[Longitudinal sleeve gastrectomy as a stand-alone bariatric procedure: Results of a multicenter retrospective study]. / La gastrectomie longitudinale (sleeve gastrectomy) comme unique chirurgie bariatrique : résultats d'une étude rétrospective multicentrique de 446 patients.

INTRODUCTION: Sleeve gastrectomy as an isolated procedure is a new option in bariatric surgery. The aim of this study was to evaluate its short and medium term (2 years) results in a multicenter setting. MATERIALS: This is a retrospective study including 446 patients undergoing surgery in 14 teaching, private, and public hospitals. RESULTS: The immediate post-operative course were uneventful in 83.3% of patients. Minor complications occurred in 10.9% of patients and major complications in 5.3%. Suture line leaks occurred in 4.3% of the whole series. There was no mortality and the rate of reoperation was 2%. Overall mean weight loss after two years was 32 kg and the mean excess weight loss was 62%. Weight loss was significantly greater in non super-obese patients (p=0.0003). CONCLUSIONS: This study confirms the feasibility of sleeve gastrectomy in a multicenter setting; it is efficacious at two years as an isolated bariatric procedure for non super-obese patients. It is possible that an additional second-stage procedure may be necessary for super-obese patients.

[Adjuvant chemotherapy followed by conformal chemoradiotherapy in gastric carcinoma]. / Chimiothérapie adjuvante suivie d'une chimioradiothérapie conformationnelle dans les cancers de l'estomac.

PURPOSE: Analysis of the feasibility and results of adjuvant chemotherapy followed by conformal chemoradiotherapy after surgery for gastric carcinoma. PATIENTS AND METHODS: Twenty-six patients (R0 or R1) were treated postoperatively by three cycles of 5-fluorouracil (5-FU) and cisplatin, followed by a concomitant association of LV5FU2 chemotherapy with a conformal radiotherapy of 45 Gy. RESULTS: The tumor was classified pT3-T4 in 77% of the patients and 92.5% had a nodal involvement (pN1: 54%; pN2: 31%). FEASIBILITY: (1) Adjuvant chemotherapy: nausea/vomiting grade II/III: 12 patients (48%); neutropenia grade III/IV: two patients; completed in all patients, except one. (2) Chemoradiotherapy: nausea/vomiting grade II/III: 10 patients; diarrhea grade II/3: two patients; oesophagitis grade II/III: two patients; myocardial infarction/pulmonary embolism: two patients. All patients except one received the planned dose of 45Gy. Radiotherapy was interrupted in six cases, with a median duration of 14 days. Survival: with a median follow-up of 30 months, 65% of the patients were alive without disease; median survival was 32 months. CONCLUSION: This postoperative schedule was judged feasible. It allowed the deliverance of a more intensified chemotherapy than the classical schedule. Its clinical benefit must be evaluated in a phase III trial.

[Memory, brain, a machine for learning and rememberingy]. / Le cerveau, machine à apprendre et à mémoriser.

Following a previous paper describing how memory appeared in the nervous system in mammalians, during evolution, and how its significant growth led to hominization, the present paper intends to show the prevailing place it occupies in human brain. Memory, an attribute of cortex, is an engraving of neuronal circuits created during information analysis of data input in the cortex. It is created either by repetition of information or by increase in brain activity, under the influence of a central brain system. In the brain of human newborns, immature and unprogrammed, but endowed with a great capacity for learning, the whole organization and programming will be possible through learning and remembering. Communication pathways between functions are memory pathways. Brain becomes a memory machine and every cortical area is a memory territory. Its lesion results in a disturbance corresponding exactly to forgetting what has been stored in that territory.

[Memory: a view of the history of central nervous system]. / La mémoire dans l'histoire du système nerveux.

In order to stress the role and importance of memory in human nervous system, this first paper intends to show how it appeared during evolution with the cortex of brain hemispheres and how its significant growth is the cause (and not consequence) of hominization. This growth seems related to a discontinuation of the fetal period during gestation. It leads to birth before the brain is mature, substituting a genetic maturation by an epigenetic maturation through learning. This discontinuation of pregnancy is related to a purely mechanical and obstetrical cause, depending on maternal pelvis. Evolution from quadrupedia to bipedia transformed the pelvis, obliging the newborn to make his way not downward but forward, through a narrow inextensible pass. This history of memory, showing its role in human species evolution, may lead to a reflection on its role in the evolution of all the species possessing a cortex. Above all, it will allow to understand how and in which way human brain is a sort of machine totally associated with memory.

[Affectivity in the nervous system]. / L'affectivité dans le système nerveux.

Affectivity is an ambiguous term, related altogether to, mood, well-being, ill-being, emotional states, and at the same time to individual sensitivity, capacity to feel moved, as well as feelings and passions. We want to show that those states, as different as they may seem, belong to the perception by the central nervous system of past or present modifications, of an organism reacting to situations it has to cope with. Opposite to common opinion, this affectivity is not "generated" by the cerebral cortex but by the central brain. It results from memory input by the limbic system and from information processing by the hypothalamus and the reticular system, and from processing of mood and emotional rates provoked by self reactions in order to perpetuate survival, protection or one's own species. Considered as "favourable" or "unfavourable" after analyses by the limbic cortex, those states become in the central brain "pleasure" or "aversion", and generate motivation for action, to follow-on or to stop. From the limbic cortex, those motivations are transmitted to the contiguous prefrontal cortex. The prefrontal cortex is a center for action imitation. One may imagine it as a center for conscious cortical activity and for affective memory. This organisation of affectivity and affective memory settings in 2 different centers and at two different levels of the nervous system: the limbic cortex and the prefrontal neo-cortex. The prefrontal neo-cortex only is conscious, but the limbic cortex, although unconscious, is a source of motivation. One is led to describe an unconscious affectivity. It is impossible to talk about this affectivity without mentioning Freud's unconscious.

[Pleasure, pain and affectivity in the nervous system]. / Le plaisir, la douleur et l'affectivité dans le système nerveux.

Affectivity plays an essential role in human life. It gives life its quality, and is responsible for what human beings have always considered to be main endeavor happiness. Still, looking for its description or organisation, in physiology or neurology, treatises is fruitless; there only one of its components is described pain, with no mention of pleasure. We wish to show, here, first, that pain and pleasure, depend of a same function, of which they are, of sorts, both extremities, and which in nothing but the most primitive function of the nervous system, and secondly, that this function in one of the components of an "affectivity center", which has its organisation in the limbic system. This center, integrating all the informations that arrives to the nervous system, triggers to each of them neuro-vegetative and neuro-hormonal informations that are "felt" by the organism, and thus transforms the information in a subjective feeling.

Primary intestinal gamma-delta T-cell lymphoma with evidence of Epstein-Barr virus.

AIMS: Primary intestinal T-cell lymphomas account for about 5% of all primary gastrointestinal lymphomas and are mostly associated with coeliac disease. They usually express the CD3-associated T-cell receptor alpha/beta heterodimer and HML1, and some are related with Epstein-Barr virus (EBV). As far as we know, the present report describes the first case of primary gamma-delta (gamma delta) EBV-associated intestinal T-cell lymphoma without enteropathy. Only hepatosplenic, nasal and cutaneous gamma delta T-cell lymphomas have previously been described. METHODS AND RESULTS: Our case concerned a 43-year-old man with no history of coeliac disease, who presented with multifocal small bowel involvement showing high grade T-cell lymphoma with medium sized and large pleomorphic cells and a small pleomorphic T-cell component. Angioinvasion and angiocentricity were occasionally present. Immunohistochemical studies of lymphoma cells showed a T-cell gamma delta phenotype (CD3+, CD2+, TCR delta 1+, V delta 2+ and beta F1-) without expression of CD4, CD8, CD5, or HML1. Most tumour cells were positive for the cytotoxic granular proteins TiA1 and granzyme B. Rearrangement of the TCR gamma chain gene was demonstrated by polymerase chain reaction and in-situ hybridization with EBER probes revealed strong nuclear positivity in virtually all neoplastic cells. CONCLUSION: We described the first case of primary intestinal gamma delta T-cell lymphoma without enteropathy in which EBV might fulfil a pathogenic role.

[Human language and the immaturity of the human brain at birth]. / Le langage de l'Homme et l'immaturité du cerveau humain à la naissance.

Language does not exist because of a specific structure in the human brain. It uses actually specialized areas dedicated to other functions such hearing and oro-pharyngo-laryngeal motricity. Language needs a long apprenticeship which is possible because the human brain is able to learn. This ability to learn is probably due to a "brain immaturity" at birth. This immaturity may be interpreted as the consequence of an "interruption" of the gestation period.

Cutaneous sparganosis in France: the second case described from Europe. Case report.

The first case of sparganosis is reported from France. The patient, a 21-year-old man, presented with a subcutaneous lump on the chest, and the diagnosis was made on histological examination after needle biopsy. He achieved a complete recovery.

Predicting common bile duct lithiasis: determination and prospective validation of a model predicting low risk.

BACKGROUND: The aim of this two-part prospective study was: (1) to identify simple, noninvasive, preoperative factors associated with low or very low risk of common bile duct lithiasis (CBDL); and (2) to test the validity of the statistical model obtained during Part One by the postcholecystectomy follow-up of patients classified into a low-risk group. PATIENTS AND METHODS: In Part One of the study, preoperative clinical, biologic, and ultrasonographic data, and intraoperative cholangiographic findings were collected from 503 consecutive patients undergoing cholecystectomy for symptomatic lithiasis from 1985 to 1989. Using the data obtained in Part One, a linear logistic model was used prospectively in Part Two to determine the prediction of absence of CBDL in 279 consecutive patients. No jaundice, normal transaminase levels, common bile duct (CBD) diameter < 8 mm, and no intrahepatic duct enlargement defined the low-risk group of CBDL. RESULTS: In Part One, CBDL was present in 84 (17%) of all patients. Five parameters were used to classify 73% of all patients as low risk of CBDL and 27% as high risk. In the low-risk groups, CBDL was present in 1% of 116 cases with acute gallbladder complications, and 5% of 250 cases with no acute gallbladder complications. In Part Two, 171 (61%) patients were classified in the low-risk group (Group 1), and CBD stones were not sought by any additional preoperative investigations or intraoperative cholangiography (IOC). One hundred eight patients (39%) were considered at risk of CBDL (Group 2). Mean follow-up was 20.6 months (median 19); 2 patients (1%) in the low-risk group presented a symptomatic retained stone. CONCLUSIONS: This study validated this simple model for predicting risk of CBDL and avoiding invasive preoperative investigations--as well as IOC--in more than 60% of symptomatic cholelithiases. In addition, this model seemed useful for defining patients in whom further exploration for CBDL was justified, since 42 (39%) of the 108 Group 2 patients were proved to have CBDL.

[Consciousness]. / Essai sur la conscience.

"Consciousness" is the feeling that each individual has of his own existence (self-awareness) and also the state which permits him to perceive his environment (consciousness and wakefulness). These two types of consciousness, apparently quite different, are in fact the two converging stems of the perceptions that the nervous system provides to the organism. To explain this better, it is necessary to refer to the evolution of the nervous system organization among the species and to imagine what perception the nervous system provides at each stage of this evolution, or in each species harbouring a nervous system corresponding to a given stage. At the beginning, the role of the nervous system is to protect the organism and only by an automatic and reflex organization. It corresponds to an unconscious alertness which permits to perceive the environment; it is the prefiguration of the future consciousness. Self-awareness seems to appear with the centrencephalic and limbic structures which are the highest part of the nervous system in the inferior mammals and the central part in man. At this stage, acquisition memory and affectivity with its different manifestations (emotions, mood, pain...) are established. This kind of consciousness is difficult to imagine since it is only sensorial and affective. Mental consciousness appears with the mental activity in the cerebral hemispheres. It is more than likely that it exists in the superior mammals though it is impossible to imagine what it corresponds to. It reaches the highest development in the man in whose the frontal lobes have the largest extent. Speech is the most striking figure of this development. At each stage of the evolution, consciousness expresses the nervous system activity, centered on a perception, the level of which corresponds to the improvements occurring at each stage and superadded to the previous ones. Hence it is obvious that consciousness has no specific center or pathway. It relies upon structures that participate in triggering and regulating the nervous activity and that utilize the particular centers of perception and analysis. These structures are: the reticular formation and the diffuse thalamic system.(ABSTRACT TRUNCATED AT 400 WORDS)