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patients with localized osteosarcoma of the extremity were treated with neoadjuvant chemotherapy. Preoperative chemotherapy consisted of two cycles of methotrexate (MTX) (high or moderate doses) followed by 6 days by cisplatin (CDP). Surgery was an amputation or a rotation plasty, or a limb salvage. Necrosis was good in 52% of cases, fair in 36%, and poor in 12%. Postoperative chemotherapy consisted of Adriamycin (doxorubicin [ADM]) and bleomycin (BCD) for poor responders; and ADM, MTX, and CDP for fair responders. Good responders were treated as fair responders or with only MTX and CDP. At a 47-month follow-up, 66 patients remained continuously disease free and 61 patients developed metastases. Six of these patients had also a local recurrence. According to the grade of necrosis, the cumulative disease-free probability at 5 years was 67% for good responders, 42% for fair responders, and for poor responders 10% at 45 months. According to the doses of MTX, survival at 5 years was 58% for patients who received high doses and 42% for patients treated with moderate doses. No differences in the rate of survivors were observed between amputated patients and patients treated with limb salvage. The authors conclude that (1) a limb salvage procedure is possible in about 70% of cases and as safe as demolitive surgery, if adequate surgical margins are achieved; (2) good responders have a better prognosis than fair and poor responders if postoperative chemotherapy is sufficiently prolonged and also includes ADM; (3) a different postoperative chemotherapy for poor responders did not improve their prognosis: and (4) a multidrug regimen using high doses of MTX is probably more effective than moderate doses.

PurposeEarly surgical management is the standard of care for penile fracture. Conservative treatment is an option with recent reports revealing lower success rates. We reviewed the data and long-term outcomes of patients with penile injury submitted to surgical or conservative treatment.Materials and MethodsBetween January 2004 and February 2012, 42 patients with penile blunt trauma on an erect penis were admitted to our center. We analyzed the following variables: age, etiology, symptoms and signs, diagnostic tests, treatment used, complications and erectile function during the follow-up. One patient was excluded due to missing information. Thirty-five patients underwent surgical repair and 6 patients were submitted to conservative management.ResultsMean follow-up was 19.2 months (range, 7 days to 72 months). The mean elapsed time from trauma to surgery was 21.3±12.5 hours. Trauma during sexual relationship was the main cause (80.9%) of penile fracture. Urethral injury was present in five patients submitted to surgery. Dorsal vein injury occurred in three patients with false penile fracture and concomitant spongious corpus lesion was present in three patients. During follow-up, 31 cases (88.6%) of the surgical group and four cases (66.7%) of the conservative group reported sufficient erections for intercourse, with no voiding dysfunction and no penile curvature. However, the remaining two patients (33.3%) from the conservative group developed erectile dysfunction and three patients (50%) developed penile deviation.ConclusionsSurgical approach provides excellent functional outcomes and lower complications. Early surgical management of penile fracture provides superior results and conservative approach should be avoided.

There are successful protocols for dispersing carbon nanotubes and graphene oxide in physiological media by using biocompatible polymers, which enable their use in nanomedicine. However, there is not a clear understanding regarding the mechanisms of the colloidal stabilization manifested (i.e., electric, steric or electrosteric or through depletion forces). Here we show that the manifestation of a particular mechanism of stabilization for oxidized carbon nanotubes (CNTs) and graphene oxide (GO) in the presence of Pluronic F-127 (PF127) and short-and long-chain polyethylene glycol (PEG 1,500 or 35,000 respectively) depends on a proper matching between the nanocarbon morphology and the polymer chain length, chemical structure and concentration. The high aspect ratio one dimensional morphology of CNTs enables an initial steric and electrosteric stabilization through the nanotube wrapping (i.e., adsorption) by PF127 present in low concentrations (<0.1%). Depletion stabilization for CNTs manifests when PF127 is present in high concentrations (≥1.0%), thus enabling the formation of highly stable CNT colloids even in a 0.9% NaCl saline solution. This depletion stabilization depends little on the CNT structure (i.e., single-or multi-wall), surface charge (i.e., zeta potential), oxidation and carboxylation degree or the nanotube length. On the other hand, large-sized sheets of GO could be colloidally stabilized in NaCl 0.9% only in the presence of PEG 35,000 through repulsive depletion forces, whose manifestation occurs with a polymer concentration threshold of 5.0 wt%. Comparatively, in a physiological saline solution, PF127 is able to colloidally stabilize CNTs to a much large extent than PEG 35,000 stabilizes the large GO sheets.

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The present work seeks to evaluate the biocompatibility of experimental glass ionomer cements (GIC) prepared from niobium-calcium fl uoro-alumino-silicate glass powder and two commercial GICs. The GICs were implanted into the subcutaneous connective tissue of sixty rats. The rats were sacrifi ced during four varying time periods: 7, 15, 30, and 60 days and histopathological examinations were then performed. The Kruskal-Wallis test was performed to evaluate any signifi cant differences between the materials. Additionally, multiple comparisons of the mean rank were also carried out using the Dunn test (p<0.05). No signifi cant differences were observed that one GIC was superior to the other. The tissue response for all of the GICs tested was similar in all the periods examined.

BackgroundParagangliomas (PGL) are rare tumors derived from neural crest cells, whose origins may vary along the chain of the sympathetic nervous system. Such tumors are often characterized by secretion of catecholamines, but sometimes they are biochemically inactive, which makes diagnosis often challenging. Malignant paraganglioma is defined by the presence of this tumor at sites where chromaffin cells are usually not found or by local invasion of the primary tumor. Recurrence, either regional or metastatic, usually occurs within 5 years of the initial complete resection but long-term recurrence is also described. Malignancy is often linked to a SDHB mutation. Preoperative embolization has been applied in the surgical management of PGLs with the objective to decrease intra-operative blood loss and surgery length without complications.Case PresentationWe report two cases of patients with abdominal or pelvic malignant PGLs who have been treated surgically at our center after preoperative embolization. Surgery was a very challenging procedure with multiple surgical teams involved and embolization did not prevent major blood loss and intraoperative complications. Patients required adjuvant treatment with either chemotherapy or radiotherapy.ConclusionsMany studies in the adult population have established recommendations for the diagnosis and therapeutic management of PGL, but few studies concern the pediatric population. Because malignant PGL is more important in the pediatric population, screening and early diagnosis of PGL is advisable in children with genetic predisposing. Surgical resection is the mainstay of treatment, but a multimodal approach is often required due to the complexity of cases.  The role of preoperative embolization is not established and in our experience it has provided little benefit and major complications.

Objective: To evaluate the length hospital stay and predictors of prolonged hospitalization after RRP performed in a high-surgical volume teaching institution, and analyze the rate of unplanned visits to the office, emergency care, hospital readmissions and perioperative complications rates. Materials and Methods: Retrospective analysis of prospectively collected data in a standardized database for patients with localized prostate cancer undergoing RRP in our institution between January/2010 - January/2012. A logistic regression model including preoperative variables was initially built in order to determine the factors that predict prolonged hospital stay before the surgical procedure; subsequently, a second model including both pre and intraoperative variables was analyzed. Results: 1011 patients underwent RRP at our institution were evaluated. The median hospital stay was 2 days, and 217 (21.5%) patients had prolonged hospitalization. Predictors of prolonged hospital stay among the preoperative variables were ICC (OR. 1.40 p=0.003), age (OR 1.050 p<0.001), ASA score of 3 (OR. 3.260 p<0.001), prostate volume on USG-TR (OR, 1.005 p=0.038) and African-American race (OR 2.235 p=0.004); among intra and postoperative factors, operative time (OR 1.007 p=0.022) and the presence of any complications (OR 2.013 p=0.009) or major complications (OR 2.357 p=0.01) were also correlated independently with prolonged hospital stay. The complication rate was 14.5%. Conclusions: The independent predictors of prolonged hospitalization among preoperative variables were CCI, age, ASA score of 3, prostate volume on USG-TR and African-American race; amongst intra and postoperative factors, operative time, presence of any complications and major complications were correlated independently with prolonged hospital stay.