[Day case laparoscopic sacral colpopexy for genital prolapse]. / Prise en charge ambulatoire de la promontofixation laparoscopique pour prolapsus génital.

OBJECTIVE: To demonstrate the feasibility of day case laparoscopic sacral colpopexy with the help of a fast tracking protocol. METHODS: Three motivated patients suffering from external cystocele have been strictly selected from September 2011 to October 2011 according to criteria such as Body Mass Index, ASA score, comorbidities et French day case rules. Laparoscopic sacral colpopexies consisted in anterior and posterior polyesther meshes sutured with non-resorbable wires. We are used to proceed through a SILS(©) unique ombilical port. We have used standard and straight laparoscopic instruments and laparoscope. The bladder catheter has been removed two hours after surgery, the patients have been encouraged to stand up and they have received a light meal before Chung score has been quoted. The patients have been discharged in the evening before 7 pm. RESULTS: The patients are 65, 67 and 66 years old, two of them had a past history of pelvic surgery. We did not deplore any complication during the procedure, no blood loss, no laparoscopic conversion (additional trocar); the procedures durations were 92, 120 and 124 min. These three patients have not been readmitted. Clinical examination has been scheduled between 6 and 8 weeks after surgery. We did not describe any pelvic or parietal complication, no early recurrence. CONCLUSION: We have demonstrated here the feasibility in good security conditions of day case laparoscopic sacral colpopexy for genital prolapse. A fast tracking protocol is essential and selecting the patients is required.

Role of the region 3' to Xist exon 6 in the counting process of X-chromosome inactivation.

During early embryogenesis of female mammals, one of the two X chromosomes is randomly chosen to be inactivated in each cell, leading to the transcriptional silencing of thousands of genes on this chromosome. This random X-inactivation process also occurs during in vitro differentiation of female embryonic stem (ES) cells. A locus on the X chromosome, the X inactivation centre (Xic) is initially 'counted', given that at least two copies of Xic must be present per diploid genome in order for inactivation to occur. The counting process ensures that one X chromosome remains active in diploid cells. In the mouse, the essential functions of Xic can be assured by a 450-kb region containing the Xist gene. Xist maps within Xic (refs 7-10) and is necessary in cis for inactivation. The Xist transcript is a 15-kb RNA which is confined within the nucleus and coats the inactive X chromosome. In order to characterize functional elements within Xic and the Xist gene, we created a 65-kb cre/loxP deletion extending 3' to Xist exon 6. In undifferentiated ES cells, Xist expression from the deleted X chromosome was markedly reduced. In differentiated XX ES cells containing one deleted X chromosome, the X inactivation process still occurred but was never initiated from the unmutated X chromosome. In differentiated ES cells that were essentially XO, the mutated Xic was capable of initiating X inactivation, even in the absence of another Xic. These results demonstrate a role for the region 3' to Xist exon 6 in the counting process and suggest that counting is mediated by a repressive mechanism which prevents inactivation of a single X chromosome in diploid cells.

Genetics. Reprogramming X inactivation.

Inactivation of one of the two X chromosomes occurs in all cells of female adult mice so that genes are expressed from only one X chromosome. In a Perspective, Clerc and Avner describe an elegant series of experiments in mouse embryos cloned from adult and embryonic female cell nuclei (Eggan et al.) that reveal how the inactivation state of the X chromosomes is reprogrammed.

Reg genes are CCK2 receptor targets in ElasCCK2 mice pancreas.

We previously demonstrated that expression of the gastrin receptor, CCK2R, in pancreatic acini of transgenic ElasCCK2 mice induced alteration of acinar morphology and differentiation, increased sensitivity to a carcinogen and development of preneoplastic lesions and tumours. Reg proteins are suggested to be involved in pancreatic cancer and in regeneration of endocrine pancreas. Reg I gene is a known target of gastrin. We examined whether an expression of CCK2R in the pancreatic acini of ElasCCK2 mice is linked to induction of Reg proteins expression. We analyzed Reg expression by Western-blot and immunohistochemistry in pancreas from ElasCCK2 and control mice. Islet neogenesis, glucose homeostasis, insulin secretion and content were also evaluated. Reg I is exclusively produced in acini in ElasCCK2 and control mice. In tumoral pancreas, Reg I and Reg III proteins are expressed in duct-like cells in preneoplastic lesions or in the periphery of tumours and in adjacent acini. The expression of Reg III proteins is increased in ElasCCK2 pancreas before the development of preneoplastic lesions in a subpopulation of islet cells and in small islet-like cell clusters dispersed within the acinar tissue. Several criteria of an enhanced neogenesis are fulfilled in ElasCCK2 pancreas. Moreover, ElasCCK2 mice have an improved response to glucose load, an increased insulin secretion and a doubling of insulin content compared to control mice. We show that Reg proteins are targets of CCK2R activation and are induced during early steps of carcinogenesis in ElasCCK2 mice pancreas. Alterations of exocrine tissue homeostasis in ElasCCK2 pancreas concomitantly activate regenerative responses of the endocrine pancreas possibly linked to paracrine actions of Reg III proteins.

Cholecystokinin-2 receptor modulates cell adhesion through beta 1-integrin in human pancreatic cancer cells.

Several lines of evidence suggest that gastrin and the CCK-2 receptor (CCK2R) could contribute to pancreatic carcinogenesis by modulating processes such as proliferation, cell adhesion or migration. In the current study, we used a 'cancer gene array' and identified beta1-integrin subunit as a new gastrin-regulated gene in human pancreatic cancer cells. We also demonstrated that Src family kinases and the phosphatidylinositol-3-kinase (PI-3-kinase) pathway play a crucial role in the expression of beta1-integrin induced by gastrin. Our results also showed that gastrin modulates cell-substrate adhesion via beta1-integrin. Indeed, using blocking anti-beta1-integrin monoclonal antibodies, we completely reversed the increase in cell-substrate adhesion induced by gastrin. In addition, we observed that in response to gastrin, beta1-integrin is tyrosine phosphorylated by Src family kinases and associates with paxillin, a scaffold protein involved in focal adhesion and integrin signalling. This mechanism might be involved in gastrin-induced cell adhesion. Moreover, we showed in vivo that targeted CCK2R expression in the pancreas of Elas-CCK2 mice leads to the overexpression of beta1-integrin. This process may contribute to pancreatic tumour development observed in these transgenic animals.

Lipid-dependent proliferation of pancreatic cancer cell lines.

Capan 1, a human pancreatic cancer cell line, is routinely grown in 10% fetal calf serum (FCS). In order to characterize the factors needed for its proliferation, FCS was replaced by a synthetic serum (Ultroser G). For Capan 1 proliferation we found that Ultroser G was as efficient as FCS. A subfraction of Ultroser G containing insulin, transferrin, and lipids was found to be responsible for that response since a combination of these compounds reproduced the growth observed with 10% FCS. Lipids stimulated cell proliferation even in the absence of other factors. Other human (MIA PaCa 2, AsPC1, Panc 1) or rat (AR4-2J) pancreatic cancer cell lines tested proliferated in the reconstituted medium containing insulin (100 ng/ml), transferrin (100 micrograms/ml), fatty acid-free albumin (1 mg/ml), and bovine serum lipids (0.7%), as in 10% FCS. Furthermore, the growth of nonpancreatic cell lines (HT29, A431, CREF) was not enhanced by lipids. Lipoproteins were found to be involved in the mitogenic response of pancreatic cells to lipids, whereas phosphatidylcholine and fatty acids were either inefficient or inhibitors (MIA PaCa2 and AR4-2J). Alkaline phosphatase and amylase content, differentiation markers for Capan 1 and AR4-2J cells, respectively, were not modified by the reconstituted medium. These data suggest that lipids, insulin, and transferrin are the essential factors for the proliferation of pancreatic cancer cell lines, reproducing the growth effect of 10% FCS. Moreover, in the absence of most of the seric growth factors, pancreatic cells remained differentiated.

Evidence for a functional role of the cholecystokinin-B/gastrin receptor in the human fetal and adult pancreas.

Gastrin (G) and cholecystokinin (CCK) are gastrointestinal neuropeptides that are released into circulation during a meal. G is also transiently expressed during embryogenic and early ontogenic development of the pancreas and is believed to act on islet-cell development. Both peptides act on pancreatic endocrine function; however, the effects are dependent on the species and on cellular and molecular underlying mechanisms that remain poorly characterized. Since CCK-B/G subtype receptor is predominant over the CCK-A subtype in the human pancreas, we hypothesized that it could be expressed by islet cells. Here we present reverse transcription-polymerase chain reaction and immunohistochemistry data demonstrating that the CCK-B/G receptor is expressed in islet cells and that islet glucagon-producing cells are the major site of CCK-B/G receptor expression in adult and fetal pancreas. Moreover, G immunoreactivity was detected in the fetal human pancreas at embryogenic week 22. G- and CCK-stimulated glucagon are released from purified human islets. Concentration of CCK and G eliciting a half-maximal level of glucagon secretion were 13 +/- 6 and 8 +/- 5 pmol/l, respectively. Maximal glucagon secretion was achieved in the presence of 30 pmol/l peptides and was similar to that obtained in the presence of 10 mmol/l L-arginine (1.6 pmol x ml(-1) x 90 min(-1)). The nonpeptide antagonist of the CCK-B/G receptor, RPR-101048, fully inhibited CCK- and G-stimulated glucagon secretion at 100 nmol/l concentration. These data are consistent with the view that the CCK-B/G receptor is involved in glucose homeostasis in adult humans and mediates the autocrine effects of G on islet differentiation and growth in the fetal pancreas.

Comparative reactivity and mechanical properties of human isolated internal mammary and radial arteries.

OBJECTIVE: The aim of this study was to analyse the arterial wall mechanics and the vasoreactive properties of the radial artery in comparison with those of the internal mammary artery and to discuss their implications for coronary bypass grafts. METHODS: Measurements of pressure and diameter were obtained from cylindrical segments, whereas measurements of reactivity were obtained from ring segments from the same arteries. We used an echo-tracking technique of high resolution enabling to investigate, in vitro, the diameter and the wall thickness of arterial cylindrical segments. Furthermore, the compliance, distensibility and incremental elastic modulus of the radial and of the mammary arteries were determined for a wide range of transmural pressure (0-200 mmHg) in presence and absence of norepinephrine (NE). RESULTS: Our results show that NE caused vasoconstriction of the two arteries. Strain was found significantly higher for the radial artery than for the internal mammary artery at any given value of stress both in the presence and in the absence of NE. In presence of NE, compliance for radial artery, in the overall transmural pressure range, did not change, whereas, distensibility was significantly increased and the elastic modulus was significantly decreased. Under the same conditions, the distensibility of the mammary artery tended to decrease and its elastic modulus to increase. In parallel, the vasoreactive properties of the two arteries confirmed the previous results showing that radial artery developed a significant higher tension to vasoconstricting agents (KCl, NE and phenylephrine (PHE)) and higher relaxation to isradipine than internal mammary artery. Moreover, radial artery displayed a lesser sensitivity to sodium nitroprusside than internal mammary artery. Furthermore, sensitivity to NE was found to be 7-fold higher for radial artery than for internal mammary artery. CONCLUSION: Taken together, data on the mechanical and reactive properties of radial and internal mammary arteries show why the radial artery displayed a higher potential for spasm than the internal mammary artery and why the use of Ca2+ channel blocker can decrease the incidence of occlusion and spasm.

Differences in aortic response to vasoactive stimuli in Japanese and Lyon rats. The role of hypertension.

OBJECTIVE: We have previously shown that conduit arteries of normotensive (WKY) and hypertensive (SHR) Japanese rats differ from normotensive (LN) and hypertensive (LH) Lyon rats in terms of lower aortic thickness and higher collagen III content, whereas differences in vasoactive properties are unknown. METHODS: Aortic rings with (E+) and without (E-) endothelium were studied under resting and noradrenaline-stimulated conditions in the presence of N(omega)-nitro-L-arginine (L-NNA) alone or in association with indomethacin, bosentan and/or BQ123. RESULTS: Under resting conditions, aortas of normotensive and hypertensive Japanese rats differed from Lyon rats by higher developed tension in the presence of L-NNA and endothelium. In the absence of endothelium, normotensives differed from hypertensives in terms of stronger developed tensions in the presence of L-NNA in the two strains. Addition of indomethacin to L-NNA induced relaxation in E+ SHR and E- WKY and contraction in E-LH. By contrast, tensions were unchanged after addition of bosentan and BQ123. Under stimulated conditions, tensions were equally increased by L-NNA in E+ and unchanged in E- both in Japanese and Lyon rats whether they were normotensive or hypertensive, and indomethacin (but not bosentan) elicited higher response in Lyon than in Japanese rats in E+ and E- aorta. CONCLUSION: Under NO synthase inhibition, the vasoactive properties of Japanese and Lyon aorta differ in the presence of a cyclo-oxygenase blocker but not endothelin blockers. These results indicate that the aorta vasorelaxant tone is associated to prostanoid regulation in Lyon but not in Japanese rats. This observation appears dependent on the genetic and/or environmental background linked to the origin and not the presence of hypertension.

Relaxation of vascular smooth muscle by cicletanine in aged wistar aorta under stress conditions: importance of nitric oxide.

The vascular mechanism of action of cicletanine, an antihypertensive agent, was studied on isolated Wistar rat aortas (24-months-old) in presence and in absence of endothelium in two different stress conditions, normoxic and hypoxic, in presence of norepinephrine (NE). Under normoxic conditions, in presence of endothelium, cicletanine (10(-9)-10(-5)M) induced a concentration-dependent relaxation, whereas in absence of endothelium, cicletanine (10(-9)-10(-5)M) was ineffective although it relaxed the smooth muscle at higher concentrations (10(-4)M). At pharmacologic concentrations (below or equal 10(-5)M), relaxation induced by cicletanine, in presence of endothelium, was prevented by N(omega)-nitro-L-arginine (L-NNA) (P <.005) and relaxation induced by the highest concentration (10(-4)M) was reversed by BaCl2 (P <.005). Under hypoxic conditions, in presence of NE and endothelium, the aorta displayed an increased developed tension that was significantly (P <.05) attenuated by cicletanine (10(-5)M) and insensitive to indomethacine (10(-7)M). When the two compounds were added together, the relaxation induced by cicletanine was significantly improved (P <.005). These results indicated that cicletanine, under stress conditions, relaxes vascular smooth muscle through an endothelium-dependent action mediated by the nitric oxide (NO) synthase pathway. We proposed that the observed vascular effects could be associated with the counter-regulation mechanisms linked to the antihypertensive action of cicletanine.

VIP regulation of a human pancreatic cancer cell line: Capan-1.

VIP and secretin control the secretory function of the normal pancreas. We analysed their regulatory functions in a human pancreatic cancer cell line: Capan-1. Saturation binding experiments with 125I-VIP showed the existence of one class of binding sites of very high affinity: KD 6.4 +/- 3.0 X 10(-11) M and a low Bmax: 12 fmoles/10(6) cells, in both intact cells and membrane preparations. This site has not yet been described in normal or tumorous digestive cells. Competition binding experiments let us characterize two more binding sites, KD: 2.1 +/- 0.7 X 10(-9) M and 5.0 +/- 0.6 X 10(-8) M and the corresponding Bmax: 120 and 500 fmoles/10(6) cells. These sites are similar to those found on cells of the digestive tract. Competition binding experiments gave the following IC50: 3.0 +/- 0.9 X 10(-9) M for VIP; 2 +/- 0.6 X 10(-6) M for PHI; and 1 +/- 0.7 X 10(-5) M for secretin. VIP elicited a cAMP rise, the half maximal response being obtained at 1.2 X 10(-10) M. Secretin induced a cAMP response but only for concentrations higher than 10(-8) M. VIP receptors were found to be modulated by two factors: cell ageing and cell density. Cells chronically treated with VIP showed a slight decrease of their proliferation; insulin exerted an opposite effect. It is concluded that at the difference of normal pancreatic cells, the present cell line lacks secretin-preferring receptors and acquires some of the properties of intestinal cells.

Molecular cloning, developmental expression and pharmacological characterization of the CCKB/gastrin receptor in the calf pancreas.

We have cloned the calf predominant pancreatic cholecystokinin B (CCKB)/gastrin receptor cDNA. It encodes a 454 amino acid protein with 90% identity with the CCKB/gastrin receptor cloned in other species and tissues. However, the calf pancreatic CCKB/gastrin receptor contains a pentapeptide cassette within the third intracellular loop which is absent in the cloned human brain and stomach receptor. Quantification of the CCKB/gastrin receptor mRNA levels by reverse transcription polymerase chain reaction demonstrated the same level of transcripts at birth, +7 and +28 days. On the other hand, binding study with pancreatic membranes showing a dramatic increase (600-fold) in the number of CCKB/gastrin receptor sites between at birth and +28 days indicates that the development of the calf pancreatic CCKB/gastrin receptor occurs during the first 4 weeks of post-natal life. COS monkey cells (COS-7 cells) transiently transfected by the cloned cDNA exhibit binding of 125I-Bolton-Hunter-[Thr28,Ahx31]CCK-(25-33) and 125I-Bolton-Hunter-[Leu15]human gastrin-(2-17) to two affinity classes of sites. Kd values of the high affinity binding components indicate a 4-fold higher affinity of the receptor for sulfated gastrin than for CCK. Finally, the recombinant receptor is coupled to G proteins and [Ca2+]i mobilization, and is expressed as a glycoprotein of 82 kDa.

mRNAs encoding CCKB but not CCKA receptors are expressed in human T lymphocytes and Jurkat lymphoblastoid cells.

We previously reported the existence of pharmacologically related gastrin/CCKB type receptors (CCKB-R) in a variant of Jurkat T lymphoblastoid cells (JK(CD3- CD4+)). We studied here the expression of mRNAs encoding CCKA and CCKB receptors in various human white cells by means of Reverse Transcription-Polymerase Chain Reaction (RT-PCR). Using CCKB-R specific primers, we detected a significant expression of CCKB-R mRNA in JK(CD3- CD4+) cells. These transcripts were also expressed, at a lower level, in two other Jurkat clones (JK(CD3+ CD4-) and JK(CD3+ CD4+)), in peripheral blood lymphocytes (PBL) and in purified CD4+ and CD8+ lymphocytes. Activation of Jurkat cells and PBL by T cells mitogenic lectins (jacalin, phytohemaglutinin) did not modify CCKB-R mRNA expression. In all these cells, using CCKA-R specific primers, we could not amplify any specific cDNA fragment corresponding to this receptor. Neither CCKB-R nor CCKA-R mRNAs could be detected in monocytic cells. Our data show for the first time a constitutive expression of CCKB-R transcripts in lymphoid cells. Moreover, the modulation of immunocyte functions by cholecystokinin-related peptides could occur through CCKB-R rather than CCKA-R and affect lymphocytes rather than monocytes.

Differential tissular expression of the CCK(A) and CCK(B) gastrin receptor genes during postnatal development in the calf.

Local and temporal expression of CCK(A) and CCK(B)/gastrin receptor genes was studied in the calf with a quantitative Reverse Transcription-Polymerase Chain Reaction (RT-PCR) method. Cerebral cortex, antrum, fundus, gall bladder, pancreas and liver were analyzed in calves at 0, 2, 7, 21, 28 and 150 days of age. Cerebral cortex and pancreas expressed both receptor genes with a ratio between CCK(A) and CCK(B)/gastrin receptor transcripts varying according to the age. Gall bladder and fundus showed an exclusive expression of CCK(A) and CCK(B)/gastrin receptor mRNAs, respectively, with the highest levels of transcripts in newborn and 28-day-old calves. The rank order for CCK(A) receptor mRNA expression was gall bladder > pancreas > cerebral cortex >>> antrum and that for CCK(B)/gastrin receptor mRNA expression was cerebral cortex / pancreas / fundus >> antrum. No CCK(A) and CCK(B)/gastrin receptor mRNA was detected in liver, regardless of the age of calves. The present data represent a basis for a better understanding of the ontogeny of physiological functions linked to the CCK(A) and CCK(B)/gastrin receptors.

Usefulness of three-dimensional echocardiography for the evaluation of mitral valve prolapse: an intraoperative study.

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the feasibility of intraoperative three-dimensional (3D) transesophageal echocardiography (TEE) in patients referred for mitral valve prolapse (MVP) repair and to compare two-dimensional (2D) TEE and 3D TEE and surgical findings. METHODS: Forty-six patients (mean age 67 +/- 11 years) underwent 3D TEE intraoperatively. Measurements were made of the posterior part of mitral annulus circumference (PMAC), and the width of mitral valve surgical resection on the mitral annulus (WMVR). Using 3D TEE, MVP topography was described, and PMAC in diastole and the width of implantation of MVP on the mitral annulus (WMVP) in systole were measured. RESULTS: 3D TEE was successful in 42 patients (91%). 2D and 3DTEE correctly predicted MVP localization in 38 (90%) and 36 (86%) patients, respectively (p = NS). 3D TEE and surgical PMAC were 89 +/- 13 and 93 +/- 21 mm, respectively (p = 0.01, R = 0.42). WMVR and WMVP were 28 +/- 11 mm and 26 +/- 11 mm, respectively (p <0.0001, R = 0.82). WMVR/anatomic PMAC (0.29 +/- 0.11) and WMVP/3D echo PMAC (0.32 +/- 0.11) were correlated (p <0.0001, R= 0.69). CONCLUSION: Intraoperative 3D TEE evaluation of MVP is feasible. MVP width and its ratio to the mitral annulus were assessed, and found to correlate with surgical findings. These 3D data may be of value to the surgeon when performing mitral valve repair.

Experience of partial oesophagectomy in surgical treatment of lower and middle thoracic oesophageal cancer. From a follow-up of 366 cases.

Since carcinoma of the oesophagus is considered to be frequently multicentric, total oesophagectomy appears the only radical therapeutical approach. A follow-up of 366 patients who underwent partial oesophagectomy shows that this procedure can be curative as well as palliative and is sometimes the only procedure possible with a reasonable mortality. These patients had an oesophageal carcinoma located between the cardia and the level of the aortic arch (60.5% squamous, 37% adenocarcinoma). Of these, 22% were over 70 years of age. The surgical route was a left thoracotomy in 280 cases (with anastomosis below or above the aortic arch) or a laparotomy and right thoracotomy in 86 cases. The oesophagus was transected as high as possible and replaced by an isoperistaltic tube fashioned from the greater curvature of the stomach. Mediastinal tissues and the lesser curvature with their lymph nodes were removed. The overall operative mortality was 7% (4% in patients less than 70 and 15% over 70). Very few anastomotic fistulae were observed (6 cases) but they were always severe (6 deaths). The middle and long term results show acceptable functional sequelae and a good survival quality. The survival is 57% at 1 year, 30% at 3 years and 23% at 5 years (27% when the excision appeared curative). There was no significant difference in survival for patients whose cancer was in the mid-oesophagus compared to the lower oesophagus. There was no difference in survival in the cell type squamous or adenocarcinoma. Death was mainly due to metastatic lesions and mediastinal lymphatic recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

[Calcified constrictive pericarditis in an adolescent]. / Péricardite constrictive calcifiée chez un adolescent.

The authors report the case of an adolescent with no previous medical history with calcific pericarditis which rapidly progressed to constriction. The disease was diagnosed several months after an episode of chest pain very suggestive of acute viral pericarditis. Surgery was necessary and resulted in a complete cure of the constrictive pericarditis. The aetiologies of constrictive pericarditis are reviewed; previously, tuberculosis used to be the most common cause but it is being progressively supplanted by other pathologies.

[Cardiac compression by a large thymic cyst. Apropos of a case, review of the literature]. / Compression cardiaque par un volumineux kyste thymique en bissac. A propos d'un cas, revue de la littérature.

Thymic cysts are rare and almost always asymptomatic. The authors report the case of a 45 year old woman with a thymic cyst diagnosed after recurrent right sided heart failure resulting in signs suggestive of adiastole, regressing after "pleural" (mainly cystic) aspiration and diuretic therapy without any morphological or functional changes on Doppler echocardiography. This report concerns a rare tumour, with an exceptional volume (2 litres) extending down the cardiac borders and causing cardiac compression. It illustrates the diagnostic difficulty of a pathology with an unusual clinical presentation, despite complementary investigations including CT scan and MRI, very sensitive in this type of problem. A complete cure was obtained by total surgical ablation.

[Mechanism of action of cicletanine on the relationship between endothelium and vascular smooth muscle in the rat thoracic aorta under normoxic and hypoxic conditions]. / Mode d'action du ciclétanine sur la relation endothélium-muscle lisse vasculaire de l'aorte thoracique de rat en conditions normoxiques et hypoxiques.

OBJECTIVE: The vascular mechanism of action of cicletanine, an antihypertensive agent, was studied on isolated Wistar rat aorta in presence and in absence of endothelium both in normoxic and hypoxic conditions. DESIGN AND METHODS: Isolated aorta, from 24 month-old rats, were precontracted with noradrenaline (10(-7) M), in presence and in absence of endothelium and exposed to cumulative cicletanine concentrations in presence and absence of either L-NNA (10(-4) M) or indomethacin (Indo) (10(-7) M). Thereafter, aorta were precontracted by noradrenaline 10(-7) M, and hypoxia was induced by switching gas mixture from 95%O2/5%CO2 to 95%N2/5%CO2 during 10 minutes. Results are expressed as mean +/- sem and statistical analysis were done using one-way analysis of variance. RESULTS: When aorta were precontracted with noradrenaline (10(-7) M), in presence of endothelium, cicletanine (10(-9)-10(-4) M), induced a biphasic concentration-dependent relaxation (EC50 approximately 10(-7) M and 3 x 10(-5) M). In absence of endothelium, the effect of cicletanine was abolished (10(-9) and 10(-5) M). Whereas, at higher concentration (10(-4) M), the magnitude of the relaxation reached 94 +/- 2% and 67 +/- 5% of the initial developed tension in presence and in absence of endothelium respectively. The endothelium-dependent relaxation induced by cicletanine was significantly reduced by Indo (10(-7) M) (p < 0.05) and L-NNA (10(-4) M) (p < 0.005). Addition of 10 mM of BaCl2 significantly reversed the relaxation induced by the higher concentration of cicletanine used (p < 0.005). Under hypoxic conditions, the aorta, in presence of endothelium, displayed an increased developed tension which was significantly attenuated by cicletanine. CONCLUSION: These results indicated that cicletanine relaxes vascular smooth muscle through both, an endothelium-dependent action which was mediated by cyclooxygenase and NOsynthase pathways and an endothelium-independent action that was mediated through K+ channels opening. Under hypoxic conditions, our findings indicate that the effects of cicletanine, appear related to an endothelium protective action associated to NO release.

[Technical modification of transaxillary resection of the first rib in surgery of thoraco-brachial outlet syndromes]. / Modification technique de la résection de la première côte par voie transaxillaire dans la chirurgie des syndromes de la traversée thoraco-brachiale.

From April 1985 to September 1991, 88 patients were operated for a total of 100 thoracobrachial outlet syndromes. The patients were placed in the dorsal supine position, turned 30 degrees towards the contralateral side. The arm was suspended in slight abduction. The access obtained is identical to that obtained with the classical operation. No direct traction or compression is exerted on the pedicles during retraction and the operation requires a single assistant. The composition, indications and results of our series are similar to those reported in the recent literature. We did not observed any immediate or late neurological complications. We conclude that thoracobrachial outlet syndromes can be treated via an axillary approach using mechanical traction and a single assistant without increasing the risk of neurological complications.