Securing injection laryngoplasty with anti-reflux valve

BACKGROUND

Injection laryngoplasty (IL) is a common procedure performed by the laryngologist to treat glottal insufficiency. It can be performed under general anaesthesia (GA) or as an office-based procedure. One of the common problems faced during IL is the disconnection between the injection needle and injection material syringe due to high-pressure effect. This may lead to leakage of the injectates especially when injecting high-viscosity materials such as calcium hydroxylapatite (CaHa) or injecting through hard fibrotic scar of the vocal fold.

PURPOSE

Due to this recurring issue, we propose anti-reflux valve as a connector to link up these two devices. The function of anti-reflux valve is to ensure secure connection between these two devices and overcome the problem.

METHODS

The anti-reflux valve that can be used is NeutraClearTM needle-free connector EL-NC1000 or MicroClaveTM clear connector. In our practice, these anti-reflux valves are used together with Integra MicroFrance straight malleable injection needle (0.5 mm diameter, 250 mm length) for IL under GA. However, any other injection needle suitable for IL may also be used with these anti-reflux valves.

RESULTS

Our 3 years' experience has shown good outcome with no reported incidence of device detachment or leakage of injectates during IL procedure.

CONCLUSIONS

Anti-reflux valve is a readily available device in the operating theatre or clinic and only involve simple preparation prior to IL. It is beneficial as an added device in IL procedure.

Long-term oncological results after 400 skin-sparing mastectomies

OBJECTIVE OF THE STUDY

Skin-sparing mastectomies (SSM) have gained acceptance among teams performing immediate breast reconstruction because this technique provides the best cosmetic outcome. Nevertheless, in France, concerns have been raised that limited skin excision during mastectomy could result in an increased risk of local recurrence especially in invasive breast cancer; many surgeons continue to have reservations regarding the oncologic safety of this operation. This is a retrospective, long-term follow-up study of 400 patients operated and followed by two oncoplastic surgeons.

PATIENTS AND METHODS

A total of 400 patients with breast cancer underwent SSM with immediate breast reconstruction from January 1, 1992 to December 31, 2002. The American Joint Committee on Cancer pathological staging was Stage 0 (41.5%), Stage I (33.25%), Stage II (16%), Stage III (7.5%), while 1.75% were non-stageable.

RESULTS

With a mean follow-up period of 88 months (range: 13-215 months), the locoregional recurrence rate was 3.5%, the rate of distant metastases was 13.5%, and 83% of patients have remained free of recurrent disease.

CONCLUSION

This study provides encouraging results suggesting that skin-sparing mastectomy is a safe and reliable option for the management of selected cases of women with invasive or in situ breast cancer.

Folate-equipped nanolipoplexes mediated efficient gene transfer into human epithelial cells

Since recombinant viral vectors have been associated with serious side effects, such as immunogenicity and oncogenicity, synthetic delivery systems represent a realistic alternative for achieving efficacy in gene therapy. A major challenge for non-viral nanocarriers is the optimization of transgene expression in the targeted cells. This goal can be achieved by fine-tuning the chemical carriers and the adding specific motifs to promote cellular penetration. Our study focuses on the development of novel folate-based complexes that contain varying quantities of folate motifs. After controlling for their physical properties, neutral folate-modified lipid formulations were compared in vitro to lipoplexes leading to comparable expression levels. In addition, no cytotoxicity was detected, unlike what was observed in the cationic controls. Mechanistically, the delivery of the transgene appeared to be, in part, due to endocytosis mediated by folate receptor targeting. This mechanism was further validated by the observation that adding free folate into the medium decreased luciferase expression by 50%. In vivo transfection with the folate-modified MM18 lipid, containing the highest amount of FA-PEG(570)-diether co-lipid (w:w; 90:10), at a neutral charge ratio, gave luciferase transgene expression. These studies indicate that modification of lipids with folate residues could enhance non-toxic, cell-specific gene delivery.

Results after conservative treatment of serous borderline tumours of the ovary with stromal microinvasion but without micropapillary pattern

The aim of this study was to assess the outcomes of women treated conservatively for a serous borderline ovarian tumour with stromal microinvasion (SBOT-SMI) but without micropapillary pattern. Ten women treated conservatively for a stage I (n= 8) or stage IIIB (n= 2) tumour were followed up. With a median follow-up duration of 62 months (range 7-117 months), five recurrences developed on the preserved ovary. All lesions were borderline recurrences (with noninvasive peritoneal implants in one). All women are currently disease free. Three women achieved a spontaneous pregnancy and three became pregnant after an in vitro fertilisation procedure. This study suggests that conservative treatment of SBOT-SMI is safe.

Fine-needle aspiration for nucleic acid-ased molecular analyses in breast cancer

BACKGROUND

With the widespread development of genomic analysis, an accurate and quick method for obtaining high-quality nucleic acids is needed. The objective of the current study was to evaluate the quality and potential use of material obtained from fine-needle aspiration cytology (FNAC).

METHODS

Ultrasound- or palpation-guided FNAC was performed in 124 consecutive patients who had nodular breast lesions. The authors evaluated the amount of messenger RNA (mRNA) obtained, its quality through the RNA Integrity (RIN) score, and the factors that influenced both. For malignant lesions, the authors attempted to correlate estrogen receptor 1 (ESR1) and HER-2 (c-erb-B2) mRNA expression measured by real-time quantitative polymerase chain reaction with estrogen receptor and HER-2 detection obtained by immunohistochemistry (IHC) and/or fluorescent in situ hybridization (FISH) on the surgical specimen.

RESULTS

The amount of mRNA obtained was >1 microg in 89.5% of 124 samples (43 benign lesions and 81 adenocarcinomas). Overall, 59.3% of samples yielded >1 microg RNA with a RIN score >6. The most significant predictors of quality and quantity of mRNA were the cytopathologist who sampled the tumors and a diagnosis of cancer versus benign lesion. The median ESR1 expression level, which was expressed as the polymerase chain reaction cycle threshold (CT) level minus the average 18S value (dct), was 17.7 dct in patients with estrogen receptor-negative tumors and 11.1 dct in patients with estrogen receptor-positive tumors. The median HER-2 expression level was 15.1 dct in patients with HER-2-negative tumors and 10.7 dct in patients with HER-2-positive tumors. mRNA expression was concordant with the IHC/FISH evaluation in 90.3% of patients for estrogen receptor status and in 98.5% of patients for HER-2 status.

CONCLUSIONS

In 70% of cases, FNAC of breast lesions in well trained hands allowed the extraction of mRNA suitable for gene expression analysis.

Results after conservative treatment of serous borderline tumors of the ovary with a micropapillary pattern

OBJECTIVE

The aim of this study was to assess the outcomes of patients treated conservatively for a serous borderline ovarian tumor with micropapillary patterns (SBOT-MP).

METHODS

Retrospective study collecting cases of conservative treatment of SBOT-MP. There are 15 patients treated with conservative management for a stage I (n = 8) or III (n = 7) SBOT-MP. Eight patients underwent a unilateral salpingo-oophorectomy with a contralateral cystectomy, three a unilateral salpingo-oophorectomy, two a cystectomy, and two a bilateral cystectomy. Four patients had stromal microinvasion associated with MP at histological examination of the ovarian tumor. Noninvasive implants were observed in eight patients and invasive implants in one. Three patients had residual disease <1 cm on the peritoneum. One patient received adjuvant chemotherapy.

RESULTS

After a median interval of 63 months (range, 18-120 months), 11 recurrences were observed: six of them exclusively on the ovary, three exclusively on the peritoneum (invasive peritoneal disease in one), and two on the ovary and peritoneum. One of the last two patients succumbed to the recurrence (under the form of invasive adenocarcinoma). The other patients were actually disease free. Five patients achieved eight spontaneous pregnancies.

CONCLUSION

This study demonstrates that spontaneous pregnancies can be achieved after conservative treatment of SBOT-MP. Nevertheless, as 2/3 of patients had bilateral ovarian involvement at the time of initial management, the recurrence rate is high. However, making definitive conclusions about the safety of conservative surgery is limited by the small sample size. So, further studies are warranted to evaluate conservative management of advanced-stage disease.

Aminocarbonyl group containing Hoveyda-Grubbs-type complexes: synthesis and activity in olefin metathesis transformations

Three novel "boomerang" precatalysts bearing different aminocarbonyl functions are reported. Comparative kinetic studies show that this functional group allows for a control of the catalytic activity in metathesis transformations. The scope of the more active catalyst is investigated and shows a good tolerance to various substrates in ring-closing metathesis, enyne metathesis, and cross metathesis. ICP-MS analyses illustrate the good affinity of this catalyst for silica gel, as levels of Ru contamination lower than 6 ppm are detected in the final products.

Granular cell tumor of the breast

We report a case of a 43-yr-old woman with a granular cell tumor of the breast. She presented with a palpable mass of the left breast of 2-yr duration. On physical examination, a firm, painless, well-defined mass located at the union of the upper quadrants was observed and a palpable homolateral axillary lymph node. The tumor was dense with ill-defined borders at mammography and hypoechoic, hypovascular, and poorly limited at ultrasonography. Fine needle aspiration cytology of the lesion was performed. Cytologic examination revealed the presence of highly cellular material, composed of both large cohesive groups and single cells often admixed with connective tissue. These cells had ill-defined abundant granular cytoplasm and bland regular small nuclei. Nucleoli were inconspicuous. Neither mitoses nor necrosis were noted. The cytological diagnosis of granular cell tumor of the breast was confirmed by histological examination of the surgical specimen following a breast lumpectomy.

Synthesis of Archaeal Bipolar Lipid Analogues: A Way to Versatile Drug/Gene Delivery Systems

A synthetic route for the preparation of symmetrical and unsymmetrical archaeal tetraether-like analogues has been described. The syntheses are based upon the elaboration of hemimacrocyclic tetraether lipid cores from versatile building blocks followed by simultaneous or sequential introduction of polar head groups. Functionalizations of the tetraether lipids with neutral lactose or phosphatidylcholine polar heads and cationic glycine betaine moieties were envisaged both to increase membrane stability and to exhibit interactions with charged nucleic acids. Additionally, mannose and lactose triantennary clusters designed as multivalent ligands for selective interaction with lectin-type receptors were also efficiently synthesized for active cell/tissue targeting.

Highly recoverable pyridinium-tagged Hoveyda-Grubbs pre-catalyst for olefin metathesis. Design of the boomerang ligand toward the optimal compromise between activity and reusability

Whereas the boomerang ligand of Hoveyda-Grubbs pre-catalysts can be modified by attachment of a pyridinium tag to its benzylidene moiety, a precise adjustment of the length of the spacer allows the optimum balance to be reached between the activity of the catalyst and its recoverability, exceeding 98% after 6 catalytic runs in the best case.

Autologous fat transfer in reconstructive breast surgery: indications, technique and results

AIMS

Reconstructive techniques using flaps to preserve the enveloping skin, and even the nipple areolar complex where there is no neoplastic infiltration, have led to vast improvements in the results of reconstructive breast surgery. To further improve the cosmetic outcome, we have applied the technique of autologous fat transfer or lipoinjection, which has proven very successful in cosmetic surgery, to reconstructive breast surgery, and to the treatment of certain cosmetic sequelae of conservative breast treatment. We report our findings.

METHODS

From September 2001 to September 2005, 74 autologous fat transfers were undertaken in 69 patients, with 5 patients receiving injections in both breasts, to improve the cosmetic appearance through resurfacing and to repair certain sequelae of conservative breast treatment. Pre- and postoperative imaging, including MRI, were undertaken to monitor the viability of the fat grafts and detect any suspicious lesions; no suspect lesions were detected either pre- or postoperatively.

RESULTS

We did not undertake overcorrection, which creates irregularities of surface or contour. Five cases of cytosteatonecrosis were reported among the 74 procedures. The mean follow-up period for the patients was 11.7 months, ranging from 1 month to 3.2 years. The panel judged improvement to be good to very good in 64 breasts (86.5%) and moderate in 10 breasts (13.5%) primarily due to lack of available adipose material for harvesting in these patients.

CONCLUSION

Autologous fat transfer is now a routine procedure in our clinic due to its simplicity, safety, and reproducibility. It is systematically proposed to all of our patients as the final, perfecting procedure of breast reconstruction, irrespective of the technique used for the initial reconstructive procedure, but also to repair certain conservative treatments.

Detection of impaired growth of the corpus callosum in premature infants

OBJECTIVE

There is an urgent need for a bedside method to assess the effectiveness of neonatal therapies designed to improve cerebral development in very low birth-weight infants. The aim of this study was to assess the impact of preterm birth on the serial growth of the corpus callosum and how soon it could be detected after birth with cranial ultrasound.

METHODS

We recruited 61 very low birth-weight infants admitted to a single regional level III NICU from 1998 to 2000. Study infants had 2 cranial sonograms > or = 7 days apart in the first 2 weeks of life and further sonograms at 6 weeks and at term equivalent. At each time point, the length of the corpus callosum and cerebellar vermis was measured on midline sagittal images, with growth rates calculated in millimeters per day. We compared growth of corpus callosum and cerebellar vermis in individuals, between birth age groups, and with corrected gestational age. We used antenatal growth rate of the corpus callosum of 0.2 to 0.27 mm/day as a reference. Relationships between corpus callosum growth rates and neurodevelopmental outcome at 2 years of age (corrected) were also examined.

RESULTS

Growth of the corpus callosum was normal in most infants during the first 2 weeks of life but slowed after this (0.21 mm/day from 0-2 weeks vs 0.11 mm/day for weeks 2-6). Slowing of corpus callosum growth below expected reference range was consistently detectable by age 6 weeks for 96% of infants born between 23 and 33 weeks' gestation. Although some improvement in growth rate was observed for 15% of infants after 6 weeks, this was confined to infants born after 28 weeks. Vermis length correlated strongly with corpus callosum length. By 2 years of age, serious motor delay and cerebral palsy were associated with poorer growth of the length of the corpus callosum between 2 and 6 weeks after birth.

CONCLUSIONS

The effect of preterm birth on growth of the corpus callosum is detectable by 6 weeks after delivery in preterm infants born at gestations of 23 to 33 weeks. Reduced growth of the corpus callosum in weeks 2 to 6, places these infants at elevated risks of later psychomotor delay and cerebral palsy.

A mathematical model to predict for pre-malignant or malignant diagnosis among patients with Birad 4 breast lesions

10578

Background: Preoperative cytological or histological diagnosis of breast lesions is mandatory in order to avoid unnecessary surgical biopsies, but on the other side preoperative work-up may dangerously delay specific care of breast cancer. Solid lesions or microcalcifications (M) scored as Birad 4 are increasingly prevalent in western countries. A highly variable proportion of these lesions (20–80%) are breast cancer. Tools to help clinicians recognize cancers and preneoplastic lesions among true benign conditions may be very helpful in clinical practice. Methods: Radiological, clinical and pathological data of consecutive patients with Birad 4 breast M (N = 384 biopsies among 354 patients) or nodular lesions (N = 172 FNAC among 167 patients) seen in a multidisciplinary breast clinic were prospectively recorded. A multivariate analysis of factors predicting for a final cancer or pre-malignant diagnosis was performed and two nomograms were constructed using the R statistical package for both nodular lesions and M. They were validated by bootstrapping. Variables tested included age, size and palpability of lesion, Gail score, menopausal status, HRT use, progression of lesion (M), and presence of associated symptoms. Results: Median age was 57 years (18–92) for the entire population. Patients with nodular lesions were menopausal in 64.5%, median size of their lesion was 12 mm (4–50), 32% were palpable; 43% had a final diagnosis of breast cancer and 3.5% of atypical hyperplasia or LCIS. 69% of patients with M were menopausal, 31.25% had a final diagnosis of breast cancer and 9.8% of atypical hyperplasia or LCIS. Among patients with nodular lesions, age and palpability were the sole independent predictors of cancer or precancerous lesions (p = 0.04 and 0.004), but the other variables (Gail, menopause, HRT) added discrimination with a concordance index of 0.71. Among patients with M, the only independent predictive variable was the recent progression of the lesions (p = 0.01). The nomogram had a concordance index of 0.69. Conclusion: Our study provides two original nomograms for the prediction of the pre-malignant or malignant nature of recently discovered solid breast lesions and M. Gail model alone is not a highly useful tool in daily individual cancer prediction.

No significant financial relationships to disclose.

Growth rate of corpus callosum in very premature infants

BACKGROUND AND PURPOSE

It is desirable to develop a bedside method for assessing cerebral development in the very premature infant to monitor the effectiveness of interventions aimed at improving cerebral development. Our aim was to describe the growth trajectory of the corpus callosum (CC) on cranial sonography in very premature infants.

METHODS

We recruited 100 very-low-birth-weight infants admitted to a single regional level III neonatal intensive care unit from November 1998 to November 2000. Cranial sonography images of the CC were obtained for 64 (32 boys) infants (mean gestational age, 28 weeks; range, 23-33 weeks) in the first week of life and at term equivalency. The growth rate of the CC was compared in the 64 study infants to the expected growth rate of 0.20-0.27 mm/day from antenatal data and correlated with clinical outcome at 2 years of age by using Mental Development Index (MDI) and Psychomotor Development Index (PDI).

RESULTS

The average growth rate of the CC was half of that expected from antenatal data. Mean growth rates were similar for all gestational ages (mean, 0.11 mm/day; range, 0.05-0.29; P = .4). The CC at term equivalency was longer for those in MDI class 2 (mean, 44.3 mm) compared with MDI class 3 (mean 40.2 mm; P = .003) as well as for PDI class 2 versus 3 (P = .017).

CONCLUSION

Measurement of the length of the CC at cranial sonography is reproducible. Those with poorer neurodevelopmental outcomes have a shorter CC at term equivalency. The CC grows at a much lower rate postnatally than in utero among very premature infants.

Telerobotic-assisted laparoscopic hysterectomy for benign and oncologic pathologies: initial clinical experience with 30 patients

BACKGROUND

Telerobotic-assisted laparoscopic attempts to provide technological solutions to the inherent limitations of traditional laparoscopic surgery. The aim of this study is to report the first experience of two teams concerning telerobotic-assisted laparoscopic hysterectomy for benign and malignant pathologies.

METHODS

This study included 14 patients at the University Hospital Saint Pierre of Brussels (Belgium) and 16 patients at the Cancer Center of Nancy (France) from September 1999 to July 2003.

RESULTS

The indications for surgery were uterine malignant diseases in 12 cases (stade I) (41%), and benign pathologies of the uterus in 18 cases (59%). Five postoperative complications (17%) occurred, none related to the robotic system.

CONCLUSION

Robotic surgery can be safely performed in gynecologic and gynecologic-oncologic surgery with no increase in complication rates. A significant advance is represented by the surgeon's ergonomic improvement.

Preparation of synthetic glycoconjugates as potential vaccines against Shigella flexneri serotype 2a disease

The synthesis of three neoglycopeptides incorporating carbohydrate haptens, differing in length, covalently linked to a non natural universal T helper peptide is disclosed. They were synthesized according to a blockwise strategy based on the condensation of appropriate di-, tri-, and tetrasaccharide trichloroacetimidate donors onto an azidoethyl 2-acetamido-2-deoxybeta-D-glucopyranoside acceptor. Use of thiol-maleimide coupling chemistry allowed site-selective efficient conjugation.

Factors predicting long-term efficacy of Hylan GF-20 viscosupplementation in knee osteoarthritis

OBJECTIVES

To describe the long-term effects of Hylan GF-20 viscosupplementation in patients with knee osteoarthritis and to identify factors predicting efficacy.

METHODS

One hundred and fifty-five patients (80 women and 75 men; mean age, 69 years) with symptomatic knee osteoarthritis each received three intraarticular Hylan GF-20 injections. Effectiveness, safety, and satisfaction were evaluated 7-14 months later based on a physician's examination and a five-item questionnaire. Radiological data (distribution and degree of joint space loss), size of the effusion (none, moderate, large), injection route (anterior, medial to the patella, or lateral to the patellar), and side effects were recorded. Factors predicting effectiveness were looked for by univariate analysis followed by multivariable analysis with adjustments on age, body mass index, gender, and time from treatment to questionnaire administration.

RESULTS

Satisfaction was good in 78% and 58.9% of the patients according to the physician examination and questionnaire, respectively. Safety was considered excellent or good in 96.2% of the patients. Factors significantly (P < 0.05) associated with a good outcome were a moderate effusion, injection lateral to the patella, joint space loss in a single compartment, and radiological meniscal calcinosis.

CONCLUSION

The factors predictive of a good response to Hylan GF-20 in this study need to be confirmed, and their impact quantitated, in prospective studies.

[Cardiac arrest outside the hospital]

Out-of-hospital cardiac arrest remains a clinical problem with a survival rate of less than 5%. Prompt initiation of cardiopulmonary resuscitation and rapid delivery of advanced cardiac-life procedures are required. Combined in-hospital management by experienced cardiologists and intensive care specialists is recommended. Acute coronary-artery occlusion is frequent and poorly predicted by clinical and electrocardiographic findings. Accurate diagnosis by immediate coronary angiography can be followed if necessary by coronary angioplasty. Survivors undergo extensive work-up to determine the indications of an implantable defibrillator or coronary revascularization.

Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis

To identify the potential impact of novel therapeutic approaches, we studied the early predictive factors of survival at the onset of acute respiratory distress syndrome (ARDS) in a 24-bed medical ICU of an academic tertiary care hospital. Over a 48-mo period, a total of 3,511 adult patients were admitted and 259 mechanically ventilated patients met ARDS criteria, as defined by American-European consensus conference, i.e., bilateral pulmonary infiltrates and PaO2/FIO2 lower than 200 without left atrial hypertension. These patients were randomly included in a developmental sample (177 patients) and a validation sample (82 patients). Demographic variables, hemodynamic and respiratory parameters, underlying diseases, as well as several severity scores (SAPS, SAPS-II, OSF) and Lung Injury Score (LIS) were collected. These variables were compared between survivors and nonsurvivors and entered into a stepwise logistic regression model to evaluate their independent prognostic roles. The overall mortality rate was 65%. SAPS-II, the severity of the underlying medical conditions, the oxygenation index (mean airway pressure x FIO2 x 100/PaO2), the length of mechanical ventilation prior to ARDS, the mechanism of lung injury, cirrhosis, and occurrence of right ventricular dysfunction were independently associated with an elevated risk of death. Model calibration was very good in the developmental and validation samples (p = 0.84 and p = 0.72, respectively), as was model discrimination (area under the ROC curves of 0.95 and 0.92, respectively). Thus, the prognosis of ARDS seems to be related to the triggering risk factor, the severity of the respiratory illness, and the occurrence of a right ventricle dysfunction, after adjustment for a general severity score.

[Faun tail and sacral hemangioma associated with occult spinal dysraphism]

INTRODUCTION

Hemangiomas are the most frequent skin tumor of childhood. Usually, a "wait and see" policy is adopted. However, a sacral hemangioma may reveal occult neurodysraphism.

CASE REPORT

MRI discovered lipomyelomeningocele and a tethered spinal chord in an asymptomatic 4-month-old boy with sacral hemangioma and faun tail. Because of absence of neurological defect only surgery of the caudal appendage was performed for the moment.

DISCUSSION

Midline lombosacral lesions, as well as lipomas, hirsutism or pilonidal cyst, may be associated with occult spinal defect; the most severe is tethered chord. Renal or ano-genital anomalies can be also associated.

CONCLUSION

MRI is necessary in case of midline sacral hemangioma to detect underlying anomalies.