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Résumé: Contexte: L'évolution de la prise en charge de la maladie de Crohn (MC) rend l'existence de recommandations pour pratique clinique en France nécessaire. Méthode: Les présentes recommandations ont été réalisées selon une méthodologie validée par la Haute Autorité de Santé, d'adaptation des recommandations pour la pratique clinique émanant des sociétés savantes internationales et des travaux de consensus français. Résultats: À l'initiative de la commission éducative du Groupe d'Etudes Thérapeutiques des Affections Inflammatoires du tube Digestif (GETAID) et en collaboration avec des experts de l'Association Nationale des Hépato-gastroentérologues des Hôpitaux généraux (ANGH) et du Club de Réflexion des Cabinets et Groupes d'Hépato-Gastroentérologie (CREGG), des recommandations de pratique clinique ont été rédigées par 17 membres du GETAID, puis revues par 7 experts, gradées selon leur niveau d'évidence et selon le degré d'accord puis votées par 31 experts. Au cours de ces recommandations, les situations suivantes ont été abordées : définition, diagnostic, scores, examens complémentaires, induction de la rémission et traitement post-opératoire, maintien de la rémission et monitoring, MC compliquée (sténose, fistule). Conclusion: Des recommandations de pratique clinique sont désormais disponibles pour le diagnostic et la prise en charge de la MC. [ABSTRACT FROM AUTHOR]

Background: The foramen transversarium is a vital anatomical structure found in the cervical vertebrae of the spine. Typically, it serves as a passageway for important neurovascular structures, including the vertebral artery and vein, as well as the vertebral nerve. However, abnormal calcification or ossification of soft tissues in and around this area can lead to various clinical implications. Understanding the presence and implications of abnormal ossified structures in and around the foramen transversarium is crucial for clinicians involved in the diagnosis and management of cervical spine disorders. Aims: Accordingly, this present study was designed to evaluate the abnormal ossified structures anatomically and radiologically within and around the foramen transversarium. Materials and Methods: This study was conducted on 182 (26 sets of cervical vertebrae) dried human cervical vertebrae obtained from the respective departments of anatomy and on 190 (95 males and 95 females) adult patients who visited the radiology department for neck-related problems such as stiff neck, neck/shoulder pain, dizziness, vertigo, imbalance, visual disturbances, and cognitive impairment. Results: Among 182 examined cervical vertebrae, unilateral complete accessory foramen transversarium was found in 23 vertebrae (12.63%), bilateral complete in 19 (10.44%), bilateral incomplete in 6 (3.29%), unilateral complete double in 4 (2.19%), and unilateral complete absence of foramen transversarium in 3 (1.64%). Stenosis due to aberrant osteophytes was noted in 9 vertebrae (4.9%). Out of 190 patients, three males presented with cervical kyphosis, severe spinal canal stenosis, and spinal cord compression due to ossification of the posterior longitudinal ligament and osteophyte complexes at C3–C6, with the most significant compression at C5–C6. Conclusion: A thorough understanding of abnormal ossifications in and around the foramen transversarium is crucial for the management of cervical spine disorders; imaging modalities such as X-ray, computed tomography, and magnetic resonance imaging are crucial for recognizing and intervening in these cases, which is essential to prevent adverse neurological outcomes associated with vertebral artery involvement. [ABSTRACT FROM AUTHOR]

In recent years, coronary computed tomography angiography (CCTA), which allows for a precise anatomical analysis of the coronary network in a non-invasive manner, has become the first-line exploration tool for chest pain and stable angina. Its high negative predictive value (>98%) can exclude coronary disease if the examination is normal. Functional imaging tools, such as perfusion scanning and FFR-CT (Fractional Flow Reserve derived from Coronary CT Angiography) can be used in addition with CCTA to determine the hemodynamic significance of detected coronary stenosis. In addition, the CCTA's role has been expanded beyond simple stenosis quantification through recent technological developments, allowing for plaque analysis and caracterisation, quantification of peri-coronary fat inflammation and plaque burden. The recent introduction of photon-counting scanners on the market is of interest with a potentiel breakthrough with a very good spacial resolution equal to coronary angiography allowing for better acurate diagnosis. [ABSTRACT FROM AUTHOR]

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Copyright of Colo-Proctology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Perianastomotic stenoses, of which juxtaanastomotic stenosis is the most frequent, complicating arteriovenous fistulas (AVF) for hemodialysis, can lead to thrombosis or even the loss of the vascular approach. We report the case of a patient with juxta anastomotic stenosis treated by surgery. [ABSTRACT FROM AUTHOR]

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Introduction: Cutaneous stoma stenosis represents a frequent complication associated with continent catheterizable channel, often necessitating recurrent patients' consultation, hospital admission, and repetitive surgical interventions. Management strategies encompass dilatation, incision, and, in case of refractory stenosis, invasive surgical revision., Objectives: In this study, we aimed to assess the efficacy of buccal mucosa graft as an alternative therapeutic approach for managing cutaneous catheterizable channel stenosis., Methods: We conducted a retrospective analysis of all patients referred to our two specialized tertiary reconstructive urology centers due to continent catheterizable cutaneous channel stenosis between January 2015 and June 2023. The study cohort comprises patients who had undergone either a Mitrofanoff, an ileal continent catheterizable channel (Monti or Casal) or a Malone antegrade colonic enema procedure (MACE), all of whom exhibited stoma stenosis., Results: We identified 14 patients who underwent a total of 15 buccal mucosa graft augmentation repairs for stenosis. Following a mean follow-up duration of 30months, 11 out of 15 procedures (73%) demonstrated successful outcomes. Notably, no complication was observed, except in the 4 cases classified as failures. These failures were attributed to either stenosis recurrence (3 cases) or fleshy bud persistence (1 case). Importantly, patients did not report any concerns regarding esthetic or functional complains., Conclusions: Buccal mucosa graft emerges as a minimally invasive alternative for repairing continent catheterizable channel stenosis, yielding a promising success rate and an exceptionally low incidence rate of complications., Level of Evidence: III., (Copyright © 2024. Published by Elsevier Masson SAS.)

The aim of this article is to review unrecognized toxicities resulting from radiation therapy of digestive neoplasms. Due to their precocious occurrence, acute toxicities are well-known by radiation oncologist, and their treatment well-established. Thus, acute toxicities will not be described in this review. We will focus on incidence, diagnosis, and management of late and uncommon toxicities occurring in the digestive tract and digestive organs. Prevention, by respecting healthy tissues constraints, is the main tool to reduce incidence of those rare complications. Nonetheless, once installed, late toxicities remain a major burden in terms of quality of life and can even be life threatening. Hence, information and education about their diagnosis and management is important. [ABSTRACT FROM AUTHOR]

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Gefaesschirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: to evaluate the results of two-level urethroplasty in the treatment of complex urethral strictures in our clinical center. Patients and method: Thiswas a retrospective cross sectional study from January 2012 to September 2015 in our clinical center. Patients operated according to Bengt Johanson technique were included. The parameters studied were age, the urological history, consultation reasons, duration of evolution, stenosis characteristics and treatment outcomes. Results: twelve patients were enrolled in our study. The mean age was 48 ± 20 years. The main reason consultation reason is urine retention. The mean duration of evolution was 30 ± 25 months. The most common etiology identified was scleroinflammatory one. All the patients already had at least one medical background. The physical examination showed a periurethral gangue in 10 patients. The mean length of the urethral stricture was 6.3 ± 2.2 cm. After an average follow-up of 3.8 ± 2.3 months; the treatment outcomes were considered satisfactory in 8 patients and bad in 4 patients. Conclusion: Bengt Johanson's two level urethoplasty gives good outcomes in the treatment of complex urethral strictures. [ABSTRACT FROM AUTHOR]

Résumé: Les sténoses œsophagiennes bénignes sont fréquentes en pathologie digestive et sont à l'origine d'une dysphagie avec altération de la qualité de vie. Le traitement par dilatation endoscopique est la référence, avec souvent plusieurs sessions nécessaires de dilatation pour lever l'obstacle (trois à cinq). Les sténoses œsophagiennes réfractaires sont celles qui récidivent après cinq dilatations. La prise en charge de ces sténoses réfractaires est basée sur l'optimisation du traitement par inhibiteurs de la pompe à protons (IPP), les dilatations itératives, et des thérapies endoscopiques adjuvantes comme l'injection de corticoïdes dans la sténose pour les sténoses inflammatoires, les incisions radiaires dans les sténoses courtes ou encore la pose d'une prothèse œsophagienne couverte pendant quatre à six semaines, dont l'effet est souvent transitoire. Malgré de nombreuses études, la prise en charge des sténoses œsophagiennes réfractaires reste un problème important de prise en charge pour les praticiens et les patients. Nous faisons ici le point sur les données disponibles de la littérature pour la prise en charge des sténoses œsophagiennes réfractaires bénignes. Benign esophageal strictures are common in digestive diseases and led to dysphagia with an impaired quality of life. Treatment by endoscopic dilation is the reference, often with several sessions of dilation to remove the obstruction (three to five sessions). Refractory strictures are those that recur after five dilations. The management of these refractory strictures is based on the optimization of PPI treatment, iterative dilations, and adjunctive endoscopic therapies such as corticosteroid injections into the stricture for inflammatory strictures, radial incisions in short strictures, or covered esophageal prosthesis placement for four to six weeks. Despite numerous studies, the management of refractory stricture remains an important issue for physicians and patients. This paper reviews the literature available today for the management of benign refractory strictures in the esophagus. [ABSTRACT FROM AUTHOR]

Résumé: L'atteinte sténosante de la maladie de Crohn au niveau de l'intestin grêle est fréquente et présente des caractéristiques très variables d'un patient à un autre. La longueur de l'atteinte, son caractère inflammatoire et la présence de lésions uniques ou multiples sont autant de facteurs qui vont influencer la prise en charge. Le bilan lésionnel précis est donc l'étape initiale essentielle puisque c'est à partir de ce bilan que l'indication d'un éventuel traitement chirurgical va être discutée. Ce bilan doit au moins comprendre une iléocoloscopie associée à une imagerie de l'ensemble de l'intestin grêle. L'entéro-IRM est l'examen d'imagerie de référence de cette indication. Le traitement médical de la maladie a considérablement évolué avec l'utilisation des immunosuppresseurs et des biothérapies ciblant notamment le TNF-alpha. Ces thérapeutiques, très efficaces, sont indiquées dans les formes les plus sévères de la maladie y compris dans les formes sténosantes. Bien que ces nouveaux traitements permettent d'éviter la chirurgie chez certains patients, ils peuvent aussi augmenter la morbidité du geste chirurgical en cas d'échec. L'enjeu est d'identifier des facteurs permettant de prédire la réponse au traitement médical. Actuellement, il n'existe pas de prise en charge standardisée de la maladie de Crohn iléale sténosante et la chirurgie peut être proposée à différents moments de l'évolution de la maladie. En conséquence, la stratégie thérapeutique doit faire l'objet d'une discussion pluridisciplinaire faisant intervenir gastroentérologues et chirurgiens spécialistes de la maladie dès le début et à chaque étape (changements de ligne de traitement) de la prise en charge. In Crohn's disease, small bowel stenosis is frequent but varies widely from one patient to another. Duration of the disease, inflammatory intensity, presence of single or multiple lesions are all factors that will influence the treatment. A precise lesion assessment is therefore the first step as it is on the basis of this assessment that the indication of a possible surgical treatment will be discussed. This evaluation must include at least an ileocolonoscopy associated with imaging of the entire small intestine. Magnetic resonance enterography is the gold standard in this indication. With the introduction of immunosuppressive therapies and targeted therapies, medical treatment of Crohn's disease has considerably improved and can be proposed in patients with the most severe forms of the disease including stricturing disease. Although surgery can be avoided in some patients thanks to these new treatments, they can also increase the morbidity of the surgical procedure in case of failure. The challenge is to identify the predictive factors of good responder patients to medical therapy. Up to now, there is no consensual treatment approach to patients with ileal stricturing Crohn disease and surgical resection can be proposed at different stages of the disease. A multidisciplinary discussion of the treatment strategy, including both gastroenterologists and surgeons, should be proposed at the diagnosis and also all along the evolution of the disease to improve outcome. [ABSTRACT FROM AUTHOR]

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Copyright of Der Radiologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: La maladie de Takayasu est une artérite inflammatoire rare des vaisseaux de gros et moyen calibres. Elle prédomine dans la population féminine et orientale. Sa survenue dans la population masculine est rarement rapportée. Elle se manifeste par des signes généraux et des signes en rapport avec l'atteinte vasculaire (à type de sténose ou d'anévrisme). L'évaluation de l'activité peut être difficile du fait du manque de sensibilité des marqueurs inflammatoires biologiques et de la difficulté d'apprécier le caractère inflammatoire des lésions radiologiques. Nous rapportons le cas d'un patient âgé de 50 ans, chez qui l'exploration d'une hypertension artérielle a permis de poser le diagnostic d'une maladie de Takayasu. Takayasu disease is a rare inflammatory arteritis of large and medium vessels. It predominates in the female and eastern population. Its occurrence in the male population is rarely reported. The main symptoms are constitutional signs and those in relation to vascular damages (stenosis or aneurysm). The evaluation of the activity may be difficult due to the lack of sensitivity of biological inflammatory markers and the difficulty of assessing the inflammatory character of radiological lesions.We report the case of a 50-year-old man who was diagnosed with Takayasu's disease during exploration of hypertension. [ABSTRACT FROM AUTHOR]

Hintergrund: Bei Patienten mit Morbus Crohn (MC) stellen Anastomosenrezidive nach Eingriffen mit intestinaler Resektion ein wesentliches Problem dar. Im Jahr 2011 wurde eine neu entwickelte Anastomosentechnik vorgestellt, die als funktionelle End-zu-End-Anastomose mit breitem Durchtritt (Kono-S-Anastomose) zu einer deutlichen Reduktion der chirurgischen Rezidivrate führen soll.Ziel der Arbeit: Evaluation der Kono-S-Anastomosentechnik hinsichtlich Früh- und Spätkomplikationen sowie Rezidivrate nach intestinaler Resektion bei Patienten mit MC an einem universitären Zentrum.Methodik: Die Studie wurde im Vorfeld durch die örtliche Ethikkommission geprüft und genehmigt. Alle Patienten mit MC, die im Zeitraum 06/2015 bis 02/2017 an der Chirurgischen Klinik der Universitätsmedizin Mannheim nach Darmresektion eine Kono-S-Anastomose erhielten, wurden in die Studie eingeschlossen. Nach Aufklärung und Einholung einer schriftlichen Einverständniserklärung wurden die klinischen Daten während des stationären Aufenthaltes in einer prospektiven Datenbank erfasst und ausgewertet. Das Follow-up erfolgte mittels strukturiertem Telefoninterview.Ergebnisse: Insgesamt 53 Patienten (21 Männer und 32 Frauen) wurden eingeschlossen. Die Operationszeit betrug im Median 157 min. Bei 3 Patienten kam es zu Frühkomplikationen mit einem Clavien-Dindo-Score ≥3. Das mediane Follow-up betrug 12 Monate (4-23 Monate). 21 (45 %) Patienten waren beschwerdefrei und in keiner weiteren krankheitsspezifischen Behandlung. 25 Patienten (47 %) wurden endoskopisch und/oder mittels Magnetresonanztomographie nachuntersucht, wobei sich in keiner Modalität ein Anhalt für ein Anastomosenrezidiv ergab. Eine endoskopische Intervention war bei keinem Patienten erforderlich.Diskussion: Die Kono-S-Anastomose bei MC ist eine aufwendige Anastomosentechnik mit niedriger Morbidität. In der frühen Phase der Nachbeobachtung ist bisher noch kein behandlungswürdiges Rezidiv im Anastomosenbereich nachgewiesen worden. In der Literatur ist für Patienten mit MC nach intestinaler Resektion eine Reoperationsrate von 5 % pro Jahr angegeben, sodass erst in der Langzeitbeobachtung eine valide Aussage zur Rezidivrate gemacht werden kann. Vorteil der neuen Technik, im Vergleich zur Seit-zu-Seit-Anastomose, ist die endoskopische Dilatationsmöglichkeit, da es sich hierbei, im Gegensatz zur Seit-zu-End-Anastomose, auch morphologisch um eine End-zu-End-Anastomose handelt.Zusammenfassung: Die Kono-S-Anastomosentechnik ist eine Anastomosentechnik mit niedriger Morbidität. In der frühen Nachbeobachtungszeit traten bisher keine Rezidive im Anastomosenbereich in unserer Serie auf. Langzeitdaten werden klären müssen, inwiefern diese Technik hinsichtlich dieses Aspektes langfristig vorteilhaft ist. [ABSTRACT FROM AUTHOR]

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The CARDIO-ARSIF registry has been continuously collecting comprehensive data on coronary angiography and percutaneous coronary interventions (PCI) performed in the 36 catheterization laboratories across the Île-de-France region since 2000. Over the period from 2003 to 2022, this registry has recorded information from more than 330,000 patients, encompassing more than one million procedures. Among these procedures, 58% consisted of coronary angiography, 13% were percutaneous coronary interventions (PCI), and the remaining 28% were PCI performed on an ad-hoc basis. This extensive dataset serves as a valuable resource for both qualitative and quantitative assessments of practices and the relevance of procedures in the field of coronary invasive cardiology. The results of these analyses undergo annual validation by a dedicated scientific committee and are shared with the teams of investigators. The exploitation of this data has led to scientific publications, with one notable finding being a consistent reduction in the radiation doses received by patients, regardless of the type of procedure. [ABSTRACT FROM AUTHOR]

But: présenter les aspects anatomocliniques, étiologiques et prendre en charge les amputations de verge dans le service d’urologie. Observations: il s’agissait de trois observations cliniques. Les patients étaient âgés de 25 ans, 18 ans et 30 ans. Le motif de consultation était l’amputation totale de la verge. Le délai de consultation était de 2 heures (n = 2) et 24 heures (n = 1). L’étiologie était criminelle (n = 2) et psychogène (n = 1). L’extrémité distale de la verge amputée était emportée par les bourreaux ou dissimulée par le patient. La prise en charge consistait en: un parage, la confection d’un méat urétral, la pose d’une sonde urétrovésicale. Un accompagnement par psychothérapie était nécessaire. Conclusion: qu’elle soit d’origine criminelle ou psychogène, l’amputation totale du pénis est rarissime. Les conséquences sont urinaires, sexuelles et psychogènes. La prise en charge doit être multidisciplinaire.

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Copyright of Der Radiologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

More than 50 years ago, May and Thurner, on autopsy series, then Cockett and Thomas, on phlebographic series, described this venous vascular trap of the May-Thurner syndrome. It concerns most of the time the left primary iliac vein, trapped between the right primitive iliac artery and the anterior vertebral wall. This compression would be a factor of thrombosis and would explain the predominant left localization of the thrombotic events. The 1990s saw the development of venous endovascular techniques and thus the possibilities of treatment of this syndrome. There are many publications regarding this treatment. However, data are extremely heterogeneous and no consensual strategy has yet been proposed. The circumstances leading to the diagnosis are varied: acute thrombosis, post-thrombotic syndrome, even symptomatic patients out of any thrombotic context. They are many methods to explore deep venous obstruction but none is specifically validated. Despite this heterogeneity, published series show very good results in terms of technical success, rate of permeability or clinical improvement. Endovascular treatment has been shown to be effective and safe in retrospective case series, but objective criteria for the indication of the deployment of an endoprosthesis remain to be defined. In the absence of thrombosis, establishing a causal link between clinical symptomatology and imaging data in favor of May-Thurner syndrome may be difficult. Determining criteria to establish this link is an essential prerequisite before proposing invasive therapy. [ABSTRACT FROM AUTHOR]

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Résumé But de l’étude La sténose des artères carotides augmente avec l’âge et peut précipiter une ischémie cérébrale pendant une hypotension artérielle. Dans une étude pilote monocentrique, nous avons investigué sa prévalence à l’âge avancé et évalué son influence sur le but tensionnel et le traitement antihypertensif. Patients et méthodes Tous les patients âgés de ≥ 90 ans de l’unité médicale d’un hôpital de soins primaires ont été étudiés prospectivement pendant 15 mois à l’exception de cas avec choc circulatoire et les réadmissions. L’examen ultrasonographique des artères précérébrales a été offert à tous les patients âgés. Ont été analysées la fréquence des sténoses de l’artère carotide commune, interne et externe (ACC, ACI, ACE), la pression artérielle (PA) et les médicaments antihypertenseurs. Résultats Soixante-trois patients (92 ± 3 ans, 78 % femmes) avec une hospitalisation médiane de 11 jours ont été inclus. À l’admission, 76 % avaient des antihypertenseurs et 86 % à la sortie. La PA moyenne était à 149/77 (admission) comparé à 129/72 mmHg (sortie) ; systolique < 140 mmHg 36 % et 64 % ( p < 0,05). L’épaisseur intima-média moyen (ACC) était 8,7/9,4 mm (droite/gauche). Une plaque ou sténose < 60 % était présente (ACC/ICA/ECA) chez 19,0/19,0/31,7 % (bifurcation 74,6 %) et une sténose ≥ 60 % chez 0/7,9/19,0 % (ACI bilatérale 1,6 % ; occlusion unilatérale 3,1 %). La probabilité d’une PA systolique < 120 mmHg coïncidant avec une sténose significative de l’ACI était 1–2 %. Conclusion Concernant le risque d’ischémie cérébrale par une sténose carotidienne, un objectif tensionnel < 140 mmHg semble tolérable pour la plupart des nonagénaires. La recherche d’une sténose significative pourrait être utile si l’objectif tensionnel était plus bas. Aim Carotid artery stenosis increases with age and may cause brain ischemia if arterial hypotension occurs. We performed a monocentric pilot study to investigate its prevalence in the very elderly and to assess its potential influence on blood pressure (BP) goals during antihypertensive treatment. Methods All patients ≥ 90 years of a primary care medical ward were prospectively included over 15 months. Ultrasound exams of the precerebral arteries were offered to all elderly patients for routine evaluation of their cardiovascular risk. Frequencies of stenosed common, internal and external carotid arteries (CCA, ICA, ECA) were analyzed together with clinical BP and antihypertensive therapy. Patients with circulatory shock and readmissions were excluded. Results Sixty-three patients aged 92 ± 3 years (78% female) hospitalized for a median of 11 days were included. On admission, 76% were on antihypertensive drugs vs. 86% at discharge. Mean admission BP was 149/77 vs. 129/72 mmHg at discharge; systolic BP < 140 mmHg 36% vs 64% ( P < 0.05). Mean intima-media thickness (ACC, right/left) was 8.7/9.4 mm. Prevalence of plaque or stenosis < 60% was: CCA 19.0%, ICA 19.0%, ECA 31.7%, bulb 74.6%; of stenosis ≥ 60%: CCA 0%, ICA 7.9%, ECA 19.0%, ICA bilateral 1.6% (unilateral occlusion 3.1%, no bilateral). Coincidence of systolic BP < 120 mmHg and ACI stenosis ≥ 60% had a probability of 1–2%. Conclusion Concerning the risk of brain ischemia due to carotid artery stenosis, a BP goal < 140 mmHg should be safe for most nonagenarians. If individual BP goals are lower, searching for significant stenosis by ultrasound may be useful. [ABSTRACT FROM AUTHOR]

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Copyright of Colon & Rectum is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Post-traumatic rupture of the posterior urethra is a serious injury that can compromise the micturition and erectile prognosis of the often-young patient. The management of this lesion is still controversial, leaving the choice between early endoscopic realignment or suprapubic catheterization with deferred urethroplasty. The objective of this study was to report our clinical experience and outcomes with early endoscopic realignment (EER) for patients with pelvic fracture urethral injury., Patients and Methods: We underwent a retrospective review of patients with pelvic fracture associated urethral injury who underwent EER from 2010 to 2020. Preoperative, perioperative, and postoperative outcome data were collected. Complications for the surgical procedure were analyzed, as well as postoperative stenosis, urinary incontinence and erectile dysfunction. The primary endpoint was success, defined as satisfying micturition with no urethral stricture at the time of last follow-up., Results: Early endoscopic realignment was performed in 26 patients managed for complete post-traumatic posterior urethral rupture. The median age was 26 (16-39) years. The most common mechanism of urethral injury was road traffic accidents in 69.23% of cases. The most common urethral injury was grade 4 in 23 patients (88.46%). The median time to endoscopic realignment was 8 days (3-18). The median time to postoperative bladder catheterization was 22 (10-32) days. The median follow-up time was 34 (18-54) months. Ten patients developed urethral stricture during follow-up: 7 (26.92%) were treated with one or two internal cold blade urethrotomies, 3 required urethroplasty. There were no urethroplasty failures after a first endoscopic realignment. Two patients reported severe stress urinary incontinence. The median IIEF-5 score at the date of last news was 23 (17-25)., Conclusion: Early endoscopic realignment allows some patients to avoid a heavier surgical treatment, and doesn't compromise the realization of a later urethroplasty., (Copyright © 2023 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

La mégacalicose est une uropathie malformative rare caractérisée par une dilatation non obstructive des calices avec hypoplasie de la médullaire rénale. Nous rapportons un cas de mégacalicose associée à une sténose urétérale bilatérale d'origine infectieuse.

Nous rapportons l'observation d'un nouveau né âgé de 27 jours qui présente depuis sa naissance un syndrome subocclusif intermittent fait de vomissements bilieux avec arrêt des matières sans arrêt des gaz. L'examen clinique trouvait un nourrisson dénutri et déshydraté avec un abdomen souple non distendu. La radiographie de l'abdomen sans préparation a montré des niveaux hydro aériques grêlo-coliques (A). L'échographie abdominale couplée au Doppler couleur n'a pas objectivé d'image en faveur de sténose hypertrophique du pylore ni en faveur du volvulus du grêle d'où la réalisation d'un TOGD qui a montré une importante dilatation gastrique, du cadre duodénal ainsi que de la première anse jéjunale faisant évoquer un diaphragme jéjunal incomplet (B). L'exploration chirurgicale a trouvé une disparité de calibre entre la première et la deuxième anse jéjunale avec découverte de deux diaphragmes incomplets intéressant la deuxième anse jéjunale (C). Nous avons procédé à la résection des deux diaphragmes avec suture de l'ouverture intestinale (D) et vérification de l'étanchéité. L'évolution clinique est bonne après 17 mois de recul.

Interventional bronchology is a relatively young discipline of chest medicine. Conventional bronchoscopy has been focused on diagnoses of pulmonary infections or malignancies. However, due to recently established and upcoming therapeutic techniques, indications of interventional bronchoscopic procedures are increasingly used. The modern arsenal of these techniques is discussed in this article. [ABSTRACT FROM AUTHOR]

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Background: Staple line and anastomotic leakages are life-threatening complications after bariatric surgery. Upper gastrointestinal (GI) tract X-ray examination with oral administration of a water-soluble contrast agent can be used to detect leaks. The aim of this study was to evaluate the impact of routine upper GI tract fluoroscopy after primary bariatric surgery. Methods: Between January 2009 and December 2014 a total of 658 bariatric interventions were carried out of which 442 were primary bariatric operations. Included in this single center study were 307 sleeve gastrectomies and 135 Roux-en-Y gastric bypasses. Up to December 2012 upper GI tract fluoroscopy was performed routinely between the first and third postoperative days and the detection of leakages was evaluated. Results: In the investigation period 8 leakages (2.6 %) after sleeve gastrectomy, 1 anastomotic leakage in gastrojejunostomy and 1 in jejunojejunostomy after Roux-en-Y gastric bypass occurred. All patients developed clinical symptoms, such as abdominal pain, tachycardia or fever. In one case the leakage was detected by upper GI fluoroscopy and in nine cases radiological findings were unremarkable. No leakages were detected in asymptomatic patients. Conclusion: Routine upper GI fluoroscopy is not recommended for uneventful postoperative courses after primary bariatric surgery. [ABSTRACT FROM AUTHOR]

Takayasu arteritis is a rare, inflammatory vasculitis of unknown etiology, which affects large vessels especially the aorta and its main branches. It mainly concerns young women. The diagnosis is essentially based on the appearance of compatible vascular injuries with the imaging, in an evocative clinical and biological context.We report the case of a young woman having Takayasu arteritis with sub-renal abdominal aorta and right subclavian artery stenosis. [ABSTRACT FROM AUTHOR]

Background: Frequently, the first clinical sign of colorectal cancer is complete obstruction, which has to be considered an emergency situation. The treatment goal is to overcome ileus including reduction of the associated high morbidity and mortality. Therefore, alternative therapeutic options to emergency surgery have been sought in order to allow adequate preparation for elective surgery or stabilization of palliative patients and avoid colostoma. Therapeutic results of the placement of self-expanding metal stents (SEMS) are discussed in terms of a single-center, retrospective observational study. Methods: In 35 patients with a clinically manifest stenosis of colonic cancer, it was attempted to insert SEMS to treat ileus as the first therapeutic step. Therapeutic results were investigated with regard to technical and clinical success, spectrum and rate of complications, and survival time, differentiating between a palliative and curative group of patients. Results: Primary placement of a stent was achieved in 29 of 35 patients (82.9 %); 14 underwent the procedure with palliative and 15 with curative intention. Stent location was mainly the left hemicolon. In 2 of 15 patients (13.3 %), emergency surgery within 48 h was required because of complications, whereby in 13 patients (86.7 %), 6 patients (46.2 %) underwent elective open surgery and 7 patients (53.8 %) underwent a laparoscopic procedure. In all patients treated with curative intent, primary anastomosis was achieved, thus, avoiding a colostoma. Survival times of the palliative and curative patient groups were on average 7 and 28 months, respectively. Conclusion: In carefully selected cases, placement of SEMS in malignant stenosis of the left hemicolon with ileus can be considered a reasonable therapeutic alternative to emergency surgery since it allows surgical intervention with curative intention under more favorable conditions and also avoids a colostoma. [ABSTRACT FROM AUTHOR]

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Résumé La dysplasie fibromusculaire est définie comme une maladie de la paroi artérielle, segmentaire, non athéromateuse, entraînant une sténose des artères de grande taille. L’atteinte de l’artère rénale, la plus fréquente (60 à 100 %), se manifeste par une sténose des artères rénales, asymptomatique ou compliquée d’hypertension artérielle ou d’une altération de la fonction rénale. Les atteintes des artères carotides ou vertébrales sont moins fréquentes (10 à 35 %). La prise en charge chirurgicale des dysplasies fibromusculaires est devenue beaucoup plus rare du fait du développement des techniques d’angioplastie transluminale. Les critères anatomopathologiques ne sont plus des critères pronostiques pertinents. La présentation clinique et le profil évolutif diffèrent en fonction de la présentation angiographique (atteinte uni-focale ou multifocale), avec un taux de guérison de l’hypertension artérielle plus important au cours des atteintes uni-focales. En présence d’une dysplasie fibromusculaire rénale, ne sont revascularisés que les patients symptomatiques (hypertension artérielle récente ou résistante au traitement) ou avec une asymétrie de taille rénale ou une altération de la fonction rénale. L’angioplastie transluminale est proposée en première intention sauf en cas de lésions complexes ou de sténoses associées à un anévrysme. Fibromuscular dysplasia is a segmentary, non-atherosclerotic, non-inflammatory vascular disease that may result in stenosis, occlusion, aneurysms or dissection of medium arteries. Renal involvement is the most frequent location, described in 60–100% of patients. Renal stenosis can be asymptomatic or complicated with arterial hypertension or less frequently with renal insufficiency. Carotid and vertebral involvements are less frequent (10–35%). Surgical management of fibromuscular dysplasia is now less common because of the better efficacy of percutaneous transluminal angioplasty. Thus, histologic characteristics are no longer relevant prognostic criteria. Clinical features and outcome vary according to angiographic presentation (focal or multifocal disease), with an increased recovery rate of hypertension with focal lesions. In the presence of renal fibromuscular dysplasia, only symptomatic patients are revascularized (recent or resistant hypertension) or patients with asymmetric renal size or impaired renal function. Transluminal angioplasty is the first-line treatment except for patients with complex lesions or stenosis associated with aneurysm. [ABSTRACT FROM AUTHOR]

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La pneumatose kystique intestinale est la présence de bulles gazeuses dans la paroi et les séreuses du tube digestif. Il s'agit d'une pathologie bénigne, rare, de diagnostic radiologique et de traitement médical. Nous rapportons le cas d'un homme âgé de 42ans, opéré il y a 6ans pour une sténose du bulbe duodénal d'origine ulcéreuse, il avait bénéficié d'une gastro-entéro-anastomose avec bivagotomie tronculaire. Il a été hospitalisé pour des vomissements associés à des épigastralgies. le patient a bénéficié d'une fibroscopie oeso-gastro-duodénale qui a trouvé une stase gastrique gênant toute exploration, ce qui a conduit à la réalisation d'une tomodensitométrie abdominale qui a objectivé un énorme estomac de stase en amont d'une sténose de l'anastomose gastro jéjunale, une pneumatose kystique intestinale et un pneumopéritoine. Le patient a été opéré et l'exploration a trouvé une ascite, un volumineux estomac de stase et des adhérences entre le grêle et le colon droit, sièges de la pneumatose, provoquant un tour de spire (volvulus) de l'ancienne anastomose gastro-jéjunale. L'estomac était atone. Une gastrectomie des 2/3 emportant l'ancienne anastomose suivie d'une anastomose type Finsterer manuelle a été réalisée. Les suites post opératoires étaient simples. La pneumatose kystique intestinale est une affection bénigne, de diagnostic radiologique. Le scanner permet d'étudier la diffusion des gaz dans les séreuses digestives. Son traitement est habituellement médical alors que ses complications peuvent relever d'un traitement chirurgical comme pour notre patient.

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