Live surgery: highly educational or harmful?

PURPOSE: Live surgery (LS) is considered a useful teaching opportunity. The benefits must be balanced with patient safety concerns. To evaluate the rate of complications of a series of urologic LS performed by experts during the Congress Challenge in Laparoscopy and Robotics (CILR). METHODS: We present a large, multi-institution, multi-surgeon database that derives from 12 CILR events, from 2004 to 2015 with a total of 224 cases. Radical prostatectomy (RP) was the most common procedure and a selection of complex cases was noted. The primary measure was postoperative complications and use of a Postoperative Morbidity Index (PMI) to allow quantitative weighing of postoperative complications. RESULTS: From 12 events, the number of cases increased from 11 in 2004 to 27 in 2015 and a total of 27 surgeons. Of 224 cases (164 laparoscopic and 60 robotic), there were 26 (11.6%) complications: 5 grade I, 5 grade II, 3 grade IIIa, 12 grade IIIb and 1 grade V, the latter from laparoscopic cystectomy. Analysis of PMI was 23 times higher from cystectomy compared to RP. CONCLUSIONS: In the setting of live surgery, the overall rate of complications is low considering the complexity of surgeries. The PMI is not higher in more complex procedures, whereas RP seems very safe.

Robot-assisted radical prostatectomy: recent advances.

Robot assisted radical prostatectomy (RARP) represents the leading application of robotic surgery in the urologic field and it has become the main treatment option for localized prostate cancer (PCa) in the USA In the present review we summarized and critically analyzed the literature of the past five years about this widely used robotic procedure. RARP has continuously evolved in terms of technical modifications and procedural steps. Long-term data are now available, suggesting comparable oncological outcomes to those of open and laparoscopic radical prostatectomy. Good functional outcomes have also been demonstrated. Technological innovations and the introduction of more advanced robotic platforms featuring novel arm-integrated equipment, together with a mature clinical experience with the robotic approach, are likely to lead towards optimal outcomes. Despite the expanding clinical implementation of RARP in the management of prostate cancer, some issues related to this procedure remain matter of debate, such as costs, comparative outcomes versus other approaches, and its role in high risk disease.

[Gilles de la Tourette's syndrome: a systematic review]. / Sindrome di Gilles de la Tourette: una review sistematica.

Gilles de la Tourette's syndrome is more frequent than once believed. This syndrome is a chronic disorder whose long term outcome is generally favourable, characterized by a fluctuating course. The etiopathogenesis of Gilles de la Tourette's syndrome has not been ascertained, although the frontal-subcortical neural pathways seem to be involved. This extrapyramidal syndrome is frequently associated with attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, and behaviour problems. A correct diagnosis is the first step for a proper management of this disorder, which makes use of behavioural and pharmacological interventions.

Epidemiological survey of multiple sclerosis in Catania city.

The findings of an epidemiological survey of multiple sclerosis (MS) in the urban area of Catania reveal a new and in some respects original pattern of MS cases recorded on 31 December 1989 (prevalence day). They explain why special attention should be paid to patients residing in that area, which shows a remarkable upward trend of the MS prevalence rates calling for further study and for more targeted intervention in the fields of prevention, treatment and rehabilitation.

Effects of dopaminergic drugs on cerebellar prostaglandin concentrations.

Previous data indicate that the injection of dopaminergic drugs induces changes in cerebellar 3',5'-guanosine monophosphate (cGMP) content. Accordingly, we have investigated the effects of haloperidol, sulpiride, or apomorphine on cerebellar prostaglandin (PG) concentration, a parameter related to cGMP content. Results obtained show that dopamine receptor blocking agents, such as haloperidol and sulpiride, significantly decrease cerebellar PGE2 and PGF2 alpha concentrations, while opposite changes are induced by apomorphine, a dopamine receptor agonist.

[Effects of dopaminergic drugs on the concentrations of PGE2 and PGF2alpha in various brain regions]. / Effetti di farmaci dopaminergici sulle concentrazioni di PGE2 e PGF2alpha in alcune regioni cerebrali.

It has long been shown by Biggio and Guidotti that multisynaptic nigro-cerebellar pathway of dopaminergic origin can control cerebellar cyclic guanosinmonophosphate (cGMP) content, a good index of the activity of Purkinje cells. In this line, it has been reported that haloperidol and sulpiride, significantly decrease cerebellar cGMP content while opposite changes are observed with apomorphine. In an attempt to establish whether other cerebellar cGMP-related parameters may be influenced by dopamine drugs. Authors have investigated the effects of haloperidol, sulpiride and apomorphine on cerebellar PGE2 and PGF2alpha. Results obtained indicate that haloperidol and sulpiride significantly reduce cerebellar PGE2 and PGF2alpha content while opposite changes are induced by apomorphine. Similar results have been observed in substantia nigra but not in other brain regions, such as corpus striatum and medial basal hypothalamus. The possibility that the observed changes in cerebellar PG-content may result from the modulation of striatal dopamine receptors is discussed.