Uterine botulinum toxin injections in severe dysmenorrhea, dyspareunia and chronic pelvic pain: Results on quality of life, pain level and medical consumption

OBJECTIVE

To evaluate quality of life (Qol), pain level and medical consumption before and after uterine botulinum toxin (BT) injections in severe dysmenorrhea, dyspareunia and chronic pelvic pain.

METHODS

This was a before and after study using the database of a pilot study (Open-label non comparative study, on 30 patients, with severe dysmenorrhoea in therapeutic failure) assessing efficacy and cost of uterine injection of BT in women with chronic pelvic pain after failure of conventional treatment (hormonal and analgesics) (CT). Main clinical outcome: Patient Global Impression of Improvement (PGI-I), EuroQol health-related QoL (EQ-5D-5L), EuroQol-visual analogue scale (EQ-VAS), Female Sexual Function Index (FSFI), utility measure of health-related quality of life (also called health state preference values), cost and of health care consumption were collected prospectively and analysed in the two phases (before and after). The two timepoints were 12 months before uterine BT injection, when the patient had been receiving CT, and 12 months after uterine BT injection.

RESULTS

Median visual analogue scale scores were significantly improved by BT regarding the patients' main source of pain (31.6 vs 80.55; p < 0.00001). We also noted a significant reduction in the proportion of patients who reported dyspareunia [15 (75%) vs 3 (15%) patients, p = 0.001] and pain during menstruation (p < 0.0001). The PGI-I scale showed a significant increase in the proportion of patients who were satisfied with their treatment after receiving the BT injection. The injection of BT was frequently associated with increase in QoL and a reduction in health care consumption, and cost: 714.82 €+/- €336.43 (BT) versus 1104.16 €+/- €227.37 (CT), which could result in substantial savings approximately (389,34€) per patient.

CONCLUSION

This study revealed the clinical effectiveness of BT injections on dysmenorrhea, chronic pelvic pain as well as reduction of cost and health care consumption, in our population, which is innovative since no standard of treatment exists in this domain.

Prospective study feasibility: Screening of antenatal total abnormal pulmonary venous return

INTRODUCTION

Total abnormal pulmonary venous return is a heart defect often missed prenatally, yet at birth, it is a surgical emergency. Antenatal detection could be improved by sonographic visualization of the anastomosis of 2 pulmonary veins in a sinus into the left atrium. The objective of this study is to evaluate the feasibility of this screening method.

METHOD

Prospective observational study. Five operators selected one representative image taken during morphological ultrasound screening. Anonymized images were later assessed for quality by an expert. Both the operator and the expert were asked to rate the picture and collect clinical data. Feasibility corresponded to the percentage of images judged satisfactory by the expert; reliability corresponded to the percentage judged satisfactory by both the expert and the sonographer.

RESULTS

A total of 192 patients were included. Feasibility was 73% (95% confidence interval, 67.1%-79.7%) and reliability was 81.4% (95% confidence interval, 75.9%-86.9%). There was no learning curve.

CONCLUSION

This study confirms that visualization of the 2 pulmonary veins in a sinus into the left atrium at midtrimester screening is simple and reproducible. The next stage is to evaluate the sensitivity and specificity as a screening test of total abnormal pulmonary venous return and whether that would improve morbidity and mortality.

[Feasibility and fiability of laparoscopic surgery in the uterine cancers in normal-weight patients]

OBJECTIVES

Evaluate the fiability and feasibility of laparoscopic surgery for the management of uterine cancers [endometrial cancer (EC) and early-stage cervical cancer (ESCC)] with patients who have a BMI ≤ 30 kg/m(2), within the setting of a gynaecological oncology department.

PATIENTS AND METHODS

This retrospective, monocentric and descriptive study was carried out between January 2003 and May 2011 at the Institute Claudius-Regaud, a centre for cancer diagnosis, treatment and research. A policy promoting laparoscopy as a first choice treatment has been established at the institute since 2003.

RESULTS

Two hundred and three patients were included. Eighty-five patients were early-stage cervical cancer patients and 118 patients were endometrial cancer patients. The study shows a high fiability rate for laparoscopy in non-obese patients, with a 98.8% rate for EC patients and a 98.8% rate for ESCC patients. The feasibility rates were 80.1% and 96.6%, respectively. The incidence of laparoconversion was reported at 1.2% and 3.1% for ESCC and EC patients, respectively, while the incidence of peroperative complications was 5.9% and 7.4%. The incidence of postoperative complications rank ≥ 3 according to "Memorial secondary events grading system" was 3 (3.5%) for CCUP and 3 (2.5%) for CE.

DISCUSSION AND CONCLUSION

The results of this study show high fiability and feasibility levels for the laparoscopic treatment of uterine cancers in non-obese patients. There is no need to implement the more expensive robotic-assisted surgery in this group of patients. Mastering advanced laparoscopic surgery remains a mainstay in gynaecologic oncology.

Cervical length in asymptomatic twin pregnancies: prospective multicenter comparison of predictive indicators

Abstract Objective: To determine whether cervical shortening between 22 and 27 weeks predicts spontaneous preterm delivery before 34 weeks better than a single cervical length (CL) measurement at 22 or 27 weeks in asymptomatic twins.

METHODS

Prospective 13-center study over a 2-year-period. CL was measured in 120 asymptomatic twin pregnancies. The area under the ROC curve was calculated for each parameter and the cutoff point providing the best diagnostic performance, sensitivity and specificity for predicting spontaneous delivery<34 weeks was defined too.

RESULTS

About 13/116 women gave birth before 34 weeks. The three ROC curves differed significantly at the 0.05 level. The best cutoff points were CL≤35 mm at 22 weeks, CL≤25 mm at 27 weeks and cervical shortening≥20%. For equal sensitivity values for each, specificity for CL≤25 mm at 27 weeks was 87.5%, significantly better.

CONCLUSIONS

The performance of cervical shortening for the prediction of preterm delivery of asymptomatic twins before 34 weeks does not differ from that of CL measurements at 22 or 27 weeks. The modest predictive value of CL at 22 weeks and of cervical shortening is an argument against recommending routine CL measurements.

Irm fonctionnelle et oligodendrogliomes

The localization of functional areas obtained from functional MRI (fMRI) is useful for patients suffering from tumors contiguous to eloquent brain areas. fRMI is an efficient tool in the strategy of treatment of low grade oligodendroglioamas in the rolandic area in intact or slightly impaired patients. It can be used preoperatively to assess motor functional areas. Indeed there is a good correlation for motor cortex lesions when using comparison between fMRI and intraoperative findings. Direct integration of fMRI data into neuronavigation enables to better visualize and preserve eloquent brain areas. One must be aware of fMRI limits. It is still often used with the control of direct cortical stimulations.

Méningoencéphalocèle intradiploïque pariétale

Intradiploic meningoencephalocele is rarely found in adulthood. It is thought to be postraumatic and must be differenciated from congenital encephalocele. Imaging findings, particularly with Magnetic Resonance Imaging, are useful in determining the various linings and contents of this intradiploic defect.

[Addition of a morphinomimetic to the continuous perfusion of 0.125% bupivacaine for peridural obstetrical anesthesia. A comparative study of fentanyl and alfentanyl]

Morphinic drugs added to epidural local anesthetic during labour enhance analgesia and obstetrical conditions. Fentanyl, 1 microgram/kg-1, is safe for the newborn. Alfentanil is of faster and shorter duration and its pharmacokinetics suggests less accumulation than fentanyl. The aim of this study is to compare Alfentanil versus Fentanyl when added to an epidural continuous bupivacaine 0.125% infusion. Two groups of parturients are constituted: group A 10 micrograms/kg alfentanil, group F 1 microgram/kg fentanyl. Pain is assessed with a 0 to 10 points scale. There are no differences between the two groups for age, weight, parity, term, initial cervical dilatation and new born weight. Analgesia begins quickly in the two groups, and is more pronounced in the group A (than in the group F (p less than 0.005). Analgesia is maintained for the whole dilatation course. Pain scores increase during expulsion but are significantly lower than the initial scores. No difference is noted as regards analgesia supplementation. Obstetrical data: labour duration, oxytocin dosage, expulsion strength, instrumental extraction rate and uterin evacuation are similar in the 2 groups. No cesarean section is observed. Neonatal status, established according to Apgar scores and then Amiel Tison neurological scales (0 to 30) respectively at 30 to 120 minutes are in the same favorable ranges: Apgar score is in all cases more than 9. The neurological score is 24 (group A) and 22.9 (group F) at 30 minutes and increases significantly at 120 minutes in the 2 groups (27 in the two groups).(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization of the omega-conotoxin-binding molecule in rat brain synaptosomes and cultured neurons

omega-Conotoxin GVIA is a peptide purified from the venom of the marine snail, Conus geographus, that specifically blocks voltage-sensitive calcium channels in neurons. A mono-[125I]iodo-omega-conotoxin was prepared and specific binding to both rat brain synaptosomal membranes and cultured neurons was detected. The interaction was irreversible and the association kinetic constant k was measured at 5-7 X 10(6) M-1 s-1 in synaptosomes and at 2-4 X 10(6) M-1 s-1 on intact neurons. The binding site capacities were 650 and 60 fmol/mg of protein, respectively. No competition was detected with other calcium channel blockers or with toxins acting on Na+ or K+ channels but the binding was lowered by the divalent cations Co2+ and Ca2+. Photoaffinity experiments specifically labeled a single component with an apparent Mr of 222,000 +/- 7,000 in brain synaptosomes and 245,000-300,000 in cultured embryonic neurons.

[Hypersensitivity pneumopathies ("bird fancier's lung") in children. Diagnostic value of bronchoalveolar lavage]

A current view of "pigeon fancier's lung" in children is reported through a familial case presenting as a severe denutrition in a 9 year-old boy. Cellular and biochemical analysis of broncho-alveolar lavage fluid is essential to proper diagnosis. Treatment is based upon the eviction of inhaled antigenic organic materials issued from pigeon's droppings, corticosteroid treatment being only additional. Pulmonary fibrosis is a rare but possible complication in the outcome of the disease.