[Long-term outcome of renal transplantation: impact of surgical complications on graft survival]. / Impact à long terme des complications chirurgicales sur la survie du transplant rénal.

OBJECTIVE: To determine the incidence of surgical complications of renal transplantation at one institution, relate this to donor and recipient factors and to long-term graft survival. PATIENTS AND METHODS: A consecutive series of 145 renal transplants were audited, and a database of donor and recipient characteristics created for risk-factor analysis. An unstented Barry-Sarramon anastomosis was the most used method of ureteric reimplantation. Lich-Gregoir anastomosis was used in 28.9% of cases. The mean follow-up time was 14.4 ± 6.23 years. RESULTS: There were 67 surgical complications including ten vascular, 39 urological and 18 parietal complications. Among urological complications, 13 were urinary leaks, four distal ureteric necrosis, 13 symptomatic ureteric reflux, six primary ureteric obstructions, and one ureteric stone at some time after transplantation. The overall incidence of urological complications was 26.2%. There was no association with recipient or donor age, cold ischaemic times before organ reimplantation, dialysis duration before transplantation, operating times, or ureteric stenting. Overall surgical complications had a significant pejorative impact on graft survival (Hazard Ratio [HR]=1.805; P=0.32), but as we studied them separately, we highlighted that in fact only vascular complications had an impact on long-term graft survival (HR=17.442, P<5E-10). There was no association between urological (P=0.566) or parietal (P=0.797) complications and long-term graft outcome. CONCLUSION: The onset of a urological or a parietal complication had no impact in this series on long-term graft survival. Vascular complications dramatically increase the rate of graft loss.

[Surgical management of urinary tract endometriosis: 12 cases]. / Prise en charge chirurgicale de l'endométriose de l'appareil urinaire : à propos de 12 cas.

OBJECTIVES: Our study aimed at evaluating, retrospectively, the outcome of the surgical management of urinary tract endometriosis. PATIENTS AND METHODS: Twelve women with a mean age of 36,4 were recruited between 1994 and 2007. They all had a histologically-proven and surgically-treated endometriosis of the urinary tract. RESULTS: Seven of them had a unilateral ureteric localization, two had a bilateral ureteric localization and three had a vesical localization. One patient with bladder nodules underwent a partial cystectomy and the two other patients with bladder localization underwent a transurethral resection. Out of the nine patients who had a ureteric localization of endometriosis, seven had a ureterectomy and re-implantation with bladder psoas hitching and had no recurrence. CONCLUSIONS: Our experience showed that ureterectomy and re-implantation with bladder psoas hitching is probably the best way of preventing recurrences in the case of urethral endometriosis. In the case of bladder endometriosis, transurethral resection did not appear as the most effective treatment although it remains an acceptable alternative, especially as far as premenopausal women or young women wishing to conceive are concerned.

Stormwater overflow impacts on the sanitary quality of bathing waters.

New European Directive 2006/7/EC concerning the management of bathing water quality introduces the concept of 'active management of bathing water sanitary quality' which could lead to a temporary bathing prohibition in case of short term pollution. For the last three bathing seasons, Veolia has carried out in experimental mode this 'active management' concept at more than one hundred bathing sites with various characteristics. Results confirm the high level of microbiological pollution observed in sewer overflows during rainy periods, which is the main cause of bathing water quality deterioration. An on-line treatment solution has been successfully tested. This solution may be used in dense urban areas.

Long-term pollution simulation in combined sewer networks.

This paper presents results of long term pollution simulations on the example of the sewerage system of Grand-Couronne. This modelling work is part of a study where objective is to develop a method to define the reference flow of a WWTP. The model HYDROWORKS DM has been successfully validated in hydraulics and pollution for the sewer network, for long time simulations. A conceptual model has been built to model the pollution in the tank at the outlet of the combined system. One synthetic year of rain has been used to simulate the working of the "up stream system" of the WWTP (combined sewer + tank + separate sewer + pre-treatments) and has been successfully validated by measurements of the 1998-1999 year. If this paper is focused on the "up stream system", the SIMBA/SIMBAD WWTP model has been successfully calibrated and validated too, and the combination represents a fully validated "Integrated Model" for the sewerage system.

Comparison between nasal provocation tests and skin tests in patients treated with loratadine and cetirizine.

BACKGROUND: The effect of H1-blockers may differ depending on the target organ. OBJECTIVE: A double-blind, placebo-controlled study was carried out to compare the effect of a 7-day treatment with loratadine (10 mg daily) or cetirizine (10 mg daily) on nasal challenge with grass pollen grains and skin tests with allergen or histamine. METHODS: Twenty-four patients were enrolled, but the analysis was carried out on 23. Nasal challenge was carried out by using 5-fold increasing numbers of pollen grains. Skin prick tests were done with serial concentrations of allergens and 1 concentration of histamine. Patients were tested in a cross-over design, with each treatment being administered for the previous 7 days and with a 2-week washout period. RESULTS: By comparison with placebo, loratadine and cetirizine increased significantly the threshold number of pollen grains required to induce a positive nasal challenge (P <.001). There was no difference between loratadine and cetirizine. Skin test responses to allergen were significantly reduced by loratadine and cetirizine by comparison with placebo. Skin test responses to histamine were significantly decreased by the 2 H1-blockers, but they were more profoundly decreased by cetirizine than by loratadine. CONCLUSIONS: Both H1-blockers reduced similarly allergen-induced skin test and nasal challenge responses. Cetirizine was more effective on histamine skin test responses.