[Assessment of energy density during laser photoselective vaporisation of the prostate: A retrospective monocentric study]. / Évaluation de l'effet de la densité d'énergie délivrée lors d'une photovaporisation prostatique laser : étude rétrospective monocentrique.

INTRODUCTION: Greenlight XPS-180W® (AMS, San José, USA) photoselective vaporisation of the prostate (PVP) is considered as an alternative to transurethral resection of the prostate. The objective of this study was to assess the effect of energy density applied on adenoma during PVP treatment for benign prostate hyperplasia (BPH) on postoperative outcomes. METHODS: A single-centre retrospective study has been conducted in the department of Urology of Colmar Hospital, in patients with symptomatic BPH, treated by PVP, between January 2016 and January 2019. Patients were stratified into two groups according to energy delivered and prostate volume as determined preoperatively: Low density (<4kJ/mL) and high density (>4kJ/mL). Perioperative complications, PSA evolution and functional outcomes (International Prostate Symptom Score, quality of life, maximum urinary flow rate, post-void residual urine volume) were compared with a minimal delay of 6 months. The retreatment rate was similar in the two groups. RESULTS: A total of 215 patients were included with median follow-up of 25 months. High energy density was associated with less glandular volume. There were no statistically significant differences between the two groups concerning the perioperative complications and the functional outcomes. The postoperative reduction of the PSA level was more significant in the high-energy group (41% vs. 28%, P=0.03). CONCLUSION: The perioperative complications and functional outcomes of PVP with Greenlight XPS-180W® laser are equivalent depending on the energy density delivered. The greater decrease in postoperative PSA for high-energy density could nevertheless suggest better quality tissue destruction. LEVEL OF PROOF: 3.

Seasonally-induced alterations of some facial signs in Caucasian women and their changes induced by a daily application of a photo-protective product.

OBJECTIVES: These were two-fold: (i) to assess the possible changes in some facial signs induced in a 6-month period by the periodical shift from winter to summer in Caucasian women and (ii) to appraise the preventive effects of a strong photo-protective product. METHODS: The facial signs of two cohorts of French women (N= 40 and 42), of comparable ages were graded between winter to summer. One group was left unprotected whereas the other daily applied a strong photo-protective product for 6 months. Facial signs (structural and pigmentation-related) were graded in blind by a panel of 12 experts from photographs taken under standard conditions. A global and focused analysis of the skin colour or dark spots, when present, was carried out through spectro-radiometry under diffuse and standardized visible light, using the L*, a*, b* referential system. RESULTS: The unprotected group showed significant changes in summer as compared to winter on 10 facial signs (two-third of the studied signs) that presented an increased severity, of variable respective amplitude. Five signs among the 10 were particularly and significantly affected by the seasonal transition, of an amplitude above the precision of the grading scale. Three of these five signs concerned structural elements (wrinkles), the two others being related to vascular disorders (redness). These season-induced alterations appear efficiently reduced in the photo-protected group. The colour of the facial skin then appears more homogeneous, less red, less dull, all criteria being quantified by the L*, a*, b* referential system. The comparison with a previous work carried out on Chinese women, through a similar protocol, shows that the photo-protective product brings, in Caucasian women, a more important effect upon structural and vascular features than upon pigmentation disorders, inversely to the results previously observed in Chinese women. CONCLUSION: The alterations in some facial signs occurring in a 6-month period between winter and summer are confirmed in Caucasian women, mostly related to structural (wrinkles) and vascular elements. Such changes appear alleviated or prevented by daily applications of a strong sun photo-protective product.

6-O glucose linoleate supports in vitro human hair growth and lipid synthesis.

The hair follicle is a very active organ with a complex structure, which produces a hair fibre at a rate of 0.3 mm a day. Accordingly, the hair follicle is highly demanding in energy source, as the hair bulb matrix cells are endowed with one of the highest rates of proliferation in the human body. Moreover, recent data have shown the involvement of lipids in hair follicle function. As in vitro-grown hair follicle keeps producing a hair fibre that closely resembles the natural hair fibre, we decided to use this model to investigate the role of a new of glucose linoleate derivative (6-O-linoleyl-d-glucose: 6-O-GL) as a lipid precursor and energy provider. Our results demonstrated that 6-O-GL was (i) quite stable and surprisingly resistant to oxidative degradation, and (ii) readily taken up and metabolized by the hair follicle into various lipids, namely neutral lipids, ceramides and polar lipids. Moreover, it supported hair follicle growth and survival in a glucose- and linoleic-acid free medium. 6-O-GL thus appeared to be a bi-functional nutrient, ensuring both proper fibre quality and production by the hair follicle.

Protective effects of taurine on human hair follicle grown in vitro.

Taurine is a naturally occurring beta-amino acid produced by methionine and cysteine metabolism. It is involved in a variety of physiological functions, including immunomodulatory and antifibrotic. Taking advantage of the ability of human hair follicle grown in vitro to recapitulate most of the characteristic features of normal hair follicle in vivo, we studied (i) taurine uptake by isolated human hair follicles; (ii) its effects on hair growth and survival rate; and (iii) its protective potential against transforming growth factor (TGF)-beta1, an inhibitor of in vitro hair growth and a master switch of fibrotic program. We showed that taurine was taken up by the connective tissue sheath, proximal outer root sheath and hair bulb, promoted hair survival in vitro and prevented TGF-beta1-induced deleterious effects on hair follicle.

Ceramide binding to African-American hair fibre correlates with resistance to hair breakage.

Repetitive hair-relaxing treatments often applied to African-American hair weaken the hair structure. Therefore hair breakage is a common feature of African-American hair and an important cause of hair loss. Recently, by analysing the lipids extracted from human hair, a fraction of free-ceramide was isolated in which sphinganine was predominant. This study shows that this sphinganine-derived ceramide (i.e. C18-dhCer) binds to African-American hair and protects it from weakening caused by chemicals. To show this binding, we used two methods: radioactivity detection with a microimager and secondary ion mass spectrometry. We evaluated the benefits of C18-dhCer on African-American hair fibre, relaxed by guanidine hydroxide, using a new method called the Break'in Brush Technique (BBT). This method determines the hair breakage resistance during a brushing. Using this technique, we have shown less breakage when applying a shampoo with ceramide. The present study opens new prospects for the development of products able to increase the protection, provide better care and meet the needs of African-American hair thanks to the effect of ceramide binding.

[Fractures of the tuberculum intercondyloideum laterale in children]. / Fractures des épines tibiales chez l'enfant.

Thirty-one fractures of the tibial spine in children have been treated, two of them being old fractures. They were reviewed after a minimum follow-up of six months and a maximum of seven years. Ten were treated conservatively, 21 operatively. The mechanism is discussed. The trauma is described as either a posterior displacement of the femoral condyle or rotation and abduction of the leg with the knee flexed. The importance of testing stability under general anaesthesia is stressed. Sixteen cases had an anterior drawer sign. The medical meniscus was only injured in one case. The indications for treatment are: Conservative treatment should be given in fractures without displacement and without instability. All other types should be treated surgically with fixation of the anterior cruciate ligament made through a tunnel in the tibia. Whichever type of treatment is used, the length of immobilisation in plaster should not exceed 30 days. Twenty-seven cases were available for study. Twenty-three had excellent results, three good results and one poor result.

[Surgical management of sequelae from duodenal stenosis and atresia in the neonate (author's transl)]. / La remise en circuit du duodénum. Traitement des séquelles des atrésies et sténoses duodénales du nouveauné.

Surgical sequelae from duodenal atresia treated by gastrojejunostomy or duodenojejunostomy are rarely encountered. They usually appear in the late course of gastrojejunostomies. They are related at the duodenal distension above the stenoses which constitute a poorly drained "blind-loop" usually developed from a side to side anastomosis as observed in the small bowel. The following complications, related to the duodenal pouch have been reported in the literature: peptic ulcer, duodenitis or gastritis, abdominal pain, dumping syndrom and malnutrition. One patient developed a gangrenous calculous cholecystitis at 10 years of age. 3 patients under went revision of their previous surgery because of sequelae. One had duodenal atresia above the ampulla, one had an anular pancreas: in one the duodenal atresia was at the ligament of Treitz. All patients had a revision according to our technic described in Annales de Chirurgie Infantile, consisting in: --calibration of the duodenal pouch --end to end or end to side duodeno-duodenal anastomonsis --suppression of previous anastomosis. A good result was obtained in all 3 cases.

On the use of Micro-Imager to directly visualize drug distribution in human skin.

Knowledge of drug distribution into the skin has always been considered as a key parameter of both safety and efficiency. We describe here the use of a new and powerful device to directly visualize and quantify the skin distribution of a radioactively labelled compound on histological sections.

[Mega-ureter, mega-bladder and familial diabetes insipidus (author's transl)]. / Méga-uretère, méga-vessie et diabète insipide familial.

The authors relate a case of bilateral mega-ureter with mega-bladder caused by familial diabetes insipidus. Its treatment with ADH substances like gave a normal diuresis and a very important improvement in bilateral urinary tract distension.

The exogenous surfactant Curosurf enhances phosphatidylcholine content in isolated type II cells.

The exogenous surfactant, Curosurf, contains proteins as well as phospholipids. We investigated the possibility that these might affect the reutilization of exogenous phospholipid by type II alveolar cells isolated from rat lung. The time course of incorporation into lamellar bodies of radioactivity from tritiated dipalmitoyl-phosphatidylcholine (DPPC) contained within liposomes was studied. Rates of uptake were compared between liposomes prepared from pure phospholipids and from Curosurf. The incorporation of labelled choline into newly synthesized phosphatidylcholine was also determined in the presence of both preparations. The rate of DPPC incorporation over the first 4 h was the same, but, after 6 and 8 h, the radioactivity associated with lamellar bodies was about 40% higher from Curosurf liposomes. By contrast, both Curosurf and the phospholipid mixture enhanced choline incorporation into phosphatidylcholine to the same extent. We conclude that Curosurf enhances the surfactant-related phosphatidylcholine content of type II cells by two mechanisms, one of which depends on the presence of proteins in exogenous surfactant. The difference in incorporation of radioactivity from liposome-associated labelled dipalmitoyl-phosphatidylcholine cannot be explained just by an increase in reutilization of choline from degraded dipalmitoyl-phosphatidylcholine.

[Avulsion fractures of the distal part of the radius with anterior displacement in children]. / Les décollements--fractures de l'extrémité inférieure du radius à déplacement antérieur chez l'enfant.

The authors report 7 cases of fractures of the distal part of the radius, with a frontal displacement with children. This fracture is rare in pediatric traumatology. There is no particular type of mechanism that will provoke that fracture; in five cases the child was falling down on the palm of his hand and in two cases in a forced flexion. The problem about this fracture is the stability of the reduction. A proper function of the wrist is impossible with an imperfect result. The orthopedic treatment is often unable to stabilize the fracture. The authors need a surgical management using a plate type "Kerboull", put on the front part of the radius. They do not put the screws on the distal part of the plate to protect the epiphyseal plate. In only one case, they use Kirschner wires. The plates have been taken off one year later. The results are in all cases very good both functionally and anatomically.

Expression of retinoid nuclear receptor superfamily members in human hair follicles and its implication in hair growth.

Since clinical evidence of hair loss and hair depigmentation following etretinate therapy has been reported, we decided to study the expression levels of several members of the retinoid nuclear receptor superfamily in dermal and epithelial compartments of the human hair follicle. Additionally, we evaluated the effects of several ligands for these receptors on human hair growth in culture in vitro. We observed that the cellular/ cytoplasmic retinoic acid (RA) binding protein-II and the retinoid-X-receptor-alpha were constantly and strongly expressed in both compartments at levels comparable to those of vitamin D receptor. In dermal papilla cells, by contrast with RAR beta which was always expressed, RAR alpha and RAR gamma were not constantly expressed. In dermal sheath fibroblasts, both RAR alpha, RAR beta and RAR gamma mRNAs were moderately expressed, while in the epithelial compartment, namely the plucked hair, we observed the expression of the same genes in the absence of RAR beta. We also observed that RAR agonists all-trans RA and CD367 inhibited the survival of human hair follicles in culture in vitro, while RXR agonist CD2425 stimulated hair growth and survival at levels comparable to those of 1 alpha,25-dihydroxyvitamin D3, suggesting that RXR agonists might stimulate hair growth in humans in vivo.

Thyroid hormone receptor beta1 is expressed in the human hair follicle.

To understand better the mechanisms by which thyroid hormone can exert its effects on the hair follicle, we looked for the expression of members of the thyroid hormone receptor (TR) family in human hair follicles. Immunoreactive TRs were detected in both dermal and epithelial compartments of the human pilosebaceous unit. Using reverse transcriptase-polymerase chain reaction, we established that TRbeta1 was the predominant form of TR expressed in the human hair follicle. In addition, we investigated the effects of 3,3', 5-triiodo-L-thyronine (T3) on the survival of human hair follicles in vitro, to understand the role of this thyroid hormone on hair follicle homeostasis. A physiological level of free T3 significantly enhanced human hair survival in vitro.

Hair keratin pattern in human hair follicles grown in vitro.

The keratin family includes epithelial (soft) keratins and hair (hard) keratins, and can be divided into acidic type I and basic to neutral type II subfamilies. Recently, nine type I and six type II hair keratin genes have been characterized through the screening of a human PAC library. The expression of these genes in the hair follicle was determined in vivo and a combined catalog of acidic and basic hair keratins was established. In this study, we investigated the expression and localization of most of the human hair keratin members of both types in human hair grown in vitro. We show that in vitro growth of hair follicles for 10 days in complete William's E culture medium did not alter the expression pattern of hair keratins. Similarly to the in vivo situation, each hair keratin was localized in precise and discrete compartments of the follicle, ranging from the matrix to the upper cortex and/or the hair cuticle. This study shows that the increase in length of in vitro grown follicles was accompanied by the proper hair shaft keratinization process. It also shows that hair follicle integrity was maintained in vitro, both in terms of gross morphology and molecular organization despite the complexity of the keratin expression pattern.

[One case of complete reduplication of the bladder (author's transl)]. / A propos d'un cas de duplication vésicale.

We report one case of complete reduplication of lower urinary tract associated with bilateral vesico-urethral reflux, hip dislocation, incomplete sacral agenesis and neck malformation. The two bladders are physiologically functional and we only operated the bilateral reflux by Leadbetter-Politano procedure. A review is presented of the twenty-two published cases, with the classification.

Congenital duodenal obstruction: a review of 82 cases.

We report our experience with 82 cases of congenital duodenal obstruction. Forty-seven had intrinsic and 35 extrinsic lesions. Treatment of duodenal occlusion resulting from maldevelopment of the common mesentery is well standardized. Treatment of occlusion due to duodenal atresia or complete diaphragmatic obstruction needs re-evaluation. Our critical study of the anastomoses commonly used emphasizes that duodenojejunostomy and gastrojejunostomy should be avoided. The recommended operative technique had the following aims in order to utilize fully the duodenal circuit: 1) Reduction in size and remodeling of the proximal dilated duodenal segment; 2) End-to-end anastomosis of the proximal duodenum with the distal duodenum or the jejunum. Only the "annular pancreas" lesion is not fully amenable to this technique but, even here, an end-to-side anastomosis is eminently feasible.