RESUMO
OBJECTIVES: The aim of our study is to present early outcomes of our series of retroperitoneal-RAPN (Robot Assisted Partial Nephrectomy). MATERIALS AND METHODS: From September 2010 until December 2015, we performed 81 RAPN procedures (44 at left kidney and 37 at right). Average size was 3cm (1-9). Average PADUA score 7.1 (5-10). Average surgical time (overall and only robot time), ischemia time, blood loss, pathological stage, complications and hospital stay have been recorded. RESULTS: All of the cases were completed successfully without any operative complication or surgical conversion. Average surgical time was 177 minutes (75-340). Operative time was 145 minutes (80-300), overall blood loss was 142cc (60-310cc). In 30 cases the pedicle was late clamped with an average ischemia time of 4 minutes (2-7). None of the patient had positive surgical margins at definitive histology (49pT1a, 12pT1b, 3pT2a, 2pT3a). Hospital stay was 3 days (2-7). CONCLUSIONS: The retroperitoneal robotic partial nephrectomy approach is safe and allows treatment of even quite complex tumors. It also combines the already well known advantages guaranteed by the da Vinci® robotic surgical system, with the advantages of the retroperitoneoscopic approach.
Assuntos
Neoplasias Renais/cirurgia , Nefrectomia/métodos , Espaço Retroperitoneal/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
OBJECTIVES: This study aims to evaluate the reliability and clinical utility of NS3 sequencing in hepatitis C virus (HCV) 1-infected patients who were candidates to start a PI-containing regimen. METHODS: NS3 protease sequencing was performed by in-house-developed HCV-1 subtype-specific protocols. Phylogenetic analysis was used to test sequencing reliability and concordance with previous genotype/subtype assignment by commercial genotyping assays. RESULTS: Five hundred and sixty-seven HCV plasma samples with quantifiable HCV-RNA from 326 HCV-infected patients were collected between 2011 and 2014. Overall, the success rate of NS3 sequencing was 88.9%. The success rate between the two subtype protocols (HCV-1a/HCV-1b) was similarly high for samples with HCV-RNA >3 log IU/mL (>92% success rate), while it was slightly lower for HCV-1a samples with HCV-RNA ≤3 log IU/mL compared with HCV-1b samples. Phylogenetic analysis confirmed the genotype/subtype given by commercial genotyping assays in 92.9% (303/326) of cases analysed. In the remaining 23 cases (7.1%), 1 was HCV-1g (previously defined as subtype 1a), 1 was HCV-4d (previously defined as genotype 1b) and 1 was HCV-1b (previously defined as genotype 2a/2c). In the other cases, NS3 sequencing precisely resolved the either previous undetermined/discordant subtype 1 or double genotype/subtype assignment by commercial genotyping assays. Resistance-associated variants (RAVs) to PI were detected in 31.0% of samples. This prevalence changed according to PI experience (17.1% in PI-naive patients versus 79.2% in boceprevir/telaprevir/simeprevir-failing patients). Among 96 patients with available virological outcome following boceprevir/telaprevir treatment, a trend of association between baseline NS3 RAVs and virological failure was observed (particularly for HCV-1a-infected patients: 3/21 failing patients versus 0/22 achieving sustained virological response; Pâ=â0.11). CONCLUSIONS: HCV-NS3 sequencing provides reliable results and at the same time gives two clinically relevant pieces of information: a correct subtype/genotype assignment and the detection of variants that may interfere with the efficacy of PI.
Assuntos
Farmacorresistência Viral , Técnicas de Genotipagem/métodos , Hepacivirus/classificação , Hepacivirus/efeitos dos fármacos , Hepatite C/virologia , Mutação , Proteínas não Estruturais Virais/genética , Genótipo , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Humanos , RNA Viral/genética , Estudos Retrospectivos , Análise de Sequência de DNARESUMO
The aim of the study is to report surgical and early functional outcomes of first 100 patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD) in a single center. The main surgeon (A.P.) attended a modular training program at a referring center mentored by a worldwide-recognized robotic surgeon (P.W.). The program consisted of: (a) 10 h of theoretical lessons; (b) video session (c) step-by-step in vivo modular training. Each procedure was performed as taught, without any technique variation. Demographics, intra-operative data and post-operative complications, along with early functional outcomes, were recorded for each patient. We retrospectively evaluated the first consecutive 100 patients submitted to RARC with totally ICUD from July 2015 to December 2018. Median age at surgery was 69 years (IQR 60-74). 52 (52%), 32 (32%), and 17 (17%) patients received orthotopic neobladder, ileal conduit and uretero-cutaneostomy, respectively. Median operative time was 410 min. A median number of lymph nodes retrieved were 27 and median estimated blood loss was 240 mL with median hospitalization time of 7 days. All procedures were completed successfully without open conversion. A statistically significant improvement was found in the late (30-90 post-operative days) post-operative complications (p = 0.02) and operative time for urinary derivation. At multivariate logistic regression model ASA score ≥ 3 (OR = 4.2, p = 0.002) and number of lymph nodes retrieved (OR = 1.16, p = 0.02) were found to be predictors of 90-day complications. An adequate modular training is paramount to obtain successful results and reduce the learning curve of RARC, as demonstrated by our experience.
Assuntos
Cistectomia/educação , Cistectomia/métodos , Curva de Aprendizado , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Robóticos/métodos , Derivação Urinária/educação , Derivação Urinária/métodos , Idoso , Feminino , Humanos , Masculino , Resultado do Tratamento , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
BACKGROUND: To assess whether the addition of clinical Gleason score (Gs) 3+4 to the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria affects pathologic results in patients who are potentially suitable for active surveillance (AS) and to identify possible clinical predictors of unfavourable outcome. METHODS: Three hundred and twenty-nine men who underwent radical prostatectomy with complete clinical and follow-up data and who would have fulfilled the inclusion criteria of the PRIAS protocol at the time of biopsy except for the addition of biopsy Gs=3+4 and with at least 10 cores taken have been evaluated. One experienced genitourinary pathologist selected those with real Gs=3+3 and 3+4 in only one core according to the 2005 International Society of Urological Pathology criteria. The primary end point was the proportion of unfavourable outcome (nonorgan confined disease or Gs⩾4+3). Logistic regressions explored the association between preoperative characteristics and the primary end point. RESULTS: Two hundred and four patients were evaluated and 46 (22.5%) patients harboured unfavourable disease at final pathology. After a median follow-up of 73.5 months, there was no cancer-specific death, and 4 (2.0%) patients had biochemical relapse. There were no significant differences in terms of high Gs, locally advanced disease, unfavourable disease and biochemical relapse-free survival among patients with clinical Gs=3+3 vs Gs=3+4. At multivariable analysis, the presence of atypical small acinar proliferation (ASAP) and lower number of core taken were independently associated with a higher risk of unfavourable disease. CONCLUSION: The inclusion of Gs=3+4 in patients suitable to AS does not enhance the risk of unfavourable disease after radical prostatectomy. Additional factors such as number of cores taken and the presence of ASAP should be considered in patients suitable for AS.
Assuntos
Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Idoso , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Estadiamento de Neoplasias , Antígeno Prostático Específico/sangue , Prostatectomia/métodos , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/terapia , Curva ROCRESUMO
The purpose of the project was to develop a model for predicting costs for potential new HMO subscribers, using available cost data from fiscal year 1985 for current enrollees of a large HMO. Regression analysis of aggregated clinic, referral, and hospital cost data using a log transformation of cost indicated that 20 percent of the variation in cost could be explained by sex and coverage type of the subscriber, compared with 7 percent explainable by a simple comparison of costs for single versus family subscribers. Subscriber age, while by itself a significant and nonlinear predictor of cost, was not significant when controlled for coverage type. Application of the model to 28 large companies yielded predicted costs well correlated with observed costs (r = .75, p less than .01). Prediction was significantly better for companies with low observed mean costs than for companies with high observed mean costs.
Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Sistemas Pré-Pagos de Saúde/economia , Modelos Estatísticos , Métodos de Controle de Pagamentos/métodos , Adulto , Capitação , Demografia , Família , Feminino , Sistemas Pré-Pagos de Saúde/estatística & dados numéricos , Humanos , Masculino , Massachusetts , New Hampshire , Análise de Regressão , Fatores Sexuais , Estados UnidosRESUMO
The Authors describe two cases of jaw adamantinoma which have been treated with preserving surgical operation. The first was a very cyst which has been completely enucleated, after one year since the operation the clinical investigation and screening show a complete healing. The second, equally of cyst shape, has been treated with curettage, after 15 months since the operation it shows no sign of recurrence. The Authors conclude by saying that, while bony resection, is always efficient as surgical therapy of choice in jaw adamantinoma in other particular cases it is right to resort to having a definitive recovery.
Assuntos
Ameloblastoma/cirurgia , Neoplasias Mandibulares/cirurgia , Adolescente , Ameloblastoma/patologia , Criança , Curetagem , Feminino , Seguimentos , Humanos , Neoplasias Mandibulares/patologiaRESUMO
The "Short term prophylaxis" technique was used in 100 patients who had undergone Stomatologic surgery and Maxillo-facial surgery for post-operative prophylaxis of surgical infections according to analogous researches conducted in other surgical branches by various authors. The results obtained can be summarized as following: 1) a marked reduction in administered antibiotics (cefaloridina); 2) a marked reduction of post-operative fever; 3) a maintainment of average febrile levels at 37,8 degrees-38 degrees. The above tecnique thus allowed a more rapid mobilization of patients who had undergone surgical intervention, a reduction of the recovery period and the therapeutic costs.
Assuntos
Infecções Bacterianas/prevenção & controle , Cefaloridina/uso terapêutico , Cirurgia Bucal , Adolescente , Adulto , Idoso , Cefaloridina/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Doenças Maxilomandibulares/cirurgia , Fraturas Maxilomandibulares/cirurgia , Masculino , Má Oclusão/cirurgia , Pessoa de Meia-Idade , Neoplasias Bucais/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Extração Dentária/efeitos adversosRESUMO
The Authors have tried Althesin as a medicine for the induction and maintainement of the narcosis in the stomatological, maxillo-facial and extra and intra-oral surgery. They have deduced that CT 1341 does not constitute to the anaesthetics Ethrane and Fluothane because of the anaesthetic-level instability (restlessness of the patient and clonic movements of the limbs during the most painful operations in particular). The Authors, supporters of the balanced anaesthesia, suggest using Althesin in the narcosis induction, the maintaining of which is carried on by the N.L.A. type II medicine and by the Ethrane or Fluothane. The latest ones are to be given in very small, not dangerous quantities. The Authors have so obtained a remarkable oxygenation of the patient, a ready, calm and lucid awakening without any collateral and dangerous consequences.
Assuntos
Mistura de Alfaxalona Alfadolona , Anestesia Dentária/métodos , Dentística Operatória/métodos , Enflurano , Halotano , Neuroleptanalgesia/métodos , Cirurgia Bucal/métodos , Cirurgia Plástica/métodos , Mistura de Alfaxalona Alfadolona/administração & dosagem , Mistura de Alfaxalona Alfadolona/farmacologia , Sistema Cardiovascular/efeitos dos fármacos , Sistema Nervoso Central/efeitos dos fármacos , Fenômenos Químicos , Físico-Química , Eletroencefalografia , Enflurano/administração & dosagem , Enflurano/farmacologia , Halotano/administração & dosagem , Halotano/farmacologia , Humanos , Rim/efeitos dos fármacos , Fígado/efeitos dos fármacos , Medicação Pré-Anestésica , Respiração/efeitos dos fármacosRESUMO
OBJECTIVE: To offer a comprehensive account of surgical outcomes on a defined series of patients treated with radical retropubic prostatectomy (RRP) for prostate cancer in a single European Center after 5-year minimum follow-up according to the Survival, Continence and Potency (SCP) system. MATERIAL AND METHODS: We evaluated our Institutional database of patients who underwent RRP from November 1995 to September 2008. Oncological and functional outcomes were reported according to the recently proposed SCP system. RESULTS: The 5- and 10-year biochemical recurrence-free survival rates were 80.1% and 55.8%, respectively. At the end of follow-up, 611 (78.5%) patients were fully continent (C0), 107 (13.8%) used 1 pad for security (C1) and 60 (7.7%) patients were incontinent (C2). Of the 112 patients who underwent nerve-sparing RRP, 22 (19.6%) were fully potent without aids (P0), 13 (11.6%) were potent with assumption of PDE-5 inhibitors (P1) and 77 (68.8%) experienced erectile dysfunction (P2). The combined SCP outcomes were reported together only in 95 (12.2%) evaluable patients. In patients preoperatively continent and potent, who received a nerve-sparing and did not require adjuvant therapy, oncological and functional success was attained by 29 (30.5%) patients. In the subgroup of 508 patients not evaluable for potency recovery, oncological and continence outcomes were obtained in 357 patients (70.3%). CONCLUSION: Survival, Continence and Potency (SCP) classification offer a comprehensive report of surgical results, even in those patients who do not represent the best category, thus allowing to provide a much more accurate evaluation of outcomes after RP.
Assuntos
Disfunção Erétil/epidemiologia , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/cirurgia , Incontinência Urinária/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Disfunção Erétil/etiologia , Humanos , Itália/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária/etiologiaRESUMO
ABSTRACT Objectives The aim of our study is to present early outcomes of our series of retroperitoneal-RAPN (Robot Assisted Partial Nephrectomy). Materials and methods From September 2010 until December 2015, we performed 81 RAPN procedures (44 at left kidney and 37 at right). Average size was 3cm (1-9). Average PADUA score 7.1 (5-10). Average surgical time (overall and only robot time), ischemia time, blood loss, pathological stage, complications and hospital stay have been recorded. Results All of the cases were completed successfully without any operative complication or surgical conversion. Average surgical time was 177 minutes (75-340). Operative time was 145 minutes (80-300), overall blood loss was 142cc (60-310cc). In 30 cases the pedicle was late clamped with an average ischemia time of 4 minutes (2-7). None of the patient had positive surgical margins at definitive histology (49pT1a, 12pT1b, 3pT2a, 2pT3a). Hospital stay was 3 days (2-7). Conclusions The retroperitoneal robotic partial nephrectomy approach is safe and allows treatment of even quite complex tumors. It also combines the already well known advantages guaranteed by the da Vinci® robotic surgical system, with the advantages of the retroperitoneoscopic approach.
Assuntos
Humanos , Masculino , Feminino , Espaço Retroperitoneal/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Resultado do Tratamento , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Mechanical ventilator circuits are commonly changed at 48-h intervals. This frequency may be unnecessary because ventilator-associated pneumonia often results from aspiration of pharyngeal secretions and not from the ventilator circuit. We compared the ventilator-associated pneumonia rates and costs associated with 48-h and 7-day circuit changes. METHODS: Ventilator circuits were changed at 48-h intervals during the control period (November 1992 to April 1993) and at 7-day intervals during the study period (June 1993 to November 1993). Nosocomial pneumonias were prospectively identified using the criteria of the Centers for Disease Control and Prevention. The annual cost difference of changing circuits at 48-h and 7-day intervals was calculated using the distribution of ventilator days for the control and study periods. RESULTS: There were 1,708 patients, 9,858 ventilator days, and a pneumonia rate of 9.64 per 1,000 ventilator days in the control group (48-h circuit changes). There were 1,715 patients, 9,160 ventilator days, and 8.62 pneumonias per 1,000 ventilator days when circuits were changed at 1-week intervals (study group). Using a logistic regression model, there were significantly greater odds of developing a ventilator-associated pneumonia in surgical patients (odds ratio 1.77, P = 0.02) and patients in critical care units (odds ratio 1.54, P = 0.05), but no significant risk of ventilator-associated pneumonia in patients in whom circuits were changed at 1-week intervals (odds ratio 0.82, P = 0.22). Changing circuits at 7-day intervals resulted in a 76.6% ($111,530) reduction in the annual cost for materials and salaries. CONCLUSIONS: We found no difference in pneumonia rates with ventilator circuit changes at 48-h and 7-day intervals. Ventilator circuits can be safely changed at weekly intervals, resulting in large cost savings.
Assuntos
Pneumonia/etiologia , Respiração Artificial/efeitos adversos , Respiração Artificial/economia , Adulto , Custos e Análise de Custo , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Humanos , Unidades de Terapia Intensiva , Pneumonia/epidemiologia , Pneumonia/prevenção & controle , Estudos Prospectivos , Distribuição Aleatória , Estudos Retrospectivos , Fatores de Tempo , Ventiladores Mecânicos/efeitos adversos , Ventiladores Mecânicos/economiaRESUMO
Thirty-seven patients with advanced head and neck tumors were treated with a polychemotherapy regimen (PEV-B: platinum 30 mg/m2 i.v., epirubicin 30 mg/m2 i.v., etoposide 75 mg/m2 i.v. on days 1 and 2 every 28 days, and bleomycin 15 mg i.m. weekly up to the total dose of 300 mg). All but 7 patients were pretreated with surgery and/or radiotherapy. Thirty-six patients were evaluable for response. Partial response (PR) was observed in 19 cases (53%), no change (NC) in 13 cases (36%) and progression (P) in 4 cases (11%). The median duration of PR was 5 months. The most frequent side-effects were leukopenia (78%), vomiting (57%) and alopecia (46%). The median duration of survival was 8 months for the responders and 5 months for the non-responders.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Avaliação de Medicamentos , Epirubicina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Humanos , Leucopenia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Projetos PilotoRESUMO
The combination of radiotherapy and surgery in the treatment of advanced oral carcinoma (T3 and T4 lesions) yields good possibilities of recovery; whether radiotherapy should be given before or after surgery is still debated. Fifty patients with advanced oral carcinomas were analyzed: 24 of them were irradiated before and 26 after surgery; doses ranged from 40 to 56 Gy for the first group of patients, and from 50 to 68 Gy for the second one. The disease-free survival 48 months after the diagnosis was 36% in patients who received preoperative irradiation, and 53.6% in patients who received postoperative radiotherapy; the latter allowed local control of the disease to be significantly improved (chi 2 3.99, 0.01 less than p less than 0.05). The quality of survival was worse in the group receiving preoperative irradiation, because of radiation-induced surgical complications, which were especially observed in patients with diffuse disease. Our findings suggest that postoperative radiotherapy may be advisable if the tumor is resectable, since tolerance and local control rate were acceptable. On the contrary, nearly inoperable masses and massive neck diseases often require preoperative irradiation.
Assuntos
Carcinoma/radioterapia , Neoplasias Bucais/radioterapia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Adulto , Idoso , Carcinoma/complicações , Carcinoma/mortalidade , Carcinoma/patologia , Terapia Combinada , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/complicações , Neoplasias Bucais/mortalidade , Neoplasias Bucais/patologia , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Dosagem Radioterapêutica , Estudos RetrospectivosRESUMO
The incidence of pathological neck nodes metastases in a group of 60 patients with a diagnosis of oral squamous carcinoma is reviewed. Risk factors are a size of primary more than 4 cm and tumors of the anterior two-third of the tongue. Carcinomas of oral tongue, also of a size less than 4 cm (T1,T2), have a high incidence of subclinical metastases.