München, Univ., Diss., 2001. / Computerdatei im Fernzugriff.

München, Univ., Diss., 2001. / Computerdatei im Fernzugriff.

MATERIALI E METODI: Tra il 2012 e il 2013, abbiamo analizzato in uno studio prospettico i dati di 48 pazienti sottoposti a ThuLEP con approccio autodidatta. I pazienti sono stati rivalutati a 3, 6, 12 e 24 mesi con la valutazione del PSA, il residuo post-minzionale (RPM), l'uroflussometria (Qmax), l'ecografia transrettale e questionari validati (IPSS: international prostate symptom score e QoL: quality of life) RISULTATI: Il volume medio della prostata è di 63 ± 5,3 ml. Il tempo operatorio medio è stato di 127,58 ± 28.50 minuti. Il peso medio del tessuto asportato è stato di 30,40 ± 13,90 gr. A 6 mesi dopo l'intervento l'RPM medio è diminuito da 165,13 ± 80,15 ml a 7,78 ± 29.19 ml, mentre il Qmax medio è aumentato da 5.75 ± 1.67ml / s a 18.1 ± 5.27 ml / s. I valori medi dei IPSS e QoL hanno dimostrato un progressivo miglioramento: da 19.15 (IQR: 2-31) e 4 (IQR: 1-6) nel preoperatorio a 6.04 (IQR: 1-20) e 1.13 (IQR: 1-4), rispettivamente. Durante la curva di apprendimento si è assistito ad un progressivo aumento del peso del tessuto enucleato e ad una progressiva riduzione del tempo di ospedalizzazione e di cateterismo. Tra le principali complicanze ricordiamo un tasso di incontinenza transitoria del 12,5% a 3 mesi e del 2.1% a 12 mesi. CONCLUSIONI: ThuLEP rappresenta una tecnica chirurgica efficace, sicura e riproducibile indipendentemente dalle dimensioni della prostata. I nostri dati suggeriscono che la ThuLEP offre un miglioramento significativo dei parametri funzionali comparabili con le tecniche tradizionali, nonostante una lunga curva di apprendimento. / MATERIALS AND METHODS: Between 2012 and 2013, we prospectively analyzed the data of the first 48 patients who underwent Thulium Laser enucleation of the prostate (ThuLEP). Patients were reassessed at 3, 6, 12 and 24 months with evaluation of the PSA, post-void volume (PVR), uroflowmetry (Qmax), transrectal ultrasonography and validated questionaires (IPSS: International Prostate Symptom Score and QoL: Quality of Life). RESULTS: The mean volume of the prostate was 63 ± 5.3 ml. The mean operative time was 127.58 ± 28.50 minutes. The mean weight of the removed tissue was 30.40 ± 13.90 gr. At 6 month follow up, the mean PVR decreased from 165.13 ± 80.15 ml to 7.78 ± 29.19 ml, while the mean Qmax flow rate increased from 5.75 ± 1.67 ml/s to 18.1 ± 5:27 ml/s. The mean IPSS and QoL showed a steady improvement from 19.15 (IQR: 2-31) and 4 (IQR: 1-6) preoperatively to 6.04 (IQR: 1-20) and 1.13 (IQR: 1-4) respectively. During the learning curve, the weight of the enucleated tissue, the time of hospital stay and the catheter time improved significantly. The main complications included transient stress incontinence (12.5% ​​at 3 months and 2.1% at 12 months). CONCLUSIONS: ThuLEP is an effective, safe and reproducible surgical technique, regardless of the prostate size. Our data suggest that ThuLEP offers a significant improvement in functional outcomes comparable with traditional techniques despite a long learning curve.

Aim of the present study was to evaluate the accuracy of transrectal ultrasound biopsy (TRUS-biopsy) directed to regions with abnormal MRI and/or MRSI (magnetic resonance spectroscopic imaging ) for both the transition (TZ) and the peripheral (PZ) zones in patients who presented with persistent suspect for prostate cancer and with prior negative biopsy. We also evaluated relationship between MRSI results and histopathological findings of biopsy. 54 patients with the aforementioned characteristics underwent MRI/MRSI at least 6 months after prior negative biopsy; interval between MRI/3D-MRSI and the further TRUS-biopsy was less than 3 months. The prostate was divided in 12 regions both for imaging interpretation and biopsy. Moreover one to three cores more were taken from each region with abnormal MRI and/or 3D-MRSI. Twenty-two out of 54 patients presented cancer at MRI/MRSI-directed-TRUS-biopsy. On a patient basis the highest accuracy was obtained by assigning malignancy on a positive finding with MRSI and MRI even though it was not significantly greater than that obtained using MRI alone (area under the ROC curve, AUC: 0.723 vs. 0.676). On a region (n=648) basis the best accuracy was also obtained by considering positive both MRSI and MRI for PZ (0.768) and TZ (0.822). Twenty-eight per cent of cores with prostatitis were false positive findings on MRSI, whereas only 2.7% of benign prostatic hyperplasia was false positive. In conclusion the accuracy of MRI/MRSI-directed biopsies in localization of prostate cancer is good in patient and region analyses. The combination of both MRI and MRSI results makes TRUS-biopsy more accurate particularly in the TZ (0.822) for patients with prior negative biopsies. Histopathological analysis showed that the main limitation of MRSI is the percentage of false positive findings due to prostatitis.

Introduction Lower pole kidney stones represent at time a challenge for the urologist. The gold standard treatment for intrarenal stones <2 cm is Extracorporeal Shock Wave Lithotripsy (ESWL) while for those >2 cm is Percutaneous Nephrolithotomy (PCNL). The success rate of ESWL, however, decreases when it is employed for lower pole stones, and this is particularly true in the presence of narrow calices or acute infundibular angles. Studies have proved that ureteroscopy (URS) is an efficacious alternative to ESWL for lower pole stones <2 cm, but this is not reflected by either the European or the American guidelines. The aim of this study is to present the results of a large series of flexible ureteroscopies and PCNLs for lower pole kidney stones from high-volume centers, in order to provide more evidences on the potential indications of the flexible ureteroscopy for the treatment of kidney stones. Materials and Methods A database was created and the participating centres retrospectively entered their data relating to the percutaneous and flexible ureteroscopic management of lower pole kidney stones. Patients included were treated between January 2005 and January 2010. Variables analyzed included case load number, preoperative and postoperative imaging, stone burden, anaesthesia (general vs. spinal), type of lithotripter, access location and size, access dilation type, ureteral access sheath use, visual clarity, operative time, stone-free rate, complication rate, hospital stay, analgesic requirement and follow-up time. Stone-free rate was defined as absence of residual fragments or presence of a single fragment <2 mm in size at follow-up imaging. Primary end-point was to test the efficacy and safety of flexible URS for the treatment of lower pole stones; the same descriptive analysis was conducted for the PCNL approach, as considered the gold standard for the treatment of lower pole kidney stones. In this setting, no statistical analysis was conducted owing to the different selection criteria of the patients. Secondary end-point consisted in matching the results of stone-free rates, operative time and complications rate of flexible URS and PCNL in the subgroup of patients harbouring lower pole kidney stones between 1 and 2 cm in the higher diameter. Results A total 246 patients met the criteria for inclusion. There were 117 PCNLs (group 1) and 129 flexible URS (group 2). Ninety-six percent of cases were diagnosed by CT KUB scan. Mean stone burden was 175±160 and 50±62 mm2 for groups 1 and 2, respectively. General anaesthesia was induced in 100 % and 80% of groups 1 and 2, respectively. Pneumo-ultrasonic energy was used in 84% of cases in the PCNL group, and holmium laser in 95% of the cases in the flexible URS group. The mean operative time was 76.9±44 and 63±37 minutes for groups 1 and 2 respectively. There were 12 major complications (11%) in group 1 (mainly Grade II complications according to Clavidien classification) and no major complications in group 2. Mean hospital stay was 5.7 and 2.6 days for groups 1 and 2, respectively. Ninety-five percent of group 1 and 52% of group 2 required analgesia for a period longer than 24 hours. Intraoperative stone-free rate after a single treatment was 88.9% for group 1 and 79.1% for group 2. Overall, 6% of group 1 and 14.7% of group 2 required a second look procedure. At 3 months, stone-free rates were 90.6% and 92.2% for groups 1 and 2, respectively, as documented by follow-up CT KUB (22%) or combination of intra-venous pyelogram, regular KUB and/or kidney ultrasound (78%). In the subanalysis conducted comparing 82 vs 65 patients who underwent PCNL and flexible URS for lower pole stones between 1 and 2 cm, intreoperative stone-free rates were 88% vs 68% (p= 0.03), respectively; anyway, after an auxiliary procedure which was necessary in 6% of the cases in group 1 and 23% in group 2 (p=0.03), stone-free rates at 3 months were not statistically significant (91.5% vs 89.2%; p=0.6). Conversely, the patients undergoing PCNL maintained a higher risk of complications during the procedure, with 9 cases observed in this group versus 0 in the group of patients treated with URS (p=0.01) Conclusions These data highlight the value of flexible URS as a very effective and safe option for the treatment of kidney stones; thanks to the latest generation of flexible devices, this new technical approach seems to be a valid alternative in particular for the treatment of lower pole kidney stones less than 2 cm. In high-volume centres and in the hands of skilled surgeons, this technique can approach the stone-free rates achievable through PCNL in lower pole stones between 1 and 2 cm, with a very low risk of complications. Furthermore, the results confirm the high success rate and relatively low morbidity of modern PCNL for lower pole stones, with no difference detectable between the prone and supine position.

Despite the fact that high sodium intake has been linked to high blood pressure and an increased risk for cardiovascular disease (CVD), sufficient and irrevocable evidence to support extremely low dietary sodium intake has been lacking. The best method used for the estimation of daily sodium intake is indirectly by using 24-hour urinary sodium excretion, combined with para-aminobenzoic acid (PABA), which is used for validating completeness of urinary collection. However, the PABA validation method is not favored among researchers and the validity of high-performance liquid chromatography (HPLC) analysis for PABA has not been evaluated in a large-scale study. This study validated an improved PABA HPLC method and applied it in the sub-set of the Prospective Urban Rural Epidemiology (PURE) – 24-hour Urinary Excretion (24USE) Study for the examination of the sodium-blood pressure association. In addition, participants’ self-reported assessment of urinary collection completeness was compared to the PABA method. The HPLC analysis method for measuring PABA levels was downscaled and the reaction time lengthened to achieve higher through-put and reaction yield. By applying the optimized PABA method for evaluating urinary completeness, 612 of 681 participants’ samples contained 70%-110% PABA recovery and were extracted from the PURE24USE Study for further analysis. The average adjusted sodium excretion or intake was 3,673 ± 1,637 mg/day. The participants’ self-reports predict urinary collection completeness as measured by PABA with a sensitivity of 76.9% (95% CI: 74.4%-79.6%) and specificity of 31.7% (95% CI: 27.0%-36.4%). This moderate agreement suggests that PABA still has to be considered the gold standard, until further convincing evidence is available that self-report is more accurate than PABA. / Thesis / Master of Science in Medical Sciences (MSMS)

Aujourd’hui, l’amélioration des fréquences de coupure des transistors MOS et bipolaires ouvre la voie à de nouvelles applications THz (communication et imagerie au-delà de 110 GHz). Des méthodologies de test concernant la caractérisation en bruit hyperfréquence des transistors jusque 170 GHz ont été mises en place dans la cadre du laboratoire commun entre STMicroelectronics et l’IEMN. Cependant, une des limitations principales à la conception d’un outil de caractérisation en bruit au-delà de 170 GHz est le manque de source de bruit état-solide à ces fréquences. Cette thèse propose un nouveau type de source de bruit aux fréquences millimétriques pouvant fonctionner au-delà de 170 GHz, basée sur une solution photonique intégrée sur silicium. Cette source de bruit photonique repose sur l’éclairage d’une photodiode en germanium sur silicium par une source optique qui sera alors convertit en un bruit blanc électrique. / Today high frequency MOS and bipolar transistors are opening new opportunities for THZ applications (communication and imagery beyond 110 GHz). High frequency noise characterization test methodologies up to 170 GHz have been set up in a shared collaboration between STMicroelectronics and IEMN laboratory. Nevertheless, one of the most important limitations of noise characterization above 170 GHz is the solid-state noise source lack at these frequencies. This study proposes a new concept of noise source working at millimeter wave frequencies above 170 GHz, based on a photonic integrated on silicon solution. This photonics noise source concept relies on a Germanium-on-Silicon photodiode lighted by an optical source and converting it into an electrical noise.

Abstract in HTML and technical report in HTML and PDF available on the Massachusetts Institute of Technology Joint Program on the Science and Policy of Global Change website (http://mit.edu/globalchange/www/). / Includes bibliographical references (p. 12-14).

Universiẗat, Diss., 2001--München.

Avec la multiplication des systèmes électroniques analogiques et numériques embarqués dans les moyens de transports actuels, l’environnement électromagnétique (EM) devient de plus en plus riche en signaux de toutes sortes et, donc, il devient plus complexe à caractériser. Dans ces travaux de thèse, nous nous intéressons au GSM-R (Global System for Mobile communications - Railways). Il s’agit du nouveau système de communication radio numérique portant la signalisation actuellement en cours de déploiement sur le réseau ferroviaire européen afin d'assurer l'interopérabilité des TGV. Ainsi, tous les pays d’Europe utiliseront le même système, ce qui facilitera la circulation des trains transfrontaliers d’un pays à l’autre. En environnement ferroviaire, le GSM-R doit faire face à différentes sources de bruit EM, notamment aux perturbations EM transitoires provenant du contact glissant entre la caténaire et le pantographe. Ces perturbations couvrent de larges bandes de fréquences dont, potentiellement, celles du GSM-R. Nous proposons une méthode de classification qui permet de prédire l’effet des perturbations EM transitoires sur la qualité des transmissions GSM-R. Cette méthode de classification pourrait être mise en place à bord des trains où elle permettrait d’identifier et localiser les zones critiques pour la qualité des transmissions GSM-R. Du point de vue de la standardisation, ces travaux de recherche pourraient contribuer à l’évolution nécessaire des équipements et des méthodologies définies dans les normes CEM afin de s’adapter aux nouvelles problématiques émanant de la multiplicité des systèmes et protocoles de communication sans fils employés dans le monde des transports. / With the proliferation of analog and digital electronic systems in the current means of transport, the electromagnetic (EM) environment becomes richer and richer in all kinds of signals and, therefore, it becomes more difficult to characterize.In this thesis, we focus on a particular digital system: the GSM-R (Global System for Mobile communications - Railways). It is the new digital radio communication system under deployment on the European rail network in order to ensure the interoperability of high-speed trains in Europe. Then, all countries in Europe will use the same system, which will facilitate the movement of cross-border trains from a country to another one. In the railway environment, the GSM-R is subject to different EM noise sources, including transient EM interferences coming from the sliding contact between the pantograph and the catenary. These disturbances cover wide frequency bands including, potentially, those of the GSM-R system. We propose a classification method for predicting the effect of transient EM disturbances on the quality of GSM-R transmissions.This classification method could be implemented on trains where it could identify and locate critical areas for the quality of GSM-R transmissions along the journey. From the point of view of standardization, these research works could contribute to the necessary evolution of equipment and methods defined in EMC standards in order to cover the new problems arising from the multiplicity of wireless communication systems and protocols employed nowadays in the world of transports.