Early releases for September 8, 2011 (about CUAJ early releases)

Cancer Care Ontario Guidelines for radical prostatectomy: striving for continuous quality improvement in community practice
Todd M. Webster, Christopher Newell; John F. Amrhein, Ken J. Newell
Abstract

Effectiveness of medical treatment in overcoming the ureteral double-J stent related symptoms
Ugur Kuyumcuoglu, Bilal Eryildirim, Murat Tuncer, Gokhan Faydaci, Fatih Tarhan, Aydin Ozgül
Abstract

Diagnosis and prognosis of malignant mesothelioma of the tunica vaginalis testis
Bo Hai, Yu Yang, Yajun Xiao, Bing Li, Chaohui Chen
Abstract

Reproductibilité des classifications OMS 1973 et OMS 2004 des tumeurs urothéliales papillaires de la vessie
Soumaya Ben Abdelkrim, Soumaya Rammeh, Amel Trabelsi, Lilia Ben Yacoub-Abid, Nabil Ben Sorba, Lilia Jaïdane, Moncef Mokni
Abstract

Cancer Care Ontario Guidelines for radical prostatectomy: striving for continuous quality improvement in community practice
Abstract
Objective: Cancer Care Ontario has published an evidence-based guideline on their website “Guideline for Optimization of Surgical and Pathological Quality Performance for Radical Prostatectomy in Prostate Cancer Management: Surgical and Pathological Guidelines.” The evidentiary base for this guideline was recently published in CUAJ. The CCO guideline proposes the following: a positive surgical margin (PSM) rate of <25% for organ-confined disease (pT2), a perioperative mortality of <1%, a rate of rectal injury <1%, and a blood transfusion rate <10% in non-anemic patients. The objective of this study was to review the radical prostatectomy practice at the Grey Bruce Health Services, an Ontario community hospital, and to compare our performance in relation to the Cancer Care Ontario guideline and the literature.
Methods: We conducted a retrospective review of all radical prostatectomies performed at the Grey Bruce Health Services from January 1, 2006 to December 31, 2007. The following data were obtained from clinical records and pathology reports: patient age, pre-biopsy prostate-specific antigen, biopsy Gleason score, resected prostate gland weight, radical prostatectomy Gleason score, surgical margin status, pathological tumour stage (pT), lymph node dissection status, perioperative incidence of transfusion of blood products and if the patient was anemic (hemoglobin <140 g/L) preoperatively, incidence of rectal injury, and perioperative mortality within 30 days following surgery.
Results: Using the method proposed by D’Amico, most patients undergoing radical prostatectomy were intermediate risk (62%), with a minority of low-risk (24%) and high-risk (14%) patients. The overall PSM rate was 37%. The rate of PSMs in organ-confined disease (pT2) was 26%. There was a statistically significant trend between increasing D’Amico risk category and increasing rate of PSM (Cochran-Armitage trend test, p = 0.023). There was a strong correlation between the pathological tumour stage and the rate of PSM (Cochran-Armitage trend test, p = 0.0003). The rate of blood transfusion in non-anemic patients was 6%. There was 1 patient (0.8%) who experienced a rectal injury. There were no perioperative deaths in our study group.
Conclusion: Our results show that a community hospital group can appropriately select patients to undergo radical prostatectomy, as well as achieve an acceptable rate of PSMs. We believe that ongoing critical appraisal and reflective practice are essential to improving surgical outcomes and providing quality care.

Effectiveness of medical treatment in overcoming the ureteral double-J stent related symptoms
Abstract
Background: We investigated whether the frequency of lower urinary tract symptoms (LUTS) increased in patients in whom double-J stents were applied. We also evaluated several medical therapy protocols to treat symptoms related with ureteral stents.
Materials and Methods: A total of 108 patients, in whom unilateral double-j stent was applied during ureteral stone treatment, were included. Before the double-J stent was applied, all patients completed storage components of the “International Prostate Symptom Score” (IPSSs), quality of life components of the IPSS (IPSS-QOL) and “Overactive Bladder Questionnaire” (OABq) forms and scores were calculated. After the procedure, cases were randomized into 5 groups, an antiinflammatory was given to Group 1, spasmolytic to Group 2, anticholinergic to Group 3 and a-blocker to Group 4. No additional drug was given to Group 5 as this control group. During the fourth week of the procedure, IPSSs, IPSS-QOL and OABq forms were again completed and scores were compared with the previous ones.
Results: When all the cases were evaluated, the IPSSs, IPSS-QOL and OABq scores of patients in whom the double-J stent was applied were statistically significantly higher the procedure. Compared to the control group, the cases where the double-J stent was applied showed a higher IPSSs, IPSS-QOL and OABq scores and none of the medical therapies could prevent this increase.
Interpretation: The frequency of LUTS increased in cases where the ureteral stent was applied and discomfort continued as long as the stent stayed in the body.

Diagnosis and prognosis of malignant mesothelioma of the tunica vaginalis testis
Abstract
Objectives: The objective of this study is to evaluate the diagnosis and prognosis of malignant mesothelioma of the tunica vaginalis testis through an additional 6 patients with urogenital mesothelioma.
Methods: Six patients with urogenital mesothelioma who underwent adequate surgical procedures and histopathologic analysis from 1990 to 2009 were identified and retrospectively reviewed.
Results: Six patients between the ages of 26 and 78 years with urogenital mesothelioma, 5 of which originated in the scrotum and 1 in the spermatic cord. Histopathologic analysis showed that CK5/6 and calretinin were positive in all cases, 5 cases were positive for vimentin, and 1 case showed focal weak positive reaction with MOC3, but none of the cases stained for CEA or CD15. The overall recurrence rate of urogenital mesothelioma after surgery was 5/6, including local recurrences and fatalities due to tumour.
Conclusions: In cases of mesothelioma of the tunica vaginalis testis, the histopathologic markers we chose helped con?rm the histopathological diagnosis; adequate surgical procedures are typically not curative, and this tumour is often fatal.

Reproductibilité des classifications OMS 1973 et OMS 2004 des tumeurs urothéliales papillaires de la vessie
Résumé
Objectif : Déterminer les taux d’accord et la reproductibilité intra et inter-observateurs des classifications OMS 1973 et OMS 2004 des tumeurs urothéliales papillaires de la vessie.
Matériel et méthodes : Cent deux cas de tumeurs urothéliales papillaires de stade pTa/pT1 ont été étudiés. Deux pathologistes ont revu les lames et ont établi le grade tumoral selon les deux classifications OMS 1973 et OMS 2004. En cas de désaccord, les deux évaluateurs ont procédé à une lecture commune au microscope en double tête afin d’aboutir à un grade consensuel selon les deux classifications. La variabilité intra-observateur a été étudiée chez l’un des deux évaluateurs qui a procédé à la relecture des lames un mois après sa première lecture. Les taux d’accord entre les deux pathologistes pour chaque catégorie de grade ont été déterminés et la reproductibilité des deux classifications a été évaluée à l’aide du coefficient kappa. Une valeur de 0 à 0,2 était interprétée comme un désaccord absolu, de 0,21 à 0,4, un accord faible, de 0,41 à 0,6, un accord modéré, de 0,61 à 0,8, un accord considérable, et de 0,8 à 1, un accord absolu.
Résultats : Selon la classification OMS 1973, les proportions des grades G1, G2 et G3 étaient respectivement de 40,2 %, 50 % et 9,8 %. Selon la classification OMS 2004, les proportions respectives des tumeurs de faible potentiel de malignité, des carcinomes de bas grade et des carcinomes de haut grade de malignité étaient de 23,5 %, 60,8 % et 15,7 %. La reproductibilité intra-observateur était excellente pour les deux classifications (accord absolu). Les taux d’accord entre les deux pathologistes étaient meilleurs pour la classification OMS 2004 (kappa = 0,7) que pour la classification OMS 1973 (kappa = 0,51).
Conclusions : La reproductibilité entre observateurs de la classification OMS 2004 est supérieure à celle de 1973. La reproductibilité intra-observateur est excellente pour les deux classifications.

About CUAJ early releases

CUAJ has adopted an early release model, in which papers are published online in advance of their print publication. The print publication schedule remains the same: February, April, June, August, October, December; however, CUAJ is now posting new early release articles on its website (www.cuaj.ca) every other month (January, March, May, July, September, November). CUAJ early releases articles only apply to research articles.