bluuebunny/crossref_metadata_2025 huggingface dataset:
TN09 HEPATIC EPITHELOID HAEMANGIOENDOTHELIOMA: TWO CONTRASTING CASES
Authors: Stewart G. J. , Crawford M. D.
Published: April 2007

Epitheloid Haemangioendothelioma of the liver is a rare mesenchymal tumour the recommended treatment of which is either liver resection or hepatic transplantation, if diffuse without metastases. The Australian National Liver Transplant Unit, Sydney has assessed and treated 2 patients with this tumour found to be limited to the liver after extensive investigation.

The first case was a 43‐year‐old woman at the time of her operation in 1990. She underwent liver transplantation for a solitary biopsy proven right anterior hepatic lobe haemangioendothelioma. She has been routinely followed up for 16 years and remains recurrence free at last review.

The second case was operated upon in 2004. This 59 years old woman present with an incidental radiological finding of multiple biopsy proven Epitheloid Haemangioendothelioma, limited to the right hepatic lobe and anatomically considered resectable. A right hemi‐hepatectomy was performed, however an addition wedge resection of a non‐radiologically recognised deposit in segment III was required. Resection was planned on the basis that no evidence of liver function impairment was evident and so an extended period on the transplantation waiting list might be anticipated. It was also believed that resection would not preclude latter listing for transplantation. Suitability of the tumour for this approach was suggested by low tumour activity on PET scan. This patient has been regularly reviewed for over 3 years with no evidence of recurrence.

We will review our experience of this neoplasm in relation to the literature surrounding its management in the liver.
TS14P MANAGING AN EMERGING TRAUMA EPIDEMIC IN AUSTRALIA: ABDOMINAL STAB WOUNDS
Authors: Rozen W. M. , Ma E. H. , Jones I. T. , Judson R. T.
Published: April 2007

Purpose  The incidence of abdominal stab wounds treated at the Royal Melbourne Hospital has noticeably increased over the 12 month period to March 2006, mirroring an increase in penetrating abdominal trauma throughout many Australian trauma centers. Management protocols for abdominal stab wounds are still contentious. The current study quantifies the increase in stab wounds at the Royal Melbourne Hospital over a 24 month period and analyzes the management and investigative modalities utilized.

Methodology  A review of the Trauma Unit of the Royal Melbourne Hospital was performed for the period of March 20th 2004 until March 20th 2006. All anterior abdominal stab wounds were collated for the site of injury, investigations performed on admission, results of investigations, operations performed, and findings at operation.

Results  There were 4244 emergency trauma presentations over the 24 months period between March 20th 2004 and March 20th 2006. The second 12 month period showed a 21.5% increase in overall trauma admissions and a 91.3% increase in anterior abdominal stabbings. The percentage of stab wounds treated conservatively fell by 21.8%, with the percentage of laparotomies increasing by 14.2%. Almost 30% of all patients undergoing surgery had no visceral injury at operation. Twenty CT scans were performed preoperatively, with a sensitivity of 79% and specificity of 100%.

Conclusion  Abdominal stab wounds treated at Royal Melbourne Hospital have substantially increased over the past 12 months. Whilst management is still contentious, a management protocol for anterior abdominal stab wounds is proposed, outlining the role of CT scanning, conservative management, laparoscopy and laparotomy
TS18P POST INJURY MULTIPLE ORGAN FAILURE: THE AUSTRALIAN CONTEXT
Authors: Dewar D. C. , Balogh Z. , Mackay P.
Published: April 2007

Background  The epidemiology of post‐injury multiple organ failure (MOF) is reported to go through changes during the last 15 years. The purpose of this study is to describe the epidemiology of post‐injury MOF in Australia.

Methods  A 12‐month prospective epidemiological study was performed in a Major Trauma Service. Demographics, injury severity (ISS), physiological, MOF status and outcome data was prospectively collected on all trauma patients who met inclusion criteria (ICU admission; ISS > 15; age > 18, AIS head <3 and survival >48 hrs). MOF was defined by the Denver MOF score. Data are presented as % or Mean+/−SEM. Univariate statistical comparison was performed (Student t‐ and X‐square tests), p < 0.05 was considered significant.

Results  Twenty‐five patients met inclusion criteria (Age 39+/−5, ISS 27+/−3, Male 60%), three patients (12%) developed MOF. The maximum MOF score was 5.7 +/−1, with duration of 2.3+/−0.7 days. Two patients had respiratory and cardiac failure, while one patient had failure of respiratory, cardiac, hepatic and renal systems. All MOF patients survived. MOF patients tend to have longer ICU stays (18+/−5.5 vs 7+/−0.8 p = 0.17), were older (54+/−17 vs 38+/−5 p = 0.4). None of the previously described independent predictors (ISS, base deficit, lactate, transfusions) were different when the MOF patients were compared with the non‐MOF patients.

Conclusion  MOF is not as significant a cause of late trauma death as previously reported internationally. Our preliminary data challenges the timeliness of the 10‐year‐old independent predictors of post‐injury MOF. The epidemiology, the clinical presentation and the independent predictors of post‐injury MOF requires reassessment for the Australian context.
TS19P STUDY OF THE PATTERN OF INTRA‐ABDOMINAL SOLID ORGAN INJURY – A FIVE‐YEAR CENTRAL AUSTRALIA EXPERIENCE
Authors: Wun L. P. S. , Jacob J. , Boseto F.
Published: April 2007

Purpose  This study aimed to evaluate the pattern of solid intra‐abdominal organ injuries in Central Australia, with focus on the mechanism of injury, Injury Severity Score (ISS), distribution of injury, role of surgical intervention and their outcome. It aimed to assess if difference exists in the above perimeters between the indigenous and non‐indigenous population.

Methodology  This is a retrospective analysis of a selected group of patients as identified by ICD Codes. Database has been created for patients admitted with renal, pancreatic, hepatic and splenic trauma over a five‐year period (2001–2005). Data on demographics, mechanism of injury, distribution of injury, length of stay and ISS has been collected.

Results  Seventy‐one patients has been identified, with 51 (72%) indigenous and 20 (28%) non‐indigenous. 29 patients (41%) were involved in a Motor Vehicle Accident and 33 (46%) were assaulted. There is no statistical difference with the distribution of injury and ISS amongst indigenous and non‐indigenous populations. However there appears to have a higher incidence of surgical intervention associated with the indigenous group (28.8% versus 12.5%). This may be explained by the compliance rate as 29.4% of indigenous patients left against medical advice as compared with 0% with the non‐indigenous group.

Conclusion  The mechanism, pattern and severity of injury appear to be comparable amongst the indigenous and non‐indigenous population in Central Australia. However there is a difference in their incidence of surgical intervention. ISS may not be as useful in prediction for need for intervention in this group and a different approach to trauma management may need to be tailored to this population.
TS20P LAPAROSCOPIC REPAIR OF TRAUMATIC DIAPHRAGMATIC HERNIAE: A CASE PRESENTATION AND SYNTHESIS OF THE LITERATURE EXPERIENCE
Authors: Chong S. , Adams D. , Rahman H.
Published: April 2007

Purpose  Traumatic diaphragmatic herniae are an uncommon sequelae of abdominal trauma which present a significant diagnostic challenge, especially when unaccompanied by other intraabdominal injuries necessitating exploratory laparotomy. Laparoscopic repair is a relatively new and uncommon procedure, with the literature consisting almost entirely of isolated case reports and small case series. We present one of our own cases, and perform a quantitative analysis of the combined literature experience to date.

Methodology  Cases reports of laparoscopic repair of traumatic diaphragmatic herniae were identified by a Medline literature search. Clinical findings, technical decisions and outcomes were correlated via database.

Results  Data from 50 cases was available. There was no common standard method of repair although the majority (31/50) were accomplished without the use of mesh. The major complication rate was 4%, the overall complication rate was 16%. Defects greater than 10cm long were associated with a 41% rate of open conversion, versus 0% if less than 10cm. There were no recurrences described.

Conclusion  Laparoscopic repair of traumatic diaphragmatic herniae enjoys a low rate of major complications, whilst avoiding the morbidity of open repair. Several technical points remain open to operator preference, and we invite discussion regarding the merits of each.
TS03 RETROHEPATIC VENA CAVA INJURY REMAINS A CHALLENGE TO TRAUMA SURGEONS
Authors: Collet e Silva F. S. , Bardella R. , Porta R. M. , Poggetti R. S. , Birolini D.
Published: April 2007

Although uncommon, and despite the modern in diagnostic tools and therapeutic alternatives, retrohepatic and main hepatic veins injury remains associated with high mortality rate. Preoperative diagnosis is uncommon, and bullet trajectory may be a helpful sign in penetrating trauma patients.

Patients and Methods  Hospital records of patients sustaining retroheptic vena cava (RHVC) injury were retrospectively reviewed as to diagnosis, associated injuries, injury characteristics, surgical management, and outcome, last ten years.

Results  Eight male, 17 to 45 (mean 27.5) years‐old patients sustaining RHVC injury were reviewed. Mean trauma indexes for the 8 cases were: ISS 36.6, RTS 7.55 and TRISS 89.0; and for the group who died: ISS 41.6, RTS 7.18, and TRISS 80.5. Two patients had sustained blunt trauma (one died), and six had penetrating injuries (two died). The injury diagnosis was achieved during surgery in all cases. A transfixing RHV injury occurred in 4 (50% of the) patients, and was found in all the 3 patients who died. An atriocaval shunt was employed in four patients, 3 of them had with transfixing injury with two deaths. The number of associated injuries was higher in the patients who died. Overall mortality rate was 37.5%.

Comments  Despite advances in image diagnosis, injuries to RHVC are frequently diagnosed during surgery. Tangential injuries were managed with direct approach and sutures, and to control blending in transfixing injuries, were managed with atriocaval shunts, before suture.

Conclusion  Despite improvements in its diagnosis and management, RHVC injuries remain with a high mortality rate, mainly when transfixing, and associated with numerous associated injuries.
TS04 THE EPIDEMIOLOGY OF PELVIC FRACTURES: THE WHOLE PICTURE
Authors: Mackay P. , King K. , Mackenzie S. , McDougall D. , Evans J. , Balogh Z.
Published: April 2007

Purpose  The comprehensive describtion of the epidemiology of pelvic ring fractures (PRF) including high‐energy PRF, low‐energy PRF and those who die during the prehospital phase (pre‐H).

Methods  12‐month prospective population based study was performed in a trauma system with one Level‐1 trauma centre and seven referring hospitals (population: 0.6 million). Data were collected on all PRF from the trauma system including high‐energy, low energy fractures and pre‐H deaths with PRF. Patient demographics, injury severity score (ISS), mortality (%) and PRF‐related mortality were recorded prospectively. All high‐energy deaths had autopsy at the same forensic pathology department. Data presented as percentages (%) or mean +/− SEM.

Results  During the 12‐month period 138 patients suffered PRF (45% male, 59+/−2 years, ISS 20+/−2, 21% mortality and 8% PRF‐related mortality). Sixty‐four % of the low‐energy and 92% of the high‐energy patients were transferred directly to the trauma center. There were 57 high‐energy (71% male, 41+/−3 years, ISS 23+/−3, 14% mortality, 7% PRF‐related mortality) 63 low‐energy (20% male, 81+/−1 years, ISS 6+/−1, 5% mortality, 2% PRF‐related mortality) and 18 pre‐H died patients with PRF (47% male, 41+/−6 years, ISS 61+/−4, 100% mortality, 33% PRF‐related mortality). PRF‐related mortality was always due to bleeding.

Conclusions  The majority of PRF‐related mortality occurs pre‐H. Half of the multiple‐injured high‐energy PRF patients still die because of the pelvic bleeding. Further preventive measures and optimization of the care of PRF patients is required. Trauma centre admission of 2/3 of the low‐energy PRF is a significant load and should be further investigated in an inclusive trauma system.
VS11 OPERATIVE APPROACH FOR THORACIC OUTLET SYNDROME
Authors: Roberts‐Thomson J. H. , Lamont P. M.
Published: April 2007

Purpose  Thoracic Outlet Syndrome has been described for nearly 200 years. Its development is interesting and will be presented. A limited series from our institution is presented with emphasis on vascular complications of this problem.

Methodology  A Pub. Med engine search over the last 30 years using the titles thoracic outlet syndrome and first rib resection was done.106 articles were studied. Our 6 cases of vascular ramifications of thoracic outlet syndrome are presented.

Results  Only 1 randomised trial comparing diffferent approaches has been reported so management has been controversial. Incidence of subclavian and axillary vein thrombosis has increased. We have found the axillary approach for this condition of Paget Schroetter syndrome difficult and access made easier by using an infraclavicular or combined with a supra clavicular approach.

Conclusions  As this condition is uncommon most centres will have only limited experience. A combined endovascular and surgical decompression yields best results.
VS16P OUTCOMES OF ARTERIOVENOUS FISTULA FOR VASCULAR ACCESS
Authors: Banerjee N. , Hill A. , Bourchier R.
Published: April 2007

Introduction  Vascular access for chronic haemodialysis persists as a surgical challenge. The development of the radiocephalic arteio venous fistula in 1966 by Brescia was a milestone in vascular access surgery. There has been a move away from the use of prosthetic due to the associated complications.

A decision was made at this institution to use autologous vein in all cases recognising the consequence of using marginal veins.

Aim  To determine the Outcomes of all Radiocephalic, Bracheocephalic and Transposition arterio venous fistulae.

Method  A retrospective study by review of the case notes was carried out in March 2006.

All renal access procedures performed between 6/03 and 6/05 were reviewed.

In the new native fistulas formed during this time, the following end points were sought: Primary, secondary and functional patency at 24 hrs. 6 weeks, 6 months and 1 year.

Results  Life table analysis of the patency outcomes showed that Percentage primary patency rates for Radiocephalic and Bracheocephalic fistulae were 71% and 74% at 1 year respectively. Subgroup analysis of females, diabetics and those with BMI > 30 showed diabetics composed >40% of patients and patients with BMI >30 was 29%. Of these two subgroups primary patency rates were comparable to the whole group.

Conclusion  The population studied was different to those in other parts of the world. Favourable

Primary patency rates were obtained for this challenging group of patients.
VS18P IS ENDOVASCULAR REPAIR OF RUPTURED ABDOMINAL AORTIC ANEURYSMS CHANGING THE SELECTION CRITERIA FOR INTERVENTION? – A 5 YEAR RETROSPECTIVE AUDIT IN A SMALL TEACHING HOSPITAL
Authors: Arvapalli V. K. , Walker S. , Beasley T.
Published: April 2007

Purpose  Endovascular repair (EVR) of ruptured abdominal aortic aneurysms (RAAA) holds great promise in the treatment of this usually fatal condition. We aim to demonstrate how the impact of EVR of RAAA has started to alter our practise.

Methodology  A retrospective review of all patients presenting with RAA to a small tertiary referral teaching hospital.

Results  Between January 2001 and September 2006, 76 patients presented with RAAA. One refused surgery and 26 were treated palliatively, all but one died. Forty four underwent conventional open repair (OR) of RAAA (32 men, mean age 68.3 years) and 5 had EVR (4 men, mean age 78.5 years). All patients who underwent EVR would previously have been declined OR due to medical co‐morbidities. The mean annual 30 day mortality for OR was 57% but this has fallen from 70% in 2002 to 25% in 2006. The 30 day mortality for EVR of RAAA was 0%. Mean hospital stay following OR was 20.4 days and following EVR was 17.5 days but mean ICU length of stay was unchanged at 10 days.

Conclusion  Despite recent improvements in survival following OR of RAAA, our initial experience of EVR suggests that we can still do better. Should we be offering this new technology to patients we would previously have declined OR?
VS19P PATTERN OF PERIPHERAL ARTERIAL DISEASE IN CRITICAL LOWER LIMB ISCHEMIA
Authors: Han C. , Westcott M. , Morrison W.
Published: April 2007

Purpose  This study aims to investigate the pattern of peripheral arterial disease in critical lower limb ischemia.

Methodology  76 patients, without previous lower limb vascular surgery, presented to St. Vincent’s Hospital Melbourne with critical lower limb ischemia, manifesting either as rest pain, ischemic ulcers or gangrene over a 1 year period. Digital subtraction angiograms of lower limbs arteries were analyzed to understand the pattern of arterial atherosclerotic disease.

Results  The superficial femoral artery was occluded in 37 of 76 patients, in this group of patients the popliteal artery was reformed from collaterals in all but 5 patients. 42 patients had a single artery run off below the knee. The peroneal artery was only remaining patent artery in 61%, the anterior tibial in 29% and the posterior tibial in 10% of patients.

Conclusion  The peroneal artery is frequently the last remaining patent artery below the knee in patients with critical limb ischemia. This may have implications for surgeons in artery selection for lower limb vascular bypass surgery.
VS20P TRENDS IN EMBOLECTOMY OF THE EXTREMITIES: A POPULATION‐BASED STUDY
Authors: Norman P. , Ponosh S. , Broadhurst R. , Semmens J.
Published: April 2007

Objective  To assess community‐wide temporal trends in the rates of embolectomy of the extremities over the period 1992–2003.

Design  Population‐based study.

Methods  The Western Australian Linked Data System was used to identify cases of extremity embolectomy with a combination of diagnosis (upper or lower limb embolus) and procedure (embolectomy and revascularization) codes. Trends in age‐specific and age‐standardised rates were assessed over the period 1992–2003. Data regarding warfarin prescriptions was acquired from a separate Commonwealth Government database for the period 2000–2005.

Results  1005 patients aged 30 years were admitted for an embolectomy of the extremity during the study period. The age specific rate of embolectomy increased with age from 0.78 per 100,000 in the 30–49 year old group to 46.1 per 100 000 for those aged over 80 years and over. There was a significant downward trend between 1992 and 2003 (Cuzik’s trend test p = 0.015). This pattern was seen for all age groups. Prescriptions for warfarin increased by 50.4% over the period 2000–5.

Conclusions  The rates of embolectomy of the extremity appear to be falling. Although the cause for this trend is not known, one possible explanation is increasing prescription of warfarin.
VS04 RISK/BENEFIT ASSESSMENT FOR ELECTIVE ABDOMINAL AORTIC ANEURYSM SURGERY
Authors: Roake J. A.
Published: April 2007

Purpose  Prediction of individual survival benefit from elective surgery for infrarenal abdominal aortic aneurysm (AAA) is dependent upon a complex interplay between several independent but inter‐related variables. A computerised evidence‐based predictive model was developed to assist clinical decisions on indications for, and timing of, AAA surgery.

Methodology  A systematic review of the literature was conducted to identify independent variables that determine survival of patients with AAA. A complex Markov‐type predictive model was developed with the following outputs: Predicted risk of rupture, operative mortality, life expectancy after AAA surgery, survival with/without surgery, survival curve crossover and breakeven points and number needed to treat.

Results  Independent determinants of survival identified included predictors of a) AAA rupture (Initial diameter; Annual growth rate; Sex; Mean BP; Smoking status), b) Operative mortality (Surgical unit average mortality; Age; Sex; Cardiac, renal and pulmonary co‐morbidity), c) Life expectancy (Median life expectancy at baseline; average annual mortality secondary to co‐morbidity; adjustment for smoking, CHF or ischaemic ECG, Renal failure, COPD), and d) Post‐repair AAA‐related mortality. A sensitivity analysis demonstrated that the outputs were most sensitive to changes in AAA rupture rate and operative mortality.

Conclusions  This predictive model has the potential to assist in management of patients with AAA. While the outputs require validation as objective measures of the potential to benefit from surgery, the interpretation of their relative importance will always remain a matter for subjective judgement dependent upon individual circumstances and preferences.
VS07 PRIORITY SCORING OF UNMET NEED FOR PATIENTS WITH VARICOSE VEINS
Authors: Horrocks E. , Lewis D. R. , Roake J. A.
Published: April 2007

Purpose  Surgery for symptomatic varicose veins (vv’s) has been shown to be clinically and cost effective but few varicose vein operations are performed at Christchurch Hospital, New Zealand. A scoring system has been designed by NZ Vascular Surgeons and The Ministry of Health to grade priority of patients with vv’s. The aim of this study was to assess how many patients, recently removed from the hospital waiting list, score highly enough to still warrant surgery.

Methods  A cohort of 77 patients, returned to GP care, was identified and scored according to their clinical records. The scoring system assessed the following six areas applying a weighted score to each domain: Extent of disease; Severity of disease; Disability; Surgery (simple or complex); Contraindications to surgery and ASA Score.

Results  The median (range) age was 58 (28–81) years with a M : F ratio of 2 : 1. The mean score was 72% (range 31–96%). 66 patients (86%) achieved high enough priority scores to still need surgery.

Conclusion  Of the 77 patients recently removed from the varicose vein waiting list the vast majority still need surgery in the public system. These patients should not have been removed from the waiting list, rather additional funding is needed so that vascular surgeons can address this unmet need.
VS08 3D MODELS OF BLOOD FLOW IN THE CEREBARL‐VASCULATURE
Authors: David T. , Moore S. , Fink J.
Published: April 2007

The Circle of Willis (CoW) is a ring‐like arterial structure located in the base of the brain, responsible for the distribution of oxygenated blood throughout the cerebral mass. Among the general population, approximately 50% have a complete CoW, where among a multitude of possible anatomical variations, vessels absent from the CoW are common. Certain conditions such as a build up of atherosclerotic plaque on the arterial wall can result in ischaemic damage and stroke‐like symptoms. A 3D computer model has been developed based on the results of MRA scans of 3 patients cerebral‐vasculature including a numerical algorithm to simulate the body’s autoregulation mechanism. The intention of the present study was to investigate different anatomical states, including different vessels missing from the circle whilst occluding the main afferent arteries such as the Internal Carotid and Vertebral Arteries.

Results show that variations in inflow characteristics causes peripheral resistances to change in order to maintain sufficient blood flow to the brain tissue. This indicates that ‘pressure’ is the more physiologically correct boundary condition as opposed to the specification of an inlet ‘velocity profile’.
Effects of ground cover (straw and compost) on the abundance of natural enemies and soil macro invertebrates in vineyards
Authors: Thomson Linda J. , Hoffmann Ary A.
Published: April 2007

1 Herbicides are commonly applied under grapevines in Australia to remove weeds and thereby to avoid water loss through transpiration.

2 Interest in sustainability promotes a reduction in chemical inputs, including herbicides, leading to trials with surface mulches to suppress weeds.

3 Surface mulches may also influence the abundance of a range of invertebrates. Potentially, an increase in natural enemies will contribute to pest control and encourage a reduction in pesticide application.

4 We used three trapping methods and direct soil sampling to assess invertebrates at ground level, in the canopy and in the soil to determine the influence of mulch on natural enemies, potential pests and soil macroinvertebrates, including earthworms.

5 Collections sorted to family demonstrated that the addition of straw or compost mulches increased natural enemies collected with pitfall traps and soil organisms. However, there was no clear indication of the overall superiority of either mulch.

6 Abundance of ground beetles, parasitoid Hymenoptera and spiders collected with pitfall traps were increased by the addition of mulches. In the canopy, predatory and parasitic Diptera and predatory Hemiptera increased after mulching.

7 Earthworms collected by hand sorting soil increased with straw mulching.

8 No influence on pests was detected. Although Lepidoptera and Sigmurethra, collected in pitfall traps, increased with straw mulching, neither included pest species.

9 The results are discussed with reference to the potential economic impact of mulches.
Genetic evidence for wild‐living Aspideretes nigricans and a molecular phylogeny of South Asian softshell turtles (Reptilia: Trionychidae: Aspideretes, Nilssonia)
Authors: Praschag P. , Hundsdörfer A. K. , Reza A. H. M. A. , Fritz U.
Published: April 2007

Aspideretes nigricans was long thought to be one of the rarest turtle species of the world, being restricted to a single site in Bangladesh; its specific distinctness was repeatedly doubted. Using mtDNA sequence data of all four Aspideretes species, we provide evidence that A. nigricans is a distinct species that is sister to A. hurum. Furthermore, A. nigricans is not endemic to Bangladesh, but also occurs in Assam, India. While all applied phylogenetic analyses (Bayesian Analysis, Maximum Likelihood, Maximum Parsimony, Neighbor Joining) strongly suggest a well‐supported clade containing the four Aspideretes species and Nilssonia formosa, the monophyly of Aspideretes is at best weakly supported. We propose to synonymise the genera Aspideretes Hay, 1904 and Nilssonia Gray, 1872, resulting in an expanded genus Nilssonia with the species N. formosa (Gray, 1869), N. gangetica (Cuvier, 1825), N. hurum (Gray, 1831), N. leithii (Gray, 1872) and N. nigricans (Anderson, 1875). Genetic structure within N. nigricans is weak, while we detected two distinct genetic lineages within N. gangetica, one occurring in the Brahmaputra River system and the other in the Ganges and Indus River basins.
The expression of vascular endothelial growth factor is associated with the risk of cancer progression after radical prostatectomy
Authors: Peyromaure Michaël , Camparo Philippe , Badoual Cécile , Descazeaud Aurélien , Dinh‐Xuan Anh‐Tuan
Published: April 2007

OBJECTIVE

To analyse the prognostic value of vascular endothelial growth factor (VEGF) in men with clinically localized prostate cancer.

PATIENTS AND METHODS

Paraffin wax‐embedded sections from the radical prostatectomy (RP) specimens of 40 men operated for clinically localized prostate cancer were used to build tissue microarrays. Of these patients, 17 had cancer progression and bone metastases after RP (group 1), and 23 remained free‐of‐tumour recurrence after RP (group 2). VEGF‐A expression was examined in the RP specimens using immunohistochemistry.

RESULTS

The groups had similar tumour characteristics in terms of prostate‐specific antigen level, Gleason score, and pathological stage. VEGF‐A expression was significantly higher in group 1 than in group 2 (P = 0.046). In logistic regression analysis, VEGF‐A expression was the most significant predictive factor of cancer progression after RP.

CONCLUSION

VEGF‐A expression in prostate cancer tissue is associated with the risk of cancer progression after RP. These results suggest that VEGF‐A expression has a prognostic impact in clinically localized prostate cancer.
Renal tumour size measured radiologically before surgery is an unreliable variable for predicting histopathological features: benign tumours are not necessarily small
Authors: Remzi Mesut , Katzenbeisser Daniela , Waldert Matthias , Klingler Hans‐Christoph , Susani Martin , Memarsadeghi Mazda , Heinz‐Peer Gertraud , Haitel Andrea , Herwig Ralf , Marberger Michael
Published: April 2007

OBJECTIVE

To compare histopathological findings as a function of radiological tumour size, as published data suggest that small renal tumours are often benign and large tumours are renal cell cancer (RCC).

PATIENTS AND METHODS

Data from 543 surgically treated patients with solid renal tumours were analysed retrospectively. Tumour size measured by computed tomography (CT) before surgery was stratified into seven subgroups (cm): 0–2, 2.1–3, 3.1–4, 4.1–5, 5.1–6, 6.1–7 and >7, and correlated with final histology.

RESULTS

In all, 80 lesions (14.7%) were benign on final histology; tumour size did not correlate with benign histology (P = 0.660). Histopathological tumour size was not statistically significant different (P = 0.521) from measured tumour size on CT, and there was no statistical significance between CT and histopathological tumour size (P = 0.528). Only 13 (17%) of lesions were correctly defined as benign on CT before surgery, whereas 67 (83%) were considered to be suspicious for malignant disease. Only one patient with a tumour correctly defined as benign had a radical nephrectomy; by contrast, 28 of 67 (42%) had a radical nephrectomy for benign lesions not correctly identified as benign on CT before surgery (P < 0.001).

CONCLUSION

Substantially many renal masses are benign, independent of tumour size. Radical nephrectomy could potentially have been avoided in 42% of patients with benign renal tumours. These data provide a good argument for the use of a more refined preoperative diagnostic evaluation, in particular needle biopsy.
Pre‐clinical and clinical evaluation of estramustine, docetaxel and thalidomide combination in androgen‐independent prostate cancer
Authors: Figg William D. , Li Haiqing , Sissung Tristan , Retter Avi , Wu Shenhong , Gulley James L. , Arlen Phil , Wright John J. , Parnes Howard , Fedenko Kathy , Latham Lea , Steinberg Seth M. , Jones Elizabeth , Chen Clara , Dahut William
Published: April 2007

OBJECTIVE

To evaluate the combination of docetaxel plus estramustine (which prolongs survival in patients with androgen‐independent prostate cancer, AIPC), and thalidomide (that also adds to docetaxel activity), both pre‐clinically and clinically in AIPC.

PATIENTS, MATERIALS AND METHODS

In the pre‐clinical evaluation we injected PC3 cells subcutaneously into severely combined immunodeficient mice and started treatment after the tumour volume reached 50 mm3. We also evaluated the combination using luciferase‐labelled PC3M‐luc‐C6 cells in nude mice. We enrolled 20 patients with metastatic progressive AIPC into a phase II clinical trial to evaluate this combination. Docetaxel (30 mg/m2) was administered every week, for 3 of 4 weeks. The dose of thalidomide was 200 mg/day and estramustine was given three times a day at 1, 2, 3, 8, 9, 10, 15, 16 and 17 days.

RESULTS

In the mice, thalidomide with docetaxel plus estramustine reduced tumour volume by 88% at 17 days vs the control treatment (p = 0.001). The combination of docetaxel, estramustine and thalidomide nearly eradicated the signal from the luciferase‐expressing PC3M cells in the metastasis model. Clinically, the progression‐free time was 7.2 months with this combination; 18 of 20 patients had a decline of half or more in prostate‐specific antigen level and two of 10 patients with soft‐tissue lesions had a partial response on computed tomography. There were 24 grade 3 and two grade 4 complications associated with this combination. There was a statistically significant association between overall survival and the CYP1B1*3 genotype (P = 0.013).

CONCLUSION

Docetaxel‐based chemotherapy is now regarded as a standard regimen for metastatic AIPC. The combination of estramustine, docetaxel and thalidomide is an advantageous treatment in pre‐clinical models of prostate cancer and is a safe, tolerable and active regimen in patients with AIPC.
Differential expression of facilitative glucose transporters in normal and tumour kidney tissues
Authors: Suganuma Nobuyasu , Segade Fernando , Matsuzu Kenichi , Bowden Donald W.
Published: April 2007

OBJECTIVE

To investigate the differences in the pattern of glucose transporter (GLUT) gene expression between normal and tumour tissues and among histological subtypes of renal cell carcinomas (RCCs), as malignant cells are characterized by increased glucose uptake and use.

MATERIALS AND METHODS

Enhanced glucose uptake probably depends on the overexpression of GLUT, usually GLUT1 and/or GLUT3, but there are few comprehensive studies to evaluate the relative expression pattern and level of GLUT in normal and tumour kidney tissues, especially of the recently identified GLUT genes. In all, 71 kidney surgical samples were evaluated using reverse transcriptase‐polymerase chain reaction (RT‐PCR) for GLUT1–14 in normal and tumour (clear cell, papillary and chromophobe RCC, and oncocytoma) tissues. The expression levels for GLUT1–5, 9, 10 and 12 were quantified by real‐time quantitative PCR.

RESULTS

The RT‐PCR results showed that normal kidney tissue expresses all the GLUT isoforms. In clear cell RCC GLUT1 expression increased (P < 0.001) while GLUT4, 9 and 12 decreased (P < 0.001). In papillary RCC there were no significant increases in GLUT expression, with only GLUT12 significantly expressed at lower levels (P < 0.001). In chromophobe RCC the expression of GLUT4 increased (P < 0.05), and GLUT2 and 5 decreased (P < 0.01), whereas in oncocytoma tissue there were no significant changes in the expression of GLUT1 (P < 0.01), 2, 5, 9 (P < 0.001) and 10 (P < 0.05).

CONCLUSIONS

These results suggest that high‐affinity GLUTs might have a major role in enhanced glucose uptake in kidney tumours, and that histopathological types are characterized by specific patterns of GLUT expression.
‘Skipping’ is still a problem with radiofrequency ablation of small renal tumours
Authors: Klingler H. Christoph , Marberger Michael , Mauermann Julian , Remzi Mesut , Susani Martin
Published: April 2007

OBJECTIVE

To evaluate the homogeneity and extent of necrosis obtained with next‐generation radiofrequency ablation (RFA) equipment and techniques, as incomplete tumour necrosis, or ‘skipping’, has been documented after RFA of renal tumours and subsequent partial nephrectomy, but this was assumed to result from insufficient energy deposition with first‐generation low‐energy generators.

PATIENTS AND METHODS

In all, 17 patients with solitary renal tumours of ≤ 4 cm were treated with RFA under laparoscopic control. A state‐of‐the‐art monopolar RFA generator and 15 G multi‐tined needle probes were used. The probe tines were deployed to create an ablation zone >0.5–1.0 cm beyond the sonographically controlled tumour borders. Target temperatures of 105 °C were applied in three cycles for 10–30 min at up to 150 W. Tumours were then removed by laparoscopic partial nephrectomy and specimens evaluated by detailed histology.

RESULTS

The mean (range) resected tumour size was 22 (11–40) mm, the mean RFA time was 39 (27–59) min and the mean surgical resection time was 25 (12–45) min. In 13 patients, haemostasis was sufficient to avoid the renal pedicle being clamped. Intraoperative repeated positive margins in one patient required a laparoscopic radical nephrectomy. Thirteen (76%) renal masses showed histologically complete ablation of the entire tumour. Of the four RFA failures, three tumours were >3 cm in diameter, two were highly vascularized and three had a very heterogeneous tissue texture.

CONCLUSION

Even with state‐of‐the‐art technology, skipping remains a problem with RFA for small renal masses and renders the technique unreliable.
Health‐insurance status is a determinant of the stage at presentation and of cancer control in European men treated with radical prostatectomy for clinically localized prostate cancer
Authors: Gallina Andrea , Karakiewicz Pierre I. , Chun Felix K.‐H. , Briganti Alberto , Graefen Markus , Montorsi Francesco , Walz Jochen , Jeldres Claudio , Erbersdobler Andreas , Salonia Andrea , Suardi Nazareno , Dehò Federico , Schlomm Thorsten , Scattoni Vincenzo , Haese Alexander , Heinzer Hans , Valiquette Luc , Rigatti Patrizio , Huland Hartwig
Published: April 2007

OBJECTIVE

To determine whether health‐insurance status might result in more localized stage at presentation, more favourable stage at surgery and in a lower rate of biochemical recurrence (BCR), in patients diagnosed with prostate cancer and treated with radical prostatectomy (RP), as despite uninhibited access to healthcare, private and public health insurance are available in most European countries.

PATIENTS AND METHODS

In all, 4442 consecutive men had RP in two large European centres, of whom 2372 had public and 2070 had private health insurance. The groups were compared for several variables according to insurance status (private vs public). Means and proportions tests were complemented with logistic regression or Kaplan–Meier analyses.

RESULTS

Serum prostate‐specific antigen level (P < 0.001), clinical stage (P < 0.001), pathological Gleason sum (P = 0.02), positive surgical margin rate (18.4% vs 25.4%, P < 0.001), extracapsular extension rate (17.7% vs 20.0%, P = 0.047) and seminal vesicle invasion rate (9.6% vs 11.6%, P = 0.04) were more favourable in privately insured patients. Conversely, the rate of lymph‐node involvement was higher in those with private than public insurance (4.4% vs 3.3%, P = 0.045). In univariate analyses addressing pathological variables, private insurance was invariably protective (all P < 0.05). The Kaplan–Meier analyses showed that privately insured patients had a lower rate of BCR after RP (log‐rank P = 0.017).

CONCLUSION

Despite uninhibited access to healthcare, insurance status represents a rate‐limiting variable, which affects stage at presentation and the outcome of cancer control.
18F‐choline and/or 11C‐acetate positron emission tomography: detection of residual or progressive subclinical disease at very low prostate‐specific antigen values (<1 ng/mL) after radical prostatectomy
Authors: Vees Hansjörg , Buchegger Franz , Albrecht Susanne , Khan Haleem , Husarik Daniela , Zaidi Habib , Soloviev Dmitri , Hany Thomas F. , Miralbell Raymond
Published: April 2007

OBJECTIVES

To assess the value of positron emission tomography (PET)/computed tomography (CT) with either 18F‐choline and/or 11C‐acetate, of residual or recurrent tumour after radical prostatectomy (RP) in patients with a prostate‐specific antigen (PSA) level of <1 ng/mL and referred for adjuvant or salvage radiotherapy.

PATIENTS AND METHODS

In all, 22 PET/CT studies were performed, 11 with 18F‐choline (group A) and 11 with 11C‐acetate (group B), in 20 consecutive patients (two undergoing PET/CT scans with both tracers). The median (range) PSA level before PET/CT was 0.33 (0.08–0.76) ng/mL. Endorectal‐coil magnetic resonance imaging (MRI) was used in 18 patients. Nineteen patients were eligible for evaluation of biochemical response after salvage radiotherapy.

RESULTS

There was abnormal local tracer uptake in five and six patients in group A and B, respectively. Except for a single positive obturator lymph node, there was no other site of metastasis. In the two patients evaluated with both tracers there was no pathological uptake. Endorectal MRI was locally positive in 15 of 18 patients; 12 of 19 responded with a marked decrease in PSA level (half or more from baseline) 6 months after salvage radiotherapy.

CONCLUSIONS

Although 18F‐choline and 11C‐acetate PET/CT studies succeeded in detecting local residual or recurrent disease in about half the patients with PSA levels of <1 ng/mL after RP, these studies cannot yet be recommended as a standard diagnostic tool for early relapse or suspicion of subclinical minimally persistent disease after surgery. Endorectal MRI might be more helpful, especially in patients with a low likelihood of distant metastases. Nevertheless, further research with 18F‐choline and/or 11C‐acetate PET with optimal spatial resolution might be needed for patients with a high risk of distant relapse after RP even at low PSA values.
The modern management of upper urinary tract urothelial cancer: tumour diagnosis, grading and staging
Authors: Painter Daniel J. , Timoney Anthony G. , Denton Karin , Alken Peter , Keeley Francis X.
Published: April 2007

Three of the four mini‐reviews this month deal with the topic of upper tract urothelial cancer, intending to cover completely the issues of diagnosis, staging and grading, as well as surgical treatment, both open and laparoscopic. In this way the reader should be able to have at hand most of the relevant important information about the subject, all in one issue.
Long‐term functional outcomes of female genital reconstruction in childhood
Authors: Crouch Naomi S. , Creighton Sarah M.
Published: April 2007

There are two very interesting paediatric urology papers; in the first, authors from London describe the long‐term functional outcomes of female genital reconstruction in childhood, and in the second, authors from Italy present a morphological and manometric study of VUR.
Roles of attenuated neuronal nitric‐oxide synthase protein expression and accelerated arginase activity in impairing neurogenic relaxation of corpus cavernosum in aged rabbits
Authors: Numao Noboru , Masuda Hitoshi , Sakai Yasuyuki , Okada Youhei , Kihara Kazunori , Azuma Hiroshi
Published: April 2007

OBJECTIVE

To investigate whether changes in neuronal nitric oxide synthase (nNOS) protein expression and arginase activity are implicated in impairing the neurogenic cavernosal relaxation in aged rabbits, as NO is important in the neurogenic relaxation of corpus cavernosum during the erectile state.

MATERIALS AND METHODS

Cavernosal specimens of young adult (3–6 months old) and aged (36–48 months old) rabbits were used for isometric tension experiments, Western blot analysis, cGMP determination and measurements of NOS and arginase activities.

RESULTS

The neurogenic relaxation and cGMP production in response to electrical‐field stimulation were significantly impaired in aged cavernosal specimens. Western blot analysis showed that nNOS protein was highly expressed in cavernosal specimens from young rabbits, but was undetectable or greatly decreased in old rabbits, with no change in overall NOS activity. Arginase activity in aged cavernosal specimens was significantly higher than in young rabbits. Supplementing with excess l‐arginine, or giving S‐(2‐boronoethyl)‐l‐cysteine as an arginase inhibitor, significantly increased the neurogenic relaxation at lower frequencies only in the younger rabbits.

CONCLUSION

These results suggest that impairment of neurogenic and NO‐mediated relaxation in the aged corpus cavernosum possibly results from the down‐regulation of nNOS protein. The reduced l‐arginine bioavailability to nNOS due to accelerated arginase activity would lead to further impairment of neurogenic NO production, in concert with decreased nNOS protein expression.
Does the molecular staging in pelvic lymph nodes improve the detection of relevant prostate cancer metastases? An assessment after 6 years
Authors: Schostak Martin , Krause Hans , Miller Kurt , Schrader Mark , Kempkensteffen Carsten , Kollermann Jens
Published: April 2007

OBJECTIVE

To assess the course of cancer‐free survival and thus determine how reliably reverse transcriptase‐polymerase chain reaction (RT‐PCR) can detect prostate‐specific antigen (PSA)‐expressing cells, as patients with untreated lymph node‐positive prostate cancer tend to have a poor prognosis, whereas those treated with radical prostatectomy (RP) and immediate adjuvant hormonal therapy show excellent local disease control and a disease‐free survival comparable with that of patients with negative lymph nodes, but the detection of micrometastatic disease in pelvic lymph nodes remains a major challenge.

PATIENTS AND METHODS

Quantitative RT‐PCR was used to detect PSA mRNA expression in total RNA of 457 pelvic lymph nodes from 70 patients who had RP (53 patients) or laparoscopic lymphadenectomy (17) at our clinic in 1999/2000. For this purpose, alternate sections of lymph node tissue were either snap‐frozen for later RNA isolation or examined by standard histopathological methods. Clinicopathological data, adjuvant treatments and follow‐up data were recorded for all patients.

RESULTS

After January 2006 (6‐year observation period), 13 patients had no follow‐up data, while 27 had biochemical (PSA) recurrence or other evidence of clinical progression (two died from prostate cancer), and 30 had no signs of recurrence. Compared to the ‘reference’ standard (histopathology), the PCR method had a sensitivity of 83% and a specificity of 66%. The method had a positive predictive value of 52% and a negative predictive value of 57%.

CONCLUSION

Considered alone, pelvic lymph node PSA RT‐PCR does not predict the clinical course better than a histopathological assessment of lymph nodes. However, it also identifies some patients with negative histology who later show progression. When added to the pathological classification, PSA RT‐PCR improves the detection rate of primary lymphatic dissemination.