How to choose a mesh for the treatment of incisional hernias?

The incidence of recurrences after raphy for treatment of incisional hernias has been reported as high as 50%. So, the use of a mesh is recommended for reinforcement of the parietal abdominal wall in the management of incisional hernias. Many types of mesh are presently available with different characteristics. The use of a mesh requires to choose the appropriate material, depending on the site of the implantation and the type of performed surgical procedure.     

Two cases of neurocysticercosis mimicking brain tumor

Neurocysticercosis is an infectious disorder of the central nervous system caused by Taenia solium larvae. We report two misleading cases, mimicking high grade glioma on radiology. Two patients, aged 14 and 29 respectively, developed seizure, associated with left facial paralysis in the second. For each case, radiological data revealed a solitary lesion highly suggestive of high grade glioma. Microscopically, within an important inflammatory process, a characteristic cystic formation allowed a definite diagnosis of cysticercosis. Then, for both patients, a history of migration from endemic area was demonstrated later. These cases highlight the necessary pathological examination when neurocysticercosis mimics a brain tumor.     

Schwannian crystalline-like inclusions bodies (Fardeau-Engel bodies) revisited in peripheral neuropathies

In 1969, Fardeau and Engel described polygonal organelles containing crystalline-like structures located in the Schwann cell cytoplasm of unmyelinated fibers. Such inclusions were reported in various conditions, mainly with axonal lesions. They were also reported in a few cases of peripheral neuropathy associated with primary mitochondriopathy. Although they are surrounded by a double membrane, their mitochondrial origin is not definitely proven. Their significance remains obscure but they deserve to be better known as Fardeau-Engel bodies, so as not to be mistaken with mitochondrial crystalline inclusions, which are frequently observed in patients with ragged-red fibers in muscle.     

Leukemic dissemination within a glioblastoma in a patient with chronic lymphoid leukemia

Metastasis from an extracranial tumor to a primary central nervous system tumor is a rare event, and most reported cases concern metastases to meningiomas. The authors describe the first case of leukemic cell dissemination within a glioblastoma. The patient likely presented a genetic predisposition to multiple neoplasms, and the unusual localization of leukemic cells might be partly related to the characteristic microvascular proliferation in glioblastoma.     

Combining Cadherin Expression with Molecular Markers Discriminates Invasiveness in Growth Hormone and Prolactin Pituitary Adenomas

Although growth hormone (GH)‐ and prolactin (PRL)‐secreting pituitary adenomas are considered benign, in many patients, tumour growth and/or invasion constitute a particular challenge. In other tumours, progression relies in part on dysfunction of intercellular adhesion mediated by the large family of cadherins. In the present study, we have explored the contribution of cadherins in GH and PRL adenoma pathogenesis, and evaluated whether this class of adherence molecules was related to tumour invasiveness. We have first established, by quantitative polymerase chain reaction and immunohistochemistry, the expression profile of classical cadherins in the normal human pituitary gland. We show that the cadherin repertoire is restricted and cell‐type specific. Somatotrophs and lactotrophs express mainly E‐cadherin and cadherin 18, whereas N‐cadherin is present in the other endocrine cell types. This repertoire undergoes major differential modification in GH and PRL tumours: E‐cadherin is significantly reduced in invasive GH adenomas, and this loss is associated with a cytoplasmic relocalisation of cadherin 18 and catenins. In invasive prolactinomas, E‐cadherin distribution is altered and is accompanied by a mislocalisation of cadherin 18, β‐catenin and p120 catenin. Strikingly, de novo expression of N‐cadherin is present in a subset of adenomas and cells exhibit a mesenchymal phenotype exclusively in invasive tumours. Binary tree analysis, performed by combining the cadherin repertoire with the expression of a subset of known molecular markers, shows that cadherin/catenin complexes play a significant role in discrimination of tumour invasion.     

Comparison of complete versus partial mesh removal for the treatment of chronic mesh infection after abdominal wall hernia repair

Purpose

Treatment of chronic mesh infections (CMI) after parietal repair is difficult and not standardized. Our objective was to present the results of a standardized surgical treatment including maximal infected mesh removal.

Methods

Patients who were referred to our center for chronic mesh infection were analyzed according to CMI risk factors, initial hernia prosthetic cure, CMI characteristics and treatments they received to achieve a cure.

Results

Thirty-four patients (mean age 54?±?13 years; range 23–72), were included. Initial prosthetic cure consisted of 26 incisional hernias and eight groin or umbilical hernias of which 21% were considered potentially contaminated because of three intestinal injuries, two stomas and two strangulated hernias. The mesh was synthetic in all cases. CMI appeared after a mean of 83 days (range 30–6740) and was characterized by chronic leaking in 52 cases (50%), an abscess in 22 cases (21%) and synchronous hernia recurrence in 17 cases (16.5%). Eighty-six reinterventions were necessary, including 36 mesh removals (42%), and 13 intestinal resections for entero-cutaneous fistula (15%). The CMI persistence rate was 81% (35 reinterventions out of 43) when mesh removal was voluntarily limited to infected and/or not incorporated material, but was 44% when mesh removal was voluntarily complete (19 reinterventions out of 43; p?<?0.001). On average, 3.4 interventions (1–11) were necessary to achieve a cure, after 2.8 years (0–6). Fourteen incisional hernia recurrences occurred (41%).

Conclusions

Treatment of chronic mesh infection is lengthy and resource-intensive, with a high risk of hernia recurrence. Maximal mesh removal is mandatory.

     

Chirurgie bariatrique et fertilité

Obesity is associated with various health consequences including infertility. In women, anovulation is most often linked to polycystic ovary syndrome or can be secondary to hypogonadotrophic hypogonadism. Hypogonadotrophic hypogonadism has also been described in men in several publications. More recent data suggest that obesity can induce direct spermatogenesis alteration. Bariatric surgery has become very popular in France in the last fifteen years. It is the most effective therapy in severe obesity and is associated with a significant and long-lasting weight loss and a significant decrease in obesity-related morbidity and mortality. More than 50,000 procedures are performed every year. Bariatric surgery has positive effects on menstrual cycles in women and on hypogonadism in men. But its effects on sperm parameters seem controversial. Furthermore, few data are available concerning the impact of bariatric surgery on assisted reproductive techniques (ART) outcomes.