Primordial Follicle Transplantation within Designer Biomaterial Grafts Produce Live Births in a Mouse Infertility Model.

The gonadotoxic effects of chemotherapy and radiation may result in premature ovarian failure in premenopausal oncology patients. Although autotransplantation of ovarian tissue has led to successful live births, reintroduction of latent malignant cells inducing relapse is a significant concern. In this report, we investigated the design of biomaterial grafts for transplantation of isolated ovarian follicles as a means to preserve fertility. Primordial and primary ovarian follicles from young female mice were extracted and encapsulated into biomaterials for subsequent transplantation into adult mice. Among the formulations tested, aggregated follicles encapsulated within fibrin had enhanced survival and integration with the host tissue following transplantation relative to the fibrin-alginate and fibrin-collagen composites. All mice transplanted with fibrin-encapsulated follicles resumed cycling, and live births were achieved only for follicles transplanted within VEGF-loaded fibrin beads. The extent to which these procedures reduce the presence of metastatic breast cancer cells among the isolated follicles was evaluated, with significantly reduced numbers of cancer cells present relative to intact ovaries. This ability to obtain live births by transplanting isolated primordial and primary follicles, while also reducing the risk of re-seeding disease relative to ovarian tissue transplantation, may ultimately provide a means to preserve fertility in premenopausal oncology patients.

[Instrumental extractions using Thierry's spatulas: evaluation of the learning curve]. / Évaluation de la courbe d'apprentissage des extractions par spatules de Thierry.

OBJECTIVES: To determine the learning curve of fetal extractions with Thierry's spatulas. PATIENTS AND METHODS: Single-center prospective study following the progress of six residents in obstetrics and gynecology in learning fetal extractions by Thierry's spatulas. The instrumental extractions procedures performed by the residents were evaluated by the senior obstetrician on call according to a validated scoring rubric. In parallel, the residents would fill out a questionnaire on their own perception of their abilities at the time of the procedure. RESULTS: The six residents participated in 160 extractions using Thierry's spatulas between November and May 2011. Sixty-three (39.6%) were evaluated, i.e. an average number of 12±6 extractions per resident. After validating respectively 0, 1, 2 or 3 semesters, the mean global assessment scores (graded out of 5) obtained by the residents were 3.54, 3.18, 4.43 and 4.61. The overall average score was significantly higher when the resident participated in more than 20 extractions before the studied extraction (4.0 vs. 3.7, P<0.001). After attending more than 20 extractions, no resident had obtained the maximum evaluation score of 5/5 nor was deemed capable of performing extractions without supervision. DISCUSSION AND CONCLUSIONS: Learning extractions with Thierry's spatulas, including an objective assessment by senior doctors and a self-assessment by the residents, is a constant process over the first six months of training. Specific training simulator should be developed to enable students to achieve a threshold number of extractions, ensuring the safety of the procedure in the birthing rooms.

[Ipsilateral dual kidney transplantation: a monocentric experience about 15 cases and literature review]. / Bi-transplantation rénale par abord ipsilatéral: expérience d'un centre à propos de 15 patients opérés consécutivement et revue de la littérature.

OBJECTIVE: Our study aimed to support the viability of the concept of Ipsilateral Dual Kidney Transplantation (DKT) by presenting our initial experience and proposing a review of the literature in this subject. METHODS: Fifteen ipsilateral DKT were performed at Nice University Hospital between August 2010 and March 2012. We have described our skin incision preferences, the vascular anastomoses, and the uretero-vesical reimplantation. We have analyzed the operative duration, the cold ischemia time (CIT) of both transplants, the blood transfusion volume, the intraoperative and postoperative complications, the time to diuresis recovery, the hospital stay, and the kinetics of the creatinine clearance until the third postoperative month. We have compared our results with those of the literature. RESULTS: The average CIT of the first transplant (T1) was 17.5 ± 3.3 hours, and that of the second (T2) was 18.4 ± 3.3 hours. The mean operating time was 234 ± 67 minutes. Patients received an average of 2 units of blood during surgery [0-4] and 1.8 units in the postoperative period [0-15]. The complications rate was 26.7% and included an intraoperative T2 artery thrombosis and 3 postoperative complications consistent with a hematoma, a T2 ureteric necrosis and a T2 venous thrombosis. Two transplants were lost (6.7%) and one death (6.7%) was reported on day 40. The average length of hospital stay was 20.9 ± 7.8 days. The mean creatinine clearance values were 12.6 mL/min at D2, 35.6 mL/min at D7, 44.9 mL/min on discharge, and 48.2 mL/min at D90. CONCLUSION: Our results supported the viability of the dual kidney transplantation concept. Furthermore the ipsilateral approach shortened the procedure and limited the surgical trauma by preserving the contralateral iliac fossa, without compromising renal function recovery or increasing morbidity.

[Photovaporisation of the prostate using KTP laser in patients on antithrombotics. About a restrospective study of 120 cases]. / Photovaporisation prostatique avec le laser KTP chez les patients sous traitement antithrombotique. À propos d'une étude rétrospective sur 120 cas.

UNLABELLED: Antithrombotic (AT) medications are more and more prescribed, so complicating the surgery of benign prostatic hyperplasia (BPH). KTP laser is an alternative to the transurethral resection of the prostate thanks to its haemostatic properties. OBJECTIVES: To study the functional outcomes and complications of KTP 80W laser treatment in patients taking AT, comparing with patients without AT (nAT). PATIENTS AND METHODS: A single-center retrospective study has been conducted in the department of Urology of Nice Teaching Hospital, in patients with uncomplicated symptomatic BPH, treated with the KTP 80W laser treatment, between November 2005 and October 2009. The cohort was divided into two matched groups AT/nAT. In the AT group patients, treatment with aspirin and vitamin K antagonist (VKA) were maintained, whereas clopidogrel was discontinued. The urinary flowmetry, measurement of residual urine, International Prostate Symptom Score (IPSS) and question 8 of the IPSS score were analyzed. The duration of intervention, the amount of laser energy delivered, duration of catheterization and postoperative hospitalization, and the rate of blood transfusion have been evaluated. Clavien classification was used to characterize the postoperative complications. RESULTS: A total of 120 patients were included in two groups (50 AT/70 nAT), with a median follow-up of 24 months. The two study groups were comparable except for age which was significantly higher in patients on AT (P=0.001). The average duration of operation, of catheterization and hospital stay were significantly longer in patients receiving AT. Seven complications were reported in the AT group versus three complications in the nAT. No significant difference was reported on the evaluation of voiding parameters and IPSS score. CONCLUSION: Photovaporisation of the prostate using KTP 80W laser treatment provided functional outcomes comparable in patients on AT and untreated patients, with minimal risk of complication.

[Who limit vaginal birth for breech presentation: medical practice or Law? Discussion between a medical doctor, a lawyer and the head chief of an university hospital]. / Qui limite l'apprentissage obstétrical et la pratique de l'accouchement de la présentation du siège par voie basse : la médecine ou le droit? Discussion entre un praticien, un avocat et un responsable de service universitaire.

The mode of delivery of breech presentation still remains a debate in France. Despite the medical arguments, themselves in debate, exists a legal pressure felt by medical practitioners. Our study highlights the different opinions of medical practitioners, lawyers and medical teachers faced with breech presentation.