[Recovery after gynaecological surgery in French-speaking Belgium : survey and recommendation of the GGOLFB surgical working group]. / Convalescence après chirurgie gynécologique en Belgique francophone : sondage et recommandations du groupe de travail de chirurgie du Groupement des Gynécologues et Obstétriciens de Langue Française de Belgique.

Since the introduction of laparoscopy and mini-invasive techniques, gynaecological surgery has largely evolved. However, post-operative recommendations still remain very restrictive with poor evidence from literature. The survey, performed by the GGOLFB surgical working group, shows that the post-operative advices to the patients are very heterogeneous for the sick leave period as for more specific advices like the period of disallowance of sexual intercourse, bathing and weightlifting. It is nevertheless fundamental to prescribe clear and precise advices to patients, from the first pre-operative consultation on, which will substantially improve the perception of their recovery and promote a return to their normal activity under good conditions. It is not necessary to be too restrictive concerning certain activities in the post-operative period, neither to give too long periods of work incapacity because it may have a negative impact on their quality of life. This survey and the data from literature helped our surgical taskforce group to propose and develop harmonised recommendations on recovery and work incapacity after gynaecological surgery, taking into account the actual surgical practice in 2020.

La chirurgie gynécologique a fortement évolué depuis l'introduction de la laparoscopie et le développement de la chirurgie mini-invasive. Les recommandations post-opératoires sont souvent assez restrictives, avec peu d'évidence dans la littérature sur le bien-fondé de ces limitations. Notre sondage auprès des gynécologues francophones de Belgique montre que les consignes post-opératoires délivrées aux patientes sont très hétérogènes, aussi bien pour les durées d'incapacité de travail que pour des consignes plus spécifiques sur la durée d'absence de port de charges, de bains et de rapports sexuels. Il est pourtant fondamental de délivrer aux patientes des consignes précises, dès la consultation préopératoire, afin d'améliorer le vécu de leur convalescence et favoriser un retour aux activités dans de bonnes conditions. Il n'est pas non plus nécessaire d'être trop restrictif dans la reprise de certaines activités en postopératoire ni de recommander des incapacités de travail trop longues car elle peuvent avoir un impact négatif sur la qualité de vie des patientes. Au regard du sondage et de la revue des données de la littérature, notre groupe de travail propose des recommandations harmonisées sur la convalescence et l'incapacité de travail après chirurgie gynécologique, tenant compte des pratiques chirurgicales recommandées en 2020.

Ulcer of Lipschutz, a rare and unknown cause of genital ulceration.

Acute genital ulcers are painful and distressing to women. Lipchutz Ulcer is an uncommon disease that typically occurs in sexually inactive young women. The main differential diagnosis are sexually-transmitted or non-infectious diseases which cause genital or oro-genital ulcerations. This article aims to review the diagnosis of acute genital ulcers and, through a rare case of acute genital ulcerations, to discuss diagnostic procedures.

[Pseudotumoral pelvic actinomycosis : one should think of it]. / Le cas clinique du mois - Actinomycose pelvienne pseudo-tumorale : il fallait y penser.

Actinomycosis is a rare chronic disease caused by a group of anaerobic Gram positive bacteria. It may mimic a neoplasia at various anatomical levels. A pelvic localization is exceptional but has an increasing incidence since the use of intrauterine devices. In such cases, pelvic actinomycosis may present as a gynecological or a lower colonic malignancy. For all atypical clinical, with a prominent infectious or inflammatory context, the diagnosis of actinomycosis must be suggested and discussed with the pathologist to whom the biopsy will be submitted. In the absence of a preoperative diagnosis, an inadequately aggressive pelvic surgery might be performed and rendered particularly complex due to the adherent and diffusely inflammatory pattern of the disease. The treatment of choice remains a long-term therapy with antibiotics that leads to a complete clinical and radiological response in the majority of cases. We report the case of a 27-year-old woman with a clinical and radiological diagnosis of rectal carcinoma but with limited preoperative biopsy that revealed a pelvic actinomycosis and allowed a conservative and successful antibacterial treatment.

L'actinomycose est une pathologie bactérienne rare pouvant prendre un aspect pseudo-tumoral. La localisation pelvienne est exceptionnelle, mais d'incidence croissante depuis l'utilisation des dispositifs intra-utérins. La présentation peut alors évoquer une néoplasie gynécologique ou colique basse. Devant tout tableau clinique atypique suggérant une malignité pelvienne mais dominé par un contexte infectieux et/ou inflammatoire, le diagnostic d'actinomycose doit être évoqué et discuté avec le collègue anatomo-athologiste auquel les prélèvements histologiques seront soumis. En l'absence de diagnostic pré-opératoire, une chirurgie radicale peut être pratiquée de manière inadéquate et se révéler particulièrement délabrante en raison du caractère adhérent et diffusément inflammatoire de la lésion. Le traitement de choix est une antibiothérapie au long cours amenant à une résolution clinique et radiologique complète dans la majorité des cas. Nous rapportons le cas d'une patiente de 27 ans chez laquelle un diagnostic de néoplasie rectale primitive est suggéré cliniquement et radiologiquement, mais chez qui les biopsies pré-opératoires limitées ont permis un diagnostic d'actinomycose pelvienne et un traitement conservateur.

[Therapeutic progress in gynecology: organic diseases]. / Actualités thérapeutiques en gynécologie: pathologies organiques.

Over the last ten years, progress in evidence-based medicine coupled with technological and surgical breakthroughs have deeply changed the management of our patients. Uterine bleeding is the first cause of gynaecological consultation and the intrauterine progestin delivery system as well as new hysteroscopic procedures have optimized the therapeutic approach to this problem. Introduction of magnetic resonance imaging and interventional procedures have improved breast disease diagnosis and management; likewise sentinel node localization, introduction of aromatase and growth factors inhibitors, new radiotherapy procedures and pharmacogenomics, have helped to ameliorate breast cancer treatment. Pelvic surgery has been switching more and more towards laparoscopic procedures not only in the field of benign lesions (eg endometriosis), of surgery of prolapse and incontinence with new prosthetic materials, but also for an improved management of gynaecological cancers.

[Physiopathology and therapeutic management of stage I and II endometriosis]. / Endométriose stade I et II: implications physiopathologiques, cliniques et thérapeutiques.

Stage I and II endometriosis is defined by a r-AFS score respectively ranging from 1 to 5 and from 6 to 15. This mild, superficial endometriosis is a very common pathology occurring in infertile women. Nevertheless, these women with stage I/II endometriosis have usually few pelvic pain. This review summarizes the recent literature concerning new data on the pathogenesis of peritoneal endometriosis and its clinical management. Retrograde menstruation, peritoneal adhesion of shed endometrial tissue, and outgrowth of endometrial cells, glands and stroma, are essential elements in the pathogenesis of endometriosis according to Sampson's classic implantation theory. Nevertheless, exact pathophysiology of endometriosis remains unknown. Superficial endometriotic lesions observed by laparoscopy have to be treated. Surgical procedure is not difficult for stage I and II of endometriosis. Surgical procedure remains controversial. Carbon dioxide (CO2) Laser can be used for laparoscopic destruction of endometriosis. Newer procedures, such as SurgiTouch (Lumenis), are more effective in vaporization and decrease the risk thermal damage of contiguous structures. The monopolar scissors can also be used in order to excise the peritoneal endometriotic lesions. Medical treatment may be usefull if surgical treatment is not complete or if the pelvic cavity is hypervascularized. In these cases, Gonadotropin-Releasing Hormone agonists (Gn-RHa) are the most common and effective treatment.;

The learning curve of total laparoscopic hysterectomy: comparative analysis of 1647 cases.

STUDY OBJECTIVE: To compare the frequency of complications of total laparoscopic hysterectomy performed in the first and more recent years of our experience, and based on that, offer ways to prevent them. DESIGN: Retrospective, comparative study (Canadian Task Force classification II-2). SETTING: University tertiary referral center for endoscopic surgery. PATIENTS: During 1989-1995 and 1996-1999, 695 and 952 women, respectively, with benign pathology. INTERVENTION: Total laparoscopic hysterectomy. MEASUREMENTS AND MAIN RESULTS: No differences in patient characteristics were found between 1989-1995 and 1996-1999. Substantial decreases in major complication rates were noted, 5.6% and 1.3%, respectively. No major vessel injury occurred. Excessive hemorrhage (1.9%) and need for blood transfusion (2.2%) during the first period were statistically higher than in the second period (both 0.1%, p <0.005). Urinary complications (2.2%) including 10 bladder lacerations, 4 ureter injuries, and 1 vesicovaginal fistula occurred more frequently in the first period than in the second period (0.9%), when 6 bladder and 2 ureter lacerations and 1 vesicovaginal fistula occurred (p <0.005). One bowel injury and one bowel obstruction occurred in the first period, but no bowel complications in the second. Between periods, 33 (4.7%) and 8 (1.4%) conversions to laparotomy were necessary. During the first period there were nine reoperations; of six laparotomies, four were due to urinary injuries, one due to heavy vaginal bleeding, and one due to a vesicovaginal fistula; three diagnostic laparoscopies were required due to postoperative abdominal pain. Three reoperations during the second period were two laparoscopies due to heavy vaginal bleeding and one laparotomy due to a vesicovaginal fistula (p <0.005). Statistically significant differences in median (range) uterine weight 179.5 g (22-904 g) and 292.0 g (40-980 g) and operating times 115 minutes (40-270 min) and 90 minutes (40-180 min), respectively, were recorded (p <0.005). CONCLUSION: Laparoscopic hysterectomy was safe, effective, and reproducible after training, and with current technique, had a low rate of complications.

[Regret after tubal sterilization]. / Regrets après stérilisation tubaire.

OBJECTIVE: To examine thoroughly the profile and motivations of a group of women who regretted sterilization so much that they were prepared to undergo reversal microsurgery or in vitro fertilization treatment. MATERIAL: and methods. The study followed one hundred women from their first consultation for a period of 3 years in order to analyze the outcome of their initial decision. RESULTS: Analysis of the circumstances at the time of the sterilization indicate 3 main factors which later caused the women to regret the decision Three years after the initial consultation, 69% of the patients have withdrawn from further investigation and /or treatment for different reasons analyzed in this study. 17 of the patients have undergone reversal microsurgery and 14 have attempted one or more in vitro fertilization treatments. Of these 31 patients, 12 (38.7%) have given birth to at least one child. CONCLUSION: These results sufficiently prove that tubal sterilization is worthy of consideration as much by the patient as by the physician as a method of irreversible contraception despite the developments in tubal microsurgery or in medically assisted procreation.

Absence of antisteroid antibodies in oral contraceptive users presenting with vascular events.

Previous reports speculated that vascular events could be related to the development of antibodies against synthetic steroids contained in oral contraceptives or other hormonal treatments. This study describes original immunoassays designed to detect antisynthetic steroid antibodies. In a first step, the assays were characterized and validated using animal-raised antisteroid antibodies. In a second step, a population of 88 oral contraceptive users, 47 of them having developed a vascular thrombosis during synthetic steroid use and 41 serving as healthy control users, were tested. Detection of antibodies against ethinylestradiol, levonorgestrel, norethisterone, cyproterone acetate, and gestodene showed that the values obtained in normal oral contraceptive users as well as thrombosis patients are very low, and show no statistically significant difference between the two groups tested. Taken together, these data indicate that the "immunological hypothesis" related to antisteroid antibodies is unlikely to explain the pathogenesis of vascular events in oral contraceptive users.

Influence of two quinolones, ofloxacin and pefloxacin, on human myelopoiesis in vitro.

The influence of ofloxacin and pefloxacin on human myelopoiesis in vitro was investigated. Drug concentrations varied from 0.5 to 50 micrograms/ml, and the effect on granulomonocyte precursors was evaluated on cell cultures in agar. Our results indicate that ofloxacin and pefloxacin do not induce inhibition of myelopoiesis.

Influence of ofloxacin and pefloxacin on human lymphocyte immunoglobulin secretion and on polymorphonuclear leucocyte superoxide anion production.

The influence of two fluoroquinolone derivatives, ofloxacin and pefloxacin, on lymphocyte immunoglobulin secretion and on polymorphonuclear leucocyte superoxide anion production was assessed. Pharmacological concentrations did not influence the studied functions, while suprapharmacological concentrations decreased immunoglobulin production.

[Prevalence and prognostic significance of anti-HTLV-I and anti-HIV-2 antibodies in patients with HIV infection in the Roman region]. / Prevalenza e significato prognostico di anticorpi anti HTLV-I ed anti HIV-2 in pazienti con infezione da HIV nell'area romana.

A chronic coinfection with CMV, EBV etc. has been described in patients with HIV infection; recently a coinfection with other retroviruses has been described too. We have looked for the presence of antibodies to HTLV-I (anti HTLV-I) and to HIV-2 (anti HIV-2) in 135 HIV infected (HIV-positive) subjects living in Rome. They were 100 i.v. drug addicts, 24 homo/bisexuals, 4 partners of HIV-positive patients, 5 polytransfused and 2 without any known risk factor; 32 of them had a full-blown AIDS, 52 had ARC and 51 were symptom-free. Anti HIV, anti HTLV-I and anti HIV-2 were detected with ELISA method and confirmed by Western Blot (W.B.) technique. Antibodies to HTLV-I were found in 14 cases (10.4%) and antibodies to HIV-2 in 12 cases (8.9%). The contemporary presence of anti HIV, anti HTLV-I and anti HIV-2 was not found in any subjects. Our data fail to show a clear relationship among the coinfection with different retroviruses and the various risk factors for HIV infection and the HIV-related clinical picture (AIDS, ARC, etc.).

[Study of IgG antibodies to PPD with an immunoenzyme method (ELISA) in the serum of patients with pulmonary tuberculosis]. / Ricerca degli anticorpi IgG anti-PPD con metodica immunoenzimatica (ELISA) nel siero di pazienti affetti da tubercolosi polmonare.

ELISA has been used for the detection of IgG antibodies against PPD in 48 patients with pulmonary tuberculosis, in 10 individuals with previously treated tuberculosis and clinically recovered, in 22 PPD skin-test positive healthy volunteers and in 48 blood donors with unknown PPD skin-test. Positivity was obtained in 29 patients (83%) with active tuberculosis, in one patient (10%) with clinical recovery, in none of the healthy controls. This technique may have a potential diagnostic relevance in evaluating patients with suspected pulmonary tuberculosis.

[Analysis with immunofluorescence of antibodies attached to bacteria in urinary sediment in the diagnosis of the site of urinary infections]. / Ricerca con immunofluorescenza degli anticorpi adesi ai batteri nel sedimento urinario per la diagnosi di sede delle infezioni urinarie.

The authors assess the sensitivity and specificity of the antibody-coated bacteria assay for the localization of urinary tract infections. The results are compared with those obtained from cultures of urine samples taken from the upper tract either by ureteral catheterization or by direct puncture of the renal pelvis. In upper urinary tract infections the research of total immunoglobulins has proven positive in 71.4% of the cases; of the IgA class in 71.4%; of the IgG class in 57.1%; of the IgM class in 28.6% and of the secretory component of IgA in 60% of the patients. In case of lower urinary tract infections the research of total immunoglobulins was positive in 25% of the cases: that of the IgA class in 8.3%; of the IgG in 25%; of the IgM in 25% and of the secretory component of IgA in 22.2% of patients.

Incidence of antibodies against rabbit liver specific lipoprotein (RLSP) in chronic active hepatitis.

In chronic active hepatitis (CAH) evidence exists that circulating autoantibodies against liver specific lipoprotein (LSP) could play a role in the development of hepatocellular injury. We evaluated the presence of autoantibodies in CAH against LSP using rabbit LSP, as antigen in a radioimmunoprecipitation test. Fifty-one patients with histologically diagnosed CAH were investigated. Among these 16 were HBsAg+, 15 were HBsAg-/anti-HBc+, 10 were non-A, non-B, 10 were autoimmune CAH. Anti-LSP were detected in six of 16 (37%) HBsAg+ (mean titre of 1:198); four of 15 (33%) HBsAg-/anti-HBc+ (mean titre of 1:246); two of 10 (20%) non-A, non-B (mean titre of 1:185); seven of 10 (70%) autoimmune CAH (mean titre of 1:307). No correlation was evident between the titre of anti-LSP and the values of AST, bilirubin or IgG. The findings seem to be consistent with the following conclusions: (a) CAH patients develop an humoral immune response to determinants in LSP which are not species specific. This is further evidence that rabbit LSP could be considered a suitable alternative to the human preparation in evaluation of autoimmunity in CAH and (b) the different behaviour of anti-LSP in patients with viral CAH (B, non-A, non-B) in respect of patients with autoimmune CAH suggests a variable importance of these antibodies in the mechanism of ongoing liver cell injury according to the various types of CAH.

Cell-mediated cytotoxicity to rabbit liver-specific lipoprotein in chronic active hepatitis.

Cell-mediated cytotoxicity to 51Cr-labelled avian red blood cells coated by rabbit liver-specific lipoprotein was evaluated in 27 patients with untreated chronic active hepatitis (11 were HBsAg-positive). A significantly increased cytotoxicity was recorded in 10 of the 11 patients with HBsAg-positive chronic active hepatitis and in 13 of the 16 HBsAg-negative patients. The addition of rabbit LSP to the test system reduced to normal the cytotoxicity index in all the positive cases. Moreover, in order to evaluate the organ-specificity of cytotoxicity to rabbit LSP-coated cells, we added to the test system a macromolecular kidney protein fraction which was unable to block the cytoxicity in any of the positive cases. In 12 selected cases, which had previously shown an increased cytotoxicity to rabbit LSP-coated red blood cells, the incubation of their lymphocytes at 37 degrees C for 30 min in a plastic Petri dish resulted in the abolition of cytotoxicity. Our findings seem to indicate that cell-mediated cytotoxicity to LSP can also be detected with an antigen, not prepared from human liver. This is a further evidence that patients with chronic active hepatitis develop an immunological reactivity to not species-specific antigenic determinants in LSP.

[Serological diagnosis of hepatitis A: determination with the RIA of anti-A specific IgM after absorption of IgG with protein A of Staphylococcus aureus]. / Diagnosi sierologica dell'epatite da virus A: determinazione con il RIA delle IgM specifiche anti-A dopo adsorbimento delle IgG con proteina A di Staphylococcus aureus.

The research of specific IgM anti virus A (anti HAV-IgM), by absorbtion of IgG with Staphylococcus aureus A protein, has been conducted in the sera of 49 patients with acute hepatitis non B (HBsAg negative). Twenty-nine of these patients (59.2%) were anti HAV-IgM positive and therefore were diagnosed as viral hepatitis A, while twenty (40.8%) were anti HAV-IgM negative and were considered as non A-non B hepatitis. In the present work the practical utility of the detection specific IgM by absorbtion with A protein is discussed also in respect of the more expensive and less sensitive technique of gel fractionation of the sera. In addition our preliminary results document a decreasing incidence of viral hepatitis A in all the cases seen in the period 1978-1979. This event, which needs further investigations, could also be due to a more significant incidence of non A-non B hepatitis, probably as consequence of increasing drug-addiction.