Transplant renal artery stenosis (TRAS) is the most frequent vascular complication after kidney transplantation (KT) and has been associated with potentially reversible refractory hypertension, graft dysfunction, and reduced patient survival. The aim of the study is to describe the outcomes of a standardized Duplex Ultrasound- (DU-) based screening protocol for early diagnosis of TRAS and for selection of patients potentially requiring endovascular intervention. We retrospectively reviewed our prospectively collected database of KT from January 1998 to select patients diagnosed with TRAS. The follow-up protocol was based on a risk-adapted, dynamic subdivision of eligible KT patients in different risk categories (RC) with different protocol strategies (PS). Of 598 patients included in the study, 52 (9%) patients had hemodynamically significant TRAS and underwent percutaneous angioplasty (PTA) and stent placement. Technical and clinical success rates were 97% and 90%, respectively. 7 cases of restenosis were recorded at follow-up and treated with re-PTA plus stenting. Both DU imaging and clinical parameters improved after stent placement. Prospective high-quality studies are needed to test the efficacy and safety of our protocol in larger series. Accurate trial design and standardized reporting of patient outcomes will be key to address the current clinical needs.

A vesico-vaginal fistula (VVF) is a fistulous tract that connects bladder and vagina, causing urine leakage via the vagina. In the developed world, iatrogenic postoperative VVF is the most common case. Classically, when treating a VVF via the abdominal route, an abdominal flap is mobilized and interposed between the bladder and the vagina.In our video, we describe a robotic VVF repair technique with no omental flap interpositioning for a vaginal vault-located fistula.Duration of surgery was 95 min, estimated blood loss was <50 ml. The postoperative course was uneventful. At the 6-month follow-up, which included clinical and cystographic examinations, the patient had not experienced any recurrence.In our opinion, a two-layered suturing technique using two semi-continuous sutures for vaginal closure and perpendicular interrupted stitches for bladder closure does not require omental flap mobilization, reducing operating time and possible complications related to accidental peritoneal injuries.

INTRODUCTION:Solitary fibrous tumor (SFT) of the kidney represents a rare neoplasm, and its malignant potential seems to be scarce. Classically, a radical nephrectomy is regarded as the treatment of choice for this condition.CASE REPORT:We present the case of a 37-year-old male patient who underwent left robotic clampless partial nephrectomy of an SFT of the kidney. Our patient has been followed-up carefully, and at 15-month examination, he is free of recurrence. This is the second case of an SFT managed through a conservative approach.CONCLUSIONS:In our opinion, according to tumor's dimensions, partial nephrectomy may be considered for treating small SFTs.

Introduction We retrospectively evaluated the occurrence of post transplant renal artery stenosis (TRAS) in 808 recipients of a cadaveric renal transplantation performed in our unit between 1991 and 2013 and the outcome after a percutaneous revascularization. Materials TRAS was diagnosed when a Peak systolic Velocity(PSV) > 2.5 m/sec was found in the graft renal artery by Doppler ultrasound. Subsequently an angiography and eventually a percutaneus transluminal angioplasty (PTA) with stenting was performed. We compared renal function, blood hypertension, PSV and Resistive index (RI) at the time of the diagnosis of TRAS with the values collected at the last follow up visit. Results We found 74 (8.9%) TRAS of whom 18 due to a kinking of the artery or a non hemodinamic stenosis (defined as PSV between 2.0 and 2.5 m/sec) that didn't require angiography. 56 patients underwent an angiography. In 4 cases the stenosis was not confirmed, 51 were treated with PTA with stenting and one only with PTA without stenting. The median of the time between the diagnosis of TRAS and the renal transplantation was 70 days (range 2-3347 days). TRAS occurred near the anastomosis in 60% of the cases. We observed 1 hemorragic complication during the procedure (1.9%) that required an urgent nephrectomy. A restenosis was found in 8 cases (17%) treated again with a PTA in 4 patients, PTA and stenting in 2, and with medical therapy in 2. With a mean follow up of 5±4 years we confirmed the reduction of PSV, blood pressure and serum creatinine and an increase of RI and GFR as show in table 1.Table: No Caption available.Conclusions TRAS was found in 8.9% of our cohort of transplanted patients. The angiography is useful to confirm the diagnosis made by doppler examination and eventually treat the lesion

Background. Life expectancy after transplantation has improved, and cancer may soon be the leading cause of late death after transplantation. The guidelines of the American and European societies of nephrology and urology have not yet established the optimal frequency for screening for renal cell carcinoma (RCC) of native kidneys in patients who have undergone renal transplantation.Objective. To evaluate the prevalence, prognosis, and risk factors of RCC in a series of patients followed up for 16 years in our transplantation unit.Materials and Methods. Our study is a follow-up observational cohort study conducted in 694 consecutive renal transplant recipients admitted to our institution from July 1991 through July 2007. At our institution, ultrasound studies of the native kidneys were performed every 6 months after renal transplantation.Results. In the patient cohort studied, 10 patients developed a renal tumor (1.6% incidence). Three patients died of causes other than recurrence of RCC. Seven patients are alive with no evidence of RCC recurrence or metastatic disease after a mean (range) follow-up of 41 (12-96) months. Acquired cystic kidney disease and dialysis duration were positively associated with development of RCC.Conclusions. The incidence of RCC in the literature varies between 0.3% and 4.8%. The variability depends on the timing of follow-up, with a higher incidence in prospective studies with strict follow-up. We advise ultrasound studies performed by specialized physicians every 6 months after transplantation. More detailed guidelines designed by the major international transplantation societies are necessary.

The LMJ experimental plans include the attempt of ignition and burn of an ICF capsule with 40 laser quads, delivering up to 1.4MJ and 380TW. New targets needing reduced laser energy with only a small decrease in robustness are then designed for this purpose. A first strategy is to use scaled-down cylindrical hohlraums and capsules, taking advantage of our better understanding of the problem, set on theoretical modelling, simulations and experiments. Another strategy is to work specifically on the coupling efficiency parameter, i.e. the ratio of the energy absorbed by the capsule to the laser energy, which is with parametric instabilities a crucial drawback of indirect drive. An alternative design is proposed, made up of the nominal 60 quads capsule, named A1040, in a rugby-shaped hohlraum. Robustness evaluations of these different targets are in progress.

Extensive two-dimensional NMR analysis was employed to characterize the structural identity of the macrocyclic peptide lactam and the imide analog, a major side reaction product when allyl ester was used to protect the side chain of aspartic acid. A straightforward protocol modification was developed to minimize aspartimide formation during the synthesis of cyclic peptides.

No data are available on incisional hernia in renal transplant recipients using a midline incision. This study evaluated the incidence of abdominal wall incisional hernia, comparing two surgical approaches: midline and J-shaped incisions.Methods. Between 1991 and 2005, 415 consecutive patients underwent renal transplantation: between 1991 and 1997, 139 patients through a lateral incision; between 1997 and 2005, 137 of 276 renal trasnsplant patients via a midline incision, and 139 via a J-shaped incision. We evaluated the incidence of incisional herniae in these patients. Analyzed factor risks included: age, sex, body mass index, diabetes, reoperation, lymphocele, dialysis time, underlying renal disease, and immunosuppressive therapy.Results. During follow-up, 15 patients of 415 transplantations were dead or lost to follow-up. Incisional herniae were identified in 12 cases of 132 (9%) between 1991 and 1997. Between 1997 and 2005 we identified 3 of 133 (2.2%) patients who underwent a midline incision and 15 of 135 (11.1%) who received a J-shaped incision (P =.005). Comparing midline and J-shaped incisions before and after 1997, the incidence reduction was significant (P =.01). Comparing the incidence among patients treated with J-shaped incision before versus after 1997, the increased incidence was insignificant (P =.6). Multivariate analysis found the most important risk factor was obesity followed by polycystic kidney disease, reoperation, wound infection, and mycophenolate mofetil therapy.Conclusions. Our data showed an advantage of a midline incision. Strategies to prevent surgical complications, such as abdominal wall relaxation and poor cosmetic results, are needed; the midline incision may be a possible alternative to address this complication.

This article sums up the theoretical and experimental studies about ignition. Three experiments are salient this year on the Omega laser in collaboration with DOE laboratories (1) 3 cones of beams allow to mimic the LMJ configuration and to get symmetry measurements. (2) We measured perturbations due to hydro-instability in CHGe planar samples with face-on and side-on radiographs. (3) We improved our nuclear diagnostics, particularly the neutron image system tested on direct drive implosions. As far as LMJ target design is concerned, we defined a preliminary domain corresponding to the possible operation at 2ω. At 3ω we studied the low mode instability effects on the DT deformation (due to the laser or to the target) and on the yield. The stability is clearly improved with graded doped CH for our nominal capsule L1215.

The adoption of a non-uniform dopant profile has substantially increased the tolerance to high mode deformations of our baseline indirect-drive design. In addition, a low deuterium-tritium (DT) gas density, obtained by 'dynamic quenching' at 2.3 K below triple point, could partly compensate for the decrease in robustness due to DT ageing. Finally, the net margin regarding all laser and target technological defects is about 2. As soon as a sufficient amount of laser beams and diagnostics is available, we will shoot pre-ignition experiments to tune the point design. We are studying new targets which need less energy for these campaigns. We have estimated different direct-drive schemes using indirect-drive beams. The optimal LMJ polar direct-drive configuration is a 2-cone one and leads to marginally igniting targets. A new 2-cone direct-drive scheme, associated with focal spot zooming, allows us to reach ignition with enough margin.

INTRODUCTION:The incidence of urological complications after kidney transplantation varies from 3% to 14%, with a probable loss of the graft in 10% to 15% of cases and a mortality rate of up to 15%, despite improvements in prevention, diagnosis, and treatment as well as the use of new immunosuppressive therapies. Urinous fistulae, which are considered early complications of transplantation, are due to ischemic damage or necrosis generally occurring in the distal third of the ureter. Preservation of accessory arteries to the lower portion of the kidney is important, as they may constitute the blood supply of this segment of the collecting system or ureter. Their ligation may lead to necrosis and urinary fistulae. Ureteral stenosis, as late complication, is related to a pathology of the ureter itself, to infections, to abscesses, to fibrosis, and to ischemia. An early endoscopic approach permits resolution in 70% of cases. The aim of this retrospective study was to determine incidence and treatment of these complications.MATERIALS AND METHODS:From 1991 to 2004 we performed 453 kidney transplantations both from cadaveric and living donors. In 199 patients we performed a transvesical ureteroneocystostomy (UNCS), and in 260, an extravesical UNCS.RESULTS:The nine patients who showed fistulae (1.9%) underwent surgical treatment. In eight we used a direct ureteral reimplantation, and in one, a Boari flap technique. Nephrectomy was necessary in four patients, including two who died of septic complications. In all 26 cases of ureteral stenosis (5.6%), we used an endourological approach (anterograde or retrograde), with surgical treatment afterward in 11 patients (42%) nine direct reimplants, one anastomosis to the native ureter (transplantation from a living donor), and in one case a Boari flap technique four patients who underwent surgical treatment showed progressive damage to graft function.CONCLUSIONS:In all patients who showed fistulae we suggest surgical review: for patients with ureteral stenosis, we suggest first an endourological approach and only when it is not successful do we consider surgical treatment.

Objective: The study presents an original uterus sparing technique for transvaginal repair of total genitourinary prolapse. The technique employs a synthetic mesh of mixed polypropylene and 910 polyglactin fibers. Methods: The prosthesis creates a support for the cystocele, the cervix and the enterocele. It has four anchoring sites: two at the rear in the sacrospinous ligaments and two at the front in the arcus tendineous of the levator ani muscle. Between February 2001 and December 2004, 24 patients (mean age 66.9 years), presenting symptoms of uterine prolapse, cystocele and enterocele (POP-Q stage III-IV Aa associated to II-III-IV C), were treated with our procedure. Pre- and postoperative parameters were evaluated statistically. Results: No patient had any serious complications. The mean follow-up was 31.1 months (range 6–52). 19 patients (79.1%) have shown excellent results and have been completely cured. In 5 other cases (20.8%), the cystocele was completely cured and there was a significant improvement in the hysterocele and the enterocele. One patient required surgical treatment for postoperative stress incontinence. Statistical analysis of data regarding the pre- and postoperative prolapse stage demonstrated a high degree of objective cure rates (p < 0.0001). Conclusions: While hysterectomy remains the habitual treatment for severe uterine prolapse, our technique provides a promising alternative solution. It is also significant that there were no complications of erosion or infection associated with the prosthesis.

cadherin 350 Emphysematous pyelonephritis 123 Endopyelotomy 333 Endoscopic enucleation, bladder leiomyoma 8 Enhancer zeste homolog 2 252 Enterocystoplasty 181 Epididymitis 235 Epididymoorchitis 235 Estradiol 133 Estramustine phosphate 43 Ewing's sarcoma 184 EWS/FLI-1 translocation 184 External ureteral catheters 139 Extramedullary hematopoiesis 281 EZH2 gene expression 252 -, polycomb group protein 252 Family screening, Carney syndrome 365 Fas 80 -ligand 80 Flank incision

The Radiom model [M. Busquet, Phys Fluids B 5, 4191 (1993)] is designed to provide a radiative-hydrodynamic code with non-local thermodynamic equilibrium (non-LTE) data efficiently by using LTE tables. Comparison with benchmark data [M. Klapisch and A. Bar-Shalom, J. Quant. Spectrosc. Radiat. Transf. 58, 687 (1997)] has shown Radiom to be inaccurate far from LTE and for heavy ions. In particular, the emissivity was found to be strongly underestimated. A recent algorithm, Gondor [C. Bowen and P. Kaiser, J. Quant. Spectrosc. Radiat. Transf. 81, 85 (2003)], was introduced to improve the gold non-LTE ionization and corresponding opacity. It relies on fitting the collisional ionization rate to reproduce benchmark data given by the Averroes superconfiguration code [O. Peyrusse, J. Phys. B 33, 4303 (2000)]. Gondor is extended here to gold emissivity calculations, with two simple modifications of the two-level atom line source function used by Radiom: (a) a larger collisional excitation rate and (b) the addition of a Planckian source term, fitted to spectrally integrated Averroes emissivity data. This approach improves the agreement between experiments and hydrodynamic simulations. (C) 2004 American Institute of Physics.

First we report two studies aimed at preparing laser integration line (LIL) experiments (LIL is the prototype of LMJ): deflection of a beam with and without 'longitudinal' smoothing (associated with focusing by gratings) and the radiation temperature, T-r, in a hohlraum with long pulses (10-20 ns). Experimentally, we did not see any Langmuir decay instability able to saturate the stimulated Raman scattering in a gas bag irradiated with the Omega laser. Next, in our hydro-code FC12, we implemented an improved version of the non-LTE atomic physics model: the change in Tr in the hohlraum is negligible, but now the simulations are in agreement with experiments on x-ray conversion and on Rayleigh-Taylor instabilities (RTIs) in a spherical geometry. The RTls in polyimide foil at 70 Am were understood, but not those at 30 Am. Finally, for the target design, we confirm the hydro-stability of the four targets of the operational domain of LMJ: the doped CH ablator of the nominal target can withstand a roughness in the range 50-100 nm. The robustness studies use 19 uncertainties coming from the laser power, the beam pointing and the target fabrication. Finally, the burning of DT has been studied in detail, identifying three regimes.

In indirect drive scheme, the laser light is converted in X-rays in a hohlraum made of a high-Z material. Part of this radiation flux is absorbed by a microballoon, filled with DT, and placed in the center of the hohlraum, leading to its implosion, ignition and burn. The right control of radiation fluxes, spectrum and energy, is then an issue for the LMJ target design. The presentation will give the status of our knowledge and last improvements in our codes to reproduce at best hohlraum energetics. Validation of our simulations is ensured by a large experimental program. Hohlraum energetics cover two themes : radiation energy and flux characterization inside the hohlraum,