Ruthenium nanoparticles stabilized by 1,2,3-triazolylidene ligands in the hydrogen isotope exchange of E-H bonds (E = B, Si, Ge, Sn) using deuterium gas.

A series of ruthenium nanoparticles (Ru·MIC) stabilized with different mesoionic 1,2,3-triazolylidene (MIC) ligands were prepared by decomposition of the Ru(COD)(COT) (COD = 1,5-cyclooctadiene; COT = 1,3,5-cyclooctatriene) precursor with H2 (3 bar) in the presence of substoichiometric amounts of the stabilizer (0.1-0.2 equiv.). Small and monodisperse nanoparticles exhibiting mean sizes between 1.1 and 1.2 nm were obtained, whose characterization was carried out by means of transmission electron microscopy (TEM), including high resolution TEM (HRTEM), inductively coupled plasma (ICP) analysis and X-ray photoelectron spectroscopy (XPS). In particular, XPS measurements confirmed the presence of MIC ligands on the surfaces of the nanoparticles. The Ru·MIC nanoparticles were used in the isotopic H/D exchange of different hydrosilanes, hydroboranes, hydrogermananes and hydrostannanes using deuterium gas under mild conditions (1.0 mol% Ru, 1 bar D2, 55 °C). Selective labelling of the E-H (E = B, Si, Ge, Sn) bond in these derivatives, with high levels of deuterium incorporation, was observed.

Current management of stage I testicular germ cell tumors in a French cancer institute. A practice analysis over the 10 past years.

BACKGROUND: Testicular Germ Cell Tumors (TGCTs) represent the most frequent malignant tumour among young male adults. Orchiectomy alone cure 80% of stage I. Standard options after orchiectomy include radiotherapy (RT), chemotherapy (CT) by 1 cycle of carboplatin AUC 7 or active surveillance (SV) for seminomatous GCTs (SGCT) and retroperitoneal lymphadenectomy (RPLND), CT by 1 or 2 cycles of Bleomycine Etoposide Cisplatine (BEP) or active surveillance for nonseminomatous GCTs (NSGCT). Adjuvant treatments decrease the relapse rate after orchiectomy with substantial toxicities without any benefit on overall survival. Recent guidelines accorded utmost importance on SV rather than adjuvants strategies. The main objective of this study was to describe our current practice over the 10 past years in regard of these recommendations. METHODS: Data of 50 patients with stage I GCT treated in our institute were collected between 2006 and 2016. Demographic and anatomopathologic data were reported. Clinical practice in our center was analyzed during two periods [2006-2011] and [2012-2016] according to the European Association of Urology Guidelines in 2011. RESULTS: Patient's median age was 35.3 years. The analysis of clinical practice during the last 10 years showed that in SGCT, main treatment was RT than SV and CT. This option declined over the years (89% between 2006-2010 versus 53% between 2011-2016) whereas SV was more often employed (27% between 2011-2016 versus none between 2006-2010). Surveillance was used for 64% of NSGCT. CONCLUSIONS: In our center, RT was less used over the years for the benefit of SV which is recommended by guidelines.

Predictive factors for ipsilateral recurrence after nephron-sparing surgery in renal cell carcinoma.

BACKGROUND: Ipsilateral recurrence after nephron-sparing surgery (NSS) is rare, and little is known about its specific determinants. OBJECTIVE: To determine clinical or pathologic features associated with ipsilateral recurrence after NSS performed for renal cell carcinoma (RCC). DESIGN, SETTING, AND PARTICIPANTS: We analysed 809 NSS procedures performed at eight academic institutions for sporadic RCCs retrospectively. MEASUREMENTS: Age, gender, indication, tumour bilaterality, tumour size, tumour location, TNM stage, Fuhrman grade, histologic subtype, and presence of positive surgical margins (PSMs) were assessed as predictors for recurrence in univariate and multivariate analysis by using a Cox proportional hazards regression model. RESULTS AND LIMITATIONS: Among 809 NSS procedures with a median follow-up of 27 (1-252) mo, 26 ipsilateral recurrences (3.2%) occurred at a median time of 27 (14.5-38.2) mo. In univariate analysis, the following variables were significantly associated with recurrence: pT3a stage (p=0.0489), imperative indication (p<0.01), tumour bilaterality (p<0.01), tumour size >4cm (p<0.01), Fuhrman grade III or IV (p=0.0185), and PSM (p<0.01). In multivariate analysis, tumour bilaterality, tumour size >4cm, and presence of PSM remained independent predictive factors for RCC ipsilateral recurrence. Hazard ratios (HR) were 6.31, 4.57, and 11.5 for tumour bilaterality, tumour size >4cm, and PSM status, respectively. The main limitations of this study included its retrospective nature and a short follow-up. CONCLUSIONS: RCC ipsilateral recurrence risk after NSS is significantly associated with tumour size >4cm, tumour bilaterality (synchronous or asynchronous), and PSM. Careful follow-up should be advised in patients presenting with such characteristics.

[Comparison of open and laparoscopic partial nephrectomy: a French multicentre experience]. / Comparaison de la néphrectomie partielle par voie laparoscopique et par voie ouverte: une expérience multicentrique française.

OBJECTIVES: To compare open (OPN) and laparoscopic (LPN) partial nephrectomy (PN) techniques in the light of a French multicentre series. MATERIAL AND METHODS: Data corresponding to 741 PN (91 laparoscopic and 650 open procedures) were compared in terms of the indications, tumour diameter, operative data, complication rates and length of hospital stay. RESULTS: Tumours were smaller in the LPN group (2.7 vs 3.4 cm, p = 0.001). There were fewer malignant tumours (71.1% vs 80% p = 0.05) and fewer NP by necessity (20.9% vs 31.4%. p = 0.04) in the LPN group than in the OPN group. There were fewer hilar tumours in the LPN group than in the OPN group (LPN: 4% vs OPN: 14.8%, p = 0.03). Pedicle clamping was performed less frequently in the LPN group (33% vs 50.2%, p = 0.002) but for a significantly longer mean duration (35 minutes vs 19 minutes, p = 0.0001). The mean operating time was longer in the LPN group (163 vs 150 minutes, p = 0.02). The surgical complication rate (17.6% vs 14.3%), transfusion rate (6.6% vs 10.5%) and mean blood loss (363 vs 434 ml) were not significantly different between the 2 groups. There were significantly more urinary fistulas (12.1% vs 2.5%, p < 0.001) and medical complications (24.2% vs 14%, p = 0.01) in the laparoscopy group, but, in the longer-term, urinarvfistula rates were comparable in the 2 groups. The length of hospital stay was shorter for LPN (9.1 vs 11.2 days, p = 0.009). CONCLUSION: This comparative series, reflecting initial experience, shows that laparoscopic partial nephrectomy achieves similar operative and perioperative results to those of open partial nephrectomy. However, the indications for laparoscopic partial nephrectomy remain selective, as the pedicle clamping time and medical complication rates are higher with laparoscopic surgery. Experience and technical progress in laparoscopic partial nephrectomy should make the operative technique comparable to that of open surgery.

Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication.

OBJECTIVE: To analyse through a large multicentre series, morbidity of nephron-sparing surgery (NSS) in relation to tumour size and surgical indication. METHODS: The study included patients from eight international academic centres. Age, sex, TNM stage, tumour size, Fuhrman grade, Eastern Cooperative Oncology Group performance status (ECOG-PS), surgical margins, local and distant recurrences, and overall and cancer-specific survival rates were collected and analysed. Indication for elective or mandatory NSS, medical and surgical complication rates, mean blood loss, blood transfusion, and length of hospital stay were specifically recorded for the purpose of this study. Groups were compared for qualitative and quantitative variables by using chi(2) (Fischer exact test) and Student t tests, respectively. RESULTS: A total of 1048 NSS procedures were included in this study. Mean tumour size was 3.4+/-2.1cm. In 730 elective procedures mean operative time (p=0.002), mean blood loss (p=0.01), the need for blood transfusion (p=0.001), and urinary fistula rate (p=0.01) were significantly increased for tumours >4 cm. However, these differences did not result in significantly increased medical (p=0.4), surgical complication rates (p=0.6), or length of hospital stay (p=0.9). Finally, in elective procedures for malignant tumours, positive surgical margins, local or distant recurrence rates, and cancer-specific survival were not significantly different in tumours < or =4 cm and >4 cm. CONCLUSION: Excellent cancer control and outcomes can be achieved with NSS in carefully selected patients with tumours >4 cm. Expanding the size indication of elective NSS results in an increased but acceptable morbidity.

[Laparoscopic treatment of an isolated ureteropelvic junction disruption following blunt abdominal trauma]. / Traitement d'une rupture traumatique isolée de la jonction pyélo-urétérale par laparoscopie rétro-péritoneale.

Isolated disruption of the ureteropelvic junction following blunt abdominal trauma is rare, although not exceptional. The diagnosis may be delayed. CT-scan with excretory phase imaging is the usual mode of diagnosis. The urinary tract can be repaired by an ureteropyelic anastomosis over a stent. The authors report the first case of an isolated disruption of the ureteropelvic junction following blunt abdominal trauma repaired by retroperitoneal laparoscopy.

[Retroperitoneal laparoscopic pyeloplasty: retrospective study of 45 consecutive adult cases]. / La résection de jonction pyélo-urétérale par laparoscopie rétropéritonéale: etude rétrospective de 45 cas consécutifs chez l'adulte.

OBJECTIVE: To evaluate the results of retroperitoneal laparoscopic surgical repair of ureteropelvic junction (UPJ) syndrome. MATERIAL AND METHODS: Retrospective study of 45 consecutive Küss-Anderson-Hynes laparoscopic pyeloplasties performed over a 4-year period (December 1998-November 2002) in adults (26 women, 19 men) with a mean age of 44.8 years (range: 16-83 years). RESULTS: The mean operating time was 138 minutes (range: 75-250 minutes). Open conversion was necessary in 3 cases: necrotic pyelitis, ectopic renal artery, posterior pelvic tear. The mean hospital stay was 6.1 days. With a mean follow-up of 19 months (range: 3-58 months), the clinical success rate was 97.6% and the success rate on IVU or scintigraphy was 83.3%. CONCLUSION: This series confirms that laparoscopic pyeloplasty is a minimally invasive technique that gives better results than those of the various endopyelotomy techniques and equivalent results to those of open pyeloplasty with decreased morbidity.

[One-stage laparoscopic bilateral upper pole nephrectomy for ectopic insertion of complete ureteral duplication]. / Néphrectomie polaire supérieure laparoscopique bilatérale en un temps pour abouchement ectopique d'une duplicité urétérale complète.

Ectopic ureteric insertion of the superior renal unit in the context of complete ureteric duplication is frequently accompanied by destruction of the corresponding parenchymal territory. Surgical treatment must comprise upper pole nephrectomy with partial ureterectomy. The authors report a case of one-stage retroperitoneal laparoscopic bilateral treatment which could become the treatment of choice of this disease.

[Prognostic factors of invasive bladder cancer with lymph node invasion]. / Facteurs pronostiques des cancers infiltrants de vessie avec envahissement lymphonodal.

OBJECTIVE: To identify the prognostic factors influencing survival and to assess the value of extensive lymphadenectomy in invasive bladder cancer with lymph node invasion. MATERIAL AND METHODS: The medical records of 62 patients treated by cystectomy with curative lymphadenectomy for invasive bladder cancer with lymph node invasion were reviewed. Thirty four patients had lymph node dissection ascending at least as far as the common iliac vessels, 26 had pelvic lymph node dissection and 2 had simple lymph node biopsies. RESULTS: The 2-, 3- and 5-year actuarial survival rates were 37%, 26.6% and 23.6%, respectively, with a median survival of 18.4 months. This study appears to show the independent prognostic value of the following factors: tumour strictly confined to the bladder (< or = pT3a) (p = 0.002), < or = 2 invaded lymph nodes (p = 0.001), N1 lymph node stage (p = 0.009). Extensive lymphadenectomy would not provide any benefit in terms of survival compared to simple pelvic lymph node dissection (p = 0.8). Common iliac node invasion appears to be a factor of poor prognosis when the tumour extends beyond the bladder (> pT3a) (p = 0.018). CONCLUSION: In these patients with invasive bladder cancer and lymph node invasion, a number of invaded lymph nodes < or = 2 and local stage < or = pT3a appear to be favourable prognostic factors resulting in a 23.6% remission rate (56.8% when both factors were present simultaneously) after cystectomy plus lymphadenectomy. Extensive lymphadenectomy including the common iliac vessels would not improve survival compared to pelvic lymph node dissection, but nevertheless appears us to be justified, as the presence of common iliac lymph node invasion constitutes a significant and powerful prognostic factor to recommend adjuvant therapy.