 | | Total robotic surgery for pancreaticoduodenectomy combined with rectal cancer anterior resection | Total robotic surgery for pancreaticoduodenectomy combined with rectal cancer anterior resection
Total robotic surgery for pancreaticoduodenectomy combined with rectal cancer anterior resection
Overview
Synchronous double malignancies, including carcinoma of the ampulla of Vater and rectal carcinoma, are generally uncommon occurrences in the gastrointestinal tract. The present study reports a case of a 37-year-old man who was incidentally found to suffer from carcinoma of the ampulla of Vater and rectal carcinoma. The duodenoscopy was performed and revealed an ulcerated and bulky ampulla of Vater, the biopsy from which revealed a moderate-differentiated adenocarcinoma, A local hospital colonoscopy confirmed a tumour located in rectal 7cm from the anal margin and biopsy-confirmed poorly differentiated adenocarcinoma.
About such patient treatment, both open and laparoscopic surgery are restricted because of operation complexity, large injury, and poor cosmetic effect. surgery performed using Da Vinci robotic surgical system (DVSS). No evidence of recurrence or relapses was found in the first year after surgery. Although sporadic double malignancies are uncommon, they should be considered when evaluating cancer patients. Complex surgery performed by robotic surgery may became surgeon’s preferred treatment modality.
Acknowledgement
Authors QunGuang Jiang, TaiYuan Li, DongNing Liu and Cheng Tang,
Journal Medicine Volume 97 Issue 19
Publisher Wolters Kluwer Health, Inc
| 3 | | R 389.00 |  |
| | Clinical Practice Guidelines: Trauma Part 2 | Clinical Practice Guidelines: Trauma Part 2
Clinical Practice Guidelines: Trauma Part 2
Overview “Injury is an increasingly significant health problem throughout the world. Every day, 16 000 people die from injuries, and for every person who dies, several thousand more are injured, many of them with permanent sequelae. Injury accounts for 16% of the global burden of disease. The burden of death and disability from injury is especially notable in low- and middle-income countries. By far the greatest part of the total burden of injury, approximately 90%, occurs in such countries” (Mock et al., 2004).
The focus of pre-hospital trauma management remains the rapid access and extrication of patients to allow for the rapid assessment and control of bleeding, the airway and ventilation. There is a renewed focus on the importance of rapid transport as the most important factor for trauma survival remains time to access of definitive care and operative haemostasis.
Bleeding remains one of the most important contributors to traumatic death. The prevention of the trauma triad of death: hypothermia, acidosis and coagulopathy remain an important goal. Haemodilution and the role of pre-hospital fluid management has also received significant attention. Many well-developed trauma systems are moving towards restrictive fluid management regimes, specific haemodynamic targets and the introduction of pre-hospital initiation of blood product administration. The control and prevention of bleeding remains a central focus for pre-hospital providers.
Acknowledgement Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa | 3 | | R 410.00 | |
| | Clinical Practice Guidelines: Pain and Procedural Sedation | Clinical Practice Guidelines: Pain and Procedural Sedation
Clinical Practice Guidelines: Pain and Procedural Sedation
Overview “The management of acute traumatic pain is a crucial component of pre-hospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based protocols” (Gausche-Hill et al., 2014). Pain management is also frequently based on the assessment of need by a provider, rather than the requirements of patients. Historically only Entonox and morphine have been available for pre-hospital pain management in the local setting with the more recent introduction of ketamine. Availability of appropriate and effective treatment options, especially for non-ALS providers, remains a challenge.
Situations requiring procedural sedation and analgesia in the pre-hospital setting are common and may range from alignment of fracture to extrication and complex disentanglement during medical rescue. Until recently South African pre-hospital providers did not have agents suitable for this purpose, particularly in the setting of severe trauma and hypotension. As ketamine has been introduced into some scopes of practice providing safe and effective dissociative procedural analgesia has become a possibility. However, the use of procedural sedation and analgesia is not without risks and, at this time, no uniform practice has been suggested in the South African pre-hospital setting. Acknowledgement Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa | 3 | | R 410.00 | |
| | Clinical Practice Guidelines: Trauma Part 1 | Clinical Practice Guidelines: Trauma Part 1
Clinical Practice Guidelines: Trauma Part 1
Overview
“Injury is an increasingly significant health problem throughout the world. Every day, 16 000 people die from injuries, and for every person who dies, several thousand more are injured, many of them with permanent sequelae. Injury accounts for 16% of the global burden of disease. The burden of death and disability from injury is especially notable in low- and middle-income countries. By far the greatest part of the total burden of injury, approximately 90%, occurs in such countries” (Mock et al., 2004). The focus of pre-hospital trauma management remains the rapid access and extrication of patients to allow for the rapid assessment and control of bleeding, the airway and ventilation. There is a renewed focus on the importance of rapid transport as the most important factor for trauma survival remains time to access of definitive care and operative haemostasis. Bleeding remains one of the most important contributors to traumatic death. The prevention of the trauma triad of death: hypothermia, acidosis and coagulopathy remain an important goal. Haemodilution and the role of pre-hospital fluid management has also received significant attention. Many well-developed trauma systems are moving towards restrictive fluid management regimes, specific haemodynamic targets and the introduction of pre-hospital initiation of blood product administration. The control and prevention of bleeding remains a central focus for pre-hospital providers. Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa Clinical Practice Guidelines: Trauma Part 1 | 3 | | R 410.00 | |
| | Viral Pneumonia - Part 3 | Viral Pneumonia - Part 3
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19 The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R 420.00 | |
| | Viral Pneumonia - Part 2 | Viral Pneumonia - Part 2
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard BrawermanThe University of Pretoria | 3 | | R 420.00 | |
| | Viral Pneumonia Part 1 | Viral Pneumonia Part 1
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R 420.00 | |
| | Acute Management of Stroke | Acute Management of Stroke
Acute Management of Stroke
Overview:
The goal for the acute management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within 60 minutes of patient arrival. Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.
In patients with transient ischemic attacks (TIAs), failure to recognize the potential for near- term stroke, failure to perform a timely assessment for stroke risk factors, and failure to initiate primary and secondary stroke prevention exposes the patient to undue risk of stroke and exposes clinicians to potential litigation. TIAs confer a 10% risk of stroke within 30 days, and one half of the strokes occurring after a TIA, occurred within 48 hours.
Newer stroke trials have explored the benefit of using neuroimaging to select patients who are most likely to benefit from thrombolytic therapy and the potential benefits of extending the window for thrombolytic therapy beyond the guideline of 3 hours with t-PA and newer agents. CT angiography may demonstrate the location of vascular occlusion. CT perfusion studies can produce perfusion images and together with CT angiography are becoming more available and utilized in the acute evaluation of stroke patients. Advanced neuroimaging with diffusion and perfusion imaging may then serve an important role in identifying potentially salvageable tissue at risk and guiding clinical decision-making regarding therapy.
Acknowledgements:
Authors:
Edward C Jauch | 3 | | R 440.00 | |
| | Protocol for the systematic review of the reporting of transoral robotic surgery | Protocol for the systematic review of the reporting of transoral robotic surgery
Protocol for the systematic review of the reporting of transoral robotic surgery
Overview
This will be a comprehensive review of transoral robotic surgery and will track its innovative evolution since first published description to present day. Inclusion of all study types will allow identification of good and poor examples of the descriptions of innovative invasive procedures. The methods described are applicable to reviews of any innovative surgical or other invasive procedure.
Transoral robotic surgery (TORS) has been adopted in some parts of the world as an innovative approach to the resection of oropharyngeal tumours. The development, details and outcomes of early-to-later phase evaluation of this technique and the quality of evidence to support its adoption into practice have hitherto not been summarised. The aim of this review is to identify and summarise the early and later phase studies of, and evidence for, TORS and to understand how early phase studies report intervention development, governance procedures and selection and reporting of outcomes to optimise methods for using the Idea, Development, Exploration, Assessment, Long-term follow-up (IDEAL) framework for surgical innovation that informs evidence based practice. The protocol has been written in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist.
Acknowledgement
Authors Barry G Main, Natalie S Blencowe, Noah Howes, Sian Cousins, Kerry N L Avery, Alexander Gormley, Phil Radford, Daisy Elliott, Benjamin Byrne, Nicholas Wilson, Robert Hinchliffe, Jane M Blazeby,
Journal
BMJ Open
| 3 | | R 420.00 | |
| | Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer | Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer
Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer
Overview
Endometrial cancer is the most common gynaecologic cancer in developed countries and has been increasing at a rate of over 2.5% per year in North America for the last decade [1]. Most women are diagnosed at an early stage and surgery is the primary treatment, including total hysterectomy, bilateral salpingo-oophorectomy and surgical staging, which can include pelvic and para-aortic lymph node assessment [2].
This online course aims at evaluating patient-reported outcomes (PROs) between women treated by laparoscopic, robotic and open approaches for endometrial cancer. Historically, the preferred surgical approach for treatment of endometrial cancer has been laparotomy. However, multiple randomized controlled trials (RCTs) comparing laparoscopy to laparotomy have reported decreases in postoperative complication rates and length of hospital stay in women undergoing laparoscopy [3–6]. Importantly, there appears to be no difference in disease-free and overall survival in those women treated by a minimally invasive approach [6,7]. Based on these findings, laparoscopy, and more recently robotic surgeries, have become standard surgical approaches for endometrial cancer.
It was concluded that minimally invasive approaches result in improved QOL beyond the short-term postoperative
Acknowledgement
Author Sarah E. Ferguson, Tony Panzarella, Susie Lau, Lilian T. Given, Vanessa Samouëlian, Christopher Giede, Helen Steedi, Tien Le, Ben Renkosinski, Marcus Q, Bernardini,
Journal
Gynecologic Oncology
| 3 | | R 410.00 | |
| | Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer | Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer
Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer
Overview
Cervical cancer (CC) continues to be a global burden for women, with higher incidence and mortality rates reported annually. Many countries have witnessed a dramatic reduction in the prevalence of CC due to widely accessed robotic radical hysterectomy (RRH). This network meta-analysis aims to compare intra-operative and postoperative outcomes in way of RRH, laparoscopic radical hysterectomy (LTH) and open radical hysterectomy (ORH) in the treatment of early-stage CC. A comprehensive search of PubMed, Cochrane Library and EMBASE databases was performed from inception to June 2016. Clinical controlled trials (CCTs) of above three hysterectomies in the treatment of early-stage CC were included in this study. Seventeen 17 CCTs were ultimately enrolled in this network meta-analysis. The network meta-analysis showed that patients treated by RRH and LRH had lower estimated blood loss compared to patients treated by ORH. the SUCRA value of three radical hysterectomies showed that patients receiving RRH illustrated better conditions on intra-operative blood loss, operation time, the number of resected lymph nodes, length of hospital stay and intra-operative and postoperative complications, while patients receiving ORH demonstrated relatively poorer conditions.
Acknowledgement
Authors Yue-Mei Jin, Shan-Shan Liu, Jun Chen, Yan-Nan Chen and Chen-Chen Ren
Journal PLoS ONE
| 3 | | R 415.00 | |
| | Pregnancy following robot-assisted laparoscopic partial cystectomy and gonadotropin-releasing hormone agonist treatment within three months in an infertile woman with bladder endometriosis | Pregnancy following robot-assisted laparoscopic partial cystectomy and gonadotropin-releasing hormone agonist treatment within three months in an infertile woman with bladder endometriosis
Pregnancy following robot-assisted laparoscopic partial cystectomy and gonadotropin-releasing hormone agonist treatment within three months in an infertile woman with bladder endometriosis
Overview
Endometriosis is a benign disease defined as endometrial tissue implanting outside the uterine cavity and often causes dysmenorrhea, pelvic pain, dyspareunia and infertility. The prevalence of endometriosis has been reported in up to 50% of infertile women. This article serves to report an infertility case of deep-infiltrating bladder endometriosis conceiving following robot-assisted surgery and modified gonadotropin-releasing hormone agonist (GnRHa) treatment.
Case report: A 33-year-old infertile female presenting with dysmenorrhea was found to have a bladder mass by pelvic ultrasound. Cystoscopy revealed a protruding tumour from the posterior bladder wall, and endometriosis was highly suspected. Robot-assisted laparoscopic partial cystectomy was performed for the deep-infiltrating bladder endometriosis. With postoperative half-dose GnRHa treatment and timed intercourse, she got pregnant within 3 months.
It was concluded that robot-assisted complete resection of deep-infiltrating endometriosis and bladder repair immediately followed by GnRHa therapy and medical assistance improves reproductive outcomes efficiently in women with endometriosis-associated infertility
Acknowledgement
Author Shun-Jen Tan, Chi-Huang Chen, Shauh-Der Yeh, Yun-Ho Lin, Chii-Ruey Tzeng
Journal Taiwanese Journal of Obstetrics & Gynaecology
| 3 | | R 435.00 | |
| | Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer | Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer
Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer
Overview
The clinical application of robotic surgery in breast conserving surgery or volume replacement with robotic latissimus dorsi flap harvest (RLDFH) has been rarely reported. In this study, we report the preliminary experience and clinical outcome of robotic assisted quadrantectomy (RAQ) and immediate partial breast reconstruction (IPBR) with RLDFH.
The post-operative recovery was smooth except for seroma formation over the back, which was relieved after repeated aspiration at an outpatient clinic. The patient was satisfied with the post-operative scar and aesthetic outcome. No local recurrence, distant metastasis or case mortality was found during 5 months of follow-up. RAQ and IPBR with RLDFH is a safe alternative for small-to-medium-breast-size women with breast cancer who desire breast conservation and are indicated for volume replacement with autologous latissimus dorsi flap.
Acknowledgement
Authors Hung-Wen Lai, Shou-Tung Chen, Shih-Lung Lin, Ya-Ling Lin, Hwa-Koon Wu, Shu-Hsin Pai, Dar-Ren Chen and Shou-Jen Kuo,
Journal
Medicine Baltimore
Publisher Wolters Kluwer Health, Inc.
| 3 | | R 420.00 | |
| | Immunogenomic Classification of Colo-rectal Cancer and Therapeutic Implications | Immunogenomic Classification of Colo-rectal Cancer and Therapeutic Implications
Immunogenomic Classification of Colo-rectal Cancer and Therapeutic Implications
Overview
The immune system has a substantial effect on colorectal cancer (CRC) progression. Additionally, the response to immunotherapeutic and conventional treatment options (e.g., chemotherapy, radiotherapy and targeted therapies) is influenced by the immune system.
The molecular characterization of colorectal cancer (CRC) has led to the identification of favourable and unfavourable immunological attributes linked to clinical outcome. With the definition of consensus molecular subtypes (CMSs) based on transcriptomic profiles, multiple characteristics have been proposed to be responsible for the development of the tumour immune microenvironment and corresponding mechanisms of immune escape.
In this review, a detailed description of proposed immune phenotypes as well as their interaction with different therapeutic modalities will be provided. Finally, possible strategies to shift the CRC immune phenotype towards a reactive, anti-tumour orientation are proposed per CMS. The recognition of the impact of the immune system on the progression of CRC has led to the identification and detailed characterization of tumour immune phenotypes.
Acknowledgement
Author Jessica Roelands, Peter J. K. Kuppen, Louis Vermeulen, Cristina Maccalli, Julie Decock, Ena Wang, Francesco M. Marincola, Davide Bedognetti and Wouter Hendrickx
Journal International Journal of Molecular Sciences Volume 18 Issue 10
Publisher PubMed | 3 | | R 460.00 | |
| | In vitro immunotherapy potency assays using real-time cell analysis | In vitro immunotherapy potency assays using real-time cell analysis
In vitro immunotherapy potency assays using real-time cell analysis
Overview
A growing understanding of the molecular interactions between immune effector cells and target tumour cells, coupled with refined gene therapy approaches, are giving rise to novel cancer immuno-therapeutics with remarkable efficacy in the clinic against both solid and liquid tumours. Therefore, there is an urgent need for functional potency assays, in vitro and in vivo, that could model the complex interaction of immune cells with tumour cells and can be used to rapidly test the efficacy of different immunotherapy approaches, whether it is small molecule, biologics, cell therapies or combinations thereof.
Herein we report the development of an xCELLigence real-time cytolytic in vitro potency assay that uses cellular impedance to continuously monitor the viability of target tumour cells while they are being subjected to different types of treatments. In summary, our results demonstrate the xCELLigence platform to be well suited for potency assays, providing quantitative assessment with high reproducibility and a greatly simplified workflow.
Acknowledgement
Author Fabio Cerignoli, Yama A. Abassi, Brandon J. Lamarche, Garret Guenther, David Santa Ana, Diana Guimet, Wen Zhang, Jing Zhang and Biao Xi
Journal PLoS ONE Volume 13 Issue 3
Publisher Cross Mark
| 3 | | R 360.00 | |
| | Incidental Statin Use and the Risk of Stroke or Transient Ischemic Attack after Radiotherapy for Head and Neck Cancer | Incidental Statin Use and the Risk of Stroke or Transient Ischemic Attack after Radiotherapy for Head and Neck Cancer
Incidental Statin Use and the Risk of Stroke or Transient Ischemic Attack after Radiotherapy for Head and Neck Cancer
Overview
Interventions to reduce the risk for cerebrovascular events (CVE; stroke and transient ischemic attack [TIA]) after radiotherapy (RT) for head and neck cancer (HNCA) are needed. We aimed to test whether incidental statin use at the time of RT is associated with a lower rate of CVEs after RT for HNCA.
From an institutional database we identified all consecutive subjects treated with neck RT from 2002 to 2012 for HNCA. Data collection and event adjudication was performed by blinded teams. The primary outcome was a composite of ischemic stroke and TIA. The secondary outcome was ischemic stroke. The association between statin use and events was determined using Cox proportional hazard models after adjustment for traditional and RT-specific risk factors.
Incidental statin use at the time of RT for HNCA is associated with a lower risk of stroke or TIA.
Acknowledgement
Authors
Daniel Addison, Patrick R. Lawler, Hamed Emami, Sumbal A. Janjua, Pedro V. Staziaki, Travis R. Hallett, Orla Hennessy, Hang Lee, Bálint Szilveszter, Michael Lu, Negar Mousavi, Matthew G. Nayor, Francesca N. Delling, Javier M. Romero, Lori J. Wirth, Annie W. Chan, Udo Hoffmann, Tomas G. Neilan
Journal Journal of Stroke Publisher Cross Mark | 3 | | R 420.00 | |