Tissue distribution and quantification of the expression of mRNAs of peroxisome proliferator-activated receptors and liver X receptor-alpha in humans: no alteration in adipose tissue of obese and NIDDM patients.

Members of the peroxisome proliferator-activated receptor (PPAR) family might be involved in pathologies with altered lipid metabolism. They participate in the control of the expression of genes involved in lipid metabolism and adipocyte differentiation. In addition, thiazolidinediones improve insulin resistance in vivo by activating PPAR gamma. However, little is known regarding their tissue distribution and relative expression in humans. Using a quantitative and sensitive reverse transcription (RT)-competitive polymerase chain reaction (PCR) assay, we determined the distribution and relative mRNA expression of the four PPARs (alpha,beta, gamma1, and gamma2) and liver X receptor-alpha (LXR alpha) in the main tissues implicated in lipid metabolism. PPAR alpha and LXR alpha were mainly expressed in liver, while PPAR gamma1 predominated in adipose tissue and large intestine. We found that PPAR gamma2 mRNA was a minor isoform, even in adipose tissue, thus causing question of its role in humans. PPAR beta mRNA was present in all the tissues tested at low levels. In addition, PPAR gamma mRNA was barely detectable in skeletal muscle, suggesting that improvement of insulin resistance with thiazolidinediones may not result from a direct effect of these agents on PPAR gamma in muscle. Obesity and NIDDM were not associated with change in PPARs and LXR alpha expression in adipose tissue. The mRNA levels of PPAR gamma1, the predominant form in adipocytes, did not correlate with BMI, leptin mRNA levels, or fasting insulinemia in 29 subjects with various degrees of obesity. These results indicated that obesity is not associated with alteration in PPAR gene expression in abdominal subcutaneous adipose tissue in humans.

Migration of adjustable gastric banding from a cohort study of 4236 patients.

BACKGROUND: Experience was gained management of intra-gastric migration of adjustable gastric banding. METHODS: From July 1996 to January 2003, 4236 patients who underwent laparoscopic adjustable gastric banding were proposed for routine follow-up. Gastrograms were performed in case of band adjustment. Radiological controls and endoscopy were performed according to symptoms. RESULTS: A total of 45 cases of band migration (1.6%) were diagnosed during follow-up. All but one of the migrated bands were removed laparoscopically either by a dissection outside the stomach or through a short gastrotomy. Mortality was 0% and morbidity 8% (n = 4). CONCLUSION: The risk of an intragastric band migration remains low in the literature but could grow on account of the longer follow-up of patients. The retrieval of the band is the gold standard and must be planned promptly or delayed according to symptoms.

[Preservation of the pylorus in duodenopancreatectomy]. / La conservation pylorique au cours de la duodénopancréatectomie céphalique.

The authors present an overview of the technique of pancreatoduodenectomy with pylorus preservation. The main technical variants since the original description by Traverso and Longmire in 1978 are described. Advantages and drawbacks of the technique from a carcinologic and functional point of view are presented and discussed. Pancreatoduodenectomy with pylorus preservation appears to be the procedure of choice in most cases. However, it should be avoided in a few patients with invasion of the proximal duodenum by a periampullary carcinoma for whom a curative resection requires the addition of a gastrectomy.

[Upper digestive duplications in adults]. / Duplications digestives hautes de l'adulte.

Congenital gastrointestinal duplications are uncommonly diagnosed in adult patients, and generally present as a cystic or occasionally tubular malformation. The duplication is composed of a smooth muscle wall continuous with the muscle layer of the intestinal wall and an inner mucosal lining. From December 1988 to May 1994, five patients were operated for gastrointestinal tract duplications [esophageal (1), gastric (2), duodenal (2)]. Duplications were symptomatic in three patients, and discovered incidentally in the other two. The diagnosis was established by ultrasonography (3 patients) and computed tomography (one patient). One female presented an adenocarcinoma arising in an esophageal duplication and died one year after surgical resection. Because of potential malignant transformation, these malformations must be resected. Preoperative diagnosis is important for conservative resection, except in the presence of malignancy when resection must be curative.

[Long-term results of vertical banded gastroplasty for morbid obesity]. / Résultats à distance de la gastroplastie verticale calibrée pour obésité morbide.

UNLABELLED: Morbid obesity, defined by Body Mass Index (BMI) > 40 kg/m2, has an adverse effect on longevity due to a variety of illnesses. Among the numerous techniques proposed to control morbid obesity, Vertical Banded Gastroplasty (VBG) changes eating behavior. The aim of this study was to analyse the long term results of VBG. MATERIAL AND METHODS: Between October 1987 and July 1993, 62 patients, 7 men and 55 women, from 20 to 68 years old (Mean: 37.4 +/- 9 ans), underwent VBG for morbid obesity. Preoperative mean weight and BMI were 123 +/- 27 kg and 47.3 +/- 9.8 kg/m2 respectively. Associated diseases were diabetes mellitus (n = 31), hypertension (N = 29), hypercholesterolemia (N = 10), hypertriglyceridemia (N = 21) and joint diseases (N = 18). RESULTS: VBG was performed with a 50 mm marlex mesh in 20 cases and with a 47 to 50 mm silastic ring in 42 cases. On patient died 3 years later from alcoholic liver cirrhosis and 4 were lost to follow-up. With a mean follow-up of 31 months, mean weight and BMI were 86 +/- 21 kg (p < 0.001) and 32.1 +/- 9.8 kg/m2 (p < 0.001) respectively. Removal of the ring was performed in 3 cases, 1 because of neurologic complications and 2 at the patient's request. Eight patients (13%) failed to achieve satisfactory weight loss. Diabetes mellitus and hypertension resolved in 19 cases, hypercholesterolemia resolved in 7 cases and hypertriglyceridemia resolved in 11. CONCLUSION: VBG provides significant weight loss which reduces the frequency of medical disorders associated with obesity. This result was achieved in 87% of patients. The surgical procedure for morbid obesity must be decided conjointly with endocrinologist, psychiatrist and surgical staff for good long-term results.

[General review of the value of hepatic MRI in the diagnosis and preoperative staging of liver metastasis from colon and rectum cancer]. / Intérêt de l'IRM hépatique dans le diagnostic et le bilan préopératoire des métastases hépatiques des cancers colo-rectaux.

Hepatic resection of secondary liver neoplasms is currently the only potentially curative therapy for patients with primary colorectal carcinoma. Long-term survival is closely related to stage, regardless of the number, size and distribution of liver lesions. Preoperative detection of liver metastases is crucial in patient staging and imaging techniques must be as accurate as possible to evaluate whether hepatic resection can be performed. Among the various strategies applied to the preoperative detection of liver metastases, CT with intra-arterial portography (CTAP) has been found to be the most sensitive technique. It is an invasive evaluation with a reported sensitivity ranging from 81 to 94% but with 6 to 15% of false-positive results. Recent studies demonstrate that MRI with superparamagnetic iron oxide has an equivalent sensitivity and specificity to CTAP. This paper reviews the technique of MRI, evaluates its sensitivity and specificity, and presents the advantages and draw backs of the technique.

[Improved prognosis and treatment of hydronephrosis due to ureteropelvic junction syndrome in children]. / Amélioration du pronostic et du traitement de l'hydronéphrose par maladie de jonction pyélo-urétérale chez l'enfant.

Ureteropelvic junction obstruction in children: evolution of diagnosis and treatment. 180 hydronephrosis due to ureteropelvic junction obstruction in 162 patients have been referred to our hospital. The patients were all infants and children with an age ranging between 1 day to 15 years. Out of 9 abstinences (grade I or 11) and 7 nephrectomies for destroyed kidneys (3 of them after temporary nephrostomy), we performed 164 ureteropelvic junction resections and anastomosis, 51 of them with associated pyeloplasty. The use of a stenting catheter passing through the anastomosis and coming out as a nephrostomy in 81 cases gave us 5 mechanical complications while the complete absence of drainage gave only 3 fistulaes. 2 of these fistulaes had a spontaneous rapid healing after endoscopic ureteral catheterism. Out of 160 follow-up cases, we reoperated 6 failures with success: 5 ureteropelvic reanastomoses and one ureterocalycostomy. This study shows us that the early treatment due to antenatal ultrasound diagnosis improves the prognosis. Renal scanning with furosemide test permits to specify the surgical indication in limited cases and the presence of a residual obstruction in case of persistance of renal pelvis dilatation in the postoperative period. The posterior approach and the absence of internal drainage simplify the treatment, improve the patient comfort and limit the hospitalisation period to 5 days.

Carotid surgery in the octogenarian.

The records of 52 patients aged 80 years or older who underwent 56 carotid artery reconstructions were analyzed retrospectively. Four patients had amaurosis fugax, 27 patients had experienced one or more transient ischemic attacks, eight had a completely or partially reversible stroke, and 10 had vertebrobasilar insufficiency. Three patients were asymptomatic. Arteriograms documented stenosis > 80% on the operated side in 48 cases, whereas the contralateral carotid artery was occluded or had > 80% stenosis in 10 cases each. Two or more cerebral arteries were involved in 37 patients. CT scans were normal in only 21 (40%) patients. General anesthesia was used in 54 of 56 operations. Thirty-six endarterectomies, 18 bypasses, and two resection-anastomoses (for tortuosity) were performed. A shunt was employed in eight (14.3%) cases. One lethal stroke (1.9%) occurred during the first postoperative month. Three patients experienced nonfatal strokes, two of which gave rise to residual deficits. Two patients were lost to follow-up. For the remaining 49 patients the mean follow-up was 24 months. Two-year actuarial survival was 76.3% for the entire series and 67% for those surviving without neurologic events. This study shows that when properly selected the elderly population can safely undergo carotid surgery.

Dysplastic lesions of renal artery branches: late results of ex vivo repair.

Between November 1980 and July 1989, 29 ex vivo reconstructions were performed in 12 women and five men (mean age: 42 years) for dysplastic lesions of renal artery branches. Fifteen patients had hypertension, associated with advanced renal failure in one case. The internal iliac artery was used routinely for reconstruction. The saphenous vein was used on one side where bilateral repairs were necessary. A total of 52 distal anastomoses were performed, an average of 2.6 per revascularized kidney. Mean follow-up was four years and 10 months. No patients were lost to follow-up. There were no early or late deaths. At least one follow-up arteriogram and technetium99 diethylene triamine pentacetic acid scintiscan was obtained for all patients. Forty-five (86%) of 52 anastomoses remained patent. Eleven of 15 hypertensive patients completely recovered while four were improved. Systolic arterial blood pressure decreased by an average of 42 mmHg (p less than 0.001), and results remained stable with time. For fibromuscular dysplasia occurring in young patients whose life expectancy is usually long, this type of surgery provides excellent long-term clinical and anatomical results.

Case report. CT and ultrasound of gastric and duodenal duplications.

We present the radiological findings of gastric and duodenal duplications in four adults, in whom abdominal ultrasound, endoscopic ultrasound (EUS), and CT were primarily used for diagnosis. The diagnosis was surgically confirmed in all cases. Preoperative diagnosis of duplications was possible with ultrasound in three patients, in whom CT showed a nonspecific cystic structure. Ultrasound demonstrated a pathognomonic multilayered wall appearance suggestive of a digestive origin, including an echogenic inner mucosal layer and a hypoechoic muscular layer, better appreciated using EUS in one patient. In one case, digestive origin was confirmed by direct visualization of a peristaltic activity within the cystic wall after water ingestion. In the last patient, a non-specific heterogeneous mainly solid mass of the esophagogastric junction was found to be an adenocarcinoma arising from a duplication on the histological analysis of the surgical specimen.