Objective: The objective of this study was to identify lymphatic vessels draining from the prostate by using a fluorescence navigation (FN) system. Methods: Fourteen subjects were candidates for radical retropubic prostatectomy (RRP) and pelvic lymph node dissection (PLND). After an indocyanine green solution was injected into the prostate during RRP, lymphatic vessels draining from the prostate were analyzed using a FN system. After PLND based on lymphatic mapping by the FN system (in vivo probing) was performed in the external iliac, obturator and internal iliac regions; the fluorescence of the removed lymph nodes (LNs) was analyzed on the bench (ex vivo probing). Results: Under in vivo and ex vivo probing, the fluorescence intensity of internal iliac nodes was greater than that of external iliac or obturator nodes. Conclusion:The current study suggests that using a FN system after injecting indocyanine green is a safe and rational approach for detecting the lymphatic channel draining from the prostate. The major lymphatic pathway involved in the spreading of prostate cancer appears to relate to internal iliac LNs, which would mean that the standard PLND covering external iliac and obturator regions would not keep the cancer from spreading. RésuméObjectif : L'objectif de l'étude était de repérer les vaisseaux lymphatiques quittant la prostate à l'aide d'un système d'imagerie par fluorescence (IF). Méthodologie : Quatorze sujets devaient subir une prostatectomie radicale rétropubienne (PRR) et une lymphadénectomie pelvienne. Après injection d'une solution de vert d'indocyanine dans la prostate pendant la PRR, les vaisseaux lymphatiques drainant la prostate ont été analysés par IF. Une lymphadénectomie pelvienne fondée sur la cartographie lymphatique par IF (exploration in vivo) a ensuite été réalisée dans les régions de la fosse iliaque externe, de l'obturateur et de la fosse iliaque interne; la fluorescence des ganglions lymphatiques retirés a été analysée sans délai (exploration ex vivo). Résultats : Lors de l'exploration in vivo et ex vivo, l'intensité de la fluorescence des ganglions iliaques internes était plus forte que celle des ganglions iliaques externes ou des ganglions obturateurs. Conclusion : Cette étude porte à croire que l'IF après injection de vert d'indocyanine est une méthode sûre et rationnelle pour repérer les vaisseaux lymphatiques drainant la prostate. La principale voie lymphatique de propagation du cancer de la prostate semble être reliée aux ganglions lymphatiques iliaques internes, ce qui signifie que la lymphadénectomie pelvienne standard retirant les ganglions iliaques externes et obturateurs n'empêcherait pas le cancer de se propager.
RESULTSAmong the UCLA-PCI urinary domains, urinary function scores decreased at 3 months after RPP, but they increased 6 months after RPP. Likewise, urinary bother showed a transient decrease at 3 months, but had returned to the baseline level 6 months after RPP. Sexual function (SF) was drastically decreased at 3 months after RPP, but had slightly increased 1 year after RPP. Patients who had a nerve-sparing (NS) RPP showed better SF-related HRQL than those who did not at 6 months after RPP. This favourable alteration involving SF-related HRQL was closely associated with the NS procedure, but not with the patient age. Multivariate analysis showed that later recovery of SF was essentially related to the use of NS RPP, while early recovery of sexual bother was closely related to the patient age. CONCLUSIONSOur results confirmed the positive effect of RPP on the long-term HRQL in Japanese patients. Although NS surgery conferred the benefit of the recovery of SF, older Japanese patients were not greatly concerned about their decreased SF-related HRQL. The current results provide primary evidence for predicting the alteration of HRQL and understanding the effect of patient age and NS surgery on HRQL after RPP. KEYWORDSquality of life, longitudinal survey, radical perineal prostatectomy, prostate cancer, Japanese patients Study Type -Therapy (outcomes research) Level of Evidence 2c OBJECTIVETo investigate the longitudinal alteration of health-related quality of life (HRQL) up to 5 years after radical perineal prostatectomy (RPP) among Japanese patients with localized prostate cancer.
P Pu ur rp po os se e: : To establish the appropriate inhalation induction technique using a high concentration of sevoflurane in the elderly.M Me et th ho od ds s: : Forty-five patients, aged 70-79-yr-old, were randomly divided into three groups: 1) Group I: anesthesia was induced with propofol 2 mg·kg -1 and sevoflurane 2% (n = 15); 2) Group II: anesthesia was induced with a three-minute inhalation of sevoflurane 8%; 3) Group III: anesthesia was induced with inhalation of sevoflurane using a gradual reduction technique (8, 6, 4% for each minute). In Groups II and III, a modified vital capacity inhalation induction was performed. Mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO 2 ) were measured continuously during induction. In addition, induction time and adverse events related to anesthetic induction were recorded. R Re es su ul lt ts s: : The induction time in Group I was significantly shorter than that in Groups II and III (P < 0.05). However, there was no difference in the induction time between Groups II and III. In Groups II and III, the majority of patients required additional breaths. In comparison with the other groups, stability of MAP was maintained in Group III. The variations of HR in all groups were small. During induction, no patient experienced a decrease in SpO 2 below 96%, except for two patients in Group I. Severe respiratory adverse events were not observed. Other adverse events were similar in all groups.C Co on nc cl lu us si io on ns s: : Our results suggest that a high concentration sevoflurane induction using a gradual reduction technique may be an acceptable alternative to standard iv induction in elderly patients. II et III (P < 0,05 Objectif : Réaliser la technique appropriée d'induction par inhalation en utilisant une forte concentration de sévoflurane chez des patients âgés. Méthode : Quarante-cinq patients de 70-79 ans, ont été répartis de façon aléatoire en trois groupes : 1) groupe I : anesthésie induite avec 2 mg·kg -1 de propofol et du sévoflurane à 2 % (n = 15) ; 2) groupe II : anesthésie induite avec l'inhalation de sévoflurane à 8 % pendant 3 min ; 3) groupe III : anesthésie induite avec l'inhalation de sévoflurane selon la technique de réduction graduelle de la concentration (8, 6, 4 % pour chaque minute). Dans les groupes II et III, une induction par inhalation, avec modification de la capacité vitale, a été réalisée. La tension artérielle moyenne (TAM), la fréquence cardiaque (FR) et la saturation du sang en oxygène (SpO 2 ) ont été mesurées en continu pendant l'induction. De plus, le temps nécessaire à l'induction et les événements indésirables reliés à l'induction anesthésique ont été notés. Résultats : Le temps d'induction a été significativement plus court dans le groupe I que dans les groupes
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