[Role of nurses specializing in oncology to support the care journey for patients with penile cancer]

The role of the specialized nurse in the management of penile cancer is essential to ensure quality care and appropriate support throughout the care pathway. Prior knowledge of the pathology seems essential to us. Organization, communication and education are essential to supporting patients. LEVEL OF EVIDENCE: 3.

Prognostic significance of PI-RADS 5 lesions in patients treated by radical prostatectomy

PURPOSE

To analyse the pathological features and survival of patients with a PI-RADS 5 lesion on pre-biopsy MRI.

METHODS

We extracted from a European multicentre prospectively gathered database the data of patients with a PI-RADS 5 lesion on pre-biopsy MRI, diagnosed using both systematic and targeted biopsies and subsequently treated by radical prostatectomy. The Kaplan-Meier model was used to assess the biochemical-free survival of the whole cohort and univariable and multivariable Cox models were set up to study factors associated with survival.

RESULTS

Between 2013 and 2019, 539 consecutive patients with a PI-RADS 5 lesion on pre-biopsy MRI were treated by radical prostatectomy and included in the analysis. Follow-up data were available for 448 patients. Radical prostatectomy and lymph node dissection specimens showed non-organ confined disease in 297/539 (55%), (including 2 patients with a locally staged pT2 lesion and lymph node involvement (LNI)). With a median follow-up of 25 months (12-39), the median biochemical recurrence-free survival was 54% at 2 years (95% CI 45-61) and 28% at 5 years (95% CI 18-39). Among the factors studied, MRI T stage [T3a vs T2 HR 3.57 (95%CI 1.78-7.16); T3b vs T2 HR 6.17 (95% CI 2.99-12.72)] and PSA density (HR 4.47 95% CI 1.55-12.89) were significantly associated with a higher risk of biochemical recurrence in multivariable analysis.

CONCLUSION

Patients with a PI-RADS 5 lesion on pre-biopsy MRI have a high risk of early biochemical recurrence after radical prostatectomy. MRI T stage and PSA density can be used to improve patient selection and counselling.

Magnetic Resonance Imaging-Targeted Biopsy and Pretherapeutic Prostate Cancer Risk Assessment: a Systematic Review: Biopsie ciblée par Imagerie par résonance magnétique et évaluation pré-thérapeutique du risque de cancer de la prostate : revue systématique

INTRODUCTION

Multiparametric magnetic resonance imaging (MRI) has been included in prostate cancer (PCa) diagnostic pathway and may improve disease characterization. The aim of this systematic review is to assess the added value of MRI-targeted biopsy (TB) in pre-therapeutic risk assessment models over existing tools based on systematic biopsy (SB) for localized PCa.

EVIDENCE ACQUISITION

A systematic search was conducted using Pubmed (Medline), Scopus and ScienceDirect databases according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We included studies through October 2021 reporting on TB in pretherapeutic risk assessment models.

EVIDENCE SYNTHESIS

We identified 24 eligible studies including 24'237 patients for the systematic review. All included studies were retrospective and conducted in patients undergoing radical prostatectomy. Nine studies reported on the risk of extraprostatic extension, seven on the risk of lymph node invasion, three on the risk of biochemical recurrence and nine on the improvement of PCa risk stratification. Overall, the combination of TB with imaging, clinical and biochemical parameters outperformed current pretherapeutic risk assessment models. External validation studies are lacking for certain endpoints and the absence of standardization among TB protocols, including number of TB cores and fusion systems, may limit the generalizability of the results.

CONCLUSION

TB should be incorporated in pretherapeutic risk assessment models to improve clinical decision making. Further high-quality studies are required to determine models' generalizability while there is an urgent need to reach consensus on a standardized TB protocol. Long-term outcomes after treatment are also awaited to confirm the superiority of such models over classical risk classifications only based on SB. © 2022 Elsevier Masson SAS. All rights reserved.

Focal therapy for prostate cancer: Making the punishment fit the crime

BACKGROUND

Focal therapy is recently gaining popularity as an intermediate option between active surveillance and whole-gland treatment for localized prostate cancer.

OBJECTIVE

This comprehensive review aims to present the different focal therapy technologies available to date while tackling the rationale for focal treatment, its indications, principles and outcomes of each technique.

EVIDENCE ACQUISITION

A comprehensive review of the PubMed, Embase, and Web of Science was done. Keywords used for research were: "prostate cancer"; "focal therapy"; "focal treatment"; "High-Intensity Focal Ultrasound"; "cryotherapy"; "photodynamic therapy"; "focal laser ablation"; "irreversible electroporation"; "focal brachytherapy" and "gold nanoparticle directed therapy". Accepted languages were English and French.

EVIDENCE SYNTHESIS

Choosing the best candidate for focal therapy is crucial (localized small to medium sized Gleason≤7 lesions). Focal high-intensity focal ultrasound has shown excellent survival rates at 5 years, while maintaining good functional outcomes (urinary continence and erectile function). Focal cryotherapy, one of the oldest focal treatments for prostate cancer, has shown good oncologic outcomes, with good continence rates and fair erectile function rates. Focal laser ablation seems a safe and feasible technique, with promising results. Irreversible electroporation has demonstrated good survival outcomes with no biochemical recurrence or disease relapse in the preliminary studies. Focal brachytherapy has a good toxicity profile, a good biochemical outcome, and gives a sustained quality of life. Finally, gold nanoparticle directed therapy is safe and is being studied in current trials.

CONCLUSION

While proven to be safe in terms of continence and sexual aspects, the challenge remains to better assess oncological outcomes of these techniques in randomized longer follow-up studies.

Machine Learning Reveals the Seismic Signature of Eruptive Behavior at Piton de la Fournaise Volcano

Volcanic tremor is key to our understanding of active magmatic systems, but due to its complexity, there is still a debate concerning its origins and how it can be used to characterize eruptive dynamics. In this study we leverage machine learning techniques using 6 years of continuous seismic data from the Piton de la Fournaise volcano (La Réunion island) to describe specific patterns of seismic signals recorded during eruptions. These results unveil what we interpret as signals associated with various eruptive dynamics of the volcano, including the effusion of a large volume of lava during the August-October 2015 eruption as well as the closing of the eruptive vent during the September-November 2018 eruption. The machine learning workflow we describe can easily be applied to other active volcanoes, potentially leading to an enhanced understanding of the temporal and spatial evolution of volcanic eruptions.

Management of chronic testicular pain due to thoracolumbar junction syndrome: A pilot study

INTRODUCTION

Thoracolumbar dysfunction (TLD) had been evoked as a possible etiology of chronic testicular pain. Our study investigated the efficacy of osteopathic diagnosis and treatment of TLD in men with chronic testicular pain.

METHODS

Patients suffering from testicular pain were examined for thoracolumbar dysfunction and enrolled in a prospective trial if they have both conditions. Following standardized examination, all patients were prescribed 1 to 3 osteopathic treatment sessions, usually at weekly interval. Treatment success was evaluated using the Visual Analog scale and durability was assessed by regular follow-up. Patient satisfaction was also assessed. Comparison of pain improvement was done using Wilcoxon matched-pairs signed-ranks test. Logistic regression was used to assess for risk factors of success. A P<0.001 was used for significance.

RESULT

Out of 62 patients enrolled, 41 patients (median age 32 years, IQR 24-37) were suffering from chronic testicular pain and TLD. 37 of the 41 participants completed the treatment and follow-up according to the plan. Patients underwent a median of 2 osteopathic treatment sessions (range 1-3). Overall, pain disappeared completely in 25 patients (67.5%) and improvement was noted in 7 patients (18.9%). After initial improvement, two patients experienced relapse at their last visit (5.4%). Five patients (13.5%) had no improvement of their symptoms after osteopathic treatment. Statistically, improvement was significant with a P<0.001 and on logistic regression, site of pain and duration of pain were the sole predictors of failure.

CONCLUSION

TLD is a pathology that should be considered in the differential diagnosis in patients with chronic testicular pain and osteopathic manipulation of the spine appears to be an effective treatment option.

Combined sexual prevention targeted to LGBTI+ migrants: between ’outdoor’ and ’indoor’ hospial

Issue

It is estimated that there are about 10,000 HIV-positive and undiagnosed people in Île-de-France (French region). They are composed of 70% men, 40% of whom are MSM and 40% of sub-Saharan African migrants. A bridging process has been designed by the Public Health association AREMEDIA and developed in partnership with Fernand-Widal Hospital’s testing center, to reach underserved populations. From March 2018, a screening test session for sexually transmitted infections (STIs) is taking place weekly in the hospital walls. This action is dedicated to the population of ARDHIS association, which accompanies more than 1,000 people each year, seeking asylum because of their sexual orientation or gender identity.

Description of the problem

Despite the promotion of this ’indoor’ targeted consultation via ARDHIS volunteers and directly to asylum seekers during occasional community events, the consultation only allowed the screening of 23 people in 4 months. It has been decided to carry out screening ’outside the hospitals walls’, where the people are, in order to promote the return of results, treatment, access to PrEP, HBV vaccination at the weekly indoor hospital consultation. “Community health relays” training together with the development of phone contact procedures were developed to facilitate the access to the indoor consultation.

Results

The methodology made it possible to double the average number of consultations over the following 5 months from 5 to 10 consultations per 3-hour slot, not counting PrEP appointments and vaccines, which averaged 6 per session. By the end of 2018, 261 people were screened, 23 had a PrEP treatment and many were vaccinated. As the scheme continues to develop, the results from January to July 2019 will be reported.

Leçons

To reach the most at risk populations, specific public health approaches are needed, taking account the context and representations of the target populations. Community involvement has proven to be effective.

Key messages

To fight HIV, innovative devices are needed to reach targeted populations. This has allowed hundreds of LGBTI asylum seekers to be screened and a significant number to receive preventive treatment.

Elastic fusion biopsy versus systematic biopsy for prostate cancer detection: Results of a multicentric study on 1,119 patients

OBJECTIVES

To assess the accuracy of targeted and systematic biopsies for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in the everyday practice, evaluating the need for additional systematic biopsies at the time of targeted biopsy.

PATIENTS AND METHODS

From our multicentric database gathering data on 2,115 patients who underwent fusion biopsy with Koelis™ system between 2010 and 2017, we selected 1,119 patients who received targeted biopsies (a median of 3 for each target), followed by systematic sampling of the prostate (12 to 14 cores). Overall and clinically significant cancer detection rate (CDR) of Koelis™ fusion biopsies were assessed, comparing target and systematic biopsies. Secondary endpoint was the identification of predictors of PCa detection.

RESULTS

The CDR of targeted biopsies only was 48% for all cancers and 33% for csPCa. The performance of additional, systematic prostate sampling improved the CDR of 15% for all cancers and of 12% for csPCa. PCa was detected in 35%, 69%, and 92% of patients with lesions scored as PI-RADS 3, 4 and 5, respectively. Elevated PI-RADS score and positive digital rectal examination were predictors of PCa, whereas biopsy-naïve status was associated with csPCa.

CONCLUSION

In the everyday practice target biopsy with Koelis™ achieves a good CDR for all PCa and csPCa, which is significantly improved by subsequent systematic sampling of the prostate. The outstanding outcomes of fusion biopsy are confirmed also in biopsy-naïve patients. Elevated PI-RADS score and positive digital rectal examination are strongly associated with presence of PCa.

The impact of neutrophil-to-lymphocyte, platelet-to-lymphocyte and haemoglobin-to-platelet ratio on localised renal cell carcinoma oncologic outcomes

INTRODUCTION

The neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) are established markers of systemic inflammation. Moreover, anemia is a known adverse prognostic factor and reduced haemoglobin to platelet ratio (HPR) seems associate to poor outcomes in urothelial cancer. Aim of the current study was to explore the prognostic value of NLR, HPR and PLR in patients harboring localized RCC. Materials and Methods 184 patients undergoing partial and radical nephrectomy for renal mass in a single hospital were retrospectively analyzed. Uni- and multivariate logistic regressions were performed to assess associations between various risk factors, including NLR, PLR and HPR and locally advanced disease (≤pT2 vs.≥pT3) and tumor grade. Kaplan Meier curves and Cox regressions were constructed to assess the association of NLR, PLR and HPR to recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS). To determine thresholds for variables, we considered the 75^th percentile of our distribution of values, which was computed at 3.45 for NLR, 189 for PLR and 0.48 for HPR. A two-sided P<0.05 defined statistical significance.

RESULTS

Patients with an elevated NLR (>3.45) were more likely to present with≥pT3 stage (p=0.046). RFS was significantly different according to NLR value, with patients having an NLR>3.45 experiencing significantly worst RFS (P=0.019); similarly, an increased PLR was significantly associated to a reduced RFS (P=0.012). Restricting the Cox regression to patients with locally advanced disease (≥pT3), NLR was even more associated to recurrence (HR 3.22; 95%CI: 1.06-9.81, P=0.039). Patients exhibiting an NLR>3.45 (p=0.03) or a PLR>189 (P=0.005) did have a significantly worse CSS, while a HPR<0.48 did not predict CSS (P=0.12) on Kaplan Meier curves. Finally, an increased NLR (P=0.047), increased PLR (P=0.0006) and decreased HPR (P=0.05) were all associated to a poor overall survival on univariate analysis. On multivariate analysis, only HPR remained significantly predictive of OS (HR 0.077; 95%CI: 0.02-0.37, P=0.001).

CONCLUSIONS

In this single-center study analyzing non-metastatic RCC, an increased NLR was significantly associated to a reduced RFS, CSS and OS on univariate analyses and to RFS on multivariate analysis. Larger prospective studies are needed to validate our findings.

LEVEL OF EVIDENCE

4.

Very- and ultra-long-period seismic signals prior to and during caldera formation on La Réunion Island

Early detection of the onset of a caldera collapse can provide crucial information to understand their formation and thus to minimize risks for the nearby population and visitors. Here, we analyse the 2007 caldera collapse of Piton de la Fournaise on La Réunion Island recorded by a broadband seismic station. We show that this instrument recorded ultra-long period (ULP) signals with frequencies in the range (0.003-0.01 Hz) accompanied by very-long period (VLP) signals (between 0.02 and 0.50 Hz) prior to and during the caldera formation suggesting it is possible to detect the beginning of the collapse at depth and anticipate its surface formation. Interestingly, VLP wave packets with a similar duration of 20 s are identified prior to and during the caldera formation. We propose that these events could result from repeating piston-like successive collapses occurring through a ring-fault structure surrounding a magma reservoir from the following arguments: the source mechanism from the main collapse, the observations of slow source processes as well as observations from the field and the characteristic ring-fault seismicity.

Out-of-Hospital screening for HIV, HBV, HCV and Syphilis in a vulnerable population, a public health challenge

We explored rates of Hepatitis B virus (HBV), Human Immunodeficiency Virus, Hepatitis C virus and Syphilis in a vulnerable population (mostly intravenous drug users, sex workers and homeless people) and focused on factors associated with failure to return for results (FTR) and with having a false perception (FP) of Immunization against HBV. We performed a prospective multicenter observational study in nine mobile (Out-of-Hospital) areas of screening located in Paris from 1 January 2014 through 31 December 2014. A total of 341 patients were recruited. The proportion of FTR for results was 38.75%. In multivariate analysis, unemployment was significantly associated with FTR (OR = 4.29; IC = [1.12; 16.39]), as well as having been screened in the past (OR = 4.32, IC = [1.70; 10.97]); 18.03% of patients had a FP of an Immunization against HBV. In multivariate analysis, having one's own place of residence protected against FP (OR = 0.33, [0.12; 0.95]), while being screened in the past enhanced the risk of FP (OR = 3.28, IC = [1.06; 10.11]). The rate of FTR is a problem and use of currently available technologies, such as phone texting, might be a partial solution in conjunction with rapid tests for diagnosis. In addition, more information and comprehension of the results should be provided together with specific anti-HBV vaccination campaigns targeting these specific populations.

[Lower urinary tract dysfunction following nerve sparing radical hysterectomy: A systematic review]

INTRODUCTION

Radical hysterectomy represents the cornerstone in the management of localized cervical cancer. Despite its oncologic efficacy, radical hysterectomy is associated with a significant amount of complications and a negative impact on quality of life. Surgical technique seems to influence the functional outcomes.

AIM OF THE STUDY

A systematic review to provide an update on the lower urinary tract dysfunction following nerve sparing radical hysterectomy.

METHODS

An initial search was carried out to identify articles for further review, using Cochrane reviews and PubMed and Embase databases. The search terms used were: "nerve sparing" and "cervical cancer" or "radical hysterectomy". The Preferred Reporting Items for Systematic Reviews and Meta-Analyses process for reporting included and excluded studies was followed, with the recommended flowchart showing the numbers of papers identified and included or excluded at each stage.

RESULTS

Twenty-nine clinical studies were included. The absence of a standardized surgical technique for nerve sparing radical hysterectomy and the poor methodological quality of the studies assessing lower urinary tract dysfunction after such intervention limited clear conclusions. However, all studies reported lower incidence of urinary tract dysfunction, urodynamic abnormalities and clean intermittent catheterization following nerve sparing radical hysterectomy compared to conventional technique.

CONCLUSION

Nerve sparing radical hysterectomy is associated with reduced lower urinary tract dysfunction. A standardization of the surgical technique for nerve sparing radical hysterectomy, tailored to each individual is necessary to allow its wide spread diffusion.

The role of the meniscotibial ligament in posteromedial rotational knee stability

PURPOSE

Tears of the posterior horn of the medial meniscus (PHMM) are very common in the ACL-deficient knee. Specific lesions of the PHMM have been described in the setting of ACL rupture: ramp lesions and injuries to the meniscotibial ligament. There are little data available regarding the role these lesions play in knee instability. The aim of this study is to analyse the biomechanical consequences of ramp and meniscotibial ligament lesions on knee stability. Our hypothesis was that these lesions would cause increased instability in the setting of ACL rupture.

METHODS

A cadaveric study was undertaken: ten knees were included for analysis. The biomechanical repercussions of different meniscoligamentous injuries were studied in four stages: stage 1 involved testing the intact knee, stage 2 after transection of the ACL, stage 3 following creation of a ramp lesion, and stage 4 after detachment of the meniscotibial ligament. Four parameters were measured during the experiment: anterior tibial translation under a force of 134 N, internal and external tibial rotation under a torque of 5 Nm, and valgus angulation under a torque of 10 Nm. Measurements were taken in four knee flexion positions: 0° or full extension, 30°, 70°, and 90° of flexion.

RESULTS

There was a statistically significant increase in anterior tibial translation for stage 2 (6.8 ± 1.3 mm, p ≤ 0.001), stage 3 (9.4 ± 1.3 mm, p ≤ 0.001), and stage 4 (9.3 ± 1.3 mm, p ≤ 0.001) compared to stage 1. There was no significant difference between stage 2 and stage 3 (2.6 mm, n.s.) or stage 4 (2.5 mm, n.s.). We did, however, demonstrate an increase in anterior tibial translation of 2.6 mm after the creation on a lesion of the PHMM compared to isolated division of the ACL, for all flexion angles combined. There was an increase in internal tibial rotation between stage 1 and stage 4 (3.2° ± 0.7°, p ≤ 0.001) and between stage 2 and stage 4 (2.0° ± 0.7°, p = 0.023). A significant difference was demonstrated for external rotation under 5 Nm torque between stages 4 and 1 (2.2° ± 0.5°, p ≤ 0.001) and between stages 4 and 2 (1.7° ± 0.5°, p = 0.007) for all knee flexion angles combined. No created lesion had a significant effect on medial laxity under a 10-Nm valgus torque at any degree of knee flexion.

CONCLUSION

Lesions of the posterior horn of the medial meniscus are frequent in cases of anterior cruciate ligament rupture. These lesions appear to play a significant role in knee stability. Ramp lesions increase the forces in the ACL, and the PHMM is a secondary restraint to anterior tibial translation. Lesions of the meniscotibial ligament may increase rotatory instability of the knee.

A review of currently available vessel sealing systems

Laparoscopic surgery is rapidly expanding among urologists as a minimally invasive treatment with surgical procedures becoming increasingly challenging. Accurate haemostatis is of utmost importance in laparoscopy, as bleeding can rapidly impair the working environment conditions. We subsequently reviewed the different haemostatic tools used in laparoscopy with the focus on ultrasonic dissectors and electrothermal bipolar vessel sealer (EBVS). Briefly, there is a wide variety of haemostatic tools currently available in laparoscopy, all with their inherent advantages and limitations. The comparison of ultrasonic dissectors and EBVS shows that both systems are very attractive with similar physical properties concerning thermal spread and bursting pressure of vessels sealed. It has to be noted, however, that EBVS can handle vessels of up to 7 mm. In conclusion, haemostatic tools constitute a rapidly evolving domain with devices being developed which cause less thermal spread, while being more precise and faster. This evolution should finally allow more complex laparoscopic surgical procedures.

Modulation of the infant immune responses by the first pertussis vaccine administrations

Many efforts are currently made to prepare combined vaccines against most infectious pathogens, that may be administered early in life to protect infants against infectious diseases as early as possible. However, little is known about the general immune modulation induced by early vaccination. Here, we have analyzed the cytokine secretion profiles of two groups of 6-month-old infants having received as primary immunization either a whole-cell (Pw) or an acellular (Pa) pertussis vaccine in a tetravalent formulation of pertussis-tetanus-diphtheria-poliomyelitis vaccines. Both groups of infants secreted IFN-gamma in response to the Bordetella pertussis antigens filamentous haemagglutinin and pertussis toxin, and this response was correlated with antigen-specific IL-12p70 secretion, indicating that both pertussis vaccines induced Th1 cytokines. However, Pa recipients also developed a strong Th2-type cytokine response to the B. pertussis antigens, as noted previously. In addition, they induced Th2-type cytokines to the co-administrated antigen tetanus toxoïd, as well as to the food antigen beta-lactoglobulin. Furthermore, the general cytokine profile of the Pa recipients was strongly Th2-skewed at 6 months, as indicated by the cytokines induced by the mitogen phytohaemagglutinin. These data demonstrate that the cytokine profile of 6-month-old infants is influenced by the type of formulation of the pertussis vaccine they received at 2, 3 and 4 months of life. Large prospective studies would be warranted to evaluate the possible long-term consequences of this early modulation of the cytokine responses in infants.

[Screening for prostate cancer: role of PSA in 2006]

PSA is the best tool for prostate cancer diagnosis. The wide use of PSA with time leads to localized tumour detection with better prognostic factors. The role of PSA for screening is debatable with a doubt on the traditional cut-off of 4 ng/ml. Lowering PSA levels leads to a higher detection rate but also increases the risk of overdiagnosis. Potentially aggressive tumours can not be identified by appropriate PSA cut-off level. Even with low value of PSA < 3 ng/ml, aggressive cancers are diagnosed. The goal is to identify aggressive but still curable diseases with an acceptable accuracy. News strategies for early diagnose are reviewed with the interest of PSA for screening in 2006.

Construct Validity of the Chicken Model in the Simulation of Laparoscopic Radical Prostatectomy Suture

BACKGROUND AND PURPOSE

For a simulation to be valid, it has to be close to reality, correlate with the performance in a real case, and be able to discriminate between individuals with different degrees of experience. We explored the construct validity (ability to discriminate between experienced and inexperienced subjects) of a simulation for the urethrovesical anastomosis during laparoscopic radical prostatectomy (LRP).

MATERIALS AND METHODS

Dead chickens were used. After partial emptying of the corporal cavity, an 18F catheter was placed through the esophagus to the stomach. In the Pelvic Trainer, a laparoscopic section of the esophago-glandular-stomach junction and a suture between the two edges were performed in the same fashion as for a urethrovesical suture in LRP. Five subjects with different levels of experience in laparoscopy, ranging from nil to more than 250 LRPs, tested two types of suture. One-way ANOVA was used to detect differences in suturing time among the operators. A multiple comparison test was used to detect specific differences between operators.

RESULTS

Although suturing time had a strong negative correlation with the operator's experience, significant statistical differences in suturing time were found only between the least experienced operator and the other ones. Qualitative differences in the suture were found among operators.

CONCLUSION

This simulation correlates well with the laparoscopic (LRP) subject's experience. It can discriminate between inexperienced and experienced subjects, exhibiting moderate construct validity, but failed to reflect the different levels of experience among the most experienced subjects.

Laparoscopic Extraperitoneal Adenomectomy (Millin): Pilot Study on Feasibility

OBJECTIVE

The aim of the present work is to describe the surgical technique and to assess the feasibility of laparoscopic extraperitoneal adenomectomy in a pilot study.

METHODS

Eighteen consecutive patients in whom an open adenomectomy was planned were operated on in a laparoscopic extraperitoneal fashion. In all patients indication was based on objective signs of obstruction. The laparoscopic approach was standard in all cases as follows: creation of a preperitoneal workspace, haemostatic control of lateral venous vesicoprostatic pedicles, transversal anterior incision of the prostate capsule, progressive enucleation of the adenoma with the help of an harmonic scalpel, suture of the posterior bladder neck to the prostate fossa, closure of the prostate capsule, and retrieval of the specimen. Feasibility was assessed by objective operative parameters (reconversion, operating time, and blood loss and transfusion requirements) and per operative complications. Data on short term follow-up are also available.

RESULTS

Mean age of the patients was 67.8 years (S.D. 6.2) and mean prostatic weight calculated by TRUS 95.1cm(3) (S.D. 28.1). Mean maximal flow (Q(max)) was 4.3ml/s (S.D. 3.4) with four patients (22.2%) presenting in retention. Mean duration of intervention was 145min (S.D. 32.5) and mean blood loss 192ml (S.D. 178). Mean excised tissue was 47.6g (S.D. 30). Neither conversions to open prostatectomy nor transfusions were required. The urethral catheter remained in place an average of 3.0 days (S.D. 2.4) in 14 patients, while 4 needed a re-catheterization. Mean postoperative hospital stay was 5.9 days (S.D. 5.5). Five patients (27.7%) presented complications during follow-up, mild in most of the cases but one who required a secondary intervention for persistent obstruction.

CONCLUSIONS

Laparoscopic extraperitoneal adenomectomy (Millin's procedure) is feasible with a reasonable complication rate. Although comparison with open adenomectomy is not yet available, this technique might have potential advantages in terms of blood loss and postoperative catheter time.

Evaluation of a low-invasive strategy for prostate cancer screening with prostate-specific antigen

OBJECTIVES

To evaluate a two-step strategy for the detection of prostate cancer within the context of serial screening and compare this strategy with other screening strategies. The optimal combination of tests proposed for prostate cancer screening remains undetermined, particularly when screening is repeated over time.

METHODS

A prospective serial prostate cancer screening study with follow-up to 55 months was performed in a general community screening clinic. One thousand seven hundred seven self-referred men, 50 to 75 years old, without a history of prostate cancer agreed to undergo screening for prostate cancer on an annual basis. Serum prostate-specific antigen (PSA) measurement was the first-step screening test. If the serum PSA test was positive, a standard urologic evaluation was performed. Biopsy was recommended only if a test other than serum PSA was suspicious for cancer. The outcome measures were the biopsy rate and prostate cancer detection rate. The comparisons with other studies were age-standardized to correct for differences in age distribution.

RESULTS

The biopsy and cancer detection rates after the first test were 7.0% and 2.0%, respectively. After 4 years of the study, the cumulative biopsy rate and cumulative cancer detection rate per enrolled man was 12% and 4.1%, respectively. The comparisons between studies revealed that screening strategies using serum PSA as a first-line test had similar detection rates but lower biopsy rates than strategies performing biopsy when one of several screening tests was positive.

CONCLUSIONS

A two-step screening strategy using serum PSA alone as the initial test seemed able to detect as many cancers as when all screening tests were used at the same time but reduced the number of unnecessary biopsies.

Phosphine sampling and analysis using silver nitrate impregnated filters

In the field of industrial hygiene, besides the necessity of monitoring phosphine with direct reading apparatus to prevent accidents, there is a need for a method of sampling and analysing phosphine to control workers' exposure. The use of filters impregnated with silver nitrate to collect arsine, phosphine and stibine in workplace air has been described in the literature. Having previously chosen this type of filter to collect arsine, we studied its characteristics for phosphine capture. A filter impregnated with sodium carbonate was used both as a prefilter to collect the particles and to trap arsenic trioxide. After dissolving the silver compounds in nitric acid, ICP emission spectrometry was used to carry out the analysis. This article describes the comparative sampling we performed in a microelectronic laboratory and in a fumigation chamber (130 samples) to determine the concentration of AgNO3 impregnation solution to be used, the detection limit of the method and the retention capacity of the impregnated filters. Interference with other gases reacting with silver nitrate was studied and the storage time for sampled filters and analysis solutions was checked. The detection limit of the adopted method is better than 1 microg per filter, and the retention capacity exceeds 300 microg per filter. The problem of how to sample phosphine when H2S, NH3, or HCl is present has been solved, but the problem of sampling phosphine in atmospheres where acetylene evolves remains. Sampled filters and filter solutions are stable for more than three months at ambient temperature.

Galectin-1 and galectin-3 binding pattern expression in renal cell carcinomas

We studied 2 families of molecules whose role remains uncharacterized or obscure in the progress of renal cell carcinoma (RCC): galectins, a major class of glycoproteins, and the Thomsen-Friedenreich (T) antigen. We characterized the level of expression of galectin-1 and galectin-3 and their respective binding sites in a series of 74 RCCs. We also characterized the level of expression of laminin, a natural ligand for galectins. Finally, we characterized the level of T antigen expression and the T antigen binding sites. All levels of expression were quantitatively determined by using computer-assisted microscopy on immunohistochemically or glycohistochemically stained slides. A small concentration of galectin-1 binding sites or a large concentration heterogeneity of galectin-3 can be associated with unfavorable prognoses for patients with grade II or III RCCs. In contrast, T antigen and T antigen binding sites revealed no change across the 2 RCC groups that exhibited different clinical outcomes. We established discriminant scores that permitted a clear distinction between the 2 RCC groups analyzed. Modifications to the expression of galectin-1 and galectin-3, but not of T antigen, parallel an increase in RCC aggressiveness. Galectins represent a family of molecules with a meaningful role in RCC progression.

Developmental toxicities of methacrylic acid, ethyl methacrylate, n-butyl methacrylate, and allyl methacrylate in rats following inhalation exposure

The developmental toxicities of 4 methacrylates were studied in Sprague-Dawley rats after inhalation exposure for 6 h/day, during days 6 to 20 of gestation. The exposure concentrations were, for methacrylic acid, 0, 50, 100, 200, or 300 ppm; for ethyl methacrylate, 0, 600, 1200, 1800, or 2400 ppm; for n-butyl methacrylate, 0, 100, 300, 600, or 1200 ppm; and for allyl methacrylate, 0, 12, 25, 50, or 100 ppm. No significant increases in embryo/fetal lethality or fetal malformations were observed after exposure to any of these methacrylates. Fetal toxicity evidenced by statistically significant decreases in fetal body weights was observed at exposure levels > or = 1200 ppm ethyl methacrylate, > or = 600 ppm n-butyl methacrylate, and at 100 ppm allyl methacrylate. Statistically significant increases in the incidence of fetuses with skeletal variations and of fetuses with any variations were noted at 1200 ppm n-butyl methacrylate. These developmental effects were observed in the presence of overt signs of maternal toxicity. While maternal toxicity was observed, methacrylic acid caused no evidence of developmental toxicity up to 300 ppm.

Relative developmental toxicities of acrylates in rats following inhalation exposure

The developmental toxicities of seven acrylates were studied in Sprague-Dawley rats after inhalation exposure for 6 h/day, during days 6 to 20 of gestation. The exposure concentrations were: for acrylic acid, 50, 100, 200, or 300 ppm; for methyl acrylate, 25, 50, or 100 ppm; for ethyl acrylate, 25, 50, 100, or 200 ppm; for butyl acrylate, 100, 200, or 300 ppm; for ethylhexyl acrylate, 50, 75, or 100 ppm; for hydroxyethyl acrylate, 1, 5, or 10 ppm; and for hydroxypropyl acrylate, 1, 5, or 10 ppm. No treatment-related increases in embryo/fetal mortality or fetal malformations were observed after exposure to any of these acrylates. Fetal toxicity, indicated by reduced fetal body weight, was observed after exposure to 300 ppm acrylic acid, 100 ppm methyl acrylate, 200 ppm ethyl acrylate, and 200 or 300 ppm butyl acrylate in the presence of overt signs of maternal toxicity. While there was evidence of maternal toxicity, no significant developmental toxic effects were observed after exposure to ethylhexyl acrylate, hydroxyethyl acrylate, or hydroxypropyl acrylate at any concentration. These results indicate that inhaled acrylic acid, methyl acrylate, ethyl acrylate, butyl acrylate, ethylhexyl acrylate, hydroxyethyl acrylate, and hydroxypropyl acrylate are not selectively toxic to the embryo or fetus.

Improving the prognostic value of histopathological grading and clinical staging in renal cell carcinomas by means of computer-assisted microscopy

The present work aims to refine prognosis in cases of renal cell carcinoma (RCC) by integrating a variety of parameters with the prognostic information provided by histopathological grading and clinical staging, carried out on a series of 97 RCCs. To this end, Feulgen-stained RCC cell nuclei were characterized by means of 38 variables describing nuclear DNA ploidy levels and morphology. All of these data were subjected to a principal components analysis. On the basis of this multivariate analysis, Fuhrman grade II was subdivided into grades II- and II+, and Fuhrman grade III into grade III- and III+. The same kind of subcategorization was performed in the case of the T2 and T3 clinical stages. The results show that the classification into grade II- and III- RCCs correspond to a more favourable prognosis than grade II+ and III+, to which shorter survival periods were attributable. Similar results were obtained for the subcategorization of the T2 and T3 clinical stages. Very simple biological characterizations of these grade- or stage-related RCC groups were obtained by means of a decision tree approach applied to the cytometry-generated variables. The resulting classification rules were validated on a new series of 18 patients and enabled very accurate predictions of survival.