Background: Numerous lines of investigation [1,2,3] have indicated that the specific anatomical relationships between nerves and associated fasciae have a high clinical relevance. However, instances of nerve-fascia interface are disparately reported in the literature, and no easily accessible reference tool exists for the use of clinicians in practice.

In May of 2010, the second Highlighting Massage Therapy in CIM Research Conference took place in Seattle, WA. The conference attracted 350 attendees, including massage therapists, allied healthcare practitioners, researchers, and public health administrators. 291 attendees traveled from within the United States, 46 came from Canada, and a handful arrived from Australia, New Zealand, Italy, Greece, South Africa, and the United Kingdom (C. Leeders, personal communication, June 14, 2010). This article is a brief synopsis from the perspective of one attendee. Major themes are highlighted and implications discussed, but a comprehensive overview is not intended in this report.

Background Preoperative chemotherapy improves survival in patients with stage III non-small-cell lung cancer (NSCLC) amenable to resection. We aimed to assess the additional effect of preoperative chemoradiation on tumour resection, pathological response, and survival in these patients.Methods Between Oct 1, 1995, and July 1, 2003, patients with stage IIIA-IIIB NSCLC and invasive mediastinal assessment from 26 participating institutions of the German Lung Cancer Cooperative Group (GLCCG) were randomly assigned to one of two treatment groups. The intervention group were scheduled to receive three cycles of cisplatin and etoposide, followed by twice-daily radiation with concurrent carboplatin and vindesine, and then surgical resection (those with positive resection margins or unresectable disease were offered further twice-daily radiotherapy). The control group were scheduled to receive three cycles of cisplatin and etoposide, followed by surgery, and then further radiotherapy. The primary endpoint was median progression-free survival (PFS) in patients eligible for treatment after randomisation. Secondary endpoints in patients eligible for treatment after randomisation were overall survival (OS) and the proportion of patients undergoing surgery. Secondary endpoints in patients with tumour resection were the proportion with negative resection margins, the proportion with complete resection, the proportion with histopathological response, and the proportion with mediastinal downstaging. Additionally, exploratory (not prespecified) post-hoc analyses in terms of PFS and OS were done on patients not amenable to resection and on further subgroups of patients undergoing resection. Analyses were by intention to treat. This trial is registered on the ClinicalTrials.gov website, number NCT 00176137.Findings 558 patients were randomly assigned. 34 patients did not meet inclusion criteria and were excluded. Of 524 eligible patients, 142 of 264 (54%) in the interventional group and 154 of 260 (59%) in the control group underwent surgery; 98 of 264 (37%) and 84 of 260 (32%) underwent complete resection. In patients with complete resection, the proportion of those with mediastinal downstaging (45 of 98 [46%] and 24 of 84 [29%], p=0.02) and pathological response (59 of 98 [60%] and 17 of 84 [20%], p<0.0001) favoured the interventional group. However, there was no difference in PFS (primary endpoint) between treatment groups - either in eligible patients (median PFS 9 - 5 months, range 1.0-117.0 [95% CI 8.3-11-2] vs 10 - 0 months, range 1.0-111.0 [8.9-11.5], 5-year PFS 16% [11-21] vs 14% [10-19], hazard ratio (HR) 0 - 99 [0-81-1-19], p=0.87), in those undergoing tumour resection, or in patients with complete resection. In both groups, 35% of patients undergoing surgery received a pneumonectomy (50/142 vs 54/154). In patients receiving a pneumonectomy, treatment-related mortality increased in the interventional group compared with the control group (7/50 [14%] vs 3/54 [6%]).Interpretation In patients with stage III NSCLC amenable to surgery, preoperative chemoradiation in addition to chemotherapy increases pathological response and mediastinal downstaging, but does not improve survival. After induction with chemoradiation, pneumonectomy should be avoided.

Methods A 34-year-old female subject reported steadily increasing pain in the right shoulder over the previous 8 months. Chiropractic diagnosis and assessment by the author's clinical supervisor had identified these three conditions. Massage therapy was administered twice weekly for a total of 8 sessions. Each 75-min session included 15 min of intake and assessment, during which pain levels (PLs), sleep patterns, and functional limitations were recorded. Treatment was applied in the remaining 60 min, and consisted of Deep Tissue, Neuromuscular, and Muscle Energy techniques. The clinical supervisor conducted three extended assessments, which were performed prior to, halfway through, and after the treatment series. Results Reported PLs, sleep patterns, and functional limitations all showed substantial improvements over the course of treatment, despite a re-injury to the affected shoulder before the seventh session. Assessment by the Clinical Supervisor confirmed these results. Conclusions Massage therapy is an appropriate tool for the concurrent treatment of these three conditions. Further research should focus on the ability of massage to address pathologies normally dealt with as separate entities. Keywords Massage Scoliosis Costovertebral dysfunction Thoracic outlet syndrome Chronic pain

Objectives: Pelvic lymph node metastases indicate a poor prognosis for patients with clinically localized prostate cancer. The aim of the study was to investigate the value of extended histopathological techniques considering the extent of pelvic lymphadenectomy and preoperative risk factors.Methods: Total of 194 patients with prostate cancer were examined. At first all patients had a sampling of the sentinel lymph nodes (SLN) followed in most cases by a modified or extended pelvic lymphadenectomy. Step sections, serial sections and immunohistochemistry (IHC, pancytokeratin antibody) were analyzed in all SLN and so-called non-SLN of the first 100 patients. Later serial sections and IHC of non-SLN were left out.Results: In 26.8% lymphatic metastases were found. The detection rate of lymph node-positive patients depend significantly on the chosen extension of pelvic lymphadenectomy. Limiting the histopathological investigation to the lymph node specimen of the obturator fossa only 44.2% of lymph node-positive cases would have been identified. An additional inclusion of all lymph nodes surrounding the external iliac vessels improves the sensitivity to 65.4% (46.7% and 73.3% for the first 100 patients). Compared to the extension of pelvic lymphadenectomy the diagnostic gain of serial section and IHC (13.8% versus 53.3%) was comparably low.Conclusions: The extension of pelvic lymph node dissection is of outstanding value for the identification of node-positive patients. Limiting the number of lymph nodes to the ones with the highest probability of bearing lymphatic spread (SLN) makes the use of extensive histopathological techniques more feasible. (C) 2002 Elsevier Science B.V. All rights reserved.

At present there are neither clinical nor experimental data available on the influence of technical details on the quality and reproducibility of prostate lymphoscintigraphy. Six adult fox hounds received repeated transrectal ultrasound guided intraprostatic injections of a technetium 99m labeled nanocolloid to prove the influence of different techniques of injection (one central injection in both prostate lobes vs two peripheral injections in both lobes) on tracer accumulation in sentinel lymph nodes (SLN) and other organs. The reproducibility of the favored technique was examined and in a last step it was subject to scrutiny following a reduction of the injected volume to 1% of the prostate volume. The number of scintigraphically visualized SLN varied between four and seven. They were located in the region of the internal and external iliac vessels, presacrally, paravesically, and directly paraprostatically. In five of six cases, the localization was reproducible both with the central application of an identical volume as well as with the volume reduced central injection. Tracer accumulation of SLNs and other organs varied enormously. We expect that with the combination of both injection techniques, even with the reduced injection volume, an optimized prostate lymphoscintigraphy will be the outcome.

Object. To examine possible side effects of neurotizations in which the phrenic nerve was used, pulmonary function was analyzed pre- and postoperatively in patients with brachial plexus injury and root avulsions.Methods. Twenty-three patients with complete brachial plexus palsy underwent neurotization of the musculocutaneous nerve, with the phrenic nerve as donor material. Patients who suffered lung contusions as part of the primary injury were excluded from this study. In 12 patients (five left-sided and seven right-sided neurotizations) pre- and postoperative functional parameters were compared and additional body plethysmography was performed more than 12 months postsurgery.Of the 23, no patient experienced pulmonary problems postoperatively. Nonetheless, pulmonary functional parameters showed a vital capacity in percent of the predicted value of 9.8 +/- 6.3% (mean +/- standard deviation [SD]) in all patients examined, which was a significant reduction (p = 0.0002).In right-sided phrenic nerve transfers this reduction was significant, at 14.3 +/- 3.3% (mean +/- SD), whereas left-sided transfers showed a nonsignificant reduction of 3.6 +/- 3.5% (mean +/- SD). The observed decrease in vital capacity (VC) correlates with the maximal inspiratory pressure (Pi(max)) as an indication of clinical significance.Conclusions. When the right phrenic nerve is used as a donor in neurotization of the musculocutaneous nerve, the patient incurs a higher risk of reduced pulmonary VC. If possible,, the left phrenic nerve should be preferred. The Pi(max) has to be determined preoperatively to avoid any further decrease in the already reduced pulmonary function due to the initial injury.

Purpose: The localization of lymph node metastases in prostate cancer varies enormously. Due to high morbidity complete pelvic lymphadenectomy is often decreased to modified staging lymphadenectomy, resulting in loss of sensitivity for detecting micrometastases. Based on the promising results of intraoperative gamma probe application for identifying sentinel lymph nodes in malignant melanoma, breast and penis cancer, we identified sentinel lymph nodes in prostate cancer using a comparable technique.Materials and Methods: In 117 patients (99m)technetium nanocolloid was transrectally injected directly into the prostate under ultrasound guidance 1 day before pelvic lymphadenectomy. Thereafter dynamic lymphoscintigraphy was done. Initially lymph nodes identified as sentinel lymph nodes by the gamma probe were removed and subsequently modified pelvic lymphadenectomy was performed.Results: Lymphatic metastasis was detected in 28 cases. An average of 4 sentinel lymph nodes were identified per patient in 25 of 27 patients with micrometastasis, of which those in 24 contained micrometastasis for 96% sensitivity. In contrast, sensitivity of modified pelvic lymphadenectomy was 81.5%. In 16 patients only sentinel lymph nodes were positive. An average of 21.8 lymph nodes (range 10 to 51) was dissected per patient at pelvic lymphadenectomy. Lymph node metastasis was noted in 6 of the 46 patients with a prostate specific antigen between 4 and 10 ng./ml. and in 8 of the 64 with a stage pT2 tumor.Conclusions: Our study shows individual variability of lymphatic drainage of the prostate and limited sensitivity for detecting positive lymph nodes when the pelvic dissection area is limited. Furthermore, our experience implies that the identification of sentinel lymph nodes is feasible, not only in breast cancer and malignant melanoma, but also in prostate cancer using a comparable technique.

Because of the curative approach, the detection of lymph node metastases in squamous cell carcinoma (SCC) of the penis is of significant clinical relevance. Sentinel lymph node (SLN) identification by means of lymphangiography has been proven to be insufficiently safe. However, the high morbidity of inguinal lymphadenectomy and the considerable individual variability regarding the location of lymph node metastases justify the necessity of a technique that enables the identification of SLNs. Since 1998, SLNs have been intraoperatively identified and selectively dissected, after peritumoral injection of technetium-99m nanocolloid and using lymphoscintigraphy, in three patients (one with malignant melanoma and two with SCC). At least one SLN could be detected in each patient. The maximum surgical time was 30 min. There were no severe complications. Lymph node metastases did not occur in any patient. Upon a mean follow-up of 10 months, all patients are currently free of tumor. Owing to the long-term results of sentinel lymphadenectomy in malignant melanoma of other locations and our preliminary results with respect to penile carcinoma, we consider the current method appropriate as the only primary operation for lymph node staging in early stages and, in combination with modified inguinal lymphadenectomy, in locally advanced stages.

No AccessJournal of UrologyCLINICAL UROLOGY: Case Reports1 Apr 2000URINARY CYTOLOGY CHANGES IN PROTEASE INHIBITOR INDUCED UROLITHIASIS MICHAEL HAMM, FRIEDHELM WAWROSCHEK, and PETER RATHERT MICHAEL HAMMMICHAEL HAMM More articles by this author , FRIEDHELM WAWROSCHEKFRIEDHELM WAWROSCHEK More articles by this author , and PETER RATHERTPETER RATHERT More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67739-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "URINARY CYTOLOGY CHANGES IN PROTEASE INHIBITOR INDUCED UROLITHIASIS." The Journal of Urology, 163(4), pp. 1249–1250 References 1 Indinavir Sulfate. West Point, Pennsylvania: Merck and Co.March 1996. Google Scholar 2 : Imaging characteristics of indinavir calculi. J Urol1999; 161: 1085. Link, Google Scholar 3 : Cytologic grading of urothelial tumors. In: . New York: Springer1993: 56. Google Scholar From the Department of Urology, Augsburg Central Hospital, and Department of Urology and Pediatric Urology, Academic Hospital Dueren, Augsburg, Germany© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byHamm M, Knöpfle E, Wartenberg S, Wawroschek F, Weckermann D and Harzmann R (2018) Low Dose Unenhanced Helical Computerized Tomography For The Evaluation Of Acute Flank PainJournal of Urology, VOL. 167, NO. 4, (1687-1691), Online publication date: 1-Apr-2002. Volume 163Issue 4April 2000Page: 1249-1250 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.KeywordscytologyHIVurinary calculiprotease inhibitorsbladderMetricsAuthor Information MICHAEL HAMM More articles by this author FRIEDHELM WAWROSCHEK More articles by this author PETER RATHERT More articles by this author Expand All Advertisement PDF downloadLoading ...

Aufgrund der insgesamt noch geringen Erfahrung mit der Herz-Lungen-Transplantation (wenige hundert Eingriffe) — und noch geringerer Erfahrung mit der isolierten Lungentransplantation (ca. 150 Eingriffe weltweit) — können verbindliche und insbesondere als richtig erwiesene Indikationskriterien nicht aufgestellt werden. Alle Angaben zu Indikationen und Kontraindikationen unterliegen einer ständigen Entwicklung durch aktuelle klinische Erfahrungen. Trotzdem muß im praktischen Umfang mit Patienten ein nachvollziehbares Konzept befolgt werden, nach welchem auch zuweisende Kollegen die Frage entscheiden können, ob bzw. wann sie mit ihrem Patienten über das Thema der Lungen- oder Herz-Lungen-Transplantation sprechen sollen, um ihn ggf. bei einem geeigneten Zentrum vorzustellen.