Preliminary experience with umbilical stoma in transumbilical single-port colorectal surgery.

BACKGROUND: The umbilicus, an embryological natural orifice, is increasingly used as the only access route during single-incision laparoscopic surgery (SILS) for colorectal disease. As a part of some of these procedures, a temporary, diverting ostomy could be exteriorized through the umbilicus itself. Theoretical advantages include better preservation of the abdominal wall and potentially superior cosmetic results. The aim of the present study was to evaluate our preliminary experience in SILS colorectal resection with umbilical stoma (u-stoma). METHODS: We retrospectively reviewed all colorectal patients operated using SILS for benign or malignant disease at Paris Poissy Medical Center. Patients were selected for consideration of u-stoma with our stoma therapists. RESULTS: Between January 2010 and December 2016, 234 patients underwent colorectal SILS procedures. In 74 patients (31.6%), an ileostomy (n = 41) or a colostomy (n = 33) was fashioned. Of these, 20 (27% of all ostomies) were umbilical stomas. The 20 u-stoma patients, 10 men and 10 women, received either a loop ileostomy (n = 14) or an end (n = 4) or loop (n = 2) colostomy. The mean age was 52 years (range 29-81 years). There was no mortality. Operative stoma-related morbidity occurred in only 5% of patients (n = 1: ileal torsion volvulus). Median follow-up after stoma formation was 30 months (range 12-59 months). Adjustment to the stoma and quality of life were satisfactory as estimated by both the patient and the stoma therapist. All stomas were reversed. At a median follow-up of 27.5 months (range 7-55 months) after stoma reversal, two patients had reoperation for incisional hernia. CONCLUSION: This preliminary experience showed that u-stoma is a feasible and safe alternative to more conventional ostomy after SILS.

[Computed tomography-based virtual colonoscopy: an examination useful for the choice of the surgical management of colorectal endometriosis]. / Coloscanner à l'air avec coloscopie virtuelle: arguments dans le choix du traitement chirurgical des endométrioses colorectales.

OBJECTIVE: To evaluate the use of computed tomography-based virtual colonoscopy in the preoperative assessment of colorectal endometriosis. PATIENTS AND METHODS: We included in the study consecutive women undergoing surgical management of deep infiltrating endometriosis from August 2009 to April 2010, whose colorectal involvement had been assessed by magnetic resonance imaging (MRI) and rectal endoscopic sonography (RES). Prior to surgical procedure, a computed tomography-based virtual coloscopy was performed. Computed tomography was performed by insufflating air into the distal rectum, along with an intravenous injection of contrast agent. Then, 3D reconstruction of pictures was carried out, to allow visualization of the lumen of the rectum and the colon. Data provided by virtual colonoscopy were compared to those given by other imaging techniques and surgical exploration. RESULTS: Twenty-seven patients were included in the study: 7 women underwent colorectal segmental resection, 2 full thickness excision, 15 shaving, while in 3 of them no digestive surgical step was performed. Virtual colonoscopy provided the measurement of the length and the diameter of colorectal stenosis due to infiltrating nodule through rectal and sigmoid wall, which was presenting as an endoluminal indentation. The number of patients presenting with endometriotic nodules arising on the rectum, sigmoid colon, or both of them, were respectively 13, 7 and 7. Ovarian endometriomas were responsible for extrinsic compression leading to digestive tract stenosis in nine cases. The number of lesions and their height reported to the anus were accurately assessed in 24 women out of 27 (sensitivity of 88%). The origin of the digestive tract stenosis, i.e. either infiltrating endometriotic nodules or extrinsic compression due to ovarian endometriomas, was accurately assessed in all cases, by combining information provided by virtual colonoscopy, IRM, RES and transvaginal ultrasonography. CONCLUSION: Computed tomography-based virtual colonoscopy provides useful information about the degree and the height of digestive tract stenosis due to colorectal endometriosis. In our opinion, this information is of major interest to argue the choice of shaving or full thickness excision of nodules in a majority of women presenting with colorectal endometriosis.

[Functional MR urography in children]. / Uro-IRM fonctionnelle chez l'enfant.

MR Urography (MRU) provides both morphologic and functional information without radiation exposure. It enables the assessment of split renal function, excretion, and quantification of obstruction. MRU is thus complementary to ultrasonography in the assessment of pre- and post-natal obstructive uropathies in children. If available, MRU should be definitely preferred to intravenous urography.

[Treatment of thoracolumbar junction burst fractures (Magerl A3) by balloon kyphoplasty: anatomic study]. / Traitement des burst fractures (Magerl A3) de la charnière thoracolombaire par cyphoplastie à ballonnets: étude anatomique.

PURPOSE OF THE STUDY: Balloon kyphoplasty is a not widely used method for the treatment of vertebral burst fractures with displacement of the posterior wall. The purpose of this study was to measure the posterior height of the vertebral body and the posttraumatic canal surface area before and after balloon kyphoplasty for the treatment of burst fractures (Magerl A3). MATERIAL AND METHODS: This anatomic study was conducted on ten experimental burst fractures of the thoracolumar junction prepared on cadaver specimens. The surface area of the canal and the height of the posterior wall were measured by computed tomography before and after balloon kyphoplasty. These two variables were then compared with search for correlation. RESULTS: The posttraumatic canal surface area increased significantly after kyphoplasty (p=0.02). Gain in posterior height was not significant and there was no correlation between the two variables. Cement leakage into the canal was not observed. DISCUSSION: It is known that balloon kyphoplasty can re-establish anterior height and correct for the posttraumatic kyphosis in patients with compression fractures of osteoporotic vertebrae. The present cadaver study shows that when the posterior wall is displaced posteriorly, balloon expansion does not exaggerate the wall displacement. On the contrary, the posttraumatic canal surface area is increased due to the ligamentotaxis effect. CONCLUSION: Balloon kyphoplasty could be an alternative to posterior instrumentation for burst fractures without associated neurological deficit, even if the posterior wall is damaged. This technique can be used to reduce and stabilize the fracture while sparing the adjacent levels and limiting the risk inherent with an extensive surgical approach.

[Laparoscopic surgery of profund endometriosis with rectal affect]. / Chirurgia laparoscopica a endometriozei profunde cu atingere rectala.

OBJECTIVE: To present the principles of laparoscopic treatment for rectal endometriosis and to discuss possible postoperative outcomes. MATERIAL AND METHODS: Our series included women managed for rectal endometriosis during consecutive 20 months in the Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen--France. Patient's characteristics, symptoms, imaging examination results, surgical treatment and postoperative outcomes were all evaluated retrospectively. RESULTS: Sixteen patients presenting with rectal endometriosis were managed surgically, (mean age was 35.9 +/- 6.5 years). All women presented at least one severe painful symptom which was typical of a digestive involvement in 12 cases. MRI results suggested a rectal involvement in 14 cases, and endorectal ultrasound examination clearly showed rectal wall infiltration in all patients. The gynaecological stage of surgical treatment was carried out laparoscopically in 13 cases, and the digestive surgical stage in 7 cases. Two limited and 14 segmental rectal resections were performed. Transitory stoma was carried out in 9 women. The length of the surgical procedure depended on the number of endometriosis localizations with a median value of 6 h 30 min. Postoperative complications occurred in 6 women: 2 anastomosis stenosis, 1 anastomosis fistula, 1 abscess of the parietal wall and 1 bladder atonia. Complains of pain were completely or significantly improved in all cases. CONCLUSION: Surgical treatment for rectal endometriosis may be carried out laparoscopically. It should be reserved for women presenting with severe painful condition and may contribute to significant improvement. However, the balance of benefit and risks must also be assessed on a case to case basis prior to any decision for or against surgical treatment.

[Treating severe endometriosis by pregnancy: a risky business]. / Traitement de l'endométriose sévère par la grossesse: un pari risqué

We report the case of a young woman presenting with painful deep and rectal endometriosis. This condition had started long ago while the diagnosis had been delayed. Brutal colon occlusion followed the discontinuation of oral contraception. Left colectomy with terminal colostomy was carried out in emergency. The conservative surgical management of deep endometriosis was performed three months later. In women presenting deep endometriosis, the discontinuation of hormonal treatment in order to attempt a spontaneous pregnancy should not be recommended before undertaking a thorough endometriosis and fertility status investigation.

Dynamic MR urography in urinary tract obstruction: implementation and preliminary results.

BACKGROUND: Recent studies have demonstrated magnetic resonance (MR) capabilities in evaluating renal morphology and function in patients with urinary obstruction. The objective of this report is to support the introduction of dynamic MR renography on any MR equipment. METHODS: A custom-made device of vials filled with different concentrations of gadolinium was studied by combinations of T1-weighted gradient-echo sequences and coils. We compared the capabilities of two coils (phased array vs. standard body), the properties of dynamic sequences, and the effects of increasing concentrations of gadolinium on signal intensity. In a second section, we designed MR urography plug-ins of Image J (DICOM image software) for the analysis of dynamic studies. RESULTS: Optimized gradient-echo sequences acquired with a phased array body coil produced acceptable quality images with a linear relation between signal intensity and the lowest concentrations of gadolinium. In vitro measurements showed loss of linearity above 8 mmol/L. CONCLUSION: Theoretical calculation and data from the literature suggest that the gadolinium dose to the patient should not exceed one-fourth of the usual one (0.025 mmol/kg). Postprocessing using Image J software and the specifically designed plug-ins was validated. The collection of plug-ins is now available on the Internet.

Alterations of the Wnt signaling pathway during the neoplastic progression of Barrett's esophagus.

Aberrant activation of the Wnt signaling pathway has been reported during neoplastic progression in Barrett's esophagus (BE). However, mutations in APC and CTNNB1 genes were rarely observed. In this study, expression pattern of Wnt ligands, Frizzled receptors and APC, as well as the methylation status of the APC, SFRP1 and SFRP2 promoter genes were investigated in normal esophageal mucosa and in preneoplastic and neoplastic lesions of BE patients. Promoter methylation of APC was found in all BE samples and in 95% of esophageal adenocarcinomas (EAC). Full methylation of APC correlated with lack of expression. In EAC, nuclear translocation of beta-catenin was observed regardless of the expression of APC. WNT2 expression was higher in dysplasia and EAC than in BE, with 20/26 (77%) of the EAC showing high expression of WNT2. SFRP1 methylation occurred in all BE samples and in 96% of EAC, while SFRP2 was methylated in 73% of the normal squamous esophageal mucosa samples. In conclusion, (1) alterations of key regulators of the Wnt signaling are frequent in the pathogenesis of BE; (2) the APC and SFRP1 genes are inactivated by promoter methylation in BE; (3) the WNT2 gene is upregulated along the progression from low-grade dysplasia to EAC.

[Medium-term tolerance of anterior chamber implants in surgical treatment of severe myopia]. / Tolérance à moyen terme des implants myopiques de chambre antérieure dans le traitement chirurgical de la myopie forte.

PURPOSE: To determine the tolerance of the corneal endothelium and of the haemato-ocular barrier of phakic highly myopic eyes implanted with an anterior chamber I.O.L.ses. METHODS: Twenty-one phakic highly myopic were operated on with a Z.B.A.C.I.O.L. (manufactured by Domilens) by the same surgeon from May 1989 to June 1990. Complete examination including specular microscopy have been performed before surgery and each 6 months and a Laser Flare Cell Meter at 3 years was performed on 14 eyes. RESULTS: Two eyes of the same patient had to be explanted after surgery for important endothelial cell loss. The 19 others had no complication: no cataract, no loss of endothelial cells, no retinal detachment. 14 eyes examined with a Laser Cell Flare Meter had results within normal limits. So, 19 out of 21 eyes implanted for high myopia with Z.B.A.C.I.O.L. have excellent results 4 years after surgery. CONCLUSION: Regarding these results, it seems possible to use this technique again with the new designed Anterior Chamber I.O.L.. Rigorous follow-up of all the implanted eyes is however required.

Genetic structures of the B2 and B1 Escherichia coli strains responsible for extra-intestinal infections.

Escherichia coli strains causing human extra-intestinal infections may be divided into two groups, B1 and B2 according to the electrophoretic patterns of carboxylesterase B. This study compares the restriction fragment length polymorphism (RFLP) of ribosomal DNA (rDNA) for 45 B1 strains and 45 B2 strains to examine the genetic structure of B2 strains and to distinguish them from B1 strains. The isolates were chosen for diversity in their allozymes of esterases, B, A, C and I, their production of virulence factors (alpha-haemolysin, mannose resistant haemagglutinin and cytotoxic necrotizing factor) and certain O antigens, and their pathological and geographical origins. DNA was digested with HindIII and BamHI restriction enzymes and analysed by Southern blotting. The resulting rDNA RFLP patterns of B2 strains were distinct from those of the B1 strains. Moreover, the B2 strains appeared to be less heterogeneous than the B1 strains. The B2 strains gave 13 ribotypes (resulting from the combination of the rDNA RFLP patterns obtained with HindIII and BamHI digestions) while the B1 strains gave 32 ribotypes. Correspondence analysis of the data showed that several clusters of strains were identified in the B2 strains by particular ribotypes, certain associations of esterase B and A electrophoretic variants, O serotypes and virulence factor production. In contrast, these parameters appeared to be unrelated in the B1 strains, reflecting their heterogeneity. These findings, which differentiate two levels of genetic heterogeneity within E. coli pathogenic isolates, indicate that the B2 strains constitute a phylogenetically distinct group within the species.

Characterization of Escherichia hermannii by ribosomal DNA restriction fragment length polymorphism.

Ribosomal DNA polymorphism was used to characterize strains of Escherichia hermannii and to differentiate them from E. coli. DNA from 11 E. hermannii strains previously separated into three zymotypes by enzyme electrophoretic polymorphism was digested with HindIII and EcoRI restriction enzymes and analyzed by Southern blotting. The 10 ribotypes obtained with EcoRI fell into 3 groups which correlated with the corresponding zymotypes, and the 5 ribotypes obtained with HindIII were clearly distinct from those of E. coli strains.

[Psychological aspects of bone marrow donation in donor brothers and sisters in bone marrow transplantation]. / Les aspects psychologiques du don de moelle chez les frères et soeurs donneurs dans la transplantation de moelle osseuse.

It appears to be necessary to consider, during a bone marrow transplantation, brothers and sisters who are donors. These children face psychological difficulties, which are not always understood by medical staff and families who are mainly concerned with the health of the sick children. Systematic meetings with a hundred donors point out the distress experienced in these situations.

Correlation between DNA polymorphism and enzyme polymorphism argues in favour of the delineation of two species within Providencia alcalifaciens.

Ribosomal DNA (rDNA) polymorphism was compared to enzyme polymorphism and DNA/DNA hybridization data for the intraspecies differentiation of Providencia alcalifaciens. DNA from 27 strains previously classified into two zymotypes A1 and A2 and discriminated by two levels of DNA/DNA hybridization (delta Tm values of 0 to 1 degree C and 6 to 10 degrees C, respectively) were analysed by Southern blotting for rDNA polymorphism. The ribotypes fell into two ribogroups A1 and A2, which correlated with the corresponding zymotypes. This correlation argues for the proposed creation of two species within P. alcalifaciens.

Characterization of highly virulent Escherichia coli strains by ribosomal DNA restriction fragment length polymorphism.

Patterns of ribosomal DNA polymorphism were examined to compare carboxylesterase B type B1 strains and B2 strains of Escherichia coli isolated from extra-intestinal infections. DNA from 14 type B2 strains showing the presence of alpha-haemolysin and mannose-resistant haemagglutinin and lethality to mice and 14 type B1 strains lacking these characteristics, was digested with HindIII, EcoRI, BamHI or BglII restriction enzymes and analysed by Southern blotting. The obtained ribotypes clearly differentiated the B2 strains from the B1 strains. These results indicate that genotypes of the highly virulent B2 strains are different from that of the less virulent B1 strains.

Comparison of molecular epidemiological tools for Branhamella catarrhalis typing.

Twenty-one Branhamella catarrhalis strains selected for their diversity by esterase electrophoretic polymorphism, and belonging to 20 distinct zymotypes, were studied by restriction fragment length polymorphism (RFLP) of total DNA after ethidium bromide staining and of ribosomal DNA regions (ribotyping). The former analysis allowed the distinction of 20 patterns and the latter the delineation of 19 ribotypes. The three methods were correlated and showed a clonal diversity of the species. Esterase electrophoresis and Hinfl RFLP patterns after ethidium bromide staining appeared to be simple tools for use in B. catarrhalis epidemiology.

[Cataract surgery and implantation in diabetics. Apropos of 92 eyes]. / Chirurgie de la cataracte et implantation chez le diabétique. A propos de 92 yeux.

We examined 92 eyes (63 patients) who underwent extracapsular cataract extraction with implantation of a posterior chamber intraocular lens. Visual acuity improved by two lines or more in 65% of cases. Follow-up examination (6 months and 2 years) showed posterior capsule opacification in 30% of cases. Progression of diabetic retinopathy was mild but cystoid macular edema was present in 70% of cases with non proliferative retinopathy. Proliferative retinopathy was treated postoperative by pan retinal photocoagulation. One neovascular glaucoma occurred, secondary to a ruptured capsule.

Correlation between ribosomal DNA polymorphism and electrophoretic enzyme polymorphism in Yersinia.

Ribosomal DNA (rDNA) polymorphism was compared with electrophoretic enzyme polymorphism for the intra- and interspecies differentiation of Yersinia enterocolitica, Y. pseudotuberculosis, Y. intermedia, Y. aldovae, Y. frederiksenii and Y. kristensenii. DNA from 90 strains previously classified into six zymotypes (Y. enterocolitica and Y. frederiksenii) and into distinct enzyme electrophoretic patterns (the four other species) was digested with EcoRI or HindIII and analysed by Southern blotting. The six species were clearly differentiated from each other. In Y. enterocolitica, the subclassification of biotype 1 into zymotypes 1A and 1B was also reflected in the rDNA and the four other bio-zymotypes gave four different classes of restriction pattern. In Y. frederiksenii, both EcoRI and HindIII gave five distinct riboclasses which correlated with the zymotypes. In the four other species, the phenotype polymorphism appeared to be better correlated with the restriction fragment length polymorphism data in some enzymes than others. The data demonstrate that the inter- and intraspecies classification by rDNA polymorphism using two restriction enzymes is similar to that based on electrophoretic enzyme polymorphism. The analysis could be refined for taxonomic and epidemiological purposes by using other restriction enzymes.

A simple, sensitive method of analyzing bacterial ribosomal DNA polymorphism.

A rapid DNA extraction procedure and random primer labelling of Escherichia coli ribosomal RNA with cloned reverse transcriptase have been used to establish a simple and highly sensitive method for studying ribosomal DNA polymorphism in bacteria. Examples of inter- and intraspecies differentiation of bacteria are given and potential applications in bacterial epidemiology and taxonomy are discussed.