Endoscope-assisted minilaparotomic radical retropubic prostatectomy

OBJECTIVE: To assess the clinical efficacy of endoscope-assisted minilaparotomic radical retropubic prostatectomy (EAM-RRP) compared with conventional radical retropubic prostatectomy (cRRP). METHODS: From September 2001 to December 2003, 30 patients with localized prostate cancer were treated by EAM-RRP. The surgical manipulation was performed through the wound with thoracoscopic assistance, using standard surgical instruments. In all cases, 800 mL of blood was collected from the patient for autotransfusion. For both EAM-RRP and cRRP, the internal iliac and obturator lymph nodes were dissected before the prostate removal. Clinical indicators such as operation time, blood loss, and duration of postoperative urine incontinence were analysed in the two groups. RESULTS: The postoperative period before ambulation and the duration of postoperative urine incontinence were significantly shorter after EAM-RRP than after cRRP, while no significant difference was found in operation time, blood loss, and duration of urethral catheterization. None of the cases required allotransfusion. CONCLUSION: EAM-RRP, which had a shorter postoperative period before ambulation and continence, is considered a safe and useful technique for radical prostatectomy.     

Retention of zirconia copings on zirconia implant abutments cemented with provisional luting agents

Summary  The purpose of this study is to measure and compare the retentive force of zirconia-based all-ceramic crowns cemented on zirconia abutments using five provisional luting agents. In addition, the effect of sandblasting and thermocycling on the retentive force was evaluated. Two hundred zirconia abutments and copings were fabricated (Procera system; Nobel Biocare) and divided into five groups. Hy bond temporary cement hard (Hard), Hy bond temporary cement soft (Soft), experimental temporary cement (New), Tempbond NE (Temp) and Freegenool temporary pack (Pack) were used according to the manufacturers' instructions. Each group was divided into two groups, one with and one without sandblasting. Furthermore, thermocycling up to 2000 cycles was conducted on half of each group. After 24 h and thermocycling, the retentive force was measured using a universal testing machine. The data were subjected to analysis of variance, and comparisons of the means were performed with a Games–Howell test at a level of 95%. As a result, Hard showed the highest retentive force, sandblasting was effective for improving the durability, and no effect of sandblasting was detected in the others. New showed stability of the retentive force even after thermocycling. The retentive force of Temp and Pack decreased significantly after thermocycling even with sandblasting. The retentive forces were different from the provisional cement and sandblasting, and Temp and Pack may not be appropriate for the retention of single-tooth zirconia abutments and coping restorations.     

White blood cell count,C-reactive protein and erythrocyte sedimentation rate in respiratory syncytial virus infection of the lower respiratory tract

Laboratory findings such as white blood cell (WBC) count, C-reactive protein (CRP) concentration and erythrocyte sedimentation rate (ESR) level in patients with bronchiolitis, bronchopneumonia and lobar pneumonia caused by respiratory syncytial virus (RSV) were studied. The diagnosis of having RSV infection of the lower respiratory tract was made on the presence of RSV antigen in nasopharyngeal specimens by means of enzyme immunoassay, on chest X-ray appearances and clinical manifestations. The WBC counts in the lobar pneumonia cases (n = 25, 12 288 ± 6296/mm³) were significantly greater than those for the bronchiolitis (n = 52, 9562 ± 2720/mm³) and bronchopneumonia (n = 43, 8369 ± 3714/mm³) cases. The concentrations of CRP in lobar pneumonia cases (n = 25, 6.5 ± 7.3 mg/dL) were significantly greater than those in the bronchiolitis (n = 52, 1.9 ± 2.0 mg/dL) and bronchopneumonia (n = 43, 2.1 ± 2.4 mg/dL) cases. The ESR levels in the lobar pneumonia cases (n = 24, 43.8 ± 29. mm/h) were also significantly higher than those in the bronchiolitis (n = 34, 20.1 ± 12.3 mm/h) and bronchopneumonia (n = 40, 24.7 ± 15.9 mm/h) cases. There were no significant differences in the WBC counts, the CRP concentrations and ESR levels between the bronchiolitis and bronchopneumonia cases. These results suggest that the RSV lobar pneumonia cases are coinfected with some bacterial organisms more heavily than in the RSV bronchiolitis and bronchopneumonia cases.     

Perioperative Complications and Adverse Events after Surgery for Peripheral Nerve- and Para-lumbar Spine Diseases

Peripheral nerve diseases are common. Para-lumbar spine diseases (PLSDs) include peripheral neuropathy around the lumbar spine, e.g., cluneal nerve entrapment and gluteus medius muscle pain. While these diseases can be treated by less invasive surgery, postoperative complications have not been sufficiently investigated. We document complications after surgery for peripheral nerve diseases and PLSDs. Between July 2014 and December 2020, 678 consecutive patients with peripheral nerve diseases and PLSDs underwent 1068 surgical procedures (upper limb 200 sites, lower limb 447 sites, para-lumbar spine 394 sites, and tumor 27 sites). After excluding 27 procedures to address tumors, we examined the remaining 1,041 procedures undergone by 672 patients (average age 68.2 years) and recorded the complication rate observed within 30 days after the procedures. The overall surgical complication rate was 3.9% (41/1041 procedures); 6 procedures required surgical salvage and 35 were treated conservatively. There were no long-term sequelae from complications. The complication rate was high after surgery for lateral femoral cutaneous-, saphenous-, and common peroneal nerve entrapment and tarsal tunnel syndrome; all sites involved the lower limbs. As a result, intergroup comparison showed that the complication rate was significantly higher for the upper limb (3.0%) procedures than the lower limb (6.7%) and PLSD (1.3%) procedures. It was significantly lower for PLSD operations than lower and upper limb operations. The patient age and diabetes mellitus were significant risk factors for postoperative complications. Their rate was low in patients treated for peripheral nerve diseases and PLSDs; 34 of the 41 complications (82.9%) were related to the surgical wound.     

SYSTEMIC LUPUS ERYTHEMATOSUS: A CASE-CONTROL EPIDEMIOLOGIC STUDY IN JAPAN

Background. Systemic lupus erythematosus (SLE) is designated by the Japanese government as one of the intractable diseases and all patients, who suffer from these diseases, are registered to get financial aid for treatment. Using newly registered SLE patients, a case-control study was conducted to evaluate potential risk factors. Methods. Two-hundred and eighty-two women SLE patients, newly registered to receive financial aid for treatment, and 292 randomly selected health examination participants at public health centers (controls) were surveyed from April 1988 through March 1990. By means of a self-administered questionnaire, data concerning demographic variables, smoking and drinking habits, past medical and reproductive history, and family history were collected. Results. Based on unconditional logistic regression analysis, the risk of SLE was significantly increased for current smokers (age-adjusted odds ratio (OR) = 2.31, 95% confidence interval (CI) (1.34–3.97). Alcohol and milk intake were inversely associated with risk. Family histories of asthma and collagen diseases, including SLE, were associated with significantly elevated risk of SLE (OR = 2.07, 95% ci 1.14–3.77; OR = 5.20, 95% CI 1.08–24.95, respectively). Regarding reproductive function, women with menarche at age 15 or later had significantly higher risk than those, who started menstruating before age 12 (OR = 3.82, 95% CI 1.66–8.81 for menarche at > 15 years and OR = 2.90, 95% a 1.14–7.39 for menarche at 16y). Conclusions. Our study suggests several risk factors, including smoking, family history, and reproductive history that may increase the risk of SLE.