Breast reduction: safe in the morbidly obese?

Background: With an increasing obese population, plastic surgeons are consulted by women requesting larger breast reductions, with body mass indices in the obese to morbidly obese range (30 to >or=40 kg/m) and breasts considered gigantomastic (>2000 g resected from each breast). There have been few descriptions of outcomes in the morbidly obese population. Previous literature reports high complication rates in obese women and large-volume breast reductions.

The influence of serial prostate-specific antigen (PSA) screening on the PSA velocity at diagnosis.

Background: A prostate-specific antigen (PSA) velocity (PSAV) >2 ng/mL during the year before diagnosis has been associated with an increased risk of prostate cancer-specific mortality (PCSM) after radical prostatectomy (RP) or radiation therapy. The objective of the current study was to examine whether the proportion of men with a PSAV >2 ng/mL per year has changed significantly during the PSA era.

Methods: The authors evaluated 1095 men from a prospective prostate cancer screening study who underwent RP between 1989 and 2002.

PSA velocity is associated with gleason score in radical prostatectomy specimen: marker for prostate cancer aggressiveness.

Objectives: Conflicting evidence has been reported on the association of prostate-specific antigen velocity (PSAV) with Gleason score in prostate needle biopsy specimens. The Gleason score is an important prognostic indicator for men with prostate cancer, and, in modern practice, it frequently affects treatment decisions. To our knowledge, the relationship between preoperative PSAV and Gleason score in the radical prostatectomy specimen has not been formally demonstrated.

Vibrational overtone initiated unimolecular dissociation of HOCH2OOH and HOCD2OOH: evidence for mode selective behavior.

The vibrational overtone induced unimolecular dissociation of HMHP (HOCH(2)OOH) and HMHP-d(2) (HOCD(2)OOH) into OH and HOCH(2)O (HOCD(2)O) fragments is investigated in the region of the 4nu(OH) and 5nu(OH) bands. The unimolecular dissociation rates in the threshold region, corresponding to the 4nu(OH) band, exhibit measurable differences associated with excitation of the OH stretch of the alcohol versus the peroxide functional group, with the higher energy alcohol OH stretching state exhibiting a slower dissociation rate compared to the lower energy peroxide OH stretch in both HMHP and HMHP-d(2). Predictions using the Rice-Ramsperger-Kassel-Marcus theory give rates that are in reasonably good agreement with the measured dissociation rate for the alcohol OH stretch but considerably differ from the measured rates for the peroxide OH stretch in both isotopomers.

Current dietary zinc intake has a greater effect on fractional zinc absorption than does longer term zinc consumption in healthy adult men.

Background: No studies have examined the independent effects of current and longer-term dietary zinc intakes on zinc absorption.

Objective: We determined the effects of current compared with longer-term zinc intake on fractional zinc absorption (FZA).

Design: We studied 9 men whose usual zinc intakes were >11 mg/d.

The multidomain protein Brpf1 binds histones and is required for Hox gene expression and segmental identity.

The Trithorax group (TrxG) is composed of diverse, evolutionary conserved proteins that form chromatin-associated complexes accounting for epigenetic transcriptional memory. However, the molecular mechanisms by which particular loci are marked for reactivation after mitosis are only partially understood. Here, based on genetic analyses in zebrafish, we identify the multidomain protein Brpf1 as a novel TrxG member with a central role during development.

Combined prostate-specific antigen density and biopsy features to predict "clinically insignificant" prostate cancer.

Objectives: Prior studies have reported that men with a PSA density (PSAD) less than 0.15, less than 3 positive biopsy cores, 50% or less of any core involved, and a Gleason score 6 or lower are likely to have "insignificant" prostate cancer (CaP) in their radical prostatectomy (RRP) specimen. In this study, we examined the ability of PSAD and biopsy features to predict pathologic outcomes in a contemporary RRP population.

Long-term rates of undetectable PSA with initial observation and delayed salvage radiotherapy after radical prostatectomy.

Background: Randomized trials have shown an improvement in progression-free survival rates with adjuvant radiation therapy (ART) after radical prostatectomy for patients with a high risk of cancer recurrence. Less is known about the relative advantages and disadvantages of initial observation with delayed salvage radiation therapy (SRT).

Objective: To examine the results of SRT in a large single-surgeon radical prostatectomy series.

Relationship of prostate-specific antigen velocity to histologic findings in a prostate cancer screening program.

Objectives: For prostate cancer screening, the role of prostate-specific antigen (PSA) velocity (PSAV) in conjunction with total PSA is controversial. We evaluated the relationship of PSAV to histologic findings on biopsy and assessed whether PSAV provides independent predictive information.

Methods: From a community-based cohort of 25,276 men screened from 1991 to 2001, 1851 underwent a first biopsy for an elevated PSA and nonsuspicious digital rectal examination with a PSAV available from the year before biopsy.

Mandibular arch muscle identity is regulated by a conserved molecular process during vertebrate development.

Vertebrate head muscles exhibit a highly conserved pattern of innervation and skeletal connectivity and yet it is unclear whether the molecular basis of their development is likewise conserved. Using the highly conserved expression of Engrailed 2 (En2) as a marker of identity in the dorsal mandibular muscles of zebrafish, we have investigated the molecular signals and tissues required for patterning these muscles. We show that muscle En2 expression is not dependent on signals from the adjacent neural tube, pharyngeal endoderm or axial mesoderm and that early identity of head muscles does not require bone morphogenetic pathway, Notch or Hedgehog (Hh) signalling.

Complications of open radical retropubic prostatectomy in potential candidates for active monitoring.

Objectives: With the widespread use of prostate-specific antigen (PSA)-based screening, there is now concern about the overdiagnosis and overtreatment of men with low-risk prostate cancer (PCa). One of the most difficult aspects of PCa management is a balance of the often-competing goals of cancer control with functional outcomes and quality of life. To address this issue, we examined the potency, continence and overall complication rates associated with radical prostatectomy (RP), specifically in potential candidates for active monitoring.

Is the utility of prostate-specific antigen velocity for prostate cancer detection affected by age?

Objective: To determine whether prostate-specific antigen velocity (PSAV) is useful for prostate cancer detection in men from different age groups, and whether the same PSAV thresholds can reasonably be applied to all men aged >or=40 years.

Patients And Methods: From a large prostate cancer screening study, 13,615 men had data on age and a calculable PSAV. We used statistical analysis to examine the ability of PSAV to predict prostate cancer risk in each age decade.

Comparison of prostate specific antigen velocity in screened versus referred patients with prostate cancer.

Purpose: Despite the tremendous stage migration associated with prostate cancer screening to our knowledge it remains unproven whether prostate specific antigen based screening decreases prostate cancer specific mortality. Recent studies have shown that prostate specific antigen velocity more than 2 ng/ml per year in the year before diagnosis is associated with a significantly greater risk of prostate cancer specific mortality after treatment. This may serve as a surrogate marker for prostate cancer outcomes.

The predictive value of ICP as compared to magnetic resonance imaging in comatose patients after head injury.

Introduction: While highly increased intracranial pressure (ICP) is of high predictive value indicating a fatal outcome, the predictive value of moderately increased ICP early after head injury remains uncertain. We compared the predictive value of ICP to the predictive value of magnetic resonance imaging (MRI) early after head injury.

Methods: 55 patients with a Glasgow Coma Scale (GCS) of less than 8, for more than 24 hours after head injury were investigated.

Characteristics of prostate cancer detected by digital rectal examination only.

Objectives: To examine clinical and pathologic features and postoperative survival outcomes of men with prostate cancer detected by digital rectal examination (DRE) alone, elevated prostate-specific antigen (PSA) level alone, or abnormalities in both.

Methods: From 1989 to 2001, approximately 36,000 men participated in a prostate cancer screening study. We recommended biopsy for a PSA level greater than 4.

Improved stage and grade-specific progression-free survival rates after radical prostatectomy in the PSA era.

Objectives: Since the initiation of prostate-specific antigen (PSA) screening, the progression-free survival (PFS) rates after radical prostatectomy have markedly improved. However, few studies have evaluated whether PFS has improved for stage and grade-matched patients. Our objective was to examine differences in PFS after radical prostatectomy between the pre-PSA era (before 1992) and the PSA era, controlling for tumor stage and grade.

Prostate specific antigen velocity in men with total prostate specific antigen less than 4 ng/ml.

Purpose: A prostate specific antigen velocity threshold of 0.75 ng/ml per year has commonly been used to distinguish men with prostate cancer from those with benign prostate conditions. In addition, a prostate specific antigen velocity greater than 2 ng/ml per year has been linked to an increased prostate cancer specific mortality rate after radical prostatectomy and after radiation therapy.

Common neural systems for contact heat and laser pain stimulation reveal higher-level pain processing.

Our current knowledge of pain-related neuronal responses is largely based on experimental pain studies using contact heat or nontactile laser painful stimulation. Both stimuli evoke pain, yet they differ considerably in their physical and perceptual properties. In sensory cortex, cerebral responses to either stimulus should therefore substantially differ.

Intermediate-term potency, continence, and survival outcomes of radical prostatectomy for clinically high-risk or locally advanced prostate cancer.

Objectives: Controversy exists about the preferred treatment of patients with high-risk or locally advanced prostate cancer. We examined the intermediate-term cancer control and quality-of-life outcomes after radical retropubic prostatectomy (RRP) in selected patients.

Methods: From 1984 to 2003, 288 men with Stage cT2b (Gleason score 8 to 10 or a prostate-specific antigen level greater than 15 ng/mL) or T3 disease underwent RRP by a single surgeon.

Prostate cancer-specific mortality after radical prostatectomy or external beam radiation therapy in men with 1 or more high-risk factors.

Background: Estimates of prostate cancer-specific mortality (PCSM) were determined after radical prostatectomy (RP) or radiation therapy (RT) in men with >or=1 high-risk factors.

Methods: The study cohort comprised 948 men who underwent RP (N = 660) or RT (N = 288) for localized prostate cancer between 1988 and 2004 and had at least 1 of the following high-risk factors: a prostate-specific antigen (PSA) velocity >2 ng/mL/year during the year before diagnosis, a biopsy Gleason score of >or=7, a PSA level of >or=10 ng/mL, or clinical category T2b or high disease. Grays regression was used to evaluate whether the number and type of high-risk factors were associated with time to PCSM.

Under diagnosis and over diagnosis of prostate cancer.

Purpose: We quantified the rates of over and under diagnosis of prostate cancer in 2 large patient cohorts during the last 15 years.

Materials And Methods: A total of 2,126 men with clinical stage T1c prostate cancer were treated with radical prostatectomy during 1 of the 3 periods 1989 to 1995, 1995 to 2001 and 2001 to 2005. The respective proportions of men with a tumor that met our criteria for over diagnosis (0.

Risk of prostate cancer for young men with a prostate specific antigen less than their age specific median.

Purpose: We previously reported that the median prostate specific antigen for men 40 to 49 years old is 0.7 ng/ml and that a baseline prostate specific antigen between 0.7 and 2.

The association between total prostate specific antigen concentration and prostate specific antigen velocity.

Purpose: It has been previously demonstrated that a prostate specific antigen velocity greater than 2 ng/ml per year is associated with reduced cancer specific survival following radical prostatectomy or external beam radiation. However, men with different initial prostate specific antigen levels may be more or less likely to reach this prostate specific antigen velocity threshold. Because prostate specific antigen and prostate specific antigen velocity contain much of the same predictive information, our objective was to further examine the relationship between them.

Prostate specific antigen velocity threshold for predicting prostate cancer in young men.

Purpose: Longitudinal changes in prostate specific antigen are increasingly used to guide the recommendation for biopsy. Prostate specific antigen velocity 0.75 ng/ml yearly has been proposed to distinguish prostate cancer from benign prostate conditions.

Use of prostate-specific antigen velocity to follow up patients with isolated high-grade prostatic intraepithelial neoplasia on prostate biopsy.

Objectives: No consensus has been reached about the optimal follow-up for patients with an isolated finding of high-grade prostatic intraepithelial neoplasia (HG-PIN) on prostate biopsy. Early studies reported that approximately one half of men with HG-PIN were diagnosed with prostate cancer (CaP) within a few years. However, more recent studies, using extended biopsy protocols, have shown that HG-PIN may be less predictive of CaP on repeat biopsy in the short term.