Maternal retinoid administration has beneficial effects on lung development in the nitrofen rodent toxic model of congenital diaphragmatic hernia (DH). We wanted to investigate the effects in a surgical model, where the retinoid signaling pathway is not primarily disrupted by the toxic agent. We created DH in fetal rabbits at day 23 of gestation, administrated to the does all trans-retinoic acid (ATRA) or vehicle (VHC) intramuscularly for 8 consecutive days and harvested normal and operated (DH) fetuses at 31 d (n = 7 in each group). Normal lungs exposed to ATRA had increased surfactant protein mRNA levels without change in type II pneumocyte density. There was no measurable effect on lung-to-body weight ratio and airway morphometry by ATRA. In DH lungs (DH/VHC) surfactant protein mRNA levels were increased, as well as the density of type II pneumocytes. When supplemented with ATRA (DH/ATRA) these parameters returned to normal (VHC). Cell proliferation or apoptosis were not influenced by ATRA supplementation. In conclusion, maternal ATRA supplementation does not affect gross anatomic, morphologic or proliferation indices in hypoplastic lungs related to surgically induced DH in rabbit. However, ATRA lowers surfactant protein expression and normalizes type I/II pneumocyte ratio to what is observed in normal lungs.

Objectives

Urethral erosion (UE) is an uncommon but potentially severe complication after suburethral synthetic slings. We aimed to identify the risk factors and diagnostic modalities of UE and also functional outcome after UE surgical management. We retrospectively analyzed eight cases of UE managed in our department between 1997 and 2007. The main presumptive risk factors of UE were excessive sling tensioning (six of eight) and postoperative urethral dilation (four of eight). The most frequent symptoms included voiding difficulties (five of eight), storage symptoms (three of eight), pain (three of eight), and recurrent stress incontinence (three of eight). UE diagnosis was accessible to introital ultrasound (five of five) and confirmed by urethroscopy (eight of eight). Surgical management was performed in seven cases and included transvaginal sling removal with urethral repair (two of seven), endoscopic transurethral sling resection (four of seven), and combined approach (one of seven). All the approaches provided good functional outcomes. Transurethral endoscopy is a mini-invasive treatment of UE and should be tried first in selected cases.

Objective To determine whether the French AmbUlatory Cesarean Section (FAUCS) technique reduces postoperative pain and promotes maternal autonomy compared with the Misgav Ladach cesarean section (MLCS) technique in elective conditions. Study design One hundred pregnant women were randomly, but in a non-blinded manner, assigned to undergo FAUCS or MLCS. The primary outcome was a postoperative mean pain score (PMPS), and secondary outcomes were a combined pain/medication score, time to regain autonomy, surgical duration, calculated blood loss, surgical complications, and neonatal outcome. Results Women in the FAUCS group experienced less pain than those in the MLCS group (PMPS = 1.87 [1.04–2.41] vs. 2.93 [2.46–3.75], respectively; p < 0.001). Six hours after surgery, the combined pain/medication score for FAUCS patients was 33% lower than that for MLCS patients (p < 0.001). FAUCS patients more rapidly regained autonomy, with 94% reaching autonomy within 12 h vs. 4% of MLCS patients (p < 0.001). There were no differences in maternal surgical or neonatal complications between groups. Conclusions Our results indicate that FAUCS can reduce postoperative pain and accelerate recovery, suggesting that this technique might be superior to MLCS and should be more widely used. One potentially key difference between FAUCS and MLCS is that MLCS includes 100 mcg spinal morphine anesthesia in addition to the same anesthesia used by FAUCS. Any interpretation of apparent differences must take the presence/absence of morphine into account.