[Open versus laparoscopic radical prostatectomy: a French center experience]. / Prostatectomie radicale ouverte versus laparoscopique: expérience d'un centre français.

OBJECTIVE: To compare peri-operative outcomes of open radical prostatectomy (ORP) to laparoscopic radical prostatectomy (LRP) in a single French institution. METHODS: Between 1998 and 2003, 72 patients underwent ORP followed by 279 LRP between 2003 and 2010 for a clinically localized prostate cancer. Demographic, peri-operative and pathological data in the ORP and LRP groups were analyzed and compared. RESULTS: In the ORP group, compared to the LRP group, the following significant differences were found: patients were older (63.1 years versus 65.6), initial PSA was higher (10.2 ng/mL versus 6.7) and the proportion of T1c was higher (62.8 % versus 80.6 %). Operative blood loss (1500 mL versus 500) and length of hospitalization (9.0 days versus 6.3) were higher in the ORP group (P<0.001). Operative time was longer in the LRP group (250 min versus 160; P<0 .001). There was no significant difference regarding length of catheterization (average of 8.5 days). Anastomotic strictures were more frequent following ORP (P<0.001). Positive margins proportion in the ORP group (7.1 %) was lower than that observed in the LRP group (28.7 %) (P=0.001). Patients in the ORP group achieved early continence more frequently (P<0.01) but at 12 months postoperatively there was no significant difference. CONCLUSION: Patients in the LRP group had lower operative blood losses and a shorter length of hospitalization. However, in the ORP group, operative time was shorter and positive margins rate was lower.

[Pelvic lymph nodes dissection for prostate cancer: Minilap with speculum vs laparoscopy]. / Curage ilio-obturateur pour cancer de prostate : minilaparotomie au spéculum vs coelioscopie.

INTRODUCTION: The pelvic lymph nodes dissection (PLND) is indicated in case of prostate cancer with high risk of ganglionic metastasis. Criteria admitted for indication of PLND are PSA>or=10ng/ml and/or Gleason score >or=7. Two techniques are available for PLND: minilap and laparoscopy. The purpose of this study was to compare retrospectively minilap and the 2 ways of laparoscopy: intra- and extraperitoneum, in terms of efficiency and complications. MATERIAL AND METHOD: We reviewed 147 cases of men who's had a PLND in our department between 1992 and 2006. The distribution for every technique was: 34 cases of minilap (23%), 39 cases of intraperitoneum laparoscopy (27%) and 74 cases of extraperitoneum laparoscopy (50%). The mean age was of 67.9 years (52-79). The mean PSA was 19.01ng/ml (0.3-93) and the average Body Mass Index (BMI) was 26.75kgm(-2) (17.6-41). RESULTS: Twenty-eight patients (19%) presented a postoperating complication. There was no statistically significant difference according to technique. We did not either find statistical difference concerning the number of analyzed nodes between three groups and the duration of hospitalization. Only the mean operating time and the number of drain of Redon were statistically different. CONCLUSION: This study did not show any difference in terms of result and complications between the laparoscopy and minilap for the PLND in case of prostate cancer. We think each technique could be proposed.

[Physiological limits of variations in heart rate measured by the Holter method in 134 normal subjects]. / Etude des limites physiologiques des variations de la fréquence cardiaque par la méthode de Holter chez 134 sujets normaux.

Ambulatory 24 hour electrocardiography by the Holter method was carried out in 134 normal subjects (59 men, 75 women, mean age: 42.5 +/- 14 years). The average heart rate over 24 hours was 75 +/- 9 bpm, 82 +/- 10 bpm during the daytime and 64 +/- 8 bpm at night. Maximal and minimal momentary variations (over 5 minutes) were small during the night (+23% and -7%) and greater during the daytime (+47% and -16%). The heart rate slowed progressively over a two hour period before going to bed an increased progressively over a three hour period, reaching a peak and then slightly falling before getting up. The average heart rates of women were faster than in men (+5 bpm). The average heart rate fell with age from 30 years onwards (-0.4 bpm per year). Tobacco consumption did not seem to affect the heart rate. Supraventricular extrasystoles were observed in 68% of subjects during the day, and in 50% during the night; ventricular extrasystoles occurred in 42% of subjects by day and in 23% by night. Only 22% of subjects had no extrasystolic activity. Tobacco consumption and sex were unrelated to the incidence and frequency of extrasystoles. On the other hand, the incidence and frequency of extrasystoles were very significantly related to age.

Coracoacromial ligament section under ultrasonographic control: a cadaveric study on 20 cases.

INTRODUCTION: The coracoacromial ligament is a complex anatomical structure involved in the development of subacromial impingement; treatment is founded on sectioning the ligament, with or without associated arthroscopic acromioplasty and debridement. HYPOTHESIS: Complete coracoacromial ligament section can be performed under ultrasound, without lesion to surrounding structures. MATERIALS AND METHODS: The coracoacromial ligament was sectioned on the coracoid side, under ultrasound navigation, in 10 cadavers donated to science: i.e. 20 shoulders. After ultrasound location of the shoulder structures, sectioning was performed with a skin incision at the level of the deltopectoral sulcus. Secondary surgical control checked conservation of the acromial branch of the thoracoacromial artery, and the quality of the procedure. RESULTS: Mean surgery duration was 18.5 minutes (±5 min). Seventeen sections were complete (85%). Artery location was hampered by the impossibility of using Doppler on these cadavers, yet even so there were only 2 vascular lesions. There were no accidental rotator cuff or cartilaginous lesions. CONCLUSION: This relatively non-invasive technique is quick and less heavy than open surgery, opening up new treatment perspectives. It could be indicated in coracoid and subacromial impingement before opting for surgery, or as a complement to surgery. It does, however, involve a learning curve and requires solid ultrasound skills.

Ultrasound-guided surgical treatment for ulnar nerve entrapment: a cadaver study.

Several open and endoscopic techniques for the surgical treatment of ulnar nerve entrapment at the elbow (cubital tunnel syndrome) have been described that provide decompression with or without anterior transposition. Based on our experience with US-guided decompression for carpal tunnel syndrome in our department, we developed a similar surgical technique for the decompression of the ulnar nerve at the elbow. Using sixteen cadaver upper limbs, we performed decompression of all the structures possibly responsible for ulnar nerve compression at the elbow. The structures involved were Struthers' arcade, the cubital tunnel retinaculum, Osborne's fascia and Amadio-Beckenbaugh's arcade. The procedure was followed by anatomical dissection to confirm complete sectioning of the compressive structures, absence of iatrogenic vascular or nervous injuries and absence of nerve dislocation or instability. There were no remaining compressive structures after the release procedure. There was no iatrogenic damage to the nerves and no nerve dislocation was observed during elbow flexion or extension. In 3.4% cases, a thin superficial layer of one or more of the identified structures remained but these did not appear to compress the nerve based on US imaging. Using ultrasonographic visualization of the nerve and compressive structures is easy. Each procedure can be tailored according to the nerve compression sites. Our cadaveric study shows the feasibility of an US-guided percutaneous surgical release for ulnar nerve entrapment.

Cardiovascular beta-adrenergic blocking effects of bornaprolol in humans: relation to dose and plasma concentration.

The cardiovascular beta-blocking effects of bornaprolol were studied in healthy male volunteers after four single oral doses. The inhibition of isoproterenol-induced tachycardia was monitored for 72 h in six subjects, and the inhibition of exercise-induced tachycardia and rise of systolic blood pressure were monitored for 167 h in six other subjects. Plasma drug concentrations were determined by gas chromatography. Bornaprolol significantly reduced the resting heart rate, isoproterenol- and exercise-induced tachycardia, and effort hypertension. The peak effect was obtained within 1-2 h of drug administration and was correlated with dose. The effect on the isoproterenol test remained significant for 6 h after administration of 40 mg bornaprolol, and 72 h after 80, 120, and 240 mg. The effect of bornaprolol on the exercise test in comparison with placebo was significant during 23 h (120 and 240 mg) and 47 h (480 and 960 mg). A positive relationship was found for both tests between the maximum effect and the doses administered. A correlation was also found for each group of subjects between the time course of the plasma drug concentration and the effects of each bornaprolol dose on isoproterenol- and exercise-induced tachycardia. The beta-blocking effects in individual subjects, however, often continued long after the disappearance of detectable plasma drug concentrations.

Pharmacokinetic characteristics of bornaprolol in healthy volunteers.

1. Six young male volunteers received five single doses of bornaprolol, i.v. (20 mg) and orally (120, 240, 480, 960 mg) administered at 2-week intervals. Plasma concentrations of bornaprolol and its conjugated metabolite were determined by gas chromatography. 2. After i.v. administration, plasma bornaprolol levels were detectable over 8 h, and mean values were 60 l/h for total clearance (C1), 207 l for volume of distribution (V beta), 2.6 h for elimination half-life (t1/2 beta). After oral administration, plasma bornaprolol levels were detectable over 24-48 h, and mean values of pharmacokinetics parameters were 60 l/h for C1, 1500 l for V beta, 20 h for t1/2 beta. Maximum plasma concentrations and area under the plasma concentration-time curve increased in a non-dose-dependent manner. 3. The glucuronide conjugate appeared in the blood within 5-10 min and its plasma level greatly exceeded bornaprolol concentrations. The mean value of the ratio of the metabolite AUC/parent product AUC was 14 after i.v. administration and 13-21 following oral administration, depending on dose. The AUC for the metabolite did not increase proportionally with oral doses. 4. Bornaprolol is principally eliminated after metabolism. This process did not increase with increasing oral doses and bioavailability seemed to decrease inversely with oral dose.