Feasibility of changing for a rechargeable constant current neurostimulator in Parkinson's disease.

BACKGROUND: Little is known about outcome and settings adaptations after replacement of constant-voltage non-rechargeable implantable pulse generator (CV-nrIPG) by constant-current rechargeable IPG (CC-rIPG). OBJECTIVE: To determine the feasibility and safety of replacing a CV-nrIPG by a CC-rIPG in Parkinson's disease (PD) and the subsequent outcome. METHODS: A prospective cohort of thirty PD patients, whose CV-nrIPG was replaced by a CC-rIPG in University Hospital of Lyon between January 2017 and December 2018 (rIPG group) and 39 PD patients, who underwent the replacement of a CV-nrIPG by the same device in 2016 (nrIPG group), were enrolled in this study. Three surgeons performed the operations. Duration of hospitalization for the replacement as well as the number of in or outpatient visits during the first 3 months after the surgery were recorded. In the rIPG group, we compared preoperative DBS settings and the theoretical amplitude estimated using Ohm's law to the amplitude used at the end of follow-up. We assessed patients' and clinicians' opinion on the patient global functioning after the replacement using Clinical Global Impression score. RESULTS: Duration of hospitalization (P=0.47) and need for additional hospitalizations (P=0.73) or consultations (P=0.71) to adapt DBS parameters did not differ between the two groups. Neurological condition (CGI score) was considered as unchanged by both patients and neurologists. Final amplitude of stimulation using CC-rIPG was not predicted by Ohm's law in most cases. CONCLUSIONS: Replacing CV-nrIPG by CC-rIPG is safe and well tolerated but require neurological expertise to set the new parameters of stimulation.

Bovine semen thermoresistance tests and their correlation with pregnancy rates after fixed-time artificial insemination / Testes de termorresistência do sêmen bovino e sua correlação com taxas de prenhez após inseminação artificial em tempo fixo

The objective of the study was to determine whether or not there is a correlation between thermoresistance tests (TT) after semen thawing and pregnancy rate (PR) after fixed-time artificial insemination (FTAI). Four different TT were performed on ten samples used for AI; a rapid test (RTT) (30min / 46°C) and three slow tests (STT): STT1 (60min/38°C), STT2 (180min/38°C), and STT3 (300min/38°C). Two hundred and fifteen multiparous crossbred cows were submitted to FTAI under the following protocol: on day zero (d0) the animals received a P4 device +EB; on d7 PGF2α; on d8 P4 was removed and eCG+EC were administered; IATF was performed on d10. Three gestational diagnoses (G D) were performed on d40, d70 and d120. The mean sperm motility (%) in RTT and STTs were 19.84±6.13, 28.55±10.48, 17.62±5.87 and 8.63±3.46, respectively, and TP in the three DG 61.86%, 57.67%, and 55.81%, respectively. Through Person test a significant negative correlation (P< 0.05) was found between STT2 and PR at 60 days (r= -0.644) and between STT3 and all TPs (r= -0.774, -0.752, 0.748). It was concluded that TT parameters are not able to determine correlation between semen quality and TP.(AU)

O objetivo do presente estudo foi determinar se há ou não correlação entre testes de termorresistência (TT) após descongelamento do sêmen e taxa de prenhez (TP) após inseminação artificial em tempo fixo (IATF). Quatro diferentes TT foram realizados nas 10 amostras utilizadas para a IA; um teste rápido (RTT) (30min/46°C) e três testes lentos (STT): STT1 (60min/38°C), STT2 (180min/38°C) e STT3 (300min/38°C). Duzentas e quinze vacas cruzadas multíparas foram submetidas à IATF sob o seguinte protocolo: no dia zero (d0), os animais receberam um dispositivo de P4+EB; em d7, PGF2α; em d8, retirou-se P4 e eCG+EC administrados; no d10, foi realizada IATF. Três diagnósticos gestacionais (DG) foram feitos, em d40, d70 e d120. As médias de motilidade espermática (%) em RTT e STTs foram 19,84±6,13, 28,55±10,48, 17,62±5,87 e 8,63±3,46, respectivamente, e TP nos três DG 61,86%, 57,67% e 55,81%, respectivamente. Por meio do teste de Person, uma correlação negativa significativa (P<0,05) foi encontrada entre os resultados de STT2 e PR aos 60 dias (r=-0,644) e entre STT3 e todas TPs (r=-0,774, -0,752 e -0,748). Concluiu-se que parâmetros de TT não são capazes de determinar correlação entre qualidade do sêmen e TP.(AU)

Optimizing the deep brain stimulation care pathway in patients with Parkinson's disease.

Management of Parkinson's disease (PD) using deep brain stimulation (DBS) requires complex care in specialized, multidisciplinary centers. A well-organized, efficient patient flow is crucial to ensure that eligible patients can quickly access DBS. Delays or inefficiencies in patient care may impact a center's ability to meet demand, creating a capacity bottleneck. Analysis of the current practices within a center may help identify areas for improvement. After external audit of the DBS workflow of the Lyon Neurological Hospital and comparison with other European centers, manageable steps were suggested to restructure the care pathway. Propositions of the audit comprised, for example: (1) directly admitting referred patients to hospital, without a prior neurological outpatient visit and (2) including the preoperative anesthesia consultation in the hospital stay 1 month before surgery, not separately. This reorganization (between 2013 and 2016) was performed without increases in hospital medical resources or costs. The time from patients' first referral to surgery was reduced (from 22 to 16 months; p = 0.033), as was the number of pre- and postoperative patient visits (11-5; p = 0.025) and the total cumulative length of in-hospital stay (20.5-17.5 nights; p = 0.02). Ultimately, the total number of PD consultations increased (346-498 per year), as did the number of DBS implants per year (32-45 patients). In this single center experience, restructuring the DBS care pathway allowed a higher number of PD patients to benefit from DBS therapy, with a shorter waiting time and without decreasing the quality of care.

[Partial versus radical nephrectomy for renal cell carcinoma involving peri renal fat. Oncological and functional outcomes]. / Néphrectomie partielle versus élargie en cas d'envahissement de la graisse périrénale. Résultats oncologiques et fonctionnels.

PURPOSE: In the latest guidelines of the European Association of Urology, partial nephrectomy was a reference standard in tumors less than 7cm confined to the kidney. The invasion of the perirenal fat and therefore dissection in a potentially tumor tissue with an increased risk of recurrence. MATERIAL: From 1995 to 2009, we retrospectively evaluated the oncological outcomes of partial versus radical nephrectomy in tumors with local extension beyond the boundaries of the kidney, without adrenal involvement or metastatic lymph node extension. We evaluated the histological factors influencing the prognostic. RESULTS: A total of 43patients have been included (ten partial and 33radical nephrectomy). We did not found any significant difference in terms of specific and recurrence-free survival between partial and radical nephrectomy in tumor invading the perirenal fat (P=0.739 and P=0.683 respectively). Factors influencing the prognosis were the Fuhrman grade (P=0.010), the invasion of the urinary tract (P=0.017) and the presence of a positive surgical margin (P=0.041). The renal function was better after partial nephrectomy. The complication rate was similar between partial and radical nephrectomy. CONCLUSION: The perirenal fat invasion by kidney tumor did not impact the oncological outcomes of partial versus radical nephrectomy with better functional outcomes for partial nephrectomy.

[Intraoperative monitoring of brainstem auditory evoked potentials during microvascular decompression of cranial nerves in cerebellopontine angle]. / Monitorage peropératoire des potentiels évoqués auditifs précoces dans la chirurgie de décompression microchirurgicale des nerfs crâniens de l'angle pontocérébelleux.

Brainstem auditory evoked potentials (BAEP) monitoring is a useful tool to decrease the danger of hearing loss during pontocerebellar angle surgery, particularly in microvascular decompression (MVD). Critical complications arising during MVD surgery are the stretching of the VIII nerve - the main cause of hearing loss - labyrinthine artery manipulation, direct trauma with instruments, or a nearby coagulation, and at end of the surgery neocompression of the cochlear nerve by the prosthesis positioned between the conflicting vessel(s) and the VIIth-VIIIth nerve complex. All these dangers warrant the use of BEAP monitoring during the surgical team's training period. Based on delay in latency of peak V, we established warning thresholds that can provide useful feedback to the surgeon to modify the surgical strategy: the initial signal at 0.4 ms is considered the safety limit. A second signal threshold at 0.6 ms (warning signal for risk) corresponds to the group of patients without resultant hearing loss. The third threshold characterized by the delay of peak V is at 1 ms (warning signal for a potentially critical situation). BAEP monitoring provides the surgeon with information on the functional state of the auditory pathways and should help avoid or correct manoeuvres that can harm hearing function. BAEP monitoring during VIIth-VIIIth complex surgery, particularly in MVD of facial nerves for HFS is very useful during the learning period.

Double versus single renal allografts from aged donors.

BACKGROUND: The age limit of the cadaver kidney donors is increasing in response to the growing demand for renal transplantation. Simultaneous double kidney transplantation (SDKT) with kidneys obtained from elderly adults has been proposed to increase the transplantation number and improve its results. However, if SDKT is performed when there are no clear indications, a negative effect could be produced on the total number of transplanted patients as both kidneys would be used for only one recipient. MATERIAL AND METHODS: In December 1996 we designed a transplantation protocol to be able to extend the selection of cadaver kidney donors with normal serum creatinine levels without establishing any age limit. A pregraft renal biopsy was always performed to analyze the glomerulosclerosis (GE) percentage whenever the donors were 60 years of age or older. A SDKT was performed in a single recipient when the donor age was 75 years or older or when the donors between 60 and 74 years old had a GE rate of more than 15%. On the contrary, a single kidney transplantation was performed in two different recipients for kidneys from donors between 60 and 74 years of age with a GE rate of less than 15%. Kidneys having GE rates of more than 50% were discarded for transplantation. Donor kidneys from subjects younger than 60 years of age were always used for a single kidney transplantation. RESULTS: Based on the above mentioned protocol, from December 1996 to May 1998, 181 patients received a kidney transplantation in our hospital. These patients were divided into three groups: group I which included the SDKT recipients (n=21), group II or single kidney recipients from 60- to 74-year-old donors (n=40), and group III or recipients from <60-year-old donors (n=120). The mean follow-up time was 15+/-5 months (range 6-24). Mean donor age was 75+/-7 years in group I, this was significantly higher than in group II (67+/-4, P<0.001) and group III (37+/-15, P<0.001). The primary nonfunction rate was low in the three groups, there being no statistically significant differences (5, 5, and 4%, respectively). A significantly greater percentage of patients from group I (76%) presented immediate renal graft function as compared with group II (43%, P<0.01) and III (50%, P<0.05). The acute rejections rate was very low in all three groups (9.5, 7.5, and 22%, respectively) with significant differences between groups II and III (P<0.05). No significant differences between the different groups were observed for one year actuarial patient survival (100, 95, and 98%, respectively) or graft survival rates (95, 90, and 93%, respectively). The 6-month serum creatinine levels were excellent in the three groups, although there were significant differences between groups I and II (1.6+/-0.3 vs. 1.9+/-0.6 mg/dl, P<0.05), II and III (1.9+/-0.6 vs. 1.4+/-0.4 mg/dl, P<0.001), and I and III (P<0.05). CONCLUSIONS: Simultaneous double kidney transplantations make it possible to use kidneys from extremely elderly donors (>75 years) or those whose GE>15%. In addition, kidneys from donor 60-74 years old in which the GE<15% can be used for single kidney transplantations in two different recipients with excellent results.

[Pfeiffer syndrome associated with clover-leaf skull: 1st case described in Venezuela]. / Síndrome de Pfeiffer asociado a cráneo en trébol: primer caso descrito en Venezuela.

In 1964, Pfeiffer described a syndrome consisting of craniosynostosis, broad thumbs, broad great toes, and partial soft tissue syndactyly of the hands and feet. It belongs to acrocephalosyndactyly syndromes. We describe a male baby product of an eighth full-term uncomplicated uncontrolled pregnancy, mother and father normal and unrelated, 32 and 50 years old, respectively. He had all diagnostic and prognostic criteria of Subtype 2 Pfeiffer's Syndrome. The clinical, radiological, tomographic, and genetic aspects are discussed.

[Ectopic gas as a complication of surgical kidney biopsy]. / Gas ectópico como complicaciones de la biopsia renal quirúrgica.

Since the complications herewith presented as a consequence of surgical renal biopsy are really exceptional and references found in the existing literature rare, we have considered that the contribution of these two cases which developed a pneumomediastinum-pneumoperitoneum and pneumocele prespectively during the immediate post-surgical period would be of interest. Evolution was favourable in both cases, with spontaneous resolution of the process.

[Paratesticular liposarcoma of the spermatic cord]. / Liposarcoma paratesticular del cordón espermático.

Funiculus liposarcoma is a very uncommon tumor. Most cases have a low degree of malignancy. Inguinal orchiectomy with a wide local excision is the appropriate treatment. Liposarcoma presurgical diagnosis is very infrequent and ultrasonography is the method that can provide some help to locate it. Currently, chemotherapy indication is unclear. Due to recurrence, specially of local foci, being a possibility a periodical follow-up is necessary in these patients. Nowadays, local recurrences are treated with repeated ample local excisions and radiotherapy. This work reviews the literature and presents a new case of round cells liposarcoma of the funiculus.

[Intravesical echography. I. Anatomical correlation]. / Ecografía intravesical. I: Correlación anatómica.

The scan images of the normal bladder were obtained by intravesical ultrasonography (IVU) and the ultrasonographic-anatomic correlation were defined based on 179 procedures. Except in bladder cancer, IVU did not prove to be useful in the evaluation of other bladder conditions or adjacent structures, including gynecological disorders.

Problemas residuales por policlorados aromaticos / Residual problems caused by aromatic polychlorinated compounds

El problema de la contaminacion ambiental a traves del grupo de los bifenilos policlorados senala la necesidad de reglamentar su uso a traves de medidas estatales nacionales como internacionales. La solucion de la problematica del PCB se puede llevar a cabo a traves de la substitucion o de su limitado empleo en la produccion social. Los compuestos utilizados y sus limites de tolerancia en Colombia son ligeramente cubiertos por nuestra legislacion. Para la seguridad de los alimentos se hace imprescindible la determinacion de los valores limites para los PCB