SF-36 preoperative interest of predicting improvement of quality of life after laparoscopic management of minimal endometriosis.

THE PURPOSE OF THE STUDY: To study preoperative thresholds of the SF-36 components above which we can predict a high risk of failure in order to improve the quality of life after surgery for patients with minimal endometriosis. MATERIAL AND METHODS: Design: prospective and multicenter observational study between February 2004 and 2011. PATIENTS: 167 patients with operated minimal endometriosis. SETTING: for the Physical Component Summary (PCS) or the Mental Component Summary (MCS) subscales of the SF-36 questionnaire, an improvement defined by an increase of 5 points. INTERVENTION: evaluation by the SF-36 questionnaire the week before and one year after surgery. MEASUREMENT AND MAIN RESULTS: Success of surgery measured by an improvement in both components. We found significantly different initial variables between patients with improvement and those without: initial MCS score (P=0.0003), initial PCS score (P<0.0001) and dyspareunia (P=0.004). Multivariate analysis revealed only two significant variables. Initial MCS higher than 40 (OR=4.6) and initial PCS higher than 50 (OR=10.6) are risk factors for failure of improvement after surgery. CONCLUSION: Surgery is seldom a good treatment for improving QOL in minimal endometriosis. We set two thresholds for SF-36, 50 for PCS and 40 for MCS: above there is a very high risk of failure (86% of failure in our population). Under, the risk of failure remains high (54.3%). CANADIAN TASK FORCE CLASSIFICATION OF STUDY DESIGN: Evidence obtained from well-designed cohort or case-control studies, preferably from more than one center or research group.

[Are there anatomical and clinical correlations between minimal and deep endometriosis? First results of Auvergne's Registry of Endometriosis]. / Existe-t-il une corrélation anatomoclinique entre endométriose minime et endométriose sévère? Premiers résultats du registre régional d'Auvergne de l'endométriose.

OBJECTIVE: With a prospective study, to evaluate the existence of two distinct clinical diseases in the endometriosis syndrome, by comparing pain symptoms and quality of life from patients with minimal endometriosis (AFS-R<5) and data from patients with severe disease (deep infiltrating nodules and/or ovarian endometrioma). PATIENTS AND METHODS: Patients with minimal disease (group A with AFS-R<5) and severe endometriosis (group B) are selected from the Auvergne Endometriosis Registry which started in January 2004. They have never been treated before for endometriosis. A surgical laparoscopic and a pathological diagnosis are required for the subjects to be included. Pelvic pain is assessed using a standardized questionnaire, and a visual analogue scale, quality of life using SF-36. The two groups are compared for the incidence and the severity of pelvic pain and for the impairment of their quality of life. RESULTS: Forty-seven patients have a minimal disease, whereas 111 have a severe endometriosis. Demographic characteristics are similar in both groups. Quality of life (SF-36) and pelvic pains included chronic pelvic pain, dyspareunia, dysuria, and defecation disorders are as common and severe in both groups. However, dysmenorrhea is more affected in group B than in group A (p=0.03). DISCUSSION AND CONCLUSION: We find no relationship between severity of symptoms, quality of life, and the extent of endometriotic lesions at surgery. There would be no differences between minimal and severe disease. It could be explained by different painful mechanisms between minimal and severe endometriosis.

[Bile duct injuries at laparoscopic cholecystectomy: early repair results]. / Plaies des voies biliaires lors d'une cholécystectomie sous coelioscopie: résultat des réparations précoces.

STUDY AIM: To compare the early repair results in bile duct injuries at laparoscopic cholecystectomy to a later repair and so the early reconstruction by an end-to-end anastomosis to a Roux-en-Y bypass. PATIENTS AND METHOD: From 1990 to 2003, twelve patients were treated for bile duct injury, not diagnosed at the time of cholecystectomy and had an early repair within 30 days after the cholecystectomy. They had either a duct to duct anastomosis or a Roux-en-Y bypass at the time of the reconstruction. RESULTS: The level of the injury was Bismuth II (N=7), III (N=1), IV (N=2) and V (N=1) referral to Bismuth classification and one isolated right sectoral duct injury. Four patients had an duct to duct anastomosis and eight an hepaticojejunostomy at a median of 15.3 days after cholecystectomy. With one patient lost to follow up, the overall success rate in this series was 81.8% after reconstruction with a mean 40 months follow up. The reconstruction by an end to end anastomosis was successful in 100% of patients (with a mean 31.2 months follow up) and in 71.4% of patients after a Roux-en-Y biliary reconstruction (with a mean 45 months follow up). CONCLUSION: Good results may be performed, by an early repair in bile duct injuries at laparoscopic cholecystectomy, either by an duct to duct anastomosis or a Roux-en-Y bypass.

Mitigation of tokamak disruptions using high-pressure gas injection.

High-pressure gas-jet injection of neon and argon is shown to be a simple and robust method to mitigate the deleterious effects of disruptions on the DIII-D tokamak. The gas jet penetrates to the central plasma at its sonic velocity. The deposited species dissipates >95% of the plasma by radiation and substantially reduces mechanical stresses on the vessel caused by poloidal halo currents. The gas-jet species-charge distribution can include >50% fraction neutral species which inhibits runaway electrons. The favorable scaling of this technique to burning fusion plasmas is discussed.