Robot-assisted laparoscopic radical prostatectomy: initial experience with first 112 cases

In this study we report our initial robot-assisted laparoscopic radical prostatectomy (RALRP) experience for organ-confined prostate cancer with the first 112 cases between August 2009 and January 2011. The mean age was 61 (46?C76) years. Gleason scores ranged between 4 and 9, and the mean prostate volume was 38.7 (15?C115) ml. The mean follow-up time was 8.1 (1?C18) months. The mean operative time was 174.7 (75?C360) min, and the mean estimated blood loss was 141 (60?C800) ml. A nerve-sparing procedure was performed bilaterally in 79 cases and unilaterally in 15 cases. All the complications seen (8 out of 112 patients, 7.1%) were grade 1 and 2 according to the Clavien classsification system. Postoperatively, five (4.4%) patients needed transfusion. Mean drain extraction time was 3.2 (2?C15) days and mean hospital stay was 4 (2?C18) days. The catheter was removed on postoperative day 8.5 (6?C20). Surgical margin was positive in 13 (11.6%) patients. Forty-nine patients have 6?months and 30 patients have 12?months follow-up. The continence rate were 29.4, 64.2, 84.2, 91.1 and 96.6% immediately after catheter removal and at 1, 3, 6 and 12?months, respectively. No anastomotic stricture or urinary retention was seen in the follow-up period. RALRP is a safe and feasible technique in the treatment of localized prostate cancer. Our initial experience with this procedure shows promising short-term outcomes.     

Nichtalkoholische Fettlebererkrankungen

Nonalcoholic fatty liver diseases (NAFLD) result from an imbalance between accumulation and delivery (de novo lipogenesis) of hepatic fat. The individual food intake plays a considerable role in NAFLD pathogenesis. Unfavorable (e.g., high fructose diets) and protective (e.g., coffee, Mediterranean diet) food components have been described. Obesity, type 2 diabetes, lack of exercise, and insulin resistance are the main risk factors of NAFLD. Weight loss results in a reduction of hepatic fat, improvement of steatohepatitis, and reduction/resolution of heptic fibrosis. Despite promising studies (e.g., obeticholic acid, glitazones, vitamin E), there are no reliable data for the pharmacological treatment of NAFLD. Lifestyle changes (e.g., endurance training, slow weight loss) remain the basis of NAFLD therapy.     

The Effects of PPARgamma Agonist Rosiglitazone on Neointimal Hyperplasia in Rabbit Carotid Anastomosis Model

ABSTRACT: OBJECTIVE: Neointimal hyperplasia involving smooth muscle cell (SMC) proliferation, migration and extracellular matrix (ECM) degradation is an important component of atherosclerosis. It develops as a response to vascular injury after balloon angioplasty and vascular graft placement. Matrix metalloproteinases (MMPs) induce SMC proliferation, migration and contribute to intimal hyperplasia by degrading ECM. PPARgamma agonists inhibit SMC proliferation, migration and lesion formation. In this study, we aimed to investigate the effects of PPARgamma agonist rosiglitazone on neointimal hyperplasia and gelatinase (MMP-2 and MMP-9) expressions in rabbit carotid anastomosis model. Method: New Zealand white rabbits (n=13, 2.7-3.2 kg) were divided into placebo and treatment groups. Right carotid artery (CA) was transected and both ends were anastomosed. Treatment group (n=6) received rosiglitazone (3mg/kg/day/p.o.) and placebo group (n=7) received PBS (phosphate buffered saline, 2.5ml/kg/day/p.o.) for 4 weeks postoperatively. After the sacrification, right and left CAs were isolated. Morphometric analyses and immunohistochemical examinations for gelatinases were performed. Results: Intimal area (0.055+/-0.005 control vs 0.291+/-0.020 um2 anastomosed, p<0,05) and index (0.117+/-0.002 control vs 0.574+/-0.013 anastomosed, p<0,01) significantly increased in anastomosed arteries compared to control arteries from placebo group. However, in rosiglitazone-treated group, intimal area (0.291+/-0.020 PBS vs 0.143+/-0.027 rosiglitazone, p<0,05) and index (0.574+/-0.013 PBS vs 0.263+/-0.0078 rosiglitazone, p<0,01) significantly decreased. Furthermore, gelatinase immunopositivity was found to have significantly increased in anastomosed arteries from placebo group and decreased with rosiglitazone treatment. Conclusion: These results suggest that rosiglitazone may prevent neointimal hyperplasia, which is the most important factor involved in late graft failure, by inhibiting gelatinase enzyme expression.     

A review of the anatomy and clinical significance of adrenal veins

The adrenal veins may present with a multitude of anatomical variants, which surgeons must be aware of when performing adrenalectomies. The adrenal veins originate during the formation of the prerenal inferior vena cava (IVC) and are remnants of the caudal portion of the subcardinal veins, cranial to the subcardinal sinus in the embryo. The many communications between the posterior cardinal, supracardinal, and subcardinal veins of the primordial venous system provide an explanation for the variable anatomy. Most commonly, one central vein drains each adrenal gland. The long left adrenal vein joins the inferior phrenic vein and drains into the left renal vein, while the short right adrenal vein drains immediately into the IVC. Multiple variations exist bilaterally and may pose the risk of surgical complications. Due to the potential for collaterals and accessory adrenal vessels, great caution must be taken during an adrenalectomy. Adrenal venous sampling, the gold standard in diagnosing primary hyperaldosteronism, also requires the clinician to have a thorough knowledge of the adrenal vein anatomy to avoid iatrogenic injury. The adrenal vein acts as an important conduit in portosystemic shunts, thus the nature of the anatomy and hypercoagulable states pose the risk of thrombosis. Clin. Anat. 27:1253–1263, 2014. © 2014 Wiley Periodicals, Inc.