Urological applications of N.O.T.E.S.

While adrenal and kidney urological surgery has been performed in animal models mainly by transvesical accesses, to date, NOTES in humans remains in an investigational and developmental phase. Despite great experimental interest, no specific devices are currently available for urological indications in humans and therefore several instruments, taken from different specialist fields, have been used to access through the different natural orifices (including transgastric, transcolonic, transvaginal and transvesical approaches). Furthermore, the accumulating experience with the transvesical approach to the peritoneum suggests it presents new challenges for urologists in terms of technical demands. For these reasons, given their competition with the success of laparoscopy and minimally invasive techniques, NOTES applications in urology risk being underevaluated. In our opinion, after the initial enthusiastic phase, NOTES will cover only specific indications for urological conditions. The transvesical approach to the peritoneum however seems to be one of the best approaches for NOTES overall and certainly the most promising for urologists.     

F. N. A. C. of salivary glands

During a period of 12 years, 874 salivary gland lesions were aspirated of which 740 (86.85%) were from parotid gland. Cystic, inflammatory & neoplastic lesions were 25.25%. 54.45% & 20.30%, respectively. Plcomorphic adenoma was the commonest benign & adenoid cystic carcinoma was the most frequent malignant tumors. On cytohistologic correlation, sensilitvity of cytology for diagnosing cystic, inflammatory, neoplastic lesions proved to be 93.3%. 95.7% & 100% respectively. Overall accuracy for cytodiagnosis of malignant salivary gland lesions in our study was 96.07%.     

Combination chemotherapy of multiple myeloma--BCNU.cyclophosphamide.procarbazine.prednisolone and MCNU.cyclophosphamide.procarbazine.prednisolone therapy

Forty-four patients with progressive symptomatic multiple myeloma were treated with a protocol combining cyclophosphamide (10 mg/kg weekly), procarbazine (2 mg/kg daily), prednisolone (20 mg daily), and either BCNU (1 mg/kg weekly) (BCPP protocol) or MCNU (0.8-1 mg/kg) (MCPP protocol). Of these, 34 patients were treated with the former, and 10 patients with the latter. With BCPP protocol, 12 achieved a complete response, 11 evidenced a 75% response, and 7 displayed a 50% response. With MCPP protocol, on the other hand 2 achieved a complete response, 6 showed a 75% response, and 1 exhibited a 50% response. The median tumor halving time in both groups was 77 days and 57 days respectively. The 5-yr disease-free survival of patients treated with BCPP protocol was 62.0 +/- 10.8%. In MCPP group, 8 of 10 patients are alive with more than 49-87 weeks survival. Although myelotoxicity was moderate, other toxicities were moderate. Toxicity requiring dose modification and discontinuation of the scheduled therapy was observed.     

Role of F.E.S.S. in chronic sinusitis

Functional endoscopic sinus surgery (FESS) is a new and exciting treatment for chronic sinus disease. A prospective study of 50 patients undergoing FESS was undertaken at the department of Otolaryngology, Dayanand Medical College & Hospital, Ludhiana. Parameters studied included patient symptoms, medical history, medical therapy, radiologic findings, complications and postoperative symptoms. 62% of our patients had sinonasal polypi (ethmoidal polypi 56%, antrochoanal polypi 6%) while 38% had chronic sinusitis. Osteomeatal complex involvement (88%) was the most common preoperative CT scan findings. All the cases were subsequently suhjected to functional endoscopic sinus surgery, studied for post-operative complications and 82% of the patients achieved improvement in preoperative symptoms. It was concluded that FESS is a highly successful treatment for chronic sinus disease.     

Tympanometric evaluation of S.O.M.

A study involving 100 patients encompassing both tympanometric and surgical evaluation of 161 ears is presented.     

Address of early stage primary colonic neoplasia by N.O.T.E.S.

Natural Orifice Translumenal Endoscopic Surgery (N.O.T.E.S.) has the capacity to impact greatly on the practice of colorectal surgery. As much as potentially providing an alternative means of operative approach, its consideration and evolution is already also providing a wealth of instrument innovation that seems likely to greatly enhance the endoscopists' armamentarium for advanced endoluminal intervention. Furthermore, its aspirational concept is greatly advancing the progress of single site incision laparoscopic approaches and is speeding appreciation of translumenal assistance and operation. However, if N.O.T.E.S. is to occupy a distinct role in the surgical management of colorectal disease, it needs a niche indication of its own that constitutes a therapeutic advance with considerable clinical benefit for suitable patients. Conversely, sound development of a specific stream-lined operative strategy for N.O.T.E.S-type operations may exert a reciprocal swash upon conventional specialist practice. Thus spurred by N.O.T.E.S, localized resection may become standard therapy for early stage colonic neoplasia regardless of operative access although considerable clinical study is as yet required. Therefore, as much as ensuring feasibility and accuracy in the replication of conventional surgical maneuvers, the dawn of N.O.T.E.S. should be recognized as an opportunity for the inquisition of prevailing surgical principles and prejudices in order that colorectal operations are further honed towards perfection (above all it should be realized that avoidance of abdominal scarring is not the last barrier before surgical nirvana). This may represent the main legacy of transluminal investigation whether or not pure N.O.T.E.S. operating ever becomes a clinical reality in its own right.