Search

Summary Erectile dysfunction varied by country, affecting between 20 to 40% of men aged 60 and 69 and more than 50% of men aged over 75. Our objective was to evaluate the habits of urologists in 2018 and also evaluate the need for additional, objective tools to aid physicians when providing care. A questionnaire was sent from the French Urology Association to 1158 physicians between November and December 2018. In all, 177 urologists (15.28%) took part in the study. Only 22% of urologists regularly used a questionnaire, such as the IIEF-5. When faced with erection problems, 56.5% of them did not carry out systematic cardiology evaluations. More than half of urologists requested fasting glucose, lipid and total testosterone levels. Twenty-seven percent did not carry out additional tests. First line treatment included a phosphodiesterase 5 inhibitor in 81% of cases. Two thirds of urologists (78%) rated themselves as being correctly trained in the area of erectile dysfunction. However, only 49% systematically inquired about erection problems when faced with benign prostatic hyperplasia and 65% thought that erectile dysfunction was not treated optimally. Despite existing recommendations, only half of urologists carry out a cardiac evaluation when a finding of erectile dysfunction is made. One third of urologists do not request additional testing. Greater training, along with the use of an objective diagnostic tool could help urologists to optimise the care they provide for patients suffering from erectile dysfunction, allowing them to keep working within current guidelines. Level of evidence 3.

Objectifs Le syndrome de l’imposteur, aussi appele phenomene de l’imposteur ou syndrome de l’autodidacte, se manifeste par une forme de doute persistant aboutissant a la negation systematique du merite lie a au travail au profit de circonstances exterieures. Il peut avoir des consequences significatives sur la vie personnelle et professionnelle : burn-out, troubles anxiodepressifs, etc. Nous nous sommes interesses a sa prevalence parmi les urologues francais. Methodes Une enquete SurveyMonkey a ete envoyee a l’ensemble des urologues membres de l’AFU et des urologues en formation membre de l’AFUF entre fin novembre 2020 et janvier 2021. Le questionnaire etait anonyme et recueillait des donnees demographiques, des informations sur la pratique urologique du repondant ainsi que sa situation personnelle et familiale. La presence et l’intensite d’un syndrome de l’imposteur etait evaluee a l’aide de l’echelle de Clance, comportant 20 questions cotees de 1 a 5. Un score > 40 temoignait de la presence d’un syndrome de l’imposteur, severe si > 60, et intense > 80. Resultats Au total, 434 reponses ont ete recues, parmi lesquelles 353 etaient completes pour l’echelle de Clance (298 membres AFU, 25 assistants, 30 internes), representant toutes les tranches d’âge et modes d’exercice. Parmi ceux-ci, 251 (71 %) avaient une experience au moins moderee et 107 (30 %) severe du syndrome de l’imposteur ( Fig. 1 ). Le sexe feminin et la periode du post-internat etaient particulierement associes a la presence d’un syndrome de l’imposteur ( Fig. 2 , Fig. 3 , tous p Conclusion La prevalence du syndrome de l’imposteur, connue pour augmenter avec le niveau d’etudes, est elevee parmi les urologues francais (71 %). Les urologues femmes, ainsi que les assistants-chefs de clinique sont particulierement susceptibles de presenter un syndrome de l’imposteur. La prise de conscience de ce syndrome est importante et necessaire pour prevenir burn-out, troubles anxiodepressifs, autocensure et favoriser l’accomplissement professionnel.

Resume Contexte La maladie de Lapeyronie (ML) est une maladie inflammatoire de la verge, qui entraine la formation de plaques fibreuses cicatricielles de l’albugine avec une courbure et un raccourcissement du penis lors des erections. Il n’existe pas de standard international pour l’evaluation, le suivi ou le traitement de cette pathologie. Nous presentons dans cet article une revue de la litterature concentree sur les strategies therapeutiques decrites. Un algorithme est suggere pour faciliter l’evaluation et la prise en charge des patients. Materiels et methode La revue de la litterature a ete realisee selon la strategie PRISMA en utilisant la base de donnees PubMed et les termes Mesh : « Peyronie », « disease », « treatment » et « diagnosis ». Les resultats sont presentes d’une maniere descriptive. Resultats Plusieurs traitements ont ete proposes sans etudes randomisees prospectives englobant assez de patients. L’efficacite des therapies par voie orale est superieure dans le cadre d’une prise en charge multimodale de la phase aigue de la maladie. Les anti-inflammatoires non steroidiens et le para-aminobenzoate de potassium sont superieurs aux autres molecules pour le controle de la douleur. Le traitement local par verapamil gel, l’iontophorese et les injections intra-lesionnelles de verapamil, d’interferon alfa-2b et de collagenase clostridium histolyticum (CCH) ont revolutionne le traitement de la ML en modifiant la taille de la plaque et l’angulation du penis. Les therapies alternatives par traction ou par ondes de choc extracorporelles paraissent prometteuses. La CCH intra-lesionnelle est le seul medicament approuve par l’agence americaine des produits alimentaires et medicamenteux (FDA). Le tunellage de la plaque avant les injections de CCH ameliore davantage l’angulation. Conclusion Il existe une myriade de therapeutiques non chirurgicales disponibles pour la prise en charge de la ML, mais les preuves scientifiques de leur utilisation sont faibles. Des etudes supplementaires a grande echelle sont necessaires pour evaluer les pratiques actuelles, et concevoir des traitements plus efficaces.

Resumen Confrontés à une crise d’une ampleur exceptionnelle liée à la pandémie à coronavirus COVID-19 responsable d’une saturation selon les régions des urgences et des places en réanimation, le Comité Lithiase de l’Association Française d’Urologie (CLAFU) a élaboré pour la première fois les recommandations de prise en charge des calculs urinaires durant cette crise sanitaire.Recommendations of the Urolithiasis Committee of the French Urology Association for the management and the treatment of the stone formers patients during the COVID-19 pandemic crisis.

Objectifs Les enquetes menees par l’AFUF en 2011 puis 2018 utilisant l’echelle MBI, avaient mis en evidence chez un quart des internes et assistants en urologie un syndrome d’epuisement professionnel severe. Chez les urologues membres de l’AFU, ce taux montait a 30 % dans une enquete menee en 2017. Nous avons souhaite refaire le point dans le contexte de la crise sanitaire actuelle. Methodes Une enquete SurveyMonkey a ete envoyee a l’ensemble des urologues membres de l’AFU et des urologues en formation membre de l’AFUF. Le questionnaire etait anonyme et recueillait des donnees demographiques, des informations sur la pratique urologique du repondant ainsi que sa situation personnelle et familiale. La presence et l’intensite d’un syndrome d’epuisement professionnel etait evaluee a l’aide du Maslach Burnout Inventory (MBI), comportant 22 questions explorant les 3 aspects suivants : epuisement emotionnel, cynisme vis-a-vis du travail ou depersonnalisation, diminution de l’accomplissement personnel au travail. Resultats Au total, 434 urologues (AFU n = 362, AFUF n = 72) ont repondu a l’enquete, parmi lesquels 377 reponses etaient completes pour le MBI. Les repondants etaient des hommes (79 %)/femmes (21 %), representant toutes les tranches d’âge, exercant majoritairement en liberal (59 %). Quarante-quatre pour cent des membres de l’AFUF etaient en cours de post-internat. Quarante pour cent des interroges (soit 150 repondants) presentaient des symptomes severes dans l’une des 3 dimensions explorees ( Fig. 1 ). Le debut de carriere, le sexe feminin, le nombre d’heures travaillees par semaine et une formation ressentie de mauvaise qualite etaient significativement associes au risque de burn-out (p = 0,048, p = 0,04, p = 0,046, et p Conclusion La prevalence du burn-out etait elevee en fin d’annee 2020, aggravee par la situation sanitaire. L’identification de facteurs de risque et de facteurs protecteurs devrait ouvrir la porte a une reflexion sur les moyens de detecter, prendre en charge et prevenir la survenue des situations d’epuisement professionnel.

Objectifs L’utilisation du laser en urologie s’est developpee dans la lithiase et l’hypertrophie benigne de prostate. Malgre l’interet de cette technologie dans l’amelioration de la prise en charge chirurgicale, plusieurs evenements indesirables peuvent en resulter. Ce travail collige les declarations d’EIAS entre 2016 et 2020 dans le cadre de l’utilisation des energies laser en urologie. Methodes Il s’agit du recueil des EIAS entre mai 2016 et decembre 2020 declares par les urologues engages dans l’accreditation sur tout le territoire Francais. Ces EIAS ont ete classes selon 5 niveaux de severite. Les EIAS ont ete decrits et classes selon les phases pre-, per-, et postoperatoires. Les statistiques etaient principalement descriptives. Les interventions avec des EIAS ont ete comparees aux interventions sans EIAS en utilisant des tests du Chi2 et des tests de Wilcoxon. Resultats Sur la periode de l’etude, 1376 EIAS ont ete acceptes en urologie. Parmi ceux-ci, 149 (10,8 %) correspondaient a des situations a risques, et ont donc ete retenus. Les facteurs associes a ces EIAS cibles etaient : la defaillance de prise en charge des anticoagulants [15 (10,1 %)], la defaillance d’antibioprophylaxie [5 (3,4 %)], le defaut de communication en situation perioperatoire [23 (15,4 %)], les incidents lies a la chirurgie ambulatoire [23 (15,4 %)], le defaut du bilan preoperatoire [5 (3,4 %)], le materiel defectueux ou indisponible [43 (28,9 %)], la strategie therapeutique inadaptee [3 (2 %)] et la competence des paramedicaux [4 (2,7 %)]. Six EIAS (4 %) etaient d’une gravite majeure (niveau 3) et 5 (3,4 %) d’une gravite critique (niveau 4). Conclusion En France, 7,4 % des EIAS lies a l’utilisation du laser en chirurgie urologique sont d’une gravite majeure a critique. La formation des equipes a l’utilisation des generateurs laser et le retour d’experience concernant les resultats fonctionnels et la morbidite specifique liee paraissent necessaires afin de garantir la bonne utilisation de ces technologies, et la securite des personnel et des patients.

Resume But Preciser les symptomes du bas appareil urinaire (SBAU) lies a la pathologie diabetique, proposer des modalites de depistage, d’evaluation, de suivi et decrire les specificites de la prise en charge urologique de ces patients. Methodes Etude de la litterature a partir de la base de donnees PubMed en utilisant les mots cles suivants : « diabetes mellitus », « diabetic cystopathy », « overactive bladder », « bladder dysfunction », « urodynamics », « nocturia ». Resultats Les SBAU sont plus frequents dans la population diabetique que dans la population generale avec une prevalence estimee entre 37 et 70 % selon les series. Ils sont polymorphes, associant des troubles de la phase de remplissage et/ou de la phase de vidange, evolutifs et frequemment associes a la duree d’evolution du diabete et des complications de celui-ci. La prevalence de l’incontinence urinaire par urgenturie (IUU) et de l’incontinence urinaire a l’effort (IUE) des populations diabetiques est superieure de 10 points aux populations temoins dans la litterature. Malgre une evaluation importante dans la litterature, aucune recommandation n’encadre l’evaluation et la prise en charge des SBAU dans cette population specifique. Un depistage annuel par l’interrogatoire et l’echographie reno-vesicale avec mesure du residu post-mictionnel (RPM) est requis dans le suivi de tout patient diabetique. Le recours a un specialiste des troubles urinaires et au bilan urodynamique est requis selon les elements cliniques et paracliniques du depistage. Le type de dysfonctionnement, le risque infectieux et la dysautonomie doivent guider la prise en charge specifique de ces patients par l’urologue. Conclusion La pathologie diabetique occasionne un retentissement important sur le bas appareil urinaire. Un depistage des SBAU induits est necessaire au meme titre que les autres complications du diabete. La prise en charge des SBAU doit integrer les risques specifiques du patient diabetique, concernant le defaut de la contractilite vesicale, la dysautonomie et les complications infectieuses.

Aims To assess the impact of sacral neuromodulation (SNM) on pregnancy and vice-versa, by identifying women who had received SNM for lower-urinary tract symptoms (LUTS) and had become pregnant. Methods A cross-sectional descriptive study was carried out based on responses to an on-line questionnaire sent to practitioners listed on the InterStim enCaptureTM National Registry. Questions were related to pre-pregnancy health and SNM efficacy, deactivation of the device, its impact on LUTS, childbirth, the infant, its reactivation and postpartum effectiveness. Results Twenty-seven pregnancies were recorded among 21 women. Six women had had a pregnancy prior to implantation, two of whom had had a c-section. A total of 18.5% of women had the device disabled prior to conception. The others had their device disabled during the first trimester and did not reactivate it before delivery. Complications were reported in 25.9% of pregnancies: six women had urinary infections, including three of the four treated for chronic retention of urine (CRU), and 1 woman had pain at the stimulation site. There were 24 live births (including one premature birth and four c-sections), one spontaneous miscarriage and two voluntary interruptions of pregnancy. No neonatal disorders have been reported. Effectiveness of sacral neuromodulation decreased in 20% in postpartum. Conclusions In 27 pregnancies established during SNM for LUTS, 18.5% of patients deactivated their case before pregnancy and the others switched it off during the first trimester. Three-quarters of women with CRU had urinary infection. No adverse effects on fetuses were found. SNM effectiveness deteriorated in 20% cases after childbirth.

Resume Introduction Les troubles vesicosphincteriens (TVS) sont frequents au cours de la maladie de Parkinson (MP) et des autres syndromes parkinsoniens (SP). Ils sont responsables d’une morbidite et mortalite significative et alterent de maniere notable la qualite de vie des patients. La prise en charge therapeutique de ces TVS exige de savoir distinguer la MP des autres SP et de connaitre leur epidemiologie et physiopathologie. Objectif Proposer une strategie diagnostique et therapeutique des TVS chez les patients presentant un SP. Methode Etude de la litterature a partir de la base de donnee Pubmed en utilisant les mots cles suivants, Parkinson's disease, multiple system atrophy, lower urinary tract disorders, neurogenic bladder , overactive bladder , obstruction, anticholinergics, dopamine, prostate surgery . Resultats Parfois revelateurs de la maladie neurologique, les TVS au cours des SP posent un probleme diagnostique car ils surviennent a un âge ou diverses pathologies urogynecologiques peuvent etre intriquees avec le dysfonctionnement vesical neurogene. Le diagnostic differentiel entre MP et atrophie multisystematisee, important a connaitre par l’urologue, repose sur l’analyse semiologique clinique, la reponse au traitement dopaminergique et l’evolution clinique mais aussi sur les donnees des explorations urodynamiques. La prise en charge therapeutique de ces TVS est rendue complexe par la difficulte d’utilisation de certains traitements pharmacologiques et par les risques d’aggravation apres traitement chirurgical inapproprie. L’arsenal therapeutique comprend l’utilisation prudente des anticholinergiques, la stimulation tibiale posterieure, la stimulation profonde sous-thalamique, les injections intradetrusoriennes de toxine botulique a faibles doses et hors autorisation de mise sur le marche. La decision d’une chirurgie prostatique doit etre prise avec prudence apres avoir prouve l’obstruction sous-vesicale. Conclusion Lors de l’analyse des TVS au cours de SP, l’urologue doit savoir remettre en question le diagnostic initial de MP idiopathique. Les traitements, visant a reduire la morbi-mortalite des TVS et a ameliorer la qualite de vie des patients souffrant de ces maladies degeneratives, ne seront proposes qu’apres concertation pluridisciplinaire neuro-urologique. La decision d’une chirurgie prostatique doit etre prise avec prudence apres avoir prouve l’obstruction sous-vesicale.

The surgical care pathway of neurologic patients has two aims: preventing urinary morbidity and mortality and improving their quality of life. It requires taking into account the specificities of disabilities in domains of body functions: circulatory, ventilation and digestive physiology, motor functions, sensory functions, mental functions, and skin fragility which are responsible of dependencies in this heterogeneous group of patients. This management is necessarily multidisciplinary to be optimal and through specific clinical care pathway, providing guidance to the surgical procedure: preparation of the surgery, its realization, and post-operative rehabilitation. The indication for surgery must be coordinated and validated in neuro-urology multidisciplinary staff. Preoperative stay in a physical and rehabilitation medicine center may be useful to ensure a complete assessment and anticipate problems related to surgery. The patient will be hospitalized in the urology department in a single room suited to their disabilities and handicaps. The chronic treatments should be not modified if possible. The lack of sensitivity does not dispense anesthesia to prevent autonomic hyperreflexia, the most severe complication after high complete spinal cord injury. The laparoscopy and sub-peritoneal surgery, the early removal nasogastric tube and early refeeding make it possible to early resumption of intestinal transit. In many cases, the patients should be transferred to a physical and rehabilitation medicine during post-operative period where the nursing care will be most suitable. A quickly adapted rehabilitation must be able to reduce loss of function and physical dependence.

Objectifs Une etude realisee en 2011 revelait qu’un quart des urologues en formation (interne/chef de clinique) etait atteint d’un syndrome d’epuisement professionnel ( burn-out ). Nous avons souhaite mettre a jour les donnees epidemiologiques de cette pathologie chez les urologues francais en formation en 2018. Methodes Un auto-questionnaire en ligne comprenant le Maslach burn-out inventory et des informations sur le contexte professionnel, social et personnel a ete envoye a tous les membres de l’association francaise des urologues en formation ( n = 501) en avril 2018. Le burn-out est divise en 3 composantes etudiees separement : l’epuisement professionnel, la depersonnalisation, l’accomplissement personnel. Nous avons egalement chercher a identifier les facteurs de risque ce cette maladie. Resultats Le taux de reponse etait de 47,7 %. Les scores d’epuisements professionnels, de depersonnalisation, d’accomplissement personnel etaient respectivement de 20,5 ± 11,8 (epuisement modere), 11,6 ± 6,9 (depersonnalisation severe) et 34,6 ± 8,7 (accomplissement personnel modere). Soixante-trois participants (26 %) avaient un syndrome d’epuisement professionnel severe, 120 (50 %) un syndrome de depersonnalisation severe et 94 (39 %) un burn-out eleve sur l’accomplissement personnel. Il a ete identifie un taux significativement plus eleve d’epuisement professionnel chez les femmes, les sujets n’ayant pas de loisir regulier, travaillant plus de 65 heures par semaines et consommant des substances illicites. Une situation de couple stable, les repos de securite, le nombre d’interne dans les equipes ou la consommation tabagique n’avaient pas de repercussions significatives. Les sujets estimant etre mal formes avaient des scores significativement plus eleves dans les 3 dimensions du burn-out . Conclusion Un quart des urologues en formation sont atteints d’un syndrome d’epuisement professionnel severe et la moitie d’un syndrome severe de depersonnalisation. La diminution du temps de travail, la pratique d’un loisir regulier, associee a une hygiene de vie saine, permettraient de diminuer le risque de burn-out . L’amelioration de la formation pourrait egalement permettre de prevenir ce risque.

Study Type – Therapy (RCT) Level of Evidence 1b OBJECTIVE • To evaluate the impact of urisheaths vs absorbent products (APs) on quality of life (QoL) in men with moderate to severe urinary incontinence (UI). PATIENTS AND METHODS • A randomized, controlled, crossover trial in 61 outpatient adult men with stable, moderate to severe UI, with no concomitant faecal incontinence, was conducted from June 2007 to February 2009 in 14 urology centres. • Participants tested Conveen Optima urisheaths (Coloplast, Humlebaek, Denmark) with collecting bags and their usual AP in random order for 2 weeks each. • The impact of each on QoL was measured using the King’s Health Questionnaire (KHQ) and the short form-12 acute questionnaire, and each patient’s preference was recorded. • A 10-item patient questionnaire was also used to assess the product main advantages on an 11-point scale (0: worst; 10: best). A 72-h leakage diary was used to record the number and severity of leaks and daily product consumption. Safety was measured as the number of local adverse events. RESULTS • All dimensions of the KHQ were scored lower with urisheaths, indicating an improvement in QoL. The greatest mean score reductions were in Limitations of Daily Activities (−10.24, P= 0.01) and Incontinence Impact (−7.05, P= 0.045). • The majority (69%) of patients preferred Conveen Optima urisheaths to their usual AP (P = 0.002). • Urisheaths scored significantly higher for all categories in the patient questionnaire (efficacy, self-image, odour management, discretion, skin integrity) except ease of use. • Safety was considered to be good. CONCLUSIONS • Conveen Optima urisheaths showed a positive impact on QoL (according to the KHQ results) in moderate to severe incontinent men, who were long-term users of APs, and participants largely preferred urisheaths. • Conveen Optima urisheaths should be recommended to incontinent men in preference to APs.

Interstitial cystitis is the first cause of bladder pain. In case of failure of the usual treatments, several other modalities have been proposed. These therapeutic modalities are posterior sacral root neuromodulation, posterior tibial nerve stimulation, vanilloid agent intravesical instillation, intradetrusor botulinum toxin injections and surgery. A certain efficiency of each of these treatments in the interstitial cystitis has been reported. However, the evaluation of these treatments is limited and the level of evidence is too low to propose these treatments in routine.

In France, the prevalence of urinary incontinence is about 44%. Obesity, defined by a Body Mass Index (BMI) above 30kg/m(2), is well established as a risk factor of stress urinary incontinence. Odds ratio (OR) varies between 1.7 and 2.4. Urge or mixed incontinence also occurs in obesity. Urinary incontinence epidemiology is not well-known in obese women. Weight loss, obtained by a weight reduction diet program or bariatric surgery, improves urinary symptoms of stress, urge or mixed incontinence. Functional outcome of urge incontinence surgery is not influenced by obesity. Typically, functional outcome and morbidity of tension-free vaginal tape are not influenced by BMI variations.

Resume Certaines protheses intra-prostatiques, telles que la prothese Urospiral™, ont un interet dans la prise en charge de l’hypertrophie benigne de prostate (HBP). Elles peuvent traiter les patients âges presentant des contre-indications medicales ou anesthesiques avec pronostic vital mis en jeu. Le sevrage de la sonde vesicale a demeure est ainsi obtenu. Elles sont egalement interessantes comme « test therapeutique » chez des patients presentant des troubles urinaires obstructifs (aigus ou chroniques) et/ou irritatifs attribuables ou suspects d’etre lies a des maladies neurologiques. L’Urospiral™ est une prothese prostatique temporaire, non expansible de calibre Ch 21, dont il existe differentes tailles, en fonction de la mesure col vesical-veru montanun. La partie mediane de la prothese permet le maintien de la continence. La pose et l’ablation se font sous anesthesie locale au gel de xylocaine lors d’une urethro-cystoscopie.

The management of some neurological patients can require urinary diversion. Continent cystostomy is one of the treatment options proposed in young patients, usually for cosmetic reasons. In this article, the authors describe the main techniques used in this particular indication and then review the literature to define the results of the various techniques used, as well as the modalities of follow-up in these patients in view of the potential complications.

Multiple sclerosis (MS) is a neurological disease characterized by multiple demyelinating lesions disseminated throughout the central nervous system (nerve conduction block). The management of these patients requires a perfect knowledge of the natural history of the disease. In this article, the authors review the literature to identify the most frequent voiding disorders observed in this disease and then study the diagnostic and therapeutic modalities and the optimal modalities of follow-up in these patients, in view of the risk of various urological complications.

Background Many factors have been identified as important determinants that increase the risk of malignant melanoma (MM) developing. Patients with classic atypical mole syndrome (CAMS) have multiple such factors and are known to be at high risk for MMs developing. Objective We sought to evaluate the risk for newly diagnosed MMs developing in patients with CAMS and in a heterogeneous group of patients at high risk (ie, those with high-risk non-CAMS [HRNCAMS]) who had 1 or more risk factors: personal history of nonmelanoma skin cancers; family history of melanoma; biopsy specimen–confirmed dysplastic nevi; and meeting 1 or 2 of the 3 CAMS criteria. We also aimed to report our experience treating these patients at high risk with annual total cutaneous examination, total cutaneous photography, and dermoscopy. Methods Consecutive medical records from a private dermatology practice were reviewed. A total of 258 patients were selected who fulfilled the criteria of having: (1) total cutaneous photography as an aid for follow-up; (2) total cutaneous examination at least once per year; (3) at least 6 months of clinical follow-up; and (4) no personal history of melanomas. A total of 160 patients with CAMS and 98 with HRNCAMS were included in this study. The 10-year risk for MM developing in these 2 cohorts was computed using the Kaplan-Meier method. Results In the CAMS cohort, 28 new MMs developed in 19 patients resulting in a cumulative 10-year risk of 14% (95% confidence interval: 7-20). In the HRNCAMS cohort, 10 new MMs developed in 9 patients, and the cumulative 10-year risk was 10% (95% confidence interval: 2-17). The difference between the 2 groups was not statistically significant ( P = .91). The MMs diagnosed in both cohorts were either in situ or less than 1 mm in Breslow thickness. There were no MM metastases or MM-related deaths in either cohort during a mean follow-up period of 120 months for the CAMS and 98 months for the HRNCAMS group. Conclusion Both the patients with CAMS and HRNCAMS were at very high risk for MMs developing. The combination of total cutaneous photography, total cutaneous examination, and dermoscopy were used in treating our patients. No MM 1 mm or greater in thickness developed during follow-up in either group.

The effects of local treatment with highly purified tannic acid (HPTA) on serum transaminase and alkaline phosphatase activity in burn patients were studied, retrospectively. Temporary elevations in the activity of gamma-glutamyl transferase (GGT), aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT) and alkaline phosphatase (AP) were observed in both HPTA-treated patients and their matched controls. No statistically significant difference was found between the two patient-groups with respect to the mean enzyme activities, calculated as the areas under the curve between 5 and 15 days post-burn (PBD). These results seem to indicate that HPTA does not cause hepatotoxicity, at least when applied to a burned area corresponding to approximately 10% of the total body surface. This is in agreement with the widespread and frequent use of HPTA in the food, cosmetic and pharmaceutical industries.

Background: Opinions concerning the significance of dysplastic nevi and their management vary among dermatologists. Objective: The purpose of this study was to assess how fellows of the American Academy of Dermatology (AAD) perceive and manage dysplastic nevi. Methods: Questionnaires were sent to 1216 fellows of the AAD; 456 questionnaires were returned. Results: Almost all respondents (98%) accept the dysplastic nevus, or atypical mole, as an entity. Seventy-five percent of respondents perform follow-up total cutaneous examinations on all their patients with dysplastic nevi, and another 22% on some of them; 86% usually intend to do total removals when they perform biopsies of dysplastic nevi; 75% use margins of 2 mm or less when removing dysplastic nevi; 49% order baseline total-cutaneous photographs of some or all of their patients with multiple dysplastic nevi, although only 12% do so routinely; 67% prefer to re-excise dysplastic nevi when margins are positive, some using histologic atypia as a criterion; 60% recommend an ophthalmologic examination for at least some of their patients with many dysplastic nevi, although only 3% do so routinely; 12% always recommend cutaneous examinations of blood relatives of their patients with dysplastic nevi and another 81% recommend such examinations for at least some of their patients with dysplastic nevi; 23% use dermoscopy; 99% recommend self-examination; almost 100% recommend sunscreen use and 93%, sun avoidance. Conclusion: Most respondents, in agreement with the literature, accept the concept that patients with dysplastic nevi are at increased risk for melanoma and that methods for prevention and early detection of melanomas are appropriate for these patients. (J Am Acad Dermatol 2002;46:674-82.)

Within the group of botanical products there is a large range of variation with regard to their properties. Some products are identical to foods while others come close to or are medicines. Botanical products are regulated differently within the different member states of the European Union (EU) and globally. They are regulated either as food or as medicinal products, and in the latter case often with simplified registration procedures. These differences are caused by differences in traditional use, in cultural and historical background, in scientific substantiation and in enforcement of current legislation. One may expect that in the future differences will remain, unless EU legislation is enacted with sufficient room for different approaches. The strengths and weaknesses of the different regulatory procedures have been reviewed and evaluated as well as the current methods for quality, efficacy and safety evaluation. Criteria to categorize botanical products have been defined, such that botanical products can be regulated under the current food and medicinal regulations. Furthermore, a decision tree has been developed as a tool to distinguish herbal medicinal products from botanical health products and vice versa, and to provide a stepwise framework for the assessment of safety and efficacy.

The incidence and mortality rates of melanoma have risen for many decades in the United States. Increased exposure to ultraviolet (UV) radiation is generally considered to be responsible. Sunburns, a measure of excess sun exposure, have been identified as a risk factor for the development of melanoma. Because sunburns are primarily due to UVB (280-320 nm) radiation, UVB has been implicated as a potential contributing factor to the pathogenesis of melanoma. The adverse role of UVA (320-400 nm) in this regard is less well studied, and currently there is a great deal of controversy regarding the relationship between UVA exposure and the development of melanoma. This article reviews evidence in the English-language literature that surrounds the controversy concerning a possible role for UVA in the origin of melanoma. Our search found that UVA causes DNA damage via photosensitized reactions that result in the production of oxygen radical species. UVA can induce mutations in various cultured cell lines. Furthermore, in two animal models, the hybrid Xiphophorus fish and the opossum (Mondelphis domestica), melanomas and melanoma precursors can be induced with UVA. UVA radiation has been reported to produce immunosuppression in laboratory animals and in humans. Some epidemiologic studies have reported an increase in melanomas in users of sunbeds and sunscreens and in patients exposed to psoralen and UVA (PUVA) therapy. There is basic scientific evidence of the harmful effects of UVA on DNA, cells and animals. Collectively, these data suggest a potential role for UVA in the pathogenesis of melanoma. To date evidence from epidemiologic studies and clinical observations are inconclusive but seem to be consistent with this hypothesis. Additional research on the possible role of UVA in the pathogenesis of melanoma is required.

Currently, a global change in the approach to herbal medicinal products can be observed and in many countries new regulations are developed for this class of products. Implementation of such legislation is necessary to guarantee the quality, safety, and efficacy of herbal medicinal products. The Dutch policy is to facilitate this process and to effect a smooth transition. To achieve this, the Dutch government has laid down a Royal Decree on Herbal Food Products, which aims at increasing the safety of food supplements containing medicinal herbs. In addition, it financially supports the activities of the private Committee for the Assessment of Phytomedicines. This committee's explicit goal is to set up a self-regulating system for monitoring the quality, safety, and efficacy of herbal medicinal products. For this purpose, it has developed operational methodology and explored some of the specific problems in this respect. This arrangement is made in anticipation of specific European guidelines for herbal medicinal products.

B large congenital melanocytic nevus (LCMN), defined herein as a nevus present at birth that is predicted to be at least 20 cm in greatest diameter in adulthood, occurs infrequently. Approximately one in 20,000 infants, amounting to 200 newborns per year in the United States, is born with a LCMN. In addition, one in 500,000 newborns, translating to 10 infants, is born each year with very large LCMN of the garment or bathing-trunks type. 1 The implications for the affected infant are significant. Beside cosmetic disfigurement, a LCMN increases an individual's risk for developing malignant melanoma (MM), and may be associated with neurocutaneous melanocytosis (NCM). 2"5 There are many definitions for what constitutes a LCMN (Table 1). 6-13 As mentioned above, we elect to define LCMN based on the predicted maximum diameter of the nevus in adulthood: at least 20 cm. Congenital melanocytic nevi (CMN) generally enlarge in proportion to the growth of the skin coveting the involved area of the body. 14 Figure 1 depicts the graphs we use to predict the adult diameter of an infant's or child's CMN. 15 Clinically, LCMN can be light brown, dark brown, black, blue, or exhibit a combination of colors. The surface may be macular, papular, mamillated, hyperkeratotic, rugose, and/or nodular. The nevus may be hypertrichotic. 16 With time, LCMN may get darker or lighter, and rarely, completely disappear.5,! 6,17 LCMN can sometimes be associated with anomalies such as NCM, neurofibromatosis type I, occult spinal dysraphism, and/or the tethered cord syndromeJ 8 NCM may affect over 10% of patients with LCMN. 15 It is a s2cndrome with a poor prognosis for survival. According to one definition, NCM is characterized by the presence of an LCMN, or multiple (three or more) smallto medium-size CMN, accompanied by a benign and/or malignant melanocytic proliferation in the leptomeningesJ 9 Of the patients with central ner

BACKGROUND Thickness is known to be an important survival prognosticator for cutaneous melanoma, but controversy exists as to whether Clark level of invasion retains prognostic significance once thickness has been accounted for. A recent proposal to eliminate Clark level from the staging system for melanoma of the American Joint Committee on Cancer (AJCC) prompted the authors to investigate whether level adds useful prognostic information to Breslow thickness. They used the data base of the New York University Melanoma Cooperative Group (NYU-MCG) Registry. METHODS The analysis was based on 919 patients with AJCC Stage I or II melanomas diagnosed between 1972 and 1982 and followed for an average of 10.9 years. Melanoma thicknesses were divided into 4 categories (≤0.75, 0.76–1.50, 1.51–4.00, and >4.00 mm). Patients were cross-classified according to tumor thickness and Clark level (II–V). For each combination of thickness and level, the Kaplan–Meier survival curve and 10-year survival proportion were computed, using death from melanoma as the outcome. The impact of Clark level on survival was evaluated for each of the thickness categories. The Cox proportional hazards model was used to assess the simultaneous effect of thickness and level on survival while controlling for other important prognostic factors, i.e., age, tumor location, and presence or absence of ulceration. RESULTS Level of invasion was a significant predictor of death from melanoma in each of the four thickness categories. Likewise, in the Cox analyses, level was a significant prognostic variable, even after thickness was included in the model and regardless of whether thickness was treated as a categoric or a continuous variable. CONCLUSIONS These results confirm that both tumor thickness and level of invasion are important independent prognostic factors in AJCC Stage I and II melanomas. The authors recommend that Clark levels be kept as criteria in the AJCC staging system and be included in pathology reports. [See editorial on pages 491–6, this issue.] Cancer 2000;88:589–95. © 2000 American Cancer Society.

The authors report the case of a 44-year-old man in whom a poorly differentiated primary carcinoma of the head of the epididymis was discovered incidentally. Due to the rarity of this diagnosis, a comprehensive assessment was performed looking for a primary tumour, but without success. Despite early surgical resection, the patient developed lymph-node metastases. This exceptional tumour showed low sensitivity to chemotherapy. Malignant tumours of the epididymis are exceptional and require investigations to detect a primary tumour. Treatment is based on surgical resection, ideally via an inguinal incision, combined with chemotherapy adapted to the histological type.

Complete necrosis of the penis and scrotum due to strangulation of the external genitalia is unusually encountered in urologic emergencies. Urological conservative management is recommended. Delayed presentation is a major source of complications. We report the case of a psychotic patient, who was transferred from the emergency department in a context of complete necrosis of the external genitalia. This patient's history included chronic psychotic disorder and positive HIV serology, but he refused to take either neuroleptic or antiretroviral therapy. Complete amputation of the penis and bilateral orchidectomy were performed. We report the first six months of medical management.

Ten percent of patients with kidney cancer have associated vena cava thrombus, which is associated with a high operative morbidity. Up to now, no medical treatment has allowed regression of vena cava tumour thrombus. The authors report the case of a 62-year-old patient with left kidney cancer associated with vena cava tumour thrombus. After surgical resection, the patient relapsed in the form of vena cava thrombus associated with right renal vein thrombus, responsible for renal insufficiency requiring dialysis. Sorafenib therapy allowed regression of the vena cava thrombus, suspension of haemodialysis and local disease control with a follow-up of one year. This case report justifies a review of the place of anti-angiogenic therapy in the treatment of kidney cancer.

Objectifs Realiser un etat des lieux en France sur la neuromodulation des racines sacrees (NMS) dans le cadre des troubles du bas appareil urinaire (TBAU) et la grossesse. Methodes Il s’agit d’une etude transversale realisee a partir d’un questionnaire en ligne envoye aux investigateurs du Registre National InterStim enCaptureTM. Un questionnaire devait etre rempli par patiente enceinte. Une reponse negative etait demandee si aucune patiente n’avait ete enceinte. Les questions portaient sur : – l’indication et l’efficacite avant la grossesse ; – la desactivation et son impact sur les symptomes ; – les modalites d’accouchement ; – l’enfant ; – la reactivation du boitier et son efficacite. L’objectif principal etait de recenser le nombre de grossesses sous NMS pour TBAU. Les objectifs secondaires etaient d’evaluer l’impact de la NMS sur la grossesse et inversement. Resultats Vingt grossesses chez 17 femmes : une a eu 3 grossesses apres implantation, une en a eu deux. Les patientes etaient implantees entre 1999 et 2011, la grossesse survenait avec un delai median de 4 ans [1–8], l’âge median maternel etait de 33 ans [27–39]. Sept patientes ont eteint le boitier avant la grossesse, toutes l’ont desactive et aucune ne l’a rallume. Quatre patientes ont eu des complications pendant la grossesse : –une gene perineale ; –des colonisations ou infections urinaires. Une femme n’a pas accouche a terme, 4 ont eu une cesarienne (22,22 %) et 2 ont realise une IVG. Quinze patientes ont reactive leur boitier en post-partum, trois ont eu une degradation de l’efficacite de la NMS dont deux deplacements d’electrode. Aucun probleme neonatal n’est survenu. Conclusion Nous avons recense 20 grossesses sous NMS pour troubles vesico-sphincteriens, il y a eu 4 cesariennes, 3/5 femmes avec un trouble de la vidange ont eu des complications infectieuses. Il n’y a eu aucun probleme neonatal et l’efficacite de la NMS en post-partum s’est degradee chez 20 % d’entre elles (Tableau 1 ; Tableau 2).

Background: One of the most difficult problems in the in vivo diagnosis of cutaneous tumors is the differentiation clinically between early malignant melanoma (MM) and atypical (dysplastic) melanocytic nevi (AMNs) because these lesions share clinical features. High-quality digital imaging systems and store-and-forward technology have the potential for use in a teledermatology system with which experts would be able to immediately transmit their diagnostic opinions concerning these challenging lesions. Objective: The main purpose of this study was to determine if the clinical and dermoscopic diagnoses and the dermoscopic features of AMN and early MM are unaltered after telephonic transmission of their digitized images. Methods: Conventional and dermoscopic photographic transparencies of 22 AMNs and 9 early MMs, viewed on rearview projectors and then scanned, compressed, transmitted (Internet) and viewed on color monitors, were evaluated. Results: The concordance in the diagnosis of AMN and of early MM by all four observers, both clinically and dermoscopically, when comparing rearview-projected conventional transparency slides to transmitted, compressed, digitized images, was high. For most specific dermoscopic features, the concordance was good, although less so for the presence or absence of some dermoscopic features, namely ‘dots’, ‘blue/gray’ color and ‘red’ color. Conclusion: The results reported support the conclusion that Internet transmission of digitized images of MMs and AMNs retains sufficient informativeness for diagnostic purposes. This study is a step in the creation of an international teledermoscopy network for pigmented cutaneous lesions.

BACKGROUND Recently, the Pigmented Lesion Group at the University of Pennsylvania described a 4-variable model for predicting 10-year survival for patients with primary cutaneous melanoma. The variables are tumor thickness, anatomic site of the lesion, age, and gender. The objective of the current study was to test the validity of this model, employing the large data base of the New York University Melanoma Cooperative Group. METHODS The predicted probabilities of 10-year survival for 780 patients with primary cutaneous melanoma were determined by multivariate logistic regression, using the 4 variables. RESULTS The overall 10-year survival rate of the current study group was 78.4%. Of the four variables, tumor thickness, anatomic site of the lesion, and age were found to be independent predictors of survival. Although survival was better for women, gender was not a statistically significant factor in predicting 10-year survival when entered into the multivariate logistic regression model. In the current study, the probability of 10-year survival of patients with melanomas < 0.76 mm ranged from 93-99%, depending on the age and primary site. Age and site had more impact on the prognosis of intermediate and thick melanomas than on thin melanomas. Thus, for melanomas 0.76-1.69 mm, 1.70-3.60 mm, and thicker than 3.60 mm, the probabilities of survival ranged from 70-94%, 39-82%, and 23-68%, respectively. CONCLUSIONS The wider ranges in survival rates for thicker melanomas, depending on the other variables, emphasize the importance of including variables in addition to tumor thickness in a prognostic model. Using a large data base from a medical center, the current study supports the prognostic multivariate model of the Pigmented Lesions Group of the University of Pennsylvania; however, the authors of the current study did not find gender to be statistically significant in this multivariate model. Cancer 1997; 80:1426-31. © 1997 American Cancer Society.

Background: A substantial proportion of malignant melanomas arise in preexisting melanocytic nevi. However, the clinical and dermoscopic features of such combination lesions have not been well defined in the literature. Objective: To determine the ability to recognize in thin malignant melanomas the presence or absence of melanocytic nevi based on clinical and/or dermoscopic observations. Methods: Thirty malignant melanomas, less than 1 mm in Breslow thickness, were studied clinically, dermoscopically, and histologically for the presence or absence of features of a melanocytic nevus. Results: The ability to recognize melanocytic nevi within thin malignant melanomas was poor by clinical and dermoscopic examinations, with 30% false negatives and 23% false positives. Conclusion: One cannot depend on clinical and/or dermoscopic observations to rule out a melanocytic nevus within a thin malignant melanoma. Histopathologic study of a small portion of a combined melanocytic neoplasm could lead to the mistaken conclusion that the lesion is entirely a melanocytic nevus or entirely a malignant melanoma. Therefore, when feasible, lesions suspected of being malignant melanomas should be totally excised and step-sectioned throughout.

BACKGROUND/AIMS Atypical melanocytic nevi (AMN) share some or all of the clinical features of malignant melanoma (MM). The clinical sensitivity for diagnosing MM by physicians experienced in evaluating pigmented lesions is reported to range from 73% to 89%. This study attempted to determine whether clinical sensitivity can be increased by dermoscopy (epilumnescence microscopy, dermatoscopy). METHODS A total of 72 melanocytic neoplasms were histologically diagnosed as either AMN or early MM (

The classic atypical-mole syndrome (CAMS) and/or a history of malignant melanoma (MM) increases the risk for multiple melanomas. Case notes of 118 CAMS and 173 control patients, each with a history of MM, were reviewed for the occurrence of second primary MMs. The mean (+/-SD) age at diagnosis of the first MM was 38.8 +/- 12.8 and 48.9 +/- 14.7 years (P < 0.001) for CAMS cases and controls, respectively. Thirty-two of 118 CAMS and 18 of 173 controls developed second primary MMs, for a cumulative 10-year life-table risk of 35.5% and 17.0%, respectively (P < 0.0001). The mean number of months from the time of diagnosis of the first to the second MM was 33.9 +/- 41.8 and 58.6 +/- 57.3 months for the CAMS and controls, respectively (P = 0.08). In both cohorts the second MMs were significantly thinner, compared with the first MMs. The relative risk (RR) for developing second MMs for CAMS patients was 3.2. The RR for the CAMS cohort compared with a matched population from the United States Statistics, Epidemiology. End Results data base was 337, and for the controls, the RR was 84. All patients with MMs are at significant risk for developing multiple MMs: the risk is greater for patients with CAMS. Periodic total cutaneous examinations are indicated for life in an attempt to identify new MMs when they are thin.

Background: The incidence of malignant melanoma (MM) has rapidly increased during the past five decades. Relatively little information is available on whether the role of the dermatologist has increased concomitantly in the surgical management of this cancer. Objective: Our purpose was to learn how members of the American Academy of Dermatology (AAD) treat patients with lesions highly suspected as being MM and how the management of these patients may have changed over the past decade. This, the first of a two-part series, concerns biopsies. Methods: The data for the study were collected by means of a questionnaire that was sent to all members of the AAD practicing in the United State ( N = 7412). Results: A total of 2991 valid questionnaires were returned, a response rate of 40%. The majority of respondents (89% in 1982; 90% in 1992) stated that they performed the biopsies of pigmented lesions suspected of being MMs. Excisional biopsy was the preferred technique (58% in 1982; 68% in 1992). The type of biopsy and who performed the initial biopsy of a suspected MM were associated with the following factors: (1) the number of years in practice, (2) the type of practice, and (3) whether the dermatologist subsequently performed the definitive surgery for the MM. Regional variations in biopsy practices were also noted. Conclusion: Most AAD dermatologists who responded to the questionnaire perform the biopsies of lesions highly suspected of being MM. During the last decade an increasing proportion of dermatologists are performing excisional biopsies rather than other types of biopsies for such lesions.

BACKGROUND The incidence of malignant melanoma (MM) in the United States (US) must be known to accurately evaluate the costs that MM imposes on the health care system and society in general. Furthermore, knowledge of the incidence is needed to determine the benefit of MM prevention programs. OBJECTIVE To obtain an estimate of the incidence of MM in the US. METHODS The data for this study were collected by means of a questionnaire that was sent to all members of the American Academy of Dermatology practicing in the US (N = 7412). RESULTS Based on the mean number of MMs seen annually per dermatologist in each state and the number of dermatologists per state, the number of new in situ and invasive MMs in the US in 1992 was calculated to be 80,000. This translates to an incidence of 32 MMs per 100,000 persons. CONCLUSIONS Our estimate of 80,000 new MMs diagnosed in 1992 in the US suggests that MM places much greater burdens on the US health care system and society than that based on current published estimates.

Background. This study was designed to determine the risk of developing malignant melanoma (MM) in patients with a history of basal cell and/or squamous cell skin cancer (BCC/SCC) and to determine whether surveillance efforts can be directed toward these patients for the detection of early MMs. Methods. The study cohort was followed by annual total cutaneous examination (TCE). Controls consisted of individuals from the United States population matched for age, sex, and length of follow-up. The anatomic locations of the study cohorts'newly diagnosed MMs were plotted on an anatomic chart. The setting was a private dermatology practice. Two hundred, ninety consecutive white patients with a history of BCC/SCC but with no personal or family history of MM were followed by annual TCEs. The main outcome measures were the relative risk of developing MM and their prognosis. Results. Ten of the 290 patients developed an MM within an average of 109 months of follow-up (range, 317 years). All MMs were less than 0.70 mm in Breslow thickness and 80% occurred on usually clothed cutaneous sites. The expected number of MMs in the control population was 0.59 (P=0.006), resulting in a relative risk of 17. Conclusion. Patients with BCC/SCC skin cancer are at substantial increased risk for developing MM. Regular and life-long surveillance TCE is an inexpensive and effective method for detecting curable MMs in such patients

Skin cancers are the most common cancers in humans. The American Cancer Society estimates that in the United States more than 700,000 new skin cancers are diagnosed annually. Although the majority of nonmelanoma skin cancers occur on visibly exposed anatomic areas, most malignant melanomas occur on body sites obscured by clothing. The high mortality associated with advanced melanomas emphasizes the importance of performing regular total cutaneous examinations in all patients to detect early, easily curable lesions. A number of techniques aid in these examinations: (1) physical and psychologic preparation of the patient; (2) appropriate lighting and a suitable examination table; (3) when indicated, use of Wood's light, dermoscopy, and photography. In addition, any suspicious lesion should be biopsied promptly either in parte or in toto. Lastly, the patient should be educated about the signs and symptoms of skin cancer, the role of sunlight in causing skin cancer, and the need for sun avoidance and/or protection. By heightening public awareness of the high incidence of cancers of the skin and by emphasizing the need for routine examination of the entire cutaneous surface, most cutaneous malignancies can be diagnosed early when they can be cured by simple surgical procedures.

The objective of follow-up examinations of patients who have had Stage I invasive malignant melanoma is the early detection of local recurrences, metastases, and new primary melanomas. Model schedules for follow-up intervals were developed based on a survey of eight physicians. These melanoma experts agree that regular follow-up examinations are indicated and that the time intervals between examination vary according to the thicknesses of the melanomas. The patient follow-up schedule derived is: for melanomas up to 0.75-mm thick, every 6 months for years 1 and 2, and annually for years 3, 4, and 5; for melanomas 0.76-1.50 mm thick, every 3 months for years 1 and 2, semi-annually for years 3, 4, and 5; and for melanomas > 1.50 mm thick, every 3 months for years 1, 2, and 3, and semi-annually for years 4 and 5. After the fifth year, the recommendation is to examine all patients annually for life because of the continued risk for recurrences and new primary melanomas. For those individuals at especially high risk for developing multiple primary melanomas more frequent examinations may be appropriate.

Organ donation after cardiac death has been used for kidney and liver procurement in France since 2006. Until recently, most teams relied on in situ cold perfusion to prepare the donor before organ retrieval. Our team has used since 2007 normothermic abdominal recirculation. While this technique is presumed to be more difficult to implement, it also ensures a lower rate of primary nonfunction when compared to in situ cold perfusion. We present the efficiency results of our organ donation after cardiac death program. After 3 years, we have been able to establish a program in which we use normothermic abdominal recirculation in 97% of donors after cardiac death. The yearly efficiency of this program is comparable to the national efficiency of organ procurement from conventional deceased donors in France.

Background: There is an increased risk of new basal cell carcinomas (BCCs) developing in a person who has had a BCC. Objective: This study attempts to define the magnitude of this increased risk. Methods: The charts of 260 white patients with a histologically proven BCC were reviewed for the occurrence of new BCCs. The cumulative 5-year incidence (modified life-table method) for new BCCs developing in these patients was compared with the 5-year incidence in the general white population of the United States. Results: Of the 260 patients, new BCCs developed in 137 within an average of 38.3 months, a 5-year cumulative rate of one or more new BCCs of 45.2%. The yearly risk for new BCCs developing in the study population remained high during the 5-year interval. In the general white population of the United States, the maximal 5-year incidence was calculated to be 5% (p Conclusion: Patients with a history of BCC require life-long follow-up because of the high probability of new BCCs developing.

We determined the functional results and morbidity of balloon (ProACT™) implants for the treatment of male stress urinary incontinence after prostate surgery.Between 2002 and 2008 a prospective, noncontrolled study was conducted. The ProACT implant consists of 2 adjustable balloons placed on either side of the native striated sphincter. The implants are adjusted by inflation during followup visits. The primary efficacy end point was postoperative continence as defined by the use of 0 to 1 pad daily.A total of 128 consecutive patients underwent implantation. Mean ± SD patient age was 71 ± 42.3 years (range 52 to 87). The severity of incontinence before ProACT was moderate (71), mild (40) and severe (17). Overall 25% of patients previously underwent pelvic radiotherapy. The mean number of daily pads per patient was 1.46 (vs 4.2 at baseline). Mean followup was 56.3 months (range 24 to 95). The functional result was success in 68% of patients with moderate/mild incontinence and the explantation rate was 18%. Among the 30 patients treated with radiotherapy before ProACT the success rate was only 46% and the incidence of urethral erosion was significantly higher (p = 0.005).The ProACT implant appears to be an option for the treatment of moderate male stress urinary incontinence, especially given the minimally invasive modalities of insertion, the capacity to adjust the inflation of the balloons to achieve postoperative continence and the relative reversibility.

Synchrotron radiation is emitted whenever a beam of charged particles passes though a magnetic field. The power emitted is strongly dependent on the relativistic Lorentz factor of the particles, which itself is proportional to the beam energy and inversely proportional to the particle rest mass. Thus, synchrotron radiation is usually associated with electron accelerators, which are commonly used as light sources. However the largest proton machines reach sufficiently high energies to make synchrotron light useful for diagnostic purposes. The Large Hadron Collider at CERN will accelerate protons up to an energy of 7TeV. An optical arrangement has been made which focuses synchrotron light from two LHC magnets to image the cross-section of the beam. It is also planned to use this setup to produce a longitudinal profile of the beam by use of fast Single Photon Counting. This is complicated by the bunched nature of the beam which needs to be measured with a very large dynamic range. In this contribution we present early experimental data of the transverse LHC beam profile together with a scheme for measuring the longitudinal profile with a time resolution of 50 ps. It includes the use of a gating regime to increase the dynamic range of the photon counter and a three-stage correction algorithm to compensate for the detector's deadtime, afterpulsing and pile-up effects.

Background: The risk for the development of malignant melanoma has been reported to be higher in persons with more formal education than in individuals with less. Objective: To study whether those with more formal education are indeed at more risk for malignant melanoma than those with less formal education. Methods: This case-control study explores the relation between education and melanoma risk by analyzing data collected by the American Cancer Society. A total of 1.2 million people were surveyed for a history of cancer and followed up for 6 years for the development of any cancer. In total, 2780 white persons had a history of malignant melanoma or developed malignant melanoma during the study period. The controls were age-, sex-, and geographically matched white persons selected from the remaining people enrolled. Results: Both men and women were shown to have a statistically significant increase in the relative risk for malignant melanoma with increasing education level ( p p = 0.001, respectively). This relation was more striking in men when the relative risk with 95% confidence interval was calculated by sex for each education level. Conclusion: Americans with more formal education are at greater risk for malignant melanoma than those with less education.

Abstract Repetitive Strain Injury (RSI) negatively impacts the health and productivity of individuals and corporations. In 2006 the Bureau of Labor and Statistics reported that Repetitive Strain Injuries accounted for 30% of total workplace injuries and illnesses in America. RSI burdens American employers with annual costs as high as twenty billion dollars [2]. Many companies operate internal programs that attempt to mitigate the risk of RSI to improve the health and well being of their employees. Existing corporate programs typically focus on physical workstation set up and mechanisms that assist workers to take breaks at regular intervals. These strategies can be successful but they require active participation from workers to be effective and they do not examine one of the fundamental activities users perform while sitting at a computer, which is interacting with computer software. ExxonMobil1, Schlumberger, University of Houston-Clear Lake and Rice University have joined efforts to develop tools that can be used to measure and understand computer software's impact on the incidents of RSI. One of our primary goals is to create a short survey that measures software's potential impact on RSI. When companies are considering purchasing software, decision makers can use the survey measurements as part of their efforts to manage and mitigate the risk of RSI more effectively. Companies that design software for internal or external distribution can also make use of this information to design software that is more ergonomic. Introduction: Cumulative Trauma Disorder (CTD) and/or Repetitive Strain Injury (RSI) result from micro-traumas, that, if taken one by one, would not result in a noticeable injury, but when these micro-traumas occur repeatedly over short periods of time, their cumulative effect can result in an injury [1]. A micro-trauma could be someone having direct contact with a hard surface. This hard surface can put pressure on a variety of body parts including nerves, tendons, muscles, and may also interfere with blood flow. Another example is when someone holds his or her hand in an awkward position for an extended period of time. This static posture puts strain on the nerves, muscles, and tendons. The likelihood of injury increases significantly if the micro-traumas go untreated or people do not rest between the micro-traumas. Other factors that may lead to injuries may also include environmental factors, repetition, and forceful muscle exertion.

We report here on a novel 3-axis MEMS accelerometer intended to meet the requirements of a high volume, very low cost sensor in consumer gaming and hand-held applications. In order to balance the performance and cost requirements of such applications, this device achieves 3-axis sensing with a single proof-mass. This accomplishment required significant process, device, and test design novelty. Because of the extreme cost constraints in these markets, this design reexamines the core system trade-offs between single-chip integrated and 2-chip MEMS solutions. A 2-chip solution was chosen in this case. Minimizing package costs lead to the use of chip stacking in an over-molded plastic package. Finally, a sophisticated method of probing the sensor-only die was developed, which allowed the further development of a “no-shake” sensitivity trim algorithm which does not require mechanical stimulation of the device. Based on the design methodologies described here, a very low cost sensor with superior performance was achieved. The acceleration sensitivity achieved is 300mV/g with a noise limited resolution of 150 µg/√Hz. The offset voltage temperature coefficient is less than 0.3mV/degC.

The use of computers in the workplace is now commonplace. Correspondingly, injuries associated with computer use have increased. However, little research has been done investigating whether these injuries are associated with the software being used. One reason is the difficulty in measuring muscle strain (a predictor of muscle related injuries). Here we present preliminary results of study on the relationship between objective and subjective measures of muscle strain during computer use. As users completed sets of tasks using MSWord®, SEMG muscle activity was recorded for the muscles associated with using a keyboard and mouse. After each task set, users completed surveys asking the level of strain they experienced during the tasks. Correlations between the measures suggest that subjective measures can provide reliable information regarding the muscle strain associated with software use. These easily obtained subjective measurements could assist in producing software interaction designs that are better for users.