Comparative study of laparoscopic vs open gastrectomy in gastric cancer management

AIM:To compare long-term results of gastric cancer patients undergoing laparoscopic and open gastrec-tomy in a single unit.METHODS:From February 2000 to September 2004,all patients with adenocarcinoma of the stomach were assessed to entry in this longitudinal prospective non-randomized trial.Primary endpoint was cancer-related survival and secondary endpoints were overall survival,evaluation of surgical complications and mortality.RESULTS:Fifty-eight patients were enrolled.Forty-seven patients were followed...     

250 ms to code for action affordance during observation of manipulable objects

It is well known that viewing graspable tools (but not other objects) activates motor-related brain regions, but the time course of affordance processing has remained relatively unexplored. In this study, EEG was continuously recorded from 128 scalp sites in 15 right-handed university students while they received stimuli in the form of 150 pictures of familiar non-tool objects and 150 pictures of manipulable tools, matched for size, luminance and perceptual familiarity. To select the 300 images for the study, a wider set of preliminary stimuli was screened for motoric content by 20 judges using a 3-point scale (0 = absent; 2 = strong); pictures that scored below 1.5 or above 0.6 were excluded from the tool and non-tool categories, respectively. Tools and non-tools were presented in random order, interspersed with 25 photos of live plants. Each slide was presented for 1000 ms, with an interval ranging from 1500 to 1900 ms. The task consisted of responding to the photos of plants while ignoring the other stimuli. Both an anterior negativity (210-270 ms) and a centroparietal P300 (550-600 ms) were larger in response to tools than objects, particularly in the left hemisphere. swLORETA inverse solution identified the occipito-temporal cortex (BA19 and BA37) as the most significant source of activity (in the 210-270-ms time window) for both types of visual objects and the left postcentral gyrus (BA3) and the left and right premotor cortex (BA6) as the most significant source of activity for tools only. These data hint at an automatic access to motoric object properties even under conditions in which attention is devoted to other stimulus categories.     

Arthroscopic Resection of Talocalcaneal Coalitions

Excision of symptomatic talocalcaneal coalitions, after failure of an adequate conservative treatment, is a widely accepted surgical treatment when less than 50% of the subtalar joint is involved and in the absence of degenerative changes to the subtalar or surrounding tarsal joints. Favorable results have been reported in 80% to 100% of patients with open resection. The traditional medial incision to the subtalar joint provides excellent exposure of the middle facet but inadequate visualization of the posterior facet. Other common disadvantages of the traditional open technique include (1) risk of incisional neuroma formation, (2) risk of superficial wound infection and delayed wound healing, and (3) prolonged hospitalization for wound management and pain control. Prone ankle/subtalar arthroscopy has been reported to yield excellent results in the treatment of numerous hindfoot pathologies, with the advantage of reducing postoperative pain, hospital stay, infection rates, wound complications, and recovery time. A posterior arthroscopic technique for posterior-facet talocalcaneal coalition excision has been developed in an attempt to reduce the complications of the traditional open resection. Possible disadvantages of the arthroscopic procedure may include (1) longer learning curve, (2) increased surgical time, (3) possible tibial neurovascular bundle damage, and (4) difficulties in using interposition material.     

Harmonic Focus™ versus “knot tying” during total thyroidectomy: a randomized trial

The objective of the study is to compare the outcome of total thyroidectomy (TT) using the Harmonic Focus? (HF) versus conventional “knot tying” (KT) in terms of operative time, parathyroid function and post-operative complications. This prospective study was designed with a random allocation of subjects using a drawing technique. Eighty-one consecutive patients were submitted to TT in 2010 and randomly divided into two groups: 43 patients operated using HF (HF group) and 38 patients operated using KT (KT group). Parathyroid function was evaluated by parathyroid hormone (PTH) level at 1 h postoperatively and calcium level at first post-operative day. Indications for medical therapy were PTH < 15 pg/ml and/or calcium < 8.0 mg/dl and/or clinical signs or symptoms of hypocalcemia. Main outcomes were operative time, PTH and calcium levels, need for medical therapy and post-operative complications. Mean operative time was significantly lower in HF group compared with KT group (100 ± 34 vs. 119 ± 30 min). There were no significant differences concerning transient hypoparathyroidism requiring calcium and/or vitamin D therapy: 17 patients (39.5%) in HF group versus 21 (55.3%) in KT group. Five patients (11.6%) in HF group experienced symptomatic hypocalcemia versus 6 (15.8%) in KT group, without statistically significant difference. No patients experienced recurrent nerve injury. HF is a new ergonomic, reliable device developed for thyroid surgery. According to our results, HF is a safe, time-saving alternative to “knot tying” thyroidectomy, with no influence on parathyroid function, medical therapy and nerve injury.     

3D mechanical modeling of facial soft tissue for surgery simulation

State of the art medical image acquisition, image analysis procedures and numerical calculation techniques are used to realize a computer model of the face capable of realistically represent the force-deformation characteristics of soft tissue. The model includes a representation of the superficial layers of the face (skin, superficial musculoaponeurotic system, fat), and most facial muscles. The whole procedure is illustrated for determining geometrical information, assigning mechanical properties to each soft tissue represented in the model, and validating model predictions based on a comparison with experimental observations. The capabilities, limitations and possible future use of this approach are discussed.