Robotically Assisted Hysterectomy versus Vaginal Hysterectomy for Benign Disease: A Prospective Study.

Objectives. A prospective study was carried out to compare vaginal hysterectomy (VH) and robotically assisted hysterectomy (RH) for benign gynecological disease. Materials and Methods. All patients who underwent hysterectomy from March 2010 to March 2012 for a benign disease were included. Patients' demographics per and post surgery results were collected from medical files. A questionnaire was also conducted 2 months after surgery. Results. Sixty patients were included in the RH group and thirty four in the VH one. Operative time was significantly longer in the RH group (132.1 ± 5.7 versus 75.3 ± 6.7 min; P < 0.0001). Blood loss and length of hospital stay were significantly reduced: 47 ± 7 versus 125 ± 20 ml; P < 0.01, and 2.4 ± 0.1 versus 3.3 ± 0.2 days; P < 0.0001, respectively. Less pain was reported at D1 and D2 by RH patients, and levels of analgesia were lower compared to those observed in the VH group. No differences were found regarding the rate of conversion to laparotomy, intra- or postoperative complications. Conclusion. Robotically assisted hysterectomy appears to reduce blood loss, postoperative pain, and length of hospital stay, but it is associated with longer operative time and higher cost. Specific indications for RH remain to be defined.

[Results of infrainguinal revascularization in patients with end-stage renal disease]. / Résultats des revascularisations sous-inguinales chez les malades en insuffisance rénale terminale.

OBJECTIVES: The aim of this retrospective study was to evaluate the efficacy of bypass in patients with endstage renal disease (ESRD) and to determine predictive factors and precise bypass indications. METHOD: Forty one patients with ESRD underwent 50 bypass, 6 limbs were stage II and 44 stage III or IV according to Leriche and Fontaine classification. Revascularisations procedures were 47 infrainguinal bypass and 3 miscellaneous. Median follow up was 17,0+/-15,7 months. RESULTS: Perioperative mortality rate was 12% (n = 6). Morbidity was as follow : 1 perioperative major imputation and 8 secondary ones. There were 26 secondary death (12 from cardiac events), cumulative survival rate declined to 42,9+/-7,7% and limb salvage rate to 77,2+/-7,5% at 2 years. Primary and secondary potency rates were 53,5+/-10,4% and 70,6+/-10%. Quality of life was good in 28% of revascularised patients. Among risk factors, myocardial events showed a statistical significance in predicting survival, good runoff and bypass occlusion showed a statistical significance in predicting limb salvage. CONCLUSION: Revascularisation can be performed in ESRD patients. However to improve the results full evaluation of myocardial risks, skin lesions and infection of the feet, available autologous vein and nutritional status may be needed in those patients.

[Percutaneous transluminal angioplasty and severe limb ischaemia]. / Angioplastie transluminale percutanée et ischémie sévère des membres inférieurs.

OBJECTIVES: To determine the outcome and the place of transluminal angioplasty (ATL) in the treatment of severe limb ischaemia. MATERIALS AND METHODS: Seventy two legs at stage III and IV of Fontaine's classification have been exclusively treated by endoluminal procedures. The success was valued both on the haemodynamic post-operative improvement of the run-off flow and on the clinical statut leading to the conservation at mid-term of a functional limb. Patency and survival rate had been valued by actuarial method. RESULTS: Seventy percent of the limbs were haemodynamically improved. For the global population, a 48% clinical success rate was obtained at 6 months but 30.5% of limbs were loss. Primary patency rate was respectively 79, 71 and 68% at 6, 12 and 24 month. The quality of the run-off arteries has been the most influential factor. CONCLUSION: Endoluminal treatment of chronic limb ischaemia had lead to a clinical improvement in 48% of cases. Multi-stages and distal atherosclerotic disease of this patients limits ATL indications which results depend of run-off quality.

Correlation of parathyroid scanning and anatomy in 261 unselected patients with sporadic primary hyperparathyroidism.

BACKGROUND: Despite abundant literature on parathyroid scanning with technetium 99m-labeled cationic complexes, comprehensive clinical reports that unequivocally correlate scanning findings with the anatomy of parathyroid glands in extensive and homogeneous cohorts of patients are lacking. METHODS: We analyzed the records of patients with sporadic primary hyperparathyroidism who had had a preoperative scan with either 99mTc-labeled sestamibi or 99mTc-labeled tetrofosmin at our institution and who were cured after a bilateral surgical neck exploration procedure. RESULTS: In 261 patients, 710 normal and 347 abnormal glands (1494 +/- 2626 mg), including 15 glands within the mediastinum, were identified. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of scanning were 82%, 98%, 91%, 94%, and 94%, respectively, in 197 patients with uniglandular disease and 53%, 98%, 98%, 60%, and 72%, respectively, in 64 patients with multiglandular disease. False-positive uptakes were encountered in 17 patients (7%), 3 false-positive uptakes being within the mediastinum. If the unilateral approach had been followed, guidance with preoperative scanning would have significantly increased the number of effective unilateral neck exploration procedures (164 patients (63%) vs 78 patients (30%); P < .001). One abnormal gland would also have been neglected in 28 patients (11%). CONCLUSIONS: Preoperative scanning would limit neck exploration procedures in two thirds of patients with sporadic primary hyperparathyroidism but may also increase the risk of failure in the most challenging cases.

[Simple malaria attack]. / Accès palustre simple.

The clinical presentation of malaria is, in most of cases, a malaria attack. It occurs in 90% of imported cases in France within 30 days after return of endemic area. Characteristic malaria paroxism have three stages: chills, high fever (> 39 degrees C) and sweating stage. In this typical form, parasitaemia is easily disclosed. With the increasing spread of chemoresistance P. falciparum strains, many patients experience non specific symptoms before the onset of paroxysm, often complaining of malaise, headaches, myalgias and anorexia. In some cases temperature did not exceed 38 degrees C and physical examination revealed sometimes liver or splenic enlargement. These atypical presentations can masquerade other diseases such as a viral illness. In those patients blood smears were often negative and malaria diagnosis is carried out only by QBC or parasight test. Treatment of malaria attack needs antimalarial drugs effective against chemoresistant P. falciparum strains. Mefloquine of halofantrine can be delivered with the respect of guidelines prescription, given major side effects observed with these drugs (neuropsychiatric disorders with mefloquine and cardiac arrhythmias with halofantrine). Oral quinine sulfate can be used when the above drugs are not allowed.

[Heart rate variability and vagal syncope in the young adult]. / Variabilité sinusale et syncope vagale chez l'adulte jeune.

Heart rate variability is a sign of sympathetic activity. The authors compared two study populations of young males aged 19 to 30 years: population T comprised 15 healthy volunteers who had two negative tilt tests, one under basal conditions and the other after a bolus of isoproterenol; population S comprised 12 patients without cardiac or other disease, who were followed up for malaise and in whom the basal tilt test was positive, confirming the vagal origin of syncope. Temporal and spectral (total power, low frequency 0.04-0.15 Hz, hight frequency 0.16-0.40 Hz) data was obtained concerning heart rate variability from 24 hour Holter monitoring. The main difference between the two study populations was in the temporal data over 24 hours especially with respect to the heart rate (T = 73.5 +/- 6.9; S = 65.4 +/- 6.2/min; p = 0.004) and the percentage of successive R-R intervals varying by more than 50 ms (PNN 50) (T = 20.2 +/- 8.3%; S = 30.7 +/- 10.2%; p = 0.024). At night, the lowest SDANN/5 (standard deviation of RR intervals over periods of 5 minutes) were observed in group S (67.2 +/- 16.7 ms vs 87.3 +/- 24.4 ms; p = 0.026). No statistically significant differences between the two groups was observed in the spectral data. The temporal data of heart rate variability on Holter ECG monitoring over 24 hours could therefore have a good predictive value of the vagal origin of syncope in young adults.

An animal model for the assessment of gingival lesions.

A model of gingival inflammation was performed in Sprague-Dawley rats weighing 180-200 g. Mechanical bamboo stick-induced injury was inflammatory when bacteria contaminated the sticks. Bacteria were first obtained from gingival fluid collected from a patient with adult periodontitis. Another strain from Institut Pasteur (IP 6444) induced similar inflammation. Inflammation was then quantified 10 days later by means of elastase assays performed in gingival extracts. In parallel, elastic structures were observed and elastic fibers were quantified by automated image analysis. This technique of "impaction" was able to induce a gingival inflammatory reaction characterized by a significant increase of gingival elastase content, infiltration of gingival tissues by elicited cells, and gingival elastic fiber breakdown. These parameters were correlated, and measurement of one of them might be useful for pharmacological studies applied to the treatment of periodontal lesions. An example of results obtained from animals treated by heparine was shown.

In vitro metabolism of isaxonine phosphate: formation of two metabolites, 5-hydroxyisaxonine and 2-aminopyrimidine, and covalent binding to microsomal proteins.

Isaxonine phosphate or Nerfactor (2-isopropylaminopyrimidine) has been implicated in several cases of hepatitis which is reversible after withdrawal of the drug. In order to understand the cause of such hepatitis, the metabolic activation of isaxonine phosphate with different liver microsomes was investigated. The major metabolites were 5-hydroxyisopropylaminopyrimidine and 2-aminopyrimidine. Covalent binding to microsomal proteins was also detected. In vitro metabolic activation required intact microsomes, NADPH and O2 as cofactors and was cytochrome P-450 dependent. A sensitive fluorimetric assay of 5-hydroxyisaxonine was developed. The metabolism of isaxonine phosphate was compared in liver microsomes from rat, rabbit, dog, monkey and man and found to be qualitatively similar. Treatment of rats with phenobarbital increased the formation of 5-hydroxyisaxonine, while treatment with 3-methylcholanthrene increased the formation of 2-aminopyrimidine but decreased that of 5-hydroxyisaxonine. Inhibition and reconstitution experiments demonstrated that 5-hydroxylation of isaxonine was catalyzed by a cytochrome P-450. Metabolic oxidation of isaxonine phosphate using 5-[3H]isaxonine phosphate led to a total loss of tritium in 5-hydroxyisaxonine and partial loss of tritium in 2-aminopyrimidine and covalent binding to proteins.

Alterations of the glycan moiety of human alpha 1-acid glycoprotein in late-term pregnancy.

The carbohydrate moiety of purified alpha 1-acid glycoprotein (AGP) from healthy male adults (AGPn) and late-term pregnant women (AGPp) was analysed. Polyacrylamide gel electrophoresis with sodium dodecyl sulfate before and after N-glycanase treatment showed that AGPp had a slightly higher molecular mass due to an enriched carbohydrate moiety. BIO-GEL P-4 and Concanavalin A (Con A)-Sepharose chromatography of the oligosaccharides released by hydrazinolysis and fractionated by high-voltage electrophoresis indicated a progression towards Con A-unbound oligosaccharides and towards larger glycans in pregnancy. Carbohydrate analysis of purified AGPp and AGPn and of the most increased oligosaccharide fraction (F4A) evidenced a decrease in the fucosyl molar ratio and a slight increase in the galactosyl, N-acetyl-glucosaminyl and N-acetyl neuraminyl ratios. These results suggest that AGP contains more highly branched oligosaccharides and/or additional N-acetyllactosamine-type oligosaccharides in pregnancy.

Microheterogeneity of the carbohydrate moiety of human alpha 1-acid glycoprotein in two benign liver diseases: alcoholic cirrhosis and acute hepatitis.

To determine whether alterations of the carbohydrate moiety of human alpha 1-acid glycoprotein constitute a marker of hepatic damage we studied purified alpha 1-acid glycoprotein from healthy individuals and two groups of patients with benign liver diseases: alcoholic cirrhosis and acute viral hepatitis. The results indicate: (1) increased concanavalin A-non reactive forms in cirrhosis and hepatitis, (2) a markedly increased proportion of fucosyl residues in all cirrhotic and some hepatitis patients. Although hyperfucosylation is generally considered to be a tumor marker, the observation here in the two benign liver diseases indicates that an increased fucosyl content should be considered as a more general expression of pathological glycoconjugate metabolism.