Comparison of clinical outcomes and spectral Doppler indices of uterine and ovarian stromal arteries in women undergoing myomectomy with or without hypogastric arterial ligation.

OBJECTIVE: To compare clinical outcomes and hemodynamic alterations of uterine and ovarian stromal arteries between patients with symptomatic myomas undergoing myomectomy preceded by arterial ligation and those undergoing myomectomy alone. METHODS: In this prospective, non-randomized comparative study, myomectomy was performed on 69 women with symptomatic myomas. Myomectomy alone was performed in 31 patients (Group I) and myomectomy with concomitant bilateral hypogastric arterial ligation was performed in 38 patients (Group II). In both groups, surgical results and clinical outcomes were evaluated by peripheral hemoglobin levels, a pictorial blood-loss assessment chart, and visual analog scales. Spectral Doppler indices of uterine and ovarian stromal arteries, including peak systolic velocity, end-diastolic velocity, pulsatility index and resistance index were performed preoperatively, and 1 day and 1 or more months postoperatively. RESULTS: Twenty-two patients in Group I and 31 patients in Group II received regular follow-up examinations for a mean follow-up period of 10.1 months. Menstrual flow, dysmenorrhea and hemoglobin levels improved significantly after surgery in both groups. Blood loss during surgery was less in Group II than it was in Group I (P=0.02). Doppler indices of uterine and ovarian stromal arteries from preoperation to mean follow-up point were not significantly different between the groups, except for a significantly lower uterine artery pulsatility index in Group II (P=0.01). CONCLUSIONS: Myomectomy with hypogastric arterial ligation for symptomatic myomas is as efficient as is myomectomy alone and reduces blood loss during surgery. Serial Doppler studies showed that hypogastric ligation does not block uterine and ovarian perfusion, and even reduces the impedance of the uterine arteries. The long-term recurrence rate after myomectomy with hypogastric arterial ligation remains to be determined.     

Critères non histologiques prédictifs de malignité d’un ulcère gastrique

Acta Endoscopica - Le but de cette étude était d’étudier les caractères non histologiques des ulcères malins. Nous avons effectué de janvier 1986 à...     

Spinal concentrations of amoxicillin in purulent meningitis in children

Hundred and fifteen children suffering of purulent meningitis (S.pneumoniae: 19; H.influenzae: 44; N.meningitidis; 23; others: 29) were treated by amoxicillin 200 mg/kg/day in four intramuscular injections. Spinal taps for assay of antibiotic levels in the CSF were taken 1 or 3 or 6 hours after the injection. The levels were respectively for this samples of 6.9 -1.7-1.4 micrograms/ml during the first 48 hours of treatment and 4.4-1.7-1.9 after one week. The concentrations CSF/serum were from 5 to 9.8 per cent at the beginning of treatment.     

Hepatitis B virus serological markers in Africans with liver cirrhosis and hepatocellular carcinoma

Serum samples were collected at the time of hospitalization from 221 black Africans suffering from cirrhosis and 453 suffering from hepatocellular carcinoma (HCC). These patients came from Senegal, Burundi and Mali, and 6655 adults from different population groups in these countries were used as controls. Hepatitis B virus (HBV) serum markers, including hepatitis B surface antigen (HBsAg), anti-HBs, antibody to hepatitis B core antigen (anti-HBc), HBeAg and anti-HBe, were determined by radioimmunoassay, while alpha-fetoprotein and complexes between HBsAg and IgM were detected by ELISA tests. HBsAg was detected in 11.8-17.6% of controls as opposed to 63.3% of patients suffering from cirrhosis and 62.7% of patients suffering from HCC. There was less evidence for HBV replication in cirrhosis and HCC in older patients. A significant increase in the frequency of HBsAg/IgM complexes was found in passing from the HBsAg chronic carrier state (13.9%) to cirrhosis (29.9%) and finally to HCC (33.7%).     

Environmental lead exposure and its relationship to traffic density among Senegalese children: a cross-sectional study

Leaded-gasoline is probably the primary source of lead (Pb) exposure in Dakar (Senegal). The present cross-sectional study was undertaken to investigate the levels of Pb in Senegalese children and to present helpful data on the relationship between Pb levels and changes in biological markers of heme biosynthesis and oxidative stress. A total of 330 children, living since birth either in rural or urban areas (ie, Khombole (n = 162) and Dakar (n = 168), respectively) were included. During this cross-sectional study, the mean blood (B)-Pb level in all children was 7.32 +/- 5.33 microg/dL, and was influenced by the area of residence and gender. In rural children, 27 subjects (16.7%), 18 boys (19.6%) and nine girls (12.9%), had a B-Pb level > 10 microg Pb/dL, whereas 99 urban children (58.9%), respectively, 66 boys (71.8%) and 33 girls (43.4%), had alarmingly high B-Pb levels. Accordingly, urine delta-aminolevulinic acid levels were higher in children living in the urban area than in the rural areas (P < 0.001), and closely correlated with the B-Pb levels (P < 0.01). Moreover, glutathione peroxidase (GPx) activity, selenium (Se) level, glutathione reductase (GR) activity, and glutathione status were significantly influenced by area of residence and/or by gender. GPx activity and Se level were not only negatively correlated with B-Pb levels, but also positively correlated together (P < 0.01). Taken together, the present results allow us to conclude that urban children have higher B-Pb levels than rural children, and that of these children, boys have higher B-Pb levels than girls, leading thereby to alterations of heme biosynthesis and pro-oxidant/antioxidant balance. We also suggest that exposure to Pb and the Pb-induced adverse effects merits attention and that the development of preventive actions are of increasing importance in Senegal.     

Attitudes of Finnish doctors towards euthanasia in 1993 and 2003

Questionnaire studies on the attitudes of Finnish doctors towards euthanasia were conducted in 1993 and 2003, and the results show that they have not become more positive.The attitudes of doctors towards active euthanasia are, in general, more negative than the attitudes of the general public. The interpretations of surveys are, however, highly dependent on the formulation of the questions and, although the questions posed to these groups are similar, it is probable that the interpretations of doctors differ from those of the general public.According to most studies, most doctors, except those from The Netherlands, are against legalisation on active euthanasia. Considerable variation exists in the percentage of doctors opposing the practice. The variation is, of course, partly because of the variation in opinion, but several methodological issues also explain it. Some studies have asked direct questions about the legalisation of euthanasia—for example, in others, the questions have been about the ethical acceptance of the practice. Some studies have used case vignettes, whereas others have used general questionnaires. The knowledge and availability of palliative care may also affect the answers.¹The definition of euthanasia is of particular importance in the studies. The distinction between passive euthanasia (ie, withholding or withdrawing life‐saving treatment) and active euthanasia (ie, deliberately terminating the life of the patient with a lethal drug, for example,) has not always been clear.Although numerous studies with different methods have focused on the attitudes of doctors towards euthanasia and other practices at the end of life, we lack knowledge on possible changes in these attitudes. Legal changes in The Netherlands and Belgium, and open public discussion on these issues, most recently in the Council of Europe (http://assembly.coe.int/Documents/WorkingDocs/Doc03/EDOC9898.htm), may lead us to think that the attitudes of doctors have also become more positive. This study determined whether such a change had taken place in Finland.