Management of pelvic lymphoceles after radical prostatectomy: A multicentre community based study

<p>Abstract</p> <p>Introduction</p> <p>Pelvic lymphoceles (LC) following radical prostatectomy (LC-RP) have an incidence up to 27%. LC-managements constitute 50% of surgical interventions performed in post-RP patients.</p> <p>Objectives</p> <p>To describe a therapeutic algorithm for LC-managements based on a community based representative retrospective study.</p> <p>Patients and methods: Multicentre data from 304 patients with LC-RP were retrospectively examined for LC-managements. RPs were performed by various surgeons from 67 urological departments. All patients had undergone 3 weeks rehabilitation in a specialized hospital where the data base was generated. Indications and results of therapeutic manoeuvres were used to develop a general concept for planning therapy decisions.</p> <p>Results</p> <p>Median age was 64 years. Complications occurred in 9% (28/304) of patients. Median LC-volume was 36 ml (range 20-1800 ml). There were more complications for LCs with ≥100 ml volume than those < 100 ml (27% versus 17%, p = 0.346). Conservative therapy was the standard in uncomplicated cases (87%, 239 of 276 patients), while intervention was done in 13% (puncture and/or drainage, surgery). Surgical intervention was performed significantly more often in complicated cases (82%, 23 from 28 patients; p < 0.001). Based on these data, LCs can be stratified into 3 groups depending on the size and clinical presentation. Therapeutic decisions were used to develop the illustrated new therapy algorithm.</p> <p>Conclusions</p> <p>This study based treatment algorithm provides a rationale approach with an accurate LC-classification as regard the indications and decision making for the available LC-RP-therapies. This could facilitate management decisions. Evaluation of this concept prospectively in large patient cohort is mandatory.</p

CHARACTERIZATION OF THE 105 K SUPERCONDUCTOR Tl2Ba2CaCu208 ("2212")

International audienceHomogeneous Tl1.8Ba2CaCu208 ceramics were synthesized by a novel route, starting from Tl2Ba205 precursors and using high gas pressures. This method allows tight control of thallium losses, resulting in dense, large-grained samples with sharp superconducting transitions above 105 K. Results of a characterization by X-ray diffraction, optical micrographs and micro-probe analysis are presented, together with selected physical properties

Preparation of pure Tl2Ba2CuO6+x: the contribution of phase equilibrium studies

International audienceThe formation of the pure thallium-based cuprate Tl2Ba2CuO6+x (2201) using a convenient process in the ternary TIO1.5-BaO-CuO phase diagram is described. This process is based on the congruent formation of the oxide Tl2Ba2O5 to which CuO is mixed, constituting a quasi-binary system. In the resulting 2201 compound no trace of the main poisoning magnetic impurity BaCuO2 could be detected by AC susceptibility measurements. The orthorhombic to tetragonal transformation is asserted to be due to thallium deficiency which occurs during the heat treatments at a temperature depending on the oxygen partial pressure

Retinal cell regeneration using tissue engineered polymeric scaffolds

Degenerative retinal diseases, such as age-related macular degeneration (AMD), can lead to permanent sight loss. Although intravitreal anti-vascular endothelial growth factor (VEGF) and steroid injections are effective for the management of early stages of wet and/or neovascular AMD (nAMD), no proven treatments currently exist for dry AMD or for the advanced geographic atrophy of the retina that follows. Tissue engineering (TE) has recently emerged as a promising alternative to repair retinal damaged and restore its functions. Here, we review recent advances in TE, with a particular emphasis on retinal regeneration. We provide an overview of retinal diseases, followed by a comprehensive review of TE techniques, cells, and polymers used in the fabrication of scaffolds for retinal cell regenerations, in particular the retinal pigment epithelium (RPE). - 2019Scopu

If you could see what we see, would it bother you?

Objective The purpose of our study was to determine whether the anatomic threshold for pelvic organ prolapse (POP) diagnosis and surgical success remains valid when the patient sees what we see on exam. Methods Two hundred participants were assigned, by computer-generated block randomization, to see one of four videos. Each video contained the same six clips representative of various degrees of anterior vaginal wall support. Participants were asked questions immediately after each clip. They were asked: “In your opinion, does this patient have a bulge or something falling out that she can see or feel in the vaginal area?” Similarly, they were asked to give their opinion on surgical outcome on a 4-point Likert scale. Results The proportion of participants who identified the presence of a vaginal bulge increased substantially at the level of early stage 2 prolapse (1 cm above the hymen), with 67 % answering yes to the question regarding bulge. The proportion of participants who felt that surgical outcome was less desirable also increased substantially at early stage 2 prolapse (1 cm above the hymen), with 52 % describing that outcome as “not at all” or “somewhat” successful. Conclusion Early stage 2 POP (1 cm above the hymen) is the anatomic threshold at which women identify both a vaginal bulge and a less desirable surgical outcome when they see what we see on examination

Micro-endoscopy of the human vas deferens: a feasibility study of a novel device in several ex vivo models

The aim of this study was to show limitation as well as potential of micro-endoscopy techniques as an innovative diagnostic and therapeutic approach in andrology. Two kinds of custom-made micro-endoscopes (ME) were tested in ex vivo vas deferens specimen and in post-mortem whole body. The semi-rigid ME included a micro-optic (0.9mm outer diameter [OD], 10.000 pixels, 120 degrees vision angle [VE], 3-20mm field depth [FD]) and an integrated fibre-optic light source. The flexible ME was composed of a micro-optic (OD=0.6mm, 6.000 pixels, 120 degrees VE, 3-20mm FD). The ex vivo study included retrograde investigation of the vas deferens (surgical specimen n=9, radical prostatectomy n=3). The post-mortem investigation (n=4) included the inspection of the vas deferens via both approaches. The results showed that antegrade and retrograde rigid endoscopy of the vas deferens were achieved as a diagnostic tool. The working channel enabled therapeutic use including biopsies or baskets. Using the flexible ME, the orifices of the ejaculatory ducts were identified. In vivo cadaveric retrograde cannulation of the orifices was successful. Post-mortem changes of verumontanum hindered the examinations beyond. Orifices were identified shaded behind a thin transparent membrane. Antegrade vasoscopy using flexible ME was possible up to the internal inguinal ring. Further advancement was impossible because of anatomical angle and lack adequate vision guidance. The vas deferens interior was clearly visible and was documented by pictures and movies. Altogether, the described ME techniques were feasible and effective, offering the potential of innovative diagnostic and therapeutic approaches for use in the genital tract. Several innovative indications could be expected

Congenital intrarenal arteriovenous malformation presenting with gross hematuria after endoscopic intervention: a case report

<p>Abstract</p> <p>Introduction</p> <p>Although diagnostic ureterorenoscopy is a minimally invasive and effective diagnostic procedure, it has the potential for significant postoperative complications. We report the first case in the literature of intrarenal arteriovenous fistulas causing hemodynamic effective anemia 4 days after ureterorenoscopic biopsy.</p> <p>Case presentation</p> <p>A 63-year-old Caucasian woman presented with hemodynamic effective macrohematuria (hemoglobin 70 g/liter) 4 days after ureterorenoscopy and biopsy of the upper pole collecting system due to recurrent microhematuria. Duplex-sonography and computed tomography angiography revealed multiple arteriovenous fistulas and erosions into the calyceal system. Intra-arterial digital subtraction angiography confirmed this condition. After superselective embolization of the arteriovenous fistulas, the patient had no further episodes of bleeding or microhematuria.</p> <p>Conclusion</p> <p>If malignancies, urolithiasis or urinary tract infections are ruled out by common diagnostic procedures as the cause of recurrent minor or gross hematuria, the possibility of arteriovenous fistulas should be included in the differential diagnosis and Duplex-Sonography or the more invasive selective renal arteriography should be performed as this is the most definitive method for diagnosing arteriovenous fistula.</p

A Novel Multilayer Natural Coating for Fed-State Gastric Protection

Several nutraceutical products require gastric protection against the hostile environment in the stomach. Currently marketed synthetic and semi-synthetic coatings suffer from major shortcomings such as poor gastric protection, slow-release response to pH change, and the use of artificial ingredients. The challenge of coating natural products is further exacerbated by the relatively high gastric pH in the fed state. In this work, a novel natural enteric coating is presented as a breakthrough alternative to current solutions. Two coating systems were devised: (i) a triple-layer coating that comprises a wax layer embedded between two alginate-based coatings, and (ii) a double-layer coating, where an overcoat of organic acids (fumaric or citric acid) is applied to an alginate-based coating. The multi-layer architecture did not impact the pH-responsive nature of the coating even when more biologically relevant Krebs bicarbonate buffer of lower buffer capacity was used. Interestingly, the gastric protection barrier of organic acid-based coating remained resistant at elevated gastric pH 2, 3, or 4 for 2 h. This is the first report of using an alginate-based coating to provide gastric protection against fed-state stomach conditions (pH 2–4). Being biodegradable, naturally occurring, and with no limit on daily intake, the reported novel coating provides a superior platform to current coating solutions for pharmaceutical and nutraceutical products

Reversible magnetization below Tc in high-quality superconducting ceramics

International audienceWe have investigated the reversible magnetization below Tc in high-quality YBa2Cu307_d (Y-123), YBa2Cu4Os (Y-124), Y2Ba4Cu7O15+x (Y-247) and Bi2Sr2CaCu2O8+x (Bi-2212), Tl2Ba2Cu106+d (Tl-2201) and Tl2Ba2CalCu2O8+d (T1-2212) ceramics. Except for the stoichiometric Y-124 phase, the oxygen concentration was optimized in order to obtain the highest value of the critical temperature for which the normal-state susceptibility becomes temperature independent. Using the simple London model, we are able to fit the reversible magnetization M(T, H) outside the region near Tc with good accuracy for the nearly three-dimensional YBaCuO phases. For the very anisotropic BiSrCaCuO and TlBaCaCuO phases, we have to include an additional term to take into account the fluctuations of vortices. An important result is that Y-123 exhibits a critical field clearly higher than those of the BiSrCaCuO or TlBaCaCuO phases. We obtain for the Y-123 phase a slope at Tc μodHC2,C/dT = -4.3 T/K and an extrapolated μoHC2,C (0) = 280 T