[Severe post-obstetric perineal tears: Medium-term consequences on women's quality of life]. / Déchirures périnéales post-obstétricales sévères : conséquences à moyen terme sur la qualité de vie des femmes.

AIMS: To assess the prevalence of anal (AI) and urinary (UI) incontinence at medium term after 3rd and 4th degree anal sphincter tears and their impact on sexuality and women's quality of life. MATERIAL: It is a case-control, single center study. Sixty-eight primiparous women delivered with severe anal sphincter tear (exposed group) were compared to 136 women without (control group). Questionnaires on anal and urinary incontinence, sexual function and quality of life, using validated scores, were sent between two and five years after the first delivery. Maternal and obstetric data were collected retrospectively on the medical files. RESULTS: The answer rate was 22.5% (46/204) of which 30.9% (21/68) in the exposed group and 18.4% (25/136) in the unexposed group. In case of severe anal sphincter tear, 57.1% of women reported an AI vs 48% in the control group (P=0.76). The rate of AI for liquid stool was significantly higher in the exposed group (P=0.05). Patients with severe perineal tears reported a greater impact of symptoms on their quality of life but the difference with the control group was not significant. CONCLUSIONS: The severity of symptoms related to anal sphincter tears is common and underestimated. Preventive measures must be improved in order to maintain women's quality of life. LEVEL OF EVIDENCE: 4.

Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones.

BACKGROUND: This study was designed to explore the role of transcystic bile duct exploration (TCE) as a first line of treatment for patients with suspected or incidental common bile duct (CBD) stones. METHODS: A prospective, case-control study of clinically comparable groups of patients who underwent laparoscopic cholecystectomy (LC) alone (n = 1,854) and combined LC/TCE for CBD stones (n = 253) under the care of one surgeon was performed. Other than ultrasonography, no routine preoperative imaging was used; however, we performed routine intraoperative cholangiography on all patients. RESULTS: There was no difference in age (49 +/- 15 vs. 57 +/- 19, p = 0.7), sex (79% vs. 82% females, p = 0.6), and ASA grade (1.9 +/- 1 vs. 1.8 +/- 1, p = 0.7). A larger proportion of the TCE group presented as an emergency (TCE 45% vs. LC alone 27%, p = 0.03) and more often presented with acute biliary pain compared with LC alone (27% vs. 13%, p = 0.02). Although a majority of the patients in the TCE group had clinical or biochemical risk factors for CBD stones (86%), only 27% had suspected stones on preoperative ultrasound. The incidence of jaundice (6% vs. 20%, p = 0.01) was lower in the LC alone group compared with TCE patients. Previous abdominal surgery was noted in 34% patients who underwent LC alone and 30% in LC/TCE (p = 0.06). Significantly there was no difference in open conversion between the two groups (LC alone 0.5% vs. LC/TCE 0.6%, p = 0.07). Comparison of selected outcome parameters for LC versus TCE showed a postoperative hospital stay of 2 (1-14) vs. 2 (1-17) days (p = 0.07), presentation to resolution 1 (1-11) vs. 1 (1-11) weeks (p = 0.07), and morbidity 1.07% vs. 1.2% (p = 0.07). CONCLUSIONS: The study advocates single-session laparoscopic cholecystectomy with transcystic CBD exploration as a feasible first choice treatment and the logical next step in the management of patients with CBD stones.

Post-traumatic midbrain tremors.

We report 3 patients with post-traumatic tremor and describe the characteristics of the tremor and accompanying neurologic signs. Radiographic and pathologic examination indicated a contralateral midbrain localization of the lesion. The tremor responded to anticholinergic or dopaminergic therapy.

SABRE: a bio-inspired fault-tolerant electronic architecture.

As electronic devices become increasingly complex, ensuring their reliable, fault-free operation is becoming correspondingly more challenging. It can be observed that, in spite of their complexity, biological systems are highly reliable and fault tolerant. Hence, we are motivated to take inspiration for biological systems in the design of electronic ones. In SABRE (self-healing cellular architectures for biologically inspired highly reliable electronic systems), we have designed a bio-inspired fault-tolerant hierarchical architecture for this purpose. As in biology, the foundation for the whole system is cellular in nature, with each cell able to detect faults in its operation and trigger intra-cellular or extra-cellular repair as required. At the next level in the hierarchy, arrays of cells are configured and controlled as function units in a transport triggered architecture (TTA), which is able to perform partial-dynamic reconfiguration to rectify problems that cannot be solved at the cellular level. Each TTA is, in turn, part of a larger multi-processor system which employs coarser grain reconfiguration to tolerate faults that cause a processor to fail. In this paper, we describe the details of operation of each layer of the SABRE hierarchy, and how these layers interact to provide a high systemic level of fault tolerance.

Neuroleptic malignant-like syndrome induced by metoclopramide.

A prompt recognition of neuroleptic malignant-like syndrome is essential because of its high morbidity and mortality. A similar condition i described associated with metoclopramide, an agent with dopamine receptor-blocking properties. An increased index of suspicion for early diagnosis of this condition and adjustment of metoclopramide dosing in patients with renal failure are emphasized.

Choreoathetosis induced by cyproheptadine.

Cyproheptadine is an antihistamine with antiserotoninergic and anticholinergic properties. It is a relatively safe drug with many varied indications for usage, which rarely produces serious adverse neurologic sequelae. Reports of involuntary movement disorder secondary to cyproheptadine are rare. We present the case of a 17-year-old overdose victim which may be the first documented instance of cyproheptadine intoxication resulting in choreoathetosis. This hyperkinesia was most likely resultant from the anticholinergic properties of cyproheptadine. Although the choreoathetoid movement resolved spontaneously, the delirious state disappeared after administration of physostigmine.

Life-threatening tardive dyskinesia caused by metoclopramide.

A case of severe life-threatening tardive dyskinesia resulting in esophageal and respiratory difficulties due to metoclopramide therapy is presented. A 66-year-old man with a primary diagnosis of clear cell carcinoma of the biliary duct was treated with metoclopramide for gastrointestinal symptoms related to his chemotherapy regimen. The patient initially presented with tremor and rigidity in the upper extremities. On antiparkinsonian therapy, symptoms progressed to hemiballism and involuntary movements of the face, mouth, and tongue, with respiratory and esophageal dyskinesia. Despite discontinuance of metoclopramide, severe tardive dyskinetic symptoms resulted in placement of a gastrostomy tube to maintain nutritional support. This case along with others in the literature should emphasize the need for continuous reevaluation of metoclopramide during long-term therapy, since serious side effects have been reported to occur.

Effect of acetic and trans-aconitic acids on citric acid production by Aspergillus niger.

The effect of acetic and trans-aconitic acids on citric acid production by A. niger at different pH values was studied. The presence of acetic acid at pH 2 prevented spore germination, while it decreased the fungal growth and citric acid production at other pH values. In the presence of trans-aconitic acid the inhibition was less marked at lower than at higher pH values.

Effect of antibiotics, non-ionic detergents, and vitamins on the osmotic barriers of Micrococcus glutamicus.

The production of amino acids by the mutant strain, homoserine methionine deficient, of Micrococcus glutamicus, was studied through the elucidation of the role of chemical agent affecting the osmotic barriers. Penicillin was found to affect the cell wall integrity and to increase greatly the total amino acid content, especially in presence of high biotin content. Non-ionic detergents were found to affect the integrity of cytoplasmic membrane. The effect was not similar with the different types of detergents and not proportional to the increase of its concentration.

Survival and efficiency of cowpea rhizobia on pelleted and non-pelleted peanut seeds, treated with fungicides.

Peanut seeds were either normally inoculated with the legume inoculant Okadin, containing cowpea rhizobia, or pelleted and treated with each of the fungicides Brassical, Thiram, Orthocide 75, Falisan, Vitavax 75, and Agrosan. The seeds were then incubated at room (+/- 25 degrees C) or refrigeration temperatures (+/- 5 degrees C). Survival tests were made after 2 and 10 days. Treated seeds were also planted in pots containing Nile silt for testing the efficiency of rhizobia as affected by the fungicide and the pelleting treatments. Pelleting of peanut seeds enhanced the survival of rhizobia whether seeds were incubated at room or refrigeration temperature. Protection was more pronounced when seeds were kept at low temperature. This was true of the fungicides Brassical, Orthocide 75, Vitavax 75, Thiram, and Agrosan. Falisan, however, did not help the rhizobia to survive. All the fungicides tested reduced the number of rhizobia to nil within 10 days when the seeds were normally inoculated and then treated and incubated at room temperature. The numbers of rhizobia were appreciably reduced when incubated at refrigeration temperature. Pelleting tended to prevent the harmful effect of the fungicides. This was clearly demonstrated with a tendency of an increase in the total nitrogen of the plants. On the contrary, normally inoculated and treated seeds grew into plants with reduced amounts of total nitrogen fixed.