Ann J. Davis

Defining the implant treatment volume for patients with low risk prostate cancer: does the anterior base need to be treated?

PURPOSE An increased incidence of acute urinary retention has been reported after interstitial prostate radiation therapy when the anterior base of the prostate gland receives 100% of the prescription dose. The frequency of prostate cancer in this location as a function of the pre-treatment prostate specific antigen (PSA), biopsy Gleason score, and 1992 American Joint Commission on Cancer Staging (AJCC) was determined. METHODS AND MATERIALS One hundred four men treated at the Brigham and Womens Hospital with radical prostatectomy for clinically localized prostate cancer between 1995-1996 comprised the study population. Prostatectomy specimens were whole mounted and the location of each tumor foci enumerated. RESULTS Of 269 foci of prostate cancer found in 39 low-risk prostate cancer patients (PSA < 10 ng/ml, biopsy Gleason score < or = 6, and 1992 AJCC clinical stage T1c,2a), a single focus (0.37%) was noted in the anterior base. Conversely, 20/355 (5.6%) and 18/251 (7.2%) tumor foci were noted in the anterior base in 43 patients with intermediate risk and 24 patients with high-risk disease, respectively. CONCLUSIONS A new definition of the treatment volume excluding the anterior base for low-risk prostate cancer patients may be justified.

Subsequent Asynchronous Torsion of Normal Adnexa in Children

Children who have suffered from ovarian torsion may be at increased risk for a repetitive event. Torsion in a normal adnexa may be due to excessive mobility resulting from congenitally long supportive ligaments. Oophoropexy or shortening of the ligamentous support of the remaining functional ovary after torsion is recommended in attempt to prevent a subsequent torsion. The evaluation of young females with abdominal pain should always include the consideration of ovarian torsion. Preoperative ultrasonography is not invasive and could lead to earlier operative intervention resulting in salvage of ovarian tissue. Observation in these same children may allow a torsed edematous ovary to convert to a nonviable necrotic tissue necessitating oophorectomy. Laparoscopy is useful in cases in which the diagnosis is unclear.

Further evidence that the WT1 gene does not have a role in the development of the derivatives of the müllerian duct

OBJECTIVE Several lines of evidence suggest that expression of the WT1 transcription factor gene is necessary for normal development of the renal and male reproductive systems. Female patients with severe reproductive tract developmental defects were examined for WT1 gene mutations. STUDY DESIGN The WT1 gene was analyzed in 25 patients with congenital absence of the uterus and vagina for mutations. Genomic deoxyribonucleic acid prepared from blood leukocytes was subjected to Southern blot analysis and denaturing gradient gel electrophoresis. RESULTS Common WT1 gene deoxyribonucleic acid sequence polymorphisms were found in both normal control subjects and patients with congenital absence of the uterus and vagina. No deoxyribonucleic sequence differences or mutations likely to cause congenital absence of the uterus and vagina were detected in the patients. CONCLUSIONS The absence of WT1 gene mutations in patients with congenital absence of the uterus and vagina supports the hypothesis that WT1 expression is required only for later urogenital development, after the mesonephric and paramesonephric ducts have already formed.

Normal onset of puberty

Puberty is the sequence of events that culminates in the ability to procreate. It is widely accepted that the onset of puberty in girls occurs on average at 8 years of age and that onset prior to 8 years of age is precocious puberty. As a result of the cross-sectional study by the American Association of Pediatrics, a movement exists to change the age limit of the onset of puberty to 6 years of age in black girls and 7 years of age in white girls. We should be cautious in adhering to strict age limits when diagnosing precocious puberty. Also the rapidity and progression of puberty should be evaluated, and if appropriate, therapy to suppress pubertal development considered.

Experiences with phrenic nerve pacing in children

We report a series of four spinal cord-injured children with ventilator dependency who were implanted with radiofrequency phrenic nerve pacers. At injury, their ages ranged from 6 to 9 years. Implantation occurred from 15 to 47 months following injury. The longest term of pacing has been 59 months. One patient, who was being paced full-time, died suddenly at 32 months of a viral myocarditis. Two patients underwent bipolar phrenic implantation in the neck, while two other patients underwent bilateral thoracotomy with monopolar electrode implantation in the mediastinum. There have been no complications related to pacer dysfunction in the postoperative course. Selective pacing schedules have been developed to minimize problems related with external mechanical ventilation. Radiofrequency phrenic nerve pacing is of value in the complete rehabilitative management of these severely disabled children.

Treatment of pediatric lichen sclerosus with the CO2 laser

Abstract This report evaluates the usefulness of laser therapy in the treatment of childhood lichen sclerosus which has been unresponsive to conventional therapy. The 4 patients treated ranged in age at time of surgery from 4 2/12 to 14 2/12 years. Duration of symptomatology in these children ranged from 2 to 7 years. Laser vaporization was done to the level of the first surgical plane. Follow-up intervals ranged from 4 to 9 months. Three patients showed good-to-excellent amelioration of symptomatology and 1 patient only moderate relief with laser therapy. Conventional treatment of childhood lichen sclerosus can be unsuccessful in abating significant symptomatology and discomfort. Although follow-up intervals are short, this preliminary report indicates that laser therapy has promise in the treatment of severe childhood lichen sclerosus.

ADVANCES IN CONTRACEPTION

Many safe and effective contraceptive methods are currently available, and a stream of new products is being introduced to the market. This article presents the histories, descriptions, and future trends for oral contraceptive pills, hormonal implants and injections, and intrauterine devices. Other methods discussed include barrier methods, spermicides, and emergency contraception, and permanent sterilization.