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Roussel E, Papet E, Chati R, Schwarz L, Tuech JJ, Huet E. When Gastroplasty Is Not Feasible in Ivor Lewis Esophagectomy: A Single-Center Study of Intrathoracic Esophagojejunostomy. J Laparoendosc Adv Surg Tech A 2023; 33:1102-1108. [PMID: 37792402 DOI: 10.1089/lap.2023.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Objective: The surgical management of tumors of the esophagogastric junction is increasingly performed by minimally invasive Ivor Lewis esophagectomy. However, gastroplasty is not always feasible. The creation of a long loop is an alternative for esophageal reconstruction. The aim of this study was to evaluate the technical feasibility of using a minimally invasive thoracoscopic approach in esophagojejunostomy and to describe the contraindications for gastroplasty. Methods: All patients who had intrathoracic esophagojejunostomy in our center were identified in our database. Since 2016, the preferred approach for intrathoracic esophagojejunostomy is minimally invasive laparoscopy and thoracoscopy, using a long Roux-en-Y jejunal loop with a semimechanical triangular anastomosis technique. Results: Between January 1, 2012 and January 1, 2022, 12 patients who had esophagojejunostomy in our center were included in the study. Among them, 6 had thoracotomy and 6 had total minimally invasive thoracoscopy, representing 3.5% of surgical procedures for esophagogastric junction tumors since 2016. The mean operative time was 416.9 ± 107.47 minutes. No anastomotic leakage was observed in the minimally invasive group versus 2 leakages in the thoracotomy group. The main complication was pneumonia in 3 patients (27.3%). Finally, the main indication for intrathoracic esophagojejunostomy was tumor size with a mean of 4.72 ± 2.35 cm and the patient's surgical history. Conclusion: A total minimally invasive approach using a long jejunal loop with triangular anastomosis could be a feasible and reproducible alternative to gastroplasty to restore continuity in Ivor Lewis esophagectomy when the stomach cannot be used.
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Affiliation(s)
| | - Eloise Papet
- Department of Digestive Surgery, CHU Rouen, Rouen, France
| | - Rachid Chati
- Department of Digestive Surgery, CHU Rouen, Rouen, France
| | - Lilian Schwarz
- Department of Digestive Surgery, CHU Rouen, Rouen, France
| | | | - Emmanuel Huet
- Department of Digestive Surgery, CHU Rouen, Rouen, France
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Roussel E, Chati R, Tuech JJ, Huet E. Laparoscopic and Thoracoscopic Total Gastrectomy and Esophagectomy with a Roux-en-Y Long Loop Esophagojejunostomy for Gastroesophageal Junction Cancers (with Video). Ann Surg Oncol 2023; 30:5560-5561. [PMID: 37264287 DOI: 10.1245/s10434-023-13690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Edouard Roussel
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France.
| | - Rachid Chati
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Emmanuel Huet
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
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Huet E, Chati R, Martre P, Tuech JJ. Semi-mechanical triangular anastomosis during Ivor Lewis esophagectomy: Surgical technique. J Visc Surg 2023; 160:219-224. [PMID: 37208219 DOI: 10.1016/j.jviscsurg.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Emmanuel Huet
- Department of Digestive Surgery, University Hospital Center of Rouen, 1, rue Germont, 76031 Rouen cedex, France
| | - Rachid Chati
- Department of Digestive Surgery, University Hospital Center of Rouen, 1, rue Germont, 76031 Rouen cedex, France
| | - Paul Martre
- Department of Digestive Surgery, Private Hospital l'Estuaire, 505, rue Irène-Joliot-Curie, 76620 Le Havre, France
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, University Hospital Center of Rouen, 1, rue Germont, 76031 Rouen cedex, France.
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Martre P, Chati R, Schwarz L, Wood G, Logeay M, Grognu A, Tuech JJ, Huet E. Minimally invasive laparo-thoracoscopic Ivor-Lewis esophagectomy with semi-mechanical triangular anastomosis: Short-term outcomes of 114 consecutive patients. J Visc Surg 2023; 160:196-202. [PMID: 36333184 DOI: 10.1016/j.jviscsurg.2022.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Several surgical teams have developed so-called minimally invasive esophagectomy techniques with the intention of decreasing post-operative complications. The goal of this report is to determine the feasibility, reproducibility, morbidity and mortality of esophagectomy and intrathoracic anastomosis via thoracoscopy. METHODS This retrospective series included 114 consecutive non-selected patients who underwent Lewis Santy type esophagectomy between 2016 and 2020. The procedure was performed via abdominal laparoscopy, thoracoscopy with the patient in a supine position, without selective intubation, with intra-thoracic semi-mechanical triangular esophagogastric anastomosis. RESULTS Mean patient age was 62.8years. Conversion from laparoscopy to laparotomy was required in three patients (2.6%); no patient required conversion from thoracoscopy to thoracotomy. A semi-mechanical triangular esophagogastric anastomosis was successfully performed in all patients. Median duration of hospital stay was 16 (8-116) days. Mortality was 2.6%; 34 patients (29.8%) had major complications, 55 (48%) had a respiratory complication. The leakage rate was 12.3%; most were type I. Only 5.2% required an additional procedure. There was no mortality. CONCLUSION The analysis of this consecutive series found that this operative technique was reproducible and reliable. These results need to be confirmed by other studies. Pulmonary morbidity was high and remains the main challenge in this type of surgery.
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Affiliation(s)
- P Martre
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
| | - R Chati
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
| | - L Schwarz
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
| | - G Wood
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
| | - M Logeay
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
| | - A Grognu
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
| | - J-J Tuech
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France.
| | - E Huet
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
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Huet E, Huttin O, Girerd N, Suty-Selton C, Pace N. Identification of gaps in the management of heart failure outpatients following hospitalization: How to best implement advanced heart failure nursing? Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Consiglio M, Delfrate É, Lourenco MJ, Boulet L, Petel T, Bergeot F, Magnen L, Meret C, Folope V, Dujardin F, Huet E, Merle V. La douche préopératoire chez les patients obèses : ce qu’en disent les patients et les soignants. Rech Soins Infirm 2022; 147:92-99. [DOI: 10.3917/rsi.147.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Yailian AL, Huet E, Charpiat B, Conort O, Juste M, Roubille R, Bourdelin M, Gravoulet J, Mongaret C, Vermorel C, Bedouch P, Janoly-Duménil A. Characteristics of Pharmacists' Interventions Related to Proton-Pump Inhibitors in French Hospitals: An Observational Study. Int J Clin Pract 2022; 2022:9619699. [PMID: 35846437 PMCID: PMC9256420 DOI: 10.1155/2022/9619699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/03/2022] [Indexed: 12/31/2022] Open
Abstract
METHODS The study was based on a retrospective analysis of pharmacist interventions for DRPs detected during the medication order review and documented into the French Act-IP© database over a 12-year period. DRPs and PIs were analyzed, and independent factors of physician acceptance were assessed via multiple logistic regression. RESULTS Out of the 620,620 PIs registered, 29,694 targeted a PPI (4.8%). PPI's DRPs were mostly related to the prescription of a "drug not available at the hospital" (26.1%) and a "drug use without indication" (18.3%); PIs were mostly "drug switch" (35.9%) and "drug discontinuation" (26.1%). In all, 18,919 PIs were accepted by physicians (63.7%). Acceptance was significantly associated with patient age: less accepted for the 18-75 years group (OR = 0.59, 95 CI [0.46-0.76]), and the >75 years group (OR = 0.57, 95 CI [0.44-0.73]) vs. <18 years group; for the type of DRP, "drug use without indication" was the less accepted (OR = 0.73, 95 CI [0.63-0.85]); for the type of PI, "dose adjustment" was the less accepted (OR = 0.32, 95 CI [0.23-0.45]). CONCLUSION Pharmacists contribute to preventing DRPs associated with PPI prescriptions during the medication order review process. Moreover, they often detect PPIs used without indication and they propose drug discontinuation, which contributes to the PPI deprescribing process. PIs should be further developed in the future to reduce PPI overprescription.
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Affiliation(s)
- AL Yailian
- Pharmacy Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Université de Lyon, UR 4129 Parcours Santé Systémique, Lyon, France
| | - E. Huet
- Pharmacy Department, Dieppe Hospital, Dieppe, France
| | - B. Charpiat
- Pharmacy Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon 69004, France
- Université Grenoble Alpes, CNRS/TIMC UMR5525, F-38041, Grenoble, France
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
| | - O. Conort
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
- Clinical Pharmacy Department, Cochin Hospital, APHP Centre, Cochin, Université de Paris, Paris, France
| | - M. Juste
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
- Pharmacy Department, Auban Mouet Hospital, Epernay, France
| | - R. Roubille
- Pharmacy Department, Lucien Hussel Hospital, Vienne, France
| | - M. Bourdelin
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
- Pharmacy Department, Nord-Ouest Villefrance Hospital, Villefranche sur Saône, France
| | - J. Gravoulet
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
- Regional Union of Healthcare Professionals Pharmacists of the Grand Est (URPS), Nancy 54000, France
- Lorraine University, Faculty of Pharmacy, Nancy 54000, France
| | - C. Mongaret
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
- Pharmacy Department, Reims University Hospital, Reims, France
- Reims Champagne Ardennes, Faculty of Pharmacy, Reims, France
| | - C. Vermorel
- Université Grenoble Alpes, CNRS/TIMC UMR5525, F-38041, Grenoble, France
| | - P. Bedouch
- Université Grenoble Alpes, CNRS/TIMC UMR5525, F-38041, Grenoble, France
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
- Pharmacy Department, Grenoble Alpes University Hospital, Grenoble 38043, France
| | - A. Janoly-Duménil
- Pharmacy Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Université de Lyon, UR 4129 Parcours Santé Systémique, Lyon, France
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
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Firlej V, Majidipur A, Berry F, Soyeux P, Destouches D, Huet E, Pawlotsky J, Vacherot F, Bruscella P, De la Taille A. Régulation de TMPRSS2 par la voie des androgènes et implications dans l’infection SARS-CoV-2. Prog Urol 2021. [PMCID: PMC8557089 DOI: 10.1016/j.purol.2021.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectifs TMPRSS2 est une protéase cellulaire régulée par les androgènes dans les cellules prostatiques. L’entrée de SARS-CoV2 par fusion membranaire dans les cellules pulmonaires nécessite le clivage de Spike par TMPRSS2. Notre hypothèse est que le niveau des androgènes et la présence du récepteur des androgènes (RA) dans les cellules pulmonaires pourrait réguler l’expression de TMPRSS2 et influencerait l’entrée de SARS-CoV-2. Méthodes Les régulations de TMPRSS2 et du RA ont été étudiées dans deux lignées cellulaires pulmonaires (A549 et Calu-3) et dans des lignées de cellules prostatiques contrôles (LNCaP ou VCaP) grâce à des expériences de privation et de supplémentation en androgènes ainsi que par utilisation d’un siRNA ciblant le RA. La régulation de l’expression de ces deux gènes a été étudiée par RT-qPCR et Western blot. L’infection de SARS-CoV2 dans les cellules Calu-3 a été étudiée en condition de blocage du RA. Résultats Les études cliniques semblent montrer que les patients atteints de cancer de la prostate sous hormonothérapie ont une incidence plus faible d’infection par le SARS-CoV2 suggérant le rôle du RA dans l’infection du virus. Nos résultats montrent que les deux lignées de cellules pulmonaires utilisées (A549 et Calu-3) expriment TMPRSS2 et le RA au niveau ARNm et protéique. Dans ces lignées, il existe également une régulation de l’expression de TMPRSS2 et du RA par les androgènes. Cet effet est connu et bien retrouvé pour les lignées prostatiques. Enfin, nous avons pu montrer qu’au niveau des cellules pulmonaires, le taux d’infection par le SARS-CoV2 était moins important lorsque la voie du RA a été au préalable bloquée. Conclusion Le blocage de TMPRSS2 permettrait de limiter l’infection du virus. Nos résultats suggèrent que l’expression de TMPRSS2 est régulée par les androgènes dans des cellules pulmonaires et que la testostérone pourrait jouer un rôle dans l’infection du SARS-CoV2. Le blocage du RA serait donc une option thérapeutique envisagée pour limiter la COVID-19.
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Chati R, Huet E, Tuech JJ. Thoracoscopy guided by intraoperative indocyanine green fluorescence lymphography for post-oesophagectomy chylothorax (with video). J Visc Surg 2021; 158:526-527. [PMID: 34561188 DOI: 10.1016/j.jviscsurg.2021.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- R Chati
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - E Huet
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - J J Tuech
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France.
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Codjia T, Rebibo L, François A, Lagnel C, Huet E, Bekri S, Pattou F, Régimbeau JM, Schwarz L. Evolution of Non-alcoholic Fatty Liver Disease (NAFLD) Biomarkers in Response to Weight Loss 1 Year After Bariatric Surgery-a Post Hoc Analysis of the FibroTest Prospective Study. Obes Surg 2021; 31:3548-3556. [PMID: 33844174 DOI: 10.1007/s11695-021-05402-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Bariatric surgery is among the therapeutic options for non-alcoholic fatty liver disease (NAFLD), affecting 90% of patients with obesity. The aim of this study was to evaluate the evolution of NAFLD lesions 1 year after surgery using noninvasive markers. METHODS From November 2011 to November 2012, 253 patients with obesity undergoing bariatric surgery in three French University Hospitals were included. Histological data regarding intraoperative liver biopsy were collected at baseline, clinical, and biological data, including FibroTest®, SteatoTest®, and NASHTest®, before and after surgery. RESULTS Fibrosis' prevalence was 74.2% with a positive predictive value (PPV) for FibroTest® of 78.6% and 43.4% for significant fibrosis (Kleiner ≥ F2) with a negative predictive value (NPV) of 56.1%. NAFLD's prevalence was 84% with a PPV for SteatoTest® of 85.9% and 7.7% for NASH with an NPV for NASHTest® of 93.8%. One year after bariatric surgery, mean BMI had significantly decreased from 46.5 to 31.7 kg/m2 (p < 0.001). Fibrosis assessed by the FibroTest® showed that 82.5% of patients were F0 after surgery compared to 90.9% before. Using SteatoTest®, the percent of patient without steatosis (S0) increased from 1.6 to 49.6% after surgery, and rate of severe steatosis (S3) improved from 43.3 to 3.9%. NASHTest® revealed that the percent of patients without NASH increased from 12.8 to 73.6% and rates of NASH improved from 12 to 0.8%. CONCLUSIONS Validated noninvasive biomarkers SteatoTest® and NASHTest® suggested NAFLD and steatohepatitis improvement after bariatric surgery and might be useful tools for patient follow-up. Regarding fibrosis, FibroTest® was not accurate in patients with extreme obesity.
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Affiliation(s)
- Tatiana Codjia
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France.
| | - Lionel Rebibo
- Department of Digestive Surgery, Amiens University Hospital, 1 Rond-point du Professeur Christian Cabrol, 80000, Amiens, France
| | - Arnaud François
- Department of Anatomo-pathology, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Carole Lagnel
- Department of Biochemistry, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Emmanuel Huet
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Soumeya Bekri
- Department of Biochemistry, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - François Pattou
- Department of Digestive Surgery, Lille University Hospital, Rue Michel Polonovski, 59037, Lille, France
| | - Jean-Marc Régimbeau
- Department of Digestive Surgery, Amiens University Hospital, 1 Rond-point du Professeur Christian Cabrol, 80000, Amiens, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
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Roman H, Marabha J, Polexa A, Prosszer M, Huet E, Hennetier C, Tuech JJ, Marpeau L. Crude complication rate is not an accurate marker of a surgeon's skill: A single surgeon retrospective series of 1060 procedures for colorectal endometriosis. J Visc Surg 2021; 158:289-298. [PMID: 33451966 DOI: 10.1016/j.jviscsurg.2020.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the relationship between the rate of postoperative bowel fistula and surgeon experience. DESIGN Retrospective study. SETTING Two referral centers. PATIENTS 1060 women managed for colorectal deep endometriosis by one gynecologist surgeon from January 2005 to March 2020. INTERVENTIONS Shaving, disc excision and segmental colorectal resection. MAIN OUTCOME MEASURES Rate of bowel fistula stratified according to 4 time periods: P1 from 2005 to 2009, P2 from 2010 to 2014, P3 from 2015 to June 2018 and P4 from September 2018 to March 2020. RESULTS 68 patients (6.4%) were managed during P1, 299 patients (28.2%) during P2, 422 patients (39.8%) during P3 and 271 patients (25.6%) during P4. Both diameter of rectal infiltration and rate of complex surgical procedures progressively increased from P1 to P4. Bowel fistula rate was comparable between all 4 time periods, respectively 2.9, 3.3, 4 and 4.4%. Logistic regression model revealed that risk of fistula decreased when shaving was performed when compared to segmental resection (adj OR 0.1, 95% CI 0-0.5) and increased when deep endometriosis nodules also involved sacral roots (adjOR 4.9, 95%CI 1.8-13.3) and infiltration of the vagina (adj OR 3, 95%CI 1.3-7). No statistically significant relationship was found between surgery time period and risk of fistula. CONCLUSION Crude rates of bowel fistula following surgical management of deep endometriosis infiltrating the colon and the rectum are not an accurate marker of surgeon expertise and should be considered in conjunction with expected higher risks related to challenging procedures performed by experienced surgeons.
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Affiliation(s)
- H Roman
- Endometriosis centre, clinique Tivoli-Ducos, Bordeaux, France; Department of gynaecology and obstetrics, university hospital Aarhus, Aarhus, Denmark.
| | - J Marabha
- Endometriosis centre, clinique Tivoli-Ducos, Bordeaux, France
| | - A Polexa
- Endometriosis centre, clinique Tivoli-Ducos, Bordeaux, France
| | - M Prosszer
- Endometriosis centre, clinique Tivoli-Ducos, Bordeaux, France
| | - E Huet
- Department of surgery, Rouen university hospital, Rouen, France
| | - C Hennetier
- Expert center in the diagnosis and multidisciplinary management of endometriosis, Rouen university hospital, Rouen, France
| | - J-J Tuech
- Department of surgery, Rouen university hospital, Rouen, France
| | - L Marpeau
- Expert center in the diagnosis and multidisciplinary management of endometriosis, Rouen university hospital, Rouen, France
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Hedjoudje A, Huet E, Leroi AM, Desprez C, Melchior C, Gourcerol G. Efficacy of gastric electrical stimulation in intractable nausea and vomiting at 10 years: A retrospective analysis of prospectively collected data. Neurogastroenterol Motil 2020; 32:e13949. [PMID: 33107679 DOI: 10.1111/nmo.13949] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/09/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastric electrical simulation has been shown to relieve nausea and vomiting in medically refractory patients. Efficacy of gastric electrical stimulation has been reported mostly in short-term studies, but none has evaluated its efficacy beyond 10 years after implantation. METHODS Patients implanted at our center for medically refractory severe and chronic nausea and/or vomiting were evaluated before and over 10 years after implantation using symptomatic scale and quality of life (GIQLI) score. Improvement was defined as a reduction of more than 50% in vomiting frequency. KEY RESULTS A total of 50 patients were implanted from January 1998 to December 2009. Among them, 7 were explanted due to a lack of efficacy and/or side effects, 2 died, and 4 were lost to follow-up. Mean follow-up was 10.5 ± 3.7 years. In intention-to-treat analysis, 27/50 (54%) patients reported an improvement. Beyond 10 years, an improvement in early satiety (3.05 vs 1.76, <0.001), bloating (2.51 vs 1.70, P = .012), nausea (2.46 vs 1.35, P = .001), and vomiting (3.35 vs 1.49 P < .001) scores were observed. Quality of life improved over 10 years (GIQLI score: 69.7 vs. 86.4, P = .005) and body mass index (BMI: 23.4 vs. 26.2 kg/m2 ; P = .048). CONCLUSIONS AND INFERENCES Gastric electrical simulation is effective in the long-term in patients with medically refractory nausea and vomiting, with an efficacy of 54% at 10 years on an intention-to-treat analysis. Other long-term observational studies are warranted to confirm these results.
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Affiliation(s)
- Abdellah Hedjoudje
- Service de Physiologie Digestive, Urinaire et Respiratoire, CHU Charles Nicolle, Rouen, France.,Service d'Endoscopie Digestive, Hôpital Beaujon, Assistance publique des hôpitaux de Paris, Clichy, France
| | - Emmanuel Huet
- Service de Chirurgie Digestive, CHU Charles Nicolle, Rouen, France.,UMR INSERM 1073, Normandy University, Rouen, France
| | - Anne-Marie Leroi
- Service de Physiologie Digestive, Urinaire et Respiratoire, CHU Charles Nicolle, Rouen, France.,Centre d'Investigation Clinique INSERM 1404, CHU Charles Nicolle, Rouen, France
| | - Charlotte Desprez
- Service de Physiologie Digestive, Urinaire et Respiratoire, CHU Charles Nicolle, Rouen, France.,UMR INSERM 1073, Normandy University, Rouen, France
| | - Chloé Melchior
- UMR INSERM 1073, Normandy University, Rouen, France.,Service d'Hépato-Gastro-Entérologie, CHU Charles Nicolle, Rouen, France
| | - Guillaume Gourcerol
- Service de Physiologie Digestive, Urinaire et Respiratoire, CHU Charles Nicolle, Rouen, France.,UMR INSERM 1073, Normandy University, Rouen, France.,Centre d'Investigation Clinique INSERM 1404, CHU Charles Nicolle, Rouen, France
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Roman H, Tuech JJ, Huet E, Bridoux V, Khalil H, Hennetier C, Bubenheim M, Branduse LA. Excision versus colorectal resection in deep endometriosis infiltrating the rectum: 5-year follow-up of patients enrolled in a randomized controlled trial. Hum Reprod 2020; 34:2362-2371. [PMID: 31820806 PMCID: PMC6936722 DOI: 10.1093/humrep/dez217] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/04/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTION Is there a difference in functional outcomes and recurrence rate between conservative versus radical rectal surgery in patients with large deep endometriosis infiltrating the rectum 5 years postoperatively? SUMMARY ANSWER No evidence was found that long-term outcomes differed when nodule excision was compared to rectal resection for deeply invasive endometriosis involving the bowel. WHAT IS KNOWN ALREADY Functional outcomes of nodule excision and rectal resection for deeply invasive endometriosis involving the bowel are comparable 2 years after surgery. Despite numerous previously reported case series enrolling patients managed for colorectal endometriosis, long-term data remain scarce in the literature. STUDY DESIGN, SIZE, DURATION From March 2011 to August 2013, we performed a two-arm randomized trial, enrolling 60 patients with deep endometriosis infiltrating the rectum up to 15 cm from the anus, measuring >20 mm in length, involving at least the muscular layer in depth, and up to 50% of rectal circumference. Among them, 55 women were enrolled at one tertial referral centre in endometriosis, using a randomization list drawn up separately for this centre. Institute review board approval was obtained to continue follow-up to 10 years postoperatively. One patient requested to stop the follow-up 2 years after surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients underwent either nodule excision by shaving or disc excision, or segmental resection. Randomization was performed preoperatively using sequentially numbered, opaque, sealed envelopes, and patients were informed of randomization results. The primary endpoint was the proportion of patients experiencing one of the following symptoms: constipation (1 stool/>5 consecutive days), frequent bowel movements (≥3 stools/day), anal incontinence, dysuria or bladder atony requiring self-catheterization 24 months postoperatively. Secondary endpoints were values taken from the Knowles–Eccersley–Scott-symptom questionnaire (KESS), the gastrointestinal quality of life index (GIQLI), the Wexner scale, the urinary symptom profile (USP) and the Short Form 36 Health Survey (SF36). MAIN RESULTS AND THE ROLE OF CHANCE Fifty-five patients were enrolled. Among the 27 patients in the excision arm, two were converted to segmental resection (7.4%). One patient managed by segmental resection withdrew from the study 2 years postoperatively, presuming that associated pain of other aetiologies may have jeopardized the outcomes. The 5 year-recurrence rate for excision and resection was 3.7% versus 0% (P = 1), respectively. For excision and resection, the primary endpoint was present in 44.4% versus 60.7% of patients (P = 0.29), respectively, while 55.6% versus 53.6% of patients subjectively reported normal bowel movements (P = 1). An intention-to-treat comparison of overall KESS, GIQLI, Wexner, USP and SF36 scores did not reveal significant differences between the two arms 5 years postoperatively. Statistically significant improvement was observed shortly after surgery with no further improvement or impairment recorded 1–5 years postoperatively. During the 5-year follow-up, additional surgical procedures were performed in 25.9% versus 28.6% of patients who had undergone excision or resection (P = 0.80), respectively. LIMITATIONS, REASONS FOR CAUTION The presumption of a 40% difference concerning postoperative functional outcomes in favour of nodule excision resulted in a lack of power for demonstration of the primary endpoint difference. WIDER IMPLICATIONS OF THE FINDINGS Five-year follow-up data do not show statistically significant differences between conservative and radical rectal surgery for long-term functional digestive and urinary outcomes in this specific population of women with large involvement of the rectum. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was received. Patient enrolment and follow-up until 2 years postoperatively was supported by a grant from the clinical research programme for hospitals in France. The authors declare no competing interests related to this study. TRIAL REGISTRATION NUMBER This randomized study is registered with ClinicalTrials.gov, number NCT 01291576. TRIAL REGISTRATION DATE 31 January 2011. DATE OF FIRST PATIENT’S ENROLMENT 7 March 2011.
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Affiliation(s)
- Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux 33000, France.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Emmanuel Huet
- Department of Surgery, Rouen University Hospital, Rouen 76031, France
| | - Valérie Bridoux
- Department of Surgery, Rouen University Hospital, Rouen 76031, France
| | - Haitham Khalil
- Department of Surgery, Rouen University Hospital, Rouen 76031, France
| | - Clotilde Hennetier
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen 76031, France
| | - Michael Bubenheim
- Department of Biostatistics, Rouen University Hospital, Rouen 76031, France
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Desprez C, Melchior C, Wuestenberghs F, Huet E, Zalar A, Jacques J, Leroi AM, Gourcerol G. Pyloric distensibility measurement after gastric surgery: Which surgeries are associated with pylorospasm? Neurogastroenterol Motil 2020; 32:e13790. [PMID: 31916346 DOI: 10.1111/nmo.13790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/13/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND STUDY AIMS History of gastric surgery is found in 10% of patients with gastroparesis, and vagal lesion is often suspected to be the cause of pylorospasm. Recently, pyloric distensibility measurement using the EndoFLIP® system showed that pylorospasm was present in 30%-50% of gastroparetic patients. Our objective was to assess whether pylorospasm, diagnosed using EndoFLIP® system was observed in three different types of gastric surgeries: antireflux surgery, sleeve gastrectomy, and esophagectomy. PATIENTS AND METHODS Pyloric distensibility and pressure were measured using the EndoFLIP® system in 43 patients from two centers (18 antireflux surgery, 16 sleeve gastrectomy, and nine esophagectomy) with dyspeptic symptoms after gastric surgery, and in 21 healthy volunteers. Altered pyloric distensibility was defined as distensibility below 10 mm2 /mm Hg as previously reported. RESULTS Compared to healthy volunteers (distensibility: 25.2 ± 2.4 mm2 /mm Hg; pressure: 9.7 ± 4.4 mm Hg), pyloric distensibility was decreased in 61.1% of patients in the antireflux surgery group (14.5 ± 3.4 mm2 /mm Hg; P < .01) and 75.0% of patients in the esophagectomy group (10.8 ± 2.1 mm2 /mm Hg; P < .05), while pyloric pressure was only increased in the antireflux surgery group (18.9 ± 2.2 mm Hg; P < .01). Pyloric distensibility and pressure were similar in healthy volunteers and in sleeve gastrectomy (distensibility: 20.3 ± 3.8 mm2 /mm Hg; pressure: 15.8 ± 1.6 mm Hg) groups, with decreased pyloric distensibility affecting 18.7% of sleeve gastrectomy patients. CONCLUSION Antireflux surgery and esophagectomy were associated with pylorospasm although pylorospasm was not found in all patients. Sleeve gastrectomy was not associated with altered pyloric distensibility nor altered pyloric pressure.
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Affiliation(s)
- Charlotte Desprez
- Physiology Department, Rouen University Hospital, Rouen, France.,Nutrition, Brain and Gut Laboratory, INSERM Unit 1073, Rouen University Hospital, Rouen, France
| | - Chloé Melchior
- Nutrition, Brain and Gut Laboratory, INSERM Unit 1073, Rouen University Hospital, Rouen, France.,Hepatogastroenterology Department, Rouen University Hospital, Rouen, France
| | - Fabien Wuestenberghs
- Physiology Department, Rouen University Hospital, Rouen, France.,Nutrition, Brain and Gut Laboratory, INSERM Unit 1073, Rouen University Hospital, Rouen, France
| | - Emmanuel Huet
- Nutrition, Brain and Gut Laboratory, INSERM Unit 1073, Rouen University Hospital, Rouen, France.,Digestive Surgery Department, Rouen University Hospital, Rouen, France
| | - Alberto Zalar
- Hepatogastroenterology Department, Rouen University Hospital, Rouen, France
| | - Jérémie Jacques
- Hepatogastroenterology Department, Limoges University Hospital, Limoges, France
| | - Anne-Marie Leroi
- Physiology Department, Rouen University Hospital, Rouen, France.,Nutrition, Brain and Gut Laboratory, INSERM Unit 1073, Rouen University Hospital, Rouen, France.,Clinical Investigation Center, INSERM 0204, Rouen University Hospital, Rouen, France
| | - Guillaume Gourcerol
- Physiology Department, Rouen University Hospital, Rouen, France.,Nutrition, Brain and Gut Laboratory, INSERM Unit 1073, Rouen University Hospital, Rouen, France.,Clinical Investigation Center, INSERM 0204, Rouen University Hospital, Rouen, France
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15
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Roman H, Tuech JJ, Huet E, Bridoux V, Khalil H, Hennetier C, Bubenheim M, Brinduse LA. Corrigendum. Excision versus colorectal resection in deep endometriosis infiltrating the rectum: 5-year follow-up of patients enrolled in a randomized controlled trial. Hum Reprod 2020; 35:736. [PMID: 32060502 PMCID: PMC7105325 DOI: 10.1093/humrep/deaa019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/04/2019] [Accepted: 09/11/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux 33000, France.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Emmanuel Huet
- Department of Surgery, Rouen University Hospital, Rouen 76031, France
| | - Valérie Bridoux
- Department of Surgery, Rouen University Hospital, Rouen 76031, France
| | - Haitham Khalil
- Department of Surgery, Rouen University Hospital, Rouen 76031, France
| | - Clotilde Hennetier
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen 76031, France
| | - Michael Bubenheim
- Department of Biostatistics, Rouen University Hospital, Rouen 76031, France
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16
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Vermeulin T, Lahbib H, Lottin M, Brifault C, Diot J, Lucas M, Huet E, Di Fiore F, Michel P, Czernichow P, Merle V. Patients' perception and attitude to totally implantable venous access for urologic or digestive cancer: A cross-sectional study. Bull Cancer 2019; 106:959-968. [PMID: 31623835 DOI: 10.1016/j.bulcan.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/22/2019] [Accepted: 09/04/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Totally implanted venous access (TIVA) improves the safety and welfare of patients treated with cancer chemotherapy (CCT). We aimed to evaluate patients' perception of TIVA placement, TIVA use, and information on TIVA, and to assess the association between patients' perception and their attitude regarding a potential TIVA re-implantation. METHODS We conducted a single center cross-sectional survey in a university hospital in Northern France. Patients included were consecutive urologic or digestive cancer inpatients admitted for a CCT cycle via TIVA between April 9th and May 9th 2014. We analyzed patients' satisfaction, experience, and attitude, especially when requiring potential TIVA re-implantation under local anesthesia (LA), using a standardized questionnaire and medical records. We analyzed risk factors for refusing potential TIVA re-implantation under LA using multivariate logistic regression. RESULTS Eighty-one patients were interviewed (no refusals), including 57 with a TIVA device placed under LA in our university hospital. Among them, 52/57 (91%) reported satisfactory TIVA placement, but respectively 21/57 (37%) and 18/57 (32%) complained of painful or uncomfortable TIVA placement; 51/57 (89%) were satisfied with care provided during CCT cycles. Risk factors for refusing potential re-implantation under LA were: TIVA placement considered painful (P=0.012) or uncomfortable (P=0.038) and dissatisfaction with care provided during CCT cycles (P=0.028). DISCUSSION We show that despite good overall satisfaction regarding TIVA, some aspects were less positive and warrant improvement actions. It suggests that these actions could not only improve patients' experience of TIVA use but could also facilitate continuation of treatment in the long term.
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Affiliation(s)
- Thomas Vermeulin
- Centre Henri Becquerel, department of Medical Information, 76038 Rouen, France; Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France.
| | - Hana Lahbib
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
| | - Marion Lottin
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
| | - Caroline Brifault
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
| | - Josselin Diot
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
| | - Mélodie Lucas
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
| | - Emmanuel Huet
- Rouen University Hospital, department of Digestive Surgery, 76000 Rouen, France
| | - Frédéric Di Fiore
- Rouen University Hospital, department of Hepatogastroenterology, 76000 Rouen, France
| | - Pierre Michel
- Rouen University Hospital, department of Hepatogastroenterology, 76000 Rouen, France
| | - Pierre Czernichow
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
| | - Véronique Merle
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
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17
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Affiliation(s)
- R Chati
- Department of digestive surgery, Rouen university hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - E Huet
- Department of digestive surgery, Rouen university hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - J-J Tuech
- Department of digestive surgery, Rouen university hospital, 1, rue Germont, 76031 Rouen cedex, France.
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18
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Roman H, Bubenheim M, Huet E, Bridoux V, Zacharopoulou C, Collinet P, Daraï E, Tuech JJ. Baseline severe constipation negatively impacts functional outcomes of surgery for deep endometriosis infiltrating the rectum: Results of the ENDORE randomized trial. J Gynecol Obstet Hum Reprod 2019; 48:625-629. [PMID: 30902761 DOI: 10.1016/j.jogoh.2019.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 02/16/2019] [Accepted: 03/15/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Predictive factors of functional outcomes after the surgery of rectal endometriosis are not well identified. Our recent randomized trial did not find significant differences between functional outcomes in patients managed by radical or conservative rectal surgery. OBJECTIVE To identify preoperative factors which determine functional outcomes of surgery in patients with rectal endometriosis. STUDY DESIGN We performed a cohort study on the population of a 2-arm randomised trial, from March 2011 to August 2013. Patients were enrolled in three French university hospitals and had either conservative surgery by shaving or disc excision, or radical rectal surgery by segmental resection. The primary endpoint was the proportion of patients experiencing one of the following symptoms: constipation, frequent bowel movements, anal incontinence, dysuria or bladder atony requiring self-catheterisation 24 months postoperatively. Secondary endpoints were the values of the Knowles-Eccersley-Scott-Symptom Questionnaire (KESS), the Gastrointestinal Quality of Life Index (GIQLI), the Wexner scale, the Urinary Symptom Profile (USP) and the Short Form 36 Health Survey (SF36). A logistic regression model based on backward selection was used to screen for baseline factors that could impact the primary endpoint. A generalized estimating equations model for repeated measures was used to assess whether a trend could be observed over the follow-up period as regards gastrointestinal and quality of life scores. RESULTS 60 patients with deep endometriosis infiltrating the rectum were managed by conservative surgery (27 cases) and segmental colorectal resection (33 cases). The primary endpoint was recorded in 26 patients (48.1% for conservative surgery vs. 39.4% for radical surgery, OR = 0.70, 95% CI 0.22-2.21). There was a significant improvement in values of all gastrointestinal, quality of life and urinary scores after surgery. Comparing patients with KESS scores < 10 (reference) to those with scores between 10 and 17 (OR = 2.1, 95%CI 0.4-12.2), as well as those with scores >17 (OR = 11.1, 95%CI 2.2-20.5), revealed that the odds to record the primary endpoint are significantly higher in the latter group. Trend analyses suggest that the odds of an elevated KESS score are significantly higher at baseline than at 6 months, but significantly lower after 12 months. CONCLUSIONS Patients with severe preoperative constipation are less likely to achieve normal bowel movements after surgery for rectal endometriosis, using either radical or conservative rectal procedures.
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Affiliation(s)
- Horace Roman
- Center of Endometriosis, Clinique Tivoli-Ducos, 33000, Bordeaux, France.
| | - Michael Bubenheim
- Department of Biostatistics, Rouen University Hospital, 76031 Rouen, France
| | - Emmanuel Huet
- Department of Surgery, Rouen University Hospital, 76031 Rouen, France
| | - Valérie Bridoux
- Department of Surgery, Rouen University Hospital, 76031 Rouen, France
| | - Chrysoula Zacharopoulou
- Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; GRC-6 UPMC: Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie, Paris, France; Unité INSERM UMR_S 938, Université Pierre et Marie Curie, 75020 Paris, France
| | - Pierre Collinet
- Gynaecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France
| | - Emile Daraï
- Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; GRC-6 UPMC: Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie, Paris, France; Unité INSERM UMR_S 938, Université Pierre et Marie Curie, 75020 Paris, France
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Souche R, Nayeri M, Chati R, Huet E, Donici I, Tuech JJ, Borie F, Prudhomme M, Jaber S, Fabre JM. Thoracoscopy in prone position with two-lung ventilation compared to conventional thoracotomy during Ivor Lewis procedure: a multicenter case-control study. Surg Endosc 2019; 34:142-152. [PMID: 30868323 DOI: 10.1007/s00464-019-06742-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 03/06/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intraoperative management based on thoracoscopy, prone position and two-lung ventilation could decrease the rate of postoperative pulmonary complications after esophagectomy. The aim of this study was to compare this multifaceted approach (MIE-PP) and conventional thoracotomy for Ivor Lewis procedure after a systematic laparoscopic dissection. METHODS Data from 137 consecutive patients undergoing Ivor Lewis procedures between 2010 and 2017 at two tertiary centers was analyzed retrospectively. The outcomes of patients who underwent MIE-PP (n = 58; surgeons group 1) were compared with those of patients undergoing conventional approach (n = 79; surgeons group 2). Our primary outcome was major postoperative pulmonary complications. Our main secondary outcomes were anastomotic leak, quality of resection and mortality. RESULTS Female patients were more prevalent in the MIE-PP group (p = 0.002). Other patient characteristics, cTNM staging and neoadjuvant treatment rate were not different between groups. Major postoperative pulmonary complications were significantly lower in the MIE-PP group compared to Conventional group (24 vs. 44%; p = 0.014). Anastomotic leak occurred in 31 versus 18% in MIE-PP group and Conventional groups, respectively (p = 0.103). Complete resection rate (98 vs. 95%; p = 0.303) and mean number of harvested lymph nodes (16 (4-40) vs. 18 (3-37); p = 0.072) were similar between the two groups. Postoperative mortality rates were 0 versus 2% at day 30 (p = 0.508) and 0 versus 7.6% at day 90 (p = 0.038). CONCLUSION Short-term outcomes of minimally invasive Ivor Lewis using thoracoscopy, prone position and two-lung ventilation are at least equivalent to the hybrid approach. Anastomotic leak after MIE-PP remains a major concern.
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Affiliation(s)
- R Souche
- Digestive and Minimally Invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
| | - M Nayeri
- Digestive Surgery Department, Carémeau Hospital, University of Montpellier - Nîmes, Place du professeur Debré, 30900, Nîmes, France
| | - R Chati
- Digestive Surgery Department, Charles Nicolle Hospital, University of Rouen, 1 rue de Germont, 76031, Rouen, France
| | - E Huet
- Digestive Surgery Department, Charles Nicolle Hospital, University of Rouen, 1 rue de Germont, 76031, Rouen, France
| | - I Donici
- Digestive Surgery Department, Carémeau Hospital, University of Montpellier - Nîmes, Place du professeur Debré, 30900, Nîmes, France
| | - J J Tuech
- Digestive Surgery Department, Charles Nicolle Hospital, University of Rouen, 1 rue de Germont, 76031, Rouen, France
| | - F Borie
- Digestive Surgery Department, Carémeau Hospital, University of Montpellier - Nîmes, Place du professeur Debré, 30900, Nîmes, France
| | - M Prudhomme
- Digestive Surgery Department, Carémeau Hospital, University of Montpellier - Nîmes, Place du professeur Debré, 30900, Nîmes, France
| | - S Jaber
- Department of Reanimation and Anesthesiology, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - J M Fabre
- Digestive and Minimally Invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France
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20
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Roman H, Bubenheim M, Huet E, Bridoux V, Zacharopoulou C, Daraï E, Collinet P, Tuech JJ. Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial. Hum Reprod 2019; 33:47-57. [PMID: 29194531 PMCID: PMC5850309 DOI: 10.1093/humrep/dex336] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/11/2017] [Indexed: 12/19/2022] Open
Abstract
STUDY QUESTION Is there a difference in functional outcome between conservative versus radical rectal surgery in patients with large deep endometriosis infiltrating the rectum 2 years postoperatively? SUMMARY ANSWER No evidence was found that functional outcomes differed when conservative surgery was compared to radical rectal surgery for deeply invasive endometriosis involving the bowel. WHAT IS KNOWN ALREADY Adopting a conservative approach to the surgical management of deep endometriosis infiltrating the rectum, by employing shaving or disc excision, appears to yield improved digestive functional outcomes. However, previous comparative studies were not randomized, introducing a possible bias regarding the presumed superiority of conservative techniques due to the inclusion of patients with more severe deep endometriosis who underwent colorectal resection. STUDY DESIGN SIZE, DURATION From March 2011 to August 2013, we performed a 2-arm randomized trial, enroling 60 patients with deep endometriosis infiltrating the rectum up to 15 cm from the anus, measuring more than 20 mm in length, involving at least the muscular layer in depth and up to 50% of rectal circumference. No women were lost to follow-up. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients were enroled in three French university hospitals and had either conservative surgery, by shaving or disc excision, or radical rectal surgery, by segmental resection. Randomization was performed preoperatively using sequentially numbered, opaque, sealed envelopes, and patients were informed of the results of randomization. The primary endpoint was the proportion of patients experiencing one of the following symptoms: constipation (1 stool/>5 consecutive days), frequent bowel movements (≥3 stools/day), defecation pain, anal incontinence, dysuria or bladder atony requiring self-catheterization 24 months postoperatively. Secondary endpoints were the values of the Visual Analog Scale (VAS), Knowles-Eccersley-Scott-Symptom Questionnaire (KESS), the Gastrointestinal Quality of Life Index (GIQLI), the Wexner scale, the Urinary Symptom Profile (USP) and the Short Form 36 Health Survey (SF36). MAIN RESULTS AND THE ROLE OF CHANCE A total of 60 patients were enroled. Among the 27 patients in the conservative surgery arm, two were converted to segmental resection (7.4%). In each group, 13 presented with at least one functional problem at 24 months after surgery (48.1 versus 39.4%, OR = 0.70, 95% CI 0.22-2.21). The intention-to-treat comparison of the overall scores on KESS, GIQLI, Wexner, USP and SF36 did not reveal significant differences between the two arms. Segmental resection was associated with a significant risk of bowel stenosis. LIMITATIONS REASONS FOR CAUTION The inclusion of only large infiltrations of the rectum does not allow the extrapolation of conclusions to small nodules of <20 mm in length. The presumption of a 40% difference favourable to conservative surgery in terms of postoperative functional outcomes resulted in a lack of power to demonstrate a difference for the primary endpoint. WIDER IMPLICATIONS OF THE FINDINGS Conservative surgery is feasible in patients managed for large deep rectal endometriosis. The trial does not show a statistically significant superiority of conservative surgery for mid-term functional digestive and urinary outcomes in this specific population of women with large involvement of the rectum. There is a higher risk of rectal stenosis after segmental resection, requiring additional endoscopic or surgical procedures. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a grant from the clinical research programme for hospitals (PHRC) in France. The authors declare no competing interests related to this study. TRIAL REGISTRATION NUMBER This study is registered with ClinicalTrials.gov, number NCT 01291576. TRIAL REGISTRATION DATE 31 January 2011. DATE OF FIRST PATIENT’S ENROLMENT 7 March 2011.
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Affiliation(s)
- Horace Roman
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, 76031 Rouen, France.,Research Group EA 4308 'Spermatogenesis and Male Gamete Quality', IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France
| | - Michael Bubenheim
- Department of Biostatistics, Rouen University Hospital, 76031 Rouen, France
| | - Emmanuel Huet
- Department of Surgery, Rouen University Hospital, 76031 Rouen, France
| | - Valérie Bridoux
- Department of Surgery, Rouen University Hospital, 76031 Rouen, France
| | - Chrysoula Zacharopoulou
- Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Emile Daraï
- Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,GRC-6 UPMC, Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie, Paris, France.,Unité INSERM UMR_S 938, Université Pierre et Marie Curie, 75020 Paris, France
| | - Pierre Collinet
- Gynaecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France
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Elie T, Clavier T, Huet E, Bejar S, Veber B. Emphysème sous-cutané compliquant un pneumopéritoine post-traumatique : rare et trompeur. Presse Med 2018; 47:482-483. [DOI: 10.1016/j.lpm.2018.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 01/09/2018] [Accepted: 02/19/2018] [Indexed: 11/26/2022] Open
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Abo C, Moatassim S, Marty N, Saint Ghislain M, Huet E, Bridoux V, Tuech JJ, Roman H. Postoperative complications after bowel endometriosis surgery by shaving, disc excision, or segmental resection: a three-arm comparative analysis of 364 consecutive cases. Fertil Steril 2018; 109:172-178.e1. [DOI: 10.1016/j.fertnstert.2017.10.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/31/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
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Roman H, Darwish B, Bridoux V, Chati R, Kermiche S, Coget J, Huet E, Tuech JJ. Functional outcomes after disc excision in deep endometriosis of the rectum using transanal staplers: a series of 111 consecutive patients. Fertil Steril 2017; 107:977-986.e2. [DOI: 10.1016/j.fertnstert.2016.12.030] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/01/2016] [Accepted: 12/25/2016] [Indexed: 01/28/2023]
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Philouze G, Voitellier E, Lacaze L, Huet E, Gancel A, Prévost G, Bubenheim M, Scotté M. Excess Body Mass Index Loss at 3 Months: A Predictive Factor of Long-Term Result after Sleeve Gastrectomy. J Obes 2017; 2017:2107157. [PMID: 28250984 PMCID: PMC5303591 DOI: 10.1155/2017/2107157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/21/2016] [Accepted: 12/28/2016] [Indexed: 12/13/2022] Open
Abstract
Introduction. Laparoscopic Sleeve Gastrectomy (SG) is considered as successful if the percentage of Excess Body Mass Index Loss (% EBMIL) remains constant over 50% with long-term follow-up. The aim of this study was to evaluate whether early % EBMIL was predictive of success after SG. Methods. This retrospective study included patients who had SG with two years of follow-up. Patients had follow-up appointments at 3 (M3), 6, 12, and 24 months (M24). Data as weight and Body Mass Index (BMI) were collected systematically. We estimated the % EBMIL necessary to establish a correlation between M3 and M24 compared to % EBMIL speeds and calculated a limit value of % EBMIL predictive of success. Results. Data at operative time, M3, and M24 were available for 128 patients. Pearson test showed a correlation between % EBMIL at M3 and that at M24 (r = 0.74; p < 0.0001). % EBMIL speed between surgery and M3 (p = 0.0011) was significant but not between M3 and M24. A linear regression analysis proved that % EBMIL over 20.1% at M3 (p < 0.0001) predicted a final % EBMIL over 50%. Conclusions. % EBMIL at M3 after SG is correlated with % EBMIL in the long term. % EBMIL speed was significant in the first 3 months. % EBMIL over 20.1% at M3 leads to the success of SG.
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Affiliation(s)
- Guillaume Philouze
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France
| | - Eglantine Voitellier
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France
| | - Laurence Lacaze
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France
| | - Emmanuel Huet
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France
| | - Antoine Gancel
- Department of Endocrinology, Bois-Guillaume Hospital, 76230 Bois-Guillaume, France
| | - Gaëtan Prévost
- Department of Endocrinology, Bois-Guillaume Hospital, 76230 Bois-Guillaume, France
| | - Michael Bubenheim
- Department of Biostatistics, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France
| | - Michel Scotté
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France
- *Michel Scotté:
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Abstract
AIM OF THE STUDY During minimally invasive abdominal surgery, a laparoscope is used to film the procedure, which is transmitted to a flat screen monitor. The horizontality of the image depends on the orientation in space and the visual comfort of the surgeon. Observing the screen via a lateral angle of incidence frequently results in the camera assistant making errors in determining the horizontality of the image. Thus, what is "right" for the camera assistant is not necessarily 'right' for the surgeon. We aimed to explain the impact of these errors in laparoscope manipulation, by the description of the parallax effect. PATIENTS AND METHODS To describe this phenomenon of perceptions changing depending on the angle of view, from the basis of the parallax effect, we observed the change of position and for two observers, (the surgeon and the camera assistant) seated at two different locations, using an experimental set up (i.e., photography equipment, a screen and a pelvitrainer). RESULTS The position of the camera assistant positioned at an angle of incidence of 45° from the surgeon, the observation of the screen with a lateral incidence changes the perception of the image viewed on the screen. For correcting the conflict between the subjective visual perception of the camera assistant and the actual image horizon, the camera assistant instinctively rotates the image, which can lead to an "incorrect" image, deleterious for the surgeon. CONCLUSIONS This article introduces a previously unexplained concept in medical literature, called the parallax effect. The parallax effect results in the camera assistant making systematic errors in determining image horizontality on the screen.
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Affiliation(s)
- J Cahais
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - L Schwarz
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - V Bridoux
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - E Huet
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - J-J Tuech
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France.
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Millochau JC, Abo C, Darwish B, Huet E, Dietrich G, Roman H. Continuous Amenorrhea May Be Insufficient to Stop the Progression of Colorectal Endometriosis. J Minim Invasive Gynecol 2016; 23:839-42. [DOI: 10.1016/j.jmig.2016.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
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Csanyi M, Arnaud M, Le Pessot F, Huet E, Piton N, Sabourin JC. [About 2 cases of ectopic sebaceous glands in esophagus: Endoscopic and histological correlations from biopsies and resected specimens]. Ann Pathol 2016; 36:134-8. [PMID: 26995103 DOI: 10.1016/j.annpat.2016.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Abstract
Sebaceous glands are cutaneous annexes located in the dermis. Focal spots of ectopy of these glands are frequently identified in ectodermal tissues: they represent Fordyce's disease. However, only a few cases of ectopic sebaceous glands have been mentioned in non-ectodermic tissue. Fordyce spots of esophageal location are unusual, and most of them have been diagnosed from biopsy specimens. We report two cases of ectopic sebaceous glands in esophagus, the first diagnosed from a resected specimen, the second from biopsies. A literature review is carried out.
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Affiliation(s)
- Marie Csanyi
- Service d'anatomie et cytologie pathologiques, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
| | - Maxime Arnaud
- Service d'anatomie et cytologie pathologiques, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - Florence Le Pessot
- Service d'anatomie et cytologie pathologiques, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - Emmanuel Huet
- Service de chirurgie digestive Jean-Loygue, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - Nicolas Piton
- Service d'anatomie et cytologie pathologiques, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - Jean-Christophe Sabourin
- Service d'anatomie et cytologie pathologiques, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
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Badescu A, Roman H, Aziz M, Puscasiu L, Molnar C, Huet E, Sabourin JC, Stolnicu S. Mapping of bowel occult microscopic endometriosis implants surrounding deep endometriosis nodules infiltrating the bowel. Fertil Steril 2016; 105:430-4.e26. [DOI: 10.1016/j.fertnstert.2015.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/27/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
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Roman H, Darwish B, Bridoux V, Huet E, Coget J, Chati R, Tuech JJ, Abo C. Multiple nodule removal in multifocal colorectal endometriosis instead of “en bloc” large colorectal resection. ACTA ACUST UNITED AC 2016; 44:121-4. [DOI: 10.1016/j.gyobfe.2015.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/06/2015] [Indexed: 11/25/2022]
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Roman H, Abo C, Huet E, Bridoux V, Auber M, Oden S, Marpeau L, Tuech JJ. Full-Thickness Disc Excision in Deep Endometriotic Nodules of the Rectum: A Prospective Cohort. Dis Colon Rectum 2015; 58:957-66. [PMID: 26347968 DOI: 10.1097/dcr.0000000000000447] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND To date, a majority of patients presenting with large endometriosis of the rectum are managed worldwide by colorectal resection. However, postoperative rectal function may be impacted by radical rectal surgery. OBJECTIVE The purpose of this study was to assess the postoperative outcomes of patients with rectal endometriosis who are managed by full-thickness disc excision and to compare outcomes of the 2 procedures using a transanal approach. DESIGN This was a prospective study. SETTINGS The study was conducted at a university hospital. PATIENTS Fifty patients with colorectal endometriosis that was managed by disc excision between June 2009 and November 2014 were included in the study. INTERVENTIONS The procedure included laparoscopic deep shaving, followed by full-thickness disc excision to remove the shaved rectal area. Disc excision was performed using a semicircular transanal stapler (the Rouen technique) in 20 patients, an end-to-end anastomosis circular transanal stapler in 28 patients, and transvaginal excision in 2 patients. MAIN OUTCOMES MEASURES Preoperative and postoperative assessments of pelvic symptoms and digestive function using standardized gastrointestinal questionnaires were the main measures. RESULTS The largest diameter of specimens achieved was significantly higher using the Rouen technique (58 ± 9 mm) than the end-to-end anastomosis stapler (34 ± 6 mm). Two rectovaginal fistulas were recorded (4%), and 8 patients presented with transitory bladder voiding (16%). Median postoperative values for the Gastrointestinal Quality of Life Index and the Knowles-Eccersley-Scott-Symptom Questionnaire improved progressively 1 and 3 years after surgery. For patients intending to get pregnant, the cumulative pregnancy rate was 80%, and 63% of pregnancies were spontaneous. LIMITATIONS The study sample size is small and the design is not comparative; however, direct comparison of patients managed by disc excision and colorectal resection would be inappropriate, because of differences regarding nodule localization and size. CONCLUSIONS Disc excision is a valuable alternative to colorectal resection in selected patients presenting with rectal endometriosis, achieving better preservation of rectal function. The Rouen technique allows for successful removal of large nodules of the low and midrectum, with favorable postoperative outcomes. (See video abstract, http://links.lww.com/DCR/A208.).
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Affiliation(s)
- Horace Roman
- 1 Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France 2 Research Group EA 4308, Rouen University Hospital, Rouen, France 3 Department of Digestive Surgery, Rouen University Hospital, Rouen, France 4 Digestive Tract Research Group EA3234/IFRMP23, Rouen University Hospital, Rouen, France
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Gangloff A, Lecleire S, Di Fiore A, Huet E, Iwanicki-Caron I, Antonietti M, Michel P. Fully versus partially covered self-expandable metal stents in benign esophageal strictures. Dis Esophagus 2015; 28:678-83. [PMID: 25168061 DOI: 10.1111/dote.12260] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Self-expandable plastic stents are currently recommended for refractory benign esophageal strictures but they show disappointing results in terms of migration and long-term efficacy. We report here our experience in the management of benign esophageal strictures with partially covered (PCSEMS) and fully covered self-expandable metal stents (FCSEMS). We performed a retrospective analysis of self-expandable metal stent (SEMS) placements for benign esophageal strictures from 1998 to 2011 in Rouen University Hospital. Twenty-two patients (15 men, 7 women) attempted 40 esophageal SEMS placements (17 PCSEMS, 23 FCSEMS) during this period. All technical complications were migrations. Migration was noted after 3/17 PCSEMS (17.6%) and 4/23 FCSEMS placement (17.4%, P = ns). Clinical complications occurred after 6/17 PCSEMS and 2/23 FCSEMS placements (35.3% vs. 8.7%, P = 0.053). PCSEMS caused two major complications (fistulae) whereas FCSEMS did not cause any major complication (11.7% vs. 0%). Mean dysphagia score was significantly lower after SEMS placement (1.68 vs. 3.08, P < 0.001) with similar results for PCSEMS and FCSEMS. Stent placement resulted in long-term clinical success for 23.5% of PCSEMS and 34.7% of FCSEMS (P = 0.0505). FCSEMS provide satisfying clinical success rate with an acceptable complication rate and they could constitute a relevant therapeutic option in the management of benign esophageal strictures.
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Affiliation(s)
- A Gangloff
- Department ofGastroenterology, Rouen University Hospital, Rouen, France
| | - S Lecleire
- Department ofGastroenterology, Rouen University Hospital, Rouen, France
| | - A Di Fiore
- Department ofGastroenterology, Rouen University Hospital, Rouen, France
| | - E Huet
- Department ofDigestive Surgery, Rouen University Hospital, Rouen, France
| | - I Iwanicki-Caron
- Department ofGastroenterology, Rouen University Hospital, Rouen, France
| | - M Antonietti
- Department ofGastroenterology, Rouen University Hospital, Rouen, France
| | - P Michel
- Department ofGastroenterology, Rouen University Hospital, Rouen, France
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Roman H, Puscasiu L, Lempicki M, Huet E, Chati R, Bridoux V, Tuech JJ, Abo C. Colorectal Endometriosis Responsible for Bowel Occlusion or Subocclusion in Women With Pregnancy Intention: Is the Policy of Primary in Vitro Fertilization Always Safe? J Minim Invasive Gynecol 2015; 22:1059-67. [DOI: 10.1016/j.jmig.2015.05.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 12/13/2022]
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Vincent J, Mariette C, Pezet D, Huet E, Bonnetain F, Bouché O, Conroy T, Roullet B, Seitz JF, Herr JP, Di Fiore F, Jouve JL, Bedenne L. Early surgery for failure after chemoradiation in operable thoracic oesophageal cancer. Analysis of the non-randomised patients in FFCD 9102 phase III trial: Chemoradiation followed by surgery versus chemoradiation alone. Eur J Cancer 2015; 51:1683-93. [PMID: 26163097 DOI: 10.1016/j.ejca.2015.05.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 05/27/2015] [Accepted: 05/31/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Two randomised trials concerning thoracic oesophageal cancer concluded that for squamous cell carcinoma, chemoradiation alone leads to the same overall survival (OS) as chemoradiation followed by surgery. One of these trials, FFCD 9102, randomised only fit, compliant and operable responders to induction chemoradiation between continuation of chemoradiation and surgery. In the present analysis, the outcome in the patients not eligible for randomisation was calculated to determine if attempt of surgery should be recommended. METHODS Eligible patients had operable T3-N0/N1-M0 thoracic oesophageal cancer. After initial chemoradiation, patients with no clinical response, or with contraindication to follow any attributed treatment, were not randomised. OS was studied first in the whole population of not randomised patients, and then specifically in clinical non-responders. The impact of surgery on OS was studied in these two populations. FINDINGS Of the 451 registered patients in the trial, 192 were not randomised. Among them, 111 were clinical non-responders. Median OS was significantly shorter for non-randomised patients (11.5 months) than for randomised patients (18.9 months; p=0.0024). However, for the 112 non-randomised patients who underwent surgery, median OS was not different from that in randomised patients: 17.3 versus 18.9 months (p=0.58). Concerning clinical non-responders, median OS was longer for those who underwent surgery compared to non-operated patients: 17.0 versus 5.5 months (hazard ratio (HR)=0.39 [0.25-0.61]; p<0.0001), and again was not different from that in responding, randomised patients (p=0.40). INTERPRETATION In patients with locally advanced thoracic oesophageal cancer, overall survival did not differ between responders to induction chemoradiation and patients having surgery after clinical failure of chemoradiation. Surgery should therefore be considered in those patients who are still operable.
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Affiliation(s)
| | | | - Denis Pezet
- Hôtel-Dieu University Hospital, Clermont-Ferrand, France
| | | | | | | | - Thierry Conroy
- Alexis Vautrin Anticancer Centre, Vandoeuvre-lès Nancy, France
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Skalli S, Bertin C, Charhon N, Mouchoux C, Huet E, Charpiat B, Janoly-Dumenil A. [Pharmacist's interventions on proton pump inhibitor prescriptions in a University Hospital]. J Pharm Belg 2015:20-29. [PMID: 26466506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE In France, efforts to optimize prescribing of proton-pump inhibitors (PPIs) are rare. Various studies have shown that the prescription of these drugs is excessive. This has consequences regarding costs and iatrogenesis. The objective of this study was to describe the type of drug related problems (DRP) and pharmaceutical interventions reported by pharmacists practicing in a university hospital. METHODS Drug related problems and pharmaceutical interventions (PI) made, were recorded on a database. They were classified according to the grid code of the French Society of Clinical Pharmacy. RESULTS AND DISCUSSION Over a 3 years period, 132.890 prescriptions were analysed. 15.347 generated PI. Among them 701 (4.6%) concerned PPIs. Most frequently reported problems were: lack of indication or patients without a documented indication (24.4%), drug-drug interactions (22.4%) and inappropriate route or mode of administration (19.8%). Discontinuation has been proposed in 40.5% of cases, followed by substitution (22.0%) and dosage titration (17.3%). Physicians modified the prescription according to 51.3% of PI. The main PI, discontinuation therapy, is associated with over-prescription of this drug class. Nevertheless, the rate of DRP recorded (0.5%) is low compared to the high exposure of patients on PPIs and misuse (or overuse?) reported in the literature. CONCLUSION PI made during the analysis of prescription contributes to rationalizing the use of PPIs. The action of the pharmacist must be strengthened through training of health professionals, and communication strategies to improve practices.
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Huet E, Gabison E, Vallee B, Mougenot N, Linguet G, Riou B, Jarosz C, Menashi S, Besse S. Deletion of extracellular matrix metalloproteinase inducer/CD147 induces altered cardiac extracellular matrix remodeling in aging mice. J Physiol Pharmacol 2015; 66:355-366. [PMID: 26084217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 03/06/2015] [Indexed: 06/04/2023]
Abstract
Extracellular matrix metalloproteinase inducer (EMMPRIN), known for its ability to induce matrix metalloproteinase (MMP) expression, was proposed to play a role in the adverse cardiac extracellular matrix remodeling. After observing an age-associated increase in cardiac EMMPRIN expression in both mice and rats, the role and mechanism of action of EMMPRIN was investigated in the myocardial age-associated changes using 3, 12 and 24 month old EMMPRIN knock-out (KO) vs. wild-type (WT) mice, by cardiac echocardiography, Western blots, immunohistochemistry, ELISA and histology. Adilated cardiomyopathy characterized by a decreased ejection fraction and an enlargement of left ventricular chamber (LV) associated with LV hypertrophy, occurred in KO mice as soon as 12 month old. The increase in interstitial collagen deposition during aging in WT mice could not be detected in KO mice. This may be related to the reduced activation (48% reduction; P < 0.05) and signaling (smad2/3 nuclear translocation) of TGF-β in the 12 month old KO mice which paralleled with a greater reduction in the TGF-β known activating enzymes such as MT1-MMP and MMP-1 (33% and 37% reduction respectively, between 3 and 12 month old in KO mice; P < 0.05) as well as uPA. These findings demonstrate that EMMPRIN gene silencing is associated with an aberrant extracellular matrix remodeling, characterized by the absence of a detected age-associated fibrosis and consequently to dilated cardiopathy, indicating that a fine regulation of EMMPRIN is essential for the coordinated ECM remodeling during aging.
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Affiliation(s)
- E Huet
- Paris-Est University, Laboratory "Croissance Cellulaire, Reparation and Regeneration Tissulaire", CNRS, Creteil, France
- Paris-Est University, INSERM Unit 955, Team 7, Faculty of Medicine, Creteil, France
| | - E Gabison
- Paris Diderot University, Sorbonne Paris Cite, and A. de Rothschild Fondation, Paris, France
| | - B Vallee
- Paris-Est University, Laboratory "Croissance Cellulaire, Reparation and Regeneration Tissulaire", CNRS, Creteil, France
| | - N Mougenot
- Pierre and Marie Curie University, Sorbonne Universites, UMS 28 "Phenotypage du petit animal", Faculty of Medicine, Paris, France
| | - G Linguet
- Paris-Est University, Laboratory "Croissance Cellulaire, Reparation and Regeneration Tissulaire", CNRS, Creteil, France
| | - B Riou
- Pierre and Marie Curie University, Sorbonne Universites, INSERM UMR 1166 and Department of Emergency Medicine and Surgery, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - C Jarosz
- Paris-Est University, Laboratory "Croissance Cellulaire, Reparation and Regeneration Tissulaire", CNRS, Creteil, France
| | - S Menashi
- Paris-Est University, Laboratory "Croissance Cellulaire, Reparation and Regeneration Tissulaire", CNRS, Creteil, France
| | - S Besse
- Paris-Est University, Laboratory "Croissance Cellulaire, Reparation and Regeneration Tissulaire", CNRS, Creteil, France.
- Paris-Saclay University, Unit "Biologie Integrative des Adaptations à l'Exercice", INSERM Unit 902, Evry, and Paris-Descartes University, Sorbonne Paris Cite, Paris, France
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Gourcerol G, Tissier F, Melchior C, Touchais JY, Huet E, Prevost G, Leroi AM, Ducrotte P. Impaired fasting pyloric compliance in gastroparesis and the therapeutic response to pyloric dilatation. Aliment Pharmacol Ther 2015; 41:360-7. [PMID: 25523288 DOI: 10.1111/apt.13053] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 09/13/2014] [Accepted: 11/25/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pyloric pressure and compliance have never been investigated in health nor gastroparesis. AIM We hypothesised that pyloric pressure and/or compliance may be altered in gastroparesis. METHODS Fasting pyloric pressure and compliance were investigated in 21 healthy volunteers (HV), 27 gastroparetic patients (GP) and 5 patients who had undergone oesophagectomy without pyloroplasty as positive controls. Under videofluoroscopic control, pyloric compliance and pressure were measured by the EndoFLIP technique. Gastric emptying half time (T1/2 ) using (13) C-octanoic acid breath test, as well as symptoms and quality of life (GIQLI score) were also monitored. RESULTS Mean fasting pyloric compliance was measured at 25.2 ± 2.4 mm²/mmHg in HV, and was lower both in GP (16.9 ± 2.1 mm²/mmHg; P < 0.05) and patients with oesophagectomy (10.9 ± 2.9 mm²/mmHg; P < 0.05). By contrast, fasting pyloric pressure was not different among groups. Fasting pyloric compliance and pressure correlated with T1/2 in GP (R = -0.43; P = 0.04). Fasting pyloric compliance, but not pressure, correlated with symptoms and GIQLI score. Pyloric dilation in 10 GP with low fasting pyloric compliance (<10 mm²/mmHg) increased compliance from 7.4 ± 0.4 to 20.1 ± 4.9 mm²/mmHg (P < 0.01) and improved the GIQLI score from 72.5 ± 5.5 to 89.3 ± 6.1 (P = 0.04). CONCLUSION This prospective study assessed pyloric compliance for the first time, and showed that fasting pyloric compliance is decreased in gastroparetic patients and is associated with T1/2 , symptoms and quality of life. This suggests that pyloric compliance may be a new relevant metric in gastroparetic patients, and may be useful to target patients for pyloric dilation or botulinum toxin injection.
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Affiliation(s)
- G Gourcerol
- Physiology Department, Rouen University Hospital, Rouen, France; Nutrition, Brain and Gut Laboratory, INSERM unit 1073, Rouen University Hospital, Rouen, France; Clinical Investigation Center, INSERM 0204, Rouen University Hospital, Rouen, France
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Roman H, Quibel S, Auber M, Muszynski H, Huet E, Marpeau L, Tuech JJ. Recurrences and fertility after endometrioma ablation in women with and without colorectal endometriosis: a prospective cohort study†. Hum Reprod 2015; 30:558-68. [DOI: 10.1093/humrep/deu354] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Roman H, Huet E, Darai E, Khalil H, Tuech JJ. Colorectal Resection Versus Rectal Conservative Surgery in the Management of Rectal Endometriosis: Preliminary Results of ENDORE Randomized Trial. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2014.08.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Roman H, Arambage K, Pasquier G, Resch B, Huet E. Combined Cystoscopic and Laparoscopic Approach in Deep Endometriosis of the Bladder. J Minim Invasive Gynecol 2014; 21:978-9. [DOI: 10.1016/j.jmig.2014.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 02/21/2014] [Indexed: 11/26/2022]
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41
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Pham S, Gancel A, Scotte M, Houivet E, Huet E, Lefebvre H, Kuhn JM, Prevost G. Comparison of the effectiveness of four bariatric surgery procedures in obese patients with type 2 diabetes: a retrospective study. J Obes 2014; 2014:638203. [PMID: 24967099 PMCID: PMC4055665 DOI: 10.1155/2014/638203] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 04/23/2014] [Indexed: 02/06/2023] Open
Abstract
AIM The aim of the present retrospective study was to evaluate the efficacy of four bariatric surgical procedures to induce diabetes remission and lower cardiovascular risk factors in diabetic obese patients. Moreover, the influence of surgery on weight evolution in the diabetic population was compared with that observed in a nondiabetic matched population. METHODS Among 970 patients who were operated on in our center since 2001, 81 patients were identified as type 2 diabetes. Laparoscopic adjustable gastric banding (GB), intervention type Mason (MA), gastric bypass (RYGB), and sleeve gastrectomy (SG) were performed, respectively, in 25%, 17%, 28%, and 30% of this diabetic population. RESULTS The resolution rate of diabetes one year after surgery was significantly higher after SG than GB (62.5% versus 20%, P < 0.01), but not significantly different between SG and RYGB. In terms of LDL-cholesterol reduction, RYGB was equivalent to SG and superior to CGMA or GB. Considering the other cardiovascular risk factors, there was no significant difference according to surgical procedures. The weight loss was not statistically different between diabetic and nondiabetic matched patients regardless of the surgical procedures used. CONCLUSION Our data confirm that the efficacy of surgery to treat diabetes is variable among the diverse procedures and SG might be an interesting option in this context.
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Affiliation(s)
- Sylvie Pham
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Rouen, 76031 Rouen, France
| | - Antoine Gancel
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Rouen, 76031 Rouen, France
| | - Michel Scotte
- Department of Digestive Surgery, University Hospital of Rouen, 76031 Rouen, France
| | - Estelle Houivet
- Department of Biostatistics, University Hospital of Rouen, Institut de Recherche et d'Innovation Biomédicale, Normandie University, 76031 Rouen, France
| | - Emmanuel Huet
- Department of Digestive Surgery, University Hospital of Rouen, 76031 Rouen, France
| | - Hervé Lefebvre
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Rouen, 76031 Rouen, France
- INSERM U982 Neuronal and Neuroendocrine Differentiation and Communication, Institut de Recherche et d'Innovation Biomédicale, Normandie University, University of Rouen, 76821 Mont Saint Aignan, France
| | - Jean-Marc Kuhn
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Rouen, 76031 Rouen, France
- INSERM U982 Neuronal and Neuroendocrine Differentiation and Communication, Institut de Recherche et d'Innovation Biomédicale, Normandie University, University of Rouen, 76821 Mont Saint Aignan, France
| | - Gaetan Prevost
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Rouen, 76031 Rouen, France
- INSERM U982 Neuronal and Neuroendocrine Differentiation and Communication, Institut de Recherche et d'Innovation Biomédicale, Normandie University, University of Rouen, 76821 Mont Saint Aignan, France
- *Gaetan Prevost:
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Marchalot A, Béduneau G, Huet E, Girault C. Purulent vomica from subdiaphragmatic origin. Intensive Care Med 2013; 39:1638-9. [PMID: 23740273 DOI: 10.1007/s00134-013-2958-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Antoine Marchalot
- Department of Medical Intensive Care, Charles Nicolle University Hospital, Rouen, France.
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Schwarz L, Huet E, Yzet T, Fuks D, Regimbeau JM, Scotte M. An extremely uncommon variant of left hepatic artery arising from the superior mesenteric artery. Surg Radiol Anat 2013; 36:91-4. [PMID: 23652481 DOI: 10.1007/s00276-013-1131-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
Abstract
We report a new variation of the left hepatic artery arising from the superior mesenteric artery. The variant was discovered during radiological examinations in a patient presenting with ruptured hepatocellular carcinoma of the left liver lobe. Anatomical description was based on CT-scan and angiographic analysis. When present the left hepatic artery originates from the left gastric artery, with an incidence of 12-34 %. Knowledge of left hepatic artery anatomy is mandatory to optimize surgical and radiological management in complex clinical situations.
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Affiliation(s)
- L Schwarz
- Department of Digestive Surgery, Rouen University Hospital-Hôpital Charles Nicolle, 76031, Rouen Cedex, France
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Di Fiore F, Blondin V, Hitzel A, Edet-Sanson A, Benyoucef A, Huet E, Vera P, Michel P. 18F-fluorodeoxyglucose positron emission tomography after definitive chemoradiotherapy in patients with oesophageal carcinoma. Dig Liver Dis 2012; 44:875-9. [PMID: 22883219 DOI: 10.1016/j.dld.2012.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 04/17/2012] [Accepted: 04/23/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of the study was to investigate the value of 18F-fluorodeoxyglucose-positron emission tomography performed after definitive chemoradiotherapy in patients with locally advanced oesophageal carcinoma. METHODS Forty consecutive patients underwent 18F-fluorodeoxyglucose-positron emission tomography at baseline and after chemoradiotherapy completion. Assessment of the clinical complete response to chemoradiotherapy included oesophagoscopy plus biopsies and computed tomography scan. Cox regression analysis was used to develop the univariate and multivariate models describing the association of the independent variables with survival and local control. RESULTS A clinical complete response and 18F-fluorodeoxyglucose-positron emission tomography response were present in 29 patients (72.5%) and 13 patients (32.5%), respectively. A combined response was observed in 11 patients (27.5%). During follow-up, a local failure was detected in 27.2% of patients with 18F-fluorodeoxyglucose-positron emission tomography response versus 33.3% in non-responders (p=.9). In multivariate analysis, clinical complete response (HR 5.77, p=.009) and 18F-fluorodeoxyglucose-positron emission tomography response (HR 6.27, p=.031) were identified as independent prognostic factors of overall survival. CONCLUSION In patients treated for an esophageal cancer, the present study suggested that 18F-fluorodeoxyglucose-positron emission tomography after chemoradiotherapy completion was an independent prognostic factor of overall survival without significant impact on local recurrence prediction.
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Affiliation(s)
- Frederic Di Fiore
- Digestive Oncology Unit, Hepatogastroenterology Department, Rouen University Hospital and University of Rouen, France.
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Gourcerol G, Huet E, Vandaele N, Chaput U, Leblanc I, Bridoux V, Michot F, Leroi AM, Ducrotté P. Long term efficacy of gastric electrical stimulation in intractable nausea and vomiting. Dig Liver Dis 2012; 44:563-8. [PMID: 22387288 DOI: 10.1016/j.dld.2012.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 01/04/2012] [Accepted: 01/22/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although the efficacy of gastric electrical stimulation has been reported in short-term studies, there is a lack of data on the long-term improvement of nausea and vomiting by gastric electrical stimulation in patients with delayed or normal gastric emptying. METHODS Thirty-one patients were implanted at our centre for medically refractory severe and chronic nausea and/or vomiting. Patients were evaluated at baseline, 6 months then 5 years after implantation (mean follow-up 80±4 months) using a symptomatic and quality of life scores. KEY RESULTS Amongst the 31 patients, 4 were lost to follow-up, 6 explanted due to lack of improvement, and 1 patient died. Out of the 20 patients evaluated over 5 years, the quality of life score showed 27% improvement (p<0.01), including nausea (62%; p<0.01), vomiting (111%; p=0.03), satiety (158%; p<0.01), bloating (67%; p<0.01) and epigastric pain (43%; p=0.03). Over 5 years, 15/20 patients reported a 50% improvement with a global satisfaction rated at 64±6%. Therefore, 15/27 patients (56%) were improved by gastric electrical stimulation over 5 years in intention to treat. Improvement of nausea 6 months after implantation was predictive of 5-year success of gastric electrical stimulation (p=0.04). Finally, patients with delayed gastric emptying or with normal gastric emptying rate before surgery were similarly improved over 5 years (60% versus 50% respectively). CONCLUSION Gastric electrical stimulation is safe and effective in the long term in patients with medically refractory nausea and vomiting, with an efficacy over 50% beyond 5 years in intention to treat. Gastric emptying measured before implantation did not influence the response rate over 5 years.
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Affiliation(s)
- Guillaume Gourcerol
- Department of Physiology and INSERM UMR-1073/IRIB, Rouen University Hospital, University of Rouen, France.
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Milia-Argeiti E, Huet E, Labropoulou VT, Mourah S, Fenichel P, Karamanos NK, Menashi S, Theocharis AD. Imbalance of MMP-2 and MMP-9 expression versus TIMP-1 and TIMP-2 reflects increased invasiveness of human testicular germ cell tumours. ACTA ACUST UNITED AC 2012; 35:835-844. [PMID: 22712465 DOI: 10.1111/j.1365-2605.2012.01289.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The histological classification of testicular germ cell tumours (TGCTs) to seminoma or non-seminomatous germ cell tumours is at present the main criterion for the clinical outcome and selection of the treatment strategy. In view of the need to identify novel prognostic biomarkers for TGCTs, we investigated the expression of the matrix metalloproteinases MMP-2 and MMP-9 in testicular tumour tissues and cell lines of both seminoma and non-seminoma origin. Immunohistochemistry and zymography analysis of tumoural tissues showed significantly higher levels of MMP-2 and MMP-9 compared with normal testis with the active forms detected only in the tumour tissues. Three cell lines representative of the different tumour types, JKT-1 seminoma, NCCIT teratocarcinoma and NTERA2/D1 embryonal carcinoma were also evaluated for their expression of these MMPs using qPCR and zymography and for their invasive properties. The more invasive non-seminomatous teratocarcinoma and embryonal cells expressed considerably more MMP-2 and MMP-9 compared with seminoma cells exhibiting lower invasiveness. Furthermore, an inverse relation was observed between invasiveness and the expression of endogenous inhibitors TIMP-1 and TIMP-2. The MMP inhibitor Marimastat inhibited invasion in all cell lines, the highest inhibition was observed in the more invasive NTERA2/D1 and NCCIT cells, which presented the highest ratio of MMP-2 and MMP-9 vs. TIMP-1 and TIMP-2. These results highlight the importance of MMP-2 and MMP-9 in the invasiveness of testicular tumours and suggest that their levels, vs. those of TIMP-1 and TIMP-2, may represent potential biomarkers for testicular malignancy.
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Affiliation(s)
- E Milia-Argeiti
- Department of Chemistry, Laboratory of Biochemistry, University of Patras, Greece
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Tuech JJ, Bridoux V, Kianifard B, Schwarz L, Tsilividis B, Huet E, Michot F. Natural orifice total mesorectal excision using transanal port and laparoscopic assistance. Eur J Surg Oncol 2011; 37:334-5. [PMID: 21266304 DOI: 10.1016/j.ejso.2010.12.016] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Accepted: 12/23/2010] [Indexed: 12/19/2022] Open
Abstract
Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an emerging concept which has been recently applied to the field of rectal excision. The authors describe a case of total mesorectal excision using a transanal port and laparoscopic assistance. We described a procedure performed in a 45-year-old for a rectal adenocarcinoma (1 cm wide, T1sm3) 3 cm above the dentate line. The procedure is described in the text and in a didactic video.
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Affiliation(s)
- J-J Tuech
- Department of digestive surgery, Rouen University hospital, 1 rue Germont, 76031 Rouen 6, France.
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Ma L, Huet E, Serova M, Berthois Y, Calvo F, Mourah S, Menashi S. Antisense inhibition of amphiregulin expression reduces EGFR phosphorylation in transformed human breast epithelial cells. Anticancer Res 2010; 30:2101-2106. [PMID: 20651357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The activation of epidermal growth factor receptor (EGFR) by its ligands constitutes an important step in the metastatic process but the clinical response to its inhibition in breast cancer patients has so far been very low. In this work, we investigated the role of the EGFR ligand amphiregulin (AR) in modulating EGFR activation. For this, transformed epithelial mammary tumor cells NS2T2A1 were used in which AR or EGFR expression was down-regulated by antisense cDNA technique. This down-regulation was associated with a significant inhibition of matrix metalloproteinase-9 production as well as cell proliferation, but this inhibition was only minimally reversed by exogenously added AR or EGF. EGFR protein levels were not affected but EGFR-tyrosine phosphorylation in response to EGF was markedly reduced. Thus, the inhibition of AR expression, which impairs EGFR response to its exogenously available ligands, may represent an alternative anti-EGFR therapeutic strategy in breast cancer.
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Affiliation(s)
- L Ma
- Department of Radiotherapy, PLA General Hospital, Beijing, China
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Tsilividis B, Huet E, Lubrano J, Lacaze L, Lestrat JP, François A, Riachi G, Scotté M. Late supra-diaphragmatic lymph node recurrence following resection of a fibrolamellar hepatocarcinoma: an unusual case. Surg Radiol Anat 2009; 32:123-7. [DOI: 10.1007/s00276-009-0564-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Accepted: 09/14/2009] [Indexed: 12/31/2022]
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50
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Attia J, Boumédiène K, Pujol J, Valleton J, Huet E, Nguyen Q. Matrix Gene Expression in Dermal Fibroblasts Cultured on Hyaluronan-coated Polysulfone Membranes. J BIOACT COMPAT POL 2009. [DOI: 10.1177/0883911509105847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Polysulfone (PSU) membranes, coated and uncoated hyaluronan (HA), were compared for their ability to allow dermal fibroblast express genes related to extracellular matrix synthesis and remodeling. Fibroblasts type I and type III collagens were studied on both types of membranes; only type I collagen was synthesized on control cultures in plastic Petri dishes, whereas type III collagen was also expressed on PSU membranes. Expression of metalloproteinase (MMP)1, MMP3, and MMP2 was enhanced on PSU and HA-coated PSU membranes, with a lower level of MMP2 on HA-covered membranes. These membranes promote fetal-like matrices that provide good support for skin wound healing as well as favor nonscarring tissue repair.
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Affiliation(s)
- J. Attia
- Laboratory of Extracellular Matrix and Pathology, IFR 146 ICORE Faculty of Medicine, UnivCaen, 14032 Caen Cedex, France
| | - K. Boumédiène
- Laboratory of Extracellular Matrix and Pathology, IFR 146 ICORE Faculty of Medicine, UnivCaen, 14032 Caen Cedex, France
| | - J.P. Pujol
- Laboratory of Extracellular Matrix and Pathology, IFR 146 ICORE Faculty of Medicine, UnivCaen, 14032 Caen Cedex, France,
| | - J.M. Valleton
- CNRS UMR 6522, University of Rouen, 76821 Mont-Saint-Aignan, France
| | - E. Huet
- Laboratory CRRET, CNRS UMR 7149, Sciences UFR University of Paris X, 94010 Créteil, France
| | - Q.T. Nguyen
- Laboratory Polymers, Biopolymers, Surfaces FRE 3101, Sciences UFR University of Rouen, 76821 Mont-Saint-Aignan, Cedex, France
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