[Laparoscopic cholecystectomy in elderly patients. Apropos of 115 cases]. / La cholécystectomie coelioscopique chez la personne âgée. A propos de 115 cas.

We report a retrospective analysis of 115 elderly patients over 70 years of age who underwent laparoscopic cholecystectomy for symptomatic lithiasis between January 1990 and January 1996. This technique is perfectly adapted to elderly patients. Complications are less frequent and better tolerated than for conventional open surgery. In this series, the success rate was 97.39% with technique-related complications at 2.7%. None of these complications required reoperation.

[Trans-sutural mechanical anastomosis in esophagogastric surgery. Apropos of 25 cases]. / Anastomose mécanique trans-suturaire dans la chirurgie oeso-gastrique. A propos de 25 observations.

The essential point conditioning the success of a mechanical esophagogastric or esophagojejunal anastomosis is the performance of an esophageal purse. The authors present a variety of the technique which consists of replacing the esophageal purse by a linear stapling after having introduced the anvil in esophagus. The anvil shaft is then exteriorized through the staple line. From January 1991 to January 1994, this technique was performed on 25 patients (17 men and 8 women), with a mean-age of 66 years (range 27 to 83). The esophagojejunal anastomosis after total gastrectomy was performed on 17 patients (15 carcinomas, 1 acute gastritis with gastric haemorrhage, 1 stomal ulcer), and the esophagogastric anastomosis after partial esophagectomy for carcinoma on 8 patients. After six to twelve months neither an anastomotic stenosis nor a leakage occurred. The advantage of this technique is on one hand to simplify the performance of the anastomosis and to reduce the septic and operating time, on the other hand to avoid the complications of performing the esophageal purse.

[Double trans-suture technique in colorectal surgical anastomosis. Apropos of 45 cases]. / Anastomose double trans-suturaire dans la chirurgie colo-rectale. A propos de 45 observations.

The double trans-suture technique in colorectal anastomoses is an entirely mechanical one which consist of the transformation of two linear sutures in a circular one. During, 2 years, between March 1990 and March 1992, this technique was performed on 45 patients, of whom about two-third had a carcinoma of rectosigmoid. No postoperative mortality occurred. One patient developed an anastomatic stenosis, and another one a clinical leakage. The double trans-suture technique has not only the advantages of the double stapling technique but also avoids the incidents of performing a proximal purse.

Buserelin in premenstrual syndrome.

Buserelin, a luteinizing hormone releasing hormone agonist was administered nasally in doses of 900 micrograms daily to inhibit the ovarian cycle. Of 16 patients recruited, ten completed the treatment. Daily symptoms were measured on the Visual Analogue Scale and Trigg's trend analysis utilized for the analysis. The peak severity of symptoms (ESAmax) and the maximum global scores (Gmax) reduced on buserelin treatment. The minimum global scores (Gmin) and the minimum score for each symptom (ESAmin) increased, suggesting worsening of underlying symptoms. The difference between ESAmax and ESAmin (ESAdelta) and Gmax and Gmin (Gdelta) were calculated to determine the degree of symptom change. The delta scores for symptoms of depression, bloatedness and breast symptoms, and Gdelta were significantly reduced (p less than 0.05) on buserelin, whilst the latter significantly worsened in the follow-up months. Side-effects may limit the place of buserelin in the long-term treatment of premenstrual syndrome, although combination of additional hormonal treatment may facilitate long-term treatment.

Long-term follow-up of patients with uterine fibroids after treatment with the LHRH agonist buserelin.

Ten patients with uterine fibroids palpable abdominally were treated with the luteinizing hormone-releasing hormone (LHRH) agonist buserelin, administered intransally, 300 micrograms three times daily, for 6 months, and were then followed for a further 12 months. Oestrogen levels were markedly reduced in all patients during treatment. At the end of treatment the mean volume reductions were 44.4% (SEM 3.5) for total uterine volume and 57.3% (SEM 7.4) for volume of discrete fibroids as assessed ultrasonically. There was also marked improvement in associated symptoms. After buserelin therapy was stopped, the total uterine and discrete fibroid volumes returned to, or slightly exceeded, pretreatment volumes within 6 months in five patients, and by 12 months in two patients. Three other patients who underwent surgery for their fibroids during the first 4 months after treatment showed regrowth of fibroids to pretreatment size. Four comparable asymptomatic untreated patients showed no significant change in the total uterine or fibroid volume during six monthly ultrasonic assessments. Buserelin therapy may facilitate rather than replace surgery in the management of uterine fibroids.

Reversible trabecular bone density loss following induced hypo-oestrogenism with the GnRH analogue buserelin in premenopausal women.

Thirteen premenopausal women who each received 400 micrograms three times daily of intranasal buserelin for 6 months as treatment for endometriosis participated in this study. Cortical bone mineral content (BMC) in the mid-shaft of the right femur measured by dual photon densitometry, and trabecular bone density (TBD) in the lumbar vertebrae (L2-4) measured by quantitative computed tomography, were evaluated prior to, at the end of 6 months' buserelin treatment and after 6 months off treatment. Significant hypo-oestrogenism (P less than 0.001) was sustained during the period on treatment. The significant reduction in the mean lumbar vertebral TBD of 5.9% (P less than 0.02) observed at the end of treatment with buserelin was regained within 6 months following resumption of ovarian activity. There was a marginally significant (P = 0.07) reduction of only 0.9% in the mean femoral cortical BMC at the end of treatment. Six months after the end of treatment cortical BMC values were not significantly different from the pretreatment values. There was no significant correlation between the degree of hypo-oestrogenism and the corresponding change in vertebral TBD, (r = 0.20; P less than 0.10).

Doppler assessment of uterine blood flow changes in patients with fibroids receiving the gonadotropin-releasing hormone agonist Buserelin.

Uterine arterial blood FVWs were studied by doppler ultrasound in eight patients with large uterine fibroids who were treated with the GnRH agonist Buserelin intranasally for 4 months. At the end of treatment, reductions in the uterine and discrete fibroid volumes were associated with significant increases in the mean RI values for the uterine (P less than 0.01) and fibroid (P less than 0.001) vasculature, thus indicating reduction in blood flow.

Endocrinologic and clinical evaluation following a single administration of a gonadotrophin-releasing hormone agonist (Zoladex), in a depot formulation, to premenopausal women.

A single 3.6-mg Zoladex subcutaneous depot injection was effective in suppressing the pituitary-ovarian function for about 5 weeks in nine regularly menstruating, premenopausal volunteers. Menses returned approximately 9 weeks after the injection. Zoladex depot is a novel approach in the administration of GnRH agonists and offers great therapeutic potential.

Reversible pituitary ovarian suppression induced by an LHRH agonist in the treatment of endometriosis--comparison of two dose regimens.

Buserelin [D-Ser(TBU)6-des Gly NH2(10) LHRH ethylamide], an LHRH agonist, was administered intranasally at two dose levels, 200 micrograms t.d.s or 300 micrograms t.d.s., to 20 women with proven endometriosis, many with recurrent disease. Both dose schedules achieved significant suppression of circulating 17 beta-oestradiol levels often to within the postmenopausal range, the larger dose inducing significantly greater suppression (P less than 0.05). Serum FSH values were suppressed below baseline but serum LH remained at pretreatment levels or above, whilst on treatment. Complete resolution of endometriotic deposits was achieved in 68% of cases following 6 months treatment with dramatic and long-standing relief of symptoms with no apparent dose difference. In all other subjects there was significant reduction in the extent of endometriotic deposits and improvement in American Fertility Society classification of disease stage. The most commonly occurring side effect was hot flushes; their intensity and frequency related to the degree of suppression of serum oestradiol and the dose of Buserelin administered.

Age at menarche of schoolgirls in Khartoum.

Data on age at menarche have been collected among 1372 Sudanese girls attending state schools within the capital, Khartoum, and representing three different socioeconomic groups. The mean ages, estimated by probits, were 13.35 +/- 0.14 for the well-off girls; 13.85 +/- 0.15 for the middle class and 14.06 +/- 0.18 years for the poor girls. The results were compared with data reported from other African and other Arabic-speaking countries. Well-off Sudanese girls in Khartoum have one of the earliest recorded means of all African populations studied. It seems likely that with improvement of health care and family planning, Sudanese girls would be at least as early-maturing as girls in Northern and Central Europe.

PIP: A study of the age at menarche in 3 different social classes in Khartoum, Sudan was conducted during the academic year 1980. The girls were all Sudanese and attended state schools within the capital, Khartoum. They ranged in age from 8-18 years. The population of Khartoum is Arabic speaking and predominantly Arab in origin, but there has been some admixture with other ethnic groups in Sudan. The girls and adolescents represented 3 different income groups classified arbitrarily according to the locality of the schools as high, moderate, and low income. Only those who are more privileged attend school in Sudan. The data were collected using the status quo method. The "well off" girls in Group A menstruated at age 13.35 +or- 0.15, earlier by 0.5 years than middle class girls in Group B. The difference was statistically significant. The girls in Group C, the low income group, had a mean menarcheal age which was not significantly different from the middle income Group B. This may be due to the fact that poorer classes tend to spend most of their income on food consumption and thus the differences in the dietary pattern between B and C was not very great. Between Groups A and C there was a significant difference of 0.71 of a year. The difference was statistically significant. The mean family size was found to differ, with the poorest and the unemployed having the highest average number in the family. The "well off" girls in Khartoum have one of the earliest recorded ages of menarche in Africa. When poor girls in Khartoum with a mean of 14.06 were compared with poor girls in rural Egypt with a mean of 13.9, the difference was insignificant. It seems likely that in good environmental conditions and with family planning, Sudanese girls, or at least those in the Khartoum area, may mature as early as, or earlier than, girls of northern and Central Europe.

Contribuicao ao estudo da nanoftalmia bilateral familiar. / Familial bilateral nanophthalmos

Cinco membros de uma familia com diagnostico de nanoftalmia foram estudados, com valorizacao dos dados clinicos. O heredograma sugere heranca autossomica dominante com baixa penetrancia e expressividade variavel