Robot-assisted laparoscopic radical hysterectomy: comparison with total laparoscopic hysterectomy and abdominal radical hysterectomy; one surgeon's experience at the Norwegian Radium Hospital.

OBJECTIVES: The purpose of this study was to investigate the 3 years follow-up results regarding the recurrence pattern of robot-assisted laparoscopic radical hysterectomies and pelvic lymphadenectomies in the early stage cervical carcinoma patients and compare the results with both total laparoscopic radical hysterectomy and abdominal radical hysterectomy groups. METHODS: A total of 68 patients underwent radical hysterectomy and pelvic lymphadenectomy for early stage cervical carcinoma management. All cases (35 robot-assisted, 7 cases laparoscopy and 26 with laparotomy) were operated by the same surgeon at the Norwegian Radium Hospital. All cases were retrospectively reviewed to compare demographics, peri-operative variables such as mean operative time, estimated blood loss, lymph node counts, complications and follow-up results. RESULTS: The mean operating times (skin-to-skin) for patients undergoing robot-assisted laparoscopic radical hysterectomy (RALRH), total laparoscopic radical hysterectomy (TLRH) or abdominal radical hysterectomy (ARH) were 263±70, 364±57 and 163±26 min respectively. Patients receiving laparotomy had shortest operative time, followed by those undergoing RALRH and then laparoscopy (p<0.0001 for both). Estimated blood loss was significantly reduced in robot-assisted surgeries compared to surgeries involving laparoscopy and laparotomy (82±74 ml vs. 164±131 ml (p<0.0001) and 595±284 ml (p=0.023), respectively). The mean follow-up times were 36±14.4, 56.4±14 and 70±21 months in patients who underwent RALRH, TLRH and ARH respectively. Until now there have been 5 recurrences and one cervical cancer related death in the robot-assisted group and no recurrences in both the laparoscopy and the laparotomy group. One patient died due to primary lung cancer in the laparoscopic group and other patient died due to primary pancreatic cancer in the laparotomy group. CONCLUSIONS: Robot-assisted laparoscopic radical hysterectomy and pelvic lymph node dissection is feasible and more precise because the instruments provide better flexibility and 3-D vision. We must proceed cautiously, however, if a new treatment modality appears to present an increased recurrence rate. Therefore, patients submitted to robot-assisted laparoscopic radical hysterectomy should be followed carefully and RALRH would be encouraged as protocol setting until the long-term oncological outcome data are available.

Piperacillin/tazobactam versus imipenem/cilastatin for severe diabetic foot infections: a prospective, randomized clinical trial in a university hospital.

In this prospective, randomized, open-label clinical trial, we compared the efficacy and safety of two antibiotic regimens for severe diabetic foot infections (DFI). Sixty-two in-patients with DFI received either piperacillin/tazobactam (Pip-Tazo, n = 30) (4.5 g intravenously every 8h) or imipenem/cilastatin (IMP, n = 32) (0.5 g intravenously every 6h). The mean duration of treatment was 21 days for Pip-Tazo and 24 days for IMP. Twenty-two (73.3%) patients in the Pip-Tazo group and 26 (81.2%) patients in the IMP group had DFI associated with osteomyelitis. Successful clinical response was seen in 14 (46.7%) patients in the Pip-Tazo group and in nine (28.1%) patients in the IMP group [relative risk (RR) 1.6 (95% CI 0.84-3.25), p 0.130]. Two patients in the IMP group and none in the PIP-Tazo group relapsed [RR 2 (0.94-4.24), p 0.058]. Eighty-nine microorganisms were isolated: 38 (43%) Gram-positive and 51(57%) Gram-negative. Among patients with positive culture, 47 (96%) had complete and two (4%) had partial microbiological response. Microbiological response rates were similar in both groups (p 1.000). Amputation was performed in 18 (60%) and 22 (69%) patients in the Pip-Tazo and IMP groups (p 0.739) respectively. Side effects were more common in the Pip-Tazo group (30% vs. 9.4%), but they were generally mild and reversible. In conclusion, although the sample size was small and the results did not reach statistical significance, Pip-Tazo produced a better clinical response rate than IMP in the treatment of severe DFI. There was no significant difference between the treatment groups with respect to microbiological response, relapse and amputation rates.

Robot-assisted laparoscopic surgery in gynaecological oncology; initial experience at Oslo Radium Hospital and 16 months follow-up.

BACKGROUND: This study aimed to report our initial experience using the Da Vinci, a three-armed Intuitive Surgical robotic unit, in relation to gynae-oncological operations. METHODS: A prospective database was used in this retrospective analysis of 53 consecutive women with gynae-oncological diseases who were operated by the same surgeon in a single institution. All the patients were informed of the risks inherent with each surgical procedure as well as the potential advantages. RESULTS: 125 different procedures were performed, including total robotic radical hysterectomy (n = 25), restaging with total hysterectomy and bilateral salpingo-oophorectomy, total omentectomy, appendectomy, bilateral pelvic and para-aortic node dissections. Mean age of the patients, 45.8 (range 27-70) years; mean operative time, 219 (range 110-530) min; mean console time, 170 (range 60-445) min; mean estimated blood loss, 57 (range 10-300) ml; mean post-operative stay, 3 (range 1-6) days. No robot-related complications occurred. No conversions were reported. Mean follow-up time was 16 (range 0-28) months. CONCLUSIONS: Our preliminary experience with robotic surgery suggest that it is a safe technique and could allow complex radical operations to be performed with greater precision.

Is there any relationship between toxoplasma infection and reactive arthritis?

BACKGROUND: The diagnosis of reactive arthritis is a challenging clinical problem in daily practice. Although there are many triggering infectious agents for reactive arthritis, Toxoplasmosis, a worldwide parasitic infection has not been reported. AIM: We investigated the serologic evidence of Toxoplasma gondii ( T. gondii ) infection in patients with newly diagnosed reactive arthritis after six weeks of the onset of the first symptom but no demonstrable triggering agent for reactive arthritis. SETTING AND DESIGN: Clinical controlled study. MATERIALS AND METHODS: We screened serologically the serum toxoplasma IgM and IgG antibody (Ab) titers which revealed toxoplasma infection in 50 patients with reactive arthritis (40 female, 10 men) and no demonstrable triggering agent and control subjects (32 female, 8 male). STATISTICAL ANALYSIS: SPSS 10.0 software package program was used. RESULTS: The mean age of the patients and controls was similar (41.3+/- 12.0 vs. 39.6+/-11.8 years) respectively. The prevalence of IgG Ab titers of T. gondii in patients and controls were found to be 52% and 47.5%, respectively. Mean serum Toxoplasma IgG Ab levels were found to be 16.5+/-14.5 IU/ml, and 16.9+/-13.8 IU/ml in patients and control subjects respectively ( P> 0.05). We did not find any Toxoplasma IgM Ab titer demonstrating the acute or sub-acute infection in the serum of patients or controls. CONCLUSION: Although past Toxoplasma infection was prevalent in both groups, we did not find any subject with acute Toxoplasma infection in patients with newly diagnosed reactive arthritis and healthy controls. Despite the fact that our study group was small, we suggest that T. gondii does not seem to be a triggering agent for reactive arthritis and past infection may be a coincidental finding.

Effect of hyperthyroidism and propylthiouracil treatment on liver biochemical tests.

Liver biochemical test (LBT) changes can be commonly observed in hyperthyroid patients. Those kinds of changes could also be observed because of propylthiouracil (PTU) therapy. We prospectively evaluated LBT changes because of PTU use for 1 year in patients who had been diagnosed with hyperthyroidism first. We studied 64 patients who had been diagnosed with hyperthyroidism. These patients took at least 1-year PTU treatment. We analysed LBT at diagnosis and after 2 and 12 months of treatment with PTU. Prior to PTU treatment, 30 (46.8%) of the 64 patients had at least one LBT abnormality. We observed at least one LBT abnormality in 11 (32%) patients after 2 months and nine (26%) patients after 12 months of treatment with PTU in 34 patients whose CBT were normal before treatment. We did not observe any deterioration in clinical picture and bilirubin levels. Elevated serum LBT during the pretreatment and PTU treatment period is common and usually transient and asymptomatic. PTU could be used for long times by lowering the dose and close follow-up in patients who have elevated LBT during the pretreatment and after PTU treatment period.

Bladder pheochromocytoma encountered on sonography.

Pheochromocytomas of the bladder are rare neoplasms, constituting < 0.06% of all vesical tumours. Common presenting features of this tumour include episodes of sweating, hypertension, haematuria and postmicturition syncope. We describe a case of bladder pheochromocytoma in a 66-year-old man whose only symptom of macroscopic haematuria was initially assessed with ultrasonography. Clinical presentation highlights the need for a high index of suspicion during sonographic evaluation of bladder neoplasms because such tumours might present without symptoms of adrenergic excess.

Type 2 diabetes mellitus and osteopenia: is there an association?

We report the results of bone mineral density (BMD) measurements in type 2 diabetic patients, in comparison to healthy controls. In this prospective study, a total of 277 subjects (aged 30-60 years) with type 2 diabetes mellitus, outpatients at the Cukurova Medical School Hospital, were evaluated for BMD at L(1)-L(4) lumbar vertebrae and at the femur (neck, trochanter, Ward's triangle and total) by DEXA (dual energy X-ray absorptiometry). The patients' diabetes duration, treatment, glycemic control and chronic diabetic complications were recorded, and these data were evaluated for any relationship in respect to the BMD measurements. BMD results of the diabetic patients were compared with those of 262 healthy non-diabetic control subjects living in the same geographic region. BMD was found to be increased at the femoral neck among diabetic women and men aged 51-60 years. However, BMD values at lumbar regions of diabetic men where lower than control in all age group. There was no difference in values of BMD for both genders in the other regions. Type 2 diabetic patients may have lower, similar or higher BMD measurements at different ages and anatomic regions, so each patient should be evaluated individually. Further studies are needed to make a conclusion on this issue.

Use of the ultrasound surgical aspirator in ovarian cancer: a case-control study.

BACKGROUND: This study was undertaken to evaluate the use of the ultrasound surgical aspirator in ovarian cancer and to determine if cytoreduction was improved with its use. METHODS: The study is a retrospective case control trial. Twenty-six consecutive ovarian cancer patients who had the ultrasound surgical aspirator used during their surgery were retrospectively compared to 25 consecutive ovarian cancer patients who did not have the ultrasound surgical aspirator used during their surgeries. The latter group had their surgeries immediately before the ultrasound surgical aspirator was introduced into the hospital. Both groups were similar in age, stage, histology type, grade, and median number of chemotherapy cycles. RESULTS: Patients that had the ultrasound surgical aspirator used had a 69% optimal cytoreduction rate compared to 16% in the control group (p = .001). This was statistically significant (p = 0.001). Survival time was equal in both groups. CONCLUSIONS: Results of the study showed that use of the ultrasound surgical aspirator may permit more patients to be optimally cytoreduced.