Installation of telerobotic surgery and initial experience with telerobotic radical prostatectomy

OBJECTIVE: To assess the ability of untrained laparoscopic surgeons to learn and implement laparoscopic telerobotic radical prostatectomy (TRP) using the daVinci Surgical System (Intuitive Surgical, CA), and assess the education, safety and efficacy issues when instituting this system. PATIENTS AND METHODS: Between December 2003 and October 2004, 122 consecutive TRPs were performed by two surgeons for clinically localized prostate cancer. The individual robotic surgeon was assisted at the bedside by another surgeon. The TRP was performed robotically by the surgeon at the remote console unit. Perioperative data and pathological results were recorded. The two surgeons spent 1 week in a skills laboratory using a porcine model of laparoscopic TRP, and then cadaveric robotic prostatectomy. The first six cases were mentored by an experienced telerobotic surgeon. RESULTS: The TRP was conducted by two surgeons with no previous laparoscopic experience. There were no conversions to open surgery. Assessing the complications, postoperative continence, operating time and transfusion rates showed equivalent efficacy and safety to open and pure laparoscopic methods. CONCLUSION: TRP represents a novel computer-based surgical approach to prostate cancer, which offers the benefits of minimally invasive surgery without the extensive experience associated with the laparoscopic method. It remains to be seen whether the robotic approach can deliver better outcomes in continence and potency over time.     

Choice of appropriate surgical treatment of thyroid cancer: review of 2,244 malignant thyroid tumors

The aim of this study was to determine the appropriate surgical treatment of thyroid cancer. Follow-up results of 2,244 patients with malignant thyroid tumors were analyzed. As factors affecting the prognosis of thyroid cancer, histological type, sex, age, size of the primary tumors, extention of the primary tumor and the incidence of metastasis in excised lymphnodes were analyzed. Eight hundred and twenty-eight patients with papillary cancer were divided into 3 groups according to the combinations of the factors. Low-risk group (L group): Male under 30 years of age or female under 50 years of age, primary tumor less than 20 mm in maximum diameter, confined to one lobe and metastasis to the cervical lymphnodes less than 40%. High-risk group (H group): Male over 30 years of age or female over TP years of age, tumor more than 30 mm, primary lesion extended beyond isthmus and 40% or more metastasis to lymph nodes. Intermediate-ris group (I group): Other than the L and H groups. From the results of studies in each group on recurrence sites and recurrence rates, it was suggested that appropriate surgical treatment for L group was partial thyroidectomy or total lobectomy with local neck dissection, that for I group was total lobectomy with ipsilateral modified radical neck dissection and that for H group was subtotal thyroidectomy with bilateral modified radical neck dissections.     

Complex Anatomic Abnormalities of the Lower Leg Muscles and Tendons Associated With Phocomelia: A Case Report

Musculoskeletal anatomy is widely known to have components that stray from the norm in the form of variant muscle and tendon presence, absence, origin, insertion, and bifurcation. Although these variant muscles and tendons might be deemed incidental and insignificant findings by most, they can be important contributors to pathologic physiology or, more importantly, an option for effective treatment. In the present case report, we describe a patient with phocomelia and Müllerian abnormalities secondary to in utero thalidomide exposure. The patient had experienced recurrent bilateral foot pain accompanied by numbness, stiffness, swelling, and longstanding pes planus. These symptoms persisted despite conservative treatment with orthotics, steroids, and nonsteroidal anti-inflammatory drugs. Radiographic imaging showed dysmorphic and degenerative changes of the ankle and foot joints. Further investigation with magnetic resonance imaging revealed complex anatomic abnormalities, including the absence of the posterior tibialis and peroneus brevis, lateralization of the peroneus longus, and the presence of a variant anterior compartment muscle. The variant structure was likely a previously described anterior compartment variant, anterior fibulocalcaneus, and might have been a source of the recurrent pain. Also, the absence of the posterior tibialis might have caused the pes planus in the present patient, considering that posterior tibialis tendon dysfunction is the most common cause of acquired pes planus. Although thalidomide infrequently affects the lower extremities, its effects on growth and development were likely the cause of this rare array of anatomic abnormalities and resulting ankle and foot pathologic features.     

Discriminating alcoholic and nonalcoholic patients with conventional and factored MMPI scales: a comparison.

The factor scales were significantly more accurate than the conventional clinical scales in discriminating alcoholic from nonalcoholic patients. Whereas no single clinical scale emerged as highly important to the discrimination, Factor III emerged as very important to it. The possibility that Factor III represents an "alcoholic" factor was raised. From this study, it appears that the factor scales represent a more refined scoring version of the MMPI item pool.     

Glucuronic acid epimerase is associated with plasma triglyceride and high-density lipoprotein cholesterol levels in Turks

We narrowed chromosome 15q21-23 linkage to plasma high-density lipoprotein cholesterol (HDL-C) levels in Turkish families by fine mapping, then focused on glucuronic acid epimerase (GLCE), a heparan sulfate proteoglycan (HSPG) biosynthesis enzyme. HSPGs participate in lipid metabolism along with apolipoprotein (apo) E. Of 31 SNPs in the GLCE locus, nine analyzed by haplotype were associated with HDL-C and triglyceride levels (permuted p = 0.006 and 0.013, respectively) in families. Of five tagging GLCE SNPs in two cohorts of unrelated subjects, three (rs16952868, rs11631403, and rs3865014) were associated with triglyceride and HDL-C levels in males (nonpermuted p < 0.05). The association was stronger in APOE 2/3 subjects (apoE2 has reduced binding to HSPGs) and reached multiple-testing significance (p < 0.05) in both males and females (n= 2612). Similar results were obtained in the second cohort (n= 1164). Interestingly, at the GLCE locus, bounded by recombination hotspots, Turks had a minor allele frequency of SNPs resembling Chinese more than European ancestry; adjoining regions resembled the European pattern. Studies of glce(+/-) apoe(-/-) mice fed a chow or high-fat diet supported a role for GLCE in lipid metabolism. Thus, SNPs in GLCE are associated with triglyceride and HDL-C levels in Turks, and mouse studies support a role for glce in lipid metabolism.