1,721,017 research outputs found
Single setting 3D MRI-US guided frozen section and focal cryoablation of the index lesion in low/intermediate risk prostate cancer
Full text linkObjectives: To explore the reliability of frozen sections to diagnose prostate cancer (PCa) and to describe surgical steps of a 3D magnetic resonance imaging (MRI)– ultrasound (US)-guided prostate biopsy (PB) and focal cryoablation of the index lesion in a single setting procedure.
Patients and Methods: Patients with suspicious PCa, based on prostatic specific antigen (PSA) value and on a PIRADS 4 or 5 single lesion, as well as the steadfastness of avoiding any kind of radical treatment, were considered for enrolment. IRB and written informed consent were obtained from the patients.
The entire procedure was performed transperineally, in two consecutive surgical phases: 3D MRI–US-guided plus systematic template PB and real-time TRUS-guided focal cryoablation.
Three cores were taken from the index lesion (one for frozen section and two for final pathology), three cores from the surrounding area and systematic sampling was performed for the rest of the gland. Focal cryoablation of the index lesion was performed once confirmation of PCa was obtained by means of frozen sections. Follow-up schedule included PSA test at 3-mo interval, MRI 3-mo and 1-yr postoperatively and prostate biopsy of the treated area at 1-yr.
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Results: This report includes 14 patients with a minimum follow up time of 12 months. All patients were potent before treatment, complained no severe low urinary tract symptoms and denied consent to any radical treatment.
PCa diagnosis was histologically confirmed in all patients by frozen sections. All other cores were negative. At final histology, there was a Gleason score upgrade in three patients, from 3+3 to 3+4.
The postoperative course was uneventful and all patients were discharged on the first postoperative day.
Mean PSA value decreased from 6.37 (baseline) to 0.83 ng/mL at 3-mo evaluation. Three-mo postoperative MRI images showed complete ablation of the index lesion in all patients.
Urinary continence and erectile function were preserved in all patients, without clinically meaningful changes at EPIC questionnaire.
At one-yr follow-up, eleven patients showed no signs of persistent or recurrent disease at MRI imaging and treated area biopsies; three patients had a suspicious area at MRI and they needed treatment for confirmed disease at biopsy.
Conclusion: Single setting 3D MRI–US-guided frozen section and focal cryoablation of the index lesion could represent a step forward towards a “patient-tailored” minimally invasive approach to diagnosis and cure of low and intermediate risk PCa
Severe spasm of the left main and spontaneous intramural haematoma: A serial optical coherence tomography study
No full textNo abstract availabl
Covered Endovascular Reconstruction of Aortic Bifurcation Facilitated by Intravascular Lithotripsy With Shockwave Balloon: A Case Report
Full text linkAortoiliac occlusive disease (AIOD) is a specific form of peripheral artery disease (PAD) that affects the infrarenal aorta and iliac arteries. Patients with PAD commonly suffer from intermittent claudication (IC), a condition characterized by cramping pain during or after exercise that is relieved by rest. The first-line therapy for IC involves medical management, foot care, and structured exercise programs while revascularization therapy, which can be endovascular, surgical, or a combination of both, is generally reserved for patients with claudication who do not respond adequately to initial therapies. We present the clinical case of a 58-year-old female with hypertension, dyslipidemia, and a smoking habit who was referred to our hospital (Misericordia Hospital, Grosseto, Italy) due to bilateral IC of the buttocks and thighs. Computed tomography (CT) angiography revealed a 90% tight stenosis of the infrarenal abdominal aorta just above the iliac bifurcation with diffuse calcifications. After a careful evaluation of the patient's condition and anatomical characteristics of the atherosclerotic disease, the vascular team decided to perform covered endovascular reconstruction of aortic bifurcation (CERAB) with previous intravascular lithotripsy (IVL) with shockwave balloon using intravascular ultrasound (IVUS) as guidance, because of severe aortic luminal calcifications. We performed successful CERAB, and the patient was discharged in good clinical condition on the fifth day of hospitalization with an indication to follow optimal medical therapy. At the one-month clinical follow-up, the patient reported the disappearance of claudication with marked improvement in quality of life. This first described case of IVUS-guided IVL-facilitated CERAB demonstrates the efficacy and safety of IVL in calcific aortic disease and shows the usefulness of IVUS as guidance in peripheral calcium debulking procedures
An uncommon clinical condition: chronic thrombosis of the inferior vena cava. A case report and review of literature.
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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
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
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
Robot-assisted radical cystectomy with intracorporeal neobladder: impact of learning curve and long-term assessment of functional outcomes
No full textBACKGROUND: There is paucity of data about functional outcomes of Robot-assisted Radical Cystectomy (RARC) with intracorporeal orhotopic neobladder (ICON), and the impact of learning curve (LC) on those outcomes remains to be addressed. We aimed to report long-term functional outcomes of our single center series of RARC with ICON, assessing the role of LC in their achievement.METHODS: Patients treated with Robot assisted radical cystectomy with intracorporeal orthotopic neobladder in our center between January 2012 an August 2019 were retrospectively analysed. Preoperative, clinical, perioperative, pathologic and functional data were reported. The first cases were divided in tertiles, for assessing the impact of learning curve on the outcomes evaluated. Long-term functional outcomes of the whole cohort were evaluated.RESULTS: Overall, 167 patients were included. Concerning tertiles analysis, operative time (p<0.001), incidence of low (p=0.002) and high grade (p=0.001) complications and hospital stay (p=0.04) decreased significantly over time. Day-time continence recovery probability was significantly lower in the initial case series (1-yr rate 68.4%, 87% and 89.8 for I, II and III tertile, respectively; p=0.04;). Accordingly, Trifecta achievement was significantly higher in II and III tertiles (p=0.01). At a median follow- up of 34 months, the incidence of significant renal function deterioration of the whole cohort was 16.7%. Overall, 12, 24 and 60-mo day-time continence rates were 74.8 %, 82.7 % and 82.7 %.CONCLUSIONS: Patients treated at the beginning of the learning curve show worse perioperative and functional results. Once standardized the procedure, complications rates, hospital stay and daytime continence recovery experienced a significant improvement. At a long-term analysis of functional outcomes of our patients, renal function preservation and continence recovery results are encouraging
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