RESUMO
We describe the operative technique of robotic-assisted laparoscopic radical parametrectomy and analyze perioperative data including adequacy of resections, pathology, and complications in our initial cases. A retrospective study was performed of seven patients with gynecological cancers involving the cervix who had previously been treated with simple hysterectomies and then underwent robotic-assisted radical parametrectomies. Pathology from the initial hysterectomies and the radical parametrectomies was reviewed. Postoperative complications, operative times, estimated blood loss, and length of hospital stay were assessed. The upper part of the vagina, parametrial tissue, and bilateral pelvic lymph nodes of all seven patients who had undergone a previous simple hysterectomy were removed. The mean age was 56.4 (SD ± 10.7) years. Diagnoses from hysterectomy specimens were invasive squamous carcinoma (n = 4), endometrial adenocarcinoma (n = 2), and clear-cell papillary adenocystic cervical carcinoma (n = 1). The median number of lymph nodes removed was 8 (min 4, max 29), and one patient had nodal metastasis. The mean operative time was 228.6 (SD ± 38.9) min, estimated blood loss was 147 (SD ± 58.2) ml, and length of hospital stay was five (SD ± 2.3) days. One intraoperative complication (cystotomy) occurred and was successfully repaired. One postoperative fistula developed on postoperative day 10. This early experience demonstrates that the basic surgical and anatomical principles of radical parametrectomy can be applied to robotic-assisted laparoscopic surgery. Genitourinary fistulae are always a concern with this procedure, and minimization of electrocautery near the bladder and ureters may further reduce complications.
RESUMO
OBJECTIVE: To investigate the masseter inhibitory reflex (MIR) and its eventual changes in patients with episodic tension-type headache (TTH). METHODS: MIR was studied in 21 patients with episodic TTH and 30 healthy subjects, with age and sex matched to the study cohort. Median age of patients was 17.0 years (ranged 16~49 years), median duration of disease 12 months (1~5 years), and median frequency of headache 7.5 d per month. RESULTS: The second period of suppression (S2) of MIR was reduced in intensity and duration in 10% of controls and 66.7% (confidence interval (CI)=45.3%~85%; P<0.05) of patients with episodic TTH (chi(2)=74.9; P<0.001). In 3 (14.3%) of patients with episodic TTH, S2 was completely absent. No significant correlation between the duration of disease and headache frequency was found. CONCLUSION: Our results confirm the link between episodic TTH and reduction or absence of S2. Teenage patients with episodic TTH may exhibit marked pathological changes in S2 in contrast to older individuals.
