1,720,972 research outputs found
Extended pelvic lymphadenectomy and various radical prostatectomy techniques: is pelvic drainage necessary?
No full textOBJECTIVE:
To investigate whether routine drainage is advisable after open extended pelvic lymph node dissection (ePLND) and retropubic radical prostatectomy (RRP) by measuring the incidence of lymphoceles and comparing these results with those of a series of robot-assisted radical prostatectomy (RARP) and ePLND.
PATIENTS AND METHODS:
A total of 331 consecutive patients underwent ePLND and RRP or RARP. The first 132 patients underwent open ePLND and RRP and received two pelvic drains; these patients were prospectively randomized into two groups: group 1 (n = 66), in which the drains were shortened on postoperative (PO) days 3 and 5 and removed on PO day 7, and group 2 (n = 66), in which the drains were removed on PO day 1. The next 199 patients were assigned to two consecutive groups not receiving drainage: group 3 (n = 73) undergoing open ePLND and RRP, followed by group 4 (n = 126) treated by transperitoneal robot-assisted ePLND and RARP. All patients had ultrasonographic controls 5 and 10 days and 3 and 12 months after surgery.
RESULTS:
Lymphoceles were detected in 6.6% of all patients, 3.3% of whom were asymptomatic and 3.3% of whom were symptomatic. Symptomatic lymphoceles were detected in 0% of group 1, 8% of group 2, 7% of group 3 and 1% of group 4, with groups 2 and 3 differing significantly from group 4 (P < 0.05). In total, 5% of all patients undergoing open RRP (groups 1-3) had symptomatic lymphoceles vs 1% of patients undergoing RARP (group 4) (P = 0.06). Nodal-positive patients had significantly more symptomatic lymphoceles than nodal-negative patients (10% vs 2%) (P < 0.02).
CONCLUSIONS:
Symptomatic lymphoceles occur less frequently after open RRP and pelvic drainage over 7 days than after open RRP and pelvic drainage over 1 day or without drainage. Patients undergoing RARP without drainage had significantly fewer lymphoceles than patients receiving open RRP without drainage
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Positioning injury, rhabdomyolysis, and serum creatine kinase-concentration course in patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection.
No full textBACKGROUND AND PURPOSE:
During robot-assisted radical prostatectomy (RARP), patients remain in a steep Trendelenburg position. This can cause positioning injuries as well as rhabdomyolysis. The primary diagnostic indicator of rhabdomyolysis is elevated serum creatine kinase (CK). We investigate whether RARP with extended pelvic lymph node dissection (ePLND) in a prolonged extreme Trendelenburg position can cause positioning injuries and rhabdomyolysis.
PATIENTS AND METHODS:
We performed a prospective study of the first 60 patients undergoing RARP and ePLND for organ-confined prostate cancer at our institute. Positioning injuries were graded according to three degrees of clinical severity. Serum-CK, serum-pH, and base excess (BE) were measured before, during, and for 5 days after surgery. Rhabdomyolysis was defined by serum-CK levels >5000 IU/L.
RESULTS:
Median operative time was 317 minutes (range 200-475 min); median time in the Trendelenburg position was 282 minutes (range 170-470 min). Serum-CK was significantly elevated 6 hours postoperatively, peaking at 18 hours postoperatively. Serum-CK levels did not correlate with pH, BE, and perioperative creatinine values. Serum-CK course shows weak correlation with body mass index (BMI), operative time, Trendelenburg position time, and medium correlation with positioning injuries of any degree. Twenty-one of the 60 (35%) patients showed positioning-related injuries: 16 (27%) patients degree I, 2 (3%) patients degree II, and 3 (5%) patients degree III. Rhabdomyolysis developed in 10 patients. Postoperative renal failure did not develop in any patient receiving postoperative hypervolemic diuretic therapy nor any patient with injuries degrees I, II, or III. conclusion: Clinically relevant positioning injuries and rhabdomyolysis can occur in patients who are subjected to prolonged extreme Trendelenburg position during RARP and ePLND, especially at the beginning of the learning curve. Serum-CK increases significantly after surgery, peaking 18 hours postoperatively. Serum-CK elevation alone is not predictive of positioning injury. By very long operative and Trendelenburg times as well as high BMI with visible position injuries, we recommend serum-CK measurement 6 and 18 hours postoperatively followed by hypervolemic therapy to prevent possible renal injury from rhabdomyolysis if serum-CK >5000 IU/L
When and how should we test the tightness of the vesicourethral anastomosis after retropubic radical prostatectomy?
No full textOBJECTIVE:
To determine when the vesicourethral anastomosis (VUA) becomes tight after retropubic radical prostatectomy (RRP) and if an additional lateral view cystography provides significantly more information than the only anterior-posterior view.
PATIENTS AND METHODS:
Pressure-controlled cystography with anterior-posterior and lateral views was performed on postoperative days (POD) 3, 6 and 9 and evaluated in 100 consecutive patients after RRP.
RESULTS:
On POD 3, 6 and 9, 82, 80 and 82% of all VUA, respectively, were tight. 85% of all tight VUA on POD 3 remained tight on POD 6 and 9. Of the 52 extravasations in a total of 300 cystographies, 65% were recognizable in the anterior-posterior as well as in the lateral view cystography, 6% were seen only in the anterior-posterior view and 29% only in the lateral view.
CONCLUSIONS:
The VUA after RRP is tight in about 80% of the cases on POD 3, 6 and 9. A tight VUA on POD 3 does not exclude later extravasation on POD 6 and 9 (14%). About one third (29%) of all extravasations of VUA are seen only in the lateral view cystography after RRP
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Impact of a single-surgeon learning curve on complications, positioning injuries, and renal function in patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection.
No full textOBJECTIVE:
To assess the impact of a single-surgeon learning curve on complications, positioning injuries, and renal function in patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection for intermediate- or high-risk clinically localized prostate cancer.
METHODS:
From November 2008 to October 2012, a total of 233 consecutive patients were treated by a single surgeon experienced in open and laparoscopic procedures. Four subgroups of patients (1: cases 1-59; 2: 60-117; 3: 118-175; and 4: 176-233) were compared. Complications were classified according to the modified Clavien system. Serum creatine kinase, as an indicator of tissue injury, was measured before, during, and for 5 days after surgery. Renal function monitoring was started preoperatively and ended at discharge. Minimum follow-up was 3 months. Variables were compared using chi-square and Wilcoxon tests.
RESULTS:
Overall, 115 complications were reported in 98 of 233 patients (42%) and significantly decreased after 175 procedures (P = .028). Minor complications (Clavien grades 1-2) represented the most frequent events (86 of 115 [75%]), with a significant drop in group 4 (P <.01). Similarly, the rate of positioning injuries (groups 1-4: 31%, 29%, 29%, and 7%, respectively) showed a significant improvement in group 4 (P = .023). Creatine kinase levels significantly decreased with increased experience (group 1 vs groups 2-4: P <.01). Renal function was unaltered postoperatively.
CONCLUSION:
A surgeon with extensive open and laparoscopic experience presents a safe learning curve in regard to robot-assisted radical prostatectomy and extended pelvic lymph node dissection. With increasing experience, the rates of overall and positioning-related complications significantly decrease after 175 procedures. No detrimental effect on renal function is to be expected
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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