Extended pelvic lymph node dissection at the time of robot-assisted radical prostatectomy: Impact of surgical volume on efficacy and complications in a single-surgeon series

INTRODUCTION: We assessed the impact of surgical volume on perioperative outcomes and complications of robotic extended pelvic lymph node dissection (ePLND). METHODS: From November 2008 to October 2012, a total of 233 consecutive patients with intermediate- or high-risk clinically localized prostate cancer underwent robot-assisted radical prostatectomy (RARP) and ePLND by a single, experienced open and laparoscopic surgeon. Data were prospectively collected. Complications were classified according to the Modified Clavien System. Complications potentially related to ePLND were documented. The minimum follow-up was 3 months. To evaluate the impact of surgical volume on the results, 4 patient subgroups (subgroup 1: cases 1-59; 2: 60-117; 3: 118-175; 4: 176-233) were compared using the Chi-squared and Kruskal-Wallis tests. RESULTS: The mean (range) operative time for ePLND was 79 minutes (range: 48-144), with a steady performance over time (p = 0.784). The count of resected lymph nodes plateaued after 60 procedures (mean [range]: 13 [range: 6-32], 15 [range: 7-34], 17 [range: 8-41], 16 [range: 8-42] in Groups 1 to 4, respectively, p = 0.001). Tumour lymph node involvement was 12% in Groups 1 and 2, 7% in Group 3 and 9% in Group 4 (p = 0.075). Overall, 115 complications were reported in 98/233 patients (42%), with a significant decrease after 175 cases (p = 0.028). In Group 4, 3 patients reported an ePLND-related bleeding requiring open revision. Lymphoceles were detected in 10/233 patients (4.2%) and 1 patient (1.7%) in each of the Groups 2 to 4 required a percutaneous drainage. CONCLUSIONS: A surgeon with extensive experience is expected to achieve a safe learning curve for ePLND during RARP. A learning curve of 60 cases is suggested for optimal lymph node yield

Histologic evaluation of bone healing of adjacent alveolar sockets grafted with bovine- and porcine-derived bone: a comparative case report in humans

To evaluate and compare histomorphometrically the bone response to two xenografts, one bovine and the other porcine, grafted in adjacent extraction sockets in a human. In this case report, two adjacent maxillary premolars were extracted, and the sockets were filled with two different xenogeneic bone substitutes (first premolar with bovine bone, and second premolar with porcine bone) to counteract post-extraction volume loss. Following 6 months bone core specimens were harvested during the placement of implants at the regenerated sites. Histomorphometrically, for the bovine xenograft the percentage of newly formed bone (osteoid) was 26.85%, the percentage of the residual graft material was 17.2% and the percentage of connective tissue 48.73%, while for the porcine xenograft, newly formed bone (osteoid) represented 32.19%, residual graft material was 6.57% and non-mineralized connective tissue was 52.99%. Histological results indicated that both biomaterials assessed in this study as grafts for socket preservation technique are biocompatible and osteoconductive. Bovine bone derived demonstrated to be less resorbable than porcine bone derived. Both xenogenic biomaterials did not interfere with the normal bone reparative processe

New technologies to improve root canal disinfection

Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice

RTM process monitoring and strain acquisition by fibre optics

Abstract The development of Resin Transfer Moulding technology for advanced applications requires a detailed analysis and control of the process. Fibres optics and Fibres Bragg Gratings are useful tools to investigate composite structures during their lifetime service. They are here employed for the monitoring of manufacturing phase and the acquisition of strains during product usage in service. The adopted monitoring procedure allows to follow all the stages of the production process, evidencing their possible influences over final laminate characteristics. Resin injection, curing and cooling, mould extraction, sensor position, deformation control during mechanical testing are analysed on the basis of the signal output from fibre optic sensors embedded in a model component

Pancreas divisum. Correlation between anatomical abnormalities and bile precipitation in the gallbladder in seven patients

Pancreas divisum is a genetic defect associated with recurrent acute pancreatitis due to insufficient drainage of the accessory pancreatic duct. Seven young patients diagnosed with pancreatic divisum and thickening of the gallbladder bile as shown on magnetic resonance cholangio-pancreatography without pancreatic ductal changes underwent laparoscopic cholecystectomy. During the mean follow-up of 32 months no episode of pancreatitis was reported. There is an association between PD and higher concentration of bile in the gallbladder. Cholecystectomy can be considered curative in patients with PD in the absence of indications for major surgery

A multistage combined approach to promote diabetic wound healing in COVID-19 era

When diabetes mellitus is not properly controlled with drugs and a healthy lifestyle, it exposes patients with advanced peripheral arterial disease or critical limb ischaemia (CLI) to the most serious complications, in particular lower limb ulcers. Surgical or endovascular treatments represent the first line of intervention; in addition, the adequate management of ulcers can guarantee not only a faster wound healing but also the improvement of the patient's prognosis. To speed up this process, negative pressure wound therapy (NPWT), platelet-rich plasma (PRP), and other advanced moist wound dress- ing have been proposed. During Coronavirus disease 2019 (COVID-19) pan- demic, many patients with CLI and diabetes mellitus had difficult access to advanced treatments with a significant reduction in life expectancy. We report the cases of patients with non-healing ulcers and CLI treated with an empiric multistage approach after successful endovascular revascularisation; the post- operative course was eventful in all patients, and foot ulcers are currently in an advanced state of healing. The association between adequate revascularisation, systemic anti-inflammatory, and antibiotic therapy with the multistage advanced medications ensures healing of ulcers, limb salvage, and improvement of patient prognosis

Colecistectomia laparoscopica in situs viscerum inversus totalis: nota di tecnica

The Authors report the case of a patient admitted in Emergency Room for biliary colic. She knew her dextrocardia. ECG and chest X-ray confirmed the dextrocardia. Ultrasonography and CT scan discovered a situs viscerum inversus totalis and cholecystolithiasis responsible of the abdominal colic. Laparoscopic cholecystectomy was performed. The Authors discuss the clinical case and the particular technique used

New family host and records of Acanthocrios furnarii (Cordero & Vogelsang, 1928) (Hemiptera: Cimicidae) from Argentina, and implications in the transmission mechanism of cimicid bugs among birds’ nests

Acanthocrios furnarii (Cordero & Vogelsang, 1928) [Hemiptera: Cimicidae: Haematosiphoninae] is an ectoparasite on avian hosts from Argentina and Uruguay. It has been mostly found in mud nests of Furnarius rufus (Gmelin, 1788) [Aves: Furnariidae], but its true hosts are some of the inquiline birds that use F. rufus nests. These inquiline hosts belong to the families Emberizidae, Hirundinidae, Icteridae, Passeridae, and Troglodytidae. Outside F. rufus mud nests, A. furnarii has been found in nests of other Furnariidae, Hirundinidae, and Passeridae. The present work adds the first nonpasserine host (Falconidae) of A. furnarii, together with new records in La Pampa, Argentina. The transmission mechanism of A. furnarii, together with all other cimicid bugs from Argentina and adjacent countries, is increased considering this new host; and we also take into account the birds that nidificate in nest boxes, the cavity-nesting birds in trees and earth, and the inquiline birds in stick nests of Furnariidae and Psittacidae.Fil: Di Iorio, Osvaldo Rubén. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Biodiversidad y Biología Experimental. Laboratorio de Entomología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Turienzo, Paola Noemí. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Biodiversidad y Biología Experimental. Laboratorio de Entomología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bragagnolo, Laura Araceli. Universidad Nacional de La Pampa. Facultad de Ciencia Exactas y Naturales. Departamento de Recursos Naturales. Centro para el Estudio y Conservación de Aves Rapaces; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Santillán, Miguel Ángel. Universidad Nacional de La Pampa. Facultad de Ciencia Exactas y Naturales. Departamento de Recursos Naturales. Centro para el Estudio y Conservación de Aves Rapaces; ArgentinaFil: Grande, Juan Manuel. Universidad Nacional de La Pampa. Facultad de Ciencia Exactas y Naturales. Departamento de Recursos Naturales. Centro para el Estudio y Conservación de Aves Rapaces; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Ciencias de la Tierra y Ambientales de La Pampa. Universidad Nacional de La Pampa. Facultad de Ciencias Exactas y Naturales. Instituto de Ciencias de la Tierra y Ambientales de La Pampa; Argentin

Correlation of the International Consultation on Incontinence Questionnaire - Urinary Incontinence / Short Form to urodynamic diagnosis in women with urinary incontinence

Orientador: Viviane Herrmann RodriguesDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução: A Incontinência Urinária (IU) tem impacto na qualidade de vida da mulher, física, psicológica e socialmente. A Avaliação Urodinâmica (AU) pode ser considerada o padrão ouro no diagnóstico da etiologia da IU. Entretanto, trata-se de exame invasivo, que provoca desconforto e constrangimento à paciente e cujo resultado nem sempre reproduz a sintomatologia clínica. Objetivo: Avaliar a associação entre o "International Consultation on Incontinence Questionnaire - Urinary Incontinence/Short Form" (ICIQ-UI/SF) e a Avaliação Urodinâmica, em mulheres com incontinência urinária. Métodos: Foi realizada análise retrospectiva dos dados clínicos e AU de 358 mulheres com IU atendidas em clínica privada. Utilizou-se a curva ROC com os valores de sensibilidade e especificidade dos escores do ICIQ-UI/SF apresentados pelas pacientes, a fim de estabelecer o escore capaz de discriminar o diagnóstico urodinâmico nos grupos estudados. Para o cálculo do p valor foi utilizado o teste de qui-quadrado ou exato de Fisher. O teste de Spearman avaliou a correlação entre o ICIQ-UI/SF e os parâmetros urodinâmicos. O nível de significância foi de 5% e o software utilizado para a análise foi o SAS versão 9.2. Resultados: A média de idade entre as pacientes foi de 51,1 anos, a raça predominante foi branca e 86,5% das pacientes tiveram ao menos duas gestações. As pacientes com Incontinência Urinária de Esforço segundo a AU (grupo 1) representaram 67.3% das pacientes estudadas. As pacientes com IUE na AU e Hiperatividade Detrusora (HD) - grupo 2 - representaram 16,2% da amostra e as pacientes com HD isolada (grupo 3) representaram 7,3% do total. Em 9.2% a Avaliação Urodinâmica foi considerada normal. Pacientes dos grupos 1 e 2 apresentaram escore ? 14 no ICIQ-UI/SF, sendo esta associação significativa (p=0,01 e p=0,001, respectivamente). Foi observada significativa associação entre a PPE ? 90 cmH2O e escore ICIQ-UI/SF ? 15 (p=0,0037). O teste de Spearman mostrou significativa correlação inversa entre o escore do ICIQ-UI/SF e a PPE, porém não mostrou correlação entre este escore e a Capacidade Cistométrica Máxima (CCM) ou com o volume vesical no primeiro desejo miccional (PDM). Conclusão: Mulheres com PPE ? 90 cmH2O apresentaram escores mais altos ao ICIQ-UI/SF, porém não há correlação com a CCM ou o PDM. Foi observada associação significativa entre a IUE e a PPE ? 90 cmH2O e escores mais altos no ICIQ-UI/SFAbstract: Introduction: Urinary incontinence (UI) compromises women's quality of life, either in physical, psychological or sexual aspects. Urodynamics is considered the gold standard in the diagnosis of urinary symptoms. However it is invasive, expensive, provokes constraints to patients and is not always related to clinical complains. Objective: To evaluate the association between the "International Consultation on Incontinence Questionnaire - Urinary Incontinence/Short Form" (ICIQ-UI/SF) and urodynamics in women with urinary incontinence. Methods: It was a retrospective analysis of the data of 358 women with urinary incontinence attending a private clinic. A ROC curve was applied for sensitivity and specificity of ICIQ-UI/SF, to identify the score that would discriminate urodynamic diagnosis for the groups considered. P-value was obtained by Q-square and Fishers Exact Test. Spearman's test was used to correlate the ICIQ-UI/SF score to urodinamic parameters. Significance was 5% and the software SAS version 9.2. Results: Mean age was 51.1 years-old, the majority was white and 86.5% has been pregnant at least twice. Two hundred forty one patients (67.3%) presented stress urinary incontinence (SUI) on urodynamics (group 1), 16.2% presented SUI and Detrusor Overactivity (DO) (group 2) and 7.3% only DO. In 9.2% of the cases, urodynamics was considered normal. Women in groups 1 and 2 presented a significant association with ICIQ-UI/SF scores ? 14 (p=0.01 and p=0.001, respectively). A significant association was observed between Leak-point Pressure (LPP) ? 90 cmH2O and an ICIQ-UI/SF ? 15 (p=0.0037). Spearman's test showed a significant inverse correlation between ICIQ-UI/SF and LPP, but not to Maximum Cistometric Capacity (MCC) or First Desire to Void (FDV). Conclusions: Women with LPP ? 90cmH2O presented higher ICIQ-UI/SF scores, but no correlation was observed with MCC or FDV. Higher scores of the ICIQ-UI/SF were significantly associated with SUI and LPP ? 90cmH2OMestradoFisiopatologia GinecológicaMestra em Ciências da Saúd