French multicentre prospective evaluation of radiofrequency ablation in the management of haemorrhoidal disease.

PURPOSE: The aim of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) in the management of haemorrhoidal disease with 1 year's follow-up. METHOD: This prospective multicentre study assessed RFA (Rafaelo©) in outpatients with grade II-III haemorrhoids. RFA was performed in the operating room under locoregional or general anaesthesia. Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery. Secondary endpoints were evolution of symptoms (prolapsus, bleeding, pain, itching, anal discomfort), complications, postoperative pain and medical leave. RESULTS: A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres. Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months. At 3 months, the rate of patients reporting bleeding (21% vs. 84%, p < 0.001), prolapse (34% vs. 91.3%, p < 0.001) and anal discomfort (0/10 vs. 5/10, p < 0.0001) decreased significantly. Median medical leave was 4 days [1-14]. Postoperative pain was 4/10, 1/10, 0/10 and 0/10 at weeks 1, 2, 3 and 4. Seven patients (5.4%) were reoperated on by haemorrhoidectomy for relapse, and three for complications. Reported complications were haemorrhage (3), dysuria (3), abscess (2), anal fissure (1), external haemorrhoidal thrombosis (10), pain requiring morphine (11). Degree of satisfaction was high (+ 5 at 3 months on a - 5/+ 5 scale). CONCLUSION: RFA is associated with an improvement in quality of life and symptoms with a good safety profile. As expected for minimally invasive surgery, postoperative pain is minor with short medical leave. CLINICAL TRIAL REGISTRATION AND DATE: Clinical trial NCT04229784 (18/01/2020).

L'impact des microvariants du virus herpétique ostreid herpesvirus 1 sur la culture d'huîtres creuses dans les hémisphères Nord et Sud depuis 2008.

Mollusc farming is the third most productive aquaculture activity in the world, and the Pacific oyster (Crassostrea gigas) is one of the most important farmed species. Since 2008, mass mortalities in C. gigas due to ostreid herpesvirus 1 microvariants have challenged the viability of this industry in Europe, New Zealand and Australia. Ten years after the emergence of this disease, there is evidence that the industry has become consolidated into fewer, larger companies, with the displacement of small farming enterprises and loss of employment in coastal communities. Rather than seeking technical solutions, the industry has turned to compensatory production strategies, such as increasing the number of spat placed on farms, higher market prices for table oysters and direct marketing, which appear to have allowed profitability. Biosecurity policies and responses to outbreaks, including those from within the industry, have had unintended consequences for hatcheries and farmers in areas free of disease, mainly caused by restrictions on animal movements, and have not prevented global spread. There may be opportunities for better coordination of industry and government responses to epizootic disease emergence in aquaculture. There is certainly a need for increased adoption of technical advances from research, once these solutions have been adequately verified.

L'élevage de mollusques occupe le troisième rang mondial parmi les activités de l'aquaculture en termes de production ; l'une des principales espèces élevées est l'huître creuse (Crassostrea gigas). Depuis 2008, la rentabilité des élevages de C. gigas en Europe, en Nouvelle-Zélande et en Australie a été fortement compromise par une mortalité massive due à des microvariants du virus herpétique Ostreid herpesvirus 1. Dix ans après l'émergence de cette maladie, on observe une forte concentration du secteur autour d'entreprises moins nombreuses mais de plus grande envergure qui ont remplacé l'ancien tissu d'exploitations artisanales et occasionné un déclin de l'emploi dans les communautés littorales. Au lieu de rechercher des solutions techniques, le secteur a eu recours à des stratégies de compensation axées sur la production, par exemple en augmentant le nombre de naissains mis en place dans les fermes, en augmentant le prix des huîtres de consommation ou en développant la vente directe, stratégies dont l'impact sur la rentabilité semble avoir été positif. En revanche, les mesures de biosécurité mises en place et les réponses apportées aux foyers, y compris celles introduites par le secteur lui-même ont eu des conséquences imprévues pour les écloseries et les éleveurs des zones indemnes de maladie, principalement en raison des restrictions imposées aux transferts d'animaux, sans pour autant prévenir la propagation de la maladie à l'échelle mondiale. Une meilleure coordination des réponses sectorielles et publiques face à l'émergence des maladies épizootiques affectant l'aquaculture devrait être possible. Il sera également indispensable de recourir davantage aux avancées techniques mises au point par la recherche dès que ces solutions auront été dûment validées.

La producción de moluscos es la tercera actividad acuícola más productiva del mundo, y la ostra japonesa (o del Pacífico) (Crassostrea gigas) ocupa un lugar destacado entre las principales especies cultivadas. Desde 2008, la viabilidad de esta industria en Europa, Nueva Zelanda y Australia está amenazada por episodios de mortandad masiva de C. gigas causados por microvariantes del herpesvirus de los ostreidos 1 (ostreid herpesvirus 1). Diez años después de la aparición de la enfermedad, lo que se observa es que la industria se ha ido concentrando en unas pocas empresas de grandes dimensiones, que han desplazado a las pequeñas empresas ostrícolas y causado la pérdida de numerosos empleos en las comunidades costeras. En lugar de buscar soluciones técnicas, la industria ha optado más bien por estrategias de producción compensatorias (como aumentar el número de semillas de ostra por explotación, subir los precios de mercado de las ostras de mesa o recurrir a la comercialización directa) que parecen haber deparado rentabilidad. Las políticas de seguridad biológica y la respuesta a los brotes, incluida la del propio sector, han tenido consecuencias imprevistas para los viveros y acuicultores situados en zonas libres de la enfermedad, debido sobre todo a las restricciones impuestas a los desplazamientos de animales, sin que ello haya servido para impedir la diseminación mundial de esta patología. Puede haber margen para coordinar más eficazmente las respectivas respuestas de la industria y de los poderes públicos ante la aparición de enfermedades epizoóticas en la acuicultura. Lo que sin ninguna duda es necesario es incorporar en mayor medida los adelantos técnicos resultantes de la investigación, una vez contrastada debidamente cada solución.

Guidelines for the treatment of hemorrhoids (short report).

Hemorrhoids are a common medical problem that is often considered as benign. The French Society of Colo-Proctology (Société nationale française de colo-proctologie [SNFCP]) recently revised its recommendations for the management of hemorrhoids (last issued in 2001), based on the literature and consensual expert opinion. We present a short report of these recommendations. Briefly, medical treatment, including dietary fiber, should always be proposed in first intention and instrumental treatment only if medical treatment fails, except in grade ≥III prolapse. Surgery should be the last resort, and the patient well informed of the surgical alternatives, including the possibility of elective ambulatory surgery, if appropriate. Postoperative pain should be prevented by the systematic implementation of a pudendal block and multimodal use of analgesics.

The outcome of fistulotomy for anal fistula at 1 year: a prospective multicentre French study.

AIM: The study aimed to evaluate outcome at 1 year of one- and two-stage fistulotomy for anal fistula in a large group of patients. METHOD: A prospective multicentre observational study was designed to include patients with anal fistula treated by one- or two-stage fistulotomy. Data were collected using a self-administered questionnaire before surgery, during healing and at 1 year after surgery. RESULTS: Group A (133 patients) with a low anal fistula underwent a one-stage fistulotomy. The median Wexner scores before and after surgery were 1.0 (0-11) and 2.0 (0-18) (P = 0.032) and the median Vaizey scores were 2.0 (0-14) and 3.0 (0-21) (P = 0.055). The Wexner scores and percentage of patients before and after fistulotomy were as follows: 0-5: 88%, 86%; 6-10: 10.7%, 10.7%; 11-15: 1.0%, 2.6%; and 16-20: 0%, 2%. Eighty-seven per cent of the patients were satisfied. Group B (62 patients) underwent two-stage fistulotomy for a high transsphincteric fistula. The Wexner scores and percentage of patients before the first stage and 1 year after the second stage were as follows: 0-5: 86%, 66%; 6-10: 4.5%, 20%; 11-15: 9%, 11%; and 16-20: 0%, 2%. The median Wexner scores before the first stage and after the second stage were 1 (0-14) vs. 4 (0-19) (P < 0.001), and the median Vaizey scores were 1.5 (0-11) vs. 4 (0-20) (P < 0.001). Eighty-eight per cent of the patients were satisfied. CONCLUSION: Low transsphincteric anal fistula can be treated by fistulotomy without clinically significant continence disturbance. Treating high transsphincteric anal fistulae with two-stage fistulotomy is followed by mild continence disturbance. Satisfaction rates were high.

Sphincter-sparing anal-fissure surgery: a 1-year prospective, observational, multicentre study of fissurectomy with anoplasty.

AIM: Internal sphincterotomy is the standard surgical treatment for chronic anal fissure, but is frequently complicated by anal incontinence. Fissurectomy is proposed as an alternative technique to avoid sphincter injury. We describe 1-year outcomes of fissurectomy. METHOD: This was a prospective, multicentre, observational study. All patients with planned surgery for chronic anal fissure were included and had fissurectomy. Data were collected before surgery, at healing, and 1 year after fissurectomy. Patient self-assessed anal symptoms and quality of life (using the 36-item short-form health survey [SF-36] questionnaire). Presurgical and postsurgical variables were compared using the Wilcoxon signed-rank test for paired samples. RESULTS: Two-hundred and sixty-four patients were included (median age, 45 years; 52% women). Anoplasty was associated with fissurectomy in 83% of the 257 documented cases. The main complications were urinary retention (n = 3), local infection (n = 4) and faecal impaction (n = 1). Healing was achieved in all patients at a median of 7.5 weeks after surgery. No recurrence occurred. At 1 year, 210 (79%) questionnaires were returned. Median anal pain had dropped from 7.3/10 to 0.1/10 (P < 0.001), anal discomfort had decreased from 5.0/10 to 0.1/10 (P < 0.001) and the Knowles-Eckersley-Scott Symptom constipation score had decreased from 9/45 to 5/45 (P < 0.001). There was a nonsignificant increase in the Wexner anal incontinence score, from 1/20 to 2/20. De-novo clinically significant anal incontinence (Wexner score > 5) affected 7% of patients at 1 year, but presurgical incontinence had disappeared in 15% of patients. All SF-36 domains significantly improved. Anoplasty did not impact any result. CONCLUSION: Given its high rate of healing and low rate of de-novo anal incontinence, fissurectomy with anoplasty is a valuable sphincter-sparing surgical treatment for chronic anal fissure.

One-year outcome of haemorrhoidectomy: a prospective multicentre French study.

AIM: An evaluation was performed of the 1-year outcome of open haemorrhoidectomy (Milligan and Morgan alone or with posterior mucosal anoplasty [the Leopold Bellan procedure]). METHOD: A prospective, multicentre, observational study included all patients having a planned haemorrhoidectomy from January 2007 to June 2008. Data were collected before surgery, and at 3 months and 1 year after surgery. Patients assessed their anal symptoms and quality of life (SF-36). RESULTS: Six-hundred and thirty-three patients (median age = 48 years, 56.5% women) underwent haemorrhoidectomy either by the Milligan and Morgan procedure alone (n = 231, 36.5%) or together with the Leopold Bellan procedure (posterior mucosal anoplasty) for resection of a fourth haemorrhoid (n = 345, 54.5%), anal fissure (n = 56, 8.9%) or low anal fistula (n = 1, 0.16%). The median healing time was 6 weeks. Early complications included urinary retention (n = 3), bleeding (n = 11), local infection (n = 7) and faecal impaction (n = 9). At 1 year, the main complications included skin tags (n = 2) and anal stenosis (n = 23). There were three recurrences requiring a second haemorrhoidectomy. On a visual analogue scale, anal pain at 1 year had fallen from a median of 5.5/10 before treatment to 0.1/10 (p < 0.001), anal discomfort from 5.5/10 to 0.1/10 (P < 0.001) and the Knowles-Eckersley-Scott Symptom (KESS) constipation score from 9/45 to 6/45 (P < 0.001). The median Wexner score for anal incontinence was unchanged (2/20). De-novo anal incontinence (a Wexner score of >5) affected 8.5% of patients at 1 year, but preoperative incontinence disappeared in 16.7% of patients with this symptom. All physical and mental domains of quality of life significantly improved, and 88% of patients were satisfied or very satisfied. CONCLUSION: Complications of open haemorrhoidectomy were infrequent. Anal continence was not altered. Comfort and well-being were significantly improved at 1 year after surgery. Patient satisfaction was high despite residual anal symptoms.

Do we have to stop anticoagulant and platelet-inhibitor treatments during proctological surgery?

AIM: This prospective observation study evaluated the incidence of secondary bleeding after proctological surgery without interruption of oral anticoagulant or platelet-inhibitor treatments. METHOD: The number of episodes of postoperative bleeding was identified prospectively from the day of surgery to the last follow-up visit in consecutive patients operated on during 2010 in two units dedicated to proctology. RESULTS: A total of 2513 procedures were performed in 2314 patients (1379 men), 46 ± 16 years of age. Secondary bleeding occurred after 115 (4.6%) procedures, no later than day 24 after surgery, requiring rehospitalization in 86% of cases and further surgery and/or transfusion in 36%. The highest frequency was noted after surgery for haemorrhoids (haemorrhoidopexy, 7.9%; haemorrhoidectomy, 6.2%) (P = NS and transanal excision of rectal tumours (6.5%). On multivariate analysis, the frequency was significantly increased by clopidogrel (15%) [relative risk (RR) = 10). In patients on oral anticoagulants, bleeding occurred in 23% (RR = 5.8) if the anticoagulants were not interrupted and in 57% (RR = 42) if the anticoagulants were discontinued and replaced with heparin. CONCLUSION: During proctological surgery the overall risk of postoperative bleeding is low, but it can occur up to 3 weeks after surgery and is often severe. Maintenance treatment with oral anticoagulants is the most important risk factor, aggravated by a change to heparin. Clopidogrel also significantly increases the bleeding risk.

Prospective survey of secondary bleeding following anorectal surgery in a consecutive series of 1,269 patients.

INTRODUCTION: As little data is available about secondary bleeding after proctological surgery, we conducted a specific survey. PATIENTS AND METHODS: Patients operated between November 2008 and April 2009 were prospectively included. Patients were followed until last visit (day 21-28). Severity of bleeding was low (at home stay), moderate (hospitalisation for observation), or severe (transfusion, and/or homeostasis in operating room). RESULTS: Included were 1269 patients: haemorrhoidectomy/pexy 527 (41%), fistula treatment 273 (21%), fissurectomy 197 (15%), perianal and pilonidal abscesses 124 (10%), others 148 (12%). Before surgery 78 patients were under long-term treatment with antiplatelet or anticoagulant therapy. Seventy-eight patients (6%) demonstrated 85 bleeding events. Severity rate was: low 22%, moderate 51%, and severe 27%. Ninety-five percent of events occurred before day 15. Univariate study showed increased risk after haemorrhoidopexy (P<10-3) and anticoagulant treatment (P = 0.002), decreased risk after fissurectomy and fistulotomy (P<10-3), and no relation with age, sex or operator. After multivariate study only relationship with anticoagulant treatment remained significant. CONCLUSION: Secondary bleeding occurred in 6% of patients after proctological surgery, requiring a readmission and/or an active treatment in about 75%. Treatment with anticoagulant exposed to increased bleeding frequency.

Epidemiology of cervical spine abnormalities in asymptomatic adult professional rugby union players using static and dynamic MRI protocols: 2002 to 2006.

OBJECTIVE: In this study, the prevalence of abnormalities in the cervical spine of asymptomatic professional rugby players using both static and dynamic magnetic resonance imaging (MRI) in order to improve the detection of abnormalities and prevention of related injuries was investigated. DESIGN: Prospective observational study. SETTING: French professional rugby union clubs, between 2002 and 2006. PARTICIPANTS: 206 elite male adult players. INTERVENTION: Static sagittal T2 and axial T2* fast spin echo (FSE), and dynamic sagittal single-shot FSE weighted MRI scans of the C2-C7 region were examined for the presence of abnormalities. Participants' spines were in supine neutral position for the static protocol but were allowed complete flexibility in a sagittal plane for the dynamic protocol. MAIN OUTCOME MEASUREMENTS: The medulla-to-canal ratio (MCR) was measured at every vertebral disc level for both MRI methods. When observed, anatomical abnormalities were categorised. RESULTS: Anatomical abnormalities mainly consisted of degenerative discopathy and were most frequently observed in players aged>21 years, as well as in players whose MCR was abnormally high based on medical expertise. Most MCRs that were initially assessed as intermediate with static MRI were subsequently assessed as abnormal with dynamic MRI assessment. CONCLUSIONS: Since dynamic MRI is more accurate than static techniques in examining the cervical spine, it contributes substantially to identifying the risk of spinal injuries in professional rugby players, and when used in association with clinical assessment, it can assist in preventing spinal injury.

Humoral immune response to Klebsiella spp. In New Zealand sea lions (Phocarctos hookeri) and the passive transfer of immunity to pups.

During the 2001-02 and 2002-03 breeding seasons, epizootics of Klebsiella pneumoniae resulted in a dramatic increase of pup mortality in New Zealand sea lions (Phocarctos hookeri; NZSLs) on Enderby Island (Auckland Islands). To estimate the prevalence of infection in the NZSL population, a serologic test was developed using a Western blot and a polysaccharide antigen derived from a K. pneumoniae isolate from a NZSL pup. All archived serum samples collected between 1997 and 1998 and 2004 and 2005 at Sandy Bay Beach rookery, Enderby Island, were tested (314 pups and 302 adult females). Anti-Klebsiella antibodies were detected throughout this period, but overall, only 16% of NZSL pups between birth and 5 mo of age were seropositive compared with 95.7% of adults. There was no apparent change in antibody prevalence as a result of the two epizootics. A method to determine total immunoglobulin G (IgG) levels in sea lion serum also was developed to investigate passive immunoglobulin transfer to neonates and development of an acquired immune response. The IgG concentration was significantly lower in pups (median 2.1 mg/ml) than in adult females (median 80 mg/ml). Based on serologic results, it was not possible to determine whether K. pneumoniae was an endemic or a novel pathogen to the NZSL population because the test was not able to discriminate between Klebsiella species. However, this study suggested that the transfer of passive immunity to neonates was very low in the NZSL, especially for anti-Klebsiella antibodies.

Neonatal mortality in New Zealand sea lions (Phocarctos hookeri) at Sandy Bay, Enderby Island, Auckland Islands from 1998 to 2005.

As part of a health survey of New Zealand sea lions (Phocarctos hookeri) on Enderby Island, Auckland Islands (50 degrees 30'S, 166 degrees 17'E), neonatal mortality was closely monitored at the Sandy Bay colony for seven consecutive years. Throughout the breeding seasons 1998-99 to 2004-05, more than 400 postmortem examinations were performed on pups found dead at this site. The primary causes of death were categorized as trauma (35%), bacterial infections (24%), hookworm infection (13%), starvation (13%), and stillbirth (4%). For most pups, more than one diagnosis was recorded. Every year, two distinct peaks of trauma were observed: the first associated with mature bulls fighting within the harem and the second with subadult males abducting pups. In 2001-02 and 2002-03, epidemics caused by Klebsiella pneumoniae increased mortality by three times the mean in nonepidemic years (10.2%). The increased mortality was attributed directly to acute suppurative infection due to the bacterium and also to an increase in traumatic deaths of debilitated pups. Parasitic infection with the hookworm Uncinaria spp. was a common finding in all pups older than three weeks of age and debilitation by the parasite may have contributed to increased susceptibility to other pathogens such as Klebsiella sp. or Salmonella sp. This study provides valuable quantitative data on the natural causes of neonatal mortality in New Zealand sea lions that can be used in demographic models for management of threatened species.

Epidemiology of hookworm (Uncinaria spp.) infection in New Zealand (Hooker's) sea lion (Phocarctos hookeri) pups on Enderby Island, Auckland Islands (New Zealand) during the breeding seasons from 1999/2000 to 2004/2005.

This is the first investigation of the epidemiology of hookworm (Uncinaria spp.) infection in New Zealand sea lions (NZSLs; Phocarctos hookeri) on Enderby Island, Auckland Islands. The examination of faeces for hookworm eggs in various age categories of sea lions revealed that only pups up to at least 3 months of age harboured adult hookworms in their intestines. Gross necropsy of more than 400 pups from 1999/2000 to 2004/2005 showed that the prevalence of hookworm infection varied significantly between years and was higher from mid-January to the end of February when the majority of pups were between 3 and 9 weeks old. The average burden of adult parasites per pup was not influenced by the host's sex and body condition or by year. This study also provided evidence for transmission occurring by the transmammary route in NZSLs.

Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence.

BACKGROUND: The ability of stapled hemorrhoidopexy (SH) to cure hemorrhoidal symptoms appears to depend on patient characteristics and operative technique. We assessed the association between outcome of SH and patients' characteristics and procedure parameters (associated procedure, suture line height, doughnut size, presence of malpighian tissue or smooth muscle in specimen). METHODS: A total of 68 consecutive patients (56 males) were prospectively operated by 3 different surgeons. Hemorrhoids were grade II (6%), grade III (76%) or grade IV (18%). RESULTS: At a mean 32-week follow-up (range, 9-77), symptoms had resolved in 77% of patients, independently of any operative or clinical parameter. New onset anal incontinence occurred in 11 men (17%): all had urgency, with flatus and liquid stool incontinence in two, and flatus incontinence and mucus soiling in one. Univariate analysis revealed that persistent incontinence was associated with a staple line <6.5 mm from the dentate line, doughnut height <22 mm, and congestive external hemorrhoids; it was also operator dependent (p<0.05). At the 4-week follow-up, 19% of patients had persisting symptoms but only 8% had a demonstrable mucosal prolapse. CONCLUSION: Although the success rate of SH may not be influenced by technical variations, risk for moderate incontinence is elevated when the stapled line is low.

[Postoperative pain and long-term results after hemorrhoidal treatment with anopexy]. / Vécu de la douleur postopératoire et résultats à long terme après chirurgie hémorroïdaire par anopexie.

AIMS: Anopexy allows treatment of hemorrhoidal symptoms with a less painful postoperative course. This information is important for the patient, but may lead to dissatisfaction if pain level is higher than expected. To evaluate perceived pain and physical limitation levels in relation to patient's expectation. Evaluate long-term functional results. RESULTS: Sixty-eight consecutive patients (56 males) were prospectively included. Distribution of haemorrhoid grades were 4 grade 2 (6%), 52 grade 3 (76%) and 12 grade 4 (18%). Postoperative pain level was less or equal than expected for 85% of patients, with a better acceptance superior to 45 years. Physical limitation was equally or less important than expected for 89%. At the 32 weeks follow-up hemorrhoidal symptoms were present in 23%, uninfluenced by any patient's or operative characteristics. Incontinence with urgency was reported by 17%. Presence of an alliterated continence was linked to stapled line inferior to 6,5 mm from pectineate line, doughnut height inferior to 22 mm, external hemorrhoids and related to surgeon. CONCLUSION: Pragmatic information, although vague, about postoperative pain does not expose to patient's dissatisfaction. Functional results are not influenced by technical variation. Continence alterations are not severe, but frequent when stapled line is too close from pectineate line.

First report and characterization of adult Uncinaria spp. in New Zealand Sea Lion (Phocarctos hookeri) pups from the Auckland Islands, New Zealand.

Two species of hookworms (Uncinaria lucasi and Uncinaria hamiltoni) have been formally described from pinnipeds, but dissimilar types are noted from these hosts. This report is the first description of hookworms (Uncinaria spp.) from the New Zealand sea lion, Phocarctos hookeri. The nematodes were collected from dead pups on Enderby Island (Auckland Islands, 50 degrees 30', 166 degrees 17') during January and February, 2004. Standard measurements of male and female hookworms were obtained, providing a general morphometric characterization of the hookworm species in P. hookeri. Considerable variations in the body length of adult hookworms were noted within the same host. The arrangement of some of the bursal rays differs from that described for U. lucasi and U. hamiltoni.

[Local excision with postoperative radiotherapy for T2 or T3 distal rectal cancer. Long-term results]. / Exérèse locale avec radiothérapie préopératoire dans les cancers T2 ou T3 du bas rectum. Résultats à long terme.

STUDY AIM: To evaluate, in a prospective study of a cohort of patients, the local recurrence rate of T2 or T3 rectal cancers treated by transanal excision after preoperative irradiation. PATIENTS AND METHODS: Between 1992 and 1999, 34 patients were treated after radiotherapy by a local excision for a distal rectal carcinoma limited to (stage T2) or invading through the muscular layer (stage T3). Four patients were excluded either for palliative treatment or lost for follow-up. Thirty patients were included in the study (8 uT2, 8 uT3, 14 undetermined preirradiation stage). RESULTS: After a 74-month mean follow-up (median: 46), the 5-year local recurrence rate was 33%. Even among subgroups of patients with a significant risk factor for local recurrence (size > 40 mm, clear margin < 2 mm, uT3 stage versus uT2) there were no benefits from irradiation. CONCLUSION: Local excision of T2 or T3 rectal cancers is associated with an elevated local recurrence rate. This result is demonstrated even after adjunction of a preoperative irradiation. So, local treatment must be restricted to clearly informed patients who definitively refuse a radical intervention.

Endogenous megakaryocytic colony formation and thrombopoietin sensitivity of megakaryocytic progenitor cells are useful to distinguish between essential thrombocythemia and reactive thrombocytosis.

Diagnosis of essential thrombocythemia (ET) is controversial and remains mainly an exclusion diagnosis. Endogenous megakaryocyte colony (EMC) formation have been largely evaluated to identify specific criteria for ET, but results are impeded by the lack of medium standardization. We evaluated megakaryocyte (MK) colony formation in a serum-free collagen-based medium, without cytokine and in the presence of various concentrations of thrombopoietin (TPO). Thirty-six bone marrows from patients diagnosed with ET (n = 11), polycythemia vera (PV; n = 12), reactive thrombocytosis (RT; n = 6) and healthy donors (n = 7) were assessed. We demonstrate that 11 out 11 of the ET patients had spontaneous megakaryocyte colony-forming unit (CFU-MK) formation, in contrast to none of the RT patients and healthy donors. MK progenitors from ET patients remained responsive to TPO, because exogenous addition of TPO significantly increased cloning efficiency. Moreover, at low doses of TPO (0.5 ng/ml and 5 ng/ml), the number of positive cultures and mean number of TPO stimulated CFU-MK were significantly higher in cultures of cells from patients with ET than in patients with RT. In summary, we have described a standardized serum-free, collagen-based assay that allows differential diagnosis of ET and RT, according to endogenous CFU-MK formation and sensitivity to TPO.

[Quality of life, symptoms of dyschezia, and anatomy after correction of rectal motility disorder]. / Qualité de vie, symptômes de dyschésie et anatomie après correction d'un trouble de la statique rectale par voie basse.

AIM OF THE STUDY: To evaluate the quality of life of patients suffering from dyschezia and its correlation with symptomatic complaints and anatomical abnormalities, before and after elective surgery for rectal static disorder. PATIENTS AND METHODS: A prospective study was conducted using a general quality of life questionnaire (SF36) and a constipation specific score (PAC-QoL), a dyschezia symptom score, and defecography. RESULTS: Thirty-eight female dyschesic patients (mean age 54 years) underwent surgery for rectocele with (n=16) or without (n=14) internal rectal prolapse, an isolated internal rectal prolapse (n=3), or a total rectal prolapse (n=5). Preoperative quality of life was low, correlated with the intensity of dyschezia. Seven months after surgery, quality of life and dyschezia improved independently of the amplitude of the anatomical correction. More items improved in the constipation specific score than on the quality of life questionnaire; they were correlated with the course of dyschezia symptoms. Neither incontinence nor irritable bowel syndrome affected evolution of the symptoms. CONCLUSION: Surgery improved initially low quality of life and symptomatic complaints in patients with dyschezia and a rectal static disorder, independently of anatomic repair. Differences in changes observed in the PAC-QoL and SF36 suggest different fields of application.

Effects of two sex steroids (17beta estradiol and testosterone) on proliferation and clonal growth of the human monoblastic leukemia cell line, U937.

We investigated the effects of two sex steroids (17beta estradiol and testosterone) on five human leukemia cell lines. We observed a statistically significant inhibition of proliferation, dose and time dependent, of the human monoblastic leukemia cell line U937. This inhibition was associated with a dose dependent decrease in the number of CFU-blasts in clonogenic cultures. Cytostatic effect was obtained with doses of 5 microM for estrogen and 10 microM for androgen and was not due to a non-specific cytotoxic effect, some cell viability remained high (> 90%) even after 6 days of incubation. More accurately, we demonstrated that growth inhibition was associated with a cell cycle arrest, U937 cells accumulating in G2/M phase. This blockade was dose related with a maximum number of cells accumulating at day 4. Sensitivity of these cells to an S-phase specific agent (hydroxyurea) was not increased, suggesting that these cells were blocked in G2/M and did not undergo mitosis. Expression in U937 cells of high affinity nuclear receptors for estrogen and androgen was negative which was in favour of a type II estrogen binding site, mediated mechanism. Moreover, a small fraction of these cells underwent apoptosis or differentiation with about 12% apoptotic cells and a significant increase (more than 30%) of two myelomonocytic markers (CD13 and CD64). These results demonstrate that the proliferation of some leukemic cells may be inhibited by micromolar concentrations of sex steroids, independently of nuclear receptor expression. The main mechanism seems to be a block in cell cycle associated with modulation of apoptosis and differentiation. It provided additional evidence for the potential value of sex steroids and their analogues in the treatment of leukemias.