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10. Hémorragie digestive par rupture d'un anévrisme des artères viscérales. Présentation de quatre observations

Author

JM André, Gambiez L, Saudemont A, Quandalle P, H. Ghisbain, F. Brami, and A Zahredine

Subjects
Gynecology, medicine.medical_specialty, business.industry, Arterial disease, X ray computed, Medicine, Surgery, business
Abstract

Resume But de l'etude Les hemorragies digestives par rupture d'un anevrisme des arteres viscerales sont tres rares. Le but de cette etude est de rapporter quatre cas inedits, observes de 1990 a 1996. Materiel et methodes La premiere observation concernait un anevrisme du tronc cœliaque ouvert a la face posterieure de l'estomac et revele par une hematemese. L'exerese de l'anevrisme associee a une spleno-pancreactectomie a ete suivie d'une revascularisation de l'artere hepatique commune par un pontage implante sur l'aorte. La seconde observation concernait un anevrisme de l'artere splenique ouvert dans le canal de Wirsung, revele par un melaena et traite par exerese et spleno-pancreatectomie gauche. La troisieme observation concernait un anevrisme de l'artere hepatique commune ouvert dans le canal de Wirsung, revele par une rectorragie et traite par endo-anevrismorraphie obliterante. La quatrieme observation concernait un anevrisme de l'artere mesenterique superieure ouvert dans le duodenum, revele par hematemese et melaena et traite par endo-anevrismorraphie obliterante et revascularisation mesenterique par un pontage spleno-mesenterique. Resultats Les quatre malades ont ete traites chirurgicalement avec succes. Dans le premier cas, une cholecystite aigue non lithiasique a necessite une cholecystectomie a la 3e semaine. Dans la quatrieme observation, est apparu un infarctus splenique qui a gueri spontanement. Conclusion II s'agit d'une pathologie tres rare. La localisation de l'hemorragie a ete apportee par l'endoscopic. La lesion anevrismale a ete reconnue par l'examen scanographique et/ou par l'arteriographie cœliaque et mesenterique realisee dans tous les cas et tres utile pour la conduite du traitement. Apres excision de l'anevrisme (n=2) ou endoanevrismorraphie obliterante (n=2), la revascularisation a ete necessaire deux fois sur quatre pour les localisations cœliaque et mesenterique superieures.

Published
1998
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11. C-reactive protein (CRP), a novel adipocytokine overexpressed in mesenteric fat in Crohnʼs disease

Author

Gonzalez, F., Peyrin-Biroulet, L., Rousseaux, C., Dubuquoy, L., Thuru, Xavier, Decourcelle, C, Gambiez, L., Neut, C., Colombel, J., Desreumaux, P., Physiopathologie des Maladies Inflammatoires de l'Intestin, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Hôpital Claude Huriez [Lille], CHU Lille, Université de Lille, Droit et Santé, and Université catholique de Lille (UCL)

Subjects
[SDV]Life Sciences [q-bio], ComputingMilieux_MISCELLANEOUS, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience

Published
2007
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12. Management of common bile duct stones in the era of laparoscopic cholecystectomy

Author

Maunoury, V, Gambiez, L, Chambon, J P, Bazin, B, Canva-Delcambre, V, and Quandalle, P

Subjects
Adult, Aged, 80 and over, Cholangiopancreatography, Endoscopic Retrograde, Common Bile Duct, Male, Letter, Intraoperative Care, Adolescent, Gallstones, Middle Aged, Sphincterotomy, Endoscopic, Cholecystectomy, Laparoscopic, Humans, Female, Prospective Studies, Child, Intraoperative Complications, Aged
Abstract

This study evaluated the selective use of endoscopic retrograde cholangiopancreatography (ERCP) in the context of laparoscopic cholecystectomy (LC) while minimizing the use of operative cholangiography.There has been a long-standing debate between routine and selective operative cholangiography that has resurfaced with LC.Prospective data were collected on the first 1300 patients undergoing LC at McGill University. Preoperative indications for ERCP were recorded, radiologic findings were standardized, and technical points for a safe LC were emphasized.A total of 106 patients underwent 127 preoperative ERCPs. Fifty patients were found to have choledocholithiasis (3.8%), and clearance of the common bile duct (CBD) with endoscopic sphincterotomy was achieved in 45 patients. The other five patients underwent open cholecystectomy with common duct exploration. Intraoperative cholangiography (IOC) was attempted in only 54 patients (4.2%), 6 of whom demonstrated choledocholithiasis. Forty-nine postoperative ERCPs were performed in 33 patients and stones were detected in 17 (1.3%), with a median follow-up time of 22 months. Endoscopic duct clearance was successful in all of these. The incidence of CBD injury was 0.38%, and a policy of routine operative cholangiography might only have led to earlier recognition of duct injury in one case. The rate of complication for all ERCPs was 9% and the associated median duration of the hospital stay was 4 days. The median duration of the hospital stay after open CBD exploration was 13 days.LC can be performed safely without routine IOC. The selective use of preoperative and postoperative ERCP will clear the CBD of stones in 92.5% of patients.

Published
1995

15. Traitement des fistules anopérinéales dans la maladie de Crohn par injection d'une colle biologique: résultats d'un essai contrôlé randomisé

Author

Grimaud, JC, primary, Munoz-Bongrand, N, additional, Siproudhis, L, additional, Abramowitz, L, additional, Senejoux, A, additional, Vitton, V, additional, Gambiez, L, additional, Flourie, B, additional, Hebuterne, X, additional, Louis, E, additional, Coffin, B, additional, de Parades, V, additional, Lerebours, E, additional, Contou, JF, additional, Ganansia, R, additional, Bouhnik, Y, additional, Colombel, JF, additional, Mary, JY, additional, and Lemann, M, additional

Published
2007
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40. Management of duodenal adenomatosis in patients with familial adenomatous polyposis

Author

Fawal, H., Gambiez, L., Raad, A., Pruvot, F.R., Chambon, J.P., Saudemont, A., and Quandalle, P.

Subjects
*ADENOMA, *DUODENAL cancer, *ONCOLOGIC surgery, *DYSPLASIA, *ONCOLOGY
Abstract

Aim of the study. – To review our global management of duodenal adenomas in patients with familial adenomatous polyposis and report the results of different therapeutic approaches. To present the outcome and possible sequels of pancreaticoduodenectomy.Patients and methods. – We identified five cases of duodenal adenomas in patients with familial adenomatous polyposis over a period of 10 years (1992–2001), we followed the progression of their Spigelman score. Results of conservative and surgical treatment were collected.Results. – Duodenal adenomas were discovered 5–33 years after the first operation for colonic polyposis. The score of Spigelman was as follows: 2, stage 2; 3, stage 3; 1, stage 4. Endoscopic laser therapy followed by Sulindac prescription was proposed in three cases, with only one success. Duodenopancreatectomy was performed in four patients: once the diagnosis of adenoma was made in one patient, due to Spigelman stage 4 with severe dysplasia, because development of intramucosal carcinoma under surveillance in one patient, and after failure or complication of conservative treatment in two others. Worsening of Spigelman score was observed in two out of four patients submitted to conservative therapy. Correlation between Spigelman score and final examination of the specimen was correct in two cases. There was neither significant morbidity nor long-term nutritional sequel after pancreaticoduodenectomy.Conclusion. – Duodenal adenomas may recur or progress into malignant degeneration under conservative treatment. The pancreaticoduodenectomy is an acceptable solution for stage 4 of Spigelman, especially when severe dysplasia is present. [Copyright &y& Elsevier]

Published
2003
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42. Impaired expression of the peroxisome proliferator-activated receptor alpha during hepatitis C virus infection

Author

Dharancy, S., Malapel, M., Perlemuter, G., Roskams, T., Cheng, Y., Dubuquoy, L., Podevin, P., Conti, F., Canva, V., Philippe, D., Gambiez, L., Mathurin, P., Paris, J.C., Schoonjans, K., Calmus, Y., Pol, S., Auwerx, J., and Desreumaux, P.

Abstract

Background & Aims: Liver inflammation, fibrosis, and dyslipidemia are common features in patients with chronic hepatitis C virus (HCV) infection. Because peroxisome proliferator-activated receptor @a (PPAR@a) is highly expressed in the liver and is involved in the regulation of lipid metabolism and inflammation, we sought to determine whether HCV infection may locally impair PPAR@a expression and activity. Methods: PPAR@a expression was investigated in liver biopsy specimens of 86 untreated patients with HCV infection and controls, by using real-time polymerase chain reaction (PCR), Western blot analysis, and immunohistochemistry. PPAR@a activity was assessed by quantification of the key gene target carnitine palmitoyl acyl-CoA transferase 1 (CPT1A) messenger RNA (mRNA).The influence of HCV core protein on PPAR@a mRNA expression was analyzed in vitro by real-time PCR in HCV core-expressing HepG2 cells activated with the PPAR@a ligand fenofibric acid. Results: Hepatic concentrations of PPAR@a and CPT1A expressed by hepatocytes were impaired profoundly in the livers of untreated patients with HCV infection compared with controls. A mean decrease of 85% in PPAR@a mRNA expression paralleled with a lack of CPT1A mRNA induction also were observed in HCV core-expressing HepG2 cells compared with controls. Conclusions: HCV infection is related to altered expression and function of the anti-inflammatory nuclear receptor PPAR@a. These results identify hepatic PPAR@a as one mechanism underlying the pathogenesis of HCV infection, and as a new therapeutic target in traditional treatment of HCV-induced liver injury.

Published
2005
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43. Inflammatory alterations in mesenteric adipose tissue in Crohn's disease

Author

^@?, P., Ernst^&, O., Geboes^@?, K., Gambiez^@?, L., Berrebi^#, D., Muller-Alouf^@?, H., Hafraoui^*, S., Emilie^*^*, D., Ectors^@?, N., Peuchmaur^#, M., Cortot^*, A., Capron^@?, M., Auwerx^@?^@?, J., and Colombel^*, J.F.

Abstract

Background & Aims: Abnormalities of fat in the mesentery including adipose tissue hypertrophy and fat wrapping have been long recognized on surgical specimens as characteristic features of Crohn's disease. However, the importance, origin, and significance of the mesenteric fat hypertrophy in this chronic inflammatory disease are unknown. Peroxisome proliferator-activated receptor @c (PPAR@c) is a crucial factor involved in the homeostasis of adipose tissue, a major source of biologically active mediators. Methods: Intra-abdominal fat accumulation was quantified using a magnetic resonance imaging method in patients with Crohn's disease and controls. PPAR@c and inflammatory cytokines synthesized by mesenteric adipose tissues were assessed by quantitative polymerase chain reaction, in situ hybridization, and immunohistochemistry. Results: In vivo, patients with Crohn's disease have an important accumulation of intra-abdominal fat. This mesenteric obesity, present from the onset of the disease, is associated with overexpression of PPAR@c and tumor necrosis factor (TNF)-@a, synthesized, at least in part, by adipocytes. Conclusions: These results suggest that confined increased PPAR@c mesenteric concentrations could lead to the mesenteric fat hypertrophy, which could actively participate through the synthesis of TNF-@a in the inflammatory response. GASTROENTEROLOGY 1999;117:73-81

Published
1999
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44. Hémorragie digestive par rupture d'un anévrisme des artères viscérales. Présentation de quatre observations

Author

Quandalle, P, Gambiez, L, Brami, F, Ghisbain, H, André, JM, Zahredine, A, and Saudemont, A

Abstract

Study aimGastrointestinal bleeding by rupture of splanchnic artery aneurysms is very rare. The aim of this study is to report four cases observed between 1990 and 1996.Materials and methodsIn the first case, the celiac trunk aneurysm was revealed by hematemesis due to erosion of the posterior wall of the stomach. Excision of the aneurysm associated with splenopancreatectomy was followed by revascularization of the common hepatic artery with a bypass implanted in the aorta. The second case concerned a splenic artery aneurysm revealed by hemosuccus pancreaticus and intestinal bleeding which was treated by excision and splenopancreatectomy. In the third case, the common hepatic artery aneurysm revealed by hemosuccus pancreaticus and intestinal bleeding was treated by obstructive endoaneurysmorrhaphy. The fourth case concerned a superior mesenteric aneurysm revealed by duodenal erosion causing gastric and intestinal bleeding, which was treated by obstructive endoaneurysmorrhaphy and revascularization of the mesenteric artery by a spleno-mesenteric bypass.ResultsSurgical treatment was successful in all four patients. In the first case, an acute acalculous cholecystitis required a cholecystectomy after 3 weeks. In the fourth case, a splenic infarction disappeared spontaneously.ConclusionSuch observations are rare. The site of the bleeding was located by endoscopy. The aneurysm was recognized by contrast-enhanced computerized tomography (CT) scan and/or celiac and mesenteric arteriography which was performed in all cases and was very useful for the management of such aneurysms. After excision (n = 2) or obliterative endoaneurysmorrhaphy (n = 2), revascularization had to be done in two cases for celiac and mesenteric aneurysms.

Published
1998
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48. French Consensus Conference on acute pancreatitis: Conclusions and recommendations

Author

Bommelaer, G., Ruszniewski, P., Boissel, P., Bonmarchand, G., Bretagne, J. -F, Buscail, L., Chousterman, M., Fagniez, P. -L, Hébuterne, X., Palazzo, L., Valette, P. -J, Véber, B., Bleichner, G., Bouteloup, C., Bricard, H., Bruel, J. -M, Capellier, G., Dreyfus, L., Dumas, R., Lacroix, A., Mathey, B., Napoléon, B., Nouel, O., Quaranta, J. -F, Rotman, N., Roumieu, G., Sautereau, D., Barthet, M., Beloucif, S., P, Bernard J., Boyer, J., Brivet, F., Delattre, J. -F, Dureuil, R. B., Escourrou, J., Gambiez, L., Hastier, P., Lévy, P., Matos, C., Millat, B., Montravers, P., Moreau, J., Pezet, D., Sauvanet, A., Vilgrain, V., Vincent, J. -L, Zazzo, J. -F, Zins, M., Malka, D., isabelle rosa, Lecesne, R., Maury, E., Berthélémy, P., Pagès, P., Dupont, H., Séguy, D., Pilleul, F., Slim, K., Debette Gratien, M., Yahchouchi, E., and Heyries, L.

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