Multivariate analysis of factors affecting biochemical recurrence after radical prostatectomy

OBJECTIVE@#This study aims to evaluate the effects on biochemical recurrence (BCR) of the followingproposed prognostic factors after radical prostatectomy (RP): patients' clinical T stage, Gleason gradegroup (GG) of RP specimen, technique of operation used (open RP vs. robot-assisted laparoscopicRP), presence of positive surgical margin (PSM), length of PSM, GG at PSM, extraprostatic extension(EPE) at PSM, and presence of detectable PSA at 4-6 weeks after RP. It also aims to identify whichamong the aforementioned variables are independent predictors of risk for BCR.@*PATIENTS AND METHODS@#This is a retrospective study. Included in the study were patients who underwentRP (Open and Robot-assisted Laparoscopic technique) at two tertiary hospital branches of an academicmedical center from April 2009 to December 2015 with histopathology reports read by a singleurologic pathologist and with complete follow- up for at least one year. Excluded were those whounderwent RP but without complete follow- up. Using Pearson chi-square and z-test with level ofsignificance set at 0.05, the clinicopathologic variables including: patients clinical stage, GG of RPspecimen, length of PSM, GG at positive margins, presence of EPE at positive margins, and presenceof detectable PSA after the surgery were assessed in order to know which among these factors werepredictive of BCR. Multinomial regression analysis was also used to identify which among the variableswere independent predictors of risk for BCR.@*RESULTS@#A total of 165 patients underwent RP from April 2009 to December 2015, among which 72patients were eligible for inclusion in the final analysis. Clinical T2 stage was found to be a predictorof BCR with odds ratio of 13.000 (95%CI: 3.705 - 45.620; p < 0.001) as compared to stage T1. GGof final histopathology report of prostatectomy specimen was found to be a predictor of BCR, asthose with grade groups 4 and 5 had significantly increased risk of BCR with odds ratio of 70.778(95%CI: 8.207 - 610.426; p < 0.001) as compared to those with grade groups 1 to 3. Patients withpositive margins had increased risk of BCR, with odds ratio of 13.458 (95%CI: 13.472 - 52.171; p <0.001) compared to those with negative margins. GG at the PSM was found to be a predictor of BCR,with a grade grouping of 4 or 5 at the positive margin predicting BCR with odds ratio of 20.625(95%CI: 2.241 - 189.847; p = 0.008) as compared to grade grouping of 1 or 2 at the margin. DetectablePSA after RP was found to be a predictor of BCR, with odds ratio of 115.000 (95%CI: 19.457 -679.712; p < 0.001) as compared to undetectable PSA after RP. Technique of RP (p = 0.177), measuredlength of PSM (p = 0.713), and EPE at PSM (p = 0.146) were not found to predict BCR. Furthermore,clinical T stage (p = 0.007) and detectable PSA after RP (p < 0.001) were found to be independentpredictors of BCR among the risk factors examined.@*CONCLUSION@#Of the independent variables examined, clinical T stage, GG of RP specimen, presenceof PSM, GG at positive margins, and detectable PSA were found to be significant predictors of BCR. Technique of RP, measured length of PSM, and EPE at PSM were not found to predict BCR.Furthermore, multivariate analysis showed that only clinical T stage and detectable PSA after RPwere independent predictors of BCR. Attentive assessment of these predictors in the preoperativeperiod should aid the urologist in clinical decision-making and in advising patients regarding theirprognosis.

Pseudocholangiocarcinoma Sign: Management of Portal Cavernoma Biliopathy with Fully-Covered Self-Expandable Metal Stent

No abstract available.

La coccidioidomicosis en Argentina, 1892-2009 / Coccidioidomycosis in Argentina, 1892-2009

Los casos clínicos de coccidioidomicosis en Argentina son pocos y han tenido lugar fundamentalmente en la extensa región árida precordillerana. Este trabajo tiene como objetivos realizar una revisión retrospectiva del total de casos de coccidioidomicosis documentados en Argentina desde el año 1892 hasta 2009 y describir una serie de casos ocurridos en los últimos 4 años. En 117 años se documentaron 128 casos. Desde la primera descripción de la enfermedad en 1892 hasta 1939 se registraron 6 casos; desde 1940 hasta 1999, 59 casos (6-14 casos cada 10 años); y los 63 casos restantes (49% del total histórico) se produjeron en el último decenio. La mediana de edad de los 34 pacientes registrados en el período 2006-2009 fue de 31 años (rango: 7-89), la relación hombre:mujer fue 1,3:1; 12 de estos individuos eran inmunocomprometidos. Veintiséis casos se confirmaron por examen microscópico, por cultivo o por ambos procedimientos; los casos restantes se confirmaron por serología. Todos los aislamientos recuperados fueron identificados como Coccidioides posadasii. Treinta pacientes residían en una amplia área geográfica con epicentro en el valle de Catamarca. Entre 2006 y 2009, la tasa de incidencia en la provincia de Catamarca se incrementó desde valores históricos inferiores a 0,5 casos cada 100 000 habitantes hasta 2,0 casos cada 100 000 habitantes. Este aumento sugiere una emergencia de la coccidioidomicosis en el área.

Clinical cases of coccidioidomycosis are rare in Argentina and are generally found in the large arid precordilleran area of the country. This study aims to perform a retrospective review of all coccidioidomycosis cases documented in the country from 1892 to 2009, and to describe those occurring in the last 4 years. One hundred and twenty eight cases were documented in the 117 year-period. Since the original description of the disease in 1892 until 1939, only 6 cases were registered; between 1940 and 1999, 59 (6-14/10 yrs) and the remaining 63 (49% of total cases) occurred in the last decade. The median age of 34 patients registered in 2006-2009 was 31 years (range: 7-89), male/female ratio was 1.3:1 and 12 patients were immunocompromised. Twenty-six cases were confirmed by direct microscopy and/or culture whereas the remaining ones by serology. All isolates were identified as Coccidioides posadasii. Thirty patients lived in a vast geographic region with epicenter in Catamarca Valley. Between 2006 and 2009, annual disease incidence rates in Catamarca Province increased from historical values below 0.5/100,000 to 2/100,000 inhabitants. Such increase suggests an emergency of coccidioidomycosis in that region.

Validity and reliability of the abbreviated barratt impulsiveness scale in spanish (BIS-15S)

Introduction: This study determined the validity and reliability of a new, abbreviated version of the Spanish Barratt Impulsiveness Scale (BIS-15S) in Colombian subjects. Method: The BIS-15S was tested in non-clinical (n=283) and clinical (n=164) native Spanish-speakers. Intra-scale reliability was calculated using Cronbach’s , and test-retest reliability was measured with Pearson correlations. Psychometric properties were determined using standard statistics. A factor analysis was performed to determine BIS-15S factor structure. Results: 447 subjects participated in the study. Clinical subjects were older and more educated compared to non-clinical subjects. Impulsivity scores were normally distributed in each group. BIS-15S total, motor, non-planning and attention scores were significantly lower in non-clinical vs. clinical subjects. Subjects with substance related disorders had the highest BIS-15S total scores, followed by subjects with bipolar disorders and bulimia nervosa/binge eating. Internal consistency was 0.793 and test-retest reliability was 0.80. Factor analysis conformed a three-factor structure (attention, motor, non-planning) accounting for 47.87% of the total variance in BIS-15S total scores. Conclusions: The BIS-15S is a valid and reliable self-report measure of impulsivity in this population. Further research is needed to determine additional components of impulsivity not investigated by this measure...

Introducción: Determinar la validez y confiabilidad de una nueva versión abreviada de la Escala de Impulsividad de Barratt (BIS-15S) en la población colombiana. Método: El BIS-15S fue aplicado a sujetos hispanoparlantes no clínicos (n=283) y clínicos (n=164). Sus propiedades psicométricas se establecieron con pruebas estadísticas estandarizadas y sus factores principales se analizaron para determinar la estructura de los factores del instrumento. Resultados: 447 sujetos participaron en el estudio. Los sujetos clínicos fueron mayores y más educados que los sujetos no clínicos. Los puntajes estuvieron distribuidos normalmente en las dos poblaciones. Los puntajes total, motor, de no planeación y atención del BIS-15S fueron ignificativamente menores en sujetos no clínicos, comparados con sujetos clínicos. Los puntajes de los sujetos con abuso/dependencia a drogas fueron los más altos, seguidos de aquellos de sujetos con trastornos bipolares y bulimia nerviosa/trastorno por atracones. La consistencia interna del BIS-15S fue 0,793; su confiabilidad prueba-reprueba, 0,80. El análisis de factores conformó tres factores principales (motor, no planeación y atención) responsables de 47,87% de la varianza del puntaje total del BIS-15S. Conclusiones: El BIS-15S es una medida válida y confiable del rasgo impulsividad en la población colombiana. Son necesarios estudios adicionales para establecer otras dimensiones del rasgo no medidas por el instrumento...

Obsessive-Compulsive Disorder Symptoms in Huntington’s Disease: A Case Report / Síntomas del trastorno obsesivocompulsivo en la enfermedad de Huntington: reporte de caso

Introduction: Few cases of obsessive-compulsive disorder (OCD) symptoms preceding the clinical onset of Huntington Disease (HD) or during later stages of the disease have been reported in the literature, but the nature of this association and its neurobiological mechanisms have not been well-investigated. Objectives: To review the scientific literature regarding OCD symptoms in patients with HD and describe a case study from our clinic. Methods: Extensive literature searches were performed to identify reports of patients with concurrent HD and OCD symptoms. Results: Recent studies and the current case report suggest that OCD symptoms may predate or coincide with motor, affective or behavioral symptoms in patients with HD. The development of OCD and HD symptoms may involve structural and functional changes affecting the orbital and medial prefrontal cortex, ventromedial caudate nucleus, and pallidal sites. Conclusions: Some patients with HD develop symptoms associated with OCD. Progressive and differential neuropathological changes in the ventromedial caudate nucleus and related neural circuits may underlie this association. No specific treatment strategy has been developed to treat these patients; however some medications attenuate associated symptoms. Further testing is needed to determine the neurobiological mechanisms of these disorders.

Introducción: Algunos reportes de caso indican que pacientes con enfermedad de Huntington (EH) pueden presentar síntomas obsesivo-compulsivos (TOC) antes del desarrollo de la enfermedad y durante ésta, pero no se ha estudiado la naturaleza de esta asociación y sus mecanismos neurobiológicos. Objetivos: Revisar la literatura científica acerca de la asociación entre EH y síntomas TOC y reportar el caso de un paciente con estas condiciones. Método: Búsqueda selectiva de literatura relevante. Resultados: Estudios recientes y el caso aquí reportado sugieren que los síntomas TOC pueden presentarse antes de la EH y durante ésta. El desarrollo concurrente de estas patologías puede estar mediado por cambios estructurales y funcionales de la corteza prefrontal orbital y medial, región ventromedial del núcleo caudado y regiones palidales. Conclusiones: Algunos pacientes con EH desarrollan síntomas de TOC. Cambios neuropatológicos progresivos y diferenciales en el caudado ventromedial y circuitos dependientes pueden mediar esta asociación. No se ha desarrollado una estrategia terapéutica para el tratamiento de estos pacientes; sin embargo, algunos medicamentos parecen ofrecer mejoría sintomática parcial a los sujetos afectados. Se requieren mayores estudios acerca de los mecanismos neuropatológicos involucrados en esta asociación.

Risk factors and outcome analysis among young Filipino patients with nontraumatic intracerebral hemorrhage: A cross-sectional study

OBJECTIVES: To determine the prevalence, risk factors, etiology, location, and outcome of non-traumatic intracerebral hemorrhage (ICH) in young Filipino patients. To identify factors associated with poor outcome and mortality METHODOLOGY: Review of charts of patients age /- 45 years admitted for acute non-traumatic intracerebral hemorrhage with neuroimaging evidence of symptomatic ICH was done. Data regarding risk factors, location, etiology and outcome were analyzed using SPSS 9.01 for Windows and Epi 6 for univariate and multiple regression analysis RESULTS: Seventy subjects were included. 66 percent were males and 34 percent were females. The mean age of the subjects was 37 years old. Prevalence of non-traumatic ICH among stroke in young adults is 17 percent. The most frequent risk factors were hypertension, smoking, alcohol use, and family history of CVD. The common locations in order were basal ganglia/internal capsule (44 percent), thalamus (22 percent), lobar, and brainstem. The common causes of ICH were hypertension (46 percent), vascular malformations (16 percent) and hematologic/coagulation disorders (13 percent). Arteriography was done in 33 percent of cases. Overall in-hospital mortality rate was 8.5 percent in the acute stage of ICH. Factors independently associated with poor outcome and mortality on multivariate regression analysis were posterior circulation (p=0.005), presence of intraventricular extension (p=0.002), ICH volume 30 cc (p= 0.011), and smoking history (p=0.021) CONCLUSION: Non-traumatic intracerebral hemorrhage in young Filipino adults has a heterogenous etiology. Non-traumatic ICH occurred in 17 percent of young stroke patients. Posterior circulation involvement, presence of intraventricular extension, ICH volume of 30cc and smoking history were significant factors associated with poor outcome.

Focal segmental glomerulosclerosis in childhood: histology, glomerular morphometry, electron microscopy and immunofluorescence findings in biopsies performed early in the course of the disease.

The histological evolution of Focal Segmental Glomerulosclerosis (FSGS) is poorly documented due to variation in the time at which the biopsy is taken. We looked at patients presenting with steroid resistant nephrotic syndrome (SRNS) in which the first biopsy was performed within 3 months of presentation. FSGS lesion was demonstrable in 68.5% of cases in the first biopsy. Glomerular size was increased in 86% of patients indicating that is an early event in the course of the disease. The group was heterogenous with respect of mesangial cellularity, mesangial matrix, position of FSGS lesion in the glomeruli, glomerular size, lamina densa thickness and immunofluorescence findings. No association of morphological features was seen permitting subclassification of this group on morphological grounds. Thus, both the FSGS lesion and glomerular enlargement occur early in the evolution of idiopathic FSGS presenting with SRNS.

The endometrial cancer risk scoring / Philippine Journal of Obstetrics and Gynecology

Our objectives were to determine the most significant prognostic factors affecting node metastasis in endometrial cancer and to devise and validate a scoring system for endometrial cancer. The study design consisted of retrospective chart review (operative record and histopathology report) of all endometrial cancer patients who underwent total hysterectomy/radical hysterectomy, bilateral salpingooophorectomy, bilateral pelvic lymph node dissection and peritoneal fluid cytology from September 21, 1989 to February 19, 1999. The analysis included 262 women, 21.4% of whom had pelvic lymph node metastasis.The mean ages for those with metastasis and without metastasis were similar positive lymph node (LN) =53.18 years old; negative LN=51.89 years old; range: positive LN=31-84 years old, negative LN=23-76 years old. Most patients were of low gravidity, with mean=G3, median=G4, mode = GO. The most significant factors affecting pelvic lymph node metastasis were peritoneal fluid cytology, myometrial invasion, cervix involvement and histologic grade as determined by logistic regression and Odds ratio. A prognostic scoring system was devised. All subjects were scored according to a proposed scoring system to determine the latter's clinical utility. A cut-off score of 5 was shown to be significant for pelvic lymph node metastasis. The proposed scoring system may be used to determine the likelihood of pelvic lymph node metastasis for patients who did not have lymphadenectomy and may have an important role in determining the need for adjuvant treatment.

Reparación simultánea de fístula rectovaginal tipo IV (cloaca) y deformación de tipo "ano ectópico". Presentación de un caso y revisión de literatura / Simultaneus repair of type IV recto vaginal fistula (cloaca) and \"ectopic anus\" de formity. Report of a case and review of literature

Mujer de 40 años de edad con una fístula rectovaginal (cloacas) de siete años de evolución, asociada a una deformidad de "ano ectópico". El paso inicial de la operación fue la craeción de dos colgajos de espesor total en forma de "V". Subsecuentemente, se realizó una reparación longitudinal. La elevación inicial de los colgajos facilita la identificación de las estructuras musculares necesarias para la reparación. La sobreposición de los colgajos como paso final de la operación corrige la deformación de "ano ectópico". Los pasos esenciales del procedimiento se ilustran y se describen en detalle

`95 Survey of Korean Society of Cataract and Refractive Surgery Members

A questionnaire on a variety of ophthalmic topics was made up and sent to 150 members of the Korean Society of Cataract and Refractive Surgery-[KSCRS] in May, 1996. Forty percent [60/150] responded within the deadline in June, 1996. As the contents of the questionnaire were almost identical to the ones prepared in the USA [1994, 1995] and in Japan [1994], the answer to the questionnaire could be compared with those gathered from the USA and Japan. Over half of the respondents [57%] were in their forties. The average number of operations done per month was 26. Cataract operation accounted for over 60% of the total operations in 34% of KSCRS members. And more than 76% of the cataract operation were done using phacoemulsification technique in 31% of the respondents. There were no difference in the preferred method of local anesthesia for the cataract surgery in Korea compare to the USA or Japan. And there was less likelihood of using peribulbar anesthesia and no suture technique in Korea compared to the USA. Sixty-one percent of the Korean ophthalmic surgeon implanted the intraocular lenses even before the patients were younger than 20 years old whereas, 82% of ophthalmic surgeon in Japan did only when the patients were older than 20 years of age. For radial keratotomy as a means of correcting myopia, 91% of the Korean respondents were not performing the procedure any more, while 45% of the American respondents abandoned it. Fifty four percent of the Korean respondents and 46% of the American respondents have been doing excimer laser photorefractive keratectomy. There was no statistical difference between the two. From the answers to the qustionnaire, we found that our results did not differ significantly from those of the USA or Japan and we believe that these results reflect the present trends of cataract and refractive surgeries in Korea.