Urethral device in women with chronic urinary retention: an alternative to self-catheterization?

OBJECTIVE: To assess the efficacy and safety of a new urethral prosthesis in the management of chronic urinary retention in women as an alternative to intermittent or indwelling catheterization. METHODS: Between May 1999 and July 2000, 60 women with chronic urinary retention were prospectively enrolled in the study. The prosthesis was inserted under local anaesthesia. A magnetic control unit activates the urethral device to achieve micturition. Duration of the experience, complications and compliance were evaluated. RESULTS: Thirty patients were satisfied with the device. Discontinuation occurred in the first two weeks following implantation in 50% of cases. Bladder migration of the prosthesis occurred in two cases, urinary leakage around the device in four patients, spontaneous expulsion in two women and cystitis was diagnosed in two cases. CONCLUSION: This intraurethral prosthesis is an attractive, simple technique for use as an alternative to catheterization. Some untoward events and technical complications explained the number of discontinuations.     

Triazolopyrimidine-based dihydroorotate dehydrogenase inhibitors with potent and selective activity against the malaria parasite Plasmodium falciparum

A Plasmodium falciparum dihydroorotate dehydrogenase ( PfDHODH) inhibitor that is potent ( KI = 15 nM) and species-selective (>5000-fold over the human enzyme) was identified by high-throughput screening. The substituted triazolopyrimidine and its structural analogues were produced by an inexpensive three-step synthesis, and the series showed good association between PfDHODH inhibition and parasite toxicity. This study has identified the first nanomolar PfDHODH inhibitor with potent antimalarial activity in whole cells (EC50 = 79 nM).     

Preeclampsia: impaired inflammatory response mediated by Toll-like receptors

Monocytes may be activated in preeclampsia (PE). Toll-like receptor (TLR)-4 and TLR-2 are involved in inflammatory responses of monocytes. The objective of this study was to evaluate the production of tumor necrosis factor (TNF), an inflammatory cytokine, and interleukin (IL)-10, an immunoregulatory cytokine, by monocytes from PE patients stimulated with TLR ligands. TLR-4 and TLR-2 responses were similar in normal pregnancy and non-pregnant women. The production of TNF by monocytes stimulated with TLR ligands was significantly impaired in PE, whereas IL-10 production was not affected. The imbalance between an inflammatory and anti-inflammatory pattern of monocytes may play a role in PE pathophysiology.     

Epstein-Barr virus as a marker of biological aggressiveness in breast cancer

Purpose:

Although a potential role of the Epstein-Barr virus (EBV) in the pathogenesis of breast cancer (BC) has been underlined, results remain conflicting. Particularly, the impact of EBV infection on biological markers of BC has received little investigation.

Methods:

In this study, we established the frequency of EBV-infected BC using real-time quantitative PCR (RT–PCR) in 196 BC specimens. Biological and pathological characteristics according to EBV status were evaluated.

Results:

EBV DNA was present in 65 of the 196 (33.2%) cases studied. EBV-positive BCs tended to be tumours with a more aggressive phenotype, more frequently oestrogen receptor negative (P=0.05) and with high histological grade (P=0.01). Overexpression of thymidine kinase activity was higher in EBV-infected BC (P=0.007). The presence of EBV was weakly associated with HER2 gene amplification (P=0.08).

Conclusion:

Our study provides evidence for EBV-associated BC undergoing distinct carcinogenic processes, with more aggressive features.     

Bipolar patients, structured psychotherapeutic treatment and approaches

The current development of structured psychotherapy has brought gradual improvements to the treatment provided to bipolar patients. This psychotherapy may be either carried out individually or in a group. In this context, psychotherapeutic meditation seems beneficial.     

Frequency of Persistent Anal Symptoms After First Instrumental Delivery

PURPOSE This study was designed to evaluate persistent anal symptoms after first instrumental delivery beyond the postpartum period.METHODS This prospective study was performed in a cohort of primiparas who underwent instrumental delivery from January 1, 2001 to September 30, 2002. Questionnaires for anal symptoms were completed in the maternity ward on the day after delivery and by mail or telephone up to 12 months after the end of the inclusion period. Symptoms of fecal incontinence (solid and/or liquid stool) and precursor symptoms (flatus incontinence, soiling, and/or fecal urgency) were recorded.RESULTS Of the 212 females who completed the first questionnaire, 159 (75 percent) responded to the second. Overall, 8.8 percent of females had solid and/or liquid stool incontinence, 7.5 percent had involuntary flatus, 8.2 percent had symptoms of fecal urgency, and 24.5 percent experienced new anal symptoms, Of the five females with third-degree tears, none complained of anal incontinence. The only significant difference in delivery data between females who did and did not develop new anal symptoms was larger fetal head size in the new symptom group (96.4 vs. 93.9 mm, respectively; P < 0.05).CONCLUSIONS Frequency of new anal symptoms other than incontinence beyond postpartum period is underestimated in primiparas after instrumental delivery. Only fetal head size was found to predict occurrence of persistent anal incompetence after instrumental delivery.Reprints are not available.     

A preoperative nomogram to predict the risk of synchronous distant metastases at diagnosis of primary breast cancer

Background:

The detection of synchronous metastases at primary diagnosis of breast cancer (BC) affects its initial management. A risk calculator that incorporates many factors to evaluate an individual''s risk of harbouring synchronous metastases would be useful to adapt cancer management.

Patients and Methods:

Patients with primary diagnosis of BC were identified from three institutional databases sharing homogeneous work-up recommendations. A risk score for synchronous metastases was estimated and a nomogram was constructed using the first database. Its performance was assessed by receiver characteristic (ROC) analysis. The nomogram was externally validated in the two independent cohorts.

Results:

A preoperative nomogram based on the clinical tumour size (P<0.001), clinical nodal status (P<0.001), oestrogen (P=0.17) and progesterone receptors (P=0.04) was developed. The nomogram accuracy was 87.3% (95% confidence interval (CI), 84.45–90.2%). Overall, the area under the ROC curve (AUC) was 86.1% for the validation set from the Institut Curie-René Huguenin, and 63.8% for the MD Anderson validation set. The negative predictive value (NPV) was high in the three cohorts (97–99%).

Conclusions:

We developed and validated a strong metastasis risk calculator that can evaluate with high accuracy an individual''s risk of harbouring synchronous metastases at diagnosis of primary BC.

Condensed abstract:

A nomogram to predict synchronous metastases at diagnosis of breast cancer was developed and externally validated. This tool allows avoiding unnecessary expensive work-up.