Robot assisted laparoscopic radical prostatectomy with maximal urethral length preservation technique preserves penile length.

Penile shortening is a recognized but neglected side effect of prostate cancer treatment. In this study we explore the effect of maximal urethral length preservation (MULP) technique on penile length preservation after robot assisted laparoscopic prostatectomy (RALP). In an IRB approved study, we prospectively evaluated the stretched flaccid penile length (SFPL) pre and post RALP in subjects with a diagnosis of prostate cancer. The multiparametric MRI (MP-MRI) was utilized for surgical planning if available preoperatively. Repeated measures t-test, linear regression and 2-way ANOVA analyses were performed. A total of 35 subjects underwent RALP. Mean age was 65.8 yr (SD: 5.9), preoperative SFPL was 15.57 cm (SD: 1.66) and postoperative SFPL was 15.41 cm (SD: 1.61) p = 0.68. No change in the postoperative SFPL was recorded among 27 subjects (77.1%) while 5 subjects (14.3%) had 0.5 cm shortening, and 3 subjects (8.6%) had 1 cm shortening. Pathologic stage, preoperative MP-MRI and body mass index (BMI) were significant predictors of postoperative SFPL on linear regression analysis, p = 0.001. Among 26 subjects with pathologic stage 2 disease, no statistical difference was seen in repeated measures t-test between pre and postoperative SFPL, 15.36 vs 15.3 cm, p = 0.08. All subjects were continent by 6 months postoperatively, with no complications. We demonstrate that incorporating MULP technique and preoperative MP-MRI preserves SFPL in subjects undergoing a RALP.

Mortality related to the use of stapler devices and clip appliers: Analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience database.

BACKGROUND: Surgical staplers and clip appliers are commonly used and have a potential to malfunction, which may result in serious injury or death. These events are self-reported to the Food and Drug Administration and compiled in the Food and Drug Administration's Manufacturer and User Facility Device Experience database. This study characterizes mortality related to surgical stapler and clip applier failure reported in the Food and Drug Administration's Manufacturer and User Facility Device Experience database. METHODS: The Food and Drug Administration's Manufacturer and User Facility Device Experience database was reviewed between 1992 and 2016 for medical device reports related to surgical staplers and clip appliers filed under the following product codes: GAG, FZP, GDO, GDW, KOG, and GCJ. Adverse events including death and the type of device failure were reviewed. Temporal trends in reported deaths related to device failure were analyzed and the Healthcare Cost and Utilization Project database was used to adjust for annual surgical case volume using linear regression analysis. RESULTS: A total of 75,415 malfunctions, 21,115 injuries, and 676 deaths were associated with the use of surgical stapler and clip applier devices. Most deaths occurred postoperatively (N = 516, 76.3%) and were due to infection/sepsis (N = 89, 17.2%) or vascular injuries (N = 110, 21.3%). Intraoperative mortality (N = 79, 11.7%) was primarily due to vascular injuries (N = 73, 92.4%). Device failures resulting in death were noted both intraoperatively (N = 268, 39.6%) and postoperatively (N = 325, 48.1%). In post hoc root cause analysis, a surgical stapler and clip applier device problem was the most common attributed cause of death (N = 238, 65.4%). In the linear regression analysis, there was a significant increase in the mortality from device failure in the study period after adjusting for annual surgical volume (P < .01). CONCLUSION: Mortality related to the use of surgical staplers and clip appliers is increasing. Most deaths occurred postoperatively, and an increased awareness of potential life-threatening complications is warranted when these devices are used.

Effective heart disease prediction with Grey-wolf with Firefly algorithm-differential evolution (GF-DE) for feature selection and weighted ANN classification.

In recent time, heart disease has become common leading to mortality of many individuals. Hence, early and accurate prediction of this disease is vital to reduce death rate and enhance people's lives. Concurrently, Artificial Intelligence has gained more attention at present as it permits deeper understanding of the healthcare data thereby providing accurate prediction results. This efficient prediction will solve complicated queries regarding heart diseases and hence assists clinical practitioners to adopt smart medical decisions. Hence, this study intends to predict heart disease with high accuracy by proposing an improved feature selection and enhanced classification approach. The paper employs Grey-wolf with Firefly algorithm for effective feature selection and using Differential Evolution Algorithm for tuning the hyper parameters of Artificial Neural Network (ANN). Hence, it is named as Grey Wolf Firefly algorithm with Differential Evolution (GF-DE) for better classification of the selected features. This proposed classification model trains the neural network to obtain optimal weights and tunes huge number of hyper parameters in an efficiently. To prove this, the proposed system is comparatively analysed with existing methods in terms of performance metrics like accuracy, precision, recall and F1 score for Cleveland and Statlog dataset. In addition, statistical analysis is also undertaken to analyse the significance of proposed system. Outcomes revealed the efficiency of proposed method which makes it highly suitable for heart disease prediction in an efficient manner.

Robot-Assisted Radical Prostatectomy After Prior Transurethral Resection of Prostate: An Analysis of Perioperative, Functional, Pathologic, and Oncologic Outcomes.

Background: We performed a retrospective comparison of surgical, oncologic, and functional outcomes after robot-assisted radical prostatectomy between patients who have undergone prior transurethral resection of prostate (TURP) to TURP-naive patients. Methods: Past robotic prostatectomy hospital data were scrutinized to form two matched groups of patients: those who have undergone prior TURP and TURP-naive patients. The perioperative and pathologic data along with functional and oncologic outcomes for a period of 3 years were compared between groups. Results: Compared with TURP-naive patients, prior TURP patients experienced longer robot-assisted laparoscopic prostatectomy times (p < 0.001), increased incidence of bladder neck reconstruction (p = 0.03), greater blood loss (p = 0.0001), and lesser nerve sparing (p < 0.01). Complication rates (p = 0.3), positive surgical margin (p = 0.4), extracapsular disease (p = 0.3), or seminal vesicle invasion (p = 0.1) were comparable between groups. Continence (p = 0.5) and potency (p = 0.1) at 1 year were not different between groups. Biochemical recurrence rates were not different at 3 years (p = 0.9). Diabetes slowed recovery of continence in patients with prior TURP compared with TURP-naive patients until 6 months after surgery. Conclusion: Although prior TURP makes subsequent robotic prostatectomy more technically demanding, it can be safely performed by experienced surgeons without compromising long-term functional or oncologic outcomes.

The Impact of Heartfulness-based Elective on Middle School Students.

Objectives: There is an increasing trend in the levels of stress, anxiety, and depression among adolescents aged 12 to 17. The Heartfulness Program for Schools (HPS) is a program designed to manage stress and build social-emotional skills to cope with real-life challenges. This quantitative study explores the impact of HPS customized for middle school students. Methods: Participants recruited from the 7th and 8th grade classrooms, including the HPS group (N = 74) and control group (N = 38), completed 2 surveys that measured levels of stress and well-being at baseline and after the completion of the 13-week elective. Results: Data collected from the pre-test resulted in similar baseline scores for both groups. Post-test findings revealed a statistically significant decrease in the stress levels in the HPS group showing improvement in coping skills, stress management, and increase in overall well-being. Conclusions: This study suggests that HPS helps reduce stress levels and improve well-being in children by cultivating positivity and fostering social and self-awareness. Integrating HPS in a school curriculum will benefit the students in building their emotional intelligence, and will nurture their relationship and mental well-being within and beyond the school.

Human papillomavirus 16 and p16 positive nasal cutaneous squamous cell carcinoma in immunocompetent men in their twenties.

BACKGROUND: Cutaneous squamous cell carcinoma is usually associated with long-term ultraviolet light exposure. Human papillomavirus 16 is a high-risk mucosal human papillomavirus type, usually associated with anogenital and oropharyngeal cancer. This paper describes the first two cases of human papillomavirus 16 and p16 related nasal cutaneous squamous cell carcinoma. METHOD: Prospective case series from December 2015. RESULTS: Two young, male, fair-skinned patients had large (greater than 20 mm), rapidly growing, ulcerated lesions of the nasal tip. The tumours were excised, with at least a 6 mm margin, and the patients' noses were subsequently reconstructed. Neither patient had cervical lymphadenopathy or underwent adjuvant radiotherapy. Both patients were registered at the same general practice. The tumours were human papillomavirus 16 and p16 positive; the latter indicated that the virus was driving the disease process. Except for superficial burns, neither patient had other risk factors. CONCLUSION: Changes in sexual practices have led to an increase in human papillomavirus positive oropharyngeal carcinoma and there may be an associated increase in human papillomavirus type 16 positive nasal cutaneous squamous cell carcinoma.

Hypertension and diabetes mellitus are not associated with worse renal functional outcome after partial nephrectomy in patients with normal baseline kidney function.

OBJECTIVE: To analyze the association of hypertension and/or diabetes mellitus on renal function after partial nephrectomy in patients with normal baseline kidney function. METHODS: We identified 453 patients with baseline estimated glomerular filtration rate ≥60 that underwent robotic partial nephrectomy for a cT1 renal mass from 2008 to 2014 using a multi-institutional database. The association between estimated glomerular filtration rate and time (pre-partial nephrectomy to 24 months post-partial nephrectomy) was compared between 269 (59.4%) patients with preoperative hypertension and/or diabetes mellitus and 184 (40.6%) patients with neither hypertension nor diabetes mellitus using a multivariable model adjusting for confounders. RESULTS: The estimated glomerular filtration rate significantly decreased over time for both groups compared with baseline (average units/month: 1.8974 hypertension/diabetes mellitus, 1.2163 no hypertension/diabetes mellitus; P < 0.0001), and the estimated glomerular filtration rate decrease per month reduced over time (P < 0.0001). The estimated glomerular filtration rate began to increase at approximately 12 months for the hypertension/diabetes mellitus group, and at approximately 18 months for the no hypertension/diabetes mellitus group. Although a greater initial decline in the estimated glomerular filtration rate after partial nephrectomy was observed for the hypertension/diabetes mellitus group (0.68 units/month), this was not statistically significant (P = 0.0842); and while the rate of recovery from this decline was faster for the hypertension/diabetes mellitus group, this also was not statistically significant (P = 0.0653). The predicted estimated glomerular filtration rate was similar (83 mL/min/1.73 m2 ) for both groups 24 months after partial nephrectomy. CONCLUSIONS: There seems to be no significant association between hypertension, diabetes mellitus and renal functional outcome after partial nephrectomy in patients with normal baseline glomerular filtration rate. Renal function declines after partial nephrectomy, but then it recovers, irrespective of the presence of hypertension or diabetes mellitus.

Risk factors and prognostic implications for pathologic upstaging to T3a after partial nephrectomy.

BACKGROUND: Performing partial nephrectomy (PN) on a cT1 tumor, which postoperatively is upgraded to pT3a can possibly lead to compromise of cancer specific mortality. We therefore aimed to identify risk factors for pathologic T3a upstaging of cT1 tumors and to analyze the association between upstaging, positive surgical margins (PSM) and overall survival (OS). METHODS: The present study included patients who underwent PN for a clinically localized T1 renal mass from two datasets: 1) 1298 patients from a prospectively maintained multi-center database (MCDB); and 2) 7940 patients from the National Cancer Database (NCDB). Multivariable logistic regression models within each cohort were used to identify predictors of cT1 to pT3a upstaging and its association with PSM. Cox proportion hazards regression models were used to compare overall survival in the NCDB cohort. RESULTS: The rate of pT3a upstaging was 5.7% (N.=74) in the MCDB and 1.9% (N.=156) in the NCDB cohort. Older age (MCDB OR=1.04, P=0.001; NCDB OR=1.04, P=0.001) and larger tumor size (MCDB OR=1.89, P<0.001; NCDB OR=1.38, P<0.001) increased the likelihood of upstaging. PSM was found to be more likely for pT3a upstaged patients in both cohorts (MCDB 14.9% vs. 3.5%, P<0.001; NCDB 14.8% vs. 8.3%, P=0.006), even when adjusting for tumor size. At short term follow-up (NCDB median follow-up 27.3 months), pT3a upstaging was associated with worse OS in univariable (HR=1.89; 95% CI=1.00, 3.55; P=0.049) but not multivariable analysis (HR=1.63; 95% CI=0.86, 3.08; P=0.131). OS was 93.0% vs. 95.8% at 3 years for those with and without pT3a upstaging, respectively. CONCLUSIONS: Larger tumor size and increased age are associated with pathological upstaging to T3a for clinical T1 tumors treated with partial nephrectomy. Steps to improve identification of occult pT3a disease are necessary as its occurrence significantly increased the likelihood of a PSM, both in a high-volume multicenter cohort, as well as, a national data registry.

Lymph node yield during radical prostatectomy does not impact rate of biochemical recurrence in patients with seminal vesicle invasion and node-negative disease.

OBJECTIVES: Seminal vesicle invasion (SVI) is a risk factor for poor oncologic outcome in patients with prostate cancer. Modifications to the pelvic lymph node dissection (PLND) during radical prostatectomy (RP) have been reported to have a therapeutic benefit. The present study is the first to determine if lymph node yield (LNY) is associated with a lower risk of biochemical recurrence (BCR) for men with SVI. METHODS: A total of 220 patients from 2 high-volume institutions who underwent RP without adjuvant treatment between 1990 and 2015 and had prostate cancer with SVI (i.e., pT3b) were identified, and 21 patients did not undergo lymph node dissection. BCR was defined as a postoperative PSA>0.2ng/mL, or use of salvage androgen deprivation therapy (ADT) or radiation. Multivariable Cox proportional hazards models were used to determine whether LNY was predictive of BCR, controlling for PSA, pathologic Gleason Score, pathologic lymph node status, NCCN risk category, etc. The Kaplan-Meier method was used to determine 3-year freedom from BCR. RESULTS: Median number of lymph nodes sampled were 7 (IQR: 3-12; range: 0-35) and 90.5% underwent PLND. The estimated 3-year BCR rate was 43.9%. Results from multivariable analysis demonstrated that LNY was not significantly associated with risk of BCR overall (HR = 1.00, 95% CI: 0.98-1.03; P = 0.848) for pN0 (HR = 0.99, 95% CI: 0.97-1.03; P = 0.916) or pN1 patients (HR = 0.96, 95% CI: 0.88-1.06; P = 0.468). Overall, PSA (HR = 1.02, P<0.001) and biopsy Gleason sum ≥ 8 (HR = 1.81, P = 0.001) were associated with an increased risk of BCR, and increasing LNY increased the likelihood of detecting>2 positive lymph nodes (OR = 1.27, 95% CI: 1.06-1.65, P = 0.023). CONCLUSION: Seminal vesicle invasion is associated with an increased risk of BCR at 3 years, primarily due to pathologic Gleason score and PSA. Although greater lymph node yield is diagnostic and facilitates more accurate pathologic staging, our data do not show a therapeutic benefit in reducing BCR.

Trends in management of the small renal mass in renal transplant recipient candidates: A multi-institutional survey analysis.

INTRODUCTION: Patients with end-stage renal disease are under increased risk for renal cell carcinoma development, and radical nephrectomy is the preferred treatment in this setting. Owing to the increased surgical morbidity and mortality, active surveillance (AS) may be a valid option for treatment of small renal masses (SRM). As there is a lack of high-level evidence for treatment recommendations, we performed a survey analysis to analyze the treatment patterns of transplant surgeons. MATERIAL AND METHODS: A 21-question online survey designed to analyze the practice patterns to treat SRM in renal transplant recipient candidates was sent to active transplant centers in the United States. The list of recipients to whom the survey was distributed was obtained with permission from the American Society of Transplant Surgeons. RESULTS: We received 62 responses. All regions of United Network of Organ Sharing were represented. Radical nephrectomy was the preferred treatment (59%, n = 61), followed by AS (21.3%, n = 13), partial nephrectomy (14.8%, n = 9), and focal ablative therapy (4.9%, n = 3). Among the responders whose institutions did not allow AS, 77.4% indicated that if presented with long-term data showing safety of AS, they would perform immediate transplantation and monitor SRM. Responders were more likely to allow immediate transplantation after radical nephrectomy (77.4%), as opposed to partial nephrectomy (58.1%) and focal ablation (45.2%). CONCLUSION: Though radical nephrectomy is the preferred treatment, most transplant surgeons would consider AS if long-term safety data were available.

Primary Squamous Cell Carcinoma Arising From a Cutaneous Ureterovesical Stoma (Modified Mitrofanoff): Case Report and Review of Literature.

Squamous cell carcinoma arising from a urinary stoma is exceedingly rare, and none so far is reported from a cutaneous ureterovesical stoma. Squamous cell carcinoma usually occurs as a late complication of urinary diversion, and we report the first such case in a cutaneous ureterovesical stoma with a review of published literature.

Predictors of Medical and Surgical Complications After Robot-Assisted Partial Nephrectomy: An Analysis of 1139 Patients in a Multi-Institutional Kidney Cancer Database.

INTRODUCTION: Previous robot-assisted partial nephrectomy (RAPN) studies have identified various predictors of overall and major postoperative complications, but few have evaluated the specific role of these factors in the development of medical and surgical complications. In this study, we present an analysis of the modifiable and nonmodifiable variables influencing medical and surgical complications in a contemporary series of patients who underwent RAPN and were followed in a prospectively maintained, multi-institutional kidney cancer database. METHODS: A retrospective review of all patients who underwent RAPN at four institutions between 2008 and 2015 was performed. Multivariable logistic regression models were used to determine predictors of medical and surgical postoperative complications. RESULTS: Data from 1139 patients were available for analysis. Sixty-seven patients (5.8%) experienced a medical postoperative complication, and 82 (7.1%) experienced a surgical complication. Decreasing baseline estimated glomerular filtration rate (eGFR) (odds ratio [OR] = 0.98, p = 0.003), greater estimated blood loss (EBL) (OR = 1.002, p = 0.001), and operating surgeon (OR = 8.01, p < 0.001) were associated with an increased likelihood of surgical complications, while decreasing baseline eGFR (OR = 0.99, p = 0.054) and operating surgeon (OR = 1.96, p = 0.054) were associated with an increased likelihood of medical complications. CONCLUSION: We present complication risks in a large contemporary cohort of patients undergoing robotic partial nephrectomy (RPN) with only 11.3% of patients experiencing a medical or surgical postoperative complication. Prospective candidates for robotic PN with poor baseline renal function and/or risk factors for greater EBL, including a high body mass index, or a complex renal mass should be counseled appropriately on their increased risk for a medical or surgical postoperative complication.

Socio-demographic study on extent of knowledge, awareness, attitude, and risks of zoonotic diseases among livestock owners in Puducherry region.

AIM: This study was conducted to assess the extent of knowledge, awareness, attitude, and risks of zoonotic diseases among livestock owners in Puducherry region. MATERIALS AND METHODS: A total of 250 livestock farmers were selected randomly from eight revenue villages. And each farmer was interviewed with a questionnaire containing both open- and close-ended questions on various aspects of zoonotic diseases, a total of 49 questionnaires were framed to assess the source and transmission of infection to the farmers and to test their knowledge and awareness about zoonotic diseases. The data collected were analyzed by chi-square test using software Graph pad prism, and results were used to assess the relationship between education level and zoonotic disease awareness; risk of zoonotic diseases and its relation with independent variables. RESULTS: The present survey analysis represents that most of the respondents are belonging to the age group of 41-60 years. About 42.8% of respondents' household having a graduate. The most of the respondent are small-scale farmers and their monthly income was less than Rs. 10,000. About 61.2% of farmers were keeping their animal shed clean. About 29.6% of the respondents were ignorant about cleaning the dog bitten wound. Only 16.4% of respondents knew that diseases in animals can be transmitted to humans. Only 4.8%, 3.6%, 6.8%, and 22.4% of respondents knew about the zoonotic potential of diseases such as brucellosis, tuberculosis (TB), anthrax, and avian flu, respectively. Only 18% of the respondents were aware about zoonotic diseases from cattle. Regarding the list of zoonotic diseases contracted, 37.7% reported respiratory infection, 31.1% digestive disturbances, 15.5% had dermatological problem, and 15.5% reported indiscrete disease such as fever, body pain, and headache joint pain. From the respondent got the zoonotic disease (n=45), 51.2% of the respondent reported chronic infection and 48.8% of the respondent reported acute form of zoonotic infection. About 30% of the respondents' farm had an incidence of abortion. Our analyses showed that there was significant in educational level of respondents and treatment of dog bitten animals. Furthermore, there was statistical significance in occurrence of hand and foot lesions in the respondent and occurrence of foot-and-mouth disease outbreak in their animals. CONCLUSION: From this study, it is concluded that involvement of educated family members in farming practices can create awareness and improve knowledge toward zoonotic disease. Further creation of awareness toward zoonotic diseases is of utmost important.

Prostate biopsies: Available technique, approaches and diagnostic accuracy / Biopsias prostáticas: técnica disponible, abordajes y precisión diagnostica

Despite advances in the diagnosis of prostate cancer over the past century, it remains a leading cause of cancer related death. A recent recommendation against screening has further complicated the diagnosis and management of this condition. It remains to be demonstrated if newer diagnostic modalities will have an impact on mortality rates. Most certainly, not all prostate cancers need to be diagnosed, and methods of accurately diagnosing those cancers that lead to death needs more work. In this review article, we describe the different techniques, approaches and diagnostic accuracies of the currently used biopsy methods

A pesar de los avances en el diagnóstico del cáncer de próstata durante el siglo pasado, éste sigue siendo una causa principal de muerte relacionada con cáncer. Una recomendación reciente contra el screening ha complicado más aún el diagnóstico y tratamiento de esta enfermedad. Sigue por demostrarse si las modalidades diagnósticas más nuevas tendrán un impacto sobre las tasas de mortalidad. Con toda certeza, no es necesario diagnosticar todos los cánceres de próstata, y es necesario seguir trabajando con los métodos que permiten diagnosticar con precisión los cánceres mortales. En este artículo de revisión describimos las diferentes técnicas, abordajes y precisión diagnóstica de los métodos de biopsia utilizados actualmente

Predictors of biochemical recurrence in pT3b prostate cancer after radical prostatectomy without adjuvant radiotherapy.

BACKGROUND: Men with pathologic evidence of seminal vesicle invasion (SVI) at radical prostatectomy (RP) have higher rates of biochemical recurrence (BCR) and mortality. Adjuvant radiotherapy (XRT) has been shown to increase freedom from BCR, but its impact on overall survival is controversial and it may represent overtreatment for some. The present study, therefore, sought to identify men with SVI at higher risk for BCR after RP in the absence of adjuvant XRT. METHODS: We identified 180 patients in our institutional database who underwent RP from 1990 to 2011 who had pT3bN0-1 disease. The Kaplan-Meier method was used to estimate freedom from BCR for the overall cohort and substratified by Gleason score, PSA, surgical margin status, and lymph node positivity. Cox Proportional Hazards models were used to determine demographic and histopathological factors predictive of BCR. Time-dependent ROC curve analysis was conducted to assess the ability of the UCSF-CAPRA score to predict BCR. RESULTS: Median age was 64 years, and 52.8% of patients were preoperative D'Amico high risk. At RP, 41.4% had a positive surgical margin (PSM), and 12.2% had positive lymph nodes (LN). The most common sites of PSM were the peripheral zone (56.8%) and the apex (32.4%). Positive bladder neck margin (HR = 7.01, P = 0.035) and PSA 10-20 versus ≤10 (HR = 1.63, P = 0.047) predicted higher BCR in multivariable analyses. Median follow-up was 26 months, and 2-, 3-, and 5-year BCR-free rates were 56.1%, 49.0%, and 39.5%. Log rank tests showed that freedom from BCR was significantly less for Gleason 9-10, PSA >20, PSM, and N1 patients. The area under curve (AUC) for CAPRA in predicting BCR was 0.713 at 2 years, 0.692 at 3 years, and 0.641 at 5 years. Increasing CAPRA score was associated with an increased risk of BCR (HR = 1.33, P < 0.001). CONCLUSIONS: pT3b prostate cancer is a heterogeneous disease commonly associated with several high-risk features. Stratifying men with SVI by prognostic features (i.e., Gleason, PSA, node status, surgical margin status) and using these features to augment the CAPRA score will improve identification of those at higher risk for BCR that should be strongly considered for adjuvant XRT.

On the minimum requirements for otolaryngology clinics in National Health Service hospitals.

OBJECTIVE: This paper, a report by the Clinical Governance and Audit Committee of the Scottish Otolaryngological Society, presents a consensus view of the minimal requirements for ENT clinics in National Health Service hospitals. RESULTS AND CONCLUSION: The provision of adequate equipment and staff has gained increasing importance as the vast majority of ENT procedures can be safely performed in the out-patient or office setting.

Evaluation of marginal fit and internal adaptation of zirconia copings fabricated by two CAD - CAM systems: An in vitro study.

STATEMENT OF PROBLEM: Three main factors which determine the success of an All-ceramic restoration are esthetic value, resistance to fracture and third being the marginal fit. Marginal fit and internal adaptation are crucial factors in increasing the longevity of the restoration. Newer and economical CAD CAM systems have been introduced claiming better marginal fit and adaptation of All ceramic crowns. CAD CAM systems involves scanning of the die or the tooth preparation and milling of the restoration, which may have variations among the systems available. AIM OF THE STUDY: Our study intended to check the marginal fit and internal adaptation of commonly used CAD CAM systems namely CERAMILL and CEREC -In Lab MC XL. MATERIALS AND METHODS: Two groups of typodont teeth (n = 10) were prepared using a standardized protocol to receive All ceramic copings. 10 samples of Group A were used for fabrication of copings using CERAMILL system and 10 samples of Group B were used for fabrication of copings using CEREC -In Lab MC XL system. They were then luted with glass ionomer cement under mild finger pressure. Samples were embedded in resin and sliced longitudinally. They were then viewed under stereomicroscope and readings were measured along 15 points using ImageScope software. The P value was set at 0.05 at 95% confidence interval with 80% power. The data were checked for normality and unpaired t-test was used to evaluate the results of the two groups. RESULTS: The overall internal adaptation was 61.5 ± 5.2 µm for CERAMILL and 56.9 ± 5.7 µm for CEREC -In Lab MC XL (P < 0.05). The marginal fit for CERAMILL was 83 µm and for CEREC -In Lab MC XL was 68 µm (P < 0.05). CONCLUSION: The marginal adaptation of CEREC -In Lab MC XL (68 µm) was found to be superior to CERAMILL (83 µm) (P < 0.05). Both the CEREC -In Lab MC XL and CERAMILL copings demonstrated internal adaptation and marginal fit within acceptable discrepancy range. When corroborating both the internal adaptation and marginal fit, CEREC -In Lab MC XL was found to be better than CERAMILL.

Newer concepts in neural anatomy and neurovascular preservation in robotic radical prostatectomy.

With more than 60% of radical prostatectomies being performed robotically, robotic-assisted laparoscopic prostatectomy (RALP) has largely replaced the open and laparoscopic approaches and has become the standard of care surgical treatment option for localized prostate cancer in the United States. Accomplishing negative surgical margins while preserving functional outcomes of sexual function and continence play a significant role in determining the success of surgical intervention, particularly since the advent of nerve-sparing (NS) robotic prostatectomy. Recent evidence suggests that NS surgery improves continence in addition to sexual function. In this review, we describe the neuroanatomical concepts and recent developments in the NS technique of RALP with a view to improving the "trifecta" outcomes.

Role of endoscopic stents and selective minimal access drainage in oesophageal leaks: feasibility and outcome.

BACKGROUND: Leaks following oesophageal surgery are considered to be amongst the most dreaded complications and contributory to postoperative mortality. Controversies still exist regarding the best option for the management of oesophageal leaks due to lack of standardized treatment protocols. This study was designed to analyse the feasibility outcome and complications associated with placement of removable, fully covered, self-expanding metallic stents for oesophageal leaks with concomitant minimally invasive drainage when appropriate. METHODS: The study group included 32 patients from a prospectively maintained database of oesophageal leaks, with the majority being anastomotic leaks after minimally invasive oesophagectomy (n = 28), followed by laparoscopic cardiomyotomy (n = 3) and extended total gastrectomy (n = 1). The procedures took place between March 2007 and April 2013. RESULTS: Most patients had an intrathoracic leak (n = 22), with a mean time to detection of the leak following surgery of 7.50 days (SD = 2.23). Subsequent to endoscopic stenting, enteral feeding via a nasojejunal tube was started on the second day and oral feeding was delayed until the 14th day (n = 31). Six patients underwent thoracoscopic (n = 5) or laparoscopic drainage (n = 1) along with stenting for significant mediastinal and intra-abdominal contamination. The stent migration rate of our study was 8.54%. The overall success in terms of preventing mortality was 96%. CONCLUSION: Endoscopic stenting should be considered a primary option for managing oesophageal leaks. Delayed oral intake may reduce the incidence of stent migration. Larger stents (bariatric or colorectal stents) serve as a useful option in case of migrated stents. Combined minimally invasive procedures can be safely adapted in appropriate clinical circumstances and may contribute to better outcomes.

Two Body Wear of Newly Introduced Nanocomposite Teeth and Cross Linked Four Layered Acrylic Teeth: a Comparitive In Vitro Study.

STATEMENT OF PROBLEM: Wear of complete denture teeth results in compromise in denture esthetics and functions. To counteract this problem, artificial teeth with increased wear resistance had been introduced in the market such as nanocomposite teeth. PURPOSE: The purpose of this study was to compare the amount of wear between nanocomposite teeth and acrylic teeth. MATERIALS AND METHODS: Fifteen specimens were chosen from each group namely the nanocomposite teeth (SR_-PHONARES) and the acrylic teeth (ACRY PLUS). Maxillary premolar was only chosen for testing and the samples were customized according to the specifications of the pin on disc machine. Pin on disc machine is a two body tribometer which quantifies the amount of wear under a specific load and time. Test samples were mounted on to the receptacle of the pin on disc machine and tested under a load of 0.3 kg for 1,000 cycles of rotation against a 600 grit emery paper. The amount of wear is displayed from the digital reading obtained from the pin on disc machine. RESULTS: After statistical analysis, it was found that, the amount of wear is more in four layered acrylic teeth. The p value obtained is 0.002 (<0.005) thus implies that the difference in wear between nanocomposite teeth and acrylic teeth is statistically significant. CONCLUSION: Though the nanocomposite teeth has less amount of wear than the four layered acrylic teeth, the difference is very less and adds only to a little clinical significance but the cost of the nanocomposite is four times that of the acrylic teeth. Further clinical studies must be performed to confirm our results.