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Khanafer N, Vanhems P, Barbut F, Luxemburger C, Demont C, Hulin M, Dauwalder O, Vandenesch F, Argaud L, Badet L, Barth X, Bertrand M, Burillon C, Chapurlat R, Chuzeville M, Comte B, Disant F, Fessy MH, Gouillat C, Juillard L, Lermusiaux P, Monneuse O, Morelon E, Ninet J, Ponchon T, Poulet E, Rimmele T, Tazarourte K. Factors associated with Clostridium difficile infection: A nested case-control study in a three year prospective cohort. Anaerobe 2017; 44:117-123. [PMID: 28279859 DOI: 10.1016/j.anaerobe.2017.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Clostridium difficile infection (CDI) is a serious medical condition that is associated with substantial morbidity and mortality. Identification of risk factors associated with CDI and prompt recognition of patients at risk is key to successfully preventing CDI. METHODS A 3-year prospective, observational, cohort study was conducted in a French university hospital and a nested case-control study was performed to identify risk factors for CDI. Inpatients aged 18 years or older, suffering from diarrhea suspected to be related to CDI, were asked to participate. RESULTS A total of 945 patients were included, of which 233 cases had a confirmed CDI. CDI infection was more common in men (58.4%) (P = 0.04) compared with patients with diarrhea not related to C. difficile. Previous hospitalization (P < 0.001), prior treatment with antibiotics (P = 0.001) or antiperistaltics (P = 0.002), liver disease (P = 0.003), malnutrition (P < 0.001), and previous CDI (P < 0.001) were significantly more common in patients with CDI. Multivariate logistic regression analysis showed that exposure to antibiotics in the last 60 days (especially third generation cephalosporins and penicillins with β-lactamase inhibitor), chronic renal or liver disease, malnutrition or previous CDI, were associated with an independent high risk of CDI. Age was not related with CDI. CONCLUSIONS This study showed that antibiotics and some comorbid conditions were predictors of CDI. Patients at high risk of acquiring CDI at the time of admission may benefit from careful monitoring of antibiotic prescriptions and early attention to infection control issues. In future, these "high-risk" patients may benefit from novel agents being developed to prevent CDI.
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Affiliation(s)
- Nagham Khanafer
- Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France.
| | - Philippe Vanhems
- Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France
| | - Frédéric Barbut
- Pierre and Marie Curie University, Paris, France; National Reference Laboratory for C. difficile, Saint Antoine Hospital, Paris, France
| | - Christine Luxemburger
- Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France.
| | | | | | - Monique Hulin
- Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France.
| | - Olivier Dauwalder
- Laboratory of Micro-biology Est, Hospices Civils de Lyon, Bron, France
| | | | | | - Laurent Argaud
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Lionel Badet
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Xavier Barth
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Malik Bertrand
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Carole Burillon
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Roland Chapurlat
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Michel Chuzeville
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Brigitte Comte
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - François Disant
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Michel Henry Fessy
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Christian Gouillat
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Laurent Juillard
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Patrick Lermusiaux
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Olivier Monneuse
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Emmanuel Morelon
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Jacques Ninet
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Thierry Ponchon
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Emmanuel Poulet
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Thomas Rimmele
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
| | - Karim Tazarourte
- Groupement Hospitalier Edouard Herriot, Hos-
pices Civils de Lyon, Lyon, France
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Fanget F, Pasquer A, Djeudji F, Chabanon J, Barth X. Should the Surgical Management of Buschke-Lowenstein Tumors Be Aggressive? About 10 Cases. Dig Surg 2016; 34:247-252. [PMID: 27941342 DOI: 10.1159/000452496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/13/2016] [Indexed: 12/10/2022]
Abstract
AIMS Buschke-Lowenstein tumor (BLT) of the anal margin is a histologically benign tumor whose degeneration can lead to a deadly local evolution because of difficult and late diagnosis. The objective of this study was to report our experience and propose a therapeutic strategy for these rare tumors. METHODS From 1996 to 2014, 10 men with a median age of 45 years (25-64) were treated for a BLT of the anal margin with a first local excision possibly followed by rectal amputation. RESULTS Local perianal excision was curative in 6 cases without recurrence. The median follow-up time was 94.5 months (5-175). In 4 patients, local excision was followed by an early recurrence, justifying a complementary abdominoperineal excision (APE) of the rectum. Two patients who benefited from complementary resection are currently free from recurrence. Even if the postoperative course was uneventful, 2 died from recurrence and disease progression within 5 and 11 postoperative months each. CONCLUSION Macroscopic surgical evaluation of local tumoral invasion and extensive radical resection appears to be associated with long-term survival without recurrence. When recurrence occurs, APE of the rectum seems to be the only curative alternative. Based on low level of evidence, surgical excision is currently the only standard treatment for these lesions.
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Affiliation(s)
- Florian Fanget
- Department of Digestive and Colorectal Surgery, Edouard Herriot University Hospital, Lyon, France
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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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Pasquer A, Djeudji F, Hervieu V, Rabeyrin M, Barth X. A rare retrorectal presentation of a bronchogenic cyst: A case report. Int J Surg Case Rep 2016; 24:112-4. [PMID: 27236578 PMCID: PMC4887582 DOI: 10.1016/j.ijscr.2016.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Bronchogenic cysts are rare abnormalities and a retrorectal presentation is exceptional. Its natural history is not known, but malignant transformation is quite rare. Retrorectal bronchogenic cysts are usually asymptomatic. PRESENTATION OF THE CASE We present the case of a 36-year-old young man with a past medical history of HIV seropositivity who underwent a procedure to excise a sacral coccyx cyst at another surgical center in February 2009. A histological examination confirmed it was a sacral cyst that was resected in sano. The patient presented with a recurrence of the cyst, and this report describes the combined surgical procedure using a double sacrococcygeal and abdominal approach. DISCUSSION A complete excision without cyst rupture is recommended to reduce the risk of local recurrence and malignant transformation, as previously reported. Resection can ben performed using multiple approaches depending on the cyst's location CONCLUSION Herein, we report the case of a retrorectal bronchogenic cyst in a 36 years old man who was initially treated for a pilonidal cyst. A double surgical approach (abdominal and Kraske) resulted in complete resectioning with no reccurrence.
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Affiliation(s)
- Arnaud Pasquer
- Department of Digestive and Colorectal Surgery, Edouard Herriot University Hospital, Lyon, France.
| | - Filbert Djeudji
- Department of Digestive and Colorectal Surgery, Edouard Herriot University Hospital, Lyon, France
| | - Valérie Hervieu
- Department of Anatomopathology, Edouard Herriot University Hospital, Lyon, France; University Claude Bernard Lyon I, 8 Avenue Rockefeller, Lyon, France
| | - Maud Rabeyrin
- Department of Anatomopathology, Edouard Herriot University Hospital, Lyon, France
| | - Xavier Barth
- Department of Digestive and Colorectal Surgery, Edouard Herriot University Hospital, Lyon, France; University Claude Bernard Lyon I, 8 Avenue Rockefeller, Lyon, France
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Polo M, Duclos A, Polazzi S, Payet C, Lifante JC, Cotte E, Barth X, Glehen O, Passot G. Acute Cholecystitis-Optimal Timing for Early Cholecystectomy: a French Nationwide Study. J Gastrointest Surg 2015; 19:2003-10. [PMID: 26264362 DOI: 10.1007/s11605-015-2909-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/02/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND The recommended treatment for acute calculous cholecystitis combines antibiotics and cholecystectomy. To reduce morbidity and mortality, guidelines recommend early cholecystectomy. However, the optimal timing for surgery on first admission remains controversial. This study aims to determine the best timing for cholecystectomy in patients presenting with acute calculous cholecystitis. STUDY DESIGN The French national health-care database was analyzed to identify all patients undergoing cholecystectomy for acute cholecystitis during the same hospital stay between January 2010 and December 2013. Data regarding patients, procedures, and hospitals characteristics were collected. The relationship between surgery's timing and clinical outcome was evaluated by multiple logistic regressions. RESULTS Overall, 42,452 patients from 507 hospitals were included in the study. Postoperative complications requiring invasive treatment occurred in 961 patients (2.3 %), and the mortality rate was 1.1 %. Adverse postoperative outcomes-intensive care admission, reoperation, and postoperative sepsis-were significantly lower when surgery was performed between days 1 and 3 (3-3.3, 0.5-0.6, and 3.8-4.1 %, respectively) when compared to surgery performed on the day of admission (5.6, 1.2, and 5.2 %, p < 0.001) or from day 5 onward (4.5, 1, and 6.5 %, respectively; p < 0.001). Mortality was also significantly lower in patients undergoing cholecystectomy between days 1 and 3 after admission (0.8-1 %) when compared to patients operated on the day of admission or after day 3 (1.4 % on day 0, 1.2 % on day 4, and 1.9 % from day 5: all p < 0.001). CONCLUSION For patients with acute calculous cholecystitis, all efforts should be made to perform cholecystectomy within 3 days after hospital admission in order to decrease morbidity and mortality.
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Affiliation(s)
- Maxime Polo
- Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France
| | - Antoine Duclos
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France
- EMR 3738 Université Lyon 1, F-69364, Lyon, France
- Center for Surgery and Public Health, Brigham and Women's Hospital-Harvard Medical School, Boston, MA, USA
| | - Stéphanie Polazzi
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France
| | - Cécile Payet
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France
| | - Jean Christophe Lifante
- Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France
- EMR 3738 Université Lyon 1, F-69364, Lyon, France
| | - Eddy Cotte
- Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France
- EMR 3738 Université Lyon 1, F-69364, Lyon, France
| | - Xavier Barth
- Department of General Surgery, Hospices Civils de Lyon, Hop Ed. Herriot, 69003, Lyon, France
| | - Olivier Glehen
- Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France
- EMR 3738 Université Lyon 1, F-69364, Lyon, France
| | - Guillaume Passot
- Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France.
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France.
- EMR 3738 Université Lyon 1, F-69364, Lyon, France.
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Damon H, Barth X, Roman S, Mion F. Sacral nerve stimulation for fecal incontinence improves symptoms, quality of life and patients' satisfaction: results of a monocentric series of 119 patients. Int J Colorectal Dis 2013; 28:227-33. [PMID: 22885883 DOI: 10.1007/s00384-012-1558-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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] [Accepted: 07/31/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE Sacral nerve stimulation (SNS) is validated as an efficient treatment for fecal incontinence (FI). However, long-term results are scarce in the literature. The goal of this study was to assess the impact of SNS on FI symptoms and quality of life, based on a retrospective analysis of prospectively collected data. METHODS From 2001 to 2009, 119 patients (six men, mean age 61 years) underwent SNS testing for FI after an extensive diagnostic workup. Permanent implantation was realized when FI symptoms improved during testing, and follow-up visits were performed every 12 months thereafter. This follow-up evaluated morbidity and efficacy, based on clinical data and self-administered questionnaires including Jorge and Wexner FI score, urinary incontinence score (urinary distress inventory-6, UDI-6), gastrointestinal quality of life index (GIQLI), and auto-evaluation scale. RESULTS A permanent stimulator was implanted after a positive test in 102 patients (91 %). Ten patients were explanted during follow-up (pain in one case and absence of efficacy in nine), and 29 had the stimulator and/or the electrode changed. The mean follow-up was 48 months (range 12-84): there was a significant improvement of FI score (9 ± 1 vs 14 ± 3, p < 0.0001), UDI-6 score (8 ± 4 vs 11 ± 5, p < 0.05), and GIQLI index (p < 0.002). The improvement was present at 12 months follow-up and remained stable. Eighty percent of patients were satisfied with the treatment at the last point of follow-up. None of the pretreatment variables were predictive of SNS efficacy. CONCLUSIONS SNS improved FI and quality of life, and this efficacy remained over time. Although a complete disappearance of FI was rare, most patients were satisfied.
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Affiliation(s)
- Henri Damon
- Service d'Exploration Fonctionnelle Digestive, Hôpital Edouard Herriot, Pavillon H, Place d'Arsonval, 69437, Lyon Cedex, France
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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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Affiliation(s)
- G Fantola
- Università degli Studi di Cagliari, Chirurgia Generale M, Policlinico Universitario, Cagliari, Italy
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Monneuse O, Tissot E, Gruner L, Michaillard Kaempf F, Allaouchiche B, Etienne J, Barth X. Diagnosis and treatment of spontaneous group A streptococcal peritonitis. Br J Surg 2009; 97:104-8. [PMID: 20013929 DOI: 10.1002/bjs.6822] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Primary group A streptococcal peritonitis (PSAP) is a rare, fulminant and often fatal infection. The clinical manifestations include diffuse peritoneal signs with toxic shock syndrome and sometimes fasciitis. METHODS Patients with PSAP diagnosed between December 2002 and December 2006 were studied retrospectively, focusing on the initial presentation, diagnosis, treatment and outcome. RESULTS Six patients were identified (five women and one man). The clinical presentation was heterogeneous. All six patients had diffuse peritonitis, four had toxic shock syndrome on hospital admission and two patients also had fasciitis. All patients were treated surgically, and the final diagnosis was confirmed after operation. There were no deaths, but two patients had aesthetic sequelae owing to necrotizing fasciitis. CONCLUSION PSAP is a rare condition, often requiring aggressive surgical treatment. Group A streptococcal peritonitis should be suspected in patients with no radiological evidence of a peritoneal portal of entry and no history of ascites.
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Affiliation(s)
- O Monneuse
- Université Lyon 1, Faculté Laennec, and Emergency and Trauma Surgical Department, Hospices Civils de Lyon, Lyon, France.
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Cenedese A, Monneuse O, Gruner L, Tissot E, Mennesson N, Barth X. Initial management of extensive mesenteric venous thrombosis: retrospective study of nine cases. World J Surg 2009; 33:2203-8. [PMID: 19672653 DOI: 10.1007/s00268-009-0168-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The development of mesenteric venous thrombosis (MVT) does not necessarily require surgical intervention. The aim of this study was to assess the efficacy of avoiding early operative intervention, which can lead to significant sacrifice of the small bowel. METHODS Patients with MVT were identified using the inpatient registry for the years between 2003 and 2007. Each patient's past medical history, history of prior deep venous thrombosis or hypercoagulable state, clinical and biologic presentation, and computed tomography (CT) results were analyzed. The proportion of ischemic bowel observed on the CT scans was compared with the length of the bowel resected. RESULTS Nine patients were admitted for extensive MVT during the time period evaluated (six men, three women). All CT scans demonstrated signs of severe bowel ischemia, with a mean ischemic bowel proportion of 21% (range 5-45%). Four patients received medical management alone. Five patients underwent surgery. The mean admission time for these patients prior to the operation was 14.8 days (6-36 days). Surgery was required only in cases of intestinal perforation. The mean length of the bowel resections was 33 cm (20-45 cm). At 6 months after admission, none of the patients required parenteral nutrition. The mean follow-up evaluation period was 27 months (15-38 months). One patient died secondary to amyotrophic lateral sclerosis during the follow-up. CONCLUSIONS Initial nonsurgical management comprised of inpatient observation on a surgical ward along with systemic anticoagulation must be considered an alternative treatment strategy for MVT. This strategy delays surgery and therefore avoids short bowel syndrome.
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Affiliation(s)
- Alice Cenedese
- Digestive and Emergency Surgery Department, Pavillon G Viscéral, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.
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Gauzit R, Péan Y, Barth X, Mistretta F, Lalaude O. Epidemiology, management, and prognosis of secondary non-postoperative peritonitis: a French prospective observational multicenter study. Surg Infect (Larchmt) 2009; 10:119-27. [PMID: 18991521 DOI: 10.1089/sur.2007.092] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Despite improvements in treatment, secondary peritonitis still is associated with high morbidity and mortality rates. Better knowledge of real-life clinical practice might improve management. METHODS Prospective, observational study (January-June 2005) of 841 patients with non-postoperative secondary peritonitis. RESULTS Peritonitis originated in the colon (32% of patients), appendix (31%), stomach/duodenum (18%), small bowel (13%), or biliary tract (6%). Most patients (78%) presented with generalized peritonitis and 26% with severe peritonitis (Simplified Acute Physiology Score [SAPS] II score>38). Among the 841 patients, 27.3% underwent laparoscopy alone; 11% underwent repeat surgery, percutaneous drainage, or both. A SAPS II score>38 and the presence of Enterococcus spp. were predictive of abdominal and non-surgical infections (odds ratio [OR]=1.84; p=0.013 and OR=2.93; p<0.0001, respectively). A SAPS II score>38 also was predictive of death (OR=10.5; p<0.0001). The overall mortality rate was high (15%). Patients receiving inappropriate initial antimicrobial therapy had significantly higher morbidity and mortality rates than patients receiving appropriate therapy (44 vs. 30%; p=0.004 and 23% vs. 14%; p=0.015, respectively). The SAPS II score and rates of severe peritonitis, morbidity, and mortality were significantly lower in patients with appendiceal peritonitis. CONCLUSIONS Patients with non-postoperative peritonitis should be considered high risk and should receive appropriate initial therapy. The presence of Enterococcus spp. in peritoneal cultures significantly increased morbidity but not the mortality rate. Appendiceal peritonitis that was less severe and had a better prognosis than peritonitis originating in other sites should be considered a special case in future studies.
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Affiliation(s)
- Rémy Gauzit
- Département d'Anesthésie Réanimation, Assistance Publique Hôpitaux de Paris, CHU Hôtel-Dieu, Paris, France.
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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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Nosbaum A, Rival-Tringali AL, Barth X, Damon H, Vital-Durand D, Claudy A, Faure M. Nickel-induced systemic allergic dermatitis from a sacral neurostimulator. Contact Dermatitis 2009; 59:319-20. [PMID: 18976388 DOI: 10.1111/j.1600-0536.2008.01434.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Nosbaum
- Department of Dermatology, Edouard Herriot Hospital, Lyon, France
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Maillard E, Henry L, Mion F, Barth X, Tissot E, Mellier G, Damon H. Elytrocele with and without a history of hysterectomy (303 defecography studies). ACTA ACUST UNITED AC 2008; 32:953-9. [DOI: 10.1016/j.gcb.2008.04.036] [Citation(s) in RCA: 4] [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] [Received: 04/07/2008] [Accepted: 04/19/2008] [Indexed: 01/25/2023]
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Abstract
UNLABELLED The mechanisms of action of sacral nerve stimulation (SNS) to treat faecal incontinence remain poorly understood. THE AIMS OF OUR STUDY WERE (i) to measure the effect of SNS on rectal function and (ii) to evaluate rectal function as a predictive factor of clinical response to SNS. Rectal function was studied before and 3 months after permanent SNS in 18 patients (17 women, mean age 58.5 years) with faecal incontinence, using an electronic barostat. Rectal sensitivity and volume variations were recorded during isobaric distensions. Three months after SNS, 14 patients had a significant improvement of faecal incontience symptoms and four had not. Baseline 'maximal tolerated volume' was significantly lower in the positive response group (210 +/- 56 vs 286 +/- 30 mL, P = 0.02). Baseline rectal compliance was lower in patients with a positive response than those without, although this difference did not reach significance (6.2 +/- 3.2 vs 9.2 +/- 2.9 mL mmHg(-1),P = 0.10). Rectal compliance was not significantly modified by SNS. Our results suggest that an increased rectal capacity as measured by the maximal tolerated volume may be a predictive factor of poor response to SNS in faecal incontinence. SNS does not significantly modify rectal function.
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Affiliation(s)
- S Roman
- Digestive Physiology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
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Damon H, Schott AM, Barth X, Faucheron JL, Abramowitz L, Siproudhis L, Fayard MO, Colin C, Valancogne G, Bonniaud V, Mion F. Clinical characteristics and quality of life in a cohort of 621 patients with faecal incontinence. Int J Colorectal Dis 2008; 23:845-51. [PMID: 18506453 DOI: 10.1007/s00384-008-0489-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [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] [Accepted: 04/02/2008] [Indexed: 02/04/2023]
Abstract
AIM The aim of this study was to study a cohort of patients with faecal incontinence (FI) to gain a better insight into the clinical and epidemiological characteristics of this pathology and its repercussions on quality of life (QL). MATERIALS AND METHODS Consecutive patients with FI seen at tertiary centres filled in a self-questionnaire. The severity of FI, constipation and urinary incontinence (UI) was evaluated, respectively, by the Jorge and Wexner score, the Knowles-Eccersley-Scott Symptom score and the Urological Distress Inventory score. ROME II criteria were used to assess the existence of an associated irritable bowel syndrome. The repercussion on QL was evaluated by the Gastrointestinal Quality of Life index score and the Ditrovie score. The psychological status was assessed by the Hospital Anxiety and Depression scale. RESULTS Six hundred twenty-one patients (114 men), mean age 58 +/- 15 years (range: 20-92), with FI, filled in the questionnaire. The mean Jorge and Wexner score was 11 +/- 4. Twenty-seven presented with an irritable bowel syndrome. Thirty-eight percent had an associated constipation. A UI was associated in 48% women and 25% men. QL was significantly altered, and anxiety and depression were frequent. CONCLUSIONS FI symptoms are frequently severe, QL very altered and anxiety and depression common. FI is frequently associated with other digestive and perineal symptoms, which argue in favour of a multi-disciplinary management of FI.
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Mion F, Roman S, Barth X, Damon H. [What's new in the treatment of fecal incontinence?]. Gastroenterol Clin Biol 2008; 32:S240-S245. [PMID: 18462900 DOI: 10.1016/j.gcb.2008.04.017] [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: 05/26/2023]
Affiliation(s)
- F Mion
- Hospices civils de Lyon, exploration fonctionnelle digestive, hôpital Edouard-Herriot, 5, place d'Arsonval, 69374 Lyon cedex 03, France.
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Leger F, Henry L, Mion F, Roman S, Barth X, Colin C, Schott AM, Damon H. Clinical, sonographic and manometric characteristics and impact on quality of life of fecal incontinence in 92 men referred for endoanal ultrasonography. ACTA ACUST UNITED AC 2008; 32:328-36. [PMID: 18403147 DOI: 10.1016/j.gcb.2008.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
UNLABELLED Anal incontinence (AI) is a frequent symptom with considerable impact on quality of life. The aim of this study was to describe the clinical, sonographic and manometric characteristics of a male population with AI. MATERIALS AND METHODS Endoanal ultrasonography (EAU) was performed in 92 men referred for exploration of AI. Anal incontinence severity was evaluated by the Jorge and Wexner score (JW). The gastrointestinal quality-of-life index (GIQLI) was determined in 57% of patients. Anorectal manometry was performed in 62.6% of patients. RESULTS The average JW score was 11+/-1. Anal incontinence had considerable impact on quality of life: average GIQLI=81+/-4. Seventeen patients presented an anal sphincter defect on EAU, 16 of whom had a history of coloproctological surgery. Prior surgery was significantly more common among patients who had a defect on ultrasonography; manometry showed significantly lower resting anal pressure. CONCLUSION Our study confirms the severity of AI in a male population and its impact on quality of life. It also highlights the high prevalence of anal sphincter defects in patients with a history of anal surgery.
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Affiliation(s)
- F Leger
- Fédération des Spécialités Digestives, Hôpital Edouard-Herriot, Place d'Arsonval, 69437 Lyon Cedex, France
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Monneuse O, Gruner L, Barth X, Malick P, Timsit M, Gignoux B, Tissot E. [Gas gangrene of the abdominal wall due to underlying GI pathology: seven cases]. ACTA ACUST UNITED AC 2008; 144:307-12. [PMID: 17925736 DOI: 10.1016/s0021-7697(07)91959-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Gas gangrene of the abdominal wall is a rare clinical occurrence with high rates of morbidity and mortality. The primary source of the infection is often unknown. To analyze the primary underlying intestinal etiologies and diagnostic approaches of gas gangrene of the abdominal wall, and to highlight specific treatment problems, particularly that of constructing a colostomy exteriorized through a massively infected abdominal wall. PATIENTS AND METHODS Seven cases of abdominal wall gas gangrene due to a gastrointestinal etiology were identified. (Cases arising from proctologic sources or related to recent abdominal surgery were excluded.) During the same period, 39 other patients presenting with abdominal wall gangrene from non-intestinal sources were treated. RESULTS The etiologies were: perforated sigmoid diverticulitis (n=2), perforated appendicitis (n=1), acute pancreatitis with associated cecal perforation (n=1), and perforated colorectal cancer (n=3). Four of the seven patients died despite treatment (mortality of 57%). CONCLUSION The clinical presentations of these seven cases demonstrate that a GI source must be suspected whenever a patient presents with abdominal wall gas gangrene, even when there are no specific GI symptoms. Imaging, particularly with CT scan, is essential both to visualize the extent of tissue necrosis and to reveal underlying primary GI pathology. This optimizes the surgical approach both by allowing for complete debridement and drainage of infected tissue, and by focussing the intervention on correction of the underlying primary GI source of infection.
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Affiliation(s)
- O Monneuse
- Service d'Urgences Chirurgicales Viscérales, Hôpital Edouard Herriot - Lyon
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Monneuse O, Pilleul F, Barth X, Gruner L, Allaouchiche B, Valette PJ, Tissot E. Portal Venous Gas Detected on Computed Tomography in Emergency Situations: Surgery Is Still Necessary. World J Surg 2007; 31:1065-71. [PMID: 17429565 DOI: 10.1007/s00268-006-0589-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [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: 10/23/2022]
Abstract
BACKGROUND Portal venous gas (PVG) has been reported to be associated with lethal surgical diagnosis. Recent studies tend to confirm the clinical significance of gas in the portal vein; however, some patients are managed without surgical treatment. The aim of this study was to assess both the diagnoses and the treatment of patients with PVG in an emergency surgical setting. MATERIALS AND METHODS We performed a retrospective chart review of 15 patients with PVG in the emergency setting detected by computed tomography (CT) between July 1999 and July 2004. Characteristics assessed included age, sex, clinical presentation, first CT diagnosis of both PVG and the underlying pathology, American Society of Anesthesiologists (ASA) score, surgical findings, final clinical diagnosis, duration of hospitalization, and evolution of the illness/mortality. All patients were examined one month after operation. RESULTS This series of 5 women and 10 men ranged in age from 38 to 90 years at the time they underwent emergency surgical treatment. The mean preoperative ASA score was 4.20. Computed tomography diagnosed the underlying pathology in all cases: bowel obstruction (4 cases), bowel necrosis (9 cases), and diffuse peritonitis (2 cases). The mean length of hospital stay was 12.4 days. The mortality rate was 46.6%; (7 patients). CONCLUSIONS A wide range of pathologies can generate PVG. Computed tomography can detect both the presence of gas and the underlying pathology. In emergency situations, all the diagnosed causal pathologies required a surgical procedure without delay. We report that the prognosis was related to the pathology itself and was not influenced by the presence of PVG.
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Affiliation(s)
- Olivier Monneuse
- Digestive and Emergency Surgery Department, Hôpital Edouard Herriot, Pavillon G visceral, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France.
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Affiliation(s)
- L Montagliani
- Service de chirurgie viscérale, Hôpital du Val de Grâce, Paris.
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Monneuse O, Millon A, Pilleul F, Barth X, Gruner L, Tissot E. An adult case of acute intra abdominal organoaxial gastric volvulus. Gastroenterol Clin Biol 2006; 30:921-2. [PMID: 16885884 DOI: 10.1016/s0399-8320(06)73347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Damon H, Guye O, Seigneurin A, Long F, Sonko A, Faucheron JL, Grandjean JP, Mellier G, Valancogne G, Fayard MO, Henry L, Guyot P, Barth X, Mion F. Prevalence of anal incontinence in adults and impact on quality-of-life. ACTA ACUST UNITED AC 2006; 30:37-43. [PMID: 16514381 DOI: 10.1016/s0399-8320(06)73076-7] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [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: 01/18/2023]
Abstract
OBJECTIVE To investigate the prevalence of anal incontinence in the general population and in patients consulting gastroenterologist and gynecologist practices in the Rhône Alpes area. METHODS For the first study a questionnaire was sent to a sample of 2800 people selected randomly from the electoral roll. Another study of patients selected randomly among patients attending gynecology and gastroenterology consultations was performed. A Jorge & Wexner score above or equal to 5 was used to define anal incontinence. RESULTS For the first study, a total of 706 questionnaires was analyzed: the prevalence of anal incontinence was 5.1% [95% CI: 3.6-7.0] and the scores of each dimension of the SF-12 Health Survey were significantly lower among incontinent people than among continent people. The prevalence was significantly higher for women (7.5% [5.0-10.7]) than for men (2.4% [1.1-4.7]). Eighty-four physicians returned 835 valid questionnaires. The prevalence was 13.1% [10.1-16.6] among patients attending gastroenterology consultations and 5.0% [3.1-7.6] among those attending gynecology consultations. For 84.8% of the incontinent patients, the physician was unaware of the patient's disorder. CONCLUSION The prevalence figures we obtained coincide with data in the literature. This disorder is common and affects the patient's quality-of-life, but remains underestimated and under-diagnosed.
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Affiliation(s)
- Henri Damon
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon.
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Monneuse O, Pilleul F, Gruner L, Barth X, Tissot E. MRI evaluation in a rare case of Crohn's disease complicated by abscess of the ovary. ACTA ACUST UNITED AC 2006; 30:153-4. [PMID: 16514401 DOI: 10.1016/s0399-8320(06)73135-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Leroi AM, Parc Y, Lehur PA, Mion F, Barth X, Rullier E, Bresler L, Portier G, Michot F. Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double-blind crossover study. Ann Surg 2005; 242:662-9. [PMID: 16244539 PMCID: PMC1409867 DOI: 10.1097/01.sla.0000186281.09475.db] [Citation(s) in RCA: 176] [Impact Index Per Article: 9.3] [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 AND AIMS This is the first double-blind multicenter study examining the effectiveness of sacral nerve stimulation in a significant number of fecally incontinent patients. METHODS A total of 34 consecutive patients (31 women), median age 57 years (range, 33-73 years), underwent sacral nerve stimulation for fecal incontinence. After implantation, 27 of 34 patients were randomized in a double-blind crossover design to stimulation ON or OFF for 1-month periods. While still blinded, the patients chose the period of stimulation (ON or OFF) that they had preferred. The mode of stimulation corresponding to the selected period was continued for 3 months (final period). Outcome measures were frequency of fecal incontinence and urgency episodes, delay in postponing defecation, score severity, feeling of improvement, preference for ON or OFF, quality of life, and manometric measurements. RESULTS In the crossover portion of the study, the self-reported frequency of fecal incontinence episodes was significantly reduced during the ON versus the OFF period (P = 0.03), and this symptomatic improvement was consistent: 1) with the patients feeling of greater improvement during the ON versus OFF period (P = 0.02); 2) with the significant preference of patients (P = 0.02) for the ON versus OFF period. In the final period of the study, the frequency of fecal incontinence episodes decreased significantly (P = 0.005) in patients with the stimulator ON. The ability to postpone defecation (P = 0.01), the score for symptom severity (P = 0.0004), and the quality of life (P < 0.05) as well as anal sphincter function significantly improved. CONCLUSIONS The significant improvement in FI during the ON versus OFF period indicated that the clinical benefit of sacral nerve stimulation was not due to placebo.
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Affiliation(s)
- Anne-Marie Leroi
- Digestive Tract Research Group EA3234/IFRMP23, CHU Rouen, France.
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Poncet G, Dumortier J, Pereira A, Dumont O, Fouque P, Henry L, Scoazec JY, Barth X. [Duodenal migration of a mesenterico-caval prothesis]. Gastroenterol Clin Biol 2005; 29:1060-1. [PMID: 16435518 DOI: 10.1016/s0399-8320(05)88193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Monneuse OJY, Barth X, Gruner L, Pilleul F, Valette PJ, Oulie O, Tissot E. [Abdominal wound injuries: diagnosis and treatment. Report of 79 cases]. ACTA ACUST UNITED AC 2004; 129:156-63. [PMID: 15142813 DOI: 10.1016/j.anchir.2004.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 09/08/2003] [Accepted: 01/23/2004] [Indexed: 12/01/2022]
Abstract
INTRODUCTION - Traditionally, penetrating abdominal wounds justify routine laparotomy. However, this policy can be adapted to mechanism of injury (stab or firearm) and accuracy of imaging procedures if they eliminate visceral injury thus allowing close follow up. PATIENTS AND METHODS Retrospective study of 79 patients (May 1995-May 2002) with a penetrating abdominal wound: (47 (59%) stab wounds and 32 (41 %) firearm wounds). Correlation between imaging and surgical findings, treatment, post-operative course were studied. RESULTS Sixty-eight patients were operated on from the outset, and 11 underwent close follow-up. Of the 11 patients who had follow-up, (9 after stab wound and 2 after firearm wound), two had to be operated (1 in each group). Correlation between imaging and surgical findings was good in 34 (72%) patients after stab wound and in 21 (80%) after firearm wound; the mean number of visceral injuries was 1 and 3 respectively. Six patients (8%) died (mortality: 2% and 16% respectively), 12 (15%) had postoperative complications. CONCLUSION Penetrating abdominal stab wounds can be treated by close follow-up if imaging excludes visceral injury. Firearm wounds still justify routine laparotomy due to both multiplicity of visceral injuries and bad prognosis.
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Affiliation(s)
- O J-Y Monneuse
- Service de chirurgie digestive, hôpital Edouard-Herriot, Pavillon G, 5, place d'Arsonval, 69437 Lyon, France.
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Lapalus MG, Henry L, Barth X, Mellier G, Gautier G, Mion F, Damon H. Entérocèle : facteurs de risque clinique et associations à d'autres troubles de la statique pelvienne (à partir de 544 défécographies). ACTA ACUST UNITED AC 2004; 32:595-600. [PMID: 15450257 DOI: 10.1016/j.gyobfe.2004.05.012] [Citation(s) in RCA: 13] [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: 11/26/2003] [Accepted: 05/10/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To study, by means of defecography, clinical risk factors of enterocele and association with others pelvic floor disorders. PATIENTS AND METHODS Five hundred and forty-four consecutive female patients were investigated by colpocystodefecography with contrast medium in the small bowel. One hundred and thirty-six women with enterocele were compared to 408 women without enterocele. RESULTS There were no significant differences in age, obstetrical history (parity, foetal macrosomia, instrumental extractions or perineal tear to delivery) between the two groups. More women with enteroceles had histories of hysterectomies (60% versus 24%) or cystopexies (29% versus 13%). Others pelvic floor disorders were associated in 91% of enterocele: rectocele (25%), cystocele (42%), uterine prolapse (28%), rectal intussusception (52%), rectal prolapse (4%) and abnormal perineal descent (30%). Stress urinary incontinence was significantly more frequent in women without enterocele. DISCUSSION AND CONCLUSIONS The study has demonstrated that previous hysterectomy and cystopexy increased the risk of enterocele formation and that enterocele and others pelvic floor disorders are often concomitant. Enterocele may have a pessary effect on urinary disorders. Results of colpocystodefecography reinforce the notion of pelvic floor local disease.
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Affiliation(s)
- M-G Lapalus
- Fédération des spécialités digestives, service d'hépato-gastro-entérologie, hôpital Edouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
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Barth X, Monneuse O. [Appendicitis in the child and the adult]. Rev Prat 2004; 54:771-6. [PMID: 15253296] [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] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Xavier Barth
- Service d'urgence chirurgicale viscérale, hôpital Edouard Herriot, place d'Arsonval, 69437 Lyon Cedex.
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Parmentier H, Damon H, Henry L, Barth X, Mellier G, Mion F. Frequency of anal incontinence and results of pelvic viscerography in 291 women with pelvic organ prolapse. ACTA ACUST UNITED AC 2004; 28:226-30. [PMID: 15094671 DOI: 10.1016/s0399-8320(04)94888-9] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine the prevalence of anal incontinence in a population of 291 women with pelvic organ prolapse and evaluate the results of pelvic viscerogram in this situation. MATERIALS AND METHODS Each patient answered a standardized questionnaire on medical, obstetric and surgical past histories and answers were logged in a database. The viscerograms were performed by a single specialized radiologist. RESULTS All patients but one were parous. The prevalence of anal incontinence was 26.1%. Stress urinary incontinence and urge urinary incontinence were significantly associated with anal incontinence. No obstetric or surgical risk factor for anal incontinence was demonstrated. Viscerography demonstrated rectoceles (n=86, 29.1%), enteroceles (n=77, 26.5%), cystoceles (n=174, 59.8%), and intra-anal rectal prolapse (n=106, 36.4%). A significant association was found between intra-anal rectal prolapse and anal incontinence. CONCLUSION Anal incontinence is frequent in patients with pelvic organ prolapse, even more so in the presence of urinary incontinence, and should be investigated by pelvic viscerography. Pelvic floor dysfunction is frequently associated with enteroceles, rectoceles and rectal prolapse. Pelvic viscerograms should be systematically performed in the diagnostic work-up in patients with pelvic organ prolapse when surgical treatment is considered.
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Gautier G, Pilleul F, Crombe-Ternamian A, Gruner L, Ponchon T, Barth X, Valette PJ. Contribution of magnetic resonance cholangiopancreatography to the management of patients with suspected common bile duct stones. ACTA ACUST UNITED AC 2004; 28:129-34. [PMID: 15060457 DOI: 10.1016/s0399-8320(04)94866-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the value of magnetic resonance cholangiography (MRC) as a systematic first-line investigation in the management of patients with suspected common bile duct stones. METHODS Ninety-nine consecutive patients with clinical suspicion of choledocolithiasis were prospectively explored by MRC. All MRCs were interpreted by two radiologists with knowledge of the patient's clinical condition and laboratory results. In case of discrepancy, a third opinion was obtained to reach consensus. The definitive diagnosis was established on the basis of endoscopic exploration of the common bile duct (n=40), clinical and biological follow-up at 6 Months (n=55) or other investigations (n=4). The clinician's level of confidence, management options implemented, and impact of management decisions were used to assess the contribution of MRC. The diagnostic accuracy of MRC for common bile duct stones was also determined. RESULTS At the observed level of confidence (85.9%), MRC identified a differential diagnosis in 7.1% of patients avoiding unnecessary endoscopic exploration in 59.6%. Systematic first-line MRC enabled appropriate management in 83.8% of patients. The sensitivity, specificity, and positive and negative predictive values of MRC for the diagnosis of common bile duct stones were 95.7%, 98.7%, 95.7% and 98.7%, respectively, with excellent inter-observer agreement (kappa=0.915). CONCLUSION Magnetic resonance cholangiography can be used to efficiently screen patients who may need further invasive exploration of the common bile duct. It specifically identifies patients requiring therapeutic ERCP.
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Damon H, Henry L, Roman S, Barth X, Mion F. Influence of rectal prolapse on the asymmetry of the anal sphincter in patients with anal incontinence. BMC Gastroenterol 2003; 3:23. [PMID: 12925237 PMCID: PMC194588 DOI: 10.1186/1471-230x-3-23] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Accepted: 08/19/2003] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Anal sphincter defects have been shown to increase pressure asymmetry within the anal canal in patients with fecal incontinence. However, this correlation is far from perfect, and other factors may play a role. The goal of this study was to assess the impact of rectal prolapse on anal pressure asymmetry in patients with anal incontinence. METHODS 44 patients, (42 women, mean age: 64 (11) years), complaining of anal incontinence, underwent anal vector manometry, endo-anal ultrasonography (to assess sphincter defects) and pelvic viscerogram (for the diagnosis of rectal prolapse). Resting and squeeze anal pressures, and anal asymmetry index at rest and during voluntary squeeze were determined by vector manometry. RESULTS Ultrasonography identified 19 anal sphincter defects; there were 9 cases of overt rectal prolapse, and 14 other cases revealed by pelvic viscerogram (recto-anal intussuception). Patients with rectal prolapse had a significantly higher anal sphincter asymmetry index at rest, whether patients with anal sphincter defects were included in the analysis or not (30 (3) % versus 20 (2) %, p < 0.005). Among patients without rectal prolapse, a higher anal sphincter asymmetry index during squeezing was found in patients with anal sphincter defects (27 (2) % versus 19 (2) %, p < 0.03). CONCLUSIONS In anal incontinent patients, anal asymmetry index may be increased in case of anal sphincter defect and/or rectal prolapse. In the absence of anal sphincter defect at ultrasonogaphy, an increased anal asymmetry index at rest may point to the presence of a rectal prolapse.
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Affiliation(s)
- Henri Damon
- Fédération des Spécialités Digestives, Hôpital E. Herriot, 69437 Lyon cedex 03, France
| | - Luc Henry
- Fédération des Spécialités Digestives, Hôpital E. Herriot, 69437 Lyon cedex 03, France
| | - Sabine Roman
- Fédération des Spécialités Digestives, Hôpital E. Herriot, 69437 Lyon cedex 03, France
| | - Xavier Barth
- Urgences Viscérales, Hôpital E. Herriot, 69437 Lyon cedex 03, France
| | - François Mion
- Fédération des Spécialités Digestives, Hôpital E. Herriot, 69437 Lyon cedex 03, France
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Barth X. [Critical and unfounded commentaries]. Ann Chir 2003; 128:202; author reply 202. [PMID: 12821092 DOI: 10.1016/s0003-3944(03)00054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Damon H, Henry L, Barth X, Mion F. Fecal incontinence in females with a past history of vaginal delivery: significance of anal sphincter defects detected by ultrasound. Dis Colon Rectum 2002; 45:1445-50; discussion 1450-1. [PMID: 12432289 DOI: 10.1007/s10350-004-6448-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [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: 02/08/2023]
Abstract
PURPOSE The aim of this study was to determine the significance of anal sphincter defects detected by ultrasonography, in a population of fecal incontinent parous females without previous anoperineal surgery. METHODS From 100 consecutive incontinent patients, 61 females with at least one previous vaginal delivery and no past anoperineal surgery were studied. The severity of fecal incontinence was assessed by the Cleveland Clinic questionnaire score. Lesions of the internal or external anal sphincters, and the radial size of these defects were assessed by ultrasonography. Anal vector manometry was performed to measure anal pressures at rest and during voluntary squeeze, and the anal asymmetry index. RESULTS Twenty-three had a normal sphincter (38 percent), and 38 (62 percent) had a defect detected by ultrasonography: 20 isolated defects of the external sphincter and 18 combined defects of the internal and external sphincters. Combined defects were significantly larger. The radial size of the defects was positively correlated with the severity of clinical symptoms. Anal pressure asymmetry index was significantly increased in the group with combined defects compared with the two other groups. An index of 25 percent or greater had a very high (100 percent) negative predictive value for the presence of a defect larger than 90 degrees. CONCLUSIONS This study confirms the high prevalence of anal sphincter defects detected by ultrasonography in a population of incontinent parous females without previous proctologic surgery. The clinical symptoms are related to the size of these defects. Anal vector manometry may be a useful tool to confirm the relation between echographic anal sphincter lesions and fecal incontinence.
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Affiliation(s)
- Henri Damon
- Fédération des Spécialités Digestives, Hôpital E. Herriot, 69437 Lyon cedex 03, France
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Gignoux BM, Gruner L, Bouletreau P, Barth X, Tissot E. [Three-luminal nasojejunal tube in digestive surgery: preliminary feasibility study]. Ann Chir 2002; 127:624-8; discussion 629-30. [PMID: 12491638 DOI: 10.1016/s0003-3944(02)00822-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
STUDY AIM The benefit of enteral nutrition is an established fact for severely burned or multiple injured patients with a reduction of septic morbidity. Enteral nutrition is now possible in upper gastrointestinal tract surgery with the development of nasojejunal triple lumen tube and we report a new application with an operative placement. The aim of the study was to evaluate the nasojejunal triple lumen tube in digestive surgery. MATERIAL AND METHODS From November 1999 to August 2001, a nasojejunal triple lumen tube was placed during surgery for high surgical risk patients (n = 17) or under radioscopic control for the treatment of post operative complications (n = 6). RESULTS The surgical placement was possible in all cases. The radioscopic placement failed in two cases, one of which being solved with endoscopic procedure. There was no morbidity during the tube placement. Four patients were excluded because of early post operative death (n = 3) or premature removal of the tube by the patient (n = 1). The enteral nutrition was early in 18 patients and its mean duration was 18.2 days (range 3-75). Technical problems occurred in 9 patients and the replacement of the tube was necessary in 8 cases. CONCLUSION The nasojejunal triple lumen tube is a feasible, safe and relatively well-tolerated procedure in upper gastrointestinal tract surgery.
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Affiliation(s)
- B M Gignoux
- Service d'urgence chirurgicale viscérale, hôpital Edouard-Herriot, place d'Arsonval, 69437 Lyon, France.
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Mabrut JY, Grandjean JP, Henry L, Chappuis JP, Partensky C, Barth X, Tissot E. [IMesenteric and mesocolic cystic lymphangiomas. Diagnostic and therapeutic management]. Ann Chir 2002; 127:343-9. [PMID: 12094416 DOI: 10.1016/s0003-3944(02)00770-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [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 Study of clinical, diagnostic and therapeutic aspects of mesenteric and mesocolic cystic lymphangiomas. MATERIAL AND METHODS 15 cases were retrospectively analysed: 5 adults (mean age 36.8 years, range 26 to 46) and 10 children (mean age 23 months, range 0 to 5 years). Diagnosis was prenatal in 1 case. Symptoms were: abdominal pain (80%), fever (20%), abdominal mass (46%), occlusive syndrome (33%), chylous ascitis 1 case. Tumours were mesenteric (86%) or mesocolic (13%). RESULTS Complete resection was performed in 11 cases (including 10 bowel resections), incomplete resections in 3 and doxycycline sclerotherapy once. Mean follow-up is 5 years. One recurrence occurred 6 years after complete resection and 1 tumour increased after incomplete resection. Patient treated by sclerotherapy was non symptomatic with a 3.5 years follow-up after last injection. CONCLUSION Mesenteric and mesocolic cystic lymphangiomas are congenital benign tumours. Complete resection should be performed whenever possible. Intracystic sclerotherapy with doxycyclin is possible for unresectable lymphangiomas.
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Affiliation(s)
- J Y Mabrut
- Service de chirurgie générale, digestive et de transplantation hépatique, hôpital de la Croix-Rousse, 103, Grande-rue-de-la-Croix-Rousse, 69317 Lyon 04, France.
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Abstract
STUDY AIM The goal of this study was to evaluate the clinical and functional consequences of anal sphincter echographic lesions in patients with fecal incontinence. PATIENTS AND METHOD From January 1997 to April 2001, 100 patients with fecal incontinence (90 women, 10 men) were prospectively explored by transanal ultrasound and vectormanometry. Internal and external sphincter defects, as well as their extension, were analyzed with regard to their clinical and functional expressions (resting and squeeze anal sphincter pressures, anal sphincter asymmetry index). RESULTS Among the 100 patients, 42 had no echographic lesions, 58 had a defect: 26 had an isolated defect (internal sphincter (n = 3), external sphincter (n = 23) and 32 had combined internal and external sphincter defects. Squeeze anal pressures were significantly lower in the group of patients with combined defects, compared to the group with isolated defect or without defect. Anal asymmetry index was higher in the group of patients with combined defects, compared to the other groups. There was a positive correlation between the radial extension of the defect and the importance of clinical complaints. CONCLUSION Echographic anal sphincter lesions are frequent in fecal incontinence and are clinically and functionally significant.
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Affiliation(s)
- H Damon
- Hôpital Edouard-Herriot, 69437 Lyon, France.
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Barth X. [Intestinal obstruction of the colon: physiopathology, etiology, diagnosis, treatment]. Rev Prat 2001; 51:783-7. [PMID: 11387677] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- X Barth
- Service de chirurgie viscérale, hôpital Edouard-Herriot, 69437 Lyon
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Abstract
STUDY OBJECTIVE Hepatic portal venous gas is a radiological symptom associated with a poor prognosis (75% to 90% mortality). The aim of this retrospective study was to report 7 cases observed over a 2-year period. PATIENTS AND METHOD From June 1997 to November 1999, hepatic portal venous gas was diagnosed in 6 patients by CT scan and in one patient by echosonography. It was not detected in any case by plain abdominal X-rays. Three patients had small bowel obstruction with necrosis, three had extensive superior mesenteric infarction and one had preperforative necrosis of the colon. RESULTS One patient with extensive intestinal infarction and a metastatic head and neck cancer was not operated. Two patients were operated, but the extensive mesenteric infarction was not amenable to surgical management. Three of the 7 patients died, while the other four patients survived after resection of the necrotic small intestine (n = 3) and left colectomy extended to the transverse colon (n = 1). CONCLUSION Hepatic portal venous gas was associated with intestinal necrosis in the seven cases of this series. The severity of portal venous gas is only correlated with the severity of the disease causing portal venous gas.
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Affiliation(s)
- O Monneuse
- Service d'urgence chirurgie viscérale, hôpital Edouard-Herriot, Lyon, France
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Crombé A, Weber F, Gruner L, Martins A, Fouque P, Barth X. [Abdominopelvic ultrasonography in suspected acute appendicitis: prospective study in adults]. Ann Chir 2000; 125:57-61. [PMID: 10921186] [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: 02/17/2023]
Abstract
STUDY AIM The aim of this prospective descriptive study was to evaluate the accuracy of abdomino-pelvic ultrasonography in suspected acute appendicitis in adults. PATIENTS AND METHODS From March to July 1998, 100 consecutive patients, 63 women, 37 men (mean age: 25 years), after examination by a visceral surgeon for suspected acute appendicitis, had an abdominal ultrasonography (US) examination with high frequency transducer (7.5 to 9 MHz). The US examination concerned appendice, periappendicular tissues and neighbouring organs. The US data were correlated with the histopathologic findings in operated on patients, and with the clinical and biological follow up in non operated patients. RESULTS Fourty-seven patients had acute appendicitis; 53 were operated on and 47 non operated. Analysis of US data revealed sensitivity 91.5%, specificity 94.3%, positive predictive value 93.5%, negative predictive value 94.3%, accuracy 93%; 75% of the other diagnosis were found by US. CONCLUSION Systematic abdominal ultrasonography in suspected acute appendicitis is recommended in adults.
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Affiliation(s)
- A Crombé
- Service de radiologie abdominale et digestive, hôpital E-Herriot, Lyon, France
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Meynaud-Kraemer L, Colin C, Vergnon P, Barth X. Wound infection in open versus laparoscopic appendectomy. A meta-analysis. Int J Technol Assess Health Care 1999; 15:380-91. [PMID: 10507196] [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: 02/14/2023]
Abstract
The authors performed a meta-analysis to determine whether open or laparoscopic appendectomy would reduce wound infection incidence in adult patients with acute appendicitis. The meta-analysis included nine of seven patients from eight randomized controlled trials. Data were analyzed using the fixed effect-model method of Mantel-Haenszel. Wound infection incidence was lower in the laparoscopic group.
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Pasquiou C, Scoazec JY, Gentil-Perret A, Taniere P, Ranchere-Vince D, Partensky C, Barth X, Valette PJ, Bailly C, Mosnier JF, Berger F. [Solid pseudopapillary tumors of the pancreas. Pathology report of 13 cases]. Gastroenterol Clin Biol 1999; 23:207-14. [PMID: 10353015] [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: 02/12/2023]
Abstract
OBJECTIVES Solid pseudopapillary tumors of the pancreas are exceptional. The aims of our study were to reevaluate the mode of presentation of these tumors and to analyze the role of pathological examination in diagnostic assessment and prognostic evaluation. PATIENTS We report the clinical, radiological and pathological findings in a retrospective series of 13 patients in whom a diagnosis of solid pseudopapillary tumor of the pancreas was made between 1983 and 1997. There were 12 females (median age: 22.5 years) and one male, aged 73. RESULTS The tumor was discovered incidentally (3 cases) or because of nonspecific digestive symptoms (10 cases). Biological data were uninformative. The tumor was pancreatic in 12 cases and duodenal in 1. In all cases, imaging techniques showed an heterogeneous lesion with no or poor vascularization. A cystic component was identified in 4 cases. Surgical resection was performed in all cases. Pathological examination showed an encapsulated tumor in 8 cases, a non-encapsulated but well-limited lesion in 3 cases and an infiltrative tumor in 2 cases. At the time of diagnosis, multiple liver metastases were present in 1 case. Mean duration of follow-up was 24 months (range: 3-168). At last follow-up, all patients, including the patient with synchronous metastatic disease, were alive, without local recurrence. CONCLUSION Our study confirms that most cases of solid pseudopapillary tumors of the pancreas present with a suggestive clinical picture, including their occurrence in young women and their good prognosis after surgical resection. However, our results also underline the occurrence of cases presenting with unusual features, including old age, male sex, extra-pancreatic localization and malignant evolution. Histopathological examination is essential for the establishment of the diagnosis but morphological data are of little prognostic value.
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Affiliation(s)
- C Pasquiou
- Laboratoire d'Anatomie et de Cytologie Pathologiques, Hôpital Edouard-Herriot, Lyon
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Tissot E, Potier V, François Y, Bonnefoy M, Barth X, Braye F. [Dorso-lumbalgia and colorectal pathology]. Ann Chir 1998; 52:207. [PMID: 9752446] [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: 02/08/2023]
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Abstract
We report a case of a 17-year-old patient with an haemothorax related to an intra-abdominal spleen rupture. The nature of this haemothorax is unusual and the problem is how to obtain the etiology in this case. The spleen was in intra-abdominal position on all radiological examinations and was the source of bleeding. Therefore, laparotomy is the only convenient therapy.
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Affiliation(s)
- S Lansiaux
- Département d'anesthésie-réanimation chirurgicale d'urgence, hôpital Edouard-Herriot, Lyon, France
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Barth X, Leclercq T. [Cancer of the colon. Epidemiology, pathological anatomy, Dukes' stage, physiopathology, diagnosis, course, principles of treatment and prevention]. Rev Prat 1997; 47:1575-81. [PMID: 9366117] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- X Barth
- Orgence chirurgicale viscérale, hôpital Edouard-Herriot, Lyon
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Di Roio C, Barth X. [Ventriculoperitoneal shunt and colonic obstruction]. Ann Fr Anesth Reanim 1996; 15:1133-4. [PMID: 9180997 DOI: 10.1016/s0750-7658(96)89492-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Duhaut P, Demolombe-Rague S, Pinede L, Vedrinne JM, Pernot, Barth X, Berger F, Ninet J, Loire R, Pasquier J. Maladie de Horton systémique révélée par une polynévrite, d'évolution gravissime par ischémie digestive. Rev Med Interne 1993. [DOI: 10.1016/s0248-8663(05)80198-5] [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: 11/25/2022]
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