Laparoscopic radical prostatectomy is feasible and effective in ‘fit’ senior men with localized prostate cancer

Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE To assess the effect of age and comorbidity on short‐term complications, long‐term continence and oncological outcome after laparoscopic radical prostatectomy (LRP) for localized prostate cancer. PATIENTS AND METHODS In all, 2048 consecutive men underwent LRP for localized prostate cancer in one institution. Comorbidity was assessed using the Charlson index. Short‐term postoperative complications, transfusion rate, duration of hospital stay, long‐term continence and oncological outcome were analysed by age and comorbidity classes. RESULTS Of the 2048 men, 297 were aged ≥70 years and 281 had a Charlson index of >0 (mainly diabetes 31%, chronic pulmonary disease 26%, prior other nonmetastatic cancer 16%, prior myocardial infarction 12%). Compared with younger men, senior men had significantly higher pathological stages and tumor grades. Of those 297 men aged ≥70 years, 90 (30.3%) developed biochemical relapse, none died from prostate cancer and five (1.7%) died from another cause over a median follow‐up of 5 years. The occurrence and severity of short‐term postoperative complications were more strongly related to comorbidity than chronological age. Multivariate analysis with stepwise regression confirmed that most important predictors of short‐term postoperative complications were a Charlson index of ≥2, prostate weight of >80 g, obesity and age of ≥70 years. Postoperative continence significantly declined with age (ranging from 87% in men aged <60 years to 67.5% in men aged ≥70 years). Predictors of long‐term incontinence were age of ≥70 years, obesity and need for perioperative transfusion. CONCLUSIONS LRP is feasible and effective in fit senior men (aged ≥70 years) with localized prostate cancer, including those at high risk of dying from it.     

Ivermectin, a broad spectrum antiparasitic drug

ACTIVITY: Ivermectine, derived from beta avermectines, monocyclic lactones produced by Streptomyces avermitilis, is a potent oral microfilaricide used by veterinaries since 1981. The anti-filarial activity is two-fold: both microfilaricide and embryotoxic in female adults; it has no activity on the latter. INDICATIONS: Ivermectine is the treatment of choice in onchocercosis, induced by the nematode Onchocerca volvulus, and was included in the onchocercosis control program (programme de contr?le de l'onchocercose (OCP) in 1987. Ivermectine has also demonstrated efficacy on other filaries (Wuchereria bancrofti, Loa loa), in intestinal nematodes (Ascaris lumbrico?des, Strongyloides stercoralis) and in parasite nematodes in man (larva migrans ankylosis). ACCORDING TO THE RESULTS OF RECENT STUDIES: Its activity has been recently extended to ectoparasitosis: sarcoptes and pediculosis of the scalp.     

Field evaluation of three plant-based insect repellents against malaria vectors in Vaca Diez Province,the Bolivian Amazon

The efficacy of repellents against Anopheles darlingi, the main malaria vector in Bolivia, was evaluated. This mosquito has a peak in biting activity early in the evening. Three natural repellents (1 eucalyptus based, 1 neem based, and 1 containing several repellent essential oils) were tested in comparison with 15% deet in human landing catches in Bolivia. The eucalyptus-based repellent containing 30% p-menthane-diol applied at a dose similar to those used in practice gave 96.89% protection for 4 h. Deet gave 84.81% protection. The other 2 products did not provide significant protection from mosquito bites.     

The incubation period of kuru

BACKGROUND: Kuru is a transmissible spongiform encephalopathy that was identified in Papua New Guinea in the late 1950s. Several thousand cases of the disease occurred during a period of several decades. Epidemiologic investigations implicated ritual endocannibalistic funeral feasts as the likely route through which the infectious agent was spread. METHODS: We estimated the incubation period distribution of kuru using a back-calculation model and explored the relation among sex, age at infection, and incubation period. Key assumptions in the model were that the number of new kuru infections in a year was proportional to the number of kuru cases dying that year, and that the epidemic arose from a single case of sporadic Creutzfeldt-Jakob Disease occurring around 1900. RESULTS: The mean incubation period of kuru was estimated at between 10.3 and 13.2 years. Point estimates of the 90th percentile ranged from 21.1 to 27.0 years. The incubation period in females was estimated to be shorter than that in males. The shortest incubation periods were estimated in adult women, who may have been exposed to the largest doses of infectious material. CONCLUSIONS: Our findings suggest that the relatively young age of cases of variant Creutzfeldt-Jakob disease probably reflects increased levels of exposure in young people, rather than age-dependency in the incubation period.     

Polymorphism of the codon 129 of the prion protein (PrP) gene and neuropathology of cerebral ageing

We studied whether codon 129 polymorphism of the PrP gene modulates the presence of tau- and Abeta-associated lesions among 188 patients over 70 years of age without evidence of dementia. Val allele carriers, either heterozygotes or homozygotes, were more frequently affected by Abeta-associated lesions than non Val allele carriers, whereas there were no differences for tau-positive neurones. Val allele carriers also had more focal and diffuse Abeta deposits. This association was most significant in the highest Braak's stages for neurofibrillary tangles (>/=III). In this group, cases with at least one Val allele had nearly twice as many Abeta-associated lesions. The most affected areas were the entorhinal cortex, TF-TH and the superior temporal cortex, where odds ratios for focal Abeta deposits ranged from 3.5 to 4.6.     

The reduction of preoperative autologous blood donation for primary total hip or knee arthroplasty: the effect on subsequent transfusion rates

We conducted this quality assurance observational study to examine the effects of a change in policy regarding preoperative autologous blood donation (PABD) and indications for perioperative blood transfusion in patients undergoing primary total hip or knee arthroplasty. Two successive time periods, each including 182 successive patients treated by the same medical team and with standardized anesthesia, were compared. The first study had the following standard transfusion policy: 3 U of PABD collected (n = 119) and liberal autologous transfusion (AT). The second study introduced a specific indication for PABD, on the basis of estimated red blood cell reserve and a life expectancy of more than 10 years; 2 U of PABD was collected (n = 81), and criteria were identical for AT and allogeneic transfusion. We mainly compared the incidence of AT; allogeneic and overall transfusions; the inclusion, admission, and discharge hematocrit values; and the wastage of PABD units. This novel policy increased the number of untransfused patients by a factor of 10 (5.5% vs 56.6%) (P < 0.0001), decreased the number of PABD patients by 30% with a 2.4-fold reduction in AT (30% vs 80%) (P < 0.0001), and did not change allogeneic requirements (13% vs 15%). Although fewer autologous units were collected (172 vs 426), the wastage was higher in Study 2 (46% vs 12%) (P < 0.0001). We conclude that incorporation of patients' individual factors improves the efficiency of transfusion for total hip and total knee arthroplasty surgeries. IMPLICATIONS: We compared two transfusion policies for primary total hip or knee arthroplasties: first, a standard preoperative autologous donation with a liberal autologous transfusion policy; and second, a more restrictive indication for autologous donation that was based on patients' individual factors, with identical criteria for autologous and allogeneic transfusion. We found that this change of policy reduced autologous donation and transfusion with no increase in allogeneic transfusion.     

Bias in association studies resulting from gene-environment interactions and competing risks

The etiology, particularly the genetic basis, of multifactorial late-onset diseases is the subject of many genetic epidemiologic studies. The authors' aim in this paper was to investigate the circumstances under which competing risks can lead to bias in studies of genetic susceptibility to late-onset diseases. The authors used a model built in an epidemiologic framework to show that when a genetic risk factor and an environmental risk factor interact to cause a frequent competing risk of death, the measure of the association between the disease under investigation and the genetic risk factor will be biased if the environmental risk factor is also associated with the latter disease and is omitted from the analysis. This is an example of confounding bias, and it is the consequence of an association between the genetic risk factor and the environmental risk factor that appears over time. Numerical examples show that under certain conditions this bias can be substantial. The authors present several patterns of association in favor of such a bias. Because competing risks of death are likely to be present in older subjects, researchers studying the etiology of late-onset diseases should be aware of the possibility of this bias.     

Language in ageing persons with Down syndrome

Several cross-sectional studies and one longitudinal study were conducted on the language abilities of various cohorts of persons with Down syndrome aged between 14 and 50 years. No significant difference was observed on any of the receptive and productive morphosyntactic and lexical measures used, suggesting no marked change in the language of these persons from adolescence onto late adulthood. Repeated measures of cerebral metabolic rate (CMR) for fluorodeoxyglucose using a Positron Emission Tomography were made over a 4-year interval with 7 participants with Down syndrome aged between 37 and 49 years. A gradual decrease in global CMR for both cerebral hemispheres and for each participant was documented. It was particularly marked for 3 participants. However, no language deterioration could be associated with their marked lowering in CMR.