Comparative study of open, laparoscopic and endoscopic treatments of intermediate grade vesicoureteral reflux in children.

BACKGROUND: Low-grade vesicoureteral-reflux (VUR) are rather treated by endoscopic injection, whereas open or laparoscopic procedures are mainly performed for high-grade VURs. Management of intermediate grades is controversial and no study focused on grade III to date. This study aims to compare the results of open, laparoscopic, and endoscopic approaches in children with grade III VUR. METHODS: A multicenter comparative retrospective study included children with grade III VUR operated for febrile urinary tract infections (UTIs) from 2007 to 2016. Children without UTI, with reflux of other grades, neurological bladder, duplex system, posterior urethral valves, and bladder exstrophy were excluded. Success was defined as no recurrence of febrile UTI and was presented as event-free survival curves. RESULTS: Out of 806 children operated of VUR, 171 met the inclusion criteria (114 females). Seventy-seven children (45%) underwent an open Cohen procedure, 35 (21%) a laparoscopic Lich-Gregoir and 59 (34%) a submucosal endoscopic injection according to the centers' preference. The mean follow-up was 64 months (24-132). Groups were not different for age, sex, and circumcision status. Compared to Cohen procedure, recurrences of febrile UTI were more frequent after laparoscopic treatment (p = 0,02, 8/35) and endoscopic treatment (p = 0.001, 16/59). Redosurgery was also more frequent after laparoscopy (n = 2) and endoscopic injection (n = 14) than after open surgery (n = 0, p < 0.001). CONCLUSION: Recurrent febrile UTIs and redosurgery are more frequent after endoscopic and laparoscopic procedures in grade III VUR than open reimplantation. Whether the lower morbidity of laparoscopic or endoscopic approaches balances the risk of recurrent febrile UTI remains to be determined for intermediate grade reflux.

Selective separation of peptides contained in a rapeseed (Brassica campestris L.) protein hydrolysate using UF/NF membranes.

The ability of a charged UF membrane to fractionate the small peptides found in a rapeseed protein enzymatic hydrolysate, according to their charge characteristics, was investigated. The complexity of such a hydrolysate has required the setting up of technological alternatives to isolate the small peptides, to obtain a more efficient separation among the numerous peptide species. A preliminary step consisted of precipitation followed by filtration with a 3000 g/mol molecular weight cutoff (MWCO) membrane to obtain a solution concentrated in small peptides. The possibility of fractionating these small peptides by a charged 1000 g/mol MWCO membrane was investigated. The study enabled us to assess the contribution of electrostatic interactions during fractionation. The effect of pH and ionic strength on the peptide transmission was studied. The ionic strength contribution was considered by studying the effect on the selectivity of a desalting step by nanofiltration on a 500 g/mol MWCO membrane. Peptide transmission was lower at pH 9 than pH 4, and it was the lowest at pH 9 and low ionic strength. Ionic strength had a significant influence at pH 9 but showed no influence at pH 4. The amino acid analysis and capillary electrophoresis revealed that negatively charged (acid) peptides were found in lower proportions in the permeate. The opposite trend was observed for basic peptides, whereas neutral peptides were found in the same proportion in the retentate and the permeate. These results can be explained, according to the Donnan theory, by the existence of attractive and repulsive forces at the membrane-solution interface. Selectivity between basic and acid peptides was as high as 1.90 at pH 9 and low ionic strength. A rough sketch of a membrane-based process is proposed to fractionate rapeseed peptide mixtures. Results obtained were reproducible within 10%.

Applicability of predictive models to the peptide mobility analysis by capillary electrophoresis-electrospray mass spectrometry.

The prediction of peptide mobility by capillary electrophoresis (CE) coupled to electrospray mass spectrometry (MS) is studied in order to verify the validity of the semi-empirical models developed in classical CE. This work relies on the experimental determination of the electrophoretic mobilities of 68 peptides, different in charge and in size. The results indicate that the prediction is possible in CE-MS experiments, in spite of the restraints inherent in the coupling conditions. The best fit of experimental data was obtained with the Offord's model. The efficiency of the model was confirmed by the analysis of a peptide mixture in CE-MS.

[Enlarged retro-labyrinthic approach: application to surgery of acoustic neurinoma. Apropos of 55 cases]. / La voie rétro-labyrinthique élargie: application à la chirurgie du neurinome de l'acoustique. A propos de 55 cas.

The enlarged retro-labyrinthic route described here allows opening of the internal auditory canal, exeresis of tumors localized in the ponto-cerebellous angle and in the internal auditory canal. We used this route for 55 neurinomas of the auditory nerve (7.4% stage I, 23.6% stage II, 45.4% stage III and 23.6% stage IV). Most of the tumors in our series were > 2 cm. There were no post-operative deaths. Risk of fistulization was low, 3.8%. Post-operative meningitis (3.8%) regressed rapidly with treatment. Facial function outcome was equivalent to that obtained with the enlarged trans-labyrinthic route and reported in the literature in series treated via the sub-occipital route (83.6% for grades I and II, 11% for grade III). One patient required hypoglosso-facial anastomosis with a grade IV result at 6 months. Auditive function was preserved at a socially acceptable level in 14.5% of the patients and in 21.8% hearing aids were needed. Selecting a subgroup of 25 patients with good quality hearing prior to surgery (< 30 dB) and a tumor invading less than three-fourths of the internal auditory canal, for all tumor sizes, 28% preserved socially acceptable hearing. To these must be added 20% who had some hearing loss which could be corrected. The modulary mature of the retrolabyrinthic route is easily transposable to the trans-labyrinthic rout. Because of the potential for preserving auditive function this technique should replace the less flexible sub-occipital route.

Increase in blood plasma levels of boron and strontium in hemodialyzed patients.

Boron and strontium concentrations in blood plasma of controls and hemodialyzed patients from two Centers were determined by inductively coupled plasma emission spectrometry. Boron concentrations in blood plasma were respectively, in controls 2.6 +/- 0.9 mumol/l and in hemodialyzed patients 16.1 +/- 5.6 mumol/l before the dialysis session and 9.5 +/- 3.2 mumol/l at the end. The decrease in blood plasma during the dialysis was concomitant with an increase in the dialysis fluid (1.2 +/- 0.7 mumol/l at the beginning and 4.6 +/- 1.8 mumol/l at the end). Strontium concentrations in blood plasma were respectively, in controls 0.22 +/- 0.06 mumol/l and in hemodialyzed patients 0.62 +/- 0.24 mumol/l before the dialysis session and 0.64 +/- 0.14 mumol/l at the end. The mean concentration of strontium in the dialysis fluid was the same before (0.49 +/- 0.11 mumol/l) and after the dialysis session (0.49 +/- 0.10 mumol/l), but a transfer between plasma and dialysis fluid was shown by individual changes. Some considerations about these results are put forward but their possible clinical consequences are not yet known.

Blood plasma fluoride in haemodialysed patients.

Blood plasma fluoride was determined in 15 chronic haemodialysed patients (60.2 +/- 7.2 yr old) before and after a 4-h dialysis using dialysates with very low fluoride level, and in two control groups, the first of 20 healthy younger subjects (45.9 +/- 3.4 yr old), the second of 8 healthy older subjects (69.1 +/- 6.8 y old). Before haemodialysis the fluoride concentration (1.31 +/- 0.31 mumol/l; 24.8 +/- 5.9 micrograms/l), was higher than in both control groups (0.35 +/- 0.16 mumol/l; 6.6 +/- 3.1 micrograms/l and 0.44 +/- 0.16 mumol/l 8.4 +/- 3.0 micrograms/l, respectively). During dialysis, the mean fluoride concentration fell to 0.94 +/- 0.26 mumol/l, remaining however, significantly higher than in control subjects. The use of fluoride-free dialysates seems to partially compensate the effect of renal impairment since plasma fluoride is only moderately increased in these patients.