[Oxytocin administration during spontaneous labour: Guidelines for clinical practice. Guidelines short text]. / Recommandations pour l'administration d'oxytocine au cours du travail spontané. Texte court des recommandations.

OBJECTIVES: To define the different stages of spontaneous labour. To determine the indications, modalities of use and the effects of administering synthetic oxytocin. And to describe undesirable maternal and perinatal outcomes associated with the use of synthetic oxytocin. METHOD: A systematic review was carried out by searching Medline database and websites of obstetrics learned societies until March 2016. RESULTS: The 1st stage of labor is divided in a latence phase and an active phase, which switch at 5cm of cervical dilatation. Rate of cervical dilatation is considered as abnormal below 1cm per 4hour during the first part of the active phase, and below 1cm per 2hours above 7cm of dilatation. During the latent phase of the first stage of labor, i.e. before 5cm of cervical dilatation, it is recommended that an amniotomy not be performed routinely and not to use oxytocin systematically. It is not recommended to expect the active phase of labor to start the epidural analgesia if patient requires it. If early epidural analgesia was performed, the administration of oxytocin must not be systematic. If dystocia during the active phase, an amniotomy is recommended in first-line treatment. In the absence of an improvement within an hour, oxytocin should be administrated. However, in the case of an extension of the second stage beyond 2hours, it is recommended to administer oxytocin to correct a lack of progress of the presentation. If dynamic dystocia, it is recommended to start initial doses of oxytocin at 2mUI/min, to respect at least 30min intervals between increases in oxytocin doses delivered, and to increase oxytocin doses by 2mUI/min intervals without surpassing a maximum IV flow rate of 20mUI/min. The reported maternal adverse effects concern uterine hyperstimulation, uterine rupture and post-partum haemorrhage, and those of neonatal adverse effects concern foetal heart rate anomalies associated with uterine hyperstimulation, neonatal morbidity and mortality, neonatal jaundice, weak suck/poor breastfeeding latch and autism. CONCLUSION: The widespread use of oxytocin during spontaneous labour must not be considered as simply another inoffensive prescription without any possible deleterious consequences for mother or foetus. Conditions for administering the oxytocin must therefore respect medical protocols. Indications and patient consent have to be report in the medical file.

Localization of the ROMK potassium channel to the apical membrane of distal nephron in rat kidney.

BACKGROUND: The apical potassium (K+) channels mediate K+ recycling in thick ascending limb (TAL) and K+ secretion in cortical collecting duct (CCD). Recently, the cDNAs for a family of renal K+ channels, ROMK1, -2 and -3, were identified. Based on the biophysical properties and mRNA distribution, it is believed that these ROMK cDNAs encode the apical K+ channels of TAL and CCD. However, the information for cellular and subcellular localization of the ROMK proteins in these tubules is still not available. METHODS: Paraffin or frozen kidney sections from adult Sprague-Dawley rats were stained by polyclonal antibodies against the N- and C-terminal domain of ROMK. Immunoreactive staining was visualized by color development from horseradish peroxidase reaction. Membrane homogenates from kidney were analyzed by Western blot analysis. RESULTS: The polyclonal antibodies against cytoplasmic epitope of ROMK recognized a approximately 42 kD protein in the membrane homogenates from kidney, but not from liver. Staining by immunocytochemistry revealed that ROMK channels were localized to the apical membranes of the distal nephron in cortex and outer medulla, including thick ascending limb and collecting tubule. ROMK staining was absent in glomerulus, proximal tubule and inner medulla. Double staining of the tissue section with both ROMK-specific and H+-ATPase-specific antibodies revealed labeling of ROMK in the principal cells of the collecting tubules. CONCLUSIONS: These results further strengthen the idea that ROMK channels play important roles in the recycling of K+ in TAL and the secretion of K+ in CCD.

[Lateral trapezius flap in cervico-facial surgery. Apropos of 89 cases]. / Utilisation du lambeau latéral de trapèze en chirurgie cervico-faciale. A propos de 89 cas.

Described since 1976, the lateral trapezius flap is not very used in cervico facial reconstructive surgery because of its dissection which is considered as difficult and because of the variability of its vascular pedicle. This latter problem can be removed by the systematic use of preoperative arteriography. We present our retrospective experience of 89 flaps (70 cases of tumors and 19 cases of balistic pathology. We can conclude that the lateral trapezius flap owns specific indications: cutaneous and mucous defects of lips and cheeks, defects of pharyngeal area, defects of floor of the mouth considering of its thin thickness, mandibular defects where it takes place between reconstructive plates and revascularized bone transplants especially for the symphysis area.

[Dog bites on the face. Apropos of 200 cases]. / Les morsures de chien au niveau de la face. A propos de 200 cas.

A series of 200 patients bitten on the face by a dog between January 1979 and December 1990 was reviewed. The aim of the study was to assess our attitude of delayed sutures and to determine the origin of the dogs, their behaviour, and the circumstances of the bites. In this series, 146/200 patients (73%) were less than 15 years old and 85/200 (43%) less than 5 years old; most adults bitten had a job at risk. The rate of infectious complications was 2.5%. There were 70% (105/150) dogs from an identifiable breed (25% (38/150) pedigree) and 30% (45/150) mongrels. In 70% of the cases the victim did not know or hardly knew the dog. The study of our series and others previously published clearly demonstrates that a dog bite must never be sutured directly. By calculating the incidence of dog bite for each particular breed in France, we conclude that, with very few exceptions, no breed is more aggressive than another. Reducing the rate of dog bites implies better knowledge of dogs and respect for some common sense rules, both on the part of children and dog owners.

[Titanium plates for mandibular reconstruction and radiotherapy]. / Plaques de reconstruction mandibulaire en titane et radiothérapie.

Mandibular reconstruction plates are now used after cancer surgery in particular patients. This study assesses the irradiation of Titanium mandibular reconstruction plates in terms of both dosimetry and mid-term tolerance. Twenty patients with mandibular plates underwent radiotherapy (mean dose 60 Gy). The radiation dose on the patient itself was calculated with 3-dimensional treatment planning. A clinical and radiological evaluation of tolerance was made 6 months after the end of the treatment: intraoral and cutaneous healing and possible osteomyelitis. Mid-term tolerance was very satisfactory with only two failures at 6 months. When using parallel opposing fields, the overdosage into tissues was reduced to approximately 5 p. cent; and radiotherapy has probably no effect on titanium plate tolerance.