Monsplasty after massive weight loss: Assessment of its aesthetic and functional impact.

INTRODUCTION: Massive weight loss frequently leads to a ptosis or a pubic bulge. This deformation is a source of functional as well as aesthetic discomfort, and it also has psychological repercussions. We have analyzed the degree of satisfaction reported by 23 female patients having undergone a monsplasty procedure and have also proposed a decisional algorithm designed to facilitate surgical care according to type of pubic deformation. MATERIALS AND METHODS: This is a one-year prospective study involving 23 female patients having undergone a monsplasty procedure following massive weight loss. The interventions were all carried out in standardized fashion by the same surgeon according to stage of deformation. Analysis of the patients' degree of aesthetic and functional satisfaction was performed using a questionnaire filled out during preoperative and postoperative consultations, the latter taking place 6 months to one year after the operation. It included a self-esteem assessment based on the Rosenberg scale, appraisal of functional benefits (clothing, sexual activity, daily physical activities, intimate hygiene) and evaluation of the pubis in aesthetic terms. RESULTS: Assessment of impact on self-esteem revealed average improvement of 10.08 points, rising from 25.87 to 35.95. All of the patients, without exception, were satisfied or very satisfied with the impact of monsplasty on the different items under evaluation. stage 3 and stage 4 patients were particularly sensitive to improvement involving personal hygiene, physical activities and the clothes they wore. In most cases, they likewise reported a positive impact on their sexual experience. CONCLUSION: Abdominoplasty or body lift without monsplasty can entail long-lasting aesthetic and functional discomfort. Thorough preoperative semiological analysis is essential to optimized surgical care conducive to successful integration of the monsplasty. An appropriate caretaking attitude enhances both the aesthetic result and patient self-esteem.

Anterior fossa schwannoma mimicking an olfactory groove meningioma: case report and literature review.

Intracranial schwannomas not associated with cranial nerves account for less than 1% of surgically treated schwannomas of the central and peripheral nervous system. With only 45 cases reported to date, subfrontal schwannomas are very rare tumors, leaving the issue of their origin controversial. A 66-year-old woman presented with a 1-year history of progressive headaches. Clinical examination revealed hypoesthesia of the nasal tip. CT-scan and MRI studies revealed a large subfrontal tumor thought preoperatively to be a meningioma. Intraoperatively, a large extra-axial tumor arising from the floor of the right frontal fossa was encountered. Histopathology identified the tumor as a schwannoma. This current case gives strong clinical presumption of an origin from the anterior ethmoidal nerve. We reviewed the literature in order to establish the epidemiology of these tumors, from which there appear to be divergent profiles depending on tumor origin and histology. Despite close similarities with olfactory groove meningiomas, patient history and radiological findings provide substantial evidence for differential diagnosis.

[Evaluation of a pathway of epilepsy surgery in a polyvalent video-EEG center: retrospective analysis of a series of 295 patients]. / Évaluation d'une filière médico-chirurgicale en épileptologie au sein d'un centre de vidéo-EEG polyvalent : analyse rétrospective d'une série de 295 patients.

BACKGROUND AND PURPOSE: The supply for diagnosis and treatment is inadequate in France for epileptic patients eligible for surgery. Our institution includes a Video-electroencephalography (v-EEG) unit and a general neurosurgery department. Our objective was to evaluate the efficacy and morbidity of the surgery performed in a center non-dedicated to epilepsy surgery. METHODS: We conducted a retrospective study of a cohort of 295 patients explored with long lasting v-EEG from 1991 to 2008 in Tours in which we evaluated the efficacy and morbidity of the surgery distinguishing between hippocampal sclerosis and other epileptogenic lesions. RESULTS: Phase I directly led to surgery in 31 cases. Of them were 19 hippocampal sclerosis were operated with no surgical morbidity, and 12 other epileptogenic lesions operated with a comorbidity in two patients. Results of surgery were similar to larger studies, with 80% of patients Engel's Class I. Best results were observed in the hippocampal sclerosis group: 94.7 Class I (IA: 84%), versus 58% Class I (IA: 33%) for other etiologies. CONCLUSION: Despite the small number of operated patients, the surgical treatment keeps its efficiency without adding morbidity. v-EEG centers combined with non-specialists neurosurgical teams can contribute to improve care without reducing their quality.

[Systemic infection due to implanted leads of a cardiac pacemaker. Apropos of a case and review of the literature]. / Infection systémique sur sondes endocavitaires de stimulateur cardiaque. A propos d'un cas et revue de la littérature.

Systemic infection related to transvenous pacemaker-leads are rare, but their diagnosis is difficult. We report the observation of a 78-year-old patient whose recurrent Staphylococcus aureus septicemias linked to endocarditis related to an endovascular lead only on a third observation, characterized by an infectious bone localization. Transoesophageal echocardiography appears as the reference diagnostic method. The treatment lies in the surgical ablation of the pacing system and a prolonged antibiotic therapy. The heavy mortality caused by these pathologies leads us to reconsider the interest of a prophylaxis, particularly for elderly patients.

Colonic ischemia reveals thromboangiitis obliterans (Buerger's disease).

Two years before the appearance of distal peripheral manifestations of thromboangiitis obliterans (Buerger's disease), a young man had acute peritonitis attributable to an ischemic perforation of the sigmoid colon. Only the histological examination of excised tissue was able to differentially diagnose this entity unambiguously.

Polyarteritis nodosa related to hepatitis B virus. A prospective study with long-term observation of 41 patients.

Hepatitis B virus (HBV)-related polyarteritis nodosa (PAN) is a rare disease whose frequency has been decreasing over the past 10 years. We evaluated 41 patients with HBV-related PAN to determine the circumstances leading to infection, the clinical features of vasculitis, the prognostic factors, and the response to therapy. Most patients were first treated briefly with corticosteroids, and all were included in 2 nonrandomized prospective therapeutic trials of an antiviral agent (35 patients with vidarabine, 6 patients with interferon-alpha 2b) and plasma exchanges. The mean duration of follow-up was 69.6 +/- 44.8 months. At the end of the study, 21 (51.2%) patients had seroconverted to anti-HBeAb and 10 (24.4%) also had seroconverted to anti-HBsAb. In all, 23 (56%) patients no longer expressed serologic evidence of HBV replication. All 33 (80.5%) patients still alive at the end of follow-up recovered from PAN. Nineteen also recovered from HBV infection and were considered to be cured; 13 patients had persistent HBV infection and were considered to be in clinical recovery; and 1 patient was in remission, maintained with steroid therapy. Eight patients died during the study period; 3 deaths were directly attributable to PAN. HBV-related PAN is an acute disease, occurring shortly after infection and sharing the characteristics of classic PAN. It is not an antineutrophil cytoplasm antibodies (ANCA)-mediated vasculitis. The outcome was good for patients treated with short-term steroid therapy, antiviral agents, and plasma exchanges. We propose this protocol as the first treatment for HBV-related PAN, because it surpasses the conventional treatment with corticosteroids and cyclophosphamide, which facilitates viral replication and the development of chronic HBV infection.

Hepatitis B virus-related polyarteritis nodosa and membranous nephropathy.

We report the case of man with a history of post-transfusion chronic persistent hepatitis due to hepatitis B virus (HBV), who secondarily developed polyarteritis nodosa (PN) and membranous nephropathy (MN) simultaneously. At that time, liver biopsy yielded the diagnosis of active chronic hepatitis, and serological tests showed a high replication rate of HBV. PN was due to HBV infection, but the etiology of MN was uncertain, as it has never been described in PN, even in its microscopic form. There was no evidence of paraneoplastic syndrome or other causes of MN. Although the renal biopsy did not give any indication of HBV-related glomerulonephritis, the patient was considered to have an association of classic PN and MN, both related to HBV. Treatment combined plasmapheresis and interferon-alpha.

[Thromboembolic disease and cancer]. / Maladie thromboembolique et cancer.

Many anomalies in primary haemostasis, coagulation and fibrinolysis have been described which favour thrombosis in cancer patients. Cancer is often associated with other risk factors for thromboembolism which explain much of the increased frequency of thrombosis in these patients. Thromboembolism may precede cancer and sometimes is the inaugural manifestation leading to the diagnosis of cancer. Cancer occurs more frequently in patients with idiopathic recurrent venous thrombosis than in those with thrombosis due to other risk factors for thromboembolism. The results of antivitamin K therapy are disappointing: in retrospective series, recurrent thromboembolism occurred in 9% of the treated patients and severe haemorrhage in 27%. New therapies should be assessed in cancer patients with thromboembolism.

Treatment of polyarteritis nodosa related to hepatitis B virus with interferon-alpha and plasma exchanges.

OBJECTIVES: To test the effectiveness of and tolerance to interferon-alpha 2b (INFa2b) in association with plasma exchanges for the treatment of polyarteritis nodosa (PAN) related to hepatitis B virus (HBV). METHODS: A prospective, non blinded, multicentre trial was carried out in which patients with multisystemic HBV-related PAN were included. Each patient received the association of INFa2b and plasma exchanges. The end point of the study was control of the disease (recovery or remission) or death. RESULTS: Six patients were included in the study. Each patient had histopathological or arteriographic evidence of vasculitis and was infected with actively replicating HBV. All patients were alive at the end of the study and no longer presented clinical or laboratory evidence of systemic vasculitis. HBeAg/anti-HBeAb seroconversion was observed in four patients (66.6%) and HBsAg/anti-HBsAb in 3/6 (50%). Two patients are still being treated with INFa2b because of chronic active hepatitis. CONCLUSIONS: It is considered that this new therapeutic approach to HBV-related PAN effectively cured systemic vasculitis and was associated with control of HBV infections. Antiviral therapy may have a role to play as the first line treatment regime of virus-induced vasculitis.

Simultaneous progressive multifocal leukoencephalopathy, Epstein-Barr virus (EBV) latent infection and cerebral parenchymal infiltration during chronic lymphocytic leukemia.

We report a non-HIV patient who had B chronic lymphocytic leukemia (CLL) with progressive multifocal leukoencephalopathy (PML) and diffuse cerebral leukemic parenchymal infiltration in the presence of JC virus and Epstein-Barr virus (EBV) cerebral co-infection. Multiple subcortical hypodensities lining the cortico-subcortical junction were present within the white matter on computerized tomography (CT) scan, with large areas of high signal intensity on T2-weighted sequences on magnetic resonance imaging (MRI). JCV DNA was identified in peripheral blood nuclear cells and cerebrospinal fluid polymerase chain reaction (PCR) DNA/DNA hybridization plus Southern blot analysis. Frontal stereotactic biopsy confirmed the diagnosis of PML by immunocytochemistry, in situ hybridization (ISH) with JC Enzo probe and electron microscopy. Leukemic B cells with the same phenotype as leukemic blood cells were disseminated in the demyelinated areas. They were labeled by anti-latent membrane protein and by BamHl W EBV probe after ISH. Adhesion and activation molecules were positive for CD23. Autopsy showed diffuse visceral leukemic infiltration without acutization. EBV-transformed B lymphocytes would favour JCV penetration and/or intracerebral reactivation of previously latent JCV infection with further development of simultaneous PML and cerebral CLL infiltration in an immunosuppressed patient.

[Intra-alveolar hemorrhage in Wegener's granulomatosis. Retrospective study of 9 cases]. / Hémorragies intra-alvéolaires de la granulomatose de Wegener. Etude rétrospective de 9 cas.

Among 66 patients with Wegener's granulomatosis, 9 had an intra-alveolar haemorrhage which revealed the disease. The diagnosis was based on dyspnoea (n = 9), haemoptysis (n = 9) and anaemia (n = 9) with a mean haemoglobin level of 8 +/- 1 g/dl. Radiology showed bilateral alveolar infiltrates (n = 9), and numerous siderophages were found either in the alveolar lavage fluid (n = 7/7) or in sputum (n = 2). In every case, the alveolar haemorrhage was accompanied by a rapidly progressive extracapillary glomerulonephritis and by lesions of the upper airways which preceded it by several months or years. All patients received corticosteroids combined, in 8 cases, with cyclophosphamide. The respiratory disease improved rapidly, in contrast with the renal disease which became worse (n = 5). Two patients died in the acute phase of the vasculitis: one of acute renal failure, the other of infectious shock.

[Relapsing polychondritis and mesenteric panniculitis: apropos of 2 cases]. / Polychondrite atrophiante et panniculite mésentérique: à propos de 2 cas.

We report two cases of polychondritis associated with mesenteric panniculitis. Case 1. In February 1989, a woman born in 1949 presented with 40 degrees C fever accompanied by pain in the abdomen and pelvis. Eight days later, nodular skin lesions appeared on her lower limbs. The abdomen was swollen with gas and undepressible. An abdominal CT scan revealed partitioned peritoneal collections, and a guided needle aspiration produced a chylous fluid. Direct and indirect bacteriological examinations gave negative results. Histology showed intense inflammatory reaction with giant cells and lipophages, thereby confirming the presence of mesenteric panniculitis. Six months later, the development of chondritic lesions on the nose and the helix of the ear clinched the diagnosis of polychondritis. The patient was put on corticosteroid therapy for a few months, and in January this year (1993) she is durably asymptomatic. Case 2. In October 1977, a woman born in 1937 presented with polychondritis with prolonged fever, inflammatory syndrome and chondritic lesions of the nose, larynx and helix of the ear. In December 1978, she developed signs of abdominal obstruction. Laparotomy revealed infiltration by multiple nodular formations of the entire posterior line of attachment of the mesentery. Biopsies withdrew a puriform fluid. Histology showed a partly necrotic adipose tissue with giant cells and lipophages. High-dose corticosteroid therapy partially controlled the chondritic and abdominal manifestations. The occurrence of abdominal pain in patients with polychondritis may result from several disorders, such as iatrogenic complications, digestive tract vasculitis or ulcerative colitis, but also associated mesenteric panniculitis.

[Systemic diseases treated by corticoids, plasma exchange and cyclophosphamide: infectious complications and lymphopenia]. / Maladies systémiques traitées par corticoïdes, échanges plasmatiques et cyclophosphamide: complications infectieuses et lymphopénie.

The sporadic observation of pneumocystosis in patients suffering from systemic diseases led us to investigate the role of treatment-induced lymphopenia, affecting in particular CD4 cells. We report the results of a retrospective study on 16 patients in whom infectious complications were sought and correlated with the number of lymphocytes.

[Treatment of venous thromboembolic disease in patients with cancer]. / Traitement de la maladie thromboembolique veineuse (MTE) chez les patients cancéreux.

Results of classical anticoagulant therapy in cancer patients with venous thromboembolism (VT) are highly discussed. We retrospectively analysed the outcome of 43 patients with VT and cancer: 32% developed specific complications during either i.v. heparin therapy (10 +/- 0.9 days) or treatment by antivitamin K (106 +/- 14.9 days). Recurrence of thromboembolism (16%) and/or hemorrhages (16%) were much more frequent than in patients without cancer, underlying need for alternative therapy in cancer patients with VT.