Objectives. - To clarify the procedures related to mechanical ventilation in the intensive care unit setting: allocation of ventilators, team education, maintenance and reference documents.Study design. - Declarative survey.Methods. - Between September and December 2010, we assessed the assignment and types of ventilators (ICU ventilators, temporary repair ventilators, non-invasive ventilators [NIV], and transportation ventilators), medical and nurse education, maintenance of the ventilators, presence of reference documents. Results are expressed in median/range and proportions.Results. - Among the 62 participating ICUs, a median of 15 ventilators/ICU (range 1-50) was reported with more than one trademark in 47(76%) units. Specific ventilators were used for NIV in 22 (35%) units, temporary repair in 49 (79%) and transportation in all the units. Nurse education courses were given by ICU physicians in 54(87%) units or by a company in 29(47%) units. Medical education courses were made by ICU senior physicians in 55 (89%) units or by a company in 21 (34%) units. These courses were organized occasionally in 24(39%) ICU and bi-annually in 16 (26%) units. Maintenance procedures were made by the ICU staff in 39(63%) units, dedicated staff (17 [27%]) or bioengineering technicians (14[23%] ICU). Reference documents were written for maintenance procedures in 48 (77%) units, ventilator setup in 22 (35%) units and ventilator dysfunction in 20 (32%) ICU.Conclusions. - This first survey shows disparate distribution of ventilators and practices among French ICU. Education and understanding of the proper use of ventilators are key issues for security improvement. (C) 2013 Societe francaise d'anesthesie et de reanimation (Star). Published by Elsevier Masson SAS. All rights reserved.

You have accessJournal of UrologyModerated Poster, Wednesday, May 24, 2006, 1:00 - 3:00 pm1 Apr 20061647: Does Surgical Manipulation of Tumour Accelerate Cancer Evolution : A Prospective Longitudinal Study of Cancer Patients Undergoing Radical Prostatectomy Pascal Eschwege, Stephane Moutereau, Zahi Aboujeili, Stephane Droupy, Richard Douard, Marc Conti, Gerard Benolt, Pascal Blanchet, and Sylvain Loric Pascal EschwegePascal Eschwege More articles by this author , Stephane MoutereauStephane Moutereau More articles by this author , Zahi AboujeiliZahi Aboujeili More articles by this author , Stephane DroupyStephane Droupy More articles by this author , Richard DouardRichard Douard More articles by this author , Marc ContiMarc Conti More articles by this author , Gerard BenoltGerard Benolt More articles by this author , Pascal BlanchetPascal Blanchet More articles by this author , and Sylvain LoricSylvain Loric More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33839-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1647: Does Surgical Manipulation of Tumour Accelerate Cancer Evolution : A Prospective Longitudinal Study of Cancer Patients Undergoing Radical Prostatectomy." The Journal of Urology, 175(4S), p. 531 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 531 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Pascal Eschwege More articles by this author Stephane Moutereau More articles by this author Zahi Aboujeili More articles by this author Stephane Droupy More articles by this author Richard Douard More articles by this author Marc Conti More articles by this author Gerard Benolt More articles by this author Pascal Blanchet More articles by this author Sylvain Loric More articles by this author Expand All Advertisement Loading ...

Objectives: In women, aging is associated with profound hormonal changes. Menopause has been implicated in the etiology of urinary tract complaints including incontinence, urgency and recurrent urinary tract infections. However, the use of hormone replacement therapy for these conditions has given conflicting and disappointing results. The role of androgen changes on urinary continence in perimenopausal women has not been studied. We studied the presence of androgen receptors in pudendal motoneurons controlling the external urethral sphincter of female rats.Materials and methods: A combination of retrograde labeling of pudendal motoneurons from the external urethral sphincter and immunohistochemistry for the N-terminal portion of androgen receptors on spinal cord sections was performed in adult female rats.Results: Androgen receptors were identified in the nuclei of the ventral horn of the L5-L6 spinal cord. Pudendal motoneurons, retrogradely labeled from the external urethral sphincter, were identified in the dorsolateral nucleus of the ventral horn at the same levels. Confocal microscopy demonstrated the presence of nuclear and cytoplasmic androgen receptors in the cell bodies of these retrogradely labeled pudendal motoneurons.Conclusion: Our study demonstrated the presence of androgen receptors in the cell bodies of retrogradely labeled pudendal motoneurons controlling the urethral sphincter of female rats suggesting a role of androgens in the neuromodulation of urethral sphincter function at the spinal level. (C) 2004 Elsevier B.V. All rights reserved.

You have accessJournal of UrologyDiscussed Poster, Tuesday, May 11, 2004, 1:00 - 5:00 pm1 Apr 20041492: Laparoscopic Adrenalectomy for Large Tumours (5-10CM) Stèphane Droupy, Pascal Blanchet, Jacques Young, Pascal Eschwège, Yacine Hammoudi, Frantçois Giuliano, Vincent Izard, Gérard Benoit, and Le Kremlin Bicêtre Stèphane DroupyStèphane Droupy More articles by this author , Pascal BlanchetPascal Blanchet More articles by this author , Jacques YoungJacques Young More articles by this author , Pascal EschwègePascal Eschwège More articles by this author , Yacine HammoudiYacine Hammoudi More articles by this author , Frantçois GiulianoFrantçois Giuliano More articles by this author , Vincent IzardVincent Izard More articles by this author , Gérard BenoitGérard Benoit More articles by this author , and Le Kremlin BicêtreLe Kremlin Bicêtre More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)38700-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1492: Laparoscopic Adrenalectomy for Large Tumours (5-10CM)." The Journal of Urology, 171(4S), p. 393 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 393 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Stèphane Droupy More articles by this author Pascal Blanchet More articles by this author Jacques Young More articles by this author Pascal Eschwège More articles by this author Yacine Hammoudi More articles by this author Frantçois Giuliano More articles by this author Vincent Izard More articles by this author Gérard Benoit More articles by this author Le Kremlin Bicêtre More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose: To expand the pool of suitable organ donors we developed an organ procurement program of non-heartbeating donors during the last 15 years. We compare graft survival in patients receiving renal transplants procured from non-heartbeating with recipients of kidneys from heartbeating donors.Materials and Methods: From 1986 to 1999, 60 renal transplantations were performed with kidneys harvested from non-heartbeating donors (Mastrich category IV). Kidneys were procured using a double balloon triple lumen catheter inserted into the femoral artery. The 60 kidneys were selected from 70 non-heartbeating donors based on age younger than 50 years, warm ischemia less than 30 minutes, creatinine less than 200 mumol./l., and no hypertension or major histological lesions. Long-term results of graft survival and complications were compared with a series of 1,065 renal transplantations performed during the same period with kidneys procured from heartbeating donors.Results: Mean age of the recipients was statistically different as non-heartbeating donors were older. However, the 10-year graft survival rates were similar in both groups (50% versus 53%). Incidence of ureteral stenosis and fistula, arterial stenosis and thrombosis was not statistically different in both groups. On the other hand, delay graft function was more frequent in non-heartbeating donors (60% versus 40%, p = 0.01).Conclusions: Despite a high rate of acute tubular necrosis, kidneys harvested from non-heartbeating donors had the same graft survival rates as those procured from heartbeating donors. Surgical complications were not different. Transplantation of selected kidneys procured from non-heartbeating donors should be promoted as a response to organ shortage.

INTRODUCTION:Combined pancreas-kidney transplantation is the treatment of choice for patients with type I diabetes mellitus associated with chronic renal failure. The introduction of the bladder drainage technique constituted a marked improvement of the surgical technique with a reduction of life-threatening complications. However, drainage of pancreatic secretions via the urinary bladder causes urological complications leading, in some cases, to cystoenteric conversion. We retrospectively analysed whether pre-operative urodynamic findings may predict the subsequent development of urological complications and influence the choice of exocrine secretion drainage. PATIENTS AND METHODS:From 1987 to 1997, 39 bladder-drained simultaneous pancreas-kidney transplantations were performed in 16 men and 23 women with a mean age of 38.5 yr. All patients underwent a complete urological assessment prior to surgery, including medical history, physical examination, urethrocystography and urodynamic assessment. RESULTS:Twenty-eight patients are alive with a mean follow-up of 62 +/- 8 months. In 60% of cases, both kidney and pancreas remain functional. Seven patients experienced recurrent lower urinary tract infections. Six patients suffered from chemical urethritis (four men and two women) and six suffered from recurrent haematuria (blood transfusions were required in two patients). One patient had incrusted stones at the site of duodenal staples. Urological complications were mostly observed in the 22 patients (79%) with abnormal urodynamic characteristics (Relative risk: 5.1). Intravenous Somatostatin failed to definitively cure these complications in most cases. Seven patients (17%) (five with urethritis, two with haematuria) required cystoenteric conversion. Two patients developed post-operative ileal fistula, one cutaneous and one into the bladder. All urinary symptoms resolved in these seven patients. CONCLUSION:The frequency of specific urinary complications is high (28%) in bladder-drained simultaneous pancreas-kidney transplantation patients. These complications are statistically more frequent in the case of an abnormal pre-transplant urodynamic assessment.

We report the case of a 37-year-old man in whom penile cancer was discovered while he was treated for AIDS 4 years after a human papillomavirus (HSV) infection. Despite initially localised disease with T1 N0 staging, he died of metastasis within 3 years. A brief review of the literature regarding HPV-related cancer in HIV-infected patients is presented and therapeutic options are discussed.

L’objectif de ce travail était d’apprécier la fréquence et la prise en charge des différentes complications vasculaires lors de l’activité de transplantation rénale.Étude rétrospective des patients transplantés rénaux de 2001 à 2006 dans notre centre hospitalo-universitaire. Nous avons recensé les caractéristiques de la population de donneurs et receveurs, du déroulement du prélèvement multi-organes (PMO) et de la transplantation, afin d’étudier les complications vasculaires et leurs conséquences. Les donneurs vivants ont été exclus.Cent soixante-dix-neuf dossiers ont été analysés avec un suivi moyen de 40 mois. Soixante-douze patients transplantés avaient eu au moins une complication vasculaire, dont 32 cas de sténose de l’artère du transplant, 28 cas d’hématome dont sept drainés chirurgicalement, quatre cas de thrombose artérielle, deux cas de thrombose veineuse et une dissection artérielle. L’analyse de notre série a mis en évidence que le tabagisme (p = 0,043) était un facteur de risque des donneurs et la néphropathie glomérulaire (p = 0,0185), les coagulopathies (p = 0,0165) et l’hémodialyse (p = 0,02) étaient des facteurs de risques vasculaires pour le receveur. Les transplants présentant des artères multiples (p = 0,03) et un patch aortique calcifié (p = 0,0274) seraient plus à risque de complications postopératoires. Nos résultats démontraient que le remplissage postopératoire (p = 0,011), l’héparinothérapie (p = 0,0085), l’immunosuppression (p = 0,0478), voire l’utilisation d’amines vasopressives en peropératoire (p = 0,086) seraient également impliqués dans l’incidence des complications vasculaires.La sélection des donneurs était indispensable pour la qualité des transplants, sans négliger la préservation de l’état artériel et le dépistage des coagulopathies des receveurs afin de diminuer la morbidité de la transplantation rénale. La coordination des équipes médicales impliquées était nécessaire pour optimiser les temps d’ischémie, minimiser les risques de complications vasculaires et améliorer la survie du transplant et du patient.The aim of this study was to evaluate frequency and management of vascular complications in renal allograft.We performed retrospective analysis of patients who underwent renal allograft from 2001 to 2006 at our university hospital center. In order to access peri- and postoperative vascular complications, data were also obtained from donors and receivers, as well as organ procurement and renal transplant procedure.One hundred and seventy-nine files were analyzed with a median follow-up of 40 months, mean age of donors was 40.4 ± 11.2 years and 46.01 ± 10.6 years for receivers. Seventy-two allograft patients had at least one vascular complication, with 32 cases of renal arterial stenosis, 28 cases of hematoma with surgical exploration required in seven cases, four cases of arterial thrombosis, two cases of venous thrombosis and one arterial dissection. Our series underlines that tobacco abuse in donors is a risk factor for vascular complication (p = 0.043), as well as glomerular nephropathy (p = 0.0185), coagulopathy (p = 0.0165) and hemodialysis (p = 0.02) are risk factors for receivers. Multiple arteries in renal allograft (p = 0.03) and calcification on aortic patch (p = 0.0274) would present a greater risk of postoperative complications. Our results demonstrate that the following parameters i.e., postoperative transfusion (p = 0.011), heparin therapy (p = 0.0085), immunosuppression (p = 0.0478), and peri-operative aminovasopressive drugs (p = 0.086) could also be implicated in vascular complication occurrence.A careful selection of donors remains a major factor for renal allograft quality, however arterial evaluation and coagulopathy detection in receivers must also be performed prior to transplantation procedure. A multidisciplinary approach (nephrologist, urologist, anesthesist) will optimize vascular ischemia delay and also reduce early and late vascular complications, which could have possible consequences on renal allograft and patient survival.

L’objectif de ce travail était d’apprécier la fréquence et la prise en charge des différentes complications vasculaires lors de l’activité de transplantation rénale.Étude rétrospective des patients transplantés rénaux de 2001 à 2006 dans notre centre hospitalo-universitaire. Nous avons recensé les caractéristiques de la population de donneurs et receveurs, du déroulement du prélèvement multi-organes (PMO) et de la transplantation, afin d’étudier les complications vasculaires et leurs conséquences. Les donneurs vivants ont été exclus.Cent soixante-dix-neuf dossiers ont été analysés avec un suivi moyen de 40 mois. Soixante-douze patients transplantés avaient eu au moins une complication vasculaire, dont 32 cas de sténose de l’artère du transplant, 28 cas d’hématome dont sept drainés chirurgicalement, quatre cas de thrombose artérielle, deux cas de thrombose veineuse et une dissection artérielle. L’analyse de notre série a mis en évidence que le tabagisme (p = 0,043) était un facteur de risque des donneurs et la néphropathie glomérulaire (p = 0,0185), les coagulopathies (p = 0,0165) et l’hémodialyse (p = 0,02) étaient des facteurs de risques vasculaires pour le receveur. Les transplants présentant des artères multiples (p = 0,03) et un patch aortique calcifié (p = 0,0274) seraient plus à risque de complications postopératoires. Nos résultats démontraient que le remplissage postopératoire (p = 0,011), l’héparinothérapie (p = 0,0085), l’immunosuppression (p = 0,0478), voire l’utilisation d’amines vasopressives en peropératoire (p = 0,086) seraient également impliqués dans l’incidence des complications vasculaires.La sélection des donneurs était indispensable pour la qualité des transplants, sans négliger la préservation de l’état artériel et le dépistage des coagulopathies des receveurs afin de diminuer la morbidité de la transplantation rénale. La coordination des équipes médicales impliquées était nécessaire pour optimiser les temps d’ischémie, minimiser les risques de complications vasculaires et améliorer la survie du transplant et du patient.The aim of this study was to evaluate frequency and management of vascular complications in renal allograft.We performed retrospective analysis of patients who underwent renal allograft from 2001 to 2006 at our university hospital center. In order to access peri- and postoperative vascular complications, data were also obtained from donors and receivers, as well as organ procurement and renal transplant procedure.One hundred and seventy-nine files were analyzed with a median follow-up of 40 months, mean age of donors was 40.4 ± 11.2 years and 46.01 ± 10.6 years for receivers. Seventy-two allograft patients had at least one vascular complication, with 32 cases of renal arterial stenosis, 28 cases of hematoma with surgical exploration required in seven cases, four cases of arterial thrombosis, two cases of venous thrombosis and one arterial dissection. Our series underlines that tobacco abuse in donors is a risk factor for vascular complication (p = 0.043), as well as glomerular nephropathy (p = 0.0185), coagulopathy (p = 0.0165) and hemodialysis (p = 0.02) are risk factors for receivers. Multiple arteries in renal allograft (p = 0.03) and calcification on aortic patch (p = 0.0274) would present a greater risk of postoperative complications. Our results demonstrate that the following parameters i.e., postoperative transfusion (p = 0.011), heparin therapy (p = 0.0085), immunosuppression (p = 0.0478), and peri-operative aminovasopressive drugs (p = 0.086) could also be implicated in vascular complication occurrence.A careful selection of donors remains a major factor for renal allograft quality, however arterial evaluation and coagulopathy detection in receivers must also be performed prior to transplantation procedure. A multidisciplinary approach (nephrologist, urologist, anesthesist) will optimize vascular ischemia delay and also reduce early and late vascular complications, which could have possible consequences on renal allograft and patient survival.

UNLABELLED:The rules of organ allocation allow one of the two kidneys harvested to be transplanted locally while the other is exchanged. This rule of local priority does not exist in all countries. The purpose of this article is to determine whether this rule provides a benefit for the patient. 804 locally harvested kidneys were compared to 1196 exchanged kidneys transplanted between 1970 and 2000 by the same renal transplantation team.RESULTS:The cold ischaemia time was shorter (-6 h), the number of cases of HLA identity was lower (-0.8), the rate of acute tubular necrosis was lower (-9), and the median graft survival of was 7 months longer for local kidneys.DISCUSSION:An article analysing the North American register reached similar conclusions: the local attribution rule reduces the cold ischaemia and the graft loss at one year.CONCLUSION:The local attribution rule has the advantage of increasing the organ harvesting rate from borderline donors, reducing the cold ischaemia, and improving the results: this rule should therefore be maintained.

Background/Aims: Liver allograft is known to protect simultaneously transplanted organs from acute rejection. We have reported that only 6% of combined liver-kidney recipients, versus 32.5% of kidney recipients, develop kidney graft acute rejection. Release of soluble human leukocyte antigen (HLA) molecules by the liver has been proposed as a possible tolerogenic mechanism involved in the better acceptance of double transplants. The HLA-G molecule is acknowledged to possess tolerogenic properties.Methods: We investigated the involvement of HLA-G in allogeneic transplant acceptance by analyzing its expression in kidney and liver biopsies of 40 combined transplanted patients.Results: We demonstrate the presence of HLA-G in 14 out of 40 liver and five out of nine kidney transplants biopsies. HLA-G is expressed de novo by cells that are otherwise frequently susceptible target cells of acute rejection, i.e. liver biliary and renal tubular epithelial cells. We show a significant association between HLA-G expression in liver biliary epithelial cells and the absence of liver graft rejection. No acute or chronic rejection of the kidney graft was observed in patients in whom HLA-G was expressed in the liver graft.Conclusions: HLA-G expression in the liver allograft is associated with a lower frequency of hepatic and renal acute rejection and may be involved in the acceptance of simultaneously transplanted organs.

Purpose: We studied a series of superficial transitional cell carcinoma of the bladder to assess whether the Ki–67 labeleing index predicts recurrence and progression in a cohort of patients treated by transurethral resection alone or receiving adjuvant intravesical bacillus Calmette–Guerin therapy (BCG). Materials and Methods: From 1989 to 1990, we prospectively studied 70 consecutive cases of superficial transitional cell carcinoma of the bladder using Ki–67 immunostaining. The tumors were 43 pTa and 27 pTl. Thirteen were treated with transurethral resection only and 57 received adjuvant intravesical BCG. The median follow–up times was 64 months. The threshold index values of Ki–67 for recurrence and progression were determined using ROC curves. The relative predictive values of the Ki–67 labeling index and tumor characteristics for recurrence and progression were evaluated using Cox’s proportional hazards model. Results: A cutoff value of 13% was determined. The recurrence free survival rate at 5 years was 68% for cases with a Ki–67 labeling index of 13 or higher and 71% for those with an index of less than 13 (NS). The progression–free survival rate at 5 years was 43% in cases with an index of 13 or higher and 89% in those with an index of less than 13 (p<0.0001). Using multivariate analsis the Ki–67 labeling index is an independent risk factor for tumor progression with a relative risk of 4.61 (p<0.05). Conclusion: When BCG is used for high and intermediate risk superficial bladder cancers, the Ki–67 labeling index is an independent predictive factor of progression but not of recurrence.