Future of bariatric surgery beyond simple weight loss: Metabolic surgery.

Anatomical modifications implemented during bariatric surgery not only result in weight loss, but also lead to metabolic corrections that translate into better glycemia stability and improvement in cardiovascular and liver disorders. The logical extension of surgical indications beyond mere reduction of the body mass index (BMI) (i.e. patients with<35kg/m2) is a hot topic today in France and worldwide. Metabolic surgeries make use of multiple modalities (endoscopic, mini-invasive, invasive) that should be carried out by trained physicians and within the same type of multidisciplinary formation as that for bariatric surgery. The aim of this update is to describe the physiological mechanisms that result in the benefits of bariatric surgery, the various procedures currently available and the perspectives for this new field in visceral and digestive surgery.

[Late complications from abdominal wall surgery: report of three cases of mesh migration into hollow viscus]. / Complications tardives de la chirurgie pariétale abdominale: à propos de trois cas de migration de prothèse dans un organe creux.

Laparoscopic mesh repair of ventral abdominal wall hernias is routinely performed. Mesh detachment and migration within the abdominal cavity is a late complication of this procedure. Symptoms are non-specific and imaging diagnosis is difficult to achieve because this complication is rare and overlooked.

[Contribution of curative and preventive embolization for renal angiomyolipomas treatment]. / Apport de l'embolisation curative et préventive pour la prise en charge des angiomyolipomes rénaux.

OBJECTIVE: The purpose of this study was to present the role of embolization in the treatment of kidney angiomyolipomas (AML), for preventive care or in case of bleeding. METHODS: From March 1995 to March 2007, 22 AML in 21 patients (16 women and five men, mean age 38 years) were embolized: five AML were treated for hemorrhagic shock emergency and 16 were preventive embolization. Eight AML were discovered incidentally and nine patients had pain or hematuria. The average size of AML was 70 mm (20 to 130 mm). The embolization was performed with coils or embospheres. RESULTS: Three patients have not been embolized because of renal failure catheterization. The embolization was effective in 100% of patients treated in emergency. The six patients cared for gross hematuria and pain were asymptomatic after embolization. The average tumor size reduction was 32% with a mean time of 53.2 months (five to 101 months). Three patients (14%) have benefited from surgery remotely. CONCLUSION: Embolization is the best technique for treating bleeding secondary to AML. In preventive treatment or symptomatic, AML embolization is a treatment to offer before considering surgery.

Safe short circuit in cataract surgery: Incidence and risk factors for intraoperative medical action.

Cataract surgery has become the most frequent surgical procedure performed every year in Western countries. Perioperative patient circuit has to be adapted to the important medical needs and progress. Hence, a secure short circuit (SSC) for surgeries of the anterior segment of the eye under topical anaesthesia was created. Patients included in the circuit are selected first by surgeons and answer a medical questionnaire, they do not have any preoperative evaluation by anaesthesiologist, are monitored during surgery by the surgical team and in case of problem an intraoperative medical action (IMA) can be performed. We conducted a retrospective observational incidence study of the occurrence of the IMA, followed by a case control study. The primary outcome was to identify risk factors of IMA among the patients' medical history. Out of 2744 screened patients, 1592 patients were included during the period of November 2015 to November 2017. The rate of IMA was 5%, 81% of them presenting with intraoperative high blood pressure (HBP). In the case control study part, stepwise regression analysis revealed that a history of HBP and insulin-dependent diabetes (IDD) was significantly correlated with IMA (respectively, adjusted odds ratio 1.7, P=0.005 and 2.6, P=0.002). The low incidence of IMA showed that the SSC is a safe tool thanks to a selection and an optimised and secure pathway. A history of HBP and IDD was significantly associated with the occurrence of IMA. Therefore, an optimisation of the perioperative period would be beneficial in these cases.

Onset and offset of brain events as indices of mental chronometry.

Analysis of single-trial electroencephalogram waveforms in a reaction time task demonstrated that the onset and offset values of event-related potentials can be used as indices of the duration of information processing. Two negative waves have been identified which peak at different times in different regions of the scalp, with the second overlapping the last part of the first. These waves are related in different ways to the duration of perceptual processing.

[CT imaging features of mechanical aortic valvular prostheses and related complications]. / Aspects scannographiques des prothèses valvulaires mécaniques aortiques et de leurs complications.

Currently, multidetector row CT (MDCT) is routinely used for cardiac imaging, especially for detection of coronary artery disease and morphological and functional evaluation. Recent advances in MDCT with cardiac gating and improved spatial and temporal resolution allow non-invasive evaluation of cardiac valves with significant reduction in artifacts traditionally associated with valvular prostheses. Postsurgical follow-up of mechanical aortic valvular prostheses requires knowledge of the functioning mechanism of different valve types and related complications, some potentially lethal and sometimes of insidious onset. The most frequently used non-invasive imaging modalities to evaluate morphology and function of prosthetic heart valves are echocardiography and fluoroscopy. We present the CT imaging features of three mechanical aortic valvular prostheses and the value of CT for diagnosis of related complications as a complement to standard imaging modalities.

[Pulmonary malignant superior vena cava obstruction: endovascular stent therapy]. / Obstruction cave supérieure par cancer bronchopulmonaire : traitement endovasculaire par stent.

MATERIALS AND METHODS: Thirty-one patients underwent stent placement between June 1998 and October 2006 for superior vena cava obstruction. The initial effectiveness of the metallic stent therapy and the follow-up results were studied at one, six and 12 months. PURPOSE: We retrospectively studied the utility of metallic stent placement for the treatment of malignant superior vena cava obstruction in 31 patients (SVCO) on the basis of long-term follow-up data. RESULTS: The initial clinical success rate was 100% (31 out of 31), the primary clinical patency rate was 93% (26 out of 28) at six months. The obstruction rate of the stent was 7% (two out of 28) at six months. There was no additional stent used for recurrence. At 12 months, 27 out of 31 patients were deceased in whom there was no recurrence of SVCO until death. CONCLUSION: Stent therapy is an effective treatment for SVCO. Adjuvant therapy must to be evaluated in association with stent therapy.

Bilateral uveitis associated with nivolumab therapy.

New anticancer therapies, immune pathway inhibitors, may cause immune-related adverse events (IRAE). Immune-related ocular toxicities are rare but are potentially serious adverse events. The purpose of this article is to report a case of ocular inflammatory involvement potentially related to the immune response and the use of nivolumab, a new immunologic agent used for the treatment of a solid tumor. Despite the implication of this therapy in the occurrence of inflammation, other causes must always be ruled out. It is possible to continue this therapy in consideration of the risk/benefit ratio for each patient. Close collaboration between oncologists and ophthalmologists is necessary in the diagnosis and timely management of IRAE related to these new emerging therapies.

[Bilateral uveitis associated with nivolumab therapy]. / Uvéite bilatérale associée à un traitement par nivolumab.

Immune-related adverse events (IRAEs) are rare but serious adverse events that may be associated with inhibitors of few immune control points. The purpose here is to report the case of an inflammatory ocular disease, potentially linked to the immunity and use of nivolumab, a new immunological agent used for the treatment of a solid tumor. In spite of the involvement of this treatment in the onset of inflammation, we must always seek another cause. It is possible to continue this treatment by considering the benefit/risk balance for each patient. Close collaboration between oncologists and ophthalmologists is necessary in the diagnosis and rapid management of these IRAE ocular related to these new emerging therapies.

Anakinra in the Treatment of Patients with Refractory Scleritis: A Pilot Study.

PURPOSE: This study aimed to evaluate the safety and efficacy of anakinra for severe and refractory scleritis. METHODS: Ten patients with severe (i.e. at least 2 ocular relapses per year despite treatment) and refractory [i.e. at least to one disease modifying antirheumatic drugs (DMARDS)] scleritis were treated with anakinra (100 mg/day subcutaneously). Scleritis was associated with inflammatory systemic diseases in 60% of cases. The remission rate defined the primary outcome. RESULTS: Ninety percent of patients were complete responders with a mean follow-up of 19.4 months after starting anakinra. The corticosteroids daily dose decreased from 18.3 ± 4.1 mg to 4.2 ± 4.9 mg, (p < 0.05), at initiation of anakinra and at end of follow-up, respectively. Associated immunosuppressants were stopped in all cases except one. Side effects were observed in 4 patients who did not need anakinra withdrawal. CONCLUSIONS: This pilot study suggests the efficacy of anakinra in patients with refractory scleritis.

[Inferior mesenteric arteriovenous fistulas. Report of a case]. / Les fistules artérioportales mésentériques inférieures. A propos d'un cas.

We report a case of postoperative inferior mesenteric arteriovenous fistula. Arteriovenous fistula represents a rare disease. Symptoms are due to portal hypertension and distal ischemy. Treatment of these fistulas is embolization. Surgery is possible by ligature or excision of the fistula because vascularisation is obtained by Riolan arcade and hypogastric artery.

[Duplication of the inferior vena cava: anatomical dissection and clinical implications]. / Dédoublement de la veine cave inférieure: dissection anatomique et applications cliniques.

The duplication of the inferior vena cava is often incidentally discovered during radiological studies. The presence of this anomaly can be mistaken for retroperitoneal adenopathy. Its knowledge allows to avoid hemorrhagic complications during retroperitoneal surgery. An anatomical dissection of a duplication of the inferior vena cava is presented. Embryogenesis and variations are described. Radiological and clinical implications are discussed.

[Memory, attention and evoked potentials during aging and in Alzheimer type senile dementia]. / Mémoire, attention, potentiels évoqués au cours du viellissement et dans la démence sénile de type Alzheimer.

A study of event-related brain potentials (ERPs) in Alzheimer type dementia has been performed on 6 elderly subjects (mean age: 67.5). Patients were included if they met DSM-III criteria for primary degenerative dementia. They presented important loss of memory function (in short-term memory-STM and long-term memory-LTM) and impairment of attention. They were compared to two groups: normal elderly subjects with no memory trouble and no attention dysfunction (12 subjects, mean age: 66) and elderly subjects with minor trouble in STM and little attention disturbance (6 subjects, mean age: 68.5). The chosen procedure is a dichotic listening and selective attention paradigm. Three series of tone bursts occurred in counterbalanced order (frequent tones: 1,000 Hz, 2,000 Hz; rare tones: 1,450 Hz). Rare/frequent ratio was 10/90. Subjects were asked to press a key to the rare tones. During the task, ERPs are recorded with 16 electrodes (cross montage), using 2 different reference electrodes sites: nasion and 7th vertebra. Results are displayed with the use of chronograms, spatio-temporal maps, reaction time histograms. In Alzheimer's group compared to the 2 others: N100, N200, P300 are significantly delayed in latency. P300 has a smaller amplitude. In Alzheimer's, P300 distribution on the scalp is more frequently founded of greater amplitude on the frontal region than on the centro-parietal region while the opposite is found in normal subjects. These results suggest that memory trouble or attention dysfunction are well correlated with the abnormalities of the ERPs.

[The French Society of EEG and Clinical Neurophysiology is 40 years old]. / La Société d'EEG et de Neurophysiologie clinique de Langue française a 40 ans.

The historical reminder of the foundation of the French EEG Society and the changes which have occurred during its operation show the worry of the Society for a better efficiency all along this last fourty years. A general survey of the scientific activities disclose the contribution of the society in the papers first published in the Revue Neurologique, and, after 1971, in the Revue d'EEG et de Neurophysiologie clinique de Langue française. The French participation in other clinical neurophysiological or scientific meetings in France and abroad is underlined by the important role it has played in the life of the International Federation for EEG Societies. Training of specialized doctors and technicians in the domain of the functional exploration of the nervous system has been a standing preoccupation of the Society, with the teaching of the so-called "Attestation d'EEG" in French universities and the training of technical personnel in specialized schools.

Bleeding cecal typhoid ulcer. Value of emergency angiography for selective surgical hemostasis.

A case of bleeding cecal typhoid ulcer in a 22-year-old patient demonstrated by superior mesenteric arteriography is described. An attempt to stop hemorrhage using intraarterial vasopressin infusion, failed. However, arteriography proved helpful in locating the bleeding site, and in permitting conservative surgery, namely cecal ulcer suture to achieve hemostasis. On the basis of this case and a review of the literature, management of complicating hemorrhage resulting from typhoid fever is discussed, with particular reference to radiological procedures.

[Iatrogenic coronary stenosis after angioplasty]. / Sténoses coronaires iatrogènes après angioplastie.

Restenosis is the usual mechanism of recurrent myocardial ischaemia in the months following successful percutaneous transluminal coronary angioplasty (PTCA). Control coronary arteriography may occasionally show another cause: the constitution of a new stenosis near the dilated segment or in the left main coronary stem after angioplasty in a branch of this artery. The authors report 4 cases of patients who developed new coronary stenoses within a few weeks of PTCA, interpreted as traumatic complications of the initial procedure due to a lesion of the intima with a secondary fibrotic reaction and luminal narrowing. The guiding catheter was probably responsible for the trauma to the left main coronary stem whereas the tips of either the balloon catheter or the guide wire were thought to have been responsible for the endothelial effraction of the dilated vessels.

[Left ventricular function and secondary angioplasty after anterior infarction in simple coronary vessel disease]. / Fonction ventriculaire gauche et angioplastie secondaire après un infarctus antérieur chez le monotronculaire.

Arterial patency is a good prognostic factor in terms of survival and left ventricular function after myocardial infarction. The aim of this prospective study was to evaluate the benefit of secondary angioplasty of the infarct-related artery in single vessel, left anterior descending disease, on regional and global left ventricular function. Initial coronary angiography was undertaken at the 7th +/- 2 days after the onset of infarction. Arterial patency was assessed by the TIMI criteria and by percentage stenosis on quantitative angiography. Forty consecutive patients (Group I) underwent conventional angioplasty of the left anterior descending artery at the 9th +/- 2 days. Twelve consecutive patients (Group II) did not undergo angioplasty. A repeat coronary angiographic study was performed at 3 months. The results showed no difference between the two groups of patients in base line values. A significant improvement in arterial patency was observed in Group I (TIMI Grades II or III) and in residual stenosis at 3 months (54.7 +/- 13% versus 80.6 +/- 13%, p < 0.05). In addition, a significant improvement in ejection fraction of +4.7% (p < 0.02), of left anterior descending myocardial regional wall motion of +7.6 (p < 0.02) and a reduction of induced left ventricular end systolic volume of -2.2 ml/m2 (p < 0.05) were observed in Group I. Initial segmental hypokinesia or akinesia improved in 67.5% of patients. However, 50% of patients in Group II improved their segmental wall motion abnormalities at 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)

[Coronary angioplasty and electric alternans of the ST segment]. / Angioplastie coronaire et alternance électrique du segment ST.

Alternans of the ST segment is a rare phenomenon during coronary angioplasty. The authors report three cases. It is usually observed in left anterior descending arteries without collateral circulation. Alternans is not accompanied by haemodynamic changes and does not initiate malignant ventricular arrhythmias. It is a transient phenomenon. Electrical alternans is thought to be due to changes in the configuration of the transmembrane action potential and modifications of calcium exchanges.

[Mid-term results of 50 percutaneous aortic valvuloplasties. Follow-up studies using Doppler echocardiography]. / Résultats à moyen terme de 50 valvuloplasties aortiques percutanées. Suivi par écho-Doppler.

The aim of this study was to assess the results of percutaneous aortic valvuloplasty in 50 patients (29 men and 21 women, mean age 74 years) at 6 months by Doppler echocardiography performed 24 hours before, 24 hours, 3 and 6 months after the procedure. The following parameters were compared: maximum instantaneous transaortic pressure gradient; mean gradient; aortic valve area and index of valve patency. The initial results of catheterisation and valvuloplasty were very satisfactory as the peak-to-peak and mean pressure gradients decreased by 50 per cent and the aortic valve area increased from 0.55 +/- 0.2 to 0.83 +/- 0.30 cm2 and the success rate defined as a final surface area greater than 0.75 cm2 was 84 per cent. Unfortunately, these favourable results were not sustained in most cases: restenosis, defined as a valve area of less than 0.7 cm2, was observed in 18 per cent of patients at Day 1 and 71 per cent of patients at the 6th month; the natural history of disease was little affected with a global mortality rate at 6 months of 18 per cent through cardiac failure and sudden death; only 18 per cent of patients maintained an aortic valve area of over 0.75 cm2 at 6 months. These results suggest that percutaneous aortic valvuloplasty should be reserved for patients in whom surgery is formally contra-indicated.

[Dissection of the aorta complicated by aorto-pulmonary fistula]. / Dissection aortique compliquée de fistule aorto-pulmonaire.

The authors report the case of chronic dissection of the aorta presenting with congestive cardiac failure. The diagnosis was made for the first time by transoesophageal echocardiography which showed both the dissection of the aorta and its fistulalisation into the pulmonary artery. Aortography confirmed the diagnosis. The patient underwent surgery which consisted of suture of the fistula and replacement of the ascending aorta with a prosthetic tube. The outcome was favourable after 8 months follow-up.