Post-chemotherapy Laparoscopic Retroperitoneal Lymph Node Dissection for Mixed Malignant Germ Cell Testicular Tumors.

INTRODUCTION: Retroperitoneal lymph node dissection (RPLND) is performed to treat residual disease following chemotherapy for stage II and III testicular cancer. Significant morbidity can be associated with open RPLND. As such, laparoscopic techniques have been demonstrated to be safe and effective in select cases. Outcomes following post-chemotherapy laparoscopic RPLND for mixed malignant germ cell testicular tumors (MMGCT) are limited in the literature. PATIENTS AND METHODS: We performed a retrospective chart review for patients who underwent laparoscopic RPLND at our institution for MMGCT from May 2006 to October 2016. Patient clinical data and perioperative and oncologic outcomes were recorded. RESULTS: Twenty-three patients underwent post-chemotherapy laparoscopic RPLND. Thirty-five percent (8/23) underwent bilateral template dissection, whereas 65% (15/23) underwent a modified unilateral template dissection. Robotic assistance was utilized in 22% (5/23) of cases. Bilateral template was inferior to unilateral template RPLND in operative time, estimated blood loss, open conversion rate, length of hospital stay, and complication rate. The mean follow-up was 35.1 months and 43.3 months for the bilateral and unilateral template groups, respectively. The mean lymph node yield and recurrence rate were similar between the 2 cohorts. One recurrence of mature teratoma was noted 67 months after unilateral laparoscopic RPLND. CONCLUSIONS: In select patients, laparoscopic RPLND for stage II and III MMGCT is safe and effective in the post-chemotherapy setting. Bilateral template laparoscopic RPLND was associated with inferior perioperative outcomes, but similar oncologic outcomes compared with unilateral template. Patients requiring bilateral template RPLND should be considered for an open approach.

Mechanisms of interaction between macroalgae and scleractinians on a coral reef in Jamaica.

After several decades of disturbance, many coral reefs in the Caribbean are dominated by macroalgae. One process affecting this transition is coral-macroalgal competition, yet few studies have addressed the mechanisms involved. In this study, we investigated competition between the tall and bushy macroalga Sargassum hystrix (J. Agardh) and the branching coral Porites porites (Pallas) on a shallow reef in Jamaica. Experiments were designed to expose coral branches to different treatments to test the role of shading and abrasion by Sargassum on coral growth and polyp expansion. Corals exposed to Sargassum grew significantly more slowly (80% reduction) than controls, but this effect was absent when corals were caged to prevent physical contact with macroalgae. Light levels were reduced in both the algal and cage treatments, but shading apparently had little effect on the growth of corals in cages. Short-term measurements of integrated net water flow did not detect variation among treatments. In algal-mimic treatments, where clear plastic strips could touch but not shade the corals, growth rates were 25% lower than controls, but this effect was not statistically significant. Thus, the growth of corals in contact with Sargassum was reduced by abrasion and, to a lesser extent, by factors unique to living macroalgae. Analysis of polyp expansion showed that polyps were more frequently retracted when corals were in contact with macroalgae or algal-mimics compared to controls or cage treatment; the frequency of polyp contraction was correlated positively with growth. Together, these results suggest that abrasion-mediated polyp retraction is one of the primary mechanisms of competition utilized by tall (ca. 17 cm) macroalgae against scleractinian corals.

Successful treatment of mediastinal seminoma with vinblastine, bleomycin, and cis-platinum.

We report on 2 patients with extensive primary mediastinal seminoma treated with vinblastine, bleomycin, and cis-dichlorodiammine platinum who achieved complete remission. These patients are alive forty-six months and sixty-six months without evidence of recurrence of disease. These long-term survivors extend the experience reported previously in the literature. Mediastinal seminoma with extent beyond a rational field of radiation therapy can be treated successfully with chemotherapy.

Vitamin B-12 (cobalamin) deficiency: a heretofore undescribed control mechanism for plasma corticosteroid-binding globulin concentration in man.

Six of eight patients with Addisonian pernicious anemia were found to have diminished corticosteroid-binding globulin (CBG) concentrations, which returned within 2 weeks to normal after the im administration of cobalamin. T4-binding globulin was found to be completely normal before and after cobalamin replacement. Other estrogen-responsive proteins, i.e. ceruloplasmin, alpha 1-trypsin inhibitor, haptoglobin, transferrin, and alpha 2-macroglobulin, also did not follow CBG concentration in a parallel fashion. The immunoglobulins similarly did not follow a course parallel to that of CBG. The CBG concentration in two untreated patients had a normal increase in response to estrogen administration, similar to that described in CBG deficiency from other causes. No clue was found regarding the mechanism by which B12 influences the putative hepatic control of CBG concentration. It is speculated that at least two control points may be necessary for a normal CBG concentration. Patients with a genetic deficiency of CBG may also have to have cobalamin deficiency in order for them to reach a concentration approaching zero.