Derek J. Byrne

Antibiotic prophylaxis and open groin hernia repair.

Abstract. Antibiotic prophylaxis is not routinely given for nonimplant, clean operations, although this view has recently been challenged. We have conducted a randomized multicenter, double-blind prospective trial to compare co-amoxiclav with placebo in 619 patients undergoing open groin hernia repair. Altogether 563 (91%) patients fulfilled the protocol; 283 received co-amoxiclav and 280 placebo. There was no difference between the groups in the number of patients receiving local or general anesthetic, the type of repair performed, the use of a subcutaneous fat suture, the type of skin closure used, the use of wound analgesia, or the use of a wound drain. Patients were given a card to return to the hospital in the event of their wound discharging or their needing to see their general practitioner. All patients were reviewed at approximately 6 weeks after operation. Fifty (8.9%) patients sustained a wound infection, 25 in the co-amoxiclav group and 25 in the placebo group. We conclude that antibiotic prophylaxis is of no benefit to patients undergoing open groin hernia repair.

Comparison of serum CA 72-4 and CA 19-9 levels in gastric cancer patients and correlation with recurrence

BACKGROUND This longitudinal prospective study evaluates the serum levels of the tumor markers CA 72-4 and CA 19-9, alone or in combination, in gastric cancer patients. PATIENTS AND METHODS Serum tumor markers CA 72-4 and CA 19-9 were measured in 52 patients who had gastric adenocarcinomas and 32 with benign gastric disorders. Serial measurements of these markers were carried out in 30 cancer patients at a median follow-up time of 38 months. RESULTS CA 72-4 and CA 19-9 had sensitivities of 42% and 46% for the preoperative detection of gastric cancer. Sensitivity for the two combined was 63%. CA 72-4 provided 100% specificity, compared to 72% for CA 19-9. Postoperatively, 17 cancer patients remained disease-free. Sixteen of these maintained normal levels of CA 72-4, and 10 of CA 19-9. Thirteen patients developed recurrent disease. In 9, serum CA 72-4 levels rose from near-normal after surgery and reached diagnostic values approximately 6 months before clinical diagnosis of recurrence. Only 3 patients exhibited such a pattern with CA 19-9. CONCLUSIONS CA 72-4 is a reliable marker in gastric cancer. Postoperative serial sampling of CA 72-4 may facilitate early identification of recurrences.

Prostate size influences the outcome after presenting with acute urinary retention

1 McIntyre IG, Hart CA, Brown MD, Ross DG, George NJ, Clarke NW. The molecular staging of prostate cancer. BJU Int 2004; 94 : 1217–20 2 Kilpatrick MW, Tafas T, Evans MI et al. Automated detection of rare fetal cells in maternal blood: eliminating the falsepositive XY signals in XX pregnancies. Am J Obstet Gynecol 2004; 190 : 1571–8 3 Epenetos AA, Canti G, TaylorPapadimitriou J, Curling M, Bodmer WF. Use of two epithelium-specific monoclonal antibodies for diagnosis of malignancy in serous effusions. Lancet 1982; 2 : 1004–6 4 Makin CA, Bobrow LG, Bodmer WF. Monoclonal antibody to cytokeratin for use in routine histopathology. J Clin Pathol 1984; 37 : 975–83 5 Ellis WJ, Pfitzenmaier J, Colli J, Arfman E, Lange PH, Vessella RL. Detection and isolation of prostate cancer cells from peripheral blood and bone marrow. Urology 2003; 61 : 277–81

Superficial Granulomatous Pyoderma Gangrenosum of the Penis: A Case Report

Classic type of pyoderma gangrenosum (PG) is an uncommon ulceronecrotic cutaneous disease of uncertain aetiology characterised by broad zones of confluent ulceration with violaceous undermined margins. Some 50% of cases are associated with systemic diseases. The superficial granulomatous variant of pyoderma gangrenosum (SGPG) of the external genitalia is extremely rare Patients with this condition develop single or multiple ulcerated skin lesions often with sinus tract formation. The majority of these lesions were found on the trunk and limbs. SGPG is less likely to be associated with underlying disease processes than classic PG. We present a 58 year-old with recalcitrant penile ulceration demonstrated to be SGPG on biopsy. Although rare and poorly recognised, the histological features are sufficiently typical to allow the correct diagnosis to be established.

A learning package for medical students in a busy urology department: design, implementation, and evaluation.

OBJECTIVES The need for innovation in the delivery of quality teaching and learning for undergraduates in urology is driven by a number of factors. An increasing proportion of care is delivered in ambulatory settings, hospital inpatients are increasingly unwell, and the National Health Service staff must find a balance in their dual roles as healthcare providers and clinical teachers. We describe the design, implementation, and evaluation of an innovative learning package for undergraduate medical students in urology. This consisted of a simulated urology outpatient clinic to prepare students for learning in the outpatient environment and an on-line self- and peer-assessed learning exercise to provide students with the necessary clinical knowledge of the core problems in urology and to encourage reflection. METHODS Action research principles were used to design, deliver, and evaluate a model for teaching and learning in the outpatient setting. Fourth-year medical students at the start of a 1-week clinical teaching block were given the opportunity to participate in a simulated urology outpatient clinic. On-line support material was designed around 2 core clinical problems in urology. The evaluations were gathered using an anonymous on-line questionnaire and a pre- and postcourse test of knowledge for a sample group. RESULTS Of the students who responded, 100% found the on-line material helpful for learning about the core clinical problems. The results demonstrated a 12% improvement in scores in a knowledge test at 1 week and 18% at 1 month after the teaching block compared with the control group from the previous academic year for which the mean improvement was 7% at 1 week and 8% at 1 month after the teaching program. CONCLUSIONS The evaluation results demonstrated a positive effect on learning without compromise to the service provided to patients. This could be developed as a model for teaching and learning urology or other specialties.

SELENIUM AND PROSTATE CANCER

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Nicorandil-associated penile and anal ulceration triggered by circumcision

72-year-old man was referred to Dermatology y Urology with a 5-month history of non-healing ainful penile ulcer arising after circumcision for ecurrent non-specific balantitis associated with himosis. The patient felt that ‘it had never quite ealed properly’. Three months after the circumision, extensive ulceration developed on the shaft nd base of penis and clinically similar deep ulcertion then arose on his right buttock perianally. Relevant medical history included ischaemic eart disease, previous myocardial infarction, trial fibrillation, Type 2 diabetes mellitus and iverticular disease. Regular medications were

EARLY RESULTS OF BLADDER‐CANCER SCREENING IN A HIGH‐RISK POPULATION OF HEAVY SMOKERS

Fourth, the authors failed to describe how many cancers were detected in the peripheral (PZ) and/or transition zone (TZ). Compared with PZ cancers, TZ cancers show a different anatomical pattern of positive biopsies, with lower rates in the middle and base of the prostate. Furthermore, the correlation between needle biopsy Gleason scores and those of the radical prostatectomy specimens was clearly lower in TZ cancers. Therefore, to know the rate of PZ and/or TZ cancers would add important additional information [3]. Furthermore, the prostate volume of the patients is missing, and it is well known that cancer detection is more difficult in larger glands [4]. Therefore based on these limitations, the value of HistoScanning for prostate cancer detection is questionable.