Ablation rates with Holmium:YAG and Thulium Fiber Laser: Influence of the stone phantom homogeneity. An in vitro study.

OBJECTIVES: The lithotripsy efficiency (LE) in vitro study requires artificial or human stone samples (AS, HS). With the development of dusting lithotripsy, less ex vivo HS are available. We aimed to compare Thulium Fiber Laser (TFL) and Holmium:YAG (Ho:YAG)'s LE and define the most accurate LE parameter. METHODS: Hard and soft homogenous- and heterogenous-AS (Ho-AS, He-AS) were made to reproduce calcium-oxalate monohydrate and uric acid stones, respectively by a rapid or slow brewing of BegostonePlus (Bego) and distilled water. One hundred and fifty and 272µm-laser fibers, connected to 50W-TFL and 30W-HoYAG generators, compared three settings for TFL (FD: 0.15J/100Hz; D: 0.5J/30Hz; Fr: 1J/15Hz) and two for Ho:YAG (D-Fr). An experimental setup consisted in immerged 10mm cubic stone phantoms with a 20 seconds' lasing spiral, in contact mode, repeated four times. Stones were dried, weighted and µ-scanned (ablation weight and volume [AW and AV]). RESULTS: With He-AS, dusting AV were four- and three-fold higher with TFL compared to Ho:YAG against hard and soft (P<0.05). In fragmentation, AV were two-fold higher with TFL compared to Ho:YAG against hard (P<0.05) and soft (P<0.05). Experiments with Ho-AS were associated with non-significant differences when comparing TFL-150µm and TFL-272µm. The ablation weight-volume correlation coefficients was higher with Ho-AS than with He-AS (P<0.0001), and with hard than soft AS. If the LE can be estimated by the AW with hard AS, this approximation is not consistent for soft AS. CONCLUSION: TFL presented higher ablation rates than Ho:YAG, significant with He-AS. If the AW is acceptable and less expensive for hard Ho-AS, AV are more accurate for He-AS, which are suggested to imitate closely HS.

[How quickly can a complex stone be treated in percutaneous mini-nephrolithotomy?] / À quelle vitesse peut-on traiter un calcul complexe en mini-percutané ?

OBJECTIVES: Knowing the treatment's time of a complex stone is important for operating programming. It depends on the installation time, renal access time and the rate of fragmentation. The main objective of the study is to calculate the processing speed of complex stones by the percutaneous mini-nephrolithotomy (mini-NLPC) technique. POPULATION AND METHODS: A prospective single-center study was carried out between November 2019 and October 2020. Patients treated with mini-NLPC and with a result without fragment were included. The stone volume was measured using 3D reconstruction software and the operating time was differentiated into installation time, renal access time and fragmentation time. RESULTS: Of the 36 patients treated by the percutaneous technique, 20 patients were included. The median 3D volume of the stones was 4145 mm3 (2211-6998). The median duration of the intervention time was 104.5min (80-125). The fragmentation speed was 48.2 mm3min-1 (30.2-62.5) taking into account the total duration of the intervention and 110.4 mm3min-1 (85.3-126.5) in taking into account only the duration of fragmentation. CONCLUSION: The fragmentation speed for complex stones was 48.2 mm3min-1 (30.2-62.5) taking into account all the different operating times. It would be interesting to compare these results with that of ureteroscopy with the same methodology. LEVEL OF PROOF: C.

Isolated continent cystostomy on neurologic native bladder: Functional results.

INTRODUCTION: Continent cutaneous urinary diversion (CCUD) is proposed to patients suffering from chronic neurologic retention and undergoing intermittent self-catheterization (ISC). In case of neurogenic detrusor overactivity (NDO), augmentation enterocystoplasty is often required. The aim was to identify the prevalence of urinary stomal and/or urethral leakage in patients who had not undergone enlargement. METHODS: Monocentric, retrospective study of patients who underwent CCUD surgery in a neuro-urological context. Mitrofanoff's, Monti's or Casale's channels were performed. Patients selected had an underactive, stable, or stabilized bladder under adjuvant therapy with proper cystomanometric capacity. Prior or concomitant enterocystoplasty were excluded. Failure was defined as the occurrence of clinical leakage whatever it is through urinary stomal, or urethral. Urodynamic parameters were also reported. RESULTS: Thirty-one patients underwent surgery. Nine women had a concomitant bladder neck sling and 1 urethral closure. The mean follow-up was 7 years. 8/31 (26%) had stomal leakage and 9 urethral leakage (29%). Five spinal cord injured patients (n=14) had stomal leakage (36%) and 6 urethral leakage (43%). Of the 25 postoperative urodynamic parameters, cystomanometric bladder capacity was 419mL (vs. 514mL) and 2 additional patients had de novo NDO (9 vs. 7). DISCUSSION: The morbidity of augmentation enterocystoplasty is weighed against the presence of a well-controlled bladder preoperatively. Our study shows the appearance of leakage in some patients despite a well-balanced bladder, a decrease in mean cystomanometric capacity and an increase in the rate of NDO postoperatively. Good selection criteria for an isolated CCUD should be carefully revised and defined. LEVEL OF EVIDENCE: Grade C - retrospective study.

Simultaneous reflectometry and interferometry for measuring thin-film thickness and curvature.

A coupled reflectometer-interferometer apparatus is described for thin-film thickness and curvature characterization in the three-phase contact line region of evaporating fluids. Validation reflectometry studies are provided for Au, Ge, and Si substrates and thin-film coatings of SiO2 and hydrogel/Ti/SiO2. For interferometry, liquid/air and solid/air interferences are studied, where the solid/air samples consisted of glass/air/glass wedges, cylindrical lenses, and molded polydimethylsiloxane lenses. The liquid/air studies are based on steady-state evaporation experiments of water and isooctane on Si and SiO2/Ti/SiO2 wafers. The liquid thin-films facilitate characterization of both (i) the nano-scale thickness of the absorbed fluid layer and (ii) the macro-scale liquid meniscus thickness, curvature, and curvature gradient profiles. For our validation studies with commercial lenses, the apparatus is shown to measure thickness profiles within 4.1%-10.8% error.

Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma.

BACKGROUND: We designed a randomized clinical trial to test whether the addition of three cycles of chemotherapy during standard radiation therapy would improve disease-free survival in patients with stages III and IV (i.e., advanced oropharynx carcinoma). METHODS: A total of 226 patients have been entered in a phase III multicenter, randomized trial comparing radiotherapy alone (arm A) with radiotherapy with concomitant chemotherapy (arm B). Radiotherapy was identical in the two arms, delivering, with conventional fractionation, 70 Gy in 35 fractions. In arm B, patients received during the period of radiotherapy three cycles of a 4-day regimen containing carboplatin (70 mg/m(2) per day) and 5-fluorouracil (600 mg/m(2) per day) by continuous infusion. The two arms were equally balanced with regard to age, sex, stage, performance status, histology, and primary tumor site. RESULTS: Radiotherapy compliance was similar in the two arms with respect to total dose, treatment duration, and treatment interruption. The rate of grades 3 and 4 mucositis was statistically significantly higher in arm B (71%; 95% confidence interval [CI] = 54%-85%) than in arm A (39%; 95% CI = 29%-56%). Skin toxicity was not different between the two arms. Hematologic toxicity was higher in arm B as measured by neutrophil count and hemoglobin level. Three-year overall actuarial survival and disease-free survival rates were, respectively, 51% (95% CI = 39%-68%) versus 31% (95% CI = 18%-49%) and 42% (95% CI = 30%-57%) versus 20% (95% CI = 10%-33%) for patients treated with combined modality versus radiation therapy alone (P =.02 and.04, respectively). The locoregional control rate was improved in arm B (66%; 95% CI = 51%-78%) versus arm A (42%; 95% CI = 31%-56%). CONCLUSION: The statistically significant improvement in overall survival that was obtained supports the use of concomitant chemotherapy as an adjunct to radiotherapy in the management of carcinoma of the oropharynx.

Shear bond strength of porcelain veneers rebonded to enamel.

In this laboratory research, shear bond strength (SBS) and mode of failure of veneers rebonded to enamel in shear compression were determined. Three groups (A, B, and C; n=10 each) of mounted molar teeth were finished flat using wet 600-grit silicon carbide paper, and 30 leucite-reinforced porcelain veneers (5.0 × 0.75 mm) were air abraded on the internal surface with 50 µm aluminum oxide, etched with 9.5% hydrofluoric acid, and silanated. The control group (A) veneer specimens were bonded to enamel after etching with 37% phosphoric acid using bonding resin and a dual cure resin composite cement. Groups B and C were prepared similarly to group A with the exception that a release agent was placed before the veneer was positioned on the prepared enamel surface and the resin cement was subsequently light activated. The debonded veneers from groups B and C were placed in a casting burnout oven and heated to 454°C/850°F for 10 minutes to completely carbonize the resin cement and stay below the glass transition temperature (Tg) of the leucite-reinforced porcelain. The recovered veneers were then prepared for bonding. The previously bonded enamel surfaces in group B were air abraded using 50 µm aluminum oxide followed by 37% phosphoric acid etching, while group C enamel specimens were acid etched only. All specimens were thermocycled between 5°C and 55°C for 2000 cycles using a 30-second dwell time and stored in 37°C deionized water for 2 weeks. SBS was determined at a crosshead speed of 1.0 mm/min. SBS results in MPa for the groups were (A) = 20.6±5.1, (B) = 18.1±5.5, and (C) = 17.2±6.1. One-way analysis of variance indicated that there were no significant interactions (α=0.05), and Tukey-Kramer post hoc comparisons (α=0.05) detected no significant pairwise differences. An adhesive mode of failure at the enamel interface was observed to occur more often in the experimental groups (B = 40%, C = 50%). Rebonding the veneers produced SBS values that were not significantly different from the control group. Also, no significant difference in SBS values were observed whether the debonded enamel surface was air abraded and acid etched or acid etched only.

Anatomy of liver arteries for interventional radiology.

The availability of intra-arterial hepatic therapies (radio and/or chemo-embolisation, intra-arterial hepatic chemotherapy) has convinced radiologists to perfect their knowledge of the anatomy of the liver arteries. These sometimes, complex procedures most often require selective arterial catheterization. Knowledge of the different arteries in the liver and the peripheral organs is therefore essential to optimize the procedure and avoid eventual complications. This paper aims to describe the anatomy of the liver arteries and the variants, applying it to angiography images, and to understand the implications of such variations in interventional radiological procedures.

High-dose chemotherapy with hematopoietic stem cell transplantation in adults with bone marrow relapse of medulloblastoma: report of two cases.

Extraneural relapses of medulloblastoma are associated with a very poor outcome. We present two cases of young adults who developed bone marrow metastases after treatment of medulloblastoma. A very good response to a sequentially scheduled combination of carboplatin and etoposide was observed. Then, high-dose chemotherapy was delivered consisting of busulfan and thiotepa followed by infusion of autologous hematopoietic stem cells. Toxicity of the conditioning regimen was acceptable. The patients remained free of disease 20 and 27 months from the time of relapse, respectively. Further studies are needed to evaluate the impact of high-dose chemotherapy in terms of survival of such patients.

Barium and fecal impaction: an unusual case of bilateral hydronephrosis.

We present an interesting case report of the second adult female reported to suffer from bilateral ureteral hydronephrosis, secondary to a fecal impaction, and the first caused by complications from residual barium. This elderly patient suffers from many associated neurologic, bowel, and urinary tract problems; this case report demonstrates their close proximal relationship. Through ureteral stent placement and manual disimpaction of the barium fecaloma, the patient was able to recover her normal renal and bowel functions. Aided by the use of excellent figures, it is our intent to inform physicians that they should consider fecal impaction as a cause for bilateral ureteral hydronephrosis in predisposed patients, and also the necessity of purging the GI tract of residual barium following radiologic studies.

[Stage III and IV cancers of the oropharynx: results of a randomized study of Gortec comparing radiotherapy alone with concomitant chemotherapy]. / Cancers de l'oropharynx de stades III et IV: résultats d'une étude randomisée du Gortec comparant radiothérapie exclusive et radiothérapie avec chimiothérapie concomitante.

The aim of the study was to test whether the addition of three cycles of chemotherapy during standard radiation therapy would improve disease-free survival in patients with stages III and IV oropharynx carcinoma. A total of 226 patients have been entered in a phase III multicentric randomized trial comparing radiotherapy alone (arm A) to radiotherapy with concomitant chemotherapy (arm B). Radiotherapy was identical in the two arms, delivering, with conventional fractionation, 70 Gy in 35 fractions. In arm B patients received simultaneously 3 cycles of a four-day regimen containing carboplatin (70 mg/m2/d) and 5 fluorouracil (600 mg/m2/d) continuous infusion. The two arms were equally balanced regarding to age, gender, stage, performance status, histology, and primary tumor site. Radiotherapy compliance was similar in the two arms regarding to total dose, treatment duration and treatment interruption. Grade 3 and 4 mucositis rate was significantly higher in arm B (67% versus 36%). Skin toxicity was not different. Haematologic toxicity was higher in arm B on neutrophil count and hemoglobin level. Three-year overall actuarial survival and disease-free survival rates were respectively 51% versus 31% and 42% versus 20% for patients treated with combined modality versus radiation alone (p = 0.022 and 0.043). Local and regional control rate has been improved in arm B (66% versus 42%). The statistically significant improvement in overall survival obtained support the use of concomitant chemotherapy as an adjunct to radiotherapy in the management of carcinoma of the oropharynx.

Trilaminar skin coverage combined with cultured epithelial autografts--a new technique for treating the elderly patient with burn injuries.

Additional morbidity may be associated with standard split-thickness skin graft donor sites in elderly (65 years or older) patients with burn injuries. In an attempt to minimize the area of the donor sites and maximize autografts, we describe a new technique that uses trilaminar harvesting of skin grafts with dermolipectomy closure, and permanent coverage of the autograft layers achieved with cultured epithelial autografts in an elderly burn victim. An 80-year-old man was admitted with a 15% total body surface area burn to the bilateral lower extremities and buttocks. All meshed split-thickness skin grafts (12) applied showed excellent take, and it was reported that the cultured epithelial autograft take was approximately 90%. All dermolipectomy sites healed without infection. Our procedure proved to be a useful technique in the permanent closure of full- and partial-thickness burns in an elderly patient admitted to the burn unit.

[Retrospective analysis of results of treatment of 91 oral cavity cancers from 1982 to 1992]. / Analyse rétrospective des résultats du traitement de 91 cancers de la cavité buccale de 1982 à 1992.

PURPOSE: To analyse retrospectively the results of different treatment regimens of carcinomas of the floor of the mouth and tongue. MATERIALS AND METHODS: Between 1982 and 1992, 61 patients with carcinoma of the floor of the mouth and 30 with tongue cancer (25 stage I, nine stage II, 28 stage III, 29 stage IV) were treated in the radiotherapy department of Poitiers. Nine patients with stage I tumours were treated with 70 Gy low-dose rate brachytherapy only, without nodal dissection. Stages II and III were treated with combined surgery with neck dissection; and radiotherapy of stage II with nodal metastasis and for all stage III cases. Stage IV cases were treated either surgically if possible, or with combined chemotherapy and radiation. RESULTS: The five-year overall survival rate was 87.3% for stage I, 68.5% for stage II, 45.3% for stage III, and 0% for stage IV patients. Most relapses appeared in the first two years after treatment. Eight patients (32%) with stage I cancer developed nodal relapses, isolated in five cases. Complications of radiotherapy were acceptable. Four cases of osteonecrosis were observed after radiotherapy. All of these appeared simultaneously with a local relapse. CONCLUSION: These results are comparable with reports in the literature. The remarkable observation of our study is the high incidence of nodal recurrences after local treatment of stage I tumours. Therefore, local treatment is insufficient for early-stage tumours. The question of neck dissection for the early stage is discussed.

Underutilization of breast-conservation surgery with radiation therapy for women with stage Tis, I or II breast cancer.

Despite clinical evidence from the National Institutes of Health consensus panel in 1991 that breast-conservation surgery (BCS) with radiation therapy (RT) is appropriate treatment in early-stage breast cancer, the overall rate of acceptance and actual practice of BCS with RT has remained low. We retrospectively reviewed 228 cases of breast cancer in female patients with stage Tis, I or II breast cancer treated between 1987 and 1995. Thirty-five cases (15.4%) were stage Tis, 70 cases (30.7%) were stage I, and 123 cases (53.9%) were stage II, Overall, 57% of Tis, I or II breast cancers received conservative treatment; 57% of stage Tis, 79% of stage I, and 44% of stage II tumors. These rates of conservative therapy are higher than in other reported series in the literature. BCS with RT produces equivalent rates of morbidity and survival as MRM, and, because it preserves the breast, is preferable for the majority of women who present with stage Tis, I, or II breast cancer.

[Uterine sarcoma. Retrospective analysis of a series of 22 cases]. / Sarcomes de l'utérus. Analyse rétrospective d'une série de 22 cas.

37 uterine tumors originally diagnosed as uterine sarcomas at Fondation Bergonié between 1970 and 1982 were histologically reclassified. 15 patients were excluded from this study because of inadequate data or not confirmed initial diagnosis. The 22 remaining cases were classified as leiomyosarcomas 13, endometrial stromal sarcomas 7 and mixed mesodermal sarcomas 2. The mean age of the patients was 56. The cases were classified according to the FIGO staging system. 5 patients had previously undergone (between 1 and 8 years) a subtotal hysterectomy for uterine leiomyoma. 5 patients had stage 1 sarcoma, 13 patients stage III and 2 patients stage IV. 13 patients are dead, 7 are alive without evidence of disease, 2 are alive with evidence of disease. The 5 year actuarial survival rate was 30%. Tumor extent at diagnosis was not correlated with survival. Analysis of failures revealed : 4 metastatic, 5 metastatic and pelvic and 6 isolated pelvic failures. Prognosis was not significantly different between leiomyosarcomas and endometrial stromal sarcomas. There was no pelvic failure in patients with stage I sarcoma (treated by surgery plus radiotherapy). Survival was not found to be correlated with histopathological grade as described in soft tissue sarcomas. Nevertheless a correlation (non significant) was found between survival and mitosis count. Chemotherapy (Cyvadic) was administered in 8 advanced tumors with partial response (always below 50% of the initial tumor) in 5 patients.

[Cancer of the oral cavity without palpable adenopathy: value of external irradiation exclusively]. / Cancers de la cavité buccale sans adénopathie palpable: valeur de l'irradiation externe exclusive.

Between 1970 and 1978, 99 patients with a squamous carcinoma of the buccal cavity without palpable lymphadenopathy were treated at the Bergonié Foundation by radiotherapy only and regularly followed up. All received a minimal dose of 40-50 Grays either to the primary node groups or the entire cervico-supraclavicular areas. Eight patients developed an isolated lymph node recurrence, in two cases only in the irradiated zone. The other 6 lymph node recurrences occurred either below the radiotherapy fields when the latter had been limited to the neck (4 cases) or at the posterior border of the field (2 cases). Secondary control was possible in two patients of the 8 by combined radiotherapy and surgery. Exclusive radiotherapy for lymph node areas up to a dose of 45-50 Grays thus protected 92% of patients from a lymph node recurrence. The methods of such irradiation and in particular the extent of radiotherapy fields are then discussed on the basis of the clinical aspects of the tumour.

Liver segmentation: practical tips.

The liver segmentation system, described by Couinaud, is based on the identification of the three hepatic veins and the plane passing by the portal vein bifurcation. Nowadays, Couinaud's description is the most widely used classification since it is better suited for surgery and more accurate for the localisation and monitoring of intra-parenchymal lesions. Knowledge of the anatomy of the portal and venous system is therefore essential, as is knowledge of the variants resulting from changes occurring during the embryological development of the vitelline and umbilical veins. In this paper, the authors propose a straightforward systematisation of the liver in six steps using several additional anatomical points of reference. These points of reference are simple and quickly identifiable in any radiological examination with section imaging, in order to avoid any mistakes in daily practice. In fact, accurate description impacts on many diagnostic and therapeutic applications in interventional radiology and surgery. This description will allow better preparation for biopsy, portal vein embolisation, transjugular intrahepatic portosystemic shunt, tumour resection or partial hepatectomy for transplantation. Such advance planning will reduce intra- and postoperative difficulties and complications.

[Treatment of inflammatory breast cancer. Controlled study of a combination therapy program]. / Traitement des cancers du sein inflammatoires. Etude contrôlée d'un programme d'association thérapeutique.

The authors report 27 cases of inflammatory carcinoma of the breast (T3-T4, M0) and propose: induction chemotherapy (adriamycin, vincristin, methotrexate) conventional local and regional radiotherapy, sometimes complementary surgical exeresis, and a complement of consolidation chemotherapy (cyclophosphamid, methotrexate, fluoro-uracil or adriamycin, vincristin, and methotrexate). In these forms, where the prognosis is very bad, this therapeutic regimen may improve considerably the median remission and survival rates. But important therapeutic progress remains.

Use of percutaneous endoscopic gastrostomy tubes in burn patients.

Alimentation and decompression are imperative to the successful management of the severely burned patient. Utilization of percutaneous endoscopic gastrostomy (PEG) tubes for these purposes has become a proven effective procedure in non-burned patients with few major complications. We retrospectively reviewed placement of PEG tubes in 31 burn patients, some of whom had been admitted with additional diagnoses such as inhalation injury and/or dysphagia. In 90% of our burn patients, the use of PEG tubes was without complication. The placement of PEG tubes through burn wound areas or donor sites added no increase in wound complications. In summary, there was no mortality referable to the use of PEG tubes, there were no major operative or wound complications, and feedings were tolerated well. This study reports on the use of PEG tubes in a regional Burn Treatment Center. It shows that PEG tubes offer safe and effective alimentation and decompression in the management of burned patients.