Using clinical estimate or catheter measurement of urethral mid-point result in similar retropubic mid-urethral sling position: a randomized trial.

INTRODUCTION AND HYPOTHESIS: The objective was to determine whether standardized, intraoperative urethral measurement improves retropubic mid-urethral sling (RPMUS) positioning and if the intraoperative position remains stable at 2 weeks postoperatively. METHODS: Participants undergoing a RPMUS were randomized to mid-urethral placement as per usual surgical care (no Foley catheter measurement, no-FCM) vs urethral mid-point Foley catheter measurement (FCM). The primary outcomes were RPMUS location as determined by 2D and 3D ultrasound 2 weeks postoperatively (as percentage from urethral meatus - relative to the urethral length) and intraoperatively following the RPMUS placement. RESULTS: Forty-four women enrolled, underwent RPMUS, and provided baseline data and intraoperative ultrasound measurements; of these, 36 (82%) had interpretable intraoperative and postoperative ultrasound measurements. Demographic data were similar in the two groups. The mean RPMUS mid-point was 57 % and 55 % in measured and controls (p = 0.685); this same measurement was relatively unchanged at 2 weeks postoperatively at 57% and 54% respectively (p = 0.538). Very much and much improvement was reported on the PGI-I by 84% and 85% of participants in the FCM and no-FCM groups respectively. CONCLUSIONS: Intraoperative RPMUS position at 2 weeks after surgery is similar to the intraoperative position. Compared with usual surgical care, intraoperative measurement of urethral mid-point with a Foley catheter did not affect RPMUS sling position.

Posttransplant donor-specific anti-HLA antibodies negatively impact pancreas transplantation outcome.

During a 9-year follow-up, 167 consecutive pancreas transplant recipients (152 simultaneous pancreas-kidney [SPK]) were followed for the detection of posttransplant anti-HLA antibodies. Forty patients (24%) developed anti-HLA antibodies, 26 (65%) had donor-specific antibodies (DSA; 61% anticlass 2) and 14 (35%) non-DSA (78.6% anticlass 1). More rejection episodes were observed in patients with positive anti-HLA antibodies than in patients without antibodies (42.5% vs. 11%; p = 0.001), with the highest incidence observed in DSA patients (53.8%). More severe rejections (according to rescue therapy) were observed in DSA patients compared to non-DSA (p < 0.05) or to negative patients (p < 0.001). Contrasting with the kidney, pancreas graft survival did not differ between patients with or without anti-HLA antibodies. On the contrary, pancreas and kidney survivals were significantly lower in DSA positive patients (75% for both organs) as compared to non-DSA positive patients (100% for pancreas and 92% for kidney) or to HLA-negative patients (91% for pancreas and 89% for kidney). Nontechnical pancreas and kidney graft failures were significantly higher in positive than in negative anti-HLA patients (32.5% vs. 11%; p < 0.01). Occurrence of posttransplant DSA was an independent risk factor for both pancreas and kidney survival (HR 3.2; p = 0.039) in diabetic transplant recipients.

Artificial intelligence: a new approach for prescription and monitoring of hemodialysis therapy.

The effect of dialysis on patients is conventionally predicted using a formal mathematical model. This approach requires many assumptions of the processes involved, and validation of these may be difficult. The validity of dialysis urea modeling using a formal mathematical model has been challenged. Artificial intelligence using neural networks (NNs) has been used to solve complex problems without needing a mathematical model or an understanding of the mechanisms involved. In this study, we applied an NN model to study and predict concentrations of urea during a hemodialysis session. We measured blood concentrations of urea, patient weight, and total urea removal by direct dialysate quantification (DDQ) at 30-minute intervals during the session (in 15 chronic hemodialysis patients). The NN model was trained to recognize the evolution of measured urea concentrations and was subsequently able to predict hemodialysis session time needed to reach a target solute removal index (SRI) in patients not previously studied by the NN model (in another 15 chronic hemodialysis patients). Comparing results of the NN model with the DDQ model, the prediction error was 10.9%, with a not significant difference between predicted total urea nitrogen (UN) removal and measured UN removal by DDQ. NN model predictions of time showed a not significant difference with actual intervals needed to reach the same SRI level at the same patient conditions, except for the prediction of SRI at the first 30-minute interval, which showed a significant difference (P = 0.001). This indicates the sensitivity of the NN model to what is called patient clearance time; the prediction error was 8.3%. From our results, we conclude that artificial intelligence applications in urea kinetics can give an idea of intradialysis profiling according to individual clinical needs. In theory, this approach can be extended easily to other solutes, making the NN model a step forward to achieving artificial-intelligent dialysis control.

Preliminary results of chemoradiation as a primary treatment for vulvar carcinoma.

PURPOSE: To assess the role of chemoradiation as a primary treatment for vulvar carcinoma. METHODS AND MATERIALS: Between December 1989 and August 1997, there were 14 patients with the diagnosis of squamous cell carcinoma of the vulva. Two patients were excluded from this study because of advanced stage at presentation. Key information about the remaining 12 patients was extracted from their charts. All patients had biopsy prior to treatment, and were treated with chemoradiation. Radiation was administered to the vulva only. Surgical biopsies from the vulva and inguinal nodal dissection were done 4-6 weeks after radiation treatment. All patients were followed for evaluation of response and clinical detection of recurrence. The period of follow-up ranged from 8 to 125 months. Mean follow-up period was 41 months. RESULTS: All 12 patients showed complete response to the treatment. Only 1 patient (8.3%) developed local recurrence at 3 months posttreatment. Another patient (8.3%) developed nodal recurrence at 30 months posttreatment. Both patients were salvaged by surgical treatment and remained disease free. The actuarial 5-year disease-free survival was 43%. The actuarial 3-year disease-free survival was 84%. The majority of patients developed mild-to-moderate complications due to chemoradiation. These were well tolerated and responded to medical treatment. None of the patients developed late complications to chemoradiation treatment. CONCLUSIONS: Chemoradiation is an effective primary treatment for vulvar carcinoma as shown by these successfully managed cases.

[The frequency of various types of disk displacement and its relation to occlusion]. / Fréquence des différents types de déplacements discaux et rapports avec l'occlusion.

The aim of this study is to observe the frequency of the different types of disc displacements (d.d.) of the TMJ (ATM) and to evaluate if these types are related or not with malocclusions. One hundred patients and 13 asymtomatic volunteers underwent full clinic examination. sagittal MRI (mouth open and closed) and coronal MRI (mouth closed). The different types of disc displacements were noted and cumulated in frequency and in relation with several occlusal criteria. Unlike the general opinion stating that the antero-medial d.d. (d.d. a-m) are the most frequent amongst the internal derangements, the result of this study reveals that the antero-lateral d.d. (d.d. a-l) are more frequent amongst the patients (35.1%) and the asymptomatic volunteers in general and particularly in view of a malocclusion (exagerated anterior overlapping and posterior cross bite). The study gives rise to the question of the etiology of a antero-lateral d.d. and sets back the hypothesis of the lateral pterygoid muscle fundamental role in the disc displacements.

[Diagnosis and treatment of hydatid cysts of the liver. Apropos of 87 cases operated on between 1980 and 1992]. / Diagnostic et traitement des kystes hydatiques du foie. A propos de 87 cas opérés entre 1980 et 1992.

Human echinococcosis is still endemic in some areas of the world, including Mediterranean countries and Lebanon. Because there is no effective medical therapy, surgery remains the principal mode of treatment. A consecutive series of 87 patients operated on for liver hydatid disease between January 1980 and March 1992 in the division of General Surgery at Saint George's Hospital, Beirut, were analyzed. Patients with hydatic cysts in other sites than liver were excluded from the study. There were 39 men (45%), and 48 women (55%) aged 12 to 75 years (mean 43). The right lobe of the liver was affected in 67 cases (77%), the left lobe in 18 cases (20.6%), and both lobes in 2 cases (2.4%). Clinical symptomatology consisted of abdominal pain, fever, jaundice, urticaria, and an abdominal mass. Preoperative diagnosis was established using imaging studies: plain abdominal films, ultrasonography, computed tomography, and serologic tests. Cases were classified into 3 groups: G1 (n = 44, 50.5%) had a partial resection of the cyst followed by an external drainage; G2 (n = 15, 17.2%) had a partial resection of the cyst with a filling of the residual cavity; G3 (n = 28, 32.2%) made benefit of complete resection of the cyst (pericystectomy) with or without partial hepatectomy. In this retrospective study we compared the results of these different surgical techniques: postoperative complications and mortality, hospital stay of patient. We noted the better postoperative course of the non-drained patient (G2 and G3). Three patients died during the postoperative period because of septic complications. Conclusions and general recommendations are proposed.

The results of primary radiation therapy in the management of squamous cell carcinoma of the penis.

PURPOSE: The outcome of radical external beam radiation therapy for 26 consecutive patients with invasive carcinoma of the penis treated between 1970 and 1985 was assessed to test the efficacy, and side effects of such treatment. METHODS AND MATERIAL: A retrospective review of 26 patients with invasive carcinoma of the penis and 11 patients with carcinoma in-situ of the penis, treated at the Princess Margaret Hospital between 1970 and 1985, was performed. Radiation treatment was delivered using 60Co or 100-250 kv equipment to a dose ranging from 25 Gy in 10 fractions over 2 weeks to 60 Gy in 25 fractions over 5 weeks. The most often used XRT prescription was 50 Gy in 20 fractions over 4 weeks. RESULTS: The 5-year overall actuarial survival for patients with invasive cancers was 62% (+/- 10) and the cause-specific survival was 69% (+/- 9). The control of the primary lesion was 61.5%. Of five patients who progressed after initial radiotherapy, one patient was salvaged by penectomy. Of 11 patients who recurred after initial complete response, three did so in the penis alone and all were successfully salvaged by penectomy. Late complications were recorded in seven patients, two of whom underwent penectomy as a result. All patients with carcinoma in-situ achieved a complete response and, with follow-up ranging from 1 to 14 years, none recurred. CONCLUSION: We conclude that radiation therapy with surgery reserved for the management of local recurrence is an effective first line treatment for patients with carcinoma of the penis.