Robotic extended pyelolithotomy for complete staghorn calculus

Staghorn stones represent a therapeutic challenge to urologists. We present our experience with laparoscopic extended pyelolithotomy for treatment of staghorn and complex renal calculi in highly selected cases. This approach provides the principles of open surgery with the advantages of minimally invasive surgery. We describe our experience with robot-assisted extended pyelolithotomy for complex coralliform calculi. Since January 2007, robotic extended pyelolithotomy has been performed by transperitoneal approach in two patients with complete coralliform lithiasis (calculi average size 8 cm). One patient had history of percutaneous nephrolithotomy. Demographic and operative data were collected. All procedures were technically successful without need for open conversion. Mean estimated blood loss was 175 ml (range 50–300 ml), and mean operative time was 150 min (range 120–150 min). A perinephric drain was employed in one patient with duration of 5 days. Postoperative imaging confirmed complete stone clearance. Robotic extended pyelolithotomy is a feasible and reproducible procedure for removal of complete and partial staghorn calculi in selected patients with complex nephrolithiasis. This approach might limit the role of open surgery for these calculi, but further publications with more cases are necessary to further define its utility.     

Geographical Information Systems: A Tool to Map and Analyze Disease Spread

Objective

Use GIS to illustrate and understand the association between environmental factors and spread of infectious diseases.

Introduction

Spatial methods are an important component of epidemiological research motivated by a strong correlation between disease spread and ecological factors (1). Our case studies examine the relationship between environmental conditions, such as climate and location, and vector distribution and abundance. Therefore, GIS can be used as a platform for integrating local environmental and meteorological variables into the analysis of disease spread, which would help in surveillance and decision making.

Methods

Case study 1- Lyme disease -Lyme disease is a tickborne infection caused by the bacterium Borrelia burgdorferi. The goal of this study was to analyze the association between meteorological factors and Lyme disease risk in humans in Texas. A total of 1,212 cases reported from 138 counties in Texas from Jan 2000 to Dec 2010 were analyzed. We used temperature and precipitation raster grids to generate humidity maps for Texas region. Our results indicated that there is a strong positive association between Lyme disease incidence and humidity, with western cross timbers region having a higher risk then the low plains.Case study 2- Spinach – Motivated by the recent increase in food-borne outbreaks related to fresh produce, one of the objectives for this study was to use the geospatial analysis to elucidate factors that contribute to contamination of produce at preharvest. We collected 955 spinach samples from 13 produce farms in Colorado and Texas during 2010–2011 and tested the samples for Listeria monocytogenes, Escherichia coli O157:H7 and Salmonella contamination. The spinach contamination results were then used in conjunction with the National Resource Information (NRI) databases along with the SSURGO database to predict environmental and meteorological factors contributing to spinach contamination. Our findings would help to reduce frequency of human foodborne illnesses related to fresh produce.Case study 3- Valley fever Coccidioidomycosis or Valley Fever (VF) is a fungal zoonosis affecting humans and a variety of animal species. In this study, we used Texas Veterinary Medical Diagnostic Laboratories (TVMDL) data of all dog sera tested for coccidioidomycosis from July 1999 - December 2009. Census data on human population density for Texas were used to determine the dog population density and identify disease clusters for the 5,871 submitted dog sera over a period of 10.5 years. Both the isopleth map of the VF seropositive rates in dogs across Texas and the identified spatial and spatio-temporal clusters of the disease suggested that VF occurs in the western and southwestern part of Texas at a much higher rate than in other areas of the state (2). Since VF is not a reportable disease in TX, dogs could be used as a sentinel for human infection.

Results

The above studies illustrate the utility of GIS as a tool in integrating different ecological factors to understand disease occurrence and spread. The geographical and temporal patterns found in these studies provide benchmark to support disease control activities in Texas. Additionally, the identification of high-risk areas may be useful for decision makers to improve and prevent future disease spread.

Conclusions

Spatial epidemiological research has challenges, such as dealing with coarse level and aspatial datasets. Testing laboratories provide limited spatial information up to the zip code level due to the confidentiality concerns. Spatial analysis of such dataset prevents research at finer resolutions (Census block or block group). Despite these limitations, spatial epidemiology continues to be an invaluable field in the research and surveillance of infectious disease.     

Knowledge of and attitudes about blood-borne viruses and infection control in Brazilian dental practice

OBJECTIVE: To determine whether there were any recent changes in hepatitis B immunisation of dental staff, infection control or understanding of viral infections in Brazilian dentists.
DESIGN: A randomised survey was conducted on 740 dentists attending the National Dental Congress in Sao Paulo, Brazil in 1994.
SUBJECTS AND METHODS: The 740 dentists were questioned as to the presence of various viruses in saliva, the perceived risks of dental staff and long-term sequelae, the availability and uptake of vaccines, willingness to treat virus-infected persons, and means of infection control. Nearly 69% of respondents were female dentists, of mean age 30 years. Results were compared with a similar survey from 1990.
RESULTS: Most respondents knew that HIV and hepatitis viruses could appear in saliva and almost all knew of infective risks from hepatitis B (HBV), and the availability of the vaccine. Less than half knew of the association of HBV with liver cancer. There was a four-fold increase in those vaccinated against HBV since the low figure of 9% in 1990. Nearly two-thirds of respondents perceived an occupational risk to dental staff from HIV, and a similar proportion were also unwilling to treat virus-infected persons. A similar proportion also used chemical disinfection for some dental instruments.
CONCLUSIONS: The results show little improvement over a 4-year period except a much greater proportion of dentists were immunised against HBV. However, still only one third of dentists had been vaccinated, in a country with a high prevalence of infection in the general population.     

Single port radical prostatectomy: current status

The aim of this study is to analyze the current literature on single port radical prostatectomy (LESS-RP). Single port radical prostatectomy laparoendoscopic (LESS-RP) has established itself as a challenge for urological community, starting with the proposal of different approaches: extraperitoneal, transperitoneal and transvesical, initially described for laparoscopy and then laparoscopy robot-assisted. In order to improve the LESS-RP, new instruments, optical devices, trocars and retraction mechanisms have been developed. Advantages and disadvantages of LESS-RP are controversial, while some claim that it is a non-trustable approach, regarding the low cases number and technical difficulties, others acclaim that despite this facts some advantages have been shown and that previous described difficulties are being overcome, proving this is novel proposal of robotics platform, the Da Vinci SP, integrating the system into “Y”. The LESS-RP approach gives us a new horizon and opens the door for rapid standardization of this technique. The few studies and short series available can be result of a low interest in the application of LESS-RP in prostate, probably because of the technical complexity that it requires. The new robotic platform, the da Vinci SP, shows that it is clear that the long awaited evolution of robotic technologies for laparoscopy has begun, and we must not lose this momentum.     

Enhanced Mg2+-ATPase activity in ghosts from HS erythrocytes and in normal ghosts stripped of membrane skeletal proteins may reflect enhanced aminophospholipid translocase activity

Hereditary spherocytosis (HS) is a congenital haemolytic anaemia which is characterized by a great variety of structural defects in the red cell's membrane skeleton and/or deficiencies in particular membrane (skeletal) proteins. Enhanced (Mg²⁺)-dependent adenosine triphosphatase (Mg²⁺-ATPase) activities, varying from 115% to 160%, were invariably found in erythrocyte ghosts derived from 13 HS patients. Similarly, an enhancement of Mg²⁺-ATPase activity by 30% is observed in normal red cell ghosts that have been stripped of the greater part of their membrane skeletal proteins by treatment with a low ionic strength buffer. Reassociation of those stripped ghosts with spectrin reduces the enhanced Mg²⁺-ATPase activity to its original level. Since in both cases, HS ghosts and stripped normal ghosts, the stabilizing effects that the membrane skeleton exerts on the maintenance of an endofacial localization of the aminophospholipids are impaired, the enhanced Mg²⁺-ATPase activity is interpreted to reflect an increased activity of the aminophospholipid translocase. The present observations therefore support a role of the membrane skeleton in the stabilization of phospholipid asymmetry in the red cell membrane and consequently in reducing the energy consumption of the translocase.     

孕早期绒毛高雪氏病产前诊断法

目的采用荧光酶学手段,建立一种测定绒毛p-葡萄糖苷酶活性的方法.方法分析β-葡萄糖苷酶的酶动力学特性,并检测36例正常胎盘绒毛组织及高雪氏病胎儿绒毛酶活性.结果正常胎盘绒毛组织酶活性均数为776.3,标准差为190.5;高雪氏病胎儿绒毛酶活性为0.结论该法可成为孕早期高雪氏病产前诊断的简单、快速的方法.