[Family planning: visit without parents].
Explore the source record for details and available documents.
Abortion, Legal↗
Biomedical subjects
M Prudhomme
Publications and source records attributed to M Prudhomme.
Causes and outcomes of pouch excision after restorative proctocolectomy.
BACKGROUND: Pouch failure occurs in up to 10 per cent of patients after ileal pouch-anal anastomosis (IPAA). The aims of this study were to determine the reasons for pouch excision and to evaluate the outcome of the perineal wound after pouch excision. METHODS: Between 1984 and 2002, 91 patients with severe ileal pouch dysfunction were treated. This was a retrospective analysis of data collected prospectively from 24 patients who underwent pouch excision. RESULTS: Patients were grouped according to the final histological diagnosis. Fourteen patients with Crohn's disease developed extensive fistulous disease and/or recurrent abscesses, of whom six had a persistent perineal sinus after pouch excision. Five patients had familial adenomatous polyposis, in three of whom desmoid tumours were the cause of failure. Three patients had chronic ulcerative colitis and developed recurrent pelvic sepsis. Finally, two patients with multiple colorectal adenocarcinoma developed recurrent cancer (one) or sepsis (one). CONCLUSION: Sepsis was the principal reason for pouch excision and was usually associated with recrudescent Crohn's disease in the pouch. Perineal wound healing was problematic after pouch excision for Crohn's disease.
Adenomatous Polyposis Coli↗
[Female condom or male condom: offer a choice!].
OBJECTIVES: As in the entire Ile-de-France, the Val-de-Marne is facing an increase in female contamination by HIV, a clear increase in STI and furthermore the number of legal abortions is still high. Various recent studies have emphasized the decrease in condom use since 1998. Can the possibility of proposing another condom, more specifically controlled by women, boost condom use? PATIENTS AND METHODS: The conseil général (local government authority) thus initiated a study in the general population, from January 1st 2001 to December 31st 2001, in order to study the criteria of acceptability of the female condom (FC). RESULTS: Although the women coming to consultation had no specific requests a quarter finally tested the female condom during sexual intercourse. Among them 4 out of 10 are ready to use it again. Curiosity was the primary motivation of those who accepted to test the female condom (77 %). Women who were more at ease with their sexuality were twice more likely to test the female condom. Three main advantages were put forward by the women who tested the FC: the strength of the FC, the fact that insertion was possible prior to the sexual act and the possibility of postponing removal, the latter being considered a supplementary advantage. The disadvantages most frequently cited before use were its appearance and difficult insertion process. The frequency of utilisation of the FC was multiplied by three when women practised putting the condom in place in a non-sexual context. However, even when they recognized one or several disadvantages women accepted to test it. In addition, whenever a woman finds at least one advantage before use she is twice more likely to test it. This is where counselling by professionals in charge of presenting the FC becomes a deciding factor. DISCUSSION AND CONCLUSIONS: The chance of using at least one sort of condom is increased when a choice of condoms is available. When both male and female condoms are available, the responsibility for prevention is better balanced within the couple: each partner can then be in charge of his or her own health. However the adoption of a barrier method such as the condom, means that the individual is conscious of such a need and finds that there are benefits mainly staying in good health. However the insufficient number of prevention and health promotion campaigns in France does not favour such an awareness. The availability of inexpensive female condoms in pharmacies, supermarkets as well as free distribution by certain institutions remains an unresolved question.
Acquired Immunodeficiency Syndrome↗
[Multivisceral resections of extracolorectal lesions in familial adenomatous polyposis].
AIMS: 1/ To report our experience with multivisceral resections in familial adenomatous polyposis (FAP) for extracolorectal lesions in a cohort of nine patients. 2/ Discuss the long term results of an agressive surgery. PATIENTS AND METHODS: Nine patients (7 males and 2 females) were operated at the University Hospital of Nimes (N=4) and Nantes (N=5). The median age at the first operation was 29 years (range 18-43). A genetic study was performed in six patients and confirmed the mutation on APC gene (exon 11, 13 and 15). All the patients were operated through a classic laparotomy. RESULTS: All patients have underwent a mean of three operations (range 2-5). Eight patients have had initially a total colectomy and 4 underwent subsequent proctectomy. Seven patients had pancreaticoduodenectomy for extensive duodenal adenomas and/or carcinoma. Three had one or multiple small bowel resections for development of carcinoma and one had partial gastric resection for large adenovillous tumor. The median follow up was 25 years (range 15-37) since the first operation. Three patients were died: one of gastric cancer with hepatic metastases, one of peritoneal carcinosis after ileal resection and one of astrocytoma. CONCLUSION: With regard to these nine observations, the authors underline the possibility of multivisceral resection in FAP. Despite a major digestive mutilation, it permits a long survival with acceptable quality of life. The prognosis depends on the aggressiveness of the duodenal or jejunoileal lesions more than of the colorectal tumors if found at the first resection.
Adenoma↗
[A prospective study of the provision of emergency contraception in French family planning centers].
OBJECTIVES: To describe emergency contraception provision, including the efficacy of the method, in family planning centers in suburban Paris two years after the method became available without a prescription. PATIENTS AND METHODS: A prospective study involving two questionnaires was conducted between September 2001 and July 2002 in 27 family planning centers in the Val-de-Marne region. The first questionnaire was completed at the time emergency contraception was dispensed and the second one upon a follow-up visit. Efficacy was calculated for both perfect use (only one act of unprotected intercourse in the current menstrual cycle, emergency contraception treatment initiated within 72 hours) and typical use (including multiple acts of unprotected intercourse in the cycle and/or treatment initiated after 72 hours). RESULTS: A total of 519 requests for emergency contraception was recorded, resulting in the provision of 518 treatments. The women requesting emergency contraception were young (96% under the age of 25) and cited unprotected intercourse and problems with condom use as the main reasons for the request. Information regarding the outcome of emergency contraception treatment was available in 77% of the cases, and a failure rate of 1.9% was observed with perfect use and 2.7% with typical use. DISCUSSION AND CONCLUSIONS: This prospective study of emergency contraception prescription in family planning centers confirms data on the efficacy and safety of the method observed in similar environments. The failure rate associated with typical use is higher than that observed with perfect use.
Adult↗
Three-dimensional computer-assisted reconstruction of ductal plate in the rat embryo (Carnegie stages 19-23).
In bile duct morphogenesis it has been established that the extrahepatic bile ducts in human originate from hepatic diverticulum while intrahepatic bile ducts arise from the ductal plate (DP), a network of primitive biliary epithelium that develops in the periportal connective tissue. The aim of this work was to reconstruct in rat embryos, stages 19-23, the three-dimensional (3D) distribution of the DP by means of a computer-assisted method. Six specimens, stages 19-23, fixed, dehydrated and paraffin-embedded, were submitted to serial histological sections and stained by hematoxylin-eosin and Heidenhain techniques. The images were directly digitalized with a CCD camera. The serial views were aligned anatomically by software and the data were analyzed following segmentation and thresholding. At stage 19, the DP was not yet organized. The periportal mesoderm (M) was gaining ground with some cords of cubic cells evoking primitive ductal cells. At stage 20, a row of ductal cubic cells went around the transverse portal sinus at the junction between M and liver cells. At stage 21, the DP developed at the periphery of periportal connective tissue and appeared in direct continuity with the hepatic duct (HDu). Four evaginations emerged from the DP and were growing up in the hepatic parenchyma. At stage 23, the DP appeared as a large network in continuity with the HDu located at the periphery of periportal M and presenting several evaginations radiating in the liver parenchyma. This work in the rat embryo permits the clear visualization of the development of the junctional zone in the hepatic hilum. Three phenomena are observed: (1) proximal left and right hepatic ducts and their segmental branches are derived from DP and not from the HDu; (2) the extrahepatic biliary system is in contact with the developing hilar ducts; (3) ductal maturation begins at the hilum and proceeds centrifugally. These observations are of great relevance in explaining pathological changes appearing at the hepatic hilum of neonates: hepatic polycystic disease, intrahepatic bile duct agenesis or atresia, and cyst of the extrahepatic bile duct.
Animals↗
Anal canal strictures after ileal pouch-anal anastomosis.
PURPOSE: This study was designed to define the different types of strictures, the factors favoring their occurrence, and their treatment after ileal pouch-anal anastomosis. METHODS: Between January 1981 and June 1996, 1,884 ileal pouch-anal anastomoses were constructed at the Mayo Clinic in Rochester, Minnesota. Data were collected prospectively and included age, gender, type of underlying diseases (chronic ulcerative colitis familial adenomatous polyposis), proctologic antecedents, technique of anastomosis, intraoperative difficulties, and postsurgical complications. Strictures were categorized as nonfibrotic and fibrotic on the basis of the presence or absence of a fibrotic segment at the anal canal anastomosis that was responsible for pouch-outlet obstruction requiring at least one dilation. RESULTS: Strictures occurred in 213 patients (11.2 percent; 11 percent for chronic ulcerative colitis and 12 percent for familial adenomatous polyposis; P = not significant). Strictures were nonfibrotic in 86.4 percent of patients and fibrotic in 13.6 percent. A greater number of strictures were observed after a handsewn anastomosis (12 percent) than after a stapled anastomosis (4 percent; P = 0.03). Intraoperative technical difficulties were associated with 13 percent of all strictures regardless of the type of stricture (fibrotic, 7.5 percent; nonfibrotic, 14 percent; P = 0.4). Postoperative complications such as abscess, fistula, and pouch retraction were found in 13 percent of cases and were primarily associated with fibrotic strictures. Treatment included dilation, which was successful in 95 percent of nonfibrotic strictures but in only 45 percent of fibrotic strictures (P = 0.0001). Surgical treatment was required in 25 strictures (12 percent), including excision of the strictured segment with mucosal advancement flap (5 patients), excision of the pouch with permanent ileostomy (9 patients), or redo pouch (3 patients). With one exception, all excised pouches were associated with other perianastomotic complications, such as abscess, fistula, and pouch retraction. The remaining eight patients had other surgical procedures because of abscess (n = 3), division of an obstructive bridge (n = 2), and débridement and curettage of a fistula (n = 3) with dilation for associated strictures. CONCLUSIONS: Strictures were observed in 11.2 percent of the patients in this study. Nonfibrotic strictures responded well to anal dilation, whereas fibrotic strictures were more commonly associated with intraoperative or postoperative complications, often necessitated surgical therapy to salvage pouch function, and were eventually responsible for pouch failure in nine patients.
Adenomatous Polyposis Coli↗
Prenatal organization and morphogenesis of the sphenofrontal suture in humans.
OBJECTIVE: The aim of this study was to describe the prenatal structure and morphogenesis of the sphenofrontal suture. METHODS: Eleven human specimens, two embryos and nine fetuses, were prepared for light microscopy study of the sphenofrontal suture. Ten-micrometer sections were made with the microtome in the sagittal plane from the midline to the sphenoidal fontanelle. RESULTS: At the end of the fetal period, the sphenofrontal suture had a five-layer structure like the cranial sutures, and was formed by two different morphogenetic unities. The orbitosphenofrontal suture was formed between the membranous ossification of the orbital part of the frontal bone and the endochondral ossification of the lesser wing of the sphenoid bone, i.e. the ala orbitalis. In the early stage, a transient sphenoethmoidal cartilage was inserted between these two ossifications. The second unit, the lateral sphenofrontal suture, was formed between the frontal bone and the greater wing of the sphenoid, and the ossification was membranous in this portion. It is formed like the cranial suture, directly from the mesenchyme. CONCLUSION: The sphenofrontal suture is a typical fibrous suture arising from two morphogenetic unities.
Body Patterning↗
Risk factors of failure and immediate complication of subclavian vein catheterization in critically ill patients.
OBJECTIVE: To identify the risk factors of failure and immediate complication of subclavian vein catheterization (SVC). DESIGN: Prospective observational study. SETTING: Surgical critical care unit of a tertiary university hospital. PATIENTS: Critically ill patients requiring a first SVC. INTERVENTION: Subclavian vein catheterization was attempted in 707 patients without histories of surgery or radiotherapy in the subclavian area. Failed catheterizations, arterial punctures, pneumothoraces and misplacements of the catheter tip were recorded. Risk factors of failure and immediate complication were isolated among patients' characteristics, procedure parameters (side and number of venipunctures) and the operator's experience using a univariate +/- multivariate analysis. MEASUREMENTS AND MAIN RESULTS: Five hundred sixty-two SVCs (79.5%) were achieved without adverse events. Among the remaining 145 catheterizations, 67 (9.5%) failures, 55 (7.8%) arterial punctures, 22 (3.1%) pneumothoraces and 30 (4.2%) misplacements of the catheter tip occurred. More than one venipuncture was the only risk factor of failed catheterization [2 venipunctures, odds ratio =7.4 (2.1-26); >2 venipunctures, odds ratio =49.1 (16.8-144.1)]. More than one venipuncture and age 77 years or more were predictive of the occurrence of immediate complications [2 venipunctures, odds ratio =3.6 (1.8-7.0); >2 venipunctures, odds ratio =14 (7.7-25.3); age >or=77, odds ratio =1.8 (1.0-3.1)]. The operator's training was not predictive of failed catheterization or immediate complication. CONCLUSION: For SVC, more than one venipuncture is predictive of failed catheterization and immediate complication. Age 77 years or more was predictive of immediate complications.
Adolescent↗
Diversity of Tn4001 transposition products: the flanking IS256 elements can form tandem dimers and IS circles.
We show that both flanking IS256 elements carried by transposon Tn4001 are capable of generating head-to-tail tandem copies and free circular forms, implying that both are active. Our results suggest that the tandem structures arise from dimeric copies of the donor or vector plasmid present in the population by a mechanism in which an IS256 belonging to one Tn4001 copy attacks an IS256 end carried by the second Tn4001 copy. The resulting structures carry abutted left (inverted left repeat [IRL]) and right (inverted right repeat [IRR]) IS256 ends. Examination of the junction sequence suggested that it may form a relatively good promoter capable of driving transposase synthesis in Escherichia coli. This behavior resembles that of an increasing number of bacterial insertion sequences which generate integrative junctions as part of the transposition cycle. Sequence analysis of the IRL-IRR junctions demonstrated that attack of one end by the other is largely oriented (IRL attacks IRR). Our experiments also defined the functional tips of IS256 as the tips predicted from sequence alignments, confirming that the terminal 4 bp at each end are indeed different. The appearance of these multiple plasmid and transposon forms indicates that care should be exercised when Tn4001 is used in transposition mutagenesis. This is especially true when it is used with naturally transformable hosts, such as Streptococcus pneumoniae, in which reconstitution of the donor plasmid may select for higher-order multimers.
DNA Transposable Elements↗
Human plasma carboxylesterase and butyrylcholinesterase enzyme activity: correlations with SN-38 pharmacokinetics during a prolonged infusion of irinotecan.
PURPOSE: To characterize the relationships between human plasma irinotecan carboxylesterase-converting enzyme activity, caboxylesterase-mediated hydrolysis of p-nitrophenyl acetate (pNPA), and the butyrylcholinesterase-mediated hydrolysis of butyrylthiocholine in human plasma and to test the ability of these in vitro tests to predict the variability in SN-38 pharmacokinetics in adult patients during a prolonged infusion of irinotecan. METHODS: Individual plasma-converting enzyme activity was measured in 20 adult cancer patients participating in a pharmacokinetic and phase I clinical trial of a prolonged 96-h intravenous infusion of irinotecan. The pNPA and butyrylthiocholine hydrolysis in patient plasma was also assayed. RESULTS: The irinotecan carboxylesterase-converting enzyme in human plasma had a Vmax of 89.9 +/- 22.7 pmol/h per ml plasma and a Km of 207 +/- 56 microM (mean +/- SD, n = 3). The mean value of the specific activity of this enzyme in 20 adult cancer patients was 10.08 +/- 2.96 pmol/h per ml plasma ranging from 5.43 to 15.39 pmol/h per ml. The area-under-the-concentration-versus time curve (AUC) ratio of SN-38 to irinotecan (AUCSN-38/AUCCPT-11) was used to assess the relative SN-38 exposure to the active metabolite in individual patients. Pharmacokinetic variations in the relative exposure to SN-38 did not correlate with the measured carboxylesterase-converting enzyme activity nor with plasma butyrylcholinesterase activity in our patient population. However, it did correlate with the measured pNPA hydrolysis activity in patient plasma (r2 = 0.350, P = 0.0124, n = 18). CONCLUSIONS: Determination of patient plasma pNPA hydrolysis activity may have utility in predicting SN-38 pharmacokinetics during prolonged infusions of irinotecan.
Antineoplastic Agents, Phytogenic↗
Rebeccamycin analogues from indolo[2,3-c]carbazole.
Glycosylated indolocarbazoles related to the antibiotic rebeccamycin represent an important series of antitumor drugs. In the course of structure-activity relationship studies, we report the synthesis of two new derivatives containing an indolo[2,3-c]carbazole chromophore instead of the conventional indolo[2,3-a]carbazole unit found in the natural metabolites. The N-methylated compound 8 containing one glucose residue behaves as a typical DNA intercalating agent, as judged from circular and electric linear dichroism measurements with purified DNA. In contrast, the bis-glycosylated derivative 7 containing a glucose residue on each indole nitrogen has lost its capacity to form stable complexes with DNA. DNA relaxation experiments reveal that the two drugs 7 and 8 have weak effects on human DNA topoisomerase I. The modified conformation of the indolocarbazole chromophore is detrimental to the stabilization of topoisomerase I-DNA complexes. The lack of potent topoisomerase I inhibition leads to decreased cytotoxicity but, however, we observed that the DNA-intercalating mono-glycosyl derivative 8 is about 5 times more cytoxic than the bis-glycosyl analogue 7. The study suggests that the naturally-occurring indolo[2,3-a]carbazole skeleton should be preserved to maintain the topoisomerase I inhibitory and cytotoxic activities.
Aminoglycosides↗
[Deliverance of emergency contraception, in 1988, in family planning and education clinics (FPEC) of Val de Marne].
OBJECTIVES: To facilitate access to emergency contraception (EC). To allow the nurses in the family planning clinics to deliver it during the doctor's absence. METHODS: For one year, 1998, 1102 women requested EC in the 38 family planning clinics participating in the study. This study evaluated the utilisers and the circumstances under which dispensation occurred. RESULTS: The users of EC were young, 45% under 18 years and 90% under 25 years. There was a marked difference between the contraception the women declared they used and that which they actually did during their last episode of sexual intercourse. Women requested EC in case of condom breakage or slipping (49%), forgotten pill (8%), or after unprotected intercourse (43%). Nurses personally received 809 requests for EC, and 293 women were received by the family planning doctor. In 77% of the cases, EC was given by the nurses, and for the others after medical opinion. But only 7% had a medical "problem" (contraindications to estrogen-progestin, or cycle disorder). Among the 823 women for whom information was obtained, 22 unwanted pregnancies were observed, 18 of these patients decided to have an abortion. 97.3% efficacity. CONCLUSION: Making EC more easily available in family planning clinics with dispensation by nurses does no harm and may reduce the rate of unwanted pregnancy.
Adolescent↗
Regulation of Streptococcus pneumoniae clp genes and their role in competence development and stress survival.
In vitro mariner transposon mutagenesis of Streptococcus pneumoniae chromosomal DNA was used to isolate regulatory mutants affecting expression of the comCDE operon, encoding the peptide quorum-sensing two-component signal transduction system controlling competence development. A transposon insertion leading to increased comC expression was found to lie directly upstream from the S. pneumoniae clpP gene, encoding the proteolytic subunit of the Clp ATP-dependent protease, whose expression in Bacillus subtilis is controlled by the CtsR repressor. In order to examine clp gene regulation in S. pneumoniae, a detailed analysis of the complete genome sequence was performed, indicating that there are five likely CtsR-binding sites located upstream from the clpE, clpP, and clpL genes and the ctsR-clpC and groESL operons. The S. pneumoniae ctsR gene was cloned under the control of an inducible promoter and used to demonstrate regulation of the S. pneumoniae clpP and clpE genes and the clpC and groESL operons by using B. subtilis as a heterologous host. The CtsR protein of S. pneumoniae was purified and shown to bind specifically to the clpP, clpC, clpE, and groESL regulatory regions. S. pneumoniae Delta ctsR, Delta clpP, Delta clpC, and Delta clpE mutants were constructed by gene deletion/replacement. ClpP was shown to act as a negative regulator, preventing competence gene expression under inappropriate conditions. Phenotypic analyses also indicated that ClpP and ClpE are both required for thermotolerance. Contrary to a previous report, we found that ClpC does not play a major role in competence development, autolysis, pneumolysin production, or growth at high temperature of S. pneumoniae.
Adenosine Triphosphatases↗
Formaldehyde-induced alkylation of a 2'-aminoglucose rebeccamycin derivative to both A.T and G.C base pairs in DNA.
Rebeccamycin derivatives represent a promising class of antitumor agents. In this series, two glycosylated indolocarbazoles, NB-506 and NSC-655649, are currently undergoing clinical trials. Their anticancer activities are associated with their capacities to interact with DNA and to inhibit DNA topoisomerases. Previous studies revealed that the planar indolocarbazole chromophore can intercalate into DNA, locating the appended carbohydrate residue in one of the two helical grooves, probably the minor groove as is the case with the anthracyclines and other DNA-binding antibiotics. The sugar residue contributes significantly to the DNA binding free energy of NB-506. However, the exact positioning of the glycosyl residue of rebeccamycin derivatives in the drug-DNA complex remains poorly understood. To better understand how glycosylated indolocarbazoles interact with DNA, we investigated the interaction of a rebeccamycin derivative (85) bearing a 2'-amino group on the sugar residue. We show that the presence of the 2'-amino function permits the formation of covalent drug-DNA complexes in the presence of formaldehyde. Complementary biochemical and spectroscopic measurements attest that 85 reacts covalently with the 2-amino group of guanines exposed in the minor groove of the double helix, as is the case with daunomycin. In contrast to daunomycin, 85 also forms cross-links with an oligonucleotide containing only A.T base pairs. The covalent binding to A.T base pairs was detected using a gel mobility shift assay and was independently confirmed by thermal denaturation studies and by fluorescence measurements using a series of synthetic polynucleotides. The HCHO-mediated alkylation reaction of the drug with A.T base pairs apparently involves the 6-amino group of adenines exposed in the major groove whereas the covalent attachment to G.C base pairs implicates the 2-amino group of guanines situated in the opposite minor groove. Therefore, the results suggest that either the drug is able to switch grooves in response to sequence or it can simultaneously bind to both the minor and major grooves of the double helix. This study will help to guide the rational design of new DNA-binding antitumor indolocarbazole drugs and also provides a general experimental approach for probing minor versus major groove interactions between small molecules and DNA.
Alkylation↗
Cellular uptake and interaction with purified membranes of rebeccamycin derivatives.
Rebeccamycin is an antitumor antibiotic possessing a DNA-intercalating indolocarbazole chromophore linked to a glycosyl residue. The carbohydrate moiety of rebeccamycin and related synthetic analogues, such as the potent antitumor drug NB-506 (6-N-formylamino-12,13-dihydro-1, 11-dihydroxy-13-(beta-D-glucopyranosyl)-5H-indolo[2,3-a]pyrrolo- [3,4-c]carbazole-5,7-(6H)-dione), is a key element for both DNA-binding and inhibition of DNA topoisomerase I. In this study, we have investigated the cellular uptake of rebeccamycin derivatives and their interaction with purified membranes. The transport of radiolabeled [3H]dechlorinated rebeccamycin was studied using the human leukemia HL60 and melanoma B16 cell lines as well as two murine leukemia cell lines sensitive (P388) or resistant (P388CPT5) to camptothecin. In all cases, the uptake is rapid but limited to about 6% of the drug molecules. In HL60 cells, the uptake entered a steady-state phase of intracellular accumulation of about 0.26+/-0.05 pmol/10(6) cells, which persisted to at least 90 min. The efflux of exchangeable radiolabeled molecules was relatively weak. Fluorescence studies were performed to compare the interaction of a rebeccamycin derivative and its aglycone with membranes purified from HL60 cells. The glycosylated drug molecules bound to the cell membranes can be extracted upon washing with buffer or by adding an excess of DNA. In contrast, the indolocarbazole drug lacking the carbohydrate domain remains tightly bound to the membranes with very little or no exchange upon the addition of DNA. The membrane transport and binding properties of indolocarbazole drugs related to rebeccamycin are reminiscent to those of other DNA-intercalating antitumor agents. The uptake most likely occurs via a passive diffusion through the plasma membranes and the glycosyl residue of the drug plays an essential role for the translocation of the drug from the membranes to the internal cell components, such as DNA.
Aminoglycosides↗
[Vestigial retrorectal cyst in adults].
STUDY AIM: The aim of this retrospective study was to report three cases of retrorectal vestigial cyst in adults. PATIENTS AND METHOD: From 1977 to 1999 retrorectal vestigial cyst (RVC) was diagnosed in our department in three women who were 28, 57 and 53 years of age, respectively. RVC was revealed by either pain (n = 2) that occurred in one case in a pregnant woman, or acute intestinal obstruction (n = 1). The patients were operated on using a perineal approach in two cases and an abdominal approach in one case. RESULTS: One epidermoid cyst and two mixed cysts without any sign of malignancy were observed. Postoperative follow-up was simple in two patients, while complications occurred in the third one via an uretero-vaginal fistula which required uretero-vesical reimplantation. The first two patients, reviewed after a 1-year follow-up, had no functional trouble and no sign of recurrence. CONCLUSION: Retrorectal vestigial cysts are very rare tumors with a risk for degeneration. Computerized tomography on nuclear magnetic resonance and endorectal ultrasonography allow detection of their structure and topography and help guide their surgical approach. In the absence of malignancy, wide excision, if possible without opening of the cystic wall, leads to good results.
Acute Disease↗
Embryology and anatomy of the anorectum. Basis of surgery.
The rectum is a pelvic organ, complex in its morphology and its topographic relationships. Its double embryologic origin explains the two types of tumors that develop in the rectum: (1) lieberkühnian adenocarcinoma in the pelvic rectum and (2) squamous epithelioma in the anal canal. Its venous and lymphatic supply, intensively developed, realizes early pathway of tumoral dissemination. The pelvic relationships of the rectum and anus explain the technical difficulty of rectal surgery, especially when subperitoneal resection and anastomosis are concerned. Imaging of this area permits an early diagnosis of rectal tumors and allows a less invasive surgery with a carcinologic precision.
Anal Canal↗