Structured reporting of prostate magnetic resonance imaging has the potential to improve interdisciplinary communication.

BACKGROUND: Effective interdisciplinary communication of imaging findings is vital for patient care, as referring physicians depend on the contained information for the decision-making and subsequent treatment. Traditional radiology reports contain non-structured free text and potentially tangled information in narrative language, which can hamper the information transfer and diminish the clarity of the report. Therefore, this study investigates whether newly developed structured reports (SRs) of prostate magnetic resonance imaging (MRI) can improve interdisciplinary communication, as compared to non-structured reports (NSRs). METHODS: 50 NSRs and 50 SRs describing a single prostatic lesion were presented to four urologists with expert level experience in prostate cancer surgery or targeted MRI TRUS fusion biopsy. They were subsequently asked to plot the tumor location in a 2-dimensional prostate diagram and to answer a questionnaire focusing on information on clinically relevant key features as well as the perceived structure of the report. A validated scoring system that distinguishes between "major" and "minor" mistakes was used to evaluate the accuracy of the plotting of the tumor position in the prostate diagram. RESULTS: The mean total score for accuracy for SRs was significantly higher than for NSRs (28.46 [range 13.33-30.0] vs. 21.75 [range 0.0-30.0], p < 0.01). The overall rates of major mistakes (54% vs. 10%) and minor mistakes (74% vs. 22%) were significantly higher (p < 0.01) for NSRs than for SRs. The rate of radiologist re-consultations was significantly lower (p < 0.01) for SRs than for NSRs (19% vs. 85%). Furthermore, SRs were rated as significantly superior to NSRs in regard to determining the clinical tumor stage (p < 0.01), the quality of the summary (4.4 vs. 2.5; p < 0.01), and overall satisfaction with the report (4.5 vs. 2.3; p < 0.01), and as more valuable for further clinical decision-making and surgical planning (p < 0.01). CONCLUSIONS: Structured reporting of prostate MRI has the potential to improve interdisciplinary communication. Through SRs, expert urologists were able to more accurately assess the exact location of single prostate cancer lesions, which can facilitate surgical planning. Furthermore, structured reporting of prostate MRI leads to a higher satisfaction level of the referring physician.

[Evaluation of a prostate cancer E­health tutorial : Development and testing of the website prostata-information.ch]. / Evaluation eines Online-Tutorials zum Prostatakarzinom : Entwicklung und Überprüfung der Seite prostata-information.ch.

BACKGROUND: Due to the multitude of therapy options, the treatment decision after diagnosis of localized prostate cancer is challenging. Compared to printed booklets, web-based information technology offers more possibilities to tailor information to patients' individual needs. OBJECTIVES: To support the decision-making process as well as the communication with patients, we developed an online tutorial in a systematic process in the German-speaking part of Switzerland and then tested it in a pilot study. The study investigated users' satisfaction, the coverage of information needs, the preparation for decision making, and the subjective quality of the decision. MATERIALS AND METHODS: Based on already existing information material, the online tutorial was developed in an iterative process using focus groups with patients and urologists. For the following evaluation in eight clinics a total of 87 patients were invited to access the platform and participate in the study. Of these patients, 56 used the tutorial and 48 answered both surveys (the first one 4 weeks after the first login and the second one 3 months after treatment decision). The surveys used the Preparation for Decision Making Scale (PDMS), the Decisional Conflict Scale (DCS), and the Decisional Regret Scale (DRS). RESULTS AND CONCLUSION: Satisfaction with the tutorial is very high among patients with newly diagnosed localized prostate cancer. Users find their information needs sufficiently covered. Three months after the decision they felt that they were well prepared for the decision making (mean PDMS 75, standard deviation [SD] 23), they had low decisional conflict (mean DCS 9.6, SD 11), and almost no decisional regret (mean DRS 6.4, SD 9.6). Based on these findings, further use of the tutorial can be recommended.

Distribution and accumulation of elements (As, Cu, Fe, Hg, Mn, and Zn) in tissues of fish species from different trophic levels in the Danube River at the confluence with the Sava River (Serbia).

Pikeperch (Sander lucioperca), European catfish (Silurus glanis), common carp (Cyprinus carpio), and gobies (Neogobius gymnotrachelus, Neogobius melanostomus) were collected from the Danube River (Belgrade section), and samples of liver, muscle, or whole-body composites (in the case of gobies) were analyzed for As, Cu, Fe, Hg, Mn, and Zn with inductively coupled plasma optical spectrometry to find out if there was a correlation between accumulation of these elements in predatory and prey species, as well as in pairs of species with overlapping diets. Concentrations of all analyzed elements were either higher (Cu, Fe, Mn, Zn) in liver than in muscle, or equal (As, Hg), except for Hg in carp, which was higher in muscle. Mercury concentration in liver and muscle of predators (catfish, pikeperch) was significantly (<10(-4)) higher than in prey fishes (carp and gobies). The results indicate that Hg concentration was biomagnified through the food chain. Concentrations of As, Fe, and Hg in carp liver and gobies whole-body composite were similar, but carp had significantly (<10(-4)) higher values of Zn and Cu in liver. The regression analysis and trendline equations indicate that the concentrations of all tested elements, except for As in liver, and Mn and Fe in muscle, were similar in predatory fish (pikeperch and catfish), on one hand, and in prey fish (carp and gobies), on the other hand. Distinctly high Zn concentration in carp is very common in this species due to its physiology. Concentrations of Hg and Zn were higher than the maximum acceptable concentration due to the high pollution level in this section of the Danube River, accordingly posing a risk for the human consumption of these fish species.

[Kidney duplication with ureteropelvic junction obstruction in childhood: retroperitoneoscopic pyeloplasty]. / Doppelniere mit Nierenbeckenabgangsstenose im Kindesalter : Retroperitoneoskopische Pyeloplastik.

Laparoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO) in children is still one of the most demanding operations in urology. We report on a 12-year-old boy with UPJO in a duplicated collecting system with high ureter fissus. He was admitted with a 1-year history of recurrent flank pain and dilation of the lower duplicated collecting system. We performed a retroperitoneoscopic Anderson-Hynes pyeloplasty.

[Complete ureteral triplication--an anatomic rarity]. / Ureter triplex--eine anatomische Rarität.

INTRODUCTION: Ureteral duplications are a common malformation of the urinary tract. A complete triplication however, is very rare. CASE REPORT: We report the case of a 26-year-old female patient admitted because of a septic disorder. Sonographic examination revealed right-sided hydronephrosis. A CT scan confirmed the rare anatomic abnormality of a ureter triplex. One of the three ureters was an obstructed mega-ureter. The dilated renal pelvis was punctured and pus drained. After clinical recovery of the patient, complete resection of the obstructed megaureter and the non-functional moiety was performed. CONCLUSION: This case illustrates an extraordinarily rare malformation of the urinary tract and describes an approach for treatment.

[Experience with laparoscopic pyeloplasty for treating ureteropelvic junction obstruction in children. Technique and results]. / Laparoskopischen Pyeloplastik bei der Behandlung der Nierenbeckenabgangsstenose im Kindesalter. Erfahrungen und Ergebnisse.

INTRODUCTION: Open pyeloplasty has been the gold standard for treating ureteropelvic junction obstruction, with a success rate greater than 90%. However, during the last decade the management has been revolutionized with the introduction of laparoscopy and endourology, yielding comparable results and fewer morbid outcomes. MATERIALS AND METHODS: Between 1997 and 2007, dismembered and non-dismembered retroperitoneoscopic pyeloplasty was performed in 31 children with a medium age of 123 months (range 36-192 months). Fourteen children underwent dismembered pyeloplasty (Anderson-Hynes) and 16 children underwent non-dismembered pyeloplasty (YV plasty) and in one child we performed an ureterolysis. RESULTS: The mean operating time was 120 min (range 67-257 min). In 21 cases, intraoperative findings revealed a significant crossing vessel. Based on a furosemide nephrogram and subjective complaints, the success rate was 93%. The two failures (laparoscopic YV plasty and laparoscopic ureterolysis) occurred in the early phase of laparoscopy and have been treated by open Anderson-Hynes plasty. CONCLUSION: With increasing improvement of the suture techniques, laparoscopic pyeloplasty represents, in experienced hands, an alternative method with success rates comparable to the open technique. In our opinion, retroperitoneoscopic pyeloplasty is technically possible and feasible even in infants.

[The position of laparoscopic surgery in pediatric urology]. / Stellenwert der Laparoskopie in der Kinderurologie.

With growing experience in laparoscopic techniques there is a switch in pediatrics from ablative surgery to reconstructive procedures. Besides the established procedures such as laparoscopic nephrectomy and orchidopexy, procedures like heminephrectomy and pyeloplasty have proven practicable and become standard therapies in children and infants. Due to technical advances, as shown for our own patients, the number of treated infants is still increasing. However, laparoscopic reconstructive procedures presuppose a good deal of experience in preparation and suture techniques, and remain reserved for centers with daily experience in laparoscopy. Daily experience with difficult urological laparoscopic procedures in adults will remain more common than in pediatric centres.

[Surgery for patients with mechanical heart valves--adjustment and tailoring of anticoagulant therapy].

Valvular surgery in patients (pts) with long history of cardiac valve disease is accomplishing improvement of symptoms, functional status and longevity. The numbers are very big also in our country. Our census numbers are not reliable, but estimation of above 15000 pts with prosthetic heart valve implants is close to correct. Since significant increase in survival and longevity of those pts, the possibility and necessity for non cardiac operative procedures are also increased. Because of specificity and complex constant regular anticoagulation therapy in order to prevent catastrophic prosthetic valve thrombosis and common thromboembolic complication good, but safe reduction of anticoagulation status to accomplish also safe haemostatic condition necessary for all surgical procedures. Individual adjustment and tailoring of anticoagulant and anti aggregation therapies according to accepted international protocols should be carefully done with necessery variation depending on the non cardiac organ and system involved: urgent either minor or major surgical interventions; bleeding peptic ulcer; elective surgery including ophtalmic and common dental procedures with risk of bleeding.

Robotics and telesurgery--an update on their position in laparoscopic radical prostatectomy.

Laparoscopy is handicapped by the reduction of the range of motion from six to only four degrees of freedom. In complicated cases (i.e. radical prostatectomy), there is often a crossing of the hands of surgeon and assistant. Finally, standard laparoscopes allow only 2D-vision. This has a major impact on technically difficult reconstructive procedures such as laparoscopic radical prostatectomy. Solutions include the understanding of the geometry of laparoscopy, but also newly developed surgical robots. During the last five years, there has been an increasing development and experience with robotics in urology. This article reviews the actual results focussing on the benefits and problems of robotics in laparoscopic radical prostatectomy. Own experiences with robot-assisted surgery include more than 1200 laparoscopic radical prostatectomies using a voice-controlled camera-arm (AESOP) as well as six telesurgical interventions with the da Vinci-system. Substantial experimental studies have been performed focussing on the geometry of laparoscopy and new training concepts such as perfused pelvitrainers and models for simulation of urethrovesical anastomosis. The recent literature on robotics in urology has been reviewed based on a MEDLINE/PUBMED research. The geometry of laparoscopy includes the angles between the instruments which have to be in a range of 25 degrees to 45 degrees ; the angles between the instrument and the working plane that should not exceed 55 degrees ; and the bi-planar angle between the shaft of the needle holder and the needle which has to be adapted according to the anatomical situation in range of 90 degrees to 110 degrees . 3-D-systems have not yet proved to be effective due to handling problems such as shutter glasses, video helmets or reduced brightness. At the moment, there are only two robotic surgical systems (AESOP, da Vinci) in clinical use, of which only the da Vinci provides stereovision and all six degrees of freedom (DOF). To date, more than 3000 laparoscopic radical prostatectomies have been performed worldwide at 92 centres with this system. The main advantage of the system represents the translation of open surgical skills to laparoscopy. Despite recent development of basic tools (e.g. bipolar forceps) for the da Vinci robot, investment and maintenance costs still represent the major problem of the device. Additionally, the device does not provide any haptic sense (i.e. tactile feedback). Robotic surgery represents a turning point of surgical research. However, broad use of robotic systems is limited mainly because of the high investment and running costs. Interestingly, more than in the field of cardiac surgery, there seems to be a need for telemanipulators in urology, mainly to reduce the learning curve of standard laparoscopy. However, new training concepts used in combination with mono-tasking computerized robots (AESOP) have proved their efficacy associated with a significant cost reduction.

Intubation with transillumination: nasal or oral?

Transillumination-guided intubation is a useful back-up method when laryngoscopic intubation proves to be difficult or impossible. The Trachlight (Laerdal, N-4001 Stavanger, Norway) is suited for both nasal and oral use. Intubation times (IT) and success rates (SR) for nasal and oral intubation with the Trachlight were compared. Twenty-four medical students, inexperienced in intubation were instructed in the use of the Trachlight. A demonstration also was performed. Subsequently, they were asked to intubate a Laerdal Airway Management Trainer (Laerdal, Stavanger, Norway) using the Trachlight. Each student intubated 10 times orally and 10 times nasally (five times through the right and five times through the left nostril). The succession of the students was randomized. The intubation times were measured and the position of the tube noted. Nasal and oral intubation times for the tenth trial (steady state conditions) were compared using the rank-order test for paired observations. Oral and nasal success rates were compared using the sign test for paired observations. The differences between nasal and oral intubation concerning intubation time and the success rates were not significant. Nasal intubation with the Trachlight seems to be more difficult than the oral intubation.

Clinical and functional evaluation of the Carbomedics Prosthetic Heart Valve in the mitral position. Preliminary results.

The Carbomedics Prosthetic Heart Valve is a new bileaflet pyrolite carbon prosthesis. This paper reports the preliminary results in 40 patients who underwent mitral valve replacement (MVR) using the Carbomedics Valve in 1988. The operative mortality rate was 5% and the early results have been encouraging, with no valve related complications observed in the first post-operative year.

[Surgical treatment of breast carcinoma - 30 years' experience]. / Hirursko lecenje karcinoma dojke - tridesetodisnje iskustvo.

Although, carcinoma of the breast, because of its high frequency and many specific properties, belongs to the most studied of malignancies, it remains a fact that during the past 3 decades the incidence of mortality from this disease has changed little. The authors, drawing on their 30 years experience, demonstrate that the mortality rate and the survival rate depend on the kind of surgical intervention as well as the stage of development of the disease at the moment of operation. For this purpose a total of 655 operated cases were recorded (643 female and 12 male) using the Steinthal classification. In this series 68.1% were infertile; the upper outer quadrant was affected in 54% of cases; histologically the most frequent form was scirrhous adenocarcinoma. The greatest number of patients belonged to stage II and III, whereas the average time from the appearance of the first symptoms up to the medical examination was 6-12 months. Further spread of the disease and regional metastases were presented in more than 65% of cases. It was demonstrated that surgical procedure used depended on the extensiveness of the disease; modified radical mastectomy was performed in 54.2% of patients and Halsted's radical mastectomy in 40.15%. 185 patients were given the control examination. A strictly statistical analysis of the results confirmed that whereas the length of survival was not significantly affected by the kind of operation, the mortality rate did vary according to which surgical procedure was used. The author conclude that there is no best or unique surgical method and that each patient should be examined in a multidisciplinary way, and his treatment should be carefully planned.