Retromesenteric para-aortic lymphadenectomy in gynecologic malignancy.

UNLABELLED: In gynecologic oncology lymphadenectomy is of prognostic and therapeutic importance because recurrence-free time and survival depend on the metastatic involvement of lymph nodes. Lymphadenectomies are not performed to such an extent as they are indicated. This might be due to a laborious or problematic preparation. The authors therefore report their experience in a seldom taught preparation of the left para-aortic compartment in the form of a learning curve. MATERIALS AND METHODS: To access the left para-aortic area, the descending colon is lifted to open the retroperitoneum along the line of Toldt. The mesentery of the descending colon was separated from the kidney along the fascia of Gerota by blunt preparation. Time was measured from the incision of the peritoneum until the renal vein was clearly visible. RESULTS: The authors collected the data from the first 25 preparations. Mean duration for the left para-aortic preparation was 7.8 minutes compared to 5.9 minutes for the right side. Duration of preparation of the left area dropped from 11.0 minutes within the first patients (#1 to #5) to 3.8 minutes in the last patients (#20 to #25). No complications were observed in the study group linked to the retromesenteric approach described. CONCLUSION: Retromesenteric para-aortic lymphadenectomy is quick to learn. The authors needed 20 preparations to observe a significant drop in the time needed for preparation. Retromesenteric para-aortic lymphadenectomy offers an excellent overview that lightens lymphadenectomy and therefore reduces the risks for patients.

Total laparoscopic hysterectomy without uterine manipulator: description of a new technique and its outcome.

INTRODUCTION: Hysterectomy remains the most common major gynecological operation. This is the first study that describes a new technique of TLH without using any kind of uterine manipulator or vaginal tube (TLHwM) and analyzes the intra- and postoperative surgical outcome of the first 67 cases. PATIENTS AND METHODS: Between October 2008 and December 2009, 67 patients underwent TLH without uterine manipulator or vaginal tube. We analyzed the differences in the outcome by using three different kinds of surgical instruments: in 21 cases the TLHwM was performed using conventional 5 mm bipolar and scissors, in 22 cases using Sonosurgical, and in 24 cases using PKS cutting forceps. RESULTS: There was no intra- or postoperative complications. The overall mean operating time was by TLHwM with salpingo-oophorectomy 98 min and without salpingo-oophorectomy, 80 min. The mean operating time using cutting forceps was significantly lower. The mean uterine weight was 263 g. DISCUSSION: Uterine manipulator seems to be a safe and practical surgical method, especially for patients with vaginal stenosis and in cases of enlarged uterus. With its short operation time and no complication rate, we believe that this method is an enrichment of the laparoscopic hysterectomy techniques.

Comparison of estimates of first-year dairy manure nitrogen availability or recovery using nitrogen-15 and other techniques.

Measurements of dairy manure nutrient availability to crops typically show great variability. Approaches that are more accurate are needed to improve manure management and reduce nutrient loss to the environment. In this study, we compared direct (15N recovery) and indirect (difference method [Diff Meth] and fertilizer equivalence [FE] approach) methods of determining first-year dairy manure N availability or recovery during three cropping seasons. A field experiment was conducted on a Plano silt loam (fine-silty, mixed, superactive, mesic Typic Argiudolls) planted to corn (Zea mays L.). Plots received either manure, fertilizer N, or no N. Microplots receiving 15N-labeled manure were also established each study year. Manure was applied to a new plot each cropping season. Whole-plant N uptake was the best crop parameter to use for FE estimates. Estimates of N availability by relative effectiveness (Rel Eff), which are derived from the Diff Meth, and FE were similar (32 and 41%, respectively) and higher than unlabeled N or 15N recovery measurements because these indices factor in N use efficiency. Measures of the Rel Eff of manure N use were highly affected by control plot N uptake. The FE approach is less influenced by control plots, but it requires the inclusion of several more treatments and use of mathematical functions to describe crop response to N. These limitations are reflected in the wide ranges obtained for N availability estimates (-60 to 148%). Although apparent N recovery by the Diff Meth (14%) or direct measurements of 15N recovery (16%) were close on average, variability tended to be much lower for the 15N method. In addition, the Diff Meth was highly dependent on initial soil conditions. Use of 15N-labeled manure, although more costly and time-consuming, provided more consistent and reliable results.

Plant pathogen population dynamics in potato fields.

Modern technologies incorporating Geographic Information Systems (GIS), Global Positioning Systems (GPS), remote sensing, and geostatistics provide unique opportunities to advance ecological understanding of pests across a landscape. Increased knowledge of the population dynamics of plant pathogens will promote management strategies, such as site-specific management, and cultural practices minimizing the introduction and impact of plant pathogens. The population dynamics of Alternaria solani, Verticillium dahliae, and Pratylenchus penetrans were investigated in commercial potato fields. A 0.5-ha diamond grid-sampling scheme was georeferenced, and all disease ratings and nematode samples were taken at these grid points. Percent disease severity was rated weekly, and P. penetrans densities were quantified 4 weeks after potato emergence. Spatial statistics and interpolation methods were used to identify the spatial distribution and population dynamics of each pathogen. Interpolated maps and aerial imagery identified A. solani intra-season progression across the fields as the potato crop matured. Late-season nitrogen application reduced A. solani severity. The spatial distributions of V. dahliae and P. penetrans were spatially correlated.

Meeting the health needs of older homeless people.

Inclusion of health visiting services in packages of care for older people could play an important part in tackling the health and housing problems many experience, argues Kenneth Kelling. Here he draws attention to the often severe health problems of homeless older people and warns that current policies, far from improving their plight, will lead to further deterioration in services.