Postoperative pain after hysterectomy through vaginal routes using electro surgical bipolar vessel sealing versus conventional suture ligature

OBJECTIVES: The purpose of the study was to compare the postoperative pain of patients who had a hysterectomy through vaginal route according to the process of binding: wire or electrosurgical bipolar vessel sealing. PATIENTS AND METHODS: Retrospective study carried out in the 60 last patients who underwent a hysterectomy by vaginal route for a benign pathology in the gynaecological service of surgery of the CHI Poissy-Saint-Germain-en-Laye until March 2006. Among these patients, 32 had profited from a binding by wire and 28 of the electrosurgical bipolar vessel sealing. The studied criteria were the post-operative pain, total morphine consumption and the durations of the analgesic treatment, the hospitalisation and intervention time. RESULTS: The postoperative pain in the first 24 hours was twice lower using thermofusion; it was valid in immediate post-operative period and after 24 hours. In addition, total morphine consumption was also significantly lower using thermofusion. DISCUSSION AND CONCLUSION: This pilot study shows that the electrosurgical bipolar vessel sealing allows a reduction in the pain into the immediate postoperative period. Other prospective and randomised studies would allow it and conclude on the duration of hospitalisation, the quality of life from the patients and the cost in terms of public health.     

Syndrome hémolytique et urémique post-diarrhéique : Quand y penser ? Quel suivi ?

Haemolytic uremic syndrome (HUS) is characterized by thrombotic microangiopathy with acute renal failure, haemolytic anaemia with schizocytes and thrombocytopenia. Typical forms (D⁺ HUS) are caused by gastrointestinal infection with Escherichia coli species producing verotoxines (or Shiga toxins, STEC). It is estimated that 5-8 % of infected individuals will develop HUS following STEC infection. E. coli O157:H7 is the most commonly involved serotype and can lead to D⁺ HUS in 15 % of young infected children. Vehicles of STEC transmission are contaminated food (ground beef, unpasteurised dairy products, unwashed and uncooked fruit and vegetables), person-to-person transmission and contact with farm animals with STEC. After an average incubation period of 3 to 8 days, patients develop painful bloody diarrhoea followed by systemic toxinemia. This may lead to thrombotic microangiopathy with endothelial damage and activation of local thrombosis. Since 1996, the Institut de Veille Sanitaire (InVS) centralises all notified French cases of D⁺ HUS in children less than 15 years of age and investigates cases regrouped by time and place for the presence of STEC risk factors. The average annual incidence ranges between 0.6 and one for 100 000 children younger than 15 years and with a peak at 1 year of age. Fifty-one percent of HUS occur between June and September. Patients with a suspicion of STEC infection or bloody diarrhoea should not receive antibiotics, antimotility agents, narcotics and non-steroidal anti-inflammatory drugs. Maintenance optimal hydration provides nephroprotection. The management of HUS remains supportive. Dialysis was required for 46 % of HUS cases in 2009. For similar indication, peritoneal dialysis has to be a first choice treatment. Neurological injury is the most frequent non-renal complication and the first cause of death. Early initiation of plasmapheresis might improve the prognosis. Overall mortality rate ranges between 1 and 5 %. One third of patients suffer from long-term renal morbidity such as proteinuria, arterial hypertension and decrease of glomerular filtration rate. The longer the duration of anuria, the greater the risk of sequellae. Any patient with a history of HUS needs a long-term renal follow-up.     

Galectin-1 modulates human glioblastoma cell migration into the brain through modifications to the actin cytoskeleton and levels of expression of small GTPases

We show that high-grade astrocytic tumors with high levels of galectin-1 expression are associated with dismal prognoses. The immunohistochemical analysis of galectin-1 expression of human U87 and U373 glioblastoma xenografts from the brains of nude mice revealed a higher level of galectin-1 expression in invasive areas rather than non-invasive areas of the xenografts. Nude mice intracranially grafted with U87 or U373 cells constitutively expressing low levels of galectin-1 (by stable transfection of an expression vector containing the antisense mRNA of galectin-1) had longer survival periods than those grafted with U87 or U373 cells expressing normal levels of galectin-1. Galectin-1 added to the culture media markedly and specifically increased cell motility levels in human neoplastic astrocytes. These effects are related to marked modifications in the organization of the actin cytoskeleton and the increase in small GTPase RhoA expression. All the data obtained indicate that galectin-1 enhances the migratory capabilities of tumor astrocytes and, therefore, their biological aggressiveness.     

Technical approach to excision of renal cancers with venous thrombus extending to the right auricle. Apropos of 4 cases

The authors report four cases of renal neoplasm with associated thrombosis of the vena cava, extending to the right auricle. Three cases involved the right kidney. Three patients underwent operation with cardio-pulmonary bypass; two operations were successful and one had a fatal outcome. Although the technique of this operation has been considerably simplified, this operation is not performed routinely.     

Inherited IFNAR1 Deficiency in a Child with Both Critical COVID-19 Pneumonia and Multisystem Inflammatory Syndrome

Journal of Clinical Immunology - Inborn errors of immunity (IEI) and autoantibodies to type I interferons (IFNs) underlie critical COVID-19 pneumonia in at least 15% of the patients, while the...     

Bicentric Evaluation of Six Anti-Toxoplasma Immunoglobulin G (IgG) Automated Immunoassays and Comparison to the Toxo II IgG Western Blot

A comparative study of the Toxoplasma IgG_I and IgG_II Access (Access I and II, respectively; Beckman Coulter Inc.), AxSYM Toxo IgG (AxSYM; Abbott Diagnostics), Vidas Toxo IgG (Vidas; bioMerieux, Marcy l''Etoile, France), Immulite Toxo IgG (Immulite; Siemens Healthcare Diagnostics Inc.), and Modular Toxo IgG (Modular; Roche Diagnostics, Basel, Switzerland) tests was done with 406 consecutive serum samples. The Toxo II IgG Western blot (LDBio, Lyon, France) was used as a reference technique in the case of intertechnique discordance. Of the 406 serum samples tested, the results for 35 were discordant by the different techniques. Using the 175 serum samples with positive results, we evaluated the standardization of the titrations obtained (in IU/ml); the medians (second quartiles) obtained were 9.1 IU/ml for the AxSYM test, 21 IU/ml for the Access I test, 25.7 IU/ml for the Access II test, 32 IU/ml for the Vidas test, 34.6 IU/ml for the Immulite test, and 248 IU/ml for the Modular test. For all the immunoassays tested, the following relative sensitivity and specificity values were found: 89.7 to 100% for the Access II test, 89.7 to 99.6% for the Immulite test, 90.2 to 99.6% for the AxSYM test, 91.4 to 99.6% for the Vidas test, 94.8 to 99.6% for the Access I test, and 98.3 to 98.7% for the Modular test. Among the 406 serum samples, we did not find any false-positive values by two different tests for the same serum sample. Except for the Modular test, which prioritized sensitivity, it appears that the positive cutoff values suggested by the pharmaceutical companies are very high (either for economical or for safety reasons). This led to imperfect sensitivity, a large number of unnecessary serological follow-ups of pregnant women, and difficulty in determining the serological status of immunosuppressed individuals.Toxoplasmosis, caused by Toxoplasma gondii, is widespread in humans and warm-blooded animals. Although it is usually asymptomatic in immunocompetent humans, toxoplasmosis may cause severe disorders in pregnant women, because of the high risk of transplacental transmission and the occurrence of abortion or multiple congenital lesions in the fetus, and in immunocompromised individuals (5, 9).Life-threatening reactivation of a previous infection is commonly observed in cases of severe immunodeficiency (human immunodeficiency virus-infected patients, organ and hematopoietic stem cell transplant patients). For these patients, the detection of Toxoplasma-specific antibodies showing serological reactivation or primary infection is therefore essential for the appropriate diagnosis and prevention of severe toxoplasmosis (2, 7).The follow-up of patients with obstetric toxoplasmosis mainly depends on the detection of antitoxoplasma-specific immunoglobulin M (IgM) and IgG antibodies (14, 16, 18). The presence of toxoplasma-specific IgM at the time of the first blood test is a cause for concern. The presence of toxoplasma-specific IgG without IgM permits confirmation of the immunization of the patients and thus allows unnecessary and expensive follow-up to be avoided.For both obstetric follow-up and diagnosis in immunocompromised patients, tests for IgG are crucial. Since the 1980s, toxoplasma-specific IgG assays have been standardized by different generations of World Health Organization (WHO) standards (15), and test results have been reported in international units per milliliter (IU/ml). The dye test (DT), first described by Sabin and Feldman 60 years ago, is still the reference method for the serodiagnosis of toxoplasmosis. However, this test uses live Toxoplasma gondii and is now used in only a few laboratories (13). A good alternative, the test Toxo II IgG Western blot (LDBio, Lyon, France) has been proposed to be a confirmatory technique by Franck et al. (6). The results of this test appear to be consistent with those of DT, with a specificity of 100% and a sensitivity of 99.2%. Thus, this immunoblotting technique can be used as a very reliable and easy confirmatory test in laboratories where DT cannot be implemented.Despite the international standardization and the availability of a reference (or confirmatory) test, automated immunoassays frequently show discordance and moderate degrees of correlation (6, 12). A comparison of six random-access immunoassays (that report IgG levels in IU/ml) and the Toxo II IgG Western blot (LDBio) as a confirmatory technique was undertaken to review the analytical performance characteristics and the degree of standardization of the tests.     

ANCA-associated glomerulonephritis in systemic-onset juvenile idiopathic arthritis

Systemic-onset juvenile idiopathic arthritis is an inflammatory disease of unknown cause and is not commonly associated with kidney involvement. We describe 3 patients with systemic-onset juvenile idiopathic arthritis with high disease activity who developed antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis 1-6 years after the onset of systemic-onset juvenile idiopathic arthritis. Renal and systemic-onset juvenile idiopathic arthritis remission occurred in one patient under anti-interleukin 1 (anti-IL-1) treatment associated with immunosuppressive drugs. The other 2 patients developed end-stage renal disease, and one of those patients died. This report suggests that the diagnosis of ANCA-associated glomerulonephritis must be considered in patients with systemic-onset juvenile idiopathic arthritis with persistently active systemic disease who present with proteinuria. Furthermore, use of an anti-IL-1 agent might be an effective therapeutic option.