The feasibility of multiparametric magnetic resonance imaging for targeted biopsy using novel navigation systems to detect early stage prostate cancer: the preliminary experience.

BACKGROUND AND PURPOSE: The feasibility and diagnostic performance of multiparametric magnetic resonance imaging (mp-MRI) has to be proven further. In this study, we evaluate the role of mp-MRI for targeted biopsy of early stage prostate cancer (PCa). PATIENTS AND METHODS: A total 32 consecutive patients with transrectal ultrasonography (TRUS)-guided biopsy-proven PCa meeting low-risk criteria and pursuing active surveillance were selected to undergo mp-MRI 3 Tesla (3T) with endorectal coil. Patients were divided then into three groups based on the method used to target the mp-MRI designated region of interest (ROI): Group 1 underwent TRUS-guided prostate biopsy using an MRI-based coordinate plan (cognitive targeting). Group 2 underwent MRI-targeted TRUS-guided prostate biopsy using MyLabTMTwice, which superimposed the archived MRI images onto the real-time ultrasonography image allowing targeted biopsy of the ROI (fusion targeting). Group 3 included selected patients who had an elevation in prostate-specific antigen levels, or patients followed after radiation therapy (two patients) for suspicious unifocal MRI lesion recurrence. These patients underwent MRI-guided biopsy of the suspicious ROI using the navigation system DynaTRIM. RESULTS: The cancer detection rate in group 1 was 33.3% (3 of 10 patients), while in group 2, it was significantly higher at 46.2%. The sensitivity and specificity for group 1 was 45.5% and 33.3%, vs 61.9% and 20.8% in group 2, respectively. The positive predictive value in group 1 was 50.0% vs 53.8% in group 2 (P=0.04). In group 3, the cancer detection rate was much higher (80%) than in group 2, (P=0.005) although the majority of these patients (7 of 10) had a previously diagnosed prostate cancer on TRUS-guided 12-core biopsy. CONCLUSION: Our preliminary experience of mp-MRI suggests the detection of early stage prostate cancer with low-risk features yields potential candidates for active surveillance or focal targeted therapy. The MRI-TRUS fusion system increases diagnostic yield compared with cognitive MRI-directed TRUS-guided biopsy.

Single trocar skin puncture laparoscopic orchidopexy.

OBJECTIVE: To assess the outcomes of a modified technique for pediatric laparoscopic orchidopexy performed without instrument trocars. METHODS: A retrospective cohort study, for all laparoscopic orchidopexy performed without instrument trocars, was performed. Patient demographics, surgical technique, complications, and clinical outcomes were reviewed. All patients undergoing this procedure had a single trocar placed to insufflate and introduce the laparoscope. Skin punctures were used without trocars to introduce 3-mm instrumentation for laparoscopic orchidopexy. Initial follow-up visits were performed 2 to 4 weeks after surgery. Subsequent follow-up visits were performed at 6 to 12 months after surgery to reassess position and size of the testes. RESULTS: A total of 22 patients with 27 undescended testes (20 right, 7 left) were identified. Median age was 1.3 years old (range, 5 months-7 years). Median operative time was 61 minutes (range, 42-81 minutes) for primary unilateral procedures (18 patients). Median operative time was 84 minutes (range, 75-90 minutes) for bilateral procedures (3 patients). All procedures were performed without additional trocars. There were no intraoperative complications. Patients were followed for 1 year and discharged. No patients were lost in follow-up. Postoperatively, 26 of 27 (96%) laparoscopic orchidopexy were successful. One patient developed atrophy with subsequent orchiectomy 6 months after the initial procedure. CONCLUSION: Using skin punctures without trocars for laparoscopic orchidopexy is a safe and effective modification of standard laparoscopic orchidopexy. Further studies are warranted to compare the morbidity, ergonomics, cosmesis, costs, and reproducibility of outcomes for various options of pediatric minimally invasive surgery for intra-abdominal testes.

Extensive gluteal hematoma following InterStim implant: a case report.

Major bleeding complications following sacral nerve stimulation (SNS, InterStim) are exceptionally rare and have not been reported in the literature. We report a case of extensive gluteal hematoma following SNS procedure in a woman with a known history of thrombophilia.

Molecular profiling of small renal masses: Current status and future directions.

Small renal masses (SRMs) are renal tumors less than 4 cm in diameter. These account for the largest proportion of newly diagnosed renal cell cancers (RCC). Management of SRMs can be a dilemma if the patient is unfit to undergo partial nephrectomy. Molecular profiling enables better characterization of RCC and prediction of outcomes in terms of recurrence and progression. This article reviews the existing literature on molecular profiling of localized RCC, discusses limitations of molecular profiling, and presents the likely role that molecular profiling will play in guiding the treatment of SRMs.

Wound healing on athymic mice with engineered skin substitutes fabricated with keratinocytes harvested from an automated bioreactor.

The Kerator is a computer controlled bioreactor for the automated culture and harvest of keratinocytes that can reduce labor and materials involved in the fabrication of engineered skin substitutes (ESS). Previous studies have shown that the Kerator is comparable to tissue culture flasks by keratinocyte confluence during culture, clonogenic potential of harvested keratinocytes and microanatomy, cell viability, and surface hydration of ESS fabricated with the harvested keratinocytes. In this study, the Kerator and tissue culture flasks were further compared by keratinocyte proliferation in vitro and wound healing after transplantation of ESS to athymic mice. The number of bromodeoxyuridine-positive keratinocytes in ESS fabricated with keratinocytes harvested from Kerator after 2 wk of in vitro maturation was 34 +/- 3 per high power field (hpf) (mean +/- SEM), which was not significantly different from that fabricated with keratinocytes harvested from flasks (34 +/- 1.5 per hpf). Percentage original wound area 6 wk after surgery of ESS fabricated with keratinocytes from the Kerator was 36% +/- 3.3%, which was not significantly different from that of ESS fabricated with keratinocytes from flasks (30% +/- 4.3%). In both cases, 78% (7 of 9) mice transplanted were positive for engraftment of human keratinocytes by direct immunofluorescence for HLA-ABC antigens. These results further confirm that the ESS fabricated with keratinocytes harvested from Kerator and flasks are equivalent in vitro and in vivo. Therefore, use of Kerator for large scale production of ESS can lead to increased availability at reduced cost while maintaining ESS quality for grafting.

Medium flow rate regulates viability and barrier function of engineered skin substitutes in perfusion culture.

Perfusion culture of engineered tissues improves mass transfer of nutrients and provides flow-mediated mechanical stimulation to the developing constructs, thereby improving their anatomy and physiology in vitro. In this study, the responses to medium flow rate of engineered skin substitutes (ESS) incubated in perfusion at the air-liquid interface were investigated. ESS fabricated with autologous keratinocytes, fibroblasts, and collagen-glycosaminoglycan (GAG) sponges were incubated for 21 days at the air-liquid interface in a custom-built recirculating bioreactor system at flow rates of 5, 15, and 50 mL/min (n = 8 per condition). ESS were evaluated in vitro using histology, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, bromodeoxyuridine (BrdU) incorporation, and surface hydration. ESS incubated at 5 and 15 mL/min had histological organization comparable with that of control ESS incubated in static conditions. ESS incubated at 50 mL/min displayed a disorganized epidermal substitute and, at later time points in culture, showed greater degradation of the dermal scaffold. Cell viability measured using MTT assay was significantly higher in ESS incubated at 5 mL/min than in static controls at day 14 (mean +/- standard error of the mean 1.63 +/- 0.11 vs 1.30 +/- 0.14, p < 0.05) and day 21 (1.66 +/- 0.12 vs 1.11+/- 0.15, p < 0.05) of culture. Viability of ESS incubated at 15 mL/min was comparable with that of controls. ESS incubated at 50 mL/min had significantly lower viabilities than controls at all time points. Results of BrdU incorporation data showed that, although ESS incubated at 5 and 15 mL/min were comparable with controls, those incubated at 50 mL/min had fewer proliferating keratinocytes per high-power field than controls (2.77 +/- 0.48 vs 28.1 +/- 0.78, p < 0.05). ESS incubated at 5 mL/min had surface hydration comparable with that of controls, whereas those incubated at 15 mL/min and 50 mL/min had significantly higher surface hydration than static controls at all time points. ESS incubated at a 5 mL/min flow rate and transplanted onto full-thickness wounds on athymic mice demonstrated wound healing comparable with that of controls. From these results, it can be concluded that perfusion culture of ESS at lower flow rates increases cell viability and maintains an epidermal barrier suitable for grafting, whereas higher flow rates lead to deterioration of ESS anatomy and physiology in vitro.

Assessment of an automated bioreactor to propagate and harvest keratinocytes for fabrication of engineered skin substitutes.

Engineered skin substitutes (ESS) composed of autologous fibroblasts and keratinocytes attached to collagen-glycosaminoglycan (GAG) scaffolds are effective adjuncts in the treatment of massive burns. The Kerator, an automated bioreactor for keratinocyte culture, could hypothetically reduce labor and material requirements, and increase availability of ESS. Human keratinocytes were cultured in the Kerator and also in tissue-culture flasks. It was found that keratinocyte confluence increased exponentially with time in both the Kerator (r2=0.99) and the flasks (r2=0.96). Confluence (mean+/-SEM) of keratinocytes in the flasks (28+/-2.3%) was significantly higher than in the Kerator (18+/-0.93%) at day 4. However, there was no difference in confluence at harvest. The colony forming efficiency (CFE) and population doublings (PD) per day of keratinocytes harvested from the Kerator were 67+/-4.7% and 0.80+/-0.06, respectively, and were not different from the corresponding values for keratinocytes from flasks. ESS fabricated with keratinocytes from the Kerator or from the flasks were comparable in vitro in terms of histological anatomy, cellular viability, and surface hydration. These findings show that there are no differences between keratinocytes from the Kerator and those from the flasks regarding (a) growth to confluence, (b) CFE and growth rate (PD/day), or (c) quality of ESS in vitro, suggesting that the Kerator can automate fabrication of ESS and increase its availability for treatment of skin wounds.