RESUMEN
PURPOSE: The purpose of this study was to determine the efficacy of the Vienna nomogram prostate biopsy model in the detection of prostate cancer in our local population. We also assessed the incidence of complications from using such a template. MATERIALS AND METHODS: From January 2006 to June 2007, 120 men with either elevated prostate-specific antigen (PSA) scores (>4 ng/mL) and/or abnormal digital rectal examination were enrolled prospectively to undergo extraction of 6 to 18 cores for transrectal ultrasound-guided prostate biopsy, as indicated by the Vienna nomogram. RESULTS: The mean age was 62.6±8.3 years (range, 40-86 years). The mean PSA score was 13.42 ng/mL. The mean number of cores obtained was 9.68±3.1. According to the Vienna nomogram, 27 out of a total of 120 patients had prostate cancer, for a detection rate of 22.5%. In the group of patients with PSA scores <10 ng/mL, the detection rate was 14.9% (14 of 94 patients). The group of patients with PSA scores >10 ng/mL had a detection rate of 50% (13 of 26). The complication rate in our study was 7.5%. CONCLUSIONS: With the use of the Vienna nomogram, our prostate cancer detection rate is comparable to previously published data for Asian patients. This nomogram offers an easy tool with which to select the optimal number of prostate biopsy cores to be taken on the basis of patient age and total prostate volume. With this biopsy strategy, we also have found that the complication rate from prostate biopsy is low.
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PURPOSE: To determine whether the overall ureteral flow through an obstructed ureter using the 3F MicroStent™ that uses a novel film occlusion anchoring mechanism is comparable to the flow using a conventional 3F and 4.7F Double-J stent. MATERIALS AND METHODS: An in vitro silicone ureter model and an ex vivo porcine urinary model (kidney and ureter) were used to measure the overall flow through obstructed and unobstructed ureters with either a 3F Double-J stent (Cook), 3F MicroStent (PercSys), or 4.7F Double-J stent (Cook). Mean flow rates were compared with descriptive statistics. RESULTS: Mean flow rates through the obstructed silicone ureter (12-mm stone) for the 3F MicroStent, 3F Double-J stent, and 4.7F Double-J stent were 326.7±13.3 mL/min, 283.3±19.2 mL/min, and 356.7±14.1 mL/min, respectively. In the obstructed ex vivo porcine ureter model, the flow as a percentage of free flow was 60%, 53%, and 50 %, respectively. In both ureteral models, flow rates of the 3F MicroStent and 4.7F Double-J stents were not statistically different. CONCLUSIONS: The 3F MicroStent demonstrated drainage equivalent to a 4.7F Double-J stent, in both in vitro silicone and ex vivo porcine obstructed urinary models. We have demonstrated the crucial first step that this 3F stent, using a novel film occlusion anchoring mechanism, has equivalent, if not slightly improved, drainage rates when compared with its larger counterpart.
Asunto(s)
Drenaje/instrumentación , Drenaje/métodos , Stents , Animales , Simulación por Computador , Modelos Animales , Reología , Siliconas , Sus scrofa , Uréter/patología , Uréter/fisiopatologíaRESUMEN
BACKGROUND: Laparoscopic cholecystectomy is a commonly performed procedure in general surgical practice but it also has an inherently steep learning curve. The training of surgeons in this procedure presents a challenge to teaching hospitals, which essentially have to strike a balance between effective training and safety of the patient. The present study aims first to assess the safety of the structured training programme for this procedure at the Department of Surgery, Changi General Hospital, Singapore. Secondly, it seeks to audit the conversion and bile duct injury rates among the laparoscopic cholecystectomies performed by the department, and the factors which influence these. METHODS: Notes of all patients who underwent laparoscopic cholecystectomy in the department over an 18-month period were reviewed retrospectively and the relevant data prospectively collected. Demographics, as well as details of cases of conversion to open operation and of bile duct injury were identified and the reasons for each recorded. RESULTS: A total of 443 patients underwent laparoscopic cholecystectomy in the 18-month period. The most common indication for surgery was biliary colic/dyspepsia (61.4%), followed by cholecystitis, cholangitis, pancreatitis and common bile duct stone. The overall conversion rate was 11.5%. Three hundred and fifty-five patients were operated on by consultant surgeons, while 88 were by registrars who had been through the structured training programme. There was no statistically significant difference found in the conversion rates between these two groups (P = 0.284). Twenty-two of the 268 female (8.2%) patients had conversion to open operation, while 29 of the 175 male patients (16.6%) underwent conversion (P = 0.007). Amongst cases of cholecystitis and cholangitis, the conversion rate for patients operated on within 7 days of onset of symptoms was 35%, while those operated on 8 or more days later had a conversion rate of 29.7% (P = 0.639). There was a solitary case of bile duct injury among the 443 cases, equating to a bile duct injury rate of 0.23%. CONCLUSION: A structured training programme involving stepwise progression of training, with close supervision by consultant surgeons and a built-in system of audit can effectively train junior surgeons in laparoscopic cholecystectomy without exposing patients to undue risks.