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BACKGROUND: As robotic surgery becomes more ubiquitous, determining clinical benefit is necessary in order to justify the cost and time investment required to become proficient. We hypothesized that robotic cholecystectomy would be associated with improved clinical outcomes but also increased cost as compared with standard laparoscopic cholecystectomy. MATERIALS AND METHODS: All patients undergoing robotic or laparoscopic cholecystectomy at a single academic hospital between 2007-2017 were identified using an institutional clinical data repository. Patients were stratified by operative approach (robotic vs. laparoscopic) for comparison and propensity score-matched 1:10 based on relevant comorbidities and demographics. Categorical variables were analyzed by Chi-square test and continuous variables using Mann-Whitney U test. RESULTS: 3,255 patients underwent cholecystectomy during the study period. There were no differences in demographics or BMI, but greater rates of diabetes mellitus, hypertension, and gastroesophageal reflux disease were present in the laparoscopic group. After matching (n=106 robotic, n=1060 laparoscopic), there were no differences in preoperative comorbidities. Patients who underwent robotic cholecystectomy had lesser durations of stay (Robot: 0.1±0.7 vs. Lap: 0.8±1.9, p < 0.0001) and lesser 90-day readmission rates (Robot: 0% [0], Lap: 4.1% [43], p = 0.035); however, both operative and hospital costs were greater compared with laparoscopic cholecystectomy. CONCLUSIONS: Robotic cholecystectomy is associated with lesser duration of stay and lesser readmission rate within 90-days of the index operation, but also greater operative duration and hospital cost compared with laparoscopic cholecystectomy. Hospitals and surgeons need to consider the improved clinical outcomes but also the monetary and time investment required prior to pursuing robotic cholecystectomy.

Speech has a very significant impact on the life quality of people with cleft and lip palate. Restore tissue anatomy and functionality is the main aim of primary palatal surgery. Multiple factors are associated with successful handling, including the need for a velopharyngeal insufficiency (VPI) secondary surgery. The study's aim is to determine speech and velopharyngeal function outcomes in children with cleft palate operated in our institution and to determine VPI secondary surgery outcomes, if appropriate. Clinical records of nonsyndromic patients with cleft palate born between January 2009 and December 2012, who performed their multidisciplinary care on our institution, were analyzed retrospectively. One hundred forty-two patients received primary palatal surgery. Eighty (56%) were male and 62 (44%) female. Twenty-two had soft cleft palate, 9 hard and soft cleft palate, 84 unilateral, and 27 bilateral cleft lip and palate. Twelve percent of patients presented palatal fistula, with a significantly higher presentation in Soft Cleft Palate and Hard and Soft Cleft Palate. Twenty-seven patients (19%) had surgical indication for VPI correction, and 20 of them received VPI surgery, before school age. Cleft type and gender were significantly associated with VPI surgery indication rate. Postsurgery, 80% presented normal resonance. Nasal emission improved in 85% of patients. Nasometry decreased from 45% to 31%. Hyponasality increased by 10%. One case presented total flap dehiscence. Preoperative planning must be done carefully and individualized to succeed. Future prospective research that considers all the variables for a correct analysis is advisable, to improve our results.

Thrombin activable fibrinolysis inhibitor antigen levels (TAFI Ag ) exhibit a great inter-individual variability in healthy populations. Our aim is to determine whether variability is due to physiologic variations depending on genetic control or due to validation of the method, in order to allow a better interpretation of the results in patients with vascular diseases. With this purpose, we performed a strategy validation of specific ELISA method, Zymutest TAFI Ag Hyphen Biomed, based on a commercial monoclonal antibody. After methodology validation we have recently determined plasma TAFI Ag levels in several groups of diseases such as septic patients, menopause and cerebrovascular diseases. TAFI was finally determined in acute ischemic stroke to know its relationship with stroke evolution and response to thrombolytic treatments.

OBJETIVO: Estimar a frequência de história pregressa de chiado, descrevendo as características clínicas e formas de tratamento utilizadas. MÉTODOS: Coorte retrospectiva incluindo lactentes (6-23 meses de vida) com sintomas de infecção de vias aéreas superiores e relato de episódio prévio de chiado. Os dados foram registrados em questionário anteriormente validado. RESULTADOS: Dos 451 avaliados, 164 (36,4%; IC95% = 31,9-41,0) apresentaram história pregressa de chiado, 148 (32,8%; IC95% = 28,5-37,4) no primeiro ano de vida. A média de idade no primeiro episódio de chiado foi de 5,3±3,9 meses. Para quem começou a chiar no primeiro ano de vida, 38,5% referiram entre três e seis episódios e 14,2% > seis episódios. A média da idade no primeiro episódio foi menor para os que apresentaram > três episódios em comparação aos que apresentaram até dois episódios (3,2±2,7 versus 5,7±2,5 meses, p < 0,001). CONCLUSÃO: Um terço dos lactentes apresentou chiado no primeiro ano de vida. Quanto mais cedo ocorre o primeiro episódio, mais frequente é a recorrência do chiado. OBJECTIVE: To estimate the frequency and describe the clinical characteristics and respective treatments of previous history of wheezing. METHODS: Infants aged 6-23 months with upper respiratory tract complaints and reporting previous wheezing were followed-up retrospectively. Data were registered on a validated standardized form. RESULTS: Out of 451 infants, 164 (36.4%; 95%CI: 31.9-41.0) had a report of prior history of wheezing, 148 (32.8%; 95%CI: 28.5-37.4) during the first year of life. The mean age at the first episode of wheezing was 5.3±3.9 months. Among those who had had their first episode before 12 months of age, 38.5% reported 3 to 6 episodes and 14.2% > 6 episodes. Mean age at first episode was lower for those with > 3 episodes in comparison with those with < 2 episodes (3.2±2.7 vs. 5.7±2.5 months, p < 0.001). CONCLUSION: One third of the infants reported wheezing during the first year of life. The earlier the first episode occurs, the more frequently wheezing recurs.