A comparison of robotic, laparoscopic, and hand-sewn intestinal sutured anastomoses performed by residents

BACKGROUND: Robotic surgery offers all the advantages of laparoscopy with additional increased accuracy. The use of robotic surgery has increased in the past 5 years. It has proven particularly useful in complex surgical procedures such as intracorporeal intestinal anastomosis. As the prevalence of robotic surgery increases, so will the need for residents to be able to perform surgery using the robotic system. Our goal was to compare hand-sewn, laparoscopic, and robotic suturing techniques performed by midlevel residents using a porcine intestinal model. METHODS: Fifteen residents unfamiliar with the robotic suturing technique participated in performing an initial hand-sewn suture line and then were randomized with cross-over to laparoscopic or robotic suturing. Completion time, leak pressure, number of sutures per cm, and difficulty level were assessed. RESULTS: The mean leak pressure for hand-sewn, laparoscopic, and robotic suturing was 9.5, 3.2, and 11.4 mm Hg, respectively. The laparoscopic group had 6 and the robotic group had 1 suture line that was inadequate for testing. Suture breakage was common in the robotic group. The anastomosis was considered hard by 92% in the laparoscopic group versus 17% in the robotic group. The time it took to complete 1 cm of anastomosis was .9, 8.7, and 8.3 minutes for hand-sewn, laparoscopic, and robotic suturing, respectively. CONCLUSION: The robotic suture line performed by midlevel residents was superior to laparoscopy, although the time for anastomosis was equivalent.     

Single-stapled double-pursestring anastomosis after anterior resection of the rectum

BACKGROUND: Single-stapled double-pursestring technique for colorectal anastomosis to the mid-rectum or upper rectum is the most commonly used technique in the single institution reported here. The investigators evaluate single-stapled double-pursestring anastomosis after anterior resection of the rectum performed at a single institution. METHODS: Medical records of patients who underwent single-stapled double-pursestring anastomosis between January 2000 and May 2005 were analyzed to identify postoperative anastomotic complications. Patients with previous radiation, diverting stoma, coloanal, and hand-sewn and double-stapled anastomoses were excluded. The primary goal was to identify postoperative anastomotic complications. RESULTS: Of 160 patients, 153 (96%) no septic complications. One patient (.6%) developed anastomotic leak requiring diversion. Of the 4 patients with pelvic abscesses (2.5%), 2 were treated with antibiotics and 2 with computed axial tomography-guided drainage. CONCLUSIONS: Single-stapled double-pursestring anastomosis is reliable, with very low rates of leak, subsequent diversion, and pelvic abscess (.6%, .6%, and 2.5% respectively).     

The effect of chemotherapy on Ki-67, Bcl-2 and Bak expression in primary tumors and lymph node metastases of breast cancer

The aim of this study was the analysis of Ki-67, Bcl-2 and Bak expression in primary tumor and axillary lymph node metastases of breast cancer as well as an attempt to assess preoperative chemotherapy influence on the mentioned markers with regard to changes in the morphological appearance of the primary tumor and its metastases. Immunohistochemical examinations of Ki-67, Bcl-2 and Bak expression were conducted on sections collected from 135 patients treated surgically on invasive ductal breast cancer. Sixty-four of these patients were administered preoperative chemotherapy, whilst on 71 patients the surgery was performed without initial chemotherapy. In the group of patients without preoperative chemotherapy positive correlation in Ki-67 and Bcl-2 expression between primary tumors and lymph node metastases (p<0.0001, r=0.707; p<0.0001, r=0.604, respectively) was observed. In the group of patients after chemotherapy positive correlation between primary tumors and lymph node metastases in case of Bcl-2 and Bak proteins (p<0.04, r=0.424; p<0.02, r=0.478, respectively) was observed. It was also found that preoperative chemotherapy has an influence on the expression of proteins connected with proliferation and apoptosis and thus, it can influence neoplastic process biology. It does not have any significant impact on the proapoptotic Bak protein expression either in primary tumor or in lymph node metastases of breast cancer. However, it is related to lower expression of antiapoptotic Bcl-2 protein (p<0.0005) and of Ki-67 proliferation marker (p<0.03) in primary tumors, which indirectly indicates a beneficial influence of preoperative chemotherapy on the primary tumor. Concurrently, the influence of neoadjuvant therapy on lymph node metastases seems to be relatively small, which can limit its effectiveness.     

Correlation between foveal structure and visual outcome following macular hole surgery: a spectral optical coherence tomography study

PURPOSE: The aim of this paper is to evaluate the retinal structure after macular hole surgery and to study the correlation of structural findings with final functional outcomes, using high-speed, high-resolution spectral optical coherence tomography (SOCT). METHODS: Sixty-eight eyes of 60 patients with full-thickness macular holes were included in the study. All patients underwent pars plana vitrectomy with trypan blue staining and internal limiting membrane (ILM) peeling. Patients were evaluated by SOCT, with 6 mum axial and 12-18 mum transverse resolution and three-dimensional images of the retina. RESULTS: There were four different types of macular hole closure: U-shape, V-shape, irregular and flat/open. The following retinal abnormalities were observed in postoperative scans: photoreceptor irregularities, lack of photoreceptors (photoreceptor defect), cysts in outer retinal layers, nerve fiber layer defects, lesion of all retinal layers, and RPE defects. It was possible to evaluate photoreceptor defects on a three-dimensional image. Retinal thickness in the fovea was also measured. CONCLUSIONS: Because of excellent resolution, SOCT is capable of visualization of retinal defects after macular hole surgery. Three-dimensional examination is adequate for evaluation of photoreceptor defects. Good postoperative visual acuity is correlated with U-shape closure, normal foveal thickness and absence of photoreceptor layer defects.     

Value of the real-time myocardial contrast echocardiography for risk stratification and for the detection of significant coronary stenosis in patients with end-stage renal disease.

Sir, Coronary artery disease (CAD) is common in patients with end-stagerenal disease (ESRD), and is associated with poor clinical outcome.However, routine screening for CAD in asymptomatic ESRD patientsis usually not required, except for renal transplant candidates[1]. Myocardial contrast echocardiography (MCE) is a new bedsidetechnique providing information regarding myocardial tissueperfusion. The assumption that MCE might be useful in patientswith ESRD has not been previously investigated. Moreover, thereare no published data concerning prognostic utility of MCE inpatients with ESRD. The aim of the study was to assess the prognostic significanceof MCE in patients with ESRD, and to     

Neutrophil gelatinase-associated lipocalin (NGAL) correlations with cystatin C, serum creatinine and eGFR in patients with normal serum creatinine undergoing coronary angiography.

Sir, Neutrophil gelatinase-associated lipocalin (NGAL), a memberof the lipocalin family, is readily excreted and detected inurine, due to its small molecular size (25 kDa) and resistanceto degradation. NGAL is highly accumulated in the human kidneycortical tubules, blood and urine, after nephrotoxic and ischaemicinjuries [1]. Thus, NGAL might represent an early, sensitive,non-invasive biomarker for acute renal injury [2], and urinaryNGAL might serve as an early marker for ischaemic renal injuryin children after cardiopulmonary bypass [3]. On the other hand,serum cystatin C was proposed as a new marker of glomerularfiltration rate (GFR), even in chronic kidney disease [4]. CystatinC has a low molecular weight (13 kDa) and is freely filtered     

Occupation and breast cancer risk in Polish women: a population-based case-control study

BACKGROUND: The etiology of breast cancer is not well understood and the role of occupational exposures in breast carcinogenesis is still uncertain. METHODS: The population-based case-control study included 2,386 incident breast cancer cases diagnosed in 2000-2003, and 2,502 controls. Lifetime occupational histories and information on other potential breast cancer risk factors were obtained through personal interviews. Conditional logistic regression analyses calculated odds ratios (ORs) associated with various occupations and industries after control for potential confounders. RESULTS: We found statistically significant excesses of breast cancer among engineers (OR=2.0; 95% CI: 1.0-3.8), economists (2.1; 1.1-3.8), sales occupations-retail (1.2; 1.0-1.5), and other sales occupations (1.2; 1.0-1.5). Industries showing significantly elevated risks included special trade contractors (2.2; 1.2-4.3), electronic and electric equipment manufacturers (1.7; 1.1-2.7); and public administration/general government n.e.c. (2.7; 1.3-5.7). Each of these findings was supported by a statistically significant positive trend for duration of employment (P<0.05). A decreased breast cancer risk was observed in janitors and cleaners (0.7; 0.5-0.8). CONCLUSIONS: In this study, we found few associations for breast cancer and occupations or industries. The suggestive findings for the electronic and electric equipment manufacturing industry and for the occupations with potential exposure to magnetic fields deserve further evaluation.     

Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

PURPOSE

Imaging may produce unexpected or incidental findings with consequences for patients and ordering of future investigations. Chest radiography in patients with acute cough is among the most common reasons for imaging in primary care, but data on associated incidental findings are lacking. We set out to describe the type and prevalence of incidental chest radiography findings in primary care patients with acute cough.

METHODS

We report on data from a cross-sectional study in 16 European primary care networks on 3,105 patients with acute cough, all of whom were undergoing chest radiography as part of a research study workup. Apart from assessment for specified signs of pneumonia and acute bronchitis, local radiologists were asked to evaluate any additional finding on the radiographs. For the 2,823 participants with good-quality chest radiographs, these findings were categorized according to clinical relevance based on previous research evidence and analyzed for type and prevalence by network, sex, age, and smoking status.

RESULTS

Incidental findings were reported in 19% of all participants, and ranged from 0% to 25% by primary care network, with the network being an independent contributor (P <.001). Of all participants 3% had clinically relevant incidental findings. Suspected nodules and shadows were reported in 1.8%. Incidental findings were more common is older participants and smokers (P <. 001).

CONCLUSIONS

Clinically relevant incidental findings on chest radiographs in primary care adult patients with acute cough are uncommon, and prevalence varies by setting.Key words: cough, lung/radiography, primary care, incidental findings     

Psychometric Validation of the Sexual Function Questionnaire in Poland

Questionnaires diagnosing sexual dysfunctions in women are important tools which can facilitate the diagnosis and therapy of individual female patients. The study is aimed at the adaptation of the Sexual Function Questionnaire, which was designed by Frances H. Quirk and associates for the American population, to Polish conditions (Quirk et al. in J Sex Med 4:469–77, 1). The study group consisted of 143 women aged 20–68 who were receiving gynaecological care and displayed various types of sexual dysfunction (e.g. female sexual arousal disorder, female orgasmic disorder, dyspareunia), or none of those. The good psychometric quality of the Sexual Function Questionnaire has been confirmed with the following results: convergent validity r_s=0.62, p<0.01, construct validity was estimated by Principal Component Analysis with the promax rotation method. The 7 factors together explained 80.7% of total variance, and a reliability of 0.97 for the whole test, with that for particular domains ranging from 0.62 to 0.96 (estimated with Cronbach’s alpha). The obtained results are mostly consistent with results from studies conducted by the authors of the Questionnaire in the United States, and with the adaptation study carried out in Iran. There are, however, some differences in the assignment of questions to particular domains, as well as in the names of the domains.     

Comparison of treatment results between holmium laser endourethrotomy and optical internal urethrotomy for urethral stricture

Purpose

We comparatively evaluated urethral stricture (US) treatment outcomes, efficacy and complications, using either holmium laser endourethrotomy (HLU) or optical internal urethrotomy (OIU) since studies such as this are scarce in literature.

Methods

During 2003?C2008, 50 men aged 17?C78?years were operated on for primary or refractory US, 32 (64%) and 18 (36%) patients, respectively. The average stricture length was 1.86?cm. Strictures were single or multiple, forty-one (82%) and nine (18%) patients, respectively, and were located in the anterior or posterior urethra in 27 (54%) and 32 (64%) patients, respectively. US were iatrogenic in 32 (64%) and idiopathic in 18 (36%). Patients were divided into two groups, grpA and grpB, each containing 25 patients who were treated using either HLU or OIU, respectively. An evaluation scale of 1?C3 was adopted and took maximum flow rate (Q_max), postvoid residual (PVR), and quality of life (QL) into consideration. A score of ??1 was very good, ??2 was good, and ??3 was poor.

Results

Treatment results were evaluated after 3, 6, and 12?months, respectively. Evaluation of grpA was as follows: five (20%), nine (36%), and seven (28%) patients scored a ??1; thirteen (52%), nine (20%), and four (16%) patients scored a ??2; and seven (28%), eleven (44%), and fourteen (56%) patients scored a ??3. Evaluation of grpB: seven (28%), ten (40%), and five (20%) patients scored a ??1; eleven (44%), seven (28%), and ten (40%) patients scored a ??2; and seven (28%), eight (32%), and ten (40%) patients scored a ??3.

Conclusions

Neither complication rate nor degree of efficacy between HLU and OIU for US revealed a significant difference. We found both laser and conventional urethrotomies to be safe and effective modes of treatment.