Long term outcome of multidisciplinary management of urethro-rectal fistula after urologic surgery.

Urethro-rectal fistula (URF) is a rare but serious condition whose treatment is poorly codified. This study aims to evaluate the short and long-term results of multidisciplinary management. MATERIAL AND METHODS: We retrospectively collected the records of patients with URF operated on at the University Hospital of Tours between January 1, 2000 and January 1, 2020. Short-term and long-term results according to management are reported. RESULTS: The study included 20 patients. As an initial gesture, 11 patients underwent bladder catheterization and colostomy, seven underwent bladder catheterization alone, one underwent graciloplasty, and one, a York Mason procedure. The success rate of initial conservative management was only 5% (1/20). As a secondary or tertiary intervention, ten patients underwent a York Mason procedure and nine underwent graciloplasty. At the end of the study period, with a median follow-up of 50 months, 19 had been effectively treated for URF, 16 were able to have colostomy closure with restoration of digestive continuity while four had a permanent stoma. One patient had anal incontinence, 14% had major stress urinary incontinence. CONCLUSION: Multidisciplinary care remains a cornerstone of the treatment of URF because iterative surgeries may be required, with an overall success rate of up to 95% at the end of follow-up.

Is intraoperative heparin during renal transplantation useful to reduce graft vascular thrombosis?

OBJECTIVES: The standard treatment for end-stage renal disease is renal transplantation. As vascular anastomoses are performed during the surgery, it may expose to a risk of vascular thrombosis. This raises the question of using intravenous heparin during the procedure. The purpose of this study was to compare the incidence of renal transplant vascular thrombosis in the perioperative period based on whether the patients received or not intraoperative heparin. METHODS: A single center retrospective study was conducted on a cohort of consecutive patients who underwent renal transplantation between 2011 and 2015. Patients were divided into two groups: patients not receiving heparin vs. receiving heparin at the dose of 0.5mg/kg. A Doppler ultrasound was performed at day one postoperatively to assess the occurrence of vascular thrombosis. Hemorrhagic complications and the need for postoperative transfusion were also assessed. RESULTS: In total, 261 patients were included. Fifty-one patients received heparin (19.5%). Patient's baseline characteristics were comparable between the groups. No significant difference was found regarding the incidence of vascular thrombosis (6% for both groups, P=1). In addition, no difference was found regarding hemorrhagic complications requiring surgical revision (P=1) as well as early postoperative transfusion rate (P=0.57). CONCLUSIONS: Our results suggest that intraoperative IV heparin doesn't improve the risk of vascular thrombosis following renal transplantation. However, intraoperative IV heparin was not significantly associated with a higher rate of hemorrhagic complications suggesting that heparin can be safely used if required in some selected patients at higher risk of thrombosis. LEVEL OF EVIDENCE: 3.

Mechanism of triazolo-benzodiazepine and benzodiazepine action in anxiety and depression: behavioral studies with concomitant in vivo CA1 hippocampal norepinephrine and serotonin release detection in the behaving animal.

1. Real time, in vivo microvoltammetric studies were performed, using miniature carbon-based sensors, to concurrently detect norepinephrine (NE) release and serotonin (5-HT) release, in 2 separate electrochemical signals, within CA1 region of hippocampus in the freely moving and behaving, male, Sprague Dawley laboratory rat. 2. Concurrently, four parameters of open-field behavior, i.e. Ambulations, Rearing, Fine Movements and Central Ambulatory behavior (a measure of anxiety reduction behavior), were assayed by infrared photobeam detection. 3. Time course studies showed that the mechanism of action of the triazolobenzodiazepine (TBZD), adinazolam, (Deracyn) is dramatically different from that of the classical benzodiazepine (BZD), diazepam (Valium, i.e., adinazolam increased, whereas diazepam decreased, 5-HT release within CA1 region of hippocampus in the freely moving and behaving rat. 4. Adinazolam initially increased NE release and then decreased NE release in CA1 region of hippocampus in the freely moving and behaving rat whereas diazepam only decreased the electrochemical signal for NE; the decrease in NE produced by adinazolam was greater than the decrease in NE release produced by diazepam. 5. The Behavioral Activity Patterns, derived from same animal controls, simultaneously with detection of in vivo microvoltammetric signals for NE release and 5-HT release, showed that the BZD, diazepam, exhibited more potent sedative properties than did the TBZD adinazolam. 6. Hippocampal 5-HT and NE release effects of the TBZD, adinazolam, concomitant with behavioral effects lends explanation to the dual anxiolytic/antidepressant properties of the TBZDs.

Validation of gas and vapor sampling methods under field insult conditions.

A technique has been developed to validate gas and vapor sampling methods under field insult conditions. Laboratory validation, a necessary aspect of good laboratory practices, only tests the feasibility of a sampling method. "Field validation" determines the effectiveness of a given sampling method in the actual workplace environment where potentially interfering components may exist. A simple and inexpensive means is shown for introducing a known addition spike onto the sampling device during sampling. The validation sample is subject to the same field conditions as area or personnel samples. Upon analysis, recovery of the known addition spike within specified limits, verifies validity of the day's samples. Insufficient known addition spike recovery alerts the hygienist that something has caused sample failure, resulting in an invalid measurement of worker exposure.