Skeletal myogenesis on highly orientated microfibrous polyesterurethane scaffolds.

Skeletal myogenesis is a complex process, which is known to be intimately depending on an optimal outside-in substrate-cell signaling. Current attempts to reproduce skeletal muscle tissue in vitro using traditional scaffolds mainly suffer from poor directionality of the myofibers, resulting in an ineffective vectorial power generation. In this study, we aimed at investigating skeletal myogenesis on novel biodegradable microfibrous scaffolds made of DegraPol, a block polyesterurethane previously demonstrated to be suitable for this application. DegraPol was processed by electrospinning in the form of highly orientated ("O") and nonorientated ("N/O") microfibrous meshes and by solvent-casting in the form of nonporous films ("F"). The effect of the fiber orientation at the scaffold surface was evaluated by investigating C2C12 and L6 proliferation (via SEM analysis and alamarBlue test) and differentiation (via RT-PCR analysis and MHC immunostaining). We demonstrated that highly orientated elastomeric microfibrous DegraPol scaffolds enable skeletal myogenesis in vitro by aiding in (a) myoblast adhesion, (b) myotube alignment, and (c) noncoplanar arrangement of cells, by providing the necessary directional cues along with architectural and mechanical support.

[Sleeve gastrectomy: a new approach to bariatric surgery]. / Sleeve gastrectomie: une nouvelle intervention en chirurgie bariatrique.

Over the last 15 years, obesity surgery has developed tremendously. The two most frequently practiced procedures are the adjustable gastric ring and gastric by-pass. A new intervention has recently appeared: the sleeve gastrectomy, an essentially restrictive intervention consisting of a vertical gastrectomy including the entire greater curvature of the stomach while leaving in place an approximately 100-ml gastric tube along the lesser curvature. This intervention was initially proposed as the first part of a duodenal switch in patients whose body mass index was greater than 60 kg/m2. Since then, these indications have developed and this intervention now enjoys a certain fervor on the part of bariatric surgery teams. The objective of this mini-review is to detail the technical aspects of this procedure, its morbidity and mortality, and the long-term results, although there are currently few teams with more than 3 years of experience.

Roux-en-Y gastric bypass after failed vertical banded gastroplasty.

BACKGROUND: Vertical banded gastroplasty (VBG) was the restrictive procedure of choice for many years. However, VBG has been associated with a high rate of long-term failure. We reviewed our experience of conversion of failed VBG to Roux-en-Y gastric bypass (RYGBP). METHODS: The data on all patients undergoing conversion of failed VBG to RYGBP were reviewed. Failed VBG was defined as insufficient weight loss (BMI > 35 kg/m2) and/or VBG-related complications. RESULTS: We performed 24 conversions from VBG to RYGBP. Median age was 40 +/- 8 years (range 28 to 61). Preoperative weight was 111 +/- 25 kg (range 85 to 181), and median BMI was 41 +/- 8 kg/m2 (range 30 to 69 kg/m2). Indication for conversion was: VBG failure in 18 patients and VBG complications in 6 patients. A gastrectomy (total or proximal) had to be performed in 5 cases (21%). The conversion was performed by laparoscopy in 13 cases. Postoperative complications occurred in 4 patients (16.7%). There were no leaks, nor mortality. Postoperative BMI was 31 kg/m2 (range 25 to 42) at a median follow-up of 12 months (range 3 to 36 months). The average percentage of excess weight loss was 62% at 1 year. CONCLUSION: VBG has been associated with a significant reoperation rate for failure and/or complications. Conversion to RYGBP is effective in terms of weight loss and treatment of complications after VBG. Gastrectomy and resection of the staple-line could reduce such complications as leaks and mucocele. Although technically challenging, conversion of VBG to RYGBP is feasible, with acceptable morbidity and no mortality. The conversion is feasible laparoscopically.

[Reflection on one case of acute peritonitis due to adjustable gastric banding during pregnancy]. / Réflexion sur un cas de péritonite aiguë sur anneau gastrique modulable pendant la grossesse.

Improving the information delivered to pregnant women with adjustable gastric banding is desirable. Indeed, we report a case of peritonitis on gastric banding due to Klebsiella pneumoniae complicated with fetal death. Then, we discuss the specific risks of infection on the gastric band during pregnancy. Although, according to the literature, prophylactic fluid removal from the band in early pregnancy is not recommended, data about complications in pregnancy due to gastric banding are limited.

[Laparoscopic sigmoid resection for diverticulitis: is learning phase associated with increased morbidity?]. / Sigmoïdectomie laparoscopique pour diverticulite: la phase d'apprentissage est-elle associée à une sur-morbidité?

AIM: To assess retrospectively the results of laparoscopic sigmidectomy for diverticulitis, with intent to treat, in 58 consecutive patients operating by one surgeon compared with a control group operating by laparotomy. MATERIALS AND METHODS: From 1995 to 2001, 90 consecutive patients undergoing elective sigmoid resection for diverticulitis were divided into 3 groups: laparotomy (Group 1 : n = 32), first cases of laparoscopy (Group 2 : n = 29) and last cases of laparoscopy (Group 3 : n = 29). These 3 groups were similar according to age, sex, Body Mass Index (BMI), American society of anesthesia score (ASA), previous abdominal surgery, number of attacks of diverticulitis, and time between last attack and surgery. Following criteria were studied: operating time, conversation rate, intra-operative and post-operative morbidity, return of intestinal transit, and hospital stay. RESULTS: During laparoscopy, conversion was mandatory in 24% of the cases (7/29) in group 2 and 14% in group 3 (4/29; NS). No intra-operative morbidity was noted in the 58 laparoscopies. Mean operative time was 240 min in group 1, 259 min in group 2, and 241 min in group 3 (NS). Postoperative morbidity was observed in 31% of patients in group 1, 34% in group 2, and 10% in group 3 (p = 0.02). Returm of intestinal transit and oral ingestion and mean hospital stay were significantly shorter in group 2 and group 3 versus group 1 (p < 0.05). CONCLUSION: Our results confirm previous data demonstrating faisability of laparoscopic sigmodectomy for diverticulitis and its benefice in terms of return of intestinal transit and hospital stay. Furthermore, our study suggest that when surgeon gain experience, conversion rate, morbidity and operative time can be reduced.

A new etiology of acute abdominal emergencies in cirrhotic patient: secondary pneumococcal peritonitis with jejunitis.

We report the first case of secondary pneumococcal peritonitis associated with acute jejunitis in a 52-year-old homeless Child-Pugh C cirrhotic man without ascitis. The patient was admitted with clinical signs of peritonitis, and jaundice. Morphologic examination was unremarkable. A laparotomy revealed a diffuse peritonitis, and an acute jejunitis with prenecrotic lesion. The lesion was located within the first centimeters of the jejunum, immediately after the duodeno-jejunal angle, extented on 15 cm. A resection of the first 15 cm of the jejunum was performed with duodeno-jejunal side-to-side manual anastomosis. Gram-stain and cultures of blood, peritoneal pus, and jejunal mucosa revealed a penicillin-sensitive Streptococcus pneumoniae. Appropriate parenteral antibiotic treatment was initiated (aminopenicillin). The postoperative course was marked by a transient hepatic failure associated with an ascitis controlled by diuretics. The patient was discharged on the 26th day after surgery. This case reports a new etiology of acute abdominal emergencies in cirrhotic patients.