Search

The article presents a study to determine the surgical morbidity and mortality rates from 2002-2004. One thousand one hundred eighty-six 18-65-year-old patients undergoing colorectal surgery were examined through their Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM), Surgical Risk Scale (SRS), and Association Française de Chirurgie (AFC) records. The study shows that morbidity and mortality rates are 41% and nine percent, respectively.

The authors report a preliminary series assessing the feasibility of duodenal stenting using a surgical approach. The study included 16 patients with a malignant duodenal outlet obstruction for whom a biliaryobstruction necessitated a laparotomyor following an endoscopic stenting failure.The stent was efficient in 15 patients with a complete relieve of obstruction. These patients could have oral intake at the end of the first postoperative week. No stent obstruction occurred. The duodenal stenting by laparotomy could be a good alternative to palliative gastroenteral anasotomosis. [Copyright &y& Elsevier]

In the early Universe, the cooling mechanisms of the gas significantly rely on the HD abundance and excitation conditions. A proper modeling of its formation and destruction paths as well as its excitation by both radiative and collisional processes is then required to accurately describe the cooling mechanisms of the pristine gas. In such media, ion-molecule reactions are dominant. Their theoretical study is challenging and state-of-the-art quantum time-independent methods are computationally limited to collisions involving light molecules. Here, we report a state-to-state scattering study of the HD-H + collisional system using two different methods: an exact quantum time-independent approach and a recently developed fast and efficient statistical method. Reactive and inelastic rate coefficients were obtained for temperatures up to 300 K. The statistical method is able to reproduce exact calculations with an accuracy reaching the astrophysical needs while drastically reducing the computational resources requirements. Such results suggest that this new statistical method should be considered to provide the astrophysical community collisional data for which quantum calculations are impossible.

Inelastic collisions and elementary chemical reactions proceeding through the formation and subsequent decay of an intermediate collision complex, with an associated deep well on the potential energy surface, pose a challenge for accurate fully quantum mechanical approaches, such as the close-coupling method. In this study, we report on the theoretical prediction of temperature-dependent state-to-state rate coefficients for these complex-mode processes, using a statistical quantum method. This statistical adiabatic channel model is benchmarked by a direct comparison using accurate rate coefficients from the literature for a number of systems (H 2 + H + , HD + H + , SH + + H, and CH + + H) of interest in astrochemistry and astrophysics. For all of the systems considered, an error of less than factor 2 was found, at least for the dominant transitions and at low temperatures, which is sufficiently accurate for applications in the above mentioned disciplines.

Rotational excitation of interstellar PN molecules induced by collisions with H 2 is investigated. We present the first ab initio four-dimensional potential energy surface (PES) for the PN-H 2 van der Waals system. The PES was obtained using an explicitly correlated coupled cluster approach with single, double, and perturbative triple excitations [CCSD(T)-F12b]. The method of interpolating moving least squares was used to construct an analytical PES from these data. The equilibrium structure of the complex was found to be linear, with H 2 aligned at the N end of the PN molecule, at an intermolecular separation of 4.2 Å. The corresponding well-depth is 224.3 cm -1 . The dissociation energies were found to be 40.19 cm -1 and 75.05 cm -1 for complexes of PN with ortho-H 2 and para-H 2 , respectively. Integral cross sections for rotational excitation in PN-H 2 collisions were calculated using the new PES and were found to be strongly dependent on the rotational level of the H 2 molecule. These new collisional data will be crucial to improve the estimation of PN abundance in the interstellar medium from observational spectra.

The HeH + molecule is the first to be formed in the Universe. Its recent detection, in the interstellar medium, has increased the interest in the study of the physical and chemical properties of this ion. Here, we report exact quantum time-independent calculations of the collisional cross sections and rate coefficients for the rotational excitation of HeH + by H. Reactive and exchange channels are taken into account in the scattering calculations. Cross sections are computed for energies of up to 10 000 cm -1 , enabling the computation of rate coefficients for temperatures of up to 500 K. The strongest collision-induced rotational HeH + transitions are those with Δj = 1. Previous results obtained using approximate treatment are compared to the new ones, and significant differences are found. The new rate coefficients are also compared to those for electron-impact rotational excitation, and we found that collisions with H dominate the excitation of HeH + in media where the electron fraction is less than 10 -4 . In the light of those results, we recommend the use of the new HeH + -H collisional data in order to accurately model HeH + excitation in both the interstellar media and early Universe.

The CF + molecule is considered one of the key species for the study of fluorine chemistry in the interstellar medium (ISM). Its recent detection, as well as its potential use as a tracer for atomic fluorine in the ISM, has increased the interest in the study of the physical and chemical properties of this cation. Accurate determination of the CF + abundance in the ISM requires detailed modeling of its excitation from both radiation and collisions with the most dominant species, which are usually atomic and molecular hydrogen. Here, we report a new highly accurate potential energy surface (PES) describing the interaction between CF + and the H 2 molecule. Exact quantum time-independent calculations of the rotational excitation cross sections for collisions of CF + with both para - and ortho -H 2 are reported. Results obtained for collisions with para -H 2 are compared to previous calculations performed using an approximate PES averaged over H 2 rotation. Excitation data for collisions with ortho -H 2 are provided for the first time.

The HD molecules are key species for the cooling of pristine gas at temperatures below 100 K. They are also known to be key tracers of H 2 in protoplanetary disks and thus, they can be used as a measure of protoplanetary disks mass. Accurate modeling of the cooling mechanism and of HD abundance in astrophysical media requires a proper modeling for its excitation by both radiative and collisional processes. Here, we report quantum time-independent calculations of collisional rate coefficients for the rotational excitation of HD by H for temperatures ranging from 10 to 1000 K. The reactive and hydrogen exchange channels are taken into account in the scattering calculations. New exact quantum results are compared to previous calculations performed neglecting reactive and exchange channels. We found that for temperatures higher than ∼300 K, the impact of these channels on the rate coefficients cannot be neglected. Such results suggest that the new HD-H collisional data have to be used for properly modeling HD cooling function and HD abundance in all the astrophysical environments where HD plays a role, e.g. in photon-dominated regions, protoplanetary disks, early Universe chemistry, and primordial star forming regions.

Background: Undernutrition causes a reduction of body-fat mass and a decrease in the circulating concentration of leptin which impairs the production of proinflammatory cytokines and increases the incidence of infectious diseases. The main objective of this study was to determine whether leptin deficiency is a risk factor for ventilator-associated pneumonia (VAP)., Methods: This prospective observational case-control study was conducted in a university ICU during a 2-year period. Patients with VAP (cases) were matched (1:1) to patients without VAP (controls) according to all the following criteria: age, gender, SAPS II, and duration of ICU stay before VAP occurrence. In all patients leptin, C-reactive protein (CRP) and procalcitonin (PCT) were measured at ICU admission, and twice a week. In addition, in cases, leptin, CRP and PCT were also measured on the day of VAP diagnosis., Results: Eighty-six cases were matched with 86 controls. No significant difference was found in leptin and PCT levels between cases and controls. CRP level was significantly higher on the day of VAP in cases compared with controls (99 vs. 48 mg/L, P=0.001). Combination of CRP-leptin (CRP ≥78 mg/L and leptin ≥6.2 ng/mL on the day of VAP) was significantly (P=0.009) associated with VAP in univariate analysis. Multivariate analysis identified the combination of CRP-leptin (OR [95% CI] 3.08 [1.18-8.04], P=0.003), LOD score (1.27 [1.08-1.48], P=0.003), neuromuscular-blockers use (6.6 [2.03-21.7], P=0.002), and reintubation (3.3 [1.14-9.6], P=0.027) as independent risk factors for VAP., Conclusion: In our study, leptin level was not associated with VAP occurrence. Further studies are needed to confirm our results, and to define the exact inflammatory role of leptin, and its interest as a biomarker in ICU patients.

Background: The P-POSSUM score, the most well known of predictive scores for postoperative mortality, requires validation for population and setting., Methods: Validation methods included discrimination (C-index statistic), observed:expected (O:E) ratio, calibration with the Hosmer-Lemeshow test, and subgroup analysis (emergency surgery, cancer, age, organs). The study included 3,881 multisite patients undergoing major digestive surgery in France., Results: Discrimination via the receiver operating characteristic curve was good (C-index = 0.87). The overall O:E ratio was 1 (95% confidence interval ([95 % CI]: 0.88-1.13), and therefore the quality of the surgical performance is within normal ranges. The O:E ratio, calculated by risk ranges, showed overestimation in the low risk range, especially in the 3 % to 6 % and 6 % to 10 % ranges. Calibration was poor (p < 0.001). The model deviated from the normal pattern of calibration, with mortality lower than expected in the high-risk range. Subgroup analysis found reasonable to good discrimination of populations (C-index ranging from 0.78 to 0.93 except for liver surgery [0.67]) while calibration of individuals remained poor (p < 0.001 to 0.02)., Conclusions: Good discrimination, as well as nonsignificant overall O:E values, makes P-POSSUM a valuable tool when it is used for surgical audit to compare mortality between populations for major digestive surgery. Conversely, poor calibration (goodness-of-fit), especially in subgroup analysis, and underestimation or overestimation of O:E ratios considerably limits the value of P-POSSUM for prediction of mortality in individuals. Therefore P-POSSUM should not be used to predict outcomes for one particular patient.

Objective: To determine the impact of COPD on intensive care unit (ICU) mortality in patients with VAP., Methods: This prospective observational study was performed in a mixed ICU during a 3-year period. Eligible patients received mechanical ventilation for >48 h and met criteria for microbiologically confirmed VAP. Risk factors for ICU mortality were determined using univariate and multivariable analyses., Results: Two hundred and fifteen patients with microbiologically confirmed VAP were included. Most VAP episodes were late-onset (88%), and Pseudomonas aeruginosa was the most frequently isolated bacterium (39% of VAP episodes). ICU mortality was significantly lower in non-COPD patients (n = 150) compared to COPD patients (n = 65) (43.3% vs 60%, p = 0.027, OR [95% CI] = 1.96 [1.8-3.54]). Duration (days) of mechanical ventilation and ICU stay median (IQR) in non-COPD patients were 25 (15-42) and 30 (18-48), whereas in COPD patients were 31 (19-45) and 36 (20-48) (p > 0.05). The differences in duration (days) of mechanical ventilation and ICU stay were significant between non-COPD patients and severe COPD (GOLD stage IV) patients (p = 0.001 and p = 0.02, respectively). Multivariable analysis identified COPD [OR (95% CI) 2.58 (1.337-5)], SAPS II [1.024 (1.006-1.024)] and presence of shock at VAP diagnosis [3.72 (1.88-7.39)] as independent risk factors for ICU mortality., Conclusion: COPD, SAPS II, and shock at VAP diagnosis are independently associated with ICU mortality in patients who present VAP., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background/aims: No agent has been consistently effective in preventing formation of peritoneal adhesions and postoperative bowel obstruction after abdominal surgery. The aim of this prospective multicenter study was to assess clinical safety and efficiency of a new adhesion-reduction barrier, Methodology: Between September 2000 and April 2001, Prevadh was used in 78 patients. Operative procedures included 25 hepatic resections, 7 cholecystectomies, 32 colonic resections, 7 protectomies, 3 colostomy or recovery of continuity, 1 gynaecologic surgery and 3 others. Eleven patients were operated on by laparoscopy and 67 by laparotomy., Results: The overall incidence of abscesses and wound complications was 2.4% and 9% respectively. After a mean follow-up of 36 months (range: 4-51 months), no patients experienced adverse events related to the adhesion barrier. Surgical reoperative procedures were performed in 10 patients for unrelated causes and no bowel obstruction occurred within the protected area., Conclusions: This study confirmed the safety of Prevadh adhesion barrier and suggested that this resorbable barrier might provide prevention from adhesion formation on peritoneal injured surfaces. However, a large randomized controlled trial remains necessary to prove the real effectiveness of adhesion barriers on clinical long-term outcome.

Objective: To focus attention on the management and outcome of patients with intraductal papillary mucinous tumours of the pancreas., Design: Retrospective study and analysis of published reports., Setting: University hospital, France., Subjects: 111 patients (101 published cases and our own 10 cases) divided in two groups: the first including malignant tumours (n = 46), and the second group benign or in situ tumours (n = 61). In 4 patients the type of tumour was not known., Main Outcome Measure: Resectability, mortality and recurrence., Results: More men had benign or in situ tumours [48/61 (79%) compared with 28/46 (61%), p = 0.054]. Pancreatitis was more common among benign than malignant tumours [34/61 (58%) compared with 21/46 (46%), p = 0.33]. In group I, 39 patients had diabetes. A total of 107 patients were operated on: pancreaticoduodenectomy (n = 54, 50%), distal pancreatectomy (n = 25, 23%), total pancreatectomy (n = 4,4%), bypass (n = 2,2%). The type of resection was not mentioned in 22 records (21%). Four patients were not operated on because of their poor general condition. The resectability rate was 98% (105/107). Eleven patients had died at the time of publication. Hospital mortality rate was 3% (n = 3), mainly because 2 of the 4 who had total pancreatectomy died. With a median follow-up of 37 months, recurrence was 5% (n = 5)., Conclusion: Intraductal papillary mucinous tumours of the pancreas are well known distinctive pancreatic tumours that are usually intraductal but may develop into invasive carcinoma. They should be resected, and have a good prognosis and low recurrence rate.

Objectives: The aim of this retrospective study was to evaluate the feasibility and the morbidity of laparoscopic cholecystectomy for acute cholecystitis in elderly patients., Methods: Among 891 consecutive patients who underwent cholecystectomy, 151 had acute cholecystitis. Fifty three patients of > or = 70 years of age (group 1) were compared to 98 younger patients (group 2). Analysis was made in "intention to treat" so directly open cholecystectomies during the same period were also included., Results: Elderly patients had a lower success rate of laparoscopic treatment (52.8% versus 70.4%; p < 0.05). This difference was due to higher rate of directly open cholecystectomy in the elderly (17% versus 2%). There was no difference between both groups in conversion rate to laparotomy (30.2% versus 26.5%). Surgical morbidity was 7.5% in group 1 and 4% in group 2 (NS). General complications were more frequent in the elderly (p < 0.05). Five patients in group 1 (9.4%) died of general complications of which 3 were operated on directly by open cholecystectomy. There was no mortality in group 2., Conclusion: Acute cholecystitis in the elderly remains a severe disease in which laparoscopic treatment is only possible in about fifty percent.

Adenocarcinoma of the appendix is rarely encountered and is usually discovered fortuitously at pathology examination of the surgical specimen. Six years after surgery for degenerative villous tumor of the appendix, local and parietal recurrence led to surgery in our patient. We present here the indications for complementary hemicolectomy and management of parietal scars resulting from the initial appendectomy.

We reported a series of 446 consecutive cholecystectomies performed laparoscopically between June 1990 and January 1993. There were 354 females and 92 men, mean age 53 +/- 17 years. Laparoscopic cholangiography was attempted in 410 cases (92%) and led to the discover of a stone in the main bile duct in 18 cases (4%) and an abnormal insertion of the bladder duct in 30% (6.7%). Conversion to laparotomy was required in 84 patients (18.8%) due to difficult dissection (52), peroperative incidents or accidents (15) and abnormal hepatogram (17). No accident inherent to the operation was encountered in this series. One death occurred after laparotomic conversion for acute angiocholitis. The rate of post-operative complications was 5.6% and reoperations were required in 7 patients (1.5%).

Retrospective analysis of a consecutive series of 285 cholecystectomies carried out by laparoscopy showed that 47 patients (17.5%) required conversion laparotomy. In 55% of these cases the conversion was due to difficulty in dissecting the gallbladder or cystic duct. Peri-operative cholangiography should be performed routinely, not only to verify the vacuity of the common bile duct (13% of the conversions) but, more particularly, to ensure the integrity of the principal biliary pathway during the dissection (8.5% of the conversions). Cholecystectomy under celioscopy is a proven and safe technique, on the condition that all stages of classical surgery can be carried out under good conditions.

Blunt abdominal trauma and delayed colon perforations are not common and usually occur in patients sustaining other injuries, but also as isolated event. We report a case of delayed perforation of sigmoid colon, three days after a blunt abdominal trauma in a male adult. It was caused by disinsertion of sigmoid colon mesentery for about ten centimeters. This condition is discussed with literature review.

Schwannomas as neurofibromas are neurogenic mesenchymal tumors of the stomach. They arise from the Schwann cells of nerves of th gastric wall and are usually benign. The incidence of malignant schwannomas is uncertain because of the variable pathologic criteria used. Immunohistochemistry is a diagnostic tool used to distinguish between schwannomas and leiomyomas both constituted by spindle-cells. In this issue we report a case of malignant schwannoma with lymph node involvement. The clinical and histological features of gastric schwannomas are discussed with evaluation of their diagnostic and therapeutic modalities.

Mesenteric cysts are rare intraabdominal tumors in surgical pathology. Their etiology has been subject to much discussion. Symptoms are variable and depend on specific complications. Localisation in the gastro-hepatic mesentery is uncommon and has been reported only in two previous issues. We describe a new case with literature review.

Authors have described 2 cases of benign schwannomas of pelvian origin and with abdominal extension. The diagnosis is often late because of the absence of early clinical signs and of specific investigations. The reliability of the diagnosis is based on the mobid anatomy of the surgical pieces, the hypervascularization. Schwannomes with bone adherences complicate the surgical treatment. These tumors very seldom degenerate. The pronostic is related to the risk seldom degenerate. The pronostic is related to the risk of recurrence if their ablation is incomplete.

The authors report the exceptional case of a young boy, 14 years old, affected by Crohn's disease, first treated medically. Extension and aggravation of injuries required right hemicolectomy. An obstruction of right ureter appeared, diagnosed by echography. The investigations showed up a stenosis of right ureter. A resection-suture was performed and the follow up at two years in good.

The authors report a case of pulmonary fibrosarcoma in a newborn. The respiratory distress imposed an urgent thoracotomy at the fifth hour of live. A lobectomy was performed. Three months later a relapse occurred. A second thoracotomy permitted an incomplete resection. The total involution was achieved after 6 months of chemotherapy. Actually no recidive is shown after 20 months of follow up. Its an exceptional case. A unique one was published in 1977.