Simultaneous gingival squamous cell carcinoma in an oral lichen planus patient.

Objective: To describe a case of bilateral simultaneous squamous cell carcinoma of the gingiva affecting the mandible in a lichen planus patient and discuss the pertinent literature.

Method And Materials: We present a case of a 50-year-old woman with a history of oral lichen planus who was diagnosed with a primary and a second primary squamous cell carcinoma originating from the mandibular gingiva. A literature review did not disclose cases of gingival carcinoma arising simultaneously and bilaterally in the mandible.

Development and validation of preoperative nomogram for disease recurrence within 5 years after laparoscopic radical prostatectomy for prostate cancer.

Objectives: To develop a nomogram that allows the prediction of disease recurrence using preoperative clinical factors for patients with clinically localized prostate cancer who are candidates for laparoscopic radical prostatectomy. Few published studies have combined the clinical prognostic factors into risk profiles that can be used to predict the likelihood of recurrence or metastatic progression after laparoscopic radical prostatectomy for prostate cancer.

Methods: Using Cox proportional hazards regression analysis, we modeled the clinical data and disease follow-up data for 2272 men with clinically localized prostate cancer who had undergone laparoscopic radical prostatectomy.

Impact of prior prostate radiation on complications after radical prostatectomy.

Purpose: Salvage radical prostatectomy is associated with a higher complication rate than radical prostatectomy without prior radiotherapy but the magnitude of the increase is not well delineated.

Materials And Methods: A total of 3,458 consecutive patients underwent open radical prostatectomy and 98 underwent open salvage radical prostatectomy from January 1999 to June 2007. Data were collected from prospective surgical and institutional morbidity databases, and retrospectively from billing records and medical records.

Variability of treatment selection among surgeons for patients with cT1 urothelial carcinoma.

Objectives: To report the heterogeneity in the treatment of patients with cT1 urothelial carcinoma by different surgeons, and to report outcomes in patients with and without bacillus Calmette-Guérin (BCG) treatment.

Patients And Methods: We retrospectively reviewed 396 patients who had undergone a re-staging transurethral resection (TUR) for cT1 bladder cancer. We assessed both differences in the treatment by surgeon, and the association of early treatment with BCG with recurrence, progression and bladder cancer-specific death.

Impact of previous radiotherapy for prostate cancer on clinical outcomes of patients with bladder cancer.

Purpose: The impact of prostate cancer radiotherapy on the biological behavior of bladder cancer remains unclear. We compared the outcomes of patients with bladder cancer previously treated for prostate cancer with radiotherapy vs other treatment modalities.

Materials And Methods: We identified 144 patients diagnosed with bladder cancer between January 1992 and June 2007 with a previous prostate cancer diagnosis.

Germline BRCA mutations denote a clinicopathologic subset of prostate cancer.

Purpose: Increased prostate cancer risk has been reported for BRCA mutation carriers, but BRCA-associated clinicopathologic features have not been clearly defined.

Experimental Design: We determined BRCA mutation prevalence in 832 Ashkenazi Jewish men diagnosed with localized prostate cancer between 1988 and 2007 and 454 Ashkenazi Jewish controls and compared clinical outcome measures among 26 BRCA mutation carriers and 806 noncarriers. Kruskal-Wallis tests were used to compare age of diagnosis and Gleason score, and logistic regression models were used to determine associations between carrier status, prostate cancer risk, and Gleason score.

The depth of the prostatic apex is an independent predictor of positive apical margins at radical prostatectomy.

Objective: To determine the effect of a deep and narrow pelvis on apical positive surgical margins (PSM) at radical prostatectomy (RP), controlling for other clinical and pathological variables and surgical approach, i.e. open retropubic (RRP) vs laparoscopic (LRP), as apical dissection is expected to be more challenging at RP with a prostate situated deep in a narrow pelvis.

Comprehensive standardized report of complications of retropubic and laparoscopic radical prostatectomy.

Background: The lack of standardized reporting of the complications of radical prostatectomy in the literature has made it difficult to compare incidences across institutions and across different surgical approaches.

Objective: To define comprehensively the incidence, severity, and timing of onset of medical and surgical complications of open retropubic prostatectomy (RP) and laparoscopic radical prostatectomy (LP) using a standardized reporting methodology to facilitate comparison.

Design, Setting, And Participants: Between January 1999 and June 2007, 4592 consecutive patients underwent RP or LP without prior radiation or hormonal therapy.

Biochemical recurrence rate in patients with positive surgical margins at radical prostatectomy with further negative resected tissue.

Objective: To determine the biochemical recurrence (BCR) rate in patients with positive surgical margins (PSMs) on the prostate specimen who have additional negative tissue resected from that site (M+ -), compared to patients with negative margins (M-) and those with persistent PSM (M+), as those with PSM at radical prostatectomy (RP) are at greater risk of BCR, and in some instances where suspicious tissue is noted in the prostate bed or when frozen-section analysis shows PSM, additional tissue is resected from the suspect site of the PSM.

Patients And Methods: Between January 1999 and June 2007, 4217 consecutive patients underwent open or laparoscopic RP with no previous radiotherapy or hormonal therapy. The median (interquartile range) follow-up was 37.

Clinical outcome in a contemporary series of restaged patients with clinical T1 bladder cancer.

Objectives: To evaluate the indications for early and deferred cystectomy and to report the impact of this tailored approach on survival.

Design, Setting, And Participants: We retrospectively studied 523 patients seen at our institution who were initially diagnosed with T1 disease between 1990 and 2007.

Measurements: Variables analyzed included age, gender, multifocality, multifocal T1 disease, carcinoma in situ, grade, recurrence rate, and restaging status.

Impact of ethnicity on surgical margins at radical prostatectomy.

Objective: To determine if the rate of positive surgical margins (PSMs), and in particular apical PSMs, at radical prostatectomy (RP) for prostate cancer, is higher in African-American (AA) than Caucasian men, given their often narrower and deeper pelvis.

Patients And Methods: From 1999 to 2007, 3145 consecutive patients underwent RP, either open retropubic (RRP) or laparoscopic (LRP), with no previous treatment, by one of five surgeons. Multivariate logistic regression was used to determine the effect of ethnicity (AA vs Caucasian) on overall and site-specific PSMs, adjusting for age, body mass index, RP approach (RRP vs LRP), surgeon, surgeon case number, year of surgery, preoperative serum prostate-specific antigen level, specimen weight, estimated blood loss, pathological organ-confined status, and pathological Gleason score.

Oncologic outcome after laparoscopic radical prostatectomy: 10 years of experience.

Background: While the published short-term oncologic outcomes after laparoscopic radical prostatectomy (LRP) are encouraging, intermediate and long-term data are lacking.

Objective: We analyzed the oncologic outcome after LRP based on 10 yr of experience.

Design, Setting, And Participants: This retrospective analysis of data prospectively collected from 1998 to 2007 studies 1564 consecutive patients with clinically localized prostate cancer (cT1c-cT3a) who underwent LRP.

Pathological upgrading and up staging with immediate repeat biopsy in patients eligible for active surveillance.

Purpose: Active surveillance with selective delayed intervention is a treatment regimen used in patients with low risk prostate cancer. Decision making is based on pretreatment prostate specific antigen, clinical stage and prostate biopsy results. We reviewed our experience with immediate repeat biopsy in patients eligible for active surveillance with selective delayed intervention.

An analysis of the effect of statin use on the efficacy of bacillus calmette-guerin treatment for transitional cell carcinoma of the bladder.

Purpose: Bacillus Calmette-Guerin is an effective immunotherapy for carcinoma in situ of the bladder and it reduces recurrence from resected papillary transitional cell carcinoma of the bladder. Many patients receiving bacillus Calmette-Guerin therapy are concurrently taking statin agents, which have known immunomodulatory properties and may alter the performance of bacillus Calmette-Guerin. Some data have suggested that patients taking a statin while on bacillus Calmette-Guerin therapy experience reduced clinical efficacy.

Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology.

Background: Reporting methodology is highly variable and nonstandardized, yet surgical outcomes are utilized in clinical trial design and evaluation of healthcare provider performance.

Objective: We sought to define the type, incidence, and severity of early postoperative morbidities following radical cystectomy (RC) using a standardized reporting methodology.

Design, Setting, And Participants: Between 1995 and 2005, 1142 consecutive RCs were entered into a prospective complication database and retrospectively reviewed for accuracy.

Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer.

Background: By using the age-adjusted Charlson comorbidity index (ACCI), the authors characterized the impact of age and comorbidity on disease progression and overall survival after radical cystectomy (RC) for transitional cell carcinoma of the bladder. Also evaluated was whether ACCI was associated with clinicopathologic and treatment characteristics.

Methods: The authors evaluated 1121 patients treated by RC for transitional cell carcinoma of the bladder at a single institution (1990-2004).

A case of Castleman's disease that presented as a retroperitoneal mass.

Background: A 35-year -old man presented to a local emergency room with acute left-flank pain and a medical history of nephrolithiasis. There were no aggravating or relieving factors for the left-flank pain and no other presenting symptoms, and the physical examination was unremarkable.

Investigations: Complete blood count, urinalysis, serum tumor markers, scrotal ultrasonography, CT scan of the abdomen (with and without contrast), MRI of the abdomen.

Standardization of pelvic lymphadenectomy performed at radical cystectomy: can we establish a minimum number of lymph nodes that should be removed?

Background: The number of lymph nodes (LNs) removed during radical cystectomy (RC) for transitional cell carcinoma (TCC) of the bladder affects overall and disease-specific survival, but no consensus exists regarding the minimum number of LNs that should be removed. The goal of the current study was to determine if a threshold number of nodes exists, above which taking additional LNs has no clinical benefit.

Methods: A total of 1121 patients were identified who underwent RC for clinically localized TCC of the bladder between January 1990 and April 2004.

Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy.

Background: The GI Mentor is a virtual reality simulator that uses force feedback technology to create a realistic training experience.

Objective: To define the benefit of training on the GI Mentor on competency acquisition in colonoscopy.

Design: Randomized, controlled, blinded, multicenter trial.

Postoperative nomogram predicting risk of recurrence after radical cystectomy for bladder cancer.

Purpose: Radical cystectomy and pelvic lymphadenectomy (PLND) remains the standard treatment for localized and regionally advanced invasive bladder cancers. We have constructed an international bladder cancer database from centers of excellence in the management of bladder cancer consisting of patients treated with radical cystectomy and PLND. The goal of this study was the development of a prognostic outcomes nomogram to predict the 5-year disease recurrence risk after radical cystectomy.

Efficacy and costs of a one-day hands-on EASIE endoscopy simulator train-the-trainer workshop.

Background: The efficacy of an intensive hands-on training in endoscopic hemostasis on the compactEASIE simulator has been previously demonstrated in a randomized prospective trial. In the current study, we evaluated how quickly and effectively new tutors, without simulator training experience, are able to acquire teaching skills in endoscopic hemostasis.

Methods: Five tutors with prior Erlangen Active Simulator for Interventional Endoscopy (EASIE) teaching experience instructed 7 endoscopists without prior EASIE experience on how to teach when using the model.