Combined genioplasty, chondrolaryngoplasty, and glottoplasty: A novel scarless procedure in facial feminization surgery.

Facial feminization is a long process with multiple surgical steps that is known to improve quality of life in transgender patients. Visible scars are a frequent complaint by this community as it adds to the stigmatization in this population. Combined procedures have been shown to be effective, by reducing the number of hospitalizations and the total length of recovery periods. In this context, we propose a novel scarless procedure combining a chondrolaryngoplasty, a glottoplasty, and a genioplasty using solely a transoral approach. First, we perform a glottoplasty according to the technique described by Wendler et al. and then a contraction genioplasty. Finally, the thyroid cartilage is approached by a subplatysmal dissection, between the mandibular osteotomy fragments. For now, 15 patients have benefited from this procedure in our department. Preliminary results demonstrate that this is an easy and safe procedure with good esthetic results and good patient satisfaction.

Extension services and multifunctional agriculture. Lessons learnt from the French and Dutch contexts and approaches.

Today's acknowledgement of the multifunctionality of agriculture (MFA) implies the production of new knowledge to integrate different functions at farm level (primary production, environmental protection, food safety, etc.). At the same time, agricultural sectors of European countries have recently faced changes in the organisation of their R&D activities, including a trend of commercialisation and privatisation of advisory services for farmers. To assess the consequences of these changes on support for innovations related to MFA, this paper explores the potential of combining two analytical frameworks: an institutional economic approach (IEA) and a sociological network approach (SNA). This potential is illustrated by a historical analysis of advisory services in France and The Netherlands from 1945 until now. This analysis stresses the importance of collective procedures for the accumulation of technical knowledge in agriculture. It also shows that these procedures could not be analysed from a strictly technical perspective. They are the expression of institutional arrangements involving social groups of farmers and the state, and are grounded in national contexts. A historical perspective also enables us to understand better why the privatisation of extension services cannot meet the requirements of support for farm innovations in the MFA context.

[Vasectomy and vas deferens contraceptive surgery: legal and technical aspects]. / Vasectomie et chirurgies contraceptives déférentielles: aspects légaux et techniques.

OBJECTIVES: To analyse technical innovations, their results and the changing legislation in France concerning sterilizing or contraceptive vas deferens surgery. MATERIAL AND METHODS: A review of the literature was performed using the key words: male/contraception/vas deferens. From the 332 research articles obtained from PUBMED, we selected 54 articles for their methodological quality and the importance of their results. RESULTS: Vasectomy remains the only validated vas deferens surgical technique. Although microsurgical reconstructive techniques have improved the vas deferens restoration rate, vasectomy must be considered to be a definitive method of sterilization. The other contraceptive (reversible) vas deferens surgical techniques have not demonstrated sufficient efficacy to be used outside of the context of clinical trials. However the encouraging results ofsome ofthese studies could allow their development in the intermediate term. From a legal point of view, since the reform of sterilizing surgery in Article L2123-1 of the French Public Health Act, vasectomy is now authorized in a regulatory framework. CONCLUSION: The urology community must take into account progress in the field of contraceptive vas deferens surgical techniques.

[Partial nephrectomy by selective renal parenchymal clamping using a new clamp]. / Néphrectomie partielle par clampage parenchymateux sélectif utilisant un nouveau clamp.

OBJECTIVE: To study the results of open partial nephrectomy by selective renal parenchymal clamping using a new renal parenchyma clamp, the Réniclamp. MATERIAL AND METHODS: Partial nephrectomy was performed in 37 patients using the Réniclamp for an imperative indication in 7 patients (solitary kidneys) and an elective indication in 30 patients. The tumour was situated in a pole in 22 cases and on the lateral border of the kidney in 15 cases. The mean tumour diameter was 29 mm (range: 10 - 60 mm). RESULTS: The mean operating time was 147 minutes and the mean clamping time was 25 minutes. Mean blood loss was 191 cc (range : 50-450 cc) and no patient required blood transfusion. No cases of slipping of the clamp or renal parenchymal lesion due to the clamp were observed. COMPLICATIONS: A urinary fistula treated by endoscopy and obstructive clot of the upper urinary tract, which required endoscopic treatment and selective embolisation. The surgical margins were negative in every case. CONCLUSION: Partial nephrectomy by selective renal parenchymal clamping is an alternative to the pedicle clamping technique in almost every case of renal tumour except for central renal lesions. Réniclamp distributes the pressure homogeneously, avoiding damage to the parenchyma due to excess pressure on the proximal part of the clamp and bleeding due to insufficient pressure on the distal part of the clamp.

[Epidural abscess after prostatic biopsies]. / Abcès epidural après biopsies prostatiques.

Prostatic biopsy is a routine clinical procedure often wrongly considered to be perfectly harmless. The authors report the first case of epidural abscess after prostatic biopsy, despite properly conducted antibiotic prophylaxis. Although the epidural space is a known site of infection, the relationship with prostatic biopsies has never been previously reported. This clinical case emphasizes the need for complete patient information and the importance of anti-infective prophylaxis guidelines.