohs micrographic surgery and standard excision: a survey of American Society for Dermatologic Surgery members and a chart review at a single institution.

    PubMed

    Harris, Kalynne; Calder, Scott; Larsen, Brooke; Duffy, Keith; Bowen, Glen; Tristani-Firouzi, Payam; Hadley, Michael; Endo, Justin

    2014-08-01

    Little is known about postoperative opioid prescribing patterns among dermatologic surgeons. To better understand postoperative opioid prescribing patterns among dermatologic surgeons in the United States. Two-part analysis consisting of a retrospective chart review of 233 dermatologic surgery patients at a single institution and an e-mail survey of American Society for Dermatologic Surgery (ASDS) members. (1) Retrospective review: 35% (82/233) of the patients received an opioid prescription. Larger defect size, repair of the defect, perioral and nasal site, and surgeon A or B performing surgery predicted opioid prescription. (2) E-mail survey: 556 ASDS members practicing within the United States responded. Sixty-four percent (357/556) reported prescribing opioids after ≤10% of cases. Surgeons younger than 55 years old, male surgeons, and surgeons in the southern and western United States were more likely to prescribe opioids after >10% of cases. Seventy-six percent (397/520) believed patients used ≤50% of the opioid pills prescribed. The retrospective review suggests that opioid prescribing is predicted by characteristics of the surgery (i.e., size, defect repair type, and anatomic location) and characteristics of the surgeon (i.e., age, sex, and practice location) with significant heterogeneity in prescribing habits. The national survey results raise the possibility that patients might not take all prescribed opioid pills after dermatologic surgery. Further investigation is warranted to determine how patients are actually using prescription pain pills to balance pain control with patient safety.

  16. A single-institution, 20-year prospective experience with an affordable Fc-receptor blockade method to treat patients with chronic, refractory autoimmune thrombocytopenic purpura.

    PubMed

    Estrada-Gómez, Roberto; Vargas-Castro, Olga; Oropeza-Borges, Mabel; González-Carrillo, Martha L; Pérez-Romano, Beatriz; Ruiz-Argüelles, Guillermo J

    2007-01-01

    In a 20-year period in a single institution, 34 patients with chronic, refractory autoimmune thrombocytopenic purpura were prospectively treated with ex vivo anti-D opsonized autologous red blood cells. All patients had received previous treatment with steroids and/or immunosuppressive agents, and 11 had been splenectomized. Twenty one patients had an increase in the platelet count; in five cases, the increase was more than 50 x 10(9)/L platelets and in 16 the increase was more than 100 x 10(9)/L platelets. Early responses were observed in 20 patients and late responses in seven, whereas seven patients (20%) did not respond at all. Nine of the 20 individuals who achieved an ER had a subsequent drop in the platelet count; however, only three had a drop below 50 x 10(9)/L. When last censored, of the 34 patients, 24 (70%) had a platelet count above 50 x 10(9)/L. The 84-month thrombocytopenia-free (over 50 x 10(9)/L platelets) status of the whole group is 70%, whereas the 84-month complete remission (over 100 x 10(9)/L platelets) status of the whole group is 50%. It is concluded that the use of ex vivo anti-D opsonized red blood cells may represent another, substantially cheaper treatment of patients with chronic, refractory, autoimmune thrombocytopenic purpura.

  17. Laparo-endoscopic single-site radical cystectomy with orthotopic urinary diversion: Technique, feasibility, and the 3-year follow-up.

    PubMed

    Abdallah, Ahmed; Abdel-Hakiem, Mahmoud; El-Feel, Ahmed

    2014-09-01

    To assess the feasibility, operative morbidity and oncological outcome of laparoendoscopic single-site (LESS) radical cystectomy. Ten patients with clinical stage T1-T2 bladder cancer underwent a LESS radical cystectomy. The mean (SD) age of the patients was 64.8 (8.6) years and their mean body mass index was 25.9 (2.7) kg/m(2). The procedure was done via a single-incision laparoscopic surgery port using a rigid 5-mm 30° long-shaft laparoscope in addition to the two working instruments. A 7-cm Pfannenstiel incision was made to remove the specimens and to allow the creation of an ileal neobladder with hand assistance. In eight patients the LESS radical cystectomy was completed as scheduled, with the other two requiring a conversion, one to an open procedure due to locally advanced disease, and the other to conventional laparoscopy due to gas leakage. The mean (SD) operative duration was 236 (49) min, with a mean estimated blood loss of 575 (113) mL, and a mean hospital stay of 5.5 (0.7) days. No postoperative analgesic medications were prescribed and patients returned to normal activity after a mean (SD) of 17.6 (2.6) days. The pathological examination showed negative surgical margins for the bladder specimens, with a mean (SD) of 14 (1.9) lymph nodes retrieved. Seven patients were cancer-free within a mean (SD, range) follow-up of 37 (6, 29-44) months. LESS radical cystectomy is technically feasible, with a favourable course and convalescence, and it has an acceptable oncological outcome.

  18. [Assessing the effect of subcuticular buried sutures with subcutaneous closed suction drain to prevent surgical site infection in patients undergoing total cystectomy with urinary diversion using intestine].

    PubMed

    Kanamaru, Sojun; Tsuchihashi, Kazunari; Makino, Yuki; Shimizu, Yosuke; Ito, Noriyuki

    2014-11-01

    We assessed the effect of subcuticular buried sutures with subcutaneous closed suction drain to prevent surgical site infection (SSI) in patients undergoing total cystectomy with urinary diversion using the intestine. We reviewed the clinical charts of 43 consecutive patients who underwent total cystectomy with urinary diversion using the intestine from February 2006 to March 2011 at Nishi-Kobe Medical Center. All patients received intravenous prophylactic antibiotics before and throughout surgery as well as for three days after surgery. Skin closure was performed with interrupted vertical mattress sutures with 2-0 nylon on the first 22 patients (mattress group), and with interrupted subcuticular buried sutures with 4-0 absorbable monofilament with subcutaneous closed suction drain on the remaining 21 patients (subcuticular buried suture with subcutaneous drain; SBD group). SSI occurred in 7 (31.8%) patients in the mattress group, but did not affect any patient in the SBD group. We compared risk factors for SSI between the groups, and found that the method of skin closure was significant risk factor for SSI (P = 0.005). We concluded that interrupted subcuticular buried sutures with 4-0 absorbable monofilament with subcutaneous suction drain is effective for prevention of SSI in total cystectomy with urinary diversion using the intestine.

  19. Use of liposuction for secondary revision of irradiated and nonirradiated free flaps.

    PubMed

    Bui, Duc T; Mehrara, Babak J; Disa, Joseph J; Cordeiro, Peter G

    2004-06-01

    A number of patients with free tissue transfer require secondary revision to improve contour and regional definition to maximize function or appearance. However, there is controversy with regard to whether irradiated free flaps can be revised safely using liposuction. The purpose of this study was to compare the outcomes of revisionary procedures requiring liposuction in irradiated versus nonirradiated flaps. From December 1992 to July 2001, office and hospital records were reviewed retrospectively to identify patients who had undergone free tissue transfer and subsequent flap revision at a single institution. The number of revisions, amount of fat aspirated, timing of revision and the postoperative complications including infection, hematoma, wound dehiscence, and flap loss were reviewed. A total of 41 flap revisions using liposuction alone or with direct excision were performed on 33 free flaps (31 head and neck, 1 chest wall, and 1 extremity). The rectus musculocutaneous flap was the most commonly revised (88%). The average length of time to secondary revision of patients who had received postoperative radiotherapy to their flaps was significantly higher that those whose flaps had not been irradiated (P < 0.05). There were no postoperative complications except for 1 partial (20%) flap loss in a patient whose flap was irradiated. The difference in complication rates between the irradiated and nonirradiated group was not statistically significant. Secondary free flap revision using liposuction and direct excision is a safe technique for recontouring free flaps. There was no significant difference in complication rates for irradiated and nonirradiated flaps. Postoperative radiation therapy is therefore not a contraindication to secondary revision. However, these procedures should be delayed for several months after the acute effects of radiation have resolved.

  20. Robot-assisted Versus Open Radical Cystectomy in Patients Receiving Perioperative Chemotherapy for Muscle-invasive Bladder Cancer: The Oncologist's Perspective from a Multicentre Study.

    PubMed

    Necchi, Andrea; Pond, Gregory R; Smaldone, Marc C; Pal, Sumanta K; Chan, Kevin; Wong, Yu-Ning; Viterbo, Rosalia; Sonpavde, Guru; Harshman, Lauren C; Crabb, Simon; Alva, Ajjai; Chowdhury, Simon; De Giorgi, Ugo; Srinivas, Sandy; Agarwal, Neeraj; Bamias, Aristotelis; Baniel, Jack; Golshayan, Ali-Reza; Ladoire, Sylvain; Sternberg, Cora N; Cerbone, Linda; Yu, Evan Y; Bellmunt, Joaquim; Vaishampayan, Ulka; Niegisch, Gunter; Hussain, Syed; Bowles, Daniel W; Morales-Barrera, Rafael; Milowsky, Matthew I; Theodore, Christine; Berthold, Dominik R; Sridhar, Srikala S; Powles, Thomas; Rosenberg, Jonathan E; Galsky, Matthew D

    2017-03-31

    Little is known about the outcomes of robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) combined with perioperative chemotherapy for muscle-invasive urothelial bladder cancer (UBC). To evaluate surgical and oncological outcomes for RARC and ORC in multimodal treatment. Data from 28 centres were collected for cystectomies performed between January 2000 and July 2013. RARC or ORC combined with perioperative chemotherapy for UBC. Fisher's exact tests, χ(2) tests, and Wilcoxon rank-sum tests were used to compare the RARC and ORC groups. Logistic and Cox regression analyses were performed to evaluate potential prognostic factors. A total of 688 patients (n=603 ORC and n=85 RARC) were analysed; 60.6% received neoadjuvant chemotherapy, and 45.1% adjuvant chemotherapy. No significant differences in baseline characteristics were found between the groups. The median time from surgery to adjuvant chemotherapy was 1.9 mo for both RARC and ORC groups. The median number of lymph nodes removed was 21 (interquartile range [IQR] 14-35) for RARC and 13 (IQR 8-21) for ORC (p<0.001); the results were confirmed in subgroup analyses. Multivariable analyses revealed no difference in the rate of positive surgical margins (p=0.54 and p=0.78), rate of neobladder diversion (p=0.33 and p=0.51), relapse-free survival (p=0.31 and p=0.23), and overall survival (p=0.63 and p=0.69). The retrospective nature of the data is the major limitation. In this study, no differences in efficacy outcomes or ability to deliver adjuvant chemotherapy were observed between RARC and ORC. The increasing use of RARC is justifiable from an oncological viewpoint. In a retrospective study of patients who received perioperative chemotherapy for urothelial bladder cancer, we found no difference in key outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy. Performing RARC seems to be justifiable in the multidisciplinary setting. Copyright © 2017 European

  1. p53, p21, pRB, and p16 expression predict clinical outcome in cystectomy with bladder cancer.

    PubMed

    Shariat, Shahrokh F; Tokunaga, Hideo; Zhou, JainHua; Kim, JaHong; Ayala, Gustavo E; Benedict, William F; Lerner, Seth P

    2004-03-15

    To determine whether p53, p21, pRB, and/or p16 expression is associated with bladder cancer stage, progression, and prognosis. Immunohistochemical staining for p53, p21, pRB, and p16 was carried out on serial sections from archival specimens of 80 patients who underwent bilateral pelvic lymphadenectomy and radical cystectomy for bladder cancer (median follow-up, 101 months). p53, p21, and pRB or p16 expression was altered in 45 (56%), 39 (49%), and 43 (54%) tumors, respectively. Sixty-six patients (83%) had at least one marker altered, and 21 patients (26%) had all three altered. Abnormal expressions of p53, p21, and pRB/p16 expression were associated with muscle-invasive disease (P=.007, P=.003, and P=.003, respectively). The alteration of each marker was independently associated with disease progression (P< or =.038) and disease-specific survival (P< or =.039). In multivariable models that included standard pathologic features and p53 with p21 or p53 with pRB/p16, only p53 and lymph node metastases were associated with bladder cancer progression (P< or =.026) and death (P< or =.028). In models that included p21 and pRB/p16, only p21 and lymph node metastases were associated with bladder cancer progression (P< or =.022) and death (P< or =.028). In a model that included the combined variables p53/p21 and pRB/p16, only p53/p21 and lymph node status were associated with bladder cancer progression (P< or =.047) and death (P< or =.036). The incremental number of altered markers was independently associated with an increased risk of bladder cancer progression (P=.005) and mortality (P=.007). Although altered expression of each of the four cell cycle regulators is associated with bladder cancer outcome in patients undergoing radical cystectomy, p53 is the strongest predictor, followed by p21, suggesting a more pivotal role of the p53/p21 pathway in bladder cancer progression.

  2. Best practices in robot-assisted radical cystectomy and urinary reconstruction: recommendations of the Pasadena Consensus Panel.

    PubMed

    Wilson, Timothy G; Guru, Khurshid; Rosen, Raymond C; Wiklund, Peter; Annerstedt, Magnus; Bochner, Bernard H; Chan, Kevin G; Montorsi, Francesco; Mottrie, Alexandre; Murphy, Declan; Novara, Giacomo; Peabody, James O; Palou Redorta, Joan; Skinner, Eila C; Thalmann, George; Stenzl, Arnulf; Yuh, Bertram; Catto, James

    2015-03-01

    Robot-assisted surgery is increasingly used for radical cystectomy (RC) and urinary reconstruction. Sufficient data have accumulated to allow evidence-based consensus on key issues such as perioperative management, comparative effectiveness on surgical complications, and oncologic short- to midterm outcomes. A 2-d conference of experts on RC and urinary reconstruction was organized in Pasadena, California, and the City of Hope Cancer Center in Duarte, California, to systematically review existing peer-reviewed literature on robot-assisted RC (RARC), extended lymphadenectomy, and urinary reconstruction. No commercial support was obtained for the conference. A systematic review of the literature was performed in agreement with the PRISMA statement. Systematic literature reviews and individual presentations were discussed, and consensus on all key issues was obtained. Most operative, intermediate-term oncologic, functional, and complication outcomes are similar between open RC (ORC) and RARC. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC generally requires longer operative time than ORC, particularly with intracorporeal reconstruction. Robotic assistance provides ergonomic value for surgeons. Surgeon experience and institutional volume strongly predict favorable outcomes for either open or robotic techniques. RARC appears to be similar to ORC in terms of operative, pathologic, intermediate-term oncologic, complication, and most functional outcomes. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC can be more expensive than ORC, although high procedural volume may attenuate this difference. Robot-assisted radical cystectomy (RARC) is an alternative to open surgery for patients with bladder cancer who require removal of their bladder and reconstruction of their urinary tract. RARC appears to be similar to open surgery for most important outcomes such as the rate of

  3. Long-term outcomes of 1326 laparoscopic incisional and ventral hernia repair with the routine suturing concept: a single institution experience.

    PubMed

    Chelala, E; Baraké, H; Estievenart, J; Dessily, M; Charara, F; Allé, J L

    2016-02-01

    This retrospective chart analysis reports and assesses the long-term (beyond 10 years) safety and efficiency of a single institution's experience in 1326 laparoscopic incisional and ventral hernia repairs (LIVHR), defending the principle of the suturing defect (augmentation repair concept) prior to laparoscopic reinforcement with a composite mesh (IPOM Plus). This study aims to prove the feasibility and validity of IPOM Plus repair, among other concepts, as a well-justified treatment of incisional or ventral hernias, rendering a good long-term outcome result. A single institution's systematic retrospective review of 1326 LIVHR was conducted between the years 2000 and 2014. A standardized technique of routine closure of the defect prior to the intraperitoneal onlay mesh (IPOM) reinforcement was performed in all patients. The standardized technique of "defect closure" by laparoscopy approximating the linea alba under physiological tension was assigned by either the transparietal U reverse interrupted stitches or the extracorporeal closure in larger defects. All patients benefited from the implant Parietex composite mesh through an Intraperitoneal Onlay Mesh placement with transfacial suturing. LIVHR was performed on 1326 patients, 52.57% female and 47.43% male. The majority of our patients were young (mean age 52.19 years) and obese (average BMI 32.57 kg/m2). The mean operating time was 70 min and hospital stay 2 days, with a mean follow-up of 78 months. On the overall early complications of 5.78%, we achieved over time the elimination of the dead space by routine closure of the defect, thus reducing seroma formation to 2.56%, with a low risk of infection <1%. Post-op sepsis occurred in only nine cases. Three secondary serosal breakdowns and two late perforations were re-operated, and three diabetic patients had infected hematomas, necessitating mesh removal. Through technical improvement in the suturing concept and our growing experience, we managed to reduce the

  4. A contemporary, single-institutional experience of surgical versus expectant management of congenital heart disease in trisomy 13 and 18 patients.

    PubMed

    Costello, John P; Weiderhold, Allison; Louis, Clauden; Shaughnessy, Conner; Peer, Syed M; Zurakowski, David; Jonas, Richard A; Nath, Dilip S

    2015-06-01

    The objective of this study was to examine a large institutional experience of patients with trisomy 13 and trisomy 18 in the setting of comorbid congenital heart disease and present the outcomes of surgical versus expectant management. It is a retrospective single-institution cohort study. Institutional review board approved this study. Thirteen consecutive trisomy 18 patients and three consecutive trisomy 13 patients (sixteen patients in total) with comorbid congenital heart disease who were evaluated by our institution's Division of Cardiovascular Surgery between January 2008 and December 2013 were included in the study. The primary outcome measures evaluated were operative mortality (for patients who received surgical management), overall mortality (for patients who received expectant management), and total length of survival during follow-up. Of the thirteen trisomy 18 patients, seven underwent surgical management and six received expectant management. With surgical management, operative mortality was 29 %, and 80 % of patients were alive after a median follow-up of 116 days. With expectant management, 50 % of patients died before hospital discharge. Of the three patients with trisomy 13, one patient underwent surgical management and two received expectant management. The patient who received surgical management with complete repair was alive at last follow-up over 2 years after surgery; both patients managed expectantly died before hospital discharge. Trisomy 13 and trisomy 18 patients with comorbid congenital heart disease can undergo successful cardiac surgical intervention. In this population, we advocate that nearly all patients with cardiovascular indications for operative congenital heart disease intervention should be offered complete surgical repair over palliative approaches for moderately complex congenital cardiac anomalies.

  5. Current Trends in Regional Therapy for Melanoma: Lessons Learned from 225 Regional Chemotherapy Treatments between 1995 and 2010 at a Single Institution

    PubMed Central

    Raymond, Amanda K; Beasley, Georgia M; Broadwater, Gloria; Augustine, Christina K; Padussis, James C; Turley, Ryan; Peterson, Bercedis; Seigler, Hilliard; Pruitt, Scott K; Tyler, Douglas S

    2011-01-01

    Background Hyperthermic isolated limb perfusion (HILP) and isolated limb infusion (ILI) are utilized to manage advanced extremity melanoma but no consensus exists as to which treatment is preferable and how to monitor patients post-treatment. Study Design Using a prospectively-maintained database, we reviewed our experience with melphalan based HILP (that included 62 first time and 10 second time) and ILI (that included 126 first time and 18 second time) procedures performed in 188 patients. PET/CT was obtained 3 months post regional treatment for one year and then every 6 months thereafter. Results The overall response rate (complete response (CR) + partial response (PR)) of HILP was 81% (80% CI: 73-87%) while the overall response rate from ILI was 43% (80% CI: 37-49%) for first time procedures only. HILP had a CR rate of 55% with a median duration of 32 months, while ILI had a CR rate of 30% with median duration of 24 months. Patients who experienced a regional recurrence after initial regional treatment were more likely to achieve a CR following repeat HILP (50%, n = 10) compared to repeat ILI (28%, n = 18). Although the spectrum of toxicity was similar for ILI and HILP, the likelihood of rare catastrophic complication of limb loss was greater with HILP (2/62) than ILI (0/122). PET/CT was effective for surveillance after regional therapy to identify regional nodal and pulmonary disease that was not clinically evident, but often amenable to surgical resection (25/49, 51% of cases). In contrast, PET/CT was not effective at predicting complete response to treatment with an accuracy of only 50%. Conclusions In the largest single institution regional therapy series reported to date, we found that while ILI is effective, and well-tolerated, HILP is a more definitive way to control advanced disease. PMID:21493111

  6. Patients come from populations and populations contain patients. A two-stage scientific and ethics review: The next adaptation for single institutional review boards.

    PubMed

    Knopman, David; Alford, Eli; Tate, Kaitlin; Long, Mark; Khachaturian, Ara S

    2017-08-01

    For nearly 50 years, institutional review boards (IRB) and independent ethics committees have featured local oversight as a core function of research ethics reviews. However growing complexity in Alzheimer's clinical research suggests current approaches to research volunteer safety is hampering development of new therapeutics. As a partial response to this challenge, the NIH has mandated that all NIH-funded multi-site studies will use a single Institutional Review Board. The perspective describes a joint program to provide a single IRB of record (sIRB) for phases of multi-site studies. The approach follows two steps. One, an expert Scientific Review Committee (SRC) of senior researchers in the field will conduct the review principally of scientific merit, significance, feasibility, and the likelihood of meaningful results. The second step will be the IRB's regulatory and ethics review. The IRB will apply appropriate regulatory criteria for approval including minimization of risks to subjects and risks reasonable in relation to anticipated benefits, equitable subject selection, informed consent, protections for vulnerable populations, and application of local context considerations, among others. There is a steady demand for scientific, ethical and regulatory review of planned Alzheimer's studies. As of January 15, 2017, there are nearly 400 open studies, Phase II and III, industry and NIH sponsored trials on disease indications affecting memory, movement and mood in the US. The effort will initially accept protocols for studies of Alzheimer's disease, dementia, and related disorders effecting memory, movement and mood. Future aims will be to provide scientific review and, where applicable, regulatory and ethical review in an international context outside North America with sites possibly in Asia, Europe and Australia. Copyright © 2017 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  7. Breast cancer in malaysia: are our women getting the right message? 10 year-experience in a single institution in Malaysia.

    PubMed

    Taib, Nur Aishah; Yip, Cheng Har; Ibrahim, Mohamed; Ng, C J; Farizah, H

    2007-01-01

    The message that health care providers caring for patients with breast cancer would like to put forth, is that, not only early detection is crucial but early treatment too is important in ensuring survival. This paper examines the pattern of presentation at a single institution over a 10-year period from 1995 to 2005. In Malaysia, education outreach programmes are ongoing, with contributions not only from the public sector, but also private enterprise. Articles on breast cancer in local newspapers and women magazines and television are quite commonplace. However are our women getting the right message? Now is an appropriate time to bring the stakeholders together to formulate a way to reach all women in Malaysia, not excluding the fact that we are from different races, different education levels and backgrounds requiring differing ways of delivering health promotion messages. To answer the question of why women present late, we prospectively studied 25 women who presented with locally advanced disease. A quantitative, quasi-qualitative study was embarked upon, as a prelude to a more detailed study. Reasons for presenting late were recorded. We also looked at the pattern of presentation of breast lumps in women to our breast clinic in UMMC and in the surgical clinic in Hospital Kota Bharu, in the smaller capital of the state of Kelantan, in 2003. There is hope for the future, the government being a socially responsible one is currently making efforts towards mammographic screening in Malaysia. However understanding of the disease, acceptance of medical treatment and providing resources is imperative to ensure that health behaviour exhibited by our women is not self-destructive but self-preserving. Women are an integral part of not only the nation's workforce but the lifeline of the family - hopefully in the next decade we will see great improvement in the survival of Malaysian women with breast cancer.

  8. Two-fraction high-dose-rate brachytherapy within a single day combined with external beam radiotherapy for prostate cancer: single institution experience and outcomes

    PubMed Central

    Liu, Junyang; Kaidu, Motoki; Sasamoto, Ryuta; Ayukawa, Fumio; Yamana, Nobuko; Sato, Hiraku; Tanaka, Kensuke; Kawaguchi, Gen; Ohta, Atsushi; Maruyama, Katsuya; Abe, Eisuke; Kasahara, Takashi; Nishiyama, Tsutomu; Tomita, Yoshihiko; Aoyama, Hidefumi

    2016-01-01

    We investigated the outcomes of treatment for patients with localized prostate cancer (PCa) treated with 3D conformal radiation therapy (3D-CRT) followed by two-fraction high-dose-rate brachytherapy within a single day (2-fr.-HDR-BT/day) at a single institution. A total of 156 consecutive Asian males (median age, 67 years) were enrolled. To compare our findings with those of other studies, we analyzed our results using the D'Amico classification, assigning the patients to low- (n =5; 3.2%), intermediate- (n =36; 23.1%) and high-risk (n =115; 73.7%) groups (Stage T3 PCa patients were classified as high-risk). One patient in the D'Amico low-risk group (20%), 13 intermediate-risk patients (36.1%) and 99 high-risk patients (86.1%) underwent androgen deprivation therapy. We administered a prescription dose of 39 Gy in 13 fractions of 3D-CRT combined with 18 Gy of HDR-BT in two 9-Gy fractions delivered within a single day. We did not distinguish between risk groups in determining the prescription dose. The median follow-up period was 38 months. Of the 156 patients, one died from primary disease and five died from other diseases. The 3-year overall survival (OS) rates were 100%, 100% and 93.7%, and the 3-year ‘biochemical no evidence of disease (bNED)’ rates were 100%, 100% and 96.9% for the D'Amico low-, intermediate- and high-risk groups, respectively. No patient developed ≥ Grade 3 early toxicity. The Grade 3 late genitourinary toxicity rate was 2.6%, and no ≥ Grade 3 late gastrointestinal toxicity occurred. The efficacy and safety of this study were satisfactory, and longer-term follow-up is necessary. PMID:26983988

  9. A retrospective review of acupuncture use for the treatment of pain in sickle cell disease patients: descriptive analysis from a single institution.

    PubMed

    Lu, Kit; Cheng, Mok-Chung Jennifer; Ge, Xiaoying; Berger, Ann; Xu, Dihua; Kato, Gregory J; Minniti, Caterina P

    2014-09-01

    This retrospective study describes the use of acupuncture for adult sickle cell patients in a single institution. We identified 47 sickle cell disease patients referred for acupuncture at the National Institutes of Health between January 2005 and September 2011. All patients were enrolled in a Study of the Natural History of sickle cell disease and signed consent. We reviewed patient demographics, location of acupuncture treatment sessions (inpatient vs. outpatient), number of sessions received, sites of pain, patient pain reporting, and the use of other complementary therapies. Of the 47 patients (60% women, median age 36 y) referred for acupuncture, 42 had homozygous SS disease (89%) and 5 had SC disease (11%). Over half of the patients (51%) reported >3 sites of pain. Only 24 patients (51%) underwent acupuncture treatment. Of those who elected not to receive acupuncture, a majority (87%) accepted some other forms of complementary therapies. Nine patients underwent only inpatient acupuncture for acute vaso-occlusive crisis. Eleven patients received only outpatient acupuncture treatment for chronic pain, and 4 patients received both inpatient and outpatient treatments. For the patients who received inpatient acupuncture treatment for acute vaso-occlusive crisis, there was a significant reduction of reported pain score immediately after acupuncture treatment with an average pain reduction of 2.1 points on the numeric pain scale (P<0.0001). Excluding the 2 outliers, 75% of patients (n=13) in the outpatient setting described their pain as improved compared with prior session. To our knowledge, this is the largest retrospective review of acupuncture use in the sickle cell population. This analysis describes the use of acupuncture and raises the possibility of its use as an adjuvant for pain management in this population. Future clinical trials are needed to evaluate acupuncture's efficacy and effectiveness for pain management in different treatment settings and for

  10. Is interval appendectomy indicated after non-operative management of acute appendicitis in patients with cancer? A retrospective review from a single institution.

    PubMed

    Samdani, Tushar; Fancher, Tiffany T; Pieracci, Frederic M; Eachempati, Soumitra; Rashidi, Laila; Nash, Garrett M

    2015-05-01

    Interval appendectomy (IA) is a controversial subject, with little consensus on its use in patients undergoing treatment for malignancy. We sought to determine the frequency of recurrent appendicitis in cancer patients managed nonoperatively (NOM) during index hospitalization (IHA) for acute appendicitis (AA). Clinical presentation, cancer treatment, and follow-up were collected from electronic medical records of patients with CT scan-confirmed AA treated at a single institution between August 1999 and August 2009. Seventy-two of 109 AA patients underwent appendectomy during IHA; 34 of these 109 were NOM during IHA. Median index length of NOM patients' stay was six days (0-55), median age was 59 (18-80) years. Indications for NOM were presence of abscess or phlegmon (14), mild symptoms (13), high surgical risk (3), end-stage cancer (3), and patient declining surgery (1). Eight NOM patients underwent percutaneous drainage of abdominal abscess (median total duration of intravenous + oral antibiotics = 12 days [0-55]). There were six deaths (1 IHA, 5 NOM): four sepsis and two cancer progression. At a median of 19-month follow-up (range 1-103), four NOM patients surviving IHA had recurrent AA (11.7%) at two (n = 2) and three months (n = 2) after the first episode. Overall, six had IA (17.6%) one to seven months post AA; 25 remained asymptomatic, without IA. In conclusion, among NOM patients at a cancer center at IHA for AA, recurrent AA was early (<4 months) but uncommon. IA should be offered to those with recurrent symptoms, but appears to have a very limited role after several months of asymptomatic follow-up.

  11. Financial Impact of the Robotic Approach in Liver Surgery: A Comparative Study of Clinical Outcomes and Costs Between the Robotic and Open Technique in a Single Institution

    PubMed Central

    Daskalaki, Despoina; Brown, Marc; Bianco, Francesco M.; Tzvetanov, Ivo; Davis, Myriam; Kim, Jihun; Benedetti, Enrico; Giulianotti, Pier C.

    2017-01-01

    Abstract Background: One of the perceived major drawbacks of minimally invasive techniques has always been its cost. This is especially true for the robotic approach and is one of the main reasons that has prevented its wider acceptance among hospitals and surgeons. The aim of our study was to evaluate the clinical outcomes and economic impact of robotic and open liver surgery in a single institution. Methods: Sixty-eight robotic and 55 open hepatectomies were performed at our institution between January 1, 2009 and December 31, 2013. Demographics, perioperative data, and postoperative outcomes were collected and compared between the two groups. An independent company performed the financial analysis. The economic parameters comprised direct variable costs, direct fixed costs, and indirect costs. Results: Mean estimated blood loss was significantly less in the robotic group (438 versus 727.8 mL; P = .038). Overall morbidity was significantly lower in the robotic group (22% versus 40%; P = .047). Clavien III/IV complications were also lower, with 4.4% in the robotic versus 16.3% in the open group (P = .043). The length of stay in the intensive care unit (ICU) was shorter for patients who underwent a robotic procedure (2.1 versus 3.3 days; P = .004). The average total cost, including readmissions, was $37,518 for robotic surgery and $41,948 for open technique. Conclusions: Robotic liver resections had less overall morbidity, ICU, and hospital stay. This translates into decreased average costs for robotic surgery. These procedures are financially comparable to open resections and do not represent a financial burden to the hospital. PMID:28186429

  12. Reducing the cost and frequency of explantations associated with single-level anterior diskectomy and fusion at a single institution through education.

    PubMed

    Epstein, Nancy E; Schwall, Garry S; Hood, Donald C

    2012-03-01

    We prospectively evaluated the costs/frequency of explanted instrumentation (devices implanted but removed prior to closure) for all single-level anterior diskectomy (1-ADF) procedures performed in 2010 at a single institution before and after surgeon education. To determine whether surgeon education would reduce the costs/frequency of explantation for 1-ADF. In 2009, we reported that the cost of explanted devices was 9.2% of the cost of implanted devices. The costs/frequencies of explantation for 1-ADF performed in 2010 at the same institution by the same surgeons were analyzed before and after surgeon education. From January through April, surgeons were unaware of concerns regarding explantation. At the end of April 2010, spinal surgeons were educated about explantation costs/frequency at 2 meetings. Explantation costs/frequencies for the first 4 months of 2010 were compared with those for the last 8 months as well as with the results from 2009. Prior to surgeon education, instrumentation was explanted in 45.5% of the cases, whereas after education explantation occurred in 16% of the cases. The explantation rate (the number of explanted devices as a percentage of implanted devices) was lower after education for screws (12.5% vs. 7.7%), plates (9.4% vs. 0%), and allograft spacers (7.1% vs. 2.9%), and lower than for rates from 2009. In 2010, the overall cost of explanted devices as a percentage of implanted devices was also lower after surgeon education (5.8%) than before surgeon education in 2010 (20.0%) or 2009 (9.2%). The frequency and cost of explanted instrumentation used to perform 1-ADF were reduced through surgeon education.

  13. Clinical characteristics and prognostic factors of patients with mature T-cell lymphoid malignancies: a single-institution study of 225 cases.

    PubMed

    Xue, Wen; Sheng, Yan; Weng, Xiangqin; Zhu, Yongmei; Zhao, Yan; Xu, Pengpeng; Fei, Xiaochun; Chen, Xiaoyan; Wang, Li; Zhao, Weili

    2015-12-01

    Mature T-cell lymphoid malignancies comprise a group of heterogeneous diseases that vary in clinicopathological features, biological behavior, treatment response, and prognosis. Bone marrow (BM) infiltration is more commonly present in mature T-cell lymphoid malignancies compared with their B-cell counterparts and hence important for differential diagnosis. In this study, clinical characteristics and prognostic factors were analyzed in 225 patients with mature T-cell lymphoid malignancies treated in a single institution. These included 29 cases of T-cell lymphoproliferative disorders (T-LPD, all with BM infiltration) and 196 cases of T-/natural-killer-cell lymphoma (T/NKCL, 56 with BM infiltration and 140 without BM infiltration). The estimated 5-year overall survival (OS) rates of T-LPD and T/NKCL were 96.6% and 37.3%, respectively. T-LPD patients were less likely to exhibit poor performance status, advanced disease stage, presence of B symptoms, or abnormal level of serum β-2 microglobulin. With similar pathological characteristics, T/NKCL patients with BM infiltration showed significantly lower response rates and shorter OS than those without BM infiltration (P = 0.0264 and P < 0.0001, respectively). Multivariate analysis indicated that poor performance status, advanced disease stage, elevated serum lactate dehydrogenase level, and BM involvement were independent unfavorable prognostic factors. The Glasgow Prognostic Score may be more efficient than the International Prognostic Index in predicting disease outcome in T/NKCL. In conclusion, clinical characteristics may be useful in more effectively stratifying patients with mature T-cell lymphoid malignancies.

  14. Determination of prognosis of Philadelphia chromosome-negative myeloproliferative neoplasms with a simple clinical examination: Retrospective analysis of 71 patients in a single institution

    PubMed Central

    ITO, SHINICHI; TSUTSUMI, YUTAKA; OHIGASHI, HIROYUKI; SHIRATORI, SOUICHI; TESHIMA, TAKANORI

    2016-01-01

    Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs), including polycythemia vera (PV), essential thrombocytosis (ET) and primary myelofibrosis (PMF), are clonal hematopoietic diseases. A single-institution retrospective analysis was performed, including 71 MPN patients diagnosed at the Hakodate Municipal Hospital between April, 2001 and April, 2014, and certain clinical characteristics were identified as effective prognostic factors. The patients were categorized by risk factor scoring based on age, number of abnormal blood cell lineages and splenomegaly at diagnosis, and the association between this categorization and prognosis was analyzed using a statistical procedure. The effect of Janus kinase 2 (JAK2) V617F mutation on prognosis was also investigated. The MPN patients were consolidated into three risk groups based on the margin of intergroup survival differences: i) Score 1–2 (n=23), ii) score 3 (n=24) and iii) score 4–5 (n=24). MPN patients with scores of 4 or 5 exhibited poorer overall survival (OS) compared with those with lower scores (P<0.001). In addition, there were significant differences in event-free survival (EFS) among scoring groups (P=0.0059). PV and ET had a better prognosis compared with PMF, although this analysis suggested that PV and ET patients with scores of 4 or 5 may have a poorer prognosis in terms of OS (P=0.0052) and EFS (P=0.022) and should be closely followed up. We observed no significant prognostic effect of the JAK2V167F mutation for OS (P=0.28) or EFS (P=0.17). Our results suggested that a simple scoring system based on age, blood cell counts and presence of splenomegaly at diagnosis may be used for the long-term prognosis of MPN patients. PMID:26870357

  15. IS INTERVAL APPENDECTOMY INDICATED AFTER NON-OPERATIVE MANAGEMENT OF ACUTE APPENDICITIS IN PATIENTS WITH CANCER? A RETROSPECTIVE REVIEW FROM A SINGLE INSTITUTION

    PubMed Central

    SAMDANI, TUSHAR; FANCHER, TIFFANY T.; PIERACCI, FREDERIC M.; EACHEMPATI, SOUMITRA; RASHIDI, LAILA; NASH, GARRETT M.

    2016-01-01

    Background Interval appendectomy (IA) is a controversial subject, with little consensus on its use in patients undergoing treatment for malignancy. We sought to determine the frequency of recurrent appendicitis in cancer patients managed non-operatively (NOM) during index hospitalization for acute appendicitis (AA). Methods Clinical presentation,cancer treatment,follow-up were collected from electronic medical records of patients with CT scan-confirmed AA treated at a single institution between 7/1999 and 7/2009. Results Seventy-two of 109 AA patients underwent appendectomy during index hospitalization (IHA); 34 of these 109 were NOM during index hospitalization. Median index length of NOM patients’ stay was 6 days (0–55), median age 59 (18–80). Indications for NOM were presence of abscess or phlegmon (14), mild symptoms (13), high surgical risk (3), end-stage cancer (3), patient declining surgery (1). Eight NOM patients underwent percutaneous drainage of abdominal abscess (median total duration of IV + oral antibiotics = 12 days (0–55)). There were 6 deaths (1 IHA, 5 NOM): 4 sepsis, 2 cancer progression. At median 19-month follow-up (range 1–103), 4 NOM patients surviving index hospitalization had recurrent AA (11.7%) at 2 (n=2) and 3 months (n=2) after first episode. Overall, 6 had IA (17.6%) 1–7 months post-AA; 25 remained asymptomatic, without IA. Conclusion Among patients at a cancer center managed non-operatively at index hospitalization for AA, recurrent AA was early (<4 months) but uncommon. IA should be offered to those with recurrent symptoms, but appears to have a very limited role after several months of asymptomatic follow-up. PMID:25975342

  16. Single-institution comparative study on the outcomes of salvage cryotherapy versus salvage robotic prostatectomy for radio-resistant prostate cancer

    PubMed Central

    Vora, Anup; Agarwal, Vidhi; Singh, Prabhjot; Patel, Rupen; Rivas, Rodolfo; Nething, Josh; Muruve, Nic

    2015-01-01

    Background Although primary treatment of localized prostate cancer provides excellent oncologic control, some men who chose radiotherapy experience a recurrence of disease. There is no consensus on the most appropriate management of these patients after radiotherapy failure. In this single-institution review, we compare our oncologic outcome and toxicity between salvage prostatectomy and cryotherapy treatments. Methods From January 2004 to June 2013, a total of 23 salvage procedures were performed. Six of those patients underwent salvage prostatectomy while 17 underwent salvage cryotherapy by two high-volume fellowship-trained urologists. Patients being considered for salvage therapy had localized disease at presentation, a prostate-specific antigen (PSA) < 10 ng/mL at recurrence, life expectancy > 10 years at recurrence, and a negative metastatic workup. Patients were followed to observe cancer progression and toxicity of treatment. Results Patients who underwent salvage cryotherapy were statistically older with a higher incidence of hypertension than our salvage prostatectomy cohort. With a mean follow up of 14.1 months and 7.2 months, the incidence of disease progression was 23.5% and 16.7% after salvage cryotherapy and prostatectomy, respectively. The overall complication rate was also 23.5% versus 16.7%, with the most frequent complication after salvage cryotherapy being urethral stricture and after salvage prostatectomy being severe urinary incontinence. There were no rectal injuries with salvage prostatectomy and one rectourethral fistula in the cohort after salvage cryotherapy. Conclusion While recurrences from primary radiotherapy for prostate cancer do occur, there is no consensus on its management. In our experience, salvage procedures were generally safe and effective. Both salvage cryotherapy and salvage prostatectomy allow for adequate cancer control with minimal toxicity. PMID:27014657

  17. A single institute retrospective trial of concurrent chemotherapy with SIR-Spheres(®) versus SIR-Spheres(®) alone in chemotherapy-resistant colorectal cancer liver metastases.

    PubMed

    Cho, May; Kessler, Jonathan; Park, John J; Lee, Aram; Gong, Jun; Singh, Gagandeep; Chen, Yi-Jen; Ituarte, Philip H G; Fakih, Marwan

    2017-08-01

    The use of selective internal radiation therapy with yttrium 90 resin microspheres (SIR-Spheres(®)) in chemotherapy-resistant colorectal cancer liver metastases has been associated with favorable progression-free survival (PFS) and overall survival when given alone or concurrently with chemotherapy. We conducted a single institute retrospective trial to explore the potential impact of SIR-Spheres(®) with concurrent chemotherapy vs. SIR-Spheres(®) alone on liver PFS in patients with colorectal liver metastases (CRLM). Patients with 5-fluorouracil-refractory CRLM treated with SIR-Spheres(®) between 2009 and 2014 were identified. Patients were excluded if they received any chemotherapy/targeted regimen following radioembolization on which they did not previously progress. This strategy was adopted to minimize the impact of post-SIR-Spheres(®) systemic therapy bias on PFS. Twenty-seven patients satisfied inclusion criteria and were included in this analysis. Patients' demographics were similar between the two treatment arms, except for the median number of prior therapies. No associated ≥ grade 3 toxicities were noted. Liver disease control rates were 84% and 14% on the SIR-Spheres(®) plus chemotherapy arms and SIR-Spheres(®) alone arms, respectively (P=0.001). Median PFS in the liver was 176 days in the SIR-Spheres(®) plus chemotherapy group vs. 91 days in the SIR-Sphere(®) alone group (P=0.0009). Median overall survival was 212 days in the SIR-Spheres(®) plus chemotherapy group vs. 154 days in the SIR-Spheres(®) alone group (P=0.1023). In patients with 5-fluorouracil-refractory disease, SIR-Spheres(®) plus chemotherapy is associated with an increased liver disease control rate and a prolonged liver PFS in comparison with SIR-Spheres(®) alone.

  18. A retrospective review of acupuncture use for the treatment of pain in sickle cell disease patients: Descriptive analysis from a single institution

    PubMed Central

    Lu, Kit; Cheng, M. Jennifer; Ge, Xiaoying; Berger, Ann; Xu, Dihua; Kato, Gregory J.; Minniti, Caterina P

    2014-01-01

    Objectives This retrospective study describes the use of acupuncture for adult sickle cell patients in a single institution. Methods We identified 47 sickle cell disease (SCD) patients referred for acupuncture at the National Institutes of Health between January, 2005 and September, 2011. All patients were enrolled in a Study of the Natural History of SCD and signed consent. We reviewed patient demographics, location of acupuncture treatment sessions (inpatient versus outpatient), number of sessions received, sites of pain, patient pain reporting, and the use of other complementary therapies. Results Of the 47 patients (60% women, median age 36 years) referred for acupuncture, 42 had homozygous SS disease (89%) and 5 had SC disease (11%). Over half of the patients (51%) reported more than 3 sites of pain. Only 24 patients (51%) underwent acupuncture treatment. Of those who elected not to receive acupuncture, a majority (87%) accepted some other forms of complementary therapies. Nine patients underwent only inpatient acupuncture for acute vaso-occlusive crisis (VOC). Eleven patients received only outpatient acupuncture treatment for chronic pain, and four patients received both inpatient and outpatient treatments. For the patients who received inpatient acupuncture treatment for acute VOC, there was a significant reduction of reported pain score immediately after acupuncture treatment with an average pain reduction of 2.1 points on the numeric pain scale (p< 0.0001). Excluding the two outliers, 75% of patients (n=13) in the outpatient setting described their pain as improved compared to prior session. Discussion To our knowledge, this is the largest retrospective review of acupuncture use in the sickle cell population. This analysis describes the use of acupuncture and raises the possibility of its use as an adjuvant for pain management in this population. Future clinical trials are needed to evaluate acupuncture’s efficacy and effectiveness for pain management in

  19. Lungs from donation after circulatory death donors: an alternative source to brain-dead donors? Midterm results at a single institution.

    PubMed

    Zych, Bartlomiej; Popov, Aron-Frederik; Amrani, Mohamed; Bahrami, Toufan; Redmond, Karen Christina; Krueger, Heike; Carby, Martin; Simon, André Ruediger

    2012-09-01

    Donor organ shortage remains to be the major limitation in lung transplantation, and donation after circulatory death (DCD) might represent one way to alleviate this problem. DCD was introduced to our institution in 2007 and has been a part of our clinical routine since then. Here, we present the mid-term results of lung transplantation from DCD in a single institution and compare the outcomes with the lung recipient cohort receiving lungs from donation after brain death (DBD). Since initiation of the DCD programme in March 2007, of the 157 lung transplantations performed, 26 (16.5%) were retrieved from DCD donors, with 25 double- and 1 single-lung transplants being performed. Results were compared with standard DBD transplantations. Analyses included, amongst others, donor characteristics, survival, prevalence of primary graft dysfunction, acute rejection, lung function tests during follow-up, onset of bronchiolitis obliterans syndrome (BOS) as well as duration of mechanical ventilation, hospital and intensive care unit length of stay. While there was no significant difference between lung function, BOS and survival between the two groups, lungs from DCD donors had a higher PaO(2) (median; interquartile range) 498.3 (451.5; 525) vs. DBD 442.5 (371.25; 502) kPa before retrieval (P = 0.009). There was also a longer total ischaemic time in the DCD vs. DBD group: 320 min (298.75; 393.25) vs. 285.5 min (240; 373) (P = 0.025). All other parameters were comparable. Medium-term results after lung transplantation with organs procured after circulatory death are comparable with those obtained after standard lung transplantation. Therefore, DCD could be used to significantly increase the donor pool.

  20. Radiofrequency Energy in Hepatic Bed during Partial Cystectomy for Hydatid Liver Disease: Standing Out from the Usual Conservative Surgical Management

    PubMed Central

    Dimitrokallis, Nikolaos; Sakarellos, Panagiotis; Griniatsos, John

    2016-01-01

    Background. Surgical treatment of hydatid liver disease (HLD) is divided into conservative and radical procedures. While conservative techniques are easier and faster to perform, there is an emerging need to reduce their morbidity and recurrence rates. Our aim was to present and evaluate the efficiency and safety of the application of radiofrequency energy (TissueLink® and Aquamantys® systems) in hepatic bed during partial cystectomy. Materials and Methods. Eighteen consecutive patients with hydatid liver cysts were referred to our department between April 2006 and June 2014. Data about demographics, mortality, morbidity, and recurrence rate were obtained and analyzed retrospectively. Results. The mean follow-up was 38 months (range: 4–84 months). The postoperative course of most patients was uneventful. One case of recurrence was found in our series in a patient with 4 cysts in the right lobe, 3 years after initial treatment. He was reoperated on with the same method. Conclusions. Saline-linked RF energy seems to be an effective means to be employed in conservative surgical procedures of HLD, with satisfactory postoperative morbidity. Recurrence rates appear to be low, but further follow-up is needed in order to draw safer conclusions. PMID:27525000

  1. Diffusion-weighted magnetic resonance imaging in patients selected for radical cystectomy: detection rate of pelvic lymph node metastases.

    PubMed

    Papalia, Rocco; Simone, Giuseppe; Grasso, Rosario; Augelli, Raffaele; Faiella, Eliodoro; Guaglianone, Salvatore; Cazzato, Roberto; Del Vescovo, Riccardo; Ferriero, Mariaconsiglia; Zobel, Bruno; Gallucci, Michele

    2012-04-01

    To evaluate whether DW-MRI improves the detection of pelvic lymph nodes metastates in patients with bladder cancer undergoing radical cystectomy. 36 patients with CT scan negative for nodal metastates underwent DW-MRI before surgery. Diagnostic accuracy of DW-MRI was compared with histopathological findings. Mean ADC value was 0.85 × 10(-3) mm(3)/s in the nodal metastatic group and 1 × 10(-3) mm(3)/s in the nodal non-metastatic group (P = 0.02). The ADC cut-off value, obtained by the ROC curve was 0.86 × 10(-3) mm(3)/s. Patient-based sensitivity, specificity and positive and negative predictive values were 76.4%, 89.4%, 26.6%, and 71.4%, respectively. DW-MRI may be used to differentiate metastatic from non-metastatic lymph nodes in patients with high-grade bladder cancer. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  2. Deep Surgical Site Infections after Open Radical Cystectomy and Urinary Diversion Significantly Increase Hospitalisation Time and Total Treatment Costs.

    PubMed

    Wolters, Mathias; Oelke, Matthias; Lutze, Bettina; Weingart, Markus; Kuczyk, Markus A; Chaberny, Iris F; Graf, Karolin

    2017-01-01

    Deep surgical site infections (DSSI) usually require secondary treatments. The aim of this study was to compare the total length of hospitalisation (LOH), intensive care unit (ICU) duration, and total treatment costs in patients with DSSI versus without DSSI after open radical cystectomy (ORC) and urinary diversion. Prospective case-control study in a tertiary care hospital in patients after ORC with urinary diversion during April 2008 to July 2012. DSSI was defined based on Centers for Disease Control and Prevention criteria. Matched-pair analysis for patients with versus without DSSI was done in 1:2 ratios. Patients with superficial surgical site infections (SSI) were excluded from analysis. In total, 189 operations were performed. Thirty-eight patients (20.1%) developed SSI of which 28 patients (14.8%) had DSSI. Out of 28 patients, 27 (96.4%) were with DSSI and required surgical re-intervention. Due to insufficient matching criteria, 11 patients with DSSI were excluded from analyses. Consequently, 17 patients with DSSI were matched with 34 patients without DSSI. Significant differences were seen for median overall LOH (30 vs. 18 days, p < 0.001), median ICU duration (p = 0.024), and median overall treatment costs (€17,030 vs. €11,402, p = 0.011). DSSI significantly increases LOH (67%) and treatment costs (49%), adding up to a financial loss for the hospital of approximately €5,500 in patients with DSSI. © 2016 S. Karger AG, Basel.

  3. Radiofrequency Energy in Hepatic Bed during Partial Cystectomy for Hydatid Liver Disease: Standing Out from the Usual Conservative Surgical Management.

    PubMed

    Mantonakis, Eleftherios; Papalampros, Alexandros; Moris, Demetrios; Dimitrokallis, Nikolaos; Sakarellos, Panagiotis; Griniatsos, John; Felekouras, Evangelos

    2016-01-01

    Background. Surgical treatment of hydatid liver disease (HLD) is divided into conservative and radical procedures. While conservative techniques are easier and faster to perform, there is an emerging need to reduce their morbidity and recurrence rates. Our aim was to present and evaluate the efficiency and safety of the application of radiofrequency energy (TissueLink® and Aquamantys® systems) in hepatic bed during partial cystectomy. Materials and Methods. Eighteen consecutive patients with hydatid liver cysts were referred to our department between April 2006 and June 2014. Data about demographics, mortality, morbidity, and recurrence rate were obtained and analyzed retrospectively. Results. The mean follow-up was 38 months (range: 4-84 months). The postoperative course of most patients was uneventful. One case of recurrence was found in our series in a patient with 4 cysts in the right lobe, 3 years after initial treatment. He was reoperated on with the same method. Conclusions. Saline-linked RF energy seems to be an effective means to be employed in conservative surgical procedures of HLD, with satisfactory postoperative morbidity. Recurrence rates appear to be low, but further follow-up is needed in order to draw safer conclusions.

  4. Stripping for Revision.

    ERIC Educational Resources Information Center

    Smith, Donna

    1996-01-01

    Describes a three-step process by which students are taught to revise their writing by listing each sentence on another paper, combining sentences by eliminating redundancy, reducing information to appositives, and reducing information to participles, as well as revising the reduced number of sentences by including verbals, action verbs,…

  5. Writing as Revision.

    ERIC Educational Resources Information Center

    Della-Piana, Gabriel M.; Endo, George T.

    This proposal for a longitudinal experimental study with a treatment intervention focuses on the process of writing as revision. Revision refers to the process which occurs prior to and throughout the writing of a work, rather than the final editing. According to this process, the writer goes through five stages: preconceptions concerning style…

  6. Photobiomodulation therapy for the management of radiation-induced dermatitis : A single-institution experience of adjuvant radiotherapy in breast cancer patients after breast conserving surgery.

    PubMed

    Strouthos, Iosif; Chatzikonstantinou, Georgios; Tselis, Nikolaos; Bon, Dimitra; Karagiannis, Efstratios; Zoga, Eleni; Ferentinos, Konstantinos; Maximenko, Julia; Nikolettou-Fischer, Vassiliki; Zamboglou, Nikolaos

    2017-06-01

    Radiation therapy (RT) comprises a key component in the treatment of breast cancer. Radiation-induced skin toxicity is the major adverse event experienced by patients; however, radiodermatitis (RD) prevention and management remains trivial. It is proven that photobiomodulation (PBM) therapy using light-emitting diode (LED) increases wound healing and depicts an anti-inflammatory effect. This single-institute study evaluates the beneficial role of PBM-LED in preventing/reducing RD during breast cancer RT. Of 70 consecutively treated patients, 25 patients were treated with PBM-LED twice a week prior to adjuvant 3D conformal RT after breast-conserving surgery. RD was reported using Common Toxicity Criteria for Adverse Events Version 4.0 and pain intensity using a visual analog scale (VAS). For comparison, a control group (n = 45) received RT without PBM-LED. In addition, a "matched" group (n = 25) was generated from the control group based on propensity for potentially confounding variables. In the PBM group, 22 patients (88%) presented grade 1 and 3 (12%) grade 2 RD. In the control group, 25 patients (55.6%) developed grade 1 reactions, 18 patients (40%) grade 2, and 2 (4.4%) patients grade 3 RD. Concerning pain intensity, 15 patients (60%) of the PBM treatment arm reported no pain, 5 patients (20%) VAS 2, and 5 (20%) VAS 3. In the control group, 13 patients (28.9%) reported no pain, 2 (4.4%) VAS 1, 7 (15.6%) VAS 2, 9 patients (20%) reported VAS 3, 12 (26.7%) patients VAS 4, and 2 (4.4%) patients VAS 5. PBM-LED therapy applied prior to RT might be effective in decreasing the incidence and sequelae of radiation-induced skin toxicity in breast cancer patients treated with breast-conserving surgery.

  7. Do acute-care surgeons follow best practices for breast abscess management? A single-institution analysis of 325 consecutive cases.

    PubMed

    Barron, Alison Unzeitig; Luk, Stephen; Phelan, Herb A; Williams, Brian H

    2017-08-01

    . To our knowledge, this is the largest single institution series of the management of breast abscesses by ACS surgeons in the literature. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Febuxostat for management of tumor lysis syndrome including its effects on levels of purine metabolites in patients with hematological malignancies - a single institution's, pharmacokinetic and pilot prospective study.

    PubMed

    Takai, Mihoko; Yamauchi, Takahiro; Ookura, Miyuki; Matsuda, Yasufumi; Tai, Katsunori; Kishi, Shinji; Yoshida, Akira; Iwasaki, Hiromichi; Nakamura, Toru; Ueda, Takanori

    2014-12-01

    Tumor lysis syndrome (TLS) is a life-threatening oncological emergency, and control of serum uric acid level (S-UA) is most important. In this single-institution, short-term and pilot prospective study, the efficacy of a new xanthine oxidase inhibitor, febuxostat, as an alternative to conventional allopurinol, including its effects on hypoxanthine and xanthine, was evaluated in 10 consecutive patients with hematological malignancies at intermediate risk for TLS. Febuxostat at 40 mg (n=7) or 60 mg (n=3) daily was administered according to renal function, and induction chemotherapy was started within 24 h. The primary end-point was the reduction of S-UA to ≤ 7.5 mg/dl by day 5. The median S-UA at base-line was 8.0 mg/dl (range=3.2-10.6 mg/dl). The median S-UA on day 5 after chemotherapy was 3.3 mg/dl (range=1.1-5.8 mg/dl) (p<0.0001, by paired t-test), indicating successful control of S-UA during chemotherapy. All patients achieved S-UA ≤ 7.5 mg/dl. A simultaneous decrease in serum creatinine and increase in estimated glomerular filtration rate were seen. Serum hypoxanthine and xanthine levels (as the consequence of inhibition of xanthine oxidase) were elevated along with the decrease in S-UA. Xanthine level was elevated higher compared to hypoxanthine level and reached the level reported to cause xanthine nephropathy, but no advance of renal impairment was observed. Serum febuxostat concentrations at 2 h after administration were 891.8 ± 285.0 ng/ml (mean ± SE) for the 40-mg dose and 770.6 ± 242.7 ng/ml for the 60-mg dose (p=0.80, unpaired t-test), showing no accumulation in patients with renal impairment. No febuxostat-related adverse reactions were noted. No patients experienced progressive TLS. Febuxostat is promising for the management of TLS of an intermediate-risk patient and further observation and reevaluation regarding xanthine nephropathy should be performed. Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios

  9. A single-institution experience: the integrated vascular surgery residency's effect on fellowship and general surgery resident case volume and diversity.

    PubMed

    Carroll, Megan I; Downes, Kathryne; Miladinovic, Branko; Illig, Karl A; Armstrong, Paul A; Back, Martin R; Johnson, Brad L; Shames, Murray L

    2014-01-01

    To determine whether the formation of an integrated vascular surgery residency (0 + 5) has negatively impacted the case volume and diversity of the vascular surgery fellows (5 + 2) and chief general surgeons at the same institution. Operative data from the vascular integrated (0 + 5), independent (5 + 2), and general surgery residencies at a single institution were retrospectively reviewed and analyzed to determine vascular surgery case volumes from 2006-2012. National operative data (Residency Review Committee) were used for comparison of diversity and volume. Standard statistical methods were applied. During this period, the 5 + 2 fellows at our institution performed on average 741 (range, 554-1002) primary cases and 1091 (range, 844-1479) combined primary and secondary cases for the 2-year fellowship. Our integrated residency began in July 2007. Our fellows' primary case volumes remained relatively stable between 2006 and 2011, with a 4% increase in the number of cases, although their total (primary and secondary) case volumes fell 15%; by comparison, the equivalent national 50th percentile rates rose 16% during this time frame. Our institution's general surgery residents performed an average of 116 (range, 56-221) vascular cases individually during their 5-year residency from 2005-2011. From 2006-2011, the total case volume fell only 5%, while the national 50th percentile rate fell 24%. Across all years, however, resident and fellow volumes both continue to be above Accreditation Council for Graduate Medical Education minimum requirements, and the major vascular case volume at our institution in all groups studied remained statistically greater than or equal to the national 50th percentile of cases. Our first integrated resident to graduate finished in June 2012 with 931 total vascular cases and 249 general surgery cases for a total operative experience of 1180 cases during the 5-year residency. Finally, after an 8-year period (2003-2010) in which none of

  10. Early Detection and Treatment of Neuroblastic Tumor with Opsoclonus-Myoclonus Syndrome Improve Neurological Outcome: A Review of Five Cases at a Single Institution in Japan.

    PubMed

    Takama, Yuichi; Yoneda, Akihiro; Nakamura, Tetsuro; Nakaoka, Tatsuo; Higashio, Atsushi; Santo, Kenji; Kuki, Ichiro; Kawawaki, Hisashi; Tomiwa, Kiyotaka; Hara, Junichi

    2016-02-01

    Opsoclonus-myoclonus syndrome (OMS) is a paraneoplastic neurological disorder associated with neuroblastic tumor (NT) in childhood. Half of patients have neurological sequelae after the neurological and oncological treatment. We reviewed the neurological and oncological outcomes of NT with OMS, and discussed whether the treatment of NT would contribute to improving the neurological prognosis. We retrospectively assessed NT patients with OMS from January 2001 to December 2013 at a single institution in Japan. Demographic data, neurological and oncological status, histopathology, treatments, prognosis, and diagnosis and treatment timing were retrospectively reviewed from the records. The timings assessed were the interval between OMS onset and NT detection, initial NT therapy, and initial OMS therapy, the interval between NT therapy and OMS remission, and duration of OMS. A total of 73 patients with NT were treated during the study period, and 5 of 73 patients were diagnosed as having NT with OMS. The median age at onset of OMS was 22 months (range, 18-30 months). The median age at detection of NT was 29 months (range, 21-33 months). Three of five cases showed no uptake on meta-iodobenzylguanidine scintigraphy. The tumor histopathology was neuroblastoma in two patients, ganglioneuroblastoma in two patients, and ganglioneuroma in one patient. Primary resection was performed in three cases. All patients survived. Two of five cases presented with atypical neurological symptoms without opsoclonus. The initial neurological therapy was started within a mean of 20 days (range, 3-76 days) from the onset of OMS in all cases. Four patients received intravenous immunoglobulin, and one with persistent neurological problems received rituximab. Neurological symptoms resolved in three cases. The mean interval between the onset of OMS and the detection of NT in case without neurological sequelae was 57 days (range, 25-113 days), while in case with neurological sequelae it was 365

  11. Outcome of pN0 Triple-Negative Breast Cancer with or without Lymph Node Irradiation: A Single Institution Experience.

    PubMed

    Khalifa, Jonathan; Duprez-Paumier, Raphaelle; Filleron, Thomas; Lacroix Triki, Magali; Jouve, Eva; Dalenc, Florence; Massabeau, Carole

    2016-09-01

    The optimal management of patients with pathologically node-negative triple-negative breast cancer (pN0 TNBC) remains unclear. We hypothesized that lymph node irradiation (LNI; internal mammary chain/periclavicular irradiation) had an impact on outcomes of pN0 TNBC. A cohort of 126 consecutive patients with pN0 TNBC treated between 2007 and 2010 at a single institute were included. All radiotherapy (breast/chest wall, ±LNI) was delivered adjuvantly, following completion of surgery ± chemotherapy. Tumors were reviewed and histologic features were described. Tissue microarrays were constructed and tumors were assessed by immunohistochemistry using antibodies against ER, PR, HER2, Ki-67, cytokeratins 5/6, 14, epidermal growth factor receptor and androgen receptor. Patients were divided into two groups for statistical analysis: LNI (LNI+) or no LNI (LNI-). We focused on disease-free survival (DFS), metastasis-free survival (MFS), and overall survival (OS). Fifty-seven and 69 patients received or not LNI, respectively. Median age was 52 (range [25-76]) and 55 (range [29-79]) in LNI+ and LNI- group (p = 0.23). LNI was associated with larger tumors (p = 0.033), central/internal tumors (33 versus 4, p < 0.01) and more chemotherapy (86% versus 59.4% p < 0.01). The median follow-up was 53.5 months. The rate of first regional relapse (associated or not with distant relapse) was low in both groups. There was no difference in 4-year DFS (82.2% versus 89.9%; p = 0.266), MFS (87.0% versus 91.1%; p = 0.286) and OS (85.8% versus 89.9%; p = 0.322) between LNI+ and LNI- group, respectively. In univariate analysis, only clinical size (T >10 mm versus ≤10 mm), histologic size (pT >10 mm versus ≤10 mm) and grade 3 (versus grade 2) were found to be significantly associated with shorter DFS. Omission of LNI in patients with pN0 TNBC does not seem to result in poorer outcome. Further studies are needed to specifically evaluate LNI in pN0 TNBC with histologic grade

  12. Role of allogeneic transplantation for FLT3/ITD acute myeloid leukemia: Outcomes from 133 consecutive newly-diagnosed patients from a single institution

    PubMed Central

    DeZern, Amy E.; Sung, Anthony; Kim, Sharon; Smith, B. Douglas; Karp, Judith E.; Gore, Steven D.; Jones, Richard J; Fuchs, Ephraim; Luznik, Leo; McDevitt, Michael; Levis, Mark

    2011-01-01

    AML patients with FLT3/ITD mutations have an inferior survival compared to AML patients with wild-type (WT) FLT3, primarily due to an increased relapse rate. Allogeneic transplant represents a post-remission therapy that is effective at reducing the risk of relapse for many cases of poor-risk AML. Whether or not allogeneic transplant in first complete remission (CR) can improve outcomes for patients with FLT3/ITD AML remains controversial. Our institution has adopted a policy of pursuing allogeneic transplant, including the use of alternate donors, for FLT3/ITD AML patients in remission. As part of an IRB-approved study, we performed a review of the clinical data from November 1, 2004 to October 31, 2008 on all adult patients under the age of 60 presenting in consecutive fashion to the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins with newly diagnosed non-M3 AML. We followed their outcomes through August 1, 2010. During the study period, 133 previously untreated AML patients between the ages of 20 and 59 were diagnosed and received induction and consolidation therapy at our institution. Of these 133 patients, 31 (23%) harbored a FLT3/ITD mutation at diagnosis. The median OS (overall survival) from the time of diagnosis for the FLT3/ITD AML patients was compared to the OS of the entire cohort and found to be comparable (19.3 months versus 15.5 months p=0.56.) Historically, OS for FLT3/ITD AML patients is significantly worse than for AML patients lacking this mutation. However, the OS for the 31 FLT3/ITD patients reported here was comparable to the 102 patients with WT FLT3 over the same 4 year time period. One difference that might have contributed to the surprising outcomes for the FLT3/ITD group is our aggressive pursuit of allogeneic BMT in CR1 within this group (60% of FLT3/ITD vs. 17% with WT). Our single institution study of consecutively treated AML patients supports the hypothesis that allogeneic transplant in early CR1 improves the long term

  13. Role of allogeneic transplantation for FLT3/ITD acute myeloid leukemia: outcomes from 133 consecutive newly diagnosed patients from a single institution.

    PubMed

    DeZern, Amy E; Sung, Anthony; Kim, Sharon; Smith, B Douglas; Karp, Judith E; Gore, Steven D; Jones, Richard J; Fuchs, Ephraim; Luznik, Leo; McDevitt, Michael; Levis, Mark

    2011-09-01

    Acute myelogenous leukemia (AML) patients with FLT3/ITD mutations have an inferior survival compared to AML patients with wild-type (WT) FLT3, primarily because of an increased relapse rate. Allogeneic transplantation represents a postremission therapy that is effective at reducing the risk of relapse for many cases of poor-risk AML. Whether or not allogeneic transplantation in first complete remission (CR) can improve outcomes for patients with FLT3/ITD AML remains controversial. Our institution has adopted a policy of pursuing allogeneic transplantation, including the use of alternate donors, for FLT3/ITD AML patients in remission. As part of an instituional review board-approved study, we performed a review of the clinical data from November 1, 2004, to October 31, 2008, on all adult patients under the age of 60 presenting in consecutive fashion to the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins with newly diagnosed non-M3 AML. We followed their outcomes through August 1, 2010. During the study period, 133 previously untreated AML patients between the ages of 20 and 59 were diagnosed and received induction and consolidation therapy at our institution. Of these 133 patients, 31 (23%) harbored an FLT3/ITD mutation at diagnosis. The median overall survival (OS) from the time of diagnosis for the FLT3/ITD AML patients was compared to the OS of the entire cohort and found to be comparable (19.3 months versus 15.5 months, P = .56). Historically, OS for FLT3/ITD AML patients is significantly worse than for AML patients lacking this mutation. However, the OS for the 31 FLT3/ITD patients reported here was comparable to the 102 patients with WT FLT3 over the same 4-year time period. One difference that might have contributed to the surprising outcomes for the FLT3/ITD group is our aggressive pursuit of allogeneic bone marrow transplant (BMT) in CR1 within this group (60% of FLT3/ITD versus 17% with WT). Our single-institution study of consecutively treated

  14. The Impact of Body Mass Index on the Surgical Outcomes of Patients With Gastric Cancer: A 10-Year, Single-Institution Cohort Study.

    PubMed

    Chen, Hai-Ning; Chen, Xin-Zu; Zhang, Wei-Han; Yang, Kun; Chen, Xiao-Long; Zhang, Bo; Chen, Zhi-Xin; Chen, Jia-Ping; Zhou, Zong-Guang; Hu, Jian-Kun

    2015-10-01

    This study aimed to investigate the impact of body mass index (BMI) on the short-term and long-term results of a large cohort of gastric cancer (GC) patients undergoing gastrectomy.Recently, the "obesity paradox" has been proposed, referring to the paradoxically "better" outcomes of overweight and obese patients compared with nonoverweight patients. The associations between BMI and surgical outcomes among patients with GC remain controversial.A single-institution cohort of 1249 GC patients undergoing gastrectomy between 2000 and 2010 were categorized to low-BMI (<18.49 kg/m), normal-BMI (18.50-24.99 kg/m), and high-BMI (≥25.00 kg/m) groups. The postoperative complications were classified according to the Clavien-Dindo system, and their severity was assessed by using the Comprehensive Complication Index (CCI). The impact of BMI on the postoperative complications and overall survival was analyzed.There were 908, 158, and 182 patients in the normal-BMI, low-BMI, and high-BMI groups, respectively. The overall morbidity in the high-BMI group (24.7%) was higher than that in either the low-BMI or the normal-BMI group (20.9% and 15.5%, respectively; P = 0.006), but the mean CCI in the low-BMI group was significantly higher (8.32 ± 19.97) than the mean CCI in the normal-BMI and high-BMI groups (3.76 ± 11.98 and 5.58 ± 13.07, respectively; P < 0.001). The Kaplan-Meier curve and the log-rank test demonstrated that the low-BMI group exhibited the worst survival outcomes compared with the normal-BMI group, whereas the high-BMI group exhibited the best survival outcomes (P < 0.001). In multivariate analysis, BMI was identified as an independent prognostic factor. In the stage-specific subgroup analysis, a low BMI was associated with poorer survival in the cases of stage III-IV diseases.Low BMI was associated with more severe postoperative complications and poorer prognosis. Despite a higher risk of mild postoperative complications, the high-BMI patients exhibited

  15. Do African American Patients Treated with Radical Cystectomy for Bladder Cancer have Worse Overall Survival? Accounting for Pathologic Staging and Patient Demographics Beyond Race Makes a Difference

    PubMed Central

    Kaye, Deborah R.; Canner, Joseph K.; Kates, Max; Schoenberg, Mark P.; Bivalacqua, Trinity J.

    2016-01-01

    Background: It is estimated that 74,000 men and women in the United States will be diagnosed with bladder cancer and 16,000 will die from the disease in 2015. The incidence of bladder cancer in Caucasian males is double that of African American males, but African American men and women have worse survival. Although factors contributing to this disparity have been analyzed, there is still great uncertainty as to why this disparity exists. Objective: To evaluate whether the disparities in bladder cancer survival after radical cystectomy for transitional cell carcinoma (TCC) of the bladder amongst African American (AA) and Caucasian patients is attributable to patient demographics, year of diagnosis, and/or tumor characteristics. Methods: Using Surveillance, Epidemiology, and End Results Program (SEER) data from 1973–2011, African American and Caucasian patients treated with a radical cystectomy for TCC of the bladder were identified. Primary outcomes were all-cause and cancer-specific mortality. Differences in survival between African Americans and Caucasian patients were assessed using chi-square tests for categorical variables and Student’s t-tests for continuous variables. Cox proportional hazards regression was used to measure the hazard ratio for African Americans compared to Caucasians for all-cause and cancer-specific mortality. In addition, coarsened matching techniques within narrow ranges, were used to match African American and Caucasian patients on the basis of age, sex, and cancer stage. Following matching, differences in all-cause and cancer-specific mortality were again assessed using a stratified Cox proportional hazards model, using the matching strata for the regression strata. Results: The study cohort consisted of 21,406 African American and Caucasian patients treated with radical cystectomy for bladder urothelial cancer, with 6.2% being African American and 73.9% male. African American patients had worse all-cause and cancer

  16. Revision arthroscopic Bankart repair.

    PubMed

    Abouali, Jihad Alexander Karim; Hatzantoni, Katerina; Holtby, Richard; Veillette, Christian; Theodoropoulos, John

    2013-09-01

    Failed anterior shoulder stabilization procedures have traditionally been treated with open procedures. Recent advances in arthroscopic techniques have allowed for certain failed stabilization procedures to be treated by arthroscopic surgery. The aim of this systematic review was to determine the outcomes of revision arthroscopic Bankart repair. We searched Medline, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for articles on revision arthroscopic Bankart repairs. Key words included shoulder dislocation, anterior shoulder instability, revision surgery, and arthroscopic Bankart repair. Two reviewers selected studies for inclusion, assessed methodologic quality, and extracted data. We included 16 studies comprising 349 patients. All studies were retrospective (1 Level II study and 15 Level IV studies). The mean incidence of recurrent instability after revision arthroscopic Bankart repair was 12.7%, and the mean follow-up period was 35.4 months. The most common cause for failure of the primary surgeries was a traumatic injury (62.1%), and 85.1% of patients returned to playing sports. The reasons for failure of revision cases included glenohumeral bone loss, hyperlaxity, and return to contact sports. With proper patient selection, the outcomes of revision arthroscopic Bankart repair appear similar to those of revision open Bankart repair. Prospective, randomized clinical trials are required to confirm these findings. Level IV, systematic review of Level II and Level IV studies. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. Cementless acetabular revision arthroplasty

    PubMed Central

    Jain, Rina; Schemitsch, Emil H.; Waddell, James P.

    2000-01-01

    Objective To evaluate the effects of clinical factors on outcome after acetabular revision with a cementless beaded cup. Design Retrospective case series. Setting Tertiary care referral centre. Patients Forty-one patients who underwent acetabular revision with a cementless cup were followed up for a mean of 3.4 years. Interventions Acetabular revision with a beaded cementless cup in all patients. A morcellized allograft was used in 10 patients. Outcome measures A modified Harris hip score (range of motion measurement omitted), the SF-36 health survey, and the Western Ontario McMaster (WOMAC) osteoarthritis index. Multivariate analysis was used to evaluate the effects of age, gender, morcellized allografting, time to revision from the previous operation, acetabular screw fixation and concurrent femoral revision on outcome. Results Gender accounted for a significant portion of the variation seen in the SF-36 physical component scores (r = 0.36, p = 0.02), with women tending to have worse results. Increasing age was associated with lower WOMAC index function scores (r = 0.36, p = 0.03), whereas concurrent femoral revision tended to have a positive effect on WOMAC index function (r = 0.39, p = 0.01). None of the potential clinical predictors had any significant effect on the SF-36 mental component scores, or WOMAC index pain and stiffness scores. Conclusions In cementless acetabular revision arthroplasty, physical function, as measured by generic and limb-specific scales, may be affected by gender, age and the presence of a concurrent femoral revision. Time to revision from the previous operation, morcellized allografting and screw fixation of the acetabulum did not affect outcomes. This information may provide some prognostic value for patients’ expectations. PMID:10948687

  18. Evaluation of the improved tubeless cutaneous ureterostomy technique following radical cystectomy in cases of invasive bladder cancer complicated by peritoneal metastasis

    PubMed Central

    LIU, ZAN; TIAN, QIUYE; XIA, SHUNYAO; YIN, HUAIFU; YAO, DAYONG; XIU, YOUCHENG

    2016-01-01

    Radical cystectomy, as the most common surgical treatment for patients with invasive bladder cancer (IBC) complicated by peritoneal metastasis, is usually accompanied by a urinary diversion procedure. In this study, we evaluated the improved tubeless cutaneous ureterostomy technique by comparing the resulting clinical effects with either a traditional ureterostomy and an ileal conduit urinary diversion. Clinical data from 85 patients who underwent 1 of the 3 procedures between April 2012 and April 2015 were analyzed retrospectively. In total, 30 patients underwent improved tubeless cutaneous ureterostomy, 28 patients underwent a traditional cutaneous ureterostomy and 27 underwent an ileal conduit urinary diversion following radical cystectomy. The incidence of complications, including stoma infection, nipple atrophy, terminal necrosis, urine leakage, external orifice stenosis, uronephrosis and ureterectasia in the group of patients treated with the improved tubeless ureterostomy technique was significantly lower than that of the patients in the other 2 groups, and the difference was statistically significant (P<0.05). In addition, the duration of the surgery, intra-operative bleeding, the duration of the hospitalization period and the time to extubation in the patients treated with the improved tubeless ureterostomy technique were significantly decreased (P<0.05) compared with the patients in the other 2 groups. Finally, the health-related quality of life of the patients treated with the improved tubeless ureterostomy technique was significantly higher (P<0.05) than that of the patients in the other 2 groups. The findings of our study demonstrated that the use of the improved tubeless cutaneous ureterostomy technique following radical cystectomy in patients with IBC complicated by peritoneal metastasis resulted in improved clinical effects. Thus, improved tubeless cutaneous ureterostomy may be a promising alternative for enhancing the quality of life of patients

  19. A reported 20-gene expression signature to predict lymph node-positive disease at radical cystectomy for muscle-invasive bladder cancer is clinically not applicable

    PubMed Central

    van Kessel, Kim E. M.; van de Werken, Harmen J. G.; Lurkin, Irene; Ziel – van der Made, Angelique C. J.; Zwarthoff, Ellen C.; Boormans, Joost L.

    2017-01-01

    Background Neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) provides a small but significant survival benefit. Nevertheless, controversies on applying NAC remain because the limited benefit must be weight against chemotherapy-related toxicity and the delay of definitive local treatment. Therefore, there is a clear clinical need for tools to guide treatment decisions on NAC in MIBC. Here, we aimed to validate a previously reported 20-gene expression signature that predicted lymph node-positive disease at radical cystectomy in clinically node-negative MIBC patients, which would be a justification for upfront chemotherapy. Methods We studied diagnostic transurethral resection of bladder tumors (dTURBT) of 150 MIBC patients (urothelial carcinoma) who were subsequently treated by radical cystectomy and pelvic lymph node dissection. RNA was isolated and the expression level of the 20 genes was determined on a qRT-PCR platform. Normalized Ct values were used to calculate a risk score to predict the presence of node-positive disease. The Cancer Genome Atlas (TCGA) RNA expression data was analyzed to subsequently validate the results. Results In a univariate regression analysis, none of the 20 genes significantly correlated with node-positive disease. The area under the curve of the risk score calculated by the 20-gene expression signature was 0.54 (95% Confidence Interval: 0.44-0.65) versus 0.67 for the model published by Smith et al. Node-negative patients had a significantly lower tumor grade at TURBT (p = 0.03), a lower pT stage (p<0.01) and less frequent lymphovascular invasion (13% versus 38%, p<0.01) at radical cystectomy than node-positive patients. In addition, in the TCGA data, none of the 20 genes was differentially expressed in node-negative versus node-positive patients. Conclusions We conclude that a 20-gene expression signature developed for nodal staging of MIBC at radical cystectomy could not be validated on a qRT-PCR platform in a

  20. Readmission Rate and Causes at 90-Day after Radical Cystectomy in Patients on Early Recovery after Surgery Protocol.

    PubMed

    Altobelli, Emanuela; Buscarini, Maurizio; Gill, Harcharan S; Skinner, Eila C

    2017-01-27

    Background: Radical cystectomy (RC) is associated with high risk of early and late perioperative complications, and readmissions. The Enhanced Recovery After Surgery (ERAS) protocol has been applied to RC showing decreased hospital stay without increased morbidity. Objective: To evaluate the specific causes of hospital readmissions in RC patients treated before and after adoption of an ERAS protocol at our institution. Methods: We retrospectively evaluated the outcome of 207 RC patients on ERAS protocol at the Stanford University Hospital from January 2012 to December 2014. We focused on early (30-day) and late (90-day) postoperative readmission rate and causes. Results were compared with a pre-ERAS consecutive series of 177 RC patients from January 2009 to December 2011. Results: In the post-ERAS time period a total of 56 patients were readmitted, 41 within the first 30 days after surgery (20%) and 15 within the following 60 days (7%). Fever, often associated with dehydration, was the most common reason for presentation to the hospital, accounting for 57% of all readmissions. At 90 days infection accounted for 53% of readmissions. Of all the patients readmitted during the first 90 days after surgery, 32 had positive urine cultures, mostly caused by Enterococcus faecalis isolated in 18 (56%). Readmission rates did not increase since the introduction of the ERAS protocol, with an incidence of 27% in the post-ERAS group versus 30% in the pre-ERAS group. Conclusions: Despite accurate adherence to most recent perioperative antibiotic guidelines, the incidence of readmissions after RC due to infection still remains significant.

  1. Is there a measurable association of epidural use at cystectomy and postoperative outcomes? A population-based study

    PubMed Central

    Christopher Doiron, R.; Jaeger, Melanie; Booth, Christopher M.; Wei, Xuejiao; Robert Siemens, D.

    2016-01-01

    Introduction: Thoracic epidural analgesia (TEA) is commonly used to manage postoperative pain and facilitate early mobilization after major intra-abdominal surgery. Evidence also suggests that regional anesthesia/analgesia may be associated with improved survival after cancer surgery. Here, we describe factors associated with TEA at the time of radical cystectomy (RC) for bladder cancer and its association with both short- and long-term outcomes in routine clinical practice. Methods: All patients undergoing RC in the province of Ontario between 2004 and 2008 were identified using the Ontario Cancer Registry (OCR). Modified Poisson regression was used to describe factors associated with epidural use, while a Cox proportional hazards model describes associations between survival and TEA use. Results: Over the five-year study period, 1628 patients were identified as receiving RC, 54% (n=887) of whom received TEA. Greater anesthesiologist volume (lowest volume providers relative risk [RR] 0.85, 95% confidence interval [CI] 0.75–0.96) and male sex (female sex RR 0.89, 95% CI 0.79–0.99) were independently associated with greater use of TEA. TEA use was not associated with improved short-term outcomes. In multivariable analysis, TEA was not associated with cancer-specific survival (hazard ratio [HR] 1.02, 95% CI 0.87–1.19; p=0.804) or overall survival (HR 0.91, 95% CI 0.80–1.03; p=0.136). Conclusions: In routine clinical practice, 54% of RC patients received TEA and its use was associated with anesthesiologist provider volume. After controlling for patient, disease and provider variables, we were unable to demonstrate any effect on either short- or long-term outcomes at the time of RC. PMID:27800053

  2. Quality of Life Assessment With Orthotopic Ileal Neobladder Reconstruction After Radical Cystectomy: Results From a Prospective Italian Multicenter Observational Study.

    PubMed

    Imbimbo, Ciro; Mirone, Vincenzo; Siracusano, Salvatore; Niero, Mauro; Cerruto, Maria Angela; Lonardi, Cristina; Artibani, Walter; Bassi, Pierfrancesco; Iafrate, Massimo; Racioppi, Marco; Talamini, Renato; Ciciliato, Stefano; Toffoli, Laura; Visalli, Francesco; Massidda, Davide; D'Elia, Carolina; Cacciamani, Giovanni; De Marchi, Davide; Silvestri, Tommaso; Creta, Massimiliano; Belgrano, Emanuele; Verze, Paolo

    2015-11-01

    To assess health-related quality of life (HRQoL) parameters in patients who received radical cystectomy (RC) with ileal orthotopic neobladder (IONB) reconstruction and to identify clinic-pathologic predictors of HRQoL. From January 2010 to December 2013, a multicenter, retrospective on 174 RC-IONB patients was carried out. All patients completed the following questionnaires: the European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer-specific instruments (QLQ-BLM30) and the IONB-Patient Reported Outcome (IONB-PRO). Univariate and multivariate analyses were computed to identify clinic-pathologic predictors of HRQoL. Median age was 66 years (range, 31-83), and 91.4% of patients were men. Median follow-up period was 37 months (range, 3-247). The EORTC QLQ-C30 revealed that age >65 years, absence of urinary incontinence, and absence of peripheral vascular disease were independent predictors of deteriorated body image. A follow-up > 36 months and the presence of urinary incontinence were independent predictors of worsened urinary symptoms, whereas the absence of urinary incontinence was an independent predictor of a worsened body image according to EORTC QLQ-BLM30 results. A follow-up >36 months and the absence of urinary incontinence were independent predictors of better functioning in terms of relational life, emotional life, and fatigue as revealed by the IONB-PRO. Age, presence of urinary incontinence, length of follow-up, and comorbidity status may influence postoperative HRQoL and should all be taken into account when counseling RC-IONB patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Readmission Rate and Causes at 90-Day after Radical Cystectomy in Patients on Early Recovery after Surgery Protocol

    PubMed Central

    Altobelli, Emanuela; Buscarini, Maurizio; Gill, Harcharan S.; Skinner, Eila C.

    2017-01-01

    Background: Radical cystectomy (RC) is associated with high risk of early and late perioperative complications, and readmissions. The Enhanced Recovery After Surgery (ERAS) protocol has been applied to RC showing decreased hospital stay without increased morbidity. Objective: To evaluate the specific causes of hospital readmissions in RC patients treated before and after adoption of an ERAS protocol at our institution. Methods: We retrospectively evaluated the outcome of 207 RC patients on ERAS protocol at the Stanford University Hospital from January 2012 to December 2014. We focused on early (30-day) and late (90-day) postoperative readmission rate and causes. Results were compared with a pre-ERAS consecutive series of 177 RC patients from January 2009 to December 2011. Results: In the post-ERAS time period a total of 56 patients were readmitted, 41 within the first 30 days after surgery (20%) and 15 within the following 60 days (7%). Fever, often associated with dehydration, was the most common reason for presentation to the hospital, accounting for 57% of all readmissions. At 90 days infection accounted for 53% of readmissions. Of all the patients readmitted during the first 90 days after surgery, 32 had positive urine cultures, mostly caused by Enterococcus faecalis isolated in 18 (56%). Readmission rates did not increase since the introduction of the ERAS protocol, with an incidence of 27% in the post-ERAS group versus 30% in the pre-ERAS group. Conclusions: Despite accurate adherence to most recent perioperative antibiotic guidelines, the incidence of readmissions after RC due to infection still remains significant. PMID:28149935

  4. Risk factors and timing of venous thromboembolism after radical cystectomy in routine clinical practice: a population-based study.

    PubMed

    Doiron, R Christopher; Booth, Christopher M; Wei, Xuejiao; Siemens, D Robert

    2016-11-01

    To describe the risk factors and timing of perioperative venous thromboembolism (VTE) and its association with survival for patients undergoing radical cystectomy (RC) in routine clinical practice. The population-based Ontario Cancer Registry was linked to electronic records of treatment to identify all patients who underwent RC between 1994 and 2008; VTE events were identified from hospital diagnostic codes. Multivariate logistic regression analysis was used to determine the factors associated with perioperative VTE. A Cox proportional hazards regression model explored the associations between VTE and survival. Of the 3 879 patients included in the study, 3.6% (141 patients) were diagnosed with VTE at ≤1 month of their surgical admission date. This increased to 4.7% (181) at ≤2 months and 5.4% (211) at ≤3 months. In all, 55% of VTE events presented after hospital discharge. In multivariate analysis, factors associated with VTE included higher surgeon volume (P = 0.004) and increased length of hospital stay (LOS; P < 0.001). Lymph node yield and adjuvant chemotherapy were not associated with VTE. VTE was associated with an inferior cancer-specific survival [hazard ratio (HR) 1.35, 95% confidence interval (CI) 1.13-1.62] and overall survival (HR 1.27, 95% CI 1.08-1.49). Over half of VTE events in RC patients occur after hospital discharge, with a substantial incidence up to 3 months after surgery. Limited actionable risk factors for VTE were identified other than LOS. In this population-based cohort, VTE was associated with inferior long-term survival. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

  5. Lymph node count at radical cystectomy does not influence long-term survival if surgeons adhere to a standardized template.

    PubMed

    Fransen van de Putte, Elisabeth E; Hermans, Tom J N; Werkhoven, Erik van; Mertens, Laura S; Meijer, Richard P; Bex, Axel; Wassenaar, Annabeth E; van der Poel, Henk G; van Rhijn, Bas W G; Horenblas, Simon

    2015-12-01

    Multiple bladder cancer studies report that the number of removed lymph nodes (lymph node count [LNC]) at radical cystectomy (RC) is positively associated with survival. Although these reports suggest that LNC can be used as a proxy for surgical quality, all studies used variable or inconsistent pelvic lymph node dissection (PLND) templates. We therefore wished to establish whether LNC at RC influences survival if surgeons adhere to a standardized PLND template. We included 274 patients who underwent RC from January 2005 until December 2012. All RCs were performed in either one of 2 hospitals (hospital A or B) by the same 4 urologists (all from hospital A) and a standardized PLND template was applied. PLND specimens were processed by 2 independent pathology departments (hospital A and B). We used Cox regression analysis to investigate the prognostic value of LNC adjusted for patient characteristics. We also compared LNC between hospitals and surgeons and investigated the effect of both the variables on overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Median LNC was 17 (interquartile range = 12). At a median follow-up of 64.3 months, there was no association between LNC and OS (P = 0.328), CSS (P = 0.645), or DFS (P = 0.450). Median LNC was higher in hospital B than in hospital A (20.0 vs. 16.0, P = 0.003). Median LNC varied significantly among surgeons (12-20, P<0.001). Neither the hospital of surgery nor the surgeon performing PLND influenced OS (P = 0.771 and P = 0.982, respectively), CSS (P = 0.310 and P = 0.691, respectively), or DFS (P = 0.256 and P = 0.296, respectively). If surgeons adhere to a standardized template, LNC at RC does not affect long-term survival. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Predictive factors for final pathologic ureteral sections on 700 radical cystectomy specimens: Implications for intraoperative frozen section decision-making.

    PubMed

    Masson-Lecomte, Alexandra; Francois, Thomas; Vordos, Dimitri; Cordonnier, Carole; Allory, Yves; Desgrandchamps, Francois; de la Taille, Alexandre; Saint, Fabien

    2017-07-14

    To identify preoperative predictive factors for final ureteral section invasion after radical cystectomy (RC) and to validate significant factors on an external independent cohort. We retrospectively reviewed data of all consecutive RC performed for bladder cancer in 2 high-volume institutions. Clinical, pathological, and follow-up data were collected prospectively and reviewed retrospectively. Pathological evaluation was performed by 2 well-trained uropathologists in each center. Logistic regression analyses were performed to identify predictive factors for final ureteral sections involvement. Significant factors in cohort A were validated in cohort B. Receiver operating curve and area under curve were modeled to evaluate predictive accuracy of the markers. A total of 441 RC were performed in center A and 307 RC were performed in center B. Mean follow-ups were 36.2 and 38.1 months, respectively. Invasion of the final ureteral section was observed on 5.5% of patients in cohort A and 4.8% of patients in cohort B. In cohort A, multivariable logistic regression identified preoperative hydronephrosis on computed tomography scan (odds ratio [OR] = 4.9, P = 0.004) and presence of Carcinoma in situ (CIS, OR = 3.9, P = 0.01) as the only factors associated with ureteral sections positivity. In cohort B, hydronephrosis and CIS were both associated with ureteral sections positivity in univariable analysis. In multivariable analysis, only hydronephrosis remained significant (OR = 5.9, P = 0.01). Predictive accuracy of hydronephrosis and CIS combined in 1 variable was 0.72. Hydronephrosis and bladder CIS have good accuracy in predicting ureteral sections positivity after RC. In the presence of those factors, ureteral frozen sections should be performed. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Clinical–Pathologic Stage Discrepancy in Bladder Cancer Patients Treated With Radical Cystectomy: Results From the National Cancer Data Base

    SciTech Connect

    Gray, Phillip J.; Lin, Chun Chieh; Jemal, Ahmedin; Shipley, William U.; Fedewa, Stacey A.; Kibel, Adam S.; Kamat, Ashish M.; Virgo, Katherine S.; Blute, Michael L.; Zietman, Anthony L.; Efstathiou, Jason A.

    2014-04-01

    Purpose: To examine the accuracy of clinical staging and its effects on outcome in bladder cancer (BC) patients treated with radical cystectomy (RC), using a large national database. Methods and Materials: A total of 16,953 patients with BC without distant metastases treated with RC from 1998 to 2009 were analyzed. Factors associated with clinical–pathologic stage discrepancy were assessed by multivariate generalized estimating equation models. Survival analysis was conducted for patients treated between 1998 and 2004 (n=7270) using the Kaplan-Meier method and Cox proportional hazards models. Results: At RC 41.9% of patients were upstaged, whereas 5.9% were downstaged. Upstaging was more common in females, the elderly, and in patients who underwent a more extensive lymphadenectomy. Downstaging was less common in patients treated at community centers, in the elderly, and in Hispanics. Receipt of preoperative chemotherapy was highly associated with downstaging. Five-year overall survival rates for patients with clinical stages 0, I, II, III, and IV were 67.2%, 62.9%, 50.4%, 36.9%, and 27.2%, respectively, whereas those for the same pathologic stages were 70.8%, 75.8%, 63.7%, 41.5%, and 24.7%, respectively. On multivariate analysis, upstaging was associated with increased 5-year mortality (hazard ratio [HR] 1.80, P<.001), but downstaging was not associated with survival (HR 0.88, P=.160). In contrast, more extensive lymphadenectomy was associated with decreased 5-year mortality (HR 0.76 for ≥10 lymph nodes examined, P<.001), as was treatment at an National Cancer Institute–designated cancer center (HR 0.90, P=.042). Conclusions: Clinical–pathologic stage discrepancy in BC patients is remarkably common across the United States. These findings should be considered when selecting patients for preoperative or nonoperative management strategies and when comparing the outcomes of bladder sparing approaches to RC.

  8. Revised Total Coliform Rule

    EPA Pesticide Factsheets

    The Revised Total Coliform Rule (RTCR) aims to increase public health protection through the reduction of potential pathways for fecal contamination in the distribution system of a public water system (PWS).

  9. Effects of conservative laparoscopic endometrial cystectomy and use of kidney-reinforcing and blood activating traditional Chinese medicine on ovarian functions.

    PubMed

    Huang, Y H; Shen, L; Cai, A H; Liang, X F

    2015-01-30

    This study investigated functional changes in the ovaries of women who have had conservative laparoscopic endometrial cystectomy and the effects of traditional kidney-reinforcing and blood-activating Traditional Chinese Medicine (TCM) on ovarian function. Seventy female patients who underwent laparoscopic endometrial cystectomy were randomized into two groups: TCM group receiving kidney-reinforcing and blood-activating Chinese medicine (N = 35) and control group receiving only routine follow-up (N = 35). The serum levels of all study participants were measured for follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and inhibin B (INHB) prior to and after endometrial surgery. Postoperative menstruation conditions were also assessed. Compared to preoperative conditions, both LH and FSH levels during the postoperative 1st month increased in both groups, while E2 and INHB levels decreased (P < 0.05). In the TCM group, in contrast to the control group and the postoperative 1st month, we observed a decrease in LH and FSH levels during the postoperative 4th month, while E2 and INHB levels increased (P < 0.05). In this study, we found that certain TCM prescriptions lowered postoperative serum FSH and LH levels and increased the serum INHB and basal E2 levels, thereby improving the ovarian reserve.

  10. Similar Treatment Outcomes for Radical Cystectomy and Radical Radiotherapy in Invasive Bladder Cancer Treated at a United Kingdom Specialist Treatment Center

    SciTech Connect

    Kotwal, Sanjeev; Choudhury, Ananya; Johnston, Colin; Paul, Alan B.; Whelan, Peter; Kiltie, Anne E.

    2008-02-01

    Purpose: To conduct a retrospective analysis within a large university teaching hospital, comparing outcomes between patients receiving either radical surgery or radiotherapy as curative treatment for bladder cancer. Patients and Methods: Between March 1996 and December 2000, 169 patients were treated radically for muscle-invasive bladder cancer. Data were collected from patient notes. Statistical analyses were performed using Kaplan-Meier methods and Cox proportional hazards regression analysis to compare radiotherapy and surgical outcome data. Results: There was no difference in overall, cause-specific, and distant recurrence-free survival at 5 years between the two groups, despite the radiotherapy group being older (median age, 75.3 years vs. 68.2 years). There were 31 local bladder recurrences in the radiotherapy group (24 solitary), but there was no significant difference in distant recurrence-free survival. In a more recent (2002-2006) cohort, the median age of radiotherapy patients but not the cystectomy patients was higher than in the 1996-2000 cohort (78.4 years vs. 75.3 years for radiotherapy and 67.9 years vs. 68.2 years for surgery). Conclusions: Although the patients undergoing radical cystectomy were significantly younger than the radiotherapy patients, treatment modality did not influence survival. Bladder cancer patients are an increasingly elderly group. Radical radiotherapy is a viable treatment option for these patients, with the advantage of organ preservation.

  11. Evaluation of the efficacy of the transposed upper arm arteriovenous fistula: a single institutional review of 190 basilic and cephalic vein transposition procedures.

    PubMed

    Woo, Karen; Farber, Alik; Doros, Gheorghe; Killeen, Kelly; Kohanzadeh, Som

    2007-07-01

    Although autogenous brachial-basilic upper arm transpositions (BVT) have been extensively utilized, there has been significant disparity in published patency rates. Very little is known about the efficacy of autogenous brachial-cephalic upper arm transpositions (CVT). We evaluated our experience with transposed upper arm arteriovenous fistulas (tAVF) in order to assess patency and identify factors that affect efficacy. We then compared our tAVF patients with a cohort of upper arm arteriovenous grafts (AVG). A retrospective review was conducted of tAVF performed at our institution from 1998 to 2004. The tAVF group consisted of 119 BVT and 71 CVT procedures. We compared these with 164 AVG. tAVF were placed only for veins >/=2.5 mm in diameter by duplex ultrasonography. Mean follow-up was 28 months. With the exception of mean vein diameter, the patients in the BVT and CVT groups had similar demographic parameters and complication rates. Primary and secondary patency rates were 52% and 62% at 5 years for BVT and 40% and 46% at 5 years for CVT, respectively (P = NS). Multivariate analysis revealed that hemodialysis dependence at the time of fistula placement and history of previous upper arm access independently affected primary patency. History of upper torso dialysis catheters independently affected secondary patency. Comparison of the tAVF and AVG groups revealed that tAVF patients were significantly younger, more likely to be male, less likely to be African American (AA) and less likely to have a history of previous AV access. The primary patency rate for tAVF was significantly higher than for AVG: 48% vs 14% at 5 years (P < .001). The secondary patency rate for tAVF was also significantly higher than for AVG: 57% vs 17% at 5 years (P < .001). Among the tAVF procedures, 9% required one or more revisions to maintain secondary patency, compared to 51% with the AVG group (P < .001). Multivariate analysis revealed that presence of AVG and a history of previous upper arm

  12. Acetabular Cup Revision.

    PubMed

    Kim, Young-Ho

    2017-09-01

    The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.

  13. Predictors of preoperative delays before radical cystectomy for bladder cancer in Quebec, Canada: a population-based study.

    PubMed

    Santos, Fabiano; Dragomir, Alice; Kassouf, Wassim; Franco, Eduardo L; Aprikian, Armen

    2015-03-01

    To characterise and measure different components of preoperative delays experienced by patients with bladder cancer before radical cystectomy (RC) in the province of Quebec, Canada and to identify the predictors of long waiting times. We conducted a retrospective cohort study using the data of patients who underwent RC for bladder cancer between 2000 and 2009 in Quebec. The cohort was obtained with the linkage of two provincial health databases: the Régie de l'assurance maladie du Québec database (data on medical services dispensed to Quebec residents), and the Fichier des évenements démographiques de l'Institut de la statistique du Québec database (demographic data on births and deaths). For the entire cohort, we determined several components of delay from first medical visit related to bladder cancer symptoms until RC. Predictors of long delays were analysed using logistic regression. We analysed a total of 2778 patients who met the inclusion criteria. The median urologist referral delay was 32 days. The median delays between first urologist visit and RC and between transurethral resection of bladder tumour (TURBT) to RC were 90 days and 46 days, respectively. The median overall delay was 116 days. All components of delay progressively increased from the decade of the 1990s to the decade of the 2000s. Male gender was a protective factor for several components of delay, which suggests that gender-related variations may exist in the course of care for bladder cancer (odds ratio 0.67, 95% CI 0.50-0.89 for overall delay). Patient age and gender were associated with delayed urologist referral, delayed time to TURBT, and long overall waiting time. Factors related to the health system were associated with long cystoscopy delays. Median preoperative delays among patients with bladder cancer have been increasing and remain unacceptably long. Patient's age, gender and type of hospital facility were associated with long waiting times. © 2014 The Authors. BJU

  14. A Novel Risk Stratification to Predict Local-Regional Failures in Urothelial Carcinoma of the Bladder After Radical Cystectomy

    SciTech Connect

    Baumann, Brian C.; Guzzo, Thomas J.; He Jiwei; Keefe, Stephen M.; Tucker, Kai; Bekelman, Justin E.; Hwang, Wei-Ting; Vaughn, David J.; Malkowicz, S. Bruce; Christodouleas, John P.

    2013-01-01

    Purpose: Local-regional failures (LF) following radical cystectomy (RC) plus pelvic lymph node dissection (PLND) with or without chemotherapy for invasive urothelial bladder carcinoma are more common than previously reported. Adjuvant radiation therapy (RT) could reduce LF but currently has no defined role because of previously reported morbidity. Modern techniques with improved normal tissue sparing have rekindled interest in RT. We assessed the risk of LF and determined those factors that predict recurrence to facilitate patient selection for future adjuvant RT trials. Methods and Materials: From 1990-2008, 442 patients with urothelial bladder carcinoma at University of Pennsylvania were prospectively followed after RC plus PLND with or without chemotherapy with routine pelvic computed tomography (CT) or magnetic resonance imaging (MRI). One hundred thirty (29%) patients received chemotherapy. LF was any pelvic failure detected before or within 3 months of distant failure. Competing risk analyses identified factors predicting increased LF risk. Results: On univariate analysis, pathologic stage {>=}pT3, <10 nodes removed, positive margins, positive nodes, hydronephrosis, lymphovascular invasion, and mixed histology significantly predicted LF; node density was marginally predictive, but use of chemotherapy, number of positive nodes, type of surgical diversion, age, gender, race, smoking history, and body mass index were not. On multivariate analysis, only stage {>=}pT3 and <10 nodes removed were significant independent LF predictors with hazard ratios of 3.17 and 2.37, respectively (P<.01). Analysis identified 3 patient subgroups with significantly different LF risks: low-risk ({<=}pT2), intermediate-risk ({>=}pT3 and {>=}10 nodes removed), and high-risk ({>=}pT3 and <10 nodes) with 5-year LF rates of 8%, 23%, and 42%, respectively (P<.01). Conclusions: This series using routine CT and MRI surveillance to detect LF confirms that such failures are relatively common

  15. Correlation of the Caprini Score and Venous Thromboembolism Incidence Following Primary Total Joint Arthroplasty-Results of a Single-Institution Protocol.

    PubMed

    Bateman, Dexter K; Dow, Robert W; Brzezinski, Andrzej; Bar-Eli, Howard Y; Kayiaros, Stephen T

    2017-07-05

    Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis, is a serious complication after total joint arthroplasty (TJA). Risk assessment models are increasingly used to provide patient-specific risk stratification. A recently implemented protocol mandates calculation of a Caprini Score for all surgical patients at our institution. We investigated the accuracy of the Caprini Score in predicting VTE events following TJA. A retrospective review of patients undergoing primary total hip (THA) and total knee arthroplasty (TKA) over a 1-year time period was performed. The 90-day postoperative incidence of emergency department evaluations, hospital readmissions, medical complications, need for revision surgery, and symptomatic VTE was recorded. "Preoperative" Caprini Scores routinely recorded per protocol and calculated during review ("Calculated") were compared and assessed for relationship with VTE events. A "VTEstimator" Score was calculated for each patient. Three hundred seventy-six arthroplasties (151 TKA and 225 THA) meeting inclusion criteria were identified. Ten patients (2.5%) had symptomatic VTE postoperatively, with 3 pulmonary embolism (0.8%) and 7 deep vein thrombosis (1.8%). Eight VTE (5.3%) occurred following TKA and 2 (0.9%) occurred following THA. For each surgical characteristic evaluated, no significant difference was observed between mean Preoperative or Calculated Caprini Scores for patients with and without VTE (P > .05). Additionally, the distribution of VTEstimator Scores for patients with and without VTE was not significantly different (P = .93). The Caprini risk assessment model does not appear to provide clinically useful risk stratification for TJA patients. Alternative risk stratification protocols may provide assistance in balancing safety and efficacy of thromboprophylaxis. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Patient Outcomes and Predictors of Success After Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Johnson, William R.; Makani, Amun; Wall, Andrew J.; Hosseini, Ali; Hampilos, Perry; Li, Guoan; Gill, Thomas J.

    2015-01-01

    Background: Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample. Purpose: To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients’ medical records were also thoroughly reviewed. Results: Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P < .017). Conclusion: Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction

  17. Proposed Revisions to Method 202

    EPA Pesticide Factsheets

    EPA is proposing the following revisions to Method 202: Revisions to the procedures for determining the systematic error of the method, which is used to correct the results of the measurements made using this method; Removes some procedural options to

  18. Additional benefit of hemostatic sealant in preservation of ovarian reserve during laparoscopic ovarian cystectomy: a multi-center, randomized controlled trial.

    PubMed

    Song, Taejong; Lee, San-Hui; Kim, Woo Young

    2014-08-01

    Is hemostasis by hemostatic sealant superior to that achieved by bipolar coagulation in preserving ovarian reserve in patients undergoing laparoscopic ovarian cystectomy? Post-operative ovarian reserve, determined by serial serum anti-Müllerian hormone (AMH) levels, was significantly less diminished after ovarian hemostasis when hemostatic sealant was used rather than bipolar coagulation. Hemostasis achieved with bipolar coagulation at ovarian bleeding site results in damage to the ovarian reserve. A prospective, multi-center randomized trial was conducted on 100 participants with benign ovarian cysts, between December 2012 and October 2013. Participants were randomized to undergo hemostasis by use of either hemostatic sealant (FloSeal™) or bipolar coagulation during laparoendoscopic single-site (LESS) ovarian cystectomy. The primary end-point was the rate of decline of ovarian reserve calculated by measuring serum AMH levels preoperatively and 3 months post-operatively. Age, parity, socio-demographic variables, preoperative AMH levels, procedures performed and histologic findings were similar between the two groups of patients. There were also no differences in operative outcomes, such as conversion to other surgical approaches, operative time, estimated blood loss, or perioperative complications between the two groups. In both study groups, post-operative AMH levels were lower than preoperative AMH levels (all P < 0.001). The rate of decline of AMH levels was significantly greater in the bipolar coagulation group than the hemostatic sealant group (41.2% [IQR, 17.2-54.5%] and 16.1% [IQR, 8.3-44.7%], respectively, P = 0.004). Some caution is warranted because other ovarian reserve markers such as serum markers (basal FSH and inhibin-B) or sonographic markers were not assessed. The present study shows that the use of a hemostatic sealant during laparoscopic ovarian cystectomy should be considered, as hemostatic sealant provides the additional benefit of

  19. Revising Russian History.

    ERIC Educational Resources Information Center

    Wertsch, James V.

    1999-01-01

    Examines the production of new history textbooks that appeared after the breakup of the Soviet Union. Argues that the radical revisions in official history in this context are shaped by the Bakhtinian process of "hidden dialogicality." Suggests that the importance of hidden dialogicality between narrative forms must be considered. (SC)

  20. School Safety Handbook. Revised.

    ERIC Educational Resources Information Center

    Association of School Business Officials International, Reston, VA.

    The revised edition of this handbook represents a concerted effort to bring school safety to the forefront of business managers' daily and long-range planning activities. Although statistics show few fatalities on school grounds, schools appear to have a high frequency and incident rate of nonfatal injuries. According to the introduction, school…

  1. Scar revision - slideshow

    MedlinePlus

    ... anatomy URL of this page: //medlineplus.gov/ency/presentations/100098.htm Scar revision - series—Normal anatomy To use the sharing features on this page, please enable JavaScript. Go to slide 1 out of 4 Go to slide 2 ...

  2. Hospital Nurse Aide. Revised.

    ERIC Educational Resources Information Center

    Iowa Univ., Iowa City. Coll. of Education.

    This report presents results of a project to revise the current 120-hour advanced nurse aide course to include all recommended minimum competencies. A three-page description of project objectives, activities, and outcomes is followed by a list of the competencies for the 75-hour nurse aide course for long-term care and for the 120-hour advanced…

  3. Residential Wiring. Revised.

    ERIC Educational Resources Information Center

    Taylor, Mark

    This competency-based curriculum guide contains materials for conducting a course in residential wiring. A technically revised edition of the 1978 publication, the guide includes 28 units. Each instructional unit includes some or all of the following basic components: performance objectives, suggested activities for teachers and students,…

  4. School Safety Handbook. Revised.

    ERIC Educational Resources Information Center

    Association of School Business Officials International, Reston, VA.

    The revised edition of this handbook represents a concerted effort to bring school safety to the forefront of business managers' daily and long-range planning activities. Although statistics show few fatalities on school grounds, schools appear to have a high frequency and incident rate of nonfatal injuries. According to the introduction, school…

  5. The effect on erection and orgasm of cystectomy, prostatectomy and vesiculectomy for cancer of the bladder: a clinical and electromyographic study.

    PubMed

    Bergman, B; Nilsson, S; Petersén, I

    1979-04-01

    Forty-three men who had been subjected to cystectomy and concomitant prostatectomy, vesiculectomy and urethrectomy were interviewed about their pre-operative and post-operative sexual activities at a mean of 3 (range 1 to 8) years after operation. Twenty-eight of the 38 men (74%) who had been sexually active continued to have some form of sexual activity, 21 of them achieving orgasm. Only 3 men had penile erection; 2 of them had been subjected to prostatectomy and 1 to prostatic resection. One of these men treated by prostatectomy had also had urethrectomy. Electromyographic registration from the striated external urethral sphincter, the bulbocavernosus muscle and the levator ani muscle showed normal duration of muscular contractions and length of interval between contractions after operation. The pattern of impulses during organs did not differ from that of normal men.

  6. Midterm Results of Porous Tantalum Femoral Cones in Revision Total Knee Arthroplasty.

    PubMed

    Potter, G David; Abdel, Matthew P; Lewallen, David G; Hanssen, Arlen D

    2016-08-03

    Severe bone loss during a revision total knee arthroplasty (TKA) remains a challenging problem. The purpose of this study was to determine the midterm clinical outcomes, fixation as evaluated radiographically, and survivorship of tantalum femoral cones used during revision TKAs in patients with severe femoral bone loss. From 2003 to 2011, 159 tantalum metaphyseal femoral cones were implanted in 157 patients at a single institution. Knee Society scores, radiographic results, and implant survivorship were analyzed. Two patients were lost to follow-up. Nineteen died of causes unrelated to the surgery but had been followed for >2 years and thus were included in the study. The mean age at the time of the index surgery was 64 years, and 82 patients were male. The mean duration of follow-up was 5 years (range, 2 to 10 years). The mean Knee Society score increased from 47 preoperatively to 65 at the most recent follow-up evaluation (p = 0.1). Radiographically, all 134 unrevised femoral cones were seen to be well fixed without any evidence of loosening. At 5 years, 23 cones had been revised: 14 because of infection, 6 because of aseptic loosening of the cone (all in hinged TKAs in patients with a Type-3 defect), and 3 because of ligamentous instability. The 5-year survivorship was 96% when the end point was revision of the cone due to aseptic loosening, 84% when it was revision of the cone for any reason, and 70% when it was any reoperation. In what we believe to be the largest series of such implants, femoral cones provided a durable and reliable option for metaphyseal fixation during revision TKA with severe femoral bone loss. Aseptic failure of the femoral cone was associated with use of a hinged TKA in a patient with a Type-3 bone defect. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  7. Oncologic outcomes and survival in pT0 tumors after radical cystectomy in patients without neoadjuvant chemotherapy: results from a large multicentre collaborative study.

    PubMed

    Rouprêt, Morgan; Drouin, Sarah J; Larré, Stéphane; Neuzillet, Yann; Botto, Henry; Hitier, Maryam; Rigaud, Jerome; Crew, Jeremy; Xylinas, Evanguelos; Salomon, Laurent; Cornu, Jean-Nicolas; Iborra, François; Champetier, Denis; Rozet, François; Flamand, Vincent; Bastide, Cyrille; Cormier, Luc; Durand, Xavier; Lunardi, Pierre; Rischmann, Pascal; Nouhaud, François-Xavier; Ferlicot, Sophie; Patard, Jean-Jacques; Floch, Aurélie Paule; Irani, Jacques; Peyronnet, Benoit; Bensalah, Karim; Poissonnier, Laura; Grès, Pascale; Droupy, Stéphane; Casenave, Julien; Wallerand, Hervé; Soulié, Michel; Pfister, Christian

    2011-12-01

    To assess the postsurgical survival of patients with urothelial carcinoma of the bladder with pT0 tumor at pathologic examination of cystectomy specimens. A multi-institutional, retrospective database was analyzed with data from 4758 radical cystectomy (RC) patients who underwent RC without neoadjuvant chemotherapy and who were diagnosed with pT0 on the basis of the pathologic specimen. Survival curves were estimated. A multivariate Cox model was used to evaluate the association between prognosis factors and disease recurrence or survival. Overall, 258 patients (5.4%) were included in the study. The median age was 64 years. At last resection, 171 tumors were invasive (at least pT2), and 87 were not. Median follow-up was 51 months. At multivariate analysis, initial location of the tumor and absence of lymphadenectomy were associated with tumor recurrence (P = 0.03 and P = 0.005, respectively) and specific mortality (P = 0.005 and 0.001, respectively). The main limitation of the study is its retrospective design, which is due to the rarity of this situation. Cancer-specific and recurrence-free survival rates were 89 and 85%, respectively, at 5 years and 82 and 80%, respectively, at 10 years. Despite acceptable oncological outcomes, patients with a pT0 tumor at the time of RC are still at risk of recurrence and progression and should not be considered to be entirely cured. In this population, stringent follow-up according to current recommendations should be effective.

  8. Alvimopan, a peripherally acting μ-opioid receptor antagonist, is associated with reduced costs after radical cystectomy: economic analysis of a phase 4 randomized, controlled trial.

    PubMed

    Kauf, Teresa L; Svatek, Robert S; Amiel, Gilad; Beard, Timothy L; Chang, Sam S; Fergany, Amr; Karnes, R Jeffrey; Koch, Michael; O'Hara, Jerome; Lee, Cheryl T; Sexton, Wade J; Slaton, Joel W; Steinberg, Gary D; Wilson, Shandra S; Techner, Lee; Martin, Carolyn; Moreno, Jessica; Kamat, Ashish M

    2014-06-01

    We evaluated the effect of alvimopan treatment vs placebo on health care utilization and costs related to gastrointestinal recovery in patients treated with radical cystectomy in a randomized, phase 4 clinical trial. Resource utilization data were prospectively collected and evaluated by cost consequence analysis. Hospital costs were estimated from 2012 Medicare reimbursement rates and medication wholesale acquisition costs. Differences in base case mean costs between the study cohorts for total postoperative ileus related costs (hospital days, study drug, nasogastric tubes, postoperative ileus related concomitant medication and postoperative ileus related readmissions) and total combined costs (postoperative ileus related, laboratory, electrocardiograms, nonpostoperative ileus related concomitant medication and nonpostoperative ileus related readmission) were evaluated by probabilistic sensitivity analysis using a bootstrap approach. Mean hospital stay was 2.63 days shorter for alvimopan than placebo (mean±SD 8.44±3.05 vs 11.07±8.23 days, p=0.005). Use of medications or interventions likely intended to diagnose or manage postoperative ileus was lower for alvimopan than for placebo, eg total parenteral nutrition 10% vs 25% (p=0.001). Postoperative ileus related health care costs were $2,340 lower for alvimopan and mean total combined costs were decreased by $2,640 per patient for alvimopan vs placebo. Analysis using a 10,000-iteration bootstrap approach showed that the mean difference in postoperative ileus related costs (p=0.04) but not total combined costs (p=0.068) was significantly lower for alvimopan than for placebo. In patients treated with radical cystectomy alvimopan decreased hospitalization cost by reducing the health care services associated with postoperative ileus and decreasing the hospital stay. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. [Results of radical cystectomy for management of invasive bladder cancer with special reference to prognostic factors and quality of life depending on the type of urinary diversion].

    PubMed

    Słojewski, M

    2000-01-01

    Bladder cancer is one of the main problems in urology in terms of diagnosis and treatment, due to its high incidence, high recurrence rate, and difficulties in prognosis of its natural history. According to Polish epidemiological reports, bladder cancer was the fifth cause of death due to malignant diseases in 1993 (1.2% in females and 4.0% in males). Radical cystectomy remained for over forty years the main method of treatment in cases of invasive bladder cancer. Improvements in postoperative care, surgical techniques and methods of urine diversion made cystectomy a widely performed, low mortality procedure. The analysis of prognostic factors with their influence on survival is helpful in patient qualification and prognosis of long-term outcome. The objective was to study retrospectively the results of radical cystectomy in cases of invasive bladder cancer with an emphasis on negative prognostic factors affecting survival. An evaluation of the quality of life (QL) depending on urine diversion method was performed. The material consisted of 95 patients (77 males and 8 females, mean age 59.6) who underwent cystectomy at the Department of Urology, Pomeranian Academy of Medicine, between 1989 and 1998. In 46 cases (48.4%) the Bricker's ileal conduit was performed. Ileal neobladders were created in 24 cases (25.2%) and in 25 patients (26.3%) other types of urine diversion were used. Among 37 survivals (38.6%) 20 patients were evaluated by means of physical examination, abdominal ultrasonography, laboratory parameters, blood gas analysis, urine culture, and QL questionnaires. Median follow-up time was 17.4 months. Survival curves were calculated according to the Kaplan-Meier's method. Statistical significance was established using Cox and Cox-Mantel tests. Histopathologic examination revealed transitional cell carcinoma in 97.8% of the bladders. Basing on the pathologic stage, patients were assigned to 2 groups: organ confined disease (pT2-3a, 41.3%) and perivesical or

  10. Avoiding revision rhinoplasty.

    PubMed

    Waite, Peter D

    2011-02-01

    Reoperation of the nose is challenging and sometimes emotionally difficult for the surgeon and patient. There are multiple pitfalls to be avoided and it is always best to carefully diagnose and establish a surgical treatment plan. Even among the best of plans and surgical techniques, revision may be necessary. The patient and surgeon should understand the limitations of the surgical techniques and the individual anatomy. Published by Elsevier Inc.

  11. Grafting in revision rhinoplasty.

    PubMed

    Bussi, M; Palonta, F; Toma, S

    2013-06-01

    Rhinoplasty is one of the most difficult aesthetic surgery procedures with a high rate of revision. In revision rhinoplasty the surgeon should explore the patient's concerns and then verify the possibility to satisfy expectations after complete internal and external examination of the nose. For the vast majority of complex secondaries, an open approach is the only reasonable method. In fact, in secondary nasal surgery, because of the scarring process following the primary operation, dissection is tedious, and landmarks are lost. One of the main objectives for the surgeon who approaches secondary rhinoplasty is to restore the structural support of the nose and to replace the lost volume of soft tissues. To achieve this purpose, the surgeon must often rely on grafts. An ideal grafting material must be easy to sculpt, resistant to trauma, infection and extrusion, mechanically stable, inert and readily available. For all these reasons, autogenous cartilage grafts harvested from septum, auricular concha and rib represent the first choice in rhinoplasty. In order to obtain a camouflage graft that provides natural contouring to the nose, temporalis fascia can be used. All these carefully trimmed grafts are useful in tip revision surgery, in secondary surgery of the dorsum and to resolve or reduce functional problems.

  12. Survival up to 5–15 years in young women following genital sparing radical cystectomy and neobladder: oncological outcome and quality of life. Single–surgeon and single–institution experience

    PubMed Central

    Elganozoury, Hossam

    2015-01-01

    Introduction This is an observational retrospective study utilising long term patient follow–up for 15 years to determine the survival and quality of life in women (age range 20–54 years) after having been treated for carcinoma of the bladder by radical cystectomy with preservation of genital organs. Material and methods The study included 13 female patients with urothelial carcinoma of the bladder treated with genital sparing radical cystectomy during the period of 1995 until 2006. They had orthotopic ileal neobladder. Follow–up included recurrence–free survival, metastases–free survival, overall survival, continence, and sexual function. Results Genital sparing cystectomy was done in 13 women. Seven women were between the ages of 20–37, and 6 women were aged 38–54. Overall survival of 10–15 years was 61.53%, survival from 5 to 9 years was 38.46%. The procedure was done in 9 women with a muscle–invasive tumor of stage T2– T3a. Non–muscle invasive T1 tumor was present in four patients. Quality of life was assessed by continence, which was good in 10/13 patients. Three women needed CIC. Sexual function was tested by female sexual function index >20–30 and was scored at 84.61%. Conclusions The study provides evidence of safety and efficacy of radical cystectomy with sparing of genital organs in women aged 20 to 54 with urothelial carcinoma of the bladder. Oncological outcome for 5–15 years was good; continence and sexual function were good. This procedure should be considered when surgical approach appears to be feasible. The limitation of our findings is the small sample size of this case series. PMID:26251729

  13. Neck Pain: Revision 2017.

    PubMed

    Blanpied, Peter R; Gross, Anita R; Elliott, James M; Devaney, Laurie Lee; Clewley, Derek; Walton, David M; Sparks, Cheryl; Robertson, Eric K

    2017-07-01

    The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to neck pain. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. doi:10.2519/jospt.2017.0302.

  14. Revision Total Elbow Arthroplasty.

    PubMed

    Ramirez, Miguel A; Cheung, Emilie V; Murthi, Anand M

    2017-08-01

    Despite recent technologic advances, total elbow arthroplasty has complication rates higher than that of total joint arthroplasty in other joints. With new antirheumatic treatments, the population receiving total elbow arthroplasty has shifted from patients with rheumatoid arthritis to those with posttraumatic arthritis, further compounding the high complication rate. The most common reasons for revision include infection, aseptic loosening, fracture, and component failure. Common mechanisms of total elbow arthroplasty failure include infection, aseptic loosening, fracture, component failure, and instability. Tension band fixation, allograft struts with cerclage wire, and/or plate and screw constructs can be used for fracture stabilization.

  15. Revision and Validation of the Revised Teacher Beliefs Survey.

    ERIC Educational Resources Information Center

    Benjamin, Jane

    This study revised the Teacher Beliefs Survey (S. Wooley and A. Wooley, 1999; TBS), an instrument to assess teachers beliefs related to constructivist and behaviorist theories of learning, and then studied the validity of the revised TBS. Drawing on a literature review, researchers added items for the existing constructs of the TBS and added a new…

  16. Why do patients decline surgical trials? Findings from a qualitative interview study embedded in the Cancer Research UK BOLERO trial (Bladder cancer: Open versus Lapararoscopic or RObotic cystectomy).

    PubMed

    Harrop, Emily; Kelly, John; Griffiths, Gareth; Casbard, Angela; Nelson, Annmarie

    2016-01-19

    Surgical trials have typically experienced recruitment difficulties when compared with other types of oncology trials. Qualitative studies have an important role to play in exploring reasons for low recruitment, although to date few such studies have been carried out that are embedded in surgical trials. The BOLERO trial (Bladder cancer: Open versus Lapararoscopic or RObotic cystectomy) is a study to determine the feasibility of randomisation to open versus laparoscopic access/robotic cystectomy in patients with bladder cancer. We describe the results of a qualitative study embedded within the clinical trial that explored why patients decline randomisation. Ten semi-structured interviews with patients who declined randomisation to the clinical trial, and two interviews with recruiting research nurses were conducted. Data were analysed for key themes. The majority of patients declined the trial because they had preferences for a particular treatment arm, and in usual practice could choose which surgical method they would be given. In most cases the robotic option was preferred. Patients described an intuitive 'sense' that favoured the new technology and had carried out their own inquiries, including Internet research and talking with previous patients and friends and family with medical backgrounds. Medical histories and lifestyle considerations also shaped these personalised choices. Of importance too, however, were the messages patients perceived from their clinical encounters. Whilst some patients felt their surgeon favoured the robotic option, others interpreted 'indirect' cues such as the 'established' reputation of the surgeon and surgical method and comments made during clinical assessments. Many patients expressed a wish for greater direction from their surgeon when making these decisions. For trials where the 'new technology' is available to patients, there will likely be difficulties with recruitment. Greater attention could be paid to how messages about

  17. Benefit of Adjuvant Chemotherapy and Pelvic Lymph Node Dissection in pT3 and Node Positive Bladder Cancer Patients Treated with Radical Cystectomy

    PubMed Central

    Boström, Peter J.; Mirtti, Tuomas; van Rhijn, Bas; Fleshner, Neil E.; Finelli, Antonio; Laato, Matti; Jewett, Michael A.; Moore, Malcom J.; Sridhar, Srikala; Nurmi, Martti; Tannock, Ian F.; Zlotta, Alexandre R.

    2016-01-01

    Background: Benefits of adjuvant chemotherapy (AC) and extent of pelvic lymph node dissection (PLND) in radical cystectomy (RC) are debated. Results from randomized trials are still expected. Objective: To analyze the effects of AC and PLND in two academic centers with opposite policies regarding their use. Methods: 581 bladder cancer patients who underwent RC without neoadjuvant chemotherapy, from Toronto (University Health Network), Canada, and Turku University Hospital, Finland were included. Disease specific survival (DSS) and failure patterns were assessed. Results: Centers differed in PLND rate (93% and 36% in Toronto and Turku respectively, p <  0.001), PLND extent (≥10 removed nodes, 58% vs. 8%, p <  0.001) and AC rate (21% vs. 2%, p <  0.001). Survival between centers among pT≤1 or pT4 patients was similar. pT3 patients in Toronto had an improved 10 year DSS (43% vs. 22%, p = 0.025). Distant failures were less common after AC (HR 0.56, 95%  CI 0.33–0.98, p <  0.042). In node positive (N+) patients, mortality was significantly higher in Turku (HR 2.19, 95%  CI 1.44–3.34, p <  0.001) and lower in patients receiving AC (HR 0.60, 95%  CI 0.37–0.99, p = 0.044). 41% DSS at 10 years was observed in N+ Toronto patients. Limitations included the non-randomized retrospective design and absence of propensity score analysis. Conclusion: Combining AC and PLND to RC is associated with improved survival in pT3 and N+ patients. PLND did not affect survival independently but helps in selecting patients for AC. Our data adds to the growing body of evidence supporting the usefulness of AC in addition to PLND in high risk patients operated by cystectomy. PMID:27376145

  18. Gendered Performances during Peer Revision

    ERIC Educational Resources Information Center

    Styslinger, Mary E.

    2008-01-01

    This study explored the ways gender is accomplished in varied social contexts during the peer revision process in a secondary English classroom. Using a post-structural feminist theoretical framework, an analysis of classroom discourse provided a basis for understanding the performance of gender during peer revision, the effects of gender…

  19. Interior Design: Revision as Focus.

    ERIC Educational Resources Information Center

    Smede, Shelly D.

    2000-01-01

    Describes how the author teaches her eighth-grade students to revise their writing, providing "working revision days" in class, offering direction and structure, and thereby helping students learn how much impact going back to a piece of writing and making sweeping changes can have on the end result. (SR)

  20. Emotion Processes in Knowledge Revision

    ERIC Educational Resources Information Center

    Trevors, Gregory J.; Kendeou, Panayiota; Butterfuss, Reese

    2017-01-01

    In recent years, a number of insights have been gained into the cognitive processes that explain how individuals overcome misconceptions and revise their previously acquired incorrect knowledge. The current study complements this line of research by investigating the moment-by-moment emotion processes that occur during knowledge revision using a…

  1. Multimodal Revision Techniques in Webtexts

    ERIC Educational Resources Information Center

    Ball, Cheryl E.

    2014-01-01

    This article examines how an online scholarly journal, "Kairos: Rhetoric, Technology, Pedagogy," mentors authors to revise their webtexts (interactive, digital media scholarship) for publication. Using an editorial pedagogy in which multimodal and rhetorical genre theories are merged with revision techniques found in process-based…

  2. Multimodal Revision Techniques in Webtexts

    ERIC Educational Resources Information Center

    Ball, Cheryl E.

    2014-01-01

    This article examines how an online scholarly journal, "Kairos: Rhetoric, Technology, Pedagogy," mentors authors to revise their webtexts (interactive, digital media scholarship) for publication. Using an editorial pedagogy in which multimodal and rhetorical genre theories are merged with revision techniques found in process-based…

  3. TRICARE reimbursement revisions. Final rule.

    PubMed

    2012-06-27

    This final rule provides several necessary revisions to the regulation in order for TRICARE to be consistent with Medicare. These revisions affect: Hospice periods of care; reimbursement of physician assistants and assistant-at-surgery claims; and diagnosis-related group values, removing references to specific numeric diagnosis-related group values and replacing them with their narrative description.

  4. Surgical Scar Revision: An Overview

    PubMed Central

    Garg, Shilpa; Dahiya, Naveen; Gupta, Somesh

    2014-01-01

    Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods. PMID:24761092

  5. Revision Trabeculectomy: Pearls and Pitfalls

    PubMed Central

    Crowston, Jonathan

    2012-01-01

    ABSTRACT Revision trabeculectomy is used to describe any surgical intervention subsequent to an existing trabeculectomy. Mostly, it is used to describe resurgery for failure of trabeculectomy, as defined by inadequate pressure control. Revision may also be performed for unsafe, uncomfortable or leaking blebs. Mostly bleb failure occurs within the subconjunctival space, although the flap and ostium may be involved or causative. Clear surgical principles, meticulous surgical technique and scrupulous postoperative care are key to successful revision surgery. This review is an attempt to elucidate the technique of bleb revision for bleb failure. How to cite this article: Coote M, Crowston J. Revision Trabeculectomy: Pearls and Pitfalls. J Current Glau Prac 2012;6(3):131-138. PMID:26997769

  6. A three-dimensional head-mounted display system (RoboSurgeon system) for gasless laparoendoscopic single-port partial cystectomy.

    PubMed

    Fujii, Yasuhisa; Kihara, Kazunori; Yoshida, Soichiro; Ishioka, Junichiro; Matsuoka, Yoh; Numao, Noboru; Saito, Kazutaka

    2014-12-01

    We developed a new three-dimensional (3D) head-mounted display (HMD) system (RoboSurgeon system) that combines a high-definition 3D organic electroluminescent HMD with a high-definition 3D endoscope and applies it to minimally invasive surgery. This system presents the surgeon with a higher quality of magnified 3D imagery in front of the eyes, regardless of head position. We report 5 cases of RoboSurgeon gasless laparoendoscopic single-port partial cystectomy, which is carried out as part of our selective bladder-sparing protocol, with a technique utilizing both an intravesical and extravesical approach. While carrying out the surgery, the system provides the surgeon with both excellent 3D imagery of the operative field and clear imagery of the cystoscopy. All procedures were safely completed and there were no complications except for a case of postoperative lymphorrhea. Our experience shows that the 3D HMD system might facilitate maneuverability and safety in various minimally invasive procedures.

  7. Variability in surgical quality in a phase III clinical trial of radical cystectomy in patients with organ-confined, node-negative urothelial carcinoma of the bladder

    PubMed Central

    Mata, Douglas A.; Groshen, Susan; von Rundstedt, Friedrich-Carl; Skinner, Donald G.; Stadler, Walter M.; Cote, Richard J.; Lerner, Seth P.

    2015-01-01

    Background and Objectives Previous studies have shown that variability in surgical technique can affect the outcomes of cooperative group trials. We analyzed measures of surgical quality and clinical outcomes in patients enrolled in the p53-MVAC trial. Methods We performed a post-hoc analysis of patients with pT1-T2N0M0 urothelial carcinoma of the bladder following radical cystectomy (RC) and bilateral pelvic and iliac lymphadenectomy (LND). Measures of surgical quality were examined for associations with time to recurrence (TTR) and overall survival (OS). Results We reviewed operative and/or pathology reports for 440 patients from 35 sites. We found that only 31% of patients met all suggested trial eligibility criteria of having ≥15 lymph nodes identified in the pathologic specimen (LN#) and having undergone both extended and presacral LND. There was no association between extent of LND, LN#, or presacral LND and TTR or OS after adjustment for confounders and multiple testing. Conclusions We demonstrated that there was substantial variability in surgical technique within a cooperative group trial. Despite explicit entry criteria, many patients did not undergo per-protocol LNDs. While outcomes were not apparently affected, it is nonetheless evident that careful attention to study design and quality monitoring will be critical to successful future trials. PMID:25873574

  8. Ten Years of Complete Remission of Pulmonary Metastasis after Post-Cystectomy Palliative Cisplatin-Gemcitabine Chemotherapy with Gefitinib for Muscle Invasive Bladder Cancer: A Case Report.

    PubMed

    Fahmy, Omar; Scharpf, Marcus; Schubert, Tina; Feyerabend, Susan; Stenzl, Arnulf; Schwentner, Christian; Fend, Falko; Gakis, Georgios

    2016-01-01

    Muscle-invasive bladder cancer (MIBC) is considered one of the most lethal malignancies with high metastatic potential. Usually, metastatic bladder cancer carries worse prognosis with a median survival rate of approximately 6 months, which can be prolonged for up to 14 months with palliative systemic chemotherapy. We present the case of a 61-year-old male patient diagnosed with localized MIBC 10 years ago. He underwent nerve-sparing radical cystectomy with ileal neobladder, but developed pulmonary metastatic disease 7 months postoperatively. Six cycles of gemcitabine/cisplatin combination chemotherapy with an addition of gefitinib as daily oral medication were administered within a randomized phase II clinical trial; this resulted in complete remission of the pulmonary metastases. Until now, the patient is still on gefitinib daily without any side effects. Although, the addition of gefitinib to standard systemic chemotherapy has not been shown to improve the survival in metastatic urothelial cancer, this case represents a very pleasant albeit uncommon long-term outcome. © 2016 S. Karger AG, Basel.

  9. A three-dimensional head-mounted display system (RoboSurgeon system) for gasless laparoendoscopic single-port partial cystectomy

    PubMed Central

    Fujii, Yasuhisa; Yoshida, Soichiro; Ishioka, Junichiro; Matsuoka, Yoh; Numao, Noboru; Saito, Kazutaka

    2014-01-01

    We developed a new three-dimensional (3D) head-mounted display (HMD) system (RoboSurgeon system) that combines a high-definition 3D organic electroluminescent HMD with a high-definition 3D endoscope and applies it to minimally invasive surgery. This system presents the surgeon with a higher quality of magnified 3D imagery in front of the eyes, regardless of head position. We report 5 cases of RoboSurgeon gasless laparoendoscopic single-port partial cystectomy, which is carried out as part of our selective bladder-sparing protocol, with a technique utilizing both an intravesical and extravesical approach. While carrying out the surgery, the system provides the surgeon with both excellent 3D imagery of the operative field and clear imagery of the cystoscopy. All procedures were safely completed and there were no complications except for a case of postoperative lymphorrhea. Our experience shows that the 3D HMD system might facilitate maneuverability and safety in various minimally invasive procedures. PMID:25562007

  10. Comparison of pathological staging and grading of urothelial bladder carcinoma in post-transurethral resection and post-radical cystectomy specimens.

    PubMed

    Poletajew, S; Fus, Ł; Walędziak, M; Pomada, P; Ciechańska, J; Wasiutyński, A; Radziszewski, P; Górnicka, B

    2014-12-01

    Staging and grading of bladder cancer have a substantial impact on patients' prognosis. However, due to the relatively low quality and quantity of specimens from transurethral resection (TUR), initial histopathological examination may not be fully reliable. The aim of this study was to assess the repeatability of staging and grading in post-TUR and post-radical cystectomy (RC) specimens. Staging and grading in TUR and RC specimens were compared in a group of 181 consecutive patients. All microscopic examinations were performed by dedicated uropathologists. Median time from TUR to RC was 45 days. Additionally, an attempt to identify potential clinical variables influencing the risk of discrepancies was made. In post-RC specimens, the disease was down-staged in 13.8% and up-staged in 54.6% of patients (K = -0.03, p < 0.02). Muscle-invasive bladder cancer was diagnosed in 67.6% of patients initially staged as T1. Cancer was down-graded in 10.3% and up-graded in 17.9% of patients (K = 0.44, p < 0.02). Early onset of disease, female sex and time interval from transurethral resection of bladder tumor (TURBT) to RC had no effect on incidence of discrepancies. Pathological post-TUR examination is not predictive for the final stage of cancer. The incidence of under- or overgrading of bladder cancer is significant, and efforts should be made to reduce it.

  11. 78 FR 48667 - Revised Company Registration System

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-09

    ... Energy Regulatory Commission Revised Company Registration System AGENCY: Federal Energy Regulatory Commission. ACTION: Notice. SUMMARY: This document revises the effective date of the Revised Company... in Docket No. RM07-16-000, et al. (February 7, 2013 Order) directing revisions to the...

  12. Annotation and Classification of Argumentative Writing Revisions

    ERIC Educational Resources Information Center

    Zhang, Fan; Litman, Diane

    2015-01-01

    This paper explores the annotation and classification of students' revision behaviors in argumentative writing. A sentence-level revision schema is proposed to capture why and how students make revisions. Based on the proposed schema, a small corpus of student essays and revisions was annotated. Studies show that manual annotation is reliable with…

  13. Annotation and Classification of Argumentative Writing Revisions

    ERIC Educational Resources Information Center

    Zhang, Fan; Litman, Diane

    2015-01-01

    This paper explores the annotation and classification of students' revision behaviors in argumentative writing. A sentence-level revision schema is proposed to capture why and how students make revisions. Based on the proposed schema, a small corpus of student essays and revisions was annotated. Studies show that manual annotation is reliable with…

  14. Knowledge-Directed Theory Revision

    NASA Astrophysics Data System (ADS)

    Ali, Kamal; Leung, Kevin; Konik, Tolga; Choi, Dongkyu; Shapiro, Dan

    Using domain knowledge to speed up learning is widely accepted but theory revision of such knowledge continues to use general syntactic operators. Using such operators for theory revision of teleoreactive logic programs is especially expensive in which proof of a top-level goal involves playing a game. In such contexts, one should have the option to complement general theory revision with domain-specific knowledge. Using American football as an example, we use Icarus' multi-agent teleoreactive logic programming ability to encode a coach agent whose concepts correspond to faults recognized in execution of the play and whose skills correspond to making repairs in the goals of the player agents. Our results show effective learning using as few as twenty examples. We also show that structural changes made by such revision can produce performance gains that cannot be matched by doing only numeric optimization.

  15. [Pressure sore revision surgery].

    PubMed

    Dorsche, Karin Marion

    2010-02-22

    Pressure sores are a major problem for patients as well as society in general. Immobilised patients are especially at risk. This group of patients with pressure sores should be hospitalised to perform surgical revision of the wound and reconstruction using a flap. Such surgery demands extensive postoperative relief of the flap. The University Centre for Wound Healing at Odense University Hospital has tested the effects of a reduction of the formerly recommended relief period from three to two weeks. In this article we report results covering all patients who have undergone surgery and reconstruction of pressure sores during the period from 1st October 2001 to 1st November 2008. The results are divided into two periods: the period before and the period after the introduction of the reduced relief period. A total of 80 patients were included; 34 in the first period and 46 in the second period. We achieved a considerable reduction in median length of stay from 38 to 27 days with no increase in surgical or complication frequency. Furthermore, the share of fully healed remained unchanged. We believe that there is no risk in shortening the immobile postoperative relief phase following reconstruction of pressure wounds in immobilised patients.

  16. Arthroscopic revision of Bankart repair.

    PubMed

    Neri, Brian R; Tuckman, David V; Bravman, Jonathan T; Yim, Duke; Sahajpal, Deenesh T; Rokito, Andrew S

    2007-01-01

    The success of revision surgery for failed Bankart repair is not well known. This purpose of this study was to report the success rates achieved using arthroscopic techniques to revise failed Bankart repairs. Twelve arthroscopic revision Bankart repairs were performed on patients with recurrent unidirectional shoulder instability after open or arthroscopic Bankart repair. Follow-up was available on 11 of the 12 patients at a mean of 34.4 months (range, 25-56 months). The surgical findings, possible modes of failure, shoulder scores (Rowe score, University of California Los Angeles [UCLA], Simple Shoulder Test), and clinical outcome were evaluated. Various modes of failure were recognized during revision arthroscopic Bankart repairs. Good-to-excellent results were obtained in 8 patients (73%) undergoing revision stabilization according to Rowe and UCLA scoring. A subluxation or dislocation event occurred in 3 (27%) of the 11 patients at a mean of 8.7 months (range, 6-12 months) postoperatively. Arthroscopic revision Bankart repairs are technically challenging procedures but can be used to achieve stable, pain-free, functional shoulders with return to prior sport. Owing to limited follow-up and the small number of patients in this study, we were unable to conclude any pattern of failure or selection criteria for this procedure.

  17. Cholécystectomie laparoscopique pour cholécystite aiguë lithiasique: à propos de 22 cas colligés à l'hôpital de la renaissance de Ndjamena

    PubMed Central

    Kaimba, Bray Madoué; Mahamat, Youssouf; Akouya, Seid Dounia

    2015-01-01

    Déterminer la faisabilité de la cholécystectomie laparoscopique pour cholécystite aiguë lithiasique dans notre contexte d'exercice, et d'en évaluer les résultats. Nous rapportons une série de 22 patients ayant bénéficié d'une cholécystectomie laparoscopique pour cholécystite aiguë lithiasique sur une période de 16 mois (Décembre 2013- Mars 2015). Sur 22 patients été opérés, il y avait une nette prédominance féminine (20 femmes soit 91%). La durée moyenne de l'intervention était de 90 mn avec des extrêmes de 38 et 142 mn. L’âge moyen de nos patients était de 42 ans avec des extrêmes de 16 à 65 ans. La durée d'hospitalisation a été de 2 à 6 jours avec une moyenne de 3 jours. Le taux de conversion en laparotomie était de 4.5%. Les suites opératoires immédiates ont été simples dans 90.9% des cas. Les complications concernaient 2 patients (9.1%) dont 1 suppuration pariétale et 1 hémorragie de paroi. La cholécystectomie laparoscopique pour cholécystite aigue lithiasique est faisable dans notre contexte au delà des 72 heures d’évolution sans majoration de risques. PMID:26587159

  18. Revised Extended Grid Library

    SciTech Connect

    Martz, Roger L.

    2016-07-15

    The Revised Eolus Grid Library (REGL) is a mesh-tracking library that was developed for use with the MCNP6TM computer code so that (radiation) particles can track on an unstructured mesh. The unstructured mesh is a finite element representation of any geometric solid model created with a state-of-the-art CAE/CAD tool. The mesh-tracking library is written using modern Fortran and programming standards; the library is Fortran 2003 compliant. The library was created with a defined application programmer interface (API) so that it could easily integrate with other particle tracking/transport codes. The library does not handle parallel processing via the message passing interface (mpi), but has been used successfully where the host code handles the mpi calls. The library is thread-safe and supports the OpenMP paradigm. As a library, all features are available through the API and overall a tight coupling between it and the host code is required. Features of the library are summarized with the following list: • can accommodate first and second order 4, 5, and 6-sided polyhedra • any combination of element types may appear in a single geometry model • parts may not contain tetrahedra mixed with other element types • pentahedra and hexahedra can be together in the same part • robust handling of overlaps and gaps • tracks element-to-element to produce path length results at the element level • finds element numbers for a given mesh location • finds intersection points on element faces for the particle tracks • produce a data file for post processing results analysis • reads Abaqus .inp input (ASCII) files to obtain information for the global mesh-model • supports parallel input processing via mpi • support parallel particle transport by both mpi and OpenMP

  19. Is definitive concurrent chemoradiotherapy effective for locally advanced head and neck cancer in the elderly aged ≥ 75 years: A single-institute, retrospective, cohort study.

    PubMed

    Lai, Kuan-Ming; Lin, Jen-Tsun; Lu, Hsueh-Ju; Liang, Chia-Chun; Chen, Mu-Kuan

    2017-08-25

    Definitive chemoradiotherapy (CRT) is the standard treatment for locally advanced head and neck cancer (HNC). However, for very elderly patients, the comparison of benefit/risk between definitive radiotherapy (RT) with and without systemic chemotherapy was equivocal. The study was a single-institute, retrospective, cohort study. Seventy patients aged ≥75 years who had a locally advanced HNC were enrolled. The patients were divided into those with CRT and those with RT alone. Survival, compliance/adverse events and independent prognostic factors were analyzed. For baseline characteristics, the patients who received RT alone had worse performance status, comorbidity score and neutrophil-to-lymphocyte ratio. However, during definitive therapy, the CRT group had more adverse events such as neutropenia, febrile neutropenia and thrombocytopenia. There were no significant differences in disease-specific survival (DSS) and overall survival (OS) (P = 0.864 and 0.788, respectively). As to OS, several independent prognostic factors were identified. Performance status (hazard ratio [HR], 2.312; confidence interval [CI], 1.176-4.546; P = 0.015), clinical T staging (HR, 2.240; 95% CI, 1.021-4.913; P = 0.004) and total RT dose (HR, 2.555; 95% CI, 1.246-5.238; P = 0.010) were independent prognostic factors of OS. Definitive RT with or without systemic chemotherapy did not significantly influence DSS and OS for very elderly patients. Therefore, for elderly patients aged ≥ 75 years who have HNC, conservative RT might be sufficient for treatment purposes. © 2017 John Wiley & Sons Australia, Ltd.

  20. Does a laparoscopic approach attenuate the body weight loss and lean body mass loss observed in open distal gastrectomy for gastric cancer? a single-institution exploratory analysis of the JCOG 0912 phase III trial.

    PubMed

    Aoyama, Toru; Sato, Tsutomu; Hayashi, Tsutomu; Yamada, Takanobu; Cho, Haruhiko; Ogata, Takashi; Oba, Koji; Yoshikawa, Takaki

    2017-06-16

    Laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer may prevent the loss of body weight and lean body mass resulting from reduced surgical stress in comparison to open distal gastrectomy (ODG). A multicenter phase III trial conducted by the Japan Clinical Oncology Group (JCOG0912 trial) was performed to confirm the non-inferiority of LADG to ODG for stage I gastric cancer in terms of relapse-free survival. This study was performed as a single-institution exploratory analysis using the data of the patients from our hospital who were enrolled in the JCOG0912 phase III trial. Body weight and lean body mass were evaluated using a bioelectrical impedance analyzer within 1 week before and at 1 week, 1 month, and 3 months after surgery. One-hundred six patients were randomized to undergo ODG (54 patients) or LADG (51 patients). Body weight loss at 1 week, 1 month, and 3 months was -3.0%, -4.9%, and -5.4%, respectively, in the ODG group and -2.7%, -4.3%, and -5.7%, respectively, in the LADG group; the differences were not statistically significant (p = 0.330, 0.166, and 0.656, respectively). Lean body mass loss at 1 week, 1 month, and 3 months was -2.8%, -4.1%, and -2.3%, respectively, in the ODG group and -2.7%, -2.9%, and -3.0%, respectively, in the LADG group; the differences were not statistically significant (p = 0.610, 0.413, and 0.925, respectively). The laparoscopic approach did not attenuate the loss of body weight and lean body mass in comparison to patients who underwent open distal gastrectomy for gastric cancer.

  1. Incidence, histopathology, and surgical outcome of tumors of spinal cord, nerve roots, meninges, and vertebral column - Data based on single institutional (Sher-i-Kashmir Institute of Medical Sciences) experience

    PubMed Central

    Bhat, Abdul Rashid; Kirmani, Altaf Rehman; Wani, Muhammed Afzal; Bhat, Mohammed Haneef

    2016-01-01

    Context: In the absence of a community-based study on the spinal tumors in the Valley, medical records of the only Regional Neurosurgical Center are available. Aim: The aim of this study is to establish a hospital-based regional epidemiology of spinal tumors in the Valley since the data are derived from a single institution. Materials and Methods: A retrospective analysis of 531 malignant and nonmalignant tumors of spinal cord, its coverings and vertebrae, which were managed in a Regional Neurosurgical Center under a standard and uniform medical-protocol over 30-year period from 1983 to 2014. Results: The hospital-based incidence for all spinal tumors was 0.24/100,000 persons per year. The malignant spinal cord and vertebral tumors comprised 32.58% (173/531) of all tumors, and benign spinal cord and vertebral tumors comprised 67.42% (358/531). The extradural–intradural tumors such as metastatic lesions and primary malignant vertebral tumors were on rise with 16.38% (87/531) cases. The children below 18 years were 5.46% (29/531), of which 55.17% (16/29) were below 9 years. The most common primary bone malignancy was multiple myeloma (54.54% =12/22). Histopathologically, the most common metastatic deposit in the spinal canal was non-Hodgkin's lymphoma (24.61% =16/65). A mortality of 3.20% (17/531) was noted. Recurrences were noted in 4.90% (26/531), and adjuvant therapies were given to 16.38% (87/531) patients. Conclusion: The malignant spinal cord and vertebral tumors, especially metastatic deposits, are on rise in elderly population. The surgical outcome, in terms of recovery and spinal stability, of benign tumors, is comparatively better than malignant ones. The study reveals a low regional incidence (hospital-based) of spinal tumors. PMID:27365955

  2. Critical appraisal of the impact of individual surgeon experience on the outcomes of laparoscopic liver resection in the modern era: collective experience of multiple surgeons at a single institution with 324 consecutive cases.

    PubMed

    Goh, Brian K P; Teo, Jin-Yao; Lee, Ser-Yee; Kam, Juinn-Huar; Cheow, Peng-Chung; Jeyaraj, Premaraj; Chow, Pierce K H; Ooi, London L P J; Chung, Alexander Y F; Chan, Chung-Yip

    2017-09-15

    Most studies analyzing the learning experience of laparoscopic liver resection (LLR) focused on the experience of one or two expert pioneering surgeons. This study aims to critically analyze the impact of individual surgeon experience on the outcomes of LLR based on the contemporary collective experiences of multiple surgeons at single institution. Retrospective review of 324 consecutive LLR from 2006 to 2016. The cases were performed by 10 surgeons over various time periods. Four surgeons had individual experience with <20 cases, four surgeons with 20-30 cases, and two surgeons with >90 cases. The cohort was divided into two groups: comparing a surgeon's experience between the first 20, 30, 40, and 50 cases with patients treated thereafter. Similarly, we performed subset analyses for anterolateral lesions, posterosuperior lesions, and major hepatectomies. As individual surgeons gained increasing experience, this was significantly associated with older patients being operated, decreased hand-assistance, larger tumor size, increased liver resections, increased major resections, and increased resections of tumors located at the posterosuperior segments. This resulted in significantly longer operation time and increased use of Pringle maneuver but no difference in other outcomes. Analysis of LLR for tumors in the posterosuperior segments demonstrated that there was a significant decrease in conversion rates after a surgeon had experience with 20 LLR. For major hepatectomies, there was a significant decrease in morbidity, mortality, and length of stay after acquiring experience with 20 LLR. LLR can be safely adopted today especially for lesions in the anterolateral segments. LLR for lesions in the difficult posterosuperior segments and major hepatectomies especially in cirrhosis should only be attempted by surgeons who have acquired a minimum experience with 20 LLR.

  3. Incidence, histopathology, and surgical outcome of tumors of spinal cord, nerve roots, meninges, and vertebral column - Data based on single institutional (Sher-i-Kashmir Institute of Medical Sciences) experience.

    PubMed

    Bhat, Abdul Rashid; Kirmani, Altaf Rehman; Wani, Muhammed Afzal; Bhat, Mohammed Haneef

    2016-01-01

    In the absence of a community-based study on the spinal tumors in the Valley, medical records of the only Regional Neurosurgical Center are available. The aim of this study is to establish a hospital-based regional epidemiology of spinal tumors in the Valley since the data are derived from a single institution. A retrospective analysis of 531 malignant and nonmalignant tumors of spinal cord, its coverings and vertebrae, which were managed in a Regional Neurosurgical Center under a standard and uniform medical-protocol over 30-year period from 1983 to 2014. The hospital-based incidence for all spinal tumors was 0.24/100,000 persons per year. The malignant spinal cord and vertebral tumors comprised 32.58% (173/531) of all tumors, and benign spinal cord and vertebral tumors comprised 67.42% (358/531). The extradural-intradural tumors such as metastatic lesions and primary malignant vertebral tumors were on rise with 16.38% (87/531) cases. The children below 18 years were 5.46% (29/531), of which 55.17% (16/29) were below 9 years. The most common primary bone malignancy was multiple myeloma (54.54% =12/22). Histopathologically, the most common metastatic deposit in the spinal canal was non-Hodgkin's lymphoma (24.61% =16/65). A mortality of 3.20% (17/531) was noted. Recurrences were noted in 4.90% (26/531), and adjuvant therapies were given to 16.38% (87/531) patients. The malignant spinal cord and vertebral tumors, especially metastatic deposits, are on rise in elderly population. The surgical outcome, in terms of recovery and spinal stability, of benign tumors, is comparatively better than malignant ones. The study reveals a low regional incidence (hospital-based) of spinal tumors.

  4. Are Increased Tumor Aneuploidy and Heightened Cell Proliferation Along With Heterogeneity Associated With Patient Outcome for Carcinomas of the Uterine Cervix? A Combined Analysis of Subjects Treated in RTOG 9001 and a Single-Institution Trial

    SciTech Connect

    Wolfson, Aaron H. Winter, Kathryn; Crook, William

    2008-01-01

    Purpose: To look for possible associations between measurements of DNA index (DI), S-phase fraction (SPF), and tumor heterogeneity (TH) using flow cytometry and overall survival for patients with invasive cervical carcinoma treated with definitive irradiation. Methods and Materials: A total of 57 patients with International Federation of Obstetrics and Gynecology Stages IB{sub 2} through IVB cervical carcinomas treated with definitive radiotherapy with or without concurrent chemotherapy were enrolled into this registry study that involved flow cytometric analysis of fresh tissue from each cervical cancer obtained by pretreatment biopsy. These specimens were evaluated for DNA aneuploidy (DI {<=}1.5 vs. >1.5), SPF ({<=}15% vs. >15%), and TH (uniploid vs. multiploid). Results: In these analyses 27 of the patients were treated in Radiation Therapy Oncology Group protocol 9001, and an additional 30 were offered chemoradiation at a single institution. Forty-one patients had DI {<=}1.5 and 16 DI >1.5. Twenty-nine patients had SPF {<=}15%, 26 >15%, and 2 had no determinable SPF. Forty-three patients had uniploid and 14 multiploid tumors. The 4-year estimated overall survival rate for the entire study cohort was 62% (95% confidence interval 48%-74%). With a median follow-up of 3.7 years, there were no observable associations by univariate analysis for DI, SPF, or TH concerning patient survival. Conclusions: There were no statistically significant associations among DI, SPF, or TH and patient outcome. Additional studies are indicated to identify tumor biomarkers that could predict patients at risk for disseminated disease.

  5. Shed urinary ALCAM is an independent prognostic biomarker of three-year overall survival after cystectomy in patients with bladder cancer

    PubMed Central

    Egloff, Shanna A. Arnold; Du, Liping; Loomans, Holli A.; Starchenko, Alina; Su, Pei-Fang; Ketova, Tatiana; Knoll, Paul B.; Wang, Jifeng; Haddad, Ahmed Q.; Fadare, Oluwole; Cates, Justin M.; Lotan, Yair; Shyr, Yu; Clark, Peter E.; Zijlstra, Andries

    2017-01-01

    Proteins involved in tumor cell migration can potentially serve as markers of invasive disease. Activated Leukocyte Cell Adhesion Molecule (ALCAM) promotes adhesion, while shedding of its extracellular domain is associated with migration. We hypothesized that shed ALCAM in biofluids could be predictive of progressive disease. ALCAM expression in tumor (n = 198) and shedding in biofluids (n = 120) were measured in two separate VUMC bladder cancer cystectomy cohorts by immunofluorescence and enzyme-linked immunosorbent assay, respectively. The primary outcome measure was accuracy of predicting 3-year overall survival (OS) with shed ALCAM compared to standard clinical indicators alone, assessed by multivariable Cox regression and concordance-indices. Validation was performed by internal bootstrap, a cohort from a second institution (n = 64), and treatment of missing data with multiple-imputation. While ALCAM mRNA expression was unchanged, histological detection of ALCAM decreased with increasing stage (P = 0.004). Importantly, urine ALCAM was elevated 17.0-fold (P < 0.0001) above non-cancer controls, correlated positively with tumor stage (P = 0.018), was an independent predictor of OS after adjusting for age, tumor stage, lymph-node status, and hematuria (HR, 1.46; 95% CI, 1.03–2.06; P = 0.002), and improved prediction of OS by 3.3% (concordance-index, 78.5% vs. 75.2%). Urine ALCAM remained an independent predictor of OS after accounting for treatment with Bacillus Calmette-Guerin, carcinoma in situ, lymph-node dissection, lymphovascular invasion, urine creatinine, and adjuvant chemotherapy (HR, 1.10; 95% CI, 1.02–1.19; P = 0.011). In conclusion, shed ALCAM may be a novel prognostic biomarker in bladder cancer, although prospective validation studies are warranted. These findings demonstrate that markers reporting on cell motility can act as prognostic indicators. PMID:27894096

  6. The association of ABO blood type with disease recurrence and mortality among patients with urothelial carcinoma of the bladder undergoing radical cystectomy.

    PubMed

    Gershman, Boris; Moreira, Daniel M; Tollefson, Matthew K; Frank, Igor; Cheville, John C; Thapa, Prabin; Tarrell, Robert F; Thompson, Robert Houston; Boorjian, Stephen A

    2016-01-01

    To evaluate the association of ABO blood type with clinicopathologic outcomes and mortality among patients with urothelial carcinoma of the bladder treated with radical cystectomy (RC). We identified 2,086 consecutive patients who underwent RC between 1980 and 2008. Postoperative recurrence-free survival (RFS) and cancer-specific survival (CSS) were estimated using the Kaplan Meier method and compared with the log-rank test. Cox proportional hazards regression models were used to evaluate the association of ABO blood type with outcomes. A total of 913 (44%), 881 (42%), 216 (10%), and 76 (4%) patients had blood type O, A, B, and AB, respectively. Median postoperative follow-up among survivors was 11.0 years (interquartile range: 7.7-15.9y). Overall, 1,561 patients died, with 770 deaths attributable to bladder cancer. Non-O blood type was associated with significantly worse 5-year RFS (65% vs. 69%; P = 0.04) and/or CSS (64% vs. 70%; P = 0.02). In particular, among patients with≤pT2N0 disease, the 5-year RFS for those with non-O vs. O blood type was 75% vs. 82%, respectively (P = 0.002), whereas the 5-year CSS was 77% vs. 85%, respectively (P = 0.001). Moreover, on multivariable analysis, blood type A remained independently associated with an increased risk of cancer-specific mortality (hazard ratio = 1.22; P = 0.01). Non-O blood type, particularly blood type A, is associated with a significantly increased risk of death from bladder cancer among patients undergoing RC. If validated, the utility of a multimodal therapy approach, including perioperative chemotherapy, or more frequent postoperative surveillance in this cohort warrants further study. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Trends in the Use of Chemotherapy before and after Radical Cystectomy in Patients with Muscle-invasive Bladder Cancer in Korea.

    PubMed

    Kim, Sung Han; Seo, Ho Kyung; Shin, Hee Chul; Chang, Sung Ja; Yun, Sooin; Joo, Jungnam; Ku, Ja Hyeon; Kim, Hyung Suk; Jeon, Hwang Gyun; Jeong, Byong Chang; Jeong, In Gab; Kang, Seok Ho; Hong, Bumsik

    2015-08-01

    We investigated trends in perioperative chemotherapy use, and determined factors associated with neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) use in Korean patients with muscle-invasive bladder cancer (MIBC). We recruited 1,324 patients who had MIBC without nodal invasion or metastases and had undergone radical cystectomies (RC) between 2003 and 2013. The study's cut-off time for AC was three months after surgery, and the study's timespan was divided into three periods based on NAC use, namely, 2003-2005, 2006-2009, and 2010-2013. Complete remission was defined as histologically confirmed T0N0M0 after RC. NAC and AC were administered to 7.3% and 18.1% of the patients, respectively. The median time interval between completing NAC and undergoing RC was 32 days and the mean number of cycles was 3.2. The median time interval between RC and AC was 43 days and the mean number of cycles was 4.1. Gemcitabine and cisplatin were most frequently used in combination for NAC (49.0%) and AC (74.9%). NAC use increased significantly from 4.6% between 2003 and 2005 to 8.4% between 2010 and 2013 (P < 0.05), but AC use did not increase. Only 1.9% of patients received NAC and AC. Complete remission after NAC was achieved in 12 patients (12.5%). Multivariable modeling revealed that an advanced age, the earliest time period analyzed, and clinical tumor stage ≤ cT2 bladder cancer were negatively associated with NAC use (P < 0.05). While NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice.

  8. The morbidity of laparoscopic radical cystectomy: analysis of postoperative complications in a multicenter cohort by the European Association of Urology (EAU)-Section of Uro-Technology.

    PubMed

    Albisinni, Simone; Oderda, Marco; Fossion, Laurent; Varca, Virginia; Rassweiler, Jens; Cathelineau, Xavier; Chlosta, Piotr; De la Taille, Alexandre; Gaboardi, Franco; Piechaud, Thierry; Rimington, Peter; Salomon, Laurent; Sanchez-Salas, Rafael; Stolzenburg, Jens-Uwe; Teber, Dogu; Van Velthoven, Roland

    2016-02-01

    To analyze postoperative complications after laparoscopic radical cystectomy (LRC) and evaluate its risk factors in a large prospective cohort built by the ESUT across European centers involved in minimally invasive urology in the last decade. Patients were prospectively enrolled, and data were retrospectively analyzed. Only oncologic cases were included. There were no formal contraindications for LRC: Also patients with locally advanced tumors (pT4a), serious comorbidities, and previous major abdominal surgery were enrolled. All procedures were performed via a standard laparoscopic approach, with no robotic assistance. Early and late postoperative complications were graded according to the modified Clavien-Dindo classification. Multivariate logistic regression was performed to explore possible risk factors for developing complications. A total of 548 patients were available for final analysis, of which 258 (47%) experienced early complications during the first 90 days after LRC. Infectious, gastrointestinal, and genitourinary were, respectively, the most frequent systems involved. Postoperative ileus occurred in 51/548 (9.3%) patients. A total of 65/548 (12%) patients underwent surgical re-operation, and 10/548 (2%) patients died in the early postoperative period. Increased BMI (p = 0.024), blood loss (p = 0.021), and neoadjuvant treatment (p = 0.016) were significantly associated with a greater overall risk of experiencing complications on multivariate logistic regression. Long-term complications were documented in 64/548 (12%), and involved mainly stenosis of the uretero-ileal anastomosis or incisional hernias. In this multicenter, prospective, large database, LRC appears to be a safe but morbid procedure. Standardized complication reporting should be encouraged to evaluate objectively a surgical procedure and permit comparison across studies.

  9. A double-blind randomized controlled clinical trial to assess the effect of Doppler optimized intraoperative fluid management on outcome following radical cystectomy.

    PubMed

    Pillai, Praveen; McEleavy, Irene; Gaughan, Matthew; Snowden, Christopher; Nesbitt, Ian; Durkan, Garrett; Johnson, Mark; Cosgrove, Joseph; Thorpe, Andrew

    2011-12-01

    Cardiovascular optimization via esophageal Doppler can minimize gastrointestinal hypoperfusion, reducing the risk of multiple organ dysfunction and postoperative complications during major surgery. We assessed the effect of esophageal Doppler guided cardiovascular optimization in patients undergoing radical cystectomy. We conducted a prospective, randomized, double-blind controlled trial at a United Kingdom teaching hospital between 2006 and 2009. A total of 66 patients were randomized to a control arm (34) and an intervention arm (32). The control group received standard intraoperative fluids. The intervention group received (additional) Doppler guided fluid. Primary outcomes were markers of gastrointestinal morbidity such as ileus, flatus and bowel opening. Secondary outcomes were postoperative nausea and vomiting, wound infection and operative intravenous fluid volumes (total and hourly). There were significant reductions in the control and intervention arms in the incidence of ileus (18 vs 7, p <0.001), flatus (5.36 vs 3.55 days, p <0.01) and bowel opening (9.79 vs 6.53 days, p = 0.02), respectively. Nausea and vomiting were significantly reduced in the study group at 24 and 48 hours postoperatively (11 vs 3, p <0.01 and 13 vs 1, p <0.0001). Wound infection rates were significantly reduced (8 vs 1 superficial, p <0.01 and 10 vs 2 combined, p <0.01). Study patients received significantly higher volumes (ml/kg per minute) of intravenous fluid (0.19 vs 0.23, p <0.01) related to a significantly higher volume (ml/kg) in the first hour of surgery (14.1 vs 21.0, p = 0.0001). Cardiovascular optimization using esophageal Doppler significantly improved postoperative markers of gastrointestinal function. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  10. Health-related Quality of Life After Radical Cystectomy: A Cross-sectional Study With Matched-pair Analysis on Ileal Conduit vs Ileal Orthotopic Neobladder Diversion.

    PubMed

    Cerruto, Maria Angela; D'Elia, Carolina; Siracusano, Salvatore; Saleh, Omar; Gacci, Mauro; Cacciamani, Giovanni; De Marco, Vincenzo; Porcaro, Antonio Benito; Balzarro, Matteo; Niero, Mauro; Lonardi, Cristina; Iafrate, Massimo; Bassi, Pierfrancesco; Imbimbo, Ciro; Racioppi, Marco; Talamini, Renato; Ciciliato, Stefano; Serni, Sergio; Carini, Marco; Verze, Paolo; Artibani, Walter

    2017-10-01

    To examine the different and health-related quality of life (HR-QoL) outcomes between ileal conduit (IC) and ileal orthotopic neobladder (IONB) in patients who underwent radical cystectomy (RC), by using validated self-reported cancer-specific instruments. This retrospective, cross-sectional, multicenter cohort study included 148 and 171 patients with either IC or IONB. HR-QoL was evaluated with Quality of Life Core Questionnaire and bladder module (BLM)-30 European Organisation for Research and Treatment of Cancer questionnaires. Baseline HR-QoL scores were dichotomized at the median to give "good" or "poor" score profiles. A matched-pair analysis compared HR-QoL aspects between 79 IC patients and 79 IONB patients. At univariate analysis IONB resulted favorable for physical functioning, emotional functioning, cognitive functioning (CF), fatigue, dyspnea, appetite loss, constipation (CO), and abdominal bloating flatulence (AB). At multivariate analyses, IONB showed better scores for emotional functioning (85 vs 79, P = .023), CF (93 vs 85, P <.001), CO (16 vs 31, P <.001), and AB (12 vs 25, P <.001). A significant worsening of sexual and urinary function was observed for IONB patients in the long-term. At matched-pair analysis, global health status was similar (65 vs 62, P = .385). Significantly better scores were observed in the IONB group for the following items: CF (P = .007), fatigue (P = .003), pain (P = .019), dyspnea (P = .016), CO (P = .001), and AB (P = .00). IONB and IC after RC were similar in terms of global health status. IONB provides better results in some aspects of HR-QoL related to bowel function, but a worsening of urinary and sexual functions. Further randomized controlled trials are needed to confirm these data. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Concordance in Biomarker Status Between Bladder Tumors at Time of Transurethral Resection and Subsequent Radical Cystectomy: Results of a 5-year Prospective Study

    PubMed Central

    Passoni, Niccolò M.; Shariat, Shahrokh F.; Bagrodia, Aditya; Francis, Franto; Rachakonda, Varun; Xylinas, Evanguelos; Kapur, Payal; Sagalowsky, Arthur I.; Lotan, Yair

    2016-01-01

    Purpose: To assess the concordance rate in alterations of molecular markers at the time of transurethral resection (TUR) and subsequent radical cystectomy (RC) among patients with high-grade urothelial carcinoma of the bladder (UCB). Methods: We prospectively performed immunohistochemical staining p53, p21, p27, Ki-67 and cyclin E1 on TUR and on RC specimens from 102 patients treated with RC and bilateral lymphadenectomy for high-grade UCB. We analyzed the concordance rate of individual markers and of the number of altered markers. Concordant and discordant findings were reported in the overall population and according to clinical stage. Results: Median patient age was 74 years (IQR 67–79) and mostly male (86%). Median time from TUR to RC was 1.5 months (IQR 1.0–2.4). Clinical stage at time of RC was cTa/Tis/T1 in 50% , cT2 in 47% , and cT4 in 1% of patients Nine (9%) patients received neoadjuvant chemotherapy. The concordance of biomarkers between TUR and RC specimens was 92.2% , 77.5% , 80.4% , 77.5% , and 83.3% for cyclin E1, p21, p27, p53 and Ki-67, respectively. The concordance between number of altered biomarkers was 51.0%. Conclusions: The rate of individual marker alterations at time of TUR closely approximates that found at RC specimens. However, the correlation of number of altered markers is lower. Molecular marker status at TUR could help predict the marker status at RC and may help guide multimodal therapeutic planning. PMID:27376130

  12. Change in Psoas Muscle Volume as a Predictor of Outcomes in Patients Treated with Chemotherapy and Radical Cystectomy for Muscle-Invasive Bladder Cancer

    PubMed Central

    Zargar, Homayoun; Almassi, Nima; Kovac, Evan; Ercole, Cesar; Remer, Erick; Rini, Brian; Stephenson, Andrew; Garcia, Jorge A.; Grivas, Petros

    2017-01-01

    Objective: Sarcopenia, or the age-related loss of skeletal muscle mass and function, has been investigated as a potential marker of adverse outcomes among surgical patients. Our aim was to assess for changes in psoas muscle volume (PMV) following administration of neoadjuvant chemotherapy (NAC) in patients with bladder cancer and to examine whether changes in PMV following NAC are predictive of perioperative complications, pathologic response or survival. Methods: During the period of 2009–2013, patients undergoing NAC and radical cystectomy (RC) at our institution with pre and post NAC cross sectional images available were included. Bilateral total psoas muscle volume (PMV) was obtained from pre- and post- NAC images and the proportion of PMV change was calculated by dividing the change PMV by pre-NAC PMV. Analyses for the assessment of factors predicting PMV loss, partial/complete pathologic response (pPR/pCR), complications, readmission, cancer specific (CSS), recurrence-free (RFS) and overall survival (OS) were performed. Results: Total of 60 patients had complete radiological data available. Post-NAC PMV and BMI declines were statistically significant, 4.9% and 0.05%, respectively. NAC dose reduction/delay was a significant predictor of PMV loss (coefficient B 4.6; 95% CI 0.05–9.2; p = 0.047). The proportion of PMV decline during NAC was not a predictor of pPR, pCR, complications, readmission, CSS, RFS, or OS. Conclusions: We observed an interval decline in PMV during the period of NAC administration and this decline was more than it could be appreciated with changes in BMI during the same period. PMV decline was associated with the need for dose reduction/dose delay during NAC. In our series, PMV changes occurring during NAC administration were not predictive of pathologic response to chemotherapy, postoperative complications or survival. PMID:28149936

  13. The association of preoperative serum albumin level and American Society of Anesthesiologists (ASA) score on early complications and survival of patients undergoing radical cystectomy for urothelial bladder cancer.

    PubMed

    Djaladat, Hooman; Bruins, Harman Maxim; Miranda, Gus; Cai, Jie; Skinner, Eila C; Daneshmand, Siamak

    2014-06-01

    To evaluate the impact of the preoperative American Society of Anesthesiologists (ASA) score and serum albumin level on complications, recurrences and survival rates of patients who underwent radical cystectomy (RC) for urothelial bladder cancer (UBC). In all, 1964 patients underwent RC for UBC at our institution between 1971 and 2008. Preoperative serum albumin and ASA score were available in 1471 and 1140 patients, respectively. A complication was defined as any surgery related/unrelated event leading to lengthening hospital stay or re-admission. Endpoints were 90-day complication (90dC) rate, recurrence-free survival (RFS) and overall survival (OS). The median (range) follow-up was 12.4 (0.2-27.3) years. In all, 197 patients (13.4%) had a low albumin level (<3.5 g/dL) and 740 (64.8%) had a high ASA score (3 or 4). Low serum albumin and a high ASA score were associated with higher 90dC rate (42% vs 34%, P = 0.03 and 40% vs 28%, P < 0.001, respectively). On multiple logistic regression analysis, a high ASA score remained independently associated with increased 90dC rate (hazard ratio [HR] 1.52, P = 0.005) and decreased OS (HR 1.45, 95% confidence interval [CI] 1.13-1.86). A low serum albumin level was also independently associated with RFS (HR 1.68, 95% CI 1.16-2.43) and OS (HR 1.93, 95% CI 1.43-2.63). A low serum albumin level was independently associated with cancer recurrence and decreased OS after RC. A high ASA score was also independently associated with decreased OS. These parameters potentially could be used as prognosticators after RC. © 2013 The Authors. BJU International © 2013 BJU International.

  14. A greater number of dissected lymph nodes is associated with more favorable outcomes in bladder cancer treated by radical cystectomy: a meta-analysis

    PubMed Central

    Lin, Fengsheng; Chen, Pengliang; Pang, Shiyu

    2016-01-01

    The optimal extent of lymph node dissection (LND) is currently not established, and the debate regarding the association between the number of dissected nodes and the outcomes of bladder cancer treated by radical cystectomy (RC) is still ongoing. Therefore, the present meta-analysis was performed to clarify this potential relationship. Eligible studies were retrieved via an electronic search for studies published up to April 2016, and by manual review of the references. A total of 25 cohort studies involving 41,400 bladder cancer patients who underwent RC were included. The summary relative risk estimates (SRRE) based on the highest compared with the lowest categories of LND were estimated by variance-based meta-analysis. Heterogeneity among the study results was explored through stratified analyses. Overall, bladder cancer patients with the highest category of LND had 28%, 34% and 36% reduced risks, corresponding to overall survival (SRRE = 0.72; 95% CI, 0.64–0.80), cancer-specific survival (SRRE = 0.66; 95% CI, 0.54–0.80) and recurrence-free survival (SRRE = 0.64; 95% CI, 0.50–0.82), respectively, compared with patients with the lowest category of LND. In summary, the patients with a greater number of dissected lymph nodes had statistically significant survival advantages in terms of the outcomes of bladder cancer following RC. The number of dissected lymph nodes could be an independent prognostic factor for bladder cancer. These findings need to be validated in prospective and larger epidemiological studies with a longer follow-up period. PMID:27542252

  15. Does skip metastasis or other lymph node parameters have additional effects on survival of patients undergoing radical cystectomy for bladder cancer?

    PubMed Central

    Baltaci, Sumer; Aslan, Guven; Can, Cavit; Cal, Cag; Elhan, Atilla; Turkeri, Levent; Mungan, Aydin

    2015-01-01

    Purpose To investigate the effects of lymph node metastasis, skip metastasis, and other factors related to lymph node status on survival in patients who underwent radical cystectomy (RC) and extended lymph node dissection (eLND). Materials and Methods RC and eLND were performed in 85 patients with a diagnosis of bladder cancer. Disease-free survival (DFS) and overall survival (OS) were determined by using a Cox proportional hazards model that included the number of excised lymph nodes, the presence of pathological lymph node metastasis, the anatomical level of positive nodes, the number of positive lymph nodes, lymph node density, and the presence of skip metastasis. Results The mean number of lymph nodes removed per patient was 29.4±9.3. Lymph node positivity was detected in 85 patients (34.1%). The mean follow-up duration was 44.9±27.4 months (2-93 months). Five-year estimated OS and DFS for the 85 patients were 62.6% and 57%, respectively. Three of 29 lymph node-positive patients (10.3%) had skip metastasis. Only lymph node positivity had a significant effect on 5-year OS and DFS (p<0.001). No difference in OS and DFS was found between the three patients with skip metastasis and other lymph node-positive patients. Other factors related to lymph node status had no significant effect on 5-year OS and DFS. Conclusions No factors related to lymph node status predict DFS and OS, except for lymph node positivity. OS and DFS were comparable between patients with skip metastasis and other lymph node-positive patients. PMID:25964836

  16. Revision of Primary Series Maps

    USGS Publications Warehouse

    ,

    2000-01-01

    In 1992, the U.S. Geological Survey (USGS) completed a 50-year effort to provide primary series map coverage of the United States. Many of these maps now need to be updated to reflect the construction of new roads and highways and other changes that have taken place over time. The USGS has formulated a graphic revision plan to help keep the primary series maps current. Primary series maps include 1:20,000-scale quadrangles of Puerto Rico, 1:24,000- or 1:25,000-scale quadrangles of the conterminous United States, Hawaii, and U.S. Territories, and 1:63,360-scale quadrangles of Alaska. The revision of primary series maps from new collection sources is accomplished using a variety of processes. The raster revision process combines the scanned content of paper maps with raster updating technologies. The vector revision process involves the automated plotting of updated vector files. Traditional processes use analog stereoplotters and manual scribing instruments on specially coated map separates. The ability to select from or combine these processes increases the efficiency of the National Mapping Division map revision program.

  17. The revised classification of eukaryotes

    PubMed Central

    Adl, Sina M.; Simpson, Alastair. G.; Lane, Christopher E.; Lukeš, Julius; Bass, David; Bowser, Samuel S.; Brown, Matt; Burki, Fabien; Dunthorn, Micah; Hampl, Vladimir; Heiss, Aaron; Hoppenrath, Mona; Lara, Enrique; leGall, Line; Lynn, Denis H.; McManus, Hilary; Mitchell, Edward A. D.; Mozley-Stanridge, Sharon E.; Parfrey, Laura Wegener; Pawlowski, Jan; Rueckert, Sonja; Shadwick, Lora; Schoch, Conrad; Smirnov, Alexey; Spiegel, Frederick W.

    2012-01-01

    This revision of the classification of eukaryotes, which updates that of Adl et al. (2005), retains an emphasis on the protists and incorporates changes since 2005 that have resolved nodes and branches in phylogenetic trees. Whereas the previous revision was successful in re-introducing name stability to the classification, this revision provides a classification for lineages that were then still unresolved. The supergroups have withstood phylogenetic hypothesis testing with some modifications, but despite some progress, problematic nodes at the base of the eukaryotic tree still remain to be statistically resolved. Looking forward, subsequent transformations to our understanding of the diversity of life will be from the discovery of novel lineages in previously under-sampled areas and from environmental genomic information. PMID:23020233

  18. The revised classification of eukaryotes.

    PubMed

    Adl, Sina M; Simpson, Alastair G B; Lane, Christopher E; Lukeš, Julius; Bass, David; Bowser, Samuel S; Brown, Matthew W; Burki, Fabien; Dunthorn, Micah; Hampl, Vladimir; Heiss, Aaron; Hoppenrath, Mona; Lara, Enrique; Le Gall, Line; Lynn, Denis H; McManus, Hilary; Mitchell, Edward A D; Mozley-Stanridge, Sharon E; Parfrey, Laura W; Pawlowski, Jan; Rueckert, Sonja; Shadwick, Laura; Shadwick, Lora; Schoch, Conrad L; Smirnov, Alexey; Spiegel, Frederick W

    2012-09-01

    This revision of the classification of eukaryotes, which updates that of Adl et al. [J. Eukaryot. Microbiol. 52 (2005) 399], retains an emphasis on the protists and incorporates changes since 2005 that have resolved nodes and branches in phylogenetic trees. Whereas the previous revision was successful in re-introducing name stability to the classification, this revision provides a classification for lineages that were then still unresolved. The supergroups have withstood phylogenetic hypothesis testing with some modifications, but despite some progress, problematic nodes at the base of the eukaryotic tree still remain to be statistically resolved. Looking forward, subsequent transformations to our understanding of the diversity of life will be from the discovery of novel lineages in previously under-sampled areas and from environmental genomic information.

  19. HEDR modeling approach: Revision 1

    SciTech Connect

    Shipler, D.B.; Napier, B.A.

    1994-05-01

    This report is a revision of the previous Hanford Environmental Dose Reconstruction (HEDR) Project modeling approach report. This revised report describes the methods used in performing scoping studies and estimating final radiation doses to real and representative individuals who lived in the vicinity of the Hanford Site. The scoping studies and dose estimates pertain to various environmental pathways during various periods of time. The original report discussed the concepts under consideration in 1991. The methods for estimating dose have been refined as understanding of existing data, the scope of pathways, and the magnitudes of dose estimates were evaluated through scoping studies.

  20. Revised evaluations for ENDF/B-VI Revision 2

    SciTech Connect

    Wright, R.Q.

    1993-03-01

    The purpose of this paper is to report on revised cross-section evaluations for 17 nuclides that have been prepared for ENDF/B-VI Revision 2. The nuclides considered include five fission products and various isotopes of cadmium and hafnium. The previous ENDF/B-VI evaluations for these 17 nuclides were carried over from ENDF/B-V and were completed in the 1974--1980 time period. By utilizing the experimental data that have become available since 1980 the revised evaluations will result in significant improvements in the evaluated nuclear data files. The primary emphasis was placed on the resolved and unresolved resonance regions, but new experimental data were also used to improve the cross sections for energies above the unresolved resonance region. Negative elastic scattering cross sections were encountered in some of the previous evaluations; since the revised evaluations use multilevel Breit-Wigner (MLBW) parameters, rather than single-level Breit-Wigner (SLBW), this problem is eliminated.

  1. Pooled Analysis of Clinical Outcome of Patients with Chemorefractory Metastatic Colorectal Cancer Treated within Phase I/II Clinical Studies Based on Individual Biomarkers of Susceptibility: A Single-Institution Experience.

    PubMed

    Sartore-Bianchi, Andrea; Amatu, Alessio; Bonazzina, Erica; Stabile, Stefano; Giannetta, Laura; Cerea, Giulio; Schiavetto, Ilaria; Bencardino, Katia; Funaioli, Chiara; Ricotta, Riccardo; Cipani, Tiziana; Schirru, Michele; Gambi, Valentina; Palmeri, Laura; Carlo-Stella, Giulia; Rusconi, Francesca; Di Bella, Sara; Burrafato, Giovanni; Cassingena, Andrea; Valtorta, Emanuele; Lauricella, Calogero; Pazzi, Federica; Gambaro, Alessandra; Ghezzi, Silvia; Marrapese, Giovanna; Tarenzi, Emiliana; Veronese, Silvio; Truini, Mauro; Vanzulli, Angelo; Siena, Salvatore

    2017-08-01

    .63-9.33], respectively, p = 0.06). This single-institution retrospective study indicates that in a heavily pretreated population approximately 4% of mCRC tumors display a potential actionable molecular context suitable for therapeutic intervention. Application of molecular selection is challenging but improves clinical outcome even in later lines of treatment.

  2. Immediate versus deferred chemotherapy after radical cystectomy in patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder (EORTC 30994): an intergroup, open-label, randomised phase 3 trial.

    PubMed

    Sternberg, Cora N; Skoneczna, Iwona; Kerst, J Martijn; Albers, Peter; Fossa, Sophie D; Agerbaek, Mads; Dumez, Herlinde; de Santis, Maria; Théodore, Christine; Leahy, Michael G; Chester, John D; Verbaeys, Antony; Daugaard, Gedske; Wood, Lori; Witjes, J Alfred; de Wit, Ronald; Geoffrois, Lionel; Sengelov, Lisa; Thalmann, George; Charpentier, Danielle; Rolland, Frédéric; Mignot, Laurent; Sundar, Santhanam; Symonds, Paul; Graham, John; Joly, Florence; Marreaud, Sandrine; Collette, Laurence; Sylvester, Richard

    2015-01-01

    Patients with muscle-invasive urothelial carcinoma of the bladder have poor survival after cystectomy. The EORTC 30994 trial aimed to compare immediate versus deferred cisplatin-based combination chemotherapy after radical cystectomy in patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder. This intergroup, open-label, randomised, phase 3 trial recruited patients from hospitals across Europe and Canada. Eligible patients had histologically proven urothelial carcinoma of the bladder, pT3-pT4 disease or node positive (pN1-3) M0 disease after radical cystectomy and bilateral lymphadenectomy, with no evidence of any microscopic residual disease. Within 90 days of cystectomy, patients were centrally randomly assigned (1:1) by minimisation to either immediate adjuvant chemotherapy (four cycles of gemcitabine plus cisplatin, high-dose methotrexate, vinblastine, doxorubicin, and cisplatin [high-dose MVAC], or MVAC) or six cycles of deferred chemotherapy at relapse, with stratification for institution, pT category, and lymph node status according to the number of nodes dissected. Neither patients nor investigators were masked. Overall survival was the primary endpoint; all analyses were by intention to treat. The trial was closed after recruitment of 284 of the planned 660 patients. This trial is registered with ClinicalTrials.gov, number NCT00028756. From April 29, 2002, to Aug 14, 2008, 284 patients were randomly assigned (141 to immediate treatment and 143 to deferred treatment), and followed up until the data cutoff of Aug 21, 2013. After a median follow-up of 7.0 years (IQR 5.2-8.7), 66 (47%) of 141 patients in the immediate treatment group had died compared with 82 (57%) of 143 in the deferred treatment group. No significant improvement in overall survival was noted with immediate treatment when compared with deferred treatment (adjusted HR 0.78, 95% CI 0.56-1.08; p=0.13). Immediate treatment significantly prolonged progression-free survival compared with

  3. Revised Human Health Risk Assessment on Chlorpyrifos

    EPA Pesticide Factsheets

    We have revised our human health risk assessment and drinking water exposure assessment for chlorpyrifos that supported our October 2015 proposal to revoke all food residue tolerances for chlorpyrifos. Learn about the revised analysis.

  4. Diet History Questionnaire: Database Revision History

    Cancer.gov

    The following details all additions and revisions made to the DHQ nutrient and food database. This revision history is provided as a reference for investigators who may have performed analyses with a previous release of the database.

  5. Final CSAPR Revisions Rule (77 FR 10324)

    EPA Pesticide Factsheets

    EPA finalizes revisions to the Transport Rule (76 FR 48208). These revisions address discrepancies in unit-specific modeling assumptions that affect the proper calculation of Transport Rule state budgets and assurance levels in several states.

  6. Revision Process and Practice: A Kindergarten Experience

    ERIC Educational Resources Information Center

    Chase, Maggie

    2012-01-01

    Many educators teach students that are reluctant about the revisions process in writing. However, this longitudinal study follows a group of students from kindergarten through 8th grade who embraced the importance of the revision process. (Contains 8 figures.)

  7. 24 CFR 968.225 - Budget revisions.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... competitively funded, by deleting or substantially revising approved work items or adding new work items that... originally approved modernization program, the PHA needs to delete or revise approved work items or add new...

  8. 24 CFR 968.225 - Budget revisions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... competitively funded, by deleting or substantially revising approved work items or adding new work items that... originally approved modernization program, the PHA needs to delete or revise approved work items or add new...

  9. Special Consolidated Checklists for Toxicity Characteristics Revisions

    EPA Pesticide Factsheets

    This checklist consolidates the changes to the Federal code addressed by the Toxicity Characteristic (TC) Rule [55 FR 11798; March 29, 1990; Revision Checklist 74] and subsequent revisions which have occurred through December 31, 2002.

  10. Automated revision of CLIPS rule-bases

    NASA Technical Reports Server (NTRS)

    Murphy, Patrick M.; Pazzani, Michael J.

    1994-01-01

    This paper describes CLIPS-R, a theory revision system for the revision of CLIPS rule-bases. CLIPS-R may be used for a variety of knowledge-base revision tasks, such as refining a prototype system, adapting an existing system to slightly different operating conditions, or improving an operational system that makes occasional errors. We present a description of how CLIPS-R revises rule-bases, and an evaluation of the system on three rule-bases.

  11. Soft tissue trauma and scar revision.

    PubMed

    Mobley, Steven R; Sjogren, Phayvanh P

    2014-11-01

    Numerous techniques and treatments have been described for scar revision, with most studies focusing on the adult population. A comprehensive review of the literature reveals a paucity of references related specifically to scar revision in children. This review describes the available modalities in pediatric facial scar revision. The authors have integrated current practices in soft tissue trauma and scar revision, including closure techniques and materials, topical therapy, steroid injection, cutaneous laser therapy, and tissue expanders.

  12. Revised Accounting for Business Combinations

    ERIC Educational Resources Information Center

    Wilson, Arlette C.; Key, Kimberly

    2008-01-01

    The Financial Accounting Standards Board (FASB) has recently issued Statement of Financial Accounting Standards No. 141 (Revised 2007) Business Combinations. The object of this Statement is to improve the relevance, representational faithfulness, and comparability of reported information about a business combination and its effects. This Statement…

  13. Standards for Reading Professionals. Revised.

    ERIC Educational Resources Information Center

    International Reading Association, Newark, DE.

    A revision of a 1992 publication, this booklet presents standards intended to assist in the establishment and evaluation of programs of teacher preparation, to guide the assessment of the qualifications of literacy professionals, and to inform private and state agencies, policymakers, and the general public as they shape literacy instruction now…

  14. Ethical considerations in revision rhinoplasty.

    PubMed

    Wayne, Ivan

    2012-08-01

    The problems that arise when reviewing another surgeon's work, the financial aspects of revision surgery, and the controversies that present in marketing and advertising will be explored. The technological advances of computer imaging and the Internet have introduced new problems that require our additional consideration. Copyright © 2012 by Thieme Medical Publishers, Inc.

  15. Revised adage graphics computer system

    NASA Technical Reports Server (NTRS)

    Tulppo, J. S.

    1980-01-01

    Bootstrap loader and mode-control options for Adage Graphics Computer System Significantly simplify operations procedures. Normal load and control functions are performed quickly and easily from control console. Operating characteristics of revised system include greatly increased speed, convenience, and reliability.

  16. Air Pollution Primer. Revised Education.

    ERIC Educational Resources Information Center

    Corman, Rena

    This revised and updated book is written to inform the citizens on the nature, causes, and effects of air pollution. It is written in terms familiar to the layman with the purpose of providing knowledge and motivation to spur community action on clean air policies. Numerous charts and drawings are provided to support discussion of air pollution…

  17. Modern Indian Psychology. Revised Edition.

    ERIC Educational Resources Information Center

    Bryde, John F.

    Written on the basis of senior Indian verbal relatings collected over a 23-year span, this revised edition on modern Indian psychology incorporates suggestions from Indian students and their teachers, Indian and non-Indian social studies experts, and other Indian people. The book contains 6 major divisions: (1) "Culture and Indian…

  18. How Adults Learn. Revised Edition.

    ERIC Educational Resources Information Center

    Kidd, J. R.

    The book's emphasis is on learning during the years of adulthood and examines present-day practice of adult education for practitioners. This revised edition brings up to date advances in such areas of learning as controversial theory; the effects of environment; sensory processes; intellectual capacities; motivation and attitude; transactional…

  19. Nuffield Chemistry: Revised and Revisited.

    ERIC Educational Resources Information Center

    Dawson, B. E.

    1980-01-01

    Presents data from a survey of schools, colleges, and other institutions and entering candidates for the special GCE examination using Nuffield O-level materials. Examines the effects of curriculum design on subject choice in these institutions. Reviews teacher comments on the publications associated with revision of course materials. (Author/CS)

  20. Error Correction, Revision, and Learning

    ERIC Educational Resources Information Center

    Truscott, John; Hsu, Angela Yi-ping

    2008-01-01

    Previous research has shown that corrective feedback on an assignment helps learners reduce their errors on that assignment during the revision process. Does this finding constitute evidence that learning resulted from the feedback? Differing answers play an important role in the ongoing debate over the effectiveness of error correction,…

  1. Collaborative Revision on a Computer.

    ERIC Educational Resources Information Center

    Cornell, Cynthia; Newton, Robert

    A study investigated the effects of using a computer image projected on a large screen to teach revision to college students. Subjects, 19 students at DePauw University, enrolled in a writing intensive literature course in a Writing across the Curriculum program, were divided into test and control groups. It was hypothesized that the modeling of…

  2. Modern Indian Psychology. Revised Edition.

    ERIC Educational Resources Information Center

    Bryde, John F.

    Written on the basis of senior Indian verbal relatings collected over a 23-year span, this revised edition on modern Indian psychology incorporates suggestions from Indian students and their teachers, Indian and non-Indian social studies experts, and other Indian people. The book contains 6 major divisions: (1) "Culture and Indian…

  3. Air Pollution Primer. Revised Education.

    ERIC Educational Resources Information Center

    Corman, Rena

    This revised and updated book is written to inform the citizens on the nature, causes, and effects of air pollution. It is written in terms familiar to the layman with the purpose of providing knowledge and motivation to spur community action on clean air policies. Numerous charts and drawings are provided to support discussion of air pollution…

  4. DDN New User Guide. Revision.

    DTIC Science & Technology

    1992-10-01

    it to the sender . Many mail programs allow you to use a local text editor to revise or correct the text of the message you are ptepermg. The mail ...23 5.1 Electronic M ail .................................................. 23 5.1.1 UNIX Mail Examples...25 Sending Mail Via UNIX ........................................ 25 Reading UNIX Mail

  5. Mastectomy with immediate breast reconstruction after neoadjuvant chemotherapy and radiation therapy. A new option for patients with operable invasive breast cancer. Results of a 20 years single institution study.

    PubMed

    Monrigal, E; Dauplat, J; Gimbergues, P; Le Bouedec, G; Peyronie, M; Achard, J L; Chollet, P; Mouret-Reynier, M A; Nabholtz, J M; Pomel, C

    2011-10-01

    To evaluate the feasability of immediate breast reconstruction (IBR) following mastectomy after neoadjuvant chemotherapy (NACT) and radiation therapy (RT) for operable invasive breast cancer (OIBC), in terms of incidence of local complications, locoregional control and survival. From 1990 to 2008, 210 patients were treated by NACT, RT and mastectomy with IBR for OIBC. One hundred and seven patients underwent a latissimus dorsi flap with implant (LDI), 56 patients a transverse rectus abdominis musculocutaneous (TRAM) flap, 25 an autologous latissimus dorsi flap (ALD) and 22, a retropectoral implant (RI) reconstruction. Forty-six (21.9%) early events were recorded: 20 necrosis, 9 surgical site infections and 6 haematomas, requiring further surgery in 23 patients. More necrosis were observed with TRAM flap reconstructions (p = 0.000004), requiring more surgical revision than LD reconstructions. Seromas represented 42% of early complications in LD reconstructions. Fifty-five patients presented with late complications (26.2%) with mainly implant complications (capsular contracture, infection, dislocation, deflation) (23.6%), requiring reintervention in 14 cases. There were more delayed surgical revisions in RI reconstructions (p = 0.0005). The 5 years overall and disease-free survival rates were respectively 86.7% and 75.6%. Sixty-four patients presented at least one recurrence (30.5%) with 5 local, 9 locoregional and 54 distant relapses. This therapeutic sequence does not seem to increase the IBR morbidity nor alter disease-free and overall survival. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. 7 CFR 3015.115 - Budget revisions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Budget revisions. 3015.115 Section 3015.115..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Programmatic Changes and Budget Revisions § 3015.115 Budget revisions. (a) Nonconstruction projects. (1) Except as provided in paragraph (a)(2) of...

  7. 24 CFR 968.225 - Budget revisions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Budget revisions. 968.225 Section... Fewer Than 250 Units) § 968.225 Budget revisions. (a) A PHA shall not incur any modernization cost in excess of the total HUD-approved CIAP budget. A PHA shall submit a budget revision, in a form prescribed...

  8. Graphic Arts: Program/Curriculum Revision.

    ERIC Educational Resources Information Center

    Martin, Timothy L.

    In the years since the Williamsport Area Community College's Graphic Arts Program was last revised, the graphic arts industry has been changed by an influx of new technologies. The graphic arts program and curriculum was revised to provide graduates with skills required by the industry. The objectives of this revision were to (1) identify…

  9. Revising: New Essays for Teachers of Writing.

    ERIC Educational Resources Information Center

    Sudol, Ronald A., Ed.

    Intended to help writing teachers better understand how to help students effectively revise their written work, this book contains essays that, as a group, focus on the problem of the definition of revision. The first half of the book discusses the background of revision, while the second half discusses contexts and techniques for application. The…

  10. "SOAR" to the Stars through Revising.

    ERIC Educational Resources Information Center

    Johnson, Jan

    1995-01-01

    Explains how a teacher uses the acronym SOAR (Sentences Organized and Revised) as the core of a game designed to motivate a class to revise their work through the promise of popcorn, free time, or snacks for their revision work. Describes a worksheet that forces students to pay attention to various parts of their paper. (TB)

  11. Humeral windows in revision total elbow arthroplasty.

    PubMed

    Peach, Chris A; Salama, Amir; Stanley, David

    2016-04-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery.

  12. Competencies Revisited: Revising the Overseas ESL Curriculum.

    ERIC Educational Resources Information Center

    Kharde, Linda Smith; Corey, Kathleen

    1986-01-01

    This paper reports on the review and revision of the Overseas Refugee Training Program's curriculum in English as a second language. The discussion focuses on the rationale and guidelines for the revision, the resources used to guide the process, and the criteria used in the selection of competencies. Specific intentions in revising the list of…

  13. 22 CFR 214.14 - Charter revision.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Charter revision. 214.14 Section 214.14 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADVISORY COMMITTEE MANAGEMENT Establishment of Advisory Committees § 214.14 Charter revision. (a) Sponsoring A.I.D. Bureaus and Offices initiate revisions to...

  14. 22 CFR 214.14 - Charter revision.