Catheter-less robotic radical prostatectomy using a custom-made synchronous anastomotic splint and vesical urinary diversion device: report of the initial series and perioperative outcomes

OBJECTIVE

To study the feasibility of avoiding a urethral catheter after robotic radical prostatectomy by using suprapubic diversion with a urethral splint, as urethral catheterization is often a source of major discomfort and pain to the patient, and can cause more concern to the patient than the procedure; we present the outcomes of a pilot study.

PATIENTS AND METHODS

This pilot study involved 30 patients; in group 1 (the study group of 10 patients) we used a custom‐made suprapubic catheter which provided a small anastomotic splint, multiple holes for drainage and the ability to retract the splint to give a voiding trial before removing the drainage device. Group 2 was a control group of 20 patients who had standard urethral catheterization with an 18 F Silastic Foley catheter. Demographic, intraoperative and outcome data were measured and analysed. Urethral symptoms were recorded using a specially developed questionnaire.

RESULTS

The two groups were comparable in terms of age, serum prostate specific antigen level, body mass index, Gleason scores, tumour stage, operative duration, amount of bleeding, console times, anastomotic leakage and postoperative retention rates. The study group had significantly less penile shaft or tip pain and discomfort during walking or sleeping. No patient in either group had haematuria or clot retention requiring irrigation.

CONCLUSION

Urethral catheter‐less robotic radical prostatectomy is feasible. The advantages are decreased penile shaft and tip pain, and decreased patient discomfort and an earlier return of continence.     

Successful use of subcutaneous anakinra in hemophagocytic lymphohistiocytosis precipitated by candidiasis in a patient with systemic lupus erythematosus: A case report and description of a novel therapeutic regimen

Hemophagocytic lymphohistiocytosis (HLH) is a rare and often fatal condition characterized by inappropriate immune system activation leading to a “cytokine storm”, and ultimately resulting in end-organ damage. Causes include primary defects in genes involved in immune-mediated cytolytic pathways, or secondary triggers such as infection or malignancy. We describe a case of HLH precipitated by fungal infection which occurred as a consequence of immunosuppression for management of systemic lupus erythematosus (SLE) and necrotizing myopathy. The patient presented with immune-mediated disease of the muscles and lung which was treated with high-dose corticosteroids and aggressive immunosuppression. HLH emerged in the context of confirmed candidiasis and features of severe sepsis. The patient responded rapidly to antifungal therapy and high-dose anakinra, which was administered subcutaneously and progressively weaned over 4 weeks. She completed HLH treatment as an outpatient and remains well at 12 months with controlled SLE and no recurrence of HLH.     

Toward assessing traumatic events and stress symptoms in preschool children from low-income families

Traumatic events can seriously disrupt the development of preschool children. Yet few studies capture developmentally specific examples of traumas and the expression of distress for this age group. Mothers and teachers of 138 preschoolers from low-income families were interviewed about traumatic events and completed a new measure assessing their child's traumatic stress symptoms. They reported traumatic events as the death of a person, death of a pet, family violence, high conflict divorce, sudden family loss, accident or injury, and viewing the World Trade Center attack. Factor analysis of 17 trauma symptoms revealed three internally consistent and valid scales: Intrusions, Emotional Reactivity, and Fears, plus a Total omnibus score. Traumatic stress symptoms varied by the type of event. Scores were higher for traumatic events involving close family members than for distal events.     

ELMO1 and Dock180, a bipartite Rac1 guanine nucleotide exchange factor, promote human glioma cell invasion

A distinct feature of malignant gliomas is the intrinsic ability of single tumor cells to disperse throughout the brain, contributing to the failure of existing therapies to alter the progression and recurrence of these deadly brain tumors. Regrettably, the mechanisms underlying the inherent invasiveness of glioma cells are poorly understood. Here, we report for the first time that engulfment and cell motility 1 (ELMO1) and dedicator of cytokinesis 1 (Dock180), a bipartite Rac1 guanine nucleotide exchange factor (GEF), are evidently linked to the invasive phenotype of glioma cells. Immunohistochemical analysis of primary human glioma specimens showed high expression levels of ELMO1 and Dock180 in actively invading tumor cells in the invasive areas, but not in the central regions of these tumors. Elevated expression of ELMO1 and Dock180 was also found in various human glioma cell lines compared with normal human astrocytes. Inhibition of endogenous ELMO1 and Dock180 expression significantly impeded glioma cell invasion in vitro and in brain tissue slices with a concomitant reduction in Rac1 activation. Conversely, exogenous expression of ELMO1 and Dock180 in glioma cells with low level endogenous expression increased their migratory and invasive capacity in vitro and in brain tissue. These data suggest that the bipartite GEF, ELMO1 and Dock180, play an important role in promoting cancer cell invasion and could be potential therapeutic targets for the treatment of diffuse malignant gliomas.     

Cecal volvulus occurring after laparoscopic appendectomy.

Less than 2% of cases of intestinal obstruction in adults is caused by cecal volvulus. Although recent abdominal surgery has been implicated, no previous case of cecal volvulus has been reported after laparoscopic appendectomy.     

A study on utilization of anti–asthmatic drugs at a medical college hospital in India

ObjectiveTo study the usage of anti-asthmatic dugs and enumerate the patients' non-compliance.MethodsThe study was conducted from 5th Feb, 2006 to 5th Mar, 2006. The samples were from the general medicine ward. All patients with respiratory tract infection who received anti–asthmatic drugs were included in the study. Data were collected from clinical notes and structured patient's data, and patient interview utilizing a piloted questionnaire data collection form. The questionnaire included patient demographics, anti–asthmatics prescribed, dose, frequency and previous treatment if any and its duration, concomitant medications etc.Results26.31% of patients were 61–70 years old. Among 57 patients, 91.23% of patients received multi–therapy, 8.77% of patients received mono–therapy, 59.65% of patients took over the counter (OTC) drugs and 57.89% of patients were non compliant. Anti–asthmatic drugs were prescribed to asthmatic patients as oral, inhalation and others (injections), and more than one route were used for administration of drugs.ConclusionThe anti-asthmatics are used to treat breathing difficulties such as allergy. Poor compliance to treatment is common among the patients, which makes it difficult to manage asthma and increases both morbidity and mortality. It is suggested that interventions have to be done by providing counseling and improving the current prescribing trend for better and rational utilization.     

Backscattered Dose Perturbation Effects at Metallic Interfaces Irradiated by High-Energy X- and Gamma-Ray Therapeutic Beams

PURPOSE: To analyze backscattered dose enhancements near different metallic interfaces for cobalt-60 ((60)Co) gamma rays and 6- and 18-MV photon beams. MATERIAL AND METHODS: Measurements were carried out with a PTW thin-window, parallel-plate ionization chamber and an RDM-1F electrometer. Thin sheets of aluminum, mild steel, copper, cadmium and lead were used as inhomogeneities. The chamber was positioned below the inhomogenities with the gantry maintained under the couch. RESULTS: It can be noticed that the backscatter dose factor (BSDF) reaches the saturation value within few millimeters of all inhomogeneities and the thickness at which the saturation value is reached depends on the atomic number of the inhomogeneity. The amount of backscattered radiation was noticed to be greater with lesser-energy photons ((60)Co) compared to the high erenergy photons. The BSDF varies across the beam when the inhomogeneity is present due to the change in beam quality. The backscattered electrons from lead inhomogeneity have a range in the order of 5-7 mm. CONCLUSION: Higher atomic number inhomogeneities result in an increase in BSDF, as they have higher scattering cross section for the secondary electrons. The increase in dose was noticed for few millimeters upstream from the metallic inhomogeneity, which suggests that the range of backscattered electrons is very small. Since the factors affecting the BSDF at the interface are energy dependent, it is expected that the variation in BSDF will also be sensitive to the beam energy.     

Endobronchial pseudo-tumour caused by herpes simplex.

Herpes simplex virus (HSV) causes tracheobronchitis and pneumonitis; however, to date, there has only been one report of an endobronchial mass caused by HSV type II. This case study describes a 68-yr-old female with severe kyphoscoliosis who was intubated for acute on chronic hypercapnic respiratory failure and developed blood-tinged endotracheal secretions. Fibreoptic bronchoscopy demonstrated an endobronchial mass in the right middle lobe. Cultures grew HSV type I and biopsy specimens demonstrated cytopathological changes consistent with HSV infection. This is the first reported case of HSV type I presenting as an endobronchial tumour.