Pelviperitonitis by colorectal perforation in the third trimester of pregnancy after surgery for deep pelvic endometriosis.

OBJECTIVE: To report a severe complication after colorectal resection for rectovaginal endometriosis. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 37-year-old patient treated with colorectal resection 3 years ago for rectovaginal endometriosis was admitted with a rectal perforation at 37 weeks' gestation. INTERVENTION(S): Caesarean section and simple interrupted stitch of the perforation by absorbable Vicryl. MAIN OUTCOME MEASURE(S): Determination of the cause of the perforation in healthy rectal tissue above the anastomosis. RESULT(S): The most likely mechanism was secondary colonic hyperpressure owing to stenosis of the colorectal anastomosis. CONCLUSION(S): Young patients planning to conceive but scheduled to undergo colorectal resection should be made aware of the significant complication rate associated with this procedure and the promising results of nodule excisions. We recommend close monitoring of patients suffering from chronic constipation after resection for rectosigmoid endometriosis.

Modular bioreactor for primary human hepatocyte culture: medium flow stimulates expression and activity of detoxification genes.

Down-regulation of detoxification genes, notably cytochrome P450 (CYPs), in primary hepatocyte cultures is a long-standing and major concern. We evaluated the influence of medium flow in this model. Hepatocytes isolated from 12 different liver donors were cultured either in a multichamber modular bioreactor (MCmB, flow rate 250-500 µL/min) or under standard/static conditions, and the expression of 32 genes, enzyme activities and biological parameters were measured 7-21 days later. mRNA expression of genes involved in xenobiotic/drug metabolism and transport, including CYP1A1, 1A2, 2B6, 2C9, 3A4 (and activities for some of them), UDP-glucuronosyltransferase (UGT) 1A1, UGT2B4, UGT2B7, glutathione S-transferase (GSTα), and multidrug resistance protein 1 (MDR1) and MRP2, were specifically up-regulated by medium flow as compared with static controls in all cultures tested. In 2-week-old cultures, expression of detoxification genes reached levels close to or higher than those measured in freshly isolated hepatocytes. In contrast, CYP2D6 and most of other tested genes were not affected by medium flow. We conclude that medium flow specifically interferes with, and up-regulates, the activity of xenosensors and/or the expression of detoxification genes in primary human hepatocytes. Down-regulation of detoxification genes in conventional (static) cultures is therefore partly a consequence of the absence of medium circulation.

Use of human hepatocytes to investigate HCV infection.

Investigations on the biology of hepatitis C virus (HCV) have been hampered by the lack of small animal models. Efforts have therefore been directed to designing practical and robust cellular models of human origin able to support HCV replication and production in a reproducible and physiologically pertinent manner. Different systems have been constructed based on hepatoma or other cell lines, sub-genomic and genomic replicons, productive replicons, and immortalized hepatocytes. Although these models are practical for high-throughput screenings, they present several drawbacks related to the nature of the virions and the fact that the cells are not differentiated. Adult primary human hepatocytes infected with natural serum-derived HCV virions represent the model that most closely mimics the physiological situation. This chapter describes our experience with this culture model.