Mechanical and antibacterial properties of hybrid polymers composite reinforcement for biomedical applications.

This research investigates the biocompatibility, mechanical strength, and tribological properties of a hybrid composite material composed of high-density polyethylene (HDPE), hydroxyapatite (HAp), and titanium dioxide nanoparticles (Ti O2). The study explores the microstructural characteristics of the composite material using scanning electron microscopy (SEM), transmission electron microscopy (TEM), and X-ray diffraction (XRD). Samples of HDPE-30%HAp with varying concentrations of Ti O2 (5, 10, 15, and 20%) were prepared and extruded using a twin-screw machine. The hybrid composite materials underwent mechanical tests (tensile, flexural, and hardness), tribological tests (friction and wear rate), and antibacterial tests (resistance to Escherichia coli and Staphylococcus aureus bacteria). The results indicate that the optimal hybrid composite sample was HDPE-30%HAP-10% Ti O2, which demonstrated excellent mechanical properties (maximum tensile strength of 25.93 MPa and young modulus of 480 MPa) and a low coefficient of friction (COF∼ 0.07) while achieving high wear resistance (wear rate in the order of 10-4 m m3N-1 m-1). The study shows that the improvement in mechanical properties results in a corresponding improvement in tribological properties. The antibacterial tests revealed that the hybrid composite material exhibited resistance to E. coli and S. aureus bacteria. The findings of this study suggest that the HDPE-30%HAP-10% Ti O2 composite is a promising material for use in biomedical applications due to its excellent biocompatibility and desirable mechanical and tribological properties. The study demonstrates the potential of reinforced hybrid composite materials in overcoming the disadvantages of monolithic and hybrid micro-composites and highlights the importance of investigating the microstructural, tribological, and mechanical strength characteristics of composite materials for biomedical applications.

The Effectiveness of Tamoxifen in the Prevention of Recurrent Urethral Strictures Following Internal Urethrotomy.

OBJECTIVE: Tamoxifen was not used earlier in clinical practice to decrease the urethral re-stricture rate after visual internal urethrotomy (VIU). In this study, we are the first to report the use of Tamoxifen as an adjuvant therapy to decrease the re-fibrosis and stricture recurrence post-VIU. PATIENTS AND METHODS: Between 2015 and 2017, 60 patients underwent VIU for post-traumatic bulbar urethral stricture ≤1 cm. They were randomly divided into 2 groups (30 patients each). The Tamoxifen group cases received Tamoxifen 10 mg twice daily for 6 months post-VIU. The control group did not receive any medications. All patients were evaluated using the IPSS score, uroflowmetry, and perineal ultrasonography preoperatively at 3 and 6 months. RESULTS: At presentation, there was no significant difference between patients of both groups in terms of IPSS score, Qmax, stricture width, and length. At 6 months follow-up, the mean IPSS score for the Tamoxifen group was 12.3 (8-19) in comparison with 20 (12-26) in the control group (p < 0.001). The Tamoxifen group had mean Qmax 11.1 mL/s (9-14), while those of the control group had mean Qmax 8.2 mL/s (6-10; p < 0.001). Using perineal ultrasound, only stricture width showed to be significantly smaller in the Tamoxifen group (p = 0.001). CONCLUSION: Tamoxifen seemed to be effective in reducing the recurrence of urethral stricture post-VIU. There was a significant improvement of the clinical outcome regarding Qmax and IPSS score after Tamoxifen adjuvant therapy.

Management of anterior caliceal stones >15 mm.

Anterior caliceal stones represent a challenge to endourologist to select the best modality of management with the least morbidity. To study different treatment modalities of management of anterior caliceal stones >15 mm. It is an observational prospective study of patients with anterior caliceal stones more than 15 mm. Inclusion criteria were patients with isolated anterior caliceal stones, or branched anterior caliceal stones with posterior caliceal extension. Patients were evaluated using non-contrast CT preoperatively. They were divided into three groups: group 1 underwent PCNL through posterior caliceal puncture in cases with wide anterior calyx infundibulum or obtuse infundibulopelvic pelvic, group 2 underwent PCNL through anterior caliceal access in cases with narrow infundibulum or acute infundibulopelvic angel and group 3 underwent flexible ureteroscopy and laser lithotripsy. Intraoperative and postoperative findings were recorded and compared. Eighty eight patients were included in this study, Group 1 (44 patients) group 2 (28 patients), and group 3 (16 patients). Operative time was not significantly different across the three groups (68 ± 11.5, 72 ± 9 and 74 ± 11 min in group 1, 2 and 3, respectively, P = 0.053). Fluoroscopy time was significantly shorter for group 3 (2 ± 0.5 m, P = 0.0001) compared to group 1 and 2 (5.6 ± 4.6 and 4.5 ± 1.4 min), respectively. There were no significant differences in stone-free rates after initial treatment between the three groups; 84, 82, and 69 %, in groups 1, 2 and 3, respectively (P = 0.4). Postoperative hemoglobin drop was noted to be highest for group 2 and lowest for group 3 which was significantly different (1.7 ± 0.8, 2.2 ± 1.1, and 0.3 ± 0.3 g/dl, for patients in groups 1, 2 and 3 respectively, P = 0.0001). Group 2 showed the highest post-operative complication rate (21 %) in comparison to group 1 (11 %) and group 3 (6 %), however, differences were not statistically significant (P = 0.3). PCNL through posterior or anterior caliceal puncture is an excellent modality to treat anterior caliceal stones with high stone clearance rate. Despite the higher chance of bleeding with anterior caliceal puncture, it is still inevitably needed in difficult anterior caliceal stones with unfavorable anatomy. RIRS is a good alternative to PCNL with the advantage of less radiation exposure and less bleeding.

Different Score Systems to Predict Mortality in Living Donor Liver Transplantation: Which Is the Winner? The Experience of an Egyptian Center for Living Donor Liver Transplantation.

INTRODUCTION: Many scoring systems have been proposed to predict the outcome of deceased donor liver transplantation. However, their impact on the outcome in living donor liver transplantation (LDLT) has not yet been elucidated. This study sought to assess performance of preoperative Model for End-Stage Liver Disease (MELD) score in predicting postoperative mortality in LDLT and to compare it with other scores: MELDNa, United Kingdom End-Stage Liver Disease (UKELD), MELD to serum sodium ratio (MESO), updated MELD, donor age-MELD (D-MELD) and integrated MELD (iMELD). METHODS: We retrospectively analyzed data from 86 adult Egyptian patients who underwent LDLT in a single center. Preoperative MELD, MELDNa, MESO, UKELD, updated MELD, D-MELD, and iMELD were calculated. Receiver-operator characteristic (ROC) curves and area under the curve (AUC) were used to assess the performance of MELD and other scores in predicting postoperative mortality at 3 months (early) and 12 months. RESULTS: Among the 86 patients, mean age 48 ± 7 years, 76 (88%) were of male sex and 27 (31.4%) had died. Preoperative MELD failed to predict early mortality (AUC = 0.63; P = .066). Comparing preoperative MELD with other scores, all other scores had better predictive ability (P < .05), with D-MELD on the top of the list (AUC = 0.68, P = .016), followed closely by UKELD (AUC = 0.67, P = .025). After that were iMELD, MESO, and MELDNa with the same predictive performance (AUC = 0.65; P < .05); updated MELD had the lowest prediction (AUC = 0.640; P = .04). Moreover, all scores failed to predict mortality at 12 months (P > .05). CONCLUSIONS: Preoperative MELD failed to predict either early or 1-year mortality after LDLT. D-MELD, UKELD, MELDNa, iMELD, and MESO could be used as better predictors of early mortality than MELD; however, we need to develop an effective score system to predict mortality after LDLT.

Milk of calcium stones: radiological signs and management outcome.

Milk of calcium (MOC) is a rare type of stone that was first described in 1940 by Ludin and Howald who reported MOC in renal cysts. Milk of calcium is a viscous colloidal suspension of calcium salts. Stasis, obstruction and infection are important predisposing factors. Due to a layering effect, characteristic radiological signs especially in CT can help in diagnosis to avoid unsuccessful shock wave lithotripsy. This is the largest reported case series, in which radiological signs by CT scan to predict renal MOC stones, clinical picture and management outcome are described in detail. Cases with suspected renal milk of calcium stones were studied over 7 years (2008-2015). All cases were diagnosed preoperatively by non-contrast CT. Urine cultures were performed in all patients preoperatively. Intra-operative and postoperative findings were reported. Stones retrieved were sent for chemical analysis using an infrared method. Seven cases of milk of calcium renal stones were included in this study. These stones were faint radio-opaque in two cases and radiolucent in five cases. All cases were diagnosed preoperatively with non-contrast CT. Their Hounsfield units (HU) ranged from 114 to 612. All stones were located in a dependent position (gravitational effect) in the posterior aspect of dilated calyces. Five cases exhibited the typical fluid level and two cases demonstrated semilunar (half moon) pattern in the anterior surface of the stones. All cases underwent PCNL with suction and retrieval of soft stones without the need for disintegration. When stones demonstrate a low Hounsfield unit, are arranged in dependent positions within dilated calyces and exhibit fluid level or semilunar pattern on non-contrast CT, milk of calcium stones should be considered. PCNL is an effective modality for management of renal milk of calcium stones.

Effect of Isomorphous Substitution on the Thermal Decomposition Mechanism of Hydrotalcites.

Hydrotalcites have many important applications in catalysis, wastewater treatment, gene delivery and polymer stabilization, all depending on preparation history and treatment scenarios. In catalysis and polymer stabilization, thermal decomposition is of great importance. Hydrotalcites form easily with atmospheric carbon dioxide and often interfere with the study of other anion containing systems, particularly if formed at room temperature. The dehydroxylation and decomposition of carbonate occurs simultaneously, making it difficult to distinguish the dehydroxylation mechanisms directly. To date, the majority of work on understanding the decomposition mechanism has utilized hydrotalcite precipitated at room temperature. In this study, evolved gas analysis combined with thermal analysis has been used to show that CO2 contamination is problematic in materials being formed at RT that are poorly crystalline. This has led to some dispute as to the nature of the dehydroxylation mechanism. In this paper, data for the thermal decomposition of the chloride form of hydrotalcite are reported. In addition, carbonate-free hydrotalcites have been synthesized with different charge densities and at different growth temperatures. This combination of parameters has allowed a better understanding of the mechanism of dehydroxylation and the role that isomorphous substitution plays in these mechanisms to be delineated. In addition, the effect of anion type on thermal stability is also reported. A stepwise dehydroxylation model is proposed that is mediated by the level of aluminum substitution.

Laparoscopic varicocelectomy in infertile men: does age matter?

INTRODUCTION: Varicocele affects up to 15% of men in the general population. In couples with subfertility, the prevalence of varicocele in male partners was about 12%. In certain countries like the Middle East and Arabian Gulf, it is not rare to find people in their 5th or 6th decades or even older, who are seeking infertility clinics wishing to achieve paternity. OBJECTIVES: What are the results of laparoscopic varicocelectomy in relatively older infertile men (>40 years) in comparison with young infertile men (<40 years)? METHODS: It is a prospective observational study done in Farwaniya Hospital, Kuwait. Patients (83 cases) were categorized into two age groups: group I (55 patients) with age ranging from 25 to 40 years, and group II (28 patients) with age >40 years (range 41-53 years). Cases with clinically detectable varicocele only were included (grade II and III). Cases who underwent varicocelectomy for pain were excluded from the study as well as cases with previous abdominal surgeries. Cases with subclinical and mild varicocele (grade I) were also excluded from the study. The intra- and postoperative parameters as well as the improvement in semen quality were compared in both groups. Patients were seen after 3 and 6 months as outpatients. Cases were followed up for a mean period of 1 year (range from 6 to 22 months). RESULTS: The intraoperative and postoperative parameters as well as the improvement in semen quality were compared in both groups. There was colonic adhesion to the posterior peritoneum covering internal spermatic veins in 3 cases in group I (3.6%) and in 5 cases in group II (17.8%). This required more dissection to retract the colon and to expose the internal spermatic veins. The mean operative duration for laparoscopic varicocelectomy was significantly longer in group II (75 vs. 45 min in group I). After 3 months, 26 cases (47.2%) of group I and 11 cases (39.2%) of group II had improvement in semen quality. After 6 months, there was improvement in semen quality in 32 cases (58.2%) in group I and in 15 cases in group II (53.5%). CONCLUSIONS: Laparoscopic varicocelectomy in relatively old men is sometimes more difficult technically with relatively longer operative duration. However, it can achieve improvement in semen quality comparable to relatively younger patients. Further randomized controlled trials are needed to draw a more relevant conclusion about the impact of age in the outcome of laparoscopic varicocelectomy.

Effect of major burns on early and late activating markers of peripheral blood T lymphocytes.

It is known that lymphocytes immunophenotype is a reflection of the functional level of the immune system. The immunosuppressive effect of major burns is also known for many years. T lymphocytes of 50 major burn patients were analyzed in base line (BL) samples at 24 hours and at 1 week and 2 weeks after burn, using monoclonal antibodies of CD3, CD4, CD8, CD25 (IL2R) and HLA-DR by flow cytometry and ß2-microglobulin (ß2-m) by ELISA. Recorded values were compared with those of 50 healthy donors. There was statistically significant reduction in absolute number of CD3 positive cells (CD3+) (p<0.000) and CD4/CD8 ratio (p=0.01) in the first 24 hours in comparison with controls. CD25 (IL-2R) shows insignificant upregulation on T lymphocytes after burn with significant upregulation of HLA-DR. The absolute number of CD3+ cells began to increase after 2 weeks (p=0.03) but remained less than controls (p=0.08). CD4/CD8 ratio was more or less same as healthy controls after 2 weeks. Upregulation of CD25 was insignificantly increased and that of HLA-DR was markedly increased after 2 weeks (p=0.001). Significant negative correlations were detected between mean values of ß2-m and both absolute numbers of CD3 and CD4 positive cells in BL and one week samples. In addition there was significant correlation between mean values of ß2-m and values of CD25 expression in the BL samples. The obtained data is suggestive of persistent activation of T lymphocytes two weeks after major burns whereas early shedding of ß2-m is related to activation of lymphocytes increasing their susceptibility to apoptosis, both indicative of altered immune response. Burn intensivists and surgeons should be keen to support the patients' immune system in the first hours following major burns. This support will ensure free-bacteremic blood with a consequent better prognosis.

Lower pole midsize (1-2 cm) calyceal stones: outcome analysis of 56 cases.

OBJECTIVES: To compare efficacy of shockwave lithotripsy (SWL) with percutaneous nephrolithotomy (PNL) and retrograde ureterorenoscopy (RUR) in the management of midsize (1-2 cm) lower calyceal stones and the impact of lower pole (LP) anatomy on lithotripsy results. PATIENTS AND METHODS: Between 2007 and 2011, 56 patients with lower calyceal stones 1-2 cm were indicated for intervention. 24 patients were treated with SWL, 19 with PNL, and 13 with RUR. RESULTS: Mean age at surgery was 53, 45 and 47 years for SWL, PNL and RUR, respectively. Mean stone size was 15.6 ± 4.3, 17.3 ± 3.3 and 14.5 ± 3.2 mm, respectively. The stone-free rate was 62.5, 89.4 and 74.6%, respectively (p > 0.05). The mean time of procedures was 48.3 ± 16 min compared to 63 ± 32 and 76 ± 34 min in PNL and RUR, respectively (p > 0.05). In the SWL group there was a significant difference in LP anatomical measurements between the stone-free group and residual stone group. CONCLUSION: SWL is an effective treatment modality for patients with favorable LP calyceal anatomy. PNL and RUR with laser lithotripsy are effective therapeutic alternative options in midsize (1-2 cm) lower calyceal stones. This study may be limited by its retrospective nature and modest sample size, but it is enhanced by comparing three different treatment modalities.

A case of complete renal duplex with h-shaped ureter.

We present a case of complete renal duplex with H-shaped double ureter opening into the bladder with 2 separate orifices. It is an extremely rare variety of renal duplex which was reported only once in the literature. Fifty-four-year-old male presented to our department with right renal pain. Noncontrast CT revealed stone midthird right ureter with duplex right kidney. Retrograde ureteropyelography and ureteroscopy revealed this rare anomaly.

Penile epidermal inclusion cyst.

We report a case of epidermal inclusion cyst in a 32-year-old male. This was a complication of circumcision that was neglected over years to form stones and urethrocutaneous fistula. Complete excision of the cyst and repair of the fistula were performed successfully. Histopathological examination confirmed our diagnosis.

Fashioning reversed axial pattern forearm tissues in different challenging conditions of the forearm territory as a reliable substitute for free tissue transfer.

AIM: Traumatic tissue defects, chronic ulcerations, burn contractures and post-oncological excisions are the main problems affecting the hand and forearm areas. This work addresses the question of whether reversed axial island flaps from the forearm area could be applicable to any form of soft tissue defects in the territory of the forearm, and whether they could be considered reliable substitutes for free tissue transfer. METHOD: Thirteen patients who sought surgical treatment for soft tissue defects of the hand, wrist, and distal forearm regions were included in this evaluation report. The patients complained of four different etiologies, and their resultant tissue defects were managed by reversed radial forearm flap in eight cases and by the ulnar variety of the reversed forearm flap in another five cases. Selection of the flap option depended on the site of the pathology, size and thickness of the resultant defect, special needs of the defect, vascular limitations, and the like-tissue reconstruction objective. RESULTS: All flaps survived well with no complications. Both donor and recipient sites healed successfully. The selected flaps were ideal in their specific application. Harvesting reversed forearm flaps does not require high surgical skills or special equipment, venous congestion is less significant than with free flaps, and the patients do not need intensive immediate postoperative care and supervision. CONCLUSION: This is an easy and reliable technique requiring short operating time, and initiation of early physiotherapy is permitted, making forearm flaps reliable substitutes for free flap applications with all the associated complications.

Catatonia, neuroleptics and brain damage--a case report.

Catatonia is a syndrome that encompasses multiple motor signs. It can be the only presenting clinical feature in a patient with underlying multiple neuropsychiatric syndromes. The authors present a case of amisulpiride-induced catatonia, further evaluation suggested neuroleptic malignant syndrome (NMS) and showed the occurrence of temporal lobe epilepsy (TLE) and underlying brain pathology with marked frontoparietal atrophy and periventricular white matter hyperintensities. The pathological substrate of catatonia and its complex association with neuropsychiatric syndromes are discussed.

Reconstruction of the chest wall.

Chest wall reconstructions can be a complex and challenging procedure and may require a multidisciplinary approach. The most common indications for chest wall reconstruction are repair of defects due to tumor resection, infection, radiation necrosis, congenital deformities or trauma. The repair of complex chest wall defects presents a challenging problem for the reconstructive surgeon. Although the majority of such defects can be repaired with the use of local and regional musculocutaneous flaps, more complicated cases require increasingly sophisticated reconstructive techniques. As defects increase in size, microsurgical techniques are necessary to augment blood flow to pedicled flaps or to provide free flap coverage from distant sites. A better understanding of the respiratory mechanics and local anatomy is crucial in managing these complex defects.

Static management of lagophthalmos following facial nerve paralysis using standardized weights.

OBJECTIVE: Peripheral facial nerve paralysis is accompanied by inability to properly close the eye and protect the cornea. The implantation of a standardized upper eyelid gold weight implant allows gravitational pull on the relaxed eye. METHODS: Custom-made gold implants were surgically implanted pre-tarsally in the upper eyelids of 37 patients with facial nerve paralysis. RESULTS: Excellent results were achieved in 36 patients. Repeated extrusion occurred in one case. CONCLUSION: This is a simple, reliable and especially reversible surgical procedure for the rehabilitation of the paralyzed eye.

Different surgical reconstruction modalities of the post-burn mutilated hand based on a prospective review of a cohort of patients.

This study covered 40 patients (22 females and 18 males) suffering from post-burn hand deformities admitted to Assiut University Hospital and Luxor International Hospital (Egypt) from June 2004 to May 2006. Their ages ranged between 4 and 45 yr (mean, 24.5 yr). They presented a variety of post-burn hand deformities, e.g. dorsal hand contracture (14 cases), volar contracture (10 cases), first web space contracture (3 cases), post-burn syndactyly (2 cases), wrist deformity (3 cases), skin and tendon affection (2 cases), and complex deformity (6 cases). All the patients underwent a variety of surgical procedures specific to the individual post-burn hand deformity. Post-operative splinting of the hand for 10 days was performed in patients with skin graft to prevent recontracture. The post-operative physiotherapy programme started in the second week in order to achieve good functional results. The follow-up period ranged from 6 to 20 months. The results were satisfactory in most of the cases as regards the quality of coverage, which was achieved in the majority of cases. In one case there was partial loss of the skin graft, which healed by secondary intention; full range of motion was achieved in most patients, but not those with joint affections. On the basis of our results, we can conclude that the management of post-burn hand deformities depends on several factors. Initial treatment of the burned hand is of great importance for the prevention of secondary deformities. In secondary burn management the first step is the release of the contracture, which should be complete and include all contracted structures. The second step is the proper selection of methods of coverage for resultant defects, using either skin grafts or flaps depending on the presence of exposed tendons, nerves, or joints. The third step in order to obtain a very good function is the activation of an intensive physiotherapy programme immediately after the operation.

Different surgical reconstruction modalities of the post-burn mutilated hand based on a prospective review of a cohort of patients*.

This study covered 40 patients (22 females and 18 males) suffering from post-burn hand deformities admitted to Assiut University Hospital and Luxor International Hospital (Egypt) from June 2004 to May 2006. Their ages ranged between 4 and 45 yr (mean, 24.5 yr). They presented a variety of post-burn hand deformities, e.g. dorsal hand contracture (14 cases), volar contracture (10 cases), first web space contracture (3 cases), post-burn syndactyly (2 cases), wrist deformity (3 cases), skin and tendon affection (2 cases), and complex deformity (6 cases). All the patients underwent a variety of surgical procedures specific to the individual post-burn hand deformity. Post-operative splinting of the hand for 10 days was performed in patients with skin graft to prevent recontracture. The post-operative physiotherapy programme started in the second week in order to achieve good functional results. The follow-up period ranged from 6 to 20 months. The results were satisfactory in most of the cases as regards the quality of coverage, which was achieved in the majority of cases. In one case there was partial loss of the skin graft, which healed by secondary intention; full range of motion was achieved in most patients, but not those with joint affections. On the basis of our results, we can conclude that the management of post-burn hand deformities depends on several factors. Initial treatment of the burned hand is of great importance for the prevention of secondary deformities. In secondary burn management the first step is the release of the contracture, which should be complete and include all contracted structures. The second step is the proper selection of methods of coverage for resultant defects, using either skin grafts or flaps depending on the presence of exposed tendons, nerves, or joints. The third step in order to obtain a very good function is the activation of an intensive physiotherapy programme immediately after the operation.

Laparoscopic pyeloplasty: status and review of literature.

The ideal treatment for ureteropelvic junction (UPJ) obstruction should have the highest success rate, enable treatment of all types of obstruction, allow removal coexisting renal stones, and be minimally invasive. Open pyeloplasty offers all these features except the last (minimal invasiveness), whereas endourology techniques guarantee only the last one. Different techniques of pyeloplasty can be applied laparoscopically, although the best results are seen with dismembered pyeloplasty (Anderson-Hynes technique). Various methods of tissue approximation have been devised to avoid the difficult-to-master, time-consuming conventional suturing technique. Laparoscopic (antegrade) stenting is preferred by some surgeons, but we consider retrograde stenting is superior, as this rules out the presence of associated distal-ureteral obstruction. The transperitoneal approach has the advantages of a larger working space and readily identifiable anatomic landmarks. However, access to the renal pelvis requires considerable mobilization and retraction of the overlying loops of bowel. The retroperitoneal approach has the perceived disadvantage of a somewhat limited working space and absence of readily identifiable intra-abdominal anatomic structures such as the liver and spleen. However, the retroperitoneal approach has the advantage of greater familiarity, better detection of crossing vessels, direct and rapid access to the UPJ, and less risk of ileus. The robot-assisted technique has made suturing easier and may allow expansion of advanced laparoscopic procedures to surgeons without expertise in advanced laparoscopic surgery. The optimal length of follow-up after pyeloplasty is still unclear. Although most failures occur within the first 2 years, failures continue to appear after 5 and 10 years.

Impact of psoriasis on quality of life in Kuwait.

BACKGROUND: Psoriasis can seriously affect the quality of life (QOL) of patients and has a strong impact on social relations, psychological status and daily activities. OBJECTIVE: The aim of this study was to describe the impact of different grades of severity in psoriasis on QOL in patients in Kuwait. PATIENTS/METHODS: We used the Dermatology Quality Of Life scale (DQOLS) developed by Morgan and then validated for use in Kuwait to study a sample of 330 out-patients with psoriasis. RESULTS: Overall, physical activities were affected in greater than 50% of cases. This figure increased significantly with increased severity of psoriasis. Also, social relationships were disrupted in more than half of the patients but with no significant difference between different grades of severity. All psychological feeling items were affected by psoriasis to variable degrees. However, significant differences related to the severity of psoriasis were detected: feeling embarrassed, feeling short tempered, feeling depressed, and feeling a lack of hope. One third of cases declared their sexual activities were affected by psoriasis. CONCLUSION: Data provided should improve the physicians' awareness of the importance of patients' QOL and enhance psychological evaluation of the psoriatic patient which will promote his/her positive outcome and compliance with treatment.

Laparoscopic pyeloplasty: evolution of a new gold standard.

OBJECTIVES: To report our series of laparoscopic dismembered pyeloplasty for the treatment of primary and secondary ureteropelvic junction obstruction and to review the current status of this procedure. METHODS: A total of 170 consecutive cases of laparoscopic pyeloplasty (156 for primary and 14 for secondary ureteropelvic junction obstruction) were performed or supervised by a single surgeon (C.G.E). A four-port extraperitoneal approach was used in all but 3 cases, which were performed transperitoneally. RESULTS: The median operative time was 140 minutes. The complication rate was 7.1%, and the conversion rate was 0.6%, with no conversion in the last 161 cases. The median postoperative hospital stay was 3 nights. Crossing vessels were encountered in 42% of cases, and in 11 patients, coexisting renal calculi were successfully removed. At a median follow-up of 12 months, the success rate was 96.2%. CONCLUSIONS: Laparoscopic dismembered pyeloplasty produces functional results comparable to that of open surgery with the advantages of a minimally invasive procedure. Our results are consistent with previous series and support the view that laparoscopic pyeloplasty is moving rapidly toward replacing open surgery as the gold standard in the treatment of ureteropelvic junction obstruction.