Resonantly pumped eye-safe Er3+:YAG SPS-HIP ceramic laser.

We report for the first time laser action in resonantly-pumped transparent polycrystalline Er3+:YAG ceramic developed through a 2-step approach combining spark plasma sintering and HIP post treatment. Microstructural and spectroscopic properties, as well as the laser performance of large scale 0.5at.% Er:YAG transparent polycrystalline ceramic are discussed. A maximum slope efficiency of ∼31% and optical-optical efficiency of 20% was measured.

Compositional dependence on the in vitro bioactivity of invert or conventional bioglasses in the Si-Ca-Na-P system.

The bioactivity of 34 invert or conventional glasses in the P-free and P-containing Si-Ca-Na system was evaluated by examining the in vitro Hydroxy Carbonate Apatite (HCA) formation time. The silica content in the glasses varies between 39.48 and 55 mol %. The surfaces of glasses after soaking in simulated body fluid at 37 degrees C were analyzed by Fourier transform infraRed spectroscopy and scanning electron microscopy coupled with energy dispersive spectroscopy. To understand the HCA formation mechanism, the modification of the glass surface structure was studied. The aim was to understand, in the Si-Ca-Na-P system, the function of each constituent on glass reactivity. It was noted that the bioactivity of Si-Ca-Na-P glasses depends on the P ratio. One of the P-free glasses is as bioactive as the Hench's Bioglass noted 45S5, because it needs 12 h to develop HCA as for Hench's one. In the quaternary system, some of the P-rich and Na, Si-poor glasses are more bioactive than 45S5 (6-10 h to obtain HCA). Two phosphorus effects were observed: the repolymerization of the silicate network and the formation of phosphate-modifier cation complexes.

[Male sexual dysfunction and its treatment in neurourology]. / Les dysfonctions sexuelles masculines et leurs traitements en neuro-urologie.

The management of sexual dysfunction has been revolutionized over recent years with the arrival of new treatments for erectile dysfunction. In parallel, groups specialized in neurosexology have gradually emerged in order to improve the patient's fertility. This article presents the disorders most frequently encountered in spinal cord injury and the main approaches to management.

Transcriptional control of thyroglobulin gene expression by cyclic AMP.

Transcription of thyroglobulin (Tg) gene is under the positive control of thyrotropin (TSH). The mechanism of this control has been further investigated. Rats were treated with triiodothyronine (T3) to decrease their endogenous TSH production. Following the intravenous injection of bovine TSH, a 3-fold stimulation of Tg gene transcription could be detected in isolated nuclei as early as 1 h after treatment. The TSH effect was also observed in tissue fragments incubated in vitro under conditions where a concomitant stimulation of cAMP accumulation was detected. Forskolin, a universal activator of adenylate cyclase, was able to mimic TSH action on Tg gene transcription. We conclude that TSH controls transcription of Tg gene directly via its known interaction with receptors on thyrocytes and that cAMP is a physiological mediator of this effect.

Fibroblast growth factor receptor 1 (FGFR1) is over-expressed in benign prostatic hyperplasia whereas FGFR2-IIIc and FGFR3 are not.

OBJECTIVE: Benign prostatic hyperplasia (BPH) is one of the major public health problems among men: 50% of men over 55 are concerned with this disease. Prostate growth is under the control of androgens which act by means of several growth factors such as fibroblast growth factors (FGFs), epidermal growth factor and transforming growth factor beta. Basic FGF (bFGF) has been shown to stimulate prostatic stromal growth. In BPH, bFGF concentration is two- to threefold higher than in normal prostate. In this work, the bFGF receptors (FGFR1, FGFR2-IIIc and FGFR3) genes expression was evaluated to study the correlation between the expression of bFGF receptors and induction of BPH. METHODS: The expression of FGFRs was analyzed by RT-PCR, FGFR1 was localized by immunohistochemistry and protein expression was evaluated by Western blot. RESULTS: A two- to eightfold over-expression of FGFR1 was observed in BPH compared with normal prostates. FGFR1 was localized in the stroma both in BPH and in normal prostates and 1.5- to 2.5-fold over-expression of the protein was observed. The expression of FGFR2-IIIc and FGFR3, more secondary receptors, was not significantly different between BPH and normal prostates. CONCLUSIONS: bFGF receptors and particularly FGFR1 seem to be involved in the induction and evolution of BPH and probably potentiate bFGF over-expression effects in BPH.

Assessment of the efficacy and safety of Viagra (sildenafil citrate) in men with erectile dysfunction during long-term treatment.

Long-term efficacy and safety of sildenafil was assessed in 1008 patients with erectile dysfunction (ED) enrolled in four flexible-dose (25 - 100 mg), open-label, 36- or 52-week extension studies. After 36 and 52 weeks, 92% and 89% of patients felt that treatment with sildenafil had improved their erections. Responses to a Sexual Function Questionnaire indicated that 52 weeks of sildenafil treatment resulted in clinically significant improvements in the duration and firmness of erections, overall satisfaction with sex life, and the frequency of stimulated erections. Commonly reported adverse events (AEs) were headache, flushing, dyspepsia, and rhinitis, which were generally mild to moderate. Reports of abnormal vision were consistent with previous clinical trials. The occurrence of treatment-related cardiovascular AEs, such as hypertension, tachycardia, and palpitation, was <1%. Discontinuations due to treatment-related AEs were low (2%). Long-term therapy does not diminish the efficacy of sildenafil in patients with ED and remains well tolerated.

[Adjuvant radiotherapy after radical prostatectomy. Apropos of a series of 73 patients in Lyons (France)]. / La radiothérapie adjuvante après prostatectomie radicale. A propos d'une série lyonnaise de 73 patients.

PURPOSE: Descriptive analysis of adjuvant radiation therapy after radical prostatectomy. MATERIALS AND METHODS: From 1986 to 1993, 73 patients (median age, 64.5 years; Gleason score > or = 7 : 36 pts; T1:22; T2:40; T3:11) were included into the study. On the operative specimen, the cancer grades were pT2:5 (involvement of the apex), pT3:67, pT4:1, pN1-2:8. Radiation therapy was performed after a mean resting period of 112 days. The target volume was the prostatic area. The technique used was a four-field box with an 18 MV-X photon beam. The dose was 50 Gy/20 fractions/5 weeks. No hormonal treatment was administered, except for 5 patients for a short duration. RESULTS: The median follow up was 46 months. One anastomotic local failure was salvaged by trans-urethral resection, three distant metastatic failures. Out of 72 patients with a PSA < 3 ng/mL at the end of radiotherapy, 13 showed an isolated elevation. The 5-year overall survival rate was 93%. The event-free survival was 72% after 5 years. Pathological differentiation and Gleason score were significantly correlated with the survival. There was no complication related to radiotherapy. CONCLUSION: Elective adjuvant radiation therapy for pT3 prostate adenocarcinoma after radical prostatectomy provides a good local control with minimal morbidity.

Basic fibroblast growth factor and keratinocyte growth factor over-expression in benign prostatic hyperplasia.

The prostate growth is under the indirect control of androgens through the medium of many growth factors. The fibroblast growth factors (FGFs) seem to play an important part in stimulating the development of this organ. In this work, the expression of two FGFs: bFGF (or FGF2) and KGF (or FGF7), was studied in RT-PCR and semi-quantified in densitometry. Both genes expression was increased in BPH in comparison with normal prostates. A two to three times and a 1.5 to four times over-expressions were observed for bFGF and KGF, respectively. An over-expression of these growth factors could lead to a cell multiplication resulting in a pathological development of the prostate size. Moreover, bFGF and KGF act in parallel in the prostate, one stimulating the prostatic stroma and the other one stimulating the epithelium. These two growth factors could participate in the increase of the two tissues constituting the prostate.

[Value of antibody coated bacteria in the localization and follow-up of chronic urinary tract infections (author's transl)]. / Intérêt de la recherche des anticorps fixés sur les bactéries dans la localisation et la surveillance des infections urinaires chroniques.

Antibody coating of urinary bacteria was performed in order to localize the site of recurrent urinary tract infections in 39 para or tetraplegics. The antibody-coated bacteria test was positive with anti human globulin in 19 out of 39 patients: upper urinary tract infections 7/10, prostatitis 3/3, lower urinary tract infections 9/26. Of the 19 patients with positive antibody-coated bacteria test 14 were tested with monospecific antisera: 13 were IgG positive and 11 were IgA positive; IgM was never present. Among the 11 IgA positive tests, we search for the presence of IgA secretory piece in 8 and all were positive. The immunoglobulins on the bacterial wall result, in part, from local production of urinary antibody. Although positive results with anti human globulins occurred frequently in patients with lower urinary tract infections, this test appears to be a useful screening test for localization of infection in patients with recurrent urinary tract infection.

[Structure and expression of thyroglobulin gene]. / Structure et expression du gène de la thyroglobuline.

Thyroglobulin is composed of two 300000 dalton polypeptide chains, translated from an 8000 base mRNA. Preparation of a full length cDNA and its cloning in E. coli have lead to the demonstration that the polypeptides of thyroglobulin protomers were identical. Used as molecular probes, the cloned cDNA allowed the isolation of a fragment of thyroglobulin gene. Electron microscopic studies have demonstrated that this gene contains more than 90% intronic material separating small size exons (less than 200 bp). Sequencing of bovine thyroglobulin structural gene is in progress. Preliminary results show evidence for the existence of repetitive segments. Availability of cloned DNA complementary to bovine and human thyroglobulin mRNA allows the study of genetic defects of thyroglobulin gene expression in the human and in various animal models.

[Analysis of 278 sphincterotomies of the urethral stria in 232 male patients]. / Analyse de 278 sphinctérotomies du strié urétral chez 232 hommes.

The authors report 278 external sphincterotomies performed on 232 male neurological patients, presenting with specific etiologies requiring surgery: vesico-ureteral reflux (33.6%), ureterohydronephrosis (18.9%), and spontaneous hyperreflexia (7.4%). The level of the spinal cord injury was superior to T8 in 32.3% of cases (double the corresponding figure for paraplegic patients) and inferior to L1 in 31.2% (25% more than for paraplegics). Short-term results are good in 70% of cases, in terms of dysuria and infection. Iterative sphincterotomy is required in 19.8% of cases, and surgery of the neck of the bladder is required in 34.8%. In the medium term, 83.7% of the good results show an improvement. Continence is achieved in 14.4%, and 12.2% of the patients are incontinent. The mortality rate was 1%, and 10% of the patients suffered from postoperative hemorrhage. Long-term results show 3.2% of secondary impotence, and 10% of patients requiring urinary diversion.

[Sacral root neuromodulation for the treatment of urinary incontinence reported to detrusor hyperactivity]. / Traitement de l'incontinence urinaire secondaire à une hyperactivité vésicale par neuromodulation sacrée.

BACKGROUND AND PURPOSE: This paper reviews therapeutic sacral neuromodulation for treating urinary urge incontinence related to detrusor hyperactivity. METHODS: We reported data from our department and from the international literature on topics such as the physiological basis of neuromodulation, techniques of testing, chronic implantation and clinical results. RESULTS: In an intention to treat analysis , neuromodulation results varied from 21.5 to 25% globally. On implanted patients, the response rate varied from 40 to 88% and was stable. Sub-chronic test morbidity was very rare. Surgical revision rate was reported from 6.25 to 37.7%. CONCLUSIONS: Neuromodulation strongly ameliorates approximately a third of all the patients with urge urinary incontinence due to detrusor hyperactivity. New technical improvements should lead to better results in the future.

[Sexual examination of spinal cord injured males]. / L'examen sexologique du blessé médullaire.

This article describes the sexual examination of spinal cord injured males. It comprises a clinical interview followed by a neurological exam which purpose is to distinguish the lesion level with respect to sacral and thoracic-lumbar innervation of the genitalia. It also comprises a physiological recording of sexual responses to reflexogenic and psychogenic stimulation. The neurological exam allows prediction of sexual responses in 83% of the cases, while the clinical interview only allows a prediction in 47% of the cases. With this sexual examination it has been possible to determine the sexual capacity of spinal cord injured males, a capacity which is discusses with respect to the lesion level and the type of stimulation inducing erection.

[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.

[Paraclinical explorations of urination disorders in men]. / Explorations paracliniques des troubles mictionnels chez l'homme.

The uroflowmetry is still the only criteria to show and analyse a dysuria unknown by the patient two times out of three. This analysis will allow us to appreciate the follow-up of the desobstruction regarding the therapeutic which has been chosen. The ultrasonography (renal ultrasonography and prostate) can easily detect bladder and renal failures. It provides good information on anatomical and shape of the prostate but less information on urethral obstruction because dynamic ultrasonography is carried out in a few cases. The intravenous pyelography seems to be out of date but it will give the most important parameters to appreciate the urinary problems allowing the analysis of the physiological micturation by voiding urethrography. The retrograd urethrography provides good imaging diagnosis but gives a better image of urethral stenosis in a very important dysuria. It is not appropriate to say that it is an invasive procedure. The endoscopy is very convenient. It could be used during an examination and need no anesthetic to be performed with an optical fibroscope. The urodynamic examination is needed only in a major dysuria without real obstruction or detrusor instability. First the obstruction has to be evaluated by the previous examinations. It could point out that some bladders are hypocontractile and in these cases, surgery will be inappropriate. Also it allows us to test the effectiveness of external sphincter pressure to determine the prognostic of continence and even to treat the incontinence by biofeedback.