Comparison of robotic-assisted vs conventional laparoscopy for extraperitoneal paraaortic lymphadenectomy.

OBJECTIVE: To evaluate the perioperative outcomes of robotic-assisted extraperitoneal paraaortic lymphadenectomy for locally advanced cervical cancer and to compare to a previous series of patients from our institution undergoing the same procedure by conventional laparoscopy. METHODS: 17 patients with locally advanced cervical cancer (FIGO stages IB2, IIA2 and IIB-IVA) underwent pretherapeutic extraperitoneal paraaortic lymphadenectomy by robotic-assisted laparoscopy. Perioperative outcomes including age, BMI, FIGO stage, operating time, blood loss, complications and length of hospital stay were compared to a series of 83 patients from our institution undergoing the same procedure by conventional laparoscopy. RESULTS: The median values for operating time and hospital days for the robotic-assisted and conventional laparoscopy groups were 150 vs. 150 min and 2 vs 2 days, respectively. In the robotic group, blood loss was lower (90 vs 20 ml, p<0.05) and more aortic nodes were removed (14 vs 17 nodes, p<0.05). Docking time was 7 min (range 3-15). There were no intraoperative complications. There were no differences for postoperative complications (17.6% vs 8.4%). CONCLUSION: Robotic-assisted and conventional laparoscopy provide similar perioperative outcomes other than lower blood loss and higher number of aortic nodes removed (both without clinical impact) in robotic patients for the performance of extraperitoneal paraaortic lymphadenectomy in patients with locally advanced cervical cancer. We believe that robotic surgery is an additional tool to perform the same surgical procedure. HIGHLIGHTS: Robotic-assisted and conventional laparoscopic extraperitoneal paraaortic lymphadenectomy provide similar perioperative outcomes.

[The clinical incidence of frontal dementia]. / Incidencia clínica de la demencia frontal.

INTRODUCTION AND OBJECTIVES: Although the neuropathology of Pick s disease and the frontal lobe dementias has been well defined, the complexity of the clinical diagnosis makes epidemiological studies difficult. The objective of this study was to determine the annual clinical incidence of fronto temporal dementia. PATIENTS AND METHODS: A retrospective observational study was made of the diagnoses of all persons attended in UVAMID during the period 1999 2000. Clinical evaluation was standardized following a protocol of the UVAMID. This included a clinical history obtained by interviewing the patient and a reliable informant, general medical and neurological examination, neuropsychological examination and a battery of complementary tests. RESULTS: In clinical practice the incidence of the different types of dementia varies between 93/100,000 in Alzheimer type dementia and 14/100,000 in DFT f. When age groups are considered, there is a progressive increase in the incidence of DFT f with 12/100,000 in the age group 46 69 years and 57/100,000 in the group of 75 79 years. CONCLUSIONS: The results of this study show that cases of DFT f form 2.7% of the new cases occurring annually. The main limitation of this study is that since these patients were referred for consultation from primary care centres, they form a non representative clinically biased sample which limits extrapolation of the results.

Incidencia clínica de la demencia frontal / The clinical incidence of frontal dementia

Introducción y objetivos. A pesar de que la neuropatología de la enfermedad de Pick y de las demencias del lóbulo frontal está bien definida, la complejidad del diagnóstico clínico dificulta los estudios epidemiológicos. El objetivo del presente trabajo es determinar la incidencia clínica anual de la demencia frontotemporal. Pacientes y métodos. Estudio restrospectivo observacional del diagnóstico de todos los sujetos que acudieron a la UVAMID entre los años 1999 y 2000. La valoración clínica se realizó de modo estandarizado siguiendo el protocolo de la UVAMID, que incluye la historia clínica realizada a través de una entrevista al paciente y a un informador fiable, un examen médico general y neurológico, una exploración neuropsicológica y un conjunto de pruebas complementarias. Resultados. La incidencia en la práctica clínica de los diversos tipos de demencia varía entre 93/100.000 para la demencia tipo Alzheimer y 14/ 100.000 para la DFT-f. Por grupos de edad, se observa un aumento progresivo de la incidencia de la DFT-f, 12/100.000 para el grupo de entre 46 y 69 años y 57/100.000 para el grupo de 75-79 años. Conclusiones. Los resultados del presente estudio señalan que los casos de DFT-f representaron el 2,7 por ciento del total de casos nuevos anuales. La principal limitación del presente trabajo es que los pacientes, al ser remitidos a consulta desde los centros de atención primaria, forman una muestra no representativa, clínicamente sesgada, que limita la extrapolación de los resultados (AU)