Aportaciones de la fluorescencia a la cirugía endocrina

The use of fluorescence in surgery has expanded and become widespread in recent years, which has led to a real technological phenomenon with the emergence of devices adapted for use in laparoscopic and robotic approaches. Fluorescence-guided surgery in the field of endocrine surgery is also on the rise. More and more articles describe its use in surgery of the thyroid, parathyroid and adrenal glands, although the series are still modest in size and protocols have not been standardized. There are currently several developing areas for the application of fluorescence in endocrine surgery, including the use of fluorescence with indocyanine green in adrenal gland surgery, the identification and prediction of parathyroid perfusion with indocyanine green, and autofluorescence of the parathyroid glands. The objective of this article is to review the current applications of fluorescence in endocrine surgery.     

Circulation intraosseuse : de la physiologie à la pathologie

Blood flow within bones is unique in two ways: the blood circulates within a closed cavity in which pressure must remain constant, a feat achieved in part thanks to the considerable distensibility of the intraosseous vessels and, above all, veins; the intraosseous circulation allows traffic of minerals between the blood and bone tissue and sends the blood cells produced within the bone marrow into the systemic circulation. In contrast, the arterioles and capillaries within bones have the same anatomic structure as those located elsewhere in the body and are susceptible to arteriosclerosis, arteritis, or thrombosis. The mechanisms that regulate blood flow within bone are incompletely understood, probably because they are difficult to study in vivo. The cytokines and growth factors that regulate intraosseous angiogenesis also regulate bone remodeling, and close links exist between the blood supply to bone and bone formation and resorption : most diseases characterized by increased bone resorption are associated with increased bone vascularization. The vascular bud located at the center of bone multicellular units (BMUs) may determine the timing of bone resorption and bone formation. Avascular bone necrosis and bone infarction may result from acute blood vessel occlusion (thrombosis, lipid emboli, fat cell hypertrophy with compression of intraosseous capillaries), whereas arteriosclerosis may contribute to the development of osteoporosis.     

El peso de la comorbilidad del paciente se correlaciona con la gravedad de la disfunción eréctil

Objective

To explore the potential relationship between erectile dysfunction (ED), low testosterone levels, and the Charlson Comorbidity Index (CCI).

Cancer et religiosité : la connaissance de la maladie affecte-elle le degré de la foi en Dieu ?

ObjectiveTo measure the influence of knowledge of one's cancer on the degree of religious faith in patients.MethodQuestioning of 117 patients with cancer who were admitted to the oncology department of the Hôtel Dieu de France Hospital during the period from 24 November 2005 to 1 December 2005, and filling out of an Arabic version of the SCSORF questionnaire: the higher the score on this questionnaire, the more it indicates a high level of religious faith.ResultsWe found a higher score in patients who knew about their disease than in those who did not (p<0.001), a higher score in women than in men (p<0.05), a higher score in Muslims than in Christians (p<0.01), but Christians had a higher score on the question concerning comfort in religious faith (p<0.001), a higher score in patients with relapse of their disease than those with no relapse (p<0.01), and a higher score in patients who were not taking benzodiazepines than in those who were taking them (p<0.05). We also found a positive correlation between education level and knowledge of the disease (p<0.05), a positive correlation between the time lapsed since diagnosis and the frequency of prayer (p<0.05), and a negative correlation between education and the preference for being in a group of people of the same faith (p<0.05).ConclusionThis study is the first to demonstrate that knowing one's cancer diagnosis is a factor that increases the degree of religious faith, independently of the everyday stress experienced by the patient. This underscores the importance of the patient's faith in better controlling the symptoms of the disease and the side effects of the treatments, with a reduction in the use of benzodiazepines.     

Anesthésie péridurale pour la chirurgie de la cheville et du pied: influence de la position assise

The effects of the sitting position on the quality of both sensory and motor blockade of segments L5 and S1 and the haemodynamic consequences during epidural anaesthesia were studied on 39 patients undergoing ankle or foot surgery. After insertion of an epidural catheter with the patient in the lateral position, 19 patients were kept sitting for 15 min following the injection of the local anaesthetic and 20 remained supine for the duration of anaesthesia (control group). All patients received a dose of 20 ml of 1.73% carbonated lidocaine with epinephrine 1:200,000. The quality and time of onset of the sensory blockade for segments L1-S2 as well as its cephalad spread were comparable in both groups. Fourteen patients of the sitting group achieved motor blockade of more than three of five myotomes compared with five patients in the supine group (P less than 0.001). The maximum decrease in mean arterial pressure occurred sooner in the sitting group (14 +/- 9 min) than in the control group (21 +/- 10 min; P less than 0.01) and was more severe (-24 +/- 10% vs -16 +/- 10% respectively; P less than 0.05). Our results indicate that placing the patient in the sitting position for 15 min after inducing epidural anaesthesia does not influence caudal sensory blockade but does increase the depth of motor blockade.     

Control de la hemostasia durante la nefrectomía parcial laparoscópica sin renorrafia parenquimatosa: la experiencia Vivostat®

ObjectiveTo present our experience using an autologous fibrin sealant prepared with the Vivostat system^® to control haemostasis without any renal parenchymal reconstruction.Material and methodsWe performed 45 laparoscopic partial nephrectomies using this haemostatic agent. The surgical steps were: colon mobilization, identification of ureter, renal vessels and renal tumor, renal artery control with Rummel tourniquet, tumor excision with harmonic scalpel, application of fibrin glue to the resection bed twice (before and after kidney reperfusion). Patients were evaluated for acute or delayed bleeding.ResultsMean age was 63.9 years (33-80); mean tumor size was 2.5 cm (1.5-4); mean operative time was 136.1 min (90-180). Mean warm ischemia time was 19.2 min (10-30). Mean blood loss was 97 ml (50-300). Individual haemostatic stitches were performed before application of the sealant if acute bleeding was observed (14 cases). We did not achieve any case of postoperative bleeding from resection bed or renal failure. 1 patient required transfusion due to an abdominal wall haematoma. 65% were clear cell carcinoma, 10% were papillary carcinoma, 20% were oncocitoma. Free margin rate was 100%. Mean hospital stay was 4 days (2-6). Mean follow-up was 14 months (5-45).ConclusionsExcluding renorrhaphy during laparoscopic partial nephrectomy is feasible and safe. Our initial experience with the vivostat system in laparoscopic partial nephrectomy has been encouraging, but longer follow-up is needed to determine the real benefit of this surgical technique in laparoscopic partial nephrectomy