Publications by authors named "Kristen Scarpato"

23 Publications

  • Page 1 of 1

PTEN Expression and Morphologic Patterns in Prostatic Adenocarcinoma.

Histopathology 2021 Jul 29. Epub 2021 Jul 29.

Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.

Aims: Cribriform morphology, which includes intraductal carcinoma (IDCP) and invasive cribriform carcinoma, is an indicator of poor prognosis in prostate cancer. PTEN loss is a predictor of adverse clinical outcomes. The association between PTEN expression and morphologic patterns of prostate cancer is unclear.

Methods And Results: We explored the association between PTEN expression by immunohistochemistry, Gleason pattern 4 morphologies, IDCP, and biochemical recurrence (BCR) in 163 radical prostatectomy specimens. IDCP was delineated from invasive cribriform carcinoma by p63 positive immunohistochemical staining in basal cells. Combined invasive cribriform carcinoma and IDCP were associated with a higher cumulative incidence of BCR (HR: 5.06 [2.21, 11.6], p< 0.001). When including PTEN loss in the analysis, invasive cribriform carcinoma remained predictive of BCR (HR: 3.72 [1.75, 7.94], p=0.001), while PTEN loss within invasive cribriform carcinoma did not. Glomeruloid morphology was associated with lower odds of cancer stage pT3 and lower cumulative incidence of BCR (HR: 0.27 [0.088, 0.796], p=0.018), while PTEN loss within glomeruloid morphology was associated with a higher cumulative incidence of BCR (HR: 4.07 [1.04, 15.9], p=0.043).

Conclusions: PTEN loss within glomeruloid pattern was associated with BCR. The presence of any cribriform pattern was associated with BCR, despite PTEN loss not significantly associated with invasive cribriform carcinoma. We speculate that other drivers independent from PTEN loss may contribute to poor prognostic features in cribriform carcinoma.
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http://dx.doi.org/10.1111/his.14531DOI Listing
July 2021

Editorial Comment.

J Urol 2021 Jul 13:101097JU000000000000185501. Epub 2021 Jul 13.

Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.

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http://dx.doi.org/10.1097/JU.0000000000001855.01DOI Listing
July 2021

Differential effect of body mass index by gender on oncological outcomes in patients with renal cell carcinoma.

J Cancer Res Ther 2021 Apr-Jun;17(2):420-425

Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.

Objectives: To investigate the relationship between gender, body mass index (BMI), and prognosis in renal cell carcinoma (RCC) patients.

Materials And Methods: We retrospectively reviewed 1353 patients with RCC who underwent a partial or radical nephrectomy between 1988 and 2015. The association among sex, BMI, stage, grade, overall survival (OS), and recurrence-free survival (RFS) was analyzed.

Results: The median age of the patients was 59.4 ± 11.9 years. Female patients had proportionally lower grade tumors than male patients (Grade I-II in 75.5% vs. 69.3% in women and men, respectively, P = 0.022). There was no relationship between Fuhrman grade and BMI when substratified by gender (p > 0.05). There was a nonsignificant trend toward more localized disease in female patients (p = 0.058). There was no relationship between T stage and BMI when stratified by gender (p > 0.05). Patients with higher BMI had significantly better OS (p = 0.0004 and P = 0.0003) and RFS (P = 0.0209 and P =0.0082) whether broken out by lower 33 or 25 percentile. Male patients with higher BMI had significantly better OS and RFS rates. However, there was no relationship between BMI and OS or RFS for female patients (P > 0.05). Multivariate analysis of the entire cohort demonstrated that a BMI in the lower quartile independently predicts OS (hazard ratio 1.604 [95% confidence interval: 1.07-2.408], P = 0.022) but not RFS (P > 0.05). When stratified by gender, there was no relationship between BMI and either OS or RFS (P > 0.05).

Conclusions: Increasing BMI was associated with RCC prognosis. However, the clinical association between BMI and oncologic outcomes may be different between men and women.
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http://dx.doi.org/10.4103/jcrt.JCRT_546_18DOI Listing
June 2021

EDITORIAL COMMENT.

Urology 2021 Apr;150

Vanderbilt University Medical Center, Nashville, TN.

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http://dx.doi.org/10.1016/j.urology.2020.08.069DOI Listing
April 2021

Fighting the 'other pandemic' - systemic racism in urology.

Nat Rev Urol 2021 01;18(1):1-2

Department of Surgery, Division of Urology, Virginia Commonwealth University, Richmond, VA, USA.

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http://dx.doi.org/10.1038/s41585-020-00406-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734900PMC
January 2021

Virtual grand rounds as a novel means for applicants and programs to connect in the era of COVID-19.

Am J Surg 2021 05 2;221(5):956-961. Epub 2020 Sep 2.

University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address:

Background: COVID-19 has disrupted the 2020-2021 residency application cycle with the cancellation of away rotations and in-person interviews. This study seeks to investigate the feasibility and utility of video conferencing technology (VCT) as an opportunity for applicants to interact with faculty from outside programs.

Methods: 18 prospective urology applicants were randomized to 6 urology programs to give a virtual grand rounds (VGR) talk. Presentations were recorded and analyzed to determine audience engagement. Students were surveyed regarding perceived utility of VGR. Faculty were surveyed to determine system usability of VCT and ability to evaluate the applicant.

Results: 17 students completed the survey, reporting a 100% satisfaction rate with VGR. A majority felt this was a useful way to learn about outside programs. 85 physicians completed the faculty survey, with nearly half feeling confident in their ability to evaluate the applicant. Video transcription data shows sessions were interactive with minimal distractions.

Conclusions: VGR can be a useful means for medical students to express interest in programs as well as an additional marker for faculty to evaluate applicants.
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http://dx.doi.org/10.1016/j.amjsurg.2020.08.044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467106PMC
May 2021

Postoperative Opiate Use in Urological Patients: A Quality Improvement Study Aimed at Improving Opiate Disposal Practices.

J Urol 2019 02;201(2):371-376

Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.

Purpose: We aimed to determine trends in postoperative opiate management among urological patients, identify associations with opiate keeping and foster appropriate opiate disposal after surgery via introduction of an educational handout.

Materials And Methods: We retrospectively analyzed opiate practices in 68 patients who had undergone urological surgery. In a separate consecutive cohort of 59 patients we distributed a handout detailing FDA (Food and Drug Administration) approved disposal methods. Patient opiate obtainment, use and disposal were assessed via telephone interviews with prescription filling data verified using the Tennessee CSMD (Controlled Substances Monitoring Database). Opiate keeping was defined as possessing any opiates more than 3 weeks after surgery or more than 4 times the duration of the postoperative prescription, whichever was longer.

Results: Opiate keeping was observed in 41 patients (72%) in our initial cohort. Of these patients 68% left the medication unsecured at home. Major barriers to opiate disposal included concern for return of disease specific pain in 44% of patients and unrelated pain in 29%. As assessed on a short test, opiate keepers were less knowledgeable about safe disposal practices compared to nonkeepers (72% vs 85%, p = 0.005). Among opiate keepers there was an improvement in knowledge scores after the intervention (66% to 77%, p = 0.03). When comparing pre-education to post-education, there was no detectable improvement in the rate of opiate keeping (72% vs 68%, p = 0.66) or proper disposal (9% vs 8%, p = 1.0).

Conclusions: Opiate keeping is common following urological surgery and a major barrier to disposal is concern for the return of disease specific pain. Future interventions aimed at limiting opiate keeping should combine evidence-based prescription practices and targeted patient education.
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http://dx.doi.org/10.1016/j.juro.2018.09.052DOI Listing
February 2019

The Impact of Health Literacy and Clinicodemographic Factors on Use of Discharge Services after Radical Cystectomy.

J Urol 2017 09 8;198(3):560-566. Epub 2017 Apr 8.

Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address:

Purpose: There are few data on the relationship between health literacy and discharge disposition. We hypothesized that patient discharge needs after radical cystectomy are affected by health literacy.

Materials And Methods: We identified 504 patients who underwent radical cystectomy and completed the validated BHLS (Brief Health Literacy Screen) after November 2010. Bivariate and logistic regression analyses were performed to determine whether health literacy is associated with the use of discharge resources after radical cystectomy.

Results: Of patients treated with radical cystectomy 50.6% required discharge services and had lower health literacy (BHLS 11.9 vs 12.5, p = 0.016) than patients discharged home without services. On multivariable analysis older age (OR 1.1, 95% CI 1.0-1.1, p = 0.002), female gender (OR 2.3, 95% CI 1.2-4.4, p = 0.019), body mass index (OR 1.1, 95% CI 1.0-1.1, p = 0.034), Charlson comorbidity index score (OR 1.1, 95% CI 1.0-1.2, p = 0.037) and length of stay (OR 1.1, 95% CI 1.0-1.2, p = 0.019) were significantly associated with the use of discharge resources. Patients with continent vs incontinent urinary diversion were less likely to require discharge services (OR 0.4, 95% CI 0.2-0.8, p = 0.013).

Conclusions: Older age, female gender, body mass index, comorbidities, length of stay and incontinent diversion are associated with increased use of discharge resources after radical cystectomy. Low health literacy may affect patient discharge disposition but it was not significant on multivariable analysis. Factors that influence the complex self-care required of patients after cystectomy should be considered during discharge planning.
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http://dx.doi.org/10.1016/j.juro.2017.04.018DOI Listing
September 2017

Current Management of Refractory Germ Cell Tumors and Future Directions.

Curr Oncol Rep 2017 Feb;19(2)

Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Vanderbilt-Ingram Cancer Center, 691 Preston Research Building, Nashville, TN, 37232, USA.

Purpose Of Review: We review current management strategies for patients with relapsed and refractory germ cell tumors (GCTs), defined as relapsed or persistent disease following at least one line of cisplatin-based chemotherapy. Additionally, we discuss future directions in the management of these patients.

Recent Findings: Recent studies involving targeted therapies have been disappointing. Nevertheless, studies of the management of refractory germ cell cancer are ongoing, with a focus on optimal utilization of high-dose chemotherapy and autologous stem cell transplant, as well as the role of immune checkpoint inhibitors in refractory germ cell tumors. Studies aiming to identify those patients who may benefit from more intensive treatment up front to prevent the development of refractory disease are also in progress. Testicular germ cell tumors are among the most curable of all solid tumor malignancies, with cure being possible even in the refractory, metastatic setting. Treatment of refractory disease remains a challenging clinical scenario, but potentially practice changing studies are ongoing.
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http://dx.doi.org/10.1007/s11912-017-0572-yDOI Listing
February 2017

The Impact of Health Literacy on Surgical Outcomes Following Radical Cystectomy.

J Health Commun 2016 23;21(sup2):99-104. Epub 2016 Sep 23.

a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , Tennessee , USA.

Health literacy is the ability to obtain, comprehend, and act on medical information and is an independent predictor of health outcomes in patients with chronic health conditions. However, little has been reported regarding the potential association of health literacy and surgical outcomes. We hypothesized that patient complications after radical cystectomy would be associated with health literacy. In a sample of 368 patients, we found that higher health literacy scores (as determined by the Brief Health Literacy Screen) were associated with decreased odds of developing minor complications (odds ratio = 0.90, 95% confidence interval [0.83, 0.97]). Health literacy should be considered when caring for patients undergoing radical cystectomy and should serve as a potential indicator of the need for additional resources to improve postoperative outcomes.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5080660PMC
http://dx.doi.org/10.1080/10810730.2016.1193916DOI Listing
October 2017

Oncologic Outcomes after Anterior Exenteration for Muscle Invasive Bladder Cancer in Women.

J Urol 2016 Oct 7;196(4):1030-5. Epub 2016 May 7.

Department of Urologic Surgery, Vanderbilt University Medical Center, Meharry Medical College, (CE, JW), Nashville, Tennessee; Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma (MSC). Electronic address:

Purpose: We investigated oncologic and urinary outcomes after anterior exenteration for urothelial cell carcinoma in females, identifying tumor characteristics associated with female pelvic organ involvement. We hypothesized that a lack of trigonal or bladder floor tumor, intraoperative palpable posterior mass and clinical lymphadenopathy is associated with a lack of female pelvic organ involvement.

Materials And Methods: We retrospectively reviewed the charts of female patients who underwent radical cystectomy at our institution from 1999 to 2014. Patient and operative characteristics were extracted from the electronic medical record, and performance of hysterectomy was tested for association with disease recurrence. Categorical and continuous variables were analyzed with the chi-square and Student t-test, and Kaplan-Meier analysis was performed to determine recurrence-free survival according to hysterectomy performance. Women who had neobladder creation were additionally evaluated for an association between hysterectomy status, and nighttime wetting and catheter use.

Results: Of 322 eligible patients 160 with urothelial cancer did not have a hysterectomy before cystectomy. Mean followup was 2.2 years (SD 2.8). There were 22 patients (13.8%) who had recurrence during followup. No patient or surgical factor other than use of adjuvant chemotherapy or radiation (p <0.01) was associated with recurrence. Of 139 women 32 (23.0%) who underwent exenteration had female pelvic organ involvement. At least 1 of the 3 characteristics of interest were present in 28 of 99 (28.3%) women with any genitourinary organ involvement compared to only 4 of 40 (10.0%) of those who did not (p=0.01). Nighttime continence ranged between 21.9% and 48% but there was no significant association with continence and hysterectomy status.

Conclusions: Lack of trigonal/bladder floor tumor, palpable posterior mass and clinical lymphadenopathy is associated with the absence of pelvic organ involvement. Individualized risk assessment using these factors along with patient preferences should be used to guide surgical planning.
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http://dx.doi.org/10.1016/j.juro.2016.04.090DOI Listing
October 2016

Magnetic resonance-ultrasound fusion prostate biopsy in the diagnosis of prostate cancer.

Urol Oncol 2016 07 12;34(7):326-32. Epub 2016 Apr 12.

Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.

The advent of multiparametric magnetic resonance imaging (MRI) has ushered in a new era for urologists who perform prostate needle biopsies. The fusion of MRI with transrectal ultrasound (US) allows the direct targeting of suspicious lesions, which has been shown to improve the performance of conventional random biopsy techniques by increasing detection of clinically relevant disease while also decreasing detection of low-risk cancer. However, as with any new technology, many questions regarding effectiveness, reproducibility, and generalizability still remain. In this review, we (1) provide a summary of the various sequences that comprise a MRI of the prostate; (2) evaluate the 3 different ways of incorporating MRI into targeted biopsies of the prostate including in-bore MRI-guided biopsy, cognitive fusion, and device-mediated fusion; (3) review the sensitivity of MR-US fusion in the detection of clinically significant and clinically insignificant disease; and (4) review the barriers to the widespread implementation of MR-US fusion into everyday practice. Whereas other articles in this issue of Urologic Oncology Seminars will discuss other aspects of MRI in the management of prostate cancer, the purpose of this article is to provide an overview of MR-US fusion biopsies in the diagnosis of prostate cancer.
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http://dx.doi.org/10.1016/j.urolonc.2016.03.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912896PMC
July 2016

Use of mpMRI in active surveillance for localized prostate cancer.

Urol Oncol 2016 07 29;34(7):320-5. Epub 2016 Mar 29.

Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville TN 37232.

Introduction: In an effort to limit prostate cancer (PCa) overdiagnosis and overtreatment, which have occurred in response to widespread prostate specific antigen testing, numerous strategies aimed at improved risk stratification of patients with PCa have evolved. Multiparametric magnetic resonance imaging (MRI) is being used in concert with prostate specific antigen testing and prostate biopsies to improve sensitivity and specificity of these tests. There are limited data on how multiparametric MRI can be incorporated into active surveillance (AS) protocols.

Evidence Acquisition: A PubMed literature search of available English language publications on PCa, AS, and MRI was conducted. Appropriate articles were selected and included for review. Bibliographies were also used to expand our search.

Evidence Synthesis: Data from 41 studies were reviewed. AS inclusion criteria and protocols varied among studies, as did indications for use of MRI. Technological improvements are briefly highlighted. Studies are broadly categorized and discussed according to the role of MRI in patient selection, disease staging, and monitoring in AS protocols.

Conclusions: Although improvements in MRI technology have been useful for biopsy guidance and in the diagnosis and staging of PCa, this literature search demonstrates that more prospective research is needed, specifically regarding how this promising technology can be incorporated into AS protocols.
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http://dx.doi.org/10.1016/j.urolonc.2016.02.020DOI Listing
July 2016

Natural biology and management of nonmuscle invasive bladder cancer.

Curr Opin Oncol 2016 May;28(3):210-5

Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Purpose Of Review: This article reviews the natural biology of noninvasive bladder cancer and its management strategies while summarizing the most recent advances in the field.

Recent Findings: Nonmuscle invasive bladder cancer (NMIBC) has a tendency to recur and progress. Risk stratification has helped triage patients but improved tools, including biomarkers, are still needed. Enhanced endoscopy with photodynamic imaging, narrow band imaging, optical coherence tomography and confocal laser endomicroscopy show promise for diagnosis, risk stratification and disease monitoring. Attempts at better treatment, especially in refractory high-risk cases, include the addition of intravesical hyperthermia, combination and sequential therapy with existing agents and the use of novel agents such as mycobacterial cell wall extract. New data are emerging regarding the potential role of active surveillance in low-risk patients.

Summary: NMIBC represents a variety of disease states and continues to pose management challenges. As our understanding of tumor biology improves and technology advances, achieving better outcomes through individualized care may be possible.
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http://dx.doi.org/10.1097/CCO.0000000000000278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390683PMC
May 2016

Optimal management of muscle-invasive bladder cancer - a review.

Res Rep Urol 2015 4;7:143-51. Epub 2015 Sep 4.

Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.

Muscle-invasive bladder cancer is a complex disease requiring aggressive management. Patients are often older with comorbid conditions that impact treatment options. This review describes the available therapies for invasive urothelial carcinoma, including chemotherapy, radical extirpative surgery, and bladder-preserving strategies.
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http://dx.doi.org/10.2147/RRU.S73566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567228PMC
September 2015

Management of noninvasive bladder cancers.

Curr Opin Oncol 2015 May;27(3):185-90

Department of Urological Surgery, Vanderbilt University Medical Center, South Nashville, Tennessee, USA.

Purpose Of Review: To summarize clinical management of nonmuscle-invasive bladder cancer (NMIBC) and discuss recent advances in the field.

Recent Findings: NMIBC remains a common and expensive clinical entity. Prevention, early detection, and risk-adapted treatment are the mainstays of clinical management, all of which may improve as a result of recent research. Photodynamic diagnosis has demonstrated improved detection of nascent disease, and specific clinical scenarios have been identified in which photodynamic diagnosis may improve clinical outcomes. New intravesical chemotherapeutic and immunotherapeutic agents challenge our current paradigm for intermediate/high-risk NMIBC and may delay need for cystectomy after bacillus Calmette-Guerin failure. Progress in risk stratification increasingly permits individualized management regimens for NMIBC.

Summary: NMIBC includes many heterogeneous disease states with a variety of clinical behaviors that may evolve over time. Improved detection and risk stratification promise assignment of the optimal treatment option for an individual patient at a given time.
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http://dx.doi.org/10.1097/CCO.0000000000000173DOI Listing
May 2015

Editorial comment.

J Urol 2014 Sep 10;192(3):736. Epub 2014 Jun 10.

Division of Urology, University of Connecticut, Farmington, Connecticut.

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http://dx.doi.org/10.1016/j.juro.2014.04.107DOI Listing
September 2014

Macrophage migratory inhibitory factor promotes bladder cancer progression via increasing proliferation and angiogenesis.

Carcinogenesis 2013 Dec 3;34(12):2891-9. Epub 2013 Jul 3.

Division of Urology.

Macrophage migratory inhibitory factor (MIF) is a proinflammatory cytokine shown to promote tumorigenesis. Using the N-butyl-N-(4-hydroxybutyl)-nitrosamine (BBN) model of bladder cancer, we previously showed that MIF knockout mice display decreased angiogenesis and invasion compared with wild-type. This study examines the role of MIF in bladder cancer via use of oral inhibitors of MIF. In vitro, high-grade bladder cancer cells were treated with recombinant human MIF +/- (rhMIF+/-) inhibitor. Measurements included cell counts, proliferation by (3)H-thymidine incorporation (TdR), extracellular signal-regulated kinase (ERK) phosphorylation by western blot analysis, messenger RNA (mRNA) expression by quantitative PCR and protein secretion by enzyme-linked immunosorbent assay. Treatment with rhMIF increased ERK phosphorylation, cell counts, TdR and mRNA expression and protein secretion of vascular endothelial growth factor, which were blocked by specific inhibitors of ERK and MIF. In vivo, 3-month-old male C57Bl/6 mice were given BBN for 22 and 16 weeks in study 1 and study 2, respectively. Mice (n = 8-10 per group) were gavaged with vehicle or doses of MIF inhibitors daily from weeks 16-22 in both studies. Average bladder weights, reflecting tumor mass, tumor stage/burden, mitotic rate and proliferation indices, and microvessel densities were reduced in inhibitor groups versus controls. In summary, MIF promotes bladder cancer via increasing cell proliferation and angiogenesis and oral inhibitors of MIF may prove useful in treatment of this disease.
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http://dx.doi.org/10.1093/carcin/bgt239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845890PMC
December 2013

Does heparin prophylaxis reduce the risk of venous thromboembolism in patients undergoing robot-assisted prostatectomy?

J Endourol 2013 Jun 6;27(6):800-3. Epub 2013 Mar 6.

Department of Urology, University of Connecticut Medical Center, Farmington, CT 06030, USA.

Background And Purpose: Venous thromboembolism (VTE) is a major complication of urologic surgery. Data are limited regarding the benefits of heparin prophylaxis for patients undergoing minimally invasive urologic surgery. The American Urological Association recommends sequential compression devices (SCDs) for urologic laparoscopic and robot-assisted procedures but provides no clear recommendations for the use of pharmacologic prophylaxis. We compare the rates of postoperative VTE in two groups of patients undergoing robot-assisted prostatectomy (RP) by two surgeons-one who consistently used heparin with SCDs (group 1) and the other who used SCDs alone (group 2) for prophylaxis.

Patients And Methods: An Institutional Review Board approved, prospectively managed database was analyzed. Group 1 received SCDs just before induction and 5000 units of heparin subcutaneously just after induction. SCDs were continued postoperatively, and heparin was administered twice a day until discharge. VTE rate, patient age, body mass index (BMI), operative time, lymphocele rate, length of stay (LOS), estimated blood loss (EBL), Gleason score, and pathologic stage were compared. Categorical variables were analyzed with the chi square test of proportions and continuous variables with t test using SPSS v 14 software.

Results: There were 1486 consecutive patients who underwent RP between August 2007 and December 30, 2011. Of these, 922 patients received heparin/SCDs and 564 received SCDs alone. Age, BMI, EBL, medial LOS, Gleason score, and pathologic stage were the same in the two groups. There was a higher rate of positive nodes in group 2 (1.3% vs 3.5%). There was one lymphocele in each group. Although operative times were longer in group 2 (229 vs 170 min, P<0.001), the incidence of VTE was not statistically different (1.0% vs 0.7%, P=0.78). BMI, operative time, EBL, and the performance of lymph node dissection were not associated with VTE.

Conclusions: The risk of VTE in patients undergoing RP is low and not significantly reduced with the administration of prophylactic heparin/SCDs compared with SCDs alone.
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http://dx.doi.org/10.1089/end.2012.0532DOI Listing
June 2013

Primary renal synovial sarcoma in a 13-year-old boy.

J Pediatr Surg 2011 Sep;46(9):1849-51

Department of Urology, University of Connecticut School of Medicine, Farmington, CT 06030, USA.

Primary renal synovial sarcoma is a rare entity with fewer than 40 cases reported in the literature. Its clinical presentation and radiographic features, namely, its often complex cystic appearance, make it difficult to differentiate from other benign or malignant renal lesions. Although there are certain consistent morphological and immunohistochemical features, diagnosis ultimately depends on molecular studies. Prognosis is poor, and there currently exists no defined treatment protocol. Herein, we describe the youngest reported case of primary renal synovial sarcoma in the literature.
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http://dx.doi.org/10.1016/j.jpedsurg.2011.06.034DOI Listing
September 2011

Polymorphic mucin antigens CpMuc4 and CpMuc5 are integral to Cryptosporidium parvum infection in vitro.

Eukaryot Cell 2009 Apr 23;8(4):461-9. Epub 2009 Jan 23.

Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA 02111, USA.

Cryptosporidium, a waterborne enteric parasite, is a frequent cause of diarrheal disease outbreaks worldwide. Thus far, the few antigens shown to be important for attachment to and invasion of the host cell by Cryptosporidium are all mucin-like glycoproteins. In order to investigate other antigens that could be important for Cryptosporidium host-parasite interactions, the Cryptosporidium genome databases were mined for other mucin-like genes. A single locus of seven small mucin sequences was identified on chromosome 2 (CpMuc1 to -7). Reverse transcriptase PCR analysis demonstrated that all seven CpMucs were expressed throughout intracellular development. CpMuc4 and CpMuc5 were selected for further investigation because of the significant sequence divergence between Cryptosporidium parvum and C. hominis alleles. Rabbit anti-CpMuc5 and -CpMuc4 antibodies identified several polypeptides in C. parvum lysates, suggestive of proteolytic processing of the mucins. All polypeptides were larger than the predicted molecular weight, which is suggestive of posttranslational processing, most likely O-glycosylation. In immunofluorescence assays, both anti-CpMuc4 and -CpMuc5 antibodies reacted with the apical region of sporozoites and revealed surface-exposed epitopes. The antigens were not shed during excystation but did partition into the aqueous phase of Triton X-114 extractions. Consistent with a role in attachment and invasion, CpMuc4 and CpMuc5 could be detected binding to fixed Caco-2A cells, and anti-CpMuc4 peptide antibodies inhibited Cryptosporidium infection in vitro. Sequencing of CpMuc4 and CpMuc5 from C. hominis clinical isolates identified several polymorphic alleles. The data suggest that these antigens are integral for Cryptosporidium infection in vitro and may be potential vaccine candidates.
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http://dx.doi.org/10.1128/EC.00305-08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669191PMC
April 2009
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