Randomized trial of laparoscopic v open nephrectomy

BACKGROUND AND PURPOSE: Clayman and associates first described laparoscopic nephrectomy in 1990. This paper describes the first randomized controlled trial to compare laparoscopic with open surgery for simple and radical nephrectomy. PATIENTS AND METHODS: Between 2001 and 2004, 45 patients requiring simple or radical nephrectomy (tumors as large as 8 cm) were randomized to either open surgery through a loin incision or laparoscopic nephrectomy (transperitoneal). Outcome measures included operative time, complications, hospital stay, pain scores, time to return to normal activities, and quality of life scores (EuroQol). RESULTS: The mean operative time was 105 minutes in the laparoscopic group and 93 minutes in the open-surgery group (P = 0.4). Blood loss, complications, and the mortality rate were similar in the two groups, as was the hospital stay at a median of 4 days in the laparoscopic group and 5 days in the open group (P = 0.9). Postoperative visual analog pain scores averaged 3.6 in the laparoscopic group compared with 5.4 in the open group (P = 0.02). There was no difference in pain scores at 3 months. Return to normal activities was faster in the laparoscopic group at 42 days v 62 days in the open group (P = 0.04). CONCLUSIONS: Laparoscopic nephrectomy is associated with less postoperative pain and a faster return to normal activities than open nephrectomy.     

Etiologic Classification Criteria of ARCO on Femoral Head Osteonecrosis Part 2: Alcohol-Associated Osteonecrosis

Background

Although alcohol is a leading risk factor for osteonecrosis of the femoral head (ONFH) and its prevalence reportedly ranges from 20% to 45%, there are no unified classification criteria for this subpopulation. In 2015, Association Research Circulation Osseous decided to develop classification criteria for alcohol-associated ONFH.

Malignant gastric outlet obstructions: treatment by means of coaxial placement of uncovered and covered expandable nitinol stents

PURPOSE: To assess whether coaxial placement of uncovered and covered expandable nitinol stents overcomes the disadvantages of the increased migration rate seen with covered stents and the tumor ingrowth seen in uncovered stents in the treatment of malignant gastric outlet obstructions. MATERIALS AND METHODS: Two types of expandable nitinol stent were designed: an uncovered stent and a covered stent. Under fluoroscopic guidance, the uncovered and covered stents were placed coaxially with complete overlap in 39 consecutive patients with malignant gastric outlet obstruction caused by stomach cancer. Food intake capacity was graded on a scale of 0-4. Stent patency rate was estimated by the Kaplan-Meier method. RESULTS: Technical success rate was 97% (38 of 39 patients). After stent placement, food intake capacity improved at least one grade in 36 patients. Stent migration occurred in three patients (8%), that is, partial (n = 2) or complete (n = 1) upward migration of the inner covered stent into the stomach. Two of these patients were treated by placement of an additional covered stent. During the mean follow-up period of 134 days (range, 15-569 d), 10 patients developed recurrent symptoms of obstruction with tumor overgrowth being the most common cause. Nine underwent placement of an additional covered stent with good results. The median period of primary stent patency was 157 days (mean, 278 d). The 30-, 60-, and 180-day patency rates were 97%, 91%, and 39%, respectively. Four patients (10%) died within 1 month after the procedure. CONCLUSION: Coaxial stent placement technique seems to contribute to decreasing the migration rate of the stent and decrease the rate of recurrent obstruction by preventing or delaying tumor ingrowth.     

Sensitivity of LR115 detector in diffusion chamber to Rn in the presence of Rn

Determination has been made of the sensitivity of LR115 type 2-track detectors (in units of m) to ²²²Rn, measured in the presence of ²²⁰Rn. Measurements have been made by means of a widely used diffusion chamber while Monte Carlo simulations have also been conducted. The experimentally derived sensitivities for ²²²Rn and ²²⁰Rn were found to be 0.470±0.022 and 0.486±0.042 m, respectively. For Monte Carlo simulations, the sensitivities to ²²²Rn gas were found to range from 0.618×10^–2 m (assuming that all ²¹⁸Po progeny decay before deposition onto the internal walls of the diffusion chamber) to 0.405×10^–2 m (assuming that all ²¹⁸Po progeny are deposited on the internal walls of the same containment vessel before decaying). The sensitivity to ²²⁰Rn gas of 0.465×10^–2 m found from Monte Carlo simulations agrees to within uncertainty with experimental findings. The experimentally derived sensitivity value for ²²²Rn indicates that 30% of the ²¹⁸Po progeny decay before deposition onto the internal walls of the diffusion chamber.