Functional outcomes of clinically high-risk prostate cancer patients treated with robot-assisted radical prostatectomy: a multi-institutional analysis.

BACKGROUND: To ascertain 3-year urinary continence (UC) and sexual function (SF) recovery following robot-assisted radical prostatectomy (RARP) for clinically high-risk prostate cancer (PCa). METHODS: Retrospective analyses of a prospectively maintained database for 769 patients with D'Amico high-risk PCa undergoing RARP at two tertiary care centers in the United States and Europe between 2001 and 2014. The association between time since RARP and recovery of UC (defined as 0 pad/one safety liner per day) and SF (defined as sexual health inventory for men (SHIM) score ⩾17) was tested in separate preoperative and post-operative Cox-proportional hazards regression models. Sensitivity analyses were conducted using continence 0 pad per day and erection sufficient for intercourse as end points for UC and SF recovery, respectively. RESULTS: Mean age of the cohort was 62.3 years, and 62.1% harbored ⩾PT3a disease. Nerve sparing (unilateral or bilateral) RARP was performed in 87.7% of patients. Kaplan-Meier estimates of UC recovery at 12, 24 and 36 months after surgery was 85.2%, 89.1% and 91.2%, respectively, while 33.8, 52.3 and 69.0% of preoperatively potent men (preoperative SHIM ⩾17; n=548; 71.3%) recovered SF. Similar results were noted in sensitivity analyses. Patient age and year of surgery were associated with UC and SF recovery; additionally, preoperative SHIM score, degree of nerve sparing, pT3b-T4 disease and surgical margins were associated with SF recovery over the period of observation. CONCLUSIONS: Patients with D'Amico high-risk PCa treated with RARP may continue to recover UC and SF beyond 12 months of surgery and show promising outcomes at 3-year follow-up. Appropriate patient selection and counseling may aid in setting realistic expectations for functional recovery post RARP.

[Thrombophlebitis of the lower limbs: a convenient diagnosis?]. / Tromboflebiti degli arti inferiori: diagnosi di comodo?

Venous thrombosis may expose the patient to short (pulmonary embolism) or long term complications (postphlebitic syndrome), invalidating and onerous for society. The main point is identifying or excluding this pathology by anamnesis, clinical findings and bloodless diagnostics as Doppler c.w. and vascular duplex scanner. We suggest a decision flow chart helpful for diagnosis and therapeutics.

The power transfer from the neuromuscular machinery to its load as a vegetative and somatic behaviour.

Models have been proposed in literature describing the contraction of visceral and somatic muscles as an interaction between the time-varying elastances of them and the loads they are working against. The aim of this paper is: 1) to make clear similarities between the models of visceral and somatic muscular contraction; 2) to stress the concept that the power transfer from a time-varying elastance to its load is a behaviour, i.e. an interaction between the entire neuromuscular machinery and the surrounding environment; 3) to propose a theory describing the various physiological and pathological behaviours of both visceral and somatic muscles as different ways of coupling between the time-varying muscular elastances and their loads. In this theory it is assumed that the entire neuromuscular machinery acts as a whole to set the most appropriate power transfer to achieve behavioural goals.

[Temporal decay of the effect of a single vagal stimulation on cardiac rhythm in the rabbit]. / Decadimento temporale dell'effetto di singoli stimoli vagali sul ciclo cardiaco, nel coniglio.

The negative chronotropic effect of a single stimulus randomly delivered through right, left or both vagi respectively, within the cardiac cycle was studied in anaesthetized rabbits. The effect was analyzed on the P-P cycles subsequent the stimulus application, calculating percentagewise the delay observed in definite time-lapses, equalized to two pre-stimulus cycles. The results indicate that the efficacy of the negative chronotropic effect of vagal stimulation shows the least delay the closer the stimulus to the wave, while the delay is higher when the stimulus is delivered within the central portion of the cycle.

[Integration of the effects of a single stimulus applied to the vagus nerve on the right and the left, in the rabbit heart]. / Integrazione degli effetti di singoli stimoli applicati ai nervi vaghi di destra e di sinistra, nel cuore di coniglio.

It was reported by the literature that a train stimulation, simultaneously delivered on the two vagi, resulted in a decrement of the negative chronotropic effect, when it was compared to the sum of the effects obtained by the stimulation of the two nerves, separately. Our data indicate that the size of the chronotropic effect obtained by the simultaneous application on the two vagi of a single supraliminar stimulus, randomly applied within the P-P cycle, in rabbits, can be equal, higher or lower than the sum of the same stimulation separately delivered to the two nerves. The results could depend upon the different amount of acetylcholine released during stimulation. The hypothesis is put forward that different patterns of the neuro-cardiac junction regulation might be activated according to the quantity of released neuromediator.