Measuring thermal spread during bipolar cauterizing using an experimental pneumoperitoneum and thermal sensors

Objective

During nerve-sparing robot-assisted radical prostatectomy (RARP) bipolar electrocoagulation is often used but its use is controversial for the possible thermal damage of neurovascular bundles. Aim of the study was to evaluate the spatial-temporal thermal distribution in the tissue and the correlation with the electrosurgery-induced tissue damage in a controlled, CO2-rich environment modelling the laparoscopy conditions..

Methods

We manufactured a sealed plexiglass chamber (SPC) equipped with sensors to reproduce experimentally the environmental conditions of pneumoperitoneum during RARP. We evaluated in 64 pig musculofascial tissues (PMTs) of approximately 3 cm³ × 3 cm³ × 2 cm³ the spatial-temporal thermal distribution in the tissue and the correlation with the electrosurgery-induced tissue damage in a controlled CO2-rich environment modeling the laparoscopy conditions. Critical heat spread of bipolar cauterizing during surgical procedure was assessed by the employment of a compact thermal camera (C2) with a small core sensor (60 × 80 microbolometer array in the range 7-14 μm).

Results

Bipolar instruments used at 30 W showed a thermal spread area of 18 mm² when applied for 2 s and 28 mm² when applied for 4 s. At 60 W, bipolar instruments showed a mean thermal spread and 19 mm² when applied for 2 s; and 21 mm² when applied for 4 s. Finally, histopathological analysis showed that thermal damage is distributed predominantly on the surface rather than in depth.

Conclusions

The application of these results is very interesting for the definition of an accurate use of bipolar cautery during nerve-sparing RARP. It demonstrates the feasibility of using miniaturized thermal sensors, thus addressing the potential for next developments regarding the design of thermal endoscopic devices for robotic use.

Thermal endoscope based on cost-effective LWIR camera cores

The implementation of a thermal endoscope based on the LWIR camera cores Lepton and a custom miniaturized electronics is reported. The sensor and the PCB can be inserted into a cylindrical protective case of diameter down to 15mm, inox tube or plastic, 3D printable envelope, with an optical window in Germanium. Two PCBs were developed for assembling the endoscope in two different schemes, to enable frontal or lateral thermal vision setup. The thermal endoscope unit is controlled by a Raspberry external unit. The Infrared Vision Software is provided for controlling the acquisition of thermal frames, and for the thermographic calculation of the object temperature from the input parameters on object surface emissivity and environment. In general, the device enables to perform thermography in applications in which traditional larger equipment cannot be employed, as nondestructive diagnostics in confined space in the engineering field. The thermal endoscope was designed with dimensions also compatible for robotic-assisted/traditional minimally-invasive surgery.

Repeat partial nephrectomy for recurrence of Von Hippel-Lindau-related renal cell carcinoma in an autotransplanted kidney

Von Hippel-Lindau disease predisposes to develop renal cell carcinoma (RCC). Treatment is frequently challenging due to presence of bilateral tumors and high risk of recurrence. We present the case of a VHL-patient with bilateral recurrence of clear-cell RCC after bilateral partial nephrectomy and autotransplantation on one side. Recurrence on the transplanted kidney was treated with repeat partial nephrectomy with good oncological and functional outcomes. This approach is feasible in centres with wide experience in partial nephrectomy and renal transplantation when minimally invasive tumor ablation is not indicated.

PCA-based method for managing and analyzing single-spot analysis referenced to spectral imaging for artworks diagnostics

Artworks diagnostics is based on the joint use of several nondestructive techniques to acquire complementary information on the materials. A common practice in the field is to perform the analyses with single-spot analytical techniques, e.g. spectroscopy-based, after a preliminary screening of the artwork with full-field imaging-based techniques. We present a method and its practical implementation for fusing and analyzing data collected using analytical systems that acquire single spot measurements mapped to spectral imaging stacks. The fused dataset of single-spot and imaging observations is analyzed using principal component analysis (PCA). The effectiveness of the method for artworks diagnostics is shown on spectroscopy and imaging datasets of an ancient canvas painting. The results of the PCA analysis on the final fused dataset are compared against the PCA analysis performed on the original datasets from single-spot and imaging measurements taken separately. We propose two practical implementations of the procedure, one based on using graphical user interface (GUI) and open-source GIS software (QGIS), the other one based on an open-source Python module, named SPOLVERRO, specifically developed for this project and released on a public repository. The method allows conservation scientists to analize effectively the heterogeneous datasets acquired in a diagnostic campaign.

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single-spot spectroscopy data are referenced on imaging data.

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the sampling area of each spectroscopy spot is used for extracting and averaging the respective imaging data values.

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the final matrix is analyzed using PCA for extracting further information.

The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer

BACKGROUND

Several randomized controlled trials assessed the outcomes of patients treated with neoadjuvant hormonal therapy (NHT) before radical prostatectomy (RP). The majority of them included mainly low and intermediate risk prostate cancer (PCa) without specifically assessing PCa-related death (PCRD). Thus, there is a lack of knowledge regarding a possible effect of NHT on PCRD in the high-risk PCa population. We aimed to analyze the effect of NHT on PCRD in a multicenter high-risk PCa population treated with RP, using a propensity-score adjustment.

METHODS

This is a retrospective multi-institutional study including patients with high-risk PCa defined as: clinical stage T3-4, PSA >20 ng ml^-1 or biopsy Gleason score 8-10. We compared PCRD between RP and NHT+RP using competing risks analysis. Correction for group differences was performed by propensity-score adjustment.

RESULTS

After application of the inclusion/exclusion criteria, 1573 patients remained for analysis; 1170 patients received RP and 403 NHT+RP. Median follow-up was 56 months (interquartile range 29-88). Eighty-six patients died of PCa and 106 of other causes. NHT decreased the risk of PCRD (hazard ratio (HR) 0.5; 95% confidence interval (CI) 0.32-0.80; P=0.0014). An interaction effect between NHT and radiotherapy (RT) was observed (HR 0.3; 95% CI 0.21-0.43; P<0.0008). More specifically, of patients who received adjuvant RT, those who underwent NHT+RP had decreased PCRD rates (2.3% at 5 year) compared to RP (7.5% at 5 year). The retrospective design and lack of specific information about NHT are possible limitations.

CONCLUSIONS

In this propensity-score adjusted analysis from a large high-risk PCa population, NHT before surgery significantly decreased PCRD. This effect appeared to be mainly driven by the early addition of RT post-surgery. The specific sequence of NHT+RP and adjuvant RT merits further study in the high-risk PCa population.

Determination of the Urinary Stone Chemical Composition Using the Hounsfield Unit

Objectives

To determine the chemical composition of pure and mixed urinary calculi by multislice helical computed tomography (CT) in an in-vitro setting. CT is becoming the preferred radiologic examination in diagnosis and management of calculus disease. The management of calculus disease can be facilitated by ascertaining stone composition. Recent in-vitro studies have suggested that CT can be used to predict the composition of urinary stones on the basis of differences in radiodensity (measured in Hounsfield units, HU) supporting the clinician in selecting the more opportune therapeutic strategy. Aim of our study is to compare the radiodensity and chemical composition of urinary stones with the purpose of identifying the cut-off value of HU with high specificity.

Materials e Methods

A total of 76 patients with urinary stones, candidate to treatment, were assessed in a multislice helical scanner within an air-filled environment (Ge Healthcare light Speed, 120 KV; 150–250 mA 1.5 pitch thick speed 2.5; interval 2.5) differentiating dimensions and radiodensity. The chemical compositions of urinary stones were assessed on the basis of the differences in densities measured in Hounsfield units. Chemical analysis of stone has been done, using colorimetrical kit Ecoline (DiaSys Diagnostic System GmbH, Germany) validated versus IR Spectrometry. HU density values are expressed as median and interquantile range (IQR). Statistic analysis has been done using SPSS 15.0 (SPSS Inc., Chicago, IL, USA).

Results

The stones were assigned to seven different groups according to the chemical composition: calcium oxalate in 57%, calcium oxalate and phosphate in 16%, calcium urate-oxalate 12%, uric acid in 5%, struvite and calcium phosphate in 4%, struvite and calcium oxalate in 5%, cystine in 1%. Uric acid stone density (Ur+Ur/Ox-Ca, n=13; HU 487, IQR 352 - 594) was significantly lower than both Ox-Ca pure (n=44; HU 639, IQR 460 -942) (Bonferroni correction p=0012) and phosphate (Ox / P-Ca+struvite, n=19; HU 801, IQR 502 -1205) (Bonferroni correction p=0006), while no difference was evident between oxalate and phosphate stones. Areas under ROC curve for uric acid stone identification (toward phosphate and oxalate) or for phosphate stone identification (toward uric acid and oxalate) were respectively 0.73 (95%IC 0.59–0.87) and 0.62 (95%IC 0.46–0.79). Cut-off values of 352 HU (first quartile uric distribution) and 1205 HU (third quartile phosphates distribution) allow to identify a specificity of 91% and 96%, respectively, for uric acid or phosphates stones.

Conclusions

Although our data underline an association between radiodensity and chemical composition, confirming literature, the big overlap of distributions of HU values limits clinical application. It is possible to identify specific HU cut-off values for uric acid and phosphates stone, however it is necessary to verify these results in a larger sample. The spiral TC is useful to study the chemical composition of the urinary stone, but a larger sample is necessary to calculate more accurate radiodensity cut-off values.

What is the Best Number of Core to Improve Saturation Biopsy Detection Rate?

Prostate core saturation biopsy (SB) is today considered in patients where clinical or biochemical hypothesis of prostate cancer (PCa) is still present after previous normal core biopsies. The technique rationale is to increase the detection rate (DT) both by increasing the number of cores for the pathologist, in order to obtain more tissue to be analyzed, and both by mapping regions that are not usually investigated with a standard or extended prostate biopsy. Moreover, the technique is not free from complications and today, one of the main controversies about SB is how many cores have to be taken in order to maintain high detection rate with low complication rate. Aim of the present retrospective study is to compare safety and DT of 3 different schemes of SB, performed with different number of cores.

Materials and Methods

We retrospectively reviewed the data of 106 patients who underwent SB from January 2003 to December 2008 at 2 urological divisions. SB was performed in all cases as a further biopsy because of biochemical and/or clinical hypothesis of PCa, in patients previously undergoing one or more baseline core biopsies. SB was performed under general anesthesia by 3 urologists in each division. Core biopsies were obtained using a Boston Scientific TruPath 18G 15cm needle, in transrectal ultrasound-guided approach. All patients were submitted to a 32.core SB scheme. We compared the 32-core scheme with a 28 and a 24-core scheme, each one including peripheral, transitional and anterior prostatic portion biopsies. End-points of the study were: DT and safety. Statistical analysis was carried out using chi-square test (p<0.05).

Results

Mean age was 65.4 (50–79) years, mean PSA at biopsy was 11.2 ng/ml (3.23–30) and mean number of previous biopsies was 1.5 (1–5). Median value of cores positive for PCa in the 32, 28 and 24-core scheme was 2 (1–10), 2 (2–12) and 1.5 (0–11), respectively. Homogeneous distribution of positive cores was registered in all records, but in 3 areas (right base external, left base external, left transitional basal) the detection rate was very low (0–0.1%). PCa was found more frequently in base in median portion of left and right prostatic lobes. In the 32-core SB scheme, DT was 30.1 %, whereas in the 28 and 24-core SB scheme DT proved to be 28.7% and 29.1%, respectively. No statistical difference was found among the schemes in terms of detection rate (p>0.05). A Gleason score >7 was registered in 62.5% of cases. As far as safety is concerned, 20 patients (19%) developed complications. In all cases neither hospitalization nor surgery were required and all patients were treated by medical therapy (e.g. indwelling catheterization, antibiotics).

Conclusions

SB after a previous standard core biopsy is a safe technique and increases DT of PCa. Although there is a propensity in increasing the number of core biopsies to obtain higher DT, our data suggests that DT does not increase when more than 24 cores are taken. Therefore, SB should be considered as second biopsy in patients with previous negative first standard core biopsy.

Morbility and Outcomes of Radical Prostatectomy in Patients with Clinically Advanced Prostatic Cancer

In this study we have reviewed patients with prostate cancer clinically advanced at the diagnosis, and subjected at radical prostatectomy, to evaluate the morbility, mortality, and results of the surgery. We have subjected 38 patients with sure clinically advanced disease to radical prostectomy (PSA average 80 ng/mL). An ureteral injury and no rectal lesion have been observed. The rate of urinary incontinence have not been increased in comparison with the literature data, while more frequently are been developed stenosis of bladder neck (26%).

At 2 years the 15% of the patients is disease free survival. Our opinion is that radical prostectomy in patients with locally advanced prostate cancer is feasible and the rate of the complications is acceptable.

Predictive Factors of Prostate Cancer in Patients Subjected a Prostatic Re-Biopsy, with Psa in the Grey Zone

In this study we have tried to define which are the most useful predictive factors in the diagnosis of the prostate cancer in patients with first negative biopsy and with PSA in the grey zone. We have therefore analysed 123 patients subjected at re-biopsy: in 25 patients (20%) it is been diagnosed a prostate cancer at the second biopsy, while in 98% (80%) also the second biopsy was negative.

The PSA ratio and the PSA density of the transitional zone have demonstrated having the highest sensitiveness in finding patients with cancer at the re-biopsy (92% and 88%) in comparison with the ER and the TRUS (20% and 32%). Moreover the PSA DTZ let spare the 41% of the re-biopsy that will result negatives.

[Does PSA density of the transition zone represent a useful parameter in the diagnosis of prostate carcinoma?]

Prostate specific antigen (PSA) has unequivocally proved its clinical usefulness ad a serum marker for prostate cancer. In order to enhance the specificity of serum PSA, several diagnostic parameters have been employed including PSA density of transition zone (TZ). The authors report their experience on the efficacy of PSA density TZ with level of PSA < 4 ng/ml, between 4-10 ng/ml, > 10 ng/ml, in the diagnostic of prostate cancer. The PSA density of TZ resulted uscless for PSA levels < 4 ng/ml, but improved the diagnostic specificity associated to PSA serum in the PSA levels ranging between 4-10 ng/ml and > 10 ng/ml.

Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy

AIMS AND BACKGROUND

In addition to nausea and vomiting following chemotherapy treatment, cancer patients can experience these side effects prior to a treatment session, the so-called anticipatory nausea and vomiting. As various psychological and neurophysiological aspects have been claimed to be implied in its etiopathogenesis, the present paper aims to shortly review the etiological, epidemiological and therapeutical assumptions on the topic, in particular the psychological-behavioral therapies.

PATIENTS AND METHODS

The present study was carried out on 16 consecutive adult cancer patients affected by chemotherapy-induced anticipatory nausea and vomiting who had received at least four treatment cycles. All of them were submitted to induction of relaxation followed by hypnosis.

RESULTS

In all subjects anticipatory nausea and vomiting disappeared, and major responses to chemotherapy-induced emesis control were recorded in almost all patients.

CONCLUSIONS

The experience highlights the potential value of hypnosis in the management of anticipatory nausea and vomiting; furthermore, the susceptibility to anticipatory nausea and vomiting is discussed under the psychoanalytic point of view.

The impact of a psychological intervention on quality of life in non-metastatic breast cancer

The aim of this study was to determine whether psychological intervention had a beneficial effect on the quality of life and behaviour of women diagnosed with breast cancer. 36 consecutive patients with non-metastatic breast cancer assigned to surgery and systemic chemotherapy were randomised to receive either psychological intervention (weekly cognitive individual psychotherapy and bimonthly family counselling) or standard follow-up. Personality (16-PF and IIQ), quality of life (FLIC), and depression (BDI) scores were the endpoints for this study, and the questionnaires were completed by the patients at diagnosis, and up to 9 months after diagnosis. Cognitive psychotherapy and family counselling improved both depression and quality of life indexes compared with the control group. Better emotional coping behaviours were also revealed by some changes in personality traits in the intervention group.