Citations

Summary Objective To demonstrate the safety and effectiveness of responsive stimulation at the seizure focus as an adjunctive therapy to reduce the frequency of seizures in adults with medically intractable partial onset seizures arising from one or two seizure foci. Methods Randomized multicenter double‐blinded controlled trial of responsive focal cortical stimulation (RNS System). Subjects with medically intractable partial onset seizures from one or two foci were implanted, and 1 month postimplant were randomized 1:1 to active or sham stimulation. After the fifth postimplant month, all subjects received responsive stimulation in an open label period ( OLP ) to complete 2 years of postimplant follow‐up. Results All 191 subjects were randomized. The percent change in seizures at the end of the blinded period was −37.9% in the active and −17.3% in the sham stimulation group (p = 0.012, Generalized Estimating Equations). The median percent reduction in seizures in the OLP was 44% at 1 year and 53% at 2 years, which represents a progressive and significant improvement with time (p < 0.0001). The serious adverse event rate was not different between subjects receiving active and sham stimulation. Adverse events were consistent with the known risks of an implanted medical device, seizures, and of other epilepsy treatments. There were no adverse effects on neuropsychological function or mood. Significance Responsive stimulation to the seizure focus reduced the frequency of partial‐onset seizures acutely, showed improving seizure reduction over time, was well tolerated, and was acceptably safe. The RNS System provides an additional treatment option for patients with medically intractable partial‐onset seizures.

Objectives To evaluate short‐term outcomes of holmium laser enucleation of the prostate ( HoLEP ) and photoselective vaporisation of the prostate ( PVP ) in patients with benign prostatic hyperplasia (BPH) and chronic urinary retention ( CUR ). Patients and Methods A retrospective chart review was performed of all patients with CUR who underwent HoLEP or PVP at our institution over a 3‐year period. CUR was defined as a persistent post‐void residual urine volume ( PVR ) of >300 mL or refractory urinary retention requiring catheterisation. Results We identified 72 patients with CUR who underwent HoLEP and 31 who underwent PVP . Preoperative parameters including median catheterisation duration (3 vs 5 months, P = 0.71), American Urological Association Symptom Index score ( AUASI ; 18 vs 21, P = 0.24), and PVR (555 vs 473 mL, P = 0.096) were similar between the HoLEP and PVP groups. The HoLEP group had a larger prostate volume (88.5 vs 49 mL, P < 0.001) and higher PSA concentration (4.5 vs 2.4 ng/mL, P = 0.001). At median 6‐month follow‐up, 71 (99%) HoLEP patients and 23 (74%) PVP patients were catheter‐free ( P < 0.001). Of the voiding patients, postoperative AUASI (3 vs 4, P = 0.06), maximum urinary flow rate (23 vs 18 mL/s, P = 0.28) and PVR (56.5 vs 54 mL, P = 1.0) were improved in both groups. Conclusions Both HoLEP and PVP are effective at improving urinary parameters in men with CUR . Despite larger prostate volumes, HoLEP had a 99% successful deobstruction rate, thus rendering patients catheter‐free.

Angiosarcoma of the seminal vesicle is an extremely rare malignancy, with few published case reports in the literature. We present a case of primary angiosarcoma of the seminal vesicle in a 45-year-old male who was treated with multimodality therapy, consisting of neoadjuvant chemotherapy and chemoradiation followed by surgical resection and intraoperative radiation therapy. He has been free of cancer recurrence for more than six years after completion of therapy. To our knowledge, this represents the longest reported survival of a patient with this rare tumor, and one of the few cases reported using a multimodality therapy approach.

Abstract In order to select samples that are optimally informative for sequence analysis, studies for the Genetic Epidemiology Consortium, we implemented three strategies for analysis, taking into account the known family histories of lung cancer. Susceptibility for lung cancer arises from a complex interplay between largely unknown genetic factors and smoking behavior. In order to optimize our ability to identify genetic factors for lung cancer we have recruited individuals with extensive family histories of lung cancer and also collected information about their smoking behaviors. For this study, we have modeled family history to identify individuals to select for sequencing using three approaches. First, we used an expert opinion approach in which multiple investigators evaluated pedigree structures with family history to reach a consensus priority in selecting individuals. Second we developed an approximation that assumes a low penetrance among noncarriers and uses known cancer status in first degree relatives. Third, we used the cancer, smoking behaviors and family information along with a likelihood that models penetrance according to genetic susceptibility and an interaction with smoking to estimate the probabilities individuals carry susceptibility factors. In this analysis we compare results among these methods. We evaluate effectiveness of these methods using simulation-based approaches. Citation Format: Christopher Amos, Joan Bailey-Wilson, Susan Pinney, Maria de Andrada, Colette Gaba, Diptasri Mandal, Ming You, Margaret Spitz, Marshall Anderson. Optimal strategies for selecting samples for sequencing families with a common cancer: The Genetic Epidemiology of Lung Cancer Consortium. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A106.

The traditional route for teaching cardiac anatomy involves didactic instruction, cadaver dissections, and familiarization with the main structure and relationships of the cardiac chambers, valves, and vasculature. In contemporary cardiac electrophysiology, however, a very different view of anatomy is required including details rarely appreciated with a general overview. In this review, we discuss the critical advances in cardiac electrophysiology that were possible only because of understanding detailed anatomic relationships. While we briefly discuss the clinical relevance, we explain in depth the necessary structural information for the student of clinical anatomy. Interspersed through the text are boxes that highlight and summarize the critical pieces of knowledge to be borne in mind while studying the fascinating structural anatomy of the human heart. Clin. Anat. 27:885–893, 2014. © 2014 Wiley Periodicals, Inc.

We present a standardized method for using four-dimensional ultrasound (4D US) guidance for peripheral nerve blocks. 4D US allows for needle tracking in multiple planes simultaneously and accurate measurement of the local anesthetic volume surrounding the nerve following injection. Additionally, the morphology and proximity of local anesthetic spread around the target nerve is clearly seen with the described technique. This method provides additional spatial information in real time compared to standard two-dimensional ultrasound.