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Resume But de l’etude Le but de l’etude etait d’evaluer le role pronostique de 4 solutions de conservation en transplantation hepatique (TH). Patients et methodes Il s’agit d’une etude retrospective a partir de toutes les TH de tous les centres francais (n = 22) enregistrees dans la base de donnees prospective de l’Agence de la Biomedecine (Cristal) entre 2008 et 2013. Les solutions de preservation utilisees etaient : Celsior, IGL-1, SCOT 15 ou UW. Les criteres d’exclusion etaient : solution inconnue ou inhomogene ou solution HTK (3 % seulement des TH). Le critere principal de jugement etait la survie des patients. Les criteres secondaires etaient la survie des greffons et la duree de reanimation. Resultats Parmi 6347 TH realisees, 4928 ont ete incluses pour lesquelles la solution de preservation utilisee etaient Celsior (30 %), IGL-1 (44 %), SCOT 15 (10 %) et UW (16 %). La survie des patients etait de 86 %, 80 % et 74 % a 1, 3 et 5 ans, respectivement, sans difference entre les 4 solutions (p = 0,78). La survie des greffons etait respectivement de 82 %, 75 % et 69 % a 1, 3 et 5 ans, sans difference entre les 4 solutions (p = 0,80). Le sejour en reanimation etait different selon la solution utilisee en analyse univariee (p Conclusion Le type de solution de conservation utilisee (Celsior, IGL-1, SCOT 15 ou UW) n’a pas d’influence sur la survie des patients ou des greffons apres TH.

BackgroundThe prognostic value of the primary neoplasm responsible for pseudomyxoma peritonei (PMP) remains poorly studied. The aim of this study was to determine the prognosis for patients with extra-appendicular PMP (EA-PMP) treated optimally with complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).MethodsAll patients treated for PMP with CCRS and HIPEC between 1994 and 2016 were selected retrospectively from a French multicentre database. Patients with EA-PMP had pathologically confirmed non-neoplastic appendices and were matched in a 1 : 4 ratio with patients treated for appendicular PMP (A-PMP), based on a propensity score.ResultsSome 726 patients were identified, of which 61 (EA-PMP group) were matched with 244 patients (A-PMP group). The origins of primary tumours in the EA-PMP group included the ovary (45 patients), colon (4), urachus (4), small bowel (1), pancreas (1) and unknown (6). The median peritoneal carcinomatosis index was comparable in EA-PMP and A-PMP groups (15·5 versus 18 respectively; P = 0·315). In-hospital mortality (3 versus 2·9 per cent; P = 1·000) and major morbidity 26 versus 25·0 per cent; P = 0·869) were also similar between the two groups. Median follow-up was 66·9 months. The 5-year overall survival rate was 87·8 (95 per cent c.i. 83·2 to 92·5) per cent in the A-PMP group and 87 (77 to 96) per cent in the EA-PMP group. The 5-year disease-free survival rate was 66·0 (58·7 to 73·4) per cent and 70 (53 to 83) per cent respectively.ConclusionOverall and disease-free survival following treatment with CCRS and HIPEC is similar in patients with pseudomyxoma peritonei of appendicular or extra-appendicular origin.

International audience; Objective - The goal of this study was to evaluate the prognostic role of four preservation solutions in liver transplantation (LT). Patients and methods - This is a retrospective study originating from 22 French centers performing LT, registered in the prospective databank of the Cristal Biomedicine Agency between 2008 and 2013. The preservation solutions used were Celsior (CS), Institut Georges Lopez (IGL)-1, Solution de Conservation des Organes et des Tissus (SCOT) 15 and University of Wisconsin (UW) solutions. Exclusion criteria were preservation with unknown or inhomogeneous solutions, or Histidine-tryptophan-ketoglutarate (HTK) solution (representing only 3% of LT). Patient survival was the main endpoint. Secondary endpoints were graft survival and duration of stay in intensive care. Results - Of 6347 LT performed, 4928 were included in this study, for which the distribution of preservation solution was CS (30%), IGL-1 (44%), SCOT 15 (10%) and UW (16%). Patient survival was 86%, 80% and 74% at 1, 3 and 5 years after LT, respectively, without any statistically significant difference between the four solutions (P=0.78). Graft survival was 82%, 75% and 69% at 1, 3 and 5 years after LT, respectively, without any statistically significant difference between the four solutions (P=0.80). Duration of intensive care was different according to the solution used in univariate analysis (P

Purpose: Diffuse malignant peritoneal mesothelioma (DMPM) is a severe disease with mainly locoregional evolution. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the reported treatment with the longest survival. The aim of this study was to evaluate the impact of perioperative systemic chemotherapy strategies on survival and postoperative outcomes in patients with DMPM treated with curative intent with CRS-HIPEC, using a multi-institutional database: the French RENAPE network. Patients and methods: From 1991 to 2014, 126 DMPM patients underwent CRS-HIPEC at 20 tertiary centres. The population was divided into four groups according to perioperative treatment: only neoadjuvant chemotherapy (NA), only adjuvant chemotherapy (ADJ), perioperative chemotherapy (PO) and no chemotherapy before or after CRS-HIPEC (NoC). Results: All groups (NA: n Z 42; ADJ: n Z 16; PO: n Z 16; NoC: n Z 48) were comparable regarding clinicopathological data and main DMPM prognostic factors. After a median follow-up of 61 months, the 5-year overall survival (OS) was 40%, 67%, 62% and 56% in NA, ADJ, PO and NoC groups, respectively (P Z 0.049). Major complications occurred for 41%, 45%, 35% and 41% of patients from NA, ADJ, PO and NoC groups, respectively (P Z 0.299). In multivariate analysis, NA was independently associated with worse OS (hazard ratio, 2.30; 95% confidence interval, 1.07e4.94; P Z 0.033). Conclusion: This retrospective study suggests that adjuvant chemotherapy may delay recurrence and improve survival and that NA may impact negatively the survival for patients with DMPM who underwent CRS-HIPEC with curative intent. Upfront CRS and HIPEC should be considered when achievable, waiting for stronger level of scientific evidence.

Introduction La radiochimiotherapie neoadjuvante (RCT) des cancers localement avances (T3-T4 et/ou N + ) du haut rectum (plus de 10 cm de la marge anale) (CHRLA) est debattue. Le but de ce travail etait de comparer les resultats a court et long terme des patients presentant un CHR avec et sans RCT. Methodes Les patients avec CHRLA non metastatique suivi plus de 5 ans de 5 CHU francais ont ete inclus. Les resultats operatoires, oncologiques et fonctionnels a long terme des CHRLA ont ete compares entre ceux avec chirurgie d’emblee (groupe C) et ceux avec RCT (groupe RCT). Resultats Cent vingt-sept patients ont ete inclus : 79 dans le groupe (C) et 48 dans le groupe (RCT), avec un suivi median de 67 mois. L’exerese totale du mesorectum etait significativement plus frequente dans le groupe RCT vs C (58 % vs 20 %, p Conclusions La radiochimiotherapie neoadjuvante ne semble pas apporter de benefice en cas de cancer localement avance du haut rectum. En revanche, elle semble associee a une morbidite postoperatoire plus importante.

Gallbladder volvulus is a rare disease and can lead to an acute cholecystitis. We report the case of an elderly woman with a gallbladder volvulus, diagnosed at CT scan and treated by surgery and endoscopic sphincterotomy.

Vascular renal anomalies are frequent, multiple and well described and result from errors in vessel embryogenesis between the 6th and 10th week of gestation. Historically, variations are described in anatomic dissection and currently mostly in image interpretation. We report an anatomic variation concerning the right renal vein which, to our knowledge, has never been described in the literature either by dissection or by radiological examination. This variation was discovered during the routine dissection of an embalmed male body. It consists of a Y-shaped right renal vein and is associated with multiple retroperitoneal variations: a bilateral accessory renal artery, a trident ending of the right renal artery and a left testicular vein variation. Venous and arterial renal anatomy and its variations are fundamentally important in renal surgery, especially concerning living donor renal grafts. These variations may be diagnosed thanks to injected tomodensitometry which has a good sensitivity and specificity for anomalies. Preoperative diagnosis of an anatomic vascular renal variation may reduce morbidity during surgery, which is why precise examination of injected tomography should be mandatory.

Discipline Clinique. Introduction et but de l’etude L’adenocarcinome pancreatique est un enjeu majeur de sante publique. Lorsque la maladie est decouverte a un stade localise, la chirurgie carcinologique associee a la chimiotherapie adjuvante est le meilleur traitement susceptible de conduire a une survie prolongee. Malgre des progres incontestables, la chirurgie pancreatique est grevee d’une morbidite elevee (40 a 50 %) justifiant une meilleure selection des patients. Le but de cette etude etait de determiner les facteurs pronostiques preoperatoires, notamment biologiques et nutritionnels, sur la survie sans recidive des patients atteints d’un adenocarcinome pancreatique resecable. Materiel et methodes Au total, patients atteints d’un adenocarcinome pancreatique et operes au CHRU de Besancon entre 2006 et 2014 ont ete retrospectivement inclus. Les parametres clinico-biologiques et nutritionnels ont ete recueillis au diagnostic et un mois apres la chirurgie. La sarcopenie radiologique etait definie par une valeur de l’index musculaire squelettique inferieure a 52,4 cm 2 /m 2 chez l’homme et inferieure a 38,5 cm 2 /m 2 chez la femme. Les analyses statistiques ont permis de developper un score pronostique. Resultats et analyse statistique Au total, 58,5 % des 94 patients inclus dans l’analyse finale etaient sarcopeniques en preoperatoire et 19,1 % presentaient une lymphopenie. En analyse univariee, les parametres suivants etaient correles a la survie sans recidive (SSR) : la taille tumorale, le taux serique de Ca 19,9, la lymphopenie et la sarcopenie. En analyse multivariee, seules la lymphopenie et la sarcopenie etaient independamment correlees a la SSR (HR = 4,6 ; p p = 0,0047 respectivement). La constitution d’un score incluant ces 2 parametres a permis d’identifier 3 groupes de patients avec un profil pronostique different a savoir : le groupe sans lymphopenie ni sarcopenie, le groupe sarcopenie sans lymphopenie et le groupe lymphopenie sans sarcopenie (SSR respectives : 21,2 ; 11,5 et 5,6 mois p Conclusion La sarcopenie apparait en plus de la lymphopenie comme un marqueur pronostique preoperatoire dans l’adenocarcinome pancreatique localise et devrait etre evaluee en pratique courante pour discuter de l’orientation therapeutique des malades.

Resume Introduction. – Le ganglioneurome est une tumeur nerveuse benigne rare de localisation retroperitoneale frequente. Nous rapportons l'observation d'une patiente de 22 ans dont la tumeur a ete revelee par une colique nephretique compliquee d'une pyelite et d'un abces renal. Exegese. – La patiente a presente des douleurs lombaires febriles brutales et des signes urinaires. Une riche iconographie a permis de visualiser, notamment l'echographie avec contraste, une volumineuse masse retroperitoneale. L'exerese chirurgicale par laparotomie a ete realisee. Les modes de revelation du ganglioneurome sont varies et trompeurs. Les examens biologiques et radiologiques permettent de suspecter le diagnostic, mais seule l'histologie de la piece operatoire l'affirmera. Conclusion. – Devant une volumineuse masse retroperitoneale avec etat general conserve, on doit envisager le diagnostic de ganglioneurome car l'exerese chirurgicale complete permet une guerison sans recidive. Prealablement, l'ensemble des autres diagnostics differentiels doit etre elimine.

Resume But de l'etude. – Il etait de determiner si l'utilisation d'un renfort innovant implantable en site intraperitoneal permettait une reduction des couts du sejour hospitalier par rapport a une implantation intraparietale d'un renfort conventionnel. Patients et methodes. – De janvier 1998 a juin 2000, 52 patients ont ete operes d'une eventration de la paroi abdominale anterieure par laparotomie avec implantation d'un renfort intraperitoneal Parietex® composite. Les couts d'intervention, d'anesthesie, de sejours global et postoperatoire de ce groupe ont ete compares aux memes donnees d'un groupe de 21 patients operes a une periode anterieure avec un renfort Mersuture® mis en position retromusculaire. Resultats. – Les resultats cliniques qui montraient une baisse significative des durees de sejour, d'anesthesie et d'intervention en faveur du renfort Parietex® composite etaient confirmes par l'evaluation medicoeconomique avec une diminution de ces memes couts. Conclusion. – L'utilisation d'un dispositif chirurgical innovant modifiant la technique operatoire pouvait engendrer des economies de sante malgre son surcout a l'achat et procurer au patient un meilleur confort au cours de son sejour hospitalier.

La cartographie des preferences utilise souvent une equation multi-lineaire pour modeliser la preference des consommateurs en fonction de la description des produits. Cet article, qui etudie les preferences de 639 consommateurs pour 24 produits laitiers, montre que ce modele n'est pas bien adapte, mais qu'il faut lui preferer un modele quadratique. Les meilleurs resultats sont obtenus en segmentant les consommateurs en groupes ayant des comportements homogenes.

Resume Objectif de l'etude La maladie de Caroli est une dilatation des voies biliaires segmentaires intrahepatiques. Le plus souvent diffuse, elle est beaucoup plus rarement localisee a un seul lobe du foie, essentiellement a gauche. Le diagnostic est souvent porte avec retard a la suite de gestes chirurgicaux ou endoscopiques inadequats. L'objectif de cette etude etait d'analyser une serie de 12 patients atteints d'une forme monolobaire, dont trois a localisation droite et tous traites par hepatectomie. Patients et methodes Une serie de 12 observations a ete recueillie entre 1974 et 1997. Il y avait six hommes et six femmes d'âge moyen 51 ans. L'etude a porte sur les circonstances de decouverte de l'affection. Le delai moyen entre les premiers symptomes et le diagnostic definitif etait de 12,5 ans. Huit des 12 patients avaient eu 22 gestes chirurgicaux ou endoscopiques avant l'intervention d'exerese. Dans cette serie, l'echographie pre-operatoire et/ou la tomodensitometrie ont toujours etabli le diagnostic. Six patients n'avaient pas de lithiase vesiculaire. Resultats Le traitement chirurgical d'exerese a ete une lobectomie gauche (sept cas), une hepatectomie gauche (deux cas) et une hepatectomie droite (trois cas). Une anastomose biliojejunale intrahilaire a ete etablie dans cinq cas. L'examen anatomopathologique des pieces d'hepatectomie montrait dans tous les cas une dilatation kystique des voies biliaires intrahepatiques segmentaires et sous-segmentaires sous forme de cavites kystiques de quelques millimetres a 4 cm contenant des calculs. Il y avait dans deux cas une fibrose hepatique congenitale et dans un cas, une heterotopie pancreatique intrahepatique. Aucune lesion de cholangiocarcinome n'a ete observee. Un patient a developpe dans les suites operatoires une fistule biliaire necessitant une reintervention. A distance, tous ont eu une evolution favorable a l'exception d'un patient decede d'un cancer colique apres trois ans. Conclusion Associee a d'autres malformations, et notamment a une fibrose hepatique congenitale, cette affection habituellement diffuse porte le nom de syndrome de Caroli. La forme monolobaire, localisee le plus souvent a gauche, repond au terme de maladie de Caroli. Les formes monolobaires et les formes diffuses sont revelees par des acces de cholangite et, dans plus de la moitie des cas, par une lithiase de la voie biliaire principale en l'absence de lithiase de la vesicule.

Background Chromaffin cells from the adrenal gland secrete a mixture of compounds that have a strong analgesic effect, especially when administered intrathecally. Many studies in animal models have shown that discordant xenogeneic cell isolates, including chromaffin cells, can survive and have biologic effects when transplanted within a semipermeable membrane capsule. Methods To evaluate the clinical potential of encapsulated cell therapy, a human-scale implant containing bovine chromaffin cells was developed, characterized, and implanted in the subarachnoid space of seven patients with severe chronic pain not satisfactorily managed with conventional therapies. Patients received no pharmacologic immunosuppression. Cell devices were implanted during minimally invasive surgery, and device design allowed retrieval. All devices were recovered after implant periods of 41 to 176 days. Results Postexplant histologic analysis, immunostaining, and secretory function all confirmed survival and biochemical function of the encapsulated cells. Reductions in morphine intake and improvement in pain ratings were observed in several patients. Conclusions This study represents the first successful trial of encapsulated xenogeneic cells in humans. The preliminary findings of pain reduction warrant the initiation of a randomized, double-blind phase II study to evaluate the potential efficacy of the procedure.

The gene therapy approach presented in this protocol employs a polymer encapsulated, xenogenic, transfected cell line to release human ciliary neurotrophic factor (hCNTF) for the treatment of Amyotrophic Lateral Sclerosis (ALS). A tethered device, containing around 10(6) genetically modified cells surrounded by a semipermeable membrane, is implanted intrathecally; it provides for slow continuous release of hCNTF at a rate of 0.25 to 1.0 micrograms/24 hours. The semipermeable membrane prevents immunologic rejection of the cells and interposes a physical, virally impermeable barrier between cells and host. Moreover, the device and the cells it contains may be retrieved in the event of side effects. A vector containing the human CNTF gene was transfected into a line of baby hamster kidney cells (BHK) with calcium phosphate using a dihydrofolate reductase-based selection vector with a SV40 promoter and contains a HSV-tk killer gene. hCNTF is a potent neurotrophic factor which may have utility for the treatment of ALS. Systemic delivery of hCNTF in humans has been frustrated by peripheral side effects, the molecule's short half life, and its inability to cross the blood-brain barrier. The gene therapy approach described in this protocol is expected to mitigate such difficulties by local intrathecal delivery of a known quantity of continuously-synthesized hCNTF from a retrievable implant.

Unity requires that a program has at least one transition to verify a progress property. We propose a method to eliminate this side condition that clutters mechanized proofs.

BackgroundThe aim of this study was to compare in-hospital morbidity and mortality rates after elective laparoscopic and open colorectal surgery for sigmoid diverticular disease (SDD).MethodsThis prospective national multicentre observational study included all consecutive patients undergoing open or laparoscopic elective colectomy for SDD in a 4-month period between June and September 2002. Postoperative in-hospital mortality and morbidity in the two groups were compared.ResultsThree hundred and thirty-two consecutive patients undergoing either laparoscopic (163 patients) or open (169 patients) colectomy for SDD were analysed. Overall postoperative mortality and morbidity rates were 0·3 and 23·8 per cent respectively. The morbidity rate was significantly higher in the open than in the laparoscopic group (P < 0·001), leading to a significantly longer hospital stay (P < 0·001). The morbidity rate remained significantly higher in the open group when the patients were matched for age (P = 0·015) or American Society of Anesthesiologists score (P = 0·028). An open procedure (relative risk (RR) 2·13 (95 per cent confidence interval (c.i.) 1·29 to 3·45)), age over 70 years (RR 1·62 (95 per cent c.i. 1·14 to 2·30)) and intraperitoneal contamination (RR 2·54 (95 per cent c.i. 1·18 to 5·50)) were identified as independent risk factors for morbidity.ConclusionA laparoscopic approach to elective treatment of SDD may be associated with reduced postoperative morbidity and hospital stay. A randomized study is required to confirm these results.

Determine the gain of hospitalization cost using a new intraperitoneal mesh compared to the retro-muscular pre-fascial implantation of a polyester mesh.From January 1998 to June 2000, 52 patients with incisional hernia of the anterior abdominal wall were operated using intraperitoneal Parietex composite Mesh. The cost of surgery, anesthesia and hospitalization in this group were compared to similar data from a group of 21 patient where a Mesrsuture mesh in a prefascial retromuscular position was used.Parietex Composite Mesh in intraperitoneal position allows a significative reduction in surgery time, anesthesia time and hospitalization. The clinical results were confirmed by cost savings.Using new innovative medical device changing surgery technique insures significant cost saving despite its initial additional cost and increases patient's comfort during hospitalization.

The aim of the present study was to analyse, retrospectively on a large panel of patients (149), the influence of the donor liver characteristics on the outcome of human hepatocyte isolation obtained from resected liver biopsies from surgical waste after hepatectomy. Among the pre-operative parameters, the type of disease, age and sex of the patient, previous chemotherapy, alcohol or tobacco consumption did not affect the yield, viability, attachment rate and function of the isolated human hepatocytes. Pre-operative biological and anatomopathological data indicated that, while mild steatosis (/=10% steatotic hepatocytes) did also not affect the outcome of hepatocyte isolation, stronger steatosis (10% steatotic hepatocytes) tended to decrease hepatocyte yield. Cholestasis, as assessed by gamma-glutamyl transferase serum values, significantly negatively correlated with the percentage of digested liver and the yield of viable cells. Intra-operative clamping time, that is, warm ischaemia, longer than 30 min was found to decrease both the percentage of digested liver and cell yield. Among the post-operative parameters, the percentage of digested liver decreased when biopsy weights were higher than 100 g, the use of glue tended to increase both the percentage of digested tissue and the yield of viable cells.In conclusion, human diseased livers appear to be a valuable source of isolated functional human hepatocytes. We recommend, for an optimal isolation, to use liver biopsies weighing less than 100 g, to glue the section surfaces of the biopsies and to avoid the use of moderate steatotic livers (10% steatotic hepatocytes) and cholestatic livers, as well as livers undergoing warm ischaemia or clamping during resection due to the decrease in cell yield.

With the ATM block transfer with a delayed transmission (ABT/DT) capability, the amount of bandwidth allocated to the different cell flows of a connection (namely the CLP=0+1 and possibly the OAM cell flows) is constant over an ATM block and is referred to as the block cell rate (BCR). Successive BCR values are dynamically negotiated between the user and the network via the exchange of resource management cells. The BCR negotiation for a given ATM block may be initiated either by the source or the destination. As a basic principle, before transmitting an ATM block the source should receive an explicit authorization from the network. This paper gives the existence proof of a protocol for supporting the ABT/DT capability as specified in the May 1996 version of lTU-T Recommendation I.371.

Endoscopic ultrasonography is considered a highly accurate procedure for diagnosing small pancreatic tumors and assessing their locoregional extension.To evaluate the impact of endoscopic ultrasonography on the management of pancreatic adenocarcinoma in clinical practice.Sixty-four consecutive patients (mean age 70.5 plus/minus 11.9 years) hospitalized for staging or diagnosis of pancreatic adenocarcinoma were retrospectively (from January 1995 to November 1997) or prospectively studied (from December 1997 to August 1999).Group 1 consisted of 52 patients with pancreatic adenocarcinoma which was discovered using computerized tomography scanning and/or ultrasound. Endoscopic ultrasonography was utilized for staging purposes only in patients who were considered to be operable and the tumor to be resectable based on computerized tomography scanning criteria. Group 2 consisted of 12 patients who were diagnosed as having a pancreatic adenocarcinoma using endoscopic ultrasonography whereas computerized tomography scanning and ultrasound was negative.The impact of endoscopic ultrasonography was analyzed on the basis of the number of patients requiring endoscopic ultrasonography as a staging procedure (Group 1) and by evaluating the performance of endoscopic ultrasonography in determining resectability (Groups 1 and 2) based on the surgical and anatomopathological results.Endoscopic ultrasonography was performed in 20 out of 64 patients (31.3%): 8/52 in Group 1 (15.4%) and all 12 patients of Group 2. Endoscopic ultrasonography correctly assessed an absolute contraindication to resection in 11 cases. Resection was confirmed in 8 of the 9 cases selected by endoscopic ultrasonography. The positive predictive value, negative predictive value and overall accuracy of endoscopic ultrasonography for determining resection were 89%, 100%, and 95%, respectively.The impact of endoscopic ultrasonography seems especially relevant for the detection of pancreatic tumors after negative computerized tomography scanning, and for the prevention of unnecessary laparotomies as complementary staging after ultrasonography and computerized tomography scanning.

Introduction Les ganglioneuromes sont des tumeurs rares, issues des cellules de la crete neurale, localisees le long de leur axe de migration et se developpant a partir du systeme nerveux sympathique [1] . Leur localisation surrenalienne represente 20 % des cas. Observation Patient de 24 ans, presentant des douleurs lombaires d’aggravation progressives, des episodes d’hematurie macroscopique et un amaigrissement de 7 kg en 8 mois. Une echographie abdomino-pelvienne est realisee qui retrouve une deformation du pole superieur du rein droit, ayant fait l’objet par la suite d’un examen scannographique retrouvant une tumeur surrenalienne droite calcifiee de 59 mm x 56 mm x 87 mm, cloisonnee, bien limitee, totalement encapsulee. Le bilan endocrinien revient en faveur d’une masse surrenalienne non secretante. Devant le caractere symptomatique et apres discussion en RCP RENATEN, une indication a une surrenalectomie droite avec curage pediculaire renal est posee. L’analyse histologique revient en faveur d’un ganglioneurome de 9 cm. Discussion Le ganglioneurome est une tumeur rare, benigne, non secretante, souvent de decouverte fortuite. Le diagnostic est histologique. Les principaux diagnostics differentiels sont : pheochromocytome, paragangliome et ganglioneuroblastome. La recherche d’une predisposition genetique est inutile. L’evolution est lente mais l’augmentation de volume est la regle. Le pronostic est lie aux complications mecaniques et le traitement est chirurgical.

Introduction Les lesions du foie et du diaphragme droit sont frequemment associees dans les traumatismes abdominaux fermes (39 % des cas). Ces lesions posent la question de la voie d’abord, en raison du risque d’aggravation des lesions traumatiques du foie lors de sa mobilisation pendant la laparotomie. Le but de notre etude etait de valider la faisabilite et la securite d’une approche par thoracoscopie droite. Methodes Entre juin 1998 et 2008, six patients ont ete pris en charge dans notre service pour des traumatismes fermes responsables de lesions associees du foie et diaphragmatique droite. Les criteres d’inclusion etaient l’absence de lesions abdominales necessitant une laparotomie en urgence en particulier une perforation d’organe creux, l’instabilite hemodynamique, l’existence d’une lesion cerebrale, l’existence d’une extravasation de produit de constrate hepatique au scanner et un etat respiratoire contre-indiquant une intubation selective. Les donnees telles que l’âge, l’ISS (Injury severity Score), la nature et la localisation des lesions hepatiques, la presence d’une lesion thoracique associee, le delai de prise en charge, les donnees peroperatoires, les durees operatoire, de drainage thoracique et d’hospitalisation ont ete analysees. L’intervention etait pratiquee sous anesthesie generale en decubitus lateral gauche et le bras droit laisse pendant. Une sonde d’intubation double lumiere etait systematiquement utilisee. La colonne de coelioscopie a gauche du patient et un optique de 0° C ou 30° C choisit suivant les preferences de l’operateur. Entre 3 et 4 thoracoports etaient utilises. Resultats La mediane de l’âge des patients etait de 35 ans (20-58) et l’ISS de 27,5 (12-43). Le score moyen de Mirvis etait de 2,66 (2-4). Tous les patients presentaient des lesions hepatiques, dont trois hematomes avec rupture capsulaire du dome. Il existait chez tous les patients des contusions pulmonaires avec hemothorax associe. Les ruptures diaphragmatiques furent traitees par un surjet de fil non resorbable avec utilisation d’une prothese chez deux patients. La duree operatoire moyenne fut de 165 minutes (150-240). La duree moyenne de drainage thoracique fut de 5 jours (4-7), la duree moyenne d’hospitalisation dans notre unite fut de 8 jours (6-12) et la mediane de la duree d’hospitalisation totale de 13 jours (6-29). Conclusion Un mois apres la sortie de l’hopital, 4 patients etaient totalement asymptomatiques et 2 necessitaient des antalgiques de palier 1 de maniere occasionnelle. Un controle scanographique ne montrait pas de recidive. Les resultats de cette etude pilote montrent que l’approche thoracoscopique dans les lesions associees hepatique et diaphragmatique droite, est faisable et sure chez des patients selectionnes.

We report a case of surgically confirmed strangulation of small bowel through a defect in the greater omentum. Computed tomography demonstrated the presence and the location of this very unusual internal abdominal hernia. Those findings are presented.

The involvement of cell membrane fatty acids in resistance of Pseudomonas aeruginosa to Quaternary Ammonium Compounds (QACs) stresses was investigated. The strain was grown in a medium with increasing concentrations of different biocides: two QACs, and two non-QACs. In the presence of two QACs only, the strain was able to grow with increasing concentrations. During cellular adaptation to QACs, the resistance to the same biocide increased. A principal component analysis was performed with whole of fatty acid compositions which highlighted a specific variation for the cultures in presence of QACs. These modifications gave evidence of the outer membrane involvement in cellular response to the presence of QACs.

The influence of temperature and physiological state on fatty acid profiles of cell membranes of a gram-negative bacteria was studied in this work. It has been shown that fatty acid composition is largely modified by these two parameters. Lipids play an important role in the composition and the function of cell membranes. These modifications of membrane structures are very important to understand because of their consequences on cell viability.

Alveolar hydatid disease is an uncommon parasitosis found in the northern hemisphere, caused by the larval stage of a tapeworm growing in the liver: Echinococcus multilocularis. It behaves like a malignant tumor, producing liver necrosis and invading the biliary tract, main vessels and surrounding structures.Review of the different therapeutic approaches in hepatic alveolar echinococcosis over 21 years in an epidemic area.The various surgical approaches (all types of hepatectomy, palliative surgical procedures and liver transplantation) were combined with medical, endoscopic and radiological interventional treatment. Recently, asymptomatic forms were more frequently encountered.The wide use of ultrasonography and specific serological tests have led to early diagnosis, allowing more curative hepatectomies.

The role of membrane fatty acid composition in the resistance of Pseudomonas aeruginosa ATCC 15442 to the bactericidal activity of Quaternary Ammonium Compounds (QACs) was investigated. The strain was grown in a medium with increasing concentrations of a QAC, benzyldimethyltetradecylammonium chloride (C14) and two non-QACs, sodium dichloroisocyanurate and tri-sodium phosphate. In the presence of C14 only, the strain was able to grow in concentrations higher than the minimal inhibitory concentration. As the strain adapted to C14, resistance to bactericidal activity of the same biocide increased. For the non-QACs, no change was noted when cells were grown in the presence of biocides. The C14-adapted cells showed variations in membrane fatty acid composition. A hierarchical clustering analysis was used to compare all fatty acid compositions of cultures in the presence, or not, of the three biocides used here and another QAC studied previously. The clusters obtained underlined specific variations of membrane fatty acids in response to the presence of QACs. Furthermore, with a simple linear regression analysis, a relationship was shown between the membrane fatty acids and the resistance developed by the strain against the bactericidal activity of C14.

The role of membrane fatty acid composition in the resistance of Pseudomonas aeruginosa ATCC 15442 to the bactericidal activity of didecyldimethyl ammonium bromide (DDAB) was investigated. In this study, the strain was sub-cultured in a medium with increasing DDAB concentrations. After adaptation, Ps. aeruginosa was able to grow until the DDAB concentration in the medium was about five times greater than the Minimal Inhibitory Concentration. Resistance of cells to the bactericidal activity of DDAB also increased gradually during adaptation. This resistance was dependent on the presence of the biocide, as it quickly decreased when the cells were transferred to medium without biocide. Adapted cells showed changes in membrane fatty acid composition. The modifications mainly affected lauric, beta-hydroxylauric and palmitic acids, and they underlined the implication of the membranes in the cell response to the presence of the biocide. Simple linear regression analysis showed that the membrane fatty acid composition of Ps. aeruginosa played an important part in the resistance mechanisms of cells to the bactericidal activity of DDAB.

BACKGROUND: Caroli's disease is the dilatation of the segmental intrahepatic bile ducts. It usually affects the entire liver but can occasionally involve only one lobe, commonly the left. This study included 12 cases of unilobular disease, nine localised in the left lobe and three in the right lobe, which were all treated by liver resection. PATIENTS AND METHODS: These 12 patients underwent surgery between 1974 and 1997. There were six men and six women (mean age: 51 years). The initial presentation and diagnosis were reported. The mean interval between the first symptoms and diagnosis was 12.5 years. Eight of the 12 patients had undergone 22 surgical or endoscopic procedures prior to liver resection. In the present series a preoperative ultrasonogram or CT scan established the diagnosis in all cases. Six patients did not have stones in the gallbladder. RESULTS: Surgical treatment consisted in seven left lobectomies, two left hepatectomies and three right hepatectomies (Couinaud's classification). A intrahilar cholangiojejunostomy was performed in five cases. Pathological examination showed cystic dilatation of the intrahepatic segmental and subsegmental bile ducts, measuring from a few millimetres to 4 cm, which contained calculi. Two cases were associated with congenital hepatic fibrosis. An intrahepatic focus of ectopic pancreatic tissue was seen in one case. There were no cases with cholangiocarcinoma. One patient developed a biliary fistula which required reoperation. All patients had an uneventful long term postoperative course except for one patient who died of colon carcinoma 3 years postoperatively. CONCLUSION: When associated with other malformations, most notably congenital hepatic fibrosis, this commonly diffuse disease is called Caroli's syndrome. The unilobar form, most usually involving the left lobe of the liver, is called Caroli's disease. Both monolobar and diffuse types are often characterised by recurrent bouts of cholangitis and, in over half of the cases, by common bile duct stones without gallbladder stones

Concomitant radiochemotherapy has totally changed the treatment of oesophagus cancer. After numerous phase II studies that indicated their feasibility and efficacy, randomised phase III studies recently demonstrated their ability to improve survival. In operable cancer, preoperative radiochemotherapy increases the overall survival in adenocarcinoma, and the disease-free survival in squamous cell cancers, in comparison to surgery alone. In locally advanced disease, radiochemotherapy is considered as standard treatment. At this moment the effective drugs are 5-fluorouracil, mitomycin C and cisplatinum. The aims of current studies are to increase further the therapeutic ratio, the ways being refinements of radiotherapy and new chemotherapy delivery modalities. Finally the efficacy of radio-chemotherapy is questionning the role of surgery in this disease.

Human Fasciola hepatica infection is usually discovered either early, during the acute (invasive) phase, or in the advanced phase, which is characterized by biliary complications. We report a case of liver distomatosis with nodular intra-hepatic lesions in a 58-year-old woman. Radiological investigations showed 3 nodular lesions in the VII segment, which were difficult to distinguish from liver metastases or liver abscesses. Distomatosis serology was positive with passive hemagglutination. After a 5-day treatment with praziquantel, clinical symptoms resolved quickly while serological tests became negative. Radiological images slowly decreased to a calcified scar at 13 months. No side-effects were noted. Praziquantel, whose efficacy in the common presentations of liver distomatosis has recently been demonstrated, also seems effective and well tolerated in case of nodular intra-hepatic lesions.

Chromaffin cells from the adrenal gland secrete a mixture of compounds that have a strong analgesic effect, especially when administered intrathecally. Many studies in animal models have shown that discordant xenogeneic cell isolates, including chromaffin cells, can survive and have biologic effects when transplanted within a semipermeable membrane capsule.To evaluate the clinical potential of encapsulated cell therapy, a human-scale implant containing bovine chromaffin cells was developed, characterized, and implanted in the subarachnoid space of seven patients with severe chronic pain not satisfactorily managed with conventional therapies. Patients received no pharmacologic immunosuppression. Cell devices were implanted during minimally invasive surgery, and device design allowed retrieval. All devices were recovered after implant periods of 41 to 176 days.Postexplant histologic analysis, immunostaining, and secretory function all confirmed survival and biochemical function of the encapsulated cells. Reductions in morphine intake and improvement in pain ratings were observed in several patients.This study represents the first successful trial of encapsulated xenogeneic cells in humans. The preliminary findings of pain reduction warrant the initiation of a randomized, double-blind phase II study to evaluate the potential efficacy of the procedure.

The gene therapy approach presented in this protocol employs a polymer encapsulated, xenogenic, transfected cell line to release human ciliary neurotrophic factor (hCNTF) for the treatment of Amyotrophic Lateral Sclerosis (ALS). A tethered device, containing around 10(6) genetically modified cells surrounded by a semipermeable membrane, is implanted intrathecally; it provides for slow continuous release of hCNTF at a rate of 0.25 to 1.0 micrograms/24 hours. The semipermeable membrane prevents immunologic rejection of the cells and interposes a physical, virally impermeable barrier between cells and host. Moreover, the device and the cells it contains may be retrieved in the event of side effects. A vector containing the human CNTF gene was transfected into a line of baby hamster kidney cells (BHK) with calcium phosphate using a dihydrofolate reductase-based selection vector with a SV40 promoter and contains a HSV-tk killer gene. hCNTF is a potent neurotrophic factor which may have utility for the treatment of ALS. Systemic delivery of hCNTF in humans has been frustrated by peripheral side effects, the molecule's short half life, and its inability to cross the blood-brain barrier. The gene therapy approach described in this protocol is expected to mitigate such difficulties by local intrathecal delivery of a known quantity of continuously-synthesized hCNTF from a retrievable implant.

AC is the most common cause of end-stage liver failure in Europe and the United States. Since at present OLT is the best treatment for end-stage liver diseases, AC has recently become an increasing indication of OLT and its results are comparable with those of subjects transplanted for non alcoholic liver diseases (non ALD). However, the long-term results of OLT for patients with AC are still unknown, and information concerning the incidence of new malignancies following OLT is lacking. The aim of our study was to establish the prevalence and characteristics of the new cancers among patients transplanted for AC (group A) at our liver transplant unit and to compare these results with those of the other patients transplanted for non AC (group B). Patients and methods: between March 1986 and December 1994, a total of 163 adult patients underwent OLT. 27 patients who died before the first month post-OLT were excluded from the study. Thus, 61 patients (52 men) in group A and 75 (40 men) in group B were studied. The mean age at the time of OLT was comparable between the 2 groups of patients (group A = 50.7 years ± 8.1 SD; group B = 49.3 ± 12.4 SD) (p = 0.9). The mean duration of follow-up since OLT was also comparable in the 2 groups of patients (group A = 37.9 months ± 25.8 SD; group B = 42.2 months ± 36.3 SD) (p = 0.3). Standard immunosuppresive treatment was the same in the 2 groups and consisted of steroids, ciclosporine and azathioprine.

Background TH-302 is a hypoxia targeted prodrug with a hypoxia-triggered 2-nitroimidazole component designed to release the DNA alkylator, bromo-isophosphoramide mustard (Br-IPM), when reduced in severe hypoxia. A randomized Phase 2B study (NCT01144455) was conducted to assess the benefit of G + T to standard dose G as first-line therapy of PAC. Materials and methods An open-label multi-center study of two dose levels of TH-302 (240 mg/m2 or 340 mg/m2) in combination with G versus G alone (randomized 1:1:1). G (1000 mg/m2) and T were administered IV over 30-60 minutes on Days 1, 8 and 15 of a 28-day cycle. Patients on the G could crossover after progression and be randomized to a G + T arm. The primary efficacy endpoint was a comparison of progression-free survival (PFS) between the combination arms and G alone (80% power to detect 50% improvement in PFS with one-sided alpha of 10%). Summary PFS outcome has previously been reported; more detailed PFS as well as the initial overall survival (OS) data are presented. Results 214 pts were treated; 164 (77%) Stage IV and 50 (23%) Stage IIIB. Median age 65 (range 29-86); 126 M/88 F; 40% ECOG 0/60% ECOG 1. Receiving 6 or more cycles: 32% G; 45% G + T240; 55% G + T340. Median PFS was 3.6 mo in G vs 5.5 mo in G + T240 (p = 0.031) and 6.0 mo in G + T340 (p = 0.008). Poorer prognostic factors (older age, poorer performance status, reduced albumin) were associated with larger treatment effect. Median OS was 7.0 mo in G vs 9.0 in G + T240 and 9.5 mo in G + T340. RECIST best response was 12% in G vs 17% in G + T240 and 27% in G + T340. CA19-9 decreases were significantly greater G + T340. A >50% CA19-9 decrease was 52% with G vs 50% with G + T240 and 70% with G + T340. AEs leading to discontinuation were: 16% G, 15% G + T240 and 11% G + T340. Rash (45% in G + T340) and stomatitis (36% in G + T340) were greater in combination, 4 pts Grade 3 rash. Grd 3/4 thrombocytopenia were 11% G, 39% G + T240 and 59% G + T340 and Grd 3/4 neutropenia were 28% G, 56% G + T240 and 59% G + T340. Conclusions The combination of G plus TH-302 improved the efficacy of G. A TH-302 dose of 340 mg2 was identified for future studies. Skin and mucosal toxicity and myelosuppression were the most common TH-302 related AEs with no increase in treatment discontinuation. Disclosure All authors have declared no conflicts of interest.