Impact of Transplantation Timing on Renal Graft Survival Outcomes and Perioperative Complications.

Nighttime organ transplantation aims to decrease cold ischemia duration, yet conflicting data exists on its impact on graft function and perioperative complications. This multicenter TRANSPLANT'AFUF study including 2,854 patients, transplanted between 1 January 2011, and 31 December 2022, investigated nighttime kidney transplantation's impact (8:00 p.m.-8:00 a.m.) versus daytime (8:00 a.m.-8:00 p.m.) on surgical complications and graft survival. Overall, 2043 patients (71.6%) underwent daytime graft, while 811 (28.4%) underwent nighttime graft. No impact was observed of timing of graft surgery on graft survival with a median survival of 98 months and 132 months for daytime and nightime grafting, respectively (p = 0.1749). Moreover, no impact was observed on early surgical complications (Clavien I-II = 20.95% for DG and 20.10% for NG; Clavien III-IV-V = 15.42% for DG and 12.94% for NG; p = 0.0889) and late complications (>30 days) (Clavien I-II = 6.80% for DG and 5.67% for NG; Clavien III-IV-V = 12.78% for DG and 12.82% for NG; p = 0.2444). Noteworthy, we found a significant increase in Maastricht 3 donors' rates in nighttime transplantation (5.53% DG vs. 21.45% NG; p < 0.0001). In conclusion, nighttime kidney transplantation did not impact early/late surgical complications nor graft survival.

Potential histological discordance revealed by second review in the national rare gynecological cancer network (TMRG).

INTRODUCTION: Since 2010, the network of rare malignant tumors of the ovary (TMRG) was developed to optimize the management of patients, also allowing a histological second opinion of rare ovarian tumors. The aim of this work was to study the contribution of second opinion to improve histological diagnostic accuracy on ovarian rare malignant tumors included in the TMRG database. MATERIAL AND METHODS: Histological data of patients diagnosed with a rare ovarian tumor included in TMRG network over a one-year period (2018) were collected. Initial diagnoses were compared with second opinion from national gynecological pathologist experts. The modalities of histological second opinion requests were studied, as well as the histological characteristics of the tumors. The discordances were classified as minor (if the modification of histological diagnosis did not change patient management) and major (if the patient management can be modified). RESULTS: Of 1185 included patients, 937 matched the inclusion criteria. Full concordance between primary diagnosis and expert second opinion was reached in 611 cases (65,3%), minor discordance was seen in 114 (12,2%) and major discordance in 209 (22,3%) of cases. In systematic review requested by the network, 26% (n = 137) of cases were reported with a change in histological diagnosis, while the change concerned 44% (n = 186) of cases for a second opinion spontaneously requested by the initial pathologist. The discrepancies concerned all categories of ovarian tumors, with a majority of mucinous tumors (43% of major discordances), followed by stromal and sex-cord tumors (13.8% of major discordances) and clear cell tumors (12,4% of major discordances). CONCLUSION: This analysis confirms the diagnostic difficulty of ovarian tumors, due to their rarity and morphological heterogeneity. French pathologists are aware of these difficulties and spontaneously refer ovarian tumors with unusual histology for a second opinion and collaborate with rare tumor networks for systematic review.

Hemoperitoneum in peripartum: A case-series.

Hemorrhages are the first cause of perinatal deaths in French women. Thirteen percent of these deaths are not linked to obstetrical problems but rather to hemoperitoneum. These incidents are under-diagnosed and as a result, treatment is delayed and fetal and maternal mortality increases. We report three cases of patients, all White female in their last trimester of a non-problematic pregnancy presenting with hemoperitoneum and resulting in different outcomes. The analysis of published materials and of our cases leads us to infer that a diagnosis of hemoperitoneum must be considered in pregnant women when abdominal pain, symptoms of shock and a decrease in hemoglobin are associated. An immediate response and intensive care followed by hemostatic surgery give these patients the best chance to survive.

Networking for ovarian rare tumors: a significant breakthrough improving disease management.

BACKGROUND: Rare ovarian tumors represent >20% of all ovarian cancers. Given the rarity of these tumors, natural history, prognostic factors are not clearly identified. The extreme variability of patients (age, histological subtypes, stage) induces multiple and complex therapeutic strategies. METHODS: Since 2011, a national network with a dedicated system for referral, up to 22 regional and three national reference centers (RC) has been supported by the French National Cancer Institute (INCa). The network aims to prospectively monitor the management of rare ovarian tumors and provide an equal access to medical expertise and innovative treatments to all French patients through a dedicated website, www.ovaire-rare.org. RESULTS: Over a 5-year activity, 4612 patients have been included. Patients' inclusions increased from 553 in 2011 to 1202 in 2015. Expert pathology review and patients' files discussion in dedicated multidisciplinary tumor boards increased from 166 cases in 2011 (25%) to 538 (45%) in 2015. Pathology review consistently modified the medical strategy in 5-9% every year. The rate of patients' files discussed in RC similarly increased from 294 (53%) to 789 (66%). An increasing number (357 in 5 years) of gynecologic (non-ovarian) rare tumors were also registered by physicians seeking for pathological or medical advice from expert tumor boards. CONCLUSION: Such a nation-wide organization for rare gynecological tumors has invaluable benefits, not only for patients, but also for epidemiological, clinical and biological research.

Magnetic resonance imaging and computed tomography in the assessment of mandibular invasion by squamous cell carcinoma of the oral cavity. Influence on surgical management and post-operative course.

INTRODUCTION: Preoperative evaluation of the bone for invasion by oral cavity squamous cell carcinoma remains challenging. The aim of our study was to compare the accuracy of MRI and CT in detecting mandibular invasion by oral squamous cell carcinoma of the oral cavity, with histologic results as the reference standard, and to assess the influence on surgical management and post-operative course. PATIENTS AND METHODS: Patients who were clinically suspected of having bone invasion from oral cavity carcinoma were retrospectively included. A single senior radiologist reviewed MRI images and CT-scans, independently, for the presence or absence of mandibular invasion. The different surgical procedures were compared in terms of length of hospital stay and occurrence of surgical complications. RESULTS: Histological mandibular invasion occurred in 9 of 35 patients (25.7%). None of the preoperative imaging tests failed to detect bone invasion which resulted in a sensitivity of 100% for both MRI and CT. CT had slightly higher specificity than MRI (61.9% and 57.1% respectively) in predicting bone invasion, but no statistically significant difference was found (P=0.32). Specificity of CT and MRI was higher in the edentulous group (75% and 625% respectively) than in the dentate group (53.8% both), although no statistically significant difference was found. The length of hospital stay was increased in the segmental resection group (25±14.5 days) compared to the marginal resection group (13±4.6 days; P=0.004) and to the hemimandibulectomy group (15±7.2 days; P=0.014). Occurrence of post-operative complications, across all categories, was increased in the segmental resection group (70%, n=7/10; P=0.006) compared to the marginal resection group (8.3%, n=1/12) and to the hemimandibulectomy group (23.1%, n=3/13; P=0.04). CONCLUSION: MRI and CT being equivalent in detecting mandibular invasion, we suggest MRI as single imaging technique in the preoperative assessment of oral cavity SCC. Specificity could be increased if combined with PET/CT, in order to reduce the number of unnecessary mandibular interruptions.

Unexpectedly long half-life of metformin elimination in cases of metformin accumulation.

INTRODUCTION: In a study of the oral administration of a single dose of metformin to healthy participants, the estimated half-life (t½ ) for the elimination of the drug from erythrocytes was found to be 23.4 h (compared with 2.7 h for metformin in plasma). However, these pharmacokinetic indices have not been well defined in metformin accumulation. METHODS: We systematically reviewed all the data on plasma and erythrocyte metformin assays available in our centre. We then selected patients with a plasma metformin concentration ≥ 5 mg/l and in whom the metformin concentration had been remeasured once or more at least 5 days after admission. RESULTS: Twelve patients met the aforementioned criteria. All but one of these patients displayed generally severe lactic acidosis on admission (mean ± sd pH and lactate: 6.88 ± 0.35 and 14.8 ± 6.56 mmol/l, respectively) and 11 were treated with dialysis. The mean ± sd time interval between the first and last blood sample collections for metformin measurement was 8.3 ± 3.2 days (range 5-14 days). Five days after the first sample had been collected, metformin was still detectable in plasma and in erythrocytes in all patients. Metformin remained detectable for up to 13 days (both in plasma and in erythrocytes). The estimated mean terminal t½ for metformin in plasma and erythrocytes was 51.9 and 43.4 h, respectively. CONCLUSIONS: The prolonged elimination of accumulated metformin (even after dialysis therapy) challenges the traditional view that the drug clears rapidly because of a short half-life in plasma.

[Visceral larva migrans with cardiac manifestation: a case report and literature review]. / Syndrome de larva migrans viscéral avec atteinte cardiaque: une observation et revue de la littérature.

INTRODUCTION: Toxocariasis is a roundworm infection that may be associated with serious cardiac manifestations. We report one case and review another 12 cases in the literature. CASE REPORT: A 74-year-old man, presented with clinical features of myopericarditis. Eosinophil count was 20,000/mm(3). The ELISA and Western Blot were positive for Toxocara canis. The patient was treated with corticosteroids and antiparasite treatment. The outcome was rapidly favorable. DISCUSSION: In the other 12 cases, the cardiac manifestations were often severe: six myocarditis, three tamponades and three Loeffler's endocarditis have been published. Four therapeutic strategies have been reported: symptomatic treatment alone was associated with worse progressive; antiparasite treatment alone or companied with corticosteroids and corticosteroids alone had good results. CONCLUSION: The toxocariasis should be investigated systematically in case of eosinophilic cardiomyopathy. The treatment strategy is still controversial.

Venous thrombo-embolism as a complication of cross-sex hormone treatment of male-to-female transsexual subjects: a review.

Administration of cross-sex hormones to male-to-female transsexual subjects, usually oestrogens + often anti-androgens, such as cyproterone acetate, carries a risk of venous thromboembolism (VTE). VTE usually occurs in the first year of oestrogen administration. Ethinyl oestradiol, due to its chemical structure, was in 2003 identified as a major factor in the occurrence of VTE. Most clinics do not prescribe ethinyl oestradiol any longer, but people who take hormones without medical supervision use often oral contraceptives containing ethinyl oestradiol, many times in overdose. Cessation of use of ethinyl oestradiol and peri-operative thrombosis prophylaxis for surgery have reduced prevalence rate of VTE. Other oral oestrogens should not be overdosed, and transdermal oestrogen is to be preferred. Thrombosis prophylaxis for surgery is mandatory. It seems advisable to stop hormone use at least 2 weeks before major surgery, to be resumed only after 3 weeks following full mobilisation.

[Enophtalmos of the anophtalmic socket: incidence of the orbital morphology and therapeutic implications. Clinical study of 86 cases]. / Énophtalmie de la cavité anophtalme : incidence de la morphologie orbitaire et implications thérapeutiques. Étude clinique de 86 cas.

AIM OF THE STUDY: From a light asymmetry to a sunken eye aspect, a great disparity between the results after anophtalmic socket rehabilitation is noticeable: what are the factors involved in the degree of residual enophtalmos following excision of the eye? The litterature's response is based on physiopathological considerations around intraorbital architectural disturbance. We propose a geometrical approach related to the existence of different morphological types of orbit. PATIENTS AND METHOD: Eighty-six records of eviscerated and enucleated patients have been studied and submitted to a statistical analysis. A preliminary study has defined four types of orbit depending on the shape and operture of the orbital "window": two opposite types IA and III, a type II intermediate and a particular one, the type IB. A classification of enophtalmos' degree allows to analyze the parameters chosen and to identify the predictive factors. RESULTS: The statistical analysis confirms the incidence of the orbital morphology on the degree of enophtalmos but do not support the theories based on the intraorbital septal architecture changes. Depending on the orbital shape and the container-content relation, the volume loss is more visible on the whole orbitopalpebral surface of opened and high orbit but remains centered on the anteroposterior position of the implant of a closed and lengthened orbit. At the contrary to the type III, the type IA is not favorable for the anophtalmic patient and predispose to a higher degree of enophtalmos. This new approach has therapeutic implications on primary and secondary surgery for volume loss replacement. CONCLUSION: The success of anophtalmic socket rehabilitation is influenced by the orbital morphological type that has to be considered in the therapeutic strategy.

[Hepatopulmonary syndrome and diffuse interstitial lung disease]. / Syndrome hépatopulmonaire et pneumopathie interstitielle diffuse idiopathique.

INTRODUCTION: The association between interstitial pneumonia and hepatopulmonary syndrome (HPS) has rarely been described. OBSERVATION: We report the cases of two patients, 62 and 64 years old, who presented with idiopathic interstitial pneumonia (IIP) and severe, disproportionate hypoxemia, PaO(2) 42 and 47 mmHg, respectively. This hypoxemia lead to search for associated disease. The diagnosis of right-to-left shunt was established by the 99mTc-MAA perfusion lung imaging. A contrast cardiac echography confirmed the intrapulmonary shunt. Both patients were found to have hepatic cirrhosis, classed as Child Grade A6 and C10. In this context of chronic hepatopathy, the diagnosis of SHP associated with IIP was established. Liver transplantation, the only way to cure the lung consequences of the HPS, was planned. CONCLUSION: These two cases highlight the importance of searching for right-to-left shunt in patients who have lung disease with severe disproportionate hypoxemia. Liver transplantation is the only way to cure the lung consequences of the hepathopathy. The rare association between ILD and HPS raises problems when deciding to go forward to transplantation in the absence of a histological diagnosis of the lung disease and where the prognosis of the lung disease is unclear.

[Effects of hypomagnesemia]. / Les effets de l'hypomagnésémie.

INTRODUCTION: The clinical consequences of plasmatic magnesium variations are underecognized in clinical practice. The dosage of plasmatic magnesium is underused and not reliable. Moreover, hypomagnesemia is often associated with other metabolic disorders (hypocalcemia, hypokaliemia), which are responsible for several symptoms. CASE REPORT: We report an 85-year-old man who presented with repeated bronchospasm, confusion, and abdominal and muscular pain, attributed to low magnesium serum level. We then review pathophysiology, various etiologies, clinical features, diagnostic challenge and treatment of low magnesium serum level. CONCLUSION: Hypomagnesemia is poorly known and diagnosed. Therapeutic issues have not been clearly defined.

[Erectile dysfunction, sexuality and sociocultural aspects]. / Dysfonction érectile, sexualité et influence socioculturelle.

Perception of sexuality varies considerably from population to population and their cultural inheritance, depending on whether you consider occidental, oriental or African cultures. In a wider concept of environment, worries, anxiety or stress induced by work, family, social and economic factors may have a negative impact on sexual functions. Quantitative surveys on sexuality try to measure the incidence of love feelings on sexual behaviour but they cannot determine the close overlaps between mind and body. To give his partner satisfaction, men do not always need performing well. Men also have right to love women, their own ways and according to their means. Impotence or erectile dysfunction (ED) is nowadays a subject that is more and more studied on conceptual, epidemiological as much as clinical levels. Taking this trouble into consideration is relatively new for the general public and seems to coincide with the launching towards the end of the last decade of the first real effective oral treatment, the phosphodiesterase 5 (PDE5) inhibitors and of the communication developed around this event. Demand for sexual problems management seems to be on the increase.

[Erectile dysfunction in diabetic patients]. / Dysfonction érectile chez les diabétiques.

Because of its frequency, erectile dysfunction must be systematically screened for in diabetic patients because, according to a survey by the ADIRS-AFD, it has affected 66% of patients for a mean of 6 years, and 77% wish it could be treated. From a physiopathological point of view, erectile disorders in diabetic patients are related to the vascular and neurological complications of diabetes and the various associated risk factors. The treatment to propose is at first iPDE5, although there is a risk of lesser efficacy in a diabetic patient and potential contraindications with the administration of derived nitrates. Intracavernous injections of PGE1 are efficient and safe second line and specialised advice is only required in the case of failure.

[Couple, sexuality and sexual health]. / Couple, sexualité et santé sexuelle.

Sexuality remained for a long time in the intimacy domain, judged worthy of a consultation reason only and yet as an illness cause or a male failure. Besides, dyspareunia and various women's illnesses took more time to be worthy of interest and care. And now it seems almost as if a turnaround were taking place. This mutation will probably induce some cultural changes. This paper focuses on the fifty-year-old man, in a world in which sexuality, from a universal right, becomes an obligation with the need for means and results, a requirement for performance. In order to discover how to approach these old problems with nowadays tools, we carried out a Medline review on sexuality and impotence, or erectile dysfunction (ED), which is a real problem in public health policy concerning more than 150 million men all over the world and more than 2 million in France. The analysis of the main papers associated with our own experience, allows us to better understand the changes in men/women relationship and the disclosure of male fragility, visible in the management of their well-being, their state of anxiety fowards this new women's control which probably influences their attitude in front of ageing and its consequences.

Acceptance, efficacy and preference of Sildenafil in patients on long term auto-intracavernosal therapy: a study with follow-up at one year.

PURPOSE: To assess the acceptance, long term efficacy and preference of Sildenafil in impotent patients previously on auto-intracavernosal therapy. MATERIALS AND METHODS: The patients were the 107 men (mean age 58.4 y) on auto-intracavernosal therapy (auto-IC) for more than 6 months (mean duration 32.7 months >12 months in 100) who were consecutively seen within 6 months of the launch of Sildenafil in France. If there was no contra-indications to Sildenafil they were proposed a trial of Sildenafil at home. Following this trial they were given the possibility to change their therapy and were followed for 1 y at 3 months intervals. RESULTS: Three patients had contra-indications to Sildenafil. Of the remaining 104, 45 (43%) refused the trial, mainly because they were afraid of possible cardiac risks (n=21, including 51% of the psychogenic and mixed patients compared to 8% of the predominantly organic ones). Among the 59 who tried it, Sildenafil gave good results in 46 (78%), including 100% of the predominantly psychogenic and 61.5% of the predominantly organic ones) with minimum effective doses of 25 mg in 7, 50 mg in 18 and 100 mg in 21. It failed in 9 (15%) and gave average results in 4 (penetration with a non fully satisfying erection). There was a clear relationship between the sensitivity to Sildenafil and that to Alprostadil, the vasoactive agent predominantly used for the auto-ICIs. Every 46 patients with good result of Sildenafil elected to continue with this drug, including 3 who used both Sildenafil and auto-ICIs in alternance. Every 4 patients with average results elected to continue with auto-ICI including 1 who also used Sildenafil in alternance. Five of the 50 patients with good or average results were lost to follow-up within 6 months. At the 1 y follow-up visit, 43 of the 45 others were still using Sildenafil, in alternance with auto-ICI in 1. No one reported a decrease in efficacy with time. The 2 patients with average results still in the study were on auto-ICIs. CONCLUSION: Sildenafil is highly effective in the impotent men previously treated with auto-ICI and its efficacy is maintained at least for 1 y. When tried and effective it is preferred by most men but almost half of our patients refused trying it.