MRI-targeted biopsy for detecting prostate cancer: have the guidelines changed our practices and our prostate cancer detection rate?

International Urology and Nephrology - In our center, until 2018, MRI-targeted biopsy was underused. Since January 2018, we systematically performed MRI-targeted biopsy for suspicious...     

Two minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg

Chronic exertional compartment syndrome (CECS) of the leg is a pathological condition often related to overuse in subject who engage repetitive physical activities. Fascial release is the mainstay of surgical management. The purpose of this study was to evaluate the results obtained with a double incision decompressive fasciotomy. Eighteen consecutive athletes with a diagnosis of anterior and/or lateral CECS of the leg were operated on with a minimal double incision fascial release after a mean period of 4 months after onset of symptoms. In 11 cases (61%) CECS was bilateral. Surgery was performed without tourniquet and active mobilization was starting immediately. Sports activities were resumed gradually at a mean period of 25 days. The athletes were followed until 2 years. All resumed pre-injury level sports activity. Two patients (18%) of the 11 who underwent to bilateral fasciotomy referred a sensation of leg weakness for an average period of 3 months. The surgical technique presented in this paper seems to be a good mean to treat anterior and lateral leg CECS. The use of tourniquet is deconselled to obtain an accurate intraoperative haemostasis so reducing the risk of post-operative haematoma.     

Povidone-iodine sclerotherapy of primary symptomatic lymphocele after kidney transplantation

International Urology and Nephrology - To report the efficacy and safety of povidone-iodine sclerotherapy of primary symptomatic lymphocele after kidney transplantation in a large contemporary...     

Paediatric acute lymphadenitis: Emergency department management and clinical course

ObjectivesTo describe clinical characteristics and management of acute lymphadenitis and to identify risk factors for complications.MethodsHealth record review of children ≤17 years with acute lymphadenitis (≤2 weeks) in a tertiary paediatric emergency department (2009–2014); 10% of charts were reviewed by a blinded second reviewer. Multivariate logistic regression identified factors associated with intravenous antibiotic treatment, unplanned return visits warranting intervention, and surgical drainage.ResultsOf 1,023 health records, 567 participants with acute lymphadenitis were analyzed. The median age = 4 years (interquartile range [IQR]: 2 to 8 years), and median duration of symptoms = 1.0 day (IQR: 0.5 to 3.0 days). Cervical lymphadenitis was most common. Antibiotics were prescribed in 73.5% of initial visits; 86.9% of participants were discharged home. 29.0% received intravenous antibiotics, 19.3% had unplanned emergency department return visits, and 7.4% underwent surgical drainage. On multivariate analysis, factors associated with intravenous antibiotic use included history of fever (odds ratio [OR]=2.07, 95% confidence interval [CI]: 1.11 to 3.92), size (OR=1.74 per cm, 95% CI: 1.44 to 2.14), age (OR=0.84 per year, 95% CI: 0.76 to 0.92), and prior antibiotic use (OR=4.45, 95% CI: 2.03 to 9.88). The factors associated with unplanned return visit warranting intervention was size (OR=1.30 per cm, 95% CI: 1.06 to 1.59) and age (OR=0.89, 95% CI: 0.80 to 0.97). Factors associated with surgical drainage were age (OR=0.68 per year, 95% CI: 0.53 to 0.83) and size (OR=1.80 per cm, 95% CI: 1.41 to 2.36).ConclusionsThe vast majority of children with acute lymphadenitis were managed with outpatient oral antibiotics and did not require return emergency department visits or surgical drainage. Larger lymph node size and younger age were associated with increased intravenous antibiotic initiation, unplanned return visits warranting intervention and surgical drainage.     

Effects of the type of release medium on drug release from PLGA-based microparticles: experiment and theory

The major objectives of the present study were: (i) to prepare 5-fluorouracil (5-FU)-loaded, poly(lactic-co-glycolic acid) (PLGA)-based microparticles, which can be used for the treatment of brain tumors, (ii) to study the effects of the type of release medium on the resulting drug release kinetics, and (iii) to get further insight into the underlying drug release mechanisms. Spherical microparticles were prepared by a solvent extraction method and characterized using different techniques, including size exclusion chromatography (SEC), differential scanning calorimetry (DSC), scanning electron microscopy (SEM) and particle size analysis before and upon exposure to various release media. Interestingly, very different drug release patterns (including mono-, bi- and tri-phasic ones) were observed, depending on the pH, osmolarity and temperature of the release medium. An adequate mathematical theory was used to quantitatively describe the experimentally measured 5-FU release patterns. The model considers the limited solubility of the drug, polymer degradation as well as drug diffusion and allowed to determine system and release medium specific parameters, such as the diffusion coefficient of the drug. In particular, the pH and temperature of the release medium were found to be of major importance for the resulting release patterns. Based on the obtained knowledge the selection of an appropriate release medium for in vitro tests simulating in vivo conditions can be facilitated, and "stress tests" can be developed allowing to get rapid feedback on the release characteristics of a specific batch.     

Effect of the size of biodegradable microparticles on drug release: experiment and theory.

The aim of this study was to investigate the effect of the size of biodegradable microparticles (monolithic dispersions) on the release rate of an incorporated drug in a quantitative way. 5-Fluorouracil-loaded, poly(lactic-co-glycolic acid)-based microparticles were prepared with a solid-in-oil-in-water solvent extraction technique. In vitro drug release from different-sized particle fractions was measured in phosphate buffer pH 7.4. Differential scanning calorimetry (DSC), scanning electron microscopy (SEM) and size exclusion chromatography (SEC) were used to monitor the degradation behavior of the polymer and morphological changes of the microparticles upon exposure to the release medium. Based on these experimental results, an appropriate mathematical theory was identified and used to get further insight into the underlying physical and chemical processes, which are involved in the control of drug release. Interestingly, the relative as well as the absolute release rate of the drug increased with increasing microparticle radius, despite of the increasing diffusion pathways. SEC, DSC and SEM analysis revealed that the degradation behavior of the matrix forming polymer was not significantly affected by the size of the devices and that autocatalytic effects do not seem to play a major role. Importantly, the initial drug loading significantly increased with increasing radius of the drug delivery system. Thus, large microparticles became more porous during drug release than small microparticles, leading to higher apparent diffusivities and drug transport rates. This effect overcompensated the effect of the increasing diffusion pathways with increasing microparticle radius, resulting in increased drug release rates with increasing device dimension. The applied mathematical model, considering drug diffusion with non-constant diffusivities (to account for polymer degradation) was able to quantitatively describe the observed drug release patterns. Importantly, an exponential relationship could be established between the diffusion coefficient and the initial loading of the drug. Based on this dependency, it was possible to predict the resulting drug release kinetics for arbitrary microparticle sizes in a quantitative way.     

Characterization of Biological Material Adsorption to the Surface of Nanoparticles without a Prior Separation Step: a Case Study of Glioblastoma-Targeting Peptide and Lipid Nanocapsules

Pharmaceutical Research - Current preclinical therapeutic strategies involving nanomedicine require increasingly sophisticated nanosystems and the characterization of the complexity of such...