[Autologous fascia pubovaginal slings in women with stress urinary incontinence at high risk of mesh/device-related complications]. / Bandelette aponévrotique pubovaginale pour incontinence urinaire d'effort chez les femmes à risque de complications prothétiques.

INTRODUCTION: Very popular in many parts of the world, autologous fascial pubovaginal sling (AFPVS) remains marginally used in France. However, it may be of particular interest in patients carrying a high risk of mesh-related or device-related related complications. The aim of the present series was to report the outcomes of AFPVS in this high-risk population. MATERIAL AND METHODS: The charts of all female patients who underwent a fascial sling for SUI at a single academic center between April 2019 and May 2021 were reviewed retrospectively. Only patients deemed at high-risk of device/mesh related complications were included in the present analysis: female with a neurological condition who were doing clean intermittent catheterization (CIC), female with SUI after radical cystectomy and ileal neobladder, female with urethral/bladder extrusion of any synthetic material placed for SUI. Success was defined as complete resolution of SUI at 3 months. RESULTS: Sixteen patients were included in this study: 13 rectus fascia slings and 3 fascia lata slings. The success rate was 56.3% (9/16 patients). Four patients were improved but not completely dry (25%). Two patients had major postoperative complications (i.e. Clavien grade 3 or higher, 11.2%). Two patients had a persisting significant post-void residual (PVR) postoperatively, managed by self-catheterization (transition to self-catheterization at 3 months: 2/8, 25%). CONCLUSION: The use of autologous fascia pubovaginal sling is an interesting option in female SUI patients with high risk of device/mesh related complications with satisfactory functional outcomes. LEVEL OF PROOF: 4.

Real time capable infrared thermography for ASDEX Upgrade.

Infrared (IR) thermography is widely used in fusion research to study power exhaust and incident heat load onto the plasma facing components. Due to the short pulse duration of today's fusion experiments, IR systems have mostly been designed for off-line data analysis. For future long pulse devices (e.g., Wendelstein 7-X, ITER), a real time evaluation of the target temperature and heat flux is mandatory. This paper shows the development of a real time capable IR system for ASDEX Upgrade. A compact IR camera has been designed incorporating the necessary magnetic and electric shielding for the detector, cooler assembly. The camera communication is based on the Camera Link industry standard. The data acquisition hardware is based on National Instruments hardware, consisting of a PXIe chassis inside and a fibre optical connected industry computer outside the torus hall. Image processing and data evaluation are performed using real time LabVIEW.

Does race affect postoperative outcomes in patients with low-risk prostate cancer who undergo radical prostatectomy?

OBJECTIVES: To assess the magnitude of racial disparities in prostate cancer outcomes following radical prostatectomy for low-risk prostate cancer. METHODS: We retrospectively reviewed our database of 2407 patients who under went radical prostatectomy and isolated 2 cohorts of patients with low-risk prostate cancer. Cohort 1 was defined using liberal criteria, and cohort 2 was isolated using more stringent criteria. We then studied pre- and postoperative parameters to discern any racial differences in these 2 groups. Statistical analyses, including log-rank, chi(2), and Fisher's exact analyses, were used to ascertain the significance of such differences. RESULTS: Preoperatively, no significant differences were found between the white and African-American patients with regard to age at diagnosis, mean prostate-specific antigen, median follow-up, or percentage of involved cores on prostate biopsy. African-American patients in cohort 1 had a greater mean body mass index than did white patients (26.9 vs 27.8, P = .026). The analysis of postoperative data demonstrated no significant difference between white and African-American patients in the risk of biochemical failure, extraprostatic extension, seminal vesicle involvement, positive surgical margins, tumor volume, or risk of disease upgrading. African-American patients in cohort 2 demonstrated greater all-cause mortality compared with their white counterparts (9.4% vs 3.1%, P = .027). CONCLUSIONS: In patients with low-risk prostate cancer treated with radical prostatectomy, there exist no significant differences in surrogate measures of disease control, risk of disease upgrading, estimated tumor volume, or recurrence-free survival between whites and African-Americans.

[Perioperative myocardial infarction and cardiac complications after noncardiac surgery in patients with prior myocardial infarction. I. Clinical data and diagnosis, incidence]. / Perioperativer Myokardinfarkt und weitere kardiale Komplikationen nach nichtkardialen Wahloperationen bei Patienten nach Myokardinfarkt. I: Klinische Daten und Diagnostik, Inzidenz.

UNLABELLED: Patients with a prior myocardial infarction (MI) have a high risk of perioperative reinfarction compared with the normal population (5%-8% vs. 0.1%-0.7%) [10]. According to Rao [13], a reduction of this risk is possible when patients are monitored invasively and all haemodynamic parameters are kept within the physiological range. In most institutions it is not feasible to treat patients as Rao recommended: this would overstrain both hospital structure and financial resources. We studied the incidence of perioperative MI and other cardiac events in patients with prior MI. During the study period the anaesthesia and intensive care methods of our institution were neither changed nor influenced. In addition to this clinical evaluation, we performed perioperative Holter electrocardiographic monitoring and measured serum levels of the recently introduced marker troponin T (parts II and III). METHODS: Institutional informed consent was obtained. The study was planned prospectively. All patients with prior MI (156) and/or coronary artery bypass grafting (CABG) (4) who were scheduled for elective noncardiac surgery between April 1992 and March 1993 were included. The following information was acquired and tabulated: age, sex, body weight, preoperative risk factors, ASA classification, preoperative blood pressure, pulse rate, and ECG (interpreted by an independent cardiologist), serum electrolytes, haemoglobin, creatine kinase (CK), CKMB faction, creatinine. Preoperative regular medications, type of anaesthesia, type, site, and duration of surgery, and intraoperative haemodynamic changes were documented. The patients were divided into four groups depending on the time interval between MI and surgery (group I: 0-3 months, group II: 3-6 months, group III: > 6 months, group IV silent MI and prior CABG without infarction). We then studied the number of patients who developed a perioperative MI or died of cardiac causes within 7 postoperative days (n = 160). Because of early discharge of 21 patients, we could study the occurrence of cardiac events within 7 postoperative days in 139 patients only. Definitions of perioperative MI included [3]: changes of ST pattern (horizontal ST depression > 0.1 mV or elevation > 0.2 mV) during 30 s and longer; new T-negativation or Q-wave; pathological CKMB fraction (> or = 6% of total CK); and angina pectoris; two of these criteria were required to be positive (WHO). Definitions of cardiac events included: ischaemia: any reversible horizontal depression of the ST segment of more than 0.1 mV or any ST segment rise of more than 0.2 mV. Patients with bundle branch block (BBB) were excluded; angina pectoris: any chest pain that disappered after application of nitroglycerine; arrhythmia: any change from preoperative rhythm or appearence of ventricular premature beats; and left ventricular failure: clinical and radiological signs of ventricular failure. Statistical evaluation of the demographic data was performed by the Kruskall-Wallis test; categoric variables were examined using the chi 2 test and Fisher's exact test. P values of less than 0.05 were considered significant. RESULTS: Six of the 160 patients with prior MI developed a perioperative MI (3.8%); 2 of them (33%) died of cardiac causes (3rd and 6th postoperative day). All of these patients were in groups III or IV (interval > 6 months). Forty-two patients had one or more other cardiac events; arrhythmias (22) and ischaemia (14) were most common. Intraoperative hypotension was associated with postoperative MI (5 of 58 vs. 1 of 102). Preoperative congestive heart failure (4 of 18 vs. 3 of 121) and major surgery (7 of 68 vs. 0 of 71) led more often to postoperative left ventricular failure. Patients who received beta-blocking agents preoperatively had significantly fewer ischaemic cardiac events (0 of 28 vs. 14 of 90, 21 patients excluded with BBB) but differed in mean age (67 vs. 71 years). The use of beta-blocking agents was not associated with a reducti

Biofeedback effect on electromyography responses in patients with spinal cord injury.

OBJECTIVE: To determine if electromyography (EMG) biofeedback procedures using an operant conditioning paradigm could significantly increase voluntary EMG responses from the triceps muscles of long term cervical spinal cord injured individuals. DESIGN: Intervention study with before-after trial measurement with each subject as its own control. SETTING: University outpatient clinic. PARTICIPANTS: One hundred individuals with cervical spinal cord injuries C6 or higher that were greater than 1-year duration, and who had less than normal strength and recordable EMG activity from the triceps, and who had reached a plateau in return of function. The first 100 individuals meeting this criteria who presented sequentially for EMG testing and biofeedback were included. No subjects were deleted from the sample. INTERVENTION: Muscle strength and surface EMG recording during attempts at elbow extension were obtained. The EMG pretest data were derived from the highest average recorded voluntary EMG response from the triceps during elbow extension. One 45-minute treatment session of EMG biofeedback for the triceps in an operant conditioning paradigm was provided for each of the 100 subjects. Seventy-five subjects received an average of 3 additional biofeedback treatment sessions. The posttest EMG data were derived from EMG measurements of the triceps during attempts at elbow extension from the 45-minute biofeedback treatment session and from the last additional biofeedback treatment session in a similar manner to the pretest procedures. MAIN OUTCOME MEASURES: A significant increase in EMG activity occurred from the triceps (p < or = .001) after one biofeedback treatment session and further significant increases in EMG activity occurred after additional biofeedback treatment sessions (p < or = .001). Initial muscle strength and initial EMG levels were not determining factors for response to the biofeedback. CONCLUSIONS: The results suggest the efficacy of biofeedback for increasing voluntary EMG responses in long term spinal cord injury patients.

[Thrombolysis in acute occlusion of cerebral blood vessels]. / Thrombolyse beim akuten Verschluss zerebraler Gefässe.

Thrombolysis may achieve recanalization in cases of occlusion of the cerebral vessels. If therapy is initiated in good time, development of cerebral infarction may be at least partially prevented. Thrombolytic treatment was performed in 14 patients at the Wagner-Jauregg Hospital within a period of one year. Urokinase was given locally, while rtPA was applied locally and/or systemically. 4 patients had an occlusion of the internal carotid artery, 6 an occlusion of the middle cerebral artery, and 4 an occlusion of the basilar artery. Complete recanalization was achieved in 6 patients, partial recanalization in 4, and no recanalization in 4. The neurological outcome of the cases with complete recanalization was good with the exception of one patients who died. Partial recanalization resulted in a fair outcome in 2 patients, while the other 2 died. 3 out of the 4 patients in whom no recanalization was achieved died. Our findings show that this form of therapy may considerably improve the natural history of the disease, provided recanalization is achieved in good time. They encourage us to continue this form of therapy and to work at improving the therapeutic criteria.

Motor units in incomplete spinal cord injury: electrical activity, contractile properties and the effects of biofeedback.

The electrical and contractile properties of hand muscles in a selected population of quadriplegic subjects were studied intensively before and after EMG biofeedback. Spontaneously active motor units and units that could only be slowly and weakly activated were observed in these subjects, in addition to units that were voluntarily activated normally. This suggests a considerable overlap of surviving motor neurons to a single muscle that are below, near or above the level of a lesion. Despite the common occurrence of polyphasic potentials and other signs of neuromuscular reinnervation, the average twitch tension of single motor units in hand muscles of quadriplegic subjects was not significantly different from that in control subjects. Nor did it increase after biofeedback training that typically increased the peak surface EMG by a factor of 2-5 times. The percentage of spontaneously active units was also constant. The surface EMG may be increased during biofeedback by using higher firing rates in motor units that can already be activated, rather than by recruiting previously unavailable motor units.

Rehabilitation therapy for patients with long-term spinal cord injuries.

The functional effects of three types of therapy for subjects with long-term incomplete cervical spinal cord injuries were investigated. Men and women, aged 18 to 45 years, were assigned to one of four groups using a restricted randomization process. The training period was divided into two consecutive eight-week time blocks where subjects received either (1) supervised physical exercise therapy (PET), (2) neuromuscular stimulation (NMS), or (3) electromyographic (EMG) biofeedback. Group 1 received EMG biofeedback followed by PET; Group 2 received EMG biofeedback followed by NMS; Group 3 received NMS followed by PET; and Group 4 received 16 weeks of PET. Dependent measures (manual muscle tests, self-care scores, mobility measures, and voluntary EMG activity) were assessed before training, at eight weeks, and after 16 weeks of training. A significant improvement (p less than .05) across time was found on all dependent measures except voluntary EMG. No difference was found on comparisons between groups.

A medical evaluation of the effects of computer assisted muscle stimulation in paraplegic patients.

An examination of the medical and physiological effects of functional electrical stimulation (FES) applied to the quadriceps muscle of five paraplegic male volunteers with complete spinal cord injuries was performed. FES training was provided three days a week over a 12-week period using a progressive resistive exercise protocol. Stimulation was applied through use of a closed-loop microprocessor-based FES system. Prior to the start of and immediately following the 12-week training period, subjects were assessed on several measures, including quadriceps muscle bulk and histochemistry, laboratory studies, echocardiography, and arm ergometry exercise. Results of the study indicated substantial increases in muscle strength and muscle bulk. At the outset of the study one patient suffered a patellar fracture. No significant changes in pretraining and posttraining general examinations, laboratory studies, echocardiography, or arm ergometry exercise testing were noted.

Recognition of matching tasks and stimulus novelty as a function of unilateral brain damage.

A 96-trial tachistoscope recognition task was given to 15 left-hemisphere-damaged, 12 right-hemisphere-damaged, and 30 non-brain-damaged subjects. Procedure called for a first stimulus presented for 250 msec, a 1-sec. pause, and a second stimulus for 250 msec. The stimuli were 12 animal drawings used in repeated series according to a random schedule. Six animals were familiar and six were novel. For half of the trials, the two pictures were of different animals. Size and position of the animal picture were controlled. Both reaction time and accuracy were independently scored. Judgments of same and different appear to function as if they are governed by different processes. For the control group, measures of same and different judgments do not correlate highly despite high internal consistency of subtests. Recognition of same becomes impaired with brain damage, but more so if the damage is rightsided. Recognition of different judgments shows considerably less sensitivity to the effects of unilateral brain damage.

Reflex conditioning in a spinal man.

A man with a completely transected spinal cord and a spastic neurogenic bladder was conditioned to void upon the presentation of an external stimulus. A classical conditioning paradigm was employed in which strong abdominal shock (unconditioned stimulus) was paired with an initially neutral mild electrical stimulation of the thigh (conditioned stimulus; CS). After the pairing trials, a reliable conditioned response of urination was elicited by the CS alone. The conditioned response did not extinguish over time, and the procedure left the bladder with clinically safe residual amounts of urine. Practical implications of the conditioning technique for the treatment of spastic neurogenic bladder conditions in spinally injured patients are discussed, as is the theoretical significance of conditioning at the reflex level in the absence of cortical involvement.

The effect of unilateral brain damage on the appearance of question-induced CLEM reactions.

Three groups of subjects--34 non brain damaged, 15 left hemisphere damaged patients, and 15 right hemisphere damaged patients--were administered 40 questions facing the questioner while eye-movement following each question was recorded. 20 of the questions required subjects to indicate how many letters were in a given word. 20 questions tested their visuospatial capacity. The control group revealed a marked tendency to look to the left visual field regardless of the content of the question. The tendency to left-look or right-look, however, was not found to be related to education, age, length of hospitalization, the score on the "letters in a word" test, or the score on the visuospatial test. The left hemisphere damaged group performed remarkably like the control in that they too looked more to the left visual field than to the right. The right hemisphere damaged group, however, did not show a significant difference between left looking and right looking in response to both questionnaires. The findings were discussed in relation to the previous work of Kinsbourne (1972), and Gur, Gur and Harris (1975).

Conditioned responding of the neurogenic bladder.

Classical conditioning techniques were employed to condition responding of the spastic neurogenic bladder in a man with quadriparesis and urinary incontinence secondary to spinal cord injury at the cervical level. A neutral stimulus of mild electrical stimulation to the thigh was paired temporally with an unconditioned stimulus (UCS) of stronger electrical stimulation of the lower abdomen, and then was presented alone as a conditioned stimulus (CS) to elicit the conditioned response (CR) of voiding. The previously neutral CS reliably elicited large amounts of urine and left little residual urine in the subject's bladder. Following the experimental sessions, the subject self-applied the CS on a predetermined schedule during his daily routine outside of the laboratory. The CS initially was successful, but after several days the CR exhibited extinction. Additional CS-UCS pairing sessions did not reinstate the responses satisfactorily. Aspects of the experimental procedure and the results are discussed as well as the feasibility of conditioning the human spinal cord in the absence of an intact central nervous system

Biofeedback as an experimental treatment for postural hypotension in a patient with a spinal cord lesion.

A man having severe postural hypotension resulting from a spinal cord lesion at level T3, was trained to raise and lower his blood pressure with the use of biofeedback. The procedure consisted of 11 learning sessions during which the subject's task was to effect specific changes of his blood pressure without skeletal muscle or respiratory involvement. Blood pressure was continuously monitored and reported to the subject, and positive verbal reinforcement for correct changes was also supplied. Analysis of the results revealed that the subject had learned to produce large voluntary changes in pressure. This learned ability was then applied in a standing position resulting in counteracting the postural hypotension. Suggestions for further research and implications for clinical applications are discussed.