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Segmental duodenectomy for gastrointestinal stromal tumor of the duodenum

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World Journal of Gastroenterology 2010年第22期16卷 2788-2792页

作者： Nicolas Christian Buchs Pascal Bucher Pascal Gervaz Sandrine Ostermann Franois Pugin philippe morel Department of Surgery University Hospital Geneva

AIM: To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management. METHODS: All patients who underwent surgery for non-metastatic GIST of the duodenum in a single institution since 2000 were prospectively followed up. Seven patients (median age 51 years, range: 41-73 years) were enrolled: five underwent SD and two underwent PD. RESULTS: All the patients had a complete resection (R0), with no postoperative morbidity and mortality. Among the SD group, GIST was classified as low risk in two patients, intermediate risk in two, and high risk in one, according to the Fletcher scale, (vs two high risk patients in the PD group). With a median followup of 41 (18-85) mo, disease-free survival (DFS) rateswere 100% after SD and 0% after PD (P < 0.05). The median DFS was 13 mo in the PD group. CONCLUSION: Whenever associated with clear surgical margins, SD is a reliable and curative option for most duodenal GISTs, and is compatible with longterm DFS.

关键词： Gastrointestinal stromal tumor Duodenal neoplasms Segmental duodenectomy Pancreaticoduodenectomy

Biological mesh reconstruction of the pelvic floor following abdominoperineal excision for cancer:A review

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World Journal of Clinical Oncology 2017年第3期8卷 249-254页

作者： Boris Schiltz Nicolas Christian Buchs Marta Penna Cosimo Riccardo Scarpa Emilie Liot philippe morel Frederic Ris Division of Visceral Surgery Department of SurgeryUniversity Hospitals of Geneva Department of Colorectal Surgery Churchill HospitalOxford University Hospitals

Extralevator abdominoperineal excision and pelvic exenteration are mutilating operations that leave wide perineal *** large wounds are prone to infection and perineal herniation,and their closure is a major concern to most *** approaches to the perineal repair exist,varying from primary or mesh closure to myocutaneous *** technique has its own associated advantages and potential complications and the ideal approach is still *** the present study,we reviewed the current literature and our own local data regarding the use of biological mesh for perineal wound *** evidence suggests that the use of biological mesh carries an acceptable risk of wound complications compared to primary closure and is similar to flap *** addition,the rate of perineal hernia is lower in early follow-up,while long-term hernia occurrence appears to be similar between the different ***,it is an easy and quick reconstruction *** more expensive than primary closure,the cost associated with the use of a biological mesh is at least equal,if not less,than flap reconstruction.

关键词： Biological mesh Rectal cancer Pelvic exenteration Abdominoperineal resection Primary perineal wound closure Perineal wound infection Perineal hernia

Squamous cell carcinoma of the anus-an opportunistic cancer in HIV-positive male homosexuals

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World Journal of Gastroenterology 2011年第25期17卷 2987-2991页

作者： Pascal Gervaz Alexandra Calmy Ymer Durmishi Abdelkarim S Allal philippe morel Department of Surgery Geneva University Hospital and Medical School Departments of Infectious Diseases Geneva University Hospital and Medical School Department of Radiation Oncology Hopital Cantonal de Fribourg

Squamous cell carcinoma of the anus （SCCA） is a com- mon cancer in the human immunodeficiency virus （HIV）- infected population, and its incidence continues to in- crease in male homosexuals. Combined chemoradiation with mitomycin C and 5-fiuorouracil was poorly tolerated by severely immunocompromised patients in the early 1990s. In the era of highly active antiretroviral therapy （HAART）, however, recent data indicate that：（1） most HIV patients with anal cancer can tolerate standard chemotherapy regimens; and （2） this approach is associ- ated with survival rates similar to those of HIV-negative patients. However, HIV-positive patients with SCCA are much younger, more likely to develop local tumor recur- rence, and ultimately die from anal cancer than immune competent patients. Taken together, these findings suggest that anal cancer is an often fatal neoplasia in mid- dle-aged HIV-positive male homosexuals. In this popula- tion, SCCA is an opportunistic disease resulting in patients with suboptimal immune function from persistent infection and prolonged exposition to oncogenic human papillomaviruses （HPVs）. Large-scale cancer-prevention strategies （routine anuscopy and anal papanicolaou test- ing） should be implemented in this population. In addi- tion, definitive eradication of oncogenic HPVs within the anogenital mucosa of high-risk individuals might require a proactive approach with repeated vaccination.

关键词： Anal cancer Chemoradiation Highly activeantiretroviral therapy Human immunodeficiency virus Human papillomaviruse Outcome

Endothelial nitric oxide synthase regulation is altered in pancreas from cirrhotic rats

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World Journal of Gastroenterology 2006年第2期12卷 228-233页

作者： Jean-Louis Frossard Rafael Quadri Antoine Hadengue philippe morel Catherine M Pastor Division de Gastroenterologie Hpitaux Universitaires de Geneve Departement de Chirurgie Hopitaux Universitaires de Geneve Laboratoire de Physiopathologie Hepatique et Imagerie Moleculaire Hpitaux Universitaires de Geneve

AIM： To determine whether biliary cirrhosis could induce pancreatic dysfunction such as modifications in endothelial nitric oxide synthase（eNOS） expression and whether the regulation of eNOS could be altered by the regulatory proteins caveolin and heat shock protein 90 （Hsp90）, as well as by the modifications of calmodulin binding to eNOS. METHODS： Immunoprecipitations and Western blotting analysis were performed in pancreas isolated from sham and cirrhotic rats. RESULTS： Pancreatic injury was minor in cirrhotic rats but eNOS expression importantly decreased with the length （and the severity） of the disease. Because coimmunoprecipitation of eNOS with both Hsp90 and caveolin similarly decreased in cirrhotic rats, eNOS activity was not modified by this mechanism. In contrast, drrhosis decreased the calmodulin binding to eNOS with a concomitant decrease in eNOS activity. CONCLUSION： In biliary cirrhosis, pancreatic injury is minor but the pancreatic nitric oxide （NO） production is significantly decreased by two mechanisms： a decreased expression of the enzyme and a decreased binding of calmodulin to eNOS.

关键词： Pancreas Biliary cirrhosis Endothelial NO synthase Caveolin Heat shock protein 90

Neutrophil depletion-but not prevention of Kupffer cell activation-decreases the severity of cerulein-induced acute pancreatitis

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World Journal of Gastroenterology 2006年第8期12卷 1219-1224页

作者： Catherine M Pastor Alain Vonlaufen Fabianna Georgi Antoine Hadengue philippe morel Jean-Louis Frossard Laboratoire de Physiopathologie Hépatique et Imagerie Moléculaire H■pitaux Universitaires de GenèveB■timent CRoom 6-79524 Rue Micheli-du-Crest1205 GenevaSwitzerland Division of Gastroentérologie et Hépatologie H■pitaux Universitaires de Genève24 Rue Micheli-du-Crest1205 GenevaSwitzerland Département APSI H■pitaux Universitaires de Genève24 Rue Micheli-du-Crest1205 GenevaSwitzerland Département de Chirurgie H■pitaux Universitaires de Genève24 Rue Micheli-du-Crest1205 GenevaSwitzerland

AIM： To determine whether neutrophil depletion and Kupffer cell inhibition might combine their protective effects to decrease the severity of acute pancreatitis. METHODS： Nice had cerulein administration to induce acute pancreatitis and were pretreated with either anti-mouse neutrophil serum or gadolinium chloride （GdCh） to prevent Kupffer cell activation, or both treatments. Injury was assessed in pancreas and lungs. Myeloperoxidases （MPO） assessed neutrophil infiltration. Interleukin-6 （IL-6） and IL-10 were measured in serum, pancreas, lungs and liver. RESULTS： In mice with acute pancreatitis, neutrophil depletion reduced the severity of pancreatitis and pancreatitis-associated lung injury. Kupffer cell inactivation by GdCh had less protective effect, although IL-6 and IL-10 concentrations were significantly decreased. The protective treatment brought by neutrophil depletion was not enhanced by Kupffer cell inactivation and both treatments did not combine their protective effects. CONCLUSION： Our results confirm the role of activated neutrophils in aggravating organ injury in acute pancreatitis while the role of Kupffer cell activation is less obvious.

关键词： Acute pancreatitis Cytokines Neutrophils Kupffer cells Pulmonary injury

Islet transplantation in multicenter networks:the GRAGIL example

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介入放射学杂志 2006年第10期15卷 626-631页

作者： Thierry Berney Pierre-Yves Benhamou Laurence Kessler philippe morel the Division of Visceral and Transplantation Surgery Geneva University Hospitals24rue Micheli-du-Crest1211 Geneva 14Switzerland MDMSc the Division of Endocrinology Grenoble University Hospital CenterGrenobleFranceand the Division of EndocrinologyStrasbourg University Hospital CenterStrasbourgFrance MD the Division of Visceral and Transplantation Surgery Geneva University Hospitals24rue Micheli-du-Crest1211 Geneva 14Switzerland MD the Division of Visceral and Transplantation Surgery Geneva University Hospitals24rue Micheli-du-Crest1211 Geneva 14Switzerland MD.

Purpose of review The enthusiasm generated by the results of the Edmonton protocol of islet transplantation is inciting a great number of institutions to start such ***,the procedure of islet isolation and purification is costly,complex and technically *** order to share costs and to avoid facing the steep learning curve of the procedure,many centers interested in islet transplantation have looked into collaborating with experienced groups serving as core islet isolation *** findings The proof of principle that remote islet processing and shipment could be successfully implemented with obtainng the Portland/Minneapolis,Huddinge/Giessen and Houston/Miami ***,in order to increase both the donor pool and the number of patients gaining access to islet transplantation,multicenter networks,such as the Swiss-French GRAGIL consortium and the 4-country Nordic Network in Scandinavia have been *** GRAGIL group has been fully operational since 1999,allowing the transplantation of 27 islet preparations processed in Geneva,Switzerland into 20 recipients in France over the course of 4.5 *** issues in the design of such networks are discussed based on the example of the GRAGIL *** The feasibility and the efficiency of islet transplantation in multicenter networks have been *** strategy allows to increase the donor pool and the accessibility to islet transplantation in an extended population area.(J Intervent Radiol,2006,15: 626-631)

关键词：胰岛移植胰岛分离糖尿病病例

Perforated duodenal diverticulum, a rare complication of a common pathology: A seven-patient case series

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World Journal of Gastrointestinal Surgery 2013年第3期5卷 47-50页

作者： Andrea Rossetti Nicolas Christian Buchs Pascal Bucher Stephane Dominguez philippe morel Division of Visceral Surgery and Transplantation Department of Surgery University Hospital of Geneva Clinic for Visceral and Vascular Surgery

Duodenal diverticula (DD) are frequently encountered and are usually asymptomatic, with an incidence at autopsy of 22%. Perforation of DD is a rare complication (around 160 cases reported) with potentially dramatic consequences. However, little evidence regarding its treatment is available in the literature. The aim of this study was to review our experience of perforated DD, with a focus on surgical management. Between January 2001 and June 2011, all perforated DD were retrospectively reviewed at a single centre. Seven cases (5 women and 2 men; median age: 72.4 years old, rang: 48-91 years) were found. The median American Society of Anesthesiologists' score in this population was 3 (range: 3-4). The perforation was located in the second portion of duodenum (D2) in six patients and in the third portion (D3) in one patient. Six of these patients were treated surgically: five patients underwent DD resection with direct closure and one was treated by surgical drainage and laparostomy. One patient was treated conservatively. One patient died and one patient presented a leak that was successfully treated conservatively. The median hospital stay was 21.1 d (range: 15-30 d). Perforated DD is an uncommon presentation of a common pathology. Diverticular excision with direct closure seems to offer the best chance of survival and was associated with a low morbidity, even in fragile patients.

关键词： Duodenal perforation Duodenum Duodenal diverticulum Surgical management

Management of hepatocellular adenoma: Solitary-uncomplicated, multiple and ruptured tumors

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World Journal of Gastroenterology 2005年第36期11卷 5691-5695页

作者： Christian Toso Pietro Majno Axel Andres Laura Rubbia-Brandt Thierry Berney Leo Buhler philippe morel Gilles Mentha Abdominal and Transplant Surgery University Hospital Geneva Switzerland Clinical Pathology University Hospital Geneva Switzerland

AIM： While hepatocellular adenomas （HAs） have often been studied as a unique entity, we aimed to better define current management of the various forms of HAs. METHODS： Twenty-five consecutive patients operated for solitary-uncomplicated （9）, multiple （6）, and ruptured （10） HAs were reviewed according to management strategies and outcomes. RESULTS： All solitary-uncomplicated HAs （ranged 2.2- 14 cm in size） were removed. Out of 25 HAs, 2 （8%） included loci of carcinoma. In the multiple HA group, previously undiagnosed tumors were identified during surgery in 5/6 cases. In three cases with multiple spread HA, several lesions had to be left unresected. They remained unmodified after 4-, 6-, and 6-year radiological follow-up. Patients with ruptured HA （ranged 1.7-10 cm in size） were initially managed with hemodynamic support and angiography, allowing the embolizaUon of actively bleeding tumors in two patients. All ruptured tumors were subsequently removed 5.5 d （range 4-70 d） after admission. CONCLUSION： Tumors suspected of HA, regardless of the size, should be resected, because of high chances of rupture causing bleeding, and/or containing malignant foci. Although it is desirable to remove all lesions of multiple HA, this may not be possible in some patients, for whom long-term radiological follow-up is advised. Ruptured HA can be managed by hemodynamic support and angiography, allowing scheduled surgery. 2005 The WJG Press and Elsevier Inc. All rights reserved

关键词： Liver Adenoma Management Surgery

Soluble CD40 ligand in prediction of acute severe pancreatitis

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World Journal of Gastroenterology 2006年第10期12卷 1613-1616页

作者： Jean Louis Frossard philippe morel Brenda Kwak Catherine Pastor Thierry Berney Léo Buhler Alain Von Laufen Sandrine Demulder Francois Mach Division of Gastroenterology Geneva University HospitalGenève Switzerland Clinic of Digestive Surgery Geneva University Hospital Genève Switzerland Division of Cardiology Geneva University Hospital Genève Switzerland

AIM： TO assess the early predictability of the soluble CD40L （sCD40L） in pancreatitis severity. METHODS： Between February 2000 and February 2003, 279 consecutive patients with acute pancreatitis were prospectively enrolled in our study. In this report, 40 patients with mild and 40 patients with severe pancreatitis were randomly studied, sCD40L concentrations were measured 48 hours after admission. RESULTS： sCD40L levels were significantly higher 48 hours after admission in severe pancreatitis than in mild pancreatitis. Using a cutoff of 1000 pg/L, the sensitivity and specificity of sCD40L to detect a severe course of the disease were 78% and 62% respectively compared to 72% and 81% for CRP. Logistic regression analysis found that CRP was the only statistically significant marker able to detect a severe course of the disease. CONCLUSION： These findings indicate that CRP remains a valuable marker to determine the severity and prognosis of acute pancreatitis whereas sCD40L levels should be assessed in further studies.

关键词： Acute pancreatitis Prognostic factor sCD40