A new silver based composite material for SPA water disinfection.

A new composite material based on alumina (Al2O3) modified by two surface nanocoatings - titanium dioxide (TiO2) and silver (Ag) - was studied for spa water disinfection. Regarding the most common microorganisms in bathing waters, two non-pathogenic bacteria Escherichia coli (Gram-negative) and Staphylococcus epidermidis (Gram positive) were selected as surrogates for bacterial contamination. The bactericidal properties of the Al2O3-TiO2-Ag material were demonstrated under various operating conditions encountered in spa water (temperature: 22-37 °C, presence of salt: CaCO3 or CaCl2, high oxygen content, etc.). Total removal of 10(8) CFU mL(-1) of bacteria was obtained in less than 10 min with 16 g L(-1) of material. Best results were observed for both conditions: a temperature of 37 °C and under aerobic condition; this latest favouring Reactive Oxygen Species (ROS) generation. The CaCO3 salt had no impact on the bactericidal activity of the composite material and CaCl2 considerably stabilized the silver desorption from the material surface thanks to the formation of AgCl precipitate. Preliminary tests of the Al2O3-TiO2-Ag bactericidal behaviour in a continuous water flow confirmed that 2 g L(-1) of material eliminated more than 90% of a 2.0 × 10(8) CFU mL(-1) bacterial mixture after one water treatment recycle and reached the disinfection standard recommended by EPA (coliform removal = 6 log) within 22 h.

[Contraception's choice: women's opinion, satisfaction and profile. Results of a French national survey of a representative sample of 5963 women]. / Contraception des femmes françaises de 15 à 45ans: enquête nationale sur un échantillon représentatif de 5963 femmes.

OBJECTIVES: To describe French women's use of contraceptive methods and study their satisfaction and expectations about contraception. PATIENTS AND METHODS: A survey carried out by mail questionnaire filled in by a representative sample group of French women aged 15 to 45 years (Panel Postal Metascope TNS Sofres) in June 2007. RESULTS: Of 10,000 questionnaires sent out, 6044 questionnaires were returned, of which 5963 were usable. Seventy-three percent of women surveyed used some method of contraception, of which 46% was an oral contraceptive, 15% an IUD and 7% used condoms. A minority used new contraceptive methods (implant, patch, vaginal ring). The average age at first sexual relationship was 17.8 years. It was 18.5 among 40-45-year-olds and gradually reduced to 16.7 in the under 25-year-olds. Twenty-three percent of pregnancies remain unwanted and unplanned. For 96% of patients, the choice of contraception was considered to be important. Thirty-six percent thought that contraception could be harmful to health. Only 63% of women believed themselves to be well informed the first time they used contraception. Satisfaction for contraception method was evaluated from 7.3/10 (condom) to 9.7/10 (sterilization). DISCUSSION AND CONCLUSION: Twenty-seven percent of women do not use any contraception and 23% of pregnancies are unwanted despite a large offering of contraceptives. Our study enables the drawing of 'patient-profiles' for the main methods of contraception in order to better determine women's expectations and to pass the findings on to health professionals.

Can rectal endoscopic sonography be used to predict infiltration depth in patients with deep infiltrating endometriosis of the rectum?

OBJECTIVES: To evaluate the diagnostic accuracy of rectal endoscopic sonography (RES) in the prediction of the infiltration depth of rectal endometriosis and to ascertain whether RES could be used to choose between segmental bowel resection and a more conservative approach, such as shaving or discoid resection. METHODS: In this retrospective study, 38 consecutive patients with symptomatic deep infiltrating endometriosis of the rectum who underwent laparoscopic colorectal resection were included. RES results for infiltration depth of rectal endometriosis were compared with results of pathological examination. The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), positive and negative likelihood ratios (LRs) and test accuracy were calculated for the presence of infiltration of the muscularis layers and submucosal/mucosal layers, as demonstrated by RES and confirmed by histopathological analysis. RESULTS: For the detection of muscularis layer infiltration by endometriosis, the PPV of RES was 100%, whereas for the detection of submucosal/mucosal layer involvement, the sensitivity was 89%, specificity was 26%, PPV was 55%, NPV was 71%, test accuracy was 58% and positive and negative LRs were 1.21 and 0.40, respectively. CONCLUSIONS: RES is a valuable tool for detecting rectal endometriosis as endometriotic infiltration of the muscularis layer can be predicted accurately. However, RES is less accurate in detecting submucosal/mucosal layer involvement and cannot, therefore, be used to choose between bowel resection and a more conservative approach.

[Diagnosis and treatment of pelvic splenosis during exploration of infertility]. / Diagnostic et traitement de splénose pelvienne au cours d'un bilan d'infertilité.

Splenosis is the heterotopic autotransplantation of splenic tissue that usually follows traumatic splenectomy. Rare pelvic localizations are reported. We report here a case of a 36-year-old woman, followed for secondary infertility. On transvaginal ultrasound pelvic scanning hypervascular paracervical nodules were demonstrated. Pelvic splenosis was suspected regarding the patient's medical past (post-traumatic splenectomy). Surgical exploration and resection were decided considering the nodule localization, the risk during ovarian punction for IVF, and the hypothetical risk of bleeding at delivery. Generally, it is recommended to leave in place the splenic tissue, which may be immunologically functional.

The influence of weather and geographical conditions on flight dynamics of WCR adults.

Since the appearance of western corn rootworm (Diabrotica virgifera virgifera Le Conte) (Coleoptera: Chrysometidae) in Romania, many researchers have been made, in more or less success. In this study we try to clarify the ecology of the species in order to predict its evolution and its potential area of distribution. In Romania, this species was signalled for the first time in 1996, in western part of country neighbouring with Hungary. This region is an important area for maize production for seed and silage. Together, the climatic conditions, altitude and their influence on species behaviour and distribution have become more apparent. Their habitat and survival strategies are strongly dependent on local weather patents and altitude. In order to investigate the potential impact of weather and altitude on pest populations, a clear understanding of the nature and characterization of pest is required. In general, most pest species are influenced by warm, rainfall and altitude. Taking into consideration our data from the years 2008 and 2009, we can emphasize a very serious influence of air temperature, rainfall and altitude on WCR flight dynamics in adults. Dry and warm conditions generally lead to increasing of insects' number. Our data shown positive correlations between air temperature (daily mean) and adults number captured on pheromone traps (daily mean), but the there are limits from which these become negative. The same trend was recorded in previous research period (2004-2006). The rainfall is an important factor that influences adults' dynamics in maize fields. Excessive rainfall leads to adults' number decreasing. Our daily observations showed a decreasing number of beetles while rainfall increases. Regarding the altitude, we observed a decreasing number of WCR adults at once the attitude increase. For capture of adults we used pheromone traps, in 3 replications (T1, T2 and T3) at difference altitude where maize was grown. Significant relationship of WCR flight dynamic with weather and geographical conditions were found. Activities were carried out under the PN-II-ID-PCE-2007-1/RO project.

[Bladder endometriosis: diagnosis and treatment. A series of 24 patients]. / Endométriose vésicale : diagnostic et traitement. A propos d'une série de 24 patientes.

OBJECTIVE: This study aims to show the treatment outcome in women affected by bladder endometriosis. PATIENTS AND METHODS: Retrospective review of records of 24 women with deep vesical endometriosis treated between 1998 and 2007. RESULTS: All cases had cyclic symptoms even though they were not specific. A percentage of 66% of women had concomitantly deep nodules of the rectovaginal septum and/or uterosacral ligaments. Five patients (20.8%) had previously undergone a transurethral resection (TUR) of the bladder lesion, but this therapy has failed in all cases. Partial cystectomy was carried out in 14 patients (60.8%) and an extramucosal dissection of the endometriotic lesion in nine patients (39.2%). Laparoscopy was used in 19 cases (82.6%). Recurrence of bladder endometriotic lesions was documented in two patients. This was mainly due to an incomplete initial treatment. Success rate, defined by total improvement of symptoms after the initial treatment, was estimated at 86.7% in this series. The only complication encountered was a pelvic hematoma with bladder compression that required a ureteral cannulation (JJ). Seven patients out of 11 became pregnant; four of them were infertile before the surgical treatment. DISCUSSION AND CONCLUSION: Diagnosis of bladder endometriosis is often difficult to make because of its non-specific symptoms. The management is mainly surgical and resection should be complete. TUR is not an optimal treatment for bladder endometriosis.

[Urinary functional and urodynamic preoperative evaluation of patients with deep pelvic surgical endometriosis: about 12 cases]. / Evaluation fonctionnelle urinaire et urodynamique préopératoire des patientes présentant une endométriose profonde pelvienne chirurgicale: à propos de 12 cas.

OBJECTIVES: Laparoscopic surgery of deep endometriosis, including uterosacral ligament and rectal localisation, generally induces postoperative urinary disorders, caused by sacral plexus nerve lesions. However, during presurgical consultation, patients with these symptoms frequently present some urinary disorders. Our objective was to prospectively evaluate the reality of pre-existant urinary disorders by performing urodynamic tests. PATIENTS AND METHODS: This study is a prospective, descriptive and non-comparative study about 12 consecutive patients consulting for a surgical assumption of deep endometriosis, including clinical and radiological lesions on the uterosacral ligaments, on the uterine torus and/or on the rectum. RESULTS: A total of 12 patients whose ages ranged from 24 to 42 (mean age 34.6 +/-5.3 years). The mean parity was 0.5+/- 0.8 children (0-2). A clinical examination and multiple preoperative imaging techniques (abdominopelvic ultrasonography [US] and Magnetic Resonance Imaging [MRI]) were used to diagnose a deep endometriosis. During consultation, four patients presented no urinary dysfunction (33%). The eight other patients presented at least one of the following symptoms: increased daytime frequency, urinary incontinence, straining, increased night time frequency, urgency, mictional burns, bladder cramps, reduction in the bladder sensation. Any urinary infection was systematically eliminated. Multiple imaging techniques allowed to diagnose: an adnexal lesion in three cases (25%), adenomyosis in three cases (25%). Endometriosis was detected on the rectum in eight cases (66.7%), on the uterine torus in nine cases (75%) and on the uterosacral ligaments in 10 cases (83.3%). No vesical localisation was found. The urodynamic tests performed before surgery were totally normal in only two cases (16.7%). Three patients had a true postmictional residue (25%), but only one was pathological (more than 100 mL). The mean urethral fence pressure was 87.8 +/- 33.5 cm H20 (38-150). Four patients had a urethral hypertonia (30%), three patients a urethral instability (25%), three patients a dysuria (25%), two patients a hypersensitive bladder (16.7%), two patients had an insufficiency of the urethral sphincter (16.7%), one patient a big hypoesthetic bladder (8.3%) and one patient a small bladder capacity. DISCUSSION AND CONCLUSION: Patients with deep endometriosis on the uterosacral ligaments and/or on the former face of the rectum frequently have urinary disorders. Consulting such patients is fundamental since it allows to diagnose them but it is not sufficient. Performing urodynamic tests can precisely determine and quantify real disorders. These disorders are neurological, probably related to lesions of the inferior hypogastric plexus and not to a lesion of the bladder. In this prospective study, there is no correlation between the preoperative disorders and the localisation of the lesions. A further study on a greater number of patients is necessary to define possible improvements and complications related to the surgery.

[Rupture of non-communicating rudimentary pregnant uterine horn in a pseudo-unicornuate uterus at 23 weeks of amenorrhea. Case report]. / Rupture d'une corne utérine rudimentaire non communicante gravide sur un utérus pseudo-unicorne à 23 semaines d'aménorrhée. A propos d'un cas.

Pregnancy in the rudimentary horn of a unicornuate uterus is an extremely rare form of ectopic gestation associated with a high risk of uterine rupture. We report the case of a pregnancy developed in a non communicating rudimentary horn of a unicornuate uterus complicated by horn rupture at 23 weeks of amenorrhea showing as an acute abdominal pain and massive hemoperitoneum. This patient's uterine abnormality was known before, as this woman has delivered two years before at term a healthy boy by cesarean section. This past pregnancy was located in the normal horn and the non communicating rudimentary horn seemed at this time normal. This uterine malformation is presented with its gynecological and obstetrical entailments as well as methods that could prevent such outcome.

[Reproductive outcome after laparoscopic treatment of endometriosis in an infertile population]. / Fertilité après chirurgie coelioscopique de l'endométriose pelvienne chez des patientes en échec de grossesse.

OBJECTIVES: To evaluate fertility outcome after laparoscopic management of endometriosis in an infertile population. MATERIALS AND METHODS: A retrospective analysis of 64 patients presenting more than one year infertility and a pregnancy-wish associated with minimal to severe endometriotic lesions (stage I to IV according to the revised American Fertility Society (rAFS) classification), treated using laparoscopic surgery in order to remove the entire lesions. We excluded women under 20 years and over 40, as well as those with other infertility factors (tubal non endometriosis-related, hormonal or sperm). Fertility of the remaining 34 patients was studied in relation to endometriosis stage and to pregnancy's mode (spontaneous or induced). RESULTS: Pregnant women percentage was 65% (22 patients) within a 8.5 months (quartiles: 3; 15.5) [range: 1; 52] post-surgical time, and 86.5% pregnancies issued with a delivery. The rate of pregnant women depended on stage of endometriosis (89% for stages I-II, and 56% for stages III-IV). Sixty percent pregnancies were spontaneous within a 5 months (3; 9) [1; 52] post-surgical time to pregnancy average. When pregnancies were obtained with assisted reproductive techniques, the median post-surgical time to pregnancy was 12 months (9; 22) [2; 31]. Among women with stages I-II endometriosis, the median post-surgical time to pregnancy was 2 months when spontaneous and 20.5 months when induced (P=0.007). In case of stages III-IV endometriosis, pregnancy's delay was 8 and 12 months respectively (P=0.79). Among the 21% women who had had an induced pregnancy failure before surgery, 71% became pregnant and 80% spontaneously. Eighteen patients (53%) had an ovarian endometrioma and 50% of them became pregnant. Among the 4 patients who had colorectal endometriosis requiring colorectal resection, 1 pregnancy was obtained. CONCLUSIONS: These findings suggest that in a context of more than one year infertility only related to endometriosis, it is reasonable to offer these patients a complete operative laparoscopic treatment of their lesions, which enables 65% of them to be pregnant within a 8.5 months post-surgical median time to pregnancy and spontaneously in 60%. In case of stages I-II endometriosis we suggest a spontaneous pregnancy try during 8 to 12 months before starting induced pregnancy therapeutics instead of stages III-IV endometriosis where induced methods should be used after only 6 or 8 months.

[Ovarian and peritoneal sarcoidosis mimicking an ovarian cancer]. / Sarcoïdose péritonéale et ovarienne simulant un cancer de l'ovaire.

Ovarian and peritoneal sarcoidosis is a very rare condition, with an atypical clinical presentation close to that of ovarian cancer. An erroneous diagnosis could induce a definitive castration. A 38-year-old woman was admitted because of ascites and weight loss. A computerized tomography scan revealed multiple soft tissue nodules in the pelvis, on the ovaries as well as peritoneal deposits. Histological examination after laparoscopic biopsy was indicative of sarcoidosis. Corticosteroids were given to the patient and the symptoms quickly subsided. This case with its clinical presentation is discussed in comparison with previously reported cases.

[Laparoscopic surgery of deep endometriosis. About 118 cases]. / Traitement coelioscopique de l'endométriose profonde. A propos de 118 cas.

OBJECTIVE: To evaluate risks and benefits of laparoscopic surgery of deep endometriosis, especially with bowel involvement with the aim of improve the inform consent of patients and choice of adequate management. PATIENTS AND METHODS: Observational continuous study on 118 patients suffering from deep endometriosis (48 with bowel endometriosis) treated by laparoscopic surgery. RESULTS: 95.6% of the patients improved their symptoms (93.7% for dyspareunia). Upon the 29 infertile patients, 21 (72%) got pregnant, including 14 (66%) spontaneously. During operative time, 3 laparotomies occurred, two of them for haemorrhage. During postoperative time, 4 major complications (2 rectal fistulas and 2 ureteral necrosis) and minor complications occurred. DISCUSSION AND CONCLUSIONS: Those data confirm the efficiency of laparoscopic treatment of deep endometriosis especially for pain relief and fertility. Nevertheless, few but severe complications may occur. Therefore, it is imperative to deliver clear, loyal and appropriate information before to proceed to such a treatment.

[Caesarean section: closure or non-closure of peritoneum? A randomized trial of postoperative morbidity]. / La césarienne: avec ou sans péritonisation? Etude randomisée de la morbidité postopératoire.

OBJECTIVE: To evaluate postoperative morbidity with non-closure of the visceral and parietal peritoneum during caesarean section. PATIENTS AND METHODS: A prospective randomized study of 170 patients. Operative time, postoperative pain, postoperative morbidity (febrile morbidity, wound haematoma, wound infection, postoperative ileus) and length of hospital stay were compared between the two groups. RESULTS: Duration of operation was significantly shorter without peritoneal closure (38.89 vs 42.00 minutes; P<0.05). Wound haematoma were more frequent when peritoneum was closed (P<0.029). There were no significant difference between the two groups for postoperative ileus, length of hospital stay, postoperative pain and other complications. DISCUSSION AND CONCLUSION: We report the first French study on this subject. In this study, non-closure of both visceral and parietal peritoneum is associated with shorter operation duration and seems to reduce immediate complications. A long-term evaluation of morbidity, regarding adhesions is necessary.