PURPOSE:Sentinel lymph node biopsy (SLNB) has been described as a minimally invasive method for lymph node staging in patients with a penile carcinoma and nonpalpable inguinal nodes in national and international guidelines of involved professional societies. However, this method is rarely used. The aim of this study was to validate reliability and morbidity of this method and to discuss radiation exposure of persons involved.METHODS:Twenty-eight patients with histologically negative sentinel lymph nodes in 47 groins with nonpalpable inguinal lymph nodes were included in this study (17 T1(a/b)-, 8 T2- and 3 T3-stages). We recorded prospectively all cases of lymph node recurrence and complications in patients with initially nonpalpable inguinal lymph nodes and histologically negative sentinel lymph nodes. False-negative findings and morbidity were calculated as qualitative criteria. Inguinal regions with palpable lymph nodes and/or evidence of metastases were not considered in accordance with the guidelines.RESULTS:During a median follow-up of 68 (4-131) months, we observed one case of bilateral lymph node recurrence and one case of prolonged inguinal lymphorrhea, which could be managed conservatively. Per inguinal region, false-negative rate was 4.25%, and morbidity rate was 2.12%; seen per patient, the rates were both 3.57%.CONCLUSIONS:Sentinel lymph node biopsy under use of radioactive tracers is a reliable method of lymph node staging in patients with penile carcinoma and nonpalpable inguinal lymph nodes. The methodical complexity is justified by high reliability and low radiation exposure for both patient and medical staff and low morbidity rates.

We examined the quantity and localization of pelvic lymph node (LN) metastases in patients undergoing extended pelvic lymphadenectomy (ePLND). A total of 174 patients with intermediate and high-risk prostate cancer underwent radical prostatectomy (RP) and ePLND. We analyzed the relationship between the number of LNs removed and the number, frequency and topography of LN metastases. In group 1 (intermediate risk patients, n=115) the average number of LNs removed was 20.5, LN metastases were found in 15 patients (13 %) and the localizations were in the external iliac artery 19 %, the internal iliac artery 32 %, the obturator foramen 36 %, the common iliac artery 7 %, Marcille's triangle 3 % and sacral regions 3 %. In group 2 (high-risk patients, n=59) the average number of LNs removed was 23.9, LN metastases were found in 19 patients (32 %) and the localizations were the external iliac artery 15 %, the internal iliac artery 26 %, the obturator foramen 19 %, the common iliac artery 29 %, Marcille's triangle 6 % and sacral regions 5 %. The full number of metastases was detected only if more than 15 LNs were removed in group 1 and 18 LNs in group 2. At least 15 LNs in the intermediate risk group and at least 18 LNs in high risk group should be removed. The ePLND should include the common iliac artery, the internal iliac artery, Marcille's triangle and sacral regions.

Zusammenfassung Einleitung Wir haben die Häufigkeit von Lymphknotenmetastasen bei ausgedehnter pelviner Lymphadenektomie (ePLND) ausgewertet. Material und Methoden Der radikalen Prostatektomie und ePLND unterzogen sich 174 Patienten mit „Intermediate-“ und „High-risk-Prostatakarzinom“. Ausgewertet wurden Zahl der entfernten Lymphknoten (LK) sowie Zahl und Lage der Metastasen. Ergebnisse In der Gruppe 1 („intermediate risk“; n = 115) wurden durchschnittlich 20,5 LK entfernt. Bei 15 (13%) Patienten wurden Metastasen gefunden: A. iliaca externa 19%, A. iliaca interna 32%, Fossa obturatoria 36%, A. iliaca communis 7%, Marcille-Dreieck 3%, sakral 3%. In der Gruppe 2 („high risk“; n = 59) wurden durchschnittlich 23,9 LK entfernt. Bei 19 (32%) Patienten wurden Metastasen gefunden: A. iliaca externa 15%, A. iliaca interna 26%, Fossa obturatoria 19%, A. iliaca communis 29%, Marcille-Dreieck 6%, sakral 5%. Die volle Zahl LK-Metastasen war nachweisbar, wenn > 15 LK in Gruppe 1 und > 18 LK in Gruppe 2 entfernt wurden. Schlussfolgerung Die PLND sollte um die A. iliaca communis, die A. iliaca interna, das Marcille-Dreieck und den sakralen Bereich erweitert werden. Bei „Intermediate-“ und „High-risk-Patienten“ sollten mindestens 15 bzw. 18 LK entfernt werden.

Extended lymph node dissection during radical prostatectomy for prostate cancer remains a disputed area. Sentinel lymph scans help identify the first lymph node stages in the lymph drainage of the prostate. This study was designed to investigate the detection rate of lymph node metastasis by extended lymph node dissection and sentinel lymph node scanning in patients undergoing radical retropubic prostatectomy (RRP) for localized prostate cancer.In this study at our department from 2005 to 2006, a total of 108 patients with localized prostate carcinoma were treated with radical prostatectomy including extended lymph node dissection. A sentinel lymph node scan with 160 MBq of technetium-99m-Nanocoll (Tc) was performed I day before surgery. A C-Trak gamma probe (AEA Technologies, Morgan Hills, CA, USA) was used intraoperatively to detect the sentinel lymph nodes. Scan findings were correlated with tumor stage, Gleason score, prostate-specific antigen (PSA) level, and histological lymph node status.Scans revealed sentinel lymph nodes on the film 2 h after Tc administration in 98 of 108 patients (91%). Histologically proven lymph node metastases were detected in 15 of those 98 patients (15%) with a positive sentinel scan. Those 15 patients had a PSA level greater than 10 ng/ml or a Gleason score greater than 6 and at least a pT2 tumor. Specifically, six patients had a pT2 tumor, and nine patients had a pT3 tumor. Of patients placed in a risk group defined as PSA above 10 ng/ml or Gleason score greater than 6,15 out of 50 patients (30%) had sentinel positive lymph nodes with metastasis.These data suggest that extended sentinel lymph node dissection helps identify lymph node metastasis in patients with PSA above 10 ng/ml or a Gleason score above 6 in 30% of cases. Further studies will show whether these numbers will hold true in patients undergoing radical prostatectomy for prostate cancer.

Die ausgedehnte Lymphknotendissektion bei der radikalen Prostatektomie des Prostatakarzinoms (PCA) bleibt ein umstrittenes Thema. Sentinel-Lymphknotenszintigraphien helfen, die ersten Lymphknotenstationen der Lymphdrainage der Prostata darzustellen. Diese Untersuchung wurde entwickelt, um die Entdeckungsraten von Lymphknotenmetastasen im Rahmen der ausgedehnten Lymphknotendissektion und Sentinel-Lymphknotenszintigraphien bei Patienten, die sich einer radikalen Prostatektomie bei lokalisiertem PCA unterziehen, weiter zu untersuchen.

To evaluate an intervention for improving the delivery of early enteral nutrition (EN) in patients receiving mechanical ventilation with prone positioning (PP).Eligible patients receiving EN and mechanical ventilation in PP were included within 48 h after intubation in a before–after study. Patients were semi-recumbent when supine. Intolerance to EN was defined as residual gastric volume greater than 250 ml/6 h or vomiting. In the before group (n = 34), the EN rate was increased by 500 ml every 24 h up to 2000 ml/24 h; patients were flat when prone and received erythromycin (250 mg IV/6 h) to treat intolerance. In the intervention group (n = 38), the EN rate was increased by 25 ml/h every 6 h to 85 ml/h, 25° head elevation was used in PP, and prophylactic erythromycin was started at the first turn.Compared to the before group, larger feeding volumes were delivered in the intervention group (median volume per day with PP, 774 ml [IQR 513–925] vs. 1170 ml [IQR 736–1417]; P < 0.001) without increases in residual gastric volume, vomiting, or ventilator-associated pneumonia.An intervention including PP with 25° elevation, an increased acceleration to target rate of EN, and erythromycin improved EN delivery.

Die nichtinvasive Diagnostik durch Blasentumormarker hat in den letzten Jahren eine Vielzahl von experimentellen wie kommerziellen Verfahren hervor gebracht. Vergleichende Untersuchungen einzelner Marker zur Diagnostik, Nachsorge oder Rezidiverkennung beim Blasenkarzinom laufen sowohl retrospektiv wie prospektiv sowie uni- und multizentrisch.

INTRODUCTION:The number of noninvasive diagnostic tests for bladder cancer has increased tremendously over the last years with a large number of experimental and commercial tests. Comparative analyses of tests for diagnosis, follow-up, and recurrence detection of bladder cancer were performed retrospectively as well as prospectively, unicentrically, and multicentrically. METHODS:An analysis of multicentric studies with large patient numbers compared with our own Kiel Tumor Bank data is presented. The Kiel Tumor Bank data looked prospectively at 106 consecutive bladder tumor patients from the year 2006. Special focus was put on urine cytology as a reference test, as well as the commercial NMP 22 Bladder Chek. RESULTS:The analysis of the NMP 22 Bladder Chek showed an overall sensitivity of 69% for all tumor grades and stages, with a specificity of 76%. Comparison to multicentric data with an overall sensitivity of 75% for all tumor grades and stages, with a specificity of 73%, showed results similar to those in the literature. Urine cytology showed a comparable overall sensitivity of 73% for all tumor grades and stages, with a specificity of 80%. CONCLUSIONS:A large number of noninvasive tests for bladder cancer follow-up with reasonable sensitivity and specificity can currently be used. Because of limited numbers of prospective randomized multicentric studies, no single particular marker for bladder cancer screening can be recommended at this point in time.

Moderate activity of systemic chemotherapy for advanced urothelial cancer has been reported for more than 30 years. Only with the advent of potent combination therapy in the mid-1980s have clinically significant response rates and prolonged survival been documented. Due to the small number of cases and poor prognosis, knowledge is scant about the therapeutic effect of "second-line" polychemotherapy in metastatic upper tract urothelial cancer. We report an interesting case of a 59-year-old man suffering from urothelial cancer of the renal pelvis with pulmonary, lymphogenous, and bone metastases who had an unexpected response to "second-line" chemotherapy with only 2 treatment cycles of gemcitabine/paclitaxel (partial remission) after 24 treatment cycles of gemcitabine/cisplatin in "stable disease" with progression between the therapeutic intervals.