Evaluation of severe caustic gastritis by computed tomography and its impact on management.

INTRODUCTION: Serious caustic burns of the stomach that present with no clinico-biological severity criteria (CBSC) can be treated conservatively. However, even if there are no CBSC at admission, 20% of patients still require delayed emergency surgery for peritonitis due to gastric perforation thus showing the limitations of this strategy in the diagnosis of irreversible gastric necrosis lesions. The aim of this study was to identify reliable computed tomography (CT) signs of irreversible gastric necrosis in patients with stage 3 endoscopic lesions. PATIENTS AND METHODS: In a prospective study from March 2014 to January 2017, thoraco-abdomino-pelvic CT scan was performed in 30 consecutive patients with stage 3 endoscopic gastric lesions. The CT results were concealed from the clinicians and compared to CBSC results. RESULTS: Twenty patients were treated conservatively and ten patients were operated on. Seventy percent of the patients underwent urgent delayed surgery for symptoms that developed late but before alterations in the CBSC. The CT scan showed a perfusion defect (PD) of gastric mucosal enhancement in all patients operated on for gastrointestinal distress, and could have provided an early diagnosis of irreversible gastric necrosis. CONCLUSION: CT was a more effective diagnostic tool for the diagnosis of irreversible gastric necrosis following caustic ingestion than a strategy based on digestive endoscopy and the use of CBSC. CT could eventually replace gastrointestinal endoscopy in the emergency evaluation of gastroesophageal caustic burns.

A posterior approach pancreaticoduodenectomy with portal vein resection in a large adenocarcinoma of the uncinate process of the pancreas - case report.

A portal vein invasion is no longer a contraindication for resection in pancreatic cancer, but increased morbidity and mortality rates can be encountered. Hereby it is presented the case of a patient diagnosed with a large adenocarcinoma of the uncinate process of the pancreas, who underwent aposterior approach pancreaticoduodenectomy, with en bloctang ential resection of the portal vein, and total mesopan creasexcision. A posterior approach allows a negative resection margins pancreaticoduodenectomy, with a good local control of the disease, despite the in creas.

[Diffuse leiomyomatosis with genital involvement and Alport syndrome. Report of two cases]. / Léiomyomatose diffuse avec atteinte génitale et syndrome d'Alport. A propos de deux cas.

We observed the cases of two young women who both developed esophageal and perineal tumors successively. The esophageal component usually is the first manifestation. Esophagectomy, with or without gastrectomy is generally required. The genital affection involves the periclitoridian region, the minora and majora labia. Tracheobronchial localization is less common, but it may be lethal due to bronchospasm. An association between diffuse leiomyomatosis and Alport syndrome is not fortuitous. Recently, molecular biology has enabled to understand the combination of the two pathologies by showing the presence of a deletion on adjacent X chromosome genes, COL4A5 and COL4A6, which are involved in the synthesis of type IV collagen fibres. Leiomyomatosis and Alport syndrome are transmitted as X-linked dominant traits. Women with diffuse leiomyomatosis transmit Alport syndrome. An antenatal diagnosis can be proposed for such patients.

Prenatal diagnosis of ring chromosome 14 after intracytoplasmic sperm injection.

OBJECTIVE: To collect extensively abnormal cytogenetic results in pregnancies obtained after intracytoplasmic sperm injection (ICSI). DESIGN: Case report. SETTING: University Hospital of Nantes, France. PATIENT(S): A couple with 5 years of primary infertility and severe male factor undergoing ICSI procedure. INTERVENTION(S): Ultrasound-guided transvaginal follicular aspiration, amniocentesis, and medical abortion. MAIN OUTCOME MEASURE(S): Serum levels of E2, beta-hCG, and fetal chromosomal karyotype. RESULT(S): Ultrasonic observation at 12 weeks revealed an 8-mm thick cystic hygroma in the nuchal area. Because the karyotypic analysis was [46,XX,r(14)/45,XX,-14], medical abortion was performed at 14 weeks, after the patients gave their informed consent. CONCLUSION(S): According to the prevalence of this unusual chromosomal abnormality in humans, such abnormal cytogenetic results have to be collected extensively to assess the feasibility of using ICSI procedure.

[Evaluation of the risk-benefit ratio of hormonal replacement therapy for menopause and susceptible elements in maximizing compliance]. / Evaluation de l'équilibre risque-bénéfice du traitement hormonal substitutif de la ménopause et éléments susceptibles de maximiser l'observance.

We recall that the rules of prescription of a hormonal replacement therapy (HRT) must involve compliance. The explanations of stopping HRT are multiple: denial of menopause, omitting to take the HRT by absence of immediate benefits, poor understanding of the interest of long term HRT, side effects and the fear of breast cancer. Information associated to the individual assessment of the balance between risks and benefits will allow improvement in compliance.

[Menopausal hormone replacement therapy and prevention of neurologic complications]. / Traitement hormonal substitutif de la ménopause et prévention des complications neurologiques.

Aging of the population in industrialized countries, as a result of increased life expectancy, is associated with an increased risk of neurological diseases. Prevention of disability is one of the objectives of hormone replacement therapy of menopause (HRTM). Based on a review of the literature, the authors present the benefits of HRTM in terms of prevention of neurological complications. Estrogens directly and indirectly influence the neurological status. A decreased incidence of cerebrovascular accidents and dementia of the Alzheimer type and improvement of cognitive function in cases of dementia have been reported in several clinical and epidemiological papers. These data need to be confirmed by large-scale prospective studies conducted by epidemiologists and neurologists.

[Pelvic pain and endometriosis]. / Douleurs pelviennes et endométriose.

Endometriosis is defined by the presence outside the uterine cavity of tissue histologically and functionally similar to the endometrium. Endometriosis consists of glands and an underlying cytogenic stroma. This ectopic tissue can react to hormonal stimulation: estrogens and progesterone (growth, decidualisation, withdrawal bleeding). Pain is correlated with the depth of implantation of endometriosis lesions. Deeply infiltrating endometriosis exceeds 6 mm in depth, with an incidence of between 6 and 20% of women complaining of pelvic pain. The authors review the various types of treatment and mention the special role of celio-surgery and prolonged hormone therapy.

Detection of human papillomavirus in squamous intraepithelial lesions by consensus and type-specific polymerase chain reaction.

Polymerase chain reaction (PCR) was used to identify human papillomavirus (HPV) in 216 cervical biopsy specimens from women referred to the gynecological out-patient unit for colposcopy because of an abnormal smear. HPV DNA was screened using type-specific primers for HPV6, 11, 16, 18, 31 and 33 (TS-PCR) as well as a consensus primer located in the E1 region of the HPV genome (C-PCR). TS-PCR specificity was validated by Southern blot analysis. Low-grade (SIL 1) and high-grade (SIL 2) squamous intraepithelial lesions were found in 165 biopsies. HPV16 detection was better with PCR than Southern blot, particularly for SIL 1 and SIL 2. The fact that 10% of HPV16 (all SIL 2) were not detected by C-PCR indicates that both PCR techniques should be performed. C-PCR also detects uncharacterized HPV types (8.6% prevalence in our results), mainly in SIL 1 and SIL 2. HPV16, the most frequently isolated type (prevalence 21%), was associated with SIL 2 in 83% of cases. A low HPV prevalence was found in specimens without dysplastic cells. These results suggest that PCR may be an important tool for identifying women at risk for developing dysplasia or cervical cancer.

[Cancer of the ovary and medically assisted reproduction]. / Cancer de l'ovaire et procréation médicalement assistée.

Case reports and epidemiologic studies have recently indicated a possible link between ovarian stimulation, ovarian cancer and ovarian tumours. We sent a questionnaire to 116 French IVF centers to determine whether ovarian cancer had occurred in women treated during the last 10 years. The 19 cases of ovarian cancer reported have since been studied more thoroughly in a follow up questionnaire. Six can now be excluded, and the 13 remaining cases are compared. Five of these patients had fewer than 4 stimulation cycles here. Imputability was considered probable for 2 patients, possible for 5 patients, improbable for 3 and highly improbable for 3. Histologically, 6 (46%) cases involved borderline lesions. These results indicate that there is no need to change medical practice, but we are convinced that prospective epidemiologic research should be carried out immediately.

[Ultrasound and twin pregnancy. The effect of placentation on fetal biometric growth and quantitative abnormalities of the amniotic fluid]. / Echographie et gémellité. Influence de la placentation sur la croissance biométrique foetale et les anomalies quantitatives de liquide amniotique.

Neonatal retarded growth and hypotrophy are more frequent in monochorial, biamniotic twin pregnancies than in bichorial ones. The authors consider the various pathogeneses which have been suggested to account for this phenomenon.

Carbon dioxide laser treatment of cervical dysplasia in teenagers.

Over a 6-year period, 40 young women under 20 years of age with cervical intraepithelial neoplasia (CIN) grade I (58%) to grade III (10%) were treated by laser vaporisation or excisional conisation. This prevalence of CIN in young women (nearly 4% of laser-treated cases) underscores the need for detection of cervical abnormalities in all teenagers engaged in sexual relations. The colposcopically-guided carbon dioxide laser technique is the treatment of choice for vaporisation and conisation of intraepithelial lesions (extending to the periphery of the cervix in 20% of cases) and for vaporisation of associated condylomatous lesions of the cervix (75%), vagina (23%), vulva (48%) and/or anus (8%).

[Typing of papillomaviruses in cervical dysplasias. Its value in treatment]. / Typage des papillomavirus dans les dysplasies du col. Intérêt pour leur traitement.

The typing fo Human Papillomavirus (HPV) was carried out in cervical lesions in order to decide on the best therapy to carry out in mild and medium dysplasias of the cervix. 131 patients who had an iodo-negative zone or a smear suggesting an HPV infection had microbiopsies carried out under colposcopic control. Every lesion had two biopsies carried out side by side to study the histopathology and the virology. Dysplastic lesions were found in 93 biopsies. A search for the DNA of HPV 6a, 16 and 18 was carried out using a Southern blot technique with 32P following the method of Random multipriming. Hybridization was carried out in strict and non-strict conditions. In 43 cases out of 93 dysplasias a virus was found: 2 HPV 6a, 14 HPV 16, 1 HPV 18 and 26 X HPV's (not typed). The number of HPV's that could be detected increased according to the severity of the dysplasia which was also found in frequency of type 16. Where the biopsies showed no dysplasia type 16 was found in four out of seven viruses. In this study electrophoretic profiles for type 16 were found in four cases suggesting that they were integrated into the chromosome of the cell. The low percentage of HPV found in mild or moderate dysplasias (4 type 16 out of 61 biopsies) shows that at present this test can not be used as an aid in choosing treatment.

Effect of human parathyroid hormone on the cAMP production and the endocrine functions of trophoblast cells from first trimester placenta.

Our previous study on teratocarcinoma cells suggested the role of human parathyroid hormone (hPTH) in early development of the placenta. The purpose of this study was to evaluate the possible role of hPTH on the functions of first trimester trophoblast cells. Adenylate cyclase activity in crude membranes from first trimester human placental villous tissue is stimulated 2-fold by hPTH (1-34) (10(-6) mol.l-1) from 265 +/- 32 to 532 +/- 80 pmol of cAMP/mg protein/15 min. A similar stimulation of adenylate cyclase is observed in human term placental villous tissue but not in 3 different choriocarcinoma cell lines. In order to evaluate the possible role of hPTH on the functions of first trimester human trophoblast cells, these cells were isolated by dispase and cultured (2 x 10(5) cells per plate) in DMEM supplemented with 20% fetal calf serum with or without 100 ng/ml of epidermal growth factor (EGF), for 4 d. On d 2 of culture, hPTH (10(-7) mol.l-1) stimulates cAMP production of these cells from 0.52 +/- 0.2 to 2.58 +/- 0.57 pmol.h-1 per 10(6) cells (mean +/- SEM). As compared to control (30 ng/ml), the output of hCG is increased by 1.5- (NS), 2- (P less than 0.01) and 3- (P less than 0.01) fold by EGF, hPTH, and hPTH added with EGF, respectively. Dibutyryl cAMP (10(-3) mol.l-1) increased hCG secretion by 3-fold (P less than 0.05). EGF and hPTH added separately or together significantly stimulated (P less than 0.01) the secretion of free alpha subunit 2-fold from 35 ng/ml to 70 ng/ml. In contrast, hPTH and EGF added separately did not change the secretion of free beta hCG. However, added together, they significantly increased (P less than 0.01) the secretion of free beta hCG after 48 h of culture, maximal stimulation (2.5 fold) being observed at d 4 of culture. In conclusion, human trophoblast cells are target cells for hPTH. hPTH acts in association with EGF in promoting expression of endocrine activity of these cells, such as hCG secretion. Trophoblast cells provide a model for the study of the cooperative effect between a peptide hormone and a growth factor in the regulation of endocrine function.

Characterization and differentiation of human first trimester placenta trophoblastic cells in culture.

A preparation of highly enriched isolated cytotrophoblasts was obtained from first trimester placenta using dispase incubation of villous tissue at 4 degrees C, followed by a spontaneous cell release at 37 degrees C. After 24 h of culture, 90-95% of the cells were immunostained by anticytokeratin antibody, showing their epithelial characteristic. After 48 h of culture, these cells differentiated into syncytiotrophoblast, as shown by optic and electron microscopic study. The secretion of hCG, and of its free alpha and beta subunits, and the secretion of hPL were studied as a function of cell culture time. While the level of secreted hCG and its free subunits was stable during 72 h of culture, the hPL level was undetectable during the first 48 h of culture, increasing continuously afterwards. Addition of dibutyryl cAMP from the start or after 96 h of cell culture induced an increase of hCG production and of its free subunits and also stimulated the secretion of hPL. This suggests that these cells maintained the capacity to respond to stimuli which increased intracellular cAMP level. Such a cell culture is of interest in further determining the mechanisms of early gestation involved in the differentiation and growth of placental cytotrophoblasts, and in the regulation of their endocrine functions.