Validation of quantitative real-time polymerase chain reaction for detection of Legionella pneumophila in hospital water networks.

BACKGROUND: Rapid monitoring of Legionella pneumophila (Lp) is essential to reduce the risk of Legionnaires' disease in healthcare facilities. However, culture results take at least eight days, delaying the implementation of corrective measures. Here, we assessed the performance of a qPCR method and determined qPCR action thresholds for the detection of Lp in hospital hot water networks (HWNs). METHODS: Hot water samples (N = 459) were collected from a hospital HWN. Lp were quantified using iQ-Check® Quanti real-time PCR Quantification kits (Bio-Rad) and the results were compared with those of culture. qPCR thresholds corresponding to the culture action thresholds of 10 and 1000 cfu/L were determined on a training dataset and validated on an independent dataset. RESULTS: Lp concentrations measured by culture and qPCR were correlated for both the training dataset (Spearman's correlation coefficient ρ = 0.687, P<0.0001) and the validation dataset (ρ = 0.661, P<0.0001). Lp qPCR positivity thresholds corresponding to culture action thresholds of 10 cfu/L was 91 genome units (gu) per litre (sensitivity, 86.4%; negative predictive value - NPV, 93.3%) and that corresponding to culture action thresholds of 1000 cfu/L was 1048 gu/L (sensitivity, 100%; NPV, 100%). CONCLUSION: Detection of Lp by qPCR could be implemented with confidence in hospitals as a complement to culture in the monitoring strategy to speed up the implementation of corrective measures.

Female outlet obstruction after repeated collagen injections.

An elderly woman who presented with severe irritative lower urinary tract symptoms after three consecutive collagen injections was diagnosed as being obstructed. The diagnosis was based on urodynamic, cystoscopic, and radiographic findings that disclosed numerous collagen deposits obstructing the bladder outlet and the proximal urethra. A transurethral resection of the collagen was performed with improvement in symptoms and flow pattern. Although irritative lower urinary tract symptoms after collagen injection could be related to local inflammatory changes, persistence and eventually worsening of these symptoms should alert to the presence of iatrogenic bladder outlet obstruction.

Proposed cutoff values to define bladder outlet obstruction in women.

OBJECTIVES: There is no accepted urodynamic definition of outlet obstruction in women. Currently, the diagnosis is made on the basis of history and radiographic and endoscopic findings. The goal of this study is to design a pressure-flow nomogram (PdetQmax/Qmax) and define cut-off values for obstruction. METHODS: Two groups were studied prospectively in an open study: 124 control and 35 clinically obstructed patients. All had a complete history, physical examination, normal neurologic evaluation, cystoscopy, voiding cystography, and urodynamics-with-pressure-flow study. Pressure-flow plot and receiver operator characteristic curves (ROCs) were constructed to determine optimal cut-off values to predict obstruction for peak flow rate (Qmax) and detrusor pressure at maximal flow (PdetQmax). RESULTS: The etiology of obstruction was previous anti-incontinence surgery (n = 13), large cystocele (n = 11), urethral stricture (n = 6), and other (n = 5). On the basis of ROC curves, using cut-off values of Qmax of 15 mL/s or less and 12 mL/s or less, sensitivity was 85.7% and 71.4%, and specificity 78.2% and 90.3%, respectively. Using cut-off values of PdetQmax of more than 25 and more than 30 cm H2O, sensitivity was 74.3% and 71.4%, and specificity 79.8% and 88.7%, respectively. Using a combined cut-off value of Qmax of 1 5 mL/s or less and PdetQmax of more than 20 cm H2O, sensitivity was 74.3% and specificity was 91.1%. CONCLUSIONS: Based on this prospective, controlled study, preliminary cut-off values were obtained for refining the definition of outlet obstruction in women.

[Transvaginal closure of the bladder neck in women with a neurogenic bladder and destroyed urethra]. / La fermeture du col vésical par voie vaginale chez la femme neurologique incontinente ayant un urèthre détruit.

Complete destruction of the urethra is one of the long-term complications of continuous bladder catheterization in women with advanced neurogenic bladder, resulting in a continuous urine leak around the catheter. This type of incontinence can be treated by closure of the bladder neck associated with suprapubic bladder drainage. Several approaches hve been proposed: abdominal, vaginal and mixed abdominal-vaginal. Each of these techniques is described, together with their results. Closure of the bladder neck decreases the nursing care, reduces the risk of perineal infectious and cutaneous complications and improves the patient's quality of life. Ileal urinary diversion is not always possible in these patients who often have a poor general status. Transvaginal closure of the bladder neck therefore constitutes one of the treatment options.

[The Martius flap in vaginal surgery: technic and indications]. / Le lambeau de Martius en chirurgie vaginale: technique et indications.

The Martius pedicle adipose flap can be used as an interposition flap during complex vaginal operations. It is a simple, rapid technique allowing raising of a well vascularized adipose flap with a mean length of 8 to 12 cm. It can be used in certain forms of vaginal repair, such as high supratrigonal vesicovaginal fistula, after bladder perforation, for obstructed urethra after colposuspension, after urethral destruction following prolonged bladder catheterization in a neurological patient, during repair of a complex urethral diverticulum or during transvaginal insertion of an artificial sphincter. After describing the flap raising operative technique, the various operative indications are presented.

[Urethrolysis after surgical cure of stress urinary incontinence using colpopexy: surgical technics]. / L'uréthrolyse après cure chirurgicale de l'incontinence urinaire d'effort par colpopexie: techniques chirurgicales.

OBJECTIVE: Infravesical obstruction can occur after surgical cure for urinary stress incontinence (USI). Apart from palliative treatments with limited effects, this iatrogenic complication can be corrected by complete urethrolysis. The various indications and techniques of this surgery are presented. METHOD: Urethrolysis is designed to release the urethra and bladder neck and can be performed via a transvaginal or retropubic approach. Some authors then recommend resuspension of the bladder neck, while others use a Martius or omentum flap to reduce the risk of restenosis. RESULTS: The success of urethrolysis is measured by the return of normal micturition with complete disappearance of the irritating and/or obstructive symptoms. The success rate for the transvaginal procedure varies from 65% to 92% according to different teams, while the success rate via an abdominal incision was 93% in one series. CONCLUSION: Urethrolysis is a difficult surgical technique, whose long-term results have not yet been precisely determined. The transvaginal route is associated with a low morbidity and remains our personal preference to release the obstructed urethra after operation for USI.

[Metastasis of renal adenocarcinoma to the spermatic cord and the epididymis: 2 cases]. / Métastases d'adénocarcinome rénal au niveau du cordon spermatique et de l'épididyme: deux observations.

Metastases of renal cell carcinoma are exceptional in the spermatic cord and epididymis (17 cases reported in the literature). The authors report two cases of metastases occurring 30 and 44 months after radical nephrectomy, respectively. Both patients are alive without metastases after surgical resection, with a follow-up of 4 and 8 years after the diagnosis of renal cancer, respectively. The mechanism of development, usually retrograde venous spread, and the particular features of these metastatic sites are discussed.

[Value of three-dimensional surface reconstruction scanning in urology. Preliminary results]. / Intérêt du scanner avec reconstruction tridimensionnelle de surface en urologie. Résultats préliminaires.

The development of helicoidal CT acquisition allows 3D reconstruction of vessels, cavities or parenchyma of mobile organs such as the kidney. The value of this 3D surface reconstruction was investigated in various areas of urology: congenital malformations (horseshoe kidney, megaureter, ectopic organs), acquired malformations (diverticulum, trabeculated bladder), renal stones, particularly staghorn calculi, and renal transplantation. The fields of interest of 3D CT scans are still poorly defined, but are probably threefold: diagnostic, therapeutic and for teaching purposes. 3D representation completes classical axial scans and, in some cases, competes with other more invasive imaging techniques.

[Renal and adrenal involvement in von Hippel-Lindau disease: clinical features and therapeutic strategies]. / Atteintes rénales et surrénaliennes dans la maladie de von Hippel-Lindau: aspects cliniques et stratégies thérapeutiques.

OBJECTIVES: We report our experience of renal and/or adrenal manifestations of von Hippel-Lindau disease and propose a practical approach. METHODS: Eight patients (mean age: 43 years) presented with predominant renal and adrenal lesions in 6 cases and 2 cases, respectively. RESULTS: All patients are alive with a mean follow-up of 8.1 years. A local recurrence after partial nephrectomy was observed in two cases. Two patients are in renal failure and are treated by dialysis and two patients require hormone replacement therapy for adrenal insufficiency. CONCLUSIONS: The predegenerative nature of simple renal was not observed. Conservative renal surgery is adapted to small renal tumours, with a low cytological grade and without any distant lesions in the same kidney. Radical nephrectomy is reserved for large lesions (greater than 5 cm) with a high cytological grade. The presence of pheochromocytoma must be systematically excluded. Preservation of the adrenal gland in the case of homolateral renal surgery for cancer is recommended. The reliability of the genetic test allows early diagnosis of this disease.

[Rapid prototyping and bone reconstruction]. / Prototypage rapide et reconstruction osseuse.

The authors describe the main techniques for rapid prototyping used in the medical field, with particular emphasis on Laser stereolithography. They describe the basics of the technique as well as the procedures they currently use to construct anatomic specimens from scanned images. For more than 10 years, the targets of researchers in the field of bone reconstruction in craniofacial surgery have been: to design a system to acquire data directly from CT-scans, to optimize modelling, processing and materials, to verify the possibility of producing prefabricated prostheses with data from preoperative models (22 cases). The target of integrating this technique into therapeutic protocols has been reached. The current trend in research is to produce prostheses from biocompatible materials directly from CT scan data by Laser stereolithography.

[The value of sialo-MRI in the study of salivary gland duct pathology]. / Intérêt de la sialo-IRM dans l'exploration des pathologies canalaires des glandes salivaires.

Usual imaging diagnostic for salivary glands is sialography. Sialography is not stripped of disadvantages and failures. The MRI-sialography is an examination which is carried out without any injection of contrast's product (without catheterization or intravenous injection). It is thus noninvasive and painless. The complete study of salivary gland and its ducts is always possible and could not be blocked by local or loco-regional conditions. It allows exploration of several salivary glands in the same time. We think that the MRI-sialography must find its place in the diagnosis arsenal for salivary pathology in spite of its current handicaps represented by its cost and the difficulty of access to the apparatuses.

[Orthopedic treatment of labio-maxillo-palatal clefts: our approach]. / Traitement orthopédique des fentes labio-maxillo-palatines: notre attitude.

Many authors use a preliminary orthopedic procedure before cleft lip and palate surgical closure in order to prevent possible bone distortion following the rupture of the muscle belts resulting from the cleft. Actually, this is generally not only an orthopedic treatment but rather a surgical orthopedic step which includes lip adhesion before the surgical closure of the clefts. Following the procedures proposed by Georgiade and Latham, we have used since 1996 a treatment based on traction applied with an elastic chain on splints attached by transmaxillary pins for certain types of clefts, namely unilateral complete clefts with endognathy of the small fragment, unilateral complete clefts larger than 7 mm, bilateral wide complete clefts with premaxilla protrusion, and bilateral wide complete clefts with collapsus and premaxillary protrusion. Technical procedures vary with the type of cleft. Standard procedures with or without jacks are used for the other types of complete clefts. These orthopedic procedures with elastic traction are performed between the 3rd and 6th week, before lip adhesion of the upper part of the lip (combined with release of skin and subcutaneous tissues from the underlying alar cartilage). A palatine plate with or without a jack, fitted most of the time with a spring for nostril support, is then inserted until surgical closure.