Hernie Inguinoscrotale de l’Uretère: Fait Clinique et Revue de la Littérature

la hernie intrascrotale de l’uretère est une situation rare, nous rapportons un cas clinique, compliqué d’hydronéphrose gauche chez un patient de 83ans, l’anomalie avait été reconnue en peropératoire.Mots clés: Hernie, de l’uretère, le scrotum, hydronéphros

Management of encrusted ureteral stents

Objectives: To present our experience in managing encrusted ureteral stents and to review the literature on the subject.Methods: A total of 22 patients with encrusted ureteral stent were treated in our department. Encrustation of the stent and associated stone burden were evaluated using plain radiography, sometimes supplemented by intravenous urography or ultrasonography. The treatment method was determined by the site of encrustation, the size of the stone burden and the availability of endourologic equipment.Results: Stents were inserted for stone disease in 17 patients, for congenital abnormality in 3 and for ureteric obstruction by malignancy in 2. Stents were left in place for a mean of 10.8 months (range 5–34 months). The site of encrustation was in the bladder in 15 (68.2%), ureter in 13 (59%) and kidney in 8 patients (36.4%); more than one site was involved in 11 (50%) cases. For upper coil encrustations, retrograde ureterorenoscopy was performed in 9 cases, percutaneous nephrolithotomy in 4 and open pyelolithotomy in 2. For lower coil encrustation, fragmentation by grasper and/or transurethral cystolithotripsy was attempted in 11 cases, and suprapubic cystolithotomy was required for failure in 7 cases. Sixteen patients (72.7%) were rendered stone-free and 5 (22.7%) had clinically insignificant residual stones (3mm or less).Conclusions: Encrustation is one of the most difficult complications of ureteral stents and its management is a complex clinical scenario for the treating surgeon. The combination of several surgical techniques is often necessary but the best treatment remains the prevention of this problem by providing patient education

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

The contribution of periapical nerve block in transrectal ultrasound-guided prostate biopsy: Results from a prospective randomized trial

Objective: Periprostatic nerve block has been shown to be the most effective method to reduce pain during transrectal ultrasound (TRUS) guided prostate biopsy, but the ideal technique remains controversial. The aim of this studywas to compare pain control between bilateral basal block (BBB) alone and BBB combined with periapical nerve block (PNB).Patients and methods: From November 2007 to May 2009, 182 consecutive patients with abnormally elevated serum prostate-specific antigen (PSA) or suspicious digital rectal examination (DRE) underwent TRUS-guided needle biopsy of the prostate. The patients were prospectively randomized after informed consent had been obtained. Group 1 (n = 90) underwent bilateral basal block (BBB) with periprostatic infiltration of 8 ml 1% lidocaine into the neurovascular bundle at the prostate-seminal vesicle junction on each side. Group 2 (n = 92) underwent BBB with the addition of periapical nerve block (PNB) using 2 ml 1% lidocaine per side. A visual analog scale (VAS) was used to evaluate the patient’s perception of pain during the biopsy.Results: The mean patient age was 64.6±8.2 years and the average VAS was 1.9±2.0. The mean VAS was lower in Group 2 compared with Group 1, 1.6±1.9 versus 2.2±2.0 (p = 0.026). In the subgroup aged 56–65 years the mean VAS was 1.26±0.6 in Group 1 versus 2.46±0.5 in Group 2 (p = 0.001), and in the subgroup aged 66–87 years it was 1.41±0.5 in Group 1 versus 1.66±0.75 in Group 2 (p = 0.554).Conclusions: BBB combined with PNB seems to be more effective to BBB alone to reduce pain during TRUS-guided prostate biopsy and may be of maximum benefit for younger patients

Tractography reproducibility challenge with empirical data (TraCED): The 2017 ISMRM diffusion study group challenge

Background: Fiber tracking with diffusion-weighted MRI has become an essential tool for estimating in vivo brain white matter architecture. Fiber tracking results are sensitive to the choice of processing method and tracking criteria. Purpose: To assess the variability for an algorithm in group studies reproducibility is of critical context. However, reproducibility does not assess the validity of the brain connections. Phantom studies provide concrete quantitative comparisons of methods relative to absolute ground truths, yet do no capture variabilities because of in vivo physiological factors. The ISMRM 2017 TraCED challenge was created to fulfill the gap. Study Type: A systematic review of algorithms and tract reproducibility studies. Subjects: Single healthy volunteers. Field Strength/Sequence: 3.0T, two different scanners by the same manufacturer. The multishell acquisition included b-values of 1000, 2000, and 3000 s/mm2 with 20, 45, and 64 diffusion gradient directions per shell, respectively. Assessment: Nine international groups submitted 46 tractography algorithm entries each consisting 16 tracts per scan. The algorithms were assessed using intraclass correlation (ICC) and the Dice similarity measure. Statistical Tests: Containment analysis was performed to assess if the submitted algorithms had containment within tracts of larger volume submissions. This also serves the purpose to detect if spurious submissions had been made. Results: The top five submissions had high ICC and Dice >0.88. Reproducibility was high within the top five submissions when assessed across sessions or across scanners: 0.87–0.97. Containment analysis shows that the top five submissions are contained within larger volume submissions. From the total of 16 tracts as an outcome relatively the number of tracts with high, moderate, and low reproducibility were 8, 4, and 4. Data Conclusion: The different methods clearly result in fundamentally different tract structures at the more conservative specificity choices. Data and challenge infrastructure remain available for continued analysis and provide a platform for comparison. Level of Evidence: 5. Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2020;51:234–249

Tractography reproducibility challenge with empirical data (TraCED): The 2017 ISMRM diffusion study group challenge

Background Fiber tracking with diffusion‐weighted MRI has become an essential tool for estimating in vivo brain white matter architecture. Fiber tracking results are sensitive to the choice of processing method and tracking criteria. Purpose To assess the variability for an algorithm in group studies reproducibility is of critical context. However, reproducibility does not assess the validity of the brain connections. Phantom studies provide concrete quantitative comparisons of methods relative to absolute ground truths, yet do no capture variabilities because of in vivo physiological factors. The ISMRM 2017 TraCED challenge was created to fulfill the gap. Study Type A systematic review of algorithms and tract reproducibility studies. Subjects Single healthy volunteers. Field Strength/Sequence 3.0T, two different scanners by the same manufacturer. The multishell acquisition included b‐values of 1000, 2000, and 3000 s/mm2 with 20, 45, and 64 diffusion gradient directions per shell, respectively. Assessment Nine international groups submitted 46 tractography algorithm entries each consisting 16 tracts per scan. The algorithms were assessed using intraclass correlation (ICC) and the Dice similarity measure. Statistical Tests Containment analysis was performed to assess if the submitted algorithms had containment within tracts of larger volume submissions. This also serves the purpose to detect if spurious submissions had been made. Results The top five submissions had high ICC and Dice >0.88. Reproducibility was high within the top five submissions when assessed across sessions or across scanners: 0.87–0.97. Containment analysis shows that the top five submissions are contained within larger volume submissions. From the total of 16 tracts as an outcome relatively the number of tracts with high, moderate, and low reproducibility were 8, 4, and 4. Data Conclusion The different methods clearly result in fundamentally different tract structures at the more conservative specificity choices. Data and challenge infrastructure remain available for continued analysis and provide a platform for comparison. Level of Evidence: