Survival after pelvic lymphadenectomy and radical cystectomy in patients with lymph-node metastatic transitional-cell carcinoma of the bladder

The objective of this study was to determine the clinical outcome of patients with invasive transitional cell carcinoma of the bladder and pelvic lymph node metastases treated by radical cystectomy and bilateral pelvic lymphadenectomy in a single institution. From January 1980 to December 1993, 116 patients with transitional cell carcinoma of the bladder underwent bilateral pelvic lymphadenectomy and radical cystectomy at the Montreal General Hospital. Of these patients, 25 (21.6%) were found to have nodal metastases and form the basis of this retrospective analysis. Extent of nodal disease was as follows: 7 (28%) with N1, 17 (68%) with N2, and 1 (4%) patient with N3 disease. Of the 25 patients, 9 (36%) were alive with no evidence of disease and 1 (4%) died at 42 months from cardiovascular disease without clinical evidence of cancer recurrence. The median follow-up interval for these 10 patients was 26.5 months (mean, 31.4 months; range, 7-104 months). Fourteen (56%) patients died of recurrent bladder cancer and one patient was alive with systemic disease at 14 months. The median survival was estimated at 27 months, with 73% alive at 1 year, 51% alive at 2 years, and 33% alive at 3 years. Our data suggests that long-term survival free of disease can be achieved by radical surgery in some patients with node-positive bladder cancer.

Newly synthesized chitosan nanoparticles loaded with caffeine/moringa leaf extracts Halt Her2, BRCA1, and BRCA2 expressions

Breast cancer is among the highest morbidity and mortality rates in women around the world. In the present investigation we aimed to synthesis novel nanosystem combining two naturally important anticancer agents with different mechanism of action namely Moringa oleifera and caffeine. Firstly, chemical analysis of Moringa oleifera extract and caffeine was done by gas chromatography-mass spectroscopy (GC-MS) in order to assess the main chemical compounds present and correlate between them and the possible anticancer effect. The novel nanosystem was characterized through dynamic light scattering techniques which revealed the stability and homogeneity of the prepared M. oleifera leaves extract/Caffeine loaded chitosan nanoparticles, while FTIR and transmission electron microscope (TEM) proved the shape and the successful incorporation of M. oleifera leaves extract/Caffeine onto the nanochitosan carrier. Our initial step was to assess the anticancer effect in vitro in cancer cell line MCF-7 which proved the significant enhanced effect of M. oleifera leaves extract/Caffeine nanosystem compared to M. oleifera leaves extract or caffeine loaded nanoparticles. Further studies were conducted in vivo namely tumor biomarkers, tumor volume, bioluminescence imaging, molecular and histopathological investigations. The present study proved the potent anticancer effect of the synthesized M. oleifera leaves extract/Caffeine loaded chitosan nanoparticles. Mo/Caf/CsNPs exhibited a large number of apoptotic cells within the tumor mass while the adipose tissue regeneration was higher compared to the positive control. The prepared nanoparticles downregulated the expression of Her2, BRCA1 and BRCA2 while mTOR expression was upregulated. The aforementioned data demonstrated the successful synergistic impact of Moringa and caffeine in decreasing the carcinoma grade.

Right vs left side thoracoscopic sympathectomy: effects of CO2 insufflation on haemodynamics

BACKGROUND AND AIMS

Currently, few reports of the haemodynamic impact of intrapleural CO2 insufflation in the clinical setting are available. Therefore, we conducted the present study to compare the haemodynamic changes between right and left side thoracoscopic sympathectomy (TS) for treatment of palmar hyperhidrosis (PH) under general anaesthesia.

MATERIALS AND METHODS

20 adult patients (17 males) undergoing TS were randomly allocated to two groups (each 10); group A, right side and group B, left side TS procedures were performed under general anaesthesia with single-lumen endotracheal tube. Besides the routine monitoring of vital signs, non-invasive cardiac output monitor (NICO) was used to record the stroke volume (SV), cardiac output (CO) and cardiac index (CI). Intrapleural CO2 insufflation was used. Anaesthesia was maintained with 1 MAC sevoflurane in 50% nitrous oxide in oxygen with incremental doses of sufentanil and atracurium when required. Haemodynamic parameters were obtained every 3 min then averaged over the time of surgery at phases; I) after tracheal intubation, II) after CO2 insufflation and III) after CO2 deflation.

RESULTS

The CO, CI and SV showed decreased trend in both groups during phase II compared to phase I with significant differences (P < 0.05). Comparing the CO and CI variables revealed lower values in group A compared to group B but with non-significant differences (P > 0.05). While the SV variable showed significant low value in group A compared to group B (P < 0.05).

CONCLUSIONS

Compared to left side TS, direct compression by CO2 against the venae cava and right atrium and ventricle during right side TS caused reduction of the venous return and hence low CO, CI and SV.