Treatment outcomes of bladder stones in children with intact bladders in developing countries: A systematic review of >1000 cases on behalf of the European Association of Urology Bladder Stones Guideline panel.

INTRODUCTION: Bladder stones (BS) are still endemic in children in developing nations and account for a high volume of paediatric urology workload in these areas. The aim of this systematic review is to comparatively assess the benefits and risks of minimally invasive and open surgical interventions for the treatment of bladder stones in children. METHODS: This systematic review was conducted in accordance with Cochrane Guidance. Database searches (January 1970- March 2021) were screened, abstracted, and assessed for risk of bias for comparative randomised controlled trials (RCTs) and non-randomised studies (NRSs) with >10 patients per group. Open cystolithotomy (CL), transurethral cystolithotripsy (TUCL), percutaneous cystolithotripsy (PCCL), extracorporeal shock wave lithotripsy (ESWL) and laparoscopic cystolithotomy (LapCL) were evaluated. RESULTS: In total, 3040 abstracts were screened, and 8 studies were included. There were 7 retrospective non-randomised studies (NRS's) and 1 quasi-RCT with 1034 eligible patients (CL: n=637, TUCL: n=196, PCCL: n=138, ESWL: n=63, LapCL n=0). Stone free rate (SFR) was given in 7 studies and measured 100%, 86.6%-100%, and 100% for CL, TUCL and PCCL respectively. CL was associated with a longer duration of inpatient stay than PCCL and TUCL (p<0.05). One NRS showed that SFR was significantly lower after 1 session with outpatient ESWL (47.6%) compared to TUCL (93.5%) and CL (100%) (p<0.01 and p<0.01 respectively). One RCT compared TUCL with laser versus TUCL with pneumatic lithotripsy and found that procedure duration was shorter with laser for stones <1.5cm (n=25, p=0.04). CONCLUSION: In conclusion, CL, TUCL and PCCL have comparable SFRs but ESWL is less effective for treating stones in paediatric patients. CL has the longest duration of inpatient stay. Information gathered from this systematic review will enable paediatric urologists to comparatively assess the risks and benefits of all urological modalities when considering surgical intervention for bladder stones.

Major adverse cardiovascular events associated with VEGF-targeted anticancer tyrosine kinase inhibitors: a real-life study and proposed algorithm for proactive management.

BACKGROUND: Vascular endothelial growth factor receptor (VEGFR)-targeted tyrosine kinase inhibitors (TKIs) are widely used in cancer treatment and burdened by cardiovascular toxicity. The majority of data come from clinical trials, thus in selected populations. The aim of our study is to evaluate the cardiotoxicity profile of VEGFR-targeted TKIs and the impact of cardiovascular risk factors in a real-life population. PATIENTS AND METHODS: In this cohort, population-based study, patients treated with VEGFR-targeted TKIs, bevacizumab and trastuzumab between 2009 and 2014 were analyzed. A multi-source strategy for data retrieval through hospital, pharmaceutical and administrative databases of the Lombardy region, Italy, has been adopted. The primary endpoint was to determine the incidence and type of major adverse cardiovascular events (MACEs) along with their temporal trend. The secondary endpoint was to define the impact of cardiovascular risk factors in the occurrence of MACEs. RESULTS: A total of 829 patients were treated with VEGFR-targeted TKIs. Eighty-one MACEs occurred in the first year of follow-up [crude cumulative incidence (CCI): 9.79%] mainly consisting of arterial thrombotic events (ATEs, 31 events, CCI: 3.99%), followed by rhythm disorders (22 events, CCI: 2.66%), pulmonary embolisms and heart failures (13 events each, CCI: 1.57%). While the incidence of most MACEs showed a plateau after 6 months, ATEs kept increasing along the year of follow-up. Hypertension and dyslipidemia were associated with an increase in risk of ATEs [relative risk difference (RRD) +209.8% and +156.2%, respectively], while the presence of previous MACEs correlated with a higher risk of all MACEs in multivariate analysis (RRD 151.1%, 95% confidence interval 53.6% to 310.3%, P < 0.001). CONCLUSIONS: MACEs occur in a clinically significant proportion of patients treated with VEGFR-targeted TKIs, with ATEs being predominant, mainly associated with hypertension and dyslipidemia. A clinical algorithm for effective proactive management of these patients is warranted.

Efficacy and efficiency of Green-Light XPS 180-watt laser system for benign prostatic enlargement in patients treated with 5α-reductase inhibitors.

OBJECTIVE: Aim of the study was to evaluate efficacy and efficiency of 180-watt Green-Light XPS (GL-XPS) laser photoselective vaporization of the prostate (PVP) in patients under 5-Alpha-Reductase Inhibitors (5ARI) treatment. PATIENTS AND METHODS: A consecutive series of patients with lower urinary tract symptoms due to benign prostatic enlargement treated by PVP with the GL-XPS were enrolled. Patients were divided in two groups according to the chronic use (>6 months) of 5ARI. These two groups were compared on lasing density (kilojoules per prostate volume), vaporization efficiency (prostate volume per lasing time), vaporization power (kilojoules per lasing time), Prostate Specific Antigen (PSA) reduction from baseline, symptom score change from baseline and uroflowmetry parameters improvement. Follow-up was performed at 3, 6 and 12 months with International Prostate Symptom Score, Uroflowmetry parameters and PSA. RESULTS: Overall 193 patients were enrolled. Out of them 87/193 (45%) were on 5ARI treatment. No significant differences were recorded between the two groups at baseline. Median age was 68 years old and median prostate volume was 60 ml. In terms of laser efficiency, no statistically significant differences were recorded in terms of lasing time (25 min vs. 24.5 min; p>0.05); energy used (250 kJ vs. 221 kJ; p>0.05), lasing density (6.8 kJ/ml vs. 6.6 kJ/ml, p>0.05), vaporization efficiency (1.4 ml/min vs. 1.3 ml/min, p>0.05) and vaporization power (9.6 kJ/min vs. 9.4 kJ/min; p>0.05). Finally, no significant differences were also recorded postoperatively in the two groups in terms of PSA reduction, improvement in symptom score and uroflowmetry parameters (p>0.05). CONCLUSIONS: Thirty-seven efficacy and efficiency outcomes were not statistically different between the two groups. 5ARI does not reduce the performance and ability of the 180-watt Green-Light XPS laser system.

[The effect of corifollitropin alfa on in vitro fertilization-ICSI patients with previous failure with an FSH/HMG protocol: Preliminary report in Mexico]. / Efecto de la corifolitropina alfa en pacientes de fertilización in vitro-ICSI con falla previa en un protocolo de FSH/HMG: experiencia preliminar en México.

BACKGROUND: The daily application of drugs, often in high doses, is a factor of stress for the infertile couple. During the last decade corifollitropin alpha has allowed a friendlier scheme comparable to traditional protocols (rFSH-HMG) results. OBJECTIVE: To compare the results of corifollitropin alpha in patients with a previous cycle of IVF-ICSI with traditional scheme ovarian stimulation. MATERIALS AND METHODS: Observational, retrospective cohort study type that infertile couples were included. RESULTS: No significant differences in the dose used HFRS (2023U/ total ± 712 vs 636 U/total ± 307) and serum estradiol day shooting HGCr (1972 pg/dL vs 1107 ± 1152 pg/dL ± 775). A higher pregnancy rate was found corifollitropin alpha perhaps because it was a second attempt at in vitro fertilization. CONCLUSIONS: Reproductive outcomes in a cycle of ovarian stimulation with corifollitropin are comparable with the results of a traditional ovarian stimulation cycle. It is important to broaden the experience of the drug indication in Mexican patients.

Comparative study of select biochemical markers in cerebrospinal fluid of healthy dogs before and after treatment with nutraceuticals.

BACKGROUND: Several studies indicate that changes in cerebrospinal fluid (CSF) composition depend on the disease stage and reflect modification of brain energy metabolism (BEM). Also, it has been reported that a decline in cognitive functions may be mitigated by incorporating nutraceuticals in the diet. OBJECTIVE: Assuming the beneficial effect of nutraceuticals on BEM and oxidative damage, the aim of this study was to determine if the administration of a nutraceutical compound results in changes of select CSF biomarkers in healthy adult Beagle dogs. METHODS: Two separate CSF and blood samples were obtained from 11 healthy adult Beagle dogs, before and after 50 days of treatment with a veterinary combined nutraceutical. CSF analysis included a total nucleated cell count, total protein, glucose, sodium, chloride, potassium, pyruvate, and lactate concentrations, and calculation of lactate/pyruvate ratio. CBC and serum biochemistry were also performed. The Wilcoxon test was used to analyze the significance of the changes after nutraceutical treatment. RESULTS: All studied variables remained within reference intervals, before and after treatment. A significant increase in CSF sodium and glucose concentration, and a decrease in lactate levels, was observed after treatment (P < .05), and the lactate/pyruvate ratio was decreased after treatment (P = .05). In serum, sodium and chloride concentrations were significantly increased (P < .05), and creatinine concentration was significantly decreased (P < .05) after treatment. CONCLUSIONS: After 50 days of treatment with a nutraceutical compound, CSF glucose, sodium, and lactate concentrations, and L/P ratio were significantly different, suggesting an influence of nutraceuticals' administration on CSF composition.

Muscular dystrophy with reduced beta-sarcoglycan in a cat.

A partial beta-sarcoglycan (SG) deficiency with retention of other components of the SG complex (SGC) is described in 6-month-old, intact male domestic shorthaired kitten that was referred for evaluation of weakness, reluctance to move and dyspnoea. Neurological deficits were restricted to the neuromuscular system. Muscle biopsy revealed moderate variability in myofibre size, with numerous atrophic rounded fibres, rare myofibre necrosis, regeneration and moderate perimysial and endomysial fibrosis. Immunohistochemistry revealed decreased expression of beta- and gamma-SG and western blotting revealed markedly decreased beta-SG with normal expression of alpha-, gamma- and delta-SG, caveolin-3 and calpain-3. Sarcoglycanopathy has not previously been described in cats. In human and canine sarcoglycanopathies the deficiency in any one of the SGs leads to secondary deficiency of the entire SGC. Such spontaneously arising muscular disease in animals can provide valuable models for equivalent human disorders.

[Assessment of patient's comfort and functioning of a totally implantable venous system placed in the safenous vein]. / Valutazione del comfort del paziente e della funzionalità di un sistema totalmente impiantabile venoso posizionato in vena safena.

BACKGROUND: When venous system of superior vena cava is not useful or when chest wall is not utilizable to place a reservoir, saphenous vein can be utilized for totally implantable venous access device (TIVAD) placement. Aim of this work is to establish the best location of the reservoir for the function and the comfort of the patient. PATIENTS AND METHODS: All the patients submitted to TIVAD placement from January 1995 to October 2004 at the Department of Surgical Science, Organs Transplantations and Advanced Technologies of University of Catania have been considered to the present study. Age, sex, kind of disease, surgical procedure, early and late complications, function of the system and comfort to the patients in relation to the different site of reservoir placement have been studied. RESULTS: 447 TIVAD have been implanted in 258 males and 189 females aged from 31 to 79 years in the period considered for the study. Solid tumors represent the majority of the indications and all the TIVAD have been implanted by surgical cutdown to avoid all the early complications related to the percutaneous approach. Two patients received their TIVAD using saphenous vein by surgical cut-down, and no early complications have been recorded. The reservoirs have been placed respectively: in the chest wall in the first patient; and in the anterior wall of the abdomen, close to the anterosuperior iliac crest, firstly and later in the anterolateral face of the thigh in the second one. The first patient had non complications instead the second one referred discomfort with both reservoir locations. CONCLUSIONS: For the comfort of the patient related to the reservoir position in case of saphenous vein utilization chest wall should represent the best studies are required to validate the appropriate reservoir location.

Adsorption of triblock copolymers and their homopolymers at laponite clay/solution interface. Role played by the copolymer nature.

The adsorption thermodynamics of copolymers, based on ethylene oxide (EO) and propylene oxide (PO) units, at the laponite (RD) clay/liquid interface was determined at 298 K. The copolymer nature was tuned at molecular level by changing the hydrophilicity, the architecture and the molecular weight (Mw) keeping constant the EO/PO ratio. Polyethylene (PEGs) and polypropylene (PPGs) glycols with varying Mw and their mixture were also investigated to discriminate the role of the EO and the PO segments in the adsorption process. Enthalpies of transfer of RD, at fixed concentration, from water to the aqueous macromolecule solutions as functions of the macromolecule molality were determined. They were treated quantitatively by means of a model based on two equilibria: (1) one-to-one binding between the macromolecule and the site on the solid and (2) two-to-one binding following which one macromolecule interacts with another one adsorbed onto the solid. The good agreement between the equilibrium constants obtained from calorimetry and those determined from kinetic experiments confirmed the reliability of the experimental and theoretical approaches. Almost all of the systems investigated are highlighted by the one-to-one binding; the L35 and 10R5 systems present both equilibria. The insights provided by the thermodynamics of adsorption of their homopolymers onto RD were fruitful in obtaining detailed information on the nature of the forces involved between RD and the copolymers. The data obtained in the present work clearly evidenced that for comparable polymer Mw, PPG is more suitable in building up a steric barrier around the RD particles and, indeed, exhibits several advantages and no drawbacks. Moreover, the parent copolymers may properly functionalize the RD surface by exploiting both their high affinity to the solid surface and the ability to self-assemble onto it as L35 and 10R5 clearly showed.

[Ultrasonographic evaluation of timing in emergency cervical cerclage]. / Valutazione ecografica del timing nel cerchiaggio cervicale d'emergenza.

The aim of the present paper is to utilise endovaginal ultrasonography as an instrument for establishing the most appropriate moment for carrying out cervical cerclage after interrupting uterine contractions in a situation of near miscarriage. A patient at 20 weeks and 4 days of gestation, with contractions, integral membranes and complete dilatation, was laid in the Trendelemburg position, keeping the bladder moderately full, and given tocolytic therapy. After 14 days cerclage was carried out on a reconstituted neck. At 37 weeks and 1 day, the patient delivered a female newborn weighing 3.100 g. The Trendelemburg position, the moderately full bladder and tocolytic therapy with endovaginal ultrasonographic monitoring can move the timing of surgery forward so as to render it safer and more useful for prognostic purposes.

Muerte debida a lesiones no jerarquizadas en los politraumatismos con lesiones predominantes en el cráneo / Death caused by non ranked injuries in politraumatism with prevailing skull injuries

Alrededor del 20 por 100 de los traumatismos craneoencefálicos van acompañados de otros traumatismos diversos (torácicos, cervicales). La detección precoz de estas lesiones y la reducción del tiempo entre el traumatismo y el posible tratamiento en un centro calificado, con medio de transporte adecuado y asistencia durante el mismo, hacen que hoy en día los traumatismos sean más manejables y de mejor pronóstico. Se presenta el caso de una paciente que sufrió un politraumatismo con las lesiones más significativas en el cráneo debido a que el automóvil en que viajaba fue embestido por un ferrocarril, falleciendo como consecuencia de un shock hipovolémico que no fue detectado. Se ilustra a los médicos forenses sobre los signos que deben buscarse en la operación autopsia para diferenciar la real causa de muerte y a los médicos emergentólogos y anestesistas que signos y síntomas se deben jerarquizar para el correcto diagnóstico y tratamiento (AU)

Around 20 % of the cranioencephalic traumas were accompanied by various different traumatisms (chest, neck). The early detection of these injuries and a reductiva in the time between the traumatism and possible treatment in a qualified center, with adequate means of transport and assistance, make it easier to deal with traumatism and enable better prognosis. We reported the case of a patient who suffered a politraumatism in which the most important injuries were to the skull due to the fact that the car in which she was travelling was hit by a train, with the patient dying as a consequence of a hipovolemic shock which was not detected. We illustrate for forensic Physicians the signs that must be found in the autopsy, to distinguish the real cause of death; and for emergentology doctors and anesthesists what symptoms and signs must be ranked for correct diagnosis and treatment (AU)

CD 34 expression in chronic and neoplastic liver diseases.

BACKGROUND: Capillarisation of hepatic sinusoids is a well recognized phenomen occurring in long standing liver disease, in hepatic cirrhosis as well as in hepatocellular carcinoma. To study immunohistochemically the expression and distribution of CD34 in chronic liver disease and hepatocellular carcinoma in order to evaluate the possible diagnostic implication of this marker. METHODS: Sixty-five samples of liver tissue showing normal liver, different degrees of chronic inflammation, cirrhosis and histological features of hepatocellular adenoma and carcinoma (HCC) were included in the study. The specimens were fixed in formalin and embedded in paraffin and an immunohistochemical investigation was performed by the standard avidin-biotin-peroxidase complex method with CD34. RESULTS: The sinusoids of normal liver showed no immunoreactivity. The sinusoids of liver affected by different degrees of chronic active hepatitis showed no or focal immunostaining for CD34; an increased immunoreactivity was observed in the periportal sinusoids of the cirrhotic nodules whereas diffuse and strong staining was observed in the overall HCC as well as in the hepatocellular adenoma tested. CONCLUSIONS: In HCC, immunoreactivity for CD34 represents an effective method to evaluate angiogenesis and to distinguish well-differentiated HCC from non-neoplastic liver. Its role in clinical stage and prognostic evaluation needs further investigation.

Development of muscle pathology in canine X-linked muscular dystrophy. II. Quantitative characterization of histopathological progression during postnatal skeletal muscle development.

We have characterized the time course of muscle pathology development during the postnatal maturation of quadriceps and tibialis anterior muscle in dystrophic golden retriever dogs. We determined the percentages of degenerating, regenerating, calcium-positive, hypercontracted, albumin-positive, and C3 complement fraction-positive muscle fibers and the extent of connective tissue proliferation in animals from neonate to adult. Necrotic fibers increased from days 2 to 30, decreased at 60 days (to 0.8%) and increased in older animals to a stable level of around 2%. Hypercontracted fibers peaked at 15 days (19.1%) and declined to 3.7% in adults. Regenerating fibers were numerous at 15 and 30 days (10%), declined at 60 days to 4.7% and declined further in adults. Calcium- and albumin-positive fibers peaked at 30 days (6.5% and 13.8%, respectively) and then declined to around 3% and 5%, respectively, in older dogs. In dystrophic dogs, the extent of fibrosis was significantly greater on 15 days than in controls, but did not then increase with age. In carriers, calcium- and albumin-positive fibers always expressed dystrophin abnormally. Muscle damage occurs before completion of muscle maturation in dystrophic dogs. While necrosis and hypercontraction remain stable in adults, fiber regeneration declines to very low levels. In contrast to Duchenne muscular dystrophy, muscle fibrosis in the muscle studied does not increase with age.

Effects of non-ionic micelles on transient chaos in an unstirred Belousov-Zhabotinsky reaction.

The behaviour of the Ce(IV)-catalyzed Belousov-Zhabotinsky (BZ) system has been monitored at 20.0 degrees C in unstirred batch conditions in the absence and presence of different amounts of the non-ionic micelle-forming surfactants hexaethylene glycol monodecyl ether (C10E6) and hexaethylene glycol monotetradecyl ether (C14E6). The influence of the non-ionic surfactants on both the kinetics of the oxidation of malonic acid (MA) by Ce(IV) species and the behaviour of the BZ reaction in stirred batch conditions has also been studied over a wide surfactant concentration range. The experimental results have shown that, in unstirred batch conditions, at surfactant concentrations below the critical micelle concentration (c.m.c.) no significant change in the dynamics of the Belousov-Zhabotinsky system occurs. Beyond this critical concentration the presence of micelles forces the BZ system to undergo a chaos-->quasi-periodicity-->period-1 transition. Thus, the surfactant concentration has been considered as a bifurcation parameter for a Ruelle-Takens-Newhouse (RTN) scenario. Addition of increasing amounts of non-ionic surfactants has no significant effect on the kinetics of the reaction between MA and Ce(IV), but it influences the oscillatory parameters of the stirred BZ system. At surfactant concentrations below the c.m.c. all the oscillatory parameters are practically unaffected by the presence of surfactant, while beyond this critical value the induction period is the same as in aqueous solution but both the oscillation period and the duration of the rising portion of the oscillatory cycle decrease. In all cases, the experimental trends have been ascribed to the enhancement in the medium viscosity due to the presence of micelles.

Multimodal therapy of hepatocarcinoma: personal experience on 90 cases.

BACKGROUND/AIMS: In recent years, surgical and non-surgical options have been developed in the treatment of hepatocellular carcinoma in cirrhotic patients. We review our personal series from 1995-1999, in order to assess the choice of treatment. METHODOLOGY: Of 90 cases of hepatocellular carcinoma observed in the years 1995-1999, 15 underwent curative resective surgery; in 42 cases TAE, PEI or RITA were utilized (9 of them as multimodal therapy). In the remaining 33 patients any kind of therapy was scheduled. RESULTS: The mean survival of the 15 resected patients was 18 months, non-statistically better than RITA survival, compared by Log-Rank test. Perioperative mortality calculated in all procedures was 5.2% (2 pts surgery, 1 pt TAE). CONCLUSIONS: The high percentage of not treated hepatocellular carcinomas in our series is generally due to large tumor size diagnosed in advanced Child's stage. PEI, TAE and RITA have to be considered effective and safe for palliation for HCCs. However, surgical resection represents the curative therapy in selected cirrhotic patients affected by HCC.

Totally implantable venous access device inserted during major abdominal operations for cancer. A new technique.

Totally implantable venous access devices are usually implanted by surgical cut-down technique or by percutaneous approach, after a first surgical procedure. The authors describe a new surgical approach utilizing the right gonadal vein or the vena cava for totally implantable venous access device placement in patients submitted to major digestive surgical procedures for tumors. This new surgical approach allows one to avoid a second operative procedure.

[Migration of the catheter of a totally implantable venous system. A rare mechanical complication]. / Migrazione del catetere di un sistema totalmente impiantabile. Una rara complicanza meccanica.

Catheter migration, represents a rare, mechanical complication following the use of totally implantable venous devices. A case, in which the catheter was inserted into the right internal jugular vein by percutaneous route, without radiological control, is described. Following the chemotherapy infusion drugs, the patient developed a catheter displacement and subcutaneous extravasation. Etiological hypotheses and modalities of prevention are discussed.

Feasibility of a porto-intracaval shunt for liver total vascular exclusion in the rabbit: preliminary report.

The animals do not tolerate prolonged caval and/or portal clamping which induces negative pathophysiological events such as release of kinins, damage of the intestinal mucosa, and bacterial translocation. In human liver surgery, these problems have been solved by bio-pump for veno-venous bypass. In order to find a simple method to reproduce a veno-venous bypass, we developed the porto-intracaval shunt and used it in six adult rabbits. The shunt tested was a self constructed 7-french polyurethane shunt modeled as an inverted Y. The inferior vena cava vein below the diaphragm and below the liver and the portal vein were gently dissected. The two longer branches of the shunt were inserted in the cava vein, while the remaining branch of the Y shunt was inserted in the portal vein. After clamping the hepatic artery, the liver was partially resected in three animals and after 60 min the shunt was removed. The insertion of the shunt was always easy and the animals tolerated well the procedure and the anhepatic phase. Our study has been performed in order to test especially the technical feasibility of this shunt in an effort to reduce portal and caval stasis during the anhepatic phase of the surgical procedures that require caval and portal clamping. The technical feasibility has been obtained but we believe that the materials and dimensions of the shunt have to be perfected and adapted depending on the size of the cava and portal veins.