[Is the internet a reliable source of information for patients eligible for breast reconstruction by DIEP flap?] / Internet : source fiable d'information pour des patientes éligibles à la reconstruction mammaire par lambeau de DIEP ?

INTRODUCTION: Informing breast reconstruction patients is a major factor in shared medical decision-making. In the light of the development of multimedia, patients face a paradoxical duality: the possibility of consulting various sources while having impression of a lacking the needed information. The objective of this study is to assess the quality of the available information around MR by DIEP on Youtube. METHODS: For this descriptive study, we reviewed 531 videos resulted from the terms "DIEP breast reconstruction". 39 videos were analyzed in detail. The evaluation criteria established from the SOFCPRE sheet were listed in 43 items divided into 4 themes. A score representing the percentage of correct information is then calculated. RESULTS: The average length of the videos is 40'05″±46'45″. The average total score is 42.52%. Concerning the subgroups, the themes generalities and physiopathology have the highest result (66.10% of the correct items). This is followed by technique and perioperative preparation (51.65%), postoperative (27.35%) and finally complications (22.76%). Only 2 videos have an excellent total score (>80%). CONCLUSION: The information on breast reconstruction by DIEP flap on Youtube seems insufficient and lacks quality. The surgeon should strive to provide the highest quality of information and refer patients to reliable sources.

Surgical practices of cosmetic breast augmentation by implants among 411 French plastic surgeons.

INTRODUCTION: Breast augmentation is one of the most frequently performed cosmetic surgeries in the world. However, there is no standardized surgical procedure for performing breast augmentation. Many modalities exist for this surgery which may explain why practices vary greatly from one surgeon to another. The aim of this study was to evaluate current practices of breast augmentation by implant in France and changes in practices among French plastic surgeons. MATERIAL AND METHODS: This observational study was conducted between February 2020 and January 2021. An online questionnaire with 62 questions was sent to 729 French plastic surgeons. The questions concerned: the population of surgeons interviewed, pre-operative aspects, surgical technique and post-operative management. RESULTS: 411 plastic surgeons responded, 5.1% of surgeons impose a nicotine screening test on patients. 99.76% and 95.59% reported that they used silicone gel implants and round prostheses. All used smooth or micro-textured shells. The inframammary approach was the most used by 66.2% of plastic surgeons. The implants placed were between 250 and 300 cc on average and were mainly placed in "Dual plane" by 42% of surgeons. In order to reduce bacterial contamination, 26% of surgeons soaked the implants in a povidone-iodine solution and 23% used an insertion sleeve. The most frequent early complication was hematoma, while capsular contracture was a late complication. CONCLUSION: This study provides new data on current surgical practices of breast augmentation in France, allowing more informed choices and opening up perspectives for more standardized practices in the future.

[Urodynamic profile of voiding disorders persisting after treatment of posterior urethral valve]. / Profil urodynamique des troubles vésico-sphinctériens persistants après cure de valves de l'urètre postérieur.

PURPOSE: Posterior urethral valves (PUV) are the most common cause of bladder outlet obstruction in infancy that impairs renal and bladder function. MATERIAL AND METHODS: We realize a retrospective study and examined 35 boys with urinary disorders post-treatment of PUV, seen at the urodynamic consultation. RESULTS: The mean age: 7.56 years, urinary problems are dominated by recurrent urinary tract infections and urinary leakage, morphological assessment is marked by the constant expansion of the urinary tract and bladder, 18 children have end-stage renal disease of which 8 are candidates for transplantation. About urodynamic, the uroflowmetry with measure of post-void urine residue: dysuria with significant residual urine in 14 children; for cystometry, 20 children with bladder hyperactivity, 9 bladders are hypotonic hypoactive with high capacity, 6 explorations are normal. CONCLUSION: Urodynamic explorations are all interest when voiding symptoms persist after endoscopic section valves and despite a good radiological result.

Glycopeptide intermediate Staphylococcus aureus and prevalence of the luk-PV gene in clinical isolates, in Northern Lebanon.

OBJECTIVES: The aim of our study was to confirm the identification of 113 meticillin-resistant Staphylococcus aureus (MRSA) strains by pyrosequencing, to determine the susceptibility of these clinical isolates to various classes of antibiotics, to determine the minimum inhibitory concentration (MIC) to glycopeptides, and to detect mecA and luk-PV genes. METHODOLOGY: The Staphylococcus species was identified by pyrosequencing of the variable region (V3) of the 16SrRNA. The susceptibility of these 113 strains of MRSA to antibiotics was determined by the disk diffusion method on Mueller-Hinton agar. The MIC of glycopeptides was determined by using the dilution method on solid media. mecA gene and luk-PV gene were detected by PCR. RESULTS: The disk diffusion method proved full susceptibility to vancomycin, teicoplanin, and linezolid; whereas MIC (dilution method) indicated that 5/113 strains were resistant to teicoplanin, giving a probability of having heterogeneous glycopeptide intermediate S. aureus (hGISA) strains. The mecA gene was detected in all MRSA strains ruling out the probability of having new variants of this gene in the tested strains. The luk-PV gene was detected in 28 out of 113 MRSA strains (24.8%). CONCLUSION: The originality of this study was the detection of hGISA strains knowing that they were susceptible to glycopeptides according to the diffusion method. Thus it is necessary to check the level of susceptibility of MRSA clinical isolates to glycopeptides for immunodeficient patients, by determining the MIC.

[Intrauterine growth retardation and lung development]. / Retard de croissance intra-utérin et développement pulmonaire : approche expérimentale et clinique.

Epidemiological studies have shown that intrauterine growth restriction is associated with increased respiratory morbidity in the neonatal period with an increased risk of bronchopulmonary dysplasia. Respiratory consequences of environmental intrauterine changes extend into childhood and adulthood with abnormal lung function tests. In animal models, changes in surfactant and alveolarization disorders vary from one study to another. Moreover, the molecular mechanisms involved are poorly understood. Fetal adaptations to intrauterine malnutrition result in permanent changes in lung structure, raising the question of lung "programming".

Management of paediatric tuberculosis in provincial and district hospitals in Afghanistan.

Case detection, diagnosis and treatment of tuberculosis 1 B) in children are challenging issues vorldwide. This study in Afghanistan aimed to evaluate paediatric TB case management, including contact investigation, at health facilities where all diagnostic processes were available. In 7 out of 8 regions of the country 1 province was selected. Documents used for management of paediatric TB cases were reviewed in 15 distinct hospitals and 8 provincial hospitals in the selected provinces. The key issues which emerged were: a low suspect rate among total outpatients (0.4%) and a very low suspect rate among children aged < 5 years; low performance of suspect management (68.5% suspects received further examinations); low utilization of other diagnostic methods; a high early defaulter rate (14.0%); and insufficient coverage of contact management (74.0%). This survey indicated that the Afghanistan national TB programme needs to develop plans to improve the quality of diagnosis, suspect management and contact management in paediatric TB cases.

Management of paediatric tuberculosis in provincial and district hospitals in Afghanistan

Case detection, diagnosis and treatment of tuberculosis [TB] in children are challenging issues worldwide. This study in Afghanistan aimed to evaluate paediatric TB case management, including contact investigation, at health facilities where all diagnostic processes were available. In 7 out of 8 regions of the country 1 province was selected. Documents used for management of paediatric TB cases were reviewed in 15 distinct hospitals and 8 provincial hospitals in the selected provinces. The key issues which emerged were: a low suspect rate among total outpatients [0.4%] and a very low suspect rate among children aged < 5 years; low performance of suspect management [68.5% suspects received further examinations]; low utilization of other diagnostic methods; a high early defaulter rate [14.0%]; and insufficient coverage of contact management [74.0%]. This survey indicated that the Afghanistan national TB programme needs to develop plans to improve the quality of diagnosis, suspect management and contact management in paediatric TB cases

[Benefits and harms to the newborn of maternal attempt at trial of labor after prior caesarean versus elective repeat caesarean delivery]. / Bénéfices et risques néonataux de la tentative de voie basse comparée à la césarienne programmée en cas d'antécédent de césarienne.

OBJECTIVE: To evaluate neonatal outcome after elective repeat cesarean delivery (ERCD) versus trial of labor (TOL) after previous cesarean delivery. METHODS: This systematic evidence review is based on Pubmed search, Cochrane library and experts recommendations. RESULTS: The risks of fetal, perinatal and neonatal mortality are low after previous cesarean delivery but significantly higher for TOL as compared with ERCD. The risk of bag-and-mask ventilation and intubation for meconium-stained amniotic fluid are higher for TOL as compared with ERCD. Infants born after ERCD are more likely presented transient tachypnea. The risk of hypoxic encephalopathy/asphyxia is low after previous cesarean delivery but significantly higher for TOL as compared with ERCD. The risk of neonatal sepsis after previous cesarean delivery is significantly higher for TOL as compared with ERCD. There is no significant difference between TOL or ERCD regarding NICU admission. The strength of evidence is low to conclude about the impact of route of delivery upon birth trauma and Apgar score. CONCLUSIONS: The risk of the main neonatal complications is low whatever the route of delivery after previous caesarean delivery. However, the risk of perinatal mortality, bag-and-mask ventilation, perinatal asphyxia, is higher after TOL compared with ERCD. The risk of transient tachypnea is higher after ERCD compared with TOL.

Capnocytophaga species and preterm birth: case series and review of the literature.

Capnocytophaga, a genus of Gram-negative anaerobes that inhabit the oral cavity, has been reported to be an unusual cause of chorioamnionitis and neonatal infection. We report five cases of Capnocytophaga spp. infections in preterm infants (one proven infection and four probable infections) and review 14 previously reported cases. We suggest that Capnocytophaga sp. may be responsible for some occult causes of chorioamnionitis or preterm birth, and that the prevalence of this infection may be higher than previously reported.

[Apnea of prematurity: what's new?]. / Apnées du prématuré : données récentes.

Prematurity apnea remains a major clinical problem that requires treatment choices which are sometimes difficult. Prematurity apnea occurs in most infants of gestational age at birth less than 33 weeks. It is a developmental disorder which usually reflects a "physiological" immaturity of respiratory control. However, neonatal diseases may be associated and play an additive role, resulting in an increased incidence of apnea. Careful screening should therefore be performed in order to make sure that no other factor than immaturity is involved in the occurrence of apnea. Short apnea (less than 10s, without hypoxemia and bradycardia), due to immaturity, are not clinically relevant. More prolonged apnea, that last for more than 15 or 20s, and / or apnea associated with bradycardia or oxygen desaturation, results in short-term disturbances of cerebral haemodynamics and oxygenation, which may negatively impact on neurodevelopmental outcome. Evaluating the immediate severity of apnea and the risks that apnea may affect long-term outcome remains a challenge. The choice of treatments is based on a few evidences. Caffeine citrate, which reduces the incidence of apnea, has been used for decades. However, a thorough evaluation of risks and benefits of this medication has been performed only recently. Caffeine citrate was found to be safe and resulted in unexpected benefits. In treated infants, compared with controls, indeed, a decreased incidence of the following complications was recorded: bronchopulmonary dysplasia at 36 weeks of conceptional age, patent ductus arteriosus, cerebral palsy at 18 months of age. Nasal CPAP can be used in association with caffeine citrate, when the latter is not effective enough.

[Abnormal ocular findings in the nursery and in the first few weeks of life: a mandatory, yet difficult and neglected screening]. / Anomalies oculaires en maternité et dans les premières semaines de vie: un dépistage obligatoire, difficile et négligé

Recommendations issued by the French Health Ministry include ocular screening in the first days of life and at 2 and 4 months. The aim is to detect ocular abnormalities requiring early treatment, in order to improve the prognosis. Paediatricians working in the nursery should therefore be trained in order to perform ocular screening, which requires using an ophthalmoscope. This is not yet common practice in all nurseries. Red-reflex is one of the most important elements of testing. Possible diagnoses suggested by abnormal red-reflex include retinoblastoma, or abnormalities of eye transparency, such as cataract. Any detected ocular abnormality requires specialised consultation. At the present time, paediatricians remain insufficiently aware and trained about ocular screening.

CTLA4 gene polymorphism in Italian patients with colorectal adenoma and cancer.

BACKGROUND AND AIMS: Colorectal cancer is a major health problem. Colonoscopic colorectal cancer screening is cumbersome and expensive. Identification of genetic risk of colorectal cancer may help to select the subjects who could benefit from colonoscopy. The immune system plays a fundamental role in the human-environment interaction, and the carcinogenic effects of many environmental factors are mediated by the chronic activation of the immune system in a genetic-controlled fashion. Cytotoxic T lymphocyte associated antigen 4 (CTLA4) plays an inhibitory role in regulating lymphocyte functions. The loss of CTLA4 function is responsible for loss of mucosal lymphocyte tolerance. The G allele at position +49 of exon 1 of the CTLA4 gene affects the CTLA4 function. We evaluated in an association study the role of CTLA4 A+49G polymorphism as a risk factor for colorectal neoplasm. PATIENTS AND METHODS: Five hundred and fifty-six patients (male 295; female 261) who underwent colonoscopy at our Centre were enrolled in the study and divided into three groups: Colorectal cancer (132 patients, M/F 68/64, mean age 66+/-11 years); Colorectal adenoma (186 patients, M/F 110/76, mean age 65+/-11 years); Healthy controls (238 patients, M/F 117/121, mean age 63+/-10 years). DNA was extracted from peripheral blood, CTLA4 gene was amplified by using specific primers, and A+49G polymorphism was analysed by restriction enzyme digestion. RESULTS: No statistically significant differences in the genotype distribution among Control and Adenoma groups (p=0.93), Control and Carcinoma groups (p=0.52), and Adenoma and Carcinoma groups (p=0.53) were observed. CONCLUSION: There is no significant correlation between CTLA4 A+49G polymorphism and the risk of colorectal neoplasm among Italian Caucasians.

[Neonatal lenticulostriate vasculopathy. Mid and longterm outcome (70 cases)]. / Devenir des enfants ayant présenté une vasculopathie lenticulostriée néonatale (70 cas).

OBJECTIVES: If the pattern of neonatal lenticulostriate vasculopathies (NLSV) is well-known, the prognosis is unknown except in TORCH syndromes. This study was aimed to describe the short, mid and long-term outcome of NLSV of various origins. POPULATION AND METHODS: Of 9138 neonates (1981-2000) which were submitted to an early brain ultrasound study, 70 presented with a pattern of minor (35), moderate (27) or severe (8) NLSV, a single finding in 42 cases and in association with minor peri-intraventricular haemorrhage and/or leukomalacias in 28. The maternal and neonatal charts were reviewed, and the survivors were followed according to our usual policy. RESULTS: Of nine deaths, eight cases included severe congenital defects (metabolic or malformations or acquired: transfused monochorial twins). Of 61 survivors, eight were lost to follow-up within the first year, 53 were followed for 21 months to 9 years and 7 months (median 4 years 5 months). Of 53 children, 35 (66%) were strictly normal, eight had minor deviations, four had moderate and six had major neurodevelopmental deficits. Of 34 survivors with isolated NLSV and known follow-up, 27 were normal (79%) versus 8/19 (42%) in associated NLSV. CONCLUSIONS: Minor or moderate isolated NLSV generally have a good long-term prognosis. Associated forms of any severity depend mainly upon the severity of periventricular leukomalacias. Major forms of NLSV must be a warning sign of a possible underlying congenital anomaly which will rule the vital and functional prognosis.

Achalasia.

AIM: Achalasia is a disease of unknown etiology resulting from degeneration of the esophageal Auerbach submucous plexus. This degeneration makes normal relaxation of the cardia during swallowing impossible leading to dysphagia, chest pain and regurgitation of varying degree. Until 15 years ago the main conservative treatment for achalasia was dilatation of the cardia with the Starck apparatus. Such approach to achalasia was usually reported as fairly effective, but complicated by an exceedingly high rate of perforation. This led most centers to replace the Starck procedure with pneumatic or hydrostatic balloon dilators. The aim of our study was to evaluate safety, early and late results of the Starck procedure. METHODS: Our report is based on the retrospective analysis of 21 patients [male/female: 12/9, mean age 46 years (range-65)] who underwent 52 Starck procedures for esophageal achalasia. The effectiveness of the Starck procedure was assessed according to the scale of Vantrappen and Hellemans. RESULTS: After the scheduled 2 Starck sessions, an excellent result was seen in 10 patients (50%), a good result in 8 (40%); 2 patients (10%) showed a poor result. One month after the last Stark procedure 1 patient (5%) experienced gastroesofageal reflux easily managed with protein pump inhibitors. During or after dilations no major complications were observed. CONCLUSIONS: The Starck procedure, now replaced by the new Rigiflex pneumatic dilator, resulted effective and safe in experienced hands.

Corneal organ culture: effects of serum and a stabilised form of L-glutamine.

AIMS: Organ culture medium for corneas contains labile components, such as L-glutamine, whose loss could be a limiting factor to the length of storage. The medium is also supplemented with fetal bovine serum (FBS), which can vary significantly between different batches. The aim of this study was to establish the need for FBS during corneal organ culture, and to determine whether substitution of L-glutamine by the stable dipeptide L-analyl-L-glutamine was beneficial. METHODS: Porcine corneoscleral discs were suspended in 80 ml of organ culture medium (HEPES buffered Eagle's MEM with Earle's salts, 26 mmol/l NaHCO3, penicillin, streptomycin, and amphotericin B) and kept at 34 degrees C. The medium contained either 2 mmol/l L-glutamine or 2 mmol/l L-analyl-L-glutamine, and was either serum free or contained 2% FBS. At weekly intervals, five corneas from each group were stained with trypan blue and alizarin red S, and the surface area and shape of 100 endothelial cells were determined for each cornea. RESULTS: No differences were observed between corneas in organ culture medium with L-glutamine or L-analyl-L-glutamine. In serum free medium, endothelial cell density remained constant for the first week, but then declined rapidly over the next 2 weeks. With 2% FBS, there was no loss of endothelial cells for the first 2 weeks, but cell density had halved by the fourth week of organ culture. CONCLUSION: The presence of 2% FBS extended the period of endothelial stability, but no advantage was gained from the stabilised form of L-glutamine. The overall loss of endothelial cells was much greater than would be expected for human corneas.

Clinical use of posterior electrocardiographic leads: a prospective electrocardiographic analysis during coronary occlusion.

Posterior electrocardiographic leads have been described for quite a while; however, their use in diagnosing acute posterior wall myocardial infarction and identifying infarct-related arteries has not been well used. We prospectively studied electrocardiographic changes during balloon occlusion of single-vessel right coronary artery (RCA) and circumflex coronary arteries (LCX). Thirty four inflations were performed in RCAs and 38 in LCXS. Analysis of the patients with ECG changes revealed that the most common ECG change during RCA occlusion was inferior ST-segment elevation in leads II, III, and aVF (95 percent), and the most common change during LCX occlusion was posterior ST elevation in leads V7, V8, and V9 (68 percent). ST elevation was always seen in inferior leads in the RCA group and in posterior leads in the LCX group. Thus posterior leads helped identify RCA versus LCX as the infarct-related artery. ST elevation was also noted by posterior leads in seven (36.8 percent) additional patients. Thus there was a definite added benefit of posterior leads during LCX occlusion. In the appropriate clinical setting, posterior leads may help in differentiating LCX occlusion from RCA occlusion.