Cure of inguinal hernias with large preperitoneal prosthesis: Experience of 2,312 cases.

It is clear that the recurrence rates after nonprosthetic methods for the repair of inguinal hernias, like McVay, Bassini or Shouldice techniques, are high (6-10%). Since 20 years, we are convinced, in the GREPA-EHS group, about the advantages of the use of a prosthetic mesh in majority of patients for repairs of primary or recurrent inguinal hernias and incisional hernias. We describe our typical technique for the cure of all inguinal hernias. We place a large supple mesh, by open inguinal route, posterior to the transversalis fascia and anterior to the peritoneum. We have made a double modification in the initial technique of Rives - the use of a very large unsplit prosthesis (15 × 17 cm) and the parietalization of the spermatic cord helped by a wide opening of the Fruchaud's orifice by diversion of the epigastric vessels. The positioning of the mesh is about the same as in the TEP technique but with the advantages of reduction in the vital laparoscopic risks and reinforcement of the wall by a short tension-free McVay technique.For this prospective study, we repaired 2,312 consecutive hernias in 1,828 patients, 284 of which were recurrent. We present our results in terms of quality of repairs, recurrence rates (0.4%), morbidity rate (8%), and mortality rate (0.8%).This technique involves the placement by an open incisional route of a large preperitoneal sheet of mesh for initial treatment of all inguinal hernias - including scrotal, giant or femoral - to ensure a definitive solid muscular wall, even for recurrent hernias.

[Clear cell sarcoma of the kidney in a young adult]. / Sarcome à cellules claires du rein chez un jeune adulte.

We report a case of clear cell sarcoma of kidney (CCSK), in a young adult. This highly malignant renal tumor usually arises in children of one or two year old and represents 4% of renal tumors. The aggressivity of this tumor and its affinity to give bone metastasis imply to recognize it in order to institute appropriate chemotherapy.

Self-cloning in filamentous fungi: application to the construction of endothiapepsin overproducers in Cryphonectria parasitica.

The filamentous ascomycete fungus Cryphonectria parasitica naturally secretes endothiapepsin, an aspartic proteinase. It is cultured on a commercial scale as a source of the milk-clotting enzyme for cheese making. Our objective was to increase enzyme production of an industrial C. parasitica strain by a new technique of self-cloning; it consisted in the screening for transformants producing higher levels of endothiapepsin and having integrated only the DNA fragment of interest. Such genetically improved strains that are devoid of any foreign genes should be more readily acceptable for the production of food-grade enzymes.

Study of pH and temperature-induced transitions in urate oxidase (Uox-EC1.7.3.3) by microcalorimetry (DSC), size exclusion chromatography (SEC) and enzymatic activity experiments.

Purified recombinant urate oxidase (urate oxygen oxidoreductase EC 1.7.3.3. re-Uox) has been studied by means of differential scanning calorimetry (DSC) in correlation with enzymatic activity measurements and size exclusion chromatography. Differential scanning calorimetry curves versus pH show two endothermal effects in the pH range 6-10. The first endotherm reveals a maximum stability between pH 7.25 and pH 9.5 corresponding to a temperature of transition T(m1) of 49.0 degrees C and an enthalpy of transition of 326 kJ mol(-1). This value dramatically decreases below pH 7.25. The behavior of the second endotherm is more complex but the temperature of transition T(m2) is constant between pH 9 and 7.25 and a maximum for the corresponding enthalpy is obtained near pH 8 with DeltaH(2)=272 kJ mol(-1). An optimal pH of 8.0 for the stability of the enzymatic activity at elevated temperature was also found which was in good agreement with calorimetric results. Reversibility of the first endotherm is obtained from 20 to 51.5 degrees C. The calorimetric result is correlated to enzymatic activity, purity by size exclusion chromatography (SEC) and protein concentration measurements. In contrast, for the second endotherm, after heating up to 68.9 degrees C, no reversibility was found. Interaction with structural analogues of urate has been studied by DSC. 8-Azahyooxanthine has only a small effect and caffeine has no effect at all. With 8-azaxanthine, a rapid increase of the T(m1) function of the concentration is obtained. At high concentration T(m1) reached the T(m2) value which remained unaffected.

Photosensitive and phototriggered pityriasis rubra pilaris.

We report a 59-year-old man with photosensitive and photodistributed pityriasis rubra pilaris. The phototriggering of the lesions was obtained by the iterative polychromatic phototest (3 times the minimal erythema dose (MED) on 3 consecutive days) and was also observed on the supra MED sites, which began the 10th day and persisted several months. Our results are comparable to those already obtained in photosensitive psoriasis, which helped us to identify the clinical similarities of photosensitivity in these two instances of dermatosis.

[The endometrium under the effects of hormone replacement therapy in menopause with percutaneous estradiol and low-dose micronized progesterone]. / L'endomètre sous traitement hormonal substitutif de la ménopause par estradiol percutané et progestérone micronisée à faible dose.

AIM: The aim of our study is to evaluate the effects of a new combined association of percutaneous estradiol with oral micronized progesterone during 25 days/month and to confirm that a low dose of progesterone (100 mg/day) can adequately counteract endometrial proliferation induced by estradiol. METHODS: 78 endometrial tissue samples were obtained in a multicenter study on the effects of hormonal replacement therapy of the menopause. Endometrial biopsies were performed on average at the 6.6 month of the hormonal substitution (range: 5-13 months) after 12 days minimum exposure to progesterone. The morphological evaluation was performed blindly. RESULTS: All endometria are only slightly developed, without hyperplasia. Four groups were individualized: subatrophic endometrium (3), quiescent endometrium (48), slightly active endometrium (18), and endometrium with marginal secretion (6). Rare mitosis images have only been found in slightly active endometria. Their number is always very much below the normal proliferative phase with only 3 cases between less than 3 and 6 mitoses per 1000 glandular epithelial cells. CONCLUSION: A low micronized progesterone dose (100 mg/day) over a long period (25 days per month) allows to efficiently control the estrogen-induced endometrial proliferation. This adequate endometrial response is responsible for a high incidence of amenorrhea, often asked by patients, and for rare spottings.

[The value of extemporaneous study of the surgical margins of cancers of the upper aero-digestive tract. Apropos of 129 cases of oral and oropharyngeal tumors]. / Intérêt de l'étude extemporanée des limites d'exérèse dans les cancers des voies aéro-digestives supérieures (V.A.D.S.). A propos de 129 cas de tumeurs buccales et oro-pharyngées.

129 patients, who had oral cavity or oropharyngeal carcinoma underwent excision with intraoperative histopathologic examination. Thanks to this method, the number of satisfying resections has increased from 25% to 75%. Whatever the quality of the surgical excision may be, postoperative radiotherapy improves the prognosis.

Prognostic factors in soft tissue sarcomas. A multivariate analysis of 109 cases.

Prognostic factors were evaluated in 109 soft tissue sarcomas of the extremities, walls of the trunk, head, and neck. All lesions were graded according to the systems proposed by the National Cancer Institute (NCI) and the French Federation of Cancer Centers (FNCLCC), and a correlation was found between tumor grade and prognosis. Univariate analysis selected the following variables as unfavorable prognostic factors: invasive tumor margins, extra-compartmental status, deep tumors, tumor diameters over 5 cm, inadequate excision, presence of necrosis, high mitotic count, histologically undifferentiated tumors, and blood vessel invasion. These variables were found to be interdependent. Multivariate analysis selected quality of surgery as the most important variable for predicting local recurrences. The factors selected with regard to overall and metastasis-free survival were tumor size, tumor margins, necrosis, and adequacy of excision. These results permitted classification of patients into four prognostic groups: two with good and two with bad prognosis. Five-year survival for the four groups was 100%, 83%, 53%, and 0%; 5-year metastatic rates were 0%, 12%, 67%, and 100%. Similar groups were obtained when the variables of tumor margins and size were combined with an adaptation of the NCI grading (low-grade tumors/high-grade tumors without necrosis/high-grade tumors with necrosis). Comparative analysis showed that patients with tumors of the same histologic grade or type were not necessarily classed in the same prognostic groups. A better clinicopathologic correlation was obtained using a combination of prognostic factors than with histologic grading or typing alone.

Mechanism of selectivity in ion-pair high-performance liquid chromatography of aminoglycoside antibiotics using perfluorinated pairing ions.

The behaviour of perfluorinated carboxylic acids as pairing ions for the chromatography of the aminoglycoside antibiotics was studied. As with perhydrogenated pairing ions, the capacity factor can be modified according to the percentage of organic modifier and the nature and concentration of perfluorinated pairing ion in the mobile phase. The special selectivity effect observed with trifluoroacetic acid was investigated and interpreted as a concerted mechanism involving ionic and hydrophobic interactions.

[Cutaneous and visceral sarcoidosis. Apropos of an exceptional form]. / Sarcoïdose cutanée et viscérale. A propos d'une forme exceptionnelle.

We present here an exceptional case of cutaneous and vascular sarcoidosis associated with lesions of the liver, spleen and lymph nodes. The disease began when this male patient was 27 years' old and gradually extended over 35 years, despite long-term systemic corticosteroid therapy. Clinically, the initial cutaneous lesions were atrophic, erythematous and squamous, resembling those of erythroderma; they were located on the skin of the right popliteal fossa, the left arm, the neck, the upper part of the chest and around the waist. Subsequently, they spread slowly to involve almost the entire skin, except for the face, right upper limb, left lower limb, hands and feet. The most ancient of these lesions were distinctly black. The skin was paper thin due to complete disappearance of the subcutaneous tissue. Left temporo-parietal alopecia of the cicatricial type developed towards the end of the patient's life. The nails remained normal throughout, and there were no other cutaneous signs of sarcoidosis. Initially, the venous network was clearly visible beneath the atrophic skin, but later on, the veins became grossly dilated and sacculated in those areas which had first been invaded by skin atrophy. Phlebography of the left upper limb confirmed the venous dilatation, while arteriography of the upper limbs showed multiple sacciform aneurysms of the subclavian, axillary and brachial arteries, with distal thrombosis of the latter vessel. Histology showed typical lesions of sarcoidosis in a vein; no arterial biopsy was performed. The muscles had a nodular and sclerous appearance; amyotrophy developed in the last stages of the disease; tendons and joints were normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical studies with human growth hormone releasing factor in normal adults and patients.

The recent availability of human growth hormone releasing factor (hGRF) encouraged thorough investigations of human growth hormone secretion. Moreover it is now possible to put forward a therapeutic application for this hormone. Herein, we report the dose-effect relationship obtained between hGRF and GH response in normal young men submitted to IV administration of doses ranging from 2.5 to 600 micrograms per subject, in three protocols. In some subjects the 2.5 micrograms dose elicited GH secretion as compared with placebo. A highly significant dose-effect was observed (based on GH-AUC and GH-peak) for doses ranging from 5 to 80 micrograms. Responses were identical above 80 micrograms. We conclude that the optimal dose required to elicit maximum GH release with minimal unwanted effects is 80 micrograms in adults. These are related to the dose and observed for doses up to 80-150 micrograms. Subcutaneous administration also induced GH-release, with relationship to the doses used (100, 300 and 600 micrograms per subject). The mean response to the highest dose (600 micrograms) was comparable in timing and magnitude to that obtained with a 100 microgram intravenous dose. Bioactivity of GH released under hGRF was proven in the Nb2 lymphoma cell multiplication assay and a high correlation was obtained between bioassay and radioimmunoassay. GH was present in blood after hGRF under 3 molecular forms corresponding to little, big and big-big GH with percentages of 50, 30 and 20, respectively. An early and slight increase in prolactin was found to be related to the hGRF doses above 80 micrograms. No change was observed for doses less than 80 micrograms.(ABSTRACT TRUNCATED AT 250 WORDS)

Investigation of human growth hormone releasing factor in adults.

A dose-effect relationship between human growth hormone (GH) releasing factor (hGRF) and GH response was demonstrated for doses ranging from 5 micrograms per subject (minimal active dose) to 40-80 micrograms per subject (minimal dose for maximal effect). Bioactivity of GH released under hGRF was proven in the Nb2 lymphoma cell multiplication assay. Unwanted effects were observed for doses equal to or larger than 150 micrograms. Pharmacokinetic parameters were calculated from the immunoreactive GRF plasma concentrations obtained after intravenous injections of various doses. The half-lives were 6.8 +/- 0.4 min and 43.2 +/- 3 min for distribution and elimination phases, respectively. Subcutaneous administration of hGRF was shown to be effective for promoting GH release, with doses higher than those required by intravenous administration. Intermittent intravenous injection of hGRF, at 3-hour intervals, resulted in a decrease in the magnitude of GH response in normal subjects.

Comparative studies of lipopolysaccharide and exopolysaccharide from a virulent strain of Pseudomonas solanacearum and from three avirulent mutants.

The composition of the Pseudomonas solanacearum lipolysaccharide (LPS) was found to be similar to that described for the LPS of enterobacteria. The lipid A contained fatty acids and glucosamine in a molar ratio of 5:2. The LPS fraction contained 2-keto-3-deoxyoctulosonic acid, L-glycero-D-mannoheptose, hexoses (glucose, rhamnose, and glucosamine), and a pentose (xylose). The LPSs from the wild-type strain (GMI1000), from the spontaneous rough mutant (GMI2000), and from their respective acridine orange-resistant (Acrr) mutants (GMI1178 and GMI2179) contained the same component sugars in their polysaccharide moieties, but the relative amounts of each sugar varied greatly. Spontaneous mutation to the rough type was characterized by a decrease in the ratio of rhamnose to glucose, whereas a reverse effect was seen for the acridine orange resistance mutation from the parent strains (GMI1000 and GMI2000) to the respective mutant strains (GMI1178 and GMI2179). The exopolysaccharide (EPS) from GMI1000 was found to be composed of two fractions: a heteropolysaccharide (galactosamine, glucose, and rhamnose) excluded from Sephadex G-50 and an additional glucan with a lower molecular weight. Strains GMI1000 and GMI1178 produced comparable amounts of EPS, GMI2179 synthesized less EPS, and GMI2000 produced no detectable EPS. High-pressure liquid chromatography and 13C nuclear magnetic resonance analyses revealed some differences between these EPSs. The glucan fraction seemed to be the major component of the EPS from GMI2179, whereas GMI1000 and GMI1178 EPSs contained both fractions and appeared to differ in the structures of their heteropolysaccharide fractions. Viscosity measurements confirmed differences between whole EPSs produced by the three strains.

[Conservative surgical treatment of acute pancreatitis. Strategy and technic]. / Traitement chirurgical conservateur des pancréatites aiguës. Stratégie et technique.

Not all patients with acute pancreatitis can be cured by medical treatment alone; surgery is mandatory when signs of aggravation or complications are present. The authors propose a new strategy involving bilateral subcostal laparotomy, wide approach to the pancreas, evaluation of the lesions and therapeutic decision: either abstention or excision which may be performed according to rules or adapted to each case. The abdominal wall is then closed, often around a pre- and peripancreatic Mikulicz's drain. This method has substantial advantages: the dangers of hasty and inappropriate surgical procedures on ill-defined lesions are avoided, necrotic areas can be removed, drainage is facilitated and possible reoperations are restricted to the supramesocolic cavity.

[Treatment of inguinal hernia with unsplit mersylene prosthesis. Significance of the parietalization of the spermatic cord and the ligation of epigastric vessels]. / Cure des hernies de l'aine par prothèse de mersylène "non fendue". Intérêt de la pariétalisation du cordon et de la ligature des vaisseaux épigastriques.

The authors describe their technique of "thorough" dissection of the spermatic cord by the inguinal route. After parietalization of the cord and ligature of the epigastric vessels, a wide prosthesis of unsplit mersylene can be inserted through the groin behind the muscular layer brought down to Cooper's ligament. From their experience of 120 patients operated upon and without relapse at follow-up, they feel able to recommend this method in cases of recurrent hernias with weak walls and large sac and of hernias occurring in elderly of obese subjects.