[Longitudinal sleeve gastrectomy as a stand-alone bariatric procedure: Results of a multicenter retrospective study]. / La gastrectomie longitudinale (sleeve gastrectomy) comme unique chirurgie bariatrique : résultats d'une étude rétrospective multicentrique de 446 patients.

INTRODUCTION: Sleeve gastrectomy as an isolated procedure is a new option in bariatric surgery. The aim of this study was to evaluate its short and medium term (2 years) results in a multicenter setting. MATERIALS: This is a retrospective study including 446 patients undergoing surgery in 14 teaching, private, and public hospitals. RESULTS: The immediate post-operative course were uneventful in 83.3% of patients. Minor complications occurred in 10.9% of patients and major complications in 5.3%. Suture line leaks occurred in 4.3% of the whole series. There was no mortality and the rate of reoperation was 2%. Overall mean weight loss after two years was 32 kg and the mean excess weight loss was 62%. Weight loss was significantly greater in non super-obese patients (p=0.0003). CONCLUSIONS: This study confirms the feasibility of sleeve gastrectomy in a multicenter setting; it is efficacious at two years as an isolated bariatric procedure for non super-obese patients. It is possible that an additional second-stage procedure may be necessary for super-obese patients.

[Adjuvant chemotherapy followed by conformal chemoradiotherapy in gastric carcinoma]. / Chimiothérapie adjuvante suivie d'une chimioradiothérapie conformationnelle dans les cancers de l'estomac.

PURPOSE: Analysis of the feasibility and results of adjuvant chemotherapy followed by conformal chemoradiotherapy after surgery for gastric carcinoma. PATIENTS AND METHODS: Twenty-six patients (R0 or R1) were treated postoperatively by three cycles of 5-fluorouracil (5-FU) and cisplatin, followed by a concomitant association of LV5FU2 chemotherapy with a conformal radiotherapy of 45 Gy. RESULTS: The tumor was classified pT3-T4 in 77% of the patients and 92.5% had a nodal involvement (pN1: 54%; pN2: 31%). FEASIBILITY: (1) Adjuvant chemotherapy: nausea/vomiting grade II/III: 12 patients (48%); neutropenia grade III/IV: two patients; completed in all patients, except one. (2) Chemoradiotherapy: nausea/vomiting grade II/III: 10 patients; diarrhea grade II/3: two patients; oesophagitis grade II/III: two patients; myocardial infarction/pulmonary embolism: two patients. All patients except one received the planned dose of 45Gy. Radiotherapy was interrupted in six cases, with a median duration of 14 days. Survival: with a median follow-up of 30 months, 65% of the patients were alive without disease; median survival was 32 months. CONCLUSION: This postoperative schedule was judged feasible. It allowed the deliverance of a more intensified chemotherapy than the classical schedule. Its clinical benefit must be evaluated in a phase III trial.

[Memory, brain, a machine for learning and rememberingy]. / Le cerveau, machine à apprendre et à mémoriser.

Following a previous paper describing how memory appeared in the nervous system in mammalians, during evolution, and how its significant growth led to hominization, the present paper intends to show the prevailing place it occupies in human brain. Memory, an attribute of cortex, is an engraving of neuronal circuits created during information analysis of data input in the cortex. It is created either by repetition of information or by increase in brain activity, under the influence of a central brain system. In the brain of human newborns, immature and unprogrammed, but endowed with a great capacity for learning, the whole organization and programming will be possible through learning and remembering. Communication pathways between functions are memory pathways. Brain becomes a memory machine and every cortical area is a memory territory. Its lesion results in a disturbance corresponding exactly to forgetting what has been stored in that territory.

[Memory: a view of the history of central nervous system]. / La mémoire dans l'histoire du système nerveux.

In order to stress the role and importance of memory in human nervous system, this first paper intends to show how it appeared during evolution with the cortex of brain hemispheres and how its significant growth is the cause (and not consequence) of hominization. This growth seems related to a discontinuation of the fetal period during gestation. It leads to birth before the brain is mature, substituting a genetic maturation by an epigenetic maturation through learning. This discontinuation of pregnancy is related to a purely mechanical and obstetrical cause, depending on maternal pelvis. Evolution from quadrupedia to bipedia transformed the pelvis, obliging the newborn to make his way not downward but forward, through a narrow inextensible pass. This history of memory, showing its role in human species evolution, may lead to a reflection on its role in the evolution of all the species possessing a cortex. Above all, it will allow to understand how and in which way human brain is a sort of machine totally associated with memory.

Cutaneous sparganosis in France: the second case described from Europe. Case report.

The first case of sparganosis is reported from France. The patient, a 21-year-old man, presented with a subcutaneous lump on the chest, and the diagnosis was made on histological examination after needle biopsy. He achieved a complete recovery.

Polydioxanone in digestive surgery. An experimental study.

An experimental study was carried out to analyze the reaction of polydioxanone suture. Two hundred ten single layer colonic anastomoses were performed in rats and histopathologically studied at nine different times between the 2nd and 180th postoperative days. Eighteen of 105 abdominal wound closures were studied in the same way between the 7th and 90th days. Polydioxanone was resorbed slowly in approximately 6 months with minimum inflammation. We believe that polydioxanone is actually the suture material of choice for all biliary and biliodigestive sutures.

Predicting common bile duct lithiasis: determination and prospective validation of a model predicting low risk.

BACKGROUND: The aim of this two-part prospective study was: (1) to identify simple, noninvasive, preoperative factors associated with low or very low risk of common bile duct lithiasis (CBDL); and (2) to test the validity of the statistical model obtained during Part One by the postcholecystectomy follow-up of patients classified into a low-risk group. PATIENTS AND METHODS: In Part One of the study, preoperative clinical, biologic, and ultrasonographic data, and intraoperative cholangiographic findings were collected from 503 consecutive patients undergoing cholecystectomy for symptomatic lithiasis from 1985 to 1989. Using the data obtained in Part One, a linear logistic model was used prospectively in Part Two to determine the prediction of absence of CBDL in 279 consecutive patients. No jaundice, normal transaminase levels, common bile duct (CBD) diameter < 8 mm, and no intrahepatic duct enlargement defined the low-risk group of CBDL. RESULTS: In Part One, CBDL was present in 84 (17%) of all patients. Five parameters were used to classify 73% of all patients as low risk of CBDL and 27% as high risk. In the low-risk groups, CBDL was present in 1% of 116 cases with acute gallbladder complications, and 5% of 250 cases with no acute gallbladder complications. In Part Two, 171 (61%) patients were classified in the low-risk group (Group 1), and CBD stones were not sought by any additional preoperative investigations or intraoperative cholangiography (IOC). One hundred eight patients (39%) were considered at risk of CBDL (Group 2). Mean follow-up was 20.6 months (median 19); 2 patients (1%) in the low-risk group presented a symptomatic retained stone. CONCLUSIONS: This study validated this simple model for predicting risk of CBDL and avoiding invasive preoperative investigations--as well as IOC--in more than 60% of symptomatic cholelithiases. In addition, this model seemed useful for defining patients in whom further exploration for CBDL was justified, since 42 (39%) of the 108 Group 2 patients were proved to have CBDL.

Subarachnoid hemorrhage due to intraspinal tumors.

Five cases of subarachnoid hemorrhage arising from an intraspinal tumor are presented, Three of these were ependymomas in the region of the cauda equina. One was a neurofibroma at L1. The fifth was a hemangioblastoma in the upper lumbar region. The literature dealing with subarachnoid hemorrhage due to intraspinal lesions is reviewed. The majority of cases of spinal subarachnoid hemorrhage are due to arteriovenous malformations, but 50 cases in which the bleeding developed from a neoplasm have been reported.

Intradural extramedullary spinal arterio-venous malformations fed by the anterior spinal artery.

There is a small group of spinal arteriovenous malformations which differ from all of the others. They receive their blood supply from the anterior spinal artery but are located outside of the spinal cord and its pia mater. Six such malformations from our series of 150 spinal arteriovenous malformations 1,4 are reported. They differ in their clinical manifestations from the others. They can be extirpated with improvement in the patient's clinical manifestations.

Spinal cord arteriovenous malformations and the Klippel-Trenaunay-Weber syndrome.

Five cases in which the Klippel-Trenaunay-Weber syndrome was associated with a spinal cord arteriovenous malformation are reported: they formed part of a series of 150 spinal arteriovenous malformations. Hypertrophic lesions, dilated arteries and varicose veins were present in every case, but cutaneous angiomatosis was found in only two. In each case, there was an intramedullary AVM. The relationship of the Klippel-Trenaunay-Weber syndrome to the regional angiomatous phacomatoses is discussed.

[Chlamydia trachomatis perityphlitis, an anatomo-clinical entity? Study of 3 cases]. / Pérityphlite à "Chlamydia trachomatis" une entité anatomo-clinique? Etude de trois cas.

The authors describe three cases of perityphlitis secondary to Chlamydia trachomatis infection and revealed at laparotomy. Clinically, the symptoms invariably mimicked acute appendicitis. The pathogen was identified by a direct immunofluorescent assay with specific monoclonal antibodies (Microtrak). Prompt cure was achieved by doxycycline therapy. Thus, peroperatively, the discovery of an isolated perityphlitis with a normal appendix should raise the possibility of a C. trachomatis infection, even if there is no salpingitis.

[Anatomo-pathological evolution of single-layer end-to-end digestive anastomoses. A study of 210 colonic anastomoses in rats from the 2d to the 180th day]. / Evolution anatomo-pathologique des anastomoses digestives bord à bord en un plan. Etude de 210 anastomoses coliques chez le rat du 2e au 180e jour.

Two hundred and ten left colonic single-layer end-to-end anastomoses (105 by extramucosal continuous suture, 53 by extramucosal interrupted sutures, 52 by total continuous suture) performed on 105 rats with microsurgical techniques using a slowly resorbed suturing material were examined histologically at nine different times between the 2nd and the 180th days. The histopathological evolution of the inflammatory granuloma, the granulation tissue, the reepithelialization process and the restoration of the smooth muscle layers are described. The rate and the amount of inflammation were found to differ between animals and three different types of evolution could be schematized. The differences could not be due to the suturing techniques since continuous and interrupted sutures gave the same results, but rather to the manner of treating the intestinal cut edges before and during suturing. The amount of inflammation was found to decrease with the operator's training.

[Intravenous cholangiography is not indicated before cholecystectomy for uncomplicated lithiasis]. / La cholangiographie intra-veineuse est inutile avant cholécystectomie pour lithiase non compliquée. Etude prospective de 100 cas.

The purpose of this prospective study was to assess the usefulness of intravenous cholangiograms before elective cholecystectomy for lithiasis. The accuracy of preoperative intravenous cholangiography to detect choledocolithiasis was compared with that of routine operative cholangiography. All patients had preoperative intravenous cholangiography provided that they did not have known common bile duct gallstones or a previous history of adverse reaction to iodine. As well, patients presenting with cholestasis, cholecystitis or cholangitis were excluded. A choledocotomy was performed when the operative cholangiography disclosed choledocolithiasis; the preoperative intravenous cholangiograms were shown to the surgeon only after the operation. One hundred patients were selected among 206 consecutive operations for biliary lithiasis. A choledocolithiasis was detected in 3 preoperative and in 9 operative cholangiographies. Twelve choledocotomies were performed: one or more stones (1 to 12) were found in 9 patients; operative cholangiography was accurate in all these cases whereas preoperative cholangiography was accurate in only 2 (sensitivity = 22 percent). We conclude that preoperative cholangiography is useless before elective cholecystectomy for lithiasis and is unreliable to select patients in which operative cholangiography could be omitted.

[Ileal duplication in adults. Value of 99m pertechnetate scintigraphy]. / Duplication iléale de l'adulte. Intérêt de la scintigraphie au 99m pertechnétate.

Duplications of the small bowel are an uncommon group of congenital malformations whose symptoms rarely occur in adults. We report the case of a 21 year-old man who suffered during four years from symptoms related to the ulceration of ectopic gastric mucosa in an ileal duplication (spontaneously resolving peritonitis, pelvic abscess, recurrent gastrointestinal bleeding and chronic abdominal pain). Radiological and endoscopic explorations and a first laparotomy failed to provide the diagnosis. 99m pertechnetate (99mTcO4) scintigraphy demonstrated ectopic gastric mucosa and guided the radiological detection of an ileal ulceration. Injection of 99mTcO4 during a second laparotomy located the ectopic gastric mucosa at the level of a tumefaction found on the mesenteric side of the terminal ileum. Duplication was only recognized at pathological examination of the ileal resection. This case emphasizes the need to evoke a duplication in clinical circumstances like those described in this patient as well as the usefulness of 99mTcO4 in the diagnosis of such a malformation.

[Super-selective arteriography and embolization of the internal carotid]. / Artériographie super-sélective de la carotide interne et embolisation

The aim of superselective arteriography of the internal carotid is to opacify the small calibre arteries which were only slightly visible or not visible at all previously, to isolate an arterial area and to study its anastomoses and its venous drainage. The use of the balloon probe makes it possible to explore the very winding branches of the carotid siphon and the branches of the Sylvian artery or of the anterior cerebral artery. With a balloon probe pierced at the end, one can inject a contrast substance thereby making it possible to carry out superselective arteriography. With an unpierced balloon probe, a branch of the Sylvian or of the anterior cerebral artery can be temporarily occlused in order to study (in an unanaesthetised patient) the possibility of cutting off this artery without neurological complications when it is supplying a malformation. The various methods of embolisation are reviewed (plastic bells, silicones, detachable balloons) as well as their advantages and their dangers.

[Anterior angiomas of the spinal cord and their treatment]. / Les angiomes antérieurs de la moelle et leur traitement

For a long time surgical removal of intra-medullary angiomas was considered as impossible. Accurate localization of the lesion by spinal angiography, microsurgical techniques allow to overcome this surgical challenge. 15 cases of spinal arteriovenous malformations fed by the anterior spinal artery have been operated. Criterias for surgery and post-operative results are mainly dependant upon the neurological states and the anatomical type of the malformations (type I, II, III, IV), Total removal of the malformations was performed in 12 cases with post-operative control angiography in seven instances.

[Spinal meningeal hemorrhage due to tumors: a report on 5 cases with arteriography (author's transl)]. / Les hémorragies méningées spinales tumorales. A propos de 5 cas artériographiés.

Meningeal hemorrhages in 5 patients with tumors of the cauda equina are reported. In each case there were signs from the brain area which led to a false diagnosis of ruptured intracranial aneurism, before attention was drawn to the cauda equina by a relapse with hemorrhage or other signs. The value of medullary arteriography for positively diagnosing cauda equina tumors, and their differential diagnosis from medullary arteriovenous malformations--principal cause of spinal meningeal hemorrhages--is discussed, as well as the necessity for systematically evoking this topography in children and young adults when arteriographic exploration is negative.

[Medullary angiomas and the Klippel-Trenaunay-Weber syndrome]. / Angiomes médullaires et syndrome de Klippel-Trénaunay-Weber.

5 cases of an association of Klippel-Trenaunay-Weber syndrome and of spinal cord angiomas are reported amongst a series of 150 cases of malformation of the cord. The hypertrophic element, arterial dilatations and varices were found to be constant, in constant to cutaneous angiomatosis which was found in only 2 cases. There were intraspinal angiomas in all cases. The relationship between Klippel-Trenaunay-Weber syndrome and regional angiomatous phacomatoses are discussed.

[Acute interhemispheric subdural hematomas]. / Hématomes sous-duraux aigus interhémisphériques.

Three cases of acute interhemispheric subdural hematomas, one of which bilateral, are reported. These are secondary to cranial traumatism and/or to treatment by anticoagulants and have stereotyped clinical signs. Following a lucid period, intracranial hypertension appears, then a sudden predominantly crural hemiparesis or even paraplegia. The aspects shown by computerized tomography are characteristic. The literature and our experience suggest that the best treatment is complete evacuation of the hematoma by craniotomy performed before alteration of consciousness.