An MRI comparison of anatomical changes related to surgical treatment of prolapse by vaginal or abdominal route.

PURPOSE: The aim of this study was to determine whether or not abdominal or vaginal access is the best choice for treating genital prolapse in term of anatomical postoperative results, using an MRI pre and postoperative assessment. MATERIALS AND METHODS: Prospective study was conducted on 43 consecutive patients planned for surgery for genital prolapse from October 2001 to February 2002. The patients were studied with dynamic and static MRI sequence 4 months after surgery to indicate surgical effects on organ position. The position was evaluated with respect to the pubo coccygeal line in a dynamic sequence. RESULTS: Fifteen patients had their prolapse corrected by laparotomy always associated with sub-total hysterectomy, anterior and posterior prosthetic mesh with promontory fixation to the prevertebral ligament. Sixteen others were subjected to vaginal route with vaginal hysterectomy, paravaginal suspension followed in all cases by suspension of the vaginal cuff using Richter's technique and myorraphy of the levators. Finally, 12 patients benefited from a suspension of a sacrospinous suspension and myorraphy of the levators, without paravaginal suspension. Measure of the MRI organ location showed no significant difference except for bladder position in vaginally operated women (P = 0.02). Vaginal length and axis were comparable in all groups. CONCLUSION: Our study confirmed the objective effectiveness of the anatomical prolapse corrections conducted by abdominal route using sacropexy or by vaginal route using sacrospinous fixation. The correction provided by vaginal route always results in a return of the bladder and the vaginal fundus to their normal positions, which clearly demonstrates the short-term effectiveness of these surgical suspensions. Prolapse corrections by vaginal route did not result in any shortening of the vagina or postoperative change in vaginal orientation. Further evaluations will be needed to assess the long-term results.

Evidence for specific TRPM8 expression in human prostate secretory epithelial cells: functional androgen receptor requirement.

TRPM8 (melastatine-related transient receptor potential member 8), a member of the transient receptor potential (TRP) superfamily of cation channels, has been shown to be a calcium-channel protein. TRPM8 mRNA has also been shown to be overexpressed in prostate cancer and is considered to play an important role in prostate physiology. This study was designed to determine the androgen-regulation mechanisms for TRPM8 mRNA expression and to identify the phenotype of TRPM8-expressing cells in the human prostate. Our findings show that trpm8 gene expression requires a functional androgen receptor. Furthermore, this article argues strongly in favour of the fact that the trpm8 gene is a primary androgen-responsive gene. Single-cell reverse transcriptase PCR and immunohistochemical experiments also showed that the trpm8 gene was mainly expressed in the apical secretory epithelial cells of the human prostate and trpm8 down-regulation occurred during the loss of the apical differentiated phenotype of the primary cultured human prostate epithelial cells. The androgen-regulated trpm8 expression mechanisms are important in understanding the progression of prostate cancer to androgen-independence. These findings may contribute to design a strategy to predict prostate cancer status from the TRPM8 mRNA level. Furthermore, as the TRPM8 channel is localized in human prostate cells, it will be interesting to understand its physiological function in the normal prostate and its potential role in prostate cancer development.

Resilience and vulnerability of northern regions to social and environmental change.

The arctic tundra and boreal forest were once considered the last frontiers on earth because of their vast expanses remote from agricultural land-use change and industrial development. These regions are now, however, experiencing environmental and social changes that are as rapid as those occurring anywhere on earth. This paper summarizes the role of northern regions in the global system and provides a blueprint for assessing the factors that govern their sensitivity to social and environmental change.

[Medical treatment of laryngotracheal stenosis (author's transl)]. / Traitement médical des sténoses laryngo-trachéales.

The authors review the various types of treatment involving drugs and physical agents used for the non-surgical therapy of laryngotracheal stenosis. They emphasize three interesting propositions: the use of zinc sulphate, of lathyrogens and muscle relaxants, an extensive experimental study of which would be worthwhile in the particular context of laryngotracheal stenosis.

[Chondronecrosis of the cricoid after prolonged intubation (author's transl)]. / Les chondronécroses du cricoïde après intubation prolongée. A propos de 4 observations.

On the basis of 4 cases of partial chondronecrosis of the cricoid after prolonged intubation, the authors review the literature which contains very few similar cases. With regard to pathogenesis, in the light of experimental studies and clinical findings, they emphasize the importance of two lesional factors: excessive diameter of the intubation tube and excessive deflection of the patients' head. All of these factors increase the pressure applied by the tube to the region inferior to the posterior commissure. These parameters would appear to be more important than the duration of intubation itself. The prognosis of these lesions is related to the extent of necrosis: poor when the latter involves the major part of the chaton, generally good when it is limited to partial lysis of the cartilage which may be associated with arytenoid sequestration. Calibration procedures were used in each case. It should be borne in mind that such methods are inadequate for the treatment of massive chondronecrosis which requires repeated operation.