Novel approach for pain control in patients undergoing prostate biopsy: iliohypogastric nerve block with or without topical application of prilocaine-lidocaine: a randomized controlled trial.

PURPOSE: To investigate the efficacy of a novel anesthetic technique called iliohypogastric nerve block (INB) for pain control in patients undergoing prostate biopsy. MATERIALS AND METHODS: A total of 59 consecutive patients who underwent transrectal ultrasound guided prostates biopsies were included in the study. Patients were randomized into four groups: (1) control, no method of anesthesia was administered, (2) intrarectal prilocaine-lidocaine cream application, (3) INB and (4) INB + intrarectal prilocaine-lidocaine cream application (combined group). Patients were asked to use a scale of 0-10 in a Visual Analogue Scale (VAS) questionnaire about pain during probe insertion (VAS 1) and prostate biopsy (VAS 2). RESULTS: The mean VAS 1 and VAS 2 scores were 0.7 and 4.9 for controls, 0.5 and 1.8 for INB, 0.5 and 2.6 for the intrarectal cream group, and 0.4 and 1.8 for the combined group. The mean VAS 1 scores were not different between groups. However, the mean VAS 2 scores were significantly lower in INB, prilocaine-lidocaine cream and combined groups compared to the control group (P < .001). In addition, the INB group had significantly lower VAS 2 scores compared to the cream application group (P = .03). On the other hand, there was no difference between the INB and combined groups (P = .8). CONCLUSION: Any form of anesthesia was superior to none. However, INB alone seemed to be superior to prilocaine-lidocaine cream application in patients undergoing prostate biopsy. Addition of prilocaine-lidocaine cream application to INB may not provide better analgesia. 

Evaluation of elbow joint proprioception with RehabRoby: a pilot study.

OBJECTIVE: The aim of this study was to evaluate the proprioceptive sense of elbow flexion through a robot-assisted rehabilitation system, RehabRoby, and to understand the usability of RehabRoby as a robotic system in physiotherapy. METHODS: The study included 20 volunteer, healthy students studying either physiotherapy (PT) (5 females and 5 males) or electrical and electronics engineering (EEE) (5 females and 5 males). Using the RehabRoby, they were asked to flex their elbow joints in pronation actively and then against a comfortable resistance to the target angles (20°, 45° and 90°), with eyes open and closed. Angle of movement and applied torque for each target angle and error of movement with respect to the target angle (error of matching) were recorded as absolute values. Participants' socio-demographic and physical features were also evaluated. RESULTS: Physiotherapy students had less matching error at 45° with eyes opened than EEE students. A negative correlation was found between resistive elbow flexion and applied torque while eyes closed at 20° (p<0.05). Biceps brachii strength and being female were significant predictive factors for the least matching error in active elbow flexion at 20° with eyes closed. Error of matching at 45° without vision was lower in the PT group (-0.31) than in the EEE group (0.77). In addition, it was noticed that biceps brachii muscle strength played an important role in the proprioceptive sense of the motion at 20°. CONCLUSION: The RehabRoby can be considered a usable system for the evaluation of joint proprioception sense. With future validity studies, the RehabRoby may be used to assess, diagnose and improve the proprioceptive sense of patients.

Evaluation of proprioceptive sense of the elbow joint with RehabRoby.

In recent years, robot-assisted rehabilitation systems have been an active research area that can quantitatively monitor and adapt to patient progress, and ensure consistency during rehabilitation. In this work, an exoskeleton type robot-assisted rehabilitation system called RehabRoby is developed. A control architecture, which contains a high level controller and a low level controller, is designed for RehabRoby. Proprioceptive sense of healthy subjects has been evaluated during the execution of a task with RehabRoby. Additionally, usability of RehabRoby has been evaluated using a questionnaire.

Preoperative staging of renal cell carcinoma with multidetector CT.

PURPOSE: To evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) for preoperative staging of renal cell carcinoma (RCC) using the 1997 TNM (tumor, node, metastasis) classification. MATERIALS AND METHODS: We conducted a retrospective review of MDCT in 57 consecutive patients with RCC performed for tumor staging before radical (n = 51) or partial nephrectomy (n = 6). The scanning protocol of MDCT consisted of unenhanced and biphasic contrast-enhanced scans during corticomedullary and nephrographic phases. MDCT and surgical-histopathologic staging were performed using the 1997 TNM staging system. The results of MDCT were compared with the histopathological results. Agreement between the two staging methods was evaluated using the kappa (kappa) statistic. RESULTS: Consistency between MDCT and histopathologic staging was excellent for T staging (kappa= 0.87), fair for N staging (kappa= 0.40), and excellent for M staging (kappa= 1.00). Fifty-one of 57 tumors were correctly staged, five overstaged and one understaged by MDCT, with an overall accuracy of 89%. MDCT was able to correctly identify and localize the extension of the tumor thrombus in all 10 patients. In the evaluation of nodal involvement, 42 of 57 patients (74%) were correctly staged, 11 (19%) overstaged, and four (7%) understaged. CONCLUSION: MDCT with a dynamic contrast enhancement protocol is an accurate method for preoperative staging of RCC. MDCT with multiplanar reconstruction capability enables a reliable detection and characterization of the tumor, but the involvement of lymph nodes by tumor is still difficult to predict because it is based on node size criterion only.