[Bilateral breast cancer. Incidence and risk factors]. / Cancer du sein bilatéral. Incidence et facteurs de risque.

OBJECTIVE: To clarify, thanks to a retrospective study of 24 bilateral breast cancer cases, the frequency, the risk factors and the prognosis of bilateral breast cancers. PATIENTS AND METHOD: Between 1984 and 1999, out of 506 patients treated for unilateral non-metastatic breast cancer at Gynecologic and Obstetric ward, at Maternity Souissi of Rabat, 24 cases of bilateral breast cancers were diagnosed. Our results were compared to those of the literature. RESULTS: The frequency of bilateral breast cancers was 4.7% (24/506). In 87.5% of cases, these were metachronous cancers with a mean interval of 45 months (12-144 months). Patients under 40 at first cancer ran a fivefold superior risk than women more than 40 (P < 0.05). In cases of T3 or T4 tumors, the risk was 10-fold superior to that in smaller ones (P < 0.05). DISCUSSION AND CONCLUSION: Significantly more first metachronous tumors were invasive adenocarcinoma cancers. Histologic type of first and second tumor was the same in all cases. The prognosis depends at once on the first and second cancer staging and the treatment must be done according to the same rules as in the first cancer.

[Renal transplantation and pregnancy. Report of a case]. / Transplantation rénale et grossesse. A propos d'un cas.

The authors report a case, the first in Morocco, of a kidney transplanted woman pregnancy. The pregnancy occurred eleven months after the kidney transplantation. The renal function has not been modified. Treatment immunosuppressor has been maintained. The pregnancy evolution has been marked by a moderate hypertension arterial without child reverberation. To shortcoming this observation and to the lights of data of the literature, authors recalls factors that condition the stability of the renal function and the good progress of pregnancy and insist on the necessity of the scheduling of pregnancy and a multidisciplinary surveillance.

[Malignant schwannoma of the breast. A case report]. / Schwannome malin du sein. A propos d'un cas.

Malignant schwannoma is a very rare sarcomatous tumor of unknown etiology. Primary mammary localization is exceptional. Clinically, the tumor manifests as an isolated painless nodule visualized as a benign nodule on standard radiogram. Positive diagnosis is provided by pathology. Treatment is surgical. The risk of local recurrence imposes a radical treatment. We report one case and review the literature, underlining the difficulties encountered in diagnosis and emphasizing the recurrent nature of this tumor after conservative treatment.

[Complete non-obstetrical uterine inversion]. / Inversion utérine complète non obstétricale.

A rare case of a gynaecologic uterine inversion is reported emphasizing on the exceptional character of the gynecologic uterine inversion and the pathogenic problems which are tackled. Gynaecologic inversion results from a tumor implanted on fundus of the uterus or from the essential atrophy of suspension ligaments of the uterus. Treatment depends on the anatomic type and the stage.

[In vitro effects of the alkalinization of 0.25% bupivacaine and 2% lidocaine]. / Effets in vitro de l'alcalinisation de la bupivacaïne 0.25% et de la lidocaïne 2%.

Recent clinical studies have suggested that alkalinization of local anaesthetic agents may shorten the onset time and lengthen their duration of action. In clinical practice, sodium bicarbonate 1.4 and 4.2% are often added to local anaesthetic agents to obtain these effects. We evaluated pH changes of 4 local anaesthetic solutions commonly used for obstetrical epidural anaesthesia, in order to develop titration curves with sodium bicarbonate 1.4 and 4.2%. Local anaesthetic agents tested included lidocaine 2% and bupivacaine 0.25% with and without epinephrine. Each one was divided in 10 mL aliquots, and supplemented with 25 micrograms of sufentanil (1 mL). The pH measurement were made with a pH-meter P 500 with a combined electrode (TBC 12/HS) in the standard solution and after incremental addition of 0.5 mL of 1.4 or 4.2% sodium bicarbonate. The percentage of the free form of local anaesthetic was calculated for each step, using the Henderson-Hasselbalch equation. Results showed that alkalinization is not beneficial with epinephrine free solutions. Increasing volumes of sodium bicarbonate, buffered the acidic effect of sodium bisulfite present in solutions containing epinephrine, and increased the percentage of the free form of local anaesthetic to the level of epinephrine free solutions. From this pH point upwards, the gain is poor and precipitates are generated. This study suggests that 1 mL of 4.2% sodium bicarbonate for 10 mL of local anaesthetic solution is the best theorical choice for alkalinization of a local anaesthetic associated with epinephrine.

Correlations between mean LH levels and LH pulse characteristics: differences between normal and anovulatory women.

OBJECTIVE: Since LH secretion occurs as a series of pulses, relationships between mean LH levels and LH pulse characteristics are to be expected. The aim of this study was to determine whether such relationships are similar in normal women and anovulatory patients. DESIGN: We studied the correlations between mean LH levels and the products amplitude x frequency and area x frequency of LH pulses in normal women and in patients with disorders of ovulation. Blood samples were taken from each subject every 10 minutes during 6 hours on the 8th day after the last menses. PATIENTS: The patients were divided into three groups: patients with polycystic ovary syndrome (n = 11), patients with idiopathic anovulation (n = 14) and patients with short luteal phase (n = 13). Their results were compared to those of 12 normal women. MEASUREMENTS: LH was evaluated with an immunoradiometric assay. LH data were analysed with a 3 standard deviation threshold criterion for significant peaks, and with cluster analysis algorithm using 1, 2.5 and 5% false positive error rates and 'optimal parameters' (which give less than 5% false positive and false negative error rates in LH male data). RESULTS: Highly significant correlations between amplitude x frequency, area x frequency and mean LH were found in normals and patients with short luteal phase; no significant correlation was found in patients with polycystic ovary syndrome, while significant correlations were found in patients with idiopathic anovulation only with some of our criteria for peak detection. CONCLUSION: The differences that we found between the groups suggest that when commonly used methods are employed to determine LH pulse characteristics, most of the significant LH pulses are taken into account in normals and patients with short luteal phase, but not in anovulatory patients, especially in patients with polycystic ovary syndrome. This method using two correlations appears to be a simple and useful way to show the differences in the mechanisms by which mean LH levels are achieved in normal subjects and patients.

Properties of membranous phospholipase C from WRK1 cell: sensitivity to guanylnucleotides and bacterial toxins.

As previously described, WRK1 plasma membrane possesses a vasopressin-sensitive phospholipase C [G. Guillon et al., 1986, FEBS Lett. 196, 155-159]. In the present study, we examined the sensitivity of this enzyme to guanylnucleotides. GTP gamma S induces a time- and dose-dependent stimulation of Ins(1,4,5)P3 and Ins(1,4)P2 accumulation. No accumulation of InsP1, Ins(1,3,4)P3 or Ins(1,3,4,5)P4 occurred under similar conditions. Gpp(NH)p produced the same effect but was less potent. GTP and a nonhydrolyzable analogue of ATP, App(NH)p, were without effect. Calcium also stimulated the phospholipase C activity in a time- and dose-dependent manner. In the absence of calcium, the activity of GTP gamma S was considerably reduced. Physiological calcium concentrations (between 10(-8) and 10(-7) M), allowed maximal GTP gamma S stimulation of phospholipase C activity. In this system, the presence of vasopressin alone did not generate inositol phosphate accumulation. However, this hormone: (i) reduced the lag-time observed during GTP gamma S stimulation, (ii) increased the sensitivity of phospholipase C to GTP and to GTP gamma S, and (iii) did not modify the stimulation of phospholipase C induced by maximal doses of GTP gamma S. Unlike sodium fluoride, GTP gamma S elicited an irreversible activation of phospholipase C. Calcium, GTP gamma S and sodium fluoride stimulated the phospholipase C activity via mechanisms sharing a common step, since their maximal effects were not additive. Cholera toxin treatment, known to produce complete ADP-ribosylation of 'alpha s' subunits, partially reduced the basal and the maximal GTP gamma S-mediated stimulation of phospholipase C activity as well as that caused by vasopressin. This inhibition was not mimicked by treatment with either forskolin or pertussis toxin.

[Not Available]. / Action comparée de deux antibiotiques lonophores (Nigéricine et Epinigéricine) sur les teneurs en ADN macronucléaire du cilié Tetrahymena pyriformis GL, en culture synchrone.

Antibiotics (30 mg/1) added at T 60 mn. lead, in a part of the population, to an increase of the macronuclear DNA content resulting from DNA activity during a phase S 2 which begins after the phase G 2. The largest cells have the highest DNA content and the longest generation time. The results are confirmed by autoradiography with tritiated thymidine. The percentage of macronuclear labelling increases from T 150 to a maximum at T 180, and it is greater with nigericin (46%) than with epinigericin (37%). Thus, epinigericin is less toxic than nigericin.

Mechanisms of phospholipase C activation: a comparison with the adenylate cyclase system.

Many hormones, neurotransmitters or other signaling molecules exert their biological activities through the stimulation of a specific phospholipase C. Once activated, this enzyme hydrolyzes polyphosphoinositide into inositol trisphosphate and diacylglycerol, two products known to regulate the cytosolic calcium concentration and the activity of protein kinase C, respectively. The molecular mechanisms leading to the activation of phospholipase C after the binding of the signal molecule to its specific receptor remain unclear. Yet, recent studies demonstrated that at least three molecules were implicated: the receptor, the phospholipase C and a GTP binding protein. In this review, we have summarized the properties of such systems and, more particularly, those of the vasopressin-sensitive phospholipase C present in WRK1 cells. The existence of many functional and structural analogies for the receptors which regulate adenylate cyclase activity is discussed.

[Hemorrhagic hepatic lesions in toxemia of pregnancy]. / Les lésions hépatiques hémorragiques de la toxémie gravidique.

One case of hepatic hemorrhage during toxemia of pregnancy is reported. This complication occurs in the last trimester of the pregnancy or immediately after labor. The diagnosis is usually made per-operatively. The anatomical lesions are subcapsular hematomes or spontaneous rupture of the liver. Surgery is only treatment and must be conservative. The very high mortality rate has generally been attributable not only to uncontrolled hemorrhage but also to disorders of hemostasis associated and to multiple organe failure.

[Brachial plexus block and locoregional anesthesia of the upper limb. Apropos of 50 cases]. / Bloc du plexus brachial et anesthésie loco-régionale du membre supérieur. A propos de 50 cas.

The authors report their experience about 50 cases of supra clavicular plexus block realised by Kulenkampff method. The anesthesia obtained has been complete in 84% of cases and in the 16% remaining general anesthesia was necessary to permit surgery. A case of late moderate pleural detachment and a case of post anesthesia paresthesia both spontaneously resolving were registered. Actually the adoption of perivascular techniques of brachial plexus anesthesia (interscalenic, supraclavicular, axillary) have greatly improved the performance of this variety of upper limb locoregional anesthesia, thus reducing the percentage of failure and eliminating or reducing the risk of pneumothorax. Locoregional anesthesia of the upper limb should constitute a daily method in the surgery of upper limb and not a technic subordinated to the contra-indications of general anesthesia.

[Compensation for bleeding in a surgical milieu. Importance of normovolemic hemodilution. Apropos of 25 cases]. / Compensation du saignement en milieu chirurgical. Intérêt de l'hémodilution normovolémique. A propos de 25 observations.

In order to get round blood supply difficulties, 25 patients undergoing hemorrhagic interventions (blood loss average of 1,500 ml) were subjected to the techniques of normovolemic hemodilution. Preoperatively a volume of 1,080 ml of blood was taken in every patient (a total of 271 in all patients together); the blood was simultaneously replaced by 1,300 ml of macromolecules (modified fluid gelatin polymer and/or low molecular weight dextran according to disponibility). Two thirds of the taken amount are transfused to the patients preoperatively immediately after surgical hemostasis has been achieved or when the hematocrit is about 20%; the last third is administered in the immediate postoperative period. The economy of blood realised by this technique is considerable (119 units of homologous blood). The rationale depends on two essential particularities: on one hand, the diminution of blood loss since at a hematocrit of 25% the loss is only 50% of the globular mass which would have disappeared at normal hematocrit; on the other hand, the compensation of hemorrhage by transfusion of fresh autologous blood, eliminating homotransfusion reactions. The main hematocrit obtained 24 hours after transfusion is about 34%. Thus, economy of blood and rheological advantages (amelioration of microcirculation, increase of capacity of oxygen transport, increase of tissular oxygenation) must induce physicians to reexamine their behaviour in transfusion strategy and compensation of hemorrhage because the optimal hematocrit in normovolemy is of about 30%.