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Borie F.,Nimes University Hospital Center
Surgical endoscopy | Year: 2013

Lesions involving the ampulla of Vater are rare entities (0.1-0.2 %) with high malignant potential (90 %) [1]. As a treatment, the surgical procedure known as duodenopancreatectomy was the main option, whatever the tumor's stage or nature. Yet with improvements of endoscopic diagnostic and therapeutic techniques, management of these lesions has been modified, enabling endoscopic removal of adenoma and adenocarcinoma-in situ. Thus, when endoscopic treatment is not possible, surgical ampullectomy is still an alternative option to duodenopancreatectomy [1, 2]. The continuous improvements in surgical techniques and instruments now allow the safe realization of laparoscopic ampullectomy, despite the few cases described in the literature [3, 4]. Here we present a surgical technique in a 52-year-old patient with an ampulloma. The ampulloma was discovered during a gastroscopy for abdominal pain. The endoscopic ultrasound with biopsy revealed a 15-mm adenoma with moderate-grade dysplasia. The thoracoabdominal CT scan was normal. The procedure was performed as shown. The tumor histology showed a R0 resection (5-mm surgical margin) of an adenoma with focal high-grade dysplasia. At 3-year follow-up, outcomes were unremarkable, without any complications. Source

Guedj A.M.,Nimes University Hospital Center
Diabetes & metabolism | Year: 2010

To consider the arguments for screening outside the standard screening period of 24 to 28 weeks of gestation. A search of the literature between 1990 and 2010 was performed using the PubMed® and Cochrane® databases. Recommendations from learned societies in diabetology and obstetrics & gynaecology were consulted. Gestational diabetes mellitus screening is classically recommended between weeks 24 and 28 of pregnancy, the period during which glucose tolerance deteriorates. However, the increasing prevalence of type 2 diabetes in women of childbearing age with risk factors requires earlier screening. Fasting blood glucose should be measured at the fi rst visit during early pregnancy for these patients. The diagnostic threshold is the same as for patients who are not pregnant, i.e. blood glucose > 1.26 g/l. However, the benefit of screening for gestational diabetes during early pregnancy for women with risk factors has not been supported by prospective studies. Therefore oral glucose tolerance testing during early pregnancy is not currently recommended for the detection of gestational diabetes. Screening for gestational diabetes, regardless of the recommended screening policy, must be performed between weeks 24 and 28 of pregnancy. There are no reasons to consider subsequent screening for gestational diabetes at a later stage. Source

Sexual dysfunctions are a quality of life main concern following prostate cancer treatment. After both radiotherapy and brachytherapy, sexual function declines progressively, the onset of occurrence of erectile dysfunction being 12-18 months after both treatments. The pathophysiological pathways by which radiotherapy and brachytherapy cause erectile dysfunction are multifactorial, as patient comorbidities, arterial damage, exposure of neurovascular bundle to high levels of radiation, and radiation dose received by the corpora cavernosa at the crurae of the penis may be important in the aetiology of erectile dysfunction. Diagnosis and treatment of postradiation sexual dysfunctions must integrate pretherapeutic evaluation and information to provide to the patient and his partner a multidisciplinary sexual medicine management. © 2010 Société française de radiothérapie oncologique (SFRO). Source

Corbeau P.,Nimes University Hospital Center | Corbeau P.,French National Center for Scientific Research | Corbeau P.,Montpellier University | Reynes J.,Montpellier University | Reynes J.,Montpellier University Hospital Center
Blood | Year: 2011

Although highly active antiretroviral therapy has enabled constant progress in reducing HIV-1 replication, in some patients who are "aviremic" during treatment, the problem of insufficient immune restoration remains, and this exposes them to the risk of immune deficiency-associated pathologies. Various mechanisms may combine and account for this impaired immunologic response to treatment. A first possible mechanism is immune activation, which may be because of residual HIV production, microbial translocation, co-infections, immuno-senescence, or lymphopenia per se. A second mechanism is ongoing HIV replication. Finally, deficient thymus output, sex, and genetic polymorphism influencing apoptosis may impair immune reconstitution. In this review we will discuss the tools at our disposal to identify the various mechanisms at work in a given patient and the specific therapeutic strategies we could propose based on this etiologic diagnosis. © 2011 by The American Society of Hematology. Source

Ripoche J.,Nimes University Hospital Center
Journal of visceral surgery | Year: 2011

The prevalence of parastomal hernia (PSH) varies considerably in the literature. This condition impacts negatively on quality of life. Yet there is no surgical consensus concerning treatment. The aim of the study was to determine treatment and recurrence rates of PSH in a large population of ostomy patients. This retrospective study was carried out by a self-administered questionnaire in a population drawn at random from the database of the French federation of ostomy patients (FSF). Seven hundred and eighty-two patients were eligible for the study. The mean duration of follow-up was 10.5 years. PSH was reported by 202 patients (25.6%) and appeared on average 18 months after creation of the stoma. In multivariate analysis, ileostomy had a lower risk of developing PSH than did colostomy; age mote than 60 years and peristomal complications at the time of stoma creation increased the risk. Only 24% of patients with PSH were free from symptoms related to the hernia. The main complaints were pain (35%), difficulties in fitting a stomal appliance with leakage (28%); 114 patients (56%) underwent operative repair. The morbidity rate of reoperation was 33%, and 57 patients (52%) had recurrence of PSH within an average of 6 months. Transposition of the stoma to another location and the use of prosthetic mesh decreased recidivism AF recurrence? PSH aggravates the inherently diminished quality of life of stoma patients. There are many proposed surgical treatments but recurrence occurs in more than half of patients. Randomized trials on the treatment of PSH are nonexistent. The use of a prosthetic mesh may reduce the risk of recurrence. The prophylactic use of prophylactic mesh at the time of initial stoma formation is a strategy worthy of consideration. Copyright © 2011. Published by Elsevier Masson SAS. Source

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