[Prospective evaluation of the direct costs of prostate enucleation by the HoLEP® laser during the learning curve period]. / Évaluation prospective des coûts directs de l'énucléation prostatique par le laser HoLEP® pendant la courbe d'apprentissage.

OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) has been shown to be effective in treating large prostates compared to prostate transurethral resection (TURP). There are no published data evaluating specifically the impact of the learning curve on the direct costs of HoLEP. The objective of this study was to evaluate the direct costs generated by the use of HoLEP laser during the learning curve period. METHOD: The costs of all medical devices (DM) and drugs used, pre- and post-operative parameters during surgery have been prospectively collected between March and October 2016. RESULTS: A total of 32 patients were included in the study with a mean age of 70.8 years and a mean prostate volume of 68.6 cm3. The mean cost of anesthesia was 39.0 € and that of drugs and DM used for surgery was 257.95 € but could reach 470.76 € in case of conversion to bipolar resection. The mean duration of enucleation and morcellation was 150minutes with a mean weight of enucleated specimens of 40.4g. The total mean duration of patient care was 197minutes at an estimated hourly cost of € 636. CONCLUSIONS: Despite some limitations, this study makes it possible to analyze the direct costs of the management of benign prostatic hypertrophy using HoLEP, an innovative surgical technique, and to specify that these costs are more related to bipolar conversion and voluminous adenomas especially during the learning curve. LEVEL OF EVIDENCE: 5.

Probing Stereoselectivity in Ring-Opening Metathesis Polymerization Mediated by Cyclometalated Ruthenium-Based Catalysts: A Combined Experimental and Computational Study.

The microstructures of polymers produced by ring-opening metathesis polymerization (ROMP) with cyclometalated Ru-carbene metathesis catalysts were investigated. A strong bias for a cis,syndiotactic microstructure with minimal head-to-tail bias was observed. In instances where trans errors were introduced, it was determined that these regions were also syndiotactic. Furthermore, hypothetical reaction intermediates and transition structures were analyzed computationally. Combined experimental and computational data support a reaction mechanism in which cis,syndio-selectivity is a result of stereogenic metal control, while microstructural errors are predominantly due to alkylidene isomerization via rotation about the Ru═C double bond.

[Secondary recurrent haemorrhage with peristomal varices complicating a urinary derivation according to Bricker and treated efficiently by endoscopic way]. / Hémorragie récidivante secondaire à des varices péristomiales compliquant une dérivation urinaire selon Bricker et traitée efficacement par voie endoscopique.

Stomal varices developed in patients with cirrhosis and enterostomy can be source of important haemorrhages. It is a rare event but often recurrent and difficult enough to treat efficiently. In certain cases, consequences can be severe. We report the case of a 63-years-old patient with medical history of hepatic cirrhosis who underwent a radical cystoprostatectomy with urinary derivation type Bricker. Five years afterwards, he developed stomal varices very haemorrhagic treated efficiently by endoscopic way, without any recurrence 12 months later. This observation shows that stomal haemorrhages can be treated by endoscopic way.

[Association between influenza vaccination and mortality due to COVID-19]. / Asociación entre la vacunación contra influenza y la mortalidad por COVID-19.

Background: It has recently been suggested that influenza vaccination may be a factor associated with decreased COVID-19 mortality. Methods: An age-matched case-control study based on hospital cases. We included subjects aged 18 years and older with a diagnosis of moderate to severe COVID-19. Infection was corroborated by RT-PCR test for SARS-COV-2. Deceased subjects were considered cases, controls were patients discharged due to improvement of acute symptoms. We used bivariate analysis to determine factors associated with death from COVID-19, and calculated odds ratios and 95% confidence intervals. Results: A total of 560 patients were included in the study, 214 (38.2%) were considered cases and 346 (61.7%) controls. A significant difference was observed with the presence of type 2 diabetes mellitus [54% vs. 39.3% between cases and controls, respectively (p=.04)] and having received influenza vaccination (p= .02). Type 2 diabetes mellitus was associated with higher COVID-19 mortality [OR 1.8 (95% CI 1.2-2.5) p=.01], whereas having been immunised against influenza in 2019 was associated with lower mortality in this group of patients [OR .6 (95% CI .4-.9) p=.02]. Conclusions: Influenza vaccination in the previous year appears to be associated with lower mortality from COVID-19; whereas type 2 diabetes mellitus is confirmed as a condition associated with higher mortality.

[Case report and review of the literature: a perineal schwannoma]. / Cas clinique et revue de la littérature: un schwannome périnéal.

Schwannoma is a rare and benign peripheral nerve sheath tumor arising from Schwann cells. Perineal localisation is exceptional. It is most frequently isolated but can be associated with neurofibromatosis 2 or schwannomatosis. This article describes a case of perineal schwannoma, its management and update diagnosis modality and treatment of this tumor.

Thermo- radio- and optically stimulated luminescence of Ce-doped KYF4 single crystals.

The goals of this work are to determine the luminescence properties of KYF4 single crystals doped with different concentrations of Ce3+ ions and to evaluate their possible application as a detector of beta radiation. In particular, thermoluminiscence, radioluminiscence and optically stimulated luminescence properties of KYF4: Ce3+ exposed to beta radiation have been studied and very good dosimetric properties have been obtained within the dose range 0.02-20 Gy.

[Acute myocardial infarction associated to the Sildenafil consumption. A case report and review of the literature]. / Infarto agudo de miocardio asociado al consumo de sildenafil. Aportación de caso y revisión de la literatura.

Erectile dysfunction affects more than 30 million men in The United States. Since the FDA approved the use of Sildenafil, prescription of this medication has been raising. Adverse events of Sildenafil includes: fatigue, dyspnea, and hypotension. Reported adverse cardiac events associated with the medication use include myocardial infarction, ventricular tachycardia, angina and death, raising concerns about the safety of this agent in patients with coronary artery disease. Published guidelines regarding the management of cardiac patients with erectile dysfunction suggest that Sildenafil may be hazardous in patients with ischemic heart disease. In patients using Sildenafil, myocardial infarctions have been reported to the Food and Drug Administration. Now, we report a patient with myocardial infarction after taking 100 mg of Sildenafil without sexual activity.

[Polyorchidism: a case report and review of the literature]. / Poliorquidismo: aportación de un caso y revisión de la literatura actual.

Polyorchidism is an uncommon congenital defect. In fact, less than one hundred cases have been reported in the medical literature worldwide. This problem should be considered in the differential diagnosis of all scrotal masses. It is associated with multiple other urologic entities including malignancy. It is for this reason that it is important to be familiar with potential diagnostic and therapeutic strategies. This diagnosis is usually documented by imaging, specifically doppler ultrasound (US) and magnetic resonance imaging (MRI). The risk of malignancy approaches 6% in Polyorchidism and therefore several authors have advocated surgery as the most appropriate therapeutic approach. However, recent reports suggest that asymptomatic patients with normal imaging could be observed. We present a 14 year old boy with polyorchidism which was diagnosed clinically and confirmed with imaging. His treatment and a review of the literature are presented as well.

Extended incubation times improve corneal endothelial cell transplantation success.

To investigate the ability of extended incubation times to improve the success of endothelial cell transplantation, eight human donor corneas were denuded of their native endothelium, seeded twice during a 1-hr interval with a suspension of cultured infant human corneal endothelial cells, and then incubated for 144 hr under standard conditions. Subsequently the corneas were transplanted into African green monkeys using routine penetrating keratoplasty techniques. Rotational autografts and corneas devoid of endothelial cells served as controls. The seeded corneas appeared hazy at the time of surgery (mean pachymetry 48 hr postoperatively, 0.794 mm). Six corneas (75%) subsequently cleared, yielding a mean corneal thickness of 0.541 +/- 0.040 and 0.554 +/- 0.040 at 6 and 12 postoperative months, respectively. All control eyes showed advanced edema (thickness, greater than 1.0 mm) and developed extensive neovascularization. Clinically, the extended postseeding incubation corneas were observed to clear more rapidly and stabilize their thickness earlier than corneas incubated for only 24-48 hr. Scanning electron microscopy of extended postseeding incubation corneas revealed an intact monolayer of contact-inhibited cells with the hexagonal mosaic typical of corneal endothelium in vivo and improved intercellular contact compared with corneas incubated for only 24-48 hr.

EGF cell surface receptor quantitation on ocular cells by an immunocytochemical flow cytometry technique.

A method is presented for the rapid flow cytometric determination of epidermal growth factor (EGF) receptor densities on the surface of cultured ocular cells. The technique uses a biotinylated monoclonal antibody directed against the EGF receptor in conjunction with a streptavidin-bound fluorochrome and requires the specific fluorescence per cell to be measured as a function of ligand and receptor concentration. Because the measurement is noninvasive and restricted to cell surface-bound material, the cells can be kept in a physiologic environment, even at the moment of assay. Calculated receptor densities ranged from 5142/cell (infant human corneal endothelium) to 35,678/cell (infant human keratocytes) to greater than 5 x 10(5)/cell for an A431 control cell line. Species and donor age differences were noted, as was transient receptor downregulation after EGF administration. Flow cytometry represents a valuable time saving procedure for large scale applications while providing the same level of sensitivity as standard radioimmunoassays. This technique is applicable to quantitation of other growth factor cell surface receptors and could greatly expand the use of flow cytometry in the research laboratory.

Vasodilator effects of sodium nitroprusside, levcromakalim and their combination in isolated rat aorta.

1. The endothelial modulation of the relaxant responses to the nitric oxide (NO) donor sodium nitroprusside (SNP) and the KATP channel opener levcromakalim (LEM) and the interactions between these agents were analysed in isolated rat aorta. 2. LEM-induced relaxation was unchanged by endothelium removal or by the presence of L-NAME (10-4 M) or ODQ (10-6 M). In contrast, in KCl- (25 mM), but not in noradrenaline- (NA, 10-6 M) contracted arteries, SNP-induced relaxation was augmented by endothelium removal but not by L-NAME, indomethacin, glibenclamide nor charybdotoxin plus apamin. 3. The isobolographic analysis of the interactions between exogenously activated KATP channels and cyclic GMP using mixtures of SNP and LEM revealed that there were no interactions between both drugs at the proportions at which both drugs were active. However, the points for the SNP : LEM mixtures in proportions 10:1 and 1:10,000 (i.e. at concentrations at which LEM and SNP were inactive, respectively) fell significantly above the line of additivity indicating that there were negative interactions between both drugs at these selected proportions (about 5- and 2 fold inhibition, respectively). The former interaction was sensitive to glibenclamide, whereas the latter was insensitive ODQ. The magnitude of the 10:1 SNP:LEM interaction was smaller in endothelium-intact arteries and was absent in arteries stimulated by NA. 4. In conclusion, the relaxations induced by LEM and SNP were additive. However, the presence of endothelium and low concentrations of LEM inhibited SNP-induced relaxation. Both inhibitory effects were not additive and were only observed in KCl- and not in NA-contracted aortae.

Nitric oxide- and nitric oxide donors-induced relaxation and its modulation by oxidative stress in piglet pulmonary arteries.

Inhaled nitric oxide (iNO) is widely used in the treatment of pulmonary hypertension while inhaled NO donors have been suggested as an alternative therapy. The differential susceptibility to inactivation by oxidative stress and oxyhaemoglobin of NO and two NO donors, sodium nitroprusside (SNP) and S-nitroso-N-acetyl-penicillamine (SNAP) were analysed in isolated endothelium-denuded pulmonary arteries from 2-week-old piglets stimulated with U46619. NO, SNAP and SNP relaxed the arteries (pIC(30)=7.73+/-0.12, 7.26+/-0.17 and 6.43+/-0.13, respectively) but NO was not detected electrochemically in the bath after the addition of SNP and only at concentrations at which SNAP produced more than 50% relaxation. The sGC inhibitor ODQ (10(-6) M) or the sarcoplasmic Ca(2+)-ATPase thapsigargin (2x10(-6) M) markedly inhibited the relaxation induced by NO, SNAP and SNP. Addition of oxyhaemoglobin (3x10(-7) M) or diethyldithiocarbamate (1 mM) markedly inhibited NO- (pIC(30)=6.88+/-0.07 and 6.92+/-0.18, respectively), weakly inhibited SNAP- and had no effect on SNP-induced relaxation. Xanthine oxidase (5 mu ml(-1)) plus hypoxanthine (10(-4) M) markedly inhibited NO- (pIC(30)=6.96+/-0.12) but not SNAP- or SNP-induced relaxation. Superoxide dismutase (SOD), MnCl(2), diphenileneiodonium and exposing the luminal surface of the rings outwards (inversion) potentiated the relaxant responses of NO (pIC(30)=8.52+/-0.16, 8.23+/-0.11, 8.01+/-0.11 and 8.20+/-0.10, respectively). However, SOD did not modify the NO detected by the electrode and had no effect on SNAP- or SNP-induced relaxation. Therefore, the kinetics and local distribution of NO release of NO donors influence the susceptibility to the scavenging effects of oxyhaemoglobin and superoxide.

Heterologous transplantation versus enhancement of human corneal endothelium.

The ability to successfully transplant human corneal endothelium would offer a significant advance in the treatment of many corneal diseases. To investigate the feasibility of this, we established cultures of endothelial cells derived from neonatal human corneas. Eye bank donor corneas were either enhanced with a suspension of cultured endothelial cells or underwent endothelial cell removal and subsequent replacement with cultured endothelium. Following a 48-h incubation, the corneas were transplanted into the eyes of nonhuman primates. Over a 12-month period, 67% of the corneas with complete endothelial cell replacement thinned and remained clear, with a mean corneal thickness of 0.57 mm. Enhanced corneal buttons demonstrated a significantly lower success rate (35%), with opacified and thickened corneas. Control eyes in which the native endothelium was removed demonstrated advanced corneal edema and vascularization, with a mean corneal thickness in excess of 1 mm. By utilizing established tissue-culture techniques, we have demonstrated that human corneal endothelium, when cultured and subsequently transplanted, retains its in vivo pump function. Although further studies are warranted, these results indicate that transplanted human corneal endothelial cells can function normally and suggest the possibility of endothelial cell replacement for therapeutic purposes.

Ureteropelvic invagination procedure for endopyelotomy (Gelet technique): review of 51 consecutive cases.

Between 1990 and 1995, we performed 51 endopyelotomies on 38 cases of primary and 13 of secondary obstruction of the ureteropelvic junction (UPJ) using the ureteropelvic invagination technique. Of the 51 patients in the series, 49 have been followed for a minimum of 3 months postoperatively (mean follow-up 16 months). Overall, success was achieved in 38 (77.5%). Endoscopic endopyelotomy was successful in 11 of 13 cases (84.5%) with secondary strictures. When the technique was used for the treatment of primary UPJ stricture, the success rate was only 75% (27 of 36). The presence of a crossing vessel was identified as the cause of failure in five cases of primary strictures; hence, we advocate the use of angiography to identify crossing vessels preoperatively. We recommend the use of the ureteropelvic invagination technique as the first-line therapy for primary hydronephrosis in adults in the absence of a crossing vessel.

Transplantation of cultured human neonatal corneal endothelium.

Human neonatal corneal endothelial cells were successfully maintained in tissue culture, morphologically resembling adult corneal endothelium. Eyebank donor corneas were obtained, denuded of their native endothelium and seeded with a suspension of the cultivated neonatal endothelial cells. After 48 hours, the eye-bank tissue was then transplanted into the eyes of Rhesus monkeys. Over a five month period, five of eight transplants cleared, with a mean central corneal thickness of 0.480 mm and endothelial cell densities ranging from 560 to 1650 cells/mm2. All control eyes without donor endothelium remained cloudy. In the experimental group three eyes initially thinned but subsequently became edematous. Further studies are needed to improve the seeding procedure and to assess the long-term viability of transplanted endothelium.

Microcarrier cell culture of neonatal human corneal endothelium.

Fresh isolates of neonatal human corneal endothelial cells were maintained in tissue culture using a technique employing collagen-coated, dextran-based microcarrier beads. This method provides large yields of endothelial cells suitable for biochemical and/or transplant studies without exposing the cells to enzymatic passage. Our results suggest that microcarrier culture of human corneal endothelial cells can provide a useful in vitro system for the growth and maintenance of actively mitotic cells.

[Intravesical BCG-therapy: comparison of side effects of Connaught (Toronto) and Pasteur (Paris) strains]. / BCG-thérapie intravésicale: comparaison des effets secondaires des souches Connaught (Toronto) et Pasteur (Paris).

INTRODUCTION: Urologists have felt that the adverse effects of intravesical BCG-therapy have been more serious and more frequent since the use of the Connaught strain. The objective of this retrospective study was to compare the toxicity of this new strain with that previously used in France (Pasteur strain). MATERIAL AND METHODS: After endoscopic resection, 89 patients with stage Ta grade 1-2 recurrent or T1 grade 3 and/or CIS bladder tumour were treated with 6 instillations of 150 mg of BCG Pasteur from 1992 to 1996 (50 patients: group 1) or 81 mg of BCG Connaught from January 1997 to December 1998 (39 patients: group 2). Adverse effects were classified as minor, lasting less than 48 hours (bladder irritation syndrome and/or macroscopic haematuria and/or fever less than 38 degrees C), moderate (requiring symptomatic treatment, reduction of the dose or an increased interval between instillations), and major (contraindication to continuation of treatment). RESULTS: 74% of patients in group 1 presented at least one adverse effect versus 77% in group 2. The reasons for permanent discontinuation of BCG-therapy in groups 1 and 2, respectively, were as follows: malaise during instillation (1 vs 0), bladder irritation syndrome not controlled by symptomatic treatment (4 vs 5) and epididymitis (0 vs 1). Pulmonary tuberculosis was diagnosed in one patient from group 2, one year after the last instillation. The frequency and severity of adverse effects were not statistically different between the two groups. The number of patients discontinuing BCG-therapy because of severe complications was also not statistically different between the two groups. CONCLUSION: This study did not reveal any difference of toxicity between Connaught and Pasteur strain in intravesical BCG-therapy of superficial bladder tumours.

[Deferred adjustment of the tension of tension-free vaginal tape (TVT) after surgical repair of stress urinary incontinence in women]. / Ajustement différé de la tension de matériel prothétique sous-uréthral (TVT) après cure chirurgicale d'incontinence urinaire d'effort de la femme.

INTRODUCTION: Urinary retention is a frequent complication of repair of female urinary incontinence treated by tension-free vaginal tape (TVT). The authors report a modification of the original technique designed to decrease the risk of postoperative dysuria and retention. MATERIAL AND METHODS: One hundred and twenty four patients with pure stress urinary incontinence were treated by TVT. In 74 patients (group 1), the TVT was placed according to the original Swedish technique. In 50 patients (group 2), no tension was applied to the suprapubic extremities of the TVT during the operation, but they were preserved and buried in an antiseptic dressing. On the day after the operation, traction was applied to the suprapubic TVT in the case of persistent incontinence. The immediate postoperative results and the results at 3 months, in terms of continence and urethral obstruction, were compared. RESULTS: Perfect continence was obtained in 84 +/- 6.5% and 94 +/- 4.2% of patients in groups 1 and 2, respectively (p = 0.08). Acute urinary retention (15% vs 2%, p < 0.03) and post-voiding residual urine > 50 cc (38% vs 10% on D1 and 14% vs 2% at 3 months) were more frequent in group 1. At 3 months, the reduction in maximum and mean flow rate was lower in group 2 (p < 0.03). In group 2, deferred traction of the TVT was necessary in 20% of cases, without causing any major infectious complications or pain. CONCLUSION: Deferred traction of TVT appears to decrease the rate of dysuria and urinary retention following repair of female urinary incontinence by tension-free vaginal tape (TVT). This technical modification does not affect the results on continence, which appears to be at least as satisfactory. This technical variant appears to be associated with a low morbidity.