Complications of laser prostatectomy: a review of recent data

Introduction: Laser techniques for the treatment of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE) have emerged as an alternative to transurethral resection of the prostate (TURP) and open prostatectomy (OP). Materials and methods: A Medline search over the past 4years was performed to assess the safety, intra- and postoperative morbidity of various laser techniques. Results: Data on holmium laser enucleation of the prostate (HoLEP) show the highest grade of evidence with two meta-analyses available and prove the low intra- and postoperative morbidity with reproducible long-term results. Photoselective vaporization of the prostate (PVP) with the Greenlightlaser (potassium titanyl phosphate, KTP or lithium borate, LBO) is characterized by excellent haemostatic properties in patients with or without oral anticoagulation. Long-term results show a reoperation rate comparable with TURP; however, there is a lack of randomized trials. Various types of diode lasers with different wavelengths are available for laser vaporization; despite their favourable haemostatic properties, a higher invasion depth seems to result in necrosis of the tissue leading to a higher rate of reoperation. Thulium-laser resection of the prostate shows promising intra- and postoperative morbidity, but data are limited and initial results need to be confirmed in large-scale trials. Conclusion: In summary, HoLEP- and KTP-, or LBO-laser vaporization of the prostate are the most mature techniques of laser prostatectomy and treatment alternatives to TURP and OP, whereas the clinical value and durability of procedures with diode laser systems and the thulium laser need to be confirmed in high-quality prospective RCT

RICH FEMALE GRAVES OF THE 1st MILLENNIUM B.C. IN SOUTHWEST GERMANY

Rich female graves in southwestern Germany are only recognisable archaeologically from about 600 B.C. onwards. During the Urnfield Culture and the Hallstatt C phase, male burials predominate among the rich graves. The earliest known female graves from the Western Hallstatt Culture to contain gold artefacts come from burial mounds 4 and 2 of the Bettelbühl cemetery near the Heuneburg. Furthermore, the discovery of tumulus 4, which contained a "princess grave" and the burial of a small girl, indicates that social rank and status at the Heuneburg were hereditary by at least the early 6th century BC. The female graves of the Bettelbühl necropolis represent the start of an early Celtic tradition which last for more than 250 years. One of the last examples of this tradition being the grave from Waldalgesheim, which dates to the decades around 300 BC. From the middle of the 2nd century BC onwards rich female graves are only sporadically attested in southwestern Germany. The rich female graves of Southwest Germany may be interpreted as representing members of an emerging aristocratic ruling class. The social importance and power of some women, which is attested archaeologically, was probably based on a matrilineal kinship or inheritance system. The archaeological sources indicate that these prominent women also held political and religious offices, and exercised power in their own right.Rich female graves in southwestern Germany are only recognisable archaeologically from about 600 B.C. onwards. During the Urnfield Culture and the Hallstatt C phase, male burials predominate among the rich graves. The earliest known female graves from the Western Hallstatt Culture to contain gold artefacts come from burial mounds 4 and 2 of the Bettelbühl cemetery near the Heuneburg. Furthermore, the discovery of tumulus 4, which contained a "princess grave" and the burial of a small girl, indicates that social rank and status at the Heuneburg were hereditary by at least the early 6th century BC. The female graves of the Bettelbühl necropolis represent the start of an early Celtic tradition which last for more than 250 years. One of the last examples of this tradition being the grave from Waldalgesheim, which dates to the decades around 300 BC. From the middle of the 2nd century BC onwards rich female graves are only sporadically attested in southwestern Germany. The rich female graves of Southwest Germany may be interpreted as representing members of an emerging aristocratic ruling class. The social importance and power of some women, which is attested archaeologically, was probably based on a matrilineal kinship or inheritance system. The archaeological sources indicate that these prominent women also held political and religious offices, and exercised power in their own right.Las ricas tumbas femeninas en el suroeste de Alemania se detectan arqueológicamente a partir del 600 a.C. Durante la Cultura de los Campos de Urnas y la fase Hallstatt C, los enterramientos masculinos son predominante entre las tumbas ricas. La tumbas femeninas más antiguas de la Cultura de Hallstatt Occidental, que contienen artefactos de oro, provienen de los túmulos 4 y 2 del cementerio de Bettelbühl cerca del Heuneburg. Además, el descubrimineto del túmulo 4, que contenía una “tumba de una princesa” y el enterramiento de una niña pequeña, indica que el rango y el estatus en el Heuneburg eran hereditarios, al menos desde inicios del siglo VI a.C. Las tumbas femeninas de la necrópolis de Bettelbühl representan el inicio de una temprana tradición celta que perduraría al menos 250 años. Uno de los últimos ejemplos de esta tradición proviene de una tumba de Waldalgesheim, que data de la década entorno al 300 a.C. Desde la mitad del siglo II a.C. en adelante, las tumbas femeninas ricas se atestiguan solo esporádicamente en el suroeste de Alemania. Estas tumbas deben ser consideradas como representación de los miembros de una aristocracia emergente de la clase dominante. La importancia social y el poder de algunas mujeres, documentadas arqueológicamente, se basaba probablemente en un sistema de parentesco matrilineal o hereditario. Las fuentes arqueológicas indican que estas mujeres prominentes también detentaban oficios políticos y religiosos y ejercían el poder en su propio beneficio

Diagnostik und Therapie der Harnleitersteinkolik

Summary: Acute ureteral colic presents with a complex of acute and characteristic flank pain that usually indicates the presence of a stone in the urinary tract. Diagnosis and management of renal colic have undergone considerable evolution and advancement in recent years. The application of noncontrast helical computed tomography (CT) in patients with suspected ureteral colic is one major advance in the primary diagnostic process. The superior sensitivity and specificity of helical CT allow ureterolithiasis to be diagnosed without the potential side effects of contrast media. Initial management is based on three key concepts: (A) rational and fast diagnostic process (B) effective pain control (C) and understanding of the impact of stone location and size on the natural course of the disease and definitive urologic management. These concepts are discussed in this review with reference to contemporary literatur

Patients' perception of surgical outcomes and quality of life after retroperitoneoscopic and open pyeloplasty

PURPOSE To report postoperative health-related quality of life (HRQoL) and patients' subjective evaluations of open pyeloplasty (OP) and retroperitoneoscopic pyeloplasty (RP) and influences on preoperative counselling. METHODS 107 patients (age 16-80 years, mean 31.5) with symptomatic primary ureteropelvic junction obstruction who underwent OP (32) or RP (75) were evaluated prospectively. HRQoL was evaluated using Short Form 36 (SF-36) questionnaires with 1 year follow-up. Operative outcomes were evaluated using a self-designed questionnaire regarding cosmetic outcomes, objective postoperative/current pain, convalescence and return to work. RESULTS The mean operative time was 174.4 vs. 161.4 min for RP versus OP, respectively, without intraoperative complications/conversions. There was an advantage for RP--except for two domains--without significance in any of the eight SF-36 domain scores. An advantage favouring RP in all aspects of the second questionnaire with significance in four aspects (cosmetic results, scar length, pain and convalescence) was found. Five weeks postoperatively, 58.7% (RP) vs. 25.8% (OP) were fully convalescent compared to 87.0% (RP) vs. 71.0% (OP) at 8 weeks. Similarly, 58.7 vs. 45.1% returned work 5 weeks postoperatively while 93.5 vs. 74.2% did so after 8 weeks, respectively. The small sample size, more questions on satisfaction/regret and mixed design are the main study limitations. CONCLUSION RP provides the same functional results beside earlier convalescence, better HRQoL and patients' convenience with surgery, which favours its inclusion in preoperative counselling providing patients with realistic postoperative expectations

ETMR-05: Single-cell transcriptomics of ETMR reveals developmental cellular programs and tumor-pericyte communications in the microenvironment [Abstract]

BACKGROUND: Embryonal tumors with multilayered rosettes (ETMR) are pediatric brain tumors bearing a grim prognosis, despite intensive multimodal therapeutic approaches. Insights into cellular heterogeneity and cellular communication of tumor cells with cells of the tumor microenvironment (TME), by applying single-cell (sc) techniques, potentially identify mechanisms of therapy resistance and target-directed treatment approaches. MATERIAL AND METHODS: To explore ETMR cell diversity, we used single-cell RNA sequencing (scRNA-seq) in human (n=2) and murine ETMR (transgenic mode; n=4) samples, spatial transcriptomics, 2D and 3D cultures (including co-cultures with TME cells), multiplex immunohistochemistry and drug screens. RESULTS: ETMR microenvironment is composed of tumor and non-tumor cell types. The ETMR malignant compartment harbour cells representing distinct transcriptional metaprograms, (NSC-like, NProg-like and Neuroblast-like), mirroring embryonic neurogenic cell states and fuelled by neurogenic pathways (WNT, SHH, Hippo). The ETMR TME is composed of oligodendrocyte and neuronal progenitor cells, neuroblasts, microglia, and pericytes. Tumor-specific ligand-receptor interaction analysis showed enrichment of intercellular communication between NProg-like ETMR cells and pericytes (PC). Functional network analyses reveal ETMR-PC interactions related to stem-cell signalling and extracellular matrix (ECM) organization, involving factors of the WNT, BMP, and CxCl12 networks. Results from ETMR-PC co-culture and spatial transcriptomics pointed to a pivotal role of pericytes in keeping ETMR in a germinal neurogenic state, enriched in stem-cell signalling. Drug screening considering cellular heterogeneity and cellular communication suggested novel therapeutic approaches. CONCLUSION: ETMR demonstrated diversity in the microenvironment, with enrichment of cell-cell communications with pericytes, supporting stem-cell signalling and interfering in the organization of the tumor extracellular matrix. Targeting ETMR-PC interactions might bring new opportunities for target-directed therapy

Complications of laser prostatectomy : a review of recent data

Laser techniques for the treatment of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE) have emerged as an alternative to transurethral resection of the prostate (TURP) and open prostatectomy (OP)

The Heuneburg - Supply networks and sphere of influence around the protohistoric hillfort

International audienceAs a major political and economic centre north of the Alps during the late Hallstatt period, the Heuneburg enjoys a key position in the study ofthe Iron Age in Europe. The almost 3 ha hillfort and the rich burial mounds surrounding it, however, are only the tip of the iceberg in a complexand extensive network. The Heuneburg is situated in an advantageous geographical position at the gateway to the Alps and on the upper reachesof the Danube, at the crossroads of the Mediterranean to the south, the Atlantic to the west, the Baltic and the British Isles to the north andthe Black Sea to the east. The Attic ceramics as well as Greek and Italic transport amphorae found on the hillfort, the import of Mediterraneanarchitectonic technology (mudbricks wall, monumental stone gate) as well as the amber beads or the bracelets made from sapropelite from theburials, bear witness to this exceptional location. The human and material resources used for the construction of the fortified settlement and forthe erection of monumental burial mounds also attest to a strong hierarchy which extends far beyond the Heuneburg itself. In order to gain abetter understanding of this organisation, the landscape and periphery of the Heuneburg as well as the supply of raw materials (e.g. iron, gold,sapropelite) are the focus of a research project which was launched in 2014 with the support of the German Research Foundation (DeutscheForschungsgemeinschaft). Intended to run for twelve years, the project has already led to the investigation of surrounding hillforts (Alte Burg,Große Heuneburg, Bussen) forming a network of power centres linked to the Heuneburg. This network is based on a rich hinterland with openrural settlements (Ensmad, Emerfeld) which supplied natural and agricultural resources for the Heuneburg and the other hilltop settlements. Thediscovery of craft districts on the hilltop plateau and in the lower town of the Heuneburg, linked in particular to bronze metallurgy, bears witnessto the central position of the site within the supply networks. The more recently discovered traces of activity of goldsmiths on the plateau pointin the same direction.The present paper explores the central role of the Heuneburg in short- and long-distance exchanges on the basis of the data acquired over thepast seven years within the research project. The various surrounding hillforts, the open rural settlements and how they are interrelated withthe Heuneburg will be discussed, as well as the exploitation of resources in the hinterland, craft production, provenance and circulation of rawmaterial and manufactured goods within the Heuneburg’s sphere of influence

Combinations of caudal myxopapillary ependymoma and dermal sinus: A single shared embryologic lesion?

A female child presenting with acute flaccid paraparesis at 18 months was found to have a dermal sinus in combination with a dermoid cyst and a myxopapillary ependymoma of the cauda equina and conus medullaris. A possible embryologic relation between these lesions is discussed