Abdominal wall paresis as a complication of laparoscopic surgery

Purpose: Abdominal wall nerve injury as a result of trocar placement for laparoscopic surgery is rare. We intend to discuss causes of abdominal wall paresis as well as relevant anatomy. Methods: A review of the nerve supply of the abdominal wall is illustrated with a rare case of a patient presenting with paresis of the internal oblique muscle due to a trocar lesion of the right iliohypogastric nerve after laparoscopic appendectomy. Results: Trocar placement in the upper lateral abdomen can damage the subcostal nerve (Th12), caudal intercostal nerves (Th7-11) and ventral rami of the thoracic nerves (Th7-12). Trocar placement in the lower abdomen can damage the ilioinguinal (L1 or L2) and iliohypogastric nerves (Th12-L1). Pareses of abdominal muscles due to trocar placement are rare due to overlap in innervation and relatively small sizes of trocar incisions. Conclusion: Knowledge of the anatomy of the abdominal wall is mandatory in order to avoid the injury of important structures during trocar placement

Stamm Gastrostomy for Postoperative Gastric Decompression in Gynecologic Oncology Patients

Objective. The aim of this study was to report our experience with Stamm gastrostomy for postoperative gastric decompression on a gynecologic oncology service. Methods. This was an observational study over the 9-year period ending in October 2000. A 24 French MIC gastrostomy with the Stamm technique was used. Criteria for a gastrostomy are outlined in the text and tubes placed for palliation were excluded. Patients were followed to determine length of open drainage, time to removal, related complications, and those who may have benefited. Results. A total of 167 patients had 174 nonpalliative gastrostomy tubes placed. Nine percent of the patients had related complications with a major complication rate of 2%. Overall, approximately one-third of the patients appeared to benefit from the gastrostomy tube. Conclusion. The results support the safety and efficacy of the MIC gastric tube in patients undergoing extensive gynecologic cancer surgery which is likely to impact the function of the gastrointestinal tract

Biphasic pulses enhance bleomycin efficacy in a spontaneous canine perianal tumors model

Perianal tumors (adenoma and carcinoma of the hepatoid glands) are frequently reported in veterinary literature. They are locally aggressive tumors with a low tendency to metastatic spread. An hormonal ethiology has been identified for the development of perianal adenomas in male dogs, while the carcinomas are free from hormonal influence. Standard treatments include surgery, cryotherapy or, in selected cases, radiation therapy. In this article we describe the outcome of a small cohort of canine patients with perianal tumors treated with bleomycin selectively driven by trains of biphasic pulses (electrochemotherapy). Twelve canine patients, eight with adenoma and four with carcinoma of the perianal glands, entered the study and received two sessions of ECT under sedation. The pets had local injection of bleomycin at the concentration of 1.5 mg/mg and five minutes after the chemotherapy, trains of 8 biphasic electric pulses lasting 50 + 50 μs each, with 1 ms interpulse intervals, were delivered by means of modified caliper and needle array electrodes or, for difficult districts, through paired needle electrode. The overall response rate was 91% with a 83% of complete response (10/12); one dog had a PR that lasted 12 months and another had progressive disease. Electrochemotherapy appears as a safe and efficacious modality for the treatment of perianal tumors and warrants further investigations

Electroanalytical exploitation of quinone-thiol interactions: application to the selective determination of cysteine.

Square wave voltammetry was applied to the detection of cysteine through the use of an indirect assay that exploits the reaction of the thiol with a quinone indicator. Voltammetric discrimination between unreacted quinone and the corresponding quinone-cysteine adduct is possible with clear resolution of the latter peak providing a linear response from 5 to 47 microM. The selectivity of the approach was assessed with no interference from cystine, lysine, paracetamol or 4-aminophenol. The response recorded in the presence of a massive excess of ascorbic acid was also investigated and the integrity of the approach confirmed. The effects of other sulfhydryl thiols, homocysteine and glutathione, were also assessed and found to present no appreciable change in the voltammetric profile. The practical utility of the approach was investigated through examining the response to cysteine in urine

Electroanalytical exploitation of quinone-thiol interactions: application to the selective determination of cysteine

Square wave voltammetry was applied to the detection of cysteine through the use of an indirect assay that exploits the reaction of the thiol with a quinone indicator. Voltammetric discrimination between unreacted quinone and the corresponding quinone-cysteine adduct is possible with clear resolution of the latter peak providing a linear response from 5 to 47 microM. The selectivity of the approach was assessed with no interference from cystine, lysine, paracetamol or 4-aminophenol. The response recorded in the presence of a massive excess of ascorbic acid was also investigated and the integrity of the approach confirmed. The effects of other sulfhydryl thiols, homocysteine and glutathione, were also assessed and found to present no appreciable change in the voltammetric profile. The practical utility of the approach was investigated through examining the response to cysteine in urine

Cost of illness of urothelial bladder cancer in Italy

Claudio Gerace,1 Francesco Montorsi,2 Rosa Tambaro,3 Giacomo Cartenì,4 Stefano De Luca,5 Marcello Tucci,6 Giuseppe Martorana,7 Umberto Basso,8 Leonardo Cardosi,1 Cristina Teruzzi1 1Temas s.r.l.-QuintilesIMS, Integrated Market Access Department, 2Department of Urology, IRCCS Ospedale San Raffaele, Milano, Italy; 3Department of Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy; 4A.O.R.N. A. Cardarelli, Unità Operativa Complessa di Oncologia Medica, Napoli, Italy; 5Department of Urology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Torino Italy; 6Department of Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Torino Italy; 7Department of Urology, Ospedale Policlinico S. Orsola-Malpighi, Bologna, Italy; 8Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IRCCS, Padova, Italy Background: Urothelial bladder cancer (UBC) is the ninth most common cancer worldwide. In Italy, the prevalence of the disease is approximately 10%, making it the fourth most prevalent cancer in the country. The increase in prevalence requires continuous surveillance and care, resulting in a significant burden on Italian National Health Service, making any improvement to the strategy for diagnosing and treating this disease important to the medical and scientific community. The aim of this study was to evaluate the UBC cost of illness in the Italian context, collecting the total costs of the disease.Methods: An economic analysis was carried out in the context of the National Health Service, using data collected from six centers, in order to evaluate direct costs in terms of outpatient, inpatient, and emergency care; pharmaceuticals and follow-up procedures; and indirect costs in terms of productivity losses. Data were collected through aggregated form reports, focusing on patients with an existing diagnosis of UBC who were treated in the last year. The Italian Association of Medical Oncology (AIOM) guidelines were used to identify diagnostic and therapeutic procedures. Statistical analysis was conducted to explore variations among centers.Results: The weighted mean total annual cost per patient was € 3,591, where the cost for superficial disease was € 3,252 and that for metastatic disease was € 606. The analysis confirmed a proportional relation between disease severity and disability grade. The UBC cost of illness, considering prevalence and incidence data coming from the 2016 AIOM/Italian Association of Cancer Registries report, was € 1,187,036,344. Indirect costs accounted to 44%, represented by estimated productivity losses.Conclusion: Our analysis represents the first economic study of UBC in the Italian context, as well as the first real-life evidence of the current therapeutic algorithm. This study opens the possibility for further analysis on the indirect cost components that represent a great burden for the society, especially for those in the severest stages of the disease with high disability grades. Keywords: cost of illness, cost analysis, economic evaluation, urothelial bladder cancer, direct costs, indirect cost

Exploring urban verticality during the 2011 flood in Bangkok, Thailand

Geographers have a long-established research interest in the ways infrastructures shape urban flood vulnerability and how urbanites cope with urban flooding. In this paper, I contribute to this literature by exploring the three-dimensional city during an urban flooding situation. Within a case study (based on interviews and ethnographic observations), I attend to ad hoc coping practices of a diverse city population during the 2011 flood in Bangkok. I foreground the vertical direction of these strategies and the affordances of the urban built environment and urban infrastructures that enabled such coping. The paper thus stages a conversation between established literature on urban flood vulnerability and coping with an emerging interest in vertical urbanism literature. Through this conversation between the two literatures, research on urban verticality is probed to consider verticality as a crucial dimension of urbanism during times of flood disasters