Feasibility of sacrocolpopexy by outpatient laparoscopic surgery.

INTRODUCTION: Sacrocolpopexy (SP) is a common intervention that is most often performed by laparoscopy. This intervention usually involves standard hospitalization. Evaluation of whether this procedure can be safely carried out by outpatient hospitalization (OH) is of considerable relevance. The aim of our study was hence to evaluate the feasibility of SP by OH. PATIENTS AND METHODS: This was an observational multicenter study that included women who underwent SP by OH. The main assessment criteria were the success rate of OH and the rate of rehospitalisation in the month following the intervention. The secondary assessment criteria were the rate of complications in the month following the surgery, the level of patient satisfaction evaluated by a set of straightforward questions and two validated questionnaires (the Patient Global Impression of Improvement [PGI-I] and the Core questionnaire for the assessment of Patient Satisfaction with general Day care [COPS-D]). RESULTS: There were 55 women operated on by OH. The success rate for the OH was 49/55 (89.1% (80.7-97.3%)). Of the 31/55 women (56.4%) who answered the PGI-I questionnaire, 27/31 (87.1%) stated that the intervention improved their condition. Of the 30/55 women who answered the COPS-D questionnaire, 26/30 (86.7%) women were "satisfied" or "very satisfied" with the conditions for their discharge from the OH. CONCLUSION: The success rate for SP by OH was high in this study, with a very substantial level of patient satisfaction. These findings nonetheless ought to be confirmed with series involving higher numbers of women.

Laparoscopic hysterectomy after concurrent radiochemotherapy in locally advanced cervical cancer compared to laparotomy: A multi institutional prospective pilot study of cost, surgical outcome and quality of life.

OBJECTIVE: Laparoscopy allows hysterectomies after chemoradiation to be performed without opening the abdominal wall. We measured the costs and quality of life for locally advanced cervical cancer patients operated on via laparoscopy compared to laparotomy. STUDY DESIGN: We conducted an observational prospective multicenter study on locally advanced cervical cancer patients undergoing an extrafascial hysterectomy after concurrent chemoradiotherapy (CRT). We assessed the costs from the medical visit before surgery up to the first month after surgery from the providers' perspective and measured the quality of life using the EORTC QLQ-C30 and QLQ-CX24 up to six months. RESULTS: Sixty two patients (39 laparoscopy and 23 laparotomy) from December 2008 to November 2011 were included. There was no difference in operative time, or intraoperative and post-operative complication rates between the two groups. Intraoperative transfusion and abdominal drain were significantly lower in the laparoscopy group (respectively, p = 0.04 and p < 0.01), as well as the duration of hospital stay (7.3 d vs. 5.7 d, p < 0.001). All patients who underwent laparoscopic hysterectomy were discharged to home, whereas 4 laparotomy patients used convalescence homes (p = 0.01). Mean costs at one month were €10,991 for laparotomy and €11,267 for laparoscopy (p = 0.76). Sexual activity is better for the laparoscopy group at six months (p = 0.01). CONCLUSION: Laparoscopy for an extrafascial hysterectomy after CRT in locally advanced cervical cancer patients brought better quality of life with similar costs compared to laparotomy, and should therefore be the first choice for surgeons.

New evidence of heterogeneity in social anxiety disorder: defining two qualitatively different personality profiles taking into account clinical, environmental and genetic factors.

PURPOSE: To study qualitatively different subgroups of social anxiety disorder (SAD) based on harm avoidance (HA) and novelty seeking (NS) dimensions. METHOD: One hundred and forty-two university students with SAD (SCID-DSM-IV) were included in the study. The temperament dimensions HA and NS from the Cloninger's Temperament and Character Inventory were subjected to cluster analysis to identify meaningful subgroups. The identified subgroups were compared for sociodemographics, SAD severity, substance use, history of suicide and self-harm attempts, early life events, and two serotonin transporter gene polymorphisms (5-HTTLPR and STin2.VNTR). RESULTS: Two subgroups of SAD were identified by cluster analysis: a larger (61% of the sample) inhibited subgroup of subjects with "high-HA/low-NS", and a smaller (39%) atypical impulsive subgroup with high-moderate HA and NS. The two groups did not differ in social anxiety severity, but did differ in history of lifetime impulsive-related-problems. History of suicide attempts and self-harm were as twice as frequent in the impulsive subgroup. Significant differences were observed in the pattern of substance misuse. Whereas subjects in the inhibited subgroup showed a greater use of alcohol (P=0.002), subjects in the impulsive subgroup showed a greater use of substances with a high-sensation-seeking profile (P<0.001). The STin2.VNTR genotype frequency showed an inverse distribution between subgroups (P=0.005). CONCLUSIONS: Our study provides further evidence for the presence of qualitatively different SAD subgroups and the propensity of a subset of people with SAD to exhibit impulsive, high-risk behaviors.

Common and distinct neural correlates of facial emotion processing in social anxiety disorder and Williams syndrome: A systematic review and voxel-based meta-analysis of functional resonance imaging studies.

BACKGROUND: Social Anxiety Disorder (SAD) and Williams-Beuren Syndrome (WS) are two conditions which seem to be at opposite ends in the continuum of social fear but show compromised abilities in some overlapping areas, including some social interactions, gaze contact and processing of facial emotional cues. The increase in the number of neuroimaging studies has greatly expanded our knowledge of the neural bases of facial emotion processing in both conditions. However, to date, SAD and WS have not been compared. METHODS: We conducted a systematic review of functional magnetic resonance imaging (fMRI) studies comparing SAD and WS cases to healthy control participants (HC) using facial emotion processing paradigms. Two researchers conducted comprehensive PubMed/Medline searches to identify all fMRI studies of facial emotion processing in SAD and WS. The following search key-words were used: "emotion processing"; "facial emotion"; "social anxiety"; "social phobia"; "Williams syndrome"; "neuroimaging"; "functional magnetic resonance"; "fMRI" and their combinations, as well as terms specifying individual facial emotions. We extracted spatial coordinates from each study and conducted two separate voxel-wise activation likelihood estimation meta-analyses, one for SAD and one for WS. RESULTS: Twenty-two studies met the inclusion criteria: 17 studies of SAD and five of WS. We found evidence for both common and distinct patterns of neural activation. Limbic engagement was common to SAD and WS during facial emotion processing, although we observed opposite patterns of activation for each disorder. Compared to HC, SAD cases showed hyperactivation of the amygdala, the parahippocampal gyrus and the globus pallidus. Compared to controls, participants with WS showed hypoactivation of these regions. Differential activation in a number of regions specific to either condition was also identified: SAD cases exhibited greater activation of the insula, putamen, the superior temporal gyrus, medial frontal regions and the cuneus, while WS subjects showed decreased activation in the inferior region of the parietal lobule. CONCLUSIONS: The identification of limbic structures as a shared correlate and the patterns of activation observed for each condition may reflect the aberrant patterns of facial emotion processing that the two conditions share, and may contribute to explaining part of the underlying neural substrate of exaggerated/diminished fear responses to social cues that characterize SAD and WS respectively. We believe that insights from WS and the inclusion of this syndrome as a control group in future experimental studies may improve our understanding of the neural correlates of social fear in general, and of SAD in particular.

Investigation of the possible association between nosocomial candiduria and candidaemia.

This study aimed to determine whether candiduria is associated with the occurrence of nosocomial candidaemia. In the case-control part of the study, 115 cases (nosocomial candidaemia) and 115 controls (nosocomial bacteraemia) were similar in age, severity of condition and time of hospitalisation. There was a significant association of candidaemia with candiduria (OR 9.79; 95% CI 2.14-44.76). In the microbiology part of the study, 23 pairs of Candida-positive urine and blood cultures were obtained from 23 patients. In ten (43%) cases, the urine and blood culture isolates belonged to different species, and molecular typing showed a difference in two of the 13 cases yielding the same species from both specimens. Overall, there was a significant association between candiduria and candidaemia, but the Candida isolates from urine and blood were different for 52% of the patients. Thus, the data indicated that the urinary tract was probably not a source for the candidaemia.

Management of choledocholithiasis during pregnancy by magnetic resonance cholangiography and laparoscopic common bile duct stone extraction.

Management of common bile duct (CBD) stones during pregnancy is a difficult problem. The authors reported the case of a patient who was 22 weeks' pregnant who had a symptomatic CBD stone successfully treated by the association of magnetic resonance cholangiography and laparoscopic CBD stone removal. The patient delivered a healthy baby boy at 39 weeks. Magnetic resonance cholangiography and laparoscopic CBD exploration is a viable option in the management of CBD stones in pregnant patients that carries a low risk for the fetus while preserving the advantages of minimally invasive surgery for the mother.

[Body changes during pregnancy]. / Modifications de l'organisme maternel au cours de la grossesse.

Pregnancy induces numerous changes in the physiology of the woman. Those changes are necessary for the embryo and fetus to have a normal growth, and for the woman to adapt to that physiologic event. A 50% raised cardiac flow is the consequence of increased systolic flow and cardiac frequency. Blood volume is about 40% larger than in non-pregnant woman. It is the consequence of enlargement of the plasmatic volume (50%), and the red cells mass (30%). Those different changes explain the physiologic anemia of pregnancy. The main part of the blood volume increase corresponds to an enlargement of the venous system, but without any change of the central venous pressure. Arterial pressure remains unchanged throughout the pregnancy, or sometimes gently decreases (10%). Those changes are more important during an effort, particularly during the labor. Increase of cerebral blood flow (as a consequence of a raised cardiac flow) is limited by the cerebral autoregulation. As a consequence, there is no evidence for dramatic cerebral hemodynamic changes during pregnancy. Nevertheless, autoregulation is less effective for arterial pressure over than 150 mmHg, what can induce an hemorrhagic stroke. Blood levels of steroïd (progesterone, oestrogens) and peptidic (HCG, HPL) hormones are increased. Oestrogens are said to make capillary fragile, and progesterone is responsible for the enlargement of the venous system. In order to prevent an hemorrhagic accident, pregnancy induces a lack of fibrinolysis, and an excess in coagulation. The consequence is the ability of the pregnant and post-partum woman to develop venous thrombosis.

Results of duodenopancreatectomy for solitary pancreatic metastasis from renal cell carcinoma.

The pancreas is an uncommon site of metastasis from renal cell carcinoma. We present five patients with solitary pancreatic metastasis from renal cell carcinoma located in the head of the pancreas, treated by duodenopancreatectomy. There were no perioperative deaths. Mean survival was 48 months; three patients were alive at the end of the study (at 27, 46, and 88 months, respectively) and two patients died, at 13 and 70 months. The 3- and 5-year survival rates of our patients together with 22 previously reported patients were 86% and 68%, respectively. We advocate aggressive surgical treatment when the metastatic disease is limited to the pancreas.

[Is ultrasound screening for ovarian cancer possible in 1998?]. / Le dépistage échographique du cancer de l'ovaire est-il possible en 1998?

Ovarian cancer is the most common cause of gynecologic cancer death, as most patients present with advanced disease, in which the prognosis is poor. Five year-survival is only 35% for all stages, while it exceeds 90% in stage I. Consequently, there has been heightened interest in the development of screening modalities that can detect ovarian cancer at an early stage to reduce the mortality of this disease. Unfortunately, transvaginal sonography and color Doppler imaging still have a high false positive rate and low specificity increasing the number of surgical procedures, even among women with a strong family history of ovarian cancer. Psychological impact and economical cost has also to be discussed when considering such programs.

Metastatic gastric cancer arising from breast carcinoma: endoscopic ultrasonographic aspects.

Linitis plastica of the stomach was diagnosed in four patients. Endoscopic ultrasonography (EUS) was performed in four cases; they were monitored by EUS and had their treatment adapted accordingly. According to the present study, the typical criteria of gastric linitis at EUS are: (a) rigidity of the gastric wall; (b) a wall thickness exceeding 6 mm; (c) a second enlarged layer marginally more echogenic than the fourth hypoechogenic layer (muscularis propria); (d) a third hyperechogenic enlarged layer; and (e) a poor demarcation between layers. Gastric linitis appears more likely to be specific metastasis from lobular breast carcinoma. In most of the follow-up cases, EUS showed correlation with a subsequent decrease of the CA15.3 level. At present, EUS seems to be the most effective and least invasive examination for clinical diagnosis and treatment surveillance of secondary gastric linitis arising from infiltrating lobular carcinoma (ILC) of the breast.

Inhibin assays of ovarian cyst liquid obtained by needle aspiration may allow differential diagnosis between functional and organic cysts.

Radioimmunoassays of estradiol, CA125 and inhibin were carried out on ovarian cyst fluid samples. The samples were taken from ten women with functional cysts and 15 women with organic cysts. Statistical analysis shows that estradiol and inhibin assays allows satisfactory differential diagnosis between functional and organic cysts. However, the inhibin assay provides more precise results and appears to be a more reliable marker than estradiol. The differential diagnosis between the two types of cyst would indicate the use of coelioscopic surgery especially in the case of organic cysts, avoiding unnecessary risks for patients with functional cysts.

[Granulomatous mastitis and corynebacteria infection. Two case reports]. / Mastites granulomateuses et corynébactéries. A propos de deux observations.

Diagnosis of granulomatous mastitis must be based on a multidisciplinary approach. First, it's necessary to eliminate carcinomatous mastitis. Usually, the diagnosis is unknown except for tuberculous and sarcoidosis granulomatous mastitis. On observations in two cases of Corynebacterium granulomatous mastitis, we discussed the diagnosis and therapeutic approach. When there is a clinical suspicion of granulomatous mastitis, surgical biopsy with immediate histological analysis and bacteriological culture of mammary tissue should be performed. This multidisiplinary approach should reduce the number of idiopathic granulomatous mastitis observed. Antibiotic treatment is required after biopsy or surgical excision of granuloma.

[Stenosis of the rectum secondary to an invasive adenocarcinoma of the prostate. Apropos of 3 cases]. / Sténose du rectum secondaire à un envahissement d'un adénocarcinome de prostate: a propos de trois observations.

There exist rare cases in which a prostatic carcinoma invades the perirectal space producing an extrinsic rectal stenosis. Three cases are discussed. Differential diagnosis with a rectal tumor is difficult clinically, but endorectal ultrasound and deep rectal biopsies must provide the correct diagnosis in most cases. Hormonotherapy is recommended, but prognosis is reserved.

[On the use of an anabolic hormone in the acute myocardial infarction. Experimental trial on 486 patients (author's transl)]. / Sull'impeigo di un anabolizzante nella fase acuta dell'infarto miocardico. Sperimentazione clinica controllata su 486 pazienti

An anabolic hormone, methandrostenolone, was shown to be able to decrease significantly the cicatrization-time on animals with induced sperimental acute myocardial infarction (AMI). A controlled clinical trial was performed on group of 246 patients affected by AMI, giving them methandrostenolone at dose of 25 mg im.m. per day, for the first ten days from the beginning of symptoms. An omogeneous group of 240 patients with AMI was used as control. The mortality rate resulted 13,4% in the treated group 18,7% in the control's. 10 patients in the treated group (4,2%) died of cardiac failure versus 17 (7,1%) in the control group, 9 (3,7%) of cardiac rupture in the former versus 6 (2,4%) in the latter. As far as these differences are concerned statistical significance was not reached. A larger number of patients would be requested.