Laparoscopic robotic pyeloplasty using the Zeus Telesurgical System

We present the initial clinical experience using a robot to perform a laparoscopic dismembered pyeloplasty at a Canadian centre. Five patients were confirmed to have ureteropelvic junction obstructions through nuclear renography, cross sectional imaging and intravenous pyelography. After performing a retrograde ureteropyelography and double J stent placement, laparoscopic dismembered pyeloplasty was performed by a single surgeon at a remote workstation using the ZeusTM Telepresence Surgery System (Intuitive Surgicala). The mean total operative time was 225+/-48 minutes, anastomotic time was 71+/-16 minutes, and the mean time required to set-up the robot was 30+/-17 minutes. The estimated blood loss was less than 100 ml in each case. A mean total of 22+/-10 mg of morphine sulfate equivalents were used for analgesia, and the patients were discharged home after a mean of 58+/-10 hrs. There were no robotic failures, and all evaluable patients are free of pain and demonstrable obstruction. One patient developed a delayed urine leak, which resolved with percutaneous drainage. The robot provides the ability to perform complicated operations with precision through elimination of tremor, scaling of motion, and through the use of 'wristed' instruments that enhance the freedom of movement normally limited by straight-shafted laparoscopic needle drivers. The development of robotic telesurgery is still in its infancy, and the significance of its role in urologic surgery continues to be evaluated.     

CT findings in a child with reflux oesophagitis.

We report the case of a 7-month-old boy who presented with a history of vomiting since birth. A computed tomography study showed circumferential thickening of the lower oesophageal wall with enhancement of the mucosa. After a period of antireflux medication, the patient underwent simultaneous oesophageal dilatation and Nissen fundoplication. He is doing well at 2-year follow up.     

Effect of strawberry (Fragaria × ananassa) leaf extract on diabetic nephropathy in rats

Diabetic nephropathy is a clinical syndrome characterized by albuminuria, hypertension and progressive renal insufficiency. The aim of this study was to investigate the effect of strawberry (Fragaria × ananassa) leaf extract on diabetic nephropathy in rats. Streptozotocin (STZ) diabetic rats were orally treated with three doses (50, 100 and 200 mg/kg) of strawberry leaf extract for 30 days. Nephropathy biomarkers in plasma and kidney were examined at the end of the experiment. The three doses of strawberry leaf extract significantly decreased the levels of blood glucose, urea nitrogen, plasma creatinine, kidney injury molecule (Kim)‐1, renal malondialdehyde (MDA), tumour necrosis factor alpha (TNF‐α), interleukin (IL)‐ 6 and caspase‐3 in diabetic rats. Meanwhile, the levels of plasma insulin, albumin, uric acid, renal catalase (CAT), superoxide dismutase (SOD) and vascular endothelial growth factor A (VEGF‐A) were significantly elevated in diabetic rats treated with strawberry leaf extract. These results indicate the role of strawberry leaves extract as anti‐diabetic, antioxidant, anti‐inflammatory and anti‐apoptosis in diabetic nephropathy.     

Effectiveness of intervention led by a community pharmacist for improving recognition of sleep apnea in primary care – a cohort study

Despite its high prevalence and major public health ramifications, obstructive sleep apnea syndrome (OSAS) remains underdiagnosed. The aim of this study was to determine whether the involvement of a community pharmacist (CP) in the care pathway of a patient at risk of OSAS, through the implementation of a community pharmacist (CP) intervention, was effective, i.e. increased the use of diagnostic tests in this population. We compared a cohort of patients included in a research protocol (exposed to a CP intervention) with patients having the same characteristics taken from a general population database who did not receive the intervention (unexposed group). The aim of the CP intervention was to educate patients about the risk of untreated OSAS, encouraging them to consult their general practitioner, and urging the doctor to continue investigations. We included 782 patients at risk of OSAS, i.e. taking one or more anti‐hypertensive drugs, being overweight (body mass index >25) and snoring almost every night (88 in the exposed group and 694 in the unexposed group). After a 6‐month follow‐up, the number of patients who underwent an OSAS diagnostic test was significantly higher in the exposed group compared to the unexposed group (22.7 versus 11.4%, P = 0.003). Being exposed to the pharmacist intervention was associated with a higher chance of undergoing a diagnostic test for OSAS, adjusted odds ratio: 2.24 (1.25–4.01). In conclusion, these findings provide arguments for the implementation of a CP OSAS screening intervention in CP routine practice.