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Karam E, Hollenbach M, Ali EA, Auriemma F, Gulla A, Heise C, Regner S, Gaujoux S, Regimbeau JM, Kähler G, Seyfried S, Vaillant JC, De Ponthaud C, Sauvanet A, Birnbaum D, Regenet N, Truant S, Pérez-Cuadrado-Robles E, Bruzzi M, Lupinacci RM, Brunel M, Belfiori G, Barbier L, Salamé E, Souche FR, Schwarz L, Maggino L, Salvia R, Gagniére J, Del Chiaro M, Leung G, Hackert T, Kleemann T, Paik WH, Caca K, Dugic A, Muehldorfer S, Schumacher B, Albers D. Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study. Surgery 2023; 173:1254-1262. [PMID: 36642655 DOI: 10.1016/j.surg.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Ampullary lesions are rare and can be locally treated either with endoscopic papillectomy or transduodenal surgical ampullectomy. Management of local recurrence after a first-line treatment has been poorly studied. METHODS Patients with a local recurrence of an ampullary lesion initially treated with endoscopic papillectomy or transduodenal surgical ampullectomy were retrospectively included from a multi-institutional database (58 centers) between 2005 and 2018. RESULTS A total of 103 patients were included, 21 (20.4%) treated with redo endoscopic papillectomy, 14 (13.6%) with transduodenal surgical ampullectomy, and 68 (66%) with pancreaticoduodenectomy. Redo endoscopic papillectomy had low morbidity with 4.8% (n = 1) severe to fatal complications and a R0 rate of 81% (n = 17). Transduodenal surgical ampullectomy and pancreaticoduodenectomy after a first procedure had a higher morbidity with Clavien III and more complications, respectively, 28.6% (n = 4) and 25% (n = 17); R0 resection rates were 85.7% (n = 12) and 92.6% (n = 63), both without statistically significant difference compared to endoscopic papillectomy (P = .1 and 0.2). Pancreaticoduodenectomy had 4.4% (n = 2) mortality. No deaths were registered after transduodenal surgical ampullectomy or endoscopic papillectomy. Recurrences treated with pancreaticoduodenectomy were more likely to be adenocarcinomas (79.4%, n = 54 vs 21.4%, n = 3 for transduodenal surgical ampullectomy and 4.8%, n = 1 for endoscopic papillectomy, P < .0001). Three-year overall survival and disease-free survival were comparable. CONCLUSION Endoscopy is appropriate for noninvasive recurrences, with resection rate and survival outcomes comparable to surgery. Surgery applies more to invasive recurrences, with transduodenal surgical ampullectomy rather for carcinoma in situ and early cancers and pancreaticoduodenectomy for more advanced tumors.
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Affiliation(s)
- Elias Karam
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France.
| | - Marcus Hollenbach
- University of Leipzig Medical Center, Medical Department II-Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, Leipzig, Germany
| | - Einas Abou Ali
- Department of Gastroenterology, Digestive Oncology, and Endoscopy, Cochin Hospital, Paris, France
| | - Francesco Auriemma
- Humanitas Clinical and Research Hospital, Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy
| | - Aiste Gulla
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania; Johns Hopkins University, MedStar Georgetown University Hospital, General Surgery, Washington, DC
| | - Christian Heise
- Martin-Luther University Halle-Wittenberg Department of Medicine I-Gastroenterology, Pulmonology, Halle, Germany
| | - Sara Regner
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, Paris, France
| | | | - Jean M Regimbeau
- Department of Digestive Surgery, Center Hospitalo-Universitaire Amiens-Picardie, Amiens, France
| | - Georg Kähler
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Steffen Seyfried
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Jean C Vaillant
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Charles De Ponthaud
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Alain Sauvanet
- Department of Digestive Surgery, Beaujon Hospital, APHP, Clichy, France
| | - David Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Nicolas Regenet
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Nantes, France
| | - Stéphanie Truant
- Deparment of Digestive Surgery, Centre Hospitalo-Universitaire de Lille, France
| | | | - Matthieu Bruzzi
- Department of Digestive Surgery, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Renato M Lupinacci
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Martin Brunel
- Department of Digestive Surgery, Hôpital André Mignot, Versailles, France
| | - Giulio Belfiori
- Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy
| | - Louise Barbier
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
| | - Ephrem Salamé
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
| | - Francois R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire de Rouen, France
| | - Laura Maggino
- Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
| | - Roberto Salvia
- Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
| | - Johan Gagniére
- Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, Clermont-Ferrand, France; U1071 Inserm / Clermont-Auvergne University, Clermont-Ferrand, France
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, CO
| | - Galen Leung
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, PA
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
| | - Tobias Kleemann
- Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Germany
| | - Woo H Paik
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Republic of Korea
| | - Karel Caca
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases, RKH Clinic Ludwigsburg, Germany
| | - Ana Dugic
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | - Steffen Muehldorfer
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | | | - David Albers
- Department of Medicine and Gastroenterology, Contilia Clinic Essen, Germany
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2
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Busoni S, Bruzzi M, Giomi S, Poggiali C, Quattrocchi M, Betti M, D'Urso D, Fedeli L, Mazzoni LN, Paolucci M, Rossi F, Taddeucci A, Bettarini S, Tortoli P, Belli G, Bernardi L, Gasperi C, Campanella F. Surgeon eye lens dose monitoring in interventional neuroradiology, cardiovascular and radiology procedures. Phys Med 2022; 104:123-128. [PMID: 36401940 DOI: 10.1016/j.ejmp.2022.11.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study investigated the radiation dose to surgeon eye lens for single procedure and normalised to exposure parameters for eight selected neuroradiology, cardiovascular and radiology interventional procedures. METHODS The procedures investigated were diagnostic study, Arteriovenous Malformations treatment (AVM) and aneurysm embolization for neuroradiology procedures, Coronary Angiography and Percutaneous Transluminal Coronary Angioplasty (CA-PTCA), Pacemaker and Implantable Cardioverter-Defibrillator implantation (PM-ICD), Endovascular Aortic Repair (EVAR) and Fenestrated Endovascular Aortic Repair (FEVAR) for cardiovascular and electrophysiology procedures. CT-guided lung biopsy was also monitored. All procedures were performed with table-mounted and ceiling-suspended shields (0.5 mm lead equivalent thickness), except for FEVAR and PM-ICD where only a table mounted shield was present, and CT-guided lung biopsy where no shield was used. Dose assessment was performed using a dosemeter positioned close to the most exposed eye of the surgeon, outside the protective eyewear. RESULTS The surgeon most exposed eye lens median Hp(3) equivalent dose for a single procedure, without protective eyewear contribution, was 18 μSv for neuroradiology diagnostic study, 62 μSv for AVM, 38 μSv for aneurysm embolization, 33 μSv for CA-PTCA, 39 μSv for PM-ICD, 49 μSv for EVAR, 2500 μSv for FEVAR, 153 μSv for CT-guided lung biopsy. CONCLUSIONS In interventional procedures, the 20 mSv/year dose limit for surgeon eye lens exposure might be exceeded if shields or protective eyewear are not used. Surgeon eye lens doses, normalised to single procedures and to exposure parameters, are a valuable tool for determining appropriate radiation protection measures and dedicated eye lens dosemeter assignment.
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Affiliation(s)
- S Busoni
- Health Physics Unit, AOU Careggi (Firenze University Hospital), Italy.
| | - M Bruzzi
- Physics and Astronomy Department, University of Florence, Italy
| | - S Giomi
- Health Physics Unit, AOU Careggi (Firenze University Hospital), Italy; Physics and Astronomy Department, University of Florence, Italy
| | - C Poggiali
- Health Physics Unit, AOU Careggi (Firenze University Hospital), Italy; Physics and Astronomy Department, University of Florence, Italy
| | | | - M Betti
- Health Physics Unit, AUSL Toscana Centro, Italy
| | - D D'Urso
- Health Physics Unit, AULSS 2 Marca Trevigiana, Italy
| | - L Fedeli
- Health Physics Unit, AUSL Toscana Centro, Italy
| | - L N Mazzoni
- Health Physics Unit, AUSL Toscana Centro, Italy
| | - M Paolucci
- Health Physics Unit, AUSL Umbria 2, Italy
| | - F Rossi
- Health Physics Unit, AOU Careggi (Firenze University Hospital), Italy
| | - A Taddeucci
- Health Physics Unit, AOU Careggi (Firenze University Hospital), Italy
| | - S Bettarini
- Health Physics Unit, AOU Careggi (Firenze University Hospital), Italy
| | - P Tortoli
- Health Physics Unit, AOU Careggi (Firenze University Hospital), Italy
| | - G Belli
- Health Physics Unit, AOU Careggi (Firenze University Hospital), Italy
| | - L Bernardi
- Health Physics Unit, AUSL Toscana Centro, Italy
| | - C Gasperi
- Health Physics Unit, AUSL Toscana Sud-Est, Italy
| | - F Campanella
- Department of Medicine, Epidemiology, Workplace and Environmental Hygiene, INAIL, Italy
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3
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Bruzzi M. SP-0368 Radiographic and tomographic proton imaging. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03959-7] [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: 10/18/2022]
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Busoni S, Bruzzi M, Bettarini S, Betti M, Fedeli L, Mazzoni L, Quattrocchi M, Rossi F, Taddeucci A, Tortoli P, Belli G, Bernardi L, Doria S, Gasperi C, Gori C, Piffer S, Redapi L, Campanella F. Surgeon eye-lens dose monitoring in interventional procedures: a multi-centre and multi-procedure survey. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00060-6] [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] [Indexed: 10/19/2022] Open
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Voron T, Karoui M, Lo Dico R, Malicot KL, Espin E, Cianchi F, Jürgen W, Buggenhout A, Bruzzi M, Denimal F, Cazelles A, Douard R, Lepage C, Taieb J. Impact of laparoscopy on oncological outcomes after colectomy for stage III colon cancer: A post-hoc multivariate analysis from PETACC8 European randomized clinical trial. Dig Liver Dis 2021; 53:1034-1040. [PMID: 34112615 DOI: 10.1016/j.dld.2021.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/20/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND In colon cancer (CC), surgery remains the mainstay of treatment with curative intent. Despite several clinical trials comparing open and laparoscopic approaches, data on long-term outcomes for stage III CC are lacking. METHODS This post-hoc analysis of the European PETACC8 randomized phase 3 trial included patients from 340 sites between December 2005 and November 2009, with long follow-up (median 7.56 years). Patients were randomly assigned to FOLFOX or FOLFOX+cetuximab after colonic resection. The surgical approach was left to the referring surgeon's discretion. RESULTS Among 2555 patients included, 1796 (70.29%) were operated on by open surgery and 759 (29.71%) by laparoscopy. The 5-year OS rate was better after laparoscopic resection (85.4%, 95%CI 82.5-87.7) than after open surgery (80.2%, 95%CI 78.2-82.0; p = 0.002). The 5-year DFS rate was also better after laparoscopy (p = 0.016). However, in multivariate analysis using a propensity matching, the surgical approach was not found to be an independent prognostic factor for OS or DFS. OS (p = 0.0243) and DFS (p = 0.035) were increased after laparoscopic surgery in KRAS/BRAF WT sub-group CONCLUSION: We showed that laparoscopic resection has comparable long-term outcomes to open surgery in patients with stage III CC. For those with RAS and BRAF WT CC, laparoscopic colectomy may favorably impact survival.
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Affiliation(s)
- Thibault Voron
- Sorbonne Université, Department of Digestive and General Surgery, Saint Antoine Hospital, Paris, France
| | - Mehdi Karoui
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France.
| | - Réa Lo Dico
- Université de Paris, Department of Digestive Surgery, Saint Louis Hospital, AP-HP, Paris, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, Faculty of Medecine, Dijon, France; EPICAD INSERM UMR LNC 1231, University of Burgundy Franche Comté, Dijon France
| | - Eloy Espin
- Department of General Surgery, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Fabio Cianchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Weitz Jürgen
- Department of Visceral, Thoracic and Vascular surgery, University Hospital Carl Gustav Carus of the Technical University Dresden, Germany
| | - Alexis Buggenhout
- Department of surgical gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Matthieu Bruzzi
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Fabrice Denimal
- Department of Digestive Surgery, Centre Hospitalier Départemental Vendée, La Roche sur Yon, France
| | - Antoine Cazelles
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Richard Douard
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Come Lepage
- EPICAD INSERM UMR LNC 1231, University of Burgundy Franche Comté, Dijon France; HepatoGastroenterology and Digestive oncology department, University hospital Dijon, University of Burgundy and Franche Comté, FFCD, EPICAD INSERM LNC-UMR 1231, Dijon, France
| | - Julien Taieb
- Université de Paris, Department of Digestive Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France
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Voron T, Moszkowicz D, Hobeika C, Collard M, Bruzzi M, Beghdadi N, Catry J, Duchalais E, Manceau G, Lakkis Z, Allard MA, Cauchy F, Maggiori L. Re: Moszkowicz D, et al. "Operating room hygiene: Clinical practice recommendations SFCD-ACHBT". J Visc Surg 2021; 158:285-286. [PMID: 33583727 DOI: 10.1016/j.jviscsurg.2021.01.010] [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: 11/19/2022]
Affiliation(s)
- T Voron
- Department of General and Digestive Surgery, Saint Antoine Hospital, Assistance Publique des Hôpitaux de Paris (APHP), University of Paris 6, France
| | - D Moszkowicz
- General and digestive surgery department, Louis Mourier Hospital, Assistance Publique Hôpitaux de Paris (APHP), University of Paris, France
| | - C Hobeika
- Service de chirurgie digestive, hépato-bilio-pancréatique et transplantation, Pitié-Salpétrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), University of Paris 6, France
| | - M Collard
- Department of digestive, hepato-bilio-pancreatic and transplantation surgery, Beaujon Hospital, Paris, Assistance Publique Hôpitaux de Paris, (APHP), University of Paris, France
| | - M Bruzzi
- Department of digestive surgery, Européen Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (APHP), University of Paris, France
| | - N Beghdadi
- Hepatobiliary Center, Paul Brousse Hospital, Assistance Publique des Hôpitaux de Paris (APHP), University of Paris 11, France
| | - J Catry
- Department of General, Digestive and Endocrine Surgery, Saint-Louis Hospital, Assistance Publique des Hôpitaux de Paris (APHP), University of Paris, France
| | - E Duchalais
- Department of Digestive and Endocrine Surgery, CHU Nantes, University of Nantes, France
| | - G Manceau
- Service de chirurgie digestive, hépato-bilio-pancréatique et transplantation, Pitié-Salpétrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), University of Paris 6, France
| | - Z Lakkis
- Department of Visceral, Digestive and Cancer Surgery, CHRU Besançon, University of Franche-Comté, France
| | - M-A Allard
- Department of digestive surgery, Européen Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (APHP), University of Paris, France
| | - F Cauchy
- Department of digestive, hepato-bilio-pancreatic and transplantation surgery, Beaujon Hospital, Paris, Assistance Publique Hôpitaux de Paris, (APHP), University of Paris, France
| | - L Maggiori
- Department of General, Digestive and Endocrine Surgery, Saint-Louis Hospital, Assistance Publique des Hôpitaux de Paris (APHP), University of Paris, France.
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Lurbe I Puerto K, Bruzzi M, Rives-Lange C, Poghosyan T, Bretault M, Chatellier G, Vilfaillot A, Chevallier JM, Czernichow S, Carette C. Telemedicine intervention on physical activity recovery after bariatric surgery: the MyGoodTrip randomized controlled trial (Preprint). JMIR Form Res 2020; 7:e26077. [PMID: 36976624 PMCID: PMC10132008 DOI: 10.2196/26077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 10/19/2021] [Accepted: 01/25/2023] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite bariatric surgery showing significant weight loss trajectories for many patients, a substantial proportion regain weight after the first year following surgery. The addition of telemedicine to standard care could support patients with engaging in a more active lifestyle and thus improve clinical outcomes. OBJECTIVE Our aim was to evaluate a telemedicine intervention program dedicated to the promotion of physical activity including digital devices, teleconsultation, and telemonitoring the first 6 months following bariatric surgery. METHODS This study employed a mixed methods design based on an open-label randomized controlled trial. Patients were included during the first week after bariatric surgery; then, they were randomized into 2 intervention groups: The TelePhys group received a monthly telemedicine consultation focusing on physical activity coaching, while the TeleDiet group received a monthly telemedicine consultation involving diet coaching. Data were collected using a watch pedometer and body weight scale, both of which were connected wirelessly. The primary outcome was the difference between the 2 groups in the mean numbers of steps at the first and sixth postoperative months. Weight change was also evaluated, and focus groups and interviews were conducted to enrich the results and capture perceptions of the telemedicine provided. RESULTS Among the 90 patients (mean age 40.6, SD 10.4 years; 73/90, 81% women; 62/90, 69% gastric bypass), 70 completed the study until the sixth month (n=38 TelePhys; n=32 TeleDiet), and 18 participants agreed to be interviewed (n=8 Telephys; n=10 TeleDiet). An increase in the mean number of steps between the first and sixth months was found in both groups, but this change was significant only in the TeleDiet group (P=.01). No difference was found when comparing both intervention groups. Interviewed participants reported having appreciated the teleconsultations, as the individualized tailored counseling helped them to make better choices about behaviors that could increase their likelihood of a daily life in better health. Weight loss followed by social factors (such as social support) were identified as the main facilitators to physical activity. Family responsibilities, professional constraints as well as poor urban policies promoting physical activity, and lack of accessibility to sport infrastructure were their major barriers to postoperative lifestyle adherence. CONCLUSIONS Our study did not show any difference in mobility recovery after bariatric surgery related to a telemedicine intervention dedicated to physical activity. The early postoperative timing for our intervention may explain the null findings. eHealth interventions aiming to change behaviors and carried out by clinicians require support from structured public health policies that tackle patients' obesogenic environment in order to be efficient in their struggle against sedentary lifestyle-related pathologies. Further research will need to focus on long-term interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02716480, https://clinicaltrials.gov/ct2/show/NCT02716480.
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Affiliation(s)
- Katia Lurbe I Puerto
- Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Matthieu Bruzzi
- Service de Chirurgie Digestive, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Claire Rives-Lange
- Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
- METHODS team, Epidemiology and Biostatistics Sorbonne Paris Cité Center, INSERM 1153, Paris, France
| | - Tigran Poghosyan
- Service de Chirurgie Digestive, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Marion Bretault
- Service de Nutrition, Centre Spécialisé Obésité, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancour, France
| | - Gilles Chatellier
- Université de Paris, Paris, France
- Unité de recherche clinique, Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurelie Vilfaillot
- Unité de recherche clinique, Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Marc Chevallier
- Service de Chirurgie Digestive, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Sebastien Czernichow
- Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
- METHODS team, Epidemiology and Biostatistics Sorbonne Paris Cité Center, INSERM 1153, Paris, France
| | - Claire Carette
- Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
- Centre d'investigation clinique, INSERM 1418, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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Poghosyan T, Levenson G, Bruzzi M, Rives-Lange C, Czernichow S, Chevallier JM, Douard R. Fistulojejunostomy for Chronic Fistula After Sleeve Gastrectomy. Obes Surg 2020; 30:3638-3639. [PMID: 32388707 DOI: 10.1007/s11695-020-04660-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/27/2022]
Abstract
The most dreadful complication after sleeve gastrectomy (SG) is staple line leak. Its rate varies between 1 and 2%. With the development of interventional endoscopy, its treatment is currently fairly standardized and allows healing in the majority of cases without revisional surgery. However, if endoscopic treatment fails, surgical treatment becomes unavoidable. Fistulojejunostomy is a surgical option in the management of chronic fistula after SG. Laparoscopic fistulojejunostomy in a patient with chronic fistula after SG is difficult but feasible. This procedure allows complete healing and nutritional recovery in the case of failure of other endoscopic modalities.
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Affiliation(s)
- Tigran Poghosyan
- Department of Digestive, Oncologic and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and UFR Paris Descartes, Université de Paris, 20 Rue Leblanc, 75015, Paris, France.
| | - Guillaume Levenson
- Department of Digestive, Oncologic and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and UFR Paris Descartes, Université de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Matthieu Bruzzi
- Department of Digestive, Oncologic and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and UFR Paris Descartes, Université de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Claire Rives-Lange
- Department of Nutrition, AP-HP, Hôpital Européen Georges Pompidou and UFR Paris Descartes, Université de Paris, Paris, France
| | - Sebastien Czernichow
- Department of Nutrition, AP-HP, Hôpital Européen Georges Pompidou and UFR Paris Descartes, Université de Paris, Paris, France
| | - Jean-Marc Chevallier
- Department of Digestive, Oncologic and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and UFR Paris Descartes, Université de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Richard Douard
- Department of Digestive, Oncologic and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and UFR Paris Descartes, Université de Paris, 20 Rue Leblanc, 75015, Paris, France
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9
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Abstract
In some cases, in addition to the usual difficulties that the bariatric surgeon may encounter during standard bariatric procedures, anatomical anomalies such as situs inversus can pose an additional technical challenge. A 58-year-old patient with total situs inversus underwent Roux-en-Y gastric bypass (RYGB) surgery in our department. The main difficulty was the realization of a mirrored RYGB. Laparoscopic RYGB in a patient with situs inversus totalis is feasible but requires significant concentration and three-dimensional coordination to perform the mirrored procedure.
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Affiliation(s)
- Tigran Poghosyan
- Department of Digestive, Oncologique and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and Univsersité de Paris, UFR Paris Descartes, Paris, France.
| | - Matthieu Bruzzi
- Department of Digestive, Oncologique and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and Univsersité de Paris, UFR Paris Descartes, Paris, France
| | - Claire Rives-Lange
- Department of Nutrition, AP-HP, Hôpital Européen Georges Pompidou and Univsersité de Paris, UFR Paris Descartes, Paris, France
| | - Sebastien Czernichow
- Department of Nutrition, AP-HP, Hôpital Européen Georges Pompidou and Univsersité de Paris, UFR Paris Descartes, Paris, France
| | - Jean-Marc Chevallier
- Department of Digestive, Oncologique and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and Univsersité de Paris, UFR Paris Descartes, Paris, France
| | - Richard Douard
- Department of Digestive, Oncologique and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and Univsersité de Paris, UFR Paris Descartes, Paris, France
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10
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Bruzzi M, Glomaud A, M'Harzi L, Poghosyan T, Chevallier JM, Douard R. Robotic Roux Limb Placement for Chronic Fistula After Sleeve Gastrectomy: a Novel Approach for a Technically Challenging Surgery? Obes Surg 2019; 30:349-351. [PMID: 31713149 DOI: 10.1007/s11695-019-04264-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Matthieu Bruzzi
- INSERM 970, Équipe 2, PARCC, HEGP, Paris, France.
- General and Digestive Surgery Unit, |Georges Pompidou, AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France.
- Paris Descartes Faculty of Medicine, Paris, France.
| | - Adrien Glomaud
- General and Digestive Surgery Unit, |Georges Pompidou, AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France
| | - Leila M'Harzi
- General and Digestive Surgery Unit, |Georges Pompidou, AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France
| | - Tigran Poghosyan
- General and Digestive Surgery Unit, |Georges Pompidou, AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France
- Paris Descartes Faculty of Medicine, Paris, France
| | - Jean-Marc Chevallier
- General and Digestive Surgery Unit, |Georges Pompidou, AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France
- Paris Descartes Faculty of Medicine, Paris, France
| | - Richard Douard
- General and Digestive Surgery Unit, |Georges Pompidou, AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France
- Paris Descartes Faculty of Medicine, Paris, France
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11
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Bruzzi M, M'harzi L, Poghosyan T, Ben Abdallah I, Papadimitriou A, Ragot E, El Batti S, Balaya V, Taieb J, Chevallier JM, Douard R. Arterial vascularization of the right colon with implications for surgery. Surg Radiol Anat 2019; 42:429-435. [PMID: 31637473 DOI: 10.1007/s00276-019-02359-9] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/04/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE During right-sided colectomies, surgeons encounter major anatomical variations at the level of the right colon, leading to morbidity. Due to the confusion surrounding the colonic arterial vessels emerging from the superior mesenteric artery (SMA) to vascularize the right part of the colon, this review aimed to describe the arterial vessels found in the mesocolic structures of the ascending colon, the hepatic flexure and the right transverse colon. METHODS A review of the literature was performed using the MEDLINE database. Only human studies were included. All dissection, angiographic, arterial cast and corrosion studies were analyzed. RESULTS This review demonstrates that the right colon, the hepatic flexure and the right transverse colon are vascularized by three significant arteries emerging from the SMA and forming one peripheral paracolic arc: (1) the ileocolic artery (ICA), the most constant vessel (99.8%) with low variability; (2) the right colic artery (RCA), the most inconstant vessel (2/3 of cases) with high variability in its origin; and (3) the middle colic artery (MCA), a constant vessel (95%) with variation in its origin and its number. The marginal artery is almost constant (100%) and represents the only peripheral arterial arc at the level of the right side of the colon. CONCLUSIONS Three arteries emerging from the superior mesenteric artery exist: the ICA, the RCA and the MCA. The ICA and the MCA are the most constant. Knowledge of this vascular anatomy is essential for performing right-sided colectomies.
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Affiliation(s)
- Matthieu Bruzzi
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France. .,Paris Descartes Faculty of Medicine, Paris, France. .,INSERM 970, Équipe 2, PARCC, HEGP, Paris, France. .,Service de Chirurgie générale et digestive, Hôpital européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
| | - Leila M'harzi
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France.,Paris Descartes Faculty of Medicine, Paris, France.,INSERM 970, Équipe 2, PARCC, HEGP, Paris, France
| | - Tigran Poghosyan
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France.,Paris Descartes Faculty of Medicine, Paris, France.,INSERM 970, Équipe 2, PARCC, HEGP, Paris, France
| | | | - Argyri Papadimitriou
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France
| | - Emilia Ragot
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France
| | | | | | - Julien Taieb
- Paris Descartes Faculty of Medicine, Paris, France.,Digestive Oncology Unit, Georges Pompidou AP-HP University Hospital, Paris, France
| | - Jean-Marc Chevallier
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France.,Paris Descartes Faculty of Medicine, Paris, France
| | - Richard Douard
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France.,Paris Descartes Faculty of Medicine, Paris, France
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12
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Moszkowicz D, Hobeika C, Collard M, Bruzzi M, Beghdadi N, Catry J, Duchalais E, Manceau G, Voron T, Lakkis Z, Allard MA, Cauchy F, Maggiori L. Operating room hygiene: Clinical practice recommendations. J Visc Surg 2019; 156:413-422. [DOI: 10.1016/j.jviscsurg.2019.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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13
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M��Harzi L, Bruzzi M, Chevallier JM, Douard R. One anastomosis gastric bypass and esojejunostomy in rats: surgical techniques. ACTA ACUST UNITED AC 2019. [DOI: 10.20517/2574-1225.2019.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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14
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Bruzzi M, Auclin E, Lo Dico R, Voron T, Karoui M, Espin E, Cianchi F, Weitz J, Buggenhout A, Malafosse R, Denimal F, Le Malicot K, Vernerey D, Douard R, Emile JF, Lepage C, Laurent-Puig P, Taieb J. Influence of Molecular Status on Recurrence Site in Patients Treated for a Stage III Colon Cancer: a Post Hoc Analysis of the PETACC-8 Trial. Ann Surg Oncol 2019; 26:3561-3567. [PMID: 31209667 DOI: 10.1245/s10434-019-07513-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recurrence patterns in stage III colon cancer (CC) patients according to molecular markers remain unclear. The objective of the study was to assess recurrence patterns according to microsatellite instability (MSI), RAS and BRAFV600E status in stage III CC patients. METHODS All stage III CC patients from the PETACC-8 randomized trial tested for MSI, RAS and BRAFV600E status were included. The site and characteristics of recurrence were analyzed according to molecular status. Survival after recurrence (SAR) was analyzed. RESULTS A total of 1650 patients were included. Recurrence occurred in 434 patients (26.3%). Microsatellite stable (MSS) patients had a significantly higher recurrence rate (27.2% vs. 18.7%, P = 0.02) with a trend to more pulmonary recurrence (28.8% vs. 12.9%, P = 0.06) when compared to MSI patients. MSI patients experienced more regional lymph nodes compared to MSS (12.9% vs. 4%, P = 0.046). In the MSS population, the recurrence rate was significantly higher in RAS (32.2%) or BRAF (32.3%) patients when compared to double wild-type patients (19.9%) (p < 0.001); no preferential site of recurrence was observed according to RAS and BRAFV600E mutations. Finally, decreased SAR was observed in the case of peritoneal recurrence or more than two recurrence sites. CONCLUSIONS Microsatellite, RAS and BRAFV600E status influences recurrence rates in stage III CC patients. However, only microsatellite status seems to be associated with specific recurrence patterns. More than two recurrence sites and recurrence in the peritoneum were associated with poorer SAR.
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Affiliation(s)
- M Bruzzi
- Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France.
| | - E Auclin
- Department of Digestive Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France.,Methodological and Quality of Life in Oncology Unit, EA 3181, University Hospital of Besançon, Besançon, France
| | - R Lo Dico
- Department of Digestive and Oncological Surgery, Lariboisière Hospital, AP-HP, Paris, France
| | - T Voron
- Department of Digestive and General Surgery, Saint Antoine Hospital, AP-HP, Sorbonne Université, Paris, France
| | - M Karoui
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University Hospital, AP-HP, Paris VI University Institute of Cancerology, Paris, France
| | - E Espin
- Department of General Surgery, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - F Cianchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - J Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus of the Technical University Dresden, Dresden, Germany
| | - A Buggenhout
- Department of Surgical Gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - R Malafosse
- Department of Digestive Surgery, Ambroise-Paré Hospital, AP-HP, Boulogne, France
| | - F Denimal
- Department of Digestive Surgery, Centre Hospitalier Départemental Vendée, La Roche Sur Yon, France
| | - K Le Malicot
- Statistical Department, Fédération Francophone de Cancérologie Digestive, EPICAD, INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, Dijon, France
| | - D Vernerey
- Methodological and Quality of Life in Oncology Unit, EA 3181, University Hospital of Besançon, Besançon, France
| | - R Douard
- Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - J F Emile
- Pathology Department, Ambroise-Paré Hospital, AP-HP, Boulogne, France
| | - C Lepage
- Hepato-Gastroenterology Department, Dijon University Hospital and EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - P Laurent-Puig
- Department of Biology, European Georges Pompidou Hospital, AP-HP, INSERM-UMR-S1147, Paris, France
| | - J Taieb
- Department of Digestive Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France
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15
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Voron T, Bruzzi M, Ragot E, Zinzindohoue F, Chevallier JM, Douard R, Berger A. Anastomotic Location Predicts Anastomotic Leakage After Elective Colonic Resection for Cancer. J Gastrointest Surg 2019; 23:339-347. [PMID: 30076589 DOI: 10.1007/s11605-018-3891-x] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/16/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anastomotic leakage (AL) is a potential feared complication after colorectal resection, which is associated with an increased risk of postoperative mortality and frequently requires additional surgery. The aim of this study was to assess major independent risk factors for AL after elective colonic resection for cancer, including anastomotic location. METHODS Among 1940 consecutive patients referred to our institution for colorectal adenocarcinoma, 1025 patients had elective colonic resection with intraperitoneal anastomosis without diverting stoma. Risk factors were assessed among preoperative, operative, and histological data. RESULTS Clinical AL was observed in 36 patients (3.5%) with 24 patients requiring revisional surgery (67%). In multivariate analysis, endoscopic impassable tumor and colo-colic or ileo-colic anastomosis were independent risk factors for AL. The occurrence of AL was associated with poor overall (43.1 months vs. 146.4 months; p < 0.001) and disease-free survival (40.5 months vs. 137.3 months; p = 0.003). CONCLUSION Anastomotic leakage occurs more frequently after colo-colic and ileo-colic anastomosis than after intraperitoneal colorectal anastomosis. The right colectomy appears to be at higher risk of AL, with a greater risk of surgical intervention than after an elective left colectomy. Ileo-colic anastomosis should be avoided in cases of suboptimal conditions.
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Affiliation(s)
- Thibault Voron
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France. .,Faculté de Médecine Paris Descartes, Paris, France.
| | - Matthieu Bruzzi
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France.,Faculté de Médecine Paris Descartes, Paris, France
| | - Emilia Ragot
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France
| | - Franck Zinzindohoue
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France.,Faculté de Médecine Paris Descartes, Paris, France
| | - Jean-Marc Chevallier
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France.,Faculté de Médecine Paris Descartes, Paris, France
| | - Richard Douard
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France.,Faculté de Médecine Paris Descartes, Paris, France
| | - Anne Berger
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France.,Faculté de Médecine Paris Descartes, Paris, France
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16
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Talamonti C, Bartoli A, Scaringella M, Baldi A, Masi L, Pallotta S, Bruzzi M. 213. Pre-treatment verification of stereotactic plans using a bi-dimensional diamond detector. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.224] [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] [Indexed: 10/27/2022] Open
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17
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Abstract
Complicated Meckel's diverticulum represents a common etiology of acute abdomen in children. However, this condition is less frequent in adults. We reviewed the records of adult patients who underwent the surgical removal of complicated Meckel's diverticulum between 2001 and 2017 at 2 tertiary French medical centers. We then analyzed the clinical characteristics, mode of presentation, and management for all patients.The Meckel's diverticulum was resected in 37 patients (24 males and 13 females). The mean patient age was 46.1 ± 21.4 years. The most common clinical presentations of complicated Meckel's diverticulum were diverticulitis (35.1%, n = 13), small-bowel obstruction (35.1%, n = 13), and gastrointestinal bleeding (29.8%, n = 11) (anemia, n = 1; hematochezia, n = 10). Age distribution was significantly different (P = .02) according to the 3 Meckel's diverticulum complications: patients with diverticulitis (P = .02) were statistically more frequently over 40 (P = .05), significantly older than patients with gastrointestinal bleeding who were more frequently <40 (P = .05). There was a preoperative diagnosis available for 15 of the 37 patients (40%). An exploratory laparoscopy was necessary to determine the cause of disease for the other 22 patients (60%). An intestinal resection was performed in 33 patients (89%) and diverticulectomy was performed in 4 patients (11%). There was heterotopic tissue found in only 6 patients (16%). Postoperative complications were as follows: 1 death by cardiac failure in a 92-year-old patient and 2 patients with postoperative wound infections. The follow-up time was 3 to 12 months.The correct diagnosis of complicated Meckel's diverticulum in adults is difficult due to the lack of specific clinical presentation. As a result, exploratory laparoscopy appears to play a central role in cases of acute abdomen with uncertain diagnosis.
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Affiliation(s)
- Alina Parvanescu
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Matthieu Bruzzi
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
- ANCRE, EA 4465, Paris Descartes University, Paris
| | - Thibault Voron
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Camille Tilly
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Franck Zinzindohoué
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Jean-Marc Chevallier
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
- ANCRE, EA 4465, Paris Descartes University, Paris
| | - Marco Gucci
- Digestive Surgery Unit, Avicenne University AP-HP Hospital
- UFR SMBH, Paris-Nord, Faculty of Medicine, Bobigny, France
| | - Philippe Wind
- Digestive Surgery Unit, Avicenne University AP-HP Hospital
- UFR SMBH, Paris-Nord, Faculty of Medicine, Bobigny, France
| | - Anne Berger
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Richard Douard
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
- ANCRE, EA 4465, Paris Descartes University, Paris
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18
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Abstract
One-anastomosis gastric bypass is an alternative to the "gold-standard" Roux-en-Y gastric bypass. This technique appears to be safe and efficient, but controversy remains regarding the long-term theoretical risk of subsequent biliary reflux and its possible complications, such as cancer. The aim of the present narrative review was to summarize some of the current thoughts on biliary reflux. Research has established that exposure to chronic bile reflux in humans and rats (outside the "bariatric surgery" box) induce esophageal intestinal metaplasia and esophageal adenocarcinoma. Although one-anastomosis gastric bypass can theoretically induce chronic biliary reflux, the incidence of biliary reflux and risk of cancer have not been prospectively evaluated. Clarification of this controversial issue is urgently needed.
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Affiliation(s)
- Matthieu Bruzzi
- Service de chirurgie digestive, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris cedex, France. .,Université Paris Descartes, Paris, France.
| | - Jean-Marc Chevallier
- Service de chirurgie digestive, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris cedex, France.,Université Paris Descartes, Paris, France
| | - Sébastien Czernichow
- Université Paris Descartes, Paris, France.,Service de Nutrition, Hôpital Européen Georges Pompidou, Paris, France
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19
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Abou Ghazaleh R, Bruzzi M, Bertrand K, M'harzi L, Zinzindohoue F, Douard R, Berger A, Czernichow S, Carette C, Chevallier JM. Is Mini-Gastric Bypass a Rational Approach for Type-2 Diabetes? Curr Atheroscler Rep 2017; 19:51. [PMID: 29063974 DOI: 10.1007/s11883-017-0689-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 12/14/2022]
Abstract
PURPOSE OF REVIEW Morbid obesity and type-2 diabetes mellitus (T2DM) are both major public health problems. Bariatric surgery is a proven and effective treatment for these conditions; laparoscopic Roux-en-Y gastric bypass (RYGB) is currently the gold-standard treatment. One-anastomosis gastric bypass (OAGB) is described as a simpler, safer, and non-inferior alternative to RYGB to treat morbid obesity. Concerning T2DM, experts of the OAGB procedure report promising metabolic results with good long-term remission of T2DM; however, heterogeneity within the literature prompted us to analyze this issue. RECENT FINDINGS OAGB has gained popularity given its safety and long-term efficacy. Concerning the effect of OAGB for the treatment of T2DM, most reports involve non-controlled single-arm studies with heterogeneous methodologies and a few randomized controlled trials. However, this available literature supports the efficacy of OAGB for remission of T2DM in obese and non-obese patients. Two years after OAGB, the T2DM remission and improvement rate increased from 67 to 100%. The results were improved and stable in the long term. The 5-year T2DM remission rate increased from 82 to 84.4%. OAGB is non-inferior compared with RYGB and even superior to other accepted bariatric procedures, such as sleeve gastrectomy and adjustable gastric banding. OAGB is an efficient, safe, simple, and reversible procedure to treat T2DM. The literature reveals interesting results for T2DM remission in non-obese patients. High-level comparative studies are required to support these data.
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Affiliation(s)
- Reem Abou Ghazaleh
- Service de chirurgie digestive, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris Cedex, France
| | - Matthieu Bruzzi
- Service de chirurgie digestive, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris Cedex, France. .,Université Paris Descartes, Paris, France. .,ANCRE, EA 4465, Université Paris Descartes, Paris, France.
| | - Karen Bertrand
- Service de chirurgie digestive, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris Cedex, France
| | - Leila M'harzi
- Service de chirurgie digestive, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris Cedex, France
| | - Franck Zinzindohoue
- Service de chirurgie digestive, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris Cedex, France.,Université Paris Descartes, Paris, France
| | - Richard Douard
- Service de chirurgie digestive, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris Cedex, France.,Université Paris Descartes, Paris, France.,ANCRE, EA 4465, Université Paris Descartes, Paris, France
| | - Anne Berger
- Service de chirurgie digestive, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris Cedex, France.,Université Paris Descartes, Paris, France
| | - Sébastien Czernichow
- Université Paris Descartes, Paris, France.,Service de Nutrition, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris Cedex, France
| | - Claire Carette
- Service de Nutrition, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris Cedex, France
| | - Jean-Marc Chevallier
- Service de chirurgie digestive, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris Cedex, France.,Université Paris Descartes, Paris, France.,ANCRE, EA 4465, Université Paris Descartes, Paris, France
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20
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Beaupel N, Bruzzi M, Voron T, Nasser HA, Douard R, Chevallier JM. Management of acute intra-abdominal sepsis caused by leakage after one anastomosis gastric bypass. Surg Obes Relat Dis 2017; 13:1297-1305. [PMID: 28576683 DOI: 10.1016/j.soard.2017.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 12/09/2016] [Revised: 02/25/2017] [Accepted: 04/04/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Leakage after one-anastomosis gastric bypass (OAGB) is fortunately rare (<1%), but it remains the most severe complication. Few published data exist on this specific issue. OBJECTIVES To analyze the results from patients who presented with acute intra-abdominal sepsis (AIAS) caused by leakage after OAGB. SETTING A university public hospital in France. METHODS Between October 2006 and February 2016, 17 consecutive patients with a diagnosis of AIAS caused by leakage after OAGB were included. Preoperative characteristics, clinical symptoms, radiologic findings, management, morbidity, and mortality were assessed. RESULTS All 17 patients were included in the study. There were 4 men (23.5%), the median age was 48 years, and median preoperative body mass index (BMI) was 51 kg/m2. The most frequent clinical sign was tachycardia (65%). An oral contrast computed tomography scan was performed in 15 patients (88%) and showed a diagnosis of AIAS in 93% of cases. The median time between OAGB and leak diagnosis was 4 days. A gastrojejunal anastomosis (GJA) leak was the most frequent origin (41%). Sixteen patients (94%) were managed surgically (laparotomy n = 11, laparoscopy n = 5) and one medically. There were no deaths. The overall morbidity rate was 47% (major = 41%). Six patients underwent an emergency conversion into Roux-en-Y gastric bypass (RYGB) (in cases of GJA, gastric-tube, and biliary-limb leakages) and were compared to 6 patients who did not undergo conversion but who could have benefited. We observed a tendency toward a reduced overall morbidity rate (16.7% versus 83.3%, P = .08) and shorter lengths of stay in the "conversion to RYGB" group. CONCLUSION The management of AIAS caused by leakage after OAGB was safe, effective, and mostly surgical. Emergency conversion to RYGB in cases of GJA, gastric-tube, or biliary-limb perforation was feasible and safe.
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Affiliation(s)
- Nathan Beaupel
- Service de Chirurgie Générale et Digestive, Hôpital Européen Georges Pompidou, Paris, France; Université Paris Descartes, Paris, France
| | - Matthieu Bruzzi
- Service de Chirurgie Générale et Digestive, Hôpital Européen Georges Pompidou, Paris, France; Université Paris Descartes, Paris, France.
| | - Thibault Voron
- Service de Chirurgie Générale et Digestive, Hôpital Européen Georges Pompidou, Paris, France; Université Paris Descartes, Paris, France
| | - Haydar A Nasser
- Service de Chirurgie Générale et Digestive, Hôpital Européen Georges Pompidou, Paris, France; Université Paris Descartes, Paris, France
| | - Richard Douard
- Service de Chirurgie Générale et Digestive, Hôpital Européen Georges Pompidou, Paris, France; Université Paris Descartes, Paris, France
| | - Jean-Marc Chevallier
- Service de Chirurgie Générale et Digestive, Hôpital Européen Georges Pompidou, Paris, France; Université Paris Descartes, Paris, France
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Bruzzi M. [Bariatric surgery: technical characteristics]. Rev Prat 2017; 67:440-443. [PMID: 30512893] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Bariatric surgery: technical characteristics. Morbid obesity has become a major public health problem, and the most effective treatment in the long-term, recognized by the experts, is bariatric surgery. This treatment significantly improves weight loss, obesity related comorbidities, but also quality of life and life expectancy. It changes the digestive physiology using two major principles: the gastric restriction (in order to reduce the food intake) and the intestinal malabsorption (in order to reduce the food absorption). Experts speak about restrictive procedures (adjustable gastric banding, Sleeve gastrectomy) or mixed procedures (Roux-en-Y gastric bypass, one-anastomosis gastric bypass, bilio-pancreatic derivations). Unfortunately, there is no "ideal" procedure for a specific patient. The surgical procedure must be safe and efficient, and its choice depends of the surgeon's experience and the patient's choice. To date, the Roux-en-Y gastric bypass remains the gold standard treatment for morbid obesity.
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Affiliation(s)
- Matthieu Bruzzi
- Service de chirurgie digestive, hôpital européen Georges-Pompidou, université Paris-Descartes, Paris, France. ANCRE, EA 4465, université Paris-Descartes, Paris, France
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Bruzzi M, Duboc H, Gronnier C, Rainteau D, Couvelard A, Le Gall M, Bado A, Chevallier JM. Long-Term Evaluation of Biliary Reflux After Experimental One-Anastomosis Gastric Bypass in Rats. Obes Surg 2017; 27:1119-1122. [DOI: 10.1007/s11695-017-2577-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Chevallier JM, Bruzzi M, Douard R, Berger A. Long-term Results After One Anastomosis-Gastric Bypass for Super-Super Obesity (BMI ≥ 60 kg/m2). Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.060] [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: 11/28/2022]
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McGrath D, O’Brien B, Bruzzi M, Kelly N, Clauser J, Steinseifer U, McHugh P. Evaluation of cover effects on bare stent mechanical response. J Mech Behav Biomed Mater 2016; 61:567-580. [DOI: 10.1016/j.jmbbm.2016.04.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/25/2016] [Accepted: 04/15/2016] [Indexed: 11/28/2022]
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Talamonti C, Baldi A, Scaringella M, Zani M, Pasquini D, Pace E, Livi L, Pallotta S, Bruzzi M. PO-0801: Large area 2D polycrystalline CVD diamond dosimeter under intensity modulated beams. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32051-5] [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: 11/16/2022]
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Talamonti C, Baldi A, Scaringella M, Pace E, Pasquini A, Livi L, Pallotta S, Zani M, Bruzzi M. Characterization of a bidimensional polycrystalline CVD diamond dosimeter with photon beams. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.225] [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] [Indexed: 11/28/2022] Open
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Patroni A, Bonnet S, Bourillon C, Bruzzi M, Zinzindohoué F, Chevallier JM, Douard R, Berger A. Technical difficulties of left colic artery preservation during left colectomy for colon cancer. Surg Radiol Anat 2015; 38:477-84. [PMID: 26526820 DOI: 10.1007/s00276-015-1583-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 06/11/2015] [Accepted: 10/22/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE Low-tie ligation in colorectal cancer surgery is associated with technical difficulties in left colic artery preservation. We aimed to evaluate and classify the anatomical and technical difficulties of left colic artery (LCA) preservation at its origin and along its route at the inferior border of the pancreas. METHODS A vascular reconstruction computed tomography prospective series of 113 patients was analyzed. The inferior mesenteric artery (IMA) branching pattern according to Latarjet's classification (Type I, separate LCA origin, Type II, fan-shaped branching pattern) and the distances between the IMA and the LCA origins and between the LCA and the Inferior mesenteric vein (IMV) at the inferior border of the pancreas were measured. RESULTS The IMA branching pattern was Type I in 80 (71 %) patients and Type II in 33 (29 %) patients. The IMA-LCA distance was 39.8 ± 12.2 mm. The LCA-IMV distance at the inferior border of the pancreas was 20.5 ± 21.7 mm. When classified based on this distance, 75 (66 %) patients were classified into the Near subgroup (<20 mm) (7.7 ± 4.1 mm) and 38 (34 %) into the Far subgroup (≥20 mm) (45.6 ± 20.4 mm, p < 0.001). A Type I subgroup F accounted for 27 % of the patients. CONCLUSIONS Left colic artery preservation is highly feasible at its origin in more than two-thirds of cases due to the separate origin. The addition of a high IMV ligation increases the risk of damage to the LCA at the inferior border of the pancreas because the distance to the IMV is less than 20 mm in two-thirds of cases.
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Affiliation(s)
- A Patroni
- URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France.,General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France
| | - S Bonnet
- Digestive Surgery Unit, Percy Military Hospital, Clamart, France
| | - C Bourillon
- Paris Descartes Faculty of Medicine, Paris, France.,Radiology Unit, Georges Pompidou AP-HP University Hospital, Paris, France
| | - M Bruzzi
- URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France.,General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France
| | - F Zinzindohoué
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France.,Paris Descartes Faculty of Medicine, Paris, France
| | - J M Chevallier
- URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France.,General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France.,Paris Descartes Faculty of Medicine, Paris, France
| | - R Douard
- URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France. .,General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France. .,Paris Descartes Faculty of Medicine, Paris, France.
| | - A Berger
- General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France.,Paris Descartes Faculty of Medicine, Paris, France
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Bruzzi M, Lefèvre JH, Desaint B, Nion-Larmurier I, Bennis M, Chafai N, Tiret E, Parc Y. Management of acute sigmoid volvulus: short- and long-term results. Colorectal Dis 2015; 17:922-8. [PMID: 25808350 DOI: 10.1111/codi.12959] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 11/04/2014] [Accepted: 02/13/2015] [Indexed: 02/08/2023]
Abstract
AIM The best form of prophylactic management of a decompressed sigmoid volvulus (SV) is controversial especially in the elderly. We have studied our experience with this condition to assess the short- and long-term results of SV management. METHOD All patients treated for SV in our department between 2003 and 2013 were retrospectively included. Emergency decompression was attempted in all patients in whom there was no sign of peritonitis. Planned surgical resection was the procedure of choice in young patients. Percutaneous endoscopic colopexy (PEC) was used in high surgical risk patients. RESULTS There were 65 patients (45 males) of median age 71.5 (24-99) years. Non-surgical reduction was performed in 62 with a success rate of 95% (59/62). Recurrence after initial decompression was 67% at a median follow-up of 5 (1-14) years. A prophylactic surgical resection was performed with primary anastomosis in 33 patients. There were no deaths and the major morbidity rate was 6%. At a mean follow-up of 62 months, only 1 (3%) patient had had a recurrence (at 130 months). PEC was performed in six patients of median age 90 (84-99) years and with a median American Society of Anesthesiologists score of 4. Complications included local site infection (n = 2), pain (n = 1) and abdominal wall bleeding (n = 1). After a median follow-up of 2 (1-4) years, three patients died from medical causes and one recurrence occurred 13 months after removal of the PEC tube. CONCLUSION Prophylactic treatment after initial decompression of SV results in a low rate of recurrence. Planned sigmoid resection is safe and effective. In frail elderly patients, PEC is satisfactory.
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Affiliation(s)
- M Bruzzi
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - J H Lefèvre
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - B Desaint
- Department of Gastroenterology and Endoscopy, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - I Nion-Larmurier
- Department of Gastroenterology and Endoscopy, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - M Bennis
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - N Chafai
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - E Tiret
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - Y Parc
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
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McGrath D, O׳Brien B, Bruzzi M, McHugh P. Nitinol stent design – understanding axial buckling. J Mech Behav Biomed Mater 2014; 40:252-263. [DOI: 10.1016/j.jmbbm.2014.08.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 08/28/2014] [Accepted: 08/31/2014] [Indexed: 11/25/2022]
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Bruzzi M, Rau C, Voron T, Guenzi M, Berger A, Chevallier JM. Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-up. Surg Obes Relat Dis 2014; 11:321-6. [PMID: 25614356 DOI: 10.1016/j.soard.2014.09.004] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [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: 04/28/2014] [Revised: 08/08/2014] [Accepted: 09/03/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Laparoscopic mini-gastric bypass (LMGB) is an alternative to the laparoscopic Roux-en-Y gastric bypass (LRYGB), which is considered to be the gold standard in the treatment of morbid obesity. OBJECTIVES Present 5-year results of 175 patients who had undergone a LMGB between October 2006 and October 2008. SETTING University public hospital, France. METHODS Complete follow-up was available in 126 of 175 patients (72%) who had LMGB. Mortality, morbidity, weight loss, co-morbidities, and quality of life were assessed. Weight loss was determined as a change in body mass index (BMI) and percent excess BMI loss (%EBMIL). Quality of life in the treatment group was analyzed using the Gastrointestinal Quality of Life Index (GIQLI) and was compared with a retrospectively case matched preoperative control group. RESULTS There were no deaths. Thirteen patients (10.3%) developed major complications. Marginal ulcers occurred in 4% of patients. Incapacitating biliary reflux developed in 2 (1.6%) who required conversion into RYGB. Gastric pouch dilation occurred in 4 patients (3.2%) and inadequate weight loss with severe malnutrition in 2 (1.6%). At 5 years, mean BMI was 31±6 kg/m(2) and mean %EBMIL was 71.5%±26.5%. Postoperative GIQLI score of the treatment group was significantly higher than preoperative score of the control group (110.3±17.4 versus 92.5±15.9, P<.001). Social, psychological, and physical functions were increased significantly. No significant differences were found in gastroesophageal reflux or diarrhea symptoms between the 2 groups. Long-term follow-up showed an improvement in all co-morbidities. CONCLUSIONS At 5 years, LMGB was safe, effective, and provided interesting quality of life results.
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Affiliation(s)
| | - Cédric Rau
- Hôpital Européen Georges Pompidou, Paris, France
| | | | | | - Anne Berger
- Hôpital Européen Georges Pompidou, Paris, France
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Talamonti C, Zani M, Menichelli D, Friedl F, Scaringella M, Livi L, Bruzzi M, Bucciolini M. Novel Epitaxial Silicon Array for Quality Assurance in Radiation Therapy. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2566] [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: 11/17/2022]
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Bruzzi M, Le Goux C, Pignot G, Amsellem-Ouazana D, Vieillefond A, Patard JJ, Zerbib M. [Pronostic value of parenchyma renal invasion of pT3 upper tract urinary carcinoma]. Prog Urol 2014; 24:556-62. [PMID: 24975790 DOI: 10.1016/j.purol.2013.12.005] [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: 08/11/2013] [Revised: 12/01/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Upper tract urinary carcinoma (UTUC) pT3 tumors are a heterogeneous entity including tumors invading the renal parenchyma, tumors with peripelvic fat invasion or peri-ureteral fat invasion. The aim of this study was to evaluate the prognostic significance of these three different groups of pT3 tumors. PATIENTS AND METHODS Between 1998 and 2012, 205 patients with UTUC were operated in two centers, including 52 patients with pT3 tumor stage. pT3 tumors were divided into three groups: peri-ureteral fat invasion (pT3U, n = 16), peripelvic fat invasion (pT3G, n = 21), and renal parenchyma invasion (pT3P, n = 15). The prognostic significance of the type of tumor infiltration was evaluated on specific and disease-free survival. RESULTS Median follow-up was 18.9 months [6-133.4]. In univariate analysis, renal parenchyma invasion was associated with a better prognostic in both specific (P = 0.026) and disease-free survival (P = 0.031) compared with peripelvic or peri-ureteral fat invasion. Mutivariate analysis retained the pT3 subgroup as an independant prognostic factor in both specific and disease-free survival (P = 0.02). CONCLUSION pT3 tumors with renal parenchyma invasion had a better prognosis than those with peripelvic or peri-ureteral fat invasion. The heterogeneity of the pT3 group should be taken into account to improve the care of patients.
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Affiliation(s)
- M Bruzzi
- Service d'urologie, hôpital Bicêtre, université Paris-Sud Paris XI, 94270 Le Kremlin-Bicêtre, France
| | - C Le Goux
- Service d'urologie, hôpital Bicêtre, université Paris-Sud Paris XI, 94270 Le Kremlin-Bicêtre, France.
| | - G Pignot
- Service d'urologie, hôpital Bicêtre, université Paris-Sud Paris XI, 94270 Le Kremlin-Bicêtre, France
| | - D Amsellem-Ouazana
- Service d'urologie, hôpital Cochin, université Paris Descartes Paris V, 75014 Paris, France
| | - A Vieillefond
- Service d'anatomopathologie, hôpital Cochin, 75014 Paris, France
| | - J-J Patard
- Service d'urologie, hôpital Bicêtre, université Paris-Sud Paris XI, 94270 Le Kremlin-Bicêtre, France
| | - M Zerbib
- Service d'urologie, hôpital Cochin, université Paris Descartes Paris V, 75014 Paris, France
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Talamonti C, Menichelli D, Zani M, Friedl F, Scaringella M, Bruzzi M, Bucciolini M. SU-E-J-91: Novel Epitaxial Silicon Array for Quality Assurance in Photon and Proton Therapy. Med Phys 2014. [DOI: 10.1118/1.4888143] [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: 11/07/2022] Open
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Talamonti C, Bruzzi M, Menichelli D, Scaringella M, Zani M, Bucciolini M. EP-1457: Dosimetric characterization of a monolithic epitaxial silicon dosimeter for quality assurance in radiotherapy. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31575-9] [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: 11/16/2022]
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Talamonti C, Bruzzi M, Bucciolini M, Civinini C, Cuttone G, Pallotta S, Randazzo N, Sipala V, Scaringella M, Vanzi E. PD-0409: Proton radiographic and tomographic images from PRIMA experiment. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32715-8] [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: 11/15/2022]
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Legras A, Bruzzi M, Nakashima K, Hillion ML, Loisance D, Kirsch M. Colder is better during hypothermic circulatory arrest for acute type a aortic dissection. SCAND CARDIOVASC J 2012; 47:121-8. [DOI: 10.3109/14017431.2012.743673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Antoine Legras
- Department of Cardiac Surgery, Assistance Publique – Hôpitaux de Paris,
Henri Mondor Hospital, Créteil, France
| | - Matthieu Bruzzi
- Department of Cardiac Surgery, Assistance Publique – Hôpitaux de Paris,
Henri Mondor Hospital, Créteil, France
| | - Kuniki Nakashima
- Department of Cardiac Surgery, Assistance Publique – Hôpitaux de Paris,
Henri Mondor Hospital, Créteil, France
| | - Marie-Line Hillion
- Department of Cardiac Surgery, Assistance Publique – Hôpitaux de Paris,
Henri Mondor Hospital, Créteil, France
| | - Daniel Loisance
- Department of Thoracic and Cardiovascular Surgery, Assistance Publique – Hôpitaux de Paris,
Pitié-Salpêtrière Hospital, Paris, France
| | - Matthias Kirsch
- Department of Thoracic and Cardiovascular Surgery, Assistance Publique – Hôpitaux de Paris,
Pitié-Salpêtrière Hospital, Paris, France
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Legras A, Bruzzi M, Nakashima K, Hillion ML, Loisance D, Kirsch M. Risk factors for hospital death after surgery for type A aortic dissection. Asian Cardiovasc Thorac Ann 2012; 20:269-74. [PMID: 22718714 DOI: 10.1177/0218492311435423] [Citation(s) in RCA: 5] [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: 11/16/2022]
Abstract
This study was undertaken to identify perioperative risk factors for hospital death in patients undergoing surgery for acute type A aortic dissection. Between 2000 and 2009, 101 consecutive patients underwent emergency surgery for acute type A aortic dissection. Four patients died before institution of cardiopulmonary bypass or completion of the procedure. In the remaining 97 (68 men; mean age, 63.4±16.7 years), proximal repair was performed using ascending aortic replacement with valve re-suspension in 52 (53.6%) and composite valve graft replacement in 44 (45.4%). Distal repair required hemi- or total arch replacement in 42 (43.3%) patients. Overall hospital mortality reached 25.8% (25/97 patients). Logistic regression analysis revealed that advanced age, location of an intimal tear in the arch or more distally, and preoperative coronary malperfusion were significant independent risk factors for hospital death. No procedure-related variables were significant risk factors. Current hospital mortality in patients undergoing emergency surgery for acute type A aortic dissection remains high, but seems to be mainly determined by preoperative variables. More aggressive proximal or distal repairs were not associated with increased mortality.
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Affiliation(s)
- Antoine Legras
- Cardiovascular and Thoracic Surgery Service, Hospital Henri Mondor, 51 Avenue du Mare´chal de Lattre de Tassigny, 94010 Cre´teil Cedex, France
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Bruzzi M, Chesi A, Baldi A, Tarani F, Mori R, Scaringella M, Carnevale E. Cryogenic thermal storage system for discontinuous industrial vacuum processes. EPJ Web of Conferences 2012. [DOI: 10.1051/epjconf/20123304006] [Citation(s) in RCA: 1] [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] [Indexed: 11/14/2022] Open
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Talamonti C, Pallotta S, Bruzzi M, Bucciolini M, Cirrone P, Civinini C, Cuttone G, lo presti D, Marrazzo L, Randazzo N, Scaringella M, Stancampiano C. 1423 poster IMAGING CHARACTERIZATION OF PRIMA PROTON IMAGING DEVICE. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71545-6] [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: 11/15/2022]
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Borchi E, Bruzzi M, Lombardi L, Menichelli D, Miglio S, Pirollo S, Sciortino S, Serafini D. Photo-Induced Current Spectroscopy in Undoped Cvd Diamond Films. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-588-277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractCombined TSC and PICTS measurements have been used to determine the activation energies (Et) and capture cross-sections (σ) of the trap levels inside the bandgap of CVD diamond in the energy range 0.4−0.7 eV. High temperature TSC analysis has been performed to determine the trap parameters in the energy range from 0.9 to 1.3 eV. A fieldmap in the Et−σ plane has been obtained from the combination of the TSC and PICTS data depicting the regions corresponding to two isolated trap levels and to a continuous distribution of states. The concentrations of defects have been calculated from the TSC signals and the measurement of the charge collection efficiency of the diamond samples.
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Kirsch M, Legras A, Bruzzi M, Louis N. Fate of the distal aorta after surgical repair of acute DeBakey type I aortic dissection: A review. Arch Cardiovasc Dis 2011; 104:125-30. [DOI: 10.1016/j.acvd.2010.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 11/15/2010] [Accepted: 11/16/2010] [Indexed: 11/27/2022]
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Ravagnan L, Piseri P, Bruzzi M, Miglio S, Bongiorno G, Baserga A, Casari CS, Li Bassi A, Lenardi C, Yamaguchi Y, Wakabayashi T, Bottani CE, Milani P. Influence of cumulenic chains on the vibrational and electronic properties of s p-s p2 amorphous carbon. Phys Rev Lett 2007; 98:216103. [PMID: 17677788 DOI: 10.1103/physrevlett.98.216103] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Indexed: 05/11/2023]
Abstract
We report the production and characterization of a form of amorphous carbon with s p-s p(2) hybridization (atomic fraction of sp hybridized species > or =20%) where the predominant sp bonding appears to be (=C=C=)(n) cumulene. Vibrational and electronic properties have been studied by in situ Raman spectroscopy and electrical conductivity measurements. Cumulenic chains are substantially stable in high vacuum conditions for temperatures lower than 250 K and they influence the electrical transport properties of the s p-s p(2) carbon through a self-doping mechanism by pinning the Fermi level closer to one of the mobility gap edges. Upon heating above 250 K the cumulenic species decay to form graphitic nanodomains embedded in the s p(2) amorphous matrix thus reducing the activation energy of the material. This is the first example of a pure carbon system where the s p hybridization influences bulk properties.
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Affiliation(s)
- L Ravagnan
- Dipartimento di Fisica and CIMAINA, Università di Milano, Via Celoria 16, I-20133 Milan, Italy
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De Angelis C, Bucciolini M, Casati M, Løvik I, Bruzzi M, Lagomarsino S, Sciortino S, Onori S. Improvements in CVD diamond properties for radiotherapy dosimetry. Radiat Prot Dosimetry 2006; 120:38-42. [PMID: 16606663 DOI: 10.1093/rpd/nci508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The goal of this work was to compare the behaviour of a chemical vapour deposited (CVD) diamond sample, grown at the University of Florence using a local procedure, with that of a commercial CVD diamond. The comparison was performed exposing both systems to 25 MV photons and measuring the current response during irradiation. Properties of dosimetric interest such as stability of response, dose rate dependence and rise time were investigated. After a preliminary study, which evidenced better performances of the commercial device with respect to the local CVD diamond, the latter was irradiated with a high fluence of fast neutrons. As a result of the neutron treatment, the quality of the CVD home-made diamond has been improved to match with that of the commercial dosemeter.
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Affiliation(s)
- C De Angelis
- Istituto Superiore di Sanità and INFN, Viale Regina Elena 299, 00161 Roma, Italy.
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Bruzzi M, Bucciolini M, Lagomarsino S, Menichelli D, Miglio S, Pini S, Scaringella M, Sciortino S. Deep Levels in CVD Diamond and Their Influence on the Electronic Properties of Diamond-Based Radiation Sensors. ACTA ACUST UNITED AC 2002. [DOI: 10.1002/1521-396x(200210)193:3<563::aid-pssa563>3.0.co;2-d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cuttone G, Azario L, Barone Tonghi L, Borchi E, Boscarino D, Bruzzi M, Bucciolini M, Cirrone G, De Angelis C, Della Mea G, Fattibene P, Gori C, Guasti A, Maggioni S, Mazzocchi S, Onori S, Pacilio M, Petetti E, Piermattei A, Pirollo S, Quaranta A, Raffaele L, Rigato V, Rovelli A, Sabini M, Sciortino S, Zatelli G. The CANDIDO project: development of a CVD diamond dosimeter for applications in radiotherapy. ACTA ACUST UNITED AC 1999. [DOI: 10.1016/s0920-5632(99)00609-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Adam W, Bauer C, Berdermann E, Bergonzo P, Bogani F, Borchi E, Brambilla A, Bruzzi M, Colledani C, Conway J, Dabrowski W, Delpierre P, Deneuville A, Dulinski W, van Eijk B, Fallou A, Fizzotti F, Foulon F, Friedl M, Gan K, Gheeraert E, Grigoriev E, Hallewell G, Hall-Wilton R, Han S, Hartjes F, Hrubec J, Husson D, Kagan H, Kania D, Kaplon J, Karl C, Kass R, Knöpfle K, Krammer M, Logiudice A, Lu R, Manfredi P, Manfredotti C, Marshall R, Meier D, Mishina M, Oh A, Pan L, Palmieri V, Pernicka M, Peitz A, Pirollo S, Polesello P, Pretzl K, Procario M, Re V, Riester J, Roe S, Roff D, Rudge A, Runolfsson O, Russ J, Schnetzer S, Sciortino S, Speziali V, Stelzer H, Stone R, Suter B, Tapper R, Tesarek R, Trawick M, Trischuk W, Vittone E, Walsh A, Wedenig R, Weilhammer P, White C, Ziock H, Zoeller M. Recent results with CVD diamond trackers. ACTA ACUST UNITED AC 1999. [DOI: 10.1016/s0920-5632(99)00566-6] [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] [Indexed: 11/25/2022]
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Bacci T, Borchi E, Bruzzi M, Meier D, Santoro M, Sciortino S. Synthesis of low leakage current chemical vapour deposited (CVD) diamond films for particle detection. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s0920-5632(97)00578-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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