Procedures and results of endoscopy for the treatment of complications after bariatric surgery [Modalités et résultats de la prise en charge endoscopique des complications de la chirurgie bariatrique]
Decoster S.,Service des Maladies de lAppareil Digestif |
Branche J.,Service des Maladies de lAppareil Digestif |
Caiazzo R.,Service de Chirurgie Generale et Endocrinienne |
Bulois P.,Clinique de la Louviere |
And 3 more authors.
Bariatric surgery is more and more practiced and appears to be the most efficient treatment against morbid obesity after failure of a medical treatment. Treatment of surgical complications is a matter for multidisciplinary approach including endoscopy. With a review of our own experience on 53 patients since 2009, we will expose an update to clarify the procedures and results of endoscopy for surgical complications treatment after bariatric surgery. © 2013 Springer-Verlag France. Source
Descazeaud A.,Limoges University Hospital Center |
Azzousi A.R.,Angers University Hospital Center |
Ballereau C.,Clinique de la Louviere |
Bruyere F.,CHU de Tours |
And 7 more authors.
Journal of Endourology
Purpose: To evaluate blood loss during transurethral resection of the prostate (TURP), and its predictive factors, using the chromium 51 (51Cr) labeling method. Patients and Methods: From January to June 2008, 41 patients who underwent TURP for symptomatic benign prostatic hyperplasia (BPH) at four French urology centers were included in the analysis. Red cells volume was measured by the 51Cr method 1 day before TURP, and on postoperative day 3. Overall blood loss was estimated by multiplication of red cells volume loss and preoperative venous hematocrit value. Results: Mean preoperative red cells volume was 1997mL. Mean loss of red cells volume was 209ml, which corresponds to an estimated blood loss of 507mL. Mean delta of hematocrit and hemoglobin were 1.4% and 0.71g/dL, respectively. In univariate analysis, prostate volume, weight of resected tissue, preoperative red cells volume, and resection time were significantly and directly associated with loss of red cells volume (P=0.038, P=0.004, P=0.002, and P=0.039, respectively). Bipolar and monopolar TURP did not lead to significant difference of red cells loss. In multivariate analysis, both preoperative red cells volume and weight of resected tissue were independent predictors of red cells loss (P=0.017 and P=0.048 respectively). Conclusion: We present the first study to measure blood loss secondary to TURP using the 51Cr method. This technique allowed evaluating blood loss not only during the surgical procedure but also during the postoperative period. We learned from this study that, on average, blood loss from the procedure until postoperative day 3 was more than 500mL, which is larger than previously reported amounts as measured by other methods. Because significant blood loss might occur during the postoperative period, the 51Cr method should be used to measure blood loss when evaluating new emerging techniques to manage BPH. Copyright 2010, Mary Ann Liebert, Inc. Source
Legendre A.,Pediatric Cardiology Unit |
Chantepie A.,Pediatric Cardiology Unit |
Belli E.,Marie Lannelongue Hospital |
Vouhe P.R.,University of Paris Descartes |
And 5 more authors.
Journal of Thoracic and Cardiovascular Surgery
Objectives: The long-term patency rate of coronary artery bypass grafting for which arterial grafts are used is known to be high in the pediatric population. However, this issue remains uncertain in children under 3 years of age. Here, we report the outcome in this specific population. Methods: From July 1988 to July 2007, 18 children less than 3 years of age (age at operation, 0.1-35 months; median, 4 months) underwent 20 coronary artery bypass graft operations using an arterial graft. Indications for bypass grafting were coronary artery complications related to the arterial switch operation for transposition of the great arteries in 12 patients (coronary obstruction in 8 patients, peroperative coronary anomalies precluding coronary transfer in 4 patients), congenital anomalies of the coronary arteries in 4 patients, and Kawasaki disease in 2 patients. Results: After a mean follow-up of 55 months (range, 1-176 months; median, 41 months), patency of 19 bypass grafts was assessed. One was occluded and 2 have necessitated a percutaneous procedure. Two patients died suddenly (1 with an occluded graft and 1 with a patent graft and hypertrophic myocardiopathy) 3.5 and 4.6 months, respectively, after bypass grafting. Conclusions: Coronary artery bypass grafting should be considered as a possible alternative for coronary revascularization in young children. Although our series shows quite a good patency rate, this procedure remains a technical challenge and requires careful follow-up. © 2010 The American Association for Thoracic Surgery. Source
Niccolai P.,CH Princesse Grace de Monaco |
Ouchchane L.,CHU Clermont Ferrand |
Ouchchane L.,University Clermont |
Ouchchane L.,French National Center for Scientific Research |
And 17 more authors.
Canadian Journal of Surgery
Background: A greater incidence of persistent pain after inguinal herniorrhaphy is suspected with the open mesh procedure than with laparoscopy (transabdominal preperitoneal), but the involvement of neuropathy needs to be clarified. Methods: We examined the cumulative incidence of neuropathic persistent pain, defined as self-report of pain at the surgical site with neuropathic aspects, within 6 months after surgery in 2 prospective subcohorts of a multicentre study. We compared open mesh with laparoscopy using different analysis, including a propensity-matched analysis with the propensity score built from a multivariable analysis using a generalized linear model. Results: Considering the full patient sample (242 open mesh v. 126 laparoscopy), the raw odds ratio for neuropathic persistent pain after inguinal herniorrhaphy was 4.3. It reached 6.8 with the propensity-matched analysis conducted on pooled subgroups of 194 patients undergoing open mesh and 125 undergoing laparoscopy (95% confidence interval 1.5-30.4, p = 0.012). A risk factor analysis of these pooled subgroups revealed that history of peripheral neuropathy was an independent risk factor for persistent neuropathic pain, while older age was protective. Conclusion: We found a greater risk of persistent pain with open mesh than with laparoscopy that may be explained by direct or indirect lesion of nerve terminations. Strategies to identify and preserve nerve terminations with the open mesh procedure are needed. ©2015 8872147 Canada Inc. Source
Colomb F.,University of Lille Nord de France |
Krzewinski-Recchi M.-A.,University of Lille Nord de France |
El MacHhour F.,French Institute of Health and Medical Research |
Mensier E.,Clinique de la Louviere |
And 6 more authors.
Bronchial mucins from severely infected patients suffering from lung diseases such as chronic bronchitis or cystic fibrosis exhibit increased amounts of sialyl-Lewisx (NeuAcα2-3Galβ1-4[Fucα1-3]GlcNAc- R, sLex) glycan structures. In cystic fibrosis, sLex and its sulfated form 6-sulfo-sialyl-Lewisx (NeuAcα2-3Galβ1- 4[Fucα1-3](HO3S-6)GlcNAc-R, 6-sulfo-sLex) serve as receptors for Pseudomonas aeruginosa and are involved in the chronicity of airway infection. However, little is known about the molecular mechanisms regulating the changes in glycosylation and sulfation of mucins in airways. Herein, we show that the pro-inflammatory cytokine TNF increases the expression of α2,3-sialyltransferase gene ST3GAL4, both in human bronchial mucosa and in A549 lung carcinoma cells. The role of sialyltransferase ST3Gal IV in sLex biosynthesis was confirmed by siRNA silencing of ST3GAL4 gene. BX is the major transcript isoform expressed in healthy bronchial mucosa and in A549 cells, and is up-regulated by TNF in both models. Bioinformatics analysis and luciferase assays have confirmed that the 2 kb genomic sequence surrounding BX exon contains a promoter region regulated by TNF-related transcription factors. These results support further work aiming at the development of anti-inflammatory strategy to reduce chronic airway infection in diseases such as cystic fibrosis. © 2012 Published by Elsevier Masson SAS. All rights reserved. Source