Validation of the Pelvic Organ Prolapse Quantification Index (POP-Q-I): a novel interpretation of the POP-Q system for optimization of POP research

Even though very precise at describing pelvic organ position, our criticism to the Pelvic Organ Prolapse Quantification (POP-Q) system is its limited ability to quantify the prolapse itself, since it still classifies prolapse into four stages, almost the same way as Baden and Walker (Clin Obstet Gynecol 15(4):1070-1072, 1972) did in 1972. As a result, the same grade can include a wide prolapse intensity range. The objective of this study was to assess inter-observer reliability in the Pelvic Organ Prolapse Quantification Index (POP-Q-I; Lemos et al., Int Urogynecol J 18(6):609-611, 2007) on a prospective randomized trial. Fifty consecutive women were prospectively examined by two members of the urogynecology staff, blinded to each other's results. Spearman's rank correlation was used to assess inter-observer reliability. Excellent correlation coefficients were observed, with an overall coefficient of 96.5% (CI: 0.889-1.042; p < 0.0001). The POP-Q-I is a method that makes POP research more efficient by directly measuring prolapse as a continuous variable, which is statistically more powerful than the categorical variables proposed by the POP-Q system. This study suggests that the POP-Q-I is applicable to clinical POP research.     

Estudio prospectivo que compara laparoscopia y cirugía abierta para el tratamiento de cálculos ureterales impactados

Introduction and objectivesTo investigate two ureterolithotomy approaches for treatment of large and impacted upper ureteral stones, we prospectively evaluated the perioperative features of consecutive patients submitted to ureterolithotomy following failure of endourological treatment.MethodsOf the 110 patients included in the study, 34 underwent laparoscopic ureterolithotomy. Patients were divided into three ureterolithotomy subgroups (group A, 76 open procedures; group B, 16 transperitoneoscopies and group C, 19 retroperitoneoscopies). All procedures were performed into a urology residency program.ResultsThe patients’ age, sex, ASA classification and stones characteristics showed no significant difference between the groups. Overall, complication rates and the operation times recorded were similar. One patient had bilateral stones and both sides were managed in a single transperitoneoscopy procedure. Three retroperitoneoscopies were converted to an open surgery due technical difficulties. A prolonged urinary leakage occurred in 3/35 cases (8.5%) where 2 patients were treated by placing a ureteral catheter. Both laparoscopic groups have significantly less analgesia requirements and shorter hospitalization (p < 0.001 and p = 0.003, respectively). All patients were stone-free in the follow-up 1-month visit.ConclusionsTo our knowledge, this is the first prospective comparison of laparoscopic and open ureterolithotomy in a laparoscopic training scenario. Even though these procedures were performed by limited laparoscopic experience urologists, laparoscopy offered significant advantages over traditional open ureterolithotomy, resulting in improved analgesia, shorter hospital stays and similar complication rates.     

Genotypic and phenotypic evidence of T-cell leukemia in a patient successfully treated by interferon-alpha for typical hairy cell leukemia.

A 53-year-old man was diagnosed to have typical hairy cell leukemia. Immunophenotyping of frozen splenic tissue showed clonality of hairy cells for mu lambda, confirmed by the corresponding immunoglobulin gene rearrangements. The patient was successfully treated with interferon-alpha (IF-alpha). In the fifth year of treatment with IF-alpha the morphology of peripheral blood mononuclear cells (PBMC) and of bone marrow infiltration changed with the appearance of numerous small to intermediate shaped lymphocytes of a T-helper phenotype. Frank leukemia, resistant to IF-alpha treatment and ultimately aggressive chemotherapy, developed. Emergence of this second clonal disease was confirmed by rearrangement studies performed on PBMC; rearrangements of both alleles of the TCR beta were identified, whereas the JH and lambda IVS genes were in germline configuration. The outgrowth of a second, malignant T-cell clone paralleled by the disappearance (down-regulation?) of the initial B-cell clone while under cytokine treatment is consistent with the possibility that IF-alpha favoured the emergence of this second clone.     

Oral delivery of BCG Moreau Rio de Janeiro gives equivalent protection against tuberculosis but with reduced pathology compared to parenteral BCG Danish vaccination

There is a need for an improved vaccine to better control human tuberculosis (TB), as the only currently available TB vaccine, bacillus Calmette–Guerin (BCG) delivered parenterally, offers variable levels of efficacy. Therefore, recombinant strains expressing additional antigens are being developed alongside alternative routes to parenteral delivery. There is strong evidence that BCG Moreau (RdJ) is a safe and effective vaccine in humans when given by the oral route. This study compared the efficacy of a single oral dose of wild type BCG Moreau Rio de Janeiro (RdJ), or a recombinant RdJ strain expressing Ag85B-ESAT6 fusion protein, formulated with and without lipid to enhance oral delivery, with subcutaneous BCG Danish 1331 and saline control groups in a guinea pig aerosol infection model of pulmonary tuberculosis. Protection was measured as survival at 30 weeks post-challenge and reduced bacterial load and histopathology in lungs and spleen. Results showed that a single oral dose of BCG Moreau (RdJ) or recombinant BCG Moreau (RdJ)-Ag85B-ESAT6, formulated with or without lipid, gave protection equivalent to subcutaneously delivered BCG Danish in the 30 weeks post-challenge survival study. The orally delivered vaccines gave reduced pathology scores in the lungs (three of the four formulations) and spleens (all four formulations) compared to subcutaneously delivered BCG Danish. The oral wild type BCG Moreau (RdJ) in lipid and the unformulated oral wild type BCG Moreau (RdJ) vaccine also gave statistically lower bacterial loads in the lungs and spleens, respectively, compared to subcutaneously delivered BCG Danish. This study provides further evidence to show that lipid formulation does not impair vaccine efficacy and may enhance the delivery and stability of oral vaccines intended for use in countries with poor health infrastructure. Oral delivery also avoids needles (and associated cross-infection risks) and immunisation without the need for specially trained medical professional staff.     

Transluminal angioplasty in a surgical setting. 150 cases

Since 1985, 150 transluminal angioplasty operations have been performed by surgical teams, in the operating theater, for treatment of atheromatous lesions of the lower extremities, either as a complement to or in replacement of direct surgical repair. 150 angioplasties were carried out on patients with severe stage II lesions (72%). There was one or several significant stenosis in 140 of cases, and one short segmental thrombosis in 10 cases (1 common iliac and 9 superficial femoral or popliteal). These angioplasties fell into the following categories: 60 iliac, 78 femoral-popliteal and 12 angioplastic repairs of stenosis to iliac or distal femoral surgery (anastomosis, grafting, endarterectomy...). Angioplasty was combined with revascularization or lumbar sympathectomy in 29% of cases. It was performed singly in most cases (71%) and carried out percutaneously (45%) or by limited superficial proximal femoral approach under local anesthesia (26%), either directly or when the percutaneous approach failed. Eight cases of thrombosis (5.3%) developed during the first month: 2 cases after iliac angioplasty and 6 cases after femoral-popliteal angioplasty. Five deaths occurred consecutively to myocardial infarction. At long term, 4 cases of iliac thrombosis and 3 cases of thrombosis complicating femoral-popliteal angioplasty were detected. The overall cumulative permeability rate was 89% at 30 months, and there was no significant difference at one year's time between iliac and femoral-popliteal angioplasty patients (90% and 86%, respectively). Data collected from digital angiographic monitoring allowed to detect 9 cases of residual or recurrent stenosis (2 iliac, 6 femoral-popliteal and 1 postoperative lesions). Two repeat femoral-popliteal angioplasties were successfully performed.(ABSTRACT TRUNCATED AT 250 WORDS)