Penile prosthesis implantation: A single center 25 years of experience.

OBJECTIVES: We analyzed the long-term results of malleable and inflatable penile prosthesis: the rates of complications, revision surgery and patient satisfaction. MATERIALS AND METHODS: Between January 1996 and December 2020, a total of 138 patients underwent implantation of a malleable or inflatable types penile prosthesis. The data of the patients were derived from the patient files and digital recording system. The patients were contacted face-to-face interaction if possible. If it is not possible, phone connection was made. RESULTS: The median age of patients was 56 (21-83) years. Fourteen (10.2%) 1-piece, 46 (33.3%) 2-piece and 78 (56.5%) 3-piece penile prosthesis were implanted. The mostly used perioperative antibiotic was teicoplanin+amikacin in 107 patients. Total complication rate was 30% (n=42). Prosthesis infection constituted 9% (n=13) of these complications. The total satisfaction rate was 89.1%. There was no correlation between the complications and antibiotic regimen or prosthesis type (P=0.488, P=0.454, respectively). The rate of infection showed a slight increase in 3-piece penile prosthesis without any statistically significance (P=0.633). The patients with complications expressed more dissatisfaction compared to those without complications (P=0.001). CONCLUSIONS: In our series, penile prosthesis implantation seems to be a recommended treatment method with high patient satisfaction in the treatment of refractory erectile dysfunction. LEVEL OF EVIDENCE: 4.

La densidad de los ganglios linfáticos en la linfadenectomía retroperitoneal como marcador novel para predecir la recurrencia en pacientes con cáncer testicular de células germinales: estudio de casos y controles y experiencia clínica a largo plazo de un hospital de referencia terciario / Lymph node density in retroperitoneal lymph node dissection as a novel marker for predicting recurrence in patients with germ cell testicular cancer: A case-control study and long-term clinical experience of a tertiary referral hospital

INTRODUCCIÓN Y OBJETIVOS: El objetivo de este estudio retrospectivo fue analizar la densidad de los ganglios linfáticos (GL) en la disección de los GL retroperitoneales (DGLRP) para evaluar la masa residual tras quimioterapia como factor predictivo de recurrencia en pacientes con cáncer testicular de células germinales (CTCG). MATERIALES Y MÉTODOS: Se revisaron retrospectivamente los datos de 185 pacientes operados por CTCG entre diciembre del 2004 y febrero del 2017. Se calculó la densidad de los GL. Los pacientes se compararon estadísticamente en términos de características demográficas, características tumorales, niveles de marcadores tumorales séricos, estrategias de tratamiento y resultados patológicos según los subtipos de CTCG. Se realizó un análisis de correlación para determinar los parámetros relacionados con la enfermedad recurrente. RESULTADOS: La mediana de seguimiento fue de 79 (31-179) meses y la mediana de edad de los pacientes fue de 23 (16-71). El tamaño medio del tumor fue de 4 (1-18) cm. Cinco (2,7%) pacientes tenían enfermedad metastásica en el momento del diagnóstico inicial. Se detectó seminoma, TCG no seminomatoso y CTCG de tipo mixto en 62 (33,5%), en 60 (32,4%) y en 63 (34,1%) pacientes, respectivamente. Tras la orquiectomía inguinal, 48 (25,9%) pacientes recibieron seguimiento, 126 (68,1%) pacientes se sometieron a quimioterapia y 11 (5,9%) pacientes recibieron radioterapia. Un total de 21 (11,4%) pacientes se sometieron a DGLRP posquimioterapia. Se observó recurrencia precoz y tardía en 3 (1,6%) y 2 (1,1%) pacientes, respectivamente. Se encontró una correlación negativa leve/moderada, pero significativa, entre la recurrencia y el número de GL con depósitos metastásicos y la densidad de los GL (r = -0,490, p = 0,024 y r = -0,450, p = 0,041, respectivamente). CONCLUSIONES: Hubo una correlación negativa entre el número de GL con depósitos metastásicos y la densidad de GL con la enfermedad recurrente

INTRODUCTION AND OBJECTIVES: In this retrospective study, we aimed to evaluate lymph node (LN) density in retroperitoneal lymph node dissection (RPLND) to analyze whether residual mass after chemotherapy might behave as predicting factor for recurrence in patients with germ cell testicular cancer (GCTC). MATERIALS AND METHODS: The data of 185 patients that were operated between 12/2004 and 02/2017 because of GCTC were reviewed retrospectively. LN density was calculated. The patients were compared statistically in terms of demographic features, tumor characteristics, serum tumor marker levels, treatment strategies, and pathological results according to GCTC subtypes. Correlation analysis was performed to determine the parameters related to recurrent disease. RESULTS: The median follow-up was 79 (31-179) months and the median age of the patients was 23 (16-71). The median tumor size was 4 (1-18) cm. Five (2.7%) patients had metastatic disease at initial diagnosis. Seminoma, non-seminomatous-GCT and mix type-GCTC was detected in 62 (33.5%), 60 (32.4%) and 63 (34.1%) patients, respectively. Following inguinal orchiectomy, 48 (25.9%) patients underwent follow-up, 126 (68.1%) patients underwent chemotherapy and 11 (5.9%) patients underwent radiotherapy. A total of 21 (11.4%) patients underwent post-chemotherapy RPLND. Early and late recurrence was seen in 3 (1.6%) and 2 (1.1%) of the patients, respectively. A mild to moderate, negative, but significant correlation was found between the recurrence and the number of LNs containing metastatic deposits and LN density (r = -0.490, P = .024 and r = -0.450, P=.041, respectively). CONCLUSIONS: There was a negative correlation between the number of LNs containing metastatic deposits and LN density and recurrent disease

Lymph node density in retroperitoneal lymph node dissection as a novel marker for predicting recurrence in patients with germ cell testicular cancer: A case-control study and long-term clinical experience of a tertiary referral hospital. / La densidad de los ganglios linfáticos en la linfadenectomía retroperitoneal como marcador novel para predecir la recurrencia en pacientes con cáncer testicular de células germinales: estudio de casos y controles y experiencia clínica a largo plazo de un hospital de referencia terciario.

INTRODUCTION AND OBJECTIVES: In this retrospective study, we aimed to evaluate lymph node (LN) density in retroperitoneal lymph node dissection (RPLND) to analyze whether residual mass after chemotherapy might behave as predicting factor for recurrence in patients with germ cell testicular cancer (GCTC). MATERIALS AND METHODS: The data of 185 patients that were operated between 12/2004 and 02/2017 because of GCTC were reviewed retrospectively. LN density was calculated. The patients were compared statistically in terms of demographic features, tumor characteristics, serum tumor marker levels, treatment strategies, and pathological results according to GCTC subtypes. Correlation analysis was performed to determine the parameters related to recurrent disease. RESULTS: The median follow-up was 79 (31-179) months and the median age of the patients was 23 (16-71). The median tumor size was 4 (1-18) cm. Five (2.7%) patients had metastatic disease at initial diagnosis. Seminoma, non-seminomatous-GCT and mix type-GCTC was detected in 62 (33.5%), 60 (32.4%) and 63 (34.1%) patients, respectively. Following inguinal orchiectomy, 48 (25.9%) patients underwent follow-up, 126 (68.1%) patients underwent chemotherapy and 11 (5.9%) patients underwent radiotherapy. A total of 21 (11.4%) patients underwent post-chemotherapy RPLND. Early and late recurrence was seen in 3 (1.6%) and 2 (1.1%) of the patients, respectively. A mild to moderate, negative, but significant correlation was found between the recurrence and the number of LNs containing metastatic deposits and LN density (r= -0.490, P=.024 and r= -0.450, P=.041, respectively). CONCLUSIONS: There was a negative correlation between the number of LNs containing metastatic deposits and LN density and recurrent disease.

Successful Treatment of Renal Infiltration Complicated by Atypical Hemolytic Uremic Syndrome in a Leukemic Child.

Renal infiltration in children with acute leukemia has been reported previously; however, it has rarely been described in association with atypical hemolytic uremic syndrome (aHUS). We present a case of 9-year-old boy who developed life-threatening aHUS in the 1st week of Burkitt leukemia/lymphoma diagnosis with renal infiltration. Complete resolution of aHUS was achieved after therapeutic plasma exchange. This is an uncommon complication of Burkitt leukemia/lymphoma in a pediatric case.

Frequencies of ADH1C alleles and genotypes in a Turkish head and neck cancer population.

Squamous cell carcinoma of the head and neck (SCCHN) have been reported to be related to both genetic and environmental factors, including alcohol consumption and alcohol-metabolizing enzymes such as alcohol dehydrogenase (ADH). We conducted a hospital-based, case-control study including 50 cases with diagnosed SCCHN and 100 controls with non-neoplastic conditions such as upper respiratory tract infection. The genomic DNA was isolated from peripheral blood leukocytes. The ADH1C*1 wild-type and ADH1C*2 variant alleles were analyzed with an RFLP method by using SspI as restriction enzyme. The ADH1C*1 allele frequencies were 0.89 (CI95% = 0.84-0.91) in controls and 0.77 (CI95% = 0.71-0.83) in cases, and respective frequencies of the ADH1C*2 allele were 0.11 (CI95% = 0.07-0.14) and 0.23 (CI95% = 0.17-0.29) among controls and cases (P = 0.01). The ADH1C*1/*1 genotype frequency was significantly higher in the control group (77%) compared to that of the cases (58%) (P = 0.02).These findings suggest that a lower presence of ADH1C*1 allele is associated with SCCHN, but larger numbers are needed to more precisely estimate the interaction, if any, with ADH1C. Interestingly, the ADH1C allele and genotype frequencies in our control group living in Denizli were significantly different compared to a previously published report from healthy volunteers living in Ankara (P < 0.0001).

Peak expiratory flow monitoring to screen for asthma in patients with allergic rhinitis.

AIM: To investigate the benefit of using peak expiratory flow (PEF) monitoring to screen for asthma in allergic rhinitis patients. METHODS: Eighty-nine consecutive patients with allergic rhinitis but never assessed for asthma were included in this prospective study. Their allergic status was determined by skin prick tests. All of the subjects filled in a questionnaire on asthma-like symptoms. If they reported such symptoms, pulmonary function tests were carried out. Then, PEF was checked twice daily for 3 weeks. RESULTS: Thirty-six percent of our study group were male and 64% were female patients with a mean (SD) age of 36.3 (14.0) years. Skin prick tests were positive to grass mixture in 71 (79.8%) patients, to tree mixture in 51 (57.3%), to mite in 46 (51.7%), and to epidermal mix in 26 (29.2%) patients. Thirty-six patients (41%) reported 3 or more asthma symptoms. Lung function test results for these 36 patients showed obstruction for 11.1% (4 patients); the remaining patients (88.9%) had normal function parameters. The subjects who reported 3 or more asthma symptoms but had normal lung function monitored their PEF for 3 weeks. Sixteen (50%) patients from this group and the 4 patients with demonstrated airway obstruction had more than 20% diurnal variation in PEF. These 20 patients' asthma symptoms disappeared after they received 3 months of low-dose inhaled corticosteroid therapy. CONCLUSION: It is necessary to look for asthma in patients suffering from allergic rhinitis. PEF monitoring is a low-cost, objective approach to asthma diagnosis that can be performed by a patient with allergic rhinitis even if spirometry is normal. Knowledge of this technique is of utmost importance because delay in diagnosis will result in the unsatisfactory treatment of the disease.

Preterm birth and maternal country of birth in a French district with a multiethnic population.

OBJECTIVES: This analysis explores the association between preterm birth and maternal country of birth in a French district with a multiethnic population. DESIGN: Prospective observational study. SETTING: District of Seine-Saint-Denis in France POPULATION: 48,746 singleton live births from a population-based birth register between October 1998 and December 2000. METHODS: We compare preterm birth rates by mother's country of birth controlling for demographic and obstetric factors as well as insurance coverage and timing of initiation of antenatal care. MAIN OUTCOME MEASURES: Overall preterm birth rates and preterm birth rates by timing of delivery (<33 weeks versus 33-36 weeks of gestation), mode of onset (spontaneous or indicated preterm birth) and the presence of hypertension in pregnancy. RESULTS: Women born in Northern Africa, Southern Europe and South/East Asia did not have higher preterm birth rates than women born in continental France. Rates were significantly higher for women born in the overseas French districts in the Caribbean and Indian Ocean and Sub-Saharan Africa. Excess risk was greatest for early preterm births, medically indicated births and preterm births associated with hypertension. CONCLUSIONS: Patterns of preterm birth with relation to timing, mode of onset and medical complications among of Afro-Caribbean origin should be confirmed in future research.

[Poor management of diarrhea in children in France]. / La mauvaise prise en charge de la diarrhée de l'enfant en France.

Every year in France infant diarrhoea is responsible for the death of 50-80 children under the age of 5 and the hospitalization of approximately 50,000 children principally related to the deshydration which it causes. A significant number of these deaths and hospitalizations could be avoided by simple measures aimed at preventing dehydration, measures which have been codified and internationally promoted by the WHO for the past 25 years. In France, a large number of physicians do not yet apply them; they do not prescribe oral rehydration salts in case of infant diarrhoea, but prescriable antidiarrhoeal drugs which are ineffective on dehydration and are formally rejected by the WHO in these cases. Looking through the prism of this collective failure, one can identify the various causes which put into question the entire French health system: Lack of epidemiological observation; Lack of targeting health actions and initiatives towards children; Insufficient medical culture; Very ambiguous relationships between the state and the pharmaceutical industry; System of continuing medical education strongly linked to the pharmaceutical industry and incapable, to date, of raising up the challenge of a change in practice, which is nevertheless necessary.

Montelukast as an adjuvant to mainstay therapies in patients with seasonal allergic rhinitis.

BACKGROUND: Drug selection for optimal treatment of allergic rhinitis may be difficult and involve many diverse factors. OBJECTIVE: To evaluate montelukast, in the treatment of patients with seasonal allergic rhinitis, as an adjuvant to mainstay therapies, i.e., antihistamines and corticosteroids. METHODS: The study was a prospective, three-phased (per lasted 2 weeks) clinical trial. In phase I, patients were separated into two groups, based on the predominating symptoms: (1) runners (patients with moderate to severe sneezing/itchy, watery nose/itchy, watery eyes), and (2) blockers (patients with moderate to severe nasal congestion). The runners received antihistamine loratidine 10 mg daily, and the blockers received intranasal corticosteroid mometasone furoate 200 microg. In phase II, if patients were dissatisfied with the initial treatment, they were assigned to receive another study drug additionally. In phase III, for the patients unsatisfied with the treatment of loratidine plus mometasone furoate, montelukast 10 mg once daily was added. RESULTS: Of the 169 patients who entered phase I, 150 could be evaluated for treatment efficacy and safety. There were 108 runners and 42 blockers. Physicians' and patients' assessments indicated that in phase I 58 runners (60.0% of 50 runners) and 36 blockers (33.3% of six blockers) were satisfied with their therapy. In phase II, 30 runners (27.7%) and two blockers (4.7%) were satisfied with the addition of other study drug. Totally 62.6% of patients were satisfied at the end of phase I, and 84.0% at the end of phase II. Sixteen patients (66.6% of 24 patients) were satisfied with the addition of montelukast to the previous two drugs (in total, 10.6% of patients). Fourteen patients (12.2%) treated with loratadine, and three patients (0.3%) treated with mometasone, reported side-effect. CONCLUSION: The results of this trial indicate that 10% of patients with seasonal allergic rhinitis may be treated with the supplement of montelukast to mainstay therapy.

Preterm birth in a French population: the importance of births by medical decision.

This analysis describes the prevalence of preterm birth by medical decision among 50,307 live births from the district of Seine-Saint-Denis in France, using a classification that distinguishes between medically decided preterm births associated with premature rupture of membranes and those for other reasons. Thirty-seven percent of singleton and 28% of twin preterm births result from labour induction or a caesarean section in the absence of labour. One-quarter of singleton indicated preterm births are associated with premature rupture of membranes. Between 28 and 31 weeks of gestation, 40% of all singleton preterm births result from a medical decision not associated with premature rupture of membranes. The high levels of indicated preterm birth must be taken into account in evaluations of preterm birth rates and trends in developed countries.

Infarction after fine needle aspiration biopsy of pleomorphic adenoma of the parotid gland.

BACKGROUND: Fine needle aspiration (FNA) is a well-established and safe method for the rapid diagnosis of pleomorphic adenoma. A few clinically important complications, including bleeding, infection and inflammatory reactions, result from FNA. In a small number of cases FNA has been followed by varying degrees of necrosis in some organs. In the literature there are a few reports associated with necrosis in a pleomorphic adenoma of the parotid gland following FNA. CASE: A 27-year-old female had a two-year history of a right parotid mass. FNA revealed pleomorphic adenoma. A histologic diagnosis of pleomorphic adenoma of the right parotid with infarction was made. CONCLUSION: Necrosis associated with infarction may cause diagnostic problems. It is not a sufficient sign of malignant transformation.

[Regionalization of perinatal care in the Seine-Saint-Denis department of France]. / Evolution de la régionalisation des soins périnatals dans le département de la Seine-Saint-Denis de 1989 à 1999.

OBJECTIVE: To evaluate a policy designed to regionalize perinatal care in the Seine-Saint-Denis department of France. METHODS: The place of birth of every preterm infant (born before 33 weeks gestation) in 1998-1999 was compared with that for the period of 1989-1992. The 1989-1992 data came from a prenatal mortality study. For the 1998-1999 period, we used data from an area-based birth registry recording an experimental health certificate. RESULTS: In 1989-1992, 40% of live births before 33 weeks gestation took place in level I maternity units, 37.2% in level II maternity units, and 13.0% in level III maternity units. In 1998-1999, 5.4% took place in level I maternity units, 28.9% in level II maternity units and 65.1% in level III maternity units. The number of postnatal transfers of very preterm infants declined markedly. In 1998-1999, 109 pregnant women were transferred to a level III maternity hospital. This constituted 1.2% of the women who gave birth in Seine-Saint-Denis during this period. CONCLUSION: The policy to regionalize perinatal care and increase maternal transfers was well accepted and successfully implemented. The delivery of very preterm infants in maternity hospitals without neonatal units became a rare event.

Importance of mastoid pneumatization on secretory otitis media.

Secretory otitis media is the most common middle ear disease of childhood. It heals spontaneously, by medical therapy or by minor surgical procedures in most of the cases. Sequelae such as retraction pockets and adhesive otitis that lead to cholesteatoma rarely occur, but initially it is hard to diagnose which patient will acquire a sequela. It is well known that mastoid pneumatization is poor in the patients who had complications like retraction pocket, adhesive otitis and cholesterol granuloma. The aim of this study was to determine if any relationship exists between mastoid pneumatization and secretory otitis media. Lateral mastoid X-rays of 47 children with secretory otitis media were evaluated. After 2 months of follow-up with medical therapy, 30 of the 47 patients needed ventilation tube insertion. The remaining 17 patients showed total recovery with medicines only. Control X-rays of the operated patients were taken 6 months after the operation. Mastoid pneumatizations of patients healed with medicine were compared with the operated patients. There were statistically significant differences between the mastoid pneumatizations of surgically and medically treated groups. In addition we observed a statistically significant difference between the mastoid areas of the preoperative and the postoperative X-rays. We concluded that mastoid pneumatization might be considered as a prognostic indicator in secretory otitis media. The estimated prognosis is poor when the mastoid pneumatization is poor.