[Psychological impact of the announcement of an abnormal cervical smear: How to improve patient experience and information? COLANX: a multicenter study in Seine-Maritime]. / Impact psychologique de l'annonce d'un frottis cervico-utérin anormal : comment améliorer le vécu et l'information des patientes ? COLANX : une étude multicentrique en Seine-Maritime.

INTRODUCTION: When an anomaly in the screening by cervical smear or by the HPV-HR test is detected, the women are called for a colposcopy. Waiting for colposcopy is often an anxiety-provoking situation for women, probably linked to a widespread ignorance of the value of screening and the pathophysiology of HPV infection. METHODS: The COLANX was a multicentric study, in Seine-Maritime, conducted with 8 colposcopist practitioners. Self-questionnaires were distributed to volunteer women, summoned for a first abnormal smear result, at the exit of colposcopy and filled out immediately on site. This questionnaire evaluated: the psychological impact of the announcement of the abnormal cervico-uterine smear, its impact on the sexual quality of life, the epidemiological characteristics of the population studied, the modalities of the announcement made of the abnormal result, the satisfaction of the women and their desire for additional information. 131 questionnaires were included, from June 1, 2020 to January 18, 2021. RESULTS: 61.5% of responding women presented proven psychological distress, as evidenced by a GHQ-12 score ≥ 2. The state of psychological distress was significantly different depending on the time left by the practitioner between the announcement of the abnormal cytology result and the colposcopy appointment. The GHQ-12 score was significantly different according to the initial classification of the cervico-uterine smear, high in case of suspicion of high-grade lesions in particular. 36.3% of patients had a significant deterioration in their sexual quality of life, demonstrated by an ASEX score ≥ 18. The women were statistically more satisfied when the announcement of their abnormal screening result had been made by telephone or during a consultation, rather than by mail, but no significant difference was found on the presence or absence of distress psychological according to this mode of announcement. 52.3% of the women in this study expressed a request for additional information support, preferably written support (for 89.4% of these women), to be delivered when the abnormal screening was announced (for 76, 5% of these women). DISCUSSION: The main results of the COLANX study are consistent with those of the literature, in particular concerning the negative psychological impact in the announcement of an abnormal smear result. CONCLUSION: The new methods of organized screening will increase the use of colposcopy for many women. There is a significant impact on their psyche and their intimate life. The issuance of additional information during this announcement would probably reduce this anxiety.

The Influence of SARS-CoV-2 on Minimally Invasive Therapeutic Approach for Benign Prostatic Hyperplasia.

Introduction: The COVID-19 pandemic definitely changed the management of patients with benign prostatic hyperplasia (BPH). This study followed the modalities of treatments in patients with BPH associated with SARS-CoV-2 attending the Urology Clinic of "Sf. Ioan" Emergency Clinical Hospital, Bucharest, Romania. Material and methods:The present study included 81 patients (mean age 63.2 years, age range 55-87 years) with SARS-CoV-2 and BPH who were admitted to our Urology Department between January 2021 and January 2022. The diagnosis of SARS-CoV-2 was based on the PCR test and that of BPH by using the diagnostic triad consisting of digital rectal examination, PSA, free PSA and ultrasound examination. It should be noted that some of the hospitalized patients were following treatment with alpha blockers and/or 5-alpha-reductase inhibitors at the time of admission. Results:Out of the 81 hospitalized cases, 13 required emergency endoscopic intervention under spinal anaesthesia (TURP or TURisP) for haemostasis because those patients presented with persistent haematuria which did not respond to conservative treatment. A number of 17 cases showed acute urinary retention during hospitalization and a urethrovesical catheter was fitted and will be re-evaluated urologically after the COVID episode. Of the remaining 51 subjects with BPH, 17 already had chronic urinary retention on admission, with urethrovesical probe present, 13 cases began during hospitalization with alpha-blocker treatment associated with 5-alpha-reductase inhibitors; meanwhile, there were no urological interventions to modify the treatment regimen in the remaining 21 patients, who were strictly managed on the side of COVID-19 infection. Conclusion:There was no clear influence of the evolution of patients with BPH due to SARS-CoV-2 pathology, and the general management trend was to delay chronic cases until the time of viral infection remission.

[Increase rate of ambulatory and management of the care path in breast cancer surgery]. / Augmentation du taux de prise en charge ambulatoire et organisation du parcours de soins en chirurgie sénologique.

OBJECTIVE: To describe practices and impact of ambulatory surgery rate, patient satisfaction after Nursing Support and Post Ambulatory Follow-up Device at Home at the Henri Becquerel Center (DIASPAD CHB) has been set up during surgical management in breast cancer. METHOD: This is a prospective monocentric observational study carried out between January 2017 and December 2018. Patients eligible for the study should undergone breast cancer surgery without reconstruction. Outpatient care was possible if patients met medical, surgical, psychosocial and environmental criteria according to the characteristics of the foreseeable operating suites. We evaluated the progression of the ambulatory hospitalization rate since the DIASPAD CHB beginning and compared the use of this device in conventional and ambulatory hospitalization. RESULTS: Since January 2017, 1312 patients undergone breast cancer surgery without reconstruction. After DIASPAD CHB implementation, ambulatory surgery rate increased from 46 % to 81.7 % for patients operated for breast cancer. The satisfaction rate of patients and nurses was 99 %. CONCLUSION: DIASPAD CHB enabled ambulatory care to take a important share in surgical care in breast cancer by ensuring collaboration between healthcare professionals, anticipation, programming and coordination of care.

Consenso de la Sociedad Iberoamericana de Oculoplástica para el diagnóstico y manejo de las distonías faciales / Consensus of the Iberoamerican Oculoplastic Society for diagnosis and management of facial dystonia

Objetivo: Proponer una guía para el diagnóstico y el manejo de pacientes con distonías faciales por parte de un grupo de expertos en órbita y oculoplástica miembros de la Sociedad Iberoamericana de Oculoplástica. Material y métodos: Se realizó una discusión dirigida interactiva entre el panel de expertos y los asistentes al VI Congreso de la Sociedad Iberoamericana de Oculoplástica realizado en las instalaciones del Hospital Nuestra Señora de la Luz en la Ciudad de México el 22 de octubre de 2018, presentando la experiencia basada en la evidencia y la experiencia personal para el diagnóstico y el tratamiento de distonías faciales. Al encuentro asistieron alrededor de 200 médicos oftalmólogos especialistas en oculoplástica originarios de Norte, Centro y Sudamérica, así como de España y Portugal. La discusión se centró en los siguientes sub-temas: fisiopatología, diagnóstico, manejo médico y manejo quirúrgico. Conclusiones: El diagnostico de las distonías faciales es clínico y rara vez requiere estudios complementarios de imagen. El oftalmólogo es generalmente el médico de primer contacto y está capacitado para ser el médico tratante salvo casos muy específicos de espasmo hemifacial, donde el manejo en conjunto con neurocirugía puede resultar beneficioso. El tratamiento de primera elección es la toxina botulínica. La terapia con neurolépticos orales y la miectomía del músculo orbicular se reservan para casos refractarios, ya que no presentan buena respuesta clínica como terapias de primera elección. El uso crónico de toxina botulínica no modifica el curso natural de la enfermedad

Objective: To propose guidelines for the diagnosis and treatment of facial dystonia prepared by a group of experts in orbit and oculoplastics from the Iberoamerican Oculoplastic Society. Material and methods: An interactive discussion between the expert panel and those attending the 6th Iberoamerican Society of Oculoplastics Congress, which took place at the Hospital Nuestra Señora de la Luz in Mexico City on 22 October 2018, providing their personal experience based on evidence for diagnosis and treatment of facial dystonia. Around 200 ophthalmologists specialised in oculoplastics from North, Central and South America, Spain, and Portugal were involved. Discussion was focused on the following themes: pathophysiology, diagnosis, medical management, and surgical management. Conclusions: Facial dystonia diagnosis is clinical; therefore, image studies are rarely needed. The ophthalmologist is generally the first physician to be consulted, and is able to be the treating physician, with the exception of specific cases of hemifacial spasm where management with neurosurgery may be beneficial. Botulinum toxin is the treatment of choice. Treatment with oral neuroleptics and myectomy of the orbicularis oculi muscle are reserved for refractory cases, since these do not have an adequate clinical response as first choice treatments. Persistent use of botulinum toxin does not modify the natural course of the disease

Consensus of the Iberoamerican Oculoplastic Society for diagnosis and management of facial dystonia. / Consenso de la Sociedad Iberoamericana de Oculoplástica para el diagnóstico y manejo de las distonías faciales.

OBJECTIVE: To propose guidelines for the diagnosis and treatment of facial dystonia prepared by a group of experts in orbit and oculoplastics from the Iberoamerican Oculoplastic Society. MATERIAL AND METHODS: An interactive discussion between the expert panel and those attending the 6th Iberoamerican Society of Oculoplastics Congress, which took place at the Hospital Nuestra Señora de la Luz in Mexico City on 22 October 2018, providing their personal experience based on evidence for diagnosis and treatment of facial dystonia. Around 200 ophthalmologists specialised in oculoplastics from North, Central and South America, Spain, and Portugal were involved. Discussion was focused on the following themes: pathophysiology, diagnosis, medical management, and surgical management. CONCLUSIONS: Facial dystonia diagnosis is clinical; therefore, image studies are rarely needed. The ophthalmologist is generally the first physician to be consulted, and is able to be the treating physician, with the exception of specific cases of hemifacial spasm where management with neurosurgery may be beneficial. Botulinum toxin is the treatment of choice. Treatment with oral neuroleptics and myectomy of the orbicularis oculi muscle are reserved for refractory cases, since these do not have an adequate clinical response as first choice treatments. Persistent use of botulinum toxin does not modify the natural course of the disease.

[Limitations of breast reconstruction using exclusive lipofilling: A retrospective study over 10 years]. / Limites de la reconstruction mammaire par lipofilling exclusif : étude rétrospective sur 10 ans.

OBJECTIVES: The primary objective was to assess the failure rate of exclusive lipofilling breast reconstruction. The secondary objectives were the identification of failure predictive factors of exclusive lipofilling breast reconstruction and the early complications. METHODS: We performed a retrospective study in Normandy analysing cases of secondary breast reconstruction by exclusive lipofilling after radical mastectomy, from January 2006 to December 2016. We compared a group of patients who completed exclusive lipofilling breast reconstruction (n=22) with a group of patients who underwent other techniques of breast reconstruction (n=16). RESULTS: The failure rate of breast reconstruction by exclusive lipofilling was 32.6%. Need of adjuvant chemotherapy treatment was associated with a higher failure rate than exclusive lipofilling breast reconstruction (81.2% vs. 45.5%, P<0.05). The age of patients was significantly higher in case of reconstruction failure (45.2 vs. 50.9 years mean age, P<0.05). Need of adjuvant radiotherapy treatment was not associated with a higher failure rate than exclusive lipofilling breast reconstruction. The main complications were cutaneous burn due to cannula and haematoma at the donor site (11/22) and breast haematoma (11/22). CONCLUSIONS: Informing patients of the risk of breast reconstruction failure due to the high adipocytes resorption, is necessary when patients are undergoing exclusive lipofilling breast reconstruction. A prospective study with greater workforce is needed to shore these results and assess postoperative complications.

Port catheter versus peripherally inserted central catheter for postoperative chemotherapy in early breast cancer: a retrospective analysis of 448 patients.

PURPOSE: We aimed to compare the complication rate between port catheters (PC) and peripherally inserted central catheters (PICC) for the administration of postoperative chemotherapy for breast cancer. METHODS: All patients treated from January 2010 to August 2012 at the Centre Henri Becquerel for early breast cancer requiring postoperative chemotherapy were retrospectively screened. The primary endpoint was the occurrence of a major complication related to the central venous catheter. Major complications were defined as any grade 3 event according to CTCAE 4.0, delay in chemotherapy >7 days, change of the device, life-threatening event, event requiring a hospitalization, or a prolongation of hospitalization. RESULTS: A total of 448 patients were included; 290 had a PC and 158 a PICC. Overall, 31 major complications related to the central venous catheter were observed: 13 for patients with a PC (4.5%) and 18 for patients with a PICC (11.4%). In univariate analysis, having a PICC was the only factor significantly associated with a higher risk of major complications (HR = 2.83, p = 0.0027). We observed a trend for a higher risk of major complications for patients older than 60 years or with BMI >25 (p = 0.06). In multivariate analysis, having a PICC was the only predictive factor of major complications (HR = 2.89, p = 0.004). CONCLUSIONS: In univariate and multivariate analysis, having a PICC instead of a PC was the only predictive factor of device-related major complication. If confirmed prospectively by the NCT02095743 ongoing trial, this result might modify the management of adjuvant chemotherapy administration.

Psoriasis Vulgaris in Children - Case Presentation.

A seven-year-old girl, with erythematous-squamous rash, was admitted to our clinic to decide upon the diagnosis and treatment, being transferred from a county hospital. Heredo-collateral antecedents - an aunt, related to her mother, with psoriasis. When admitted, the patient presented prominent non-pruriginous erythematous plaques, clearly marked and covered by thick, silvery-white scales, easily exfoliating, all over at the level of: scalp, earlobes, neck, torso, limbs, periungual, axillary and genital areas. The dermatological examination: psoriasis vulgaris in patches and plaques, a diagnosis also confirmed histopathologically. Using a local dermatologic treatment, the evolution was favorable, the patient initially presenting thick squamae, then, gradually, there occurred the psoriasis whitening. We presented this case since psoriasis is rarely met at this early age.

Histopathological Study on Conservatively Operated Breast Carcinomas.

In this histopathological study we looked at 303 cases of breast carcinomas, managed though conservative breast surgery and later analysed with the help of a classical histopathological technique, paraffin embedding. The carcinomas were assessed in terms of tumor size, lymph node status, histological type, correlation between invasive tumors and an situ carcinoma component, resection margins, grading and patients age. Following assessment, we looked at associations between above morphological and clinical parameters and ipsilateral local recurrences. We concluded that more than half of our cases were carcinomas, measuring between 2 cm and 5 cm, with no associated lymph node involvement, in keeping with pTNM criteria for stage II. By far, in our study, the most frequent histopathological type was type NOS (63.37%) followed by invasive lobular carcinoma (10.56%) and mixed ducto-lobular invasive carcinoma (6.27%). Other types of invasive carcinoma were rarer, each representing less than 4% of cases. In regards to in situ carcinomas we noted the most common histological types to be both cribriform intraductal carcinoma and comedocarcinoma, each identified in 1.65% of cases. Amongst invasive breast carcinomas, infiltrating ductal carcinoma not otherwise specified (NOS) was found to be most commonly associated with in situ ductal carcinoma lesions. This was seen in 34.9% of cases, and was the only type associated with an extensive in situ component. Analysing the grading of mammary carcinomas in our study showed that the vast majority of cases (63.04%) were grade 3 tumors. In regards to surgical resection margins, ¾ of cases were noted to have negative margins. Tumor recurrences were noted in 12 cases. These cases were most commonly noted to reoccur following initial poorly differentiated, infiltrating ductal carcinomas, not otherwise specified (NOS), with positive resection margins, measuring less than 2 cm. Patiens tended to be under the age of 40 and had positive lymph nodes. The emergence of local recurrences after conservative surgery for early breast cancer is singnificantly linked to poorly differentiated primary tumors (p <0.05) but not correlated with histological type, presence of extensive intraductal carcinoma component, size of primary breast tumor or lymph node status ( p> 0.05). In terms of increasing the risk of ipsilateral recurrence the most important aspect highlighted in our sudy was the status of the resection margins. Patients with positive resection margins had a significantly high risk to develop recurrences after the conservative surgery, compared to those with negative margins (p <0.001).

NEUROENDOCRINE RENAL CARCINOMA - THERAPEUTIC AND DIAGNOSTIC ISSUES.

INTRODUCTION: Neuroendocrine renal carcinoma represents less than 1% of all primary neoplasia of the kidney. Most frequently poorly differentiated carcinoma is diagnosed in advanced stages and they have an aggressive evolution and limited survival rate. Neuroendocrine carcinomas that arise from the renal pelvis are frequently associated with squamous cell carcinoma or adenocarcinoma. MATERIAL AND METHOD: We present the case of a female patient, known for 3 years before with an undefined retroperitoneal lymph node metastasis, being diagnosed at present with a left large cell neuroendocrine renal carcinoma, who initially had lymph node metastasis. RESULTS: Until now, 118 cases of primary neuroendocrine renal carcinomas have been reported. A limited number of poorly differentiated neuroendocrine carcinomas have been reported. DISCUSSION: Due to the clinical and biological findings, the aggressive evolution with early metastasis of lung and bone, the patient is included in the group of poorly differentiated carcinomas. In these cases, multimodal treatment is a gold standard. After surgical treatment and palliative chemotherapy with platinum salts, we obtained a partial remission of the disease and the control of symptoms. CONCLUSIONS: Regarding large cell neuroendocrine carcinoma, the surgical treatment remains the treatment of choice. Chemotherapy can determine limited results, improve the quality of life and enhance the overall survival rate.

Clinical and Pathological Analysis of Two Cases of Cutaneous Malignant Melanoma.

The purpose of this study was the clinical and histo-immunohistochemical analysis of two cases: a cutaneous pigmented facial malignant melanoma and a lumbar congenital nevus with malignant transformation. A series of clinical elements raised the suspicion of some malignant melanocytic lesions and the histopathological analysis through the paraffin embedding technique confirmed the clinical suspicion. The immunohistochemical analysis using the streptavidin-biotin-peroxydase method of the facial malignant melanoma showed: S100 protein intense and diffuse positive, Tyrosinase diffuse positive, HMB45 strong and focal positive, Cyclin D1 positive in approximately 40% and Ki-67 positive in almost 70% of the tumor cells. The malignant melanoma developed on the nevocellular nevus displayed: S100 protein intense and diffuse positive, both in the nevus cells and in the malignant melanocytes as well, Tyrosinase intense and diffuse positive in the malignant melanocytes, poor and focal positive in the nevus cells and HMB45 intense and focal positive in the malignant cells and positive in the isolated nevus cells. Cyclin D1 was positive in about 70% of the malignant cells, but negative in the nevus area and Ki-67 was found positive in relatively 30% of the malignant melanocytes, also in less than 1% of the nevus cells. The pattern and the intensity of the Tyrosinase and HMB45 immunoexpression are important in the differentiation of the nevus cells from the malignant melanocytic cells. The immunoexpression of Cyclin D1 does not correlate directly with the proliferating activity of the malignant melanocytic cells in all types of malignant melanomas.

NBI - plasma vaporization hybrid approach in bladder cancer endoscopic management.

OBJECTIVES: A prospective study was performed aiming to evaluate the surgical efficacy, perioperative safety profile, diagnostic accuracy and medium term results of a multi-modal approach consisting in narrow band imaging (NBI) cystoscopy and bipolar plasma vaporization (BPV) when compared to the standard protocol represented by white light cystoscopy (WLC) and transurethral resection of bladder tumors (TURBT). MATERIALS & METHODS: A total of 260 patients with apparently at least one bladder tumor over 3 cm were included in the trial. In the first group, 130 patients underwent conventional and NBI cystoscopy followed by BPV, while in a similar number of cases of the second arm, classical WLC and TURBT were applied. In all non-muscle invasive bladder tumors' (NMIBT) pathologically confirmed cases, standard monopolar Re-TUR was performed at 4-6 weeks after the initial intervention, followed by one year' BCG immunotherapy. The follow-up protocol included abdominal ultrasound, urinary cytology and WLC, performed every 3 months for a period of 2 years. RESULTS: The obturator nerve stimulation, bladder wall perforation, mean hemoglobin level drop, postoperative bleeding, catheterization period and hospital stay were significantly reduced for the plasma vaporization technique by comparison to conventional resection. Concerning tumoral detection, the present data confirmed the NBI superiority when compared to standard WLC regardless of tumor stage (95.3% vs. 65.1% for CIS, 93.3% vs. 82.2% for pTa, 97.4% vs. 94% for pT1, 95% vs. 84.2% overall). During standard Re-TUR the overall (6.3% versus 17.4%) and primary site (3.6% versus 12.8%) residual tumors' rates were significantly lower for the NBI-BPV group. The 1 (7.2% versus 18.3%) and 2 (11.5% versus 25.8%) years' recurrence rates were substantially lower for the combined approach. CONCLUSIONS: NBI cystoscopy significantly improved diagnostic accuracy, while bipolar technology showed a higher surgical efficiency, lower morbidity and faster postoperative recovery. The combined technique offered a reduced rate of residual tumors at Re-TUR, both globally as well as for orthotopic tumors. Substantially lower recurrence rates were found at 1 and 2 years among the NBI-BPV cases.

Intraoperative complications after 8150 semirigid ureteroscopies for ureteral lithiasis: risk analysis and management.

OBJECTIVES: To evaluate semirigid retrograde ureteroscopy complications on a significant series of patients and to establish the factors associated with the occurrence of intraoperative complications. PATIENTS AND METHODS: Between June 1994 and June 2013, 8150 semirigid ureteroscopic procedures for ureteral lithiasis were performed in 7456 patients. We used semirigid ureteroscopes(8 9.8F Wolf, 8 and 10F Storz, Olympus Endoeye digital 8.5 9.9F). Lithotripsy was done with pneumatic, electrohydraulic or Ho:YAG laser lithotripters. The preoperative parameters including gender, calculi location and size, impaction, degree of hydronephrosis, stone number and associated malformation as well as intraoperative aspects (stone extractors, fragmentation devices, operative time and surgeon experience) were evaluated in relation with complication rate. RESULTS: The stone-free rate after a single ureteroscopic procedure was 90.9%. Intraoperative incidents occurred in 348 cases (4.3%). The overall rate of intraoperative complications was 2.8% (228 cases). These were represented by lesions of the ureteral mucosa (139 cases), perforation (58 cases), bleeding (16 cases), ureteral avulsion (3 cases) and extra-ureteral stone migration (12 cases). Statistical analysis shows a significant association between the complication rate on the one hand and stone size, location and impaction,operative time and surgeon experience on the other hand. CONCLUSIONS: Due to technological advances and increased experience, the semirigid retrograde ureteroscopic treatment of ureteral lithiasis increased efficacy, while the incidence of intraoperative complications decreased. Most of these complications are minor and can be managed by conservative approach.

Ureteroscopy -- first-line treatment alternative in ureteral calculi during pregnancy?

BACKGROUND: Urolithiasis during pregnancy is not common but remains both a diagnostic and treatment challenge. The aim of the study was to assess the ureteroscopy results as definitive treatment option in pregnant women with obstructive ureteral calculi. MATERIAL METHODS: Between 2006 and 2012, in our clinical department, 54 pregnant women underwent active treatment for ureteral lithiasis and in 38 of these cases ureteroscopy was applied as definitive therapy. The average patients age was 27.2 years (range 20-37 years) and the gestation period varied between 9 to 35 weeks. Flank pain was the common presenting symptom (52 54 cases), 4 women had associated fever, and 14 complained of irritative voiding symptoms.Semirigid ureteroscopy was the first choice alternative for the first 2 trimesters while flexible approach or double J in dwelling were preferred for patients in the last trimester of pregnancy. RESULTS: Semirigid ureteroscopy allowed stone treatment in 28 32 cases. In 17 patients, calculi fragmentation using Ho:YAG laser or ballistic lithotripsy were performed, while in 11 cases, the stone was removed intact. Minor intraoperative complications were encountered in 5 patients. Postoperatively,urinary tract infection developed in 4 patients, renal colic in 2 and prolonged hematuria in one case, while 4 patients complained of stent-induced bladder irritation. Flexible ureteroscopy was successfully completed in all patients. There were no complications related to this procedure. All pregnancies were carried out to full term. CONCLUSIONS: Ureteroscopy may be considered a safe and effective first-line definitive therapeutic option in pregnant patients requiring intervention for ureteral stone.

Holmium laser intrarenal lithotripsy in pyelocaliceal lithiasis treatment: to dust or to extractable fragments?

BACKGROUND: Pyelocaliceal calculi flexible ureteroscopic approach raises problems related to operative time, associated morbidity and costs, especially by potential endoscope damage. METHODS: 5 series, each of 20 patients with single pyelocaliceal lithiasis, were analyzed: Group I with calculi 1 cm fragmented to dust, Group II with calculi 1 cm with lithotripsy in fragments, Group III with calculi of 1-2 cm fragmented to dust, Group IV with calculi of 1-2 cm with lithotripsy in fragments, Group V with calculi of 1-2 cm fragmented to dust until they reached 1 cm, and lithotripsy in fragments afterwards. In all cases Ho:YAG lithotripsy was used. RESULTS: Ureteral access sheath was used in 70% of the cases. Mean operating time was 39 min in group I, 21 min in Group II, 112 min in group III, 72 min in group IV and 51 min in group V. Minor complications occurred in 7 cases,while a single major complication occurred in group IV. CONCLUSIONS: The optimal lithotripsy method for calculi 1cm seems to be in extractable fragments. Larger calculi should be fragmented to dust until they reach 1 cm and then the lithotripsy should be continued into extractable fragments. ABBREVIATIONS: Ho: YAG - Holmium: Yttrium Aluminium Garnet, Hz - Hertz, mJ - milli joule.

The new prognostic-therapeutic index - an easy method of establishing surgical indication in the pathology of the diabetic foot.

UNLABELLED: HYPOTHESIS AND AIM: The large number of invalidating surgical interventions in patients suffering from lesions of the diabetic foot, the late recognition of the lesions and sometimes the wrongful interpretation of their severity, have made necessary a multi-parameter study of these types of patients and the elaboration of a therapeutic-prognostic index to guide the physician in adopting the adequate method of treatment. Starting with the therapeutic-prognostic index imagined by professor Traian Patrascu, we have elaborated a new therapeutic prognostic index, by adding new, statistically significant parameters, for the purpose of facilitating the surgical indication, depending on the lesion type. METHODS: A number of 929 patients who were admitted at the Surgery Clinic of the "Dr. I. Cantacuzino" Hospital, between January 2013 and June 2014, have been analyzed, of whom 450 were evaluated retrospectively and 479 prospectively. RESULTS: The new therapeutic prognostic index has been calculated for the retrospective lot, resulting into a concordance between the actual surgical intervention and the prognostic index of 79.4% and, for the patients evaluated prospectively, we have found a confirmation of the relation of 82.6% between the performed surgical intervention and the forecasted surgical intervention, by calculating the index. DISCUSSION: The new therapeutic-prognostic index represents an easy method of establishing the therapeutic conduct of the patient suffering from lesions of the diabetic foot. It is of major use in preventing the execution of such surgical interventions that may be disproportionate compared to the severity of the lesions, especially in facilities where the pathology of the diabetic foot is less known.

Diagnosis characteristics and therapeutical options of infectious complications associated with peritoneal dialysis.

INTRODUCTION: The infectious syndrome associated with peritoneal dialysis is the most important complication of this substitution method of the renal function, also being the main cause of method failure. Refractory peritonitis can cause real problems in the differential diagnosis with secondary peritonitis, which can delay the surgical intervention and endanger the patient's life. MATERIALS AND METHODS: The patients with an end stage renal disease under peritoneal dialysis, who were admitted to "I. Juvara" Surgical Clinic of "Dr. I. Cantacuzino" Clinical Hospital, between 2007 and 2011, were retrospectively analyzed for catheter removal/ replacement due to infectious complications or ultrafiltration failure. RESULTS: 55 patients were identified: 33 with infectious complications (exit-site, tunnel infections 4 and peritonitis 29) and 22 with loss of peritoneum ultrafiltration capacity. The patients with ultrafiltration failure had a longer duration of PD and a smaller number of peritonitic episodes (0.28 episodes/ year at risk in the ultrafiltration failure group vs. 0.98, in the group of infectious complications). The removal of the catheter was the only surgical procedure performed for the patients with ultrafiltration failure, while the patients with peritonitis needed additional gestures like an exploratory laparotomy with peritoneal lavage and drainage and adhesiolysis in the majority of cases. In the group with infectious complications, 4 patients died: 2 by multisystem organ failure due to prolonged sepsis, one developed an upper gastrointestinal bleeding followed by respiratory insufficiency and one had in cataclysmic gastrointestinal bleeding which rapidly led to death. CONCLUSIONS: The immediate operative approach for an infectious peritoneal syndrome under peritoneal dialysis is seldom necessary. The surgical observation is absolutely mandatory in every case. The absence of a response to the proper medical treatment is an indication of peritoneal cavity exploration including laparoscopy/ laparotomy. Any delay in the diagnosis and definitive treatment gives an extremely high mortality rate.

Foxp3 and IL17 expression in tumor infiltrating lymphocytes (TIL) and tumor cells - correlated or independent factors?

Tumor infiltrating lymphocytes (TIL), as a microenvironment component were studied in various epithelial tumors, with contradictory results. Recent data about regulatory T-cells (Treg) revealed new explanations for pro- and anti-tumor implications of TIL. Tregs immunoprofile was recently completed with Foxp3 expression. A T-cell fraction (Th) is producing cytokine IL17 and is now considered acting in tumor progression. Our study aimed to analyze immunohistochemically (IHC) Foxp3+ and IL17 expression in resected lung adenocarcinomas, since they could become possible targets in the antitumor immunotherapy. The studied material was represented by paraffin-embedded tumor fragments from 59 patients with TIL identified on HE staining. The antibodies used were Foxp3 and IL17. The statistical analysis used logistical regression on SPSS19 software (Chicago, IL, USA). TIL was usually mild or scarce. A positive statistic correlation resulted between the amounts of TIL in peritumoral and intratumoral location but without correlation to histopathological grading. Foxp3 and IL17 were present in TIL lymphocytes, tumor cells and fibroblasts; IL17 was expressed also in periendothelial cells (PEC). Foxp3 positivity was significantly correlated for lymphocytes÷tumor cells, lymphocytes÷fibroblasts and tumor cells÷fibroblasts, suggesting their concerted action. Tumor cells and lymphocytes Foxp3 expression was inversely correlated with the amount of TIL. Between lymphocytic Foxp3 and PEC IL17, we found a weak negative correlation. The TIL had a quite positive correlation with PEC IL17. In these conditions, Foxp3 could be a mediator of the tumor cells inhibitory aggression upon the immune system and could be used as a molecular target for biological antitumor therapy.

Bipolar plasma vaporization - an innovative intramural ureter detachment method during nephroureterectomy.

INTRODUCTION: Nephroureterectomy with perimeatal cystectomy is still the gold standard in the treatment of urothelial upper urinary-tract carcinoma (UUTC). Ureteral endoscopic surgery was proposed as a complementary first step in nephroureterectomy, in order to obviate the low abdominal incision. Our goal was to establish the value of a novel method of endoscopic distal ureteral management in on step nephroureterectomy for UUTC: pluck technique by using bipolar plasma vaporization. MATERIALS AND METHODS: During the last two years, we performed nephroureterectomy with pluck transurethral detachment of the intramural ureter by using bipolar plasma vaporization in 42 cases with UUTC (pTa in 16 cases, pT1 in 10 cases, pT2 in 9 cases, pT3 in 7 cases). The tumor was pyelocaliceal in 34 cases, ureteral in 7 cases, and both ureteral and pyelocaliceal in 1 case. The follow-up was performed by cystoscopy with urinary cytology, ultrasonography, intravenous urography and CT. The mean follow-up was of 14 months (range 8 to 26 months). RESULTS: All procedures were completed successfully. The complications rate was of 4.8%: 2 cases of hematuria, one imposing an endoscopic approach and another one treated conservatively. During follow-up, 6 patients had bladder recurrences, 1 had renal fossa tumors and 1 had secondary lymph-node invasion. The disease-specific mortality rate was of 4.8%. CONCLUSIONS: The endoscopic approach of the terminal ureter with bipolar plasma vaporization as part of one-step nephroureterectomy is a safe, facile and effective method offering good oncological results.