Cronificación del dolor tras episiotomía / Development of chronic pain after episiotomy

Objetivo. Analizar la incidencia de dolor crónico a los 5 meses de la realización de episiotomía y los posibles factores pronósticos asociados. Métodos. Estudio observacional de cohortes prospectivo en parturientas a las que se les realizó episiotomía. Se incluyeron las pacientes con edad igual o superior a 18 años. Se evaluó la presencia de dolor en el área de la episiotomía a las 24 y 48 h del parto mediante encuesta presencial estructurada, y a los 5 meses mediante encuesta telefónica. La variable principal fue la presencia de dolor crónico a los 5 meses. También se investigó la presencia de dolor al expulsivo y su intensidad, la presencia o no de analgesia epidural, parto instrumentado, desgarro perineal, dolor en el momento de la realización de la episiotomía, y la presencia de dispareunia e incontinencia urinaria a los 5 meses posepisiotomía. Resultados. De 87 parturientas que se incluyeron, finalizaron el estudio 78. De las pacientes que finalizaron el estudio, el 12,8% refirieron dolor crónico posepisiotomía. La analgesia epidural se relacionó con una mayor incidencia de parto instrumentado y menor dolor en el momento de la episiotomía y del expulsivo (p < 0,0005, p < 0,02 y p < 0,01, respectivamente). El dolor crónico se relacionó con el parto instrumentado (p < 0,017), así como con la presencia de dolor en reposo a las 24 y 48 h (p < 0,01), de complicaciones de la herida (p < 0,026) y de dispareunia (p < 0,001). Conclusión. Una incidencia del 12,8% de mujeres con cronificación del dolor tras el parto con episiotomía evidencia un problema de salud. Consideramos que son necesarios más estudios que confirmen nuestros resultados (AU)

Objective. To analyze the incidence of chronic pain 5 months after episiotomy, as well as potential prognostic factors. Methods. A prospective cohort observational study was conducted on pregnant women age ≥ 18 years who had undergone an episiotomy. The presence of pain was evaluated in the area of episiotomy at 24 and 48 h of delivery using a structured face-to-face questionnaire, and by telephone questionnaire at 5 months. The primary endpoint was the presence of persistent pain at 5 months. A record was made of the presence of pain at delivery, and its intensity, the presence or absence of epidural analgesia, instrumental delivery, perineal tear, and pain when episiotomy was performed, as well as the presence of dyspareunia and urinary incontinence at 5 months post-episiotomy. Results. A total of 87 parturient patients were included, of whom 78 completed the study. Of the patients who completed the study, 12.8% reported chronic episiotomy pain. Epidural analgesia was associated with a higher incidence of instrumental delivery and less pain at the time of episiotomy and expulsion (P < .0005, P < .02, and P< .01, respectively). Chronic pain is associated with operative delivery (P < .017), and with the presence of pain at rest at 24 and 48 h (P < .01), of wound complications (P < .026), and of dyspareunia (P < .001). Conclusion. An incidence of 12.8% of women developing chronic pain after delivery with episiotomy suggests a health problem. More studies are needed to confirm our results (AU)

Development of chronic pain after episiotomy.

OBJECTIVE: To analyze the incidence of chronic pain 5 months after episiotomy, as well as potential prognostic factors. METHODS: A prospective cohort observational study was conducted on pregnant women age≥18 years who had undergone an episiotomy. The presence of pain was evaluated in the area of episiotomy at 24 and 48 h of delivery using a structured face-to-face questionnaire, and by telephone questionnaire at 5 months. The primary endpoint was the presence of persistent pain at 5 months. A record was made of the presence of pain at delivery, and its intensity, the presence or absence of epidural analgesia, instrumental delivery, perineal tear, and pain when episiotomy was performed, as well as the presence of dyspareunia and urinary incontinence at 5 months post-episiotomy. RESULTS: A total of 87 parturient patients were included, of whom 78 completed the study. Of the patients who completed the study, 12.8% reported chronic episiotomy pain. Epidural analgesia was associated with a higher incidence of instrumental delivery and less pain at the time of episiotomy and expulsion (P<.0005, P<.02, and P<.01, respectively). Chronic pain is associated with operative delivery (P<.017), and with the presence of pain at rest at 24 and 48 h (P<.01), of wound complications (P<.026), and of dyspareunia (P<.001). CONCLUSION: An incidence of 12.8% of women developing chronic pain after delivery with episiotomy suggests a health problem. More studies are needed to confirm our results.

[Optimized protocols for interphase FISH analysis of imprints and sections using split signal probes]. / Application de la technique de FISH interphasique avec des sondes encadrantes dites de <> à différents types de préparations histologiques et cytologiques.

Fluorescent in situ hybridization (FISH) analysis is a molecular technique allowing the detection of recurrent translocations in cancer. Several hybridization protocols were assayed in order to evaluate their performances for interphase FISH analysis of histological sections and imprints using split probes. Adult and foetal lymphoid tissues were selected. Touch imprints of fresh (EF) or frozen (EC) tissues, sections (CF) and isolated nuclei (NI) of formol-fixed paraffin-embedded tissues were performed. The cut-off values of the IGH, IGlambda, BCL-2, BCL-6, CCND1 and MYC DNA FISH split signal probes were calculated for adult reactive lymph nodes on the different histological preparations (EC, CF, CC, NI) and on several tissues for the IGH and BCL-6 probes. In reactive lymph nodes, the cut-off values of the probes were between 3 and 13% and found independent of the preparation type. Conversely, slight but significant variations of the cut-off level were observed when different foetal control tissues were assayed with the same probe set. Finally, this study provided optimized-protocols for FISH analysis of either fresh/frozen imprints or formalin-fixed paraffin-embedded sections using split signal DNA probes.

[Interphase FISH analysis of frozen or fixed tissues for the detection of t(11;14) (q13;q32) in mantle cell lymphoma]. / Analyse par FISH interphasique de tissus congelés ou fixés pour la détection de la t(11;14)(q13;q32) dans les lymphomes du manteau.

Cytogenetic analyses have revealed that mantle cell lymphomas (MCL) are closely associated with the t(11;14)(q13;q32). This translocation juxtaposes the immunoglobulin heavy chain gene (IGH) sequences with the BCL-1 locus, leading to up-regulation of the CCND1 gene and consequently to an overexpression of cyclin D1 protein. We studied 27 MCL with characteristic morphological and immunological (CD5+, CD10-, CD20+, CD23-) features and 2 controls (reactionnal lymphadenitis) to evaluate the feasibility and the interest of FISH analysis on interphase cells from frozen or paraffin-embedded tissues. Sections (CC) and touch preparations (EC) of frozen tissues and sections of paraffin-embedded tissues (CF) were successfully hybridized with the Vysis LSI IgH/CCND1 dual color dual fusion translocation probe. The touch preparations presented a lower cellularity than sections, therefore allowing an easier analysis. Hybridization spots intensities were found stronger in CC and EC than in CF. The percentages of t(11;14) positive cells were similar in CC, EC and CF from a same patient. The percentage of non hybridized cells, analogous in CC and EC, was higher in CF. However, the CF were directly analysed on microscope without the need of any numerical picture treatment. The t(11;14) was detected in all the cases (27/27) and positive cells percentages were always higher than the probe cut-off (5%). The FISH analysis on interphase cells appears a performing and rapid technique to detect t(11;14) in MCL on both frozen and paraffin-embedded tissue, thus extending its practical and diagnostic use.

[One heat-induced antigen retrieval step allows the sequential detection of two antigens on the same slide of tissue fixed and enclosed in paraffin]. / Un seul démasquage par la chaleur permet la détection successive de deux antigènes sur la même coupe de tissu fixé et inclus en paraffine.

The heat-induced antigen retrieval (HIAR) procedure allows the immunohistochemical detection of various antigens on paraffin-embedded sections. The re-use of slides negative for the detection of a first set of antigens may be an interesting alternative in case of a limited number of slides. After HIAR, a series of Bouin's liquid-fixed tonsil sections was stained for Epithelial Membrane Antigen (EMA) which labelled epithelial cells and plasma cells. A second immunostaining for CD20 (L26) was performed on the same slides divided in two sets. The HIAR was repeated in the first set but not in the second one. A similar staining of follicular B-cells was observed in the two sets. However background staining was enhanced by repetition of HIAR. Analogous results were obtained using anti-cytokeratin (KL1) instead of anti-EMA. This was confirmed on slides for which three or four cycles of HIAR were performed prior immunostaining. Our data suggest that the renewal of the HIAR procedure must be avoided since it was found stable for at least 1 year.

Ontogenetic and regional changes in alpha-methyl-D-glucoside and L-proline intestinal transport in guinea pig.

Regional brush-border uptakes of alpha-methyl-D-glucose and L-proline as well as morphometric parameters were studied from birth until adulthood in guinea pig small intestine. Intestinal weight, length, and area were fitted to two-segmented straight lines: from birth until the 2nd wk there was a sharp rise, whereas from day 14 to the adult stage the increase was slower. In everted sleeves, total uptakes of alpha-methyl-D-glucoside were higher on day 1 in duodenum, jejunum, and ileum, diminishing with increasing age. The initial fluxes of L-proline were higher during the 1st wk, diminishing to values that kept constant thereafter. Total uptakes of L-proline relative to alpha-methyl-D-glucoside showed a peak in the 1st wk in the three segments studied, reflecting the high demand for protein during the postnatal period. Regional ratios of L-proline to alpha-methyl-D-glucoside indicated that the ileum is the segment best suited to transporting this amino acid during the first 3 wk. Changes observed in the present study indicated a different pattern between hexose and amino acid transport during development and along the small intestine of guinea pig.