Carotid surgery. Is regional anesthesia always appropriate?

We retrospectively studied a series of 385 carotid endarterectomies performed either under general anesthesia (242) or under local anesthesia (145) to compare the peri-operative mortality and morbidity rate and to identify factors which may influence the choice of anesthesia. The rate of transient ischaemic attacks (TIA), stroke, death, combined mortality, severe neurological and cardiac morbidity were not statistically different. Under general anesthesia, more shunts were inserted (17% versus 7%, p less than 0.05) and more myocardial infarctions occurred (5% versus 0%, p less than 0.05). However, more strokes due to technical imperfection were seen under regional anesthesia. We concluded that regional anesthesia is more appropriate in patients with coronary artery disease and in patients at risk of intolerance to cross clamping. General anesthesia is more appropriate in poorly cooperative patients or in those with unfavorable operative conditions.     

Auditory brainstem response in premenopausal women taking oral contraceptives

BACKGROUND: The aim of this prospective study was to evaluate the effects of the new monophasic oral contraceptives on the audiological system in premenopausal women. METHODS: The auditory brainstem response (ABR) was measured in 94 women during the follicular, periovular and luteal phases of one menstrual cycle in which ovulation was confirmed using sonography and serum progesterone concentration. The latencies for waves I, III and V were determined, and the inter-peak intervals were calculated for waves I-III, I-V and III-V. All 94 women began taking oral contraceptives: 23 women used 20 microg ethinyl estradiol (EE) plus 150 microg desogestrel, 24 women used 30 microg EE plus 75 microg gestodene, and 47 women used 15 microg EE plus 60 microg gestodene. During the third month of contraceptive intake, each subject was again tested for ABR, as above. RESULTS: The wave latencies and inter-peak intervals showed shorter values during the periovular phase with respect to the luteal phase (P < 0.05), the follicular phase for wave I and for inter-peak interval I-V (P < 0.05) of the menstrual cycle. All of the ABR results in pill users were statistically different from those of the periovular phase (P < 0.05), though similar to those of both the luteal and follicular phases (P = NS). CONCLUSIONS: ABR seems to depend on the variations of ovarian steroids during the menstrual cycle and during oral contraceptive intake.     

The popliteal entrapment syndrome

Summary Five examples of the popliteal entrapment syndrome have been reported in 4 patients aged between 17 and 41. The diagnosis in each case was made pre-operatively. The anatomical anomalies consisted in three instances of an abnormally high insertion of the inner gemellus (medial head of gastrocnemius) muscle tendon with the artery located twice in front and once in the middle of the tendon, in another instance compression was due to a hypertrophic musculus plantaris and finally, in the last instance, the anomalies were caused by abnormal fibrous bands. In two instances the artery was thrombosed, in three it was compressed in an intermittent fashion. The patients responded well to treatment, by a graft in the case of thrombosis, and by sectioning the abnormal insertions of the gemellus muscle or the fibrous bands in the others. The frequency of these different anatomical types, the relative evolutivity and the embryological hypotheses are studied in the 111 cases recorded in the literature between 1970 and 1983.

---

Le piège poplité

Résumé Cinq cas de poplitées piégées sont rapportés chez 4 patients dont l'âge était compris entre 17 et 41 ans. Le diagnostic a été fait dans chaque cas en pré-opératoire. Les anomalies anatomiques consistaient trois fois en une insertion anormalement haute du tendon du jumeau interne, l'artère siégeant 2 fois en avant et 1 fois au milieu du tendon, dans un cas en une compression par un muscle plantaire grêle hypertrophique, enfin dans le dernier cas, il s'agissait de bandes fibreuses anormales. Dans 2 cas, l'artère était thrombosée, dans 3 cas, elle était comprimée de façon intermittente. Les patients ont été traités avec succès par pontage en cas de thrombose, et par section des insertions anormales du jumeau interne ou des bandes fibreuses dans les autres cas. La fréquence des différents types anatomiques, l'évolutivité relative, et les hypothèses embryogénétiques sont étudiées à partir de 111 autres cas rapportés dans la littérature entre 1970 et 1983.

     

Colonic Cell Proliferation in Normal Mucosa of Patients with Colon Cancer

Cell kinetics parameters have been analysed in colonic mucosa at different distances from a tumour in patients with colon carcinoma. Total cell number (TCN), H thymidine labelling index (TLI), mitotic index (MI), Goblet cell index (GCI) and the distribution of labelled cells along the crypt column (cell position frequency plot) were determined in well-aligned crypts. Total cell number, GCI and the labelled cell position frequency plots were similar in different samples from the same individual. A negative linear correlation between TCN and TLI was observed. The analysis of the cell position plots showed two patterns 1) with a high concentration in the bottom fifth of the crypt and 2) with frequent labelled cells at high positions. Whereas a negative correlation between overall TLI and the percent contribution to the TLI of the lowermost fifth was seen, the correlation was positive for the next 3 fifths and labelling was absent in the last part of the crypt.     

Surveillance after treatment of differentiated thyroid cancers

The prognosis of differentiated thyroid carcinoma mainly depends on the quality of the initial treatment and on early detection and management of any recurrences. STUDY AIM: The aim of this retrospective study was to assess the modalities and duration of surveillance in these patients according to an original classification based on the initial extent of the tumour. PATIENTS AND METHOD: The modalities of detection of local recurrences and metastases and the date of the latest recurrences were assessed in a series of 509 patients with a mean follow-up of 8.2 years (range: 1 to 25 years). Most patients were treated by total thyroidectomy, followed by a therapeutic dose of radioactive iodine. The other patients with a small localized carcinoma underwent partial thyroidectomy without radioactive iodine. Patients were divided into four groups on the 7th postoperative month after follow-up scintigraphy and thyroglobulin assay: group I: microcancers (n = 117), group II: cancer without lymph node involvement or metastasis and normal thyroglobulin divided into IIA, age < 45 years (n = 100) and IIB, age > 45 (n = 94), group III: cancer with lymph node involvement and normal thyroglobulin (n = 102), group IV: high-risk cancers with metastases or regional extension other than lymph node extension or thyroglobulin > 3 micrograms/L (n = 96). RESULTS: Cancer-dependent actuarial survival rates for groups I, IIA, IIB, III, IV were 100%, 100%, 96%, 100%, and 73% at 10 years and 100%, 100%, 92%, 100%, and 86% at 15 years, respectively. Local or metastatic recurrences were sometimes detected by a single follow-up examination, while the other examinations were negative: cervical palpation, thyroglobulin assay, iodine scintigraphy, chest X-rays. The latest recurrences were observed at 12 years in groups I and IIA and at 16 years in groups IIB, III, and IV with normal thyroglobulin. CONCLUSION: This study confirms the importance of weaning thyroglobulin assays and scintigraphy which must be repeated every 5 years. Cervical palpation, thyroglobulin assay without weaning, chest X-rays may also detect recurrences. Duration of follow-up must be adapted to the initial extension and subsequent course: 15 years in groups I and IIA, 20 years in groups IIB, III, and IV with normal thyroglobulin, for at least 10 years after each recurrence, and life-long in the case of progression and thyroglobulin > 3 micrograms/L. Patients must be informed about the duration of follow-up at the 7th month when the definitive classification can be established and continuity of this follow-up must be documented in a special register.     

Critical appraisal of a non-coplanar technique for radiotherapy of breast minimising lung involvement.

BACKGROUND AND PURPOSE: To appraise the potential benefit of a conformal technique with non-coplanar fields to minimise lung irradiation in the radiation treatment of breast. PATIENTS AND METHODS: A comparative study was carried out at planning level for six patients selected for their inadequate sparing of healthy lung tissue with the reference tangential technique. Plans were designed for the conventional tangential technique, for an alternative conformal approach with three beams and for the newly proposed technique with two non-coplanar beams. RESULTS: In average for the new technique compared to the reference, mean lung dose dropped from approximately 16 to 10.5 Gy, V(20 Gy) from 29.5 to 18.2% and the dose delivered to 1/3 (1/4) of the lung volume dropped from 28.5% (67.3%) to 8.7% (13.4%). For PTV, the volume receiving at least 90% of the prescribed dose resulted 97.4% for the new and 97.3% for the reference. Conformity index improved significantly from 2.58 for the reference to 1.84 for the new technique. CONCLUSIONS: For a subgroup population of breast cancer patients, where conventional techniques failed to achieve high conformal avoidance, a treatment modality with non-coplanar beams was developed and clinically tested for six patients. It resulted dosimetrically adequate, particularly when the risk of toxicity is relevant.     

Multiscale Femoral Neck Imaging and Multimodal Trabeculae Quality Characterization in an Osteoporotic Bone Sample

Although multiple structural, mechanical, and molecular factors are definitely involved in osteoporosis, the assessment of subregional bone mineral density remains the most commonly used diagnostic index. In this study, we characterized bone quality in the femoral neck of one osteoporotic patients as compared to an age-matched control subject, and so used a multiscale and multimodal approach including X-ray computed microtomography at different spatial resolutions (pixel size: 51.0, 4.95 and 0.9 µm), microindentation and Fourier transform infrared spectroscopy. Our results showed abnormalities in the osteocytes lacunae volume (358.08 ± 165.00 for the osteoporotic sample vs. 287.10 ± 160.00 for the control), whereas a statistical difference was found neither for shape nor for density. The osteoporotic femoral head and great trochanter reported reduced elastic modulus (Es) and hardness (H) compared to the control reference (−48% (p < 0.0001) and −34% (p < 0.0001), respectively for Es and H in the femoral head and −29% (p < 0.01) and −22% (p < 0.05), respectively for Es and H in the great trochanter), whereas the corresponding values in the femoral neck were in the same range. The spectral analysis could distinguish neither subregional differences in the osteoporotic sample nor between the osteoporotic and healthy samples. Although, infrared spectroscopic measurements were comparable among subregions, and so regardless of the bone osteoporotic status, the trabecular mechanical properties were comparable only in the femoral neck. These results illustrate that bone remodeling in osteoporosis is a non-uniform process with different rates in different bone anatomical regions, hence showing the interest of a clear analysis of the bone microarchitecture in the case of patients’ osteoporotic evaluation.     

Olfactory Sensitivity Is Associated with Body Mass Index and Polymorphism in the Voltage-Gated Potassium Channels Kv1.3

Smell strongly contributes to food choice and its hedonistic evaluation. A reduction or loss of smell has been related to malnutrition problems, resulting in excessive weight loss or gain. Voltage-gated potassium channels Kv1.3 are widely expressed in the olfactory bulb, and contribute mainly to the value of the resting membrane potential and to the frequency of action potentials. Mutations in the Kv1.3 gene are associated with alterations in glycemic homeostasis and olfactory sensitivity. We evaluated the olfactory performance in 102 healthy subjects and its association with BMI and polymorphism in the human Kv1.3 gene. Olfactory performance, based on the olfactory threshold, discrimination and identification scores and their summed score (TDI), was measured using the “Sniffin’ Sticks” test. Subjects were genotyped for the rs2821557 polymorphism of the Kv1.3 gene, whose major allele T was associated with a super-smeller phenotype, lower plasma glucose levels and resistance to diet-induced obesity as compared with the minor allele C. Based on the Kv1.3 genotype, the TDI and I olfactory scores obtained by the subjects were the following: TT > TC > CC. Subjects who were TT homozygous or heterozygous exhibited lower BMIs and reached higher olfactory scores than those with the CC genotype. The results were sex-dependent: heterozygous females performed better than heterozygous males. These findings show an inverse relationship between olfactory function and BMI, and a significant effect of the Kv1.3 genotypes on the olfactory functions and on the BMIs of the subjects. Finally, they suggest that the sex-related differences in the olfactory function can be partially ascribed to the Kv1.3 gene’s polymorphism.