[Drainage in digestive surgery. French Society of Digestive Surgery].
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Abdominal Muscles↗
Biomedical subjects
Y Panis
Publications and source records attributed to Y Panis.
Early gene expression associated with regeneration is intact after massive hepatectomy in rats.
BACKGROUND: Liver regeneration occurs promptly after partial hepatectomy, although the factors regulating this response have not been fully clarified. Molecular events in the regenerative response have been widely characterized after 70% hepatectomy which represents a model of "normal" liver regeneration in rats. More extensive resection results in hepatic failure which has been attributed to a critical loss of hepatic mass. It is not known whether the pattern of genes expressed early in regeneration remains intact after lethal hepatectomy. We hypothesize that the increased expression of selected early response genes remains intact after massive hepatectomy. The aim of this study was to compare the expression of selected genes after 70 and 85% hepatectomy. MATERIALS AND METHODS: One hundred ten Wistar rats were divided into three groups: control group (sham laparotomy) (n = 30), 70% hepatectomy group (n = 40), and 85% hepatectomy group (n = 40). Animals were sacrificed at intervals. Livers were excised and divided into four equal specimens, snap frozen, and stored at -70 degrees C. RNA was extracted by standard methods and preparations were probed for protooncogenes, c-myc, c-fos, and for hepatocyte growth factor, and its receptor, c-met. After overnight exposure of autoradiographs, quantification was accomplished by densitometry of RNA slot blots. RESULTS: After 70% hepatectomy, peaks of maximal expression for both c-myc and c-met were observed after 1 and 12 h. For c-fos, peak of maximal expression was observed at 6 h. For HGF, peak was observed between 12 h and Day 2. After 85% hepatectomy, rats demonstrated similar patterns including peak expression of c-myc at 1 h, but altered peak at 12 h. For c-met, the same pattern was observed between 1 and 12 h. For HGF, two peaks were noted: a first peak at 1 h, and a peak similar to the peak observed after 70% hepatectomy at 12 h. CONCLUSIONS: These results suggest that early molecular events which are part of the regenerative response are largely intact after 85% lethal hepatectomy. We propose that liver dysfunction and the failure of regeneration observed after 85% hepatectomy is not due to alteration of early signaling. Further study will be required to define failure of the regeneration program in this model.
Animals↗
Assessing the effectiveness of mesorectal excision in rectal cancer: prognostic value of the number of lymph nodes found in resected specimens.
PURPOSE: The aim of this study was to determine whether the number of involved or uninvolved lymph nodes in resected specimens can be used to predict the effectiveness of surgical resection for rectal cancer. METHODS: Local recurrence and survival rates for 118 patients undergoing curative resection for rectal carcinoma, without adjuvant therapy, were retrospectively studied. RESULTS: Mean follow-up was 62+/-37 months. Mean number of involved or uninvolved lymph nodes per resected specimen was 12+/-7. Overall local recurrence rate was 15.2 percent. In patients without involved lymph nodes (N0 patients) and with T1 or T2 tumors, the local recurrence rate ranged from 0 to 8 percent (not significant), depending on the number of lymph nodes on the specimen. In patients without involved lymph nodes and those with T3 tumors, the actuarial survival rate at ten years was significantly lower (P < 0.05), and the local recurrence rate was higher (P < 0.02) in patients with fewer than ten lymph nodes than in those with more than ten nodes. In patients with involved lymph nodes, the mean number of nodes on the resected specimen correlated closely with the mean number involved by the tumor. CONCLUSION: The assessment of the effectiveness of rectal excision for cancer is in part helped by the number of involved or uninvolved lymph nodes found on the resected specimen. This is of particular interest in patients without involved lymph nodes and those having infiltrating T3 tumors, for whom the long-term survival and local recurrence rates were significantly better when more than ten lymph nodes were present. On the other hand, when fewer than ten nodes were found, whatever the cause, adjuvant radiotherapy had to be considered, because of the high risk of local failure rate.
Female↗
New treatment for ileal pouch-anal or coloanal anastomotic stenosis.
Persistent anastomotic stricture following ileal pouch-anal or coloanal anastomoses can be treated by transanal resection using a stapler or a more complex procedure, such as transanal pouch advancement with neoanastomosis. We propose an easier and faster technique, which does not require any particular device. Its long-term functional results are satisfactory in most patients.
Adult↗
Long-term results after curative resection for carcinoma of the gallbladder. French University Association for Surgical Research.
BACKGROUND: The surgical management of gallbladder carcinoma is controversial, especially as regards the indications for radical resection. The aim of this study was to evaluate the results of surgical treatment for gallbladder carcinoma with special reference to the extent of its histological spread. METHODS: Eighty-six patients from 25 French centers underwent resection for cure and were included in this study. They comprised 65 women and 21 men (mean age 65 +/- 21 years). Resection included radical resection in 21 patients (partial hepatectomy, regional lymphadenectomy, and common bile duct resection) and simple cholecystectomy in 65. RESULTS: There were 3 postoperative deaths (3.5%). The mean follow-up period was 25 +/- 24 months. The overall 5-year actuarial survival rate was 26%. The 5-year actuarial survival rate was 27% for patients who had radical resection. Eight patients with nodal metastasis had a 5-year survival rate of 0%, but the rate for 13 patients without such metastasis was 43% (P <0.05). For patients undergoing simple cholecystectomy, the 5-year actuarial survival rate was 44% for stage I disease, 22% for stage II, and 0% for stage III (P <0.05). CONCLUSIONS: In patients with stage I gallbladder carcinoma, outcome is good after cholecystectomy only. In stages II to IV, radical resection should only be considered in the absence of regional lymph node metastasis.
Adenocarcinoma↗
No correlation between H. pylori and blood groups in gastric cancer.
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Blood Group Antigens↗
Is there a place for ileal pouch-anal anastomosis in patients with Crohn's colitis?
It is generally agreed that ileal pouch-anal anastomosis (IPAA) is contraindicated in patients with Crohn's disease (CD), since recurrent disease will frequently necessitate pouch excision, thereby fostering to the ultimate development of a short bowel syndrome. For these reasons, patients with CD requiring coloproctectomy have up till now undergone definitive end ileostomy. However, when faced with the prospect of definitive ileostomy in young patients, the possibility to keep, even for a few years before the disease recurs, acceptable continence and defecation must be stressed. Although the failure rate is higher in patients with CD than in patients with ulcerative colitis, long-term results from recent reports, as well as from our own experience, demonstrated that in selected patients with CD (i.e. without anoperineal or ileal manifestations), pouch can be maintain in function in 55 to 90% of the patients. In these patients functional results are similar to those of patients with ulcerative colitis. In conclusion, unlike the authors who consider that IPPA is definitely contraindicated in CD, we believe that IPAA could be proposed for selected patients with CD for whom rectal resection is mandatory, as an alternative to coloproctectomy with definitive end ileostomy. The patients concerned are those with no history of anal manifestations and no evidence of small bowel involvement.
Adolescent↗
Color velocity imaging and power Doppler sonography of the gallbladder wall: a new look at sonographic diagnosis of acute cholecystitis.
OBJECTIVE: Color velocity imaging is a color sonographic technique that uses data contained in gray-scale B-mode image scan lines to determine blood flow velocity. We prospectively determined if color velocity imaging and power Doppler sonography can be used to differentiate acute from chronic cholecystitis. We analyzed the potential role of using these two color imaging techniques as an adjunct to conventional gray-scale sonography to differentiate acute from chronic cholecystitis. SUBJECTS AND METHODS: One hundred twenty-nine patients with acute right upper quadrant pain or clinically suspected cholecystitis underwent color velocity imaging and power Doppler sonography of the gallbladder as an adjunct to gray-scale sonography. Morphologic criteria were analyzed on gray-scale sonography, and the presence of flow within the gallbladder wall was assessed with color velocity imaging and power Doppler sonography. Imaging findings were compared with pathologic findings in the 50 patients who underwent cholecystectomy and with clinical and biologic findings in the 79 patients who did not undergo cholecystectomy. RESULTS: Twenty-two patients had surgically proven acute cholecystitis, 28 patients had surgically proven chronic cholecystitis, and 79 patients had no gallbladder disease. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of gray-scale sonography for revealing acute cholecystitis were 86%, 99%, 92%, 87%, and 97%, respectively. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of color velocity imaging and power Doppler sonography for revealing acute cholecystitis were 95%, 100%, 99%, 100%, and 99%, respectively. CONCLUSION: The accuracy of color velocity imaging and power Doppler sonography in revealing acute cholecystitis is significantly greater than the accuracy of gray-scale sonography.
Acute Disease↗
Are hepatomas a good target for suicide gene therapy? An experimental study in rats using retroviral-mediated transfer of thymidine kinase gene.
BACKGROUND: Suicide gene transfer into tumor cells has been proposed for the treatment of various tumors. The most common suicide gene is coded for the herpes simplex type I thymidine kinase (HSV1-TK), which converts nontoxic nucleoside analogs such as ganciclovir into toxic triphosphated compounds. This study evaluated the potential of this treatment for gene therapy of liver tumors. METHODS: The sensitivity of different colon carcinoma and hepatoma cell lines to infection by recombinant retroviruses was evaluated. Next, HSV1-TK-expressing derivatives of these cells were generated to analyze their sensitivity to ganciclovir. Finally, these cells were used to generate experimental hepatomas in rats after injection under the liver capsule, and the efficacy and safety of a ganciclovir treatment on tumor growth and survival were evaluated. RESULTS: All the different cell lines analyzed were sensitive to retroviral-mediated gene transfer, although the susceptibility of individual cell lines to this transfer varied significantly. HSV1-TK derivatives were about 1000-fold more sensitive to the toxic effects of ganciclovir than parental cells. Tumors with HSV1-TK expressing MCA-RH8994 hepatoma cells were then generated. Intraperitoneal injection of 75 mg/kg ganciclovir twice daily for 5 days dramatically reduced the size of HSV1-TK-positive tumors compared with tumor size in untreated control rats (0.4 mm3 versus 65 mm3, p < 0.02). A long-term study demonstrated that this reduction of tumor volume was associated with a significant increase in survival (p < 0.01). Pathologic examination 26 days after the end of ganciclovir injections showed that complete tumor regression was observed in two of five rats. Most important, there was no toxicity associated with these tumors. CONCLUSIONS: In a clinical perspective the good tolerance to treatment and the significant clinical effect observed were encouraging. Gene transfer methods should be established to allow efficient targeting of the tumor cells in vivo.
3T3 Cells↗
[Computed tomography of intrahepatic pancreatic pseudocysts].
PURPOSE: Intrahepatic pseudocyst complicating pancreatitis is a rare event. The goals of this paper are to report the computed tomographic (CT) features of intrahepatic pseudocyst and to analyze the role of percutaneous puncture and percutaneous drainage in the diagnosis and treatment of intrahepatic pseudocyst. MATERIAL AND METHODS: Three cases of intrahepatic pseudocyst studied by CT were retrospectively reviewed. Percutaneous puncture of the intrahepatic pseudocyst was performed in two cases, and was subsequently followed by percutaneous drainage of the intrahepatic pseudocyst in one case. RESULTS: In the three cases, intrahepatic pseudocysts appeared like multiple, hypoattenuating, homogeneous intrahepatic fluid collections, associated with intrahepatic bile duct dilatation in one case. In the two cases in which it was performed, percutaneous puncture of the pseudocyst revealed an elevated amylase level, thus confirming the diagnosis. In one case, percutaneous puncture revealed superinfection, thus indicating percutaneous drainage of the pseudocyst. CONCLUSION: The diagnosis of intrahepatic pseudocyst should be suggested in the presence of pancreatic lesions and a single or multiple intrahepatic fluid collections visible on CT. CT allows percutaneous puncture of the pseudocyst to be done, thus confirming the diagnosis and indicating subsequent performance of percutaneous drainage in complicated cases.
Aged↗
[Diagnostic strategy in abdominal injuries].
There is persistent controversy concerning the management of patients with abdominal trauma. The major point is to determine whether or not the abdominal trauma is penetrating. In rare cases (shock, abdominal gunshot wound, peritonitis, evisceration, digestive tract bleeding and abdominal stab out of place) urgent laparotomy remains mandatory. In the other cases, although some centers recommend serial abdominal exams for asymptomatic patients, with the risk of delayed laparotomy, most authors prefer a more aggressive approach. In the case of anterior penetrating abdominal trauma, diagnostic peritoneal lavage, which is an over sensitive method, could be replaced by laparoscopy, which allows both diagnosis and treatment. Triple-contrast CT scan is the first-line diagnostic modality in penetrating back and flank trauma.
Abdominal Injuries↗
A "distant" bystander effect of suicide gene therapy: regression of nontransduced tumors together with a distant transduced tumor.
Antitumor gene therapy using herpes simplex type 1 thymidine kinase (TKh) and ganciclovir (GCV) treatment has revealed an important intratumoral bystander effect. A whole tumor can be eliminated when only a fraction of its tumor cells express TKh. We now report that the bystander effect not only acts within a tumor, but also between distant tumors. One TKh+ tumor was generated simultaneously with one or multiple TKh- tumors in different rat liver lobes such that there was no contact between the resulting tumors. Both the TKh+ and the TKh- tumors regressed after GCV treatment and showed infiltration with macrophages and T lymphocytes. This distant bystander effect, which is likely immune mediated, should be of major importance for gene therapy of disseminated tumors.
3T3 Cells↗
[Surgery of advanced colorectal cancers].
Tumor recurrence after "curative" resection for colorectal carcinoma is observed in approximately half of the patients. Careful follow up after surgery of the primary tumour should allow early diagnosis of the recurrence, local or metastatic, mostly within the liver. Reoperation for resection of the recurrence should be discussed, because, if possible, it can prolong survival, or even cure some of the patients.
Colorectal Neoplasms↗
[Role of surgery in closed abdominal trauma].
Over the past twenty years, nonoperative management has increasingly been recommended for the care of patients with blunt abdominal trauma. Emergency laparotomy remains the rule in patients with hemodynamic instability or in those with peritonitis due to intestinal perforation. Surgical treatment of liver and splenic lesions tends to be more conservative. After assessment of the lesions by computed tomography, nonoperative management in intensive care unit is allowed in the majority of patients.
Abdominal Injuries↗
Progressive necrosis after hepatectomy and the pathophysiology of liver failure after massive resection.
BACKGROUND: Mortality after hepatectomy in rats increases markedly beyond the classic 2/3 resection from which complete recovery is the rule. Because an extremely small hepatocyte population can theoretically sustain life, we hypothesize that lethal liver failure after subtotal resection could be due to progressive injury occurring in the remnant liver. The obligatory increase in portal blood through the small remnant may be central to the pathogenesis because of sinusoidal injury and Kupffer's cell activation. To test this hypothesis an experimental study in rats was undertaken to characterize liver cell injury after lethal (85%) and nonlethal (70%) hepatectomy. METHODS: One hundred thirty Wistar rats were divided into three groups: control group (Sham laparotomy, n = 30), 70[5] hepatectomy group (n = 50), and 85% hepatectomy group (n = 50). Five rats in each group were killed for blood and liver collections from 15 minutes to day 14 after hepatectomy. Survival, histologic characteristics, serum activities of aspartate (AST) and alanine (ALT) aminotransferases and arginase were determined; serum level of tumor necrosis factor-alpha (TNF-alpha) and plasma level of prostaglandin E2 (PGE2) were measured by enzyme-linked immunosorbent assay. RESULTS: Whatever the extent of resection, hepatic injury, as demonstrated by increased serum levels of arginase, ALT, and AST, was observed. The kinetics of arginase release after hepatectomy mimicked quite well those of AST and ALT, representing a reliable marker of hepatocyte injury. A significantly higher, more prolonged blood release of enzymes was observed after 85% hepatectomy than after 70% hepatectomy. Because of a very short half-life the rise in arginase several hours after hepatectomy seems to indicate ongoing liver damage distinct from the surgical injury. Significant elevations of TNF-alpha were detected that were much more severe after 85% hepatectomy. PGE2 levels that increased significantly after 70% resection remained depressed after 8% hepatectomy. Light microscopy demonstrated extensive patchy necrosis after 85% hepatectomy. CONCLUSIONS: A pattern of progressive necrosis of the remnant liver was identified with Kupffer's cell dysfunction. We hypothesize that failure of down-regulation of TNF-alpha production by PGE2 could contribute to the pathophysiology of liver injury in the remnant after massive hepatectomy. These events may be initiated in part by the dramatic increase of portal flow through a too small remaining liver, and a pathologic mechanism may be amenable to pharmacologic manipulation.
Alanine Transaminase↗
Functional outcome after coloanal versus low colorectal anastomosis for rectal carcinoma.
BACKGROUND: The aim of this study was to compare retrospectively the longterm functional results of straight or J-pouch coloanal anastomosis and low colorectal anastomosis in patients operated for rectal carcinoma. STUDY DESIGN: Of the 260 patients who underwent rectal resection for carcinoma in our department during a 12-year period, 105 were included in this study. Of these, 37 had straight coloanal, 15 J-pouch coloanal, and 53 low colorectal anastomoses. RESULTS: At 1 year of followup, continence was significantly better after low colorectal than straight coloanal anastomosis (perfect continence: 81% versus 51%; p < 0.01). No significant difference was observed for continence after J-pouch coloanal and low colorectal anastomosis. Stool frequency during a 24-hour period was significantly higher after straight coloanal anastomosis than after either J-pouch coloanal (p < 0.05) or low colorectal anastomosis (p < 0.01). Night stools were significantly more frequent after straight than J-pouch coloanal anastomosis (p < 0.05). Three years after surgery, continence had improved in the three groups, as 70% of the straight coloanal group, 91% of the J-pouch coloanal group, and 94% of the colorectal anastomosis group had perfect continence (p < 0.02 versus straight coloanal anastomosis). No significant difference for continence was observed between the J-pouch coloanal and low colorectal anastomosis groups. Neither were significant differences observed among the three groups for urgency, gas/stool discrimination, stool frequency (including night stools), or the need for medication. CONCLUSIONS: The functional results of both J-pouch coloanal and low stapled colorectal anastomosis seem better than those of straight coloanal anastomosis. Both J-pouch and low-stapled procedures can safely be proposed for patients with rectal carcinoma requiring total mesorectal rectal excision; however, because low stapled colorectal anastomosis seems to us easier and faster to perform, we consider it the best option for rectal reconstruction after proctectomy for carcinoma, provided it is possible based on the level of the tumor.
Anal Canal↗
Transanal resection of a low rectal stenosis by rectal advancement and rectoanal anastomosis.
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Acetaminophen↗
Segmental reversal of the small bowel as an alternative to intestinal transplantation in patients with short bowel syndrome.
OBJECTIVE: This article reports the results of segmental reversal of the small bowel on parenteral nutrition dependency in patients with very short bowel syndrome. SUMMARY BACKGROUND DATA: Segmental reversal of the small bowel could be seen as an acceptable alternative to intestinal transplantation in patients with very short bowel syndrome deemed to be dependent on home parenteral nutrition. METHODS: Eight patients with short bowel syndrome underwent, at the time of intestinal continuity restoration, a segmental reversal of the distal (n = 7) or proximal (n = 1) small bowel. The median length of the remnant small bowel was 40 cm (range, 25 to 70 cm), including a median length of reversed segment of 12 cm (range, 8 to 15 cm). Five patients presented with jejunotransverse anastomosis, and one each with jejunorectal, jejuno left colonic, or jejunocaecal anastomosis with left colostomy. RESULTS: There were no postoperative deaths. Three patients were reoperated early for wound dehiscence, acute cholecystitis, and sepsis of unknown origin. Three patients experienced transient intestinal obstruction, which was treated conservatively. Median follow-up was 35 months (range, 2 to 108 months). One patient died of pulmonary embolism 7 months postoperatively. By the end of follow-up, three patients were on 100% oral nutrition, one had fluid and electrolyte infusions only, and, in the four other patients, parenteral nutrition regimen was reduced to four (range of 3 to 5) cyclic nocturnal infusions per week. Parenteral nutrition cessation was obtained in 3 of 5 patients at 1 years and in 3 of 3 patients at 4 years. CONCLUSION: Segmental reversal of the small bowel could be proposed as an alternative to intestinal transplantation in patients with short bowel syndrome before the possible occurrence of parenteral nutrition-related complications, because weaning for parenteral nutrition (four patients) or reduction of the frequency of infusions (four patients) was observed in the current study.
Adult↗