Aggressive angiomyxoma of the perineal region.

Aggressive angiomyxoma is a rare tumour that frequently involves the perineal region with a high risk of local recurrence. This is a case report of a 24-year-old female patient with a genital prolapse. We performed a surgical treatment. Histological examination found an aggressive angiomyxoma. The tumour recurred 1 year after surgery. Long-term follow-up is necessary.

Operative and diagnostic hysteroscopy: A novel learning model combining new animal models and virtual reality simulation.

CONTEXT: Hysteroscopy is one of the most common gynaecological procedure. Training for diagnostic and operative hysteroscopy can be achieved through numerous previously described models like animal models or virtual reality simulation. We present our novel combined model associating virtual reality and bovine uteruses and bladders. STUDY DESIGN: End year residents in obstetrics and gynaecology attended a full day workshop. The workshop was divided in theoretical courses from senior surgeons and hands-on training in operative hysteroscopy and virtual reality Essure® procedures using the EssureSim™ and Pelvicsim™ simulators with multiple scenarios. Theoretical and operative knowledge was evaluated before and after the workshop and General Points Averages (GPAs) were calculated and compared using a Student's T test. RESULTS: GPAs were significantly higher after the workshop was completed. The biggest difference was observed in operative knowledge (0,28 GPA before workshop versus 0,55 after workshop, p<0,05). All of the 25 residents having completed the workshop applauded the realism an efficiency of this type of training. The force feedback allowed by the cattle uteruses gives the residents the possibility to manage thickness of resection as in real time surgery. Furthermore, the two-horned bovine uteruses allowed to reproduce septa resection in conditions close to human surgery CONCLUSION: Teaching operative and diagnostic hysteroscopy is essential. Managing this training through a full day workshop using a combined animal model and virtual reality simulation is an efficient model not described before.

Posterior urethral valves: are neonatal imaging findings predictive of renal function during early childhood?

BACKGROUND: Obstructive renal dysplasia as observed on US is associated with posterior urethral valves and is regarded as predicting poor renal functional outcome. OBJECTIVE: To investigate whether any characteristic of urinary tract imaging at birth is predictive of renal function in children with prenatally diagnosed posterior urethral valves. MATERIALS AND METHODS: We reviewed clinical data including renal function (at birth and up to 3 years of age) and clinical outcome (urinary infection, dialysis, renal transplantation). Imaging data included US (dilatation of the urinary tract, renal cortical echogenicity, signs of cystic dysplasia, urinoma) and cystourethrography findings (vesicoureteral reflux, bladder anomalies, presence of valves) from imaging performed directly after birth. RESULTS: We retrospectively studied 30 children. Three of the 30 (10%) were in renal failure by the age of 3 years. Twelve of 14 (85%) children with parenchymal anomalies (cortical hyperechogenicity or cystic changes) and 8/9 (89%) children with bilateral high-grade reflux had normal renal function at age 3 years. One child without cystic dysplasia or reflux had abnormal renal function from birth. None of the six children with urinoma developed renal failure by the age of 3 years. CONCLUSION: Presence of cortical hyperechogenicity, cystic changes or bilateral reflux cannot be considered prognostic of renal failure by the age of 3 years.

Chemotherapy drug extravasation in totally implantable venous access port systems: how effective is early surgical lavage?

PURPOSE: Totally implantable venous access port systems (TIVAPS) are a widely used and an essential tool in the efficient delivery of chemotherapy. Chemotherapy drug extravasation (CDE) can have dire consequences and will delay treatment. The purpose of this study is to both clarify the management of CDE and show the effectiveness of early surgical lavage (ESL). METHODS: Patients who had presented to the Cancer Center of Lille (France) with TIVAPS inserted between January 2004 and April 2013 and CDE had their medical records reviewed retrospectively. RESULTS: Thirty patients and 33 events were analyzed. Implicated agents were vesicants (51.5%), irritants (45.5%) and non-vesicants (3%). Huber needle malpositionning was involved in 27 cases. Surgery was performed in 97% of cases, 87.5% of which were for ESL with 53.1% of the latter requiring TIVAPS extraction. Six patients required a second intervention due to adverse outcomes (severe cases). Vesicants were found to be implicated in four out of six severe cases and oxaliplatin in two others. Extravasated volume was above 50 ml in 80% of cases. Only one patient required a skin graft. CONCLUSIONS: CDEs should be managed in specialized centers. ESL allows for limited tissue contact of the chemotherapy drug whilst using a simple, widely accessible technique. The two main factors that correlate with adverse outcome seem to be the nature of the implicated agent (vesicants) and the extravasated volume (above 50 ml) leading to worse outcomes. Oxaliplatin should be considered as a vesicant.

[FRα: a target for prophylactic photodynamic therapy of ovarian peritoneal metastasis?]. / FRα : une cible pour la thérapie photodynamique prophylactique des métastases péritonéales ovariennes ?

Partly due to delays in its diagnosis, ovarian cancer's prognosis remains dire after primary therapy. Treatment consists in complete cytoreductive surgery and platinum-based chemotherapy. Recurrence rates are disappointingly high, as 60% of women with advanced epithelial ovarian cancer considered in remission will develop recurrent disease within five years. Special attention to undetected peritoneal metastasis and residual tumorous cells during surgery is necessary as they are the main predictors of recurrences. Targeted therapies aim to bring chemotherapy, radiotherapy and selective tumor photosensitizer (PS) agents to the targeted cell and its tumoral microenvironment. Folate receptor α (FRα) shows promising prospects in targeting ovarian cancerous cells. Indeed, with good specificity and frequent overexpression in ovarian cancer, FRα is a recurrent topic in recent publications. The aim of this review is to present FRα and the reasons that make it an ideal targeting ligand for ovarian carcinoma therapy. Prophylactic photodynamic therapy (PPDT) using new generation FRα-coupled agents combined with complete cytoreductive surgery could allow for a significant decrease in recurrence rates. Preclinical trials are being run in order to allow for human clinical applications.