[Topical cyclosporine A and risk of ocular surface neoplasia]. / Ciclosporine A topique et risque de néoplasie de la surface oculaire.

INTRODUCTION: Cyclosporine A (CsA) has well-known cutaneous carcinogenic effects when administered systemically. In ophthalmology, it is increasingly used in the form of eye drops since its indication for moderate to severe eye dry eye. The goal of this review of the literature is to evaluate a possible link between topical ocular CsA use and the occurrence of ocular surface neoplasia. MATERIALS AND METHODS: A literature review was performed. Publications evaluating the safety and efficacy of topical CsA as well as studies on the epidemiology and risk factors for conjunctival neoplasia and cases of conjunctival neoplasia were analyzed. Finally, post-market surveillance data from commercially available CsA eye drops were also evaluated. RESULTS: Five cases of conjunctival neoplasia in patients treated with systemic and/or topical CsA have been described in the literature, three with systemic administration alone, another with combined systemic and local administration, and one case of local administration alone. In these cases, no direct link with the administration of ocular topical CsA could be determined. Among the numerous prospective studies evaluating the safety and efficacy of topical CsA as well as the case-control studies evaluating the risk factors for developing conjunctival neoplasia, no relationship between the occurrence of conjunctival neoplasia and the use of topical ocular CsA was observed. CONCLUSION: Despite plausible pathophysiologic mechanisms, to date there is no evidence of an increased risk of ocular surface neoplasia with the use of topical ocular CsA. Further studies specifically addressing this question and with a longer duration are needed in order to precisely evaluate this theoretical risk.

Role of laser peripheral iridotomy in pigmentary glaucoma and pigment dispersion syndrome: A review of the literature.

PURPOSE: Pigment dispersion syndrome (PDS) is characterized by a structural abnormality of the posterior surface of the iris causing contact with the zonular fibers. It can lead to an open-angle glaucoma secondary to pigment dispersion into the trabecular meshwork. Laser peripheral iridotomy (PI) has been proposed as a treatment for pigmentary glaucoma (PG) and pigment dispersion syndrome (PDS) by reducing the dispersion of pigment. The goal of this review was to assess the effects of PI for PDS and PG. METHODS: We included six randomized controlled trials and two cohort studies (286 eyes of 218 participants). Four trials included participants with PG, and 4 trials enrolled participants with PDS with or without elevated intraocular pressure (IOP). RESULTS: Among patients with PG, at an average of 9 months of follow-up, the mean difference in IOP between groups was 2.69mm Hg less in the PI group (95% CI: -6.05 to 0.67; 14 eyes). In patients with PDS, the average IOP was statistically lower after PI as compared to baseline (Student test t=11.49, P<0.01, 38 eyes). With regard to visual field progression in participants with PG, after an average follow-up of 28 months, the risk of progression was not influenced by PI (RR 1.00 95% CI: 0.16 to 6.25; 32 eyes). No trials that enrolled patients with PDS showed a diminution of the risk of glaucoma conversion at mid- and long-terms. CONCLUSION: PI decreases the biomechanical factor causing contact between the iris and zonular fibers and may lower IOP over the long-term. Nevertheless, the effects of PI on visual field changes or progression have not been established in PG and PDS. There is no scientific evidence as of yet to advocate PI as a treatment for PDS or PG.

[Role of laser peripheral iridotomy in pigmentary glaucoma and pigment dispersion syndrome: A review of the literature [French version]]. / Intérêt de l'iridotomie périphérique au laser dans le glaucome pigmentaire et le syndrome de dispersion pigmentaire : une revue de la littérature.

PURPOSE: Pigment dispersion syndrome (PSD) is characterized by a structural abnormality of the posterior surface of the iris causing contact with the zonular fibers. It can lead to an open-angle glaucoma secondary to pigment dispersion into the trabecular meshwork. Laser peripheral iridotomy (PI) has been proposed as a treatment for pigmentary glaucoma (PG) and pigment dispersion syndrome (PDS) by reducing the dispersion of pigment. The goal of this review was to assess the effects of PI for PSD and PG. METHODS: We included six randomized controlled trials and two cohort studies (286 eyes of 218 participants). Four trials included participants with PG, and 4 trials enrolled participants with PSD with or without elevated intraocular pressure (IOP). RESULTS: Among patients with PG, at an average of 9 months of follow-up, the mean difference in IOP between groups was 2.69mmHg less in the PI group (95 % CI: -6.05 to 0.67; 14 eyes). In patients with PDS, the average IOP was statistically lower after PI as compared to baseline (Student test, t=11.49, P<0.01). With regard to visual field progression in participants with GP, after an average follow-up of 28 months, the risk of progression was not influenced by PI (RR 1.00 95 %: CI 0.16 to 6.25; 32 eyes). No trials that enrolled patients with PSD showed a diminution of the risk of glaucoma conversion at mid- and long-term. CONCLUSION: PI decreases the biomechanical factor causing contact between the iris and zonular fibers and may lower IOP over the long-term. Nevertheless, the effects of PI on visual field changes or progression have not been established in PG and PDS. There is no scientific evidence as of yet to advocate PI as a treatment for PDS or PG.

[Vulvoperineal reconstruction after extended radical vulvectomy: two reconstructive procedures]. / Reconstruction vulvopérinéale après vulvectomie radicale élargie: à propos de deux techniques de lambeau.

Poor perineal healing is often a major complication of extended radical vulvectomy in case of vulvar carcinoma. Procedures of vulvoperineal reconstruction require several criteria of quality for their use. The chosen technique should be: (1) reliable; (2) reproducible; (3) with minimal morbidity; (4) not much invasive with good anatomical and functional results. We describe two procedures of perineal reconstruction that correspond to the previous criteria: a local fasciocutaneous flap with lateral transposition and a regional musculocutaneous flap using the gluteus maximus muscle.

[Do silicone gel breast implants must be changed?]. / Faut-il changer les prothèses mammaires en gel de silicone?

Since silicone gel breast implants have been rehabilitated in 2001, we advised our patients to change prosthesis after 10 years. Our study including 150 patients shows clearly the rupture rate is very high (60%) for the textured prosthesis after 10 years, whereas it is much low for the double lumen implants (18%) after 14 years. This study and literature lead us to be very careful and change prosthesis every 12 or 13 years.

SCAP ligands are potent new lipid-lowering drugs.

Upregulation of low-density lipoprotein receptor (LDLr) is a key mechanism to control elevated plasma LDL-cholesterol levels. Here we identify a new class of compounds that directly binds to the sterol regulatory element-binding protein (SREBP) cleavage-activating protein (SCAP). We show that a 14C-labeled, photo-activatable analog specifically labeled both SCAP and a truncated form of SCAP containing the sterol-sensing domain. When administered to hyperlipidemic hamsters, SCAP ligands reduced both LDL cholesterol and triglycerides levels by up to 80% with a three-fold increase in LDLr mRNA in the livers. Using human hepatoma cells, we show that these compounds act through the sterol-responsive element of the LDLr promoter and activate the SCAP/SREBP pathway, leading to increased LDLr expression and activity, even in presence of excess of sterols. These findings have led to the identification of a class of compounds that represent a promising new class of hypolipidemic drugs.

Autologous latissimus breast reconstruction: a 3-year clinical experience with 100 patients.

This article presents our technique of autologous breast reconstruction using the latissimus dorsi flap and studies the advantages, disadvantages, and results that can be expected. A consecutive sample of 100 patients was studied. The average length of follow-up was 20 months (range 8 to 44 months), and all of the subjects were reviewed in consultation without loss to follow-up. The supplementary volume of the latissimus dorsi was obtained from five fatty zones: fat on the cutaneous paddle, fat taken from the surface of the muscle, the scapular fat pad, the anterior fatty zone, and the supra-iliac fat pad. This technique must be measured against the transverse rectus abdominis muscle (TRAM) flap, free or pedicled, when the patient needs an autologous breast reconstruction. It can be used when the TRAM flap is contraindicated (this corresponds to 45 percent of patients of our sample) or when the dorsal donor site is preferred (55 percent of cases of our sample). The major complications are rare (1 percent partial necrosis and 1 percent total necrosis of the flap). The minor complications are represented mainly by the dorsal seroma. This is the main drawback of the technique, as it occurs in 79 percent of cases and regularly in obese patients. In view of this frequency, patients should be warned of its likely occurrence. The dorsal donor-site morbidity is relatively low; 4 percent of dorsal sequelae were classed as moderate, and 96 percent were considered low. The scapular sequelae have been classed as low in 97 percent of cases, and temporary scapular sequelae aggravation has been noted in 3 percent. Results of breast reconstruction using this technique are most encouraging. The level of patient satisfaction is high; 87 percent of them were deeply satisfied, 10 percent were satisfied, and only 3 percent were poorly satisfied. This group of poorly satisfied subjects (3 percent) consists of patients who suffered a serious postoperative complication. The aesthetic results have been judged excellent by surgeons in 85 percent of the cases, good in 12 percent of the cases, and poor in 3 percent of the cases; no result has been judged bad. This technique of breast reconstruction by autologous latissimus dorsi brings a major advance in breast reconstruction. The best indications of this technique are when one can bury the cutaneous paddle: cases of skin-sparing mastectomy, cases where the latissimus dorsi flap can be combined with an abdominal advancement flap, and cases of conversion of implant reconstruction to an autologous reconstruction.

[Breast reconstruction with the autologous latissimus dorsi flap. Preliminary report of 60 consecutive reconstructions]. / Reconstruction mammaire par lambeau de grand dorsal sans prothèse. Expérience préliminaire à propos de 60 reconstructions.

Many women who have undergone or will undergo mastectomy request breast reconstruction and feel that it is an important part of their total cancer treatment. Autogenous tissue methods take a place more and more important in breast reconstruction. The autologous latissimus dorsi flap, is a recent method of autologous breast reconstruction. We have done a retrospective study based on a series of 60 consecutive reconstructions operated between march 1993 and april 1995. The advantages of the autologous latissimus dorsi flap are the same of the others autologous breast reconstruction methods: the reconstructed breasts are soft and match an opposite normal breast more successfully than those made with implants. The disadvantages of this technique is mainly the dorsal seroma that was observed in 70% of cases but was easily managed by aspirations. The aesthetics results have been judged by two surgeons as very good in 85% of cases, good in 11.6% and low in 3.3%. The satisfaction rate of the patients in high: 86.6% are pleased and 13.3% are satisfied. The autologous latissimus dorsi breast reconstruction is a safe and reliable technique and provides an excellent alternative to the TRAM flap, when the patient prefer the dorsal donor site or when there are some risk factors to do a TRAM flap. Finally this technique bring a major advance in the field of breast reconstruction, immediate or delayed.

[Value of Tissucol in dentistry and maxillofacial surgery]. / Intérêt du Tissucol en stomatologie et chirurgie maxillo-faciale.

Fibrinogen glue of human origin was used in 44 patients. Indications are of two types: as a glue mainly for dermoepidermoid grafts but also to assist mucosal suturing and bone obturation, and for hemostasis after extractions in patients with coagulation disorders (hemophilia, cirrhosis, leukemia). Positive results were obtained, particularly in hemophilic patients, the incidence and severity of secondary hemorrhage appearing to diminish.

[Comparative study of myocardial protection by coronary perfusion in deep hypothermia (10 degrees C) with or without potassium cardioplegia. Clinical, electrocardiographic, enzymatic results; biochemical and histological controls]. / Etude comparée de la protection myocardique par perfusion coronaire en hypothermie profonde (10 degrees C) avec ou sans cardioplégie au potassium. Résultats cliniques, électocardiographiques, enzymatiques, contrôles biochimiques et histologiques.

A technique of coronary perfusion with diluted blood, giving homogenous myocardial cooling (10-12 degrees C) under lignocaine perfusion, with or without potassium (K) cardioplegia is presented. The first 75 operated cases were used to adjust the optimal lignocaine (5 mg/min) and K (2 meq/min in continuous coronary perfusion, 5 meq/min in discontinuous coronary perfusion) dosage in the myocardial protection circuit. Then, 123 operated patients (78 aortic valve replacement, 30 mitro-aortic double valve replacement, 15 other operations on the ascending aorta) were classified into four groups prospectively: 1. Continuous coronary perfusion 10 degrees C, 2. Continuous coronary perfusion 10 degrees C with associated K cardioplegia, 3. Discontinuous coronary perfusion 10 degrees C, 4. Discontinuous coronary perfusion 10 degrees C with K cardioplegia. The best return of cardiac activity was observed in Group 1 and this was statistically significant with a high percentage of spontaneous heart beating after declamping the aorta (average 10 minutes), immediate efficacity of left ventricular contraction, and absence of arrhythmias, especially the transient conduction defects observed with K cardioplegia. In Group 1, during mitro-aortic valve replacement, after over 60 minutes aortic clamping, no significant reduction of ATP or myocardial phosphocreatinine or changes of hexosemonophosphates were observed, contrary to the findings after 15 minutes aortic clamping at 28 degrees C in a control group of mitral valve replacements (n = 10). Myocardial changes on electron microscopy in the subendocardial region of the left ventricle were minimal or absent, especially with respect to the mitochondria. The early post-operative course was the same in all four groups: of the 123 patients operated, early mortality was 2.4 p. 100 (1.6 p. 100 from intercurrent causes), severe arrhythmias were observed in 1.6 p. 100, supraventricular arrhythmias in 4.9 p. 100, myocardial infarction in 0.8 p. 100, electrocardiographic ischaemia in 0.8 p. 100, and atrioventricular block in 0.8 p. 100. The average enzyme level (CPK, SGOT, LDH) in the early postoperative period were low, with no correlation with the duration of aortic clamping.

[Myocardial protection by perfusion in deep hypothermia (10 degrees C) with or without cardioplegia (author's transl)]. / Protection myocardique par perfusion en hypothermie profonde (10 degrees C) avec ou sans cardioplégie.

A technique of myocardial protection using a perfusion circuit in deep hypothermia via the ascending aorta or by selective cannulation of the coronaries has been used over a period of 2 years in almost 200 patients undergoing surgery requiring prolonged aortic clamping. It ensures rapid and homogeneous cooling of the myocardium (10-12 degrees C) and meets its reduced oxygen needs. It may be completed by cardioplegia (infusion of potassium chloride or lidocaine using an automatic syringe at a determined level). This simple technique permits a rapid spontaneous return of normal effective cardiac action. No low cardiac output syndromes have been seen since it has been used. Laboratory, histological, biochemical and haemodynamic studies carried out have confirmed its harmless nature.