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ABSTRACT: Spontaneous perforation of the esophagus is an uncommon event; when it does occur, it usually affects the thoracic esophagus. We present a rare and fatal case of spontaneous perforation of the cervical esophagus in a 68-year-old woman. We believe this rupture was related to a proximal outlet obstruction secondary to cricopharyngeal muscle dysfunction.
Ear, nose, & throat journal 03/2011; 90(3):E8-E10. · 0.66 Impact Factor
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Urology 03/2011; 77(3):630. · 2.43 Impact Factor
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ABSTRACT: To compare survival in patients with clinical T1b renal tumors that are pathologically upstaged, or high-grade tumors, treated by either partial nephrectomy (PN) or radical nephrectomy (RN). The American Urological Association Guidelines recently advocated increasing use of PN in all patients with cT1 renal masses, but urologists are often hesitant to perform PN for larger more aggressive appearing cT1 renal tumors for fear of pathologic upstaging and a perceived compromise in cancer control.
From a single institutional kidney cancer registry, 2511 consecutive patients with presumed cT1 renal cell cancer underwent extirpative surgery; 1981 (79%) were found to have renal cell cancer (RCC) and 213 (10.7%) were upstaged on final pathology. In addition, 95 (5%) were found to have grade 4 cancer. Cancer-specific survival (CS) and overall survival (OS) were compared between the groups.
In the upstaged cohort, patients treated by PN (n = 96, 45%) had comparable OS and CS when studied stage for stage with those treated by RN (n = 117, 55%). Multivariate cox-proportional hazards analysis of OS in the upstaged subset demonstrated that only age, grade, and Charlson score predicted OS, whereas PN vs RN and stage did not. PN did not compromise survival in patients with grade 4 RCC compared with RN.
PN does not appear to compromise the chance for cancer cure in patients with cT1 tumors that are upstaged pathologically to pT2 or pT3 or high-grade renal masses when compared with RN. These concerns should not deter a surgeon from attempting PN when otherwise technically feasible.
Urology 03/2011; 77(5):1142-6. · 2.43 Impact Factor
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ABSTRACT: To evaluate the potential impact of the experience of the first assistant on the positive surgical margin rate (PSMR) after laparoscopic radical prostatectomy (LRP). The impact of training surgical residents and fellows on patient outcomes is difficult to quantify.
A single-institution prospective database of 303 patients who underwent LRP between 2003 and 2008 was evaluated. The potential impact of the experience of the first assistant on the PSMR was evaluated by examining the relationship between the PSMR and the time of the academic year. Multivariable logistic regression analysis was used to adjust for patient age, Gleason's sum, tumor density, and pathologic stage.
Overall positive margin rate was 18.2%. Positive margin rate for July and August (14/45, 31.1%) was significantly higher than for the remaining 10 months (41/258, 15.9%) P = .015. The increased risk of positive margin in July/August remained significant after adjusting for age, Gleason's sum, tumor density, and pathologic stage (OR 2.65, 95% CI 1.21-5.79, P = .015)
LRP performed with the first assistant in the first 2 months of the academic training year have a significantly higher PSMR.
Urology 12/2010; 77(3):626-30. · 2.43 Impact Factor
