Laparoscopic pelvic lymph node dissection for clinical staging of prostate cancer: encouraging preliminary results

OBJECTIVE: To evaluate the results of the first 72 laparoscopic pelvic lymph node dissections in patients with prostate cancer. DESIGN: Retrospective study of records. SETTING: Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands. METHOD: A retrospective study of records provided data on 72 patients with prostate cancer staged by laparoscopic lymph node dissection in the period 1993-1997. Per- and postoperative complications, operation time, number of removed lymph nodes, pathology result and duration of hospital stay were assessed. A comparison was made between the first series of 36 patients and the second series. RESULTS: In 9 patients the laparoscopic approach was converted to a laparotomy. This occurred six times in the first series of 36 patients and three times in the second series. The postoperative course was complicated six times in the first and four times in the second series. With increasing experience the mean operation time decreased from 140 min to 114 min in the second series (p < 0.0001). The mean number of nodes removed was equal in both series (7.5). Lymph node metastases were found in 20 patients (28%). Hospital stay was 2.9 days in the first series and 2.2 days in the second series (not significant). CONCLUSION: Laparoscopic pelvic lymph node dissection is a minimally invasive method for staging patients with prostate cancer. This staging procedure is of great benefit in patients scheduled for treatment with curative intent because of its accuracy and low morbidity. With increasing experience operation time, hospital stay and number of complications decrease.     

Predictive value of HemoCue capillary whole blood glucose measurements in pregnancy

OBJECTIVE: We determined the ability of capillary whole blood glucose concentrations to predict venous plasma and whole blood glucose levels. METHODS: During a standard oral glucose tolerance test in 29 pregnant women, paired capillary and venous blood samples were collected for analysis of glucose concentrations by the HemoCue photometer and by central laboratory methods. RESULTS: Glucose concentrations determined serially in a single blood sample by the HemoCue method were highly reproducible, with a coefficient of variation of 2.3%. However, glucose levels in blood from two different fingersticks from the same patient varied on average by 3 mg/dL, with a maximum difference of 14 mg/dL. Although capillary whole blood glucose results obtained by the HemoCue method correlated well with venous plasma or whole blood glucose measurements (r = 0.98 and r = 0.97, respectively) over the range investigated (60-250 mg/dL), individual capillary whole blood glucose measurements were only a fair predictor of venous values, with 95% of measured venous levels within +/- 26 mg/dL and +/- 20 mg/dL for concentrations predicted for plasma and whole blood, respectively. CONCLUSION: Sampling factors rather than measurement accuracy limit the ability of capillary whole blood glucose measurements to predict venous concentrations.     

Hyperlipoproteinemia enhances susceptibility to acute disseminated Candida albicans infection in low-density-lipoprotein-receptor-deficient mice

Recent studies have suggested the use of lipoproteins as an adjuvant treatment of lethal gram-negative infections. However, other important microorganisms for the etiology of sepsis, such as Candida species, grow better in lipid-rich environments. We investigated the effect of hyperlipoproteinemia on systemic candidiasis in low-density-lipoprotein-receptor-deficient (LDLR-/-) mice, in which the loss of the receptor results in a seven- to ninefold-higher plasma LDL level than that in their wild-type littermates (C57BL/6J). LDLR-/- mice died earlier, and the outgrowth of Candida albicans in the kidneys and livers of LDLR-/- mice was significantly higher compared with that of controls. After infection, circulating cytokine concentrations were significantly higher in LDLR-/- mice. In vitro, C. albicans grew better in plasma samples of LDLR-/- mice than in control plasma samples and peritoneal macrophages of LDLR-/- mice challenged with heat-killed C. albicans produced more cytokines than did those of controls. This latter phenomenon was probably due to increased binding of yeast cells to macrophages of LDLR-/- mice. These data suggest that hyperlipoproteinemia is deleterious in systemic candidiasis.     

Computed tomography scanning and delirium in elder patients

OBJECTIVE: 1) To examine the ordering of head CT scans in elder patients with delirium and cognitive impairment; and 2) to report CT scan findings associated with these conditions. METHODS: This was a 2-part study. Part 1 was a prospective, observational study of 560 adults > 70 years of age evaluated at 3 separate EDs using a 200-hour stratified sampling process at each ED. During Part 1, the frequencies of specific findings (i.e., delirium, impaired consciousness, and impaired cognition) and CT scan rates for these groups were determined. Part 2 was a retrospective analysis of CT scan reports and medical records (n = 279) for patients > 70 years of age in the prospective sample (n = 79) and from a sample (n = 200) of CT scans obtained at a fourth ED. Part 2 examined clinical findings detected in the ED to determine those factors that were associated with acute findings on CT scan. RESULTS: Part 1: There were 333 (59.4%) patients prospectively classified as having impaired cognition, impaired consciousness, or delirium; 79 (23.7%) of these patients had a head CT scan. Of these 3 groups, delirious patients were more frequently scanned (p < 0.001). Part 2: Of 279 CT scans, 42 (15.0%) were positive for an acute condition (hemorrhage, hematoma, space-occupying lesion, infarct). Of 42 positive scans, 40 (95.1%) were found in the 102 (36.6%) patients with either impaired consciousness or a new focal neurologic finding detected in the ED. CONCLUSIONS: Considerable variability in ED CT scan ordering exists for elder patients with neurologic findings. Impaired consciousness and/or new focal neurologic signs are associated with acute findings on CT scan in elder patients. Acute CT abnormalities are uncommon in elder ED patients with other neurologic findings. Additional prospective evaluation is warranted prior to guideline development for CT scans in this patient population.     

Prevention of vertical HIV transmission with zidovudine: projected impact of HIV testing and prenatal care

We sought to estimate the impact of maternal HIV testing and prenatal care on the potential to reduce vertical transmission through zidovudine (AZT) use by HIV-infected mothers. We evaluated the prepartum maternal HIV diagnosis rate, prenatal care, disease stage, and vertical transmission rate (from a two-part mixture model) using New York State Medicaid and vital statistics data for HIV-infected mothers and their singletons in 1985-90. We used published data to estimate the effect of AZT on vertical transmission and expert input to define other parameters for the model. Our HIV-infected (N = 1514) had a vertical transmission rate of 27.0%. HIV was diagnosed prepartum for 39.5% of women in 1990. Transmission would have been 22.2% if AZT had been taken only by the subset of women diagnosed prepartum with HIV and receiving prenatal care by 34 weeks gestation (86.7%). Transmission would have dropped to 11.2% if all women had been diagnosed prepartum with HIV and received adequate prenatal care. The observed deficiencies in prenatal care and maternal HIV diagnosis rates in this Medicaid population-based cohort must be addressed to realize the promise of AZT to reduce vertical transmission.