Lipid organization in xerosis: the key of the problem?

OBJECTIVE: Although xerosis is a common skin disorder among the population, there is no in vivo global study focusing on xerotic skin. Hence, the objective of this study was to characterize xerotic skin from the surface to the molecular scale with in vivo and non-invasive approaches. METHODS: For this purpose, 15 healthy volunteers with normal skin and 19 healthy volunteers with xerotic skin were selected by a dermatologist, thanks to a visual scorage. Firstly, the skin surface was characterized with biometric measurements. Then, the state of skin dryness was assessed by in vivo confocal microscopy. The molecular signature of xerotic skin was then determined by in vivo confocal Raman microspectroscopy. Finally, an identification of stratum corneum (SC) lipids was performed using Normal phase liquid chromatography (NP-LC) coupled to two detectors: Corona and High Resolution/Mass Spectroscopy (HR/MS). RESULTS: Results obtained at the skin surface displayed an increase in the transepidermal water loss (TEWL) and a decrease in the hydration rate in xerotic skin. Confocal microscopy revealed an alteration of the cell shape in xerotic skin. Moreover, confocal Raman microspectroscopy demonstrated directly in vivo and non-invasively the lack of organization and conformation of lipids in this skin. Finally, HPLC analyses revealed that the three ceramide sub-classes (NdS, NS and EOP) significantly decrease in xerosis. Altogether, these results identify parameters for the characterization of xerotic skin compared to normal. CONCLUSION: This study highlighted discriminative parameters from the surface to the molecular level in vivo and non-invasively between xerotic and normal skins. These results will be useful for the development of new cosmetic active ingredients dedicated to xerotic skin.

Cytotoxicity assessment of latex urinary catheters on cultured human urothelial cells.

PURPOSE: To study the toxicity of latex urinary catheters on cultured human urothelial cells (HUC). MATERIALS AND METHODS: We exposed monolayers of HUC (well characterized for their proliferation, qualitative evaluation and quantitative measurement of cytokeratins) to either pure or diluted liquid latex extracts, obtained under standard conditions or by direct contact with materials. RESULTS: The latex urinary catheter appears to be highly toxic since cell viability and metabolic activity were about 10% of those of negative controls for original extracts. Concerning direct contact, latex reduced cell viability, metabolic activity and cell proliferation of HUC on days 1, 3 and 8. CONCLUSION: The high toxicity of latex on HUC is confirmed for extracts and direct contact. Therefore, it should no longer be used for urinary catheters.

Analytical and prospective evaluation of urinary cytokeratin 19 fragment in bladder cancer.

PURPOSE: We evaluated CYFRA 21-1, an immunoradiometric assay, developed to detect soluble cytokaratin 19 fragment, for its diagnostic performance in bladder transitional cell carcinoma as well as its analytical performance. MATERIALS AND METHODS: We assessed CYFRA 21-1 in the serum and urine of 182 patients, including 66 with bladder transitional cell carcinoma (group 1), 66 with another urological pathology (group 2) and 50 free of urothelial disease (group 3). The power of urinary CYFRA as a diagnostic test for bladder transitional cell carcinoma was evaluated by receiver operating characteristics curve analysis. Analytical performance was assessed by determining intra-assay and interassay precision, and accuracy by dilution testing and recovery of supplemented analyte. RESULTS: Mean urinary CYFRA plus or minus standard deviation was 154.39+/-49.00, 22.6+/-8.9 and 2.40+/-0.14 ng./ml. in groups 1 to 3, respectively (significantly different). Receiver operating characteristics curve analysis revealed optimal 96.9% sensitivity and 67.2% specificity for a threshold value of 4 ng./ml. Analytical determination showed that intra-assay and interassay precision provides a satisfactory coefficient of variation. The assay for accuracy had acceptable recovery in diluted samples as well as in those with supplemented analyte. CONCLUSIONS: The urinary immunoradiometric CYFRA 21-1 assay performs well analytically. Urinary CYFRA 21-1 is a useful marker for diagnosing transitional cell carcinoma and provides sensitivity in low grade disease.

Cultured differentiated human urothelial cells in the biomaterials field.

To review the use of normal cultured differentiated human urothelial cells in the biomaterials field, we checked the literature for human urothelial cells in culture (HUC) both for their use in biocompatibility assessment and as bioartificial devices. The in vitro culture of differentiated human urothelium is now a simple and reliable procedure. These techniques provide new tools for biocompatibility assessment of urinary biomaterials, because for the rational design of a testing procedure, it is preferable that the particular cell culture models selected should be closely related to the end-use application. The emerging use of HUC culture should lead to the development of bioartificial tissue for urinary tract reconstruction. Tissue engineering techniques require urothelial cells and cell delivery matrices. The cytocompatibility of novel artificial delivery matrices should be assessed in vitro before implantation using cultured HUC to find the best material available.

In vitro cytocompatibility of radio-opacifiers used in ureteral endoprosthesis.

Ureteral endoprostheses are urinary catheters made of polymeric biomaterials made radio-opaque through the addition of X-ray absorbing additives such as barium, bismuth, tantale or tungsten. The aim of this work was to study the in vitro toxicity of solutions of these radio-opacifiers using two cell culture models. Primary-cultures of human urothelial cells (HUC) arising from normal adult urinary tract and permanent urothelial cell line were used. Solutions at different dilutions were placed into the wells containing monolayers of confluent cells. After 24 h incubation period, the solutions were removed and cell viability and cell metabolic activity tests were performed (Neutral Red assay and MTT assay). At a concentration lower than 1 mg l(-1) the different radio-opacifiers used showed no toxicity. From 1 to 3 mg l(-1) one can note a significant dose-dependent decrease of cell metabolic activity of solely HUC for barium chloride. At 3 mg l(-1) one can note a significant deleterious effect on HUC metabolic activity, with bismuth and tantale. For tungsten, there is no deleterious effect, but on the contrary a significant increase in HUC metabolic activity at a 0.5 mg l(-1) concentration. None of the solutions did provoke alterations in HUC viability for concentrations less than 3 mg l(-1). Interestingly, for permanent cell line one can note a solely significant decrease of cell viability at 3 mg l(-1) for tantale. All the other tested salts on permanent cell line were not significantly different from controls for cell viability as well as cell metabolic activity. HUC culture model may be of relevance for the screening of radio-opacifiers intended for ureteral endoprostheses.

[Gynecomastia]. / Gynécomasties.

Gynaecomastia is the least rare manifestation of the male breast disease. Urologists must therefore be able to distinguish the various forms of gynaecomastia, eliminate a testicular tumour and identify the main causes by performing a simple but complete assessment. Medical treatment is fairly disappointing. Surgical treatment is required in patients presenting with complications or when persistent gynaecomastia is aesthetically bothersome.

An in vitro biocompatibility evaluation of double-J stents.

OBJECTIVES: For several years, studies performed to estimate in vitro biocompatibility of urinary catheters have been carried out using permanent cell lines. However, for a rational design of the testing procedure, the cell culture model should depend on the material application. We assess the biocompatibility of 13 double-J stents using an in vitro model of normal human urothelial cells (HUC). This article aims to mimic in vitro, on HUC monolayers, the close contact existing in vivo between the urothelium and double-J stents and to evaluate the subsequent effect on these cells. METHODS: Fragments of each stent were deposited into the wells containing confluent HUC, with close contact maintained between the material and the cells. The same procedure with either no material or fragments of latex catheter was undertaken to provide the negative and positive controls, respectively. The contact was maintained for 1, 3, and 8 days. At the end of the incubation period, fragments of stent were removed and cell activity tests were performed (neutral red assay, MTT assay, and cell proliferation). RESULTS: One of the silicone stents is significantly deleterious on HUC as determined by three tests after 8 days of contact. For two copolymers, a tendency to increase cell proliferation was noted. Concerning polyurethanes, we observed significant decreases in HUC viability and cell metabolic activity for five stents after 8 days of contact. All seven polyurethane stents significantly inhibited cell proliferation. CONCLUSIONS: The HUC culture model may be of relevance for the screening of materials intended for use as double-J stents.

[The biocompatibility of catheters and stents used in urology]. / Biocompatibilité des sondes et endoprothèses utilisées en urologie.

Biocompatibility can be interpreted as the optimal combination of a series of interactions occurring at the material-tissue interface as soon as these two systems are in contact. It is a multifactorial interface property which integrates all of the phenomena involved in a biological environment i.e. absence of toxicity of the material for the body and absence of degradation of the material by the body. Biocompatibility can be evaluated in a normative context by using in vivo techniques in animals or in vitro techniques using cell cultures allowing the study of cytotoxicity (related to a concept of safety) and cytocompatibility (related to biological acceptability) of a material. Because of their intimate contact with the urothelium throughout implantation, the biocompatibility of catheters and stents constitutes a major requirement. This review presents the current data reported in the literature concerning the evaluation of the biocompatibility of materials used in urology. The main problems encountered are alterations of the urothelium, such as erosions or, on the contrary, mucosal hyperplasia, and the existence of incrustations developing on these materials.

First use of cultured human urothelial cells for biocompatibility assessment: application to urinary catheters.

For several years, studies performed to estimate in vitro biocompatibility of urinary catheters have been carried out using permanent cell lines. But for a rational design of the testing procedure, the cell culture model should relate to the material application. This work presents the results of a probe study designed to obtain an in vitro model of normal human urothelial cells (HUC) and to test the relevance of this system in cytocompatibility experiments of urinary catheters currently used.A comparison is made with continuous cell lines, the use of which is recommended by normalization bodies. We exposed monolayers of HUC (well characterized for their proliferation, qualitative evaluation, and quantitative measurement of cytokeratins) and two continuous human cell lines to liquid extracts (either pure or diluted in the culture medium) of nine available catheters, including positive (latex) and negative controls, for a 24 h incubation. Then colorimetric assays (Neutral Red and MTT) were performed. The extracts of two polyurethanes provoked a significant toxic effect on HUC only, suggesting differences in sensitivity between the models used. This effect could be due to the presence of a great amount of barium (used as a radioopacifier) in extracts, as highlighted by results of absorption emission spectroscopy. A culture model of HUC may be of relevance for the screening of materials intended for urological practice.

[Renal angiomyolipoma with venous extension associated with complete duplication]. / Angiomyolipome rénal avec extension veineuse associé à une duplicité complète.

A case of venous extension de renal angiomyolipoma is reported. The diagnosis was established preoperatively by ultrasonography and renal CT. This tumour was treated conservatively by partial nephrectomy after selective embolization because of the presence of complete duplication.

Initial evaluation of CYFRA 21-1 diagnostic performances as a urinary marker in bladder transitional cell carcinoma.

PURPOSE: CYFRA 21-1, an immunoradiometric assay developed for the detection of a soluble cytokeratin 19 fragment, is evaluated for its diagnostic performance in urine of patients with transitional cell carcinoma. MATERIALS AND METHODS: CYFRA 21-1 was investigated in serum and urine of 128 patients, including 48 with bladder transitional cell carcinoma (group 1), 44 with other urological pathological conditions (group 2) and 36 free of urothelial disease (group 3). Urinary cytopathology was also performed. RESULTS: Mean urinary CYFRA was 123.5 +/- 53, 11.9 +/- 4.8 and 2.3 +/- 0.2 ng./ml. for groups 1 to 3, respectively, and was significantly different. From the receiver operating characteristics curve, the optimal combination of 96% sensitivity and 74% specificity was determined for a threshold value of 4 ng./ml. while overall cytopathology sensitivity was 43%. CONCLUSIONS: Urinary CYFRA 21-1 may be a useful marker for diagnosing transitional cell carcinoma.

[The value of transrectal MRI in the staging of localized prostate cancer]. / Valeur de l'IRM endorectale dans la stadification du cancer de prostate localisé.

OBJECTIVE: To determine the diagnostic value of transrectal magnetic resonance imaging (MRI) in the local staging of prostatic cancer. METHOD: 75 patients suffering from clinically localized prostatic cancer were included consecutively from December 1992 to September 1996. An MRI examination (1.5 Tesla, Siemens) with a transrectal coil was performed before radical prostatectomy. The results of this examination in terms of capsular invasion, seminal vesicle lesion and apical invasion were correlated with the results of histological examination of the operative specimen and the findings of digital rectal examination, transrectal ultrasonography, serum PSA level and biopsy mapping. RESULTS: The best performance of transrectal MRI concerned elimination of seminal vesicle lesion with a specificity of 92%. The positive predictive value of transrectal MRI was 90% for the capsular invasion. The positive predictive value of transrectal MRI was 56% for the apex, the sensitivity was 40% and the specificity was 82%. When transrectal MRI did not reveal any extraprostatic involvement the risk of positive margins on radical prostatectomy was less than 6%. CONCLUSION: In this study, transrectal MRI appeared to be satisfactory to improve the staging of localized prostate cancer, especially in terms of seminal vesicle lesion and apical invasion, but, most importantly, appeared to be very useful to predict negative resection margins.

[Therapeutic strategy apropos of 122 cases of early disclosed traumatic rupture of the urethra]. / Stratégic thérapeutique à propos de 122 observations de rupture traumatique de l'urètre vue tôt.

When ureteral rupture is suspected after trauma with fracture of the pelvis, insertion of a suprapubic catheter is required as an emergency measure. Ureteral lesions must be repaired early by the 5th to 10th day after trauma. Pyelography or retrograde ureterography is required to determine whether there is total or partial rupture and the degree of damage is identified endoscopically. We operated 73 total ruptures in deferred emergency situations (58 transpubic, 14 perineal approaches) and achieved good results in 80%. There were also 41 partial ruptures treated with an indwelling catheter in which 21 developed strictures requiring secondary uretrotomy. In three particular situations (anorectal damage, infected perineal wound, polytrauma with head trauma), in 8 patients were managed with suprapubic drainage alone before repair 3 months later. Different complications, including stricture and impotency were observed.

[Conservative surgery in cancer of the kidney]. / Chirurgie conservatrice dans le cancer du rein.

Partial nephrectomy is classically indicated in patients with renal cell cancer on a single kidney, although a certain amount of debate continues on surgical technique: simple enucleation or true partial nephrectomy. Incidence of multifocal tumours has been estimated at 6 to 19.6%. The crucial problem for the surgeon is to recognize satellite tumours pre- and peroperatively since it has been estimated that 4 to 10% of renal cell carcinomas contain a multifocal disease unrecognized during surgery. Is conservative nephrectomy acceptable for patients with a functional contralateral kidney? There are several arguments in favour of the technique: fortuitously discovered tumours are generally smaller and in a less advanced stage, morbidity after conservative surgery is low compared with total nephrectomy, nephron sparing improves long-term renal function and survival at 3 to 5 years is 95 to 100%. The fact that the risk of cancer on the contralateral kidney is small (1 to 2%) compared with the risk of local recurrence and the lack of sufficiently long follow-up in large series are negative arguments. Conservative nephrectomy must therefore be considered as the best solution when nephron sparing is essential. Total nephrectomy remains the reference treatment in other cases although the discussion remains open for cases with small (< 2.5 cm) tumours.

[Tumors of the upper urinary tract in patients following bladder tumors: multicentric locations or seeding? Apropos of 14 cases]. / Tumeurs de la voie excrétrice supérieure chez les patients suivis pour tumeur de vessie: localisations multi-centriques ou greffes? A propos de 14 observations.

The occurrence of upper urinary tract tumors has been studied in 479 patients followed for bladder cancer: The incidence rate is low (2.9%) but increases with time (mean: 58 months). Some patients are more exposed: those who underwent repeated transurethral resections of Ta-T1 multifocal bladder carcinoma. Retrograde and voiding cystourethrogram seems to be useful to select a group "at risk" during the follow-up of patients with bladder tumors treated by endoscopic resection: a yearly excretory urography for upper urinary tract survey should then be performed.

Subcutaneous low-dose recombinant interleukin 2 and alpha-interferon in patients with metastatic renal cell carcinoma.

A double-institution phase II study was performed in patients with metastatic renal cell carcinoma treated subcutaneously (s.c.) with interleukin 2 (IL-2) and alpha-interferon (INF-alpha). Thirty-eight patients were treated over a course of 7 weeks. Initially (day 1 + 2) patients received s.c. IL-2 at 18 x 10(6) IU m-2. During the following 6 weeks, patients received s.c. IL-2 at 3.6 x 10(6) IU m-2 for 5 days per week and s.c. INF-alpha at 5 x 10(6) for 3 days per week. Thirty-eight patients were evaluated for response. An objective response was seen in seven patients (18.4 +/- 12.3%), with one complete response and six partial responses. Median duration of response was 6.7 months. Toxicity could be evaluated in 38 patients and was limited. Mild to moderate toxicity included fever (97%), fatigue or malaise (76%), nausea or vomiting (50%), anorexia (32%), hypotension (26%), neurological disturbances (26%) and hypercreatininaemia (39%). In addition, four grade IV haematological toxicities were noted. No cardiac side-effects were seen. IL-2 and INF-alpha given by this schedule can be safely administered in an outpatient setting. The objective response rate was similar to our previous treatments with high-dose IL-2 given as a continuous infusion.

[Long-term results of a series of 39 of Bordeaux-type bladder replacements using ileocecal grafts after total prostatectomy and cystectomy]. / Résultats à long terme d'une série de 39 remplacements vésicaux type vessie de Bordeaux par greffon iléo-caecal détubulisé après prostato-cystectomie totale.

A series of 136 bladder replacements using colon tissue was performed after total prostacystectomy for cancer of the bladder. Sixty-four Bordeaux-type ileocecal replacements were performed. The first bladder Bordeaux-type was created in March 1985. The technique involves detubulization of an ileocecal segment using 15 cm of the right colonic segment submucally according to the Goodwin technique. Uretral anastomosis uses the lower most portion of the cecum. Ileocecal anastomosis is performed manually or using a biofragmenting ring with terminoterminal junction as in the last 12 patients. After a follow-up of 1 to 8 years, 39 patients were evaluated for long-term results. The notion of need was obvious. Daytime continence was achieved in all patients. Night-time continence was achieved in 75% including several patients who had nocturnal mictions. Bladder filling occurred at low pressure with peaks from 5 to 20 cm H2O. Bladder capacity varied from 300 to 400 cc. Mean urinary flow was 21 ml/s. No cases of diarrhea were observed. Radiotransparent and asymptomatic bladder stones were seen in two cases. Mean corpuscular volume, vitamin B12 and folic acid levels were normal in 3/4 patients. No cases of elevated chloride were observed and no cases of oxaliuria occurred. Bladder Bordeaux-type construction offers a functional volume similar to the normal bladder with good metabolic tolerance, remarkable good stability over time and no deterioration of the upper urinary system.

A new biodegradable elastin-fibrin material; its use in urological, digestive and cardiovascular surgery.

A new original artificial connective matrix mainly made of elastin and fibrin-like product is used to reinforce damaged tissues and to close and restore a loss of substance in several domains of surgery: all sites in the digestive system and urinary tract; besides, it can substitute for the pericardium in iterative heart operations. In all cases, the original tissue is restored ad integrum while the biodegradable material disappears completely, without any complications.