Prospective evaluation of quality of life (SF-36v2) and nonspecific symptoms before and after cure of primary hyperparathyroidism (1-year follow-up).

BACKGROUND: Only a minority of patients with primary hyperparathyroidism (pHPT) present with the "classic" symptoms. Most patients have numerous nonspecific symptoms. The aim of this study was to evaluate patients' quality of life and nonspecific symptoms before and after cure for pHPT. METHODS: This prospective, multicentric study, which took place from May 2003 to September 2004, included 100 patients. Six academic departments of Endocrine Surgery in France participated in the study: the University of Angers, Limoges, Nancy, Nantes, Marseille, and Poitiers. Only cured patients were included. All patients were given preoperative and postoperative questionnaires (the SF-36v2 Health Survey) at 3, 6, and 12 months to evaluate quality of life and nonspecific symptoms. RESULTS: Preoperatively, the main nonspecific symptoms included the following: anxiety (89%); muscular, bone, or join pain (87%); abdominal distention (82%); forgetfulness (81%); headaches (81%); and mood swings (79%). Quality of life was significantly improved at 3 and 6 months (P < .05). At 1 year postoperatively, statistically significant improvement (P < .05) persisted in all 8 domains of the SF-36v2. At 1 year after parathyroidectomy, 5 symptoms remained significantly improved: appetite loss, weight loss, thirst, headache, and nausea. CONCLUSIONS: Operative cure of primary hyperparathyroidism significantly improves quality of life and nonspecific symptoms for at least 1 year.

Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors.

BACKGROUND: Resection for adenocarcinoma of the gastroesophageal junction (AGEJ) is associated with severe mortality and morbidity. This retrospective study aimed to evaluate mortality and morbidity after resection for AGEJ and to determine their predictive factors. STUDY DESIGN: Data from 1,192 patients (mean age 65 +/- 11 years) who underwent resection for AGEJ by members of French Association of Surgery from 1985 to 2000 were collected. A stepwise logistic regression model was built to identify by multivariate analysis the variables independently associated with mortality, morbidity, anastomotic leakage, and major pulmonary complications. RESULTS: Distribution of Siewert's type was: I = 480 (40%), II = 500 (42%), and III = 212 (18%). Most type I and II tumors were treated by esophagectomy and proximal gastrectomy (93% and 58%, respectively), using an approach including a thoracotomy (82% and 64%, respectively); type III tumors were treated mainly by total gastrectomy and distal esophagectomy (83%), through an exclusive transabdominal approach (69%). Seventy-six (6%) patients died postoperatively. Only American Society of Anesthesiologists (ASA) scores III and IV (p < 0.001) and period of study (p = 0.025) were predictive of mortality. Predictive factors of overall morbidity (overall rate = 35%) were high ASA score (p < 0.001), age more than 60 years (p = 0.020), male gender (p = 0.039), and cervical anastomosis (p = 0.001). Factors predictive of anastomotic leakage (overall rate = 9%) were high ASA score (p = 0.006) and manual anastomosis (p = 0.010). Factors predictive of major pulmonary complications (overall rate = 23%) were high ASA score (p = 0.015), age more than 60 years (p < 0.001), anastomotic leakage (p < 0.001), and abdominal complications (p = 0.003). CONCLUSIONS: ASA score is a reliable predictive factor of operative mortality and morbidity after resection of AGEJ.

Safety and feasibility of pancreaticoduodenectomy in the elderly: a matched study.

OBJECTIVES: To compare the clinical outcomes after pancreaticoduodenectomy (PD) in patients older than 70 years old against a matched cohort of patients younger than 70. METHODS: A search of the department database revealed that 285 consecutive patients underwent PD from 1996 to 2009. Forty-one patients (14%) were identified to be older than 70 years (group 1), and they were matched with 41 patients younger than 70 (group 2) according to sex, body mass index, American Society of Anesthesiologists score and tumor staging. Medical comorbidities, preoperative CA19-9 and hemoglobin levels, operative and histopathologic data, postoperative course, and survival outcomes were compared between the 2 groups of patients. RESULTS: Statistical analyses revealed no significant difference between the 2 groups, except for preoperative CA19-9 and hemoglobin levels, operating time, duration of hospitalization, and the number of lymph nodes removed. These parameters, however, did not have an impact on morbidity, mortality, and overall survival. CONCLUSIONS: Based on our study, perioperative morbidity, mortality, and overall survival are not poorer in patients older than 70. Thus, PD should not be contraindicated solely on the basis of chronological age. Moreover, PD can be rationally proposed to patients meeting the "fit elderly" definition.

Duodenal adenocarcinoma and Mut Y human homologue-associated polyposis.

Mut Y human homologue-associated polyposis is a recently described colorectal adenomatous polyposis with an autosomal recessive mode of inheritance. Several extracolonic manifestations have been reported in patients affected by Mut Y human homologue-associated polyposis (MAP). Among these, duodenal polyposis, a highly prevalent manifestation of Adenomatous Polyposis Coli related familial adenomatous polypyposis, is undoubtedly part of the clinical spectrum of the disease. The true association of other clinical manifestations with MAP remains questionable.We report the observation of two patients affected by MAP who developed an adenocarcinoma of the duodenum in the context of duodenal polyposis. These observations emphasize the malignant potential of MAP-associated duodenal polyposis and the need to enroll these patients into an upper gastrointestinal surveillance programme. Moreover, one of our patients was also diagnosed with a scapular chondrosarcoma, the other one with a high-grade astrocytoma. Although these tumours may be coincidental, we cannot rule out a real albeit rare association with MAP.

Human ENS regulates the intestinal epithelial barrier permeability and a tight junction-associated protein ZO-1 via VIPergic pathways.

Although the enteric nervous system (ENS) has been shown to regulate various mucosal functions, its role in the physiological control of the human intestinal epithelial barrier is unknown. The aim of this study was to investigate whether the ENS is able to modulate epithelial barrier permeability and a key tight junction-associated protein, zonula occludens-1 (ZO-1). Therefore, we developed a co-culture model, consisting of human submucosa containing the submucosal neuronal network and human polarized colonic epithelial monolayers (HT29-Cl.16E or Caco-2). Submucosal neurons were activated by electrical field stimulation (EFS). Permeability was assessed by measuring the flux of paracellular permeability markers (FITC-dextran or FITC-inulin) across epithelial monolayers. Expression of ZO-1 was determined by immunofluorescence, quantitative immunoblot analysis, and real time RT-PCR. Using the coculture model, we showed that EFS of submucosal neurons resulted in a reduction in FITC-dextran or FITC-inulin fluxes, which was blocked by TTX. In HT29-Cl.16E, the effect of submucosal neuron activation was blocked by a VIP receptor antagonist (VIPra) and reproduced by VIP. Furthermore, ZO-1 expression (mRNA, protein) assessed in HT29-Cl.16E, was significantly increased after submucosal neuron activation by EFS. These effects on ZO-1 expression were blocked by TTX and VIPra and reproduced by VIP. In conclusion, our results strongly suggest a modulatory role of VIPergic submucosal neuronal pathways on intestinal epithelial barrier permeability and ZO-1 expression.