Hôpital-Camfrout, France
Hôpital-Camfrout, France

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Yandza T.,Pole Digestif | Yandza T.,French Institute of Health and Medical Research | Schneider S.M.,Pole Digestif | Nishida S.,Pole Digestif | And 17 more authors.
Transplantation Proceedings | Year: 2010

A 34-year-old-man with short-bowel syndrome received an isolated small bowel graft. On postoperative day (POD) 11, ileal biopsy specimen demonstrated mild to moderate rejection that did not respond to corticosteroid bolus therapy. On POD 14, endoscopy and histologic examination revealed exfoliative rejection that was not controlled after 14 days of therapy with thymoglobulin. On POD 95, the patient underwent surgery again because of intestinal obstruction. The graft was removed 6 months after transplantation because of continuous severe abdominal pain with weight loss. After enterectomy, the patient developed multiple-organ failure and died on POD day 8. This case underlines the severity of exfoliative rejection and suggests that early enterectomy be performed when the diagnosis is made, before deterioration of clinical status and development of infectious and nutritional complications. © 2010 Elsevier Inc. All rights reserved.

Manfredi S.,University of Rennes 2 – Upper Brittany | Sabbagh C.,CHU Amiens | Vanbiervliet G.,Pole Digestif | Lecomte T.,University of Tours | And 2 more authors.
Endoscopy | Year: 2014

Placement of a colonic stenta) Pre-treatment assessmentb) Time limit for stent placementc) Endoscopic or radiological placement?d) Environment and conditioning of thepatiente Spcific equipment and endoscopef) Stent plaement proceureg) Stentsh) Particular situations and locationsi) Tehnical contraindicationsC. Success and complications ofcolonicstenta) Short-term outcomesb) Long-term outcomes. Surgical treatmentE. Colonic stent with curative intet,as a bridge to surgery F. Colonic stent with palliatve intentG. Colonic stent and anti-angiogenictreatmentTke home messages:? Whatever the situation a medical-suricaldiscussion must take place beforeany treatment deciion.The placement of a stent is not recommendedthe abence of clinical andradiological signs of obstruction, venwhen the endoscope cannot passthrough the tumour.? Iindicated, colonic stenting should beconsidered within12 to 24 hours afteradmission.Stent is contraindicated n cases of perforation,clinical and/or radiologicalsigns of colonic suffering, for cancer ofthe low and middle rectum, and whencolonic obstruction is associated withsmall bowel incarceration.Stent must be placed endoscopicallyand under radiological control.Stent placement must be performed bya trained operator in a suitable medicosurgicalunit.The use of polyethylene glycol (PEG)and other oral preparations is contraindicated.Pre- expansion and passage through thetumour stenosis by a large-caliberendoscope must be avoided.In curative intent (non metastatictumour or resectable metastases),stenting cannot be recommended asfirst-line intervention. It remains atherapeutic option in expert centres,pending validation by a randomizedstudy. In the context of curative intent,the surgical treatment of occlusion ispreferred.In the context of palliative intent(unresectable metastases, unresectablepatient), stenting can be recommendedas a first-line intervention. In thissituation surgery is another treatmentoption. In patients with a colonic stent, usinganti-angiogenic therapy may causemore frequent local complications(relative contraindication), and theplacement of a stent in a patient treatedwith anti-angiogenic treatment is notrecommended.The short-term efficacy data of stentsare generally good. There are few dataabout long-term outcomes or aboutpatients receiving chemotherapy withor without targeted therapy.

Hanachi M.,EA 4497 | Floch M.,Pole digestif | Crenn P.,EA 4497
Nutrition Clinique et Metabolisme | Year: 2012

Jejunostoma and ileostoma can cause significant mechanical, nutritional and metabolic complications, and can have psychological, social and professional impacts. Early follow-up from the preoperative phase, technical and psychological long-term supports are essential to a good patient's adaptation and quality of life. Complications must be known and prevented. This requires the mobilization of a multidisciplinary team including surgeons, stoma nurses, dieticians and nutritionists. © 2012 Elsevier Masson SAS.

Although older people are not the only ones to suffer from under-nourishment, it is more often seen in this section of the population. Moreover, sarcopenia, or involuntary loss of muscle, is linked to increasing dependence, morbidity and mortality. This affects care costs. Older people's metabolic particularities can lead to under-nourishment and sarcopenia: appetite-control disorders and secondary anorexia re-feeding resistance protein energy metabolism disorders Early and systematic detection as well as rapid care management is called for, due to the frequency of under-nourishment in older people. This begins by nutritional advice and the correcting of risk situations. Food supplements have proved their worth. Enteral nutrition can be used in cases of severe under-nourishment whilst respecting bioethical rules. The recommendations of the Haute Autorité de Santé define a care strategy based on nutritional status and ingesta levels.

The question may seem a little provocative. However, there are many colic reasons to bring the endoscopist during week-end at the bedside of the patient. To try to answer this question, we must first list the emergency in colic pathology, determine the usefulness of endoscopy in these acute situations and finally meet the specific clinical, biological, radiological criteria to get them to perform this endoscopy during open hours. All of these are answered in the light of the literature which is sometimes thin in the field. This presentation will attempt to meet this challenge. © 2012 Springer-Verlag France.

Among all ERCPs performed in an endoscopy unit, emergencies account for less than 2 %. ERCP in emergency must be done within 12 hours after the beginning of clinical symptoms. Thus ERCP can have to be performed outside of the dedicated endoscopy unit. Video-endoscopes must then be preferred. Procedures must be performed by an experimented endoscopist with access to the equipment he is used to. In all cases, strict rules for endoscopic tools disinfection have to be followed. The main indications are sepsis due to acute cholangitis and acute severe pancreatitis mostly due to a biliary stone. In spite of difficult conditions linked to the patient status, technical success of ERCP is close to 100% with few complications. Nevertheless mortality can reach 55% mostly by multi-organs failure. © 2012 Springer-Verlag France.

Medical advances have changed how death is diagnosed and defined. Total and irreversible brain damage can now be identified on the basis of sophisticated clinical and technical criteria. It allows doctors to certify the death and opens the possibility of organ donation. Brain death however upsets the normal representations and acceptance of death which complicates the issue of organ donation. © 2014 Elsevier Masson SAS.

Yandza T.,Pole Digestif | Yandza T.,French Institute of Health and Medical Research | Schneider S.M.,Pole Digestif | Novellas S.,Service de Radiologie | And 9 more authors.
Transplantation Proceedings | Year: 2010

We report the case of a 62-year-old man with short-bowel syndrome, referred for intestinal transplantation, who had esophageal varices (EV) due to superior vena cava (SVC) thrombosis. Pretransplantation work-up revealed protein S deficiency. Results of liver function tests were normal. Upper endoscopy showed grade II to III EV in the upper and middle segments of the esophagus. Computed tomography demonstrated thrombosis of the jugular, subclavian, and SVC veins and marked collateral vessels in the chest. Transient elastography yielded normal findings. A liver biopsy specimen showed a normal aspect of the liver, without fibrosis or liver cirrhosis. Presence of EV in a patient with chronic intestinal insufficiency may be related to collateral venous circulation associated with SVC thrombosis in the absence of portal hypertension. In this situation, an isolated intestinal graft is indicated. © 2010 Elsevier Inc. All rights reserved.

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