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1.
Surg Radiol Anat ; 42(12): 1441-1446, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32681224

RESUMEN

The sulcus of the caudate process is a horizontal groove on the inferior face of the liver. Its prevalence has not previously been determined. Because of its location, it represents a helpful extra-biliary landmark that could be used in biliary surgery to decrease bile duct injury. The goal of this study is to determine the prevalence of Rouviere's sulcus and describe its anatomy and relevant surgical applications. We conducted a literature review on the various characteristics of the sulcus, selecting anatomical clinical studies and dissections. We performed 10 cadaveric dissections in the Laboratory of Anatomy at Purpan University to determine the contents. We selected 12 anatomical studies, conducted between 1924 and January 1st, 2020, which included 2394 patients. The prevalence of the sulcus is 78.24% ± 9.1. Classification of Singh was used to describe anatomical characteristics. Type I ("deep sulcus") was identified in 50.4% ± 9.8 of cases, mostly consisting of Type Ia (open). Type II ("slit-like") was estimated to account for 13.3% ± 13.2, whereas Type III ("scar") described 12.3% ± 8.0. Average dimensions were estimated for length (26 mm ± 5.7), width (6.5 mm ± 1.5), and depth (7.9 mm ± 1.75). The content of the sulcus consists of the right portal vein and its division, the right hepatic artery, along with the right hepatic bile duct. The sulcus determines the orientation of the common bile duct. The sulcus of the caudate process is a reliable extra-biliary landmark, which presents a useful tool for reducing bile duct injuries during hepatobiliary surgery.


Asunto(s)
Variación Anatómica , Hígado/anatomía & histología , Humanos
2.
Cancer Radiother ; 24(2): 88-92, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32156457

RESUMEN

PURPOSE: The optimal dose in esophageal cancer patients treated with definitive chemoradiation (CRT) remains debated. We herein report on the dosimetric results, treatment-related toxicities and long-term outcomes of escalated dose up to 60Gy delivered with intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: All consecutive patients that received a definitive CRT>50Gy for an unresectable esophageal carcinoma between 2010 and 2015 were retrospectively evaluated for this study. Methodology included data base search, delayed toxicity grading, statistical testing including frequency analysis and survival analysis. RESULTS: A total of 51 patients were irradiated for a squamous cell carcinoma (86.3%) or an adenocarcinoma (13.7%). The median age at diagnosis was 62 years. Seven patients were simultaneously irradiated for another synchronous primary tumor. Forty-six patients (90.2%) received concurrent platin-based chemotherapy. The median prescribed doses were 60Gy (54-66) and 48Gy (44.8-56) delivered in 30 (27-35) fractions to the high and the low risks PTV respectively. The mean dose delivered to the lungs was 11.4Gy (IC 95%: 4.8-19.8), the median volumes receiving up to 20Gy (V20) and 30Gy (V30) were 13.5% (3.0-46.0) and 4.6% (0.7-19.8) respectively. The mean dose delivered to the heart was 13.9Gy (IC 95%:0.3-31.3) with a median V40 of 3.3% (0.0-25.0). One treatment-related death occurred within days after RT completion (neutropenic aplasia). After a median follow-up of 2.7 years (95% CI: 1.9-4.3), the 2-year overall survival, disease free survival and loco-regional control rates were 53.6%, 42.0% and 72.8% respectively. Delayed treatment related-toxicities ≤grade 3 occurred among 25 patients (62.5%) mostly esophageal stricture (79.2%). CONCLUSION: We demonstrated in this study that dose escalation using IMRT in combination with platin-based chemotherapy as a definitive treatment for esophageal carcinoma is safe and results in higher loco-regional and control survival when compared to previously reported data.


Asunto(s)
Adenocarcinoma/terapia , Carcinoma de Células Escamosas/terapia , Quimioradioterapia/métodos , Neoplasias Esofágicas/terapia , Tolerancia a Radiación , Radioterapia de Intensidad Modulada/métodos , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Quimioradioterapia/efectos adversos , Supervivencia sin Enfermedad , Fraccionamiento de la Dosis de Radiación , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Estenosis Esofágica/etiología , Femenino , Fluorouracilo/administración & dosificación , Corazón/efectos de la radiación , Humanos , Leucovorina/administración & dosificación , Pulmón/efectos de la radiación , Masculino , Persona de Mediana Edad , Compuestos Organoplatinos/administración & dosificación , Órganos en Riesgo/efectos de la radiación , Radioterapia de Intensidad Modulada/efectos adversos , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
3.
Cancer Radiother ; 23(6-7): 716-719, 2019 Oct.
Artículo en Francés | MEDLINE | ID: mdl-31421997

RESUMEN

Management of resectable esophageal carcinoma is based on a multimodal treatment associating neo-adjuvant chemoradiation before surgery. This therapeutic sequence allows a disease-free survival rate at 2 years around 45% but remains associated with a high post-operative morbidity. In case of definitive chemoradiotherapy, the dose delivered to the macroscopic disease is a controversial topic since decades and the prognosis of patients treated in this setting at the dose of 50Gy remains poor. This article proposes a review of the main published data and the ongoing studies related to the management of these patients.


Asunto(s)
Carcinoma/terapia , Quimioradioterapia Adyuvante/métodos , Neoplasias Esofágicas/terapia , Terapia Neoadyuvante , Humanos , Cuidados Preoperatorios/métodos , Dosificación Radioterapéutica , Radioterapia de Intensidad Modulada/métodos
4.
J Infect Dis ; 220(5): 830-840, 2019 07 31.
Artículo en Inglés | MEDLINE | ID: mdl-30880342

RESUMEN

The restoration of CD4+ T cells, especially T-helper type 17 (Th17) cells, remains incomplete in the gut mucosa of most human immunodeficiency virus type 1 (HIV-1)-infected individuals despite sustained antiretroviral therapy (ART). Herein, we report an increase in the absolute number of CXCR3+ T cells in the duodenal mucosa during ART. The frequencies of Th1 and CXCR3+ CD8+ T cells were increased and negatively correlated with CCL20 and CCL25 expression in the mucosa. In ex vivo analyses, we showed that interferon γ, the main cytokine produced by Th1 and effector CD8+ T cells, downregulates the expression of CCL20 and CCL25 by small intestine enterocytes, while it increases the expression of CXCL9/10/11, the ligands of CXCR3. Interleukin 18, a pro-Th1 cytokine produced by enterocytes, also contributes to the downregulation of CCL20 expression and increases interferon γ production by Th1 cells. This could perpetuate an amplification loop for CXCR3-driven Th1 and effector CD8+ T cells recruitment to the gut, while impairing Th17 cells homing through the CCR6-CCL20 axis in treated HIV-1-infected individuals.


Asunto(s)
Infecciones por VIH/metabolismo , Interferón gamma/metabolismo , Interleucina-18/metabolismo , Mucosa Intestinal/metabolismo , Intestino Delgado/metabolismo , Receptores CXCR3/metabolismo , Células Th17/metabolismo , Antirretrovirales/uso terapéutico , Linfocitos T CD4-Positivos/metabolismo , Linfocitos T CD8-positivos/metabolismo , Movimiento Celular , Quimiocina CCL20/metabolismo , Quimiocina CXCL10/metabolismo , Quimiocina CXCL11/metabolismo , Quimiocina CXCL9 , Quimiocinas CC/metabolismo , Citocinas/metabolismo , Infecciones por VIH/terapia , Humanos , Células TH1/metabolismo
5.
Colloids Surf B Biointerfaces ; 175: 91-97, 2019 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-30522012

RESUMEN

Alginate and chitosan are polysaccharides that are widely used in the biomedical field, especially as wound dressings. Controlled bioadhesion is an advanced functionality that offers the potential to reduce injuries due to the stripping-off of the biomaterial. Herein, we report the efficient grafting of poly-N(isopropylacryamide) (PNIPAM), a thermosensitive polymer that exhibits a lower critical solution temperature (LCST) at 32 °C on the alginate/chitosan polyelectrolyte complex (PEC) surface. In vitro studies did not exhibit a cytotoxic effect, and cells adhered preferentially on the LCST on PNIPAM grafted surfaces, as reported in the literature. Ex vivo investigations revealed that the adhesive behavior of the biomaterials was not the same on the liver and pancreas. The effect of the temperature on the bioadhesion to organs was unexpected, as PNIPAM surfaces exhibited higher adhesion at low temperature. The PNIPAM was therefore able to confer PEC matrix thermosensitivity, but due to the application force, interactions between PNIPAM chains and their substrate could influence bioadhesion on tissues.


Asunto(s)
Resinas Acrílicas/química , Materiales Biocompatibles/química , Temperatura , Resinas Acrílicas/síntesis química , Resinas Acrílicas/metabolismo , Alginatos/química , Alginatos/metabolismo , Animales , Materiales Biocompatibles/síntesis química , Materiales Biocompatibles/metabolismo , Adhesión Celular , Células Cultivadas , Quitosano/química , Quitosano/metabolismo , Humanos , Hígado/metabolismo , Páncreas/metabolismo , Polímeros/química , Polímeros/metabolismo , Propiedades de Superficie , Porcinos , Adhesivos Tisulares/química , Adhesivos Tisulares/metabolismo
6.
J Visc Surg ; 155(5): 355-363, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29631948

RESUMEN

INTRODUCTION: The indications for use of biological mesh prostheses are very limited because of their high cost, but include parietal repair in a contaminated setting. Their efficacy has been questioned by several recent studies. We therefore studied the results of all of our patients who received a biological prosthesis, including hernia recurrence and infectious complications. PATIENTS AND METHODS: We retrospectively reviewed the outcomes of 68 patients who underwent biological prosthesis placement from 2009 to 2015 in a single center. RESULTS: The site of implantation was on the anterior abdominal wall in 49 (72%) of cases, in the pelvis in 19 (28%). The median follow-up was 19 months. In the early post-operative period, 22 (32.3%) of patients presented with wall abscess; eight (11.7%) underwent surgical revision and seven (10.2%) underwent interventional radiological drainage. In the medium term, 41/56 (73%) had a late complication; 32 (57%) of the patients developed recurrent herniation and 15 (26.7%) of them were re-operated. In addition, nine (16%) of patients developed a late surgical site infection and eight (14.2%) a chronic residual infection. In multivariate analysis, the risk factors for recurrence were parastomal hernia (P=0.007) and a history of recurrent hernia (P=0.002). CONCLUSION: A majority of patients developed recurrent incisional herniation in the medium term. This puts the use of biological prostheses into question. These results need to be compared to those of semi-absorbable prostheses.


Asunto(s)
Pared Abdominal/cirugía , Bioprótesis/efectos adversos , Hernia Ventral/cirugía , Complicaciones Posoperatorias/epidemiología , Mallas Quirúrgicas/efectos adversos , Absceso/epidemiología , Anciano , Drenaje/métodos , Femenino , Estudios de Seguimiento , Herniorrafia/efectos adversos , Herniorrafia/estadística & datos numéricos , Humanos , Hernia Incisional/epidemiología , Hernia Incisional/etiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Recurrencia , Análisis de Regresión , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Estomas Quirúrgicos/efectos adversos , Infección de la Herida Quirúrgica/epidemiología , Factores de Tiempo , Resultado del Tratamiento
7.
HPB (Oxford) ; 19(4): 345-351, 2017 04.
Artículo en Inglés | MEDLINE | ID: mdl-28089365

RESUMEN

BACKGROUND: Spleen-preserving distal pancreatectomy with resection of the splenic vessels (VR-SPDP) is an effective procedure. However, hemodynamic changes in splenogastric circulation may lead to the development of gastric varices (GV) with a risk of gastrointestinal (GI) bleeding. This retrospective study aimed to assess the long-term postoperative clinical follow-up of patients and review the late postoperative abdominal computed tomography (CT) or endoscopic examination. METHODS: From 1988 to 2015, 48 consecutive VR-SPDP for benign or low-grade malignant disease were included. Late postoperative follow-up was undertaken with the use of a prospective database and assessment undertaken by CT and/or endoscopy. RESULTS: The median follow-up was 76 months (range: 12-334 months). Two patients were lost to follow-up. Gastrointestinal hemorrhage occurred in one patient. Endoscopy and abdominal CT showed submucosal GV in five patients. Ten patients had perigastric varices (27%), but none developed clinical complications from their varices. All varices occurred within one year after distal pancreatectomy and remained stable during follow-up. DISCUSSION: Asymptomatic varices frequently occurred in patients who underwent VR-SPDP, but bleeding risk seemed low. Abdominal CT could identify GV and distinguish submucosal varices with a higher risk of gastric bleeding.


Asunto(s)
Várices Esofágicas y Gástricas/etiología , Hemorragia Gastrointestinal/etiología , Tratamientos Conservadores del Órgano/efectos adversos , Pancreatectomía/efectos adversos , Arteria Esplénica/cirugía , Vena Esplénica/cirugía , Gastropatías/etiología , Adulto , Anciano , Bases de Datos Factuales , Várices Esofágicas y Gástricas/diagnóstico , Femenino , Estudios de Seguimiento , Hemorragia Gastrointestinal/diagnóstico , Gastroscopía , Humanos , Masculino , Persona de Mediana Edad , Pancreatectomía/métodos , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Gastropatías/diagnóstico , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto Joven
8.
Colloids Surf B Biointerfaces ; 151: 143-155, 2017 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-27992845

RESUMEN

Biomaterials surface design is critical for the control of materials and biological system interactions. Being regulated by a layer of molecular dimensions, bioadhesion could be effectively tailored by polymer surface grafting. Basically, this surface modification can be controlled by radical polymerization, which is a useful tool for this purpose. The aim of this review is to provide a comprehensive overview of the role of surface characteristics on bioadhesion properties. We place a particular focus on biomaterials functionalized with a brush surface, on presentation of grafting techniques for "grafting to" and "grafting from" strategies and on brush characterization methods. Since atom transfer radical polymerization (ATRP) and reversible addition-fragmentation chain transfer (RAFT) polymerization are the most frequently used grafting techniques, their main characteristics will be explained. Through the example of poly(N-isopropylacrylamide) (PNIPAM) which is a widely used polymer allowing tuneable cell adhesion, smart surfaces involving PNIPAM will be presented with their main modern applications.


Asunto(s)
Resinas Acrílicas/química , Materiales Biocompatibles/química , Adsorción , Adhesión Celular , Humanos , Cinética , Microscopía Electrónica de Rastreo , Polimerizacion , Polímeros/química , Propiedades de Superficie , Temperatura , Ingeniería de Tejidos/métodos
9.
Mucosal Immunol ; 9(5): 1137-50, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-26883727

RESUMEN

The gut CD4(+) T cells, particularly the T helper type 17 (Th17) subset, are not completely restored in most HIV-1-infected individuals despite combined antiretroviral therapy, when initiated at the chronic phase of infection. We show here that the CCR6-CCL20 chemotactic axis is altered, with reduced CCL20 production by small intestine epithelial cells in treated HIV-1-infected individuals. This leads to impaired CCR6(+)CD4(+) T-cell homing, particularly Th17 cells, to the small intestine mucosa. In contrast, the frequency of gut FoxP3(+) T regulatory (Treg) cells, specifically the CCR6(-) subset, was increased. The resulting imbalance in the Th17/CCR6(-) Treg ratio and the associated shift from interleukin (IL)-17 to IL-10 and transforming growth factor-ß (TGF-ß) blunts CCL20 production by enterocytes, perpetuating a negative feedback for the recruitment of CCR6(+)CD4(+) T cells to the small intestine in treated HIV-1-infected individuals.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Quimiocina CCL20/inmunología , Infecciones por VIH/inmunología , Receptores CCR6/inmunología , Linfocitos T Reguladores/inmunología , Células Th17/inmunología , Adulto , Terapia Antirretroviral Altamente Activa , Antígenos CD4/genética , Antígenos CD4/inmunología , Estudios de Casos y Controles , Quimiocina CCL20/genética , Quimiotaxis/efectos de los fármacos , Quimiotaxis/inmunología , Enterocitos/efectos de los fármacos , Enterocitos/inmunología , Enterocitos/virología , Retroalimentación Fisiológica , Femenino , Factores de Transcripción Forkhead/genética , Factores de Transcripción Forkhead/inmunología , Regulación de la Expresión Génica , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/patología , Infecciones por VIH/virología , VIH-1/efectos de los fármacos , VIH-1/crecimiento & desarrollo , Humanos , Interleucina-10/genética , Interleucina-10/inmunología , Interleucina-17/genética , Interleucina-17/inmunología , Mucosa Intestinal/efectos de los fármacos , Mucosa Intestinal/inmunología , Mucosa Intestinal/virología , Intestino Delgado/efectos de los fármacos , Intestino Delgado/inmunología , Intestino Delgado/virología , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Receptores CCR6/deficiencia , Receptores CCR6/genética , Transducción de Señal , Linfocitos T Reguladores/efectos de los fármacos , Linfocitos T Reguladores/virología , Células Th17/efectos de los fármacos , Células Th17/virología , Factor de Crecimiento Transformador beta/genética , Factor de Crecimiento Transformador beta/inmunología
10.
J Visc Surg ; 151(1): 9-16, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24388391

RESUMEN

BACKGROUND: Despite the prevalence of complex ventral hernias, there is little agreement on the most appropriate technique or prosthetic to repair these defects, especially in contaminated fields. Our objective was to determine French surgical practice patterns among academic surgeons in complex ventral hernia repair (CVHR) with regard to indications, most appropriate techniques, choice of prosthesis, and experience with complications. METHODS: A survey consisting of 21 questions and 6 case-scenarios was e-mailed to French practicing academic surgeons performing CVHR, representing all French University Hospitals. RESULTS: Forty over 54 surgeons (74%) responded to the survey, representing 29 French University Hospitals. Regarding the techniques used for CVHR, primary closure without reinforcement was provided in 31.6% of cases, primary closure using the component separation technique without mesh use in 43.7% of cases, mesh positioned as a bridge in 16.5% of cases, size reduction of the defect by using aponeurotomy incisions without mesh use in 8.2% of cases. Among the 40 respondents, 36 had experience with biologic mesh. There was a strong consensus among surveyed surgeons for not using synthetic mesh in contaminated or dirty fields (100%), but for using it in clean settings (100%). There was also a strong consensus between respondents for using biologic mesh in contaminated (82.5%) or infected (77.5%) fields and for not using it in clean setting (95%). In clean-contaminated surgery, there was no consensus for defining the optimal therapeutic strategy in CVHR. Infection was the most common complication reported after biologic mesh used (58%). The most commonly reported influences for the use of biologic grafts included literature, conferences and discussion with colleagues (85.0%), personal experience (45.0%) and cost (40.0%). CONCLUSIONS: Despite a lack of level I evidence, biologic meshes are being used by 90% of surveyed surgeons for CVHR. Importantly, there was a strong consensus for using them in contaminated or infected fields and for not using them in clean setting. To better guide surgeons, prospective, randomized trials should be undertaken to evaluate the short- and long-term outcomes associated with these materials in various surgical wound classifications.


Asunto(s)
Actitud del Personal de Salud , Hernia Ventral/cirugía , Herniorrafia/métodos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Mallas Quirúrgicas , Consenso , Femenino , Francia , Encuestas de Atención de la Salud , Herniorrafia/instrumentación , Humanos , Masculino
11.
J Visc Surg ; 149(2): e159-60, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22342770

RESUMEN

Gallbladder volvulus is a rare condition caused by torsion of the cholecystic pedicle and is favored by a long or nonexistent cholecystic mesentery. Gallbladder torsion presents clinically as gangrenous cholecystitis. Emergency cholecystectomy is the standard treatment. Lack of awareness of this condition can result in delayed diagnosis and worsen the prognosis of elderly patients.


Asunto(s)
Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Anomalía Torsional/diagnóstico por imagen , Anciano de 80 o más Años , Colecistectomía , Femenino , Enfermedades de la Vesícula Biliar/cirugía , Humanos , Radiografía , Anomalía Torsional/cirugía
12.
Gastroenterol Clin Biol ; 34(6-7): 371-9, 2010.
Artículo en Francés | MEDLINE | ID: mdl-20537487

RESUMEN

Small bowel adenocarcinoma is a rare tumor. These tumors are more often sporadic but there is some predisposing disease (Crohn disease, genetic syndrome and rarely celiac disease). Diagnosis is usually performed at an advanced stage because of non-specific nature of clinical manifestations. New methods of radiological and endoscopic exploration of small intestine should allow earlier diagnosis. Surgical resection remains the only potentially curative treatment for non-metastasic tumors. The main prognosis factor is lymph nodes involvement. The role of adjuvant chemotherapy is unclear. For metastatic tumors, 5-fluorouracil and platinum salt combination appears to be the most effective chemotherapy despite of the absence of randomized studies. A national prospective cohort study is currently evaluating the results of chemotherapy (recommended protocol: FOLFOX) as adjuvant and palliative treatment of small bowel adenocarcinoma.


Asunto(s)
Adenocarcinoma/etiología , Adenocarcinoma/terapia , Neoplasias Intestinales/etiología , Neoplasias Intestinales/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiología , Quimioterapia Adyuvante , Predisposición Genética a la Enfermedad , Humanos , Neoplasias Intestinales/diagnóstico , Neoplasias Intestinales/epidemiología , Intestino Delgado/patología , Intestino Delgado/cirugía , Metástasis Linfática , Metástasis de la Neoplasia , Pronóstico , Factores de Riesgo
13.
J Chir (Paris) ; 146(2): 191-4, 2009 Apr.
Artículo en Francés | MEDLINE | ID: mdl-19535077

RESUMEN

Major abdominal surgery may be contraindicated in patients with cirrhosis because of the high risk of intraoperative bleeding and postoperative decompensation. Careful preparation of these patients is essential, aimed especially at reducing portal hypertension. We report the case of a patient with cirrhosis complicated by hepatocellular carcinoma, whose portal hypertension manifested almost exclusively by reanastomosis from the umbilical vein. A transjugular intrahepatic portosystemic shunt (TIPS) was placed before surgery to prepare the patient for hepatic resection. In addition to the singularity of the presentation of portal hypertension, this case prompts us to consider neoadjuvant TIPS as a means of preparing these at-risk patients for major abdominal surgery.


Asunto(s)
Carcinoma Hepatocelular/cirugía , Hipertensión Portal/complicaciones , Cirrosis Hepática Alcohólica/complicaciones , Neoplasias Hepáticas/cirugía , Derivación Portosistémica Quirúrgica , Cuidados Preoperatorios , Carcinoma Hepatocelular/complicaciones , Femenino , Humanos , Neoplasias Hepáticas/complicaciones , Persona de Mediana Edad
15.
J Clin Pathol ; 59(10): 1111-3, 2006 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-17021140

RESUMEN

Clonality analysis of the immunoglobulin heavy chain (IgH) gene is helpful in identifying malignant B cell infiltrates in the bone marrow and is usually carried out on separate aspirates or on the same formalin-fixed decalcified bone marrow specimen. To determine whether the removal of the decalcification step would improve the molecular analysis, we first studied 12 bone marrow specimens with lymphoma infiltration split into a fixed and a small frozen fragment. Both the detection rate of IgH gene monoclonality and DNA quality were found to be superior in the frozen part than in the fixed part. Conversely, to evaluate whether the split would compromise histological analysis, we selected a series of 134 bone marrow specimens obtained from patients with small B cell lymphoma and showing IgH monoclonality on the frozen part. The histological detection rate of infiltrated or suspicious infiltrates (95%) on the fixed part was not altered by saving a frozen part.


Asunto(s)
Médula Ósea/patología , Linfoma de Células B/patología , Biopsia , Examen de la Médula Ósea/métodos , Criopreservación , ADN de Neoplasias/análisis , Humanos , Cadenas Pesadas de Inmunoglobulina/genética , Linfoma Folicular/patología , Invasividad Neoplásica , Estadificación de Neoplasias/métodos , Fijación del Tejido/métodos
16.
Surg Endosc ; 20(5): 721-5, 2006 May.
Artículo en Inglés | MEDLINE | ID: mdl-16508808

RESUMEN

BACKGROUND: The aim of this study was to evaluate the utility of staging laparoscopy in patients with biliary cancers in the era of modern diagnostic imaging. METHODS: From September 2002 through August 2004, 39 consecutive patients with potentially resectable cholangiocarcinoma underwent preoperative staging laparoscopy before laparotomy. Preoperative imaging included ultrasonography and triphasic computed tomography for all patients and magnetic resonance cholangiography in 35 patients (90%). Final pathological diagnosis included 20 hilar cholangiocarcinomas (HC), 11 intrahepatic cholangiocarcinomas (IHC), and eight gallbladder carcinomas (GBC). RESULTS: During laparoscopy, unresectable disease was found in 14/39 patients (36%). The main causes of unresectability were peritoneal carcinomatosis (11/14) and liver metastases (5/14). At laparotomy, nine patients (37%) were found to have advanced disease precluding resection. Vascular invasion and nodal metastases were the main causes of unresectability during laparotomy (eight out of nine). In detecting peritoneal metastases and liver metastases, laparoscopy had an accuracy of 92 and 71%, respectively. All patients with vascular or nodal involvement were missed by laparoscopy. For prediction of unresectability disease, the yield and accuracy of laparoscopy were highest for GBC (62% yield and 83% accuracy), followed by IHC (36% yield and 67% accuracy) and HC (25% yield and 45% accuracy) CONCLUSION: Staging laparoscopy ensured that unnecessary laparotomy was not performed in 36% of patients with potentially resectable biliary carcinoma after extensive preoperative imaging. In patients with biliary carcinoma that appears resectable, staging laparoscopy allows detection of peritoneal and liver metastasis in one third of patients. Both vascular and lymph nodes invasions were not diagnosed by this procedure. Due to these limitations, laparoscopy is more useful in ruling out dissemination in GBC and IHC than in HC.


Asunto(s)
Neoplasias del Sistema Biliar/patología , Laparoscopía , Adulto , Anciano , Neoplasias de los Conductos Biliares/patología , Conductos Biliares Intrahepáticos , Carcinoma/patología , Colangiocarcinoma/patología , Femenino , Neoplasias de la Vesícula Biliar/patología , Humanos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Neoplasias Peritoneales/patología , Valor Predictivo de las Pruebas
17.
J Chir (Paris) ; 141(2): 85-92, 2004 Mar.
Artículo en Francés | MEDLINE | ID: mdl-15133431

RESUMEN

Esophageal diverticula are classified by location-phrenoesophageal (Zenker's diverticulum-70%), thoracic and mediastinal (10%), and epiphrenic (20%). Almost all esophageal diverticula are acquired pulsion diverticula. The most common symptoms are dysphagia, regurgitation, thoracic pain, and pulmonary manifestations related to aspiration. Barium swallow and upper endoscopy will help to establish the diagnosis while esophageal manometry may reveal underlying dysmotility. Diverticula should not be treated unless they are symptomatic. The treatment of Zenker's diverticulum is surgical and consists of either diverticulectomy or diverticular suspension with a myotomy of the cricopharyngeus muscle via cervical approach. Transoral endoscopic stapled diverticulostomy is a new and simple approach which may become the treatment of choice, particularly in elderly and high-risk patients. Treatment of diverticula of the mid and low esophagus must take into account any motor anomalies or associated lesions. Diverticulectomy with esophageal myotomy and an anti-reflux procedure through a left thoracotomy is the standard approach, but endoscopic approaches seem feasible, particularly for epiphrenic diverticula, and may become the norm in years to come.


Asunto(s)
Divertículo Esofágico , Anciano , Divertículo Esofágico/clasificación , Divertículo Esofágico/complicaciones , Divertículo Esofágico/diagnóstico , Divertículo Esofágico/diagnóstico por imagen , Divertículo Esofágico/cirugía , Endoscopía , Esofagoscopía , Femenino , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/cirugía , Humanos , Masculino , Manometría , Persona de Mediana Edad , Radiografía Torácica , Factores de Riesgo , Toracotomía , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/cirugía
19.
Drug Metab Dispos ; 29(3): 242-51, 2001 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11181490

RESUMEN

The expression and inducibility of four CYP2C genes, including CYP2C8, -2C9, -2C18, and -2C19, was investigated in primary cultures of human hepatocytes. By the use of RNase protection assay and specific antibodies, each CYP2C mRNA and protein were quantified unequivocally. The four CYP2C mRNAs were expressed in human livers and cultured primary hepatocytes, but only the CYP2C18 protein was not detected. Compounds known to activate the pregnane X receptor (PXR) such as rifampicin, or the constitutively activated receptor (CAR) such as phenobarbital, induced CYP2C8, CYP2C9, and to a lesser extent CYP2C19 mRNAs and proteins. CYP2C18 mRNA was expressed but not inducible. The concentration dependence of CYP2C8 and CYP2C9 mRNAs in response to rifampicin and phenobarbital paralleled that of CYP3A4 and CYP2B6, the maximum accumulation being reached with 10 microM rifampicin and 100 microM phenobarbital. In contrast, dexamethasone produced maximum induction of CYP2C8 and CYP2C9 mRNAs at 0.1 microM while in these conditions neither CYP3A4 nor CYP2B6 was significantly induced. Moreover, the concentration dependence of CYP2C8 and CYP2C9 mRNAs in response to dexamethasone paralleled that of tyrosine aminotransferase. Furthermore, dexamethasone, which has been recently shown to up-regulate PXR and CAR expression through the glucocorticoid receptor, potentiated CYP2C8 and CYP2C9 mRNA induction in response to rifampicin and phenobarbital. Collectively, these results suggest the possible implication of at least three receptors in the regulation of CYP2C8 and CYP2C9 expression, i.e., glucocorticoid receptor, PXR, and/or CAR.


Asunto(s)
Sistema Enzimático del Citocromo P-450/biosíntesis , Hepatocitos/enzimología , Adulto , Anciano , Línea Celular , Células Cultivadas , Proteína de la Membrana Similar al Receptor de Coxsackie y Adenovirus , Sistema Enzimático del Citocromo P-450/genética , Sistema Enzimático del Citocromo P-450/metabolismo , Dactinomicina/farmacología , Dexametasona/farmacología , Inducción Enzimática/efectos de los fármacos , Femenino , Hepatocitos/metabolismo , Humanos , Hidroxilación , Immunoblotting , Isoenzimas/genética , Isoenzimas/metabolismo , Cinética , Hígado/enzimología , Hígado/metabolismo , Masculino , Persona de Mediana Edad , Ensayos de Protección de Nucleasas , Fenobarbital/farmacología , Receptor X de Pregnano , ARN Mensajero/análisis , ARN Mensajero/metabolismo , Receptores Citoplasmáticos y Nucleares/metabolismo , Receptores de Glucocorticoides/metabolismo , Receptores de Esteroides/metabolismo , Receptores Virales/metabolismo , Rifampin/farmacología , Tirosina Transaminasa/genética , Tirosina Transaminasa/metabolismo
20.
Ann Chir ; 125(2): 131-6, 2000 Feb.
Artículo en Francés | MEDLINE | ID: mdl-10998798

RESUMEN

STUDY AIM: The aim of this retrospective study was to compare a group of patients who underwent resection for gastric adenocarcinoma (cancer of cardia excluded) and to assess the influence of radical lymphadenectomy on postoperative mortality and morbidity and 5-year survival rate. PATIENTS AND METHOD: One hundred and six patients were operated on from 1975 to 1985 and 99 from 1986 to 1995 for gastric adenocarcinoma located in the distal portion of the stomach in 56% and 61% respectively and, undifferenciated in 56%. Gastric resection was a subtotal gastrectomy for cancers of the lower third and total gastrectomy for cancers of the middle and superior thirds. In the first group (1975-1985), a D1 lymphadenectomy was performed in all patients. In the second group (1986-1995) a D1.5 lymphadenectomy without systematic splenectomy and pancreatectomy was applied to 49 patients. RESULTS: In the second group, the proportion of curative resection was higher (85% versus 75%) along with a higher rate of total gastrectomy (42% versus 17%). The postoperative mortality rate was 2% in the first group and 1% in the second group. The morbidity rate was 33% in the first group and 15% in the second group with a rate of anastomotic leak of 11% and 2% respectively. Among the second group, the morbidity rate was 20% after D1,5 lymphadenectomy versus 10% after D1 lymphadenectomy. The overall 5-year survival rate was 29% in the first group versus 38% in the second group. In this latter group, the overall 5-year survival was 32% after D1 lymphadenectomy and 46% after D1,5 (p = 0.038). CONCLUSION: Radical lymphadenectomy without associated splenic or pancreatic resection in good general status patients may provide a better staging of resected gastric cancer without increase of the postoperative mortality. However, the influence of radical lymphadenectomy on long-term survival remains to be proven.


Asunto(s)
Escisión del Ganglio Linfático , Neoplasias Gástricas/cirugía , Anciano , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Morbilidad , Complicaciones Posoperatorias , Pronóstico , Estudios Retrospectivos , Neoplasias Gástricas/patología , Análisis de Supervivencia , Resultado del Tratamiento
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