Exposition anténatale au diéthylstilbestrol et cancer du sein

Diethylstilbestrol (DES) is a synthetic estrogen prescribed to prevent miscarriages until 1977. Its role in the development of vaginal adenocarcinoma and cervical dysplasia is known and screening codified. Recent cohort studies show that exposure to DES in utero increases breast cancer risk especially after 40 years. This article reports the observation of a breast cancer of exceptional gravity in a patient exposed to DES in utero. It details the risk of breast cancer for “DES daughters” and support possible screening modalities.     

The maternal cardiovascular effect of carbetocin compared to oxytocin in women undergoing caesarean section

ObjectiveTo compare haemodynamic changes, measured noninvasively using the USCOM monitor, after combined spino-epidural anaesthesia and after administration of two different uterotonic drugs, oxytocin and carbetocin, in a population of pregnant women during elective caesarean delivery.MethodsHaemodynamic measurements were obtained with the USCOM system, by positioning a probe at maternal suprasternal notch (SSN) until the aortic valve flow’s profile was optimally identified. Evaluations of the haemodynamic profile were obtained in seven different moments: before anaesthesia; during skin incision; 60, 180 and 300 s after administration of uterotonic drug, at closure of the uterus, at closure of the skin. Doses of uterotonic drugs were: Oxytocin 5 UI in 500 cc NaCl eV, Carbetocin 100 mcg in bolus eV. Main measured parameters were: heart rate, mean blood pressure, stroke volume, cardiac output and total vascular resistance.ResultsWe enrolled 32 pregnant women. Patients were randomized in two groups: oxytocin and carbetocin. A reduction in mean blood pressure, a reduction of total vascular resistance and an increase of cardiac output and of stroke volume were seen, while heart rate values remained stable in both treatment groups. No statistically significant differences were found.DiscussionAdministration of carbetocin is associated with a substantial global haemodynamic stability in patients undergoing elective caesarean section without any difference with oxytocin. This observation allows us to consider carbetocin comparable to oxytocin, with minimum haemodynamic impact on the maternal circulation. This minimal effect on global haemodynamic stability might extend the use of this uterotonic drug in patients at high haemorrhagic risk with preeclampsia.     

Minimum Local Analgesic Dose: Effect of Different Volumes of Intrathecal Levobupivacaine in Early Labor

Background: This double-blind, randomized study was aimed at detecting the effect of three different volumes of intrathecal levobupivacaine on the minimum local analgesic dose in early labor.

Methods: Ninety-three nulliparous women requesting combined spinal-epidural analgesia, at more than 37 weeks gestation, with spontaneous onset of labor, cervical dilatation from 2 to 5 cm, were enrolled. Parturients received 10 ml (group 10), 5 ml (group 5), or 2.5 ml (group 2.5) of the spinal solution containing plain levobupivacaine diluted with 0.9% wt/vol saline to achieve the desired dose and volume at room temperature. A lumbar epidural catheter was then placed. The initial dose for each group was 2.0 mg, and the following doses were determined by the response of the previous patient using up-down sequential allocation. The authors required the test solution to achieve a visual analog pain score of 10 mm or less to be considered effective. The up-down sequences were analyzed using the Dixon and Massey formula and regression logistic model.

Results: The minimum local analgesic dose of spinal levobupivacaine in spontaneously laboring women was 1.35 mg (95% confidence interval, 1.25-1.45 mg) in group 10, 1.63 mg (95% confidence interval, 1.51-1.76 mg) in group 5, and 1.97 mg (95% confidence interval, 1.89-2.05 mg) in group 2.5. A unit change in volume increased the odds of an effective response multiplicatively by a factor of 1.8.     

Decellularized aortic conduits: could their cryopreservation affect post-implantation outcomes? A morpho-functional study on porcine homografts

Decellularized porcine aortic valve conduits (AVCs) implanted in a Vietnamese Pig (VP) experimental animal model were matched against decellularized and then cryopreserved AVCs to assess the effect of cryopreservation on graft hemodynamic performance and propensity to in vivo repopulation by host’s cells. VPs (n = 12) underwent right ventricular outflow tract substitution using AVC allografts and were studied for 15-month follow-up. VPs were randomized into two groups, receiving AVCs treated with decellularization alone (D; n = 6) or decellularization/cryopreservation (DC; n = 6), respectively. Serial echocardiography was carried out to follow up hemodynamic function. All explanted AVCs were processed for light and electron microscopy. No signs of dilatation, progressive stenosis, regurgitation, and macroscopic calcification were echocardiographically observed in both D and DC groups. Explanted D grafts exhibited near-normal features, whereas the presence of calcification, inflammatory infiltrates, and disarray of elastic lamellae occurred in some DC grafts. In the unaltered regions of AVCs from both groups, almost complete re-endothelialization was observed for both valve cusps and aorta walls. In addition, side-by-side repopulation by recipient’s fibroblasts, myofibroblasts, and smooth muscle cells was paralleled by ongoing tissue remodeling, as revealed by the ultrastructural identification of typical canals of collagen fibrillogenesis and elastogenesis-related features. Incipient neo-vascularization and re-innervation of medial and adventitial tunicae of grafted aortic walls were also detected for both D and DC groups. Cryopreservation did not affect post-implantation AVC hemodynamic behavior and was topically propensive to cell repopulation and tissue renewal, although graft deterioration including calcification was present in several areas. Thus, these preliminary data provide essential information on feasibility of decellularization and cryopreservation coupling in the perspective of treatment optimization and subsequent clinical trials using similarly treated human allografts as innovative heart valve substitutes.     

Effect of GaAlAs low-level laser therapy on mouth opening after orthognathic surgery

To evaluate low-level laser therapy (LLLT) as an adjunct to enhance postoperative mouth opening after orthognathic surgery. Prospective clinical trial of 82 patients allocated into an intervention group (laser, LG) and a control group (no laser, CG) and subgroups according to the procedure type : (1) surgically assisted rapid maxillary expansion (SARME); (2) maxillary surgery; (3) mandibular surgery; or (4) bimaxillary surgery. LG patients received LLLT immediately after surgery and every 24 h thereafter for 3 days, using a gallium–aluminum–arsenide (GaAlAs) diode laser (780 nm, 28 spots, 14 on each side of the face, output power 2 J/spot). Maximum mouth opening was measured using digital calipers at five time points: preoperative baseline and postoperative days 2, 7, 14, and 21. ANOVA was used to evaluate difference in mouth opening across groups. Significance was accepted at P??≤??0.05. Final average mouth opening differed between women (GL1?=?94.24%, GC1?=?89.54%, GL2?=?69.39%; GC2?=?68.46%; GL3?=?65.11%; GC3?=?58.64%; GL4?=?61.85%; GC4?=?57.11%) and men (GL1?=?86.92%, GC1?=?102.44%, GL2?=?77.56%; GC2?=?81.65%; GL3?=?80.29%; GC3?=?67.63%; GL4?=?66.93%; GC4?=?55.31%). There were no significant differences between the SARME and isolated maxillary/mandibular surgery groups. In the bimaxillary groups, average mouth opening was increased in all patients who received LLLT, significantly so in male patients. LLLT with a GaAlAs diode laser (780 nm) did not affect postoperative mouth opening after SARME, isolated maxillary surgery, or isolated mandibular surgery. However, it improved mouth opening in men who had undergone bimaxillary orthognathic surgery.     

Spontaneous rupture of middle thoracic esophagus: thoracoscopic treatment

Spontaneous rupture of the esophagus (so-called Boerhaave’s syndrome) is considered a medical emergency. It carries a significant mortality rate and requires prompt treatment. The treatment of choice involves surgical repair of the esophageal defect, usually accomplished via laparotomy, thoracotomy, or both to accomplish esophageal repair and mediastinal debridement. We have treated an elderly patient with severe comorbidities with a minimally invasive approach, achieving a successful complete repair. Long-term endoscopic and radiologic follow-up confirm the good results.     

Effect of simvastatin on passive strain‐induced skeletal muscle injury in rats

Introduction: HMG‐CoA reductase inhibitors are the most frequently prescribed drugs for treatment of lipid imbalance, but they have side effects, such as myopathy. Our aim was to assess the effect of simvastatin on the inflammatory process induced by skeletal muscle injury. Methods: Rats were divided into experimental groups [control group, simvastatin (20 mg/kg) group, group treated with simvastatin (20 mg/kg) and subjected to injury, and group subjected to injury only]. Histological analysis and analyses of creatine kinase activity and C‐reactive protein were performed. Results: Animals treated with simvastatin exhibited significantly greater morphological and structural skeletal muscle damage in comparison to the control group and injured animals without treatment. Conclusions: Although simvastatin has a small anti‐inflammatory effect in the early stage after a muscle strain injury, the overall picture is negative, as simvastatin increases the extent of damage to muscle morphology. Further studies are needed. Muscle Nerve, 2012     

Involvement of Ca-dependent PKCs in the adaptive changes of μ-opioid pathways to sympathetic denervation in the guinea pig colon

In the guinea pig colon, chronic sympathetic denervation entails supersensitivity to inhibitory μ-opioid agents modulating cholinergic neurons. The mechanism underlying such adaptive change has not yet been unravelled, although protein kinase C (PKC) may be involved. A previous study indirectly demonstrated that activation of μ-opioid receptors on myenteric neurons facilitates PKC activity. Such coupling may counteract the inhibitory action of μ-opioid agents on acetylcholine overflow, since PKC, per se, increases this parameter. After chronic sympathetic denervation such restraint abates, representing a possible mechanism for development of supersensitivity to μ-opioid agents. In the present study, this hypothesis was further investigated. After chronic sympathetic denervation, Ca²⁺-dependent PKC activity was reduced in colonic myenteric plexus synaptosomes. The μ-opioid agent, DAMGO, increased Ca²⁺-dependent PKC activity in synaptosomes obtained from normal, but not from denervated animals. In myenteric synaptosomes obtained from this experimental group, protein levels of Ca²⁺-dependent PKC isoforms βI, βII and γ decreased, whereas α levels increased. In whole-mount preparations, the four Ca²⁺-dependent PKC isoforms co-localized with μ-opioid receptors on subpopulations of colonic myenteric neurons. The percentage of neurons staining for PKCβII, as well as the number of μ-opioid receptor-positive neurons staining for PKCβII, decreased in denervated preparations. The same parameters related to PKCα, βI or γ remained unchanged. Overall, the present data strengthen the concept that μ-opioid receptors located on myenteric neurons are coupled to Ca²⁺-dependent PKCs. After chronic sympathetic denervation, a reduced efficiency of this coupling may predominantly involve PKCβII, although also PKCβI and γ, but not PKCα, may be implicated.     

Lower extremity motor performance and body mass index in elderly people: the Italian Longitudinal Study on Aging

OBJECTIVES: To test the association between body mass index (BMI) and lower extremity motor performance in elderly people.
DESIGN: Multicenter, cross-sectional, observational study.
SETTING: A sample of individuals aged 65 and older recruited for the baseline survey of the Italian Longitudinal Study on Aging.
PARTICIPANTS: Two thousand six hundred seventy-two individuals (1,436 men, 1,236 women) independent with transfers and toileting and independent or requiring assistance for bathing or dressing.
MEASUREMENTS: Motor function was assessed using a Motor Performance Test (MPT), with a set of six tasks exploring lower extremity performance (LEP): rising once from a chair, turning in a half circle, tandem walking, standing on one leg, stair climbing, and walking 5 m.
RESULTS: The highest prevalence rates of difficulty in performing the tasks occurred in men and women, respectively, in tandem walking (14%, 28%), stair climbing (17.0%, 43%) and walking 5 m (15%, 30%). In both sexes, moderate (men: odds ratio (OR)=1.99, 95% confidence interval (CI)=1.16–3.43; women OR=2.07, 95% CI=1.18–3.65) and severe obesity (men: OR=3.45, 95% CI=1.21–9.89; women: OR=3.16, 95% CI=1.43–6.95) were each independently associated with overall motor performance impairment after adjusting for age, smoking, and comorbidity. Best performance was generally observed in the normal-weight and overweight groups.
CONCLUSION: The results confirm that, in both sexes, overweight is not related to motor impairment. Only in women, low BMI is associated with higher probability of overall motor performance impairment. These data suggest that moderate obesity should be distinguished from severe obesity when assessing the relationship between BMI and LEP.