[The advantage of an umbilical micro-laparotomy, "open laparoscopy", for laparoscopic surgery. Experimental study]. / Le bénéfice de la micro-laparotomie ombilicale "open laparoscopy" pour l'abord coelioscopique. Etude expérimentale.

This study was carried out to evaluate the respective safety of standard introduction of the umbilical trocar after insuflation of the abdomen through a veress needle, direct trocar insertion, and the open laparoscopy approach. Abdominal adhesion were induced by standardized peritoneal trauma in 60 New Zeland white female rabbits. Three weeks later, the animals were randomly assigned to one of three techniques: group 1: standard approach; group 2: direct trocar insertion; group 3: open laparoscopy. Twenty-four bowel injuries occurred in group 1, thirty nine in group 2, and six in group 3. The differences between groups were statistically significant (group 1 vs group 2: p = 0.03; group 3 vs group 1: p = 0.004; group 3 vs group 2: p = 0.0001). These findings favor the use of the open laparoscopy approach when abdominal adhesions are suspected. The standard approach is safer than the technique without pneumoperitoneum, but would require an endoscopic visualization of the umbilical trocar insertion to reduce the complication rate.

[Balance sheet of CETRADIM after 10 years of functioning as an alternative to hospitalization]. / Bilan du CETRADIM après 10 ans de fonctionnement en alternative a l'hospitalisation.

CETRADIM (Educational Centre for the Treatment of Diabetes and Nutritional Diseases) is a hospital department of the Roubaix (France) general hospital functioning uniquely as an alternative to conventional hospital care (outpatient clinics, day hospital, weekday hospital). Its catchment area is essentially local, covering a population of about 200,000. Its vocation is triple: care (including education), training and the supply of information to the treating team and general public. The aim of this study was to evaluate the effect of the existence of a unit of this kind on the frequency of admission of patients for conventional hospital care to the various medical departments of the Roubaix hospital. The indicator used was the percentage of conventional hospitalisation (PCH) in the Endocrinology/Diabetology/Nutrition department, calculated by dividing the number of conventional hospital stay in this specialty by the total number of hospital stay days. Data were obtained for the Roubaix hospital and for 3 hospitals in the Northern region serving comparable types of population but lacking any institution functioning totally as an alternative to hospital care. The PCH was 4.3% for the Roubaix Hospital Centre and 8.2, 8.46 and 10.6% respectively for the other three hospitals. These findings suggest that the existence of an institution such as CETRADIM reduces the number of conventional hospital stay days of patients with Endocrine/Diabetes/Nutrition diseases. Its effects on the constitution of new local care units is discussed, and arguments in favour of its role in the improvement of health care and education costs developed.

Apolipoprotein B polymorphism and altered apolipoprotein B concentrations in Congolese blacks.

The immunoreactivity of apolipoprotein B (apo B) in plasma obtained from 238 unrelated black African male subjects from the People's Republic of Congo was analysed by non-competitive Enzyme Linked-Immunosorbent Assay (ELISA) with monoclonal BIP 45 anti-LDL antibody. The polymorphism detected by BIP 45 monoclonal antibody is identical to the Ag(c,g) polymorphism. Antibody BIP 45 distinguishes three apo B allotypes (immunophenotypes) encoded by the two allelic genes apo B Ag(c) and apo B Ag(g). Because of co-dominant transmission, genotypes may be inferred from allotypes, and it has been shown that BIP 45 binds strongly to the Ag(c) factor and only weakly to the allelic Ag(g) factor. Analysis of the Congolese plasma samples indicated that 67.65% of them bound BIP 45 with low affinity (Ag(c-,g+) genotype), 28.15% with intermediate affinity (Ag(c+,g+) genotype) and 4.20% with high affinity (Ag(c+,g-) genotype). According to the Hardy-Weinberg equilibrium, this corresponds to gene frequencies of 0.817 and 0.183 for the type Ag(g)/Ag(c) alleles, respectively. After adjustment for age and body-mass index, it was found that the Ag(c) allele decreases the apo B level by 9.62 mg/dl and that the Ag(g) allele increases apo B by 0.43 mg/dl. Therefore, as much as 4.30% of the genetic variance for apo B level could be accounted for by the Ag(c,g) gene locus.