Giant Villous Adenoma of the Rectum With Prolapse: Case Report.

Colorectal polyps, frequently adenomas, are common in older adults, with villous adenomas being a notable subset due to their potential for significant malignancy risk. This case report highlights a rare instance of a giant villous adenoma in a 79-year-old female patient, challenging in both diagnosis and treatment. The patient, with a history of untreated essential arterial hypertension, was hospitalized for severe anemia following a massive rectal hemorrhage. An irreducible, prolapsed rectal mass was evident upon examination, and further investigations, including rectoscopy and abdominopelvic computed tomography scan, confirmed a villous adenoma with severe dysplasia. Given the tumor's substantial size, circumferential nature, and proximity to the dentate line, an abdominoperineal resection using the Miles technique was performed. The histopathological examination post-surgery confirmed the presence of a villous adenoma with high-grade epithelial neoplasia and localized areas of well-differentiated tubular adenocarcinoma. This case underscores the diagnostic and management complexities of large villous adenomas, emphasizing the need for meticulous surgical decision-making to ensure oncological safety and patient welfare, particularly when conservative resection may be inadequate.

Efficacy of methotrexate as anti-inflammatory and anti-proliferative drug in dermatology: Three case reports.

Methotrexate (MTX) is a folic acid analog with anti-proliferative (anti-neoplastic, cytotoxic), immunosuppressive and anti-inflammatory properties, which has been used in the treatment of various cutaneous disorders, such as psoriasis, keratoacanthoma, pityriasis rubra pilaris, atopic dermatitis, mycosis fungoides, bullous skin diseases, systemic sclerosis, morphea, lupus erythematosus, dermatomyositis and crusted scabies. Inhibition of cell proliferation is explained through its role in blocking DNA/RNA synthesis, by inhibiting dihydrofolate reductase, necessary for the production of pyrimidine and purine nucleotides. An anticancer effect can be related to α-oxoaldehyde metabolism (MTX increases methylglyoxal levels). Its anti-inflammatory property is based on the inhibition of 5-aminoimidazole-4-carboxamide ribonucleotide transformylase, thus increasing intracellular and extracellular adenosine, a purine nucleoside with anti-inflammatory effect. This drug can limit inflammation by scavenging free radicals and decreasing malondialdehyde-acetaldehyde protein-adduct production. Moreover, the anti-proliferative and anti-inflammatory effects can also be related to inhibition of the DNA methylation pathway, thus inhibiting methionine formation. The aim of the present study was to report various dermatological cases from our daily practice that demonstrate the efficacy of MTX in the treatment of cutaneous diseases, highlighting different mechanisms of action: its anti-inflammatory effect in psoriasis and its anti-proliferative, and anti-neoplastic effect in well-differentiated squamous cell carcinoma or in keratoacanthoma. Moreover, different administration pathways and doses are addressed. Assessment of the treatment plan, clinical improvement of cutaneous lesions, biologic evaluation, final aesthetic result, quality of life, as well as potential adverse effects and drug tolerance related to each case mentioned.

[Virtual reality simulation training in gynecology: review and perspectives]. / Simulation virtuelle en chirurgie gynécologique : état des lieux et perspectives.

Laparoscopic simulation has rapidly become an important tool for learning and acquiring technical skills in surgery. It is based on two different complementary pedagogic tools : the box model trainer and the virtual reality simulator. The virtual reality simulator has shown its efficiency by improving surgical skills, decreasing operating time, improving economy of movements and improving self-confidence. The main objective of this tool is the opportunity to easily organize a regular, structured and uniformed training program enabling an automated individualized feedback.

La simulation en laparoscopie est un moyen d'apprentissage et d'acquisition des gestes techniques chirurgicaux en plein essor. Elle s'appuie essentiellement sur deux outils pédagogiques complémentaires : le pelvi-trainer et la simulation virtuelle. Le simulateur virtuel a démontré son efficacité dans l'amélioration de l'habileté chirurgicale, la diminution du temps opératoire, l'amélioration dans l'économie des mouvements et l'augmentation de la confiance en soi. Il a pour principal intérêt la possibilité de mettre en place facilement un programme d'entraînement régulier, structuré et uniformisé permettant une auto-évaluation de l'interne.

Preventive Uterine Artery Occlusion: Benefits of the Laparoscopic Posterior Approach.

STUDY OBJECTIVE: To present a standardized and minimally invasive procedure to occlude uterine artery via a posterior approach. DESIGN: Step-by-step explanations of the technique using videos (Canadian Task Force classification III). SETTING: The preventive occlusion of uterine arteries during uterine surgery reduces perioperative bleeding by temporarily devascularizing the uterus. This technique, usually performed by conventional or robotically assisted laparoscopy, can be combined with surgical procedures that have a potential risk of major bleeding such as myomectomy or hysterectomy, particularly in cases of a large uterus. Here, we describe a minimally invasive technique using a laparoscopic posterior approach of the retroperitoneal space, which allows more direct access to the uterine pedicles. Institutional review board approval was obtained through our local ethics committee in Geneva University Hospitals. INTERVENTIONS: The main occlusion technique described in the literature involves a superior approach at the level of the lateral pelvic triangle. We propose to access the uterine artery via a posterior approach at the posterior and inferior level of the broad ligament. The peritoneum is opened after previous identification of the uterine artery and the ureter by transparency. After a limited dissection, the occlusion of the uterine artery is performed under direct visual control through the atraumatic placement of a 10-mm endoscopic vascular clip. CONCLUSION: The posterior peritoneal approach should be favored if, during a laparoscopic procedure, a uterine artery occlusion is chosen to reduce blood loss. This technique offers an easier and a more limited dissection to access the uterine pedicles, thus minimizing the risk of accidental injuries.