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Zerbib F, Siproudhis L, Lehur PA, Germain C, Mion F, Leroi AM, Coffin B, Le Sidaner A, Vitton V, Bouyssou-Cellier C, Chene G, Zerbib F, Simon M, Denost Q, Lepicard P, Lehur PA, Meurette G, Wyart V, Kubis C, Mion F, Roman S, Damon H, Barth X, Leroi AM, Bridoux V, Gourcerol G, Coffin B, Castel B, Gorbatchef C, Le Sidaner A, Mathonnet M, Vitton V, Lesavre N, Orsoni P, Siproudhis L, Brochard C, Desfourneaux V. Randomized clinical trial of sacral nerve stimulation for refractory constipation. Br J Surg 2016; 104:205-213. [DOI: 10.1002/bjs.10326] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/03/2016] [Accepted: 08/23/2016] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Open studies have reported favourable results for sacral nerve stimulation in the treatment of refractory constipation. Here, its efficacy was assessed in a double-blind crossover RCT.
Methods
Patients with at least two of the following criteria were included: fewer than three bowel movements per week; straining to evacuate on more than 25 per cent of attempts; or sensation of incomplete evacuation on more than 25 per cent of occasions. Response to therapy was defined as at least three bowel movements per week and/or more than 50 per cent improvement in symptoms. Responders to an initial 3-week peripheral nerve evaluation were offered permanent implantation of a pulse generator and were assigned randomly in a crossover design to two 8-week intervals of active or sham stimulation. At the end of the two trial periods, the patients received active stimulation until the final evaluation at 1 year.
Results
Thirty-six patients (34 women; mean(s.d.) age 45(14) years) underwent peripheral nerve evaluation. Twenty responded and received a permanent stimulator. A positive response was observed in 12 of 20 and 11 of 20 patients after active and sham stimulation periods respectively (P = 0·746). Pain related to the device occurred in five patients and wound infection or haematoma in three, leading to definitive removal of the pulse generator in two patients. At 1 year, 11 of the 20 patients with an implanted device continued to respond. Stimulation had no significant effect on colonic transit time.
Conclusion
These results do not support the recommendation of permanent implantation of a pulse generator in patients with refractory constipation who initially responded to temporary nerve stimulation. Registration number: NCT01629303 (http://www.clinicaltrials.gov).
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Affiliation(s)
- F Zerbib
- Department of Gastroenterology, Bordeaux University Hospital, and Université de Bordeaux and Institut National de la Santé et de la Recherche Médicale (INSERM) CIC 1401, Bordeaux, France
| | - L Siproudhis
- Department of Gastroenterology, Rennes University Hospital, and Université de Rennes, Rennes, France
| | - P-A Lehur
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - C Germain
- Clinical Epidemiology Unit, and Bordeaux University Hospital and INSERM CIC 1401-EC, Bordeaux, France
| | - F Mion
- Department of Digestive Physiology, Lyon University Hospital, and Université Claude Bernard, Lyon, France
| | - A-M Leroi
- Department of Digestive and Urinary Physiology, Rouen University Hospital, and Université de Rouen, Rouen, France
| | - B Coffin
- Department of Gastroenterology, Louis Mourier University Hospital, Assistance Publique – Hôpitaux de Paris, Colombes, and Université Denis Diderot Paris 7, Paris, France
| | - A Le Sidaner
- Department of Gastroenterology, Limoges University Hospital, Limoges, France
| | - V Vitton
- Department of Gastroenterology, Hôpital Nord, Assistance Publique – Hôpitaux de Marseille, and Plateforme d'Interface Clinique, CRN2M, Unité Mixte de Recherche 7286, and Aix Marseille Université, Marseille, France
| | - C Bouyssou-Cellier
- Department of Gastroenterology, Bordeaux University Hospital, and Université de Bordeaux and Institut National de la Santé et de la Recherche Médicale (INSERM) CIC 1401, Bordeaux, France
| | - G Chene
- Clinical Epidemiology Unit, and Bordeaux University Hospital and INSERM CIC 1401-EC, Bordeaux, France
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2
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Gallas S, Michot F, Faucheron JL, Meurette G, Lehur PA, Barth X, Damon H, Mion F, Rullier E, Zerbib F, Sielezneff I, Ouaïssi M, Orsoni P, Desfourneaux V, Siproudhis L, Mathonnet M, Menard JF, Leroi AM. Predictive factors for successful sacral nerve stimulation in the treatment of faecal incontinence: results of trial stimulation in 200 patients. Colorectal Dis 2011; 13:689-96. [PMID: 20236144 DOI: 10.1111/j.1463-1318.2010.02260.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM Sacral nerve stimulation (SNS) has a place in the treatment algorithm for faecal incontinence (FI). However, after implantation, 15-30% of patients with FI fail to respond for unknown reasons. We investigated the effect of SNS on continence and quality of life (QOL) and tried to identify specific predictive factors of the success of permanent SNS in the treatment of FI. METHOD Two hundred consecutive patients (six men; median age = 60; range 16-81) underwent permanent implantation for FI. The severity of FI was evaluated by the Cleveland Clinic Score. Quality of life was evaluated by the French version of the American Society of Colon and Rectal Surgeons (ASCRS) quality of life questionnaire (FIQL). All patients underwent a preoperative evaluation. After permanent implantation, severity and QOL scores were reevaluated after six and 12 months and then once a year. RESULTS The severity scores were significantly reduced during SNS (P = 0.001). QOL improved in all domains. At the 6-month follow-up, the clinical outcome of the permanent implant was not affected by age, gender, duration of symptoms, QOL, main causes of FI, anorectal manometry or endoanal ultrasound results. Only loose stool consistency (P = 0.01), persistent FI even though diarrhoea was controlled by medical treatment (P = 0.004), and low stimulation intensity (P = 0.02) were associated with improved short-term outcomes. Multivariate analysis confirmed that loose stool consistency and low stimulation intensity were related to a favourable outcome. CONCLUSION Stool consistency and low stimulation intensity have been identified as predictive factors for the short-term outcome of SNS.
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Affiliation(s)
- S Gallas
- ADEN EA 3234 ⁄ IFR MP 23, Rouen University Hospital, Grenoble, France
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3
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Jolibert M, Ramis O, Marciano S, Barthet M, Orsoni P, Chaumoitre K. [Answer to June e-quid de June. Inverted Meckel's diverticulum]. J Radiol 2010; 91:824-827. [PMID: 20814370 DOI: 10.1016/s0221-0363(10)70124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- M Jolibert
- Service d'Imagerie Médicale, Hôpital Nord, CHU Marseille, chemin Bourrely, 13015 Marseille.
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4
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Leroi AM, Damon H, Faucheron JL, Lehur PA, Siproudhis L, Slim K, Barbieux JP, Barth X, Borie F, Bresler L, Desfourneaux V, Goudet P, Huten N, Lebreton G, Mathieu P, Meurette G, Mathonnet M, Mion F, Orsoni P, Parc Y, Portier G, Rullier E, Sielezneff I, Zerbib F, Michot F. Sacral nerve stimulation in faecal incontinence: position statement based on a collective experience. Colorectal Dis 2009; 11:572-83. [PMID: 19508514 DOI: 10.1111/j.1463-1318.2009.01914.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Since the first paper published by Matzel et al., in 1995, on the efficacy of sacral nerve stimulation (SNS) in patients with faecal incontinence, the indications, the contraindications, the stimulation technique and follow up of implanted patients have changed. The aim of this article was to provide a consensus opinion on the management of patients with faecal incontinence treated with SNS. METHOD Recommendations were based on a critical review of the literature when available and on expert opinions in areas with insufficient evidence. RESULTS We have reviewed the indications and contraindications, proposed an algorithm for patient management showing the place of SNS. The temporary test technique, the implantation technique, the patient follow up and the approach in case of treatment failure were discussed. CONCLUSION We hope not only to provide a guide on patient management to clinical practitioners interested in SNS but also to harmonize our practices.
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Affiliation(s)
- A M Leroi
- ADEN EA 3234/IFRMP 23, Faculté de Médecine de Rouen, France.
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5
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Abstract
BACKGROUND Injecting fibrin glue has proved to be an effective means of treating anal fistulas (AF). There has been some debate, however, as to whether this technique should be used on the AF often involved in Crohn's disease (CD). AIM To assess the effectiveness of injecting heterologous fibrin glue as a means of treating AF refractory to immunosuppressive treatment in patients with CD. METHODS Fourteen CD patients (five men and nine women, average age 42 years) presenting with refractory AFs were included in this study. Heterologous fibrin glue was injected into the fistula tract under general anaesthesia under continuous endosonographic monitoring using a 7.5-MHz blind linear probe. The patients were followed up clinically and ultrasonographically for 3 months after the procedure, and then at regular intervals. RESULTS Three months after the fibrin glue injection, the fistulas had completely dried up in 10 patients (71%), the leakage had decreased in one patient (7%), and no improvement was observed in the other three patients (21%). Endosonographic findings showed that the fistula tract had completely disappeared in two cases (14%). The fistula tract was found to be non-permeable in eight cases (57%), and no change in the fistula was observed in four patients (29%). At the end of the follow-up period [average 23.4 months (12-26 months)], the leakage had completely dried up in eight of the 14 patients (57%). No side effects were observed. CONCLUSION Nearly 2 years after the use of a heterologous fibrin glue to treat an AF, over half of the patients with CD showed clinical signs of remission. Because it is easy to use and harmless as well as being effective, this method provides a good alternative to classical methods of surgical treatment.
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Affiliation(s)
- V Vitton
- Department of Gastroentrology, Hôpital Nord, Marseille, France. veronique.vitton@.ap-hm.fr
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Berdah SV, Barthet M, Emungania O, Orsoni P, Alliot P, Grimaud JC, Brunet C. Coloproctectomie totale avec anastomose iléoanale en deux temps vidéoassistée. Expérience initiale de 12 cas. ACTA ACUST UNITED AC 2004; 129:332-6. [PMID: 15297221 DOI: 10.1016/j.anchir.2004.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2003] [Accepted: 04/21/2004] [Indexed: 11/23/2022]
Abstract
AIM OF THE STUDY This study reports our early experience in two-stage video assisted restorative proctocolectomy (RPC). PATIENTS AND METHODS From May 1999 to May 2003, 12 video assisted RPCs were performed (mucosal ulcerative colitis: n = 11; familial adenomatous polyposis: n = 1). These patients were matched for age, gender, body mass index and indication for surgery, with 12 patients who underwent RPC by laparotomy (open group). RESULTS Median operative time was significantly longer in the video assisted RPC group (400 min; range: 360-490) vs open group (300 min; range: 210-390) (P = 0.003). A conversion in midline laparotomy (under the umbilicus) was necessary in 3/12 patients (25%) in the video assisted RPC group. Return to bowel function and oral intake occurred two days earlier after video assisted RPC (respectively, P = 0.009 and P = 0.0001) but length of stay was not significantly shorter in this group. A complication occurred in 3/12 patients (25%) in both groups, which lead to a reoperation in one patient in the open group (ns). CONCLUSION Two-stage videoassisted RPC is feasible at the cost of a lengthening of operative time, Nevertheless postoperative results after video assisted RPC are comparable to those obtained after RPC by laparotomy.
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Affiliation(s)
- S V Berdah
- Service de chirurgie digestive, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
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7
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Ouaïssi M, Berdah SV, Barthet M, Orsoni P, Grimaud JC, Boubli L, Brunet C. [Necrotizing enterocolitis during pregnancy in a woman operated on at six months of Hirschsprung's disease]. ACTA ACUST UNITED AC 2004; 129:34-6. [PMID: 15019853 DOI: 10.1016/j.anchir.2003.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2003] [Accepted: 12/10/2003] [Indexed: 10/26/2022]
Abstract
Necrotizing enterocolitis is a rare and severe complication of Hischsprung's disease. Aggravation of unknown or undertreated Hischsprung's disease may be seen during pregnancy. To our knowledge, the following case is the first combining those two elements: necrotizing enterocolitis in a 20 years old women operated on of Hischsprung's disease when she was six months. The final diagnosis was made 24 hours later. Definitive treatment was a three-stage ileal pouch-anal anastomosis.
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Affiliation(s)
- M Ouaïssi
- Département de pathologie digestive, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
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8
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Affiliation(s)
- M Barthet
- Department of Gastroenterology, Hôpital Nord, Chemin des Bourrely, 13915 Marseille cedex 20, France
| | - P Orsoni
- Department of Gastroenterology, Hôpital Nord, Chemin des Bourrely, 13915 Marseille cedex 20, France
| | - J-C Grimaud
- Department of Gastroenterology, Hôpital Nord, Chemin des Bourrely, 13915 Marseille cedex 20, France
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9
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Barthet M, Bellon P, Abou E, Portier F, Berdah S, Lesavre N, Orsoni P, Bouvier M, Grimaud JC. Anal endosonography for assessment of anal incontinence with a linear probe: relationships with clinical and manometric features. Int J Colorectal Dis 2002; 17:123-8. [PMID: 12014420 DOI: 10.1007/s003840100354] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS This study determined correlations of clinical and manometric features with those of anal endosonography (AES). PATIENTS AND METHODS Between 1996 and 1999 we examined 58 patients suffering from anal incontinence (AI) by AES using a linear probe and anorectal manometry following a standardized protocol. RESULTS Twelve of the 58 patients (21%) had a history of anal surgery. Of the 40 women who had under-gone at least one vaginal delivery 22 (55%) sustained an obstetric tear and 12 (30%) required forceps for delivery. A perineal descent was observed in 24 of 32 women with AI (75%) and urinary incontinence in 24 of 44 (54%). An anal sphincter defect was diagnosed in 45 of the 58 patients (77%). The internal anal sphincter defects occurring in 42 patients (72%) were significantly associated with a decrease in the resting anal pressure. The external anal sphincter defects occurring in 33 patients (57%) were significantly associated with a decrease in the voluntary anal contraction. CONCLUSION Considering AES and manometric findings, a good correlation was observed between internal sphincter defect and the resting anal pressure and between external sphincter defects and the voluntary anal contraction. AI is usually associated with a global perineal insufficiency requiring special attention in terms of both training and medical management.
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Affiliation(s)
- M Barthet
- Department of Gastroenterology, Hĵpital Nord, Marseille, France.
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10
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Abstract
The indication for laparoscopy in digestive surgery has evolved with the development of the laparoscopic material as well its increasingly frequent practice in the medical community. Those complex operations such as restorative proctocolectomy require a high level of technical skill as well as a specifically designed operative approach. The study aim was to report our experience of the video-assisted approach to restorative proctocolectomy.
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Affiliation(s)
- S V Berdah
- Service de chirurgie digestive, hôpital Nord, chemin des Bourrelly, 13915 Marseille, France.
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11
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Berdah SV, Orsoni P, Bege T, Barthet M, Grimaud JC, Picaud R. Follow-up of selective endoscopic ultrasonography and/or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy: a prospective study of 300 patients. Endoscopy 2001; 33:216-20. [PMID: 11293752 DOI: 10.1055/s-2001-12796] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND STUDY AIMS This prospective study evaluated the selective use of endoscopic retrograde cholangiography (ERC) and endoscopic ultrasonography (EUS) in the context of laparoscopic cholecystectomy (LC). PATIENTS AND METHODS Between 1993 and 1998, LC for symptomatic gallstones was indicated in 300 consecutive patients. In order to diagnose and treat choledocholithiasis preoperatively, we performed, on the basis of preoperative criteria, ERC in "high-risk" patients and EUS in "intermediate-risk" patients. Choledocholithiasis was treated by preoperative biliary endoscopic sphincterotomy (BES). LC was performed either after the endoscopic procedure or directly in "low-risk" patients. RESULTS A total of 104 patients (35%) had 118 preoperative procedures: a) EUS (n = 68; feasibility 100%): choledocholithiasis was observed in 14/68 patients (21%); b) ERC (n = 50; feasibility 94%): 36 ERC were indicated on on preoperative criteria, and 14 on the basis of EUS results. Choledocholithiasis was found in 41/ 50 patients (82%) (13/14 patients with positive EUS), 19% of "intermediate-risk" patients, and 78% of "high-risk" patients; ERC failed in three patients who had no choledocholithiasis on subsequent intraoperative cholangiography (IOC). Clearance of the common bile duct (CBD) was achieved after BES in 41/41 patients. There was no mortality; complications occurred in 4/ 300 patients (1%). No retained stones were found in patients of any of the three groups, after a mean follow-up of 32 months. CONCLUSIONS Combined endoscopic and laparoscopie management of cholecystolithiasis and choledocholithiasis is a viable option and is optimized by the use of EUS.
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Affiliation(s)
- S V Berdah
- Dept. of Digestive Diseases, North Hospital, Marseilles, France.
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12
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Linzberger N, Berdah SV, Orsoni P, Faucher D, Grimaud JC, Picaud R. [Laparoscopic posterior fundoplication in gastroesophageal reflux: mid-term results]. Ann Chir 2001; 126:143-7. [PMID: 11291677 DOI: 10.1016/s0003-3944(00)00478-8] [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: 11/29/2022]
Abstract
STUDY AIM The aim of this study was to report the mid-term results of the surgical management of gastroesophageal reflux disease (GERD) by laparoscopic posterior partial fundoplication (Toupet technique) in 100 patients, and to evaluate their post-operative quality of life. PATIENTS AND METHOD Between November 1993 and January 2000, 100 patients were surgically treated for a medically refractory GERD. Laparoscopic posterior partial fundoplication was performed by the Toupet technique. In the postoperative period, the patients were asked to answer a questionnaire by telephone. The aim of this survey was three-fold: to identify clinical symptoms indicative of recurrence; to evaluate postoperative functional impairment; to assess the postoperative quality of life. pH monitoring was also proposed in asymptomatic patients at a minimum follow-up of two years, and in all patients with clinical symptoms of GERD recurrence. RESULTS Six laparotomy conversions were necessary. The mean duration of follow-up was 18 months (range: 6 to 57 months). The rate of clinically diagnosed recurrence was 7.6%. Intermittent dysphagia was observed in 2.3% of cases. Postoperative digestive functional disorders were noted in 53% of patients without clinical recurrence, and 95.3% of them were satisfied or very satisfied with the results of surgery. CONCLUSION Laparoscopic posterior partial fundoplication by the Toupet technique can satisfactorily treat GERD without mid-term recurrence in about 94% of cases. Patient satisfaction seems mainly to depend on the disappearance of clinical symptoms of GERD. It was found that postoperative functional disorders frequently occurred, but were well tolerated. Their etiology has not yet been determined, and it is considered that factors other than the surgical procedure may also play a role.
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Affiliation(s)
- N Linzberger
- Service de chirurgie digestive, hôpital Nord, chemin des Bourrelly, 13915 Marseille, France.
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13
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Barthet M, Portier F, Heyries L, Orsoni P, Bouvier M, Houtin D, Barriere N, Mambrini P, Salducci J, Grimaud JC. Dynamic anal endosonography may challenge defecography for assessing dynamic anorectal disorders: results of a prospective pilot study. Endoscopy 2000; 32:300-5. [PMID: 10774969 DOI: 10.1055/s-2000-7385] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS The diagnosis of anorectal dynamic disorders and perineal insufficiency has been mainly based up to now on the use of defecography. Here, we performed a prospective blinded study to evaluate the accuracy of a new procedure, dynamic anorectal endosonography (DAE), by comparing it with defecography. PATIENTS AND METHODS A total of 43 women (mean age 53), presenting with outlet obstruction, were prospectively enrolled in our study. The DAE was performed with a 7.5-Mhz linear probe (Toshiba, Tokyo, Japan) with basal and straining recordings. None of the DAE or defecography operators was informed about the results of the respective other investigation. RESULTS Defecography showed a descending perineum in 29 patients (68%), a rectocele in 25 patients (58%), and a rectal intussusception in eight patients (18%). The rate of concordance between the diagnosis of descending urinary bladder at DAE and descending perineum at defecography was 35/43 (80%), and that between the descending puborectal muscle at DAE and descending perineum at defecography was 40/43 (93 %). The rates of concordance between DAE and defecography for the diagnosis of rectocele and rectal intussusception were 27/43 patients (57%) and 34/43 patients (80%), respectively. In the last 15 patients, the DAE technique was adapted in order to improve the accuracy for diagnosing rectocele by filling the rectum with water. This improved sensitivity from 36 to 86% and accuracy from 57 to 87%. CONCLUSIONS DAE is a new imaging approach to anorectal dynamic disorders, providing a highly reliable means of diagnosing perineal insufficiency as well as rectocele. DAE should be substituted for previous methods since it makes it possible at the same time to assess the anal sphincters and to avoid pelvic irradiation.
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Abstract
OBJECTIVE to define the respective advantages and pitfalls of the trans- or retroperitoneal approaches in laparoscopic abdominal aortic reconstruction (LAOR). DESIGN prospective study. MATERIAL ten patients (8 males; average age 58) underwent an aortouni- (n=2) or bifemoral bypass (n=8) to treat aortoiliac occlusive disease (n=8) or an aortic aneurysm (n=2). METHODS a retroperitoneal approach (the "apron" technique) was used in the first 5 cases (Group I) and a transperitoneal approach in the last 5 cases (Group II). RESULTS no early or late death occurred, and all bypasses remain patent after a mean follow-up of 5.7 months. Mean surgical and clamping times are similar in both groups (370 and 126 min in Group I; 324 and 137 min in Group II). One intraoperative conversion to open surgery and two postoperative surgical complications occurred in Group I. Four minilaparotomies of 8-10 cm were necessary in Group II. Two patients were discharged on postoperative day 6 in Group I and five in Group II. CONCLUSION this preliminary study shows the feasibility of LAOR through both approaches. In Group II, a better exposure of the right aortic wall and of the right iliac axis was noted and division of the inferior mesenteric artery was not always necessary.
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Affiliation(s)
- Y S Alimi
- Service de Chirurgie Vasculaire - Hôpital Nord, Université de la Méditérranée, Marseille, France
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15
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Porcher C, Orsoni P, Berdah S, Monges G, Mazet B. Distribution of heme oxygenase 2 in nerves and c-kit(+) interstitial cells in human stomach. Histochem Cell Biol 1999; 112:317-22. [PMID: 10550617 DOI: 10.1007/s004180050453] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Different populations of interstitial cells (ICs) may serve as gut pacemakers or as intermediaries between enteric nerves and smooth muscle cells. However, very little is known about the substances that ICs might use to communicate with other cells and no data are available in humans. Because carbon monoxide (CO) is emerging as a putative mediator in the regulation of gastrointestinal motility, this study examined the presence of heme oxygenase (HO2), the constitutive form of the enzyme for CO production, in human stomach with particular attention to ICs. The distribution of HO2 in nerves and ICs in human antrum was studied using specific antibodies. The immunostaining was observed using confocal laser scanning microscopy. HO2 immunoreactivity was found in myenteric neurons and nerve fibers supplying the circular muscle layer and in intramuscular c-kit(+) ICs, but not in c-kit(+) ICs surrounding the myenteric ganglia. The presence of HO2 in different cell types suggests that CO may serve as an intercellular messenger between myenteric neurons and ICs and between ICs and smooth muscle cells in human stomach.
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Affiliation(s)
- C Porcher
- Department of Physiology, CNRS 6034, Faculte de Saint-Jerome, 13397 Marseille Cedex 20, France
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16
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Abstract
BACKGROUND Alverine citrate is commonly used in the treatment of painful affections of the colon. AIM To determine whether alverine citrate acts on the vagal sensory endings. METHODS Unitary recordings were performed at the level of the vagal fibres in the nodose ganglion of anaesthetized cats using extracellular glass microelectrodes, and the patterns of response to chemical and mechanical stimuli applied to identified vagal intestinal mechanoreceptors were studied. RESULTS The intestinal mechanoreceptors located at the endings of type C vagal fibres responded mainly to mechanical stimuli (distension and contraction), but also responded to chemical substances (cholecystokinin and substance P). The most conspicuous effect of alverine (2 mg/kg) was that it significantly inhibited the pattern of vagal activity produced in response to either cholecystokinin (5-10 microg/kg), substance P (5-10 microg/kg) or phenylbiguanide (5-10 microg/kg), a 5-HT3 receptor agonist. On the other hand, the unitary vagal response to the mechanical distension was slightly enhanced by alverine, as was any spontaneous activity present. CONCLUSIONS Based on the present data, alverine citrate can be said to decrease the sensitivity of the intestinal mechanoreceptors, which is consistent with its previously established anti-spasmodic effects.
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Affiliation(s)
- A Abysique
- Laboratoire de Neurobiologie des Fonctions Végétatives - ESA CNRS 6034, Equipe Communication Cellulaire et Sensorimotricité Digestive, Marseille, France
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Orsoni P, Barthet M, Portier F, Panuel M, Desjeux A, Grimaud JC. Prospective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscess complicating Crohn's disease. Br J Surg 1999; 86:360-4. [PMID: 10201779 DOI: 10.1046/j.1365-2168.1999.01020.x] [Citation(s) in RCA: 165] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endosonography and magnetic resonance imaging (MRI) are promising methods for evaluating perineal and anorectal fistulas or abscesses. The aim of this study was to compare the results of anal endosonography (AES), MRI and surgical exploration in the assessment of anorectal fistula or abscess complicating Crohn's disease. METHODS Twenty-two patients with Crohn's disease, seven men and 15 women of mean age 38 (range 17-67) years, were included in this prospective study. All patients underwent AES (linear probe 7 MHz), MRI and operative assessment. RESULTS AES and MRI demonstrated 14 and nine abscesses respectively, whereas 11 abscesses were confirmed by surgical exploration in ten patients. The sensitivity of AES and MRI as means of evaluating anorectal abscesses was 100 and 55 per cent respectively. The agreement per patient was 86 per cent (19 of 22) for AES and 59 per cent (14 of 22) for MRI. AES and MRI demonstrated 26 and 14 fistulas respectively, whereas 27 fistulas were confirmed during surgical exploration in 16 patients. The sensitivity of AES and MRI was 89 and 48 per cent respectively. The level of agreement per patient was 82 per cent (18 of 22) for AES and 50 per cent (11 of 22) for MRI. CONCLUSION AES with a linear probe is more accurate than MRI in detecting anorectal abscesses complicating Crohn's disease, and much more accurate in the evaluation of complex fistulas.
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Affiliation(s)
- P Orsoni
- Department of Gastroenterology, Hôpital Nord, Marseille, France
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18
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Abstract
The aim of this study was to investigate the role of noradrenergic descending nervous pathways in external anal sphincter motility. For this purpose, the effects of intravenously injected adrenoceptor antagonist and agonist on the tonic electrical activity of this sphincter were studied in anesthetized cats. The effects of stimulating the region of the locus coeruleus and the effects of intravenous, intracerebroventricular and intrathecal injection of the above drugs on the electromyographic responses of this muscle to pudendal nerve stimulation were also investigated. The tonic sphincteric activity and the reflex response triggered by electrically stimulating pudendal afferent nerve fibers were inhibited by alpha1-adrenoceptor antagonist nicergoline and enhanced by alpha1-adrenoceptor agonist phenylephrine. Stimulation of the locus coeruleus area either inhibited or enhanced the reflex responses. Intracerebroventricular and intrathecal injection of the alpha2-adrenoceptor agonists, morphine and leu-enkephalin decreased the amplitude of these reflex responses. All the effects of opioids were blocked by naloxone and by spinalization performed at the cervical and lumbar levels. The direct response elicited by stimulating the sphincteric motor axons was not affected either by these drugs or by the brainstem stimulation. These results suggests the existence of a pontine neuronal network controlling the motility of the external anal sphincter via noradrenergic and opioid neurons.
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Affiliation(s)
- A Abysique
- Laboratoire de Neurobiologie des Fonctions Végétatives, Faculté de Saint-Jérôme, B.P. 352, Avenue Escadrille Normandie Niemen, 13397 Marseille Cedex 20, France
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19
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Alimi Y, Orsoni P, Hartung O, Berdah S, Lonjon T, Cador L, Picaud R, Juhan C. [Laparoscopic replacement of the abdominal aorta. Experimental study in the pig]. J Mal Vasc 1998; 23:191-4. [PMID: 9669222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Progress in abdominal laparoscopy led us to study end-to-end anastomoses performed laparoscopically. METHOD An experimental protocol in 10 castrated male pigs weighing 74-95 kg was approved by the ethics committee. After conventional anesthesia, each animal was positioned in lateral decubitus and a retropneumoperitoneum was created. CO2 inflation was maintained at 14 mmHg for insertion of 3 trocars, 5 to 10 mm width. The entire infrarenal aorta was dissected and resected with insertion of a 6 mm dacron prosthesis. Postoperative arteriography was performed in all cases. The animal was sacrificed for direct examination. RESULTS One animal died during anesthesia induction and the entire protocol was conducted in 9 animals. Mean operative time was 397 min (305-535 min) including a mean 123 min (65-150) for aortic dissection, 82 min (30-155) for proximal anastomosis and 70 min (45-105) for distal anastomosis. Total blood loss varied from 100 to 450 cc (mean 252 cc). Mean difference between pre- and postoperative hematocrits was 4% (0-6%). Among the 18 aortic anastomoses performed, arteriography showed one with moderate leakage and one anastomotic thrombus. Stenosis > 50% was found in 4 cases and < 50% in 4 cases. Analysis of the different operative parameters showed a learning curve with decreasing operative time and improved quality of the anastomoses. CONCLUSION This study demonstrates the feasibility of aortic reconstruction via retroperitoneal laparoscopy in the animal. This procedure could be introduced in man.
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Affiliation(s)
- Y Alimi
- Service de Chirurgie Vasculaire, Hôpital Nord, Chemin des Bourrellys, Marseille
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20
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Orsoni P, Berdah S, Sebag F, Picaud R. An unusual cause of dysphagia after laparoscopic fundoplication: a report on two cases. Surgery 1998; 123:241-2. [PMID: 9481412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- P Orsoni
- Department of Digestive Surgery, North Hospital, Marseilles, France
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21
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Abstract
BACKGROUND AND STUDY AIMS The aim of this retrospective study was to analyze data on the treatment of 48 cases of colonic perforation, with a view to defining the criteria for choosing between medical and surgical treatment. PATIENTS AND METHODS A questionnaire requesting information about complications of colonoscopy and their treatment was sent out to four hospital gastroenterological and surgical units. RESULTS From January 1979 to December 1993, we reviewed the records of 48 cases of colonic perforation following colonoscopy (24 perforations occurred after diagnostic colonoscopy and 24 after therapeutic colonoscopy). Diagnosis of perforation was delayed in 42% of the patients, with a mean delay of two days (range 0.5-7 days). The treatment was surgical in 35 cases, including eight in which previous medical treatment had been unsuccessful. The perforation was in the sigmoid colon in 74% of the surgical population. Operations were carried out using two procedures, including colostomy, in the case of 20 patients (57%). Colostomy closure was performed in 12 patients (60%) with no mortalities. Surgical mortality occurred in five patients (14%), in four cases due to preexisting medical diseases. Medical treatment was attempted in 21 cases, and was successful in 13, mainly in cases in which perforation had occurred after therapeutic colonoscopy (12 patients). CONCLUSION The choice of the right type of treatment for colonoscopic perforation seems to depend on the size of the lesion. Surgical treatment is appropriate when the perforation has occurred during diagnostic colonoscopy, since the lesion in this case is usually a large colonic laceration, whereas nonsurgical treatment seems to be justified after polypectomy, as long as there is rapid clinical improvement.
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Affiliation(s)
- P Orsoni
- Dept. of Digestive Surgery, North Hospital, Marseilles, France
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22
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Orsoni P, Berdah SV, Bouvier M, Grimaud JC, Picaud R. Post-operative faecal continence in patients with ulcerative colitis after ileo-anal anastomosis with preservation of the transitional zone: a report from a low-incidence region. Int J Colorectal Dis 1997; 12:209-13. [PMID: 9272449 DOI: 10.1007/s003840050091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this prospective study was to analyse post-operative faecal continence by carrying out a manometric and clinical follow-up on ten patients previously suffering from ulcerative colitis, who underwent total proctocolectomy and double-stapled ileo-anal anastomosis with preservation of the transitional zone. An annual histological analysis of the transitional zone was performed post-operatively. A 13% reduction in the length of the high-pressure zone of the anal canal (P = 0.04) was observed without any significant change in the resting anal pressure or the maximal squeeze pressures. Fifty percent of the patients showed histological signs of inflammation, without any clinical manifestations. The median number of bowel movements was 4 per day and 1 per night, and only 1 patient had occasional nocturnal soiling (less than once a week). On being questioned, 9 patients replied that they rated their continence as good or very good and 1 patient, as reasonable. These findings show that ileo-anal anastomosis, without mucosal resection preserves the normal resting anal pressure and anal function despite the reduction in the length of the high pressure zone it involves.
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Affiliation(s)
- P Orsoni
- Department of Digestive Surgery, Northern Hospital, Marseille, France
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23
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Julian-Reynier C, Eisinger F, Vennin P, Chabal F, Aurran Y, Noguès C, Bignon YJ, Machelard-Roumagnac M, Maugard-Louboutin C, Serin D, Blanc B, Orsoni P, Sobol H. Attitudes towards cancer predictive testing and transmission of information to the family. J Med Genet 1996; 33:731-6. [PMID: 8880571 PMCID: PMC1050725 DOI: 10.1136/jmg.33.9.731] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Before the organisation of breast cancer predictive testing in France, consultands' attitudes towards this kind of testing and towards passing on information about the family cancer risk to their relatives were investigated. This survey was carried out from January 1994 to January 1995 at six specialised cancer genetic clinics located in different parts of France Female consultands who were first degree relatives of cancer patients and who had at least one case of breast cancer in their family, affecting either themselves or a first degree relative or both, participated in this study. Among the 248 eligible consultands attending the clinics during the study period, 84.3% answered a post-consultation questionnaire. Among the 209 respondents, 40.7% (n = 85) were cancer patients and 59.3% (n = 124) were healthy consultands. A high consensus in favour of genetic testing was noted, since 87.7% of the sample stated that they would ask for breast cancer gene testing if this test became available. The underlying assumption of 96.6% of the women was that their health surveillance would be improved after a positive test. A high awareness of the anxiety that would be generated in a family after a positive result was observed and found to be associated (p < 0.05) with the anxiety and depressive profiles of the patients. Half of the healthy respondents said they would not change their attitude towards screening if the results of predictive testing turned out to be negative. Only 13.7% of the 161 patients who stated that the oncogeneticists asked them to contact their relatives firmly refused to do so, mainly because of difficult family relationships.
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Affiliation(s)
- C Julian-Reynier
- INSERM U379, Epidémiologie et Sciences Sociales appliquées à l'Innovation Médicale, Centre Régional de Lutte contre le Cancer, Marseille, France
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24
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Rey P, Mambrini P, Barthet M, Orsoni P, Larroque O, Salducci J, Picaud R, Grimaud JC. [Adenoma of Brunner's gland: a rare cause of duodenal obstruction]. J Chir (Paris) 1996; 133:162-6. [PMID: 8761069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pseudo-tumoral hyperplasia of the Brünner glands is an exceptional dysembryoplastic or hyperplastic lesion which develops in the submucosa of the supra papillary proximal duodenum. We report a case of Brünner adenoma which led to duodenal obstruction. In 50% of the cases, the adenoma was asymptomatic but non-specific signs may lead to barium studies. CT scan of the abdomen or esogastroduodenal endoscopy which rarely provides formal histological proof. Major complications (hemorrhage, duodenal obstruction) and lack of formal diagnosis often leads to surgery, ideally with tumor resection after duodenotomy. Other prodecures (simple observation, endoscopic polypectomy, duodenopancreatectomy, biliary or digestive bypass without tumorectomy) may be entertained depending on the functional status, the volume of the tumor, presence of complications and overall general status.
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Affiliation(s)
- P Rey
- Service d'Hépato-Gastroentérologie, Hôpital d'Instruction des Armées A. Laveran, Marseille Armées
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25
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Orsoni P, Merrot T, Berdah S, Mambrini P, Sappa P, Grimaud JC, Picaud R. [Antro-pyloric fibromuscular hyperplasia in adults: a rare cause of upper digestive stenosis]. Gastroenterol Clin Biol 1996; 20:1030. [PMID: 9119176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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26
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Orsoni P, Berdah S, Sebag F, Blumen D, Picaud R. [Atrio-caval shunt in injury to the suprahepatic vena cava. Apropos of a case and review of the literature]. J Chir (Paris) 1995; 132:438-41. [PMID: 8550708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Mortality in cases of trauma-induced lesions of the suprahepatic vena cava is high because it is difficult to expose the lesions, and consequently to control blood loss. Several techniques have been reported for treating this type of lesion. We report a case in which both suprahepatic veins were sutured after installing an atrio-cava shunt via a sternotomy. The limitations of this technique and other surgical possibilities are also discussed.
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Affiliation(s)
- P Orsoni
- Service de Chirurgie Générale et Digestive, CHU Nord, Marseille
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27
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Orsoni P, Vandenbossche D, Boukaya V, Verrier C, Audibert P, Picaud R. [A case of pure unilobar Caroli disease]. J Chir (Paris) 1994; 131:532-7. [PMID: 7738122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We describe a new case of pure Caroli disease and review of the literature. Although often sporadic, this disease is usually considered an autosomal recessive hereditary disease. It is often either associated with another congenital hepatorenal fibrocystic disease or with extrahepatic bile duct dilatation. The clinical examination and laboratory tests are of not specific if congenital hepatic fibrosis or congenital cysts of the coleduct is lacking. Certain echographic and scan images are however very specific. Complications are related to intrahepatic stone formation and to superinfections. The long-term course appears to involve increased risk of cholangiocarcinoma. Treatment of the localized form includes priority resection. In diffuse disease, treatment may be more medical with antibiotics and sometimes bile solvents. In case of failure, transplantation may be entertained.
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Affiliation(s)
- P Orsoni
- Service de chirurgie générale et digestive, CHU Nord, Marseille
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28
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Orsoni P, Verrier C, Vandenbosshe D, Grimaud JC, Salducci J, Picaud R. [The perforation of the small intestine into the free peritoneum revealing Crohn disease]. J Chir (Paris) 1994; 131:191-3. [PMID: 8083309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A new case of Crohn's disease was discovered due to a perforation of the small bowel into the free peritoneum. We recall the epidemiological, clinical and pathogenic features of this rare incident. On the basis of the data in the literature, we propose a discussion of the surgical techniques used. Resection appears to be preferred Anastomosis is usually performed later except in exceptional selected cases.
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Affiliation(s)
- P Orsoni
- Service de Chirurgie Digestive, CHU Nord, Marseille
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29
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Houvenaeghel G, Delpero JR, Giovannini M, Orsoni P, Seitz JF, Rosello R, Resbeut M, Monges G, Guerinel G. Staging of rectal cancer: a prospective study of digital examination and endosonography before and after preoperative radiotherapy. Acta Chir Belg 1993; 93:164-8. [PMID: 8237230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Between January 1988 and January 1992, 34 patients with rectal cancer were evaluated both by clinical examination and endosonography before and after pre-operative radiotherapy. Two criteria were correlated with histologic findings: confinement to the rectal wall or spread beyond, the presence of mesorectal lymph node involvement. The 32 patients who underwent endosonography before radiotherapy were staged as: uT2: 4, uT3: 26, uT4: 2 cases. Fifteen days after irradiation, endosonography showed tumour regression in all cases; uT stage was different in 15 patients, uN stage in 4 cases. Comparison of the pre-operative local invasion beyond the rectal wall with postoperative histopathy revealed a correlation with: digital examination after radiotherapy in 20 of the 31 patients with palpable tumours; endosonography before irradiation in 18 of the 32 staged tumours; endosonography after irradiation in 25 of the 32 staged tumours. The presence of mesorectal lymph node involvement determined by histologic examination was correlated with the results of endosonography after radiotherapy for 22 of the 32 staged tumours. Endosonography provides a good assessment of the tumour stage before irradiation. Since radiotherapy alters endosonographic staging of rectal cancer, this staging should be included in survival studies.
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30
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Orsoni P, Houvenaeghel G, Monges G, Delpero JR, Picaud R, Guerinel G. [Pancreas transplantation in dogs, effect on the endocrine pancreas of pancreatic duct obliteration and the mode of pancreas preservation. Histological study by surface analysis in dogs]. Chirurgie 1993; 119:168-171. [PMID: 7805469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The effects of organ preservation and of canal obliteration on the endocrine pancreas were investigated in three groups of dogs. A control group of 6 animals were used for the histological examination of the normal pancreas. Two randomized groups (A and B) of 7 dogs the caudal pancreas was autotransplanted; a fibrin glue was injected into the pancreas canals 28 days before organ removal. In the group A, each graft was rinsed in a Euro-Collins solution and immediately transplanted. In group B, each graft was rinsed and held in a preservation solution for 24 hours before transplantation. On histological slices the ratio between of the total surface area of Langerhans islets to the mean surface area of each islet was greater in the control group than in group A (p = 0.011 and 0.023); the ratio was not significantly different between the control group and the group B (p = 0.334 and 0.099). The histological surface area study suggested that the mode of organ preservation affects the endocrine pancreas and that blocking the canals has little effect.
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Affiliation(s)
- P Orsoni
- Service de Chirurgie générale et digestive, C.H.U. Nord, Marseille
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31
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Houvenaeghel G, Orsoni P, Monges G, Delpero JR, Picaud R, Guerinel G. The value of histological study by surface analysis of preserved and injected pancreatic grafts: a prospective controlled study in dogs. Int Surg 1993; 78:36-9. [PMID: 8473081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
To evaluate the effects of pancreas preservation and pancreatic duct obliteration on the endocrine pancreas, three groups of dogs were used: a control group (six) in which histologic analysis of normal pancreas was performed and two randomized groups (seven) from which the caudal pancreas was auto-transplanted, injected with fibrin glue and removed on the 28th day. In Group A, each graft was flushed out with Euro-Collins' solution and immediately transplanted. In Group B, each graft was preserved 24 hours in a preservation solution and transplanted. Islet surface ratios on the sections and mean islet surfaces were greater in the control group than in Group A (p = 0.011 and 0.023) and no different between control group and Group B (p = 0.334 and 0.099). This surface analysis study suggests that the mode of management of grafts in itself explains the alteration of endocrine pancreas and that obliteration of the pancreatic ducts has little influence on this alteration.
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Affiliation(s)
- G Houvenaeghel
- Department of Surgical Research, Salvator Hospital, Marseille, France
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32
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Orsoni P, Houvenaeghel G, Monges G, Delpero JR, Picaud R, Guerinel G. A method for the evaluation of pancreas graft preservation in dogs by histologic surface analysis. Transplant Proc 1992; 24:825-6. [PMID: 1376527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- P Orsoni
- Department of Surgery, C.H.U. Nord, Marseille, France
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33
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Touchet J, Orsoni P, Caamano A, Picaud R. [Treatment of recurrent ulcers after parietal cell vagotomy. Analysis of 18 cases]. Ann Chir 1992; 46:570-7. [PMID: 1360783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
One hundred and twenty seven patients had a follow-up of more than 4 years after parietal cell vagotomy for duodenal, pyloric or prepyloric ulcer. The recurrence rate is 15.8% (20 on 127). Eighteen patients who have recurred, had a follow-up of 2 years or more after treatment of the recurrent disease. Ten patients had a early recurrence (within 2 years); eight had a late one (more than 2 years). One patient had been operated as an emergency for perforation. Seventeen patients had first received a medical treatment. This treatment was sufficient for 10 out of 17. Seven patients were reoperated (3 partial gastrectomy), 4 partial gastrotomy associated with truncal vagotomy. Seven out of the 10 early recurrences was reoperated and only one of the 8 late recurrences was reoperated. The early recurrences seem to be more serious that the late ones. Medical treatment is always prescribed as first line therapy and a partial gastrectomy alone or with vagotomy is necessary in unsuccessful cases.
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Affiliation(s)
- J Touchet
- Service de Chirurgie Digestive, Hôpital Nord, Marseille
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34
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Arnaud A, Sarles JC, Orsoni P. [Anal fistula. Manometric study before and after surgery]. Presse Med 1991; 20:1455-6. [PMID: 1835030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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35
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Abstract
Forty patients who had sphincter repair by one surgeon over the last 15 years were reviewed. The etiology of sphincter trauma was previous surgery (22), childbirth (14), and accidental trauma (4). Eleven patients had undergone at least one previous attempt at repair. Prior to operation, 12 patients were incontinent for liquid stool and 28 for formed stool. A technique of sphincter repair without overlapping was used. An associated diverting colostomy was carried out on seven patients who had had a previous failed repair. Follow-up was an average of 17 months after operation (range, 2-96 months). After operation, 25 patients were completely continent, 6 had occasional leaks of liquid stool, 4 were continent for solid stool only, and 5 showed no improvement. Neither diverting colostomy nor overlapping sutures appear to be mandatory for a successful repair of the anal sphincter after trauma.
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Affiliation(s)
- A Arnaud
- Department of Digestive Surgery, Hopital Sainte-Marguerite, Université d'Aix Marseille II, France
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36
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Houvenaeghel G, Orsoni P, Delpero JR, Monges G, Picaud R, Guerinel G. [Obstruction of pancreatic ducts with a fibrin glue. Study after segmentary autotransplantation in dogs]. J Chir (Paris) 1991; 128:94-8. [PMID: 1709173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The effects of the main pancreatic duct with a fibrin sealant have been investigated on an experimental model of segmental pancreatic transplantation in the dog. Fourteen segmental pancreatic transplantations were performed. A cephalic pancreactectomy was performed during the same operating time. The main duct was obstructed with a fibrin sealant (Tissucol modified by addition of a solution of aprotinine concentrated at 10,000 KUI per mL). Biological follow-up consisted in: 1) Intravenous Glucose Tolerance Testing at Day 0 and Day 28 with glycaemia's integral calculus and K V Alues. 2) Measurements of glycaemia and serum amylase every three days from day 0 to day 28. Histological examination of the pancreatic tissue before and after transplantation involved a microscopy analysis reporting the degree of fibrosis and necrosis. The areas of the Langherans islets and of the fibrosis were calculated with informatic area analysis. The study was carried on non diabetic dogs at Day 28. The glycaemia's calculus of IVGTT were not significantly different before and after transplantation (p = 0.291). On the other hand, there was a significant difference of the K Values before and after transplantation (p = 0.006). Histology after transplantation revealed important lesions of fibrosis and normal or hypertropic Langherans islets in most cases. Pancreatic ducts presented with linings thickened with fibrosis. There was no fibrin sealant in the lumen. Obstruction of pancreatic ducts with a fibrin sealant induces an important fibrosis of the pancreatic exocrin tissue allowing the preservation of a satisfactory endocrine function. This technic may be used in clinical practice during the segmental pancreatic transplantations or after cephalic pancreatico-duodenectomy.
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Affiliation(s)
- G Houvenaeghel
- Service de Chirurgie, Institut J. Paoli, I. Calmettes, Marseille
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37
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Delpero JR, Houvenaeghel G, Gastaut JA, Orsoni P, Blache JL, Guerinel G, Carcassonne Y. Splenectomy for hypersplenism in chronic lymphocytic leukaemia and malignant non-Hodgkin's lymphoma. Br J Surg 1990; 77:443-9. [PMID: 2340397 DOI: 10.1002/bjs.1800770427] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Between 1 January 1980 and 31 July 1988, 62 patients with chronic lymphocytic leukaemia (CLL) or malignant non-Hodgkin's lymphoma (NHL) were splenectomized for splenomegaly and presumed hypersplenism. All patients except one had splenomegaly (mean (s.d.) weight 1585(872) g, range 150-4300 g) and 34 had massive splenomegaly (greater than 1500 g). Forty-nine patients had platelet counts less than 100 x 10(9)/l and 16 patients had anaemia with haemoglobin levels less than 10 g/dl. White cell counts were less than 3 x 10(9)/l in six NHL patients. Fifteen patients had bicytopenia, and three NHL patients had tricytopenia. The selected group of 62 patients underwent splenectomy largely because of failure to respond to medical therapy (39 patients) or inability to tolerate or start adequate chemotherapy because of very low blood counts (11 patients). There was one postoperative death, and a 29 per cent morbidity rate. The response rate was 89 per cent in the first month after splenectomy and 39 patients (63 per cent) had a continuing complete response with a median follow-up of 26 months (range 3-96 months). Twelve patients (10 with CLL) received no further therapy after splenectomy. Seven patients failed to respond and 15 relapsed after splenectomy. These 22 patients could be distinguished on the basis of: (1) lower average preoperative platelet counts (P less than 0.007), postoperative platelet counts (P less than 0.001), and postoperative rise in platelets (P less than 0.004); (2) lower average spleen weight (P less than 0.052); (3) preoperative chemotherapy (P less than 0.044). However preoperative and postoperative platelet counts were the only two variables selected by stepwise regression analysis (P less than 0.05 and P less than 0.01, respectively). Bone marrow failure did not preclude complete response after splenectomy. Long-term survivors emerged from the group of patients with continuing complete response. Of the seven patients who failed to respond, five died with a median survival of 4 months, and of the 15 patients who relapsed after splenectomy, 13 died, with a median survival of 6 months after relapse and 18 months after splenectomy. Thus, splenectomy may be an effective palliation for both CLL and NHL patients with splenomegaly and hypersplenism.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Female
- France/epidemiology
- Hemoglobins/analysis
- Humans
- Hypersplenism/surgery
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/surgery
- Lymphoma, Non-Hodgkin/blood
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, Non-Hodgkin/surgery
- Male
- Middle Aged
- Platelet Count
- Postoperative Complications/etiology
- Postoperative Complications/mortality
- Splenectomy
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38
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Grimaud JC, Sastre B, Orsoni P, Monges G, Treffot MJ, Monges A, Michotey G. [Role of formalin in the occurrence of sclerosing lesions of the bile ducts. Experimental approach in dogs. Apropos of 3 clinical cases]. J Chir (Paris) 1984; 121:163-9. [PMID: 6725446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The authors experimentally reproduced in dogs, sclerosing lesions of biliary tract similar to those that they noticed in clinical practice, after the use of a formalin solution for sterilization of the hydatid cysts of the liver. These lesions have been found with formalin solutions more concentrated than those used in surgical treatment of liver echinococcosis. Nevertheless, even with the use of lower concentrated solution in every case, inflammatory scars are produced in the liver and the biliary tract with persist several months after the formalin injection consequently, the authors recommend to forsake the abandonment of this product for surgical treatment of hydatid cyst.
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39
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Adhoute BG, Nahboo K, Lancelle D, Mora M, Rouvier R, Bleyn J, Orsoni P. Autotransfusion in surgical practice. Cardiovasc Res Cent Bull 1979; 18:45-53. [PMID: 526963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The authors have used autotransfusion of intraoperatively collected blood in 58 vascular surgery cases over a period of more than two years. The clinical results confirm the experimental and laboratory studies on the quality of the autotransfused blood. A more liberal use of intraoperative autotransfusion is advocated. Intraoperative autotransfusion is a simple, safe, inexpensive and cost-effective technique. It saves homologous banked blood and provides a readily available, compatible, normothermic transfusate with superior hematologic qualities.
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40
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Adhoute BG, Nahaboo K, Reymondon L, Lancelle D, Orsoni P, Bleyn JA. Autotransfusion applied in elective vascular surgery. J Cardiovasc Surg (Torino) 1979; 20:177-84. [PMID: 438288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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41
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Laffitte P, Orsoni P, Vergoz D, Brossard Y. [Autotransfusion in acute hemoperitoneum]. J Chir (Paris) 1975; 109:37-51. [PMID: 1127045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This procedure is well known, there were 2 000 cases reported in the literature with a very small number of complications. Is autotransfusion really efficacious? According to the author's results in 9 cases of hemoperitoneum, the red cells obtained by this method are quantitatively valid, but hemolysis starts early (6 hours) and the disappearance of the platelets and coagulation factors occurs even more early (2 hours). However, clinical tolerance is perfect, thus confirming the good experimental results obtained in animals. The true limits are hemolysis and the risk of contamination but, with appropriate apparatus and precise indications, and unsoiled blood, less than 24 hours old, autotransfusion is a good method which may provide a solution in certain emergencies.
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42
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Orsoni P. [A procedure of tight suture of the pulmonary parenchyma]. J Chir (Paris) 1970; 100:385-6. [PMID: 4923663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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43
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Orsoni P. [Continence in perineal colostomy]. J Chir (Paris) 1968; 96:519-28. [PMID: 5719370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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44
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Orsoni P. [Suspension by Cooper's ligaments of the cervix uteri or the vaginal dome in the treatment of prolapse]. J Chir (Paris) 1965; 90:407-14. [PMID: 5855694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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