Use of a surgically derived nomogram to predict high likelihood of Gleason score upgrading for favorable-risk prostate cancer treated with permanent seed brachytherapy

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Background: Crook et al have reported a 7-year disease-free survival (DFS) of 95.2% in 1,111 men with prostate cancer treated with Iodine-125 permanent seed brachytherapy (BT) at Princess Margaret Hospital. Two nomograms have been developed that estimate the likelihood of Gleason score (GS) upgrading for patients with favorable risk prostate cancer undergoing radical prostatectomy (RP). The purpose of this project was to apply these nomograms to a cohort treated with BT.

Methods: Records were examined for all men receiving prostate BT in 2006-7. 217 had favorable risk disease. The likelihood of GS upgrading was predicted using RP-derived nomograms created by Kulkarni et al (PMH, 2007) and Budaus et al (2010). Clinical and pathologic information were available on 208 patients to allow completion of the Kulkarni nomogram, and on 193 patients for the Budaus nomogram.

Results: The median age of the BT cohort was 62 years (range 44–77), and the median PSA level 4.68 ng/ml. Clinical stage was T1 in 65%, and 47.6% had positive findings on transrectal ultrasound. Median prostate volume was 33.3 cc (15.0–72.3). Uro-pathology review was available for 93%. 84.1% had extended biopsies, with 40.9% showing prostatic intraepithelial neoplasia and 10.1% inflammation. The median % of positive cores was 25%, with a median maximum % involvement per core of 20%. Two men received androgen deprivation therapy for prostate downsizing. The median predicted likelihood of GS upgrading was 51.6% using the Kulkarni nomogram, and 43.6% using the Budaus nomogram. The median PSA after 3.2 years median follow-up is 0.18 ng/mL.

Conclusions: In a population of men with favorable risk prostate cancer treated with BT, the estimated likelihood of GS upgrading using two surgical nomograms was substantial. The study cohort was taken from a larger population of patients treated over 10 years for whom 7-year DFS is 95.2%. This suggests that permanent seed brachytherapy is a highly effective treatment option for patients with favorable risk disease despite unfavorable clinical and pathologic factors. Patients should not be discouraged from brachytherapy on the basis of a high likelihood of GS upgrading.

No significant financial relationships to disclose.

Applying the Sports Medicine Australia pre-exercise screening procedures: who will be excluded?

Recently Sports Medicine Australia (SMA) and the Australian Association for Exercise and Sport Science (AAESS) developed guidelines for pre-exercise screening and supervision of fitness testing, based on the American College of Sports Medicine (ACSM) system. The procedure involves classifying individuals into one of three risk groups (apparently healthy, at higher risk, with known disease). Using data collected in a 1992 survey of 2298 Australian adults aged 18-78 years conducted by the Department of the Arts, Sport, the Environment and Territories (DASET), we calculated the percentage of the general population falling within each risk group and therefore exclusion rates (ie the proportion of subjects who, it is recommended, would require medical clearance prior to exercise or exercise testing). The analysis of data found that between 43-73% of males and 44-61% of females would require clearance. A cost analysis suggests that a rigorous application of the SMA-AAESS guidelines would cost between $250 million and $1.2 billion each year. On the basis of the results, suggestions for reviewing the guidelines have been proposed.

Report on seniors' dental care. Past experience and future challenges

After attending the CDHA North American Research Conference held in Niagara Falls last October, Ms. Bowes says she found a significant amount of interest in the area of geriatric care being expressed by those in attendance. Consequently, when she returned home, she decided to offer CDHA members an opportunity to gain some insight on this topic from her own experiences. Although no 'formal' report summarizing the findings noted here was ever forwarded to the facilities involved, Ms. Bowes says that "some of the information gathered has been used in documents and reports that were forwarded to the Ministry of Health and the local Board of Health for Simcoe County." The purpose of this report is to alert dental professionals to the future dental needs of our rapidly aging population and to perhaps assist those who are considering the provision of the elderly by outlining my personal experience.

Brutus is making rounds

Brutus made no judgments. He gave only care and devotion. As a visiting "therapist," the Doberman Pinscher brought joy and activity to nursing homes.

The doctor as patient: an encounter with Guillain-Bárré syndrome

The author describes the course and treatment of a severe acute illness that began with cranial nerve palsies and ataxia and progressed rapidly to generalized weakness with respiratory embarrassment. There was no sensory loss or elevation of the protein level in the cerebrospinal fluid. The Miller Fisher variant of Guillain-Barré syndrome was diagnosed. At the height of the illness, a period lasting about 2 weeks, the author was almost completely paralysed, retaining only a little motion in some fingers and one foot; she was able to breathe on her own but required suctioning through a tracheostomy, and her eyes had to be taped shut because of her facial paralysis. She remained mentally alert throughout. Proper care of such a helpless patient demands not only excellent technical performance of many nursing procedures but a sensitivity to the patient as a person. The author describes the many shortcomings of the care she received and the value of physiotherapy in her rehabilitation and makes a number of specific recommendations for the care of critically ill conscious patients.

Ultrastructural localisation of lactoferrin and glycoprotein in human bronchial glands

The distribution of lactoferrin and glycoprotein in human bronchial glands has been studied by electron microscopy using an immunoperoxidase method to stain the former and a periodic acid-chromic acid-silver methenamine sequence for the latter, each applied to ultrathin Epon sections. The distribution of lactoferrin corresponds to that of lysozyme. Lactoferrin and lysozyme are both confined to serous acini where the granules show a variable pattern of staining. Some serous granules are filled uniformly with lactoferrin, some lack lactoferrin in a small central core or a thin peripheral rim, and some are completely devoid of lactoferrin. Glycoprotein is present in all mucous granules but only certain serous granules. The latter may be filled uniformly with glycoprotein or glycoprotein may form a thin peripheral coat about centrally located lactoferrin and lysozyme. An electron-dense central core found in some serous granules contains neither glycoprotein, lactoferrin, nor lysozyme.

Postnatal growth of the mouse lung

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Ultrastructural immunocytochemical localisation of lysozyme in human bronchial glands

An immunocytochemical unlabelled antibody method using rabbit antihuman lysozyme, antirabbit immunoglobulin, and soluble rabbit antihorseradish peroxidase/horseradish peroxidase complexes was used to study the fine structural distribution of lysozyme in human bronchial glands. None was identified in mucous cells but there was heavy staining of the serous cell granules. The serous cell granules were not stained uniformly, suggesting the presence of other secretory products but lysozyme secretion appears to be a major function of these cells. The pathological implications of this are discussed.

Quantification and identification of particle movement in epidermis after thermal injury

Skin samples from a rabbit hind limb were taken from controls and at 5 min, 2 and 6 hr after a mild thermal injury (60 degrees C for 1 min). Large aggregates of intercellular particles, usually ribosomal in appearance, were seen in 6 hr samples and were accompanied by some peripheral aggregates of particles and by granule-coated vesicles. These structures were present in earlier samples to a lesser extent and were absent from control material. Quantitative assessment showed that intercellular particles apparently increased up to 6 hr whereas peripheral aggregation was maximum at 2 hr. Histochemical analysis confirmed that the particles contained ribonucleoprotein. Other larger particles were seen occasionally and contained carbohydrate. Lymph draining the site showed cellular changes, little change in enzyme activities, and no aggregates of particles.