bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhanced recovery after surgery (ERAS) protocols: Time to change practice?
Authors: Melnyk Megan , Casey Rowan G. , Black Peter , Koupparis Anthony J.
Published: October 2016

Radical cystectomy with pelvic lymph node dissection remainsthe standard treatment for patients with muscle invasive bladdercancer. Despite improvements in surgical technique, anesthesiaand perioperative care, radical cystectomy is still associatedwith greater morbidity and prolonged in-patient stay after surgerythan other urological procedures. Enhanced recovery after surgery(ERAS) protocols are multimodal perioperative care pathwaysdesigned to achieve early recovery after surgical procedures bymaintaining preoperative organ function and reducing the profoundstress response following surgery. The key elements of ERASprotocols include preoperative counselling, optimization of nutrition,standardized analgesic and anesthetic regimens and earlymobilization. Despite the significant body of evidence indicatingthat ERAS protocols lead to improved outcomes, they challengetraditional surgical doctrine, and as a result their implementationhas been slow.The present article discusses particular aspects of ERAS protocolswhich represent fundamental shifts in surgical practice, includingperioperative nutrition, management of postoperative ileus andthe use of mechanical bowel preparation.
A case of epididymal sarcoidosis
Authors: Smyth Lisa G. , Long Ronan M. , Lennon Gerald
Published: October 2016

Sarcoidosis is a systemic inflammatory condition that primarilyaffects the lungs, lymphatic system and skin. Extra thoracic manifestationsoccur in about 50% of cases; however, it rarely affectsthe male reproductive tract. The first documented case of epididymaland testicular sarcoid in the Irish literature is of a 25-year-oldmale who presented with a painful 1-cm extra-testicular scrotalmass. While the involvement of the male reproductive tract israre, it should be included in the differential of testicular pathology.It can be diagnosed on frozen section and may be managedconservatively.
Systematic review of overactive bladder therapy in females
Authors: Cardozo Linda
Published: October 2016

Although the prevalence of overactive bladder (OAB) is similarin both male and female populations, females have a greater tendencyto seek medical advice regarding their symptoms. A reviewof the evidence of therapy among women shows that a variety ofmodalities has been shown to be effective for symptom improvementin women with OAB. Bladder retraining/re-education shouldbe considered for all women with OAB. With respect to first-linepharmacotherapy with antimuscarinic agents, the development ofextended release preparations, bladder selective M3 antagonistsand alternative routes of delivery, have improved compliance andpersistence. Other pharmacotherapeutic options with potential forproviding benefit include antidepressants, vasopressin analogues,alpha-adrenoceptor antagonists and beta-adrenoceptor agonists.There are also a number of newer agents currently being investigated,including calcium channel blocking agents, potassium channelopening drugs, beta agonists and neurokinin receptor antagonists.Intravesical injections of botulinum toxin may be an alternative,while surgery can be considered for truly intractable cases.
Systematic review of therapy for men with overactive bladder
Authors: Chapple Christopher
Published: October 2016

Lower urinary tract symptoms (LUTS) can have multiple causes inmen. Overactive bladder (OAB) is an empirical diagnosis used asthe basis for initial management after assessing symptoms, physicalfindings, urinalysis and other indicated evaluations. In men,the diagnosis is complicated by the potential of benign prostatichyperplasia (BPH), which is a histological diagnosis. Althoughstorage symptoms (i.e., those associated with OAB) are the mostbothersome group of LUTS in men with BPH, these patients areusually treated with BPH rather than OAB drugs. The standardpharmacologic treatment of patients with bothersome voiding andstorage LUTS at low risk of progression should be an α1-AR antagonist.The combination α1-AR antagonist + antimuscarinic agentis an appropriate and valid option for male patients with voidingsymptoms and persistent storage symptoms.
Treating overactive bladder in the elderly
Authors: Wagg Adrian
Published: October 2016

The prevalence of the overactive bladder (OAB) symptom complexincreases with age. Older people also appear to experience moresevere incontinence syndromes, including OAB, than their youngercounterparts. Older patients are more likely than younger individualsto ask for medication for bladder problems and to requirehigher doses of medication. Conventional treatment for OAB withconservative and lifestyle measures in combination with antimuscarinicpharmacotherapy is effective in older people. Althoughthere is a theoretical potential for cognitive impairment with antimuscarinicagents, the newer antimuscarinics are cognitively safein cognitively intact older people.
Acute reversible kidney injury secondary to bilateral ureteric obstruction
Authors: Organ Michael , Norman Richard W.
Published: October 2016

Background: Acute reversible kidney injury (ARKI) secondary tobilateral ureteric obstruction (BUO) is a common urological problem.Our goals were to describe the etiology, management andoutcomes of such patients identified between 2006 and 2009 andto compare them with a similar historical study published in 1982.Methods: Chart review was performed on 49 patients with AKRIsecondary to BUO. ARKI was defined as ≥33% decrease in serumcreatinine after intervention. Those with malignant and benigncauses of obstruction were identified and management and outcomedata were collected.Results: Of these 49 patients, 83% had BUO secondary to malignancy,28% of these presenting for the first time. Prevalence ofbladder cancer was increased (p = 0.04) and cervix trended lower(p = 0.07) compared with the earlier study; prostate cancer wasunchanged (p = 0.51). The average survival was 239 days; 90%of patients died within a year after presenting with BUO from amalignant etiology. Compared with the 1982 group, there weretrends towards a decrease in the frequency of retroperitoneal fibrosis(p = 0.08) and an increase in bilateral ureteric calculi (p = 0.16)in the benign group.Conclusions: Patients with ARKI secondary to BUO most likelyhave an underlying malignancy, with almost a third of them beingdiagnosed for the first time. Prevalence of bladder cancer increasedwhile cervical cancer trended lower. The cause for the former isunclear; the latter may be due to aggressive screening. Prostate cancerremained unchanged despite the widespread implementation ofprostate-specific antigen testing. Patients with an underlying malignancydo poorly and those with a newly diagnosed malignancydo worst. Those with ARKI secondary to benign causes did well.
A modified approach to patient’s selection with improved clinical outcomes in sacral nerve modulation
Authors: Richard Patrick , Carmel Maude , Hage Bechir , Ramsay Sophie , Tu Le Mai
Published: October 2016

Introduction: Since the marketing of the percutaneous permanenttined leads (PPTL), many centres rely solely on these instead ofthe percutaneous nerve evaluation (PNE) as a screening tool. Atour centre, we routinely perform PNE. Moreover, with our limitedhospital resources, we have adopted a stricter definition of successin the patient selection process using an improvement of morethan 60% as a cut-off point. This study presents our experiencewith sacral nerve stimulation using PPTL as an adjunct to PNE toimprove the outcome of the screening method for patients sufferingfrom refractory voiding dysfunction.Methods: We reviewed the charts of 106 patients who underwenta PNE between 2001 and 2008. The outcome of the procedures,the complication rates and its long-term effect were reviewed.Results: Overall, 116 PNE were performed and it was successfulin 54%. Forty-five out of the 62 patients with a successful PNEunderwent the stage I procedure. Of these, 93% had a successfulstage I and were later implanted with the implantable pulse generator(IPG). The remaining 12 patients underwent the simultaneousimplantation of the PPTL and IPG using the open procedure andit was successful in 10 of them.Conclusion: The PNE is a good adjunct to the staged procedureto select the appropriate candidates for sacral nerve stimulation,especially with limited resources.
Legionella pneumonia presenting with bilateral flank pain, hyponatraemia and acute renal failure
Authors: Birkin Celia , Biyani Chandra Shekhar , Browning Anthony J.
Published: October 2016

Legionnaires’ disease (LD) is an often overlooked but a possiblecause of sporadic community acquired pneumonia. High fever,cough and gastrointestinal symptoms are non-specific symptoms.Hyponatremia is more common in LD than pneumonia linkedwith other causes. A definitive diagnosis is usually confirmed byculture, urinary antigen testing for Legionella species. Macolideor quinolone antibiotic is the treatment of choice. We describe acase of Legionella pneumonia presenting with high fever, bilateralflank pain and oliguria. It is important for clinicians to be awareof this diagnosis when managing patients with flank pain. Thecase highlights the problems in differentiating LD from renal colicand the importance of proper history, physical examination withlaboratory tests for appropriate management.
The role of resection of pulmonary metastases from prostate cancer: a case report and literature review
Authors: Wallis Christopher J.D. , English John C. , Goldenberg S. Larry
Published: October 2016

We report a case of a 53-year-old man who presented with twonodules in the lower lobe and one nodule in the upper lobe of theright lung almost 7 years after radical prostatectomy for pT3aN0M0,Gleason 4+5 disease, without evidence of osseous or lymphaticspread. Surgical resection of the lower lung nodules confirmedmetastases, but prostate-specific antigen did not drop to undetectablelevels. Isolated pulmonary metastases from prostate cancerare rare with only 33 previously described cases in the Englishlanguageliterature, 18 of which were solitary metastases. Wereview the principles of management, including metastasectomyand long-term prognosis.
Synchronous metastatic seminoma and primary retroperitoneal ganglioneuroma: case report and literature review
Authors: Michels Jorg , Van der Westhuizen Nicholas , Ross Alison
Published: October 2016

Testicular cancer is the most common malignancy in young menwith seminomas comprising almost half of all germ cell tumours.Benign ganglioneuromas are rare tumours derived from the sympatheticnervous system. They usually occur in aldolescents andyoung adults and are predominantly located in the mediastinumand retroperitoneum. We report a case of a patient with synchronousmetastatic testicular seminoma with retroperitoneal lymphnode involvement and a benign retroperitoneal ganglioneuroma(RGN) which caused diagnostic and management challenges. Thepatient had a complete response following combination chemotherapyfor his seminoma and subsequently underwent completeresection of his ganglioneuroma.
Effect of extended-term estrogen on voiding in a postpartum ovariectomized rat model
Authors: Hayashi Narihiko , Bella Anthony J. , Wang Guifang , Lin Guiting , Deng Donna Y. , Nunes Lora , Lue Tom F.
Published: October 2016

Introduction: We tested the hypothesis that extended-term (5-week) estrogentherapy would negatively impact voiding function in a postpartum, ovariectomizedrat model.Methods: Immediately after delivery, 30 primiparous Sprague–Dawley rats underwentintravaginal balloon dilation, followed by ovariectomy 1 week later. Cystometry at postpartum week 2 determined normal or abnormal voiding patterns.After randomization, one-half the normal and abnormal voiding ratsreceived 5 weeks of estrogen therapy, while the remainder received placebo. Estrogen effect was determined by repeat cystometry and immunohistochemical analysis of the urethra and vagina.Results: Abnormal voiding increased from 60.0% to 73.3% in the estrogen treated group and declined from 60% to 33% for the placebo group. Rats were then divided into 4 groups for comparison: normal voiding versus placebo(group 1), abnormal voiding versus placebo (group 2), normal voiding versus estrogen (group 3) and abnormal voiding versus estrogen (group 4). Bladdercapacity, leak point pressure and maximum voiding pressure were mostdepressed in group 4. Estrogen treatment was associated with a significant downregulationof α1A and α1D-adrenoceptors in the urethral submucosa but an upregulationof nNOS in the urethral smooth muscle.Conclusion: Extended-term estrogen therapy in a rat model of simulated birth trauma and ovariectomy resulted in a higher rate of incontinence. Immunohistochemical examination demonstrated significant downregulationof urethral α1A- and α1D-adrenoceptors and upregulation of neuronal nitric oxidesynthase (nNOS) in the urethra of estrogen-treated groups. These studies question the use of hormone replacement therapy in the treatment of postmenopausalincontinence.
Management of neonatal testicular torsion: Which way to turn?
Authors: Guerra Luis A. , Wiesenthal Joshua , Pike John , Leonard Michael P.
Published: October 2016

Objective: Perinatal testicular torsion (PTT) is a rare event with controversies surrounding its etiology, presentation, surgical management and sequelae. Our survey assessed the preferences of pediatric urologists with regard to its management.Methods: Four cases of unilateral PTT and a questionnaire containing 11 questions about management of common clinical scenarios were mailed to 26 pediatric urologists. The answers were received anonymously and they were analyzed blindly.Results: The response rate was 80% (21/26), with 90% (19/21) of respondents holding academic appointments. In the 2 first cases of PTT with a typical unilateral nonviable testis, 76% (16/21) and 67% (14/21), respectively, opted for surgery. A case of acute postnatal torsion resulted in 100% agreement to urgent scrotal exploration. In the case of an atrophic testis, none of the respondents opted for immediate surgery; yet, 38% (8/21) said they would proceed with a delayed orchiopexy of the contralateral testicle. In the question section, 10% (2/21) responded that they preferred to explore PTT immediately; whereas, 57% (12/21) would delay surgical exploration for a few days until the neonate was better stabilized. One-third of participants (7/21) would not perform a surgical exploration but would just follow the child clinically. A scrotal incision for contralateral orchiopexy was preferred by 52% (11/21), while 48% (10/21) prefer a scrotal approach but would switch to an inguinal incision if a hydrocele were present. Operative intervention was favoured by 80% (8/10) and 46% (5/11) of those with less than and greater than 10 years of practice, respectively.Conclusion: This survey revealed that 67% (14/21) of respondents preferred immediate exploration of a torted testis and contralateral orchiopexy, compared with the nonoperative approach. Scrotal incision for the exploration was preferred by most respondents. There was a trend to choose less aggressive treatment as the years of practice increase. Studies of more robust design, such as randomized controlled trials, are necessary to determine the natural history and outcomes of this uncommon type of testicular torsion.
Pathological correlation between needle biopsy and radical prostatectomy specimen in patients with localized prostate cancer
Authors: Bulbul Muhammad A. , El-Hout Yaser , Haddad Maurice , Tawil Ayman , Houjaij Ali , Diab Nizar Bou , Darwish Oussama
Published: October 2016

Objective: This study aims to evaluate the accuracy of transrectal ultrasound (TRUS) guided prostate biopsies in predicting pathological grading and tumour distributionin the final pathological specimen of patients who underwent radical prostatectomy for clinically localized prostate cancer. The study ultimately aimsto gain more understanding of the pathological behaviour of prostate cancerand the limitations of the currently available diagnostic and prognostic tools.Material and Methods: We reviewed the records of 100 patients with localizedcarcinoma of the prostate diagnosed by TRUS-guided prostate biopsyand treated with radical retropubic prostatectomy, comparing tumour lateralityand Gleason score in core biopsies with tumour distribution and Gleasonscore of the surgical specimen. We then correlated both results to diagnosticand prognostic variables such as prostate specific antigen (PSA) values and surgical margins.Results: All 44 patients with bilateral disease on needle biopsy had bilateral diseaseon final pathology, with 15 of these patients (34%) having positive margins.Of the 56 patients with unilateral disease on biopsy, 37 (66%) had bilateral disease on final pathology; however, only 4 of them (7%) had positive margins (p < 0.001). Median Gleason score on final pathology was upgraded to 7, compared with a median score of 6 on biopsies. Stratifying patients to 2 groups based on their PSA level (group 1: PSA < 10 ng/mL, 72 patients; group2: PSA > 10ng/mL, 28 patients), revealed that 57patients (79%) in group 1and 24 patients (85%) in group 2 had bilateral disease. In addition, 13 patients(18%) in group 1 and 6 patients (21%) in group 2 had positive margins.Conclusions: Sixty-six percent of patients with unilateral disease on needlebiopsy had bilateral disease on final pathology, but this does not increasetheir rate of having positive margins. Gleason score is upgraded from 6 to7. PSA did not seem to affect laterality of disease in patients selected forradical prostatectomy.
Pediatric urolithiasis: experience at a tertiary care pediatric hospital
Authors: Kit Laura Chang , Filler Guido , Pike John , Leonard Michael P.
Published: October 2016

Objective: We aimed to determine the epidemiology, risk factors, clinical characteristics, evaluation and course of patients with urolithiasis at the Children’s Hospital of Eastern Ontario to improve current diagnostic and management strategies.Methods: This was a retrospective study of children with newly identified urolithiasis between Jan. 1, 1999, and July 31, 2004. Cases were reviewed for demographics, presentation, family history, diagnostic methods and findings, metabolic and anatomic abnormalities, management, stone analysis and stone recurrence.Results: Seventy-two patients (40 male, 32 female; mean age 11.3 yr) were assessed. Mean follow-up was at 1.5 years. Eighteen patients (25%) had a family history of stones. Flank pain (63%) was the most common presentation. Eighty-two percent of urinalyses showed microscopic hematuria. Imaging comprised abdominal plain film radiography (56%) and (or) abdominal ultrasonography (74%). The mean stone size was 5 mm. Forty-one percent (28/69) of patients who underwent metabolic investigation had an abnormality. Fourteen percent of patients (10/72) had a genitourinary anatomical abnormality. Thirty-four patients (47%) passed their stones spontaneously, 25 patients (35%) required surgical intervention and 13 patients (18%) had yet to pass their stone. The mean size of spontaneously passed stones was 4 mm. Of 42 stones analyzed, 39 (93%) were composed of calcium oxalate or phosphate. Seventeen (24%) patients had stone recurrence during follow-up.Conclusion: Pediatric patients with stones present in a manner similar to adults. Abdominal plain film radiography and ultrasonography are the preferred initial radiological investigations in children as they limit radiation exposure. Metabolic abnormalities are common and may coexist with anatomic abnormalities, therefore investigations must rule these out. One-half of patients will pass their stones spontaneously. Recurrence rates are high and long-term follow-up is recommended.
Recurrent renal cell cancer: 10 years or more after nephrectomy
Authors: Abara Emmanuel , Chivulescu Iolanda , Clerk Nilam , Cano Pablo , Goth Alexis
Published: October 2016

Localized renal cell carcinoma (RCC) responds well to surgery.Patients often question how long they have to be on surveillanceafter their surgery. Several follow-up patterns have been describedin the literature. Until 2009, no published established Canadianguidelines existed to assist Canadian health-care practitioners inthe surveillance of these patients. We present 3 cases of RCC thatrecurred 10 years or longer after the initial nephrectomy. Thesecases emphasize the need for careful long-term follow-up, as recommendedin the Canadian Urological Association guidelines.We also discuss the optimism of prolonged disease survival inthe era of novel therapeutic agents that target angiogenesis.
Metastatic signet-ring cell cancer of the bladder responding to chemotherapy with capecitabine: case report and review of literature
Authors: Michels Jorg , Barbour Sean , Cavers Douglas , Chi Kim N.
Published: October 2016

Signet-ring cell cancers deriving from the bladder are rare entities and usually present with advanced incurable disease and associated poor outlook. No standard effective chemotherapeutic option has been described largely due to the rarity of this malignancy. We report a case of a patient with metastatic bladder cancer, signet-ring cell variant. The patient progressed rapidly on standard first-line bladder cancer chemotherapy with gemcitabine and carboplatin. He responded well to second-line capecitabine with a clinically meaningful progression-free survival.
Translational education: tools for implementing the CanMEDS competencies in Canadian urology residency training
Authors: Mickelson Jennifer J. , MacNeily Andrew E.
Published: October 2016

It has been more than a decade since the Royal College of Physicians and Surgeons of Canada implemented the Canadian Medical Education Directives for Specialists (CanMEDS) project. Despite frequent and widespread correspondence to Canadian practitioners and educators, the adoption of the 7 core competencies espoused by CanMEDS has been slow. Barriers to the teaching and acquisition of these skills include a lack of understanding of what they actually represent, a paucity of tools to teach them and an inability to quantify performance. It is essential to translate the goals of the CanMEDS project into clinically relevant concepts. We define the current status of the CanMEDS competencies with respect to urological training and provide some context to what has been, until now, a poorly defined and abstract educational construct.
Interferon-alfa in the treatment of patients with inoperable locally advanced or metastatic renal cell carcinoma: a systematic review
Authors: Canil Christina , Hotte Sebastien , Mayhew Linda A. , Waldron Tricia S. , Winquist Eric
Published: October 2016

A systematic review was undertaken to determine whether interferon-alfa (IFN-α) is an effective treatment for patients with inoperablelocally advanced or metastatic renal cell carcinoma (mRCC).MEDLINE, EMBASE, the Cochrane Library, guideline databasesand relevant meeting proceedings were searched. Randomizedclinical trials (RCTs) or meta-analyses comparing IFN-α-containingregimens to placebo or non-immunotherapy controls, and thatreported response rate, survival, toxicity or quality of life data wereeligible. Two systematic reviews and eight RCTs met the selectioncriteria. A Cochrane review updated in 2005 reported higher responserates and reduced one-year mortality based on 4 RCTs in patientswho received IFN-α. Of the eight RCTs, three reporting objectiveresponse rate showed significant differences favouring IFN-α. Twoof five trials reporting survival data showed longer median survivalin the IFN-α group. Adverse effects of IFN-α were consistentacross the trials with increased intensity and frequency concordantwith increased IFN-α dose. Meta-analyses of seven RCTs forobjective response and six RCTs for mortality favoured IFN-α: oddsratio 6.87 (95% Confidence Interval [CI], 3.29 to 14.35) and hazardratio 0.79 (95% CI, 0.69 to 0.91), respectively. The effectivenessof IFN-α in mRCC has been subject to skepticism. As IFN-α
Cross ectopic multicystic dysplastic kidney with ureterocele in nonectopic site
Authors: Narcı Adnan , Korkmaz Mevlit , Karakus Muhittin , Sen Tolga Altug , Surer Îlhamı , Cetinkursun Salih
Published: October 2016

Crossed renal ectopy (CRE) is the second most common fusionanomaly of the kidney, with an incidence of 1 in 7000 autopsies;it comes in second after horseshoe kidney. Crossed renal ectopy isassociated with an ectopic ureter and generally an ectopic kidneyfused with a normal kidney. A 7-month-old boy who had left-torightcrossed non-fused renal ectopy and multicystic renal dysplasiawith ureterocele in nonectopic kidney was reported in Englishlanguage literature. In this article, we present the first case of CREwhere surgical intervention has been performed.
Renal cell carcinoma presenting as an ominous metachronous scalp metastasis
Authors: Smyth Lisa G. , Casey Rowan G. , Quinlan David M.
Published: October 2016

Renal cell carcinoma (RCC) accounts for 3% all of solid organtumours and is slightly more common in men in the age range of60 to 70 years. Skin metastases occur in 3% to 6% of RCCs. Thereare only approximately 30 cases of scalp metastases secondary toRCC in the literature. They usually occur late in metastatic diseaseand are a bad prognostic marker. A 67-year-old Caucasian malepresented with a metastatic scalp lesion, 10 years post-radicaltreatment for RCC. His initial diagnosis was a T3bN0M0 RCC.He presented with a raised erythematous lesion on his parietalscalp, the histology of which demonstrated late metastatic recurrence.Shortly after this, he developed diffuse metastatic disease.Metastatic RCC can occur many years after initial diagnosis andpresent in many forms. Cutaneous metastatic lesions of RCC canmimic many other dermatologic conditions and carries an ominousprognosis. It is therefore important not only for the urologist, butalso general practitioners and patients to be vigilant of any newskin lesion as a portent of impending metastatic disease.
Laparoscopic excision of a cystic retroperitoneal adenocarcinoma arising in a focus of extra-ovarian endometriosis
Authors: Beiko Darren , Bryson S.C. Peter , Bell C. David , Pace Kenneth T.
Published: October 2016

We report an unusual case of a retroperitoneal cystic adenocarcinomaarising in a focus of extra-ovarian retroperitoneal endometriosis.The lesion was completely excised using a transperitoneallaparoscopic approach without the need for any adjuvant chemotherapyor radiation therapy. The patient remains clinically wellwith no evidence of recurrent or metastatic disease after 3 yearsof follow-up. To our knowledge, this is the first reported case ofthis type of rare extra-gonadal endometriosis-associated neoplasmwith successful laparoscopic excision.
Xanthogranulomatous cystitis associated with inflammatory bowel disease
Authors: Chung Doreen E. , Carr Lesley K. , Sugar Linda , Hladunewich Michelle , Deane Leslie A.
Published: October 2016

Xanthogranulomatous inflammation is a benign condition characterizedby the presence of multinucleated giant cells, chronicinflammatory cells and lipid-laden macrophages, known as xanthomacells. Only 22 cases of xanthogranulomatous cystitis (XGC)have been reported in the Japanese and English literature. In thisreport, we describe the twenty-third case of XGC and the third caseassociated with inflammatory bowel disease (IBD). A 50-year-oldwoman with quiescent Crohn’s disease was incidentally foundto have a bladder mass on ultrasound. The lesion was resectedthrough a transurethral approach. Pathology demonstrated XGC.At 3 months post-resection, there was no evidence of recurrenceadjacent to the previous resection scar.
Antegrade balloon occlusion of inferior vena cava during thrombectomy for renal cell carcinoma
Authors: Metcalfe Charles , Chang-Kit Laura , Dumitru Ioana , MacDonald Shaun , Black Peter
Published: October 2016

Nephrectomy with inferior vena cava (IVC) thrombectomy foradvanced renal cell carcinoma (RCC) is a challenging and morbidsurgical case. We describe the use of a simple endoluminaltechnique to occlude the suprahepatic IVC during thrombectomy.A 60-year-old male presented with a large right-sided RCC andIVC tumour thrombus. The tip of the thrombus, which was nonadherentto the caval wall, extended to the level of the hepaticveins. After complete dissection of the kidney, we obtained suprahepaticcontrol of the IVC by a large compliant balloon, introducedthrough the right internal jugular vein and inflated just below thelevel of the diaphragm. The IVC thrombectomy was performedin a bloodless field. Mean blood pressure remained stable duringIVC balloon inflation with a total occlusion time of 10 minutes.Intraprocedural completion cavogram and postoperative Dopplerultrasonography showed no residual IVC clot. Blood loss duringthe thrombectomy portion of the case was scant. The patient’spostoperative course was uncomplicated and, at the last followup,he had stable metastatic disease on sunitinib therapy. For thesurgical treatment of RCC with retrohepatic IVC tumour extension,transjugular balloon occlusion of the suprahepatic IVC offers analternative to extensive hepatic mobilization to obtain suprahepaticthrombus control. Advantages over traditional surgical methodsmay include decreased surgical time, lower risk of liver injury andtumour embolism. We suggest this method for further evaluation.
Myxoid chondrosarcoma of the scrotum: a case report and review of the literature
Authors: Mendez-Probst Carlos Enrique , Erdeljan Petar , Castonguay Mathieu , Gabril Manal , Wehrli Bret , Razvi Hassan
Published: October 2016

Extraskeletal myxoid chondrosarcomas are relatively rare soft tissuemalignant tumours, most commonly located in the extremities.Their occurrence in the genitourinary tract is extremely rare. Wepresent a clinical case report of an extraskeletal myxoid chondrosarcomaoriginating in the scrotum.
Suprapubic cystostomy: a bizarre complication of catheter migration causing ureteric obstruction
Authors: Dangle Pankaj P. , Tycast James , Vasquez Evalynn , Geary Brian , Chehval Micheal
Published: October 2016

Suprapubic catheters are used routinely for bladder drainage; however,complications are commonly reported. These complicationscould be attributed to surgical technique or the catheter itself.Complications related to surgical technique can be controlled andreduced, but catheter-related complications are unavoidable andunpredictable. We report a rare catheter-related complication leadingto obstruction of the ureter in a solitary kidney in a patientwith neurogenic bladder and voiding dysfunction managed withsuprapubic catheter drainage.
Use of a novel parenchymal clamp for laparoscopic and open partial nephrectomy
Authors: Toren Paul , Al-Essawi Turki , Mclean Anthony , Jain Umesh
Published: October 2016

Increasing data advocates the wider use of partial nephrectomy forrenal tumours amenable to this approach. We describe the initialNorth American use of a novel parenchymal clamp in an openand a laparoscopic partial nephrectomy. Initial results in 3 patients(2 open, 1 laparoscopic) demonstrate excellent preservation ofrenal function and good oncologic outcomes. Hilar dissection wasavoided in all cases and the estimated blood loss was low. In oursmall series, we found this device to be a safe and useful adjunctto partial nephrectomy.
Les torsions sur testicules cryptorchides
Authors: Gharbi Mohamed , Amri Najmeddine , Chambeh Wahib , Braiek Salem , El Kamel Rafik
Published: October 2016

But : La cryptorchidie est une pathologie assez fréquente en urologie.Elle est associée à un risque élevé d’infertilité et de dégénérescence.Elle semble aussi être associée à un risque importantde torsion. Cette entité est très peu abordée dans la littérature.Nous rapportons tous les cas de torsion sur testicule cryptorchideobservés à notre service dans le but de mieux caractériser cettepathologie et de réduire ainsi le taux d’orchidectomies.Méthodologie : Il s’agit d’une étude rétrospective portant sur tousles cas de torsion sur testicule cryptorchide opérés dans notre serviced’urologie entre 1999 et 2007. Les patients ont fait l’objetd’une description basée sur le résumé de leurs observations.Résultats : Les patients étaient âgés de 7 mois à 39 ans. La torsiontouchait le testicule droit dans 53 % des cas. Le tableau cliniquecomportait une douleur au niveau de la région inguinaled’apparition soudaine avec une masse sous-cutanée inflammatoireet douloureuse à ce niveau et surtout un hémiscrotum homolatéralvide. Dans 60 % des cas, le diagnostic était tardif et uneorchidectomie a été réalisée. Dans les autre cas, un abaissementdu testicule a été réalisé avec orchidopexie controlatéral dans lemême temps opératoire.Conclusion : Bien qu’il s’agisse d’une pathologie peu courante, latorsion sur testicule cryptorchide doit être étudiée davantage. Lediagnostic précoce permettra de sauver et d’abaisser le testiculeet faciliter ainsi le dépistage d’une éventuelle dégénérescence.Purpose: Cryptorchidism is a rather frequent pathology in urology.It is associated with a high risk of infertility and degeneration. Italso seems to be associated with a high risk of torsion. This entityis poorly studied in the literature. We studied the cases of torsionon cryptorchid testicles hospitalized at our service, to bettercharacterize this pathology and reduce the rate of orchidectomy.Methods: We underwent a retrospective study of all the casesof torsion on a cryptorchid testicle hospitalized in our service ofurology between 1999 and 2007.Results: The age of patients was between 7 months and 39 years.Torsion touched the right testicle in 53% of the cases. Patientsexperienced a brutal pain of the inguinal area with an under cutaneousmass inflammatory and a painful and empty homolateralscrotum. In 60% of the cases, the diagnosis was late and an orchidectomywas carried out. In the other cases, a lowering of thetesticle was done with the controlateral orchidopexy.Conclusion: Even though torsions on a cryptorchid testicle arerare, we should not ignore them. The early diagnosis will makeit possible to save and lower the testicle, and track a possibledegeneration.
GPS/INS/Odometer Data Fusion for Land Vehicle Localization in GPS Denied Environment
Authors: Aftatah Mohammed , Lahrech Abdelkabir , Abounada Abdelouahed , Soulhi Aziz
Published: October 2016

The main purpose of this paper is to present a fusion approach to bridge the period of Global Positioning System (GPS) outages using two proprioceptive sensors that are the Inertial Navigation System (INS) and the odometer in order to assure a continuous localization for land vehicle in urban areas where GPS signal blockage is very often. Odometer and GPS measures are exploited to correct inertial sensor errors. In fact, during GPS availability, INS is integrated with GPS to provide accurate localization solution; whereas during GPS outages, the odometer measurements are used to correct the INS error thereby improving the positioning accuracy and assuring the continuity of navigation solution. The problem of estimation of vehicle localization is realized by Kalman Filter (KF) that merges sensor measurements. The paper thus introduces results from simulation and real data.
High-Throughput Analytical Techniques for the Determination of the Residues of 653 Multiclass Pesticides and Chemical Pollutants in Tea, Part VII: A GC-MS, GC-MS/MS, and LC-MS/MS Study of the Degradation Profiles of Pesticide Residues in Green Tea
Authors: Chang Qiao-Ying , Pang Guo-Fang , Fan Chun-Lin , Chen Hui , Yang Fang , Li Jie , Wen Bi-Fang
Published: October 2016

GC-MS, GC-tandem MS (MS/MS), and LC-MS/MS were used to mathematically define the degradation profiles of pesticide residues in two field trials. Nineteen pesticides were studied in the first field trial and 11 in the second. The results of the field trials demonstrated that the degradation profiles of pesticide residues in green tea can be described with power functions to successfully estimate the amount of time, following pesticide application, pesticide residues appearing in tea in concentrations at and/or above the maximum residue limit (MRL) decrease to concentrations below the MRL. Stability tests on green tea samples stored at room temperature were conducted to determine whether pesticide-incurred green tea samples prepared according to the method used in the field trials would be suitable for the preparation of reference standards for laboratory-proficiency testing trials. This paper reports the results of a GC-MS, GC-MS/MS, and LC-MS/MS study, as well as the suitability of the samples prepared under these conditions for use as pesticide reference standards in tea analysis.
Primary care clinicians’ experiences prescribing HIV pre‐exposure prophylaxis at a specialized community health centre in Boston: lessons from early adopters
Authors: Krakower Douglas S , Maloney Kevin M , Grasso Chris , Melbourne Katherine , Mayer Kenneth H
Published: October 2016

Introduction

An estimated 1.2 million Americans have indications for using antiretroviral pre‐exposure prophylaxis (PrEP) to prevent HIV acquisition. For many of these at‐risk individuals, the best opportunity to learn about and receive PrEP will be during routine visits to their generalist primary care clinicians. However, few generalist clinicians have prescribed PrEP, primarily because of practical concerns about providing PrEP in primary care settings. The experiences of specialized primary care clinicians who have prescribed PrEP can inform the feasibility of PrEP provision by generalists.

Methods

During January to February 2015, 35 primary care clinicians at a community health centre in Boston that specializes in the care of sexual and gender minorities completed anonymous surveys about their experiences and practices with PrEP provision. Responses were analyzed with descriptive statistics.

Results and discussion

Thirty‐two clinicians (response rate=91%) completed the surveys. Nearly all clinicians (97%) had prescribed PrEP (median 20 patients, interquartile range 11–33). Most clinicians reported testing and risk‐reduction counselling practices concordant with U.S. Centers for Disease Control and Prevention guidelines for PrEP. Clinicians indicated that patients using PrEP experienced medication toxicities infrequently and generally reported high adherence. However, some clinicians’ practices differed from guideline recommendations, and some clinicians observed patients with increased risk behaviours. Most clinicians (79%) rated PrEP provision as easy to accomplish, and 97% considered themselves likely to prescribe PrEP in the future.

Conclusions

In a primary care clinic with specialized expertise in HIV prevention, clinicians perceived that PrEP provision to large numbers of patients was safe, feasible and potentially effective. Efforts to engage generalist primary care clinicians in PrEP provision could facilitate scale‐up of this efficacious intervention.
Plantar Fasciitis—A Comparison of Treatment with Intralesional Steroids versus Platelet-Rich Plasma
Authors: Acosta-Olivo Carlos , Elizondo-Rodriguez Jorge , Lopez-Cavazos Ricardo , Vilchez-Cavazos Felix , Simental-Mendia Mario , Mendoza-Lemus Oscar
Published: October 2016

Background:

Many treatment options for plantar fasciitis currently exist, some with great success in pain relief. The objective of our study was to compare the use of intralesional steroids with platelet-rich plasma (PRP), using pain scales and functional evaluation, in patients with plantar fasciitis who did not respond to conservative treatment.

Methods:

A controlled, randomized, blinded clinical assay was performed. Patients were assigned to one of the two groups by selecting a sealed envelope. The steroid treatment group received 8 mg of dexamethasone plus 2 mL of lidocaine as a local anesthetic. The PRP treatment group received 3 mL of PRP activated with 0.45 mL of 10% calcium gluconate. All of the patients were evaluated at the beginning of the study, and at 2, 4, 8, 12, and 16 weeks post-treatment with the Visual Analog Scale (VAS), Foot and Ankle Disability Index (FADI), and American Orthopedic Foot and Ankle Society (AOFAS) scale.

Results:

The right foot was the most frequently affected foot (63%). The average age of the patients was 44.8 years (range, 24–61 years). All scales used (VAS, FADI and AOFAS) showed that the difference was not statistically significant between the two groups.

Conclusions:

We can conclude that the use of PRP is an effective treatment method for patients with plantar fasciitis who do not respond to conservative treatment because PRP demonstrates an efficacy equal to that of steroids. However, the cost and the time for preparation the PRP are two of the disadvantages of this treatment.
Myofiber-specific TEAD1 overexpression drives satellite cell hyperplasia and counters pathological effects of dystrophin deficiency
Authors: Southard Sheryl , Kim Ju-Ryoung , Low SiewHui , Tsika Richard W , Lepper Christoph
Published: October 2016

When unperturbed, somatic stem cells are poised to affect immediate tissue restoration upon trauma. Yet, little is known regarding the mechanistic basis controlling initial and homeostatic ‘scaling’ of stem cell pool sizes relative to their target tissues for effective regeneration. Here, we show that TEAD1-expressing skeletal muscle of transgenic mice features a dramatic hyperplasia of muscle stem cells (i.e. satellite cells, SCs) but surprisingly without affecting muscle tissue size. Super-numeral SCs attain a ‘normal’ quiescent state, accelerate regeneration, and maintain regenerative capacity over several injury-induced regeneration bouts. In dystrophic muscle, the TEAD1 transgene also ameliorated the pathology. We further demonstrate that hyperplastic SCs accumulate non-cell-autonomously via signal(s) from the TEAD1-expressing myofiber, suggesting that myofiber-specific TEAD1 overexpression activates a physiological signaling pathway(s) that determines initial and homeostatic SC pool size. We propose that TEAD1 and its downstream effectors are medically relevant targets for enhancing muscle regeneration and ameliorating muscle pathology.
Sensory dynamics of visual hallucinations in the normal population
Authors: Pearson Joel , Chiou Rocco , Rogers Sebastian , Wicken Marcus , Heitmann Stewart , Ermentrout Bard
Published: October 2016

Hallucinations occur in both normal and clinical populations. Due to their unpredictability and complexity, the mechanisms underlying hallucinations remain largely untested. Here we show that visual hallucinations can be induced in the normal population by visual flicker, limited to an annulus that constricts content complexity to simple moving grey blobs, allowing objective mechanistic investigation. Hallucination strength peaked at ~11 Hz flicker and was dependent on cortical processing. Hallucinated motion speed increased with flicker rate, when mapped onto visual cortex it was independent of eccentricity, underwent local sensory adaptation and showed the same bistable and mnemonic dynamics as sensory perception. A neural field model with motion selectivity provides a mechanism for both hallucinations and perception. Our results demonstrate that hallucinations can be studied objectively, and they share multiple mechanisms with sensory perception. We anticipate that this assay will be critical to test theories of human consciousness and clinical models of hallucination.
Calcium handling precedes cardiac differentiation to initiate the first heartbeat
Authors: Tyser Richard CV , Miranda Antonio MA , Chen Chiann-mun , Davidson Sean M , Srinivas Shankar , Riley Paul R
Published: October 2016

The mammalian heartbeat is thought to begin just prior to the linear heart tube stage of development. How the initial contractions are established and the downstream consequences of the earliest contractile function on cardiac differentiation and morphogenesis have not been described. Using high-resolution live imaging of mouse embryos, we observed randomly distributed spontaneous asynchronous Ca2+-oscillations (SACOs) in the forming cardiac crescent (stage E7.75) prior to overt beating. Nascent contraction initiated at around E8.0 and was associated with sarcomeric assembly and rapid Ca2+ transients, underpinned by sequential expression of the Na+-Ca2+ exchanger (NCX1) and L-type Ca2+ channel (LTCC). Pharmacological inhibition of NCX1 and LTCC revealed rapid development of Ca2+ handling in the early heart and an essential early role for NCX1 in establishing SACOs through to the initiation of beating. NCX1 blockade impacted on CaMKII signalling to down-regulate cardiac gene expression, leading to impaired differentiation and failed crescent maturation.
Ultrahigh-density data storage into thin films of fullerene molecules
Authors: Nakaya Masato , Aono Masakazu , Nakayama Tomonobu
Published: October 2016

Recording nonvolatile digital data with an aerial density above terabit per square inch (Tbits/in.2), the so-called ultrahigh-density data storage, is one of the key technologies toward a sophisticated information-oriented society in the near future. To overcome the limitation of conventional magnetic data storage, one proposed solution is the use of thin films of functional molecules as recording media, in which each nonvolatile digital datum is stored into a single molecule by controlling its chemical reaction. Here, we show the recent progress in ultrahigh-density data storage using ultrathin films of C60 molecules. In this data storage, binary digits (1 and 0) are stored with an aerial density up to 180 Tbits/in.2 by controlling the bound and unbound states of C60 molecules in the films. Writing and erasing bit data have been carried out by selectively inducing the formation and annihilation of a covalent bond between neighboring C60 molecules, respectively, which are precisely controlled for a designated C60 molecule on the surface of a C60 film using the metal tip of a scanning tunneling microscopy (STM) system. It has also been shown that quantum efficiencies of STM-induced intermolecular reactions between C60 molecules are a key factor in determining the speeds of data writing and erasing as well as the reliability of these operations. Controlling the quantum efficiencies of intermolecular reactions by electrostatic charge injection from the conductive substrate to the surface layer of C60 films results in data writing with an operating speed of ∼363 bits/s.
ESPAÑA: LOS ACUERDOS DEL ESTADO CON LA SANTA SEDE Y LAS CONFESIONES MINORITARIAS
Authors:   Universidad de Cantabria (España), Mantecón Sancho Joaquín Mariano
Published: October 2016

En este artículo se lleva a cabo un somero estudio de los Acuerdos del Reino de España con la Santa Sede y con las Confesiones minoritarias de notorio arraigo, realizando un balance tras sus respectivos períodos de vigencia
LAS RELACIONES DE LA SANTA SEDE CON EL ESTADO ESPAÑOL Y CON EL ESTADO CHILENO. VARIANTES DE LA COOPERACIÓN CON Y SIN CONCORDATO (I)
Authors:   Pontificia Universidad Católica de Valparaíso, Sánchez Miguel
Published: October 2016

Las relaciones entre la Santa Sede y Chile no se rigen, hasta el momento, por un concordato completo o por acuerdos parciales, a diferencia de lo que ocurre en España. Sin embargo, existe una colaboración de facto con la Iglesia Católica en determinadas “materias mixtas”. El objetivo principal de este artículo es ofrecer una primera aproximación a las diferencias y semejanzas existentes entre la colaboración “con” y “sin” concordato en España y en Chile, respectivamente. Se esboza el marco general de las relaciones de la Santa Sede con ambos estados y se traen a colación algunas materias específicas, sin perjuicio de un desarrollo más amplio que será publicado como continuación del presente trabajo.
RELIGION-STATE RELATIONS AND THE AGREEMENTS BETWEEN THE FEDERATIVE REPUBLIC OF BRAZIL AND THE HOLY SEE
Authors:   Universidad Federal de Uberlandia (Brasil), Souza Alves Rodrigo Vitorino
Published: October 2016

Este artí­culo tiene como propósito identificar las principales caracterí­sticas del régimen brasilero de secularidad, e investigar si los acuerdos entre Brasil y la Santa Sede son admisibles a la luz de la Constitución Federal de 1988