[Robot assisted radical prostatectomy: What are the evidences at the time of a specific funding?] / Prostatectomie radicale laparoscopique robot-assistée : quelles sont les preuves à l'heure d'une demande de nomenclature spécifique ?

INTRODUCTION: Despite a decreasing number of radical prostatectomies in France, the number of robot-assisted surgeries increases. The objective of this work is to assess the interest of robotic prostatectomy before asking a specific funding from health authorities. MATERIAL AND METHODS: A systematic review of the literature on PubMed was performed. Prospective studies and meta-analyses comparing robot-assisted radical prostatectomy (RARP), laparoscopic (LRP) and open surgery (OP) were selected. RESULTS: There are only two randomized clinical trials comparing RARP and LRP. Erectile function was significantly better after RARP than after LRP. Compared to OP, sexuality evaluation, based on meta-analyses, was significantly better at 12 months and the absolute risk of erectile dysfunction significantly decreased. Continence after RARP was significantly better than LRP 3 months after surgery. Compared to OP, continence results were discordant, sometimes significantly in favor of RARP, sometimes similar. The rate of positive margins was similar whatever the technique. The long-term oncological outcomes were similar. In terms of perioperative complications, no significant difference was observed between RARP and LRP or OP. CONCLUSION: RARP provides same oncological outcomes as the open and laparoscopic approach. Continence and sexuality are better after RARP than after laparoscopic or open surgery. However, no randomized study comparing RARP and OP is available.

[Understanding the poor results after surgery for superficial venous insufficiency]. / Comprendre les mauvais résultats après chirurgie de l'insuffisance veineuse superficielle.

Effectiveness and value of surgical treatment in varicose veins remains difficult to assess for many reasons. They are discussed in details in front of this general review devoted to poor results after varicose vein surgery. An other pathology is often associated with venous insufficiency and is frequently missed and responsible of poor results. Many factors contribute to make uneasy assessment of poor results. The lack of objective criteria to appreciate the natural evolution of varicose disease different from one patient to another. The difficulty to grade clinical disease severity. Results published before the use of modern preoperative investigations make their report obsolete. Precise data of surgical treatment undertaken are often not detailed. The quality of therapists (surgeon or phlebologist) is uneasy to check. The difficulty to assess results after treatment: subjective results (patient) vs objective results (audit). Duration of follow-up. Imprecise vocabulary to qualify results. Clinical assessment remains the cornerstone but supplementary investigations must be undertaken. Duplex-Scan is currently accepted as the gold standard investigation. Phlebography or (and) plethysmography can be helpful in some cases. After detailed assessment patients can be classified in different groups. This classification allows to determinate the most adequate treatment. In some selected patients redosurgery is strongly recommended. Prevention of recurrence after surgical treatment of varicose veins can not be complete. Strict respect of several rules can however reduce it. They can be summarised as follows: Respect of temporary of definitive contraindications to surgical treatment. Thorough investigation before surgery. Preoperative precise aim of what must be treated by the surgical procedure. Correct operative procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effectiveness of combined repeat surgery and sclerotherapy after failure of surgical treatment of varicose veins]. / Valeur de l'association chirurgie itérative-sclérothérapie après échec du traitement chirurgical des varices.

UNLABELLED: From January 1985 to December 1986 one hundred and five patients (145 lower limbs) have been treated by redosurgery followed by sclerotherapy. It is a selected group because redosurgery decision was taken both by surgeon and angiologists on the basis that a significant reflux between the profunda system and the superficial system was present. The aim of this retrospective study was to assess results obtained by this therapeutic association with a follow-up from 5 to 6 years. Failure mechanisms of initial treatment, symptoms, preoperative investigations, redosurgery procedures are analysed. Results were estimated both by a questionnaire and an independent audit. Patient estimation: symptoms improvement 65%; cosmetics improvement 68%. Audit estimation: SYMPTOMS: excellent or good results: 78%, fair results: 12%, poor results: 10%. Cosmetics: excellent or good results: 30%, fair results: 53%, poor results: 17%. 82% of patients plebiscited redosurgery in cooperation with sclerotherapy.

[The point of view of the medical phlebologist on phlebography in chronic venous insufficiency of the lower extremities]. / Le point de vue du phlébologue médical sur la phlébographie dans l'insuffisance veineuse chronique des membres inférieurs.

In which cases does a medical phlebologist request a phlebography, and what type? What informations does phlebography provide and what consequences may be drawn regarding the therapeutic indications.

[Role of the external saphenous vein in repeat surgery of primary varicose veins of the lower limbs]. / La place de la saphène externe dans la chirurgie itérative des varices essentielles des membres inférieurs.

Between January 1968 and June 1978, we required to carry out 170 repeat operations for primary varicose veins of the lower limbs. In 34 operations (21.9% of cases) the re-operation involved a surgical procedure on the external saphenous: --in 6 cases, isolated ligature of the arch, --in 28 cases, stripping of the short saphenous. In our practice surgical reoperation is only indicated when there is a substantial point of leakage between deep and superficial systems. Residual varicosities after surgery require simple post-operative sclerosis. Surgery to the short saphenous is carried out in various circumstances; a) Where the initial operation involved an error in technique: Wrongly sited ligature of the arch (5 cases). This occurs less frequently than in the cases of the internal saphenous . b) Where the first operation was defective by reason of a tactical error: The short saphenous had not been recognized as responsible for varicose veins and had been ignored. Where several years after an operation on the long saphenous, insufficiency developed in the short saphenous and required treatment in its turn. Preoperative assessment involved phlebography and a Doppler examination in the majority of cases. The results are difficult to assess since in nearly two thirds of the cases, surgery to the external saphenous was combined with a further surgical procedure on the internal saphenous.

Study of the apoprotein of Folch-Pi bovine proteolipid. II. Characterization of the components isolated from sodium dodecyl sulfate solutions.

Acrylamide gel electrophoresis in dodecyl sulfate solutions of Folch-Pi apoprotein shows several bands. The different components were separated by Biogel P-200 filtration and then reduced and carboxymethylated. A comparative study of the amino acid composition, N-terminal sequence and C-terminal amino acid of the different components led to the assumption that their primary sequences are similar. Evidence for a contamination of the protein by free amino acids might explain the difference in terminal groups found by us and by other groups. It has been shown that the purified components can polymerize independently of S-S bond formation or exchange. The polymerization products were found to resist dissociation by dodecyl sulfate. It has been suggested therefore that the differences in migration rates of the various components are related to their shape rather than to their molecular weight.