scholarly journals Modified completely intrafascial radical cysprostatectomy for bladder cancer: a single-center, blinded, controlled study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiao Wang ◽  
Jia Guo ◽  
Lei Wang ◽  
Min Wang ◽  
Xiaodong Weng ◽  
...  

Abstract Background We have proposed a modified, completely intrafascial radical cysprostatectomy (RC) to treat bladder cancer patients with the aim of preserving the patients’ post-surgical urinary control and erectile function. This study aimed to evaluate the oncological and functional outcomes of this innovation relatively to that with the conventional technique. Methods A retrospective, single-center, blinded, and controlled study was conducted using the medical data of patients since the past 5 years from the hospital database. A total of 44 patients were included, including 20 who received complete intrafascial cysprostatectomy and 24 who received conventional interfascial surgeries. The patients’ continent and sexual information of 1-year follow-up after the surgery were extracted. The oncological and functional outcomes of the 2 groups were compared and analyzed. Results The demographics parameters of the 2 groups showed no significant difference. The results of follow-up of the oncological outcomes did not reveal any significant difference between the completely intrafascial group and the conventional interfascial group in terms of the positive surgical margins, local recurrences, and distant metastasis. Patients following neobladder diversion in the intrafascial group showed a faster recovery of the urinary control, with a 76.9% (10/13) daytime continent rate at 3-month, as well as 46.2% (6/13) and 58.3% (7/12) nighttime continent rates at 3-month and 6-month, respectively. Regarding the sexual functions, our results revealed significant advantages in favor of completely intrafascial technique on the post-surgical International Index of Erectile Function (IIEF)-5 score at 3-, 9-, and 12-month follow-up relative to that with the conventional interfascial process. Thus, the IIEF score of patients in the intrafascial group was 11.4 ± 3.5 at 3-month, 14.1 ± 3.6 at 9-month, and 15.2 ± 3.8 at 12-month follow-up after the cystectomy, which was significantly greater than that of the patients in the control group. Conclusions Our novel data illustrated that the modified completely intrafascial technique could result in a better sexual function and faster continence recovery for patients following RC, without any compromise in the cancer control. Thus, this technique could be considered as an alternative extirpative technique for bladder cancer treatment in a clinical setting.

Author(s):  
Mahmoud Ibrahim Kandil ◽  
Abdel-Salam Abdel-Aleem Ahmed ◽  
Rasha Shaker Eldesouky ◽  
Sherif Eltregy

Abstract Purpose The purpose of this study aimed to evaluate the efficacy of local injection of allogeneic platelet-derived growth factors in treatment of patients with tennis elbow. Patients and methods This study included 120 tennis elbow patients randomly divided into two groups. The patients were locally injected with allogeneic growth factors (treatment group) or with normal saline (control group). The outcomes were assessed using Patient-Related Tennis Elbow Evaluation (PRTEE) and quick Disabilities of the Arm, Shoulder and Hand (qDASH) scales. The clinical outcomes were accordingly classified as excellent, good and poor. The patient’s satisfaction and adverse effects were also recorded. Results There was no statistically significant difference between the two groups regarding the age, gender, dominant arm or the pre-injection scores. At three month follow-up, the reductions in the mean PRTEE and qDASH scores were 88.7% and 70.6% in the treatment group versus 21.8% and 14.9% in the control group, respectively. At the last follow-up, the outcomes in the treatment group were excellent in 85% of patients and good in 15%, versus 8% and 32% in the control group. Overall, 95% were satisfied in the treatment group compared to 25% in control group. Forty patients in the treatment group experienced mild transient post-injection pain. Conclusion This study strongly suggests that local injection of allogeneic platelet-derived growth factors could be a promising safe treatment option for tennis elbow with significant pain relief, functional improvement and patient’s satisfaction. Yet, additional larger studies are needed to assess the durability of these outcomes.


2021 ◽  
Vol 32 (2) ◽  
pp. 363-370
Author(s):  
Raşit Özcafer ◽  
Ferdi Dırvar ◽  
Abdülhamit Mısır ◽  
Yaşar Maksut Dinçel ◽  
Mehmet Özbey Büyükkuşçu ◽  
...  

Objectives: The aim of this study was to evaluate clinical and functional outcomes following the arthroscopic medial meniscal repair. Patients and methods: A total of 50 patients (42 males, 8 females; mean age: 32.9±7.6 years; range, 17 to 48 years) who underwent arthroscopic repair for longitudinal and bucket-handle medial meniscal tears between March 2005 and October 2011 were retrospectively evaluated. The patients were divided into two groups as those having a longitudinal tear (patient group, n=31) and having a bucket-handle tear (control group, n=19). Preoperative and final follow-up functional outcomes were evaluated using the Lysholm Knee Score (LKS), International Knee Documentation Committee (IKDC) score, Tegner Activity Scale (TAS) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Results: The mean follow-up was 61.7±22.8 (range, 36 to 110) months. The mean preoperative LKS, IKDC score, TAS, and KOOS scores were significantly improved at the final postoperative follow-up (p<0.05). There was no significant difference in functional outcome scores between longitudinal and bucket-handle repairs (p>0.05), and isolated repairs and concomitant meniscal repair and anterior cruciate ligament reconstruction (p>0.05). Conclusion: Arthroscopic meniscal repair provides similar mid-term functional and clinical outcomes for longitudinal and bucket-handle medial meniscal tears. Concomitant meniscal repair does not seem to affect meniscal healing.


2017 ◽  
Vol 17 (2) ◽  
pp. 437-443 ◽  
Author(s):  
Hua-dong Zhu ◽  
Zhen Gong ◽  
Bing-wei Hu ◽  
Qiao-ling Wei ◽  
Jun Kong ◽  
...  

Introduction. Opioid-induced constipation (OIC) is a principal complication secondary to analgesic therapy for cancer pain patients who suffer moderate to severe pain. In this study, we observe the efficacy and safety of transcutaneous acupoint interferential current (IFC) stimulation in those patients with OIC. Methods. A total of 198 patients were randomly allocated to the IFC group and control group in a 1:1 ratio. Finally, 98 patients in the IFC group received 14 sessions administered over 2 weeks, whereas 100 patients in the control group took lactulose orally during the same period. Observation items were documented at management stage and at follow-up stage according to Cleveland Constipation Scales (CCS), pain Numeric Rating Scales (NRS) and Patient Assessment of Constipation Quality of Life (PAC-QoL). Results. The total curative effects of the IFC group and the control group were indistinguishable (76.5% vs 70.0%, P = .299). Regarding CCS and PAC-QoL scores, no significant difference was observed between the 2 groups during the management time and at the follow-up stage of week 3 ( P > .05, respectively), but groups were distinguished at the follow-up stage of week 4 ( P < .001 and P = .031, respectively). The pain NRS decreased significantly at management stage week 2 and follow-up stage week 3 and week 4 ( P = .013, P = .041, P = .011, respectively). Conclusions. Transcutaneous acupoint IFC therapy over acupoints of Tianshu (ST25) and Zhongwan (RN12) may improve constipation and quality of life in cancer patients receiving opiates; further studies are worthwhile.


2020 ◽  
Vol 47 (1) ◽  
Author(s):  
Fatma H. EL Nouby ◽  
Nihal Ahmed Fathi ◽  
Amal Abdelaziz Fehr ◽  
Abdel-Azim Assi ◽  
Reem Mahmoud Lotfy ◽  
...  

Abstract Background Intolerance to MTX is the most common cause of non-compliance that leads to poor disease control. Treatment is usually discontinued due to intolerance which interferes with compliance of the patient to long-term treatment. Caffeine causes most of its biological effects via antagonizing all types of adenosine receptors (ARs). Our aim was to investigate the effect of caffeine intake on reducing symptoms of MTX intolerance in patients with RA. Methods Ninety patients were diagnosed as RA with MTX intolerance divided into 2 groups. Sixty patients were prescribed caffeine or dark chocolate. Control group included 30 patients who will continue MTX regimen without addition of any extra caffeine. Results Group A (caffeine group): There was no statistically significant difference between patients and controls at the start of the study. There was statistically significant decrease in methotrexate intolerance severity score (MISS) all over the study period (P = 0.001), and also MISS was statistically significantly lower in each follow-up time when compared with time 0 (P = 0.001). Group B (control group): There was statistically significant increase in MISS all over the study period (P = 0.017); also, MISS was statistically significantly higher in follow-up time 2 and time 3 when compared with time 0 (P = 0.033). We found that after 3 months, 80% of group A patients showed complete relief, 6.7% showed partial relief, 10% showed minimal relief, and 3.3% got worse. Conclusion Adding caffeine to management regimen can reduce the symptoms of MTX intolerance in RA patients. Caffeine relieved the symptoms of MTX intolerance in 80% of RA patients after 3 months of adding caffeine to management regimen.


2000 ◽  
Vol 55 (4) ◽  
pp. 129-136 ◽  
Author(s):  
Cláudio Bresciani ◽  
Joaquim Gama-Rodrigues ◽  
Victor Strassmann ◽  
Dan L. Waitzberg ◽  
Mitsunori Matsuda ◽  
...  

Several drugs and their associations are being used for adjuvant or complementary chemotherapy with the aim of improving results of gastric cancer treatment. The objective of this study was to verify the impact of these drugs on nutrition and on survival rate after radical treatment of 53 patients with gastric cancer in stage III of the TNM classification. A control group including 28 patients who had only undergone radical resection was compared to a group of 25 patients who underwent the same operative technique followed by adjuvant polychemotherapy with FAM (5-fluorouracil, Adriamycin, and mitomycin C). In this latter group, chemotherapy toxicity in relation to hepatic, renal, cardiologic, neurological, hematologic, gastrointestinal, and dermatological functions was also studied. There was no significant difference on admission between both groups in relation to gender, race, macroscopic tumoral type of tumor according to the Borrmann classification, location of the tumor in the stomach, length of the gastric resection, or response to cutaneous tests on delayed sensitivity. Chemotherapy was started on average, 2.3 months following surgical treatment. Clinical and laboratory follow-up of all patients continued for 5 years. The following conclusions were reached: 1) The nutritional status and incidence of gastrointestinal manifestation were similar in both groups; 2) There was no occurrence of cardiac, renal, neurological, or hepatic toxicity or death due to the chemotherapeutic method per se; 3) Dermatological alterations and hematological toxicity occurred exclusively in patients who underwent polychemotherapy; 4) There was no significant difference between the rate and site of tumoral recurrence, the disease-free interval, or the survival rate of both study groups; 5) Therefore, we concluded, after a 5-year follow-up, chemotherapy with the FAM regimen did not increase the survival rate.


Cephalalgia ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 1071-1080 ◽  
Author(s):  
Bjarne K Madsen ◽  
Karen Søgaard ◽  
Lars L Andersen ◽  
Birte Tornøe ◽  
Rigmor H Jensen

Background Strength training has shown effects in reducing neck pain. As neck pain is highly prevalent in tension-type headache (TTH), it is relevant to examine the effect of strength training of the shoulder muscles on TTH patients. Aim To examine the effect of strength training of the shoulder/neck muscles on TTH frequency and duration. Methods Sixty patients with TTH were randomised into strength training or a control group. The strength training group trained ten weeks with elastic resistance bands. The control group performed ergonomic and posture correction. Efficacy was evaluated at follow-up after 19–22 weeks. Results Twenty-three patients completed strength training and 21 completed ergonomic and posture correction (per-protocol). No between-group effect was detected, but within groups numerical reductions were noted in both groups from baseline to follow-up. Frequency of TTH in the strength training group decreased by 11% ( P = 0.041) and duration decreased by10% ( P = 0.036), while the ergonomic and posture correction group showed a significant reduction in frequency of 24% ( P = 0.0033) and a decrease in duration of 27% ( P = 0.041). Conclusion No significant difference between the groups was found and the within-group effects did not reach clinical significance. Combining all the elements into a multifaceted intervention could prove more useful and should be further explored in future studies. Clinical trials registration number NCT02984826


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1945.1-1945
Author(s):  
A. Fehr ◽  
F. El Noby ◽  
N. Fathi ◽  
R. Lotfy

Background:Rheumatoid arthritis is one of common form of chronic inflammatory arthritis. Methotrexate has remained anchor treatment because of its potent efficacy1. Intolerance to Methotrexate is a common cause of non-compliance2&3.Objectives:To investigate the effect of adding caffeine orally as Methylxanthines (Caffeine), act as adenosine receptor antagonists4to reduce symptoms of moderate to severe methotrexate intolerance in patients with Rheumatoid Arthritis5.Methods:A prospective, randomized controlled study conducted at Aswan University Hospital, Egypt from Jan 2018 till may 2019. Sixty patients with Rheumatoid arthritis who have had experienced moderate to severe methotrexate intolerance was enrolled in the study. The methotrexate intolerance severity score (MISS)6was evaluated at base line before initiation of study then at the next three months consecutively. Patients were randomly assigned by closed envelope method into 2 groups each containing 30 patients:Group (A); 30 patients was prescribed caffeine (coffee or dark chocolate) as an antidote to methotrexate intolerance7.Group (B); 30 matched patients acted as control group that included who will continue methotrexate regimen without addition of any extra caffeine.Results:Twenty four patients (80%) at time three follow up visit showed full improvement of symptoms of methotrexate-intolerance compared to ten patients (33.3%) at 2nd month follow up visit and seven patients (23%) at 1st month follow up visit with statistically significant difference all over the study period (P=0.005). half of study group patients discontinued anti-emetic and other drugs while none in control group did.Conclusion:Adding caffeine to management regimen can reduce the symptoms of severe methotrexate-intolerance in Rheumatoid Arthritis patients.References:[1]Friedman, B., & Cronstein, B. (2019). Methotrexate Mechanism in Treatment of Rheumatoid Arthritis. Joint Bone Spine, 86(3):301-307[2]Wang, W., Zhou, H., & Liu, L. (2018). Side effects of methotrexate therapy for rheumatoid arthritis: a systematic review. European journal of medicinal chemistry. Volume 158, 502-516[3]Bulatović, M., Heijstek, M. W., Verkaaik, M., van Dijkhuizen, E. P., Armbrust, W., Hoppenreijs, E. P., ... & Rademaker, C. M. (2011). High prevalence of methotrexate intolerance in juvenile idiopathic arthritis: development and validation of a methotrexate intolerance severity score. Arthritis & Rheumatism, 63(7), 2007-2013.[4]Malaviya, A., Baghel, S., Verma, S., Thakran, R., & Messi, C. (2019). Use of coffee for alleviating methotrexate intolerance in rheumatic diseases. Indian Journal of Rheumatology, 14(1), 79-79.[5]Ribeiro, J. A., & Sebastiao, A. M. (2010). Caffeine and adenosine. Journal of Alzheimer’s Disease, 20(s1), S3-S15.[6]Fatimah, N., Salim, B., Nasim, A., Hussain, K., Gul, H., & Niazi, S. (2016). Frequency of methotrexate intolerance in rheumatoid arthritis patients using methotrexate intolerance severity score (MISS questionnaire). Clinical rheumatology, 35(5), 1341-1345.[7]Malaviya, A. N. (2017). Methotrexate intolerance in the treatment of rheumatoid arthritis (RA): effect of adding caffeine to the management regimen. Clinical rheumatology, 36(2), 279-285.Disclosure of Interests:None declared


2019 ◽  
Vol 54 (4-5) ◽  
pp. 327-335 ◽  
Author(s):  
Julie Brennan ◽  
Angele McGrady ◽  
Jennifer Tripi ◽  
Archit Sahai ◽  
Megan Frame ◽  
...  

Research has highlighted the prevalence of burnout in medical residents and the relative rarity of evidence-based structured programs to build resiliency. This was a controlled study of an 8-h program designed to increase resiliency and decrease burnout that focused on personal awareness, improving coping skills, building social connection, and maintaining balance. The project was approved by the institutional review board. Thirty-two family medicine residents signed the consent form. Structured assessment tools were administered to the intervention group at pre-program, immediately post-program and at one- and two-year follow-up. The control group completed the same pre- and post-assessments. Post-intervention comparison of the two groups demonstrated that the intervention group showed significantly lower scores in depersonalization and emotional exhaustion on the Maslach Burnout Inventory immediately after the program. There was no significant difference in the outcomes in year1 and year 2 follow-up. Residents evaluated the program positively. Resiliency programs can be incorporated into a family medicine residency and participants benefit by lowering indicators of burnout.


2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15212-e15212
Author(s):  
Osamu Ukimura ◽  
Andre Luis de Castro Abreu ◽  
Scott Leslie ◽  
Sunao Sohji ◽  
Paul Silverman ◽  
...  

e15212 Background: Salvage cryoablation (SC) of the whole prostate is a curative option for radio (RT)-recurrent prostate cancer (PCa). Focal SC has emerged as an option for minimizing morbidity. We present our 7-year experience of oncological and functional outcomes of Salvage Focal (SFC) and Salvage Total (STC) Cryoablation (CRYO) for RT-recurrent PCa. Methods: From Dec 2003 to Aug 2010, 50 men underwent SFC (n=25) or STC (n=25) for RT-recurrent PCa. SFC patients had biopsy-proven unilateral PCa and underwent a hemi-CRYO of the prostate. STC patients underwent CRYO of the whole prostate gland. All patients were evaluated to exclude metastases prior to treatment. Two freeze-thaw cycles were used to perform transperineal prostate CRYO under TRUS guidance. Follow up was assessed by PSA, TRUS, biopsy and questionnaires at 3, 6, 12, 24 and 36 mth. Results: Median (range) age, PSA and Gleason score for the SFC group were 71 y (59-81); 2.8 ng/ml (0-8.2) and 7 (6-8), while those for STC were 73 y (57-83), 3.9 ng/ml (0.1-12) and 7 (6-9), respectively. Oncological outcomes: Within one year after SC, the median percent PSA-decrease was 89% for SFC and 98% for STC. The median (range) follow up was 31 mth (4-90) for SFC and 53 mth (12-92) for STC. No patient died. One patient treated with STC developed bone metastases. Using the Phoenix criteria (PSA nadir + 2 ng/ml), 8 SFC and 3 STC patients had biochemical failure (BF), and the 5-year biochemical free survival (BFS) was 54% and 86% respectively (p=0.05). In those patients with no BF, the median PSA remained stable, ranging from 0.2 to 0.6 ng/ml for SFC and 0.1 to 0.1 ng/ml for STC during the follow up period. Follow up biopsy-proven cancer occurred in 2 patients in the SFC group (both on the untreated side), and in 1 patient in the STC group. Functional outcomes: New onset urinary incontinence occurred in none (0) of the SFC vs 3 (13%) of the STC patients. One (4%) patient in the STC group developed a recto-urethral fistula. Conclusions: Salvage Focal and Total CRYO after RT-failure are feasible and safe. Although STC had a favorable BFS compared with SFC, there was no significant difference in disease specific or overall survival between groups. SFC offered comparable cancer control to STC with lower morbidity.


Author(s):  
Giulia Foccardi ◽  
Marco Vecchiato ◽  
Daniel Neunhaeuserer ◽  
Michele Mezzaro ◽  
Giulia Quinto ◽  
...  

Although the efficacy of cardiac rehabilitation (CR) is proven, the need to improve patients’ adherence has emerged. There are only a few studies that have investigated the effect of sending text messages after a CR period to stimulate subjects’ ongoing engagement in regular physical activity (PA). A randomized controlled pilot trial was conducted after CR, sending a daily PA text message reminder to an intervention group (IG), which was compared with a usual care control group (CG) during three months of follow-up. Thirty-two subjects were assessed pre- and post-study intervention with GPAQ, submaximal iso-watt exercise testing, a 30 s sit-to-stand test, a bilateral arm curl test, and a final survey on a seven-point Likert scale. A statistically significant difference in the increase of moderate PA time (Δ 244.7 (95% CI 189.1, 300.4) minutes, p < 0.001) and in the reduction of sedentary behavior time (Δ −77.5 (95% CI 104.9, −50.1) minutes, p = 0.004) was shown when the IG was compared with the CG. This was associated with an improvement in heart rate, blood pressure, and patients’ Borg rating on the category ratio scale 10 (CR10) in iso-watt exercise testing (all p < 0.05). Furthermore, only the IG did not show a worsening of the strength parameters in the follow-up leading to a change of the 30 s sit-to-stand test with a difference of +2.2 (95% CI 1.23, 3.17) repetitions compared to CG (p = 0.03). The telemedical intervention has been appreciated by the IG, whose willingness to continue with regular PA emerged to be superior compared to the CG. Text messages are an effective and inexpensive adjuvant after phase 2 CR that improves adherence to regular PA. Further studies are needed to confirm these results in a larger patient population and in the long term.


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