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BACKGROUND: The assessment of lymphovascular invasion (LVI) on the specimens of a transurethral resection of bladder tumors (TURBT) is very important for risk stratification and decision-making on further treatment for bladder cancer. OBJECTIVES: The present study aimed to identify clinical predictors associated with the risk of bladder cancer with LVI before a first TURBT. METHODS: A total of 291 patients underwent a first TURBT for bladder cancer at Toho University Sakura Medical Center between January 2012 and December 2016. We analyzed predictors of LVI based on data from 217 patients and predictors of high grade and ≥ pT1 tumors based on data from the medical records of 237 patients for comparison with LVI risk factors. RESULTS: Univariate analysis significantly associated LVI with episodes of gross hematuria, positive urinary cytology, and larger, non-papillary and sessile tumors. Multivariate analysis selected larger tumors [odds ratio (OR) 1.39; 95 % confidence interval (CI) 1.08-1.78; p = 0.01], and non-papillary (OR 10.05; 95% CI 3.75-26.91; p < 0.01) and sessile (OR 2.65; 95% CI 1.18-5.93; p = 0.02) tumors as significant predictors of LVI. Some predictors such as tumor size and non-papillary tumors overlapped between high-grade and ≥ pT1 bladder cancer. CONCLUSIONS: These predictors can help clinicians to identify patients with, or who are at high-risk for LVI before undergoing a first TURBT and to determine priorities for preoperative evaluation and scheduling consecutive treatments.

(1) Background: This study aimed to evaluate the associations of lymphovascular invasion (LVI) at first transurethral resection of bladder (TURBT) and radical cystectomy (RC) with survival outcomes, and to evaluate the concordance between LVI at first TURBT and RC. (2) Methods: We analyzed 216 patients who underwent first TURBT and 64 patients who underwent RC at Toho University Sakura Medical Center. (3) Results: LVI was identified in 22.7% of patients who underwent first TURBT, and in 32.8% of patients who underwent RC. Univariate analysis identified ≥cT3, metastasis and LVI at first TURBT as factors significantly associated with overall survival (OS) and cancer-specific survival (CSS). Multivariate analysis identified metastasis (hazard ratio (HR) 6.560, p = 0.009) and LVI at first TURBT (HR 9.205, p = 0.003) as significant predictors of CSS. On the other hand, in patients who underwent RC, ≥pT3, presence of G3 and LVI was significantly associated with OS and CSS in univariate analysis. Multivariate analysis identified inclusion of G3 as a significant predictor of OS and CSS. The concordance rate between LVI at first TURBT and RC was 48.0%. Patients with positive results for LVI at first TURBT and RC displayed poorer prognosis than other patients (p &lt, 0.05). (4) Conclusions: We found that the combination of LVI at first TURBT and RC was likely to provide a more significant prognostic factor.

Background: This study aimed to evaluate the associations of lymphovascular invasion (LVI) at first transurethral resection of bladder (TURBT) and radical cystectomy (RC) with survival outcomes, and to evaluate the concordance between LVI at first TURBT and RC. Methods: We reviewed 216 patients who underwent first TURBT and 64 patients who underwent RC at our hospital. Medical records were reviewed uniformly, collecting the following data: age, sex, clinical and pathological T stage, neoadjuvant chemotherapy, grade, metastasis, urinary cytology, carcinoma in situ and LVI. Results: LVI was identified in 22.7% of patients who underwent first TURBT, and 32.8% of patients who underwent RC. Univariate analysis identified ≥cT3, metastasis and LVI at first TURBT as factors significantly associated with overall survival (OS) and cancer-specific survival (CSS). Multivariate analysis identified metastasis (hazard ratio (HR) 6.560, p=0.009) and LVI at first TURBT (HR 9.205, p=0.003) as significant predictors of CSS. On the other hand, in patients who underwent RC, ≥pT3, inclusion of G3 and LVI were significantly associated with OS and CSS in univariate analysis. Multivariate analysis identified inclusion of G3 as a significant predictor of OS and CSS. The concordance rate between LVI at first TURBT and RC was 48.0%. Patients with positive results for LVI at first TURBT and RC displayed poorer prognosis than other patients (p

The aim of this study was to identify the clinical predictors related to the risk of high-grade papillary bladder cancer before first-time transurethral resection of a bladder tumor (TUR-Bt), and to develop and validate a nomogram predicting the risk of high-grade papillary bladder cancer. A retrospective clinical study of consecutive patients who underwent first-time TUR-Bt for papillary bladder cancer was performed. Medical records were reviewed uniformly, and the following data were collected: age, sex, episodes of urinary symptoms, tumor size, number of tumors, location of the largest tumor (lateral walls, base, posterior wall, dome, and anterior wall), tumor appearance (papillary or non-papillary, pedunculated or sessile), and urinary cytology. Data from 254 patients (Group A) were used for the development of a nomogram, while data from 170 patients (Group B) were used for its external validation. High-grade papillary bladder cancer was pathologically diagnosed in 51.6 and 74.6% of Group A and Group B patients, respectively. Based on univariable analyses in Group A, macrohematuria, tumor size, multiple tumors, appearance, and positive urinary cytology were selected as variables to incorporate into a nomogram. The AUC value was 0.81 for the internal validation (Group A), and 0.78 for the external validation (Group B). This novel nomogram can predict high-grade papillary bladder cancer accurately. The present nomogram can help clinicians calculate the probability in patients with bladder cancer before TUR-Bt and decide on earlier intervention and priorities for the treatment of patients diagnosed with bladder cancer.

The present study aimed to validate and compare the predictive accuracies of the Memorial Sloan Kettering Cancer Center (MSKCC) and Johns Hopkins University (JHU) web-based postoperative nomograms for predicting early biochemical recurrence (BCR) after radical prostatectomy (RP) and to analyze clinicopathological factors to predict early BCR after RP using our dataset. The c-index was 0.72 (95% confidence (CI): 0.61-0.83) for the MSKCC nomogram and 0.71 (95% CI: 0.61-0.81) for the and JHU nomogram, demonstrating fair performance in the Japanese population. Furthermore, we statistically analyzed our 174 patients to elucidate prognostic factors for early BCR within 2 years. Lymphovascular invasion (LVI) including lymphatic vessel invasion (ly) was a significant predictor of early BCR in addition to common variables (pT stage, extraprostatic extension, positive surgical margin and seminal vesicle invasion). LVI, particularly ly, may provide a good predictor of early BCR after RP and improve the accuracy of the nomograms.

A 2'S metastable helium atomic beam injector was studied for a beam probe of electric field diagnoses, which is applicable to high electric potential region in Inertial Electrostatic Confinement Fusion (IECF) plasmas where a solid probe can hardly be utilized. With deuterium background gas (∼0.1Pa) which is the minimum operation pressure of the IECF devices, the beam density was found to decrease ten times lower than beam density without background gas because of collisional effect. Also, plasma parameters in a-magnetron-discharge-based exciter were evaluated by means of Langmuir probe and emission spectroscopy. These results strongly imply a high excitation rate of ∼10 -4 into 2'S metastable state.

The methods designed for the repair of a complete cleft lip should not be used to repair an incomplete cleft lip. This results too often in the postoperative drooping of the white lip on the affected side because in most incomplete cleft lips there is more tissue on the cleft side than in complete cleft lip. We present and discuss the refinements we made in our original technique for complete cleft lip in order to adapt it to incomplete cleft lip repair. The skin design at the white skin roll follows Cronin's method with an incision perpendicular to the vermilion border. The suture that pulls the edges of the angular incisions together pushes on the white skin roll caudally. This ensures that the peak of the Cupid's bow on the cleft side does not droop postoperatively. It also ensures that it does not take on an acute angle and that the vermilion border will be a continuous line without a break. We do not create a triangular flap at the vermilion border, but we raise a triangular flap at the alar base on the cleft side and advance it to the bottom of the columella. This creates the nostril sill and corrects the flared alar base. The resulting suture line is completely straight and runs along the philtral column. In this way, the postoperative elongation of the white lip on the cleft side can be prevented.

For secondary repair of a bilateral cleft lip deformity with a short columella and defective upper lip, simultaneous correction of the lip and nose is ideal. We perform a nasal repair through a bilateral reverse-U incision and columella elongation using the upper lip. An Abbé flap is then transferred to the upper lip defect. This procedure enables total reconstruction of characteristic bilateral cleft lip deformities in one stage. We have applied this method to 15 patients (9 males and 6 females) with an average age of 18.7 years. Although some patients need jaw surgery, all have been satisfied with the results.

Hard palate mucosa is thick and rigid. Grafted with its periosteal layer, it can be a supportive material. Simultaneously, wound healing of the palatal donor site is very rapid and the patient does not experience any pain. Such characteristics of the palatal mucosal graft have led to its use in reconstruction of the eyelids, including the tarsal plate. Nevertheless, there have been very few reports on its use in this are of the face. Herein we report the use of the palatal mucosal graft in reconstruction of the eye sockets.

Prostaglandin E1 has been proven to be useful in the treatment of vascular diseases of the lower leg. Plastic surgeons have been aware of its usefulness in augmenting flap survival and have used it intraarterially or intravenously. We attempted to enhance the effect of prostaglandin E1 with heparin by local continuous intraarterial infusion of both drugs. First, we assessed the viability area of an experimental island flap model on rabbit abdomen, and confirmed the usefulness of this method. Next, we attempted to develop clinical cases using Seldinger's method. By this method, we were able to rescue the flaps with circulatory insufficiency and gain a larger survival area of an axial pattern flap.

Lagophthalmos caused by trauma or inflammation may damage the cornea and, if not adequately treated, may result in loss of eyesight. Hence surgical intervention is required at the earliest possible stage. We have developed a subcutaneous pedicle flap elevated from the temporozygomatic area and rotated 180 degrees around a small pedicle base that contains the orbicularis oculi muscle. With this flap, the entire upper eyelid can be reconstructed as an aesthetic unit in one stage so that the result is satisfactory not only functionally, but also cosmetically. The operative procedure is presented along with case reports.

SUMMARY. A technique is presented for the correction of the whistling deformity of the upper lip, which is commonly seen in patients with repaired bilateral cleft lip. Two opposing transposition flaps based on the central portion of the upper vermilion are used. The shape of these flaps resembles a two-bladed propeller, thus we call the technique the “propeller flap”. Each of the blades is rotated MO” and the resulting dog-ear helps to add volume to the upper lip tubercle. Some representative cases are presented. A common consequence of primary repair of the bilateral cleft lip is a whistling deformity of the upper lip. The tissue deficiency of the original prolabium is thought to be responsible for this. To correct the deformity, we report a technique for reconstruction of the upper lip tubercle.