Early ECMO overcomes primary graft dysfunction after heart transplant

Introduction

Primary graft dysfunction (PGD) is the main cause of early mortality after heart transplantation. Despite affecting approximately 7–8% of all recipients, the etiology and optimal treatment of this condition remains unknown. Extracorporeal membrane oxygenation (ECMO) is a key treatment modality, however optimal timing of initiation has not been established.

Methods

A single-institution retrospective study was conducted. Between January 2003 and October 2019 a total of 13 recipients experienced PGD treated with ECMO. At the beginning of 2016, our institution adopted an early ECMO policy, with PGD patients placed on ECMO prior to leaving the OR at the time of transplant. Patients were stratified into pre-2016 (n=5) and post-2016 (n=8) cohorts. Outcomes including duration of support, ICU and total hospital stay, Ejection Fraction (EF), need for vasoactive or inotropic medication, in-hospital survival, 1-year survival, and complications were analyzed.

Results

Among the pre-2016 and post-2016 cohorts there was no difference in duration of ECMO, ICU stay, and total hospital stay. The average time from release of cross-clamp to initiation of ECMO was 8.04 vs 3.05 hrs in each cohort, respectively (p=0.02). In all patients, ECMO resulted in a reduction in the need for vasopressors and inotropes as assessed by the vasoactive inotrope score. LVEF normalized within the first 5 days of therapy for all patients and was sustained after decannulation. Complication rates among cohorts were similar with respect to bleeding, stroke, infection, and need for permanent dialysis. When compared to the post-2016 cohort, the pre-2016 cohort demonstrated significantly worse in-hospital (75% vs 100%, p=0.04) and 1-year (69% vs 100%, p=0.02) survival.

Conclusions

Early initiation of ECMO results in decreased mortality for PGD after heart transplant without an increased risk of complications.

Funding Acknowledgement

Type of funding source: None

Alterations of microsatellite loci GSN and D18S51 in urinary bladder cancer

BACKGROUND

Transitional cell carcinoma (TCC) of urinary bladder cancer is the most common malignancy in the urinary system. Genetic instability is an essential property of malignant neoplasms and could be evaluated by microsatellite analysis. Alterations in numerous microsatellite loci are already described in urinary bladder TCC. The aim of this study was to investigate the usefulness of only two microsatellite loci for the detection of bladder TCC, and their correlation with the major clinicopathological parameters.

METHODS

We analyzed the tissue samples derived from 70 patients with histopathologically confirmed TCC of the urinary bladder, collected by transurethral resection, and samples of normal bladder mucosa derived from 40 patients with nonmalignant diseases. Microsatellite alleles GSN and D18S51 were amplified in paired samples of tissue and leukocyte DNA from each patient, and were analyzed by electrophoresis.

RESULTS

Microsatellite alterations at either GSN or D18S51locus, or in both, were detected in 46 out of the 70 patients (65.71 %) with TCC, but not in the patients of the control group. We found a significant statistical correlation between the frequencies of patients with microsatellite alterations in the examined loci and all three grades of histopathological T-classification. No significant correlation was found regarding the stages or the occurrence of recidivism, metastasis or cancer-related death within the two-year follow-up period.

CONCLUSIONS

This study indicates that two selected microsatellite markers could have a potential value in clinical and pathological evaluation of urinary bladder TCC, especially regarding the prediction of tumor differentiation. Additional studies and further validation of the method are needed. Hippokratia 2015; 19 (3): 200-204.

Digital quantitative immunofluorescent detection of p53 protein in urinary bladder cancer tissue samples

Bladder cancer is a significant health problem and is the fourth most common malignancy in the Western world. Histologically, transitional cell carcinoma (TCC) is the most common subtype and represents nearly 90% of all bladder cancers. Mutations of the tumour suppressor gene p53 are the most frequent genetic alteration found in human cancers, including urinary bladder carcinoma. Numerous studies have attempted to define p53 as a molecular marker with clinicopathological and predictive values. In this study we have investigated tissue samples of histopathologically confirmed TCC of the urinary bladder from 70 patients. Normal urinary bladder mucosa obtained from 40 patients with nonmalignant diseases were used as a negative control group. Immunofluorescence detection was performed using double-sandwich antibody technique, the microscope images were captured by digital camera and analyzed by ImageJ software. Corrected fluorescent intensity values corresponding to average malignant cells' nuclear p53 staining were calculated from each patient sample. We found that the mean corrected fluorescence intensity values of TCC samples grade I and II did not differ statistically significantly. On the contrary, those values were significant between the TCC grades II and III, as well as between grade I and III. In addition, a high correlation of p53 fluorescence intensity values from superficial TCC samples with the invasive TCC samples was found. However, the data showed no predictive value of p53 nuclear accumulation in TCC samples in terms of recidive, metastasis or cancer-related death, at least within the 2-years follow-up period. Given the relatively small size and heterogeneity of our patient groups, however, further studies are needed to demonstrate the clinicopathological value of digital quantitative immunofluorescent detection of nuclear p53 in TCC samples.

Evaluation of the value of p53 protein expression in the extra-capsular extension of prostate cancer

INTRODUCTION AND OBJECTIVES

The objective of this study is to identify the nuclear expression of the p53 protein in prostate cancer and to determine its relationship with clinico-pathological variables.

MATERIAL AND METHODS

The research included 83 patients, 43 of whom are patients with prostate cancer who underwent radical prostatectomy and a control group of 40 patients with benign hyperplasia of the prostate in whom a transurethral resection or a transvesical prostatectomy was undertaken. In all cases the nuclear expression of p53 protein was evaluated. A hystopatological evaluation of the tumour characteristics and the data of the local progression of the cancer were undertaken in the research group.

RESULTS

The results show that the expression of the p53 protein does not have an important correlation with the preoperative PSA, but that it is in direct correlation with the malign potential of the cancer (Gleason score, Gleason sum, primary tumour) and with the features of the disease (metastatic lymph nodes, stage of the disease).

CONCLUSION

p53 protein could be used as a valid biomarker in determining the malignant potential of the tumour and the prognosis of the disease. There is no practical use in predicting the extraprostatic extension.

Screening for prostate cancer: a controversy or fact

BACKGROUND

Adenocarcinoma of the prostate is the most frequent malignancy in men and the second leading cause of death in the male population worldwide. The screening for prostate cancer allows early diagnosis of prostate malignancy before the individual presents with symptoms. The early stage of the disease is easier to manage by different therapeutic modalities.

AIM

The aim of this review is to evaluate the reasons and facts for enthusiasm and positive approach towards the clinical decision about whether to screen or not male patients for early detection of prostate cancer.

METHODS

We performed a computerized MEDLINE search followed by a manual bibliographic review of cross-references. These reports were analyzed and the important findings were summarized. We analyzed the methods and schedule of screening, as well as advantages and disadvantages of the prostate cancer screening.

RESULTS

There were more than a hundred studies on prostate cancer screening performed but only a few are eligible for a decisive conclusion concerning the prostate cancer screening issue. We reviewed the screening methods, the schedule of screening, the advantages and disadvantages of prostate cancer screening.

CONCLUSION

The role for prostate cancer screening is not established yet. Definite proof of screening should be assumed as a decrease in the death rate of that cancer due to screening activity.

Does prostate specific antigen density correlates with aggressiveness of the prostate cancer?

BACKGROUND

As already documented, a high prostate specific antigen in men with normal size of prostate gland is more likely to be associated with an aggressive cancer as compared to others with the same prostate specific antigen and a large gland size. In this retrospective study we tested the association between Prostate Specific Antigen Density (PSAD) and tumor aggressiveness in patients with clinically localized Prostate Cancer (PCa) surgically treated by radical prostatectomy.

METHODS

We evaluated data from patients records in a cohort of 72 patients who underwent radical prostatectomy between January 2000 and June 2007. PSAD was calculated as ratio between the preoperative total prostatic specific antigen (PSA) in nanograms per milliliter with the prostate weight (PW) of prostatectomized specimen in grams or prostate volume measured with ultrasound (US). The patients were stratified into four PSAD categories: 0.1-0.15, 0.16- 0.20, 0.21-0.5 and greater than 0.51 ng/ml/gr. Parameters that were included into analysis were: PSA, measurement of the prostate volume by ultrasound (preoperatively) and prostate weight, pathological tumor stage, Gleason sum, Gleason grade, metastatic lymph nodes, seminal vesicle involvement and organ confine disease (postoperatively). Worsening of the clinicopathological properties was defined as aggressiveness.

RESULTS

There was a significant correlation between US-PSAD and PW-PSAD (p<0.001). In US-PSAD categories the statistic tests found significant correlation with the primary tumor (R=0.303, p<0.01), metastatic lymph nodes (R=0.331, p<0.01), and the organ confine disease (R=0.296, p<0.05). The PW-PSAD categories correlated significantly with the pathologic findings from other parameters. Hence, a statistically significant correlation was found with Gleason sum (R=0.246, p<0.05), Gleason grade (R=0.234, p<0.05), primary tumor (R=0.285, p<0.05), metastatic lymph node (R=0.287, p<0.05) and organ confine disease (R=0.303, p<0.01).

CONCLUSIONS

Prostate specific antigen density measurement is useful tool for the assessment of the degree of aggressiveness in clinically localized prostate cancer, and further investigation regarding its possible use as a prediction marker is justified.

Lower urinary tract reconstruction following a cystectomy: experience and results in 20 patients using the "Studer" orthotopic ileal bladder substitution

INTRODUCTION AND OBJECTIVE

To analyze the outcome, complications and functional results in patients undergoing bladder substitution with the Studer continent urinary pouch.

MATERIALS AND METHODS

At our Clinic, between January 2005 and December 2006, 20 male patients underwent a radical cystoprostatectomy followed by the Studer orthotopic bladder substitution.

RESULTS

The transitional cell carcinoma was found to be the most frequent histopathological type. The distribution by grade and pathological stage showed all were high grade infiltrating tumors localized in the bladder. We observed 3 patients with neobladder-unrelated complications: one patient with a wound infection and 2 patients with a prolonged ileus.

CONCLUSION

In conclusion, our results with urinary diversion are promising in patients recquiring a radical cystoprostatectomy. We believe that the Studer's orthotopic neobladder is an excellent alternative for patients suffering a radical cystectomy and offers a sufficient protection of the upper urinary tract with a low complication rate, good voiding function and continence (Tab. 1, Ref. 25). Full Text (Free, PDF) www.bmj.sk.

Radical retropubic prostatectomy for prostate carcinoma; first results of the Clinic of Urology in Skopje

OBJECTIVES

The aim of this retrospective study is to present our experience and results in the management of prostate carcinoma, with radical retropubic prostatectomy, for a period of seven years.

MATERIAL AND METHODS

From December 1997 to April 2005, 61 radical retropubic prostatectomies for prostate carcinoma were performed at the Clinic of Urology in Skopje. Mean age of the treated patients was 66.4 years. Mean serum PSA level was 32.75 ng/ml. None of the patients had distant or bone metastases. Mean operative time was 160 minutes and from 2 to 4 units of blood were transfused intra and postoperatively. Mean follow up time was 39 months.

RESULTS

In all of 61 patients, the RRP was performed for adenocarcinoma of the prostate. The pathological findings postoperatively showed the following pTNM grade: pT2a in 8, pT2b in 10, pT3a in 10, pT3b in 27and pT4 in 6 patients. Positive lymph nodes were found in 14 cases. Intraoperative complications occurred in 6 patients. Early postoperative complications were seen in 12 patients. Urine leakage was seen in 2 patients, incontinence (day and night) in 8 and pulmonary embolia in 2 patients. Late postoperative complications occurred in 11 patients. Stenosis of the vesicourethral anasthomosis was seen in 3 patients and incontinence (during the night only) in 8 patients. The rate of potency was not evaluated but in the last 30 cases we insisted on preservation of the neurovascular bundles in the cases that it was possible.

CONCLUSION

Radical retropubic prostatectomy is the method of choice and the golden standard for treatment of organ confined prostate carcinoma in patients with long life expectancy, no neither local nor distant metastases and good overall status. With this technique complication rates are minimal, the cure rate is very big and the patients have high quality of life. The experience of the surgeon is very important since the learning curve is crucial for diminishing operative time, postoperative complications and blood transfusions.