[Prostatic Urethral Lift under local anesthesia: Single-centre retrospective observational study]. / La pose d'implant UroLift ® sous anesthésie locale : étude observationnelle rétrospective monocentrique.

INTRODUCTION: Urolift implant placement may be preferred to conventional endoscopic surgery for patients who wish to preserve their sexuality or for those who prefer a rapid post-operative recovery. The absence of general anaesthesia is an important element that reinforces the minimally invasive aspect of the procedure and improves the speed of recovery. The aim of this work was to report our preliminary experience of Urolift treatment under local anaesthesia. MATERIALS AND METHODS: A retrospective analysis was conducted including all patients treated with Urolift between 2017 and 2021 in our centre. Local anaesthesia was based on the instillation of 2 Xylocaine gels at 4°C into the urethra 15minutes before the procedure. The primary endpoint was the successful completion of the procedure without interruption due to pain or the need for any other form of anaesthesia or analgesia. RESULTS: Twenty-seven patients were included with a median age of 65 years and a prostate volume of 46mL. The International Prostate Symptom Score (IPSS) was 23. The first 3 patients were operated on under general anaesthesia. Local anaesthesia was introduced from the fourth patient onwards. There was no recourse to other modalities of analgesia or anaesthesia or interruption of the procedure. The operating time was 10minutes and pain was assessed at 1 on a visual analogue scale. At 3 months, the IPSS score was 9 (P=0.001). CONCLUSION: This preliminary experience confirms the feasibility of placing the Urolift implant under local anaesthesia without any failure of the proposed management. The improvement in IPSS score was consistent with previously published clinical trials. LEVEL OF EVIDENCE: 3.

Effectiveness and Adverse Events of Use of Natalizumab in a Brazilian Cohort of Patients With Multiple Sclerosis.

PURPOSE: Natalizumab (NTZ) is a monoclonal antibody with confirmed efficacy in white populations with recurrent-remitting multiple sclerosis (RRMS); there are few studies, however, in mixed-race populations. Real-world studies of NTZ are needed to better understand the drug's effectiveness. This study evaluated the effectiveness and adverse events of NTZ in a cohort of Brazilian patients with MS, as well as the impact of clinical and demographic factors on patient response to treatment. METHODS: This multicenter, Brazilian observational study was conducted from January 2011 until December 2016 and included patients with RRMS (McDonald criteria 2005 and 2010) aged ≥18 years treated with NTZ for at least 3 months. Demographic, clinical, and radiologic data were obtained from medical records and during follow-up visits. The primary outcomes investigated were the absolute number of relapses and annualized rate of relapses, change in Expanded Disability Status Scale value, and presence of new lesions on magnetic resonance imaging after starting NTZ treatment; the occurrence and type of adverse events were also analyzed. In addition, the impact of demographic and clinical prognostic factors and radiologic activity on the effectiveness of NTZ was measured. Descriptive and univariate statistical analyses used a significance level of P < 0.05. RESULTS: The study enrolled 56 patients; 64% were women, and 36% were of African descent. There was a significant reduction in the mean absolute number (P = 0.001) and in the annualized rate (P = 0.001) of relapses and in the radiologic activity of the disease (P = 0.001). Furthermore, 71% of patients showed no increase in Expanded Disability Status Scale score after 1 year of treatment. The effectiveness of NTZ was not associated with the presence of clinical and demographic prognostic factors, and the most frequent adverse events during the use of NTZ were gastrointestinal symptoms; there were no cases of progressive multifocal leukoencephalopathy. IMPLICATIONS: According to patients' reports and clinicians' observations regarding clinical and radiologic benefits and tolerability to adverse events, the use of NTZ was favorable in this Brazilian MS cohort, regardless of the presence of unfavorable prognostic factors.

Meta-analysis comparing newer antipsychotic drugs for the treatment of schizophrenia: evaluating the indirect approach.

BACKGROUND: Meta-analysis is a useful method to assess the efficacy of newer antipsychotic drugs compared with older drugs or placebo. However, few trials directly compare novel drugs to each other. OBJECTIVE: The purpose of this study was to evaluate the method of indirect meta-analysis by applying it to data on olanzapine versus haloperidol and risperidone versus haloperidol to enable a comparison between olanzapine and risperidone. METHODS: Published randomized controlled trials (RCTs) of risperidone, olanzapine, and/or haloperidol were identified through literature searches (1983 to 1999) of the MEDLINE, Current Contents, and HealthSTAR databases and reviewed. Data for the Brief Psychiatric Rating Scale (BPRS) total score, the Positive and Negative Syndrome Scale (PANSS) negative subscale, the percentage of patients using anticholinergic drugs, and the percentage of patients dropping out due to lack of efficacy, side effects, or any cause were extracted and combined using the indirect method. These findings were compared with those from a direct comparative study of olanzapine and risperidone. RESULTS: The literature search yielded 8 RCTs comparing risperidone to haloperidol and 3 comparing olanzapine to haloperidol. Only 1 trial directly comparing olanzapine and risperidone was found. In this trial, the change in BPRS total and PANSS negative subscale scores tended to be higher with olanzapine by 1.80 and 1.10, respectively, but these differences were not statistically significant. Indirect meta-analysis yielded similar results. Changes in both BPRS total scores and PANSS negative subscale scores tended to be higher with olanzapine by 0.37 and 0.54, respectively, and again, the differences were not statistically significant. In the indirect meta-analysis, the rate of anticholinergic drug use was 19.5% greater among patients treated with risperidone than among patients treated with olanzapine (P < 0.05). In the direct comparative RCT, the rate was 13.1% higher among patients treated with risperidone (P < 0.05). The dropout rates were similar for patients treated with risperidone and those treated with olanzapine in both analyses. CONCLUSION: An indirect meta-analysis of studies comparing olanzapine with haloperidol and risperidone with haloperidol yielded conclusions similar to those found in a direct comparative RCT of olanzapine and risperidone.

[Radiation injuries of the small intestine. Surgical treatment]. / Lésions radiques de l'intestin grêle. Traitement chirurgical.

UNLABELLED: From 1978 to 1992, 55 patients (48 women: 87%) with a mean age of 62 years (35-89) underwent 70 operations for radiation injury of the small bowel. Primary pathology treated with radiotherapy was gynecologic cancer (40: 72%), digestive malignancy (9: 16%), male genital cancer (4: 7%), carcinoma of the bladder (2: 3%). External radiation was performed alone (47: 85.5%) or associated with intracavitary radium or cesium (8: 14.5%), mean radiation dose was 50 Gy for 35 patients and not specified for 20 but greater than 45 Gy for all patients. Fifteen patients had associated chemotherapy. Latent period between radiation injury and first symptoms was 39 months (1-16 years) and 72 months (3-26 years) between radiation and surgical treatment. There were 28 solitary lesions (mean length: 148.5 cm) with 5 associated colonic injuries, 27 multiple lesions of the small bowel (mean length: 187.5 cm) with 21 associated colonic injuries. Twenty-one lesions of the abdominal wall and 13 lesions of the urinary tract were also associated. Nineteen patients had pre-operative total parenteral nutritional assistance. Surgical treatment was performed for chronic obstruction in 46 patients, for fistulae in 5 or for an acute complication in 4 (perforating peritonitis: 3, occlusion: 1). Operations performed were: small bowel resection (32), associated with bypass (2); internal by-pass (15); dissection of adhesions and/or stomy (7). RESULTS: Operative mortality was 2 (6.2%). Morbidity occurred in 16 (29%) with 3 anastomotic fistulae. Functional results were good for 36 patients (24 resections, 7 by-pass), poor for 2 (1 resection). Failure leading to a second operation occurred in 15 (5 resections, 8 by-pass). COMMENTS: 1) pre-operative nutritional assistance improves operative results; 2) intestinal resection is preferable to internal by-pass whenever it can be performed without extreme risk or unacceptable sequelae.

[Elective cholecystectomy by celioscopy versus subcostal approach cholecystectomy. Comparative study of postoperative pain and discomfort]. / Cholécystectomie élective par coelioscopie versus abord sous-costal. Etude comparative de la douleur et du confort post-opératoire.

The aim of this prospective study was to evaluate postoperative pain and discomfort in 70 patients undergoing cholecystectomy. The choice of surgical approach was left to the surgeon. Accordingly, these patients were then divided in two groups: laparoscopic cholecystectomy (group I; n = 37); classic cholecystectomy (subcostal incision) (group II; n = 33). There was no significant difference between these groups concerning weight/height ratio, size and number of stones. Patients in group II were older (55 +/- 16 years) than those in group I (46 +/- 11 years) (P < 0.01). The mean duration of surgery was shorter in group II (96 +/- 31 min) than in group I (119 +/- 49 min) (P < 0.01). Postoperative discomfort was evaluated by (group I versus group II respectively): a) the mean length of hospital stay after surgery (3.7 +/- 1.5 versus 6.7 +/- 1.1 days, P < 0.02); b) the mean delay to return of intestinal motility (1.5 +/- 0.6 versus 2.0 +/- 0.6 days, P < 0.001); c) the mean perfusion time (1.4 +/- 0.6 versus 2.6 +/- 0.8 days, P < 0.001); d) intensity of postoperative pain which was evaluated daily. There was no significant difference between these two groups concerning the use of analgesics; however, a statistically significant difference was found in the visual and verbal scales, starting on the second postoperative day and in autonomy as early as the first postoperative day.(ABSTRACT TRUNCATED AT 250 WORDS)

[Reoperations for failure of gastroesophageal reflux surgery. Apropos of fifty reoperations]. / Réinterventions pour échec de la chirurgie du reflux gastro-oesophagien. A propos de cinquante réinterventions.

Fifty patients were reoperated for failed antireflux procedures or post-fundoplication symptoms. Cases of severe esophagitis, that is stenosis or Barrett's esophagus, were excluded. The usual cause of failure was a technical error. All of the operations, a new fundoplication in 35 cases and a total duodenal diversion in 15 cases, were performed via an abdominal incision. Operative mortality was nil. After a 42 months follow-up, according to the patient, the clinical results were good or excellent in 93% of the cases. The objective results-fibroscopy, pHmanometry, X-Ray were normal in 86%.

[Hartmann's procedure. A retrospective study of 86 cases]. / L'intervention de Hartmann. Etude rétrospective de quatre-vingt-six cas.

The purpose of this retrospective study is to define current indications and results of Hartmann's procedure (H). From 1978 to 1989, 86 H were performed, 52 (60%) as emergency surgery. Indications were: colo-rectal cancer (37): 15 complicated and 22 as an elective procedure, diverticular disease acute or complicated (24), ischemic colitis (10), volvulus of the pelvic colon (5), inflammatory bowel disease (4), colonic perforation (3), traumatic hematoma of the sigmoid mesocolon (1). Fourteen patients died after operation (mean age: 79). There was no death after elective H for cancer. Post-operative complications were numerous: pulmonary (25%), abdominal would sepsis or disruption (21%), rectal strump leakage (14%), the later being harmless due to the associated Mickulicz drainage. Seven patients were reoperated on for necrosis of the colonic stoma. Mean initial hospital stay was 31 days. Restoration of the gastrointestinal continuity was done in 27 cases (37% of the surviving patients, 76% of the diverticular diseases). The authors conclude that for complicated diverticular disease H procedure improves survival without preferable continuity. For cancer, H procedure is permanently compromising gastrointestinal in the elderly to hazardous low anastomosis, and to palliative abdomino-perineal resection.

[New material for needle jejunostomy: technique and preliminary results]. / Nouveau matériel pour jéjunostomie à l'aiguille: technique et résultats préliminaires.

New material for needle jejunostomy was evaluated. They have the following advantages: rapidity and ease of use in jejunostomy, the possibility of a high daily calorie intake, a cutaneous fixation system allowing cleaning of the feeding tube stoma. The material is presented and the insertion technique is described. The preliminary results in 30 patients showed no mortality or morbidity related to the jejunostomy. The authors stress the importance of performing needle jejunostomy whenever long-term high calorie intake is required after the operation.