Inducing intravesical hyperthermia of the ex-vivo porcine bladder wall: radiofrequency-induction versus recirculation using a custom-made device.

INTRODUCTION: Several techniques can be used to treat intravesical chemohyperthermia (ChHT). We compared radiofrequency-induced hyperthermia (RF-HT) with conductive hyperthermia (C-HT) for their ability to induce bladder wall temperatures of >40.5 °C, the target temperature for ChHT. MATERIALS AND METHODS: Fresh porcine bladders (n = 12) were placed in a temperature-controlled saline bath to simulate body temperature and circulation. HT was induced with RF-HT (43 °C) or C-HT (inflow temperature 44 and 46 °C) using a custom-made device. In two additional bladders, we varied intravesical solution and volume. Temperatures were recorded with a three-way catheter containing three mucosal and two urethral thermocouples (TCs) and a 915 MHz RF antenna, and with external TCs in the bladder wall at three different levels and three different locations. RESULTS: Target temperature (40.5 °C) was reached in the submucosa at all locations by both techniques. In the detrusor, target temperature was reached by RF-HT at the bladder neck and side wall. C-HT46 reached significantly higher submucosal temperatures at the side wall. The bladder dome seemed best heated by C-HT, although a high inflow temperature (46 vs. 44 °C) was required (ns). Intravesical saline resulted in higher temperatures than sterile water for RF-HT. A volume of 100 mL resulted in higher bladder dome temperatures for RF-HT, and higher bladder neck with lower dome temperatures for C-HT. CONCLUSION: Our results indicate a slightly superior heating capacity for RF-HT compared to C-HT, whereas for the bladder dome, the reverse seems true. Comparative studies are warranted to evaluate whether HT efficacy differs between both techniques, with emphasis on tumor location.

[Results of extracorporeal membrane oxygenation following cardiac surgery in 16 children in the St Radboud University Medical Centre, 1996-2004]. / Resultaten van extracorporele membraanoxygenatie na een hartoperatie bij 16 kinderen in het Universitair Medisch Centrum St Radboud, 1996-2004.

OBJECTIVE: Description of the results with extracorporeal membrane oxygenation (ECMO) in infants with cardiorespiratory failure after open-heart surgery. DESIGN: Prospective observational study. METHOD: Data on the indications, survival, and complications were collected from all infants treated with ECMO for cardiorespiratory failure after open-heart surgery in the period 1996-2004 in the St Radboud University Medical Centre in Nijmegen, the Netherlands. RESULTS: 17 ECMO treatments were carried out in 16 paediatric patients: 7 girls and 9 boys. All patients had severe circulatory failure, sometimes combined with respiratory insufficiency. The patients' average age was 8 months (range: 1 day-3 years and 10 months). The average duration of treatment was 137 hours (range: 8-433). In 12 of the 17 ECMO treatments, the patient was successfully weaned from ECMO and 7 patients were discharged home. 5 patients died in hospital after successful ECMO treatment. 10 of the 16 patients died. A functional univentricular heart was associated with a high mortality. Haemorrhage, renal insufficiency and; sepsis were the most frequent complications. Major causes of death were sepsis, multi-organ failure and pulmonary hypertension.

Multigestación como marcador de eficiencia reproductiva. Enseñanzas de la reproducción asistida / Multigestation like marker of reproductive efficiency. Lessons of the attended reproduction

El objetivo de este estudio fue evaluar el devenir de embriones que cohabitan en una multigestación luego de reproducción asistida (RA). Se utilizaron las tasas de reducción embrionaria espontánea como marcador de fecundidad humana. Es un estudio caso-control. Grupo de estudio: 162 mujeres embarazadas luego de un procedimiento de reproducción asistida (RA); Grupo Control A: 344 mujeres fértiles que concibieron en forma espontánea; Grupo Control B: 317 mujeres infértiles que concibieron un embarazo único luego de un procedimiento de RA. En casos y controles se evaluaron las siguientes variables: tasa de implantación, tasa de reducción embrionaria espontánea parcial y total (aborto) y tasa global de reducción embrionaria. Los resultados demuestran que el devenir de cada embrión que cohabita en una multigestación sigue un patrón similar a la de un embrión concebido en forma espontánea en mujeres fértiles. Es razonable pensar que ovocitos de estas mujeres son de mejor calidad y por ende son capaces de producir mejores embriones que las mujeres que, a pesar de concebir, tienen tasas de implantación más bajas, como son las del grupo de control B. El desafío futuro es identificar marcadores de eficiencia reproductiva que pueden ser usados en la prevención de embarazo múltiple.