Delayed repair of large myelomeningoceles

Introduction Repair of myelomeningoceles larger than 5 cm in diameter is not easy. We describe a simple technique.Patients and methods The patients with a large myelomeningocele sac were included in this study. Ten patients with a large myelomeningocele underwent surgical repair using this technique. The skin was incised in the midline proximal to the myelomeningocele sac. The incision was carried caudally and away from the midline to open the sac after identifying the fascia. The incision is carried circumferentially around the neural placode and the skin is saved as much as possible. About a 1-cm-width of the dura mater beneath the skin is left to ease the subcutaneous suturing. The dura is sutured in the midline. The skin is undermined bilaterally in the plane between the muscle and subcutaneous fat and closed with interrupted sutures in the midline.Conclusion This simple technique is appropriate for the closure of large myelomeningoceles and does not need more extensive and complex procedures.Presented at the 31st Annual Meeting of the International Society for Pediatric Neurosurgery, 14–18 September 2003, Monaco     

Gingival enlargement in children treated with antiepileptics

This study was conducted to determine the occurrence, severity, and risk factors of gingival enlargement in children treated with valproate and other nonvalproate antiepileptic drugs. A cross-sectional study was carried out in which data obtained from 68 epileptic children under treatment were compared with those from 50 controls. A structured questionnaire was used to collect data on patients' demographics, dental and oral hygiene practices, and medication history. Gingival enlargement, gingival index, plaque index, and probing depth were measured to assess periodontal health. The chi-square and Fisher exact tests were used in statistical analysis. In case of significance, a detailed chi-square analysis was carried out to determine the origin of the difference. Patients in both the valproate and nonvalproate groups showed significantly higher gingival enlargement, gingival index, plaque scores, and pocketing (P < .001 and P < .01, respectively) than the control group. In the valproate group, the duration of the treatment had a significant effect on gingival enlargement (P < .001) but not on gingival index, plaque index, and probing depth values (P > .05). Toothbrushing was most frequent in the control group (P = .000) and more frequent in the valproate group than the nonvalproate group (P = .024). Our study showed significant differences regarding gingival enlargement in children treated with valproate. These findings illustrate that epileptic children on valproate are at risk of periodontal problems.     

Double-chambered right ventricle mimicking asymmetric septal hypertrophy

Double-chambered right ventricle (DCRV) is an uncommon congenital heart disease. Anomalous muscle bundles in the right ventricle divide the right ventricle into two portions and cause intracavitary obstruction of the right ventricle. We report a patient with DCRV mimicking asymmetric septal hypertrophy. We did clinical, echocardiographic and angiographic evaluation. Surgical intervention was successfully managed.     

Endometrial cancer: what's new?

OBJECTIVES: New and much debated data of the endometrial cancer concerning the preoperative assessment of myometrial invasion, the surgical staging, and the adjuvant treatment. PATIENTS AND METHODS: Medline (1998-2002): searching for "endometrial carcinoma". RESULTS: The pap smears are useful when it is difficult to have a transvaginal ultrasonography or an MRI. We can perform the pap smears and the endometrial biopsy in the clinic. If a patient has pap smears with malignant cells or elevated preoperative CA 125, it probably is a cancer with poor prognostic factors. Surgical staging with abdominal and node evaluation is necessary. The MRI seems to be the best preoperative imaging because we have information about adnexal and abdominal metastases, pelvic or aortic nodes and the invasion of the myometrium. So it gives us information on the surgical route, and provides indication for a lymphadenectomy. The surgical staging is a part of the treatment of the endometrial cancer: an exploration of the peritoneal cavity, a pelvic lymphadenectomy, a para-aortic lymphadenectomy if the pelvic nodes are positive or if there are factors of bad prognosis (deep stage IC, grade 3, adnexal or abdominal involvement, serous carcinoma of the endometrium). It can be performed if technical conditions are correct. The adjuvant teletherapy in the documented stage IpN0 (surgical staging with pelvic lymphadenectomy) does not seem to be necessary. But we can perform an adjuvant brachytherapy (high-dose rate if it is possible) in patients with a high local recurrence (stage IC, stage I with grade 3, stage IB grade 2). CONCLUSION: The preoperative MRI is useful choosing the surgical approach, and the depth of the myometrial invasion, which can be an indication for a pelvic lymphadenectomy. The surgical staging must be a part of the treatment of the endometrial cancer. So the adjuvant teletherapy in patients with stage IpN0 documented should not be used.     

Effects of current and potential dental etchants on nerve compound action potentials

In this study, a 35% phosphoric acid gel (3M Scotchbond etchant), a nonrinse etchant (NRC), and two EDTA-containing conditioners (RC-Prep and File-Eze) were tested in vitro for blocking nerve conductance evoked in the rat sciatic nerve after local application. The phosphoric acid gel and NRC completely and irreversibly inhibited conductance. On the other hand, RC-Prep reduced the compound action potentials (cAPs) by 50% in 120 min. With File-Eze, the reduction in cAPs was less than 50% after an application time of 160 min (61.8 +/- 1.8%). At 160 min the cAPs in the RC-Prep group had been inhibited by 62.4%. These results indicated strong neurotoxic effects of phosphoric acid and NRC when applied directly on exposed pulp in the total etch procedure.     

Pulsed dye laser for Sturge-Weber syndrome

Port wine stain of Sturge-Weber syndrome represents a cosmetic prejudice with social consequences. We have treated eight patients with a 585 nm pulsed dye laser. According to our experience, the treatment is not risky provided that adequate care is taken; the cosmetic result on the V1 port wine stain component is satisfactory.     

The cost of imaging in oncology practice

The purpose of this work was to assess the part of radiology in the total cost of cancer in France. Lot of public and private organisms are in charge to assess the total health cost and their informations are easy to obtain. But there are some obstacles to focus on radiological cancer cost: radiology is performed in various places: private outpatient care practice, private and public hospitals; for same examination, cost varies according on the place were it's performed; we can assess the imaging cost in anticancer centers, but the costs of radiological examinations realised for cancer indications in general hospital are not separated from the cost of those performed for other indications; a same patient can migrate between private and public radiological structures for the same cancer, and we are not able to know the relative cost of each part or the total cost. In summary, we can assess the total cost of private radiology but not the cancer part of this cost. For public structures, we can assess the imaging department cost. Nevertheless this cost is independent of the number of examinations performed, so the paradox is: a same exploration has a different cost according on the place where it's realised. So, we need to create a tool which will permit to obtain a medical assessment of imaging cost. The FNMR (Fédération Nationale des médecins radiologues) try to produce such tool with the OPIM (Observatoire pour l'imagerie). It seems important than public radiologists think about it.     

Identification of 1-arylmethyl-3- (2-aminoethyl)-5-aryluracil as novel gonadotropin-releasing hormone receptor antagonists

Based on SAR from bicyclic GnRH antagonists such as 6-aminomethyl-7-arylpyrrolo[1,2-a]pyrimid-4-ones (1) and 2-aryl-3-aminomethylimidazolo[1,2-a]pyrimid-5-ones (2a,b), a series of novel uracil compounds (4) were derived as the GnRH antagonists. Their syntheses and initial SAR are discussed herein. This is the first time that monocycle-based GnRH receptor antagonists are reported.