Pathologic seminal vesicle invasion after radical prostatectomy for patients with prostate carcinoma: effect of early adjuvant radiation therapy on biochemical control

BACKGROUND: The authors evaluated the effect of postoperative radiation therapy on freedom from biochemical failure (bNED) in men with prostate carcinoma who had pathologic seminal vesicle invasion after radical prostatectomy and negative pelvic lymph node dissection (pT3cN0). METHODS: Between 1989 and 1995, 375 men underwent radical prostatectomy at Thomas Jefferson University Hospital. Fifty-three men (13%) had pT3cN0 prostate carcinoma and were the subject of this analysis. Men in whom prostate specific antigen (PSA) could not be detected were deemed free of biochemical failure. RESULTS: Of the 53 men with pT3cN0 prostate carcinoma, 18 had an elevated PSA immediately after surgery and received salvage radiation therapy (RT). The 3-year bNED rate for this group was only 38%. At 3 months, PSA could not be detected in the other 35 men. Fifteen of those 35 men underwent early adjuvant RT, and the other 20 were observed for biochemical failure. The 3-year bNED rate for the 15 patients treated with immediate adjuvant RT was 86%, compared with 48% for the 20 men who were observed (P = 0.01). CONCLUSIONS: These data suggest that early adjuvant RT for men with pT3cN0 prostate carcinoma and no detectable PSA postoperatively reduces the likelihood of future biochemical failure. Men with pT3cN0 prostate carcinoma and a persistently elevated postoperative PSA level are less likely to benefit from RT and should be considered for systemic therapy.     

Modified radial head--capitellum projection in elbow trauma

A new technique is described for evaluating trauma to the elbow. The modified radial head--capitellum view is an alternative radiological projection to that described by Greenspan and Norman (the radial head--capitellum view). This new projection is useful in demonstrating minimally displaced or non-displaced fractures of the radial head, capitellum and coronoid process.     

The influence of surveillance methods on surgical wound infection rates in a tertiary care spinal surgery service

We studied 13 consecutive infants admitted to our Neonatal Intensive Care Unit over 37 months from 1 June 1994 to 30 June 1997, who were diagnosed with severe persistent pulmonary hypertension (PPHN) meeting extracorporeal membrane oxygenation (ECMO) criteria as defined by Bartlett and/or Short. They were managed with conservative ventilation strategy, with emphasis on the use of moderate ventilatory pressures whilst avoiding paralysis. Peak inspiratory pressure (PIP) on intermittent mandatory ventilation was adjusted according to adequate chest excursion. High PIP was avoided. Two main ventilatory techniques were used: 1) low ventilatory rate < or = 40/min, PIP 20 to 30 cmH2O, inspiratory time (IT) 0.5 seconds, positive end-expiratory pressure (PEEP) 5 cmH2O, and 2) high ventilatory rate 100/min, PEEP 0 cmH2O, IT 0.3 seconds. The aim was to keep preductal PaO2 > or = 50 mmHg. We did not sought to achieve alkalotic pH or low PaCO2. When PIP requirements exceeded 30 to 35 cmH2O, the use of an alternative rescue therapy such as pulmonary vasodilator, high frequency ventilation and/or surfactant were considered. Only 1 infant died of PPHN. Low mortality due to PPHN can be achieved using this strategy. There is a need for a randomised controlled trial to compare this strategy with other alternative treatment strategies.     

Impact of chronic cough on quality of life

STUDY DESIGN: The biomechanical influence of in situ setting hydroxyapatite cement was examined for use in pedicle screw revision surgery. Pull-out testing of control and pedicle screws augmented with hydroxyapatite cement was performed in human cadaver vertebrae. OBJECTIVES: To determine the immediate effect of using hydroxyapatite cement to augment revision pedicle screws after failure of the primary pedicle screw fixation. SUMMARY OF BACKGROUND DATA: The potential problems associated with using polymethylmethacrylate to augment revision pedicular instrumentation have prompted the search for other solutions. The introduction of resorbable hydroxyapatite pastes may have provided new biocompatible solutions for pedicle screw revision. METHODS: Ten human cadaver vertebrae were instrumented with 6.0-mm pedicle screws in each pedicle. The screws were loaded to failure in axial tension (pull-out). The failed pedicles then were instrumented with 7.0-mm pedicle screws, either augmented with hydroxyapatite cement or nonaugmented, which also were loaded to failure. Finally, the nonaugmented 7.0-mm screw hole was reinstrumented with a hydroxyapatite cement-augmented, 7.0-mm pedicle screw and loaded to failure. RESULTS: The pull-out strength of the 7.0-mm, hydroxyapatite cement-augmented screws was 325% (P = 2.9 x 10(-5)) of that of the 6.0-mm control screws, whereas the strength of the 7.0-mm nonaugmented screws was only 73% (P = 2.0 x 10(-2)) of that of the 6.0-mm control screws. The 7.0-mm screws augmented with hydroxyapatite cement also were able to salvage 7.0-mm pull-out sites to 384% (P = 6.9E-5) of the pull-out strength of the 7.0-mm nonaugmented screws. CONCLUSIONS: Hydroxyapatite cement may be a mechanically viable alternative to polymethyl methacrylate for augmenting revision pedicular instrumentation and should be considered for future experimental, animal, and clinical testing.     

Influences of environmental conditions during infancy on final body stature

In the following article we shall investigate the Second World War with its consequences on nutrition and other living conditions for the German population to try to determine whether lack of nutrition plus other deficiencies, which infants were subjected to in Germany during this time, had any influence on their adult stature. The following data formed the basis of our investigation: (1) nutrition of infants and school-aged children during the years 1939-1948; (2) stature and weight of 6-year-old boys between 1907 and 1948; (3) infant mortality between 1935 and 1950; (4) stature of 19-year-old men who were born between 1938 and 1951. From Figure 5 it can be seen that the mean stature of 19-year-old men born between 1938 and 1951 (except for those born in 1944 and 1945) rose steadily (secular acceleration). The plot of the yearly rate of acceleration (Fig. 6) reveals a minimum in 1944-1945, and follows a general downward, U-shaped trend (P less than 0.05). On the other hand, infant mortality between 1941 and 1949 follows an upward U-shaped trend (P less than 0.05). For the 6- to 8-month-old infants during 1945-1948 nutrition was far worse than that during the preceding years. It is even likely that the nutrition for the infants had already begun to decrease in quality in 1942. We find, therefore, a close correlation between the years of high infant mortality and the growth deficiencies of the men born during these years. Since we must assume that the nutritional situation for babies and infants worsened steadily after 1942 until it is apparent that a number of environmental factors directly influence human growth. The conclusion of our analysis is that a deficit of growth occurring after the end of the fourth year can be compensated fully. We conclude, furthermore, that the growth deficits which arise before the fourth year, on the other hand, cannot be compensated fully even if good or excellent environmental conditions follow.     

Recovery of memory after posthypnotic amnesia

Notes that documentation of the reversibility of posthypnotic amnesia has been hampered by the correlation of hypnotizability with the initial level of response to amnesia suggestions. 691 college students were placed in groups differing in hypnotic susceptibility that could be matched for initial amnesia recall, thereby eliminating the ceiling effect. At virtually every point along the distribution of initial amnesia response, hypnotizable Ss were significantly better able than insusceptible Ss to recapture the previously blocked memories after the amnesia suggestion was lifted. Conversely, those Ss who showed reversibility of amnesia were more responsive overall to hypnosis than those who did not. It is concluded that reversibility is of value in distinguishing between amnesia and pseudoamnesia and between partial amnesia and nonamnesia. Furthermore, reversibility helps define posthypnotic amnesia as a process involving the disruption of retrieval processes in memory. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Optically pumped FIR lasers: Frequency and power measurements and laser magnetic resonance spectroscopy

Optically pumped FIR lasers are currently in use in both frequency metrology and laser magnetic resonance spectroscopy programs in the NBS Boulder labs. The laser for use in frequency metrology is a CW 71 μm methyl alcohol waveguide laser with over 100 mW output for frequency synthesis. Another laser with an intracavity absorption cell for laser spectroscopy has been constructed and is nearly transversely pumped. The metrology technique used to measure the frequency of these lasers is briefly reviewed and a unique power meter is described.