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Introduction: the purpose of this study was to identify factors associated with the failure of medical treatment for ectopic pregnancy (EP) in women at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital. Methods: we conducted a case-control study using a retrospective data collection over a 10-year period from January 1st 2008 to December 31st 2017. Our study included all patients treated for EP; the study group was composed of patients in whom medical treatment had been unsuccessful while the control group was composed of patients in whom medical treatment had been successful. The variables studied were: socio-demographic, clinical, paraclinical and therapeutic features. Consecutive and complete sampling were used. Multivariate analysis was performed. Results: we enrolled 92 patients, including 23 cases and 69 controls. The variables associated with the failure of medical treatment for EP after univariate analysis were: initial β-HCG (beta-human chorionic gonadotropin) level > 10000IU/L (OR=3.05; P=0.031), β-HCG level on day 4 > 10000IU/L (OR=7.15;P=0.000), β-HCG level on day 7 > 10000UI/L (0R=20; P=0.000), Fernandez score ≥ 13 (OR=3.09;P=0.020), the presence of fetal heart activity (OR=2.8; P=0.036), a history of voluntary abortion (0R=2.67;P=0.043) and primary level of education. (P=0.013). After multivariate analysis, predictors were: initial β-HCG level>10000 IU/L (OR=8.97; P=0.004), 6-HCG level on day 4>10000 IU/L (OR=8.44;P= 0.007), Fernandez score ≥ 13 (OR=1.12;P=0.005), and the presence of fetal heart activity (0R=6.09;P=0,026). Conclusion: at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital predictors of failure of medical treatment for EP were related to initial β-HCG level and fetal viability. [ABSTRACT FROM AUTHOR]

Résumé: La colo-proctologie « à la française » est une spécialité en perpétuel mouvement et ses perspectives sont nombreuses. Les grandes lignes sont la place grandissante des techniques d'épargne sphinctérienne dans la prise en charge de la fissure et des fistules anales, les techniques chirurgicales mini-invasives de la maladie hémorroïdaire, du sinus pilonidal infecté et des troubles de la statique rectale, les progrès des traitements médicaux des lésions ano-périnéales de la maladie de Crohn et de la maladie de Verneuil, la prophylaxie médicale des infections ano-rectales sexuellement transmises, les stratégies de plus en plus conservatrices dans la prise ne charge de l'incontinence anale et du cancer du rectum, l'espoir de l'éradication du cancer de l'anus par le dépistage des lésions précancéreuses et la vaccination contre les HPV oncogènes, la prise en compte de plus en plus priorisée des demandes des patients (Patient Reported Outcomes) pour une prise en charge la plus personnalisée possible, et, enfin, un enseignement élargi et réactualisé afin de mieux répondre aux différentes attentes. Bref, beaucoup d'enjeux pour la décennie à venir ! Coloproctology "à la française" is a specialty in perpetual movement and its perspectives are numerous. The main lines are the growing importance of sphincter-sparing techniques in the management of anal fissure and fistulas, minimally invasive surgical techniques for haemorrhoidal pathology, pilonidal disease and posterior floor dysfunction, progress in the medical treatment of anoperineal lesions in Crohn's disease and hidradenitis suppurativa, medical prophylaxis of sexually transmitted anorectal infections, the increasingly conservative strategies for the management of anal incontinence and rectal cancer, the hope of eradicating anal cancer by screening for precancerous lesions and vaccination against oncogenic HPV, the increasingly prioritised consideration of patients' requests (Patient Reported Outcomes) for the most personalised management possible, and, finally, expanded and updated teaching to better respond to the various expectations. In short, there are many challenges for the coming decade! [ABSTRACT FROM AUTHOR]

It has long been believed that shrines of the Greek healing deity, Asklepios, were the first hospitals in Europe. This view was challenged by Miller who proposed that the first recognisable hospitals in the Western tradition were the outcome of Christian piety in the Byzantine Empire. Miller defined a 'hospital' as "an institution which provides bed, meals, and constant nursing care for patients while they undergo medical therapy at the hands of professional physicians." My aim is to demonstrate that at least some Asklepieia did in fact meet Miller's definition of a 'hospital' and what we in the twenty-first century would recognise as a 'hospital'. [ABSTRACT FROM AUTHOR]

La prolactine biologiquement active se présente sous forme monomérique. Il existe des formes polymérisées, aussi appelées big prolactine et des formes liées à des immunoglobulines G aussi appelées macroprolactine ou big big prolactine. Nous rapportons le cas d'un patient âgé de 45 ans, opéré pour adénome à prolactine en 2012. Le macroprolactinome masculin est une tumeur de découverte tardive, ce qui rend intéressant l'étude des particularités de la macroprolactinémie afin d'établir, à la lumière des données clinico-biologiques et d'imagerie médicale, des recommandations thérapeutiques et de suivi adaptées après concertation entre neurochirurgien, endocrinologue et biologiste. The biologically active prolactin is in monomeric form. There are polymerized forms, also called big prolactin and forms linked to immunoglobulins G also called macroprolactin or big big prolactin. We report the case of a 45-year-old patient, operated for prolactin adenoma in 2012. The male macroprolactinoma is a tumor of late discovery, which makes interesting the study of these particularities in order to establish in the light of clinico-biological data and medical imaging therapeutic recommendations and adapted follow-up after consultation between neurosurgeon, endocrinologist and biologist. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: L'objectif de notre étude était d'évaluer la prise en charge médicochirurgicale de l'ulcère de Buruli (UB) dans le centre de dépistage et de traitement de l'UB (CDTUB) d'Allada au Bénin. Méthodes: Une étude rétrospective et descriptive a été réalisée de 2010 à 2014 dans le CDTUB d'Allada. Elle a inclus les patients diagnostiqués sur la base d'arguments cliniques et biologiques pour un UB et qui ont été pris en charge selon les recommandations médicochirurgicales de l'OMS. Résultats: Au total, 274 patients ont été diagnostiqués et pris en charge dont 57,7 % d'enfants de moins de 15 ans. Les lésions ulcérées (189 ; 69 %) et les lésions de catégorie II de l'OMS (144 ; 52,5 %) prédominaient. Tous les patients ont bénéficié de la bi-antibiothérapie et 43,4 % (119) des patients ont eu une chirurgie complémentaire. Les lésions de catégorie III et les lésions multifocales nécessitaient plus la chirurgie alors que les lésions de catégorie I ont plus guéri sous traitement médical. Le taux global de cicatrisation était de 92 % dont 53,3 % pour les patients ayant bénéficié uniquement de l'antibiothérapie seule et 38,7 % pour ceux ayant eu une chirurgie complémentaire. Le délai médian de cicatrisation était de 13 semaines, avec des extrêmes de 4 et 56 semaines. Conclusion: Dans le CDTUB d'Allada, la prise en charge des patients entre 2010 et 2014 a été faite grâce à l'antibiothérapie seule pour la majorité des patients. Cependant, la chirurgie occupait encore une place non négligeable. Introduction: The objective of our study was to evaluate the medico-surgical management of Buruli ulcer (BU) in the BU Screening and Treatment Center (CDTUB) of Allada in Benin. Methods: This retrospective and descriptive study retrospectively reviewed records of patients seen from 2010 to 2014 at the CDTUB of Allada. It included patients diagnosed with BU according to WHO epidemiological and clinical criteria as well as laboratory results and who were treated according to WHO medical and surgical recommendations. Results: In all, 274 patients were diagnosed and treated, 57.7% of them children younger than 15 years. Ulcerative lesions (189, 69%) and WHO category II lesions (144, 52.5%) predominated. All patients received dual antibiotic therapy and 43.4% (119) underwent surgery as well. Category III lesions and multifocal lesions required more surgery, whereas most category I lesions healed under medical treatment. The overall rate of healing was 92%: 53.3% for patients who received only antibiotic therapy and 38.7% for those who also had surgery. The median healing time was 13 weeks and ranged from 4 to 56 weeks. Conclusion: In the CDTUB of Allada, between 2010 and 2014, most patients were treated with antibiotic therapy alone, but a significant number still received surgery. [ABSTRACT FROM AUTHOR]

L'atteinte artérielle au cours de la maladie de Behçet est rare et la localisation au niveau du tronc tibio-péronier est exceptionnelle. Nous rapportons le cas d'un jeune suivi pour maladie de Behçet et chez qui l'évolution vers l'angiobehçet a été inhabituelle. Le traitement médical et l'abstention thérapeutique ont été décidés suivant un faisceau d'argument. Arterial involvement in Behcet's disease is rare and the tibioperoneal trunk localisation is exceptional. We report the case of a young men with Behcet's disease and in whom the evolution to angiobehcet was unusual. The medical treatment and the therapeutic abstention were decided according to a bundle of argument. [ABSTRACT FROM AUTHOR]

Les fistules œsotrachéales représentent une entité pathologique caractérisée par la présence d'une communication anormale entre l'arbre trachéal et l'œsophage. A travers un cas clinique de fistule œsotrachéale suite à l'ingestion d'un corps étranger, nous abordions l'aspect étiopathogénique, évaluer notre principe thérapeutique et faire une revue de la littérature. Il s'agit d'un patient de 15ans admis pour dysphagie évoluant depuis deux mois suite à l'ingestion d'un corps étranger à type de morceau d'os. L'œsophagoscopie sous anesthésie générale a permis l'extraction du corps étranger. Le Transit Oeso-gastro-duodénal (TOGD) en post-opératoire a objectivé l'orifice fistulaire siégeant au niveau de C7. L'absence de l'orifice fistulaire a été notée à J30 post-endoscopie au TOGD de contrôle. Le traitement médical est une alternative thérapeutique de la fistule œsotrachéale et doit être basé sur des critères bien définis.

La pyélonéphrite emphysémateuse est une infection nécrotique du rein caractérisée par la présence de gaz au sein du parenchyme rénal, des cavités excrétrices ou des espaces péri rénaux. Il s'agit d'une forme grave pouvant engager le pronostic vital. La prise en charge reste controversée: entre l'attitude chirurgicale et le traitement Purement médical, il existe une place pour le drainage percutané. Nous rapportons 3 cas de PNE traité par des antibiotiques seuls avec une bonne évolution, nous montrons à travers que le traitement médical pourrait suffire.

Introduction: In 2023, oculoplastics in France is experiencing a paradox with an imbalance between demand and supply of trainees. The goal of this study is to establish a factual overview of oculoplastics in France, with its limitations, and make proposals to optimize this sector., Methods: An observational study was conducted by compiling epidemiological data related to oculoplastics. This included full-time hospital practitioners (HPs) in French university hospitals (FUH), data from the distributed computerized system for health assessment (SIDES), the specialized cross-disciplinary training (FST) in oculoplastics, the interuniversity diploma (DIU) in oculoplastics, the French University Ophthalmologists College (COUF), and the French Society of Reconstructive and Aesthetic Ophthalmology (SOPREF)., Results: Of the 32 FUH, only 11 full-time HPs (among them 5 academic) are specialized in oculoplastics. Several "priority" regions are underrepresented in oculoplastic surgeons. The number of ophthalmology residency coordinators and residents participating in the oculoplastics FST are decreasing over time and favoring other subspecialties. On the SIDES platform dedicated to residents, 26 (11.5%) of the 226 courses are devoted to oculoplastics. The role of women in oculoplastics is also discussed., Conclusion: Despite offering quality theoretical training, the future of French oculoplastics is clouded by a lack of practical training. Corrective measures include increasing oculoplastic surgeons in the FUH, developing private practice fellowships, prioritizing residents from "priority" regions for the oculoplastics DIU, optimizing the inter-CHU network, creating innovative teaching resources, and organizing specific congresses for the residents., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Résumé But Le but de cette étude était d'évaluer la qualité de la prise en charge médicale de l'insuffisance cardiaque à l'hôpital national Blaise COMPAORE comparativement aux recommandations internationales. Patients et méthodes C'est une étude rétrospective réalisée chez les patients consécutifs admis pour insuffisance cardiaque documentée échographiquement d'octobre 2012 à mars 2015 dans le service de médecine et spécialités médicales de l'hôpital national Blaise COMPAORE et ayant un suivi minimum de six semaines. L'analyse des données est faite par le logiciel SPSS version 20.0. Résultats Quatre-vingt et quatre patients d'âge moyen de 57,61 ± 18,24 ans ont été inclus. L'insuffisance cardiaque aiguë représentait 84,5 % des cas avec fonction systolique du ventricule gauche altérée (77,4 %). Le taux de prescription des différents médicaments chez les insuffisants cardiaques tout type était de 88,1 % pour les diurétiques de l'anse ; 77,1 % pour les inhibiteurs de l'enzyme de conversion de l'angiotensine/antagonistes des récepteurs de l'angiotensine II et 65,5 % pour les bêtabloquants. Chez les patients avec dysfonction systolique ce taux était de 84,6 % pour l'association inhibiteurs de l'enzyme de conversion de l'angiotensine/antagonistes des récepteurs de l'angiotensine II et 75,4 % pour les bêtabloquants. Le réentraînement à l'effort a concerné 10,7 % des patients. Le taux de décès a été de 16,7 % et le taux de réhospitalisation de 16,7 %. Conclusion Le taux de prescription des médicaments majeurs de l'insuffisance cardiaque est satisfaisant. La réadaptation cardiovasculaire doit être développée. Abstract Aim The aim of this study was to assess the quality of medical management of heart failure at the National Hospital Blaise Compaoré according to the international guidelines. Patients and methods A retrospective study was performed including consecutive patients admitted for heart failure documented sonographically from October 2012 to March 2015 in the Medicine and Medical Specialties Department of National Hospital Blaise Compaore with a minimum follow-up of six weeks. Data analysis was made by the SPSS 20.0 software. Results Eighty-four patients, mean age of 57.61 ± 18.24 years, were included. It was an acute heart failure in 84.5% of patients with systolic left ventricular function impaired (77.4%). The rate of prescription of different drugs in heart failure any type was 88.1% for loop diuretics; 77.1% for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and 65.5% for betablockers. In patients with systolic dysfunction, 84.62% of patients were received the combination of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and 75.38% for betablockers. Exercise rehabilitation was undergoing in 10.7% of patients. The death rate was 16.7% and hospital readmission rate of 16.7%. Conclusion The prescription rate of major heart failure drugs is satisfactory. Cardiac rehabilitation should be developed. [ABSTRACT FROM AUTHOR]

The last french recommendations for acute diverticulitis care were published in 2006. An update was necessary in light of numerous study published on the topic since 2006. This update based on the works of the Haute Autorité de la Santé working group gives new recommendations on the initial diagnosis, the medical treatment, indications and modalities of surgery, and follow-up after treatment. Some new recommendations will change physicians habits: outpatient treatment, treatment without antibiotic, no special diet, laparoscopic lavage not recommended, resection and anastomosis with and without stoma privileged, or no more indication for colonoscopy after non complicated acute diverticulitis. [ABSTRACT FROM AUTHOR]

Abstract Radiation-induced mucositis is a common toxicity, especially in patients with head and neck cancers. Despite recent technological advances in radiation therapy, such as intensity-modulated radiotherapy, radiation-induced mucositis is still causing treatment disruptions, negatively affecting patients’ long and short term quality of life, and impacting medical resources use with economic consequences. The objective of this article was to review the latest updates in the management of radiation-induced mucositis, with a focus on pharmaceutical strategies for the prevention or treatment of mucositis. Although numerous studies analysing the prevention and management of oral radiation-induced mucositis have been conducted, there are still few reliable data to guide daily clinical practice. Furthermore, most of the tested drugs have shown no (anti-inflammatory cytokine, growth factors) or limited (palifermin) effect. Therapies for acute oral mucositis are predominantly focused on improving oral hygiene and providing symptoms control. Although low-level laser therapy proved efficient in preventing radiation-induced oral mucositis in patients with head and neck cancer, this intervention requires equipment and trained medical staff, and is therefore insufficiently developed in clinical routine. New effective pharmacological agents able to prevent or reverse radio-induced mucositis are required. Résumé La radiomucite est une toxicité fréquemment rencontrée chez les patients pris en charge par radiothérapie pour un cancer de la tête et du cou. Malgré l’avènement de la radiothérapie avec modulation d’intensité (RCMI), la radiomucite reste un effet secondaire fréquent, qui altère la qualité de vie des patients à court et long termes, et nécessite parfois des interruptions de traitement. L’objectif de ce travail était d’effectuer une synthèse de la littérature portant sur la prévention non dosimétrique et la RCMI. Même si nombreuses études ont étudié la prise en charge de la radiomucite orale, peu de données sont transférables aux patients. Par ailleurs, la plupart des molécules testées ont montré soit une efficacité limitée (palifermine), soit une absence d’efficacité (cytokines anti-inflammatoires, facteurs de croissance). Finalement, le traitement de la radiomucite orale repose principalement sur l’amélioration de l’hygiène buccodentaire et sur la prise en charge symptomatique. Le laser de basse énergie a démontré une efficacité dans des stratégies préventives, mais son coût et l’expertise nécessaire expliquent probablement sa faible disponibilité en routine. Le développement d’agents pharmacologiques pouvant prévenir ou traiter la radiomucite demeure une priorité. [ABSTRACT FROM AUTHOR]

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Proctological diseases and functional ano-rectal disorders are extremely frequent and are a growing reason for consultation. They have benefited from many advances in diagnosis: molecular biology, high-resolution anorectal manometry, magnetic resonance imaging, high-resolution anoscopy, etc. Moreover, their treatment has also taken a leap forward, particularly during the last two decades, with fissurectomy without leiomyotomy for anal fissure, minimally invasive surgery in hemorrhoidal pathology, sphincteric saving techniques for fistulas, anti-TNF-alpha and stem cell injections for anoperineal lesions of Crohn's disease, primary closure techniques for pilonidal disease, botulinum toxin injections for functional defecation disorders, laparoscopic ventral rectopexy in rectal static disorders, sacral neurostimulation in anal incontinence, radio-chemotherapy in anal cancer, mesorectal excision or organ preservation techniques in rectal cancer, development of ambulatory surgery, etc. Indeed, these various therapies help to relieve most of our patients with less constraints, simpler follow-up, better results and less frequent complications than previously. And this is not over because the research is actively in full swing. In short, there is enough to occupy several generations of proctologists!... [ABSTRACT FROM AUTHOR]

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Copyright of Douleur et Analgésie is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La toxine botulique (TB) a fait son apparition en urologie dans le champ de la neuro-urologie comme traitement de la dyssynergie vésico-sphinctérienne et de l'incontinence par hyperactivité détrusorienne neurogène. Son action est maintenant clairement démontrée et constitue désormais un traitement largement utilisé dans l'hyperactivité vésicale neurogène. La toxine botulique peut-elle constituer un traitement efficace de l'hyperplasie bénigne de prostate (HBP)? L'injection intraprostatique de TB a récemment été étudiée dans le traitement de l'HBP. Elle semble permettre une amélioration importante des symptômes urinaires sans effets secondaires significatifs et pourrait donc représenter une alternative mini-invasive intéressante aux traitements classiques de l'HBP. Les avantages de son utilisation sont la simplicité de sa mise en oeuvre, l'absence d'effets secondaires rapportés et sa durée d'action prolongée. Des études soigneusement menées, prospectives, contrôlées portant sur des effectifs plus grands sont désormais nécessaires pour confirmer ces premiers résultats. Nous proposons a à travers ce travail une exposition des connaissances actuelles des mécanismes d'action de la TB au niveau prostatique et les résultats des principales études cliniques dans l'HBP.

Résumé Les mycétomes sont des infections sous-cutanées chroniques, endémiques dans les régions tropicales sèches. Elles peuvent être dues à des actinomycètes (actinomycétomes) ou à des champignons (eumycétomes) dont la forme de développement in vivo est le grain. L’atteinte du pied est prédominante, la principale complication est l’atteinte osseuse. Les patients sont des ruraux venant des régions éloignées des centres médicaux. Ils se présentent trop souvent avec des formes évoluées, mutilantes. Une des premières conditions pour espérer un bon résultat thérapeutique est un diagnostic précoce. Le diagnostic biologique permet de distinguer les actinomycétomes des eumycétomes, indiscernables cliniquement, dont les traitements sont radicalement différents. L’identification précise de l’agent étiologique est souhaitable pour mettre en route un traitement adapté mais elle nécessite des laboratoires spécialisés. Le traitement de première ligne des actinomycétomes est l’association triméthoprime–sulfaméthoxazole (SXT). Elle doit être donnée pendant un minimum d’un an. Dans les formes répondant mal à ce traitement ou avec risque de dissémination, l’association à l’amikacine a permis d’obtenir un pourcentage élevé de guérison. D’autres options sont possibles comme l’amoxicilline–clavulanate. Ces traitements antibiotiques s’ils sont bien conduits amènent une guérison et les indications chirurgicales restent exceptionnelles. Le traitement médical des mycétomes fongiques est plus décevant et doit souvent être complété par un geste chirurgical. L’antifongique préconisé actuellement est l’itraconazole, les azolés plus récents sont en cours d’évaluation. Summary Mycetoma are chronic subcutaneous infections, endemic in dry tropical regions. It can be caused either by actinomycetes or by fungi, presenting as filamentous grains in vivo. The foot is the most common localization. The main complication is osseous involvement. Patients are rural workers living in areas situated far from medical centers. Too often, they reach well-equipped hospitals with advanced mutilating lesions. Early case detection is the first condition for good therapeutic results. Clinical presentations of actinomycetoma and eumycetoma are similar, only biological diagnosis can distinguish the two etiological forms. This distinction is essential as medical therapy for each is radically different. Precise identification of the causal agent is required for targeted treatment but it can only be realized in rare specialized laboratories. For actinomycetoma, standard therapy is trimethoprim–sulphamethoxazole (STX). Duration of treatment period is one-year minimum. In case of poor response to STX or high risk of dissemination, a combination with amikacin gave high cure rate. Other options as amoxicillin–clavulanate are available. Medical cure of actinomycetoma is generally obtained with antibiotic treatments and surgical indications are exceptional. Disappointing results were observed using antifungal in the treatment of eumycetoma and medical therapy must be completed with surgical excision. Itraconazole is now the most used drug, new triazoles are on evaluation. [ABSTRACT FROM AUTHOR]

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Objective To assess the impact of therapeutic amenorrhoea triggered by triptorelin in the digestive complaints of women with deep endometriosis infiltrating the rectum. Design Prospective series of consecutive patients with deep endometriosis of the rectum enrolled over a period of 17 consecutive months. Setting University tertiary referral center. Patients Seventy patients. Interventions Medical therapy (triptorelin 11.25 mg and add-back therapy using estradiol) administered for 3.4 ± 1.8 months before surgery. Main outcome measures Gastrointestinal standardised questionnaires before beginning medical treatment and the day before surgery. Results The most frequent digestive complaints at baseline were: defecation pain in 77.1% of patients, bloating in 60%, diarrhoea in 54.3% and constipation in 50%. The largest diameter of the rectal area infiltrated by the disease was < 1 cm in 12.2% of women, 1 to 2.9 cm in 34.3% and ≥ 3cm in 51.4%. Multiple colorectal nodules were found in 32.9%. Medical treatment led to disappearance of cyclic defecation pain in 78.6%, dyschesia in 58.3%, diarrhoea in 58.3% and bloating in 50%. Relieving digestive complaints was not significantly related to either length of triptorelin administration or size of rectal infiltration by deep endometriosis. Conclusion Therapeutic amenorrhoea averaging 3 months allowed complete improvement of various cyclic digestive complaints in more than half of patients. In selected patients, continuous therapeutic amenorrhoea could compensate for the lack of complete resection of deep infiltrating endometriosis of the rectum, when this latter is likely to result in a high rate of postoperative morbidity. [ABSTRACT FROM AUTHOR]

Current therapy for stable angina includes surgical and percutaneous revascularization, which has been improved tremendously over the last decades. Smoking cessation and regular exercise are the cornerstone for prevention of further cerebrovascular events. Medical treatment includes treatment of cardiovascular risk factors and antithrombotic management, which can be a challenge in some patients. Owing to the fact that coronary revascularization is readily accessible these days in many industrialized countries, the importance of antianginal therapy has decreased over the past years. This article presents a contemporary overview of the management of patients with stable angina in the year 2015. [ABSTRACT FROM AUTHOR]

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Résumé Objectifs Évaluation de l’efficacité d’un protocole associant la mifépristone et le misoprostol pour la prise en charge des grossesses arrêtées et des œufs clairs. Patientes et méthodes Étude monocentrique rétrospective portant sur 92 femmes prises en charge pour fausse couche retardée par un protocole associant la prise orale de 600 mg de mifépristone suivie 48 heures plus tard, en hôpital de jour, par une prise orale de 400 μg de misoprostol. Les critères d’évaluation étaient la vacuité utérine à j3 (succès de l’association mifépristone–misoprostol) et la vacuité utérine après prise en charge complémentaire par prostaglandines ou ocytocine (succès du traitement médical). Résultats Le taux de succès global du traitement médical était de 82 % (75/92), avec 69 succès à j3 (75 %). Pour 6 femmes (7 %), un traitement médical complémentaire a été efficace. Une prise en charge chirurgicale a été nécessaire chez 17 femmes (18 %). Aucun facteur prédictif de réussite du traitement médical n’a pu être mis en évidence. Discussion et conclusion L’association mifépristone–misoprostol présente une efficacité élevée pour la prise en charge des fausses couches retardées. L’apport spécifique de la mifépristone, bien que démontré pour la prise en charge d’interruption de grossesses évolutives, devrait être évalué dans l’avenir. L’effectif de cette étude n’a pas permis de mettre en évidence des facteurs prédictifs de réussite de ce type de traitement. Objectives A retrospective monocentric clinical trial was performed to evaluate the efficacy of the association of mifepristone and misoprostol for the management of early pregnancy failure. Patients and methods Ninety-two women with early pregnancy failure or anembryonic pregnancy were first treated with 600 mg of mifepristone and 48 hours later with 400 μg of misoprostol by oral administration. Successful treatment, defined as an empty uterus, was searched at day 3, with the association of misoprostol–mifepristone alone or with complementary medical treatment, prostaglandins or ocytocine. Results The overall treatment success was 82% (75 of 92 women) with 69 successful cases at day 3 (75%). Six of 92 women (7%) needed a second-line medical treatment. For the last 17 women (18%), the failure of the associated tested medical treatment lead to a secondary surgery. No prognostic factor for the successful medical treatment has been highlighted. Discussion and conclusion A high efficacy for the management of early pregnancy failure is demonstrated for the mifepristone and misoprostol medical treatment. The specific contribution of mifepristone, although proven in the cases of termination of evolutive pregnancies, should be further evaluated in the future for the specific management of early pregnancy failure. Nevertheless, no prognostic factor for the success of the propose treatment can be determined, as the amount of patients enrolled in this study was not sufficient. [ABSTRACT FROM AUTHOR]

Copyright of Sexologies is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Les Cahiers de l'Année Gérontologique is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Aim: Cardiac resynchronization therapy (CRT) is recommended for selected patients with advanced heart failure (HF) despite optimal medical treatment. However, the doses of pharmaceuticals in this population are often limited by adverse effects. We compared the drug regimens of 21 patients before and 6months after they underwent the implantation CRT systems. Methods: We studied 17 men and four women (mean age=63.4±11years) presenting in New York Heart Association HF classes III-IV, and with a left ventricular ejection fraction (LVEF)≤35% and cardiac dyssynchrony, who underwent implantation of CRT systems. Results: At baseline, 52% of patients were treated with β-adrenergic blockers (β-B), though in optimal doses in only 19%. The introduction of (β-B) was complicated by cardiogenic shock in three patients. At baseline, all patients were treated with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB), of whom 76% received optimal doses. After 6months of CRT, β-B were administered to 76% of patients, in optimaklon ACE or ARB but 75% of them were receiving maximal doses. After 6months of CRT, β blockers have been introduced in 72% of patients and maximal doses have been achieved in 60% of them. Maximal doses of ACE or ARB were reached in 95% of the study population. We noticed that systolic blood pressure was higher after implantation. There was also a significant improvement in functional status and left ventricular ejection fraction compared to baseline. Conclusion: CRT is an efficacious adjunctive device therapy to standard medical therapy for patients with heart failure and cardiac dyssynchrony. Its benefits are in addition to those afforded by standard pharmacological therapy. Achieving maximal doses of medical treatment and the possibility of introducing β blockers after CRT prove that CRT and pharmacological treatment are complementary strategies and should not be considered as competitive. [Copyright &y& Elsevier]

Résumé: Objectif: Déterminer (i) la présentation clinico-radiologique de la gonarthrose destructrice rapide (GDR) après prise en charge médicale globale incluant le lavage articulaire associé à une infiltration de corticoïdes, (ii) les facteurs prédisposant au recours ultérieur à la chirurgie. Méthodes: Étude rétrospective monocentrique ayant inclus des GDR fémoro-tibiales, définies par la perte d’au moins 50 % de l’interligne articulaire en un an, avec un suivi post-lavage articulaire d’au moins un an. Résultats: Cent onze patients étaient inclus, âge moyen : 64,1 ans, IMC : 28,9 ; 70,3 % de femmes. L’EVA douleur était à 56,1mm, indice de Lequesne : 11,9, score de WOMAC fonction : 51,9. Un épanchement intra-articulaire mécanique (216 globules blancs/mm3) a été retiré chez 102 patients (92 %), persistant depuis plus de six mois dans 71 % des cas. Le compartiment fémoro-tibial médial était concerné dans 79 % des cas. Le pincement de l’interligne articulaire avait atteint 52 % en extension et 71 % en schuss, sur une durée moyenne de suivi de 7,3 mois. La chondrocalcinose radiologique était présente dans 13,5 % des cas et l’ostéonécrose dans 12,6 % des cas. Un lavage articulaire (1 litre, 2 aiguilles de 14-gauge) associé à une infiltration de corticoïdes a été complété par des injections d’acide hyaluronique (AH) chez 71 % des patients. Quatre-vingt-neuf patients ont été revus avec une période moyenne de suivi de 55,0 mois. Trente-sept (41,6 %) avaient nécessité une intervention chirurgicale. Le délai moyen entre le lavage et la chirurgie était de 16,1 mois. La douleur était acceptable chez 100 % des patients opérés et 87,8 % des patients non opérés. L’analyse de régression multivariée a retenu l’atteinte fonctionnelle, évaluée par le temps de marche maximum, ainsi que la sévérité radiographique en extension comme étant des facteurs prédisposant à la chirurgie. Conclusion: Le devenir de la GDR semble moins sévère que prévu après une prise en charge médicale globale. [ABSTRACT FROM AUTHOR]

Copyright of Bulletin de la Société de Pathologie Exotique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Foot Medicine & Surgery / Medecine et Chirurgie du Pied is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Colon & Rectum is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The aim of this article is to argue the usefulness of the systematic administration of medical treatment in women managed for endometriosis, either alone or associated with the surgery. The authors dispute seven frequent objections against the medical treatment: the lack of curative effect, the lack of primary prevention and the risk of delaying the diagnostic, the contraceptive effect in women wishing to conceive, the adverse effects, the risk of occurence of new lesions following the arrest of the treatment, the lack of proof favourable to the efficient prevention of recurrences and the cost of the treatment. The authors conclude that to date the therapeutic amenorrhea represents an indispensable tool in the management of the endometriosis, in women both benefiting or not from surgical procedures. [Copyright &y& Elsevier]

Abstract: Two types of scoliosis have been described in adults: adult idiopathic scoliosis (AIS), as an outcome for child scoliosis, and degenerative scoliosis (DS), of late onset. These two entities are difficult to distinguish after 50 years. Menopause is a critical period for DS. In both types functional outcome is severe as a consequence of pain related to rotatory subluxation, of lateral and sagittal unbalance, of cosmetic damages, and mainly with respect to protracted disease. Radiological survey needs a 3D approach because of complex spine deformity. Treatment is aiming at the restoration of spinal balance, to slow or stop outcome and to reduce pain. Medical management includes rehabilitation, guided joint injections, and brace. Non-surgical management is important and should be considered with surgical procedures, risky in elderly patients. Early diagnostic and management are essential in scoliosis. [Copyright &y& Elsevier]

Abstract: The adhesive capsulitis of the shoulder is observed in 2 to 5 % of the general population; its incidence is increasing in certain populations (including diabetics). Outcome is usually spontaneously favourable in one to three years; but it can be much longer and recovery is uncertain, particularly in diabetic patients. The goals of treatment are: treating pain, very intense at onset, improving the range of motion to limit the risk of sequelae, reducing the duration of capsulitis. The treatment of adhesive capsulitis are poorly consolidated and there is currently no recommendation. In practice, it always begins with simple treatments (analgesics, NSAIDs, physiotherapy, infiltration of corticoids) which is usually efficient in most cases, ending with the most complex treatments (arthrodistension, mobilization under general anesthesia, arthroscopic capsulotomy). While in the first case management is done on an outpatient basis, complicated treatments require a much heavier organization; they have to be done in a specialized environment and required intensive rehabilitation. [Copyright &y& Elsevier]

Copyright of Pelvi-Perineologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Colon & Rectum is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Deep infiltrating endometriosis is a well-known female disease responsible for chronic pelvic pain, urinary dysfunction, infertility, and altered quality of life. Endometriosis and infertility are complex entities and the optimal choice of management of both of them remains obscure. Mechanism of development of the disease has to be understood to optimize patients care. The link between barrenness and endometriosis is well known, but there is no direct link between bladder lesion and infertility. Bladder endometriosis is a deeply infiltrating endometriosis lesion. Its management is first diagnostic and then remedial. In case of ineffectiveness of medical strategy, surgical treatment is indicated. However, for patient suffering from symptomatic isolated bladder endometriosis, surgical management can be offered in first intention. Isolated bladder injuries due to endometriosis are mostly treated by conservative laparoscopic surgery, after a complete evaluation of endometriosis disease and barrenness by clinical exam and imaging techniques. [Copyright &y& Elsevier]

Mifepristone, a progesterone receptor antagonist steroid, can reduce uterine fibroid tumours’ growth by several pathways. Its efficiency has been widely evaluated in symptomatic patients for more than 10 years. A significant decrease in fibroid tumours and uterine volume concomitant with better quality of life scores can be obtained with a daily administration of Mifepristone 5mg. Mifepristone can be compared with GnRH agonists in terms of efficiency. Observed adverse outcomes are hot flashes (38%), elevated hepatic enzymes (4%) and benign endometrial hyperplasia (28%). Hot flashes and endometrial hyperplasia are not observed with 5mg daily doses. Data suggest that many invasive procedures could be avoided with the routine use of Mifepristone for fibroid tumour care. However, published study periods are only three to 12 months: long lasting evaluation in larger groups of patients seems necessary before this treatment could be proposed as routine care. [Copyright &y& Elsevier]

Copyright of Lettre de Medecine Physique et de Readaptation is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Introduction: Tuberculosis dactylis is exceptional. We report one case in an 11 years old girl. Observation: N.D., 11 years old, was admitted for a right hand second finger tumour evolving since six months and linked to a trauma. Clinical examination founded a painful fusiform of the right second finger with limited movements of the finger. The hand radiography showed a second phalange osteitis of the finger without periosteitis reaction. The sedimentation rate was accelerated to 130mm at the first hour. The intracutaneous reaction with tuberculin was positive to 19mm. In her preceding, her mother would have suffered from pulmonary tuberculosis two years before incompletely treated during eight months. Histological examination showed a caseous necrosis and an epithelial giant cellular follicle. A twelve months antituberculosis polychimiotherapy permitted a healing without sequelae. Discussion: Tuberculosis dactylis has to be evoked with epidemiological, clinical, radiological and immunological arguments. The antituberculosis treatment permitted to do the retrospective diagnosis and to get a healing. [Copyright &y& Elsevier]

Abstract: Cardiovascular disease is one of the major causes of early morbidity and death in the developed world, and is becoming a serious public health concern in many developing countries. Over the last 30 years, in the USA and France, coronary angioplasty has become a standard treatment for stable angina, and this despite the recommendations of Learned Societies concerning the treatment of this condition. Today, 85 % of angioplasty procedures are performed on patients with stable angina. This study presents meta-analyses that compare medical treatment with angioplasty, and examine the impact of these strategies on more specific populations such as the elderly and post-myocardial infarction patients. To our minds, this synthesis seems to be of particular importance as the COURAGE study has rekindled the debate by showing that improvments in medical treatment and way of life reduced mortality and the recurrence of MI at five years, whereas there was no positive impact of an invasive strategy in any of the subgroups. Nevertheless, as a whole, studies on this subject underscore the value of angioplasty in the medium term for symptom relief in the case of ineffective medical treatment, notably during an acute coronary syndrome both in patients under medical treatment and in those who underwent invasive therapy at the initial phase. [Copyright &y& Elsevier]

The overactive bladder syndrome (OAB) associates urgency, frequency, nycturia, more or less associated with urinary incontinence. Its frequency is between 16 to 45 %, in the general population; the number of affected people in the USA being estimated at 34 million. Symptomatology is primarily marked by the abrupt, irrepressible need to urinate, impossible to defer, but also by a diurnal and night high mictional frequency. This OAB is more frequent when patients age increases, and affects indifferently men and women. The OAB induces a known negative impact on the quality of life and can lead to depression, sexual disorders, sleep disorders and a professional absenteism. The OAB medical treatment is actively concerned by the research since the discovery of oxybutinine. Tolterodin, solifenacin, darifenacin, trospium chloride supplement the therapeutic arsenal. New formulations (immediate and extended releases), new administration mediums (intravesical, transdermic, vaginal, rectal), new active ingredients (botulinic toxin, capsaicine, resiniferatoxine) are currently tested. The therapeutic options multiply, aiming at reducing to the maximum symptomatology, as well as the induced side effects. [Copyright &y& Elsevier]

Copyright of Lettre de Medecine Physique et de Readaptation is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)