Videotaping of surgical procedures and outcomes following extraperitoneal laparoscopic radical prostatectomy for clinically localized prostate cancer

Background

Video-recording of emerging minimally invasive surgical procedures is likely to become an integral component of patient record-keeping in the future for prostate cancer treatment. No prior work has shown the impact of videotaping of laparoscopic prostatectomy on patient outcomes. Our aim was to determine correlation between independent peer review of videotaping quality scores of extraperitoneal laparoscopic prostatectomy (ELRP) with complications, re-admissions, functional, and early oncological outcomes.

Study Design, Setting, and Participants

We conducted a single-institution prospective cohort study comparing videotaping quality scores with the outcomes of ELRP in men with localized prostate cancer. Videotaping of surgical procedures were scored by two experienced laparoscopic surgeons using a validated scoring method. Validated record-linkage methodology and self-reported questionnaires were used to assess surgical complications, re-admissions, functional, and oncological outcomes based on a common identifier called as community health index (CHI) number. Pearson correlation coefficients were calculated between the different covariates with statistical significance considered at P < 0.05. Multivariate analyses assessed oncological outcomes (positive surgical margins/biochemical recurrence), post-operative complications, and re-admission into hospital following initial hospital discharge with quality of surgical procedure.

Results

200 men were recruited into the study. 51 (25.5%) participants had post-operative complications. Record-linkage methodology identified 18 (9%) participants had re-admissions within 90 days of the procedure. 13 (6.5%) of these men required percutaneous drainage with hospital stay following re-admissions ranged between 3 and 12 days. 10 (5.0%) participants had intra/peri-operative complications. 23 (11.5%) men reported to primary care physicians for various indications. Higher quality surgical technique videotaped scores (assessed by independent peer review) had a significant correlation with early continence recovery at 3 months post-procedure, (P = 0.013), but lost statistical significance with overall continence at 1 year. No statistical correlation was observed between videotaped scores and oncological outcomes (positive surgical margins/biochemical recurrence), post-operative complications, and readmission into hospital.

Conclusions

Quality of surgical procedure assessed by independent third party videotaping score predicted early resumption of continence following extraperitoenal laparoscopic radical prostatectomy, however, it did not predict complications, oncological or functional outcome as assessed using patient reported outcomes at 12 months. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.

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Latissimus dorsi flap with vascularized lymph node transfer for lymphedema treatment: Technique, outcomes, indications and review of literature

Background and Objectives

One of the surgical treatment options for lymphedema is vascularized lymph node transfer (VLNT). We present our experience with latissimus dorsi (LD) flap based VLNT for lymphedema treatment.

Methods

We reviewed 14 consecutive patients treated with pedicled or free LD VLNT between 2014 and 2016 for recalcitrant upper or lower extremity lymphedema. Seven patients underwent lymphovenous bypass in addition to LD VLNT. Limb volume and quality of life scores using the Lymphedema Life Impact Scale (LLIS) were analyzed for quantitative and qualitative assessment.

Results

Mean duration of lymphedema was 69 months (range 24–124 months). Follow-up ranged from 3 to 12 months (mean 6.7 month). Major complications included one free flap loss and one reoperation for thrombosis. Mean preoperative volume differential between normal and affected limb was 35% (range 3–87%). Volume differential reduction was 48%, 28%, and 46% at 3, 6, and 12 months, respectively. The LLIS score improved from mean of 46.8 before surgery to a mean of 38.6 at 12 month, demonstrating improvement in quality of life.

Conclusions

The LD VLNT provides a viable option for treatment of UE and LE lymphedema in selected patients. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.

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Frontline treatment of acute myeloid leukemia in adults

Publication date: Available online 11 December 2016
Source:Critical Reviews in Oncology/Hematology
Author(s): Gevorg Tamamyan, Tapan Kadia, Farhad Ravandi, Gautam Borthakur, Jorge Cortes, Elias Jabbour, Naval Daver, Maro Ohanian, Hagop Kantarjian, Marina Konopleva
Recent years have highlighted significant progress in understanding the underlying genetic and epigenetic signatures of acute myeloid leukemia(AML). Most importantly, novel chemotherapy and targeted strategies have led to improved outcomes in selected genetic subsets. AML is a remarkably heterogeneous disease, and individualized therapies for disease-specific characteristics (considering patients' age, cytogenetics, and mutations) could yield better outcomes. Compared with the historical 5-to 10-year survival rate of 10%, the survival of patients who undergo modern treatment approaches reaches up to 40–50%, and for specific subsets, the improvements are even more dramatic; for example, in acute promyelocytic leukemia, the use of all-trans retinoic acid and arsenic trioxide improved survival from 30 to 40% up to 80 to 90%. Similar progress has been documented in core-binding-factor-AML, with an increase in survival from 30% to 80% upon the use of high-dose cytarabine/fludarabine/granulocyte colony-stimulating factor combination regimens. AML treatment was also recently influenced by the discovery of the superiority of regimens with higher dose Ara-C and nucleoside analogues compared with the "7+3"regimen, with about a 20% improvement in overall survival. Despite these significant differences, most centers continue to use the "7+3" regimen, and greater awareness will improve the outcome. The discovery of targetable molecular abnormalities and recent studies of targeted therapies (gemtuzumab ozagomycin, FLT3 inhibitors, isocitrate dehydrogenase inhibitors, and epigenetic therapies), future use of checkpoint inhibitors and other immune therapies such as chimeric antigen receptor T-cells, and maintenance strategies based on the minimal residual disease evaluation represent novel, exciting clinical leads aimed to improve AML outcomes in the near future.



http://ift.tt/2gqHL2T

Frontline treatment of acute myeloid leukemia in adults

Publication date: Available online 11 December 2016
Source:Critical Reviews in Oncology/Hematology
Author(s): Gevorg Tamamyan, Tapan Kadia, Farhad Ravandi, Gautam Borthakur, Jorge Cortes, Elias Jabbour, Naval Daver, Maro Ohanian, Hagop Kantarjian, Marina Konopleva
Recent years have highlighted significant progress in understanding the underlying genetic and epigenetic signatures of acute myeloid leukemia(AML). Most importantly, novel chemotherapy and targeted strategies have led to improved outcomes in selected genetic subsets. AML is a remarkably heterogeneous disease, and individualized therapies for disease-specific characteristics (considering patients' age, cytogenetics, and mutations) could yield better outcomes. Compared with the historical 5-to 10-year survival rate of 10%, the survival of patients who undergo modern treatment approaches reaches up to 40–50%, and for specific subsets, the improvements are even more dramatic; for example, in acute promyelocytic leukemia, the use of all-trans retinoic acid and arsenic trioxide improved survival from 30 to 40% up to 80 to 90%. Similar progress has been documented in core-binding-factor-AML, with an increase in survival from 30% to 80% upon the use of high-dose cytarabine/fludarabine/granulocyte colony-stimulating factor combination regimens. AML treatment was also recently influenced by the discovery of the superiority of regimens with higher dose Ara-C and nucleoside analogues compared with the "7+3"regimen, with about a 20% improvement in overall survival. Despite these significant differences, most centers continue to use the "7+3" regimen, and greater awareness will improve the outcome. The discovery of targetable molecular abnormalities and recent studies of targeted therapies (gemtuzumab ozagomycin, FLT3 inhibitors, isocitrate dehydrogenase inhibitors, and epigenetic therapies), future use of checkpoint inhibitors and other immune therapies such as chimeric antigen receptor T-cells, and maintenance strategies based on the minimal residual disease evaluation represent novel, exciting clinical leads aimed to improve AML outcomes in the near future.



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Supplement title page

Publication date: December 2016
Source:Cancer Epidemiology, Volume 45, Supplement 1





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Title page / Editorial Board

Publication date: December 2016
Source:Cancer Epidemiology, Volume 45, Supplement 1





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Table of contents

Publication date: December 2016
Source:Cancer Epidemiology, Volume 45, Supplement 1





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Supplement title page

Publication date: December 2016
Source:Cancer Epidemiology, Volume 45, Supplement 1





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Title page / Editorial Board

Publication date: December 2016
Source:Cancer Epidemiology, Volume 45, Supplement 1





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via IFTTT

Table of contents

Publication date: December 2016
Source:Cancer Epidemiology, Volume 45, Supplement 1





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Two coffins and a funeral: early or late caspase activation determines two types of apoptosis induced by DNA damaging agents

Abstract

Cell cytoskeleton makes profound changes during apoptosis including the organization of an Apoptotic Microtubule Network (AMN). AMN forms a cortical structure which plays an important role in preserving plasma membrane integrity during apoptosis. Here, we examined the cytoskeleton rearrangements during apoptosis induced by camptothecin (CPT), a topoisomerase I inhibitor, in human H460 and porcine LLCPK-1α cells. Using fixed and living cell imaging, we showed that CPT induced two dose- and cell cycle-dependent types of apoptosis characterized by different cytoskeleton reorganizations, time-dependent caspase activation and final apoptotic cell morphology. In the one referred as "slow" (~h) or round-shaped, apoptosis was characterized by a slow contraction of the actinomyosin ring and late caspase activation. In "slow" apoptosis the γ-tubulin complexes were not disorganized and microtubules were not depolymerized at early stages. In contrast, "fast" (~min) or irregular-shaped apoptosis was characterized by early caspase activation followed by full contraction of the actinomyosin ring. In fast apoptosis γ-tubulin complexes were disorganized and microtubules were initially depolymerized. However, after actinomyosin contraction, microtubules were reformed adopting a cortical but irregular disposition near plasma membrane. In addition to distinctive cytoskeleton reorganization kinetics, round and irregular-shaped apoptosis showed different biological properties with respect to AMN maintenance, plasma membrane integrity and phagocytes response. Our results suggest that the knowledge and modulation of the type of apoptosis promoted by genotoxic agents may be important for deciding a better therapeutic option and predicting the immune response in cancer treatment.

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Real-time verification of a high-dose-rate Ir-192 source position using a modified C-arm fluoroscope

Publication date: Available online 10 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Takayuki Nose, Masashi Chatani, Yuki Otani, Teruki Teshima, Shinichirou Kumita
PurposeHigh-dose-rate (HDR) brachytherapy misdeliveries can occur at any institution and they can cause disastrous results, even a patient death is reported elsewhere. Misdeliveries could be avoided with real-time verification methods. In 1996, we developed a modified C-arm fluoroscopic verification of an HDR Ir-192 source position in order to prevent these misdeliveries from occurring. This method provided excellent image quality sufficient to detect errors, and it has been in clinical use at our institutions for 20 years. The purpose of the current study is to introduce the mechanisms and validity of our straightforward C-arm fluoroscopic verification method.Methods and materialsConventional X-ray fluoroscopic images are degraded by spurious signals and quantum noise from Ir-192 photons, which make source verification impractical. To improve image quality, we quadrupled the C-arm fluoroscopic X-ray dose per pulse. The pulse rate was reduced by a factor of 4 to keep the average exposure compliant with the Japanese medical regulation. The images were thereby displayed with quarter-frame rates.ResultsSufficient quality was obtained to observe the source position relative to both the applicators and the anatomy. With the use of this method, 2 errors were detected among 2,031 treatment sessions for 370 patients performed within a 6-year period.ConclusionsWith the use of a modified C-arm fluoroscopic verification method, treatment errors that were otherwise overlooked were detected in real time. This method should be given consideration for widespread use.

Teaser

High-dose-rate brachytherapy misdeliveries can occur at any institution and they can cause a disastrous accident, but can be avoided with real-time verification. The simple application of conventional X-ray fluoroscopy for source position verification results only in halation due to the scattered photons from the source. We quadrupled the fluoroscopic dose per pulse to obtain better images, and reduced the pulse rate by a factor of 4 to avoid overexposure. Using this method, we detected 2 errors among 2031 sessions.


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The Lugano classification criteria are useful in primary mediastinal B-cell lymphoma. In reply to Adams and Kwee

Publication date: Available online 10 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Luca Ceriani, Peter W.M. Johnson, Maurizio Martelli, Emanuele Zucca




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Real-time verification of a high-dose-rate Ir-192 source position using a modified C-arm fluoroscope

Publication date: Available online 10 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Takayuki Nose, Masashi Chatani, Yuki Otani, Teruki Teshima, Shinichirou Kumita
PurposeHigh-dose-rate (HDR) brachytherapy misdeliveries can occur at any institution and they can cause disastrous results, even a patient death is reported elsewhere. Misdeliveries could be avoided with real-time verification methods. In 1996, we developed a modified C-arm fluoroscopic verification of an HDR Ir-192 source position in order to prevent these misdeliveries from occurring. This method provided excellent image quality sufficient to detect errors, and it has been in clinical use at our institutions for 20 years. The purpose of the current study is to introduce the mechanisms and validity of our straightforward C-arm fluoroscopic verification method.Methods and materialsConventional X-ray fluoroscopic images are degraded by spurious signals and quantum noise from Ir-192 photons, which make source verification impractical. To improve image quality, we quadrupled the C-arm fluoroscopic X-ray dose per pulse. The pulse rate was reduced by a factor of 4 to keep the average exposure compliant with the Japanese medical regulation. The images were thereby displayed with quarter-frame rates.ResultsSufficient quality was obtained to observe the source position relative to both the applicators and the anatomy. With the use of this method, 2 errors were detected among 2,031 treatment sessions for 370 patients performed within a 6-year period.ConclusionsWith the use of a modified C-arm fluoroscopic verification method, treatment errors that were otherwise overlooked were detected in real time. This method should be given consideration for widespread use.

Teaser

High-dose-rate brachytherapy misdeliveries can occur at any institution and they can cause a disastrous accident, but can be avoided with real-time verification. The simple application of conventional X-ray fluoroscopy for source position verification results only in halation due to the scattered photons from the source. We quadrupled the fluoroscopic dose per pulse to obtain better images, and reduced the pulse rate by a factor of 4 to avoid overexposure. Using this method, we detected 2 errors among 2031 sessions.


http://ift.tt/2hiwSEL

The Lugano classification criteria are useful in primary mediastinal B-cell lymphoma. In reply to Adams and Kwee

Publication date: Available online 10 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Luca Ceriani, Peter W.M. Johnson, Maurizio Martelli, Emanuele Zucca




http://ift.tt/2gorH1D