Zuclopenthixol Induced Ischemic Priapism: Case Report and Review of Literature.

Objective: Present a case of zuclopenthixol associated priapism, literature review and focus on the stuttering priapism entity as a potential serious complication as well as providing information about possible preventive treatments. Case report: A 44 year-old male patient with history of cocaine abuse with associated priapism presents with acute painful erection after starting zuclopenthixol for treatment of a psychotic episode. This episode was later followed by many other similar episodes defined as stuttering priapism. Conclusion: Acute ischemic priapism is a potential serious side effect of antipsychotics that physicians especially psychiatrists needs to be aware of especially if the patient has previous episodes in order to prevent reoccurrence.

Bladder paraganglioma. A case report.

This is a report of a 32-year-old man who presented with dyspnea upon micturition. He was found to have hematuria. Pelvic ultrasound and CT scan of the abdomen and pelvis revealed a left bladder wall polyp confirmed by cystoscopy to be a submucosal pulsating mass. Plasma free metanephrines were elevated in favor of a bladder paraganlioma while urinary metanephrines, catecholamines and MIBG scan were normal. Patient was managed by partial cystectomy with disappearance of symptoms thereafter. Pathology showed a completely excised paraganglioma. The assessment, diagnosis and treatment are illustrated.

Omega-3 fatty acids in high-risk cardiovascular patients: a meta-analysis of randomized controlled trials.

BACKGROUND: Multiple randomized controlled trials (RCTs) have examined the cardiovascular effects of omega-3 fatty acids and have provided unexplained conflicting results. A meta-analysis of these RCTs to estimate efficacy and safety and potential sources of heterogeneity may be helpful. METHODS: The Cochrane library, MEDLINE, and EMBASE were systematically searched to identify all interventional trials of omega-3 fatty acids compared to placebo or usual diet in high-risk cardiovascular patients. The primary outcome was all-cause mortality and secondary outcomes were coronary restenosis following percutaneous coronary intervention and safety. Meta-analyses were carried out using Bayesian random-effects models, and heterogeneity was examined using meta-regression. RESULTS: A total of 29 RCTs (n = 35,144) met our inclusion criteria, with 25 reporting mortality and 14 reporting restenosis. Omega-3 fatty acids were not associated with a statistically significant decreased mortality (relative risk [RR] = 0.88, 95% Credible Interval [CrI] = 0.64, 1.03) or with restenosis prevention (RR = 0.89, 95% CrI = 0.72, 1.06), though the probability of some benefit remains high (0.93 and 0.90, respectively). However in meta-regressions, there was a >90% probability that larger studies and those with longer follow-up were associated with smaller benefits. No serious safety issues were identified. CONCLUSIONS: Although not reaching conventional statistical significance, the evidence to date suggests that omega-3 fatty acids may result in a modest reduction in mortality and restenosis. However, caution must be exercised in interpreting these benefits as results were attenuated in higher quality studies, suggesting that bias may be at least partially responsible. Additional high quality studies are required to clarify the role of omega-3 fatty acid supplementation for the secondary prevention of cardiovascular disease.

Lunate Excision with Partial Bicolumnar Wrist Fusion: A New Alternative for Isolated Radiolunate Arthritis?: A Report of 2 Cases.

CASE: We report the case of 2 patients presenting with advanced isolated radiolunate arthritis with limited wrist strength and range of motion (ROM). After failure of conservative therapy, both patients underwent lunate excision and scaphocapitate and triquetrohamate joints fusion using compression headless screws. Improved functional outcomes are reported at 4 years of follow-up with painless wrists and increased grip strength and ROM. CONCLUSIONS: Lunate excision and partial bicolumnar wrist fusion lead to increased grip strength and wrist ROM. This is a unique alternative for people suffering isolated radiolunate osteoarthritis, for which no standard surgical care exists.

What's new in robotic partial nephrectomy.

OBJECTIVE: Robot assisted partial nephrectomy (RAPN) is a minimally invasive option for patients with small renal masses undergoing partial nephrectomy. In this review we provide an update on the oncological safety and renal functional outcomes following RAPN. We also discuss the novel techniques and technological advances that have contributed to the outcomes of RAPN.  METHODS: A Medline search using the keywords "partial nephrectomy", "robotic partial nephrectomy", "robot assisted partial nephrectomy", "robot assisted laparoscopic partial nephrectomy" and "laparoscopic partial nephrectomy" was conducted to identify original articles, review articles, and editorials on RAPN. RESULTS: A review of the literature suggests that RAPNis emerging as the preferred approach to minimally invasive nephron sparing surgery. RAPN is superior to laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) in terms of perioperative outcomes with equivalent mid-term oncological outcomes. RAPN has proven safety and efficacy even in complex renal tumors with equivalent oncological and functional outcomes. Novel techniques and advances in technology have contributed to the safety and efficacy of RAPN. CONCLUSION: RAPN can be considered to be the gold standard approach to minimally invasive nephronsparing surgery with equivalent oncological and  renal functional outcomes and superior perioperative outcomes when compared to OPN. Newer techniques and developments in robotic technology have contributed to improved outcomes following RAPN.

OBJETIVO: La nefrectomía parcial asistida por robot (NPAR) es una opción mínimamente invasivapara pacientes con masas renales pequeñasintervenidos mediante nefrectomía parcial. En esta revisiónpresentamos una puesta al día sobre la seguridadoncológica y los resultados funcionales después dela NPAR. También discutimos las nuevas técnicas y losavances tecnológicos que han contribuido a los resultadosde la NPAR.MÉTODOS: Se realizó una búsqueda bibliográficapara identificar artículos originales, de revisión y editorialessobre la NPAR, utilizando las palabras clave nefrectomía parcial, nefrectomía parcial robótica, nefrectomíaparcial asistida por robot, nefrectomía parciallaparoscópica asistida por robot y nefrectomía parcial laparoscópica. RESULTADOS: Una revisión de la literatura sugiere quela NPAR está emergiendo como el abordaje preferidode la cirugía conservadora de nefronas mínimamenteinvasiva. La NPAR es superior a la nefrectomía parciallaparoscópica (NPL) y la nefrectomía parcial abierta(NPA) en resultados peroperatorios con resultados oncológicosa medio plazo equivalentes. La NPAR hademostrado seguridad y eficacia, incluso en tumoresrenales complejos, con resultados oncológicos y funcionalesequivalentes. Las técnicas nuevas y los avancestecnológicos han contribuido a la seguridad y eficaciade la NPAR. CONCLUSIONES: La NPAR puede considerarse elabordaje patrón oro de referencia para la cirugía conservadorade nefronas mínimamente invasiva con resultadosoncológicos y funcionales renales equivalentes yresultados peroperatorios superiores en comparacióncon NPA. Las técnicas y desarrollos más nuevos entecnología robótica han contribuido a mejorar los resultados de la NPAR.

Botulinum Toxin A Injection in the Bladder Neck: A Promising Treatment for Urinary Retention.

Secondary to failure of optimal medical therapy and the high morbidity that accompanies surgical techniques in high risk patients, the use of de novo treatments including botulinum toxin A is emerging in the treatment of benign prostatic hyperplasia (BPH). However, the treatment of urinary retention secondary to BPH via injecting botulinum toxin into the bladder neck is not well established in the literature. This case report describes the case of a 75-year-old male patient with a chronic history of obstructive lower urinary tract symptoms (LUTS) and multiple comorbidities who was admitted to the hospital for management of recurrent urinary retention. The patient was not a surgical candidate for transurethral incision of the prostate (TUIP) or transurethral resection of the prostate (TURP). Botulinum toxin injection into the bladder neck was performed with very satisfying results. Botulinum toxin injection in the bladder neck presents a promising minimally invasive, tolerated, and cost-effective approach for the treatment of urinary retention in patients with benign prostatic obstruction who are not candidates for surgery or in whom medical treatment has failed. More research is needed to identify the efficacy of this novel approach.

Vertebral Augmentation: State of the Art.

Osteoporotic vertebral compression fractures (OVF) are an increasing public health problem. Cement augmentation (vertebroplasty of kyphoplasty) helps stabilize painful OVF refractory to medical treatment. This stabilization is thought to improve pain and functional outcome. Vertebroplasty consists of injecting cement into a fractured vertebra using a percutaneous transpedicular approach. Balloon kyphoplasty uses an inflatable balloon prior to injecting the cement. Although kyphoplasty is associated with significant improvement of local kyphosis and less cement leakage, this does not result in long-term clinical and functional improvement. Moreover, vertebroplasty is favored by some due to the high cost of kyphoplasty. The injection of cement increases the stiffness of the fracture vertebrae. This can lead, in theory, to adjacent OVF. However, many studies found no increase of subsequent fracture when comparing medical treatment to cement augmentation. Kyphoplasty can have a protective effect due to restoration of sagittal balance.

3D versus 2D Systematic Transrectal Ultrasound-Guided Prostate Biopsy: Higher Cancer Detection Rate in Clinical Practice.

Objectives. To compare prostate cancer detection rates of extended 2D versus 3D biopsies and to further assess the clinical impact of this method in day-to-day practice. Methods. We analyzed the data of a cohort of 220 consecutive patients with no prior history of prostate cancer who underwent an initial prostate biopsy in daily practice due to an abnormal PSA and/or DRE using, respectively, the classical 2D and the new 3D systems. All the biopsies were done by a single experienced operator using the same standardized protocol. Results. There was no significant difference in terms of age, total PSA, or prostate volume between the two groups. However, cancer detection rate was significantly higher using the 3D versus the 2D system, 50% versus 34% (P < 0.05). There was no statistically significant difference while comparing the 2 groups in term of nonsignificant cancer detection. Conclusion. There is reasonable evidence demonstrating the superiority of the 3D-guided biopsies in detecting prostate cancers that would have been missed using the 2D extended protocol.

Tumoral calcinosis of the cervical spine and its association with Caffey disease in a 4-month-old boy: case report and review of the literature.

Tumoral calcinosis (TC) is a rare condition involving large joints and rarely the spine. It is characterized by calcification and swelling of periarticular tissues. Caffey disease (CD) is defined by recurrent episodes of painful soft tissue swelling and cortical thickening of the underlying bones. It is a self-limited disease that occurs in the first year of life. We report the first association of CD and TC of the cervical spine in a 4-month-old boy. We suggest that TC occurred as a consequence of the repetitive reparative process that takes place in CD, adding the latter to the list of diseases that may secondarily produce TC.