Reactive nodular fibrous pseudotumor: a first report of gastric localization and clinicopathologic review.

Reactive nodular fibrous pseudotumor (RNFP) of the gastrointestinal tract is a distinct benign lesion, which could originate from a reactive proliferation of multipotential subserosal cells. This is the first case to be reported in the stomach. It was fortuitously discovered in a 60-year-old man with history of bulbar ulcer and gastritis. Gross examination revealed three lesions in the gastric wall and an adjacent lesion in the lesser omentum. Histologically, lesions were composed of a proliferation of spindle and stellate cells in a dense collagenic hyalinized background containing a mononuclear cell inflammatory infiltrate with numerous lymphoid aggregates and plasma cells with perivascular disposition. Immunohistochemistry showed staining for cytokeratins (AE1/AE3), vimentin and smooth muscle actin, without staining for the neurofilament and S100 proteins, synaptophysin, calretinin, CD117 (c-kit), CD34, desmin, caldesmon or anaplastic lymphoma kinase (ALK-1). Complete excision was performed, and no evidence of disease was found 4 months later. After analysing clinical, morphological and immunohistochemical features of this entity, the main differential diagnoses will be discussed, including calcifying fibrous pseudotumor, which shares morphological characteristics with RNFP, but which immunohistochemistry and the ultrastructural study suggest that it may be a result of another reactive process.

What is the quality of information about bariatric surgery on the internet?

BACKGROUND: The purpose of this study was to evaluate the role of Internet on patients scheduled for bariatric procedures and the quality of information available on different websites. METHODS: Between July 2003 to July 2005, patients undergoing bariatric surgical procedures completed a survey. Data were collected prospectively. One hundred valid surveys were returned. Independently, two bariatric surgeons evaluated available French and English websites using major search engines. RESULTS: Forty-two of 100 patients (42%) sought information about bariatric surgery on the Internet. Seventy-four percent of these patients (n = 31/42) used search engines with 81% visiting less than ten websites. According to the patient's evaluation, 58% of the websites visited did not provide technical details of any surgical bariatric procedures, and only 61% provided information regarding postoperative weight loss. Furthermore, 58% of websites did not provide information about the laparoscopic approach, and 54% did not give any information on potential postoperative complications. Bariatric surgeon's evaluation was similar except for two differences: laparoscopic approach and postoperative weight loss information were discussed in 90% (p < 0.001) and 43% (p < 0.1) of visited websites, respectively. CONCLUSION: When the Internet was used to search for information about bariatric surgery, search engines were preferentially used but search duration was short. Available Internet websites can be considered as moderately reliable; however, 25% of visited websites contain misleading information. Comparison between patients and surgeons views showed that patients were effective in detecting misleading information.

[Is radionuclide imaging still usefull for thyroid nodule management? A surgical point of view]. / La scintigraphie thyroïdienne est-elle encore utile pour la prise en charge d'un nodule thyroïdien? Le point de vue du chirurgien.

Preoperative management of thyroid nodule is still controversial. Since 25 years ago, preoperative evaluation of thyroid nodule has been modified and improved. The aim of this study was to review, from a surgical point of view, the role of radionuclide imaging results in the management of patients with thyroid nodules.

[Open minimally invasive parathyroid and thyroid surgery]. / Mini-incisions pour thyroïdectomies et parathyroïdectomies.

Open minimally invasive parathyroidectomy or thyroidectomy (small-incision technique) are frequently performed. Benefits and disadvantages of this approach are discussed in this review. Preoperative patients selection is mandatory and is also discussed.

Robotic-assisted pelvic organ prolapse surgery.

BACKGROUND: This study describes technical aspect and short-term results of pelvic organ prolapse surgery using the da Vinci robotic system. METHODS: During a 1-year period, 18 consecutive patients with pelvic organ prolapse were operated on using the da-Vinci system. Clinical data were prospectively collected and analyzed. RESULTS: All but one procedure was successfully completed robotically (95%). Performed procedures were colpohysteropexy (n = 12), mesh rectopexy (n = 2), or sutured rectopexy combined with sigmoid resection (n = 4). Average setup time was 21 min and significantly decreased with experience. Mean operative time was 172 min (range, 45-280). There were no mortality and no specific morbidity due to the robotic approach. Mean hospital stay was 7 days. At 6 months, all patients were free of pelvic organ prolapse and stated that they were satisfied with anatomical and functional results. CONCLUSION: Our experience indicates that using the da-Vinci robotic system is feasible, safe, and effective for the treatment of pelvic organ prolapse.

Surgical management of combined rectal and genital prolapse in young patients: transabdominal approach.

BACKGROUND: The aim of this study was to determine the anatomical and functional outcomes of the simultaneous treatment of combined rectal and genital prolapse in young patients. METHODS: Between March 2001 and June 2002, eight female patients with symptomatic rectal and genital prolapse were enrolled in this study. The median age at the time of presentation was 44 years (range 34-53). All patients underwent simultaneous transabdominal treatment of their combined prolapse. Genital prolapse was treated by colpohysteropexy. Rectal prolapse was treated by mesh rectopexy or sutured rectopexy associated with sigmoid resection. The end evaluation to assess long-term results was performed after a median duration of follow-up of 17 months (range 10-24). Patients were asked about current problems with constipation, use of laxatives, incontinence and recurrence. RESULTS: The postoperative course was uneventful in 7 out of 8 cases. None of the patients had recurrence. Three patients out of 6 remained constipated postoperatively. One patient had a new onset of constipation postoperatively. None of the patients became faecally incontinent. Seven patients (87%) stated that they had improved overall after surgery. CONCLUSION: Combined rectal and genital prolapse in young women can be safely treated simultaneously using an abdominal approach. The genital prolapse should be treated by colpohysteropexy. The rectal prolapse should be treated by mesh rectopexy in patients who are not constipated, and by sutured rectopexy plus sigmoid resection in patients who are constipated preoperatively.

Laparoscopic approach for solitary insulinoma: a multicentre study.

BACKGROUND: Surgical resection of insulinomas is the preferred treatment in order to avoid symptoms of hypoglycaemia. During the past years, advances in laparoscopic techniques have allowed surgeons to approach the pancreas and treat these lesions laparoscopically. We analysed the feasibility, safety, and outcome of patients undergoing laparoscopic resection of insulinomas in a large, retrospective, multicentre study. METHODS: Thirty-six patients with pancreatic insulinomas were enrolled in this study. All patients were suspected of having solitary insulinomas after preoperative localisation tests and underwent a laparoscopic approach. Patients, operating characteristics and outcome were analysed. RESULTS: Mean patient age was 48 years (range 20-77 years). Insulinomas were localised in the head (n=7), isthmus (n=2), body (n=14) or tail (n=13) of the pancreas before laparoscopic approach. Mean size of the lesions was 15.5 mm (range 4-25 mm). The surgical procedure was enucleation in 19 cases (52%), spleen-preserving distal pancreatectomy in 12 cases (33%), spleno-pancreatectomy in three cases (8%), one duodenopancreatectomy and one central pancreatectomy. Conversion rate was 30%. The reason for conversion in seven patients (63%) was the inability to localise the tumour during the laparoscopic procedure. In six of these cases laparoscopic ultrasonography was not performed. Mean operating time was 156 min (range 50-420 min). Postoperative course was uneventful in 23 patients (64%). Eleven patients (30%) developed specific complications of pancreatic surgery: intra-abdominal abscess (n=6) or pancreatico-cutaneous fistula (n=5). Mean duration of fistulae was 55 days (range 5-130 days) and all the fistulae were dry at follow-up. After a mean follow-up period of 26 months (range 2-87 months), 33 patients (91%) are free of symptoms, and three patients have been lost to follow-up. CONCLUSION: The laparoscopic approach is safe to treat preoperatively localised insulinoma, with a morbidity rate comparable to that for the open approach. When the tumour is not found during laparoscopy, laparoscopic ultrasonography seems to be the most efficient tool to localise it and probably to prevent conversion.

[Endocrine tumors of the gastro-intestinal tract (Carcinoid tumors)]. / Prise en charge chirurgicale des tumeurs endocrines du tractus gastro-intestinal.

Surgical management of gastro-intestinal endocrine tumors has to be adapted to tumor localization and disease extension (local and general). The aim of this literature review was to define surgical management of these unfrequent tumors.

MICRA: a compact permanent magnet Fourier transform ion cyclotron resonance mass spectrometer.

MICRA, a compact Fourier transform ion cyclotron resonance (FT-ICR) mass spectrometer is described. The amount of miniaturisation in this device, based on a 1.24 T permanent magnet, remains compatible with genuine FT-ICR performance and analytical power in the mass range 2-1000 m/z, with a mass resolving power of 73,000 at mass 132. A first application of the transportability is the repetitive coupling of MICRA with a large-scale source of IR photons, the free electron laser CLIO.

Long-term results of transanal repair of rectocele using linear stapler.

PURPOSE: This study was designed to determine the long-term outcomes of transanal rectocele repair using a linear stapler. METHODS: Between 1989 and 1999, 21 patients with symptomatic rectocele were enrolled for this study. Median age at time of presentation was 52 (range, 21-75) years. All patients underwent a transanal repair using a linear stapler. End evaluation to assess long-term results was performed after a median duration of follow-up of 58 (range, 12-118) months. Patients were asked about current problems with constipation, use of laxatives, incontinence, vaginal digitalization, presence of vaginal bulge, pain, bleeding, and sexual dysfunction. RESULTS: The postoperative course was uneventful in all cases. Sixteen (76 percent) patients had symptomatic relief. The operation reduced symptoms of obstructed defecation (21 vs. 5, preoperative vs. postoperative; P < 0.001) and the need of vaginal digitalization (21 vs. 6; P < 0.001). Only three patients (14 percent) showed no sign of improvement. Two patients (9 percent) had temporary improvement for three years before recurrence. CONCLUSIONS: Transanal repair of rectocele using a linear stapler is an easy, safe, and useful procedure for the correction of symptomatic rectocele. Successful long-term outcome can be achieved with this procedure.

[Advantages of using robotic Da Vinci system for unilateral adrenalectomy: early results]. / Quels sont les avantages de l'utilisation du système robotique DaVinci pour réaliser une surrénalectomie unilatérale ? Résultats préliminaires.

STUDY AIM: The goal of this study was to report the early results of unilateral transperitoneal adrenalectomy using robotic Da Vinci system, and to compare them to the results of the laparoscopic standard adrenalectomy. METHODS: Prospective study included all patients operated on for unilateral laparoscopic or robotic adrenalectomy from November 2000 to November 2002. RESULTS: Twenty-eight patients underwent unilateral adrenalectomy using either standard laparoscopy (14 patients) or robotic Da Vinci system (14 patients). Mean duration of robotic adrenalectomy seemed to be longer than standard laparoscopy (111 vs. 83 min; P = 0.057). This tendency decreased while surgeons' experience was increasing. Mean duration of operating room activity was similar for both types of surgery. Peroperative events without conversion, conversion rate (7%), drainage, morbidity (21%), duration of hospitalisation were similar for both types of surgery. Duration of standard laparoscopic adrenalectomy was positively correlated to patients body mass index. This correlation was absent in patients operated on by robotic Da Vinci system. CONCLUSION: This preliminary study found no objective data demonstrating that robotic Da Vinci system was superior to standard laparoscopic approach for unilateral adrenalectomy. However, we think that it is necessary to continue further evaluation of this system to demonstrate its possible superiority.

[Does the size of pheochromocytoma influence the results of its laparoscopic excision?]. / La taille d'un phéochromocytome influence-t-elle les résultats de son exérèse par voie laparoscopique?

BACKGROUND: The tumor size is considered as a limitation for laparoscopic adrenalectomy. The aim of this study was to assess diagnostic characteristics, hemodynamic modifications, and outcome of intraperitoneal laparoscopic adrenalectomy according to the size of pheochromocytoma. METHODS: Retrospective study from January 1997 to December 2000. Results were evaluated according to the size of pathologic study (< or > or = 5 cm). RESULTS: Forty two patients underwent laparoscopic adrenalectomy during this period. Among them, 11 (26%) were operated on for adrenal pheochromocytoma (6 patients < 5 cm and 5 patients > or = 5 cm). Preoperative systolic hypertension was 138 mmHg and 178 mmHg respectively (p = 0.01). Urinary metanephrine/normetanephrine rate was 1.259 and 0.268 respectively (p = 0.08). Capsular tumor effraction rate was 27%. Tumor size was 37% larger than that estimated by CT scan (24% versus 52%). Mean hospital stay was 10 days and 8 days respectively. Morbidity and mortality were 18% and 0%. All these criteria were not statistically significant among the two groups of patients. CONCLUSIONS: Pheochromocytoma size > or = 5 cm do not modify outcome of patients but is responsible for preferential noradrenaline secretion and stronger hemodynamic modifications. Tumor fragmentation rate and CT scan size underestimation seem important in this group of patients. These characteristics have to be integrated to improve laparoscopic adrenalectomy outcome of patients with pheochromocytoma > or = 5 cm.

[How to prevent surgical morbidity after a total thyroidectomy for a multinodular euthyroid goiter?]. / Comment prévenir la morbidité chirurgicale de la thyroïdectomie totale pour goitre multinodulaire euthyroïdien?

AIM OF THE STUDY: Total thyroidectomy has been advocated for the treatment of multinodular nontoxic and benign goiter. The aim of this study, based on our experience, was to define the surgical factors which permit to decrease morbidity related to total thyroidectomy for multinodular euthyroid benign goiter. METHODS AND MATERIALS: In a retrospective study performed between January 1996 and September 2000, all records of total thyroidectomy for initial treatment of multinodular euthyroid benign goiter were reviewed. This study allowed to specify recurrent and parathyroid morbidity after surgery. RESULTS: There were 51 women and 13 men with a mean age of 47 years. Recurrent laryngeal nerve injury occurred in 2 patients. It resolved in 1 patient but was permanent in another (1.6%). Transient hypocalcemia was found in 8 patients (12.5%). One patient had permanent hypocalcemia (1.6%). CONCLUSION: The results of our serie are comparable to previous reports. Systematic identification of the recurrent laryngeal nerve, and preservation of the parathyroid blood supply permit to decrease the surgical morbidity.

[Usefulness of intraoperative 123I-MIBG during reoperation for malignant pheochromocytoma: a case report]. / Utilité de la détection 123I-MIBG peropératoire lors d'une réintervention pour phéochromocytome malin: á propos d'un cas.

Intraoperative MIBG radionuclear scanning has been used to improve pathological foci localization and surgical accuracy in patients with neural crest derived tumors. This intraoperative detection has been reported in less than 10 patients during reoperation for pheochromocytoma. We report a case of 123I-MIBG intraoperative detection allowing to improve surgical resection quality during reoperation for pheochromocytoma. The use of intraoperative MIBG radionuclear scanning is helpful when reoperation for pheochromocytoma is performed.

Gas phase infrared spectroscopy of selectively prepared ions.

The first example of direct structural characterization of polyaromatic ions by coupling a Fourier transform ion cyclotron resonance mass spectrometer with an infrared free-electron laser is presented. Measurement of the IR spectra of selectively prepared ionic reactive intermediates is allowed by the association of the high peak power and wide tunability of the laser with the flexibility of the spectrometer, where several mass selection and ion reaction steps can be combined, as demonstrated in the case of iron cation complexes of hydrocarbons. The present experimental setup opens the way to understanding chemical reaction paths.

Acute mesenteric venous thrombosis: case for nonoperative management.

OBJECTIVE: Initial treatment in the management of acute mesenteric vein thrombosis (MVT) is controversial. Some authors have proposed a surgical approach, whereas others have advocated medical therapy (anticoagulation). In this study, we analyzed and compared the results obtained with surgical and medical treatment to determine the best initial management for this disease. METHODS: We retrospectively reviewed the records of patients treated for MVT in a secondary care surgical department from January 1987 to December 1999. Before January 1995, our departmental policy was to perform surgery in patients with suspected MVT. Since January 1995, we have preferred a medical approach when achievable. Each patient in this study was assessed for diagnosis, initial management (laparotomy or anticoagulation), morbidity, mortality, duration of hospitalization, the need for secondary operation, portal hypertension, and survival rates. RESULTS: Twenty-six patients were treated, 14 before January 1995 (group 1) and 12 since January 1995 (group 2). Morbidity, mortality, secondary operation, portal hypertension, and 2-year survival rates were 34.6%, 19.2%, 15.3%, 19.2%, and 76.9%, respectively. No statistical difference was observed between the two groups. The mean duration of hospitalization was 51.6 days in group 1 and 23.2 days in group 2 (P < .05). Among the 12 patients treated by means of laparotomy with bowel resection, 10 patients (83%) had mucosal necrosis without transmural necrosis at pathologic study. CONCLUSION: Nonoperative management for acute MVT is feasible when the initial diagnosis with a computed tomography scan is certain and when the bowel infarction has not led to transmural necrosis and bowel perforation. The morbidity, mortality, and survival rates are similar in cases of surgical and nonoperative management. The length of hospital stay is shorter when patients are treated with a nonoperative approach. A nonoperative approach, when indicated, avoids the resection of macroscopically infarcted small bowel (without transmural necrosis) in cases that are potentially reversible with anticoagulation alone.

Solitary rectal ulcer syndrome: a series of 13 patients operated with a mean follow-up of 4.5 years.

Solitary rectal ulcer syndrome (SRUS) is an infrequent pathology often associated with pelvic floor disorders. The aim of this retrospective study was to review the long-term results of a surgical series of SRUS. Between 1988 and 1998, 13 patients were operated on for SRUS. Seven patients had associated internal rectal prolapse (58%), two had associated total rectal prolapse (15%), and two had associated mucosal prolapse (15%). We performed simple resection of the SRUS in one case (8%), a stoma as primary operation in one (8%), three rectopexies according to Orr-Loygue (23%), and eight Delorme's operations as modified by Berman (62%). Mean follow-up was 57 months (range 15-112). Simple resection of the solitary rectal ulcer syndrome did not improve symptoms. Colostomy permitted relief of symptoms and healing of the SRUS. Two of the three rectopexies achieved good results, and the third patient relapsed at the 6th postoperative month. A secondary modified Delorme's operation permitted relief of symptoms and healing of the SRUS. Five of the eight patients (62.5%) who received modified Delorme's operations had improved at a follow-up of 46 months. We conclude that, considering the high failure rate after surgery, operations should be performed only in patients with total rectal prolapse or intractable symptoms not amenable to behavioral therapy. Delorme's operation and abdominal rectopexy help in about 60% of cases.

Ovarian strumal carcinoid tumor responsible for carcinoid heart disease.

We report a case of right ovarian strumal carcinoid tumor responsible for tricuspid regurgitation. Valve replacement and salpingo-oophorectomy were performed. Serotonin level and tomodensitometry were normal at 3-year follow-up. Rarity of strumal carcinoid tumor explains why this tumor has never been reported with carcinoid heart disease before.