Vitamin K-induced effects on body fat and weight: results from a 3-year vitamin K2 intervention study.

BACKGROUND/OBJECTIVES: Vitamin K status has been linked to fat and glucose metabolism by several authors, but whether high vitamin K intake influences body weight or composition has remained unclear. Here we tested the hypothesis that increased vitamin K intake decreases body fat or fat distribution. SUBJECTS/METHODS: In a randomized placebo-controlled human intervention trial, 214 postmenopausal women, 55-65 years of age, received either 180 mcg/day of vitamin K2 (menaquinone-7, MK-7) or placebo for 3 years. Osteocalcin (OC) carboxylation was used as a marker for vitamin K status, and fat distribution was assessed by dual-energy X-ray absorptiometry total body scan. RESULTS: In the total cohort, MK-7 supplementation increased circulating carboxylated OC (cOC) but had no effect on body composition. In those with an above-median response in OC carboxylation ('good responders'), MK-7 treatment resulted in a significant increase in total and human molecular weight adiponectin and a decrease in abdominal fat mass and in the estimated visceral adipose tissue area compared with the placebo group and the poor responders. CONCLUSIONS: The fact that changes in body composition measures or markers for fat or glucose metabolism were not associated with changes in uncarboxylated OC (ucOC) does not support the assumption that ucOC stimulates fat metabolism in humans. Instead, high vitamin K2 intake may support reducing body weight, abdominal and visceral fat, notably in subjects showing a strong increase in cOC. A causal relation between the changes in cOC and body fat or distribution cannot be concluded from these data.

[Interest of a structured laparoscopy training in a simulation center: survey of resident's point of view]. / Intérêt d'un enseignement structuré de la cœlioscopie en centre de simulation : enquête d'opinion auprès des internes.

OBJECTIVE: Assess residents satisfaction within their participation to a short and structured training to laparoscopy, gathering theoretical and practical issues. METHODS: This course was divided in two periods of 3days including an individual prospective evaluation. For each period, the residents have answered to three questionnaires trying to evaluate their experience in laparoscopy and their short term and medium term satisfaction. RESULTS: Three hundred residents from different French university hospitals have been involved in this study. After 4years, half of them were not satisfied with their chirurgical studies. Thirty-seven percent of them never attended to any surgical procedure as main operator. The training course has answered to their expectation for 95% of the residents and 85% said they now feel more confident about laparoscopy then before. According to 76% of them, it should be a compulsory and systematic training course and for 75%, they should be tested regarding their laparoscopy skills level during the resident studies period. The training on animals is the more efficient for 86% of them. CONCLUSIONS: Due to the increasing number of residents and to the legal time for rest, the time spent in the operative room has decreased. People also do not accept easily the training made on true patients. Intensive and tested training are useful and answer to residents needs. They could be systematically integrated in their global curriculum.

[Detection of cephalopelvic disproportion using a virtual reality model: a feasibility study of three cases]. / Détection des disproportions fœtopelviennes par réalité virtuelle : étude de faisabilité à propos de trois cas.

Routine daily practice shows that successful vaginal delivery for women with suspected narrow pelvis or large fetus remains possible. We present a computer software for the detection of fetopelvic disproportion based on 3D vectorial reconstructions of the fetal head and maternal pelvis with simulation of head passage through the pelvis for collision detection. Three delivery simulations were generated from MR pelvimetry data in two patients, one with narrow pelvis and the other with macrosomic fetus. Based on the simulation, fetus size in both cases was appropriate for the pelvic size, but delivery simulation for the macrosomic fetus concluded that vaginal delivery was mechanically impossible. Further evaluation of this promising software on a larger patient population is necessary.

[Spontaneous ovarian hyperstimulation syndrome in a pregnancy with hypothyroidism]. / Syndrome d'hyperstimulation ovarienne spontanée dans un contexte gravidique avec hypothyroïdie.

We report the management of spontaneous ovarian hyperstimulation syndrome in a 23-year-old patient, diagnosed at 8 gestational weeks, in a context of moderate hypothyroidism. The etiology of spontaneous ovarian hyperstimulation syndrome should seek hypersecretion of glycoprotein hormones (hCG, TSH, FSH and LH) and/or mutation of FSH and LH receptors. It will eliminate an incipient ovarian neoplasia. The laparoscopic exploration can be done if diagnosis doubt persists. A diagnostic algorithm can be proposed.

[Hysteroscopic myomectomy: recurrence and satisfaction survey at short- and long-term]. / Myomectomie hystéroscopique: récidive et enquête de satisfaction à court et long terme.

OBJECTIVES: To assess the postoperative results at short- and long-term after hysteroscopic resection of submucosal myoma giving rise to symptoms. PATIENTS AND METHODS: Retrospective study (University Hospital Estaing, Clermont-Ferrand, France) including patients operated by hysteroscopy in 2004 for one or more submucosal myomas giving rise to symptoms. A survey concerning relapse of symptoms and patient satisfaction was made by phone 4 and 6 years after surgery. RESULTS: Seventy-two patients (mean age: 45.6 years [18-70]) underwent hysteroscopy. At the time of the first survey, the rate of recurrence was 22% (n=15) with 87.5% of cases of recurrence in the first year. Nineteen percent of the patients needed subsequent treatment. The significant factors for the risk of failure of treatment included younger age, number and large size myoma, intramural extension and incomplete resection. In 2010, the overall failure rate was 31.7% (n=20). Fifty percent of the patients who had an incomplete resection required no further treatment. CONCLUSION: In 70% of cases, hysteroscopic resection remains efficient at long-term. Repeat surgery should not be systematic after incomplete resection. The patients must be fully informed, and especially with respect to the risk factors for recurrence.

Complications after surgery for deeply infiltrating pelvic endometriosis.

OBJECTIVE: to evaluate the complications after surgery for deep endometriosis. DESIGN: retrospective study. SETTING: data from the CHU Estaing database and patients' charts between January 1987 and December 2007. SAMPLE: all women given surgical treatment for deep endometriosis. METHODS: women who underwent surgery for deep endometriosis were reviewed for intra- and postoperative complications. MAIN OUTCOME MEASURES: primary outcomes were rates of intra- and postoperative complications. Complications were compared according to the procedure performed. RESULTS: a total of 568 women were included in the study, with a mean age of 32.4 years. The mean estimated diameter of the nodule felt by vaginal examination was 1.8 cm (ranging from 0.5 to 7 cm). Laparoscopic surgery was performed in 560 women (98.6%), and conversion was required in 2.3%. The mean operative time was 155 minutes. Intraoperative complications occurred in 12 women (2.1%), including six minor (1.05%) and six major (1.05%) complications. Postoperative complications developed in 79 women (13.9%), including 54 minor (9.5%) and 26 major (4.6%) complications (one woman had both minor and major postoperative complications). The overall major postoperative complication rate for women who underwent any type of rectal surgery (shaving, excision and suture, or segmental resection) was 9.3% (21 out of 226), compared with only 1.5% for the other women (five out of 342) (P < .01). Shaving presented less major postoperative complications compared with segmental resection (24 versus 6.7%; P = 0.004). CONCLUSIONS: surgery for deep endometriosis is feasible, but it is associated with major complications, especially when any type of rectal surgery must be performed.

Does prevention of intraperitoneal spillage when removing a dermoid cyst prevent granulomatous peritonitis?

In this retrospective study of 314 patients undergoing surgery for ovarian dermoid cysts, conducted over a 20-year period, we evaluated the impact of the routine use of laparoscopic surgery without recourse to laparotomy to retrieve the specimen, using an endoscopic retrieval bag placed under the cyst to prevent intraperitoneal spillage of cyst contents, and subsequent postoperative granulomatous peritonitis. Accidental cyst rupture was more frequent when a total laparoscopic approach was used (26/174 or 15% versus 39/140 or 28%; P = 0.005), but there were no cases of intraperitoneal spillage when an endoscopic bag was used. Two cases of granulomatous peritonitis developed out of 26 women with intraperitoneal spillage of cyst contents (8%). We conclude that the risk of granulomatous peritonitis can be minimised by undertaking laparoscopic removal of dermoid cysts with the routine intraoperative use of an endoscopic retrieval bag to prevent intraperitoneal spillage of cyst contents.

[Laparoscopy during pregnancy: experience of the French university hospital of Clermont-Ferrand]. / Coelioscopie en cours de grossesse: expérience du centre hospitalier universitaire (CHU) de Clermont-Ferrand.

OBJECTIVE: To describe perioperative management and perinatal outcome for patients undergoing laparoscopy during pregnancy. PATIENTS AND METHODS: We conducted a retrospective study of all cases of laparoscopy during pregnancy performed in our university hospital over a period of six years (from February 2000 to February 2006). RESULTS: We observed 34 cases managed from five to 30 weeks of gestation (11 cases of adnexal torsion, ten adnexal masses, eight appendicitis, one cholecystitis, one sigmoid volvulus, one pelvic peritonitis, two heterotopic pregnancies). Open laparoscopy was used in 12 cases. Conversion was required in two cases mainly due to adherences (one borderline lesion at 16 weeks and one tubal cyst torsion at 24 weeks). No maternal complication was observed. One miscarriage occurred at Day 1 (peritonitis, five weeks of gestation) and one patient opted for abortion. No threatened preterm labour occurred after the perioperative course and no neonate required admission in neonatology unit. DISCUSSION AND CONCLUSION: This study illustrates safety and efficacy of laparoscopy in management of surgical diseases in the gravid patient. Emergent indications are the most common, highlighting the need for all physicians to know specific recommendations related to laparoscopy during pregnancy.

[Autoimmune hepatitis and pregnancy: about a patient's three consecutive pregnancies]. / Hépatite auto-immune et grossesse: à propos de trois grossesses consécutives chez une patiente.

Spontaneous evolution of autoimmune hepatitis during pregnancy is not well known, nor are its consequences on pregnancy evolution. Immunosuppressive treatment during pregnancy is sometimes necessary but the long- and short-term consequences are unrecognized. We relate a patient's disease with autoimmune hepatitis and cirrhosis and three consecutive pregnancies with different obstetrical and medical complications.

[Are there anatomical and clinical correlations between minimal and deep endometriosis? First results of Auvergne's Registry of Endometriosis]. / Existe-t-il une corrélation anatomoclinique entre endométriose minime et endométriose sévère? Premiers résultats du registre régional d'Auvergne de l'endométriose.

OBJECTIVE: With a prospective study, to evaluate the existence of two distinct clinical diseases in the endometriosis syndrome, by comparing pain symptoms and quality of life from patients with minimal endometriosis (AFS-R<5) and data from patients with severe disease (deep infiltrating nodules and/or ovarian endometrioma). PATIENTS AND METHODS: Patients with minimal disease (group A with AFS-R<5) and severe endometriosis (group B) are selected from the Auvergne Endometriosis Registry which started in January 2004. They have never been treated before for endometriosis. A surgical laparoscopic and a pathological diagnosis are required for the subjects to be included. Pelvic pain is assessed using a standardized questionnaire, and a visual analogue scale, quality of life using SF-36. The two groups are compared for the incidence and the severity of pelvic pain and for the impairment of their quality of life. RESULTS: Forty-seven patients have a minimal disease, whereas 111 have a severe endometriosis. Demographic characteristics are similar in both groups. Quality of life (SF-36) and pelvic pains included chronic pelvic pain, dyspareunia, dysuria, and defecation disorders are as common and severe in both groups. However, dysmenorrhea is more affected in group B than in group A (p=0.03). DISCUSSION AND CONCLUSION: We find no relationship between severity of symptoms, quality of life, and the extent of endometriotic lesions at surgery. There would be no differences between minimal and severe disease. It could be explained by different painful mechanisms between minimal and severe endometriosis.

[Endometriosis related infertility]. / La stérilité par endométriose.

From the literature, the crucial knowledge were drawn among endometriosis related infertility. Endometriosis is an important factor of infertility in minimal or light stages and a major one in mild or moderate stages. Thus, a laparoscopy must be performed to confirm endometriosis when suggestive clinical or biological signs exist. In absence of them, laparoscopy can be delayed after intra-uterine inseminations (IUI). The first line treatment is laparoscopic surgery. Its efficacy is proven. It is useless to prescribe a post-operative medical treatment (GnRH analogues). Surgery leads to 25 to 40% of deliveries. It is dependant on age, infertility duration, tubo-ovarian adhesion and tubes involvement. But, surgery can be avoided and the patient is directly referred to In Vitro Fertilization (IVF) when the lesions extension is so important that surgery exposes to complications or when there is a permanent other indication for IVF (severe male infertility). When infertility persists 6 to 12 months after surgery and without patent recurrence, ovulation stimulations and IUI are performed as the second line treatment. After IUI failure, or in case of recurrence, IVF must be applied. A second surgery is not recommended. The IVF results are not impaired by the presence of endometriosis and even of endometriomas. Thus, it is useless to operate again endometriosis before IVF. In opposition, in severe stages or in cases of recurrence, a pre-IVF medical treatment (GnRH analogues) improves the results. IVF do not increased the risk of endometriosis acute growth. In case of infertility and pain, infertility is considered as the first target. But medical treatment can be prescribed between the IVF attempts.