Biomedical subjects
Publications and source records attributed to J Testart.
Only four cases of per-operative pulmonary embolus of parasites during surgery for hydatic cysts of the liver have been reported. Embolus usually occurs in patients who already have lung metastasis of hepatic cysts, suggesting a hepatic cyst in direct communication with the vena cava or suprahepatic vein. We report the first case which occurred in a patient in which there was no evidence of such communication.
We report a case of cystic adventicial disease of the popliteal artery in a 67 years old man. The realisation of the intra arterial pressure measurements, and the peroperative echography permit to diagnose important associated lesions of the intimal part of the arterial wall.
Recklinghausen disease which usually appears by tumors of the nervous system peripheral and central can present anomalies of other systems, particularly vascular anomalies. The damage of renal arteries is well known. Intracerebral aneurysms are rare. Multiple intracerebral aneurysm has been reported in only four cases. We report a case of a patient presenting three intracerebral aneurysms. The patient died of a meningial haemorrhage. This leads us to search for intracerebral aneurysms in Recklinghausen's disease, specially in presence of arterial hypertension.
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Ischemic rest pain, with or without trophic disorders and occurring very frequently at night, is responsible for insomnia and complications such as positional oedema. The pathophysiological mechanisms underlying the analgesic effect of naftidrofuryl led us to evaluate the efficacy of this treatment. 37 selected patients were given 2 daily infusions of 400 mg of naftidrofuryl for 8 days, under double-blind conditions. Evaluation criteria were pain assessment using a visual analogue scale, analgesic consumption considering both the power (WHO scale: level I paracetamol, level II dextropropoxyphene, level III morphine) and the dosage of the analgesic used (analgesic score), index of therapeutic success including the level of pain reduction and the absence of analgesic use. The results showed a significant difference in favour of naftidrofuryl for: reduction of pain, difference in the course of the analgesic score, the distribution of the population according to the index of therapeutic success. Three patients discontinued treatment due to inefficacy, but all 3 belonged to the placebo group. This study demonstrates the benefit of naftidrofuryl in pain reduction which was assessed, in particular, by the reduction of analgesic consumption.
UNLABELLED: The causes of digital necrosis are so diverse that it should be considered not as a surgical but as a medical emergency. In women, digital necrosis first suggests connective tissue disease, and especially Progressive Systemic Sclerosis. In men the causes are more diverse. In this retrospective study, we have tried to identify and categorize the cause of digital necrosis in patients without Progressive Systemic Sclerosis. The medical files of all patients admitted from 1/1/89 to 1/1/93 for digital necrosis were retrospectively reviewed. All patients with Progressive Systemic Sclerosis, either diagnosed at that time or know before, were excluded. All 45 patients in the study had an evaluation of coagulation, vascular risk factors, a cardiac examination and nailfold capillary microscopy, as well as tests for antinuclear antibodies, and cryoglobulinaemia. Other tests were done according to the clinical presentation. Upper limb angiography was done 26 times. RESULTS: there were 10 women and 35 men, mean age 53 years (24-85 years). In the women, the following diagnosis were found: atherosclerosis 1, paraneoplastic syndrome 1, one thrombocythemia, and 6 connective tissue diseases (one dermatopolymyositis, 1 essential cryoglobulinaemia, 2 lupus erythematous and two suspected secondary Raynaud's phenomenon. Twelve men had arterial diseases: 6 thromboangiitis obliterans and 6 obliterans atherosclerosis. Seven times, the cause was local: 5 hammer's syndromes, 2 thoracic outlet syndrome. In the other patients, the causes were extremely diverse: cardiac embolism (4), primary antiphospholipid syndrome (3), polyarteritis nodosa (1), leprosy seroconversion (1), connective tissue disease (3). In 4 patients (3 of whom were smokers) no cause was found.(ABSTRACT TRUNCATED AT 250 WORDS)
In long occlusions of the superficial femoral artery, possibilities of revascularization depend on the patency of the above-knee popliteal artery. In case of occlusion of the above-knee popliteal artery, the distal anastomosis is to be performed at the below-knee level or more distally; in this situation, studies demonstrate a clearcut superiority of venous bypasses over prosthetic bypasses. Patency of the above-knee popliteal artery allows to perform a shorter bypass avoiding to cross the knee joint; given comparable results between venous and prosthetic above-knee bypasses in certain series, several authors advocated the preferential, if not systematic use of prosthetic materials at this level; this attitude having the advantage of preserving the saphenous vein for later coronary or distal grafting. A critical analysis of studies advocating this therapeutic option reveals that results of prosthetic and venous above-knee bypasses are equivalent in only very restrictive clinical situations (claudication, good runoff) and for follow up less than 3 years; beyond this follow up, the use of a prosthesis increases the number of secondary procedures necessary for maintaining or restoring patency and for this reason increases slightly the overall mortality owing to the operative mortality associated with each reoperation. Apart from rare cases represented by fragile and high-risk patients, whose lifespan is likely to be short and in whom a quicker operation is advisable, indications of the use of prosthetic grafts depend on the limits of the use of the saphenous vein generated by a poor quality or an insufficient diameter.
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The technique of thoracic splanchnicectomy under video thoracoscopic control is described. This little aggressive surgical operation is indicated for very painful forms of pancreatic cancer and for some cases of chronic pancreatitis. It should relieve pain for a longer period than splanchnic nerve injection or radiotherapy.
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The effects of an antiserum (anti-COC) against ovulated mouse cumulus-oocyte complexes (COC) on in vitro fertilization of mouse oocytes were studied. Preincubation of ovulated COC with various concentrations of anti-COC led to dose-dependent impairment of fertilization rates as well as to a decrease in the number of spermatozoa attached to the zona pellucida. Anti-COC was used to probe Western blots of cumulus proteins. These cumuli were obtained from 2 experimental groups of mice corresponding to 2 different maturational stages (preovulatory immature COC or preovulatory mature COC). Two antigens (70 and 80 kDa) present in cumulus intercellular matrix from mature COC were only found as traces in matrix from immature COC. In addition, the protein pattern of the cumulus intercellular matrix was different from that of cumulus cells, whatever the COC maturational stage. These results indicate the appearance of new proteins in the cumulus oophorus during preovulatory expansion and are consistent with the contraceptive action of anti-COC.
This review summarizes the main clinical and research studies on direct and indirect effects of gonadotrophin-releasing hormone agonists (GnRHa) on follicles and oocytes in animals and humans. There is evidence for extra-pituitary actions of GnRHa, especially on follicle growth, follicular steroidogenesis, and oocyte meiotic maturation. Different effects have been reported from using various GnRHa molecules. However, a direct effect of GnRHa on oocyte quality in gonadotrophin stimulated cycles has not yet been demonstrated. Observed high pregnancy rates per ovarian puncture in in-vitro fertilization cycles using GnRHa, at least in long protocols, might result from higher numbers of oocytes recovered following administration of large doses of gonadotrophins, despite the fact that these oocytes may have a lower ability to fertilize and grow. Although there are obvious clinical advantages of using GnRHa for ovarian stimulation, more studies are needed to clarify the effects of these treatments at ovarian and uterine levels.
In order to list the negative emergency laparotomies, the records of 24,494 laparotomies performed from 1950 to 1989 were examined. 211 negative laparotomies were performed over this 40 years period: 49 for abdominal trauma, 42 for supposed intestinal obstruction, 44 for supposed peritonitis or visceral infection, 46 for presumed early post-operative abdominal complications and 30 for gastrointestinal bleeding. Over these 4 decades, the emergency laparotomy rate and negative laparotomy rate remained stable despite changes in the diagnostic tools, in the age of the patients and the frequency of their diseases.
An exceptional case of incarcerated para-hiatal hernia with gastric necrosis, developing 7 years a Toupet procedure, is reported. To our knowledge, this is the first reported case of this complication after a surgical anti-reflux procedure without diaphragmatic counter incision. The mechanism, diagnostic difficulties and treatment are discussed.
The role of protein kinase C (PKC) in the successive steps of mouse oocyte meiotic process was investigated. We have used either OAG, an analog of diacylglycerol, or mezerein, a nonphorbol ester diterpene, less tumor promoting than phorbol esters, as PKC activators, and staurosporine as PKC inhibitor. Cumulus-free oocytes were cultured in minimum essential medium with each of these PKC modulators and maturation stages were screened every two hours until the end of the process. Both PKC activators prevented GVBD at each tested dose for 4 hr (OAG) and 8 hr (mezerein), and decreased the frequencies of PB oocytes. The inhibitory effects of both activators were dose dependent and reversible. The addition of OAG to the culture medium after GVBD occurrence (i.e., after 4 hrs) did not affect PB extrusion whereas similar addition of mezerein significantly decreased the frequency of PB oocytes. Inhibition of PKC by staurosporine accelerated GVBD and increased the frequency of PB extrusion. When staurosporine was added after GVBD, PB extrusion occurred earlier but PB oocyte frequency was not increased. Fertilizability was not affected when oocyte maturation occurred in the presence of any of these substances despite the delay in maturation process. These results clearly indicate that the PKC pathway is involved in mouse oocyte meiotic process: activation of the enzyme would arrest meiotic process whereas its inhibition would participate in meiosis induction.
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In order to identify human sperm surface proteins involved in the gamete recognition process, mouse monoclonal antibodies were directed against human spermatozoa and screened with live spermatozoa by enzyme-linked immunosorbent assay (ELISA). Immunoperoxidase staining of human testis showed the early presence of four corresponding proteins on germinal cells, while six were detected primarily in testis fluid. The presence of 17 proteins was evidenced in the epididymis. Eight were detected with a decreasing gradient from the beginning to the end of the organ, including vasa efferentia for three of them. The other nine were observed in only one defined segment, usually the caput epididymis, which was found to be the most active region. Comparison of spermatozoa patterns from testis, vasa efferentia, and the three regions of epididymis pointed out a progressive coating. By contrast, three antibodies displayed a migration of spermatozoa surface domains in the course of epididymal transit. Six antibodies were found to inhibit human spermatozoa adherence to zona-free hamster oocytes, while nine promoted it. Molecular weights of antigens corresponding to nine of the antibodies ranged from 11 to 215 kDa. No correlation could be established with previously described human proteins. These observations emphasize the role of epididymis in human sperm maturation.