OBJECTIVESTo evaluate the management of acute urinary retention (AUR) associated with benign prostatic hyperplasia (BPH) in real-life practice.To identify predictors of successful trial without catheter (TWOC).MATERIALS AND METHODSIn all, 6074 men catheterized for painful AUR were enrolled in a prospective, cross-sectional survey conducted in public and private urology practices in France, Asia, Latin America, Algeria and the Middle East.Patient clinical characteristics, type of AUR and its management (type of catheterization, hospitalization, TWOC, use of α1-blockers, immediate or elective surgery) and adverse events observed during the catheterization period were recorded.Predictors of TWOC success were also analysed by multivariate regression analysis with stepwise procedure.RESULTSOf the 6074 men, 4289 (71%) had a spontaneous AUR and 1785 (29%) had a precipitated AUR, mainly as the result of loco-regional/general anaesthesia (28.5%) and excessive alcohol intake (18.2%).Presence of BPH was revealed by AUR in 44% of men. Hospitalization for AUR varied between countries, ranging from 1.7% in Algeria to 100% in France. A urethral catheter was inserted in most cases (89.8%) usually followed by a TWOC (78.0%) after a median of 5 days. Overall TWOC success rate was 61%.Most men (86%) received an α1-blocker (mainly alfuzosin) before catheter removal with consistently higher TWOC success rates, regardless of age and type of AUR. Multivariate regression analysis confirmed that α1-blocker before TWOC doubled the chances of success (odds ratio 1.92, 95% CI 1.52–2.42, P < 0.001).Age ≥70 years, prostate size ≥50 g, severe lower urinary tract symptoms, drained volume at catheterization ≥1000 mL and spontaneous AUR favoured TWOC failure. Catheterization >3 days did not influence TWOC success but was associated with increased morbidity and prolonged hospitalization for adverse events.In the case of TWOC failure, 49% of men were recatheterized and had BPH surgery and 43.5% tried another TWOC with a success rate of 29.5%. Elective surgery was preferred to immediate surgery.CONCLUSIONSTWOC has become a standard practice worldwide for men with BPH and AUR.In most cases, an α1-blocker is prescribed before TWOC and significantly increases the chance of success.Prolonged catheterization is associated with an increased morbidity.

We present the surgical technique and rationale for the management of breast implants in two patients who underwent mitral valve repair through a right minithoracotomy.

Vascular closing devices (VCDs) are widely used to replace manual compression at the femoral puncture site and to reduce the discomfort of patients undergoing percutaneous coronary procedure by shortening bed rest. Among the vascular complications related to these devices, the femoral artery stenosis or occlusion is rarely reported, and its standard management is not well established. We report a case of symptomatic femoral artery stenosis caused by suture-mediated VCD and managed using rotational atherectomy device and balloon angioplasty. In addition, we propose the possible mechanisms for this complication.

A new natural terpenoid, ixoroid (1), was isolated from the flower of Ixora coccinea, along with the known constituents stigmast-5-en-3-O-β-D-glucoside (2), 5-O-caffeoylquinic acid (3) and D-mannitol (4). The structure of ixoroid was elucidated on the basis of extensive 1D-and 2D-NMR studies and mass spectrometry as 21,23-epoxy-tirucall-7-en-3β-ol (1).

Objective: Percutaneous nephrolithotomy (PCNL) is most frequently performed procedure for renal stones 2 cm and larger. Perioperative hemorrhage being most common complication, warrants as important predicting factor of adverse outcomes. Prevention with inexpensive and safe drug like tranexamic acid (TA) would ultimately turn out to be cornerstone for establishing future guidelines. Aim of this study is to evaluate whether TA is efficacious in preventing blood loss during PCNL. Materials and Methods: Ethical review board approval taken. Sample size calculation yielded 240 patients, comprising 120 in each group. Group A receiving TA and group B receiving placebo. Age, gender, body mass index (BMI), stone size, volume and location, preoperative blood count, creatinine, urine analysis, coagulation profile and necessary radiological investigations done. Randomization through lottery method. Both patient and investigator were blinded. Hemoglobin (Hb) and hematocrit (Hct) levels done at 24 hours postoperatively and fall in values recorded. Results: Both groups were equal in characteristics like age, gender, BMI, stone size, volume and location (p>0.05). Operative variables like calyx punctured, position of puncture and operative time were also found to be similar in both groups. Median change in Hb in placebo group was 1.6 interquartile range (IQR) 4, while in TA group was 1.3 (IQR 7.8) (p=0.001). Similarly, median change in Hct level in placebo group was 3.6 (IQR 11.8) and in TA group was 2.4 (IQR 13) (p<0.001). Sixteen patients were transfused after surgery; 12 (75%) belonged to placebo group while 4 (25%) belonged to TA group (p=0.038). Hospital stay was not significantly different in both groups (p=0.177) with median of 4.0 and IQR of 0 in both groups. Conclusion: TA during PCNL reduces blood loss and minimizes blood transfusion rate.Amaç: Perkütan nefrolitotomi (PNL), 2 cm ve daha büyük böbrek taşları için en sık uygulanan prosedürdür. Perioperatif kanama en yaygın komplikasyon olup, istenmeyen sonuçların öngörülen önemli faktörüdür. Traneksamik asit (TA) gibi ucuz ve güvenli ilaçlarla önleme, nihayetinde gelecek kılavuz ilkeleri oluşturmak için temel taş haline dönüşebilir. Bu çalışmanın amacı, TA'nın PNL sırasında kan kaybını önlemede etkili olup olmadığını değerlendirmektir. Abstract Öz What's known on the subject? and What does the study add?Percutaneous nephrolithotomy is most frequently performed procedure for renal stones measuring 2 cm. Perioperative hemorrhage being most common complication, warrants as important predicting factor of adverse outcomes. Prevention with inexpensive safe drug like Tranexamic acid would ultimately turn out to be cornerstone for establishing future guidelines. Currently there is only one study published internationally highlighting this notion. Therefore this study will be beneficial for researchers in shaping the current practices.

No abstract

Bovine brucellosis is a contagious zoonotic disease that causes economic losses through abortion and infertility. A cross-sectional study was designed to determine the seroprevalence and associated risk factors of bovine brucellosis in district Gujranwala of Punjab, Pakistan. A total of 220 bovine sera (112 from buffaloes, 108 from cattle) from 46 unvaccinated herds were collected. Parallel testing by the Rose Bengal Plate Test (RBPT) and Indirect Enzyme-linked Immunosorbent Assay (I-ELISA) showed a 58.7% (27/46) herd-level and 22.7% (50/220) animal-level seroprevalence. Seroprevalence was higher (p < 0.001, OR = 7.62) in adult animals (37.2%) compared to younger animals (4.9%). A herd size of >10 animals (p = 0.021, OR = 7.83), less housing space (p = 0.037, OR = 6.39) and history of abortion at the farm (p = 0.023, OR = 5.6) were found as risk factors associated with the seropositivity of brucellosis. There was a substantial agreement between the RBPT and I-ELISA results (Cohen’s kappa coefficient (κ) = 64.16, percent agreement = 89.5%). In conclusion, a relatively higher seroprevalence was found compared to the previous reports from the country. Standardization and validation of the advanced diagnostic tests would be needed. Biosecurity, personal protection, quarantine measures and routine screening of animals at the farm level and disease awareness programs and consumption of pasteurized milk in the human population will be helpful in preventing the transmission/zoonosis of the disease.

Objectives: To compare ureterovesical jet frequency in non-obstructed versus obstructed ureter secondary to ureteric stone using ultrasonography in patients presenting with ureteral stones.Study design: Cross-sectional prospective study.