Search

Background: Robot-assisted pyeloplasty is the most frequently performed robotic procedure in children. A retroperitoneal approach limits surgical trauma and avoids peritoneal irritation. This led to the establishment of the criteria for day surgery (DS) and a related clinical care pathway., Objective: To assess the feasibility and safety of DS in children undergoing retroperitoneal robot-assisted laparoscopic pyeloplasty (R-RALP)., Design Setting and Participants: We performed a bicentric prospective study (NCT03274050) over 2 yr involving the two major paediatric urology teaching hospitals in Paris. A clinical pathway and a prospective research protocol were specifically established., Intervention: DS in selected children undergoing R-RALP., Outcome Measurements and Statistical Analysis: The primary outcomes were DS failure, 30-d complications, and readmission rates. The secondary outcomes included preoperative characteristics, perioperative parameters, and surgical outcomes. Quantitative variables were expressed as medians with interquartile ranges., Results and Limitations: Thirty-two children fulfilled specific inclusion criteria and were consecutively selected for DS following R-RALP. The median patient age was 7.6 yr (4.1-11.8) and weight 25 kg (14-45). The median console time was 137 min (108-167). There were no intraoperative complications or conversions. Six children were kept under observation overnight and discharged the following day due to persistent pain ( n  = 3), parental anxiety ( n  = 2), or a prolonged procedure ( n  = 1). The median duration of hospital stay of the 26 children in the DS setting was 12.7 h (12.2-13.2). During the 30-d period, there were four emergency room visits (15%) resulting in two patients requiring readmission (8%): one for febrile urinary tract infection (Clavien-Dindo II) and one child with no JJ stent for urinoma (Clavien-Dindo IIIb). Radiological studies confirmed improvement in dilatation for all cases with no recurrence (median follow-up: 15 mo)., Conclusions: This prospective case series is the first to demonstrate the feasibility and safety of DS in children undergoing R-RALP, obviating the need for routine inpatient care. Excellent results can be achieved by careful patient selection, a clear clinical pathway, and a dedicated team. Further evaluation is warranted to assess the cost effectiveness., Patient Summary: This study shows that day surgery after robotic pyeloplasty is both safe and effective in selected children., (© 2023 The Author(s).)

In order to examine the effect of endothelin (ET-1) as a growth factor, vascular smooth muscle cells were isolated from aortas of spontaneously hypertensive (SHR) and control (WKY) rats. Cell proliferation was determined by measurement of labelled 3H-thymidine incorporation in quiescent cells in presence of ET-1 alone or in association with another growth factor, insulin (INS). ET-1 alone (0.1 to 100 nM) increased slightly the growth of both types of cells. This effect was enhanced in presence of INS (0.1 to 10 micrograms/ml). SHR cells were more reactive than control ones. Activation of Na+/H+ exchange which is a necessary response for mitogenesis was dose dependently observed with increasing concentrations of ET-1 (0.1 to 100 nM) further confirming that ET-1 could act as a growth factor for vascular smooth muscle cells.

Cytomegalovirus is frequently isolated from immunosuppressed patients or from patients with acquired immunodeficiency syndrome. Twelve patients were studied for several months. In 7 patients more than 1 Cytomegalovirus was isolated; in one of these patients three viruses were isolated, two of them show small differences in their migration pattern and the third seems to be a different strain after restriction analysis of CMV genome. This could reflect variation in the genome of the CMV virus as it has been already shown for viruses from other families in immunocompromised patients and shows the occurrence of multiple strains infection in a single patient.

Endothelin is a potent vasoconstrictor peptide isolated from the conditioned medium of porcine aortic endothelial cells. The action of endothelin is thought to be associated with calcium entry via calcium potential channels (Yanagisawa et. al. Nature 1988; 38:411-415). The present study was designed to determine the effect of endothelin on calcium fluxes (influx and efflux) on rat aortic smooth muscle cells in culture. The unidirectional influx of calcium was measured 15, 45, 75 and 105 seconds after the addition of trace amounts of 45Ca++ (5 microCi/ml) to the cells incubated with or without endothelin. Endothelin (50nM) stimulated calcium influx from a basal level of 312 +/- 17 to 537 +/- 12 pmol/mn/10(6) cells. This stimulation was dose-dependent with an EC50 value of about 10 nM. When cells were preincubated with calcium antagonists (nifedipine, dilttiazem, D600, nicardipine and flunarizine) at a final concentration of 1 microM, the endothelin-stimulated calcium influx was not modified. The unidirectional efflux of calcium was measured after an overload of cells with 45Ca++ (5 microCi/ml) for 18 hours, over 10 seconds intervals. In the first 30 seconds after the addition of endothelin (100 nM), the amount of 45Ca++ released was 3 times that in the absence of the peptide. The effect of endothelin was concentration dependent and similar to those observed with other vasoconstrictor peptides (vasopressin and angiotensin II). The results indicate that endothelin does not directly act on voltage-dependent calcium channels. The endothelin-stimulated calcium efflux suggests a mobilization of calcium from intracellular store sites followed by extrusion through an activation of a specific receptor-dependent calcium channel.

The effect of cicletanine, a new antihypertensive drug, on histamine-induced Ca2+ release in cultured vascular smooth muscle cells from guinea-pig aorta was examined. In 45Ca2+ labelled cells, histamine increased in a dose-dependent manner the Ca2+ efflux (EC50 = 8 x 10(-6) M). This stimulation of 45Ca2+ efflux was also observed with an H1-agonist [2-pyridylethylamine dihydrochloride (2-PEA)] but not with an H2-agonist (dimaprit). Histamine- or 2-PEA-induced 45Ca2+ efflux was inhibited by an H1-antagonist (mepyramine), whereas an H2-antagonist (cimetidine) had no effect. Cicletanine was as effective as the H1-antagonist in inhibiting histamine- or 2-PEA-stimulated 45Ca2+ efflux in a dose-dependent manner (IC50 = 10(-6) M). Only the racemic form and the R(-) enantiomer of cicletanine behaved as histaminergic antagonists, the S(+) enantiomer having no effect. These results suggest that the direct effect of cicletanine on the mobilization of Ca2+ by blocking H1-receptors may participate in an antihypertensive mechanism by producing relaxation of blood vessels.