[Complications of the 180 Watt XPS™ GreenLight laser-results of 1283 procedures]

BACKGROUND

The aim of this study was to classify and analyze postoperative complications under a new inspection method. This study assessed all patients who presented to the urologic ward within the first 3 months after their surgery.

METHODS

A total of 170 patients suffered from complications due to the surgery; 29 patients experienced complications that were not directly correlated with the surgery. Age, American Society of Anesthesiologists (ASA) score, the emitted laser energy of the 180 Watt XPS™ GreenLight laser measured in joules, and the complications which led to the renewed hospitalization such as hematuria, urinary retention, and infection were analyzed and compared in the two groups of patients.

RESULTS

Most complications that occurred were urinary retention and hematuria (50.6% and 49.4% of all patients, respectively). Of the patients with hematuria, 86.75% were under anticoagulant therapy medication.

CONCLUSION

Compared with the reference approval study (Goliath trial) that included 135 multicentric patients (14.07% of patients presented with a complication classified as Clavien-Dindo II), the rate of complications was similar. This outcome is surprising because the patients treated with the GreenLight laser in the present study were classified as geriatric patients not only according to their age but also in their ASA score which is an indication of multiple other pathologies and administered medications. To achieve long-term postoperative success for these patients, the interface between the ambulatory and the hospital care should be optimized.

Pure Androgen-Secreting Adrenocortical Carcinoma Presenting with Hypoglycemia

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. Most patients present with steroid hormone excess or abdominal mass effect. Pure androgen-secreting ACCs are rare, while hypoglycemia is an unusual presentation of this malignancy. We present a 26-year-old woman with hypoglycemia and history of adrenalectomy due to a large adrenal mass which was diagnosed as nonfunctional adrenal adenoma. She was admitted in our hospital 10 days after her fetal loss with repeated episodes of severe hypoglycemia. She had a high serum dehydroepiandrosterone sulfate (DHEA-S) and her hypoglycemia was associated with low insulin and C-peptide levels. Imaging revealed liver metastasis and immunohistochemical studies of the biopsied lesions confirmed the diagnosis of ACC.

OXIDATIVE STRESS IS MARKEDLY REDUCED BY COMBINED VOLUNTARY EXERCISE AND TESTOSTERONE IN THE HEART OF DIABETIC RATS

Objective

Cardiovascular disorders in diabetes condition arise from increased oxidative stress. Both regular mild exercise and testosterone influence on body's antioxidant system in diabetes. In this study, we evaluated treatment of testosterone and voluntary exercise, alone or together on oxidative stress in the heart and blood of diabetic rats.

Methods

Type 1 diabetes was induced by intraperitoneal injection of 50 mg/kg of streptozotocin in rats. Sixty three rats have been divided into eight groups as follows: Diabetes, diabetes+ testosterone, diabetes+ exercise, diabetes+ testosterone+ exercise, diabetes+ castration, diabetes+ castration+ testosterone, Diabetes+ castration+ exercise, Diabetes+ castration+ exercise+ testosterone. Type 1 diabetes was induced by intraperitoneal injection of 50 mg/kg of streptozotocin in the male Wistar rats and after a week, castration was performed. After 42 days of treatment with testosterone (2 mg/kg/day) or voluntary exercise alone or in combination, SOD, GPX and CAT activities and MDA levels were measured in the blood and heart tissue samples in the groups of study. In the end of study, SOD, GPX and CAT activities and MDA levels were measured in blood and heart tissue samples in the groups of study.

Results

SOD, GPX and CAT activities significantly (p<0.05) increased in groups that treated either testosterone or exercise and MDA level significantly (p<0.01) decreased in the blood and heart tissue of diabetic and castrated diabetic rats. Simultaneously, treatment with testosterone and exercise had a synergistic effect on antioxidant enzymes level in diabetic and diabetic castrated rats. In the castrated animals with diabetes, SOD, GPX and CAT activities significantly decreased (p<0.05) and MDA levels significantly increased (p<0.05) in blood and heart tissue.

Conclusion

Voluntary exercise and testosterone alone or together heightened body's antioxidant system and were able to reduce the MDA levels in blood and heart of diabetic and castrated diabetic rats.

Precise position control of an electro-hydraulic servo system via robust linear approximation

This paper presents a study on electro-hydraulic servo system for the purpose of position control using a compatible linear model. The system has high level of nonlinearity and linearization introduces extra error in system model. In order to reduce this error several methods of linearization uncertainty are discussed. In spite of applying Taylor's series for all methods, several procedures are used for considering uncertainty on linearization constants. In the first procedure, a simple bound is considered for each linearization constant. In the second procedure, a polytope is extracted for the uncertainty by a graphical method. Finally, a procedure with less conservativeness and less restriction is proposed. This procedure is used to extract the linear model of the electro-hydraulic servo system for the task of position control. The resulting model is used to synthesize an output-feedback H_∞ controller for the EHSS using a Linear Matrix Inequality (LMI)-based approach. The effectiveness of the proposed method is demonstrated by simulation and experimental results. The results showed that the procedure is less conservative and has the fastest operation without any overshoot.

Evaluation of risk factors for retinopathy in preterm infant: a case-control study in a referral hospital in Iran

AIM

Aim of the study was to detect possible risk factors for retinopathy of prematurity (ROP), as a leading cause of treatable childhood blindness, among premature neonates.

METHODS

In this retrospective study, 60 premature neonates with ROP and 60 premature infants without ROP were entered and compared. Variables such as gestational age, birth weight, oxygen therapy, phototherapy, and so on were gathered and compared between the two groups.

RESULTS

Significant statistical differences were seen regarding gestational age (29.3±3.1 weeks in the ROP group vs. 31.9±2.2 in control group) and first-minute apgar score (6.55±1.7 in the ROP group vs. 7.06±2.3 in the control group). Regarding comparisons made in terms of therapeutic interventions made, only oxygen therapy and phototherapy showed significant differences between the two groups which were higher in the ROP group.

CONCLUSION

Gestational age (lower in the ROP group), first-minute Apgar score (lower mean score in the ROP group), birth weight, phototherapy, and oxygen therapy were factors discovered to affect the occurrence of ROP among premature infants. Higher birth weight and more advanced gestational age were protective factors for ROP. Oxygen therapy and multiple birth are ROP risk factors and these can be used for prediction of ROP occurrence.

Chromatin effector Pygo2 regulates mammary tumor initiation and heterogeneity in MMTV-Wnt1 mice

Little is known about chromatin mechanisms that regulate tumor-initiating cells that are proposed to be responsible for tumor recurrence and relapse. We have previously shown that Pygopus 2 (Pygo2), a chromatin effector and context-dependent Wnt signaling co-activator, regulates mammary gland development by expanding epithelial stem/progenitor cells. However, the role of Pygo2 in mammary tumorigenesis in vivo remains to be addressed. In this study, we show that epithelia-specific ablation of Pygo2 in MMTV-Wnt1 transgenic mice results in delayed mammary ductal elongation, but the hyperbranching phenotype, aberrant accumulation of stem/progenitor-like cells, and canonical Wnt signaling output are largely unaffected. Chronic loss of Pygo2 significantly delays mammary tumor onset in MMTV-Wnt1 females, whereas acute deletion of Pygo2 in MMTV-Wnt1 tumor cells leads to a significant decrease in their tumor initiating capability upon transplantation. Finally, we provide evidence supporting a role for Pygo2 in modulating the lineage potential of MMTV-Wnt1 tumor initiating cells. Collectively, our results suggest that Pygo2 acts at a step downstream of mammary stem cell accumulation to facilitate transformation, and that it regulates the tumor initiating capacity and lineage preference of the already transformed mammary cells, in MMTV-Wnt1 mice. These findings offer valuable insights into our understanding of the molecular basis of heterogeneity within breast tumors.

Electro-optic polymer spatial light modulator based on a Fabry-Perot interferometer configuration

A spatial light modulator (SLM) based on a Fabry-Perot interferometer configuration has been fabricated and tested. The Fabry-Perot spacer layer is a thin film of the SEO100 electro-optic polymer which serves as the nonlinear medium. Measurement results demonstrate the modulation of multiple pixels operating simultaneously at frequencies ranging from 300 kHz to 800 kHz which is significantly faster than SLMs based on liquid crystal and digital micromirror device technology. An average modulation contrast of 50% for all pixels is achieved with a drive voltage of 70 V(rms) at 100 kHz. Microwave speeds and CMOS compatibility are feasible with improved transmission line and cavity design.

[Are there indications for organ-preserving tumor resection in urothelial cancers of the upper urinary tract?]

PURPOSE

Identification of prognostic factors for tumor recurrence in nephronsparing surgery and tumor progression after organ-preserving surgery.

MATERIAL AND METHODS

From June 1989 to February 2003, 43 patients (47 nephron units) underwent organ-preserving surgery or the upper urinary tract because of urothelial carcinoma, with 26 (60.5 %) having an elective indication (healthy contralateral kidney).

RESULTS

The mean follow-up was 39.2 months with a range of 10.6 to 168.3 months. Ipsilateral recurrences occurred in 13 (27.6 %) of reno-ureteral units. Recurrences were significantly more common for tumors located in the renal pelvis or opposite the ureteral origin (p = 0.018). Tumor progression occurred in 8 of 43 patients (18.6 %) and significantly correlated with the T- and G-stage of the primary tumor (p = 0.006 and p = 0.002). Of the 47 conservatively treated reno-ureteral units, 38 (80.8 %) could be preserved.

CONCLUSION

Organ-preserving resection of the urothelial carcinoma of the upper urinary tract is an alternative in some patients with well-differentiated superficial tumors. A follow-up for life and a good patient compliance are necessary. Tumors of the renal pelvis have a significantly higher recurrence rate than ureteral tumors. Poorly differentiated tumors should undergo organ-preserving surgery only if the goal is palliation and in patients with solitary kidney after intensive consultation about the high risk of invasive recurrences and the development of metastases.

Gemcitabine monotherapy as second-line treatment in cisplatin-refractory transitional cell carcinoma - prognostic factors for response and improvement of quality of life

OBJECTIVES

i) To evaluate objective response, toxicity, and quality of life (QoL) of gemcitabine monotherapy as second-line treatment in patients with cisplatin-refractory, metastatic transitional cell carcinoma (TCC). ii) To assess prognostic parameters for response to treatment and for improvement of QoL parameters.

PATIENTS AND METHODS

30 patients were prospectively enrolled in this open-label, nonrandomized multicenter phase II trial. Patients received up to 6 courses of gemcitabine monotherapy (1,250 mg/m(2) on day 1 and 8 of a 21-day course). 28 of 30 patients were available for response evaluation.

RESULTS

Objective response (OR) was seen in 3/28 (11%) of patients (2 complete remissions, 1 partial remission). The mean time to progression (TTP) was 4.9 +/- 3.5 months and mean disease-specific survival time was 8.7 +/- 4.7 months. 13 of 28 patients did not progress (OR + 10 stable diseases), and TTP (8.0 +/- 2.7 months, p < 0.001) as well as survival time (10.2 +/- 3.8 months, p < 0.05) differed significantly from those who showed progressive disease within 18 weeks of treatment. Pain values significantly improved in the group of responders from 4.3 +/- 1.9 to 5.8 +/- 1.3 points (p < 0.05). Response to cisplatin pretreatment was the best prognosticator for the response to gemcitabine.

CONCLUSIONS

Gemcitabine monotherapy as second-line treatment is justified in patients with metastatic TCC who are refractory to cisplatin treatment. Patients with initially OR to cisplatin benefit most from second-line treatment. QoL remains stable during treatment, and pain improves especially in patients with bone metastases.

Preputial flap for primary closure after excision of tumors on the glans penis

In patients with large defects of the glans penis consequent to organ-preserving tumor excision, we describe a vascularized flap formed from the outer preputial leaf for primary defect coverage. We have used this successfully in 3 men in whom both erections and penile length have been preserved.

Truncated and dispersed rpl2 and rps19 pseudogenes are co-transcribed with neighbouring downstream genes in wheat mitochondria

The wheat mitochondrial genome contains only partial coding sequences for the L2 and S19 ribosomal proteins, unlike in rice or liverwort mitochondria, where these genes are functional and have a bacterial-type linkage. A single-copy stretch corresponding to the extreme 3' terminus of the wheat rpl2 gene is co-transcribed with the trans-splicing nad1 exon 4; and, at another unique location, the rps19 segment lacking the 5' coding region is co-transcribed with the downstream nad4L gene. In both cases, the 5' termini of these transcripts map to promoter consensus motifs acquired through genomic reorganization, enabling continued expression of essential downstream genes. In both wheat and rice, the rpl2 and rps19 genomic regions differ in their RNA profiles between germinating embryos and seedlings. The absence of intact rpl2 and rps19 genes in wheat mitochondria is consistent with their inactivation through DNA rearrangement/deletion after the successful transfer of functional copies to the nucleus.

Observation of stable cylindrical modes in electrically pumped circular grating-coupled surface-emitting lasers

We present the results of a comprehensive experimental study of the modal behavior of electrically pumped circular grating-coupled surface-emitting lasers with resonant second-order gratings. Our results show stable cylindrical mode operation with azimuthal orders m = 1 and m = 52. We have found that, when a passive, unpumped 0.7-microm-deep indentation is included at the center of the circular resonator contact, the modal behavior becomes more stable with respect to increasing current. This result manifests itself in the lasing of two orthogonal m = 1 modes along with one higher-order mode from threshold to 2.2 times threshold or more. The spatial coherence of the cylindrical modes over the area of the resonator leads to better beam quality. Lasers without passive central indentations exhibit mode hopping between quasi-linear modes and higher-order cylindrical modes as the current is increased.

Anticonvulsant action of 2-chloroadenosine injected focally into the perirhinal cortex in amygdaloid kindled rats

Possible anticonvulsant effects of 2-chloroadenosine injected focally into the perirhinal cortex of amygdala kindled rats were investigated over a 2 h period. Animals were microinfused (1 microl) with 2-chloroadenosine (2-CLA; 5, 10, 15, 25 and 100 nM) or artificial cerebrospinal fluid applied through a cannula located in the perirhinal cortex. At the doses employed, 2-CLA significantly reduced afterdischarge duration and stage 5 seizure duration. The latency to stage 4 seizure was increased only at the highest dose of 2-CLA (100 nM), while even at this dose no significant change in seizure stage could be seen. The maximum effect of 2-CLA was obtained 30 min after microinfusion of the drug. Pre-treatment (intraperirhinal cortex) of animals with the nonselective adenosine antagonist, caffeine (50 microM; 1 microl), blocked the anticonvulsant activity of 2-CLA. These results suggest that adenosine receptors located in the perirhinal cortex may play an important role in the suppression of seizure activity elicited from the amygdala.

Solgel grating waveguides for distributed Bragg reflector lasers

Solgel grating waveguides and their application to the fabrication of external-cavity distributed Bragg reflector (DBR) lasers are demonstrated. A new composition of aluminosilicate material is developed for the fabrication of single-mode waveguides and Bragg reflectors. An average loss of <0.2 dB/cm is measured in the single-mode waveguides at 1550 nm. The reflectors show filtering greater than 97% near 1530 nm, with a bandwidth of ~0.6 nm . The Bragg reflectors are used as feedback resonators for DBR lasers. Single-mode lasing with a sidemode suppression of better than 25 dB is demonstrated.

Focal lesions area feature of chronic inflammatory demyelinating polyneuropathy (CIDP)

In a study designed to identify the neuropathological features typical of chronic inflammatory demyelinating polyneuropathy (CIDP), we reviewed the sural nerve biopsy findings in 105 patients with this disorder. The patients' mean age at biopsy was 49 years. In 65% of patients the disease had a progressive and in 35% a relapsing-remitting course. In 47% of cases the disorder was idiopathic; the remainder had various concurrent conditions. All sural nerve biopsy specimens showed varying amounts of active demyelination associated with onion bulbs (48% of cases), endoneurial edema (55%) and inflammatory infiltrates (25%). The immunopathological hallmarks were T cell infiltration with macrophagic activation and up-regulation of major histocompatibility complex (MHC) class II expression, without B cell infiltration or immunoglobulin deposition on myelin sheaths. In 30% of cases some myelin sheaths showed C3d deposition. Analysis of proinflammatory cytokine expression invariably showed interleukin-1 in perivascular and endoneurial ramified cells and tumor necrosis factor-alpha prevalently in epineurial macrophages, whereas it detected interferon-gamma only in samples with perivascular inflammatory cells. This immunological pattern suggests that the cellular components of immunity play the major role in CIDP. In 19% of cases the neuropathological changes had a focal distribution. This distinctive feature corresponded to more active demyelination, more frequent detection of inflammatory infiltrates and more prominent immunological activation, suggesting that focal involvement is a possible step in the course of the disease.