Surgical Techniques to Optimize Early Urinary Continence Recovery Post Robot Assisted Radical Prostatectomy for Prostate Cancer.

PURPOSE OF REVIEW: A variety of different surgical techniques are thought to impact on urinary continence (UC) recovery in patients undergoing robot assisted radical prostatectomy (RARP) for prostate cancer. Herein, we review current evidence and propose a composite evidence-based technique to optimize UC recovery after RARP. RECENT FINDINGS: A literature search on studies reporting on surgical techniques to improve early continence recovery post robotic prostatectomy was conducted on PubMed and EMBASE. The available data from studies ranging from randomized control trials to retrospective cohort studies suggest that minimizing damage to the internal and external urinary sphincters and their neural supply, maximal sparing of urethral length, creating a secure vesicourethral anastomosis, and providing anterior and posterior myo- fascio-ligamentous support to the anastomosis can improve early UC recovery post RARP. A composite evidence-based surgical technique incorporating the above principles could optimize early UC recovery post RARP. Evidence from randomized studies is required to prove benefit

Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe†‡

OBJECTIVES To conduct a survey across European cardiac centres to evaluate the methods used for cerebral protection during aortic surgery involving the aortic arch. METHODS All European centres were contacted and surgeons were requested to fill out a short, comprehensive questionnaire on an internet-based platform. One-third of more than 400 contacted centres completed the survey correctly. RESULTS The most preferred site for arterial cannulation is the subclavian-axillary, both in acute and chronic presentation. The femoral artery is still frequently used in the acute condition, while the ascending aorta is a frequent second choice in the case of chronic presentation. Bilateral antegrade brain perfusion is chosen by the majority of centres (2/3 of cases), while retrograde perfusion or circulatory arrest is very seldom used and almost exclusively in acute clinical presentation. The same pumping system of the cardio pulmonary bypass is most of the time used for selective cerebral perfusion, and the perfusate temperature is usually maintained between 22 and 26°C. One-third of the centres use lower temperatures. Perfusate flow and pressure are fairly consistent among centres in the range of 10-15 ml/kg and 60 mmHg, respectively. In 60% of cases, barbiturates are added for cerebral protection, while visceral perfusion still receives little attention. Regarding cerebral monitoring, there is a general tendency to use near-infrared spectroscopy associated with bilateral radial pressure measurement. CONCLUSIONS These data represent a snapshot of the strategies used for cerebral protection during major aortic surgery in current practice, and may serve as a reference for standardization and refinement of different approache

Differential diagnosis of bacterial and viral meningitis in childhood acute meningitis: A statistical model [Çocukluk çagi akut menenji·t olgularinda bakteri·yel ve vi·ral menenji·ti·n ayirici tanisi: İstati·sti·ksel bi·r model]

Acute bacterial meningitis (BM) which is a pediatric emergency with high mortality and morbidity, must be diagnosed and treated promptly. There is no unique method to prove or rule out the diagnosis of BM in a patient with cerebrospinal fluid (CSF) findings consistent with BM but negative Gram stain and culture results. For this purpose the combination of CSF parameters are used for diagnosis. The aims of this study were to compare retrospectively the mean leukocyte count, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), CSF leukocyte and neutrophil, CSF protein and glucose values in 40 bacterial and 29 viral meningitis (VM) patients, ages between 1 month and 14 years, and to develop a statistical model for the differentiation of BM and VM cases. Logistic regression analysis was used to investigate the relationship between BM and age, CRP, ESR, leukocyte count, CSF leukocyte, neutrophil, protein and glucose values. Based on CSF protein and neutrophil ratio which were found as independent variables, the regression model could predict the patients having BM with 95% and viral meningitis with 93.2% accuracy