Inguino-abdominal combined approach for laterally extended pelvic resection: a step by step procedure

This video article demonstrates an inguino-abdominal combined approach for laterally extended pelvic resection, a major surgical procedure for locally advanced primary or recurrent gynecological cancer infiltrating the pelvic sidewall, for which palliative therapy is the only alternative.1 After local institutional review board approval (protocol No CICOG 02/03/62), we made a step by step surgical video of an inguino-abdominal combined approach for laterally extended pelvic resection , defined as an en bloc resection of a pelvic tumor with pelvic sidewall structures, including the iliopsoas and/or obturator internus muscles.2 3 The patient, a 48-year-old woman, diagnosed with single pelvic platinum resistant recurrence after five lines of chemotherapy for serous ovarian cancer G3, International Federation of Gynecology and Obstetrics (FIGO) stage IIIC, BRCA wild type. The preoperative positron emission tomography/computed tomography scan detected uptake on the right side at the level of the external iliac region and obturator fossa: the tumor surrounded the right external iliac vessels by more than 50% of their circumferences, with possible involvement of the vascular wall and venous vascular compression (Tinelli's score=4).4 The tumor extended towards the obturator fossa, with possible involvement of the inguinal canal. Due to an uncertain pathological response, the size of the recurrence, and its close contiguity with the ureter and bowel, we decided to avoid radiation therapy as it could result in a ureteral or intestinal fistula. We performed a laterally extended pelvic resection, as shown step by step in the video.The procedure was conducted until complete removal of recurrence (R0). Estimated blood loss was 1000 mL and total operative time was 240 min. The patient was discharged after 15 days; we reported a urinary infection, a likely postoperative complication. The pathology report described a lymphnodal relapse of ovarian cancer (diameter=6 cm) with infiltration of surrounding tissue and in the sano margins. Six months after surgery, the patient is alive without evidence of relapse.The borders of pelvic surgical anatomy are continually extending, requiring surgeons to use a personalized approach and to continually update their anatomic knowledge. In this context, laterally extended pelvic resection could be a feasible surgical procedure, representing a salvage treatment in recurrent or persistent primary gynecological malignancies infiltrating the pelvic sidewall, when other approaches have failed. However, additional clinical trials are needed to confirm these results.

First record of Monodontidae (Cetacea, Odontoceti) in the Mediterranean Basin from the Pliocene sands of Arcille (Grosseto, Tuscany, Italy)

• MSNUP I17602 represents one of the few monodontid skull of early Pliocene age worldwide. • This discovery testifies the presence of a monodontid taxon in the Mediterranean Basin. • The fossil skull shares several characters with the skull of both extant monodontid genera. • Past monodontid species seems to have been adapted to subtropical climate conditions

Impaired Visual Size-Discrimination in Children with Movement Disorders.

Abstract Multisensory integration of spatial information occurs late in childhood, at around eight years ( Gori, Del Viva, Sandini, & Burr, 2008 ). For younger children, the haptic system dominates size discrimination and vision dominates orientation discrimination: the dominance may reflect sensory calibration, and could have direct consequences on children born with specific sensory disabilities. Here we measure thresholds for visual discrimination of orientation and size in children with movement disorders of upper limbs. Visual orientation discrimination was very similar to the age-matched typical children, but visual size discrimination thresholds were far worse, in all eight individuals with early-onset movement disorder. This surprising and counterintuitive result is readily explained by the cross-sensory calibration hypothesis: when the haptic sense is unavailable for manipulation, it cannot be readily used to estimate size, and hence to calibrate the visual experience of size: visual discrimination is subsequently impaired. This complements a previous study showing that non-sighted children have reduced acuity for haptic orientation, but not haptic size, discriminations ( Gori, Sandini, Martinoli, & Burr, 2010 ). Together these studies show that when either vision or haptic manipulation is impaired, the impairment also impacts on complementary sensory systems that are calibrated by that one

Directed evolution to increase camptothecin sensitivity of human DNA topoisomerase I

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Cortical thickness of primary visual cortex correlates with motion deficits in periventricular leukomalacia

Abstract Impairments of visual motion perception and, in particular, of flow motion have been consistently observed in premature and very low birth weight subjects during infancy. Flow motion information is analyzed at various cortical levels along the dorsal pathways, with information mainly provided by primary and early visual cortex (V1, V2 and V3). We investigated the cortical stage of the visual processing that underlies these motion impairments, measuring Grey Matter Volume and Cortical Thickness in 13 children with Periventricular Leukomalacia (PVL). The cortical thickness, but not the grey matter volume of area V1, correlates negatively with motion coherence sensitivity, indicating that the thinner the cortex, the better the performance among the patients. However, we did not find any such association with either the thickness or volume of area MT, MST and areas of the IPS, suggesting damage at the level of primary visual cortex or along the optic radiation

Multisensory-Based Rehabilitation Approach: Translational Insights from Animal Models to Early Intervention

Multisensory processes permit combinations of several inputs, coming from different sensory systems, allowing for a coherent representation of biological events and facilitating adaptation to environment. For these reasons, their application in neurological and neuropsychological rehabilitation has been enhanced in the last decades. Recent studies on animals and human models have indicated that, on one hand multisensory integration matures gradually during post-natal life and development is closely linked to environment and experience and, on the other hand, that modality-specific information seems to do not benefit by redundancy across multiple sense modalities and is more readily perceived in unimodal than in multimodal stimulation. In this review, multisensory process development is analyzed, highlighting clinical effects in animal and human models of its manipulation for rehabilitation of sensory disorders. In addition, new methods of early intervention based on multisensory-based rehabilitation approach and their applications on different infant populations at risk of neurodevelopmental disabilities are discussed

Value of treatment for brain disorders: time matters

Covering a range of mental and neurological disorders, the Value of Treatment study examined health gains and socio-economic impacts resulting from best health interventions in comparison with current care, or – in some cases – comparison with no treatment at all

Through-and-through femorofemoral wire retrograde technique for the E-nside precannulated inner branch thoracoabdominal stent graft

The E-nside multibranched stent graft (Jotec GmbH, Hechingen, Germany) is the first and only off-the-shelf thoracoabdominal prosthesis with precannulated inner branches. Usually, after the device deployment, target vessel stenting will be facilitated by antegrade inner branch cannulation to retrieve the precannulated guide. In the literature, the use of antegrade access has been associated with the potential risk of cerebral and systemic embolization. Therefore, other retrograde techniques have been described. We have reported a new retrograde approach using a precannulated through-and-through femorofemoral wire technique for target vessel catheterization

ROSES, the only RObotic System for any Endovascular Surgery, Including the Control of an Animated Catheter Characterized by the Presence of two Controlled Curvatures

The paper presents ROSES, its robotic components, the different devices, not necessarily sterile, and its disposables, suitable for any endovascular procedure, both actually performed and presently not assisted by any robotic system, and open in the future for new application yet to come, such as what will be allowed by the new animated catheter. In fact, this is due to the mechanical configuration of the robotic actuators based on a peculiar gear train which presents a big passage hole which allows both the passage of big catheters and even hemostasis valves, as well as full control of very small catheters and guide wires. The system measures forces opposed by the body showing their value both numerically and analogically without the need of any. special tool, measures length of penetration of each catheter and guide wires recording their value. Thus, it may become in future, connected to a work station that will register in real time also the fluoroscopic images, a kind of black box of endovascular surgeries, separating completely doctor and nurses from the patient, using also cameras and microphones to replace the physical contact with the patient

Open conversion following Nellix Endovascular Aneurysm Sealing (EVAS)

The Nellix Endovascular Aneurysm Sealing (EVAS) System (Endologix, Irvine, California, USA) was presented as a novel concept in the treatment of abdominal aortic aneurysm (AAA). After numerous adverse events, the device has been voluntarily withdrawn from the market by the manufacturer. The purpose of this video is to describe the technical approach of a successful explantation of the Nellix endograft in a patient who underwent EVAS for AAA. The patient\u2019s consent for publication was obtained