Port catheter versus peripherally inserted central catheter for postoperative chemotherapy in early breast cancer: a retrospective analysis of 448 patients.

PURPOSE: We aimed to compare the complication rate between port catheters (PC) and peripherally inserted central catheters (PICC) for the administration of postoperative chemotherapy for breast cancer. METHODS: All patients treated from January 2010 to August 2012 at the Centre Henri Becquerel for early breast cancer requiring postoperative chemotherapy were retrospectively screened. The primary endpoint was the occurrence of a major complication related to the central venous catheter. Major complications were defined as any grade 3 event according to CTCAE 4.0, delay in chemotherapy >7 days, change of the device, life-threatening event, event requiring a hospitalization, or a prolongation of hospitalization. RESULTS: A total of 448 patients were included; 290 had a PC and 158 a PICC. Overall, 31 major complications related to the central venous catheter were observed: 13 for patients with a PC (4.5%) and 18 for patients with a PICC (11.4%). In univariate analysis, having a PICC was the only factor significantly associated with a higher risk of major complications (HR = 2.83, p = 0.0027). We observed a trend for a higher risk of major complications for patients older than 60 years or with BMI >25 (p = 0.06). In multivariate analysis, having a PICC was the only predictive factor of major complications (HR = 2.89, p = 0.004). CONCLUSIONS: In univariate and multivariate analysis, having a PICC instead of a PC was the only predictive factor of device-related major complication. If confirmed prospectively by the NCT02095743 ongoing trial, this result might modify the management of adjuvant chemotherapy administration.

NEUROENDOCRINE RENAL CARCINOMA - THERAPEUTIC AND DIAGNOSTIC ISSUES.

INTRODUCTION: Neuroendocrine renal carcinoma represents less than 1% of all primary neoplasia of the kidney. Most frequently poorly differentiated carcinoma is diagnosed in advanced stages and they have an aggressive evolution and limited survival rate. Neuroendocrine carcinomas that arise from the renal pelvis are frequently associated with squamous cell carcinoma or adenocarcinoma. MATERIAL AND METHOD: We present the case of a female patient, known for 3 years before with an undefined retroperitoneal lymph node metastasis, being diagnosed at present with a left large cell neuroendocrine renal carcinoma, who initially had lymph node metastasis. RESULTS: Until now, 118 cases of primary neuroendocrine renal carcinomas have been reported. A limited number of poorly differentiated neuroendocrine carcinomas have been reported. DISCUSSION: Due to the clinical and biological findings, the aggressive evolution with early metastasis of lung and bone, the patient is included in the group of poorly differentiated carcinomas. In these cases, multimodal treatment is a gold standard. After surgical treatment and palliative chemotherapy with platinum salts, we obtained a partial remission of the disease and the control of symptoms. CONCLUSIONS: Regarding large cell neuroendocrine carcinoma, the surgical treatment remains the treatment of choice. Chemotherapy can determine limited results, improve the quality of life and enhance the overall survival rate.

Intraoperative complications after 8150 semirigid ureteroscopies for ureteral lithiasis: risk analysis and management.

OBJECTIVES: To evaluate semirigid retrograde ureteroscopy complications on a significant series of patients and to establish the factors associated with the occurrence of intraoperative complications. PATIENTS AND METHODS: Between June 1994 and June 2013, 8150 semirigid ureteroscopic procedures for ureteral lithiasis were performed in 7456 patients. We used semirigid ureteroscopes(8 9.8F Wolf, 8 and 10F Storz, Olympus Endoeye digital 8.5 9.9F). Lithotripsy was done with pneumatic, electrohydraulic or Ho:YAG laser lithotripters. The preoperative parameters including gender, calculi location and size, impaction, degree of hydronephrosis, stone number and associated malformation as well as intraoperative aspects (stone extractors, fragmentation devices, operative time and surgeon experience) were evaluated in relation with complication rate. RESULTS: The stone-free rate after a single ureteroscopic procedure was 90.9%. Intraoperative incidents occurred in 348 cases (4.3%). The overall rate of intraoperative complications was 2.8% (228 cases). These were represented by lesions of the ureteral mucosa (139 cases), perforation (58 cases), bleeding (16 cases), ureteral avulsion (3 cases) and extra-ureteral stone migration (12 cases). Statistical analysis shows a significant association between the complication rate on the one hand and stone size, location and impaction,operative time and surgeon experience on the other hand. CONCLUSIONS: Due to technological advances and increased experience, the semirigid retrograde ureteroscopic treatment of ureteral lithiasis increased efficacy, while the incidence of intraoperative complications decreased. Most of these complications are minor and can be managed by conservative approach.

Holmium laser intrarenal lithotripsy in pyelocaliceal lithiasis treatment: to dust or to extractable fragments?

BACKGROUND: Pyelocaliceal calculi flexible ureteroscopic approach raises problems related to operative time, associated morbidity and costs, especially by potential endoscope damage. METHODS: 5 series, each of 20 patients with single pyelocaliceal lithiasis, were analyzed: Group I with calculi 1 cm fragmented to dust, Group II with calculi 1 cm with lithotripsy in fragments, Group III with calculi of 1-2 cm fragmented to dust, Group IV with calculi of 1-2 cm with lithotripsy in fragments, Group V with calculi of 1-2 cm fragmented to dust until they reached 1 cm, and lithotripsy in fragments afterwards. In all cases Ho:YAG lithotripsy was used. RESULTS: Ureteral access sheath was used in 70% of the cases. Mean operating time was 39 min in group I, 21 min in Group II, 112 min in group III, 72 min in group IV and 51 min in group V. Minor complications occurred in 7 cases,while a single major complication occurred in group IV. CONCLUSIONS: The optimal lithotripsy method for calculi 1cm seems to be in extractable fragments. Larger calculi should be fragmented to dust until they reach 1 cm and then the lithotripsy should be continued into extractable fragments. ABBREVIATIONS: Ho: YAG - Holmium: Yttrium Aluminium Garnet, Hz - Hertz, mJ - milli joule.

Ureteroscopy -- first-line treatment alternative in ureteral calculi during pregnancy?

BACKGROUND: Urolithiasis during pregnancy is not common but remains both a diagnostic and treatment challenge. The aim of the study was to assess the ureteroscopy results as definitive treatment option in pregnant women with obstructive ureteral calculi. MATERIAL METHODS: Between 2006 and 2012, in our clinical department, 54 pregnant women underwent active treatment for ureteral lithiasis and in 38 of these cases ureteroscopy was applied as definitive therapy. The average patients age was 27.2 years (range 20-37 years) and the gestation period varied between 9 to 35 weeks. Flank pain was the common presenting symptom (52 54 cases), 4 women had associated fever, and 14 complained of irritative voiding symptoms.Semirigid ureteroscopy was the first choice alternative for the first 2 trimesters while flexible approach or double J in dwelling were preferred for patients in the last trimester of pregnancy. RESULTS: Semirigid ureteroscopy allowed stone treatment in 28 32 cases. In 17 patients, calculi fragmentation using Ho:YAG laser or ballistic lithotripsy were performed, while in 11 cases, the stone was removed intact. Minor intraoperative complications were encountered in 5 patients. Postoperatively,urinary tract infection developed in 4 patients, renal colic in 2 and prolonged hematuria in one case, while 4 patients complained of stent-induced bladder irritation. Flexible ureteroscopy was successfully completed in all patients. There were no complications related to this procedure. All pregnancies were carried out to full term. CONCLUSIONS: Ureteroscopy may be considered a safe and effective first-line definitive therapeutic option in pregnant patients requiring intervention for ureteral stone.

[Psychological impact of the announcement of an abnormal cervical smear: How to improve patient experience and information? COLANX: a multicenter study in Seine-Maritime]. / Impact psychologique de l'annonce d'un frottis cervico-utérin anormal : comment améliorer le vécu et l'information des patientes ? COLANX : une étude multicentrique en Seine-Maritime.

INTRODUCTION: When an anomaly in the screening by cervical smear or by the HPV-HR test is detected, the women are called for a colposcopy. Waiting for colposcopy is often an anxiety-provoking situation for women, probably linked to a widespread ignorance of the value of screening and the pathophysiology of HPV infection. METHODS: The COLANX was a multicentric study, in Seine-Maritime, conducted with 8 colposcopist practitioners. Self-questionnaires were distributed to volunteer women, summoned for a first abnormal smear result, at the exit of colposcopy and filled out immediately on site. This questionnaire evaluated: the psychological impact of the announcement of the abnormal cervico-uterine smear, its impact on the sexual quality of life, the epidemiological characteristics of the population studied, the modalities of the announcement made of the abnormal result, the satisfaction of the women and their desire for additional information. 131 questionnaires were included, from June 1, 2020 to January 18, 2021. RESULTS: 61.5% of responding women presented proven psychological distress, as evidenced by a GHQ-12 score ≥ 2. The state of psychological distress was significantly different depending on the time left by the practitioner between the announcement of the abnormal cytology result and the colposcopy appointment. The GHQ-12 score was significantly different according to the initial classification of the cervico-uterine smear, high in case of suspicion of high-grade lesions in particular. 36.3% of patients had a significant deterioration in their sexual quality of life, demonstrated by an ASEX score ≥ 18. The women were statistically more satisfied when the announcement of their abnormal screening result had been made by telephone or during a consultation, rather than by mail, but no significant difference was found on the presence or absence of distress psychological according to this mode of announcement. 52.3% of the women in this study expressed a request for additional information support, preferably written support (for 89.4% of these women), to be delivered when the abnormal screening was announced (for 76, 5% of these women). DISCUSSION: The main results of the COLANX study are consistent with those of the literature, in particular concerning the negative psychological impact in the announcement of an abnormal smear result. CONCLUSION: The new methods of organized screening will increase the use of colposcopy for many women. There is a significant impact on their psyche and their intimate life. The issuance of additional information during this announcement would probably reduce this anxiety.

The Influence of SARS-CoV-2 on Minimally Invasive Therapeutic Approach for Benign Prostatic Hyperplasia.

Introduction: The COVID-19 pandemic definitely changed the management of patients with benign prostatic hyperplasia (BPH). This study followed the modalities of treatments in patients with BPH associated with SARS-CoV-2 attending the Urology Clinic of "Sf. Ioan" Emergency Clinical Hospital, Bucharest, Romania. Material and methods:The present study included 81 patients (mean age 63.2 years, age range 55-87 years) with SARS-CoV-2 and BPH who were admitted to our Urology Department between January 2021 and January 2022. The diagnosis of SARS-CoV-2 was based on the PCR test and that of BPH by using the diagnostic triad consisting of digital rectal examination, PSA, free PSA and ultrasound examination. It should be noted that some of the hospitalized patients were following treatment with alpha blockers and/or 5-alpha-reductase inhibitors at the time of admission. Results:Out of the 81 hospitalized cases, 13 required emergency endoscopic intervention under spinal anaesthesia (TURP or TURisP) for haemostasis because those patients presented with persistent haematuria which did not respond to conservative treatment. A number of 17 cases showed acute urinary retention during hospitalization and a urethrovesical catheter was fitted and will be re-evaluated urologically after the COVID episode. Of the remaining 51 subjects with BPH, 17 already had chronic urinary retention on admission, with urethrovesical probe present, 13 cases began during hospitalization with alpha-blocker treatment associated with 5-alpha-reductase inhibitors; meanwhile, there were no urological interventions to modify the treatment regimen in the remaining 21 patients, who were strictly managed on the side of COVID-19 infection. Conclusion:There was no clear influence of the evolution of patients with BPH due to SARS-CoV-2 pathology, and the general management trend was to delay chronic cases until the time of viral infection remission.

[Bipolar plasma vaporization--new endoscopic technique in non-invasive bladder cancer]. / Vaporizarea bipolara cu plasma--o noua tehnica endoscopica în cancerul vezical non-invaziv.

OBJECTIVES: The aim of our study was to evaluate the efficacy and safety of a newly introduced endoscopic technique in the treatment of non-muscle invasive bladder cancer (NMIBC), the bipolar plasma vaporization of bladder tumors (BPV-BT). MATERIALS AND METHODS: Between May and November 2009, 72 consecutive patients presenting papillary bladder tumors over 1 cm underwent BPV-BT and a 3 months follow-up. Initial biopsy followed by plasma vaporization of the tumor and biopsies of the tumoral bed were performed in all cases. The follow-up protocol included abdominal ultrasonography, urinary cytology and cystoscopy at 3 months. RESULTS: BPV-BT was successfully performed in all cases. Multiple tumors were found in 45.9% and tumors over 3 cm in 33.3% of the cases. The mean tumoral volume was 10.5 ml. The mean operative time was 16 minutes, the mean hemoglobin decrease was 0.4 g/dl, the mean catheterization period was 2.3 days and the mean hospital stay was 3.4 days. There was no major intra- or postoperative complications. The pathological exam diagnosed 58.3% pTa, 30.6% pT1 and 11.1% pT2 cases. No tumoral base biopsies were positive for malignancy. The recurrence rate was 15.6% for the NMIBC patients, 13.3% for patients with single tumor under 3 cm and 16.3% in cases of single tumors over 3 cm or multiple tumors. Orthotopic recurrent tumors were encountered in 3.1% of the cases. CONCLUSIONS: BPV-BT seems to represent a promising endoscopic treatment alternative for NMIBC patients, with good efficacy, reduced morbidity, fast postoperative recovery and satisfactory follow-up parameters.

[Increase rate of ambulatory and management of the care path in breast cancer surgery]. / Augmentation du taux de prise en charge ambulatoire et organisation du parcours de soins en chirurgie sénologique.

OBJECTIVE: To describe practices and impact of ambulatory surgery rate, patient satisfaction after Nursing Support and Post Ambulatory Follow-up Device at Home at the Henri Becquerel Center (DIASPAD CHB) has been set up during surgical management in breast cancer. METHOD: This is a prospective monocentric observational study carried out between January 2017 and December 2018. Patients eligible for the study should undergone breast cancer surgery without reconstruction. Outpatient care was possible if patients met medical, surgical, psychosocial and environmental criteria according to the characteristics of the foreseeable operating suites. We evaluated the progression of the ambulatory hospitalization rate since the DIASPAD CHB beginning and compared the use of this device in conventional and ambulatory hospitalization. RESULTS: Since January 2017, 1312 patients undergone breast cancer surgery without reconstruction. After DIASPAD CHB implementation, ambulatory surgery rate increased from 46 % to 81.7 % for patients operated for breast cancer. The satisfaction rate of patients and nurses was 99 %. CONCLUSION: DIASPAD CHB enabled ambulatory care to take a important share in surgical care in breast cancer by ensuring collaboration between healthcare professionals, anticipation, programming and coordination of care.

Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study.

OBJECTIVE: The main aim of the present study was to determine the sensitivity, specificity and accuracy of ultrasonography (US) in detecting monosodium urate and calcium pyrophosphate dihydrate crystals deposits at knee cartilage level using clinical definite diagnosis as standard reference. DESIGN: A total of 32 patients with a diagnosis of gout and 48 patients with pyrophosphate arthropathy were included in the study. Fifty-two patients with rheumatoid arthritis (RA), psoriatic arthritis or osteoarthritis (OA) were recruited as disease controls. All diagnoses were made using an international clinical criterion. US examinations were performed by an experienced sonographer, blind to clinical and laboratory data. Hyaline cartilage was assessed to detect two US findings recently indicated as indicative of crystal deposits: hyperechoic enhancement of the superficial margin of the hyaline cartilage and hyperechoic spots within the cartilage layer not generating a posterior acoustic shadow. RESULTS: Hyperechoic enhancement of the chondrosynovial margin was found in at least one knee of 14 out of 32 (43.7%) patients with gout and in a single knee of only one patient affected by pyrophosphate arthropathy (specificity=99%). Intra-cartilaginous hyperechoic spots were detected in at least one knee of 33 out of 48 (68.7%) patients with pyrophosphate arthropathy and in two disease controls one with OA and the second with RA (specificity=97.6%). CONCLUSIONS: The results of the present study indicate that US may play a relevant role in distinguishing cartilage involvement in patients with crystal-related arthropathy. The selected US findings were found to be highly specific.

[Sonography versus electrodiagnosis for the diagnosis of carpal tunnel syndrome in routine practice]. / Comparaison de l'échographie et de l'électroneurographie pour le diagnostic du syndrome du canal carpien en pratique courante.

INTRODUCTION: Many studies had been performed in the last years to prove the usefulness of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome (CTS). We wanted to determine its reliability and to compare this technology with electromyography (EMG) in ordinary diagnostic conditions. METHODS: The study involved 90 wrists with suspected CTS, 35 controlateral wrists and 52 control wrists. The diagnosis of CTS was confirmed in 81 cases by the hand symptom diagram and the Tinnel and Phalen sign. The EMG examination evaluated medianulnar sensory latency difference to the ring finger and wrist-to-palm sensory conduction velocity. For the ultrasound diagnosis, the cross sectional area of the median nerve at the level of the pisiform bone, was considered. The sensitivity and specificity of the two techniques was calculated. RESULTS: Sensitive electroneurographic parameters showed a sensibility and specificity respectively of 79 and 80%. The cut-off point for ultrasound sensibility and specificity using ROC analysis was 11mm(2) for mean cross-sectional area. Sensitivity and specificity found in this way were 72% and 56%. Reliability was good with intra- and inter-reader intraclass correlation coefficients of 0.99, and interobserver coefficient of 0.88. Sonography found seven CTS among the 17 clinical CTS with normal electrophysiological findings. A statistically correlation was found between the cross-sectional section and the sensitive electrophysiologic parameters (r=0.43, p<0.001). CONCLUSIONS: In our study, ultrasonographic diagnostic value are not as good as electrophysiological value, like found in recent literature, probably because of the composition of our group of patients which is including many causes of acroparesthesias. This can mean that in clinical practice, sonography is a complementary tool instead, for example in cases of equivocal EMG.

[Percutaneous approach in postureteroenterostomy ureteral stenosis. Experience of the Urological Department of Sf. Ioan Emergency Hospital, Bucharest]. / Abordul percutanat în stenoza ureterala postureteroenterostomie. Experienta Clinicii de Urologie a Spitalului Clinic de Urgenta "Sf. Ioan" Bucuresti.

INTRODUCTION: Uretero-enteric stenosis may raise some specific problems due to difficulties concerning the retrograde access. The aim of our study was to evaluate the effectiveness of antegrade flexible ureteroscopic approach for this specific pathology. MATERIAL AND METHODS: Between January 2002 and June 2008, a number of 7 patients underwent antegrade flexible ureteroscopy for uretero-enteric stenosis: 3 patients with stenosis of the uretero-neobladder anastomosis (Group I), 2 patients with stenosis of the uretero-sigmoidian implantation (Group II) and 2 patients with stenosis of the ureteral implantation in an ileal conduit (Group III). In Group I, we performed antegrade Nd:YAG laser star incision in 2 cases and balloon dilation in 1 case. In Group II, the antegrade Nd:YAG laser star incision was applied in 1 case and balloon dilation was performed in the other one. In Group III, we performed antegrade insertion of the guidewire followed by retrograde cold-knife incision in one case, and bipolar ureteral approach (cut-to-the-light technique) in 1 case. RESULTS: The mean operative time was 58 min. (range 25 to 120 min). We didn't describe major intraoperative complications. Ultrasonography, IVP and isotopic renogram (in selected cases) have been the follow-up evaluation methods. Postoperatively, 2 cases from Group I and all cases from Groups II and III had a good evolution, with significant reduction of the hydronephrosis degree at 6, 12 and 18 months. One patient from Group I, in which balloon dilation of the stenosis was performed, developed recurrence at 6 months. CONCLUSIONS: According to our experience, antegrade flexible ureteroscopic approach may represent an efficient and safe technique in uretero-enteric stenosis treatment. Being a minimally invasive approach, this procedure has a reduced rate of complications and good anatomical and functional results.

[Percutaneous approach in the treatment of matrix lithiasis. Experience of the urological department of "Saint John" Emergency Clinical Hospital]. / Abordul percutanat in litiaza moale. Experienta clinicii de urologie a Spitalului Clinic de Urgenta "Sfântul Iano" Bucuresti.

INTRODUCTION: Matrix lithiasis has been relatively rarely described. Our goal was to establish the value of percutaneous approach in this pathology. MATERIAL AND METHODS: Between July 1995 and January 2008 in Department of Urology of "Saint John" Emergency Clinical Hospital in Bucharest, 11 patients with pyelocaliceal matrix lithiasis (seven females and four males) were treated by percutaneous approach. The mean age was 55 years old (between 41 and 83 years old). The rigid nephroscope was exclusively used in seven cases. The approach of caliceal fragments imposed the flexible nephroscopic approach in the other four cases. The mean follow-up period was 48 months (range two to 86). RESULTS: 10/11 patients (90,9%) were stone-free at the end of procedures. In the other case, the spontaneous passage of the remaining matrix lithiasis fragments was encountered. No major complications were recorded. Recurrences occurred in two cases (18.2%), despite the long-term antibiotic therapy. CONCLUSIONS: Percutaneous approach may represent an effective and safe therapy of matrix lithiasis. The management of this pathology must associate the preoperative treatment and postoperative prophylaxis of the urinary tract infections.

[Limitations of breast reconstruction using exclusive lipofilling: A retrospective study over 10 years]. / Limites de la reconstruction mammaire par lipofilling exclusif : étude rétrospective sur 10 ans.

OBJECTIVES: The primary objective was to assess the failure rate of exclusive lipofilling breast reconstruction. The secondary objectives were the identification of failure predictive factors of exclusive lipofilling breast reconstruction and the early complications. METHODS: We performed a retrospective study in Normandy analysing cases of secondary breast reconstruction by exclusive lipofilling after radical mastectomy, from January 2006 to December 2016. We compared a group of patients who completed exclusive lipofilling breast reconstruction (n=22) with a group of patients who underwent other techniques of breast reconstruction (n=16). RESULTS: The failure rate of breast reconstruction by exclusive lipofilling was 32.6%. Need of adjuvant chemotherapy treatment was associated with a higher failure rate than exclusive lipofilling breast reconstruction (81.2% vs. 45.5%, P<0.05). The age of patients was significantly higher in case of reconstruction failure (45.2 vs. 50.9 years mean age, P<0.05). Need of adjuvant radiotherapy treatment was not associated with a higher failure rate than exclusive lipofilling breast reconstruction. The main complications were cutaneous burn due to cannula and haematoma at the donor site (11/22) and breast haematoma (11/22). CONCLUSIONS: Informing patients of the risk of breast reconstruction failure due to the high adipocytes resorption, is necessary when patients are undergoing exclusive lipofilling breast reconstruction. A prospective study with greater workforce is needed to shore these results and assess postoperative complications.

Consensus of the Iberoamerican Oculoplastic Society for diagnosis and management of facial dystonia. / Consenso de la Sociedad Iberoamericana de Oculoplástica para el diagnóstico y manejo de las distonías faciales.

OBJECTIVE: To propose guidelines for the diagnosis and treatment of facial dystonia prepared by a group of experts in orbit and oculoplastics from the Iberoamerican Oculoplastic Society. MATERIAL AND METHODS: An interactive discussion between the expert panel and those attending the 6th Iberoamerican Society of Oculoplastics Congress, which took place at the Hospital Nuestra Señora de la Luz in Mexico City on 22 October 2018, providing their personal experience based on evidence for diagnosis and treatment of facial dystonia. Around 200 ophthalmologists specialised in oculoplastics from North, Central and South America, Spain, and Portugal were involved. Discussion was focused on the following themes: pathophysiology, diagnosis, medical management, and surgical management. CONCLUSIONS: Facial dystonia diagnosis is clinical; therefore, image studies are rarely needed. The ophthalmologist is generally the first physician to be consulted, and is able to be the treating physician, with the exception of specific cases of hemifacial spasm where management with neurosurgery may be beneficial. Botulinum toxin is the treatment of choice. Treatment with oral neuroleptics and myectomy of the orbicularis oculi muscle are reserved for refractory cases, since these do not have an adequate clinical response as first choice treatments. Persistent use of botulinum toxin does not modify the natural course of the disease.

[Hexvix induced fluorescence blue light cystoscopy--a new perspective in superficial bladder tumors diagnosis]. / Cistoscopia în lumina albastra cu fluorescenta indusa de Hexvix--o noua perspectiva in diagnosticul tumorilor vezicale superficiale.

INTRODUCTION: The aim of our study was to establish the place of Hexvix blue light cystoscopy (BLC) in superficial bladder tumors (SBT) diagnosis and to compare it with standard white light cystoscopy (WLC). MATERIAL AND METHODS: Between December 2007 and February 2008, WLC and BLC and transurethral bladder resection (TURB) of all apparent detected lesions were performed in 25 cases. The patients diagnosed with superficial bladder tumors have been followed-up after 18 weeks by WLC and BLC. The control group included the same number of consecutive patients with SBT, diagnosed only by WLC, which underwent the same treatment and follow-up protocol as the study group. RESULTS: WLC identified 40 suspicious lesions (37 pathologically confirmed), while BLC detected 58 apparent tumors (52 pathologically confirmed). So, from the 54 tumors with positive histology, WLC correctly diagnosed 68.5%, with a rate of 7.5% false-positive results, while BLC diagnosed 96.3%, presenting a 10.3% rate of false-positive results. 22 cases of the study group diagnosed with SBT were followed. The tumor recurrence rate after 18 weeks was 4.5% for the study group and 22.7% for the control group. CONCLUSIONS: Hexvix fluorescence cystoscopy is a valuable diagnostic method, with considerably better results by comparison to WLC. The improved diagnostic accuracy may have a significant impact upon the recurrence rate.

Involuntary human bite to the eyebrow.

Human bites to the face are very rare and only one case of human bite to the eyebrow has so far been reported. The final functional and cosmetic result of reconstruction mainly depends on the size of the injury, the viability of the tissue and the promptness of surgical intervention. We here present one case of human bite to the eyebrow that resulted in complete avulsion and loss of tissue due to delayed presentation to the hospital. The lesion was reconstructed in two stages with good functional and decent cosmetic outcome. Unfortunately long term follow up was not possible for this patient.

[Flexible nephroscopy for upper urinary tract pathology]. / Nefroscopia flexibila în patologia caii urinare superioare.

Flexible nephroscopy was introduced in the Urological Department of Saint John Emergency Clinical Hospital in 2002 and rapidly became a routine procedure. During September 2002-October 2006, flexible nephroscopy was performed in 113 patients for: lithiasis (107 cases), uretero-pelvic junction stenosis (3 cases), caliceal diverticulum (1 case), caliceal urothelial tumors (2 cases). In all cases a 24F flexible nephroscope was used. The energy sources consisted in an electrohydraulic lithotripsy device or Ho:YAG/Nd:YAG lasers. The success rate in patients with lithiasis was 94.4%. Antegrade endopyelotomy was successfully performed in all 3 cases. Evaluation at 6, 12 and 18 months revealed a normal pyelocaliceal system in 2 cases and a significant reduction of hydronephrosis in the third one. In the patient with caliceal diverticulum, evaluation at 6 and 12 months described a large communication with the pyelocaliceal system and no lithiasis recurrence. No recurrences occurred in the patients with conservatively treated caliceal urothelial tumors. Minor complications were encountered in 7% of the cases. Flexible nephroscopy decreases the necessity for multiple access trajects, supracostal access trajects or multiple procedures, thus reducing the morbidity associated with percutaneous interventions.

[Role of Doppler ultrasonography in the diagnosis and treatment of varicocele]. / Rolul ecografiei Doppler in evaluarea pacientilor cu varicocel.

Varicocele is a frequent condition in male population. Our objectives were to asses the role of Doppler ultrasonography in varicocele diagnosis, evaluation of surgical outcome and identify predictive factors for infertility. We studied 45 patients (21-46 years old), Doppler ultrasonography being used to determine the stage and reflux grade. In all patients presence of anti-spermatic antibodies was assessed. 27 patients were surgical treated. Postoperatively, presence or absence of reflux was assessed by Doppler ultrasonography. Spermogram was repeated in infertile patients. Our patients presented stage I (12 cases), stage II (18 cases) or stage III varicocele (15 cases). 16 patients (35%) were infertile (12 with grade III and 4 with grade II reflux), in 10 of these patients high levels of anti-spermatic antibodies being detected. Postoperatively, venous reflux was absent in all 27 patients. Among infertile patients, 80% of those younger than 25 years, 42% of those with ages between 25-30 years and none of those over 30 presented postoperative improvements of spermogram. Doppler ultrasonography is a non-invasive investigation for diagnosis, evaluation of venous reflux and detection of intratesticular varicocele. Opportunity of surgical treatment and evaluation of operative outcome can be determined using Doppler ultrasonography.

[Anti-HLA antibody detection and rejection in kidney transplantation: impact of the new technologies]. / Anticorps anti-HLA et rejet en transplantation rénale: impact des nouvelltes techniques de détection.

In kidney transplantation, hyperacute rejection is mediated by anti-HLA antibody which are also responsible for antibody-mediated acute rejection. In addition anti-HLA antibody are also implicated in the physiopathological mechanism of chronic rejection. The gold standard methodology to detect anti-HLA antibody is based on the complement-dependant-cytotoxicity. This technic is neither specific nor sensitive. New powerful technologies, which are specific and very sensitive, have been developed like Elisa and flow cytometer with fluorescent micro-beads to detect anti-HLA antibody. In this article, we review the importance of anti-HLA antibody in humoral rejection. We also discussed the clinical relevance of the detection of anti-HLA antibody by these new approaches.