No abstract

OBJECTIVES To examine the operative findings, histopathology and clinical outcome of patients undergoing repeat retroperitoneal lymph node dissection (RPLND) after initial chemotherapy and RPLND (PC‐RPLND) for metastatic testicular germ cell tumour (GCT), as a small proportion relapse or have residual disease after incomplete resection in the lung, retrocrural or pelvic nodes, and retroperitoneum. PATIENTS AND METHODS Between September 1992 and May 2006, 359 patients had PC‐RPLND under the care of one surgeon, 54 of which were repeat procedures. We compared the long‐term outcome between those having primary and those having repeat PC‐RPLND. RESULTS The median (range) time from original to repeat surgery was 2.4 (0.25–26.5) years, and the median follow‐up after the repeat procedure was 5.8 (0.08–12.9) years. There was no difference in survival between patients requiring only one PC‐RPLND and those having a repeat procedure (P = 0.592). The most frequent sites of recurrent disease were: behind the great vessels/para‐aortic areas (38, 46%), in the suprahilar region (18, 18%), in the retrocrural area (16, 19%), in the pelvic nodes (10, 12%) and in the lung (one, 1%). The most common pathological findings in the repeat PC‐RPLNDs were differentiated teratoma (19, 35%), malignant teratoma undifferentiated (nine, 17%), adenocarcinoma (eight, 15%) and necrotic tissue (five, 9.2%). CONCLUSION Although a small proportion of patients with metastatic GCT might require repeat PC‐RPLND, there is no difference in survival between this group and those having one PC‐RPLND. However, to avoid cancer recurrence and reoperation, it is crucial that the first PC‐RPLND is careful and complete, preferably done in a centre with expertise in this procedure.

Like most own-group biases in face recognition, the own-age bias (OAB) is thought to be based either on perceptual expertise or socio-cognitive motivational mechanisms [Wolff, N., Kemter, K., Schweinberger, S. R., & Wiese, H. (2013). What drives social in-group biases in face recognition memory? ERP evidence from the own-gender bias. Social Cognitive and Affective Neuroscience. doi:10.1093/scan/nst024]. The present study employed a recognition paradigm with eye-tracking in order to assess whether participants actively viewed faces of their own-age differently to that of other-age faces. The results indicated a significant OAB (superior recognition for own-age relative to other-age faces), provided that they were upright, indicative of expertise being employed for the recognition of own-age faces. However, the eye-tracking results indicate that viewing other-age faces was qualitatively different to the viewing of own-age faces, with more nose fixations for other-age faces. These results are interpreted as supporting the socio-cognitive model of the OAB.

Background: As greater numbers of transperineal template prostate biopsies (TTPBs) are being performed, we have noticed that a considerable number of patients experience urinary retention post-procedure. We wanted to quantify this, and to examine factors that might predict which patients will experience retention. Patients and methods: Data analysis was performed on a prospectively maintained database on 93 consecutive patients undergoing template prostate biopsy over a 12-month period. Results: Mean patient age was 66 years (range 46-79). Mean prostate-specific antigen (PSA) was 8.34 ng/ml (1-31), mean transrectal ultrasonography (TRUS) volume 51 cc (10-133) and mean number of cores 52 (11-84). Twenty-five patients had muscle relaxant as part of their anaesthetic (27%). Fifteen patients had haematuria immediately postprocedure (16%). Twenty-six procedures were performed by a urology trainee (28%). Sixteen patients experienced retention post-template biopsy (17%). Their mean age was 67 years, mean PSA 8.9 ng/ml, mean TRUS volume 68 cc and mean number of cores 58. Of the retention group, 10 patients had muscle relaxant (63%), one patient had haematuria (6%) and four procedures were performed by a trainee (25%). Factors that significantly correlated with retention were TRUS volume (r = 0.36, p = 0.0004) and the use of muscle relaxant (r = 0.37, p = 0.0003). Age, PSA, number of cores taken, haematuria post-biopsy, and intra-operative furosemide, paracetamol, diclofenac, morphine and dexamethasone were not correlated with retention (p > 0.05). Conclusion: Patients with higher TRUS volumes are at increased risk of retention post-TTPB and should be counselled accordingly. Due to anti-muscarinic effects, muscle relaxants should not be used.

It is a question many patients ask in stone clinicdoes it matter what water I drink? Often patients cite scaling up of their water pipes or kettles as demonstrating the influence that the hardness of the water has on stone formation.Although the aetiology of urolithiasis is multifactorial, a high fluid intake is universally recommended. The recent National Institute for Health and Care Excellence (NICE) guidance on urolithiasis recommend adults drink 2.5-3 L of water per day [1]. But no guidance recommends what water is best, so does the hardness of tap water influence stone recurrence in patients with urolithiasis?What are the Differences between Hard Water and Soft Water?Tap water varies in mineral and electrolyte content dramatically between geographic areas within the same country. Water hardness is determined by the concentration of multivalent cations, predominantly calcium and magnesium. Hard water is defined as having a higher calcium carbonate (CaCO 3 ) concentration than soft water and is found in areas with chalk and limestone geology. The WHO ( https://www.who.int/water_sanitation_health/dwq/chemicals/ hardness.pdf) defines soft water as containing up to 60 mg/L CaCO 3 , whilst very hard water contains >180 mg/L CaCO 3 . CaCO 3 disassociates into Ca 2+ and CO 3 2À in the presence of dilute acid, e.g., in the digestive tract. Therefore, free Ca 2+ becomes available and contributes to daily calcium intake. How Does This Affect Urine Composition and Stone Recurrence?A double-blind, randomised crossover study of 18 calcium oxalate stone-formers (SFs) found that drinking hard mineral water (Ca 2+ 255 mg/L) was associated with a significant increase in urinary calcium concentration (although no change in oxalate excretion) compared to drinking soft mineral water (Ca 2+ 22 mg/L) or local tap water (Ca 2+ 63 AE 8 mg/L) [2]. Whether or not this in isolation influences stone recurrence is speculative. More alkaline water might be expected to increase urine citrate excretion but that did not occur in this study. Mirzazadeh et al. [3] compared 24-h urines of 15 SFs and 14non-SFs on controlled diets with soft water, moderate hardness tap water, and then mineral water. Increasing drinking water hardness increased urinary calcium levels in SFs.