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Aim Internal sphincterotomy is the standard surgical treatment for chronic anal fissure, but is frequently complicated by anal incontinence. Fissurectomy is proposed as an alternative technique to avoid sphincter injury. We describe 1-year outcomes of fissurectomy. Method This was a prospective, multicentre, observational study. All patients with planned surgery for chronic anal fissure were included and had fissurectomy. Data were collected before surgery, at healing, and 1 year after fissurectomy. Patient self-assessed anal symptoms and quality of life (using the 36-item short-form health survey [SF-36] questionnaire). Presurgical and postsurgical variables were compared using the Wilcoxon signed-rank test for paired samples. Results Two-hundred and sixty-four patients were included (median age, 45 years; 52% women). Anoplasty was associated with fissurectomy in 83% of the 257 documented cases. The main complications were urinary retention (n = 3), local infection (n = 4) and faecal impaction (n = 1). Healing was achieved in all patients at a median of 7.5 weeks after surgery. No recurrence occurred. At 1 year, 210 (79%) questionnaires were returned. Median anal pain had dropped from 7.3/10 to 0.1/10 (P 5) affected 7% of patients at 1 year, but presurgical incontinence had disappeared in 15% of patients. All SF-36 domains significantly improved. Anoplasty did not impact any result. Conclusion Given its high rate of healing and low rate of de-novo anal incontinence, fissurectomy with anoplasty is a valuable sphincter-sparing surgical treatment for chronic anal fissure.

Hemorrhoids are a common medical problem that is often considered as benign. The French Society of Colo-Proctology (Societe nationale francaise de colo-proctologie [SNFCP]) recently revised its recommendations for the management of hemorrhoids (last issued in 2001), based on the literature and consensual expert opinion. We present a short report of these recommendations. Briefly, medical treatment, including dietary fiber, should always be proposed in first intention and instrumental treatment only if medical treatment fails, except in grade ≥III prolapse. Surgery should be the last resort, and the patient well informed of the surgical alternatives, including the possibility of elective ambulatory surgery, if appropriate. Postoperative pain should be prevented by the systematic implementation of a pudendal block and multimodal use of analgesics.

Aim This prospective observation study evaluated the incidence of secondary bleeding after proctological surgery without interruption of oral anticoagulant or platelet-inhibitor treatments. Method The number of episodes of postoperative bleeding was identified prospectively from the day of surgery to the last follow-up visit in consecutive patients operated on during 2010 in two units dedicated to proctology. Results A total of 2513 procedures were performed in 2314 patients (1379 men), 46 ± 16 years of age. Secondary bleeding occurred after 115 (4.6%) procedures, no later than day 24 after surgery, requiring rehospitalization in 86% of cases and further surgery and/or transfusion in 36%. The highest frequency was noted after surgery for haemorrhoids (haemorrhoidopexy, 7.9%; haemorrhoidectomy, 6.2%) (P = NS and transanal excision of rectal tumours (6.5%). On multivariate analysis, the frequency was significantly increased by clopidogrel (15%) [relative risk (RR) = 10). In patients on oral anticoagulants, bleeding occurred in 23% (RR = 5.8) if the anticoagulants were not interrupted and in 57% (RR = 42) if the anticoagulants were discontinued and replaced with heparin. Conclusion During proctological surgery the overall risk of postoperative bleeding is low, but it can occur up to 3 weeks after surgery and is often severe. Maintenance treatment with oral anticoagulants is the most important risk factor, aggravated by a change to heparin. Clopidogrel also significantly increases the bleeding risk.

Summary Introduction As little data is available about secondary bleeding after proctological surgery, we conducted a specific survey. Patients and methods Patients operated between November 2008 and April 2009 were prospectively included. Patients were followed until last visit (day 21–28). Severity of bleeding was low (at home stay), moderate (hospitalisation for observation), or severe (transfusion, and/or homeostasis in operating room). Results Included were 1269 patients: haemorrhoidectomy/pexy 527 (41%), fistula treatment 273 (21%), fissurectomy 197 (15%), perianal and pilonidal abscesses 124 (10%), others 148 (12%). Before surgery 78 patients were under long-term treatment with antiplatelet or anticoagulant therapy. Seventy-eight patients (6%) demonstrated 85 bleeding events. Severity rate was: low 22%, moderate 51%, and severe 27%. Ninety-five percent of events occurred before day 15. Univariate study showed increased risk after haemorrhoidopexy ( P −3 ) and anticoagulant treatment ( P = 0.002), decreased risk after fissurectomy and fistulotomy ( P −3 ), and no relation with age, sex or operator. After multivariate study only relationship with anticoagulant treatment remained significant. Conclusion Secondary bleeding occurred in 6% of patients after proctological surgery, requiring a readmission and/or an active treatment in about 75%. Treatment with anticoagulant exposed to increased bleeding frequency.

Background: Infliximab is the only medical therapy that has been proven to be effective in fistulizing Crohn's disease (CD), but the recurrence rate of fistulas is high despite maintenance therapy. The aim of this prospective study was to evaluate the short- and long-term efficacy of a combined schedule with infliximab, methotrexate, and sphincter-sparing surgery in patients with severe fistulizing anoperineal CD. Methods: From January 2006 to November 2007, all consecutive patients in three referral centers with severe fistulizing anoperineal CD were prospectively included after primary drainage. At inclusion, patients received three infliximab infusions at weeks 0, 2, and 6, and maintenance therapy with methotrexate. A second optimized surgical step consisting of at least removal of setons was performed between the second and the third infliximab infusions. Results: Thirty-four CD patients (26 women; median age 38.5 years) with complex anoperineal fistula were enrolled (including 9 with recto-vaginal fistulas, and 10 with anorectal stenosis). At week 14 the response rate was 85% with 74% complete responders. At 1 year, 50% were still responders; luminal CD worsening was the major cause of relapse. Median Perineal Disease Activity Index (PDAI) and magnetic resonance imaging (MRI) scores significantly decreased from baseline to week 50. Conclusions: A combined approach with infliximab induction, two surgical sphincter-sparing steps and methotrexate is effective in achieving short-term response in severe fistulizing anoperineal CD. The best maintenance regimen remains to be determined. (Inflamm Bowel Dis 2011;)

Resume Le rugby est un sport de contact parfois violent qui expose a un risque medullaire par traumatisme mais aussi par lesions degeneratives precoces. La prevalence de ces pathologies cervicales a augmente avec le professionnalisme. Elles surviennent souvent sur des canaux cervicaux etroits developpementaux, ce qui majore le risque de complication neurologique grave. Une premiere classification des criteres d’aptitude a la pratique du rugby professionnel avait ete adoptee par la Ligue Nationale de Rugby peu apres l’avenement du professionnalisme. Les bilans d’imagerie devenus obligatoires ont permis de depister de tres nombreux canaux cervicaux retrecis chez des joueurs asymptomatiques. L’indice de Torg, utilise initialement, s’avere imparfait. Ces elements ont rendu necessaire l’adaptation de cette classification. Le nouvel outil decisionnel permet une evaluation precise du risque medullaire a l’aide des donnees de l’examen clinique et de l’IRM, voire, si necessaire, des radiographies cervicales. La nouvelle classification est presentee avec ses quatre groupes de risque et d’aptitude (groupe 0 [G0] : aucune pathologie cervicale ; groupe 1 [G1] : pathologie n’entrainant pas de contre-indication a la pratique du rugby en competition ; groupe 2 [G2] : contre-indication relative [sur risque connu, a faire accepter par le joueur] ; groupe 3 [G3] : contre-indication absolue). Elle est discutee. Le risque structurel lie a la pratique du rugby persistant neanmoins, il reste indispensable de responsabiliser le joueur en l’impliquant dans le processus decisionnel.

Parasites can have both direct and indirect impacts on organisms through changes in health, growth, reproductive success, behaviour and survival. This research investigates the effects of hookworms (Uncinaria sp.) on the growth and mortality of New Zealand sea lion (NZ sea lion, Phocarctos hookeri) pups between birth and 3 months of age. NZ sea lion pups that received ivermectin treatment to reduce their hookworm burden had higher growth rates. Hookworm infection had no significant effect on mortality rate except when overall mortality was high during epidemics caused by other pathogens. Understanding the impacts of parasites on wild populations of pinnipeds is important for the management of the species, particularly when the species is threatened, as is the case for the NZ sea lion. There are at least two reasons for this: first, to quantify the impact of the parasite on parameters of population dynamics such as offspring survival and, as a consequence, female reproductive output; and second, to gain sufficient knowledge of the host/parasite dynamics to allow the balance to be manipulated in favour of the host should this be required for conservation management.

The 2001/2002 and 2002/2003 breeding seasons of New Zealand sea lions (NZSLs) on the Auckland Islands were marked by a high pup mortality caused by acute bacterial infections. As part of a health survey from 1998/1999 to 2004/2005, tissues and swabs of lesions had been collected at necropsy to identify the bacteria associated with pup mortality. Klebsiella pneumoniae was grown in pure culture from 83% of various organs and lesions in 2001/2002 and 76% in 2002/2003, and less frequently in the following seasons (56% in 2003/2004 and 49% in 2004/2005). Pup isolates of K. pneumoniae showed identical minimal inhibitory concentrations (MIC) of cefuroxime, neomycin, cephalotin, cephalexin and dihydrostreptomycin, suggesting clonal aetiology of the pathogen. Isolates also tested negative for production of extended-spectrum beta-lactamases (ESBLs), which was not in favour of an anthropogenetic origin of the epidemic strain. Pulsed-field gel electrophoresis (PFGE) of XbaI DNA macrorestriction fragments was performed on isolates of K. pneumoniae and Klebsiella oxytoca from 35 pups, thee NZSL adult females, and from three human patients for comparison. PFGE showed that pup isolates of K. pneumoniae were genetically indistinguishable but were neither related to K. pneumoniae from humans and from NZSL adults, nor to K. oxytoca from NZSLs. It is concluded that the 2001/2002 and 2002/2003 epidemics at Sandy Bay rookery were caused by a single K. pneumoniae clonal lineage, genetically different from the strain carried by adult NZSLs. An anthropogenic origin of the K. pneumoniae clone could not be confirmed, but further investigations are required to rule-out such occurrence.

Introduction, Houari Touati Le regime des images figuratives dans la culture islamique medieval, Houari Touati Une breve histoire des portraits d'auteurs dans les manuscrits islamiques, Sheila S. Blair Reflexions preliminaires sur les portraits d'auteurs dans l'art islamique : Le cas de Moise dans le Jami' al-Tawarikh de Rashid al-Din, Mika Natif Histoire des portraits du prophete Muhammad, Oleg Grabar et Mika Natif Le portrait dans l'Orient musulman pre-moderne : une decantation du modele en son essence, Yves Porter (en collaboration avec Richard Castinel) Les representations humaines dans la peinture arabe medieval. L'exemple du Hariri-Schefer, Kata Keresztely Des idees aux images : les personnages indiens dans la miniature islamique, Eloise Brac de la Perriere Illustrations Les auteurs Cahier iconographique

Aim The study aimed to evaluate outcome at 1 year of one- and two-stage fistulotomy for anal fistula in a large group of patients. Method A prospective multicentre observational study was designed to include patients with anal fistula treated by one- or two-stage fistulotomy. Data were collected using a self-administered questionnaire before surgery, during healing and at 1 year after surgery. Results Group A (133 patients) with a low anal fistula underwent a one-stage fistulotomy. The median Wexner scores before and after surgery were 1.0 (0−11) and 2.0 (0−18) (P = 0.032) and the median Vaizey scores were 2.0 (0−14) and 3.0 (0−21) (P = 0.055). The Wexner scores and percentage of patients before and after fistulotomy were as follows: 0−5: 88%, 86%; 6−10: 10.7%, 10.7%; 11−15: 1.0%, 2.6%; and 16−20: 0%, 2%. Eighty-seven per cent of the patients were satisfied. Group B (62 patients) underwent two-stage fistulotomy for a high transsphincteric fistula. The Wexner scores and percentage of patients before the first stage and 1 year after the second stage were as follows: 0−5: 86%, 66%; 6−10: 4.5%, 20%; 11−15: 9%, 11%; and 16−20: 0%, 2%. The median Wexner scores before the first stage and after the second stage were 1 (0−14) vs 4 (0−19) (P

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The ability of stapled hemorrhoidopexy (SH) to cure hemorrhoidal symptoms appears to depend on patient characteristics and operative technique. We assessed the association between outcome of SH and patients’ characteristics and procedure parameters (associated procedure, suture line height, doughnut size, presence of malpighian tissue or smooth muscle in specimen). A total of 68 consecutive patients (56 males) were prospectively operated by 3 different surgeons. Hemorrhoids were grade II (6%), grade III (76%) or grade IV (18%). At a mean 32-week follow-up (range, 9–77), symptoms had resolved in 77% of patients, independently of any operative or clinical parameter. New onset anal incontinence occurred in 11 men (17%): all had urgency, with flatus and liquid stool incontinence in two, and flatus incontinence and mucus soiling in one. Univariate analysis revealed that persistent incontinence was associated with a staple line

Resume Buts de l'etude. – L'anopexie permet de traiter chirurgicalement la maladie hemorroidaire, avec des suites moins douloureuses que l'hemorroidectomie. Cette information importante a communiquer au patient, peut etre source d'insatisfaction si la douleur vecue depasse la douleur attendue. Evaluer la douleur et l'incapacite physique ressenties apres anopexie par rapport a celles attendues. Evaluer les resultats fonctionnels en fonction des donnees pre- et peroperatoires. Resultats. – Soixante-huit malades consecutifs (56 hommes), d'âge moyen 51 ans (25–83) ont ete inclus prospectivement. Les hemorroides etaient quatre fois de grade 2 (6 %), 52 de grade 3 (76 %) et 12 de grade 4 (18 %). La douleur postoperatoire etait egale ou moindre a celle attendue pour 85 %, avec une meilleure tolerance superieure a 45 ans (p Conclusion. – Une information pragmatique bien qu'imprecise sur la moindre douleur a attendre apres anopexie n'expose pas a la deception des malades. Les resultats fonctionnels ne sont pas influences par la technique operatoire. A l'inverse les troubles de la continence sont peu severes, mais frequents si la ligne d'agrafage est a moins de 6,5 mm de la ligne pectinee.

Transanal excision of rectal villous adenomas is a widely used surgical technique, because it is a one-step procedure, requiring no sophisticated instrumentation, and allowing complete histologic analysis of the excised tumor. Therefore, it ranks alongside radical surgery and palliative destructive procedures, but its results are highly variable in the published series. This discrepancy may be explained by the variable completeness of tumor excision because of potential dissection difficulties. Because intraoperative exposure may be a major limiting factor, one of us (JF) has developed a tractable cutaneomucous flap procedure to lower the rectal tumor to the anal verge, where control of the dissection line is easier. This retrospective review of consecutive patients operated on during ten-year period reports long-term results after transanal excision for large rectal villous adenomas with the tractable flap technique.From 1978 to 1988, 207 consecutive patients (100 males), mean age 68 (range, 24-90) years, were operated on for an apparently benign villous rectal adenoma. Twenty-one patients (10 percent) were referred after failure of previous treatments: 11 endoscopic, 8 surgical, 1 laser, 1 radiotherapy. Mean distance of lower tumor edge from anal margin was 5.6 (range, 0-13) cm and was10 cm in 82 percent.Three patients (1.5 percent), including one with a Tis carcinoma, underwent a secondary treatment for immediate gross failure of resection: one further local excision and two palliative laser destructions. Immediate postoperative course was uneventful for 96 percent; there was one death from perineal gangrenous infection, four cases of hemorrhage, and three urinary retentions. Subsequently one case of transient fecal incontinence and 11 medically managed stenoses were noted. Mean size of resected tumor was 5.4 (range, 1-17) cm. Deep excision margins concerned the rectal muscular layers in 199 patients (96 percent) and perirectal fat in 8 (4 percent). Specimen margins were negative for cancer in 175 (85 percent) and positive or unknown in 32 cases. Histologic evaluation demonstrated in situ cancer in 28 (14 percent) and invasive carcinoma in 9 (4 percent). In three patients (1 percent), two abdominoperineal resections were immediately performed (one T2 with a mucinous contingent, one T3) and one adjuvant radiotherapy (one undifferentiated T2). Four patients (2 percent) did not return for postoperative evaluation. For the remaining 198 patients, mean follow-up was 74 +/- 34 (median, 75; range, 1-168) months. Forty-four died from unrelated causes. Recurrence occurred in seven (3.6 percent) and was malignant in two, who subsequently died. Specific recurrence-free probability was 99.5 percent at one year, 96 percent at five years, and 95 percent at ten years. A lesion size6 cm (10 vs. 1 percent for smaller tumors) and the presence of an invasive carcinoma (20 vs. 3 percent without invasive carcinoma) were significantly associated with an increased probability of recurrence at five years.Providing that adequate intraoperative exposure is obtained and advanced malignant tumors receive immediate secondary treatment, transanal resection of clinically benign, large rectal villous adenomas is safe and effective. It is an alternative to rectal resection, which exposes the patient to potentially adverse effects, and also to destructive procedures, which preclude any histologic evaluation of the tumor.

Resume Objectif : Evaluer, de facon prospective, le risque de recidive locale des cancers du bas rectum stade T2 ou T3 traites par exerese transanale et radiotherapie preoperatoire. Patients et methodes : De 1992 a 1999, 34 patients ont ete traites apres radiotherapie par exerese locale d’un adenocarcinome envahissant (stade T2) ou depassant la musculeuse (stade T3), sans adenopathie perirectale en echographie endorectale ou a l’examen sous anesthesie. Quatre patients traites de facon palliative ou perdus de vue ont ete exclus de l’etude. L’analyse a porte sur les 30 patients restants (huit uT2, huit uT3 et 14 de stade pretherapeutique indetermine). Resultats : Apres un suivi moyen de 74 mois (mediane : 46), le taux de recidive locale a cinq ans etait de 33 %. Le benefice de la radiotherapie n’apparait dans aucun des sous groupes de patients avec ou sans facteur de risque significatif de recidive : taille > 40 mm, marge saine Conclusion : L’exerese locale des cancers du bas rectum de stade T2 ou T3, quelles que soient leurs caracteristiques, expose a un risque important de recidive locale. Ce resultat est constate meme en y associant une radiotherapie preoperatoire. Ce traitement ne peut etre propose qu’a un patient informe et ayant formellement refuse une exerese radicale.

Diagnosis of essential thrombocythemia (ET) is controversial and remains mainly an exclusion diagnosis. Endogenous megakaryocyte colony (EMC) formation have been largely evaluated to identify specific criteria for ET, but results are impeded by the lack of medium standardization. We evaluated megakaryocyte (MK) colony formation in a serum-free collagen-based medium, without cytokine and in the presence of various concentrations of thrombopoietin (TPO). Thirty-six bone marrows from patients diagnosed with ET (n = 11), polycythemia vera (PV; n = 12), reactive thrombocytosis (RT; n = 6) and healthy donors (n = 7) were assessed. We demonstrate that 11 out 11 of the ET patients had spontaneous megakaryocyte colony-forming unit (CFU-MK) formation, in contrast to none of the RT patients and healthy donors. MK progenitors from ET patients remained responsive to TPO, because exogenous addition of TPO significantly increased cloning efficiency. Moreover, at low doses of TPO (0.5 ng/ml and 5 ng/ml), the number of positive cultures and mean number of TPO stimulated CFU-MK were significantly higher in cultures of cells from patients with ET than in patients with RT. In summary, we have described a standardized serum-free, collagen-based assay that allows differential diagnosis of ET and RT, according to endogenous CFU-MK formation and sensitivity to TPO.

Objective In this study, the prevalence of abnormalities in the cervical spine of asymptomatic professional rugby players using both static and dynamic magnetic resonance imaging (MRI) in order to improve the detection of abnormalities and prevention of related injuries was investigated. Design Prospective observational study. Setting French professional rugby union clubs, between 2002 and 2006. Participants 206 elite male adult players. Intervention Static sagittal T2 and axial T2* fast spin echo (FSE), and dynamic sagittal single-shot FSE weighted MRI scans of the C2–C7 region were examined for the presence of abnormalities. Participants’ spines were in supine neutral position for the static protocol but were allowed complete flexibility in a sagittal plane for the dynamic protocol. Main outcome measurements The medulla-to-canal ratio (MCR) was measured at every vertebral disc level for both MRI methods. When observed, anatomical abnormalities were categorised. Results Anatomical abnormalities mainly consisted of degenerative discopathy and were most frequently observed in players aged>21 years, as well as in players whose MCR was abnormally high based on medical expertise. Most MCRs that were initially assessed as intermediate with static MRI were subsequently assessed as abnormal with dynamic MRI assessment. Conclusions Since dynamic MRI is more accurate than static techniques in examining the cervical spine, it contributes substantially to identifying the risk of spinal injuries in professional rugby players, and when used in association with clinical assessment, it can assist in preventing spinal injury.

We investigated the effects of two sex steroids (17 β estradiol and testosterone) on five human leukemia cell lines. We observed a statistically significant inhibition of proliferation, dose and time dependent, of the human monoblastic leukemia cell line U937. This inhibition was associated with a dose dependent decrease in the number of CFU-blasts in clonogenic cultures. Cytostatic effect was obtained with doses of 5 μM for estrogen and 10 μM for androgen and was not due to a non-specific cytotoxic effect, some cell viability remained high (>90%) even after 6 days of incubation. More accurately, we demonstrated that growth inhibition was associated with a cell cycle arrest, U937 cells accumulating in G2/M phase. This blockade was dose related with a maximum number of cells accumulating at day 4. Sensitivity of these cells to an S-phase specific agent (hydroxyurea) was not increased, suggesting that these cells were blocked in G2/M and did not undergo mitosis. Expression in U937 cells of high affinity nuclear receptors for estrogen and androgen was negative which was in favour of a type II estrogen binding site, mediated mechanism. Moreover, a small fraction of these cells underwent apoptosis or differentiation with about 12% apoptotic cells and a significant increase (more than 30%) of two myelomonocytic markers (CD13 and CD64). These results demonstrate that the proliferation of some leukemic cells may be inhibited by micromolar concentrations of sex steroids, independently of nuclear receptor expression. The main mechanism seems to be a block in cell cycle associated with modulation of apoptosis and differentiation. It provided additional evidence for the potential value of sex steroids and their analogues in the treatment of leukemias.

Hookworms of the genus Uncinaria have been widely reported from juvenile pinnipeds, however investigations of their systematics has been limited, with only two species described, Uncinaria lucasi from northern fur seals (Callorhinus ursinus) and Uncinaria hamiltoni from South American sea lions (Otaria flavescens). Hookworms were sampled from these hosts and seven additional species including Steller sea lions (Eumetopias jubatus), California sea lions (Zalophus californianus), South American fur seals (Arctocephalus australis), Australian fur seals (Arctocephalus pusillus), New Zealand sea lions (Phocarctos hookeri), southern elephant seals (Mirounga leonina), and the Mediterranean monk seal (Monachus monachus). One hundred and thirteen individual hookworms, including an outgroup species, were sequenced for four genes representing two loci (nuclear ribosomal DNA and mitochondrial DNA). Phylogenetic analyses of these sequences recovered seven independent evolutionary lineages or species, including the described species and five undescribed species. The molecular evidence shows that U. lucasi parasitises both C. ursinus and E. jubatus, whereas U. hamiltoni parasitises O. flavescens and A. australis. The five undescribed hookworm species were each associated with single host species (Z. californianus, A. pusillus, P. hookeri, M. leonina and M. monachus). For parasites of otarids, patterns of Uncinaria host-sharing and phylogenetic relationships had a strong biogeographic component with separate clades of parasites from northern versus southern hemisphere hosts. Comparison of phylogenies for these hookworms and their hosts suggests that the association of U. lucasi with northern fur seals results from a host-switch from Steller sea lions. Morphometric data for U. lucasi shows marked host-associated size differences for both sexes, with U. lucasi individuals from E. jubatus significantly larger. This result suggests that adult growth of U. lucasi is reduced within the host species representing the more recent host parasite association. Intraspecific host-induced size differences are inconsistent with the exclusive use of morphometrics to delimit and diagnose species of Uncinaria from pinnipeds. (C) 2013 Australian Society for Parasitology Inc. Published by Elsevier Ltd. All rights reserved.

An evaluation was performed of the 1-year outcome of open haemorrhoidectomy (Milligan and Morgan alone or with posterior mucosal anoplasty [the Leopold Bellan procedure]).A prospective, multicentre, observational study included all patients having a planned haemorrhoidectomy from January 2007 to June 2008. Data were collected before surgery, and at 3 months and 1 year after surgery. Patients assessed their anal symptoms and quality of life (SF-36).Six-hundred and thirty-three patients (median age = 48 years, 56.5% women) underwent haemorrhoidectomy either by the Milligan and Morgan procedure alone (n = 231, 36.5%) or together with the Leopold Bellan procedure (posterior mucosal anoplasty) for resection of a fourth haemorrhoid (n = 345, 54.5%), anal fissure (n = 56, 8.9%) or low anal fistula (n = 1, 0.16%). The median healing time was 6 weeks. Early complications included urinary retention (n = 3), bleeding (n = 11), local infection (n = 7) and faecal impaction (n = 9). At 1 year, the main complications included skin tags (n = 2) and anal stenosis (n = 23). There were three recurrences requiring a second haemorrhoidectomy. On a visual analogue scale, anal pain at 1 year had fallen from a median of 5.5/10 before treatment to 0.1/10 (p0.001), anal discomfort from 5.5/10 to 0.1/10 (P0.001) and the Knowles-Eckersley-Scott Symptom (KESS) constipation score from 9/45 to 6/45 (P0.001). The median Wexner score for anal incontinence was unchanged (2/20). De-novo anal incontinence (a Wexner score of5) affected 8.5% of patients at 1 year, but preoperative incontinence disappeared in 16.7% of patients with this symptom. All physical and mental domains of quality of life significantly improved, and 88% of patients were satisfied or very satisfied.Complications of open haemorrhoidectomy were infrequent. Anal continence was not altered. Comfort and well-being were significantly improved at 1 year after surgery. Patient satisfaction was high despite residual anal symptoms.

This prospective observation study evaluated the incidence of secondary bleeding after proctological surgery without interruption of oral anticoagulant or platelet-inhibitor treatments.The number of episodes of postoperative bleeding was identified prospectively from the day of surgery to the last follow-up visit in consecutive patients operated on during 2010 in two units dedicated to proctology.A total of 2513 procedures were performed in 2314 patients (1379 men), 46 ± 16 years of age. Secondary bleeding occurred after 115 (4.6%) procedures, no later than day 24 after surgery, requiring rehospitalization in 86% of cases and further surgery and/or transfusion in 36%. The highest frequency was noted after surgery for haemorrhoids (haemorrhoidopexy, 7.9%; haemorrhoidectomy, 6.2%) (P = NS and transanal excision of rectal tumours (6.5%). On multivariate analysis, the frequency was significantly increased by clopidogrel (15%) [relative risk (RR) = 10). In patients on oral anticoagulants, bleeding occurred in 23% (RR = 5.8) if the anticoagulants were not interrupted and in 57% (RR = 42) if the anticoagulants were discontinued and replaced with heparin.During proctological surgery the overall risk of postoperative bleeding is low, but it can occur up to 3 weeks after surgery and is often severe. Maintenance treatment with oral anticoagulants is the most important risk factor, aggravated by a change to heparin. Clopidogrel also significantly increases the bleeding risk.

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International audience; SPHERE is a planet hunting instrument for the VLT 8m telescope in Chile whose prime objective is the discovery and characterization of young Jupiter-sized planets outside of the solar system. It is a complex instrument, consisting of an extreme Adaptive Optics System (SAXO), various coronagraphs, an infrared differential imaging camera (IRDIS), an infrared integral field spectrograph (IFS) and a visible differential polarimeter (ZIMPOL). The performance of the IRDIS camera is directly related to various wavefront error budgets of the instrument, in particular the differential aberrations occurring after separation of the two image beams. We report on the ongoing integration and testing activities in terms of optical, mechanical, and cryo-vacuum instrument parts. In particular, we show results of component level tests of the optics and indicate expected overall performance in comparison with design-level budgets. We also describe the plans for instrumental performance and science testing of the instrument, foreseen to be conducted during coming months.

Hookworms are intestinal blood-feeding nematodes that parasitize and cause high levels of mortality in a wide range of mammals, including otariid pinnipeds. Recently, an empirical study showed that inbreeding (assessed by individual measures of multi-locus heterozygosity) is associated with hookworm-related mortality of California sea lions. If inbreeding increases susceptibility to hookworms, effects would expectedly be stronger in small, fragmented populations. We tested this assumption in the New Zealand sea lion, a threatened otariid that has low levels of genetic variability and high hookworm infection rates. Using a panel of 22 microsatellites, we found that average allelic diversity (5.9) and mean heterozygosity (0.72) were higher than expected for a small population with restricted breeding, and we found no evidence of an association between genetic variability and hookworm resistance. However, similar to what was observed for the California sea lion, homozygosity at a single locus explained the occurrence of anaemia and thrombocytopenia in hookworm-infected pups (generalized linear model,F= 11.81,p< 0.001) and the effect was apparently driven by a particular allele (odds ratio = 34.95%; CI: 7.12–162.41;p< 0.00001). Our study offers further evidence that these haematophagus parasites exert selective pressure on otariid blood-clotting processes.

During the 2001-02 and 2002-03 breeding seasons, epizootics of Klebsiella pneumoniae resulted in a dramatic increase of pup mortality in New Zealand sea lions (Phocarctos hookeri; NZSLs) on Enderby Island (Auckland Islands). To estimate the prevalence of infection in the NZSL population, a serologic test was developed using a Western blot and a polysaccharide antigen derived from a K. pneumoniae isolate from a NZSL pup. All archived serum samples collected between 1997 and 1998 and 2004 and 2005 at Sandy Bay Beach rookery, Enderby Island, were tested (314 pups and 302 adult females). Anti-Klebsiella antibodies were detected throughout this period, but overall, only 16% of NZSL pups between birth and 5 mo of age were seropositive compared with 95.7% of adults. There was no apparent change in antibody prevalence as a result of the two epizootics. A method to determine total immunoglobulin G (IgG) levels in sea lion serum also was developed to investigate passive immunoglobulin transfer to neonates and development of an acquired immune response. The IgG concentration was significantly lower in pups (median 2.1 mg/ml) than in adult females (median 80 mg/ml). Based on serologic results, it was not possible to determine whether K. pneumoniae was an endemic or a novel pathogen to the NZSL population because the test was not able to discriminate between Klebsiella species. However, this study suggested that the transfer of passive immunity to neonates was very low in the NZSL, especially for anti-Klebsiella antibodies.

As in other endurance sports, the intensity of training sessions and the pace of competition has significantly increased since rugby union became a professional sport. The case history is presented of a professional rugby player who was diagnosed with septicaemia and a lung abscess following an infected wound to the ear. The symptoms only resolved after a large dose of antibiotics and 3 months of rest. It is hypothesised that this may be an example of overtraining syndrome, but complementary blood analyses would be necessary to confirm this. The case underlines the importance of clinically assessing the individual capacity of players to recover, in order to prevent overtraining and to maintain a high level of performance during the whole season.

A SSFSE sequence is proposed in the sagittal plane for a cine-MRI of the cervical spine in front-line rugby players. Thus one can complete the static study and improve the detection of canal stenosis and the prevention of spinal cord injuries.

Two species of hookworms (Uncinaria lucasi and Uncinaria hamiltoni) have been formally described from pinnipeds, but dissimilar types are noted from these hosts. This report is the first description of hookworms (Uncinaria spp.) from the New Zealand sea lion, Phocarctos hookeri. The nematodes were collected from dead pups on Enderby Island (Auckland Islands, 50 degrees 30', 166 degrees 17') during January and February, 2004. Standard measurements of male and female hookworms were obtained, providing a general morphometric characterization of the hookworm species in P. hookeri. Considerable variations in the body length of adult hookworms were noted within the same host. The arrangement of some of the bursal rays differs from that described for U. lucasi and U. hamiltoni.

Anopexy allows treatment of hemorrhoidal symptoms with a less painful postoperative course. This information is important for the patient, but may lead to dissatisfaction if pain level is higher than expected. To evaluate perceived pain and physical limitation levels in relation to patient's expectation. Evaluate long-term functional results.Sixty-eight consecutive patients (56 males) were prospectively included. Distribution of haemorrhoid grades were 4 grade 2 (6%), 52 grade 3 (76%) and 12 grade 4 (18%). Postoperative pain level was less or equal than expected for 85% of patients, with a better acceptance superior to 45 years. Physical limitation was equally or less important than expected for 89%. At the 32 weeks follow-up hemorrhoidal symptoms were present in 23%, uninfluenced by any patient's or operative characteristics. Incontinence with urgency was reported by 17%. Presence of an alliterated continence was linked to stapled line inferior to 6,5 mm from pectineate line, doughnut height inferior to 22 mm, external hemorrhoids and related to surgeon.Pragmatic information, although vague, about postoperative pain does not expose to patient's dissatisfaction. Functional results are not influenced by technical variation. Continence alterations are not severe, but frequent when stapled line is too close from pectineate line.

The Visible Multi-Object Spectrograph VIMOS is a wide field survey instrument in the process of being commissioned for operations at the ESO-VLT. During the first commissioning period, the instrument has confirmed its excellent performances in its three basic modes of operation: direct imaging, multi-slit spectroscopy, and integral field spectroscopy. VIMOS provides the largest imaging field at the VLT with 224 arcmin2. It offers an unprecedented multiplex gain in multi-slit spectroscopy, with on order 800 slits which can be observed simultaneously. The integral field unit has a field up to 54x54 arcsec2, with 6400 spectra recorded at once. The overall efficiency of VIMOS combined to the Melipal unit #3 is confirmed to be as computed on the basis of the measured transmission of optical elements. Image quality is confirmed to be excellent, providing images limited by natural seeing in most conditions. High quality slit masks cut by the laser machine coupled to excellent geometric mask to CCD mapping lead to multi-slit spectra of excellent quality. VIMOS is expected to be offered to the ESO community for reguglar observations in early 2003.

To evaluate, in a prospective study of a cohort of patients, the local recurrence rate of T2 or T3 rectal cancers treated by transanal excision after preoperative irradiation.Between 1992 and 1999, 34 patients were treated after radiotherapy by a local excision for a distal rectal carcinoma limited to (stage T2) or invading through the muscular layer (stage T3). Four patients were excluded either for palliative treatment or lost for follow-up. Thirty patients were included in the study (8 uT2, 8 uT3, 14 undetermined preirradiation stage).After a 74-month mean follow-up (median: 46), the 5-year local recurrence rate was 33%. Even among subgroups of patients with a significant risk factor for local recurrence (size40 mm, clear margin2 mm, uT3 stage versus uT2) there were no benefits from irradiation.Local excision of T2 or T3 rectal cancers is associated with an elevated local recurrence rate. This result is demonstrated even after adjunction of a preoperative irradiation. So, local treatment must be restricted to clearly informed patients who definitively refuse a radical intervention.

To evaluate the quality of life of patients suffering from dyschezia and its correlation with symptomatic complaints and anatomical abnormalities, before and after elective surgery for rectal static disorder.A prospective study was conducted using a general quality of life questionnaire (SF36) and a constipation specific score (PAC-QoL), a dyschezia symptom score, and defecography.Thirty-eight female dyschesic patients (mean age 54 years) underwent surgery for rectocele with (n=16) or without (n=14) internal rectal prolapse, an isolated internal rectal prolapse (n=3), or a total rectal prolapse (n=5). Preoperative quality of life was low, correlated with the intensity of dyschezia. Seven months after surgery, quality of life and dyschezia improved independently of the amplitude of the anatomical correction. More items improved in the constipation specific score than on the quality of life questionnaire; they were correlated with the course of dyschezia symptoms. Neither incontinence nor irritable bowel syndrome affected evolution of the symptoms.Surgery improved initially low quality of life and symptomatic complaints in patients with dyschezia and a rectal static disorder, independently of anatomic repair. Differences in changes observed in the PAC-QoL and SF36 suggest different fields of application.