Administration of neoadjuvant chemotherapy for muscle-invasive bladder cancer in real life: Are urologists still too cautious?

INTRODUCTION: Neoadjuvant chemotherapy (NAC) is now recommended to treat muscle-invasive bladder cancer (MIBC) but is not always executed in real life. This study aims to evaluate the proportion of patients with MIBC who receive an optimal NAC, and to present the predictive factors of its achievement. METHODS: This monocenter retrospective study included all the patients who underwent radical cystectomy for≥pT2NxM0 MIBC between 2013, January and 2018, December. NAC consisted in 4-6 cycles of MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) or 4 cycles of GC (gemcitabin, and carboplatin). Demographic (sex, age, ECOG-PS, glomerular filtration rate [GFR], and cN stage), surgical (urinary derivation, time of surgery, blood loss, and complications), and oncological characteristics were analyzed. Multivariate analysis are made to find predictors of administration of NAC. RESULTS: One hundred and twenty-seven patients were included. Thirty received CNA (24%). Patients who underwent CNA were younger, with better ECOG and better GFR. Multivariate analysis showed that cN+ stage and better GFR were significantly associated to administration of NAC. Eight patients (27%) couldn't receive an optimal treatment due to toxicity. Perioperative complication rates were similar, with or without NAC. Patients who underwent NAC had a worse GFR after treatment (-17 versus +5mL/min, P<0.01). CONCLUSION: Due to the risks of toxicity, NAC can only be proposed to selected population, which is not the current patients. Immunotherapy could allow to treat more patients because of better tolerance. LEVEL OF EVIDENCE: 3.

[Evaluation of single kidney graft outcome in patients initially programmed for a dual kidney graft transplantation]. / Évaluation de greffons de bigreffe transplantés en monogreffe.

INTRODUCTION: Kidney transplantation is championed as the gold standard treatment for patients with end-stage kidney disease. According to the biomedical agency, there is an increasing number of patients waiting for kidney transplantation. Faced with organ shortage, the use of marginal grafts may well increase the number of available kidney grafts. Occasionally, during dual kidney graft transplantation, the poor quality of one of the two grafts, or other specific circumstances, may lead to transplantation of only one of the two grafts. We have compared patient outcome concerning single kidney transplantation from an initial dual kidney graft with respect to dual kidney graft transplantation. MATERIAL: Among 67 patients enrolled for a dual kidney graft, 39 dual kidney grafts (group 1) were compared with 12 grafts performed with only one of the two kidneys of a dual kidney graft (group 2) as well as 15 grafts performed following a classic kidney graft protocol (group 3). RESULTS: The survival of grafts was respectively for groups 1, 2 and 3 of 100%, 72,5% and 75,4% (P=0.17). The survival of patients was respectively for groups 1, 2 and 3 of 78.3%, 89.9% and 87.8% (P=0.47). CONCLUSION: Our study suggests that transplantation of a single kidney, initially proposed as dual kidney graft candidate, has satisfying results in terms of graft survival and patient mortality at the expense of poorer renal function in comparison to dual kidney graft. Indeed, there was no significant difference in the survival of patients and grafts. This seems promising taking into consideration that the aim of transplantation in elderly recipients is primarily to avoid dialysis, rather than having optimal post-transplantation kidney function. LEVEL OF EVIDENCE: 4.

Respiratory syncytial virus-related bronchiolitis in Puerto Rico

BACKGROUND: Respiratory syncytial virus (RSV) is an important cause of respiratory tract disease in infants and young children. Immunoprophylaxis is available for high-risk infants. This study reviews infants with bronchiolitis at three primary care hospitals to describe the epidemiology of RSV infection in Puerto Rico. METHODS: We analyzed data from 2 hospitals by obtaining the number of infants diagnosed with bronchiolitis and estimating the percentage of cases due to RSV. A third hospital included patients with confirmed RSV infection. RESULTS: There were 4,557 patients in the study. RSV infection occurred throughout the year. Data shows a progressive decrease in RSV-positive infections. CONCLUSIONS: Data confirms year-round incidence of RSV in Puerto Rico. A standardized surveillance system in Puerto Rico is imperative to determine RSV epidemiology. The decrease in positive RSV infections may be due to the introduction of immunoprophylaxis to high-risk patients.

Reproducible lateral force microscopy measurements for quantitative comparisons of the frictional and chemical properties of nanostructures.

Atomic force microscopy (AFM) is a widely used technique for characterizing the topography and frictional properties of nanostructures. Inherent misalignments between the AFM cantilever and the feedback hardware lead to crosstalk between topography data and lateral force microscopy (LFM) data. Because the degree of crosstalk depends on the positioning of the cantilever, LFM and topography data of the same structure can vary from one experiment to the next. For nanostructures with large LFM contrast, errors as large as 50% in topography and LFM can be observed. This paper describes an empirical strategy for correcting this alignment error. The technique is used to characterize the frictional properties of scanning probe-induced oxide nanostructures and the hydrogen-terminated Si(111) surfaces on which they are patterned. Reproducible differences in the frictional properties of the oxide nanostructures patterned on HF-treated and NH4F-treated Si(111) surfaces are observed and attributed to the mixed-hydride versus monohydride termination of each surface. The observed frictional contrast is consistent with known differences in surface reactivity and demonstrates how LFM measurements can provide insight into the frictional and chemical properties of nanostructures

Left ventricular outflow tract obstruction with mitral mechanical prosthesis.

Left ventricular outflow tract obstruction after mitral valve replacement may occur when the native mitral apparatus is preserved intact. Although it has usually been reported using bioprostheses, we present one case using a low-profile mechanical prosthesis. The reduction of left ventricular dimensions and valvular redundancy contributed to this complication. We obtained definitive relief of left ventricular outflow tract obstruction by transaortic exposure and partial resection of the obstructing tissue with the help of video-assisted cardioscopy.

[Angina caused by subclavian-coronary steal in patients revascularized with internal mammary artery]. / Angina por robo subclavio-coronario en pacientes revascularizados con arteria mamaria interna.

After coronary bypass surgery in the left internal mammary artery, occlusive atherosclerosis in the proximal subclavian artery can produce reverse flow in the mammary artery and myocardial ischemia (coronary-subclavian steal syndrome). This is a rare cause of recurrent myocardial ischemia. We present two patients with postoperative complete obstruction in the proximal subclavian artery and inverse flow in the mammary artery producing severe ischemia in the left anterior descending artery territory. Both patients were treated with subclavian-subclavian bypass, which in one patient was ineffective in producing an adequate anterograde flow in the left internal mammary artery. We review clinical management, diagnostic methods and therapeutic options used in the coronary-subclavian steal syndrome.

Relation between power spectrum time course during ventricular fibrillation and electromechanical dissociation. Effects of coronary perfusion and nifedipine.

To relate the evolution of ventricular fibrillation (VF) to the haemodynamic recovery after cardioversion, we characterized the differences in the ECG power spectrum (PS) time course, among different types of VF: under control conditions, with previous administration of nifedipine and on cardiopulmonary bypass (CPB). In the first few seconds VF showed a PS with a narrow peak between 8 and 15 Hz and its higher harmonics, suggesting some organization and regularity. In the following 40 seconds, the arrhythmia accelerated slightly, maintaining an organized spectrum. Afterwards, the PS became slow and irregular, losing its initial characteristics after 60 seconds. Conversely, VF on CPB maintained its organized PS, over a prolonged period. Previous administration of 0.32, 0.64 mg kg-1 of nifedipine maintained the initial characteristics of the PS for 90 and 150 seconds. Similar results were obtained with previous autonomic blockade. In another group of dogs, defibrillation was performed after successive periods of VF, to study electromechanical dissociation (EMD). In all control dogs, EMD was observed after 90 seconds of VF. Pretreatment with nifedipine postponed EMD until 120-150 seconds and was not observed in dogs on CPB. The PS time course during VF seems a reliable method of analyzing and quantifying the different types of VF. It could be related with the onset of EMD, reflecting the metabolic alterations that happen during VF. Nifedipine could delay the ischaemic effects during VF and increase the possibility of successful cardiac resuscitation.

Pregnancy after heart valve replacement.

Thirty-two women, aged 21 to 44 years, who had undergone single (25) or multiple (7) heart valve replacement conceived 46 times and gave rise to 33 live-born infants. There were 12 abortions and one stillborn; a premature baby died 24 hr post-partum. Twenty-eight patients had mechanical prostheses and 4 had porcine xenografts, 29 patients being anticoagulated with acenocoumarol during the pregnancy. Cardiac status remained clinically satisfactory under medical treatment in all but one patient who developed heart failure. Fetal complications included cerebral hemorrhage in 1 premature infant, low birth weight in 3 newborns and 1 case of nasal hypoplasia. The incidence of abortion has decreased significantly during the latter part of our experience. It was significantly greater in patients with mitral prostheses. This review suggests that inadequate cardiac function, excessive anticoagulation and a history of primary infertility may increase the risk of abortion. Better control of anticoagulant therapy (accepting an elevation of the therapeutic limit) and improved prevention of pregnancy in high-risk patients are considered responsible for the improved results seen in recent years.

Aorta--right atrial communication. Report of an unusual case.

An unusual aneurysmal aorta--right atrial communication was found in a 25-year-old man with a rounded mass in the right cardiophrenic angle. Differential diagnoses included ruptured aneurysm of the sinus of Valsalva, coronary arteriovenous fistula, rupture of a dissecting aneurysm of the ascending aorta into the right atrium, and pseudoaneurysm of the right coronary artery followed by formation of a fistula between the aneurysm and the right atrium. Closure of the communication was performed under cardiopulmonary bypass. Complete absence of the right superior vena cava with a large persistent left superior vena cava draining to the coronary sinus was an unexpected finding at operation. The origin of the communication is not known; possible anomalous coronary and noncoronary origins are considered.

Resultados del tratamiento de la lepra con tiosemicarbazona / Results of treatment of leprosy with thiosemicarbazone

1.- Se expone el resultado actual de la experiencia terapeutica com tiosemicarbazona, que iniciamos en febrero de 1950. 2.- Se estudia por separado los resultados em cuatro lotes de enfermos con distintos plazos de tratamiento. 3.- La baciloscopia en moco se negativiza en enfermos tratados m s de un año en un 80% de los casos; en los tratados de ocho meses a un año, en un 77%. En los tratados de cinco a ocho meses, en un 33%; en los tratados de tres a cinco meses, en un 28,5% de los casos. En los frotis se encuentran bacilos en formas granulosas, y en muchos de los casos que no se negativazan la cantidad de bacilos que se presenta es sensiblemente menor. Tambien se obtienen frecuentemente resultados negativos o con escasos bacilos en los frotis de lesiones. 4.- Clinicamnte se obtiene mejoria m s e menos marcada en 31 enfermos de los 16 restantes, 9 no son valorables por no presentar lesiones activas, por lo que el porcentaje de mejorias es 31-38, es decir, 81,5 por ciento. Entre los resultados obtenidos est  la recuperación de sensibilidad en algunas zonas y reaparición parcial del vello, incluso en las cejas. Son particularmente interesantes los resultados obtenidos en formas tuberculoides quiescentes. 5.- La velocidad de sedimentación baja en 19 casos, se mantiene en 21 y sube en 7. En ocho de los casos que desciende se marcam antes una onda de aumento. 6.- La tolerancia es buena en 29 enfermos (51,6%). Hay intolerancias leves en 12 (21,4%) y m s importantes en 15 (26,7%). Tienen de suspender el tratamiento seis enfermos (10,7%). La forma más frecuente es la lepromireacción; despueslos trastornos gastricos. 7 - La dosificación empleada es por termino medio, 150 ó 200 miligramos diarios de manera continuada. 8. Consideramos el medicamento como actico frente a la infeccion leprosa, bediendo entar definitivamente entre los tratamientos que podemos emplear em la terapeutica de esta ...