Robotic-assisted laparoscopic extended pelvic lymph node dissection for prostate cancer: surgical technique and experience with the first 99 cases

BACKGROUND: To date, there is still a paucity of data in the literature on robotic-assisted laparoscopic extended pelvic lymph node dissection (RALEPLND) in patients with prostate cancer. OBJECTIVE: To assess the technical feasibility of RALEPLND and to present our surgical technique. DESIGN, SETTING, AND PARTICIPANTS: From April 2006 to March 2008, we performed RALEPLND in 99 patients prior to robotic-assisted laparoscopic radical prostatectomy. Indications for RALEPLND were a prostate-specific antigen (PSA) >/=10 ng/ml or a preoperative Gleason score >/=7. The data were evaluated retrospectively. SURGICAL PROCEDURE: The transperitoneal approach was used in all cases. In order to gain optimal access to the common iliac bifurcation, the five trocars were placed in a more cephalad position than in patients undergoing radical prostatectomy without RALEPLND. After identification of important landmarks, the lymphatics covering the external iliac vein, the obturator lymphatic packet, and the lymphatics overlying the internal iliac artery were removed on both sides. MEASUREMENTS: The total lymph node yield, the frequency of lymph node metastases, and the complication rate. RESULTS AND LIMITATIONS: The median patient age was 64 yr (range: 45-78). The median preoperative PSA level was 7.7 ng/ml (range: 1.5-84.6). The median number of lymph nodes harvested was 19 (range: 8-53). In 16 patients (16%), we found lymph node metastasis. Complications occurred in seven patients (7%). CONCLUSIONS: RALEPLND is feasible, and its lymph node yield is well in the range of open series. The robotic-assisted laparoscopic approach in itself does not seem to limit a surgeon's ability to perform a complete extended pelvic lymph node dissection

Differentiation in prefrontal cortex recruitment during childhood:Evidence from cognitive control demands and social contexts

Emerging cognitive control during childhood is largely supported by the development of distributed neural networks in which the prefrontal cortex (PFC) is central. The present study used fNIRS to examine how PFC is recruited to support cognitive control in 5–6 and 8-9-year-old children, by (a) progressively increasing cognitive control demands within the same task, and (b) manipulating the social context in which the task was performed (neutral, cooperative, or competitive), a factor that has been shown to influence cognitive control. Activation increased more in left than right PFC with cognitive control demands, a pattern which was more pronounced in older than younger children. In addition, activation was higher in left PFC in competitive than cooperative contexts, and higher in right PFC in cooperative and neutral than competitive contexts. These findings suggest that increasingly efficient cognitive control during childhood is supported by more differentiated recruitment of PFC as a function of cognitive control demands with age. Keywords: Prefrontal cortex, Cognitive control, Cooperation, Competition, Children, Functional near-infrared spectroscopy (fNIRS

Information and digital literacies; a review of concepts

A detailed literature reviewing, analysing the multiple and confusing concepts around the ideas of information literacy and digital literacy at the start of the millennium. The article was well-received, and is my most highly-cited work, with over 1100 citations

Neuronal Ceroid-Lipofuscinosis in Older Dachshunds

A lysosomal storage disease with accumulation of periodic acid-Schiff- and Sudan black-positive autofluorescent granules in neurons occurred in one 51/2- and one 7-year-old dachshund. Ultrastructurally, the storage material consisted of membranous material arranged in stacks and fingerprint patterns. The disease was defined as ceroid-lipofuscinosis, and resembled a previously reported case in an adult dachshund. </jats:p

Immunohistological Studies on Primary Reticulosis of the Canine Brain

Brains of 17 dogs with primary reticulosis, and of two with metastatic and one with primary lymphosarcoma, were examined by immunohistologic techniques with antisera against the major immunoglobulin classes of the dog. On the basis of immunoglobulin in tumour cells, two reticuloses were reclassified as primary lymphosarcomas of the brain. The tumour cells in three other dogs with neoplastic reticulosis and in six dogs with microgliomatosis did not contain immunoglobulin. Many cells in inflammatory reticulosis were immunoglobulin-bearing. Although some of these lesions could have been lymphosarcomas, insufficient data were available to ascertain either an inflammatory or a neoplastic nature. It was concluded that some lesions previously classified as reticulosis are in fact primary histiocytic lymphosarcomas of the brain, while others may be true reticulosarcomas. </jats:p