Anatomic considerations of inflatable penile prosthetics: lessons gleaned from surgical body donor workshops

Surgical implantation of an inflatable penile prosthesis (IPP) remains the gold-standard treatment for severe erectile dysfunction. The ideal surgical technique requires a thorough understanding of the relevant anatomy. This includes anatomic considerations related to, but not limited to, dissection and exposure of penoscrotal fasciae and tissues, corporal configuration, and abdominal structures. Insights obtained from pre-dissected anatomic specimens can obviate urethral injury, nerve damage, corporal perforation, inappropriate sizing, crossover, or implant malposition. We present penile implant-specific anatomic dissections and topographic landmarks identified over the last decade in the course of surgical training programs provided for IPP implantation.

Raman fiber-optical method for colon cancer detection: Cross-validation and outlier identification approach

Endoscopy plays a major role in early recognition of cancer which is not externally accessible and therewith in increasing the survival rate. Raman spectroscopic fiber-optical approaches can help to decrease the impact on the patient, increase objectivity in tissue characterization, reduce expenses and provide a significant time advantage in endoscopy. In gastroenterology an early recognition of malign and precursor lesions is relevant. Instantaneous and precise differentiation between adenomas as precursor lesions for cancer and hyperplastic polyps on the one hand and between high and low-risk alterations on the other hand is important. Raman fiber-optical measurements of colon biopsy samples taken during colonoscopy were carried out during a clinical study, and samples of adenocarcinoma (22), tubular adenomas (141), hyperplastic polyps (79) and normal tissue (101) from 151 patients were analyzed. This allows us to focus on the bioinformatic analysis and to set stage for Raman endoscopic measurements. Since spectral differences between normal and cancerous biopsy samples are small, special care has to be taken in data analysis. Using a leave-one-patient-out cross-validation scheme, three different outlier identification methods were investigated to decrease the influence of systematic errors, like a residual risk in misplacement of the sample and spectral dilution of marker bands (esp. cancerous tissue) and therewith optimize the experimental design. Furthermore other validations methods like leave-one-sample-out and leave-one-spectrum-out cross-validation schemes were compared with leave-one-patient-out cross-validation. High-risk lesions were differentiated from low-risk lesions with a sensitivity of 79%, specificity of 74% and an accuracy of 77%, cancer and normal tissue with a sensitivity of 79%, specificity of 83% and an accuracy of 81%. Additionally applied outlier identification enabled us to improve the recognition of neoplastic biopsy samples.

Prognostic value of hemoglobin levels prior to radiotherapy for cervical cancer--Kuwait experience

OBJECTIVE

To evaluate hemoglobin (Hb) levels before and during radiotherapy and its role as prognostic factor on treatment results of patients treated for cancer cervix.

MATERIALS AND METHODS

One hundred and seven patients with cervical cancer were registered and managed at KCCC during 1995 - 1999. The pre-treatment and mid treatment Hb levels were found for 47 patients only. Follow-up was done for these cases aiming at evaluation the overall and disease-free survival. Statistical analysis was done using SPSS statistical package version 10.0.

RESULTS

The median age of patients were 45 and ranged between 26-80 years. Kuwaiti patients represented 21.3% of cases. The most common stage was Stage IIb representing 51.1% followed by IIIb representing 27.7%. Stage Ib and IIa represented 12.8%. About 89.4% were squamous cell carcinoma, while adenocarcinoma was 6.4%. Treatment outcome revealed 18 relapses (38.3%). Disease-free survival for cases with pre-treatment Hb level < 12 was 16.3%, while for those with Hb level > or = 12 g/dL it was 62.9%. The difference was statistically significant (P = 0.02).

CONCLUSION

Patients with pre-treatment Hb < 12 g/dL had a significantly lower disease-free survival.

Patterns of failure in cervical carcinoma and outcome of salvage therapy: a retrospective study

OBJECTIVE

The objective of this study was to study the patterns of failure after definitive therapy in cervical cancer, the treatment given to patients after recurrence and the final outcome in these patients.

MATERIALS AND METHODS

Case records of 105 patients of cervical cancer of clinical Stages I to IV treated with definitive radiation or surgery with or without post-operative radiotherapy at Kuwait Cancer Control Centre (KCCC), Kuwait from 1995 to 1999 were retrospectively analyzed. Patients who developed recurrence were studied for the pattern of their recurrences, the type of treatment received by them after their recurrence and the results of their salvage therapy.

RESULTS

The sites of failure were classified as pelvic only (P), pelvic+ distant metastasis (P+DM), or distant metastasis only (DM). Out of the thirty patients in stage Ib, the sites of first failure were, P = 5 (16.6%), P+DM = 1 (3.2%), DM = 1 (3.2%); of the fourteen patients in stage IIa, P = 2 (14%), P+DM = 1 (7%), DM = 2 (14%); of the 36 patients in stage IIb, P = 3 (8%), P+DM = 6 (16.5%), DM = 5 (14%); of the 14 patients in stage IIIb, P = 5 (35.5%), P+DM = 1 (7%), DM =0 (0%); of the 5 patients in stage IVa, 3 patients absconded after treatment and the failure rate was, P =0 (0%), P+DM = 0 (0%), DM = 1 (50%). The therapy after failure was surgery, irradiation, chemotherapy or supportive care. The median survival was evaluated as a function of time to failure after initial treatment and was 6, 6, 9, and 30 months for those failing less than 6, 6-12, 13-24 & 25-36 months after initial treatment respectively. The cohort treated initially with surgery had a better outcome of salvage therapy at relapse.

CONCLUSIONS

Long term survival can be achieved in a small percentage of selected patients who fail treatment with definitive radiation or surgery for invasive carcinoma of the uterine cervix. The probability of survival is greater for those who fail more than 24 months after initial treatment than for those who fail before 24 months. The chance of survival is also related to the initial type of treatment, site of recurrence & type of salvage therapy. The complications of salvage treatment of recurrent disease should be minimized.

Renal cell carcinoma: the experience of Kuwait Cancer Control Center, Kuwait

OBJECTIVES

This retrospective study was undertaken to analyze the profile of patients presenting with renal cell carcinoma (RCC) and treatment outcomes.

SUBJECTS AND METHODS

Records of 49 patients (36 male, 16 female, 21-75 years) treated at the Kuwait Cancer Control Center, Kuwait for RCC during the period 1993-1998 were analyzed. Forty-one patients had a nephrectomy, 18 postoperative radiotherapy and 1 patient also received adjuvant immunotherapy with interferon. Patients with metastatic disease were treated with a variety of agents including interferon, chemotherapy (vinblastine) or a hormonal agent (megestrol acetate). Data analysis was performed using SPSS statistical software package. Overall survival and disease-free survival were calculated using the Kaplan-Meier method.

RESULTS

Twenty-nine patients presented with symptoms classically associated with RCC. Metastases at diagnosis were seen in 9 patients (18%), with lung being the most frequent site. The commonest tumor subtype was clear cell carcinoma (32.6%). Thirty-nine patients (80%) achieved a complete response to treatment and relapse was documented in 10 patients (26%). The majority of failures were distant, with lung metastases being the most common. Response to salvage treatment was poor. Overall survival was 83% at 2 years. The disease-free survival was 68 and 45% at 2 and 5 years, respectively.

CONCLUSIONS

Although many patients presented with advanced local disease, a majority achieved complete response after radical surgery with or without postoperative radiation therapy. Salvage of metastatic disease proved difficult with interferon, chemotherapy.

Evaluation of cerebrospinal fluid (CSF) C-reactive protein in the diagnosis of suspected meningitis

Cerebrospinal fluid C-reactive protein (CSF-CRP) was studied in 183 consecutive infants and children with suspected meningitis, using a nephelometric technique. Cerebrospinal fluid C-reactive protein was above an empirically chosen level of 1 mg/1 in seven of 19 children with culture-proven bacterial meningitis, in only one of 15 children with viral meningitis, and three of 139 children with no meningitis. All 10 children with partially treated meningitis had CSF-CRP levels below 1 mg/1. There was good correlation between CSF-CRP and total protein levels in children with bacterial meningitis (R value 0.4999 P less than 0.05). The test was not sensitive enough for early differentiation between bacterial and viral meningitis. The test also did not add extra information regarding aetiology in partially treated meningitis.