Robotic radical prostatectomy in Greece: the learning curve and beyond. The initial 40 cases.

Radical prostatectomy is the treatment of choice for management of organ-confined prostate cancer. Minimally invasive treatments, as an alternative, have refined been recently by the introduction of da Vinci robotic technology which has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. We report on our experience with robotic radical prostatectomy using the first da Vinci robotic system in our country. During 8 months, 40 robotic radical prostatectomies were performed by a single surgical team at Athens Medical Centre (Marousi, Greece). Preoperative data collection included basic demographics, prostate-specific antigen (PSA), clinical stage, and Gleason score. Operative outcomes included operative time, estimated blood loss, and complications. Postoperative outcomes included hospital stay, pain, catheter time, pathology, PSA, return of continence, and potency. Average operative time was 186.25 min with an estimated mean blood loss of 135 ml. There were no intra-operative complications. Ninety per cent of the patients were discharged home on postoperative day 1 with mean haematocrit 36.7 (range 29-43). All patients reported minimal postoperative pain and resumed regular diet on the first postoperative day. Average catheter time was 6.6 days (range 5-10). Early continence was observed in 47.5% of the patients, seven days after catheter removal. Continence at 1, 3, and 6 months was 75, 82.5 and 95%, respectively. The overall positive margin rate was 17.5%. Ninety-five per cent of the patients had undetectable postoperative PSA levels (less than 0.1 ng/ml) at a median follow-up of 6 months. Our initial experience with robotic radical prostatectomy is very promising. The learning curve was approximately 10-12 cases. With a methodical approach we were able to implement the method safely and effectively in our practice, combining minimal morbidity with good oncological and functional outcomes.

Methods of lithotripsy in ancient Greece and Byzantium.

PURPOSE: In this article we present the medical methods of lithotripsy applied by ancient Greek and Byzantine physicians, and their influence on the development of surgery after that time. MATERIALS AND METHODS: Study and analysis of the original texts of the Byzantine medical writers, written in Greek and containing the knowledge of the ancient Greek, Hellenistic and Roman periods, were performed. RESULTS: The Byzantine method of lithotripsy was the result of the eternal knowledge of the spasmolytic, analgesic and lithotriptic effect of various herbs, together with ancient surgical techniques of stone removal from Hellenistic and Roman periods. No operation was attempted for the extraction of stones from kidneys. Rather the idea was to drop the stones to the bladder or into the urethra, or dilute them into smaller pieces with various herbs. CONCLUSIONS: Ancient Greek and Byzantine physicians described conservative and surgical methods, derived from the texts of early surgeons, to which they added their own observations.

Antibodies to collagen in patients with idiopathic pulmonary fibrosis.

STUDY OBJECTIVE: The pathogenesis of idiopathic pulmonary fibrosis (IPF) is uncertain. This investigation was undertaken to determine if antibodies to human native collagens and their chains are present in the serum of the patients with IPF and to examine their relationship with clinical factors. MATERIALS: Serum specimens were obtained from 45 subjects. The subjects were separated into three distinct groups: group 1 consisted of 16 patients with IPF; group 2a, 9 patients with pulmonary fibrotic scars from previous tuberculosis were examined as a control group; group 2b, 20 normal individuals matched by age and sex. The collagen antigens used in this study consisted of four genetically distinct types, I, II, III, IV and their corresponding chains alpha 1(I) + alpha 2(I), alpha 1(II), and alpha 1(III). METHODS: a passive microhemagglutination assay was used to test the antibody activity in the sera of both patients and controls. Titration was performed in microtiter plastic plates, using 0.5 percent cell suspension. The specificity of anticollagen antibodies was then tested using an absorption serum technique with native collagens and their chains. Hemagglutination enhancement and inhibition tests, as well as chromatography, were used to determine the type of antibodies. RESULTS: Thirteen of 16 (81 percent) patients with IPF (group 1) had antibodies against at least one type of native collagen or one type of collagen chain in titers up to 1:512. Twelve patients exhibited anticollagen antibodies with titers above 1:16. By contrast, only 2 of 9 (22 percent) subjects with fibrotic scars (group 2a) and 3 of 20 (15 percent) normal subjects (group 2b) had antibody activity in titers up to 1:8. The differences between group 1 and group 2a and 2b were statistically significant, (p < 0.05 and p < 0.001, respectively). There was an inverse, statistically significant correlation between duration of the disease (IPF) and antibody activity. The correlation coefficient between duration of the disease and titers of antibodies to type III collagen (native and/or chain) was higher than the correlation coefficient between duration of the disease and titers to collagen I. The enhancement and inhibition of agglutination tests, as well as the chromatography, showed that the agglutination factors were antibodies of IgG and IgM classes. The antibody absorption test revealed that the anticollagen antibodies were specific for each collagen and its chain and there was no cross-reaction. CONCLUSION: This study suggests that the anticollagen antibodies could be a marker of IPF activity and may perpetuate the lung tissue inflammation. It is still unclear if the autoimmunity of the collagen participates in the pathogenesis of IPF or the presence of the anticollagen antibodies is simply an epiphenomenon.

Antibodies to native and denatured collagens in sera of patients with rheumatoid arthritis.

A passive hemagglutination assay was used to detect antibodies to native human collagens and to collagen chains in the sera of 110 rheumatoid patients and those of 75 normal controls. The incidence and titer of anticollagen antibodies in rheumatoid arthritis are high, but in controls they are low or in most instances absent. No correlation was found between the stage of RA, or titers of rheumatoid factor, or ANA and the incidence and/or titers of antibody to any given type of collagen.