Major vascular injuries during gynecologic laparoscopy

Background:This study was undertaken to report our experience with major vascular injuries in gynecologic laparoscopy in order to specify the circumstances under which they occurred, the means of diagnosis, the risk factors, and the means for prevention.Study Design:Retrospective case review study.Results:Seventeen patients with 21 major vascular injuries were identified. The average age of the patients was 33.8 ± 11.6 years, and the mean body index mass was 21.6 ± 3.08 kg/m². Three of four of the accidents occurred during the set-up phase of laparoscopy (13 cases; 76.5%), and in 4 cases (23.5%) the accident occurred during the laparoscopic surgery procedure. Eleven (84.6%) of the complications occurring during the set-up phase were secondary to insertion of the umbilical trocar and 2 (15.4%) to insertion of the needle used to create the pneumoperitoneum (P-needle). Half (6 cases; 54.5%) of the major vascular injuries secondary to insertion of the umbilical trocar were observed when reusable trocars were used. In every case, the diagnosis was made during the operation. Two patients died, and two others presented a serious complication (phlebitis; acute ischemia requiring reoperation).Conclusions:Major vascular injuries are rare but serious complications of laparoscopic surgery. Prevention of these accidents relies on the surgeon’s experience and scrupulous respect of the safety rules. In the vast majority of cases, it is necessary to convert to laparotomy immediately, calling in a vascular surgeon.     

Resveratrol modulates human mammary epithelial cell O-acetyltransferase,sulfotransferase, and kinase activation of the heterocyclic amine carcinogen N-hydroxy-PhIP

Resveratrol (trans-3,4',5-trihydroxystilbene) is a natural antioxidant found in plants, such as grapes, that studies suggest has cancer chemopreventive activity. We investigated the effects of resveratrol on DNA binding via esterification reactions with 2-hydroxyamino-1-methyl-6-phenylimidazo[4,5-b]pyridine (N-OH-PhIP) - a metabolite of a mammary gland carcinogen present in cooked meats. Treatment of primary cultures of human mammary epithelial cells with 50 microM resveratrol led to a decrease in PhIP-DNA adducts ranging from 31 to 69%. Using substrate-specific assays and mammary gland tissue cytosols, resveratrol inhibited PhIP-DNA adduct formation by O-acetyltransferase and sulfotransferase catalysis. Cytosols from tumor tissue and breast reduction tissue were similarly affected. Resveratrol also suppressed O-acetyltransferase and sulfotransferase activities from the breast cancer cell lines MCF-7 and ZR-75-1. It was also observed that resveratrol stimulated ATP-dependent cytosolic activation of N-OH-PhIP in all human samples but not in mouse liver samples. In addition to resveratol's other preventive effects, the present data suggest that O-acetyltransferases and sulfotransferases may represent anti-oncogenic targets for resveratrol.     

Adhesion formation after laparoscopic resection of uterosacral ligaments in women with endometriosis

STUDY OBJECTIVE: To analyze the risk of postoperative adhesions in women who undergo laparoscopic surgical management of deep endometriosis infiltrating the uterosacral ligaments (USL). DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Forty-six women with deep endometriosis infiltrating the USL. INTERVENTION: Laparoscopic resection of all USL with deep endometriotic lesions and excision of all other endometriotic lesions, followed by second-look laparoscopy. MEASUREMENTS AND MAIN RESULTS: At second-look laparoscopy, 15 patients (32.6%) had no adhesions at the site where the USL had been resected, 24 (52.2%) had filmy avascular adhesions, and 7 (15.2%) had dense or vascular adhesions. No patient had adhesions of the binding type. Only two factors, the revised American Fertility Association (rAFS) score at initial laparoscopy and surgical modality (unilateral resection of the right USL, unilateral resection of the left USL, bilateral resection of USL) had a statistically significant influence on the risk of postoperative adhesions occurring. After adjustment, the relation with initial rAFS stage and surgical modality remained significant in the stepwise logistic regression model. CONCLUSION: These encouraging results are particularly interesting for patients with infertility due to pelvic pain syndrome. Second-look laparoscopy should not be performed routinely after laparoscopic management of deep endometriosis infiltrating the USL. We propose that it be reserved for women with rAFS stages III and IV endometriosis, especially when lesions are located on the left side.     

Does deep endometriosis infiltrating the uterosacral ligaments present an asymmetric lateral distribution?

Objective To investigate whether deeply infiltrating endometriosis occurs with equal frequency between left and right uterosacral ligaments.
Design Retrospective analysis of consecutive cases.
Setting Department of gynaecological surgery in a tertiary care university hospital in Paris, France.
Population One hundred and thirty consecutive women with laparoscopic resection of histologically proven deep endometriosis infiltrating the uterosacral ligaments.
Methods Laterality, intraoperative aspect of the uterosacral ligaments, and associated endometriosis were recorded during laparoscopy. Deep endometriosis infiltrating the uterosacral ligaments was considered as histologically proven in the presence of endometrial glands and stroma.
Main outcome measure Frequency of left- and right-sided deep endometriosis infiltrating the uterosacral ligaments.
Results The left uterosacral ligament alone was involved in 69 cases; the right uterosacral ligament alone was involved in 38 cases; both were involved in 23 cases. For patients with unilateral deep endometriosis infiltrating the uterosacral ligaments the observed proportion of endometriosis involving the left uterosacral ligament (69/107, 64.5%) was significantly different from the expected proportion of 50% (   χ ²=8.98; P < 0.01  ).
Conclusion Anatomical differences between left and right hemipelvis and differences in the frequency of ovulation between right and left ovary could explain these results.     

Differential neural activity in the human temporal lobe evoked by faces of family members and friends

In 6 patients, depth electrodes revealed differential evoked responses to familiar versus novel faces. These differential responses were obtained in the amygdala, hippocampus, and temporal neocortex but not in the dorsolateral frontal or cingulate cortex. The limbic and temporal structures that differentiated novel from familiar faces did not respond differentially to variations in luminance. Limbic structures and temporal cortex thus appear to participate in face recognition and in encoding the familiarity of visual experiences.