Natural radioactivity measurements in beach-rock samples of south-east coast of Tamilnadu, India.

The concentration of primordial radionuclides in beach-rock samples of the south-east coast of Tamilnadu, India has been measured using gamma ray spectrum of rock. The mean activities of 232Th, 238U and 40K are 144.18, 29.25 and 267.48 Bq kg(-1) respectively. In situ measurements were also carried out using environmental radiation dosemeter. The linear correlation coefficient was obtained. The average activity of concentration of 232Th in the present study is 2.5 times higher than the world median value while the activity of 238U and 40K were found to be lower. This may be due to the heavy minerals present in the study area. In the present study, the calculated activity ratio (Th/U) is higher than the crustal rocks. This may be due to changes in the crustal composition through time (mafic to felsic) that are reflected by a change in the Th and U abundances in sedimentary rocks, and also increase in carbon content with time resulted in the decrease in U content and increase in Th/U ratio.

Natural radionuclide distribution in soils of Gudalore, India.

The concentration of primordial radionuclides in soil samples of Gudalore Taluk in the Udagamandalam district has been measured from the gamma ray spectrum of the soil. The mean activities of 232Th, 238U and 40K are 75.3 +/- 44.1, 37.7 +/- 10.1 and 195.2 +/- 85.1 Bq kg-1 dry weight, respectively. The average outdoor absorbed dose rate in air at a height of 1 m above ground is 74.3 +/- 27.8 nGy h-1, corresponding to an annual effective dose equivalent of 455.6 microSv. The dose equivalent ranges from 168.3 to 1250.5 microSv. The results have been compared with other global radioactivity measurements and evaluations.

The proportional decrease in prostate specific antigen level best predicts the duration of survival after hormonal therapy in patients with metastatic carcinoma of the prostate.

OBJECTIVE: To examine the usefulness of a test for prostate specific antigen (PSA) to predict survival in hormonally treated patients with metastatic prostate cancer. PATIENTS AND METHODS: The study comprised 49 patients (mean age 72 years, SD 6) who underwent orchidectomy for metastatic prostate cancer. PSA was measured before orchidectomy and after 6 months, and the absolute, differential and proportional decreases calculated. A Cox proportional hazards regression model, which controlled for patient age, tumour (Gleason) grade and the number of skeletal metastases, was then used to evaluate these estimates of PSA as predictors of survival. RESULTS: The 6-month proportional decrease in PSA from the pre-operative level was the most accurate predictor of patient survival (P = 0.006) after hormonal therapy for metastatic prostate cancer. CONCLUSION: This information may help to direct appropriate patients to new and experimental therapies for metastatic disease.

Epididymo-orchitis after cryoablation of prostate for prostate cancer.

We report two cases of acute epididymo-orchitis developing 4 to 6 weeks after cryoablation for prostate cancer. One patient required a simple orchiectomy for epididymal abscess; the other responded to treatment with antibiotics. Since the occurrence of these two cases, we routinely perform bilateral vasectomy prior to prostate cryoablation. We suggest that an extended course of prophylactic antibiotics may also be needed in order to avoid this complication.

The role of transrectal ultrasound-guided biopsy-based staging, preoperative serum prostate-specific antigen, and biopsy Gleason score in prediction of final pathologic diagnosis in prostate cancer.

OBJECTIVES: To evaluate the role of ultra sound-guided systematic and lesion-directed biopsies, biopsy gleason score, preoperative serum prostate-specific antigen (PSA) as three objective and reproducible variables to provide a reliable combination in preoperative identification of risk of extraprostatic extension in patients with clinically localized prostate cancer. METHODS: The case records of 813 patients who underwent radical prostatectomy for clinically localized prostate cancer were analyzed. All had multiple systematic biopsies, two to three from each lobe, in addition to lesion-directed biopsies. Additionally, biopsies were done on seminal vesicles (SVs), if abnormal. Based on biopsy results, patients were classified as having stage B1 (T2a-T2b) or B2 (T2c) disease, depending on whether biopsies from one or both lobes were positive and stage C (T3) if there was evidence of SV involvement by biopsy of biopsies from areas of extracapsular extension as seen on transrectal ultrasound (TRUS) were positive. Logistic regression analyses with log likelihood chi-square test was used to define the correlation between individual as well as combination of preoperative variables and pathologic stage. RESULTS: On final pathologic examination, 473 (58%) patients had organ-confined disease, 188 (23%) had extracapsular extension (ECE), with or without positive surgical margins, and 72 (9%) had SV involvement. Eighty (10%) patients had pelvic lymph node metastases. Biopsy-based staging was superior to clinical staging in predicting final pathologic diagnosis. Logistic regression analyses revealed that the combination of biopsy-based stage, preoperative serum PSA, and biopsy Gleason score provided the best prediction of final pathologic stage. Probability plots constructed with these data can provide significant information on risk of extraprostatic extension in individual patients. CONCLUSIONS: This study demonstrates that TRUS-guided systematic biopsy in combination with preoperative serum PSA and biopsy Gleason score may provide a cost-effective approach for management decisions and prognostication in patients with prostate cancer.

Differential suppression of serum prostatic acid phosphatase and prostate-specific antigen by 5-alpha-reductase inhibitor.

OBJECTIVE: To evaluate the effect of finasteride (Proscar) on the serum levels of prostatic acid phosphatase (PAP) and prostate-specific antigen (PSA) in patients with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Thirty patients on finasteride therapy for BPH formed the study group. Serum PSA and PAP levels were monitored for 2 years while the patients were receiving finasteride. RESULTS: During 12 months of finasteride therapy the serum PSA was suppressed but serum PAP was unaffected. The baseline mean PAP value was 1.303 ng/mL prior to finasteride therapy; this changed to 1.510 ng/mL (P = 0.195) at 6 months and 1.166 ng/mL (P = 0.383) at 12 months. The serum PSA was 2.630 ng/mL at baseline, 1.757 ng/mL (P < 0.001) at 6 months and 1.545 ng/mL (P = 0.001) at 12 months. CONCLUSIONS: Further studies are warranted to determine if PAP has a role as a tumour marker in patients whose PSA is suppressed as a result of finasteride therapy.

Utility of preoperative serum prostate-specific antigen concentration and biopsy Gleason score in predicting risk of pelvic lymph node metastases in prostate cancer.

OBJECTIVES: To determine the accuracy of the preoperative serum concentration of prostate-specific antigen (PSA) plus the Gleason pathology score of biopsy specimens in predicting the presence of disease in the pelvic lymph nodes in patients with prostate cancer. METHODS: The medical records of all patients treated for prostate cancer at eight medical centers from January 1988 to June 1993 were reviewed. There were 932 patients with newly diagnosed prostate cancer for whom all relevant data were available who had undergone pelvic lymphadenectomy with (n = 912) or without (n = 20) radical prostatectomy. The rate of false-negative predictions of metastases based on combined preoperative biopsy Gleason score and serum PSA concentration was analyzed. A multivariate logistic regression analysis was performed to assess the value of preoperative serum PSA and biopsy Gleason scores individually and in combination in predicting pelvic lymph node metastases. RESULTS: The false-negative rate of metastases was 0% for preoperative PSA concentrations < or = 6 ng/mL and biopsy Gleason scores < or = 5 (n = 142) and 1.0% for PSA concentrations < or = 10 ng/mL and Gleason scores < or = 6 (n = 388). The 95% upper confidence limit for the rate of false negativity at this PSA cut-off level was 2.0%. A combination of preoperative serum PSA levels and biopsy Gleason scores provided the best prediction for the false-negative rates. CONCLUSIONS: For patients with newly diagnosed prostate cancer who have biopsy Gleason scores < or = 6 and preoperative PSA concentrations < or = 10 ng/mL (42% of our series), a staging pelvic lymphadenectomy appears to be unnecessary. The substantial cost associated with both cross-sectional imaging and staging lymphadenectomy may therefore be avoidable in this group of patients.

Fistula-in-ano: treatment by fistulectomy, primary closure and reconstitution.

One hundred and twenty cases of fistula-in-ano were treated in 11 years by fistulectomy and primary closure. Injection of dye into the tract helped in identifying the tract and its ramifications which were excised. A lateral sphincterotomy was added in most cases for relief of postoperative pain and to promote good healing. Of the cases, 83.3% healed well in 2 weeks as compared with 4-5 weeks or more with conventional methods resulting in great economy in hospital stay and morbidity. Follow-up of these cases for a variable period, up to five years, revealed only three recurrences, indicating a comparable long term effectiveness of this procedure as in the conventional method.

Surgical reconstruction of the sequelae of penile and scrotal gangrene: a plea for simplicity.

Gangrene of the scrotum with or without involvement of the penile skin and occasionally beyond these limits, is not an uncommon problem in some parts of the world. Various workers have used different techniques to provide skin cover including transplantation of testes, free skin grafts, axial groin flaps and myocutaneous flaps. This study brings out our experience with the treatment of 43 cases in the last 11 years. In three cases the gangrene had spread beyond the scrotum and penis and cover had to be supplemented with split-skin grafts. In all the other cases, cover was provided with scrotal skin remnants at the edge of the lesion and on the penis with the inner layer of the prepuce, which had remained intact.

Meatoplasty for gross urethral stenosis: a technique of repair and a review of 32 cases.

This paper is a review of the treatment of 32 cases of meatal stenosis arising as a complication of recurrent balanoposthitis (26 cases) or balanitis xerotica obliterans (six cases). There was gross scarring of the glans and the terminal urethra resulting in a contracted glans and a pinhole meatus. These deformities were treated successfully by segmental excision of all the scar on the glans and resurfacing the raw area with a local preputial or penile skin flap. In two patients a ventral midline flap was introduced as an island flap. In no case was a ventral slit made as the only definitive treatment of the meatal stenosis. Two instruments were made specifically to facilitate this type of operation.