Die Greenlight-Laservaporisation der Prostata zur Therapie des benignen Prostatasyndroms: Entwicklung und Stellenwert

Zusammenfassung: Die Greenlight-Laservaporisation hat in den letzten 10Jahren breiten Einsatz in der Therapie des benignen Prostatasyndroms (BPS) gefunden. Neben der Steigerung der Effektivität des Lasers durch eine Erhöhung der maximalen Leistung auf zunächst 80W und später 120W führten auch die guten Ergebnisse der klinischen Evaluationen zu einer zunehmenden Akzeptanz dieses Lasersystems. In der vorliegenden Arbeit werden wesentliche Ergebnisse der klinischen Evaluation der Technik aus den letzten Jahren dargelegt, an denen Schweizer Kliniken maßgeblich beteiligt waren. Hier sind v.a. die geringe peri- und postoperative Morbidität sowie die bisher guten kurz- und mittelfristigen funktionellen Ergebnisse zu nennen. Neben diesen Vorteilen, die v.a. in der nahezu blutungsfreien Durchführung des Eingriffs begründet liegen, werden jedoch ebenso die Nachteile und Limitationen der Laservaporisation beleuchtet, die möglicherweise auch spezifische klinische Nebenwirkungen zur Folge haben. Der zukünftige Stellenwert der Technik wird daher auch vor dem Hintergrund der noch ausstehenden Langzeitdaten weiter evaluiert werden müsse

Histomorphological changes after neodymium: YAG laser-coagulation of the human prostate with the Side Focus fiber: Effect of power setting and time

The objective of our study was to determine optimal treatment parameters and appropriate methods of examination for neodymium:yttrium-aluminum-garnet (Nd:YAG) high-power laser coagulation of the human prostate in relation to power setting and time. Transurethral free-beam laser coagulation was performed with the Side-Focus side-firing laser fiber in ten patients prior to planned radical surgery, of whom six underwent transperitoneal laparoscopic lymphadenectomy and laser coagulation 4-9 days prior to open surgery. Depth and volume of coagulated prostatic tissue were measured at power setting/time combinations of 40 W/90 s and 60 W/60 s, respectively, while holding total energy delivery constant. Microscopic examination in the early phase showed that epithelial cells had become loose from the basal-cell membrane. By 4-9 days there was evidence of conspicuous squamous epithelial metaplasia with a high proliferation rate as a sign of reepithelialization. Using the Side Focus side-firing laser fiber, both treatment modalities showed comparable volume coagulation. In contrast there was a significant difference between those prostates removed at 4-9 days and those removed at 60-210 min after laser coagulation. We conclude that laser-induced changes in the human prostate are conclusively discernible only after 4 day

Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer: Safety outcomes and complications

Purpose To investigate focal therapy using High Intensity Focused Ultrasound (HIFU) for the treatment of localized prostate cancer (CaP), we analyzed the safety and complications of this procedure. Methods Patients (pts) eligible for this multicenter prospective cohort study suffered from low to intermediate risk localized CaP with no prior treatment. After tumor identification on multiparametric MRI and in prostate biopsy, the lesions were treated with HIFU observing a safety margin of 8 to 10 mm. Adverse events (AE) after 30 and 90 days, as well as the required interventions were assessed and stratified for treatment localizations. Results Of the 98 men included in the study in two European centers, 35 (35.7%) experienced AEs in the first 30 days after HIFU intervention with Clavien-Dindo grade ≤ II: 15 pts (15.3%) had a postoperative urinary tract infection and 26 pts (26.5%) a urinary retention. Four pts (4.1%) underwent subsequent intervention (Clavien-Dindo grade IIIa/b). The number of late postoperative complications occurring between 30 and 90 days after intervention was low (2.0%). The highest complication rate was associated with tumors located at the anterior base (50.0%). The inclusion of the urethra in the ablation zone led to AEs in 20 out of 41 cases (48.8%) and represented a significant risk factor for complications within 30 days (odds ratio = 2.53; 95% confidence interval: 1.08–5.96; P = 0.033). Conclusions Focal therapy of CaP lesions with a robotic HIFU-probe is safe and renders an acceptable rate of minor early AEs. The inclusion of the urethra in the ablation zone leads to an increase in early complications and should be avoided whenever possible

Conjecturing Production, Imports and Consumption of Horticulture in Indonesia in 2050: a GAMS Simulation Through Changes in Yields Induced by Climate Change

IndonesianPetunjuk Perubahan iklim yang cepat saat ini telah diamati dan dibukukan secara meluas. Semua Perubahan ini secara pasti akan menyebabkan kemerosotan jumlah dan mutu lahan, air, dan iklim mikro di tempat di pertumbuhan tanaman hortikultura. Selanjutnya, dapat diprakirakan produktivitas lahan dan hortikultura akan menurun. Makalah ini bertujuan untuk mengkaji pengaruh yang dipicu Perubahan ini pada produksi, impor, dan konsumsi produk hortikultura. Penelitian ini menggunakan pendekatan model keseimbangan parsial pasar-jamak dalam kerangka simulasi. Semua hasil-hasil simulasi IFPRI memprakirakan bahwa produktivitas kelompok buah (pisang dan jeruk) dan sayuran (cabai dan bawang merah) meningkat dibandingkan keadaan baseline. Demikian pula, apabila perbandingan dilakukan terhadap hasil skenario tidak terjadi Perubahan iklim (NoCC), kesimpulan yang berbeda akan diperoleh. Pada tahun 2050, model ini memberikan petunjuk yang berlainan dengan hasil literatur dan hipotesis yang menyatakan bahwa produksi, impor, dan konsumsi terhadap hortikultura akan menurun. Sebaliknya model mengantisipasi bahwa produksi pisang, jeruk, cabai, dan bawang akan meningkat di perdesaan Jawa dan Luar-Jawa. Namun, hasil-hasil ini harus ditafsirkan secara hati-hati berhubung kesulitan penarikan kesimpulan atas pengaruh Perubahan iklim terhadap komoditas hortikultura yang berlaku secara umum, karena komoditas hortikultura jumlahnya beribu-ribu dengan sifat masing-masing yang khas. Untuk itu kajian dan penelitian yang intensif dan menyeluruh sangat diperlukan karena Perubahan iklim bukanlah fenomena jangka pendek seumur tanaman, tetapi bersifat jangka panjang. Dalam kaitannya dengan indikator perdagangan, simulasi memberikan hasil yang sama bahwa impor pisang, jeruk, cabai, dan bawang akan meningkat, tetapi impor kedua komoditas terakhir tidak besar. Skenario CSIRO_A1b, CSIRO_B1, dan MIROC_A1b memproyeksikan konsumsi nasional agregat pisang, jeruk, cabai, dan bawang akan menurun dengan Perubahan iklim, tetapi meningkat menurut Skenario MIROC_B1 . Namun, terlihat ada perbedaan konsumsi komoditas-komoditas ini antarwilayah. Konsumsi rumah tangga di Jawa menurun pada 2050, penurunan ini akan sangat terasa pada keluarga miskin di Jawa. Sementara itu, konsumsi semua kelompok rumah tangga di Luar Jawa meningkat, kecuali menurut Skenario MIROC_A1b dan Skenario CSIRO_B1, di mana konsumsi keluarga miskin di Luar Jawa menurun. Makalah menyarankan agar penelitian perakitan kultivar yang dapat menyesuaikan diri dan tahan kekeringan dan juga teknik-teknik penghematan air yang sesuai untuk tanaman hortikultura atau penggunaan air secara efisien perlu ditingkatkan. Teknologi-teknologi semacam ini sangat dibutuhkan saat ini. Cara-cara penyebarluasan atau pengkomunikasian kultivar-kultivar dan teknologi-teknologi di atas ke pihak petani kecil juga perlu digali lagi agar mereka dapat memanfaatkannya. EnglishIndication of Earth's changing climate with rapid pace currently present time has been observed and extensively documented. All these changes will undoubtedly lead to deterioration in quantity and quality of land, water, and micro-climate where the horticultural crops are grown. Subsequently, it can be anticipated that land and horticultural productivity will be depreciated. The purpose of this paper is to investigate the impact of this induced change in these horticultural crops on the production, imports, and consumption of these crops. This study adapts a multimarket model of partial equilibrium analysis to a simulation framework. All scenarios adopted by the IFPRI study predict that the yields of fruit crop group (bananas and oranges) and vegetables (Chilies and shallots) would increase compared to the baseline scenarios. But by making comparison to no climate change (NoCC) scenario after simulating it from the baseline, mixed conclusions are obtained. For 2050, the model anticipates increases in the production of bananas, oranges, shallot, and Chilies by rural households in Java and Off-Java. These findings have to be interpreted cautiously, because it is extremely difficult to make a general conclusion about the impact of climate change on horticulture for the fact that horticulture consists of thousands of crops, of which each of them has unique characteristics. More intensive and comprehensive studies are still required because climate change is not a short-term phenomenon of crop-cycle. In regard to net trade indicators, this study foresees that bananas, oranges, Chilies and onions imports would grow but the rate of growth of Chilies' and onions' imports are not significant. National consumption of bananas, oranges, Chilies and shallot are projected to fall under Scenarios CSIRO_B1 and MIROC_A1b but it increases under Scenario MIROC_B1. However, there would be disparities in consumption of bananas, oranges, Chilies and shallot among regions. Java households will experience decreases in consumption in 2050, whereas Java–poor households would suffer the most. On the other hand almost all types of Off-Java households will enjoy a positive rate of consumption changes, with the exception being the results of Scenario MIROC_A1b and Scenario CSIRO_B1 for Off-Java–poor households, which indicate a decrease in consumption. This paper recommends that more researches on assembling cultivars adaptable or tolerable to drought as well as appropriate technologies to conserve water for horticultural crops and to use the limited amount of water efficiently are in high demand today. Best means to disseminate or communicate these cultivars and technologies to smallholding horticultural-farmers ought to be explored

Photoselektive Vaporisation der Prostata: Erfahrungen mit Prostataadenomen >80cm3

Zusammenfassung: Hintergrund: Wir berichten über unsere Erfahrungen mit der photoselektiven Vaporisation der Prostata (PVP) bei Patienten mit symptomatischer benigner Prostatahyperplasie (BPH) und Prostataadenomen >80cm3. Patienten und Methode: 201Patienten mit BPH wurden in die Studie eingeschlossen; 51 (25,4%) Patienten hatten ein Prostatavolumen >80cm3 und 150 (74,6%) Patienten ein Volumen 80cm3 stellt die PVP eine durchführbare Therapieoption da

Robotic-assisted laparoscopic extended pelvic lymph node dissection for prostate cancer: surgical technique and experience with the first 99 cases

BACKGROUND: To date, there is still a paucity of data in the literature on robotic-assisted laparoscopic extended pelvic lymph node dissection (RALEPLND) in patients with prostate cancer. OBJECTIVE: To assess the technical feasibility of RALEPLND and to present our surgical technique. DESIGN, SETTING, AND PARTICIPANTS: From April 2006 to March 2008, we performed RALEPLND in 99 patients prior to robotic-assisted laparoscopic radical prostatectomy. Indications for RALEPLND were a prostate-specific antigen (PSA) >/=10 ng/ml or a preoperative Gleason score >/=7. The data were evaluated retrospectively. SURGICAL PROCEDURE: The transperitoneal approach was used in all cases. In order to gain optimal access to the common iliac bifurcation, the five trocars were placed in a more cephalad position than in patients undergoing radical prostatectomy without RALEPLND. After identification of important landmarks, the lymphatics covering the external iliac vein, the obturator lymphatic packet, and the lymphatics overlying the internal iliac artery were removed on both sides. MEASUREMENTS: The total lymph node yield, the frequency of lymph node metastases, and the complication rate. RESULTS AND LIMITATIONS: The median patient age was 64 yr (range: 45-78). The median preoperative PSA level was 7.7 ng/ml (range: 1.5-84.6). The median number of lymph nodes harvested was 19 (range: 8-53). In 16 patients (16%), we found lymph node metastasis. Complications occurred in seven patients (7%). CONCLUSIONS: RALEPLND is feasible, and its lymph node yield is well in the range of open series. The robotic-assisted laparoscopic approach in itself does not seem to limit a surgeon's ability to perform a complete extended pelvic lymph node dissection

Long-Term Oncological Efficacy of Retroperitoneoscopic Radical Nephrectomy of Localized Renal Cell Cancer pT1-3 (≤12 cm)

Investigation of oncological efficacy in retroperitoneoscopic radical nephrectomy (RRN) of patients with localized renal cell carcinoma (RCC). Consecutive patients undergoing RRN for localized stage pT1-3 RCC in 2 tertiary care centers in Switzerland were evaluated. Excellent long-term oncological efficacy was found. Our long-term follow-up validates the survival outcome from comparable literature after conventional open or laparoscopic radical nephrectomy