Transoral robotic surgery vs open surgery in head and neck cancer. A systematic review of the literature.

BACKGROUND: TORS has become one of the latest surgical alternatives in the treatment of oropharynx squamous cell carcinomas (OPSCC) and has become increasingly accepted by surgeons as a treatment option. Surgical robots were designed for various purposes, such as allowing remote telesurgery, and eliminating human factors like trembling. The study aimed to compare systematic review of the available literature in order to evaluate the safety and efficacy of Transoral Robotic Surgery (TORS) compared with open surgery. MATERIAL AND METHODS: We performed a systematic review of the available literature in order to evaluate the safety and effectiveness of TORS compared with open surgery. We compared TORS and open surgery based on 16 outcomes divided in to 3 groups: intra-operative complications, post-operative complications, and functional and oncologic outcomes. An electronic search of observational studies was carried out using the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Oral Health Group Trials Register, and Scielo. Data analysis was carried out in accordance to Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA) and the quality of the studies were evaluated using the Newcastle-Ottawa Scale. No language restrictions were imposed. RESULTS: From the 4 studies identified (Newcastle-Ottawa Scale mean score 6.5), 371 patients were revised (186 patients were treated with TORS and 185 with conventional surgery). Overall, TORS, when compared with open surgery, appears to have better functional results (less hospital time, decannulation) and fewer intraoperative and post-operative complications. There is no significant difference when assessing the oncological outcomes (positive margins, survival rate) when comparing both techniques. CONCLUSIONS: TORS has an overall better functional outcome, and less intraoperative and postoperative complications with no difference in positive margins and survival rate when compared with conventional therapy.

Seasonality of urinary tract infections in the United Kingdom in different age groups: longitudinal analysis of The Health Improvement Network (THIN).

Evidence regarding the seasonality of urinary tract infection (UTI) consultations in primary care is conflicting and methodologically poor. To our knowledge, this is the first study to determine whether this seasonality exists in the UK, identify the peak months and describe seasonality by age. The monthly number of UTI consultations (N = 992 803) and nitrofurantoin and trimethoprim prescriptions (N = 1 719 416) during 2008-2015 was extracted from The Health Improvement Network (THIN), a large nationally representative UK dataset of electronic patient records. Negative binomial regression models were fitted to these data to investigate seasonal fluctuations by age group (14-17, 18-24, 25-45, 46-69, 70-84, 85+) and by sex, accounting for a change in the rate of UTI over the study period. A September to November peak in UTI consultation incidence was observed for ages 14-69. This seasonality progressively faded in older age groups and no seasonality was found in individuals aged 85+, in whom UTIs were most common. UTIs were rare in males but followed a similar seasonal pattern than in females. We show strong evidence of an autumnal seasonality for UTIs in individuals under 70 years of age and a lack of seasonality in the very old. These findings should provide helpful information when interpreting surveillance reports and the results of interventions against UTI.

Long-term results with biosynthetic absorbable P4HB mesh in ventral abdominal wall repair: a multicentre analysis.

BACKGROUND: The aim of this multicentre study was to analyse the outcomes of biosynthetic absorbable poly-4-hydroxybutyrate (P4HB) prosthesis implantation in patients undergoing ventral hernia repair (VHR) in the context of different degrees of contamination. METHODS: From May 2016 to December 2021, a multicentre retrospective analysis of patients who underwent elective or urgent hernia repair with P4HB prosthesis was performed in seven hospitals in Spain and Portugal. Patients with a postoperative follow-up of less than 20 months and those within the theoretical period of prosthesis resorption were excluded from the study. Regarding the degree of contamination, patients were assessed according to the modified Ventral Hernia Working Group (VHWG) classification. Epidemiological data, hernia characteristics, surgical and postoperative variables (Clavien-Dindo classification) of these patients were analyzed. Risk factors related to long-term recurrence were studied by a multivariate analysis. RESULTS: In 236 cases of P4HB prosthesis implantation, repair in cases of Grade 3 was the most frequent (49.1%), followed by Grade 2 in 42.3% of cases and Grade 1 in 8.4%. The most frequent complications were Grade 1, with the majority occurring during the first year. The overall rate of surgical site occurrences (SSO) was 30%. The hernia recurrence rate was 14.4% (n = 34), with a mean postoperative follow-up time of 41 months (22-61). The multivariate analysis showed that the onlay location of the mesh (OR 1.07; CI 1.42-2.70, p = 0.004) was a significant independent risk factor for recurrence. CONCLUSIONS: The use of a P4HB bioresorbable mesh for the VHR with different degrees of contamination leads to favourable results overall, with an acceptable rate of hernia recurrence. The onlay location of the P4HB prosthesis is the main factor in recurrence in both elective and emergency settings.

Cell death pathways and autophagy in the central nervous system and its involvement in neurodegeneration, immunity and central nervous system infection: to die or not to die--that is the question.

Death rules our lives. In this short paper, we summarize new insights into molecular mechanisms of neurodegeneration. Here we review the most important processes of cell death: apoptosis and oncosis. We focus on autophagy, which is pivotal for neuronal homeostasis, in the context of neurodegeneration, infection and immunity. Its dysfunction has been linked to several neurodegenerative diseases such as Parkinson's, Huntington's and Alzheimer's diseases. Our understanding is still incomplete, but may highlight attractive new avenues for the development of treatment strategies to combat neurodegenerative diseases.

Graft Protection Against Cold Ischemia Preservation: An Institute George Lopez 1 and Histidine-tryptophan-ketoglutarate Solution Appraisal.

Cold storage of organs in preservation solutions, such as Institute George Lopez 1 (IGL-1) or histidine-tryptophan-ketoglutarate (HTK), is a mandatory step for organ transplantation. This preservation leads to an ischemic injury that affects the outcome of the organ. This article studies the liver graft eluate after organ recovery using IGL-1 or HTK solutions. We explore the influence of the volume used for washing out the liver and the consequences in the graft preservation when both solutions are used. Livers were washed out with different volumes of HTK and IGL-1 according to manufacturers' instructions and then preserved in both solutions for 24 hours at 4°C. Tissue and eluates were collected for subsequent analyses. We measured transaminases (aspartate aminotransferase and alanine aminotransferase), histology by hematoxylin/eosin staining, and red blood cell and hemoglobin counts, respectively. After washing out and cold storage, the IGL-1 processed livers showed better preservation than those with HTK solution; however, in this latter case, an important accumulation of erythrocytes was found when compared to IGL-1. These data were consistent with the higher hemoglobin and red blood cell counts observed for IGL-1 eluates after 24 hours. The volume used for washing out the organ depends on the composition and properties of the organ preservation solutions (ie, IGL-1 and HTK); this is an important factor for the graft cold preservation. The total volume used for washing out the graft should be considered because it has a direct impact on the total cost for clinical transplantations.

[Study of diastolic function in peritoneal dialysis patientes. Comparison between pulsed and Tissue Doppler]. / Estudio de la función diastólica en pacientes en diálisis peritoneal. Comparación entre doppler pulsado y tisular.

INTRODUCTION: Left ventricular hypertrophy (LVH) is the main expression of uremic cardiomyopathy. Alteration of the diastolic function is frequently associated with LVH, indicating future cardiovascular events. Recent studies suggest that the Tissue Doppler (TID) of the mitral annulus obtains parameters of diastolic function that are not influenced by other factors, unlike what occurs with the pulsed Doppler (PD), and that the relationship between the velocity of the proto-diastolic waves of both techniques (E/E') would be the most important datum to diagnose a diastolic malfunction. The objective of this study is to verify LVH prevalence in a population of End Stage Renal Disease patients (ESRD) in peritoneal dialysis (CAPD), and to study diastolic function, comparing the results of both techniques (PD/TID), as well as the possible causes that determine the appearance of diastolic malfunction in these patients. PATIENTS AND METHODS: We carried out a cross-section study with 42 patients in peritoneal dialysis. All patients had an ejection fraction of over 50% and had no clinical signs of heart failure, valvular heart disease or arrhytmia. A basic biochemistry, residual renal function, C-reactive protein and an ultrasonic study with M-mode doppler, pulsed doppler and tissue doppler of the mitral annulus, were performed in all patients. RESULTS: 26.2% of the patients had a concentric LVH, 14.3% an asymmetric LVH and 23.8% a concentric growth. The PD showed an E/A ratio under 0.75 in 20 cases (which would indicate an alteration of ventricular relaxation), an E/A between 0.75 and 1.5 in 22 (normal or pseudonormal pattern) and none with an E/A over 1.5. On the other hand, the TID showed: 24 patients with an E/A < 0.75, 16 between 0.75 and 1.5, and 2 with an E/A > 1.5. The E/E' proportion was normal in 13 cases(< 8), intermediate in 12 (8-10), and greater than 10 in 17, expressing a clear diastolic malfunction. Twelve of the 17 with diastolic malfunction had a pseudo-normal pattern with the PD. A relationship was observed between the E/A and age and hs-CRP. A relationship was also found between RRF, ejection fraction and diastolic pressure (p = 0.03, r = 0.32 and p = 0.006, r = 0.29), while, in the multivariant study, the presence of LVH was the only variable with enough significance to influence the diastolic malfunction (odds ratio of 7.6). CONCLUSIONS: Patients in CAPD have a high incidence of diastolic malfunction. LVH, present in a high percentage of patients, is one of the factors that favours its appearance. The non-invasive TID technique and the E/E' ratio have shown to be more sensitive than the PD in diagnosing a diastolic malfunction.

Clinical behaviour of prostatic specific antigen and prostatic acid phosphatase: a comparative study.

We assayed prostatic specific antigen (PSA) and prostatic acid phosphatase (PAP) serum levels in 1383 patients using a double antibody radioimmunoassay (RIA) I125. Establishing the upper normal limit in 10 ng/ml PSA and 2.5 ng/ml for PAP, the false positive results were only 1.9 and 5.1 percent in men with non-prostatic benign or malignant pathology and respectively 0 and 2.2 percent in women. We detected false positive levels for these two tumoral markers in 3.5 and 4.7 percent of patients with non-complicated benign prostatic hypertrophy, 64.8 and 19.2 percent in complicated benign prostatic hypertrophy, 24 and 16 percent in acute prostatitis and 3.3 percent in chronic prostatitis. The sensitivity in patients with prostate cancer was 87.2 percent for PSA and 64.1 percent for PAP, and there was a better correlation with PSA than PAP for tumoral spread and histological grading. Finally, clinical efficacy was higher with PSA and was no better when both markers were assayed.

Clinical utility of prostatic specific antigen and prostatic acid phosphatase serum levels in monitoring prostate cancer.

We analysed 696 prostatic specific antigen (PSA) and prostatic acid phosphatase (PAP) serum samples by double antibody radioimmunoassay (RIA)I125 in the follow-up of 122 patients with prostate cancer under treatment. PSA levels were significantly correlated to response to treatment, whereas PAP results did not differentiate patients with partial or complete remission. Progression of the disease was detected in 95.2 and 85.4% of PSA and PAP samples, and increased to 99.9% using both simultaneously. On the whole, PSA was better than PAP in monitoring prostate cancer, and the efficacy was greater using both markers together.

[Treatment of male infertility with clomiphene citrate (author's transl)]. / Tratamiento de la infertilidad masculina con citrato de clomifeno.

Ninety unselected male patients with infertility were treated with clomiphene citrate, 25 mg/day, taken on 20 consecutive days each month for a period of 3 to 12 months. The patients were divided into two groups according to sperm counts. In 39 cases of oligozoospermia with sperm counts above 10 million/ml, six pregnancies were obtained (15.4%) while a significant improvement of sperm counts occurred in 22 cases (56.4%). On the other hand, in 51 cases with azoospermia or oligozoospermia below 10 million/ml only three pregnancies occurred (5.9%) and two patients (3.9%) had significantly improved sperm counts. The indications and form of administration of clomiphene citrate are commented upon.

[Leiomyosarcoma of the bladder. Report of a new case and review of the literature]. / Leiomiosarcoma de vejiga. Aportación de un nuevo caso y revisión de la literatura.

Contribution of a new case of bladder leiomyosarcoma due to the rarity of its presentation. There are barely one hundred cases reported in the medical literature. Clinico-pathological, therapeutic and prognostic assessment of this type of bladder sarcoma and discussion on the convenience of complementary therapy after surgery.

[Infrequent cause of bilateral obstructive uropathy]. / Una causa infrecuente de uropatia obstructiva bilateral.

Muscular haematoma of the straight muscles of the abdomen are very rare to observe and, although there is a possibility of the haematoma extending to the retroperitoneum, they very rarely cause oligoanuria by compression of the urinary tract. Presentation of one case of spontaneous haematoma of the straight muscles of the abdomen with urologic damage by ureteral compression inducing oligoanuria and bilateral ureterohydronephrosis.

[Leukemoid reaction and thrombocytosis in bladder sarcoma]. / Reacción leucemoide y trombocitosis en sarcoma de vejiga.

Presentation of one case of a patient with vesical sarcoma with sustained high white blood cells and platelets plasma levels over the course of the disease. In the absence of fever and with a persistently negative blood culture, the situation was rated as a leukaemoid reaction and thrombocytosis of para-renoplastic nature. A brief comment on the features and evolution of this para-neoplastic syndrome and the outcome of the patient with vesical sarcoma is included.

[Complete hormonal blockade vs. monotherapy in the management of metastasizing prostatic cancer]. / Bloqueo hormonal completo versus monoterapia en el tratamiento del cáncer de próstata metastásico.

Evaluation of results obtained in 70 hormone-treated patients with disseminated prostate cancer. Thirty-six of them were treated via orchiectomy and 34 received also flutamide. Initial objective response rates were 47% in the monotherapy group versus 58% for those undergoing complete blockade. Decrease of PSA and PAP was also higher in the group given flutamide. Nonetheless, no significant changes were observed with regard to biological and clinical progression or patients survival.

[Impact of specific prostatic antigen on the rationalization of the use of bone gammagraphies in the follow-up of hormone-treated non- metastatic prostatic cancer]. / Impacto del antígeno prostático específico en la racionalización del consumo de gammagrafías oseas en el seguimiento del cancer de próstata no metástasico tratado hormonalmente.

Analysis of the evolution of 78 patients with hormonally-treated non-metastatic prostate cancer. During an average follow-up of 62.3 months, local clinical and metastatic progression in 14.1% and 7.7% cases, respectively, was observed. Overall, PSA detected progression of disease in 94.1% cases, with an anticipation which range between 4 and 52 months. Evidence of bone metastatic progression was confirmed in 2.1% of the 286 scintigraphies performed. Following analysis of results, by accepting their indication from a PSA level higher than 100 ng/ml, 97.9% would have been avoided, achieving a 100% sensitivity and 94.1% diagnostic efficacy.

[A vesicoileal fistula secondary to bladder cancer]. / Fístula vésico-ileal secundaria a cáncer de vejiga.

Exposition of one case of vesico-ileal fistula with atypical presentation and infrequent etiology, secondary to transitional cell vesical carcinoma. The incident is exploited to review the etiology of acquired enterovesical fistulae.

[Value of prostate-specific antigen as prognostic factor of metastatic cancer of the prostate]. / Valor del antígeno prostático específico como factor pronóstico del cáncer de próstata metástasico.

This paper examines the behaviour of PSA in 70 patients with metastatic prostate cancer. PSA serum concentration, prior to therapy, was directly related to the tumoral mass and inversely related to the histological degree, which does not constitute a prognostic factor with regard to the disease evolution. Within 3 months of therapy, PSA concentration decreased more noticeably in clinically responding patients, down to less than 10 ng/ml in 93% of them. Also, this level represented a prognostic factor with regard to the free-of-progression interval of the disease.

[Medical treatment of benign prostatic hyperplasia in patients with high surgical risk]. / Tratamiento médico de la hiperplasia prostática benigna en pacientes con alto riesgo quirúrgico.

Eight patients with prostate adenoma and high surgical risk were given leuprolide in depot. Prostate volume decreased by 44.7% after 3 months of treatment and by 58.9% at six months. Two of the 7 patients were resident vesical catheter carriers, 28% re-started spontaneous miction.

[Spontaneous bladder rupture secondary to urinary tuberculosis]. / Rotura vesical espontánea secundaria a tuberculosis urinaria.

Atraumatic spontaneous vesical fracture is an uncommon occurrence. Here we present the case of a female patient with spontaneous vesical fracture secondary to urinary tract tuberculosis. A review of current literature showed another published case similar to ours. A brief comment is made on presentation signs and symptoms and picture evolution, as well as a discussion on the predisposing factors of spontaneous vesical fracture and its treatment.

[Anuria secondary to perianeurysmal fibrosis]. / Anuria secundaria a fibrosis perianeurismática.

Presentation of one case of obstructive anuria secondary to perianeurysmal retroperitoneal fibrosis (PRF). Diagnosis was confirmed by abdominal ultrasound and CAT. The condition's initial treatment consisted in bilateral percutaneous nephrostomy. Following clinical stabilization of the patient, surgical resection of aorta aneurysm and ureterolysis with bilateral intraperitonealization was performed. A revision of the specific literature revealed 17 cases similar to ours. Clinical, diagnostic, and pathophysiologic aspects as well as recommended therapeutical procedures are analyzed.

[Giant renal angiomyolipoma]. / Angiomiolipoma renal gigante.

We present a case report of a renal angiomyolipoma with the special feature of its big size at the moment of the diagnosis. It is appreciated an important alteration of the kidney morphology and the repercussion produced in the rest of the abdominal organs. Due to this an exeresis with nefrectomy is performed. We do a bibliographic review and we analyzed the relevant aspects of this tumour.