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Study Objective We aimed to identify the prevalence of emergency department (ED) visits following outpatient gynecologic surgery. Additionally, we aimed to identify patients at highest risk for ED visits. Design Retrospective cohort study. Setting Academic medical center. Patients or Participants Women (n=2,373) age 18 and older who underwent scheduled outpatient gynecologic surgery for a benign indication between November 2017 and September 2019. Interventions Any gynecologic surgery performed for benign indications. Measurements and Main Results We extracted demographic, clinical, and perioperative characteristics from the medical record. The primary outcome was evaluation at our institution's ED within 30 days of surgery. Patients who visited the ED, as compared to those who did not, were younger (median age 37 vs. 42, p=.02) and were more likely to have a history of abdominal surgery (67% vs. 56%, p=.02) or cardiopulmonary comorbidity (53% vs. 40%, p=.007). Additionally, patients who underwent intra-abdominal as opposed to vulvovaginal surgery (50% vs. 44%, p=.04) or who experienced a postoperative complication (9% vs 4%, p=.005) were more likely to visit the ED. A total of 109 (5%) patients visited our institution's emergency room 125 times within thirty days of surgery. Forty-five (36%) ED visits resulted in admission. When adjusted for ASA class, chronic pain comorbidities, procedure performed, operative time, blood loss, and attendance at a postoperative clinic visit, the following factors were associated with significantly increased or decreased odds of visiting the emergency room in multivariate analysis: increasing age (aOR 0.5; 95% CI 0.3-0.7), cardiopulmonary comorbidities (aOR 1.9; 95% CI 1.2-3.0), and undergoing prolapse surgery as opposed to other non-hysterectomy vulvovaginal procedures (aOR 0.2; 95% CI 0.1-0.6). Conclusion Emergency department visits were uncommon after outpatient gynecologic surgery but approximately one third resulted in admission. Increased counseling of younger patients and optimization of cardiopulmonary comorbidities may help reduce this burden.

Resume Le conflit anterolateral dans les suites d’une entorse externe de la cheville est mieux connu depuis l’apport de l’arthroscopie. Une synovite chronique hypertrophique de la region anterolaterale de la cheville semble etre responsable de douleurs chroniques avec œdeme, sans instabilite ni laxite, entrainant un « conflit anterolateral » de la cheville. Les auteurs proposent l’etude des resultats du traitement arthroscopique dans une serie retrospective continue de 22 sportifs presentant un conflit tissulaire anterolateral de la cheville. Les patients ayant des atteintes osseuses ou articulaires ont ete exclus. L’âge moyen etait de 26 ans. Les patients presentaient des douleurs mecaniques anterolaterales associees a un œdeme dans les suites d’une entorse externe de la cheville. Un traitement medical et reeducatif a toujours ete entrepris pendant plus de 6 mois avant l’arthroscopie. Aucun patient ne presentait d’instabilite de cheville, ni de laxite a l’examen clinique. L’arthroscanner a ete realise dans 18 cas et l’IRM dans 4 cas. Le delai moyen entre le traumatisme et la prise en charge arthroscopique etait de 21 mois. Un debridement avec un lavage articulaire a ete realise sous arthroscopie. La reeducation a ete demarree a j2 postoperatoire. Le recul moyen etait de 23 mois. Au score de Kitaoka, 17 patients avaient un excellent resultat et trois un bon resultat. Le traitement arthroscopique a donne des benefices significatifs sur la douleur, l’œdeme, ainsi que sur la reprise des activites sportives.

There are two broad approaches to environmental ethics. The “conservationist” approach on which we should conserve the environment when it is in our interest to do so and the “preservationist” approach on which we should preserve the environment even when it is not in our interest to do so. We propose a new “relational” approach that tells us to preserve nature as part of what makes us who we are or could be. Drawing from Confucian and Daoist texts, we argue that human identities are, or should be, so intimately tied to nature that human interests evolve in relationship to nature.

L’histiocytofibrome est une tumeur mesenchymateuse localisee principalement a la peau des extremites, rarement au niveau de l’os (surtout dans les os longs y compris le femur, le tibia et l’os iliaque). Elle siege habituellement en situation epiphysaire ou metaphysaire. La localisation humerale diaphysaire est tres exceptionnelle. Peu de travaux ont decrit les caracteristiques cliniques, pathologiques et pronostiques des histiocytofibromes osseux, il est donc difficile de les differencier des autres lesions rares telles que la tumeur a cellules geantes (TCG) et le fibrome non ossifiant. Le but de cet article est de decrire cette lesion osseuse tres rare et d’en resumer les caracteristiques cliniques, therapeutiques et pronostiques a partir d’un cas et d’une revue de la litterature.

Resume Introduction La prothese totale de hanche est une intervention orthopedique privilegiee, actuellement frequente, qui a bouleverse le traitement des pathologies articulaires degeneratives et inflammatoires. Objectif L’objectif de ce travail est de determiner le devenir fonctionnel et la qualite de vie apres reeducation d’une serie de protheses totales de hanche (PTH), dans notre contexte marocain, et de les comparer a la litterature. Patients et methodes Il s’agit d’une etude prospective portant sur 93 PTH (dont 15 bilaterales) colligees au service de medecine physique et de readaptation au CHU Ibn Rochd de Casablanca, durant la periode allant de janvier 2009 a janvier 2013, indiquees dans le cadre de coxopathies inflammatoires ou degeneratives severes. L’evaluation a ete realisee en preoperatoire, a la 6e semaine et au 3e mois postoperatoires ; elle a consiste en une evaluation de la douleur, de la mobilite articulaire active et passive, de la fonction par l’indice de Postel-Merle d’Aubigne (PMA) et de la qualite de vie par l’echelle Western Ontario and McMaster Universities Arthritis Index (WOMAC). Resultats Il s’agit de 49 femmes et 29 hommes, d’âge moyen 47,23 ans (20–75 ans). L’EVA douleur moyenne est passee de 67/100 a 12/100, six mois apres la chirurgie (p = 4 × 10−4). Le score de PMA est passe de 7,2 a 14,8 (p = 5 × 10−3). Le score de qualite de vie WOMAC a ete nettement ameliore qui est passe de 89 a 36 en fin de reeducation. L’amelioration de cette derniere parait bien correlee a la diminution de la douleur et a l’amelioration du score de PMA. Discussion–conclusion Nos resultats confirment la diminution du handicap des coxopathies apres PTH, ce qui retentit positivement sur la qualite de vie des patients.

Resume Les auteurs ont revu les dossiers de sept patients pris en charge pour un hemangiome intramusculaire de l’avant-bras. Il s’agit de cinq femmes et deux hommes, âges entre 16 et 39 ans. Le delai moyen de consultation etait de 13 mois. Les signes cliniques etaient domines par le developpement d’une masse molle generalement indolore sur la loge anterieure de l’avant-bras et/ou du coude. Deux patients presentaient des signes d’atteinte nerveuse des nerfs ulnaire ou median. Le pedicule nourricier a ete l’artere ulnaire dans cinq cas et radiale dans deux cas. L’exerese a ete incomplete dans deux cas a cause de l’envahissement du nerf ulnaire par l’hemangiome. Avec un recul moyen de quatre ans, les cinq patients ayant subi une exerese complete ne presentent pas de recidive et la fonction de la main est excellente. Les auteurs insistent sur l’interet d’un diagnostic preoperatoire grâce a l’IRM qui permet de prevoir les difficultes chirurgicales dues a la proximite des elements vasculonerveux.

Resume L’objectif est de determiner le devenir fonctionnel des patients operes pour para-osteo-arthropathies neurogenes (POAN). C’est une analyse retrospective portant sur des patients suivis pour POAN. L’evaluation a comporte un bilan articulaire et un bilan fonctionnel. Il s’agit de 20 patients pour 27 articulations operees, le sex-ratio est de 1,4, l’âge moyen est de 31,6 ans (19–41 ans). Les articulations operees sont representees par les genoux a 40,7 % (11), les coudes a 37 % (10) et les hanches a 22,3 % (6). Tous nos patients ont beneficie d’une reeducation fonctionnelle basee sur la mobilisation continue passive par arthromoteur en plus du travail fonctionnel. On a note une amelioration de la mobilite au niveau de toutes les articulations operees de facon significative. Le score de Postel-Merle d’Aubigne, pour ceux operes pour la hanche, est passe de 6,6 a 8,2. Les patients operes au niveau des genoux ont vu leur bilan fonctionnel ameliore par la recuperation de la marche chez une patiente et l’acquisition d’une bonne assise pour les autres. Le bilan fonctionnel des patients operes du coude s’est ameliore en recuperant les possibilites globales de nutrition, d’hygiene et de toilettage. La chirurgie des POAN a pour principal objectif la restauration de la mobilite articulaire ainsi que la fonction. Les resultats sont generalement bons comme le confirme nos resultats.

Resume La fracture-avulsion de la tuberosite tibiale anterieure a ete bien decrite dans la litterature. Le tableau clinique et la radiographie standard permettent facilement de faire le diagnostic. Nous rapportons une observation d’une fracture-avulsion type IIA negligee pendant quatre mois, chez un patient de 17 ans. Malgre les difficultes peroperatoires, le traitement chirurgical a procure un excellent resultat fonctionnel.

The surgical stabilization of the shoulder knew many technical improvements energy. We propose a preliminary study about an engineering change by the addition of a fourth muscular bolt for the treatment of former instabilities of the shoulder. Our study is prospective gathering 16 patients having a stabilization of the shoulder by a quadruple locking using an osseous thrust by the coaracoid process, a tendineux bolt by a hammock applied thanks to the coaraco-biceps tendon to the lower bank of the sub-scapularis, a capsular bolt by joining the acromio-coracoid ligament to the glenohumeral capsule and a fourth bolt by the joining of the pectoral small tendon to the coraco-biceps. Our results evaluated by the score of Dupaly after 18 months show that the average retreat are satisfactory with an early resumption of the activity (2 months on average). The techniques of former stabilization of the shoulder are currently allowing that triple locking is indicated among all patients whose score ISIS exceeds five points. The addition of small pectoral as fourth bolt seems to us as well interesting because of the good preliminary results.

L’osteomyelite aseptique chronique est une lesion inflammatoire non infectieuse du squelette qui s’associe souvent a des lesions inflammatoires touchant d’autres organes. Nous rapportons un cas d’osteomyelite aseptique du calcaneus chez un patient de 37 ans, probablement en rapport avec une spondylarthropathie.

Myositis ossificans circumscripta is a benign lesion characterized by focal heterotopic soft tissue ossification and occurring in young people generally after localized trauma. The location of this case in the forearm is rare. The clinical signs, radiological appearance and the histological features can be confused with osseous or soft tissue sarcoma, as was the case in our patient.

Resume Un cas rare de tuberculose osseuse de la patella est rapporte. Les signes cliniques etaient une douleur inflammatoire chronique, un empâtement du genou et une raideur articulaire. Ces signes ont evolue sur une periode de deux ans. La radiographie standard montrait une osteolyse avec un interligne articulaire intact. Le diagnostic a ete etabli par biopsie chirurgicale apres arthrotomie. Le traitement a consiste en un traitement antibacillaire et un curetage osseux de la lesion, realise en urgence pour eviter l’extension intra-articulaire. La duree du traitement antibacillaire etait de neuf mois. Au recul de 42 mois, le resultat fonctionnel est bon, sans recidive infectieuse.

Resume Le kyste osseux anevrismal (KOA), qui represente 1 a 4 % des tumeurs benignes, realise une distension cavitaire a contenu hematique. Il survient entre 10 et 20 ans et rarement apres 50 ans. Son caractere benin ne doit pas faire oublier son agressivite locale, car il peut atteindre des dimensions importantes. C’est le cas de cette observation qui rapporte un KOA de l’ulna.

Decrite par Gauthier en 1974, l’osteotomie de dorsiflexion sous-capitale du deuxieme metatarsien dans la prise en charge de la maladie de Freiberg permet une restitution de l’interligne articulaire metatarsophalangien et la reduction de la pression lors du deroulement du pas susceptibles d’ameliorer la symptomatologie. Nous rapportons une serie de 11 malades souffrant de metatarsalgies statiques, dans le cadre d’une maladie de Freiberg, traites par osteotomie de Gauthier maintenue par une miniplaque. Avec un recul moyen de 26 mois, nos patients etaient tous satisfaits du resultat avec une disparition totale de la douleur et une reprise de la fonction. Le suivi radiologique etait satisfaisant.

Resume La lesion meniscale est une affection frequente en pratique sportive. Elle peut compromettre a moyen et long termes le pronostic fonctionnel du genou et, ainsi, la carriere sportive du patient, d’ou l’interet d’un diagnostic precoce et d’une prise en charge adequate. Nous rapportons une serie de 120 dossiers de lesions meniscales isolees chez une population sportive (76 % de lesions meniscales internes et 24 % de lesions meniscales externes) traitees sous arthroscopie et revues avec un recul moyen de quatre ans. Nos resultats etaient bons a excellents dans 82,5 % des cas, avec une reprise de l’activite sportive chez 90 % de nos patients dont 60 % au meme niveau preoperatoire. Cinquante-quatre pour cent des cas ont beneficie d’un controle radiologique a leur derniere consultation ; celui-ci etait normal chez 46 % d’entre eux, montrait un pincement au niveau du compartiment interne dans 22 % des cas et externe dans 32 % des cas. De par sa fiabilite, sa simplicite et sa relative innocuite, le traitement des lesions meniscales sous arthroscopie repond au cahier des charges impose par les exigences de la population sportive.

Resume La laxite chronique anterieure du genou est une affection evolutive secondaire a la rupture du LCA qui engage le pronostic fonctionnel du membre inferieur et compromet l'activite sportive. Plusieurs techniques de plasties ligamentaires ont ete decrites. Notre travail porte sur l'etude d'une serie de 118 sportifs qui presentaient une laxite chronique anterieure, operes selon la technique de Kenneth-Jones modifiee, colliges sur une periode de quatre ans allant de 1998 a 2002. Avec un recul moyen de 25 mois, le but de notre travail est d'evaluer nos resultats et de determiner la place reelle de la ligamentoplastie utilisant le tendon rotulien dans la prise en charge des laxites anterieures chroniques du genou chez le sportif.

In a preclinical model for prostate cancer gene therapy, we have tested lentiviral vectors as a practical possibility for the transfer and long-term expression of the EGFP gene both in vitro and in vivo. The human prostate cancer cell lines DU145 and PC3 were transduced using experimental conditions which permitted analysis of the expression from a single proviral vector per cell. The transduced cells stably expressed the EGFP transgene for 4 months. After injection of the transduced cell populations into Nod-SCID mice a decrease in EGFP was only observed in a minority of cases, while the majority of tumors maintained transgene expression at in vitro levels. In vivo injection of viral vector preparations directly into pre-established subcutaneous or orthotopic tumor masses, obtained by implantation of untransduced PC3 and DU145 cells led to a high transduction efficiency. While the efficiency of direct intratumoral transduction was proportional to the dose of virus injected, the results indicated some technical limitations inherent in these approaches to prostate cancer gene therapy.

Hibernoma is a rare benign tumour of brown fat. It presents as a voluminous slow-growing mass in the regions where remnants of brown fat can remain in adults. We report a case of a hibernoma on the thigh and present the diagnostic and therapeutic elements of this type of tumour, whose differential diagnosis of liposarcoma.

Summary A rare case of patella tuberculosis is reported. Clinical signs comprised chronic inflammatory pain, knee swelling and joint stiffness, with two years’ evolution. Standard X-ray showed focal osteolysis with intact joint line. Diagnosis was based on surgical biopsy during arthrotomy. Treatment comprised nine months’ antibiotherapy and bone curettage to prevent intra-articular extension. At 42 months’ follow-up, functional results were good, without recurrence of infection.

Elastofibroma dorsi is a slowly-growing benign tumor which usually occurs at the inferior angle of the scapula. It may be more of a degenerative process than a neoplasia. We seek, through our observations and a review of the literature, to clarify the characteristics of this tumor and its modes of management. We think that all doctors should be aware of this condition, in order to treat it correctly.

The Fas receptor (APO-1/CD95) is capable of inducing apoptosis of lymphoid cells and is expressed in some non-Hodgkin's lymphomas (NHLs). Fas expression is up-regulated at the surface of normal B cells upon triggering of the CD40 receptor. In this report, we investigated the sensitivity of NHLs to Fas-mediated apoptosis induced by anti-Fas monoclonal antibodies (MAbs) and its possible modulation by CD40 ligation in 18 NHL biopsy samples of various histological subtypes. Flow cytometric analysis showed that the fraction of Fas-expressing lymphoma cells was highly variable from sample to sample (from 1% to 93%, mean value 46%). The frequency of apoptotic cells was not significantly increased upon treatment with an anti-Fas MAb compared with control MAb in the 18 NHL cases analysed. The sensitivity of lymphoma cells to Fas-mediated apoptosis was correlated neither with the histological subtypes nor with the level of Fas expression. Activation of neoplastic B cells by CD40 ligation resulted in significant increases in Fas expression and Fas-induced apoptosis among the five B-NHL cases tested. The overall increase in apoptotic rates was moderate and remained lower in tumour samples than in control CD40-activated normal tonsil B cells. Altogether, our results indicate that the sensitivity to Fas-induced apoptosis is null or weak in NHL cells, irrespective of their histological subtype, and that it can be increased to a moderate and variable degree by CD40 ligation on neoplastic B cells. This may be an impediment to the development of Fas-based therapies for NHLs.

AIMS: To confirm the recent data obtained in mice, showing that the Fas ligand (FasL) is involved in the phenomenon of "immune privilege" (the apparent defect of the immune system in specific anatomical sites) and to extend this finding to humans. METHODS: The expression of FasL was analysed in a panel of histologically normal human tissues by reverse transcriptase polymerase chain reaction and Western blotting. The tissues sampled were brain, breast, bone marrow, oesophagus, kidney, liver, lung, lymph node, ovary, pancreas, pituitary gland, prostate, spleen, stomach (antrum and fundus), striated muscle, testis, thyroid, and uterus. These were obtained from patients with various neoplastic and non-neoplastic disorders; placental tissue was obtained after normal obstetric delivery, and spontaneous or voluntary abortion. RESULTS: Strong FasL expression was detected in testis and placenta. FasL expression was also detectable, although it was seen to a lesser extent, in oesophagus, prostate, lung, and uterus, which also coexpressed variable amounts of Fas mRNA or protein or both. The other organs tested for FasL expression were all negative. CONCLUSIONS: FasL in humans is expressed predominantly in immune "sanctuaries" such as testis and placenta, suggesting that, similar to mice, this expression may contribute to the immune privileged status of these organs, by preventing dangerous inflammatory responses. The coexpression of FasL and Fas in particular epithelia suggests that the physiological cell turnover of some tissues may be regulated by the Fas-FasL apoptotic pathway.

Aims—(1) To investigate the expression of the four main hormones of the digestive tract by performing reverse transcription polymerase chain reaction (RT-PCR) on a series of samples, comprising tumoral and healthy colonic tissues, hepatic metastases and colonic cell line samples; and (2) to study the patterns of labelling obtained with serological and morphological markers. Methods—After extraction and reverse transcription, gastrin, somatostatin, cholecystokinin (CCK) and transforming growth factor α (TGFα) mRNAs were detected by PCR and nested PCR using specific primers. The corresponding proteins were detected by immunohistochemistry. Results—The cell lines expressed all four mRNAs. Gastrin mRNA was present in most tumoral and metastatic samples, while the somatostatin transcript was detected in all samples and was frequently overexpressed in the normal colon. TGFα mRNA was expressed systematically in tumours of the right and transverse colon, but not in those located in the left colon; the expression of CCK mRNA was systematically absent in the left colon. Conclusions—The data presented here shed some light on the transcriptional events involved in the production of the various hormones present in the gastrointestinal tract, in both healthy and tumoral tissues. The various mRNAs expressed in cell lines are therefore not systematically expressed in the human pathology.

FAS/APO-1 (CD95) is a membrane glycoprotein belonging to the tumour necrosis factor/nerve growth factor receptor family, and which can trigger apoptosis in some lymphoid cell lines. Immunohistochemistry combined with Northern blotting allowed determination of the pattern of FAS/APO-1 expression in a series of Ki-1 [CD30] positive lymphoid malignancies, including 27 Hodgkin's disease and eight anaplastic large cell lymphomas. CD30 negative tumours used as controls included 27 B-cell non-Hodgkin's lymphomas. 14 T-cell non-Hodgkin's lymphomas, four reactive lymphadenitis, and non-lymphoid tissues. Immunohistochemistry, performed on frozen sections, revealed a strong FAS/APO-1 expression in 25 out of 27 (92%) Hodgkin's disease cases, predominantly in Reed Sternberg cells; 50 to 100% of the neoplastic cells in eight out of (100%) anaplastic large cell lymphoma cases were positive. In contrast, positive FAS/APO-1 immunostaining was observed only in 22 out of 41 (53%) CD30 negative non-Hodgkin's lymphomas. Northern blot analysis detected variable amounts of the FAS/APO-1 transcript in the immunohistochemistry-positive samples. These results suggest possible hyper-expression of FAS/APO-1 (CD95) in Hodgkin's disease and anaplastic large cell lymphomas.

The management of patients presenting with metastatic malignant melanoma (MM) is hampered by the substantial variability in survival of these patients and the lack of prognostic markers. In the search for a reliable predictive parameter, we have investigated the expression of the nm23 gene, considered to be a major regulator of the metastatic process. We have analysed by Northern blot the nm23 mRNA level in tumour tissue obtained from metastases of 20 stage II and ten stage III patients with MM. Normal human tissues and benign naevi were simultaneously examined. The level of nm23 expression was highly heterogeneous in MM metastases, with a mean value which was higher than the mean level in normal tissues and naevi. Correlative study was focused on the overall survival following resection of the metastasis in which nm23 Northern blot analysis was performed. Patients displaying higher nm23 expression in metastatic tissue (above the mean level) tended to have a longer survival than others (P = 0.08), and this difference was significant for patients presenting with isolated regional lymph node involvement (P = 0.035). The time from biopsy of the primary MM to the appearance of the first lymph node metastasis also showed a positive correlation with the nm23 mRNA level in this metastasis. The present study is not only in accordance with previous reports showing that the nm23 gene may be implicated in MM progression, but also suggests the reliable value of nm23 expression as a prognostic marker for patients presenting with metastatic MM. Images Figure 1

Juvenile aponeurotic fibroma is a rare benign tumour which occurs mainly in young patients under 20 years of age and especially during childhood. Clinical presentation is a unique, hard and painless tumour of the palm or sole. The treatment commonly accepted for this locally recurrent tumour is complete excision with function preservation. In this paper, we report on a case of juvenile aponeurotic fibroma of the thenar area with a thickening of the first metacarpal bone shaft. Bone involvement in juvenile aponeurotic fibroma is a very rare condition. We only found one report of a comparable case in literature.

The authors reexamined the files of seven patients dealt with for intramuscular hemangioma of forearm. It concerns five women and two men, between 16 and 39 years old. The average time of consultation was 13 months. The clinical signs were dominated by the development of a generally painless soft mass over the anterior compartment of the forearm and/or the elbow. Two patients presented nervous lesions signs of the ulnar or median nerves. The feeder pedicle was the ulnar artery in five cases and radial artery in two cases. The excision was incomplete in two cases because of the invasion of the ulnar nerve by the hemangioma. With four years average follow-up, the five patients having undergone a complete excision do not present a recurrence and the hand function is excellent. The authors insist on the interest of a preoperative diagnosis with the IRM, which permits to envisage surgical difficulties due to the proximity of vascular and nervous pedicles.

Hibernoma is a rare benign tumour of brown fat. It presents as a voluminous slow-growing mass in the regions where remnants of brown fat can remain in adults. We report a case of a hibernoma on the thigh and present the diagnostic and therapeutic elements of this type of tumour, whose differential diagnosis of liposarcoma.