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Role of frozen section assessment for intraductal papillary and mucinous tumor of the pancreas

World Journal of Gastrointestinal Surgery 2010年第10期2卷 352-358页

作者： Alain Sauvanet Anne Couvelard Jacques Belghiti service de chirurgie Hépatique et Pancréatique Hpital BeaujonAssistance Publique-Hopitaux de Paris Université Paris service d'Anatomie Pathologique Hpital BeaujonAssistance Publique-Hopitaux de Paris Université Paris VII

Intraductal papillary mucinous neoplasms(IPMN) of the pancreas include a spectrum of dysplasia ranging from minimal mucinous hyperplasia to invasive carcinoma and are extensive tumors that often spread along the ductal *** studies have demonstrated that preoperative imaging is not accurate enough to adapt the extent of pancreatectomy and have suggested routinely using frozen sectioning(FS) to evaluate the completeness of resection and also to check if ductal dilatation is active or passive,in order to avoid an excessive pancreatic *** main duct and branch duct analysis is needed due to the difference in the natural history of the *** accuracy averages 95%.Eroded epithelium on the main duct,severe ductal inflammation mimicking dysplasia and reactive epithelial changes secondary to obstruction can lead to inappropriate FS *** results change the planned extent of resection in up to 30% of *** optimal cut-off leading to extend pancreatectomy is not consensual and our standard option is to extend pancreatec-tomy if FS reveals:(1) at least IPMN adenoma on the main duct;or(2) at least borderline IPMN on branch ducts;or(3) invasive ***,the decision to extend resection must be taken after a multidisciplinary discussion since it does not exclusively depend on the FS result but also on age,general condition and expected prognosis after *** main limitation of using FS is the existence of discontinuous("skip") lesions which account for approximately 10% of IPMN in surgical series and can lead to reoperation in up to 8% of cases.

关键词： Intraductal papillary and mucinous tumor Pancreas Frozen section Branch duct Dysplasia Main duct

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Choledochal cyst: A difficult diagnosis

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Open Journal of Gastroenterology 2013年第1期3卷 84-86页

作者： Abdelmounaim Ait Ali Fedoua Rouibaa M. Bekkar Hicham Baba Ibrahima Sall Ahmed Bounaim Aziz Zentar A. Aourarh Khalid Sair service de chirurgie Viscérale I H?pital Militaire d’Instruction Mohammed V Rabat Maroc service de Gastro-Enterologie I Hopital Militaire d’Instruction Mohammed V Rabat Maroc

Choledochal cyst is defined as a cystic dilatation of the distal common bile duct protruding into the duo- denum. It is considered as the rarest congenital cyst of the biliary tract by 1.4%. We report a 46 years old woman who presented with recurrent jaundice associated with abdominal pain of 07 years duration. The liver function tests showed cholestasis. The abdominal scan and Biliary MRI revealed a dilatation of intrahepatic, pancreatic ducts and a dilatation of the common bile duct with a stenosis in its the lower part. The diagnosis of a common bile duct cholangiocarinoma was mentioned. The gastroscopy revealed a stenosed duodenal bulb not allowing us to perform an echo endoscopy and ERCP. An intraoperative cholangiography illustrating a cystic dilatation of the papillary region in which exist a separate protrusion of the choledochal and wirsung ducts. Therefore, we didn’t accomplish the cephalic duodeno-pancreatectomy and we decided to realize a partial resection of the papilla. The histolological examination proved the absence of any tumoral lesion and the presence of biliary mucosa layered the internal surface of the cyst. The patient is still asymptomatic after one year of the surgery.

关键词： Choledochal Cyst Jaundice Echoendoscopy Biliary MRI

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Adult human liver slice cultures:Modelling of liver fibrosis and evaluation of new anti-fibrotic drugs

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World Journal of Hepatology 2021年第2期13卷 187-217页

作者： Daria Kartasheva-Ebertz Jesintha Gaston Loriane Lair-Mehiri Pierre-Philippe Massault Olivier Scatton Jean-Christophe Vaillant Vladimir Alexei Morozov Stanislas Pol Sylvie Lagaye Institut Pasteur Immunobiologie des Cellules DendritiquesINSERM U1223Paris 75015France BioSPC Universitéde ParisParis 75005France service de chirurgie digestive Hépato-biliaire et EndocrinienneAPHPGroupe Hospitalier CochinParis 75014France service de chirurgie digestive et Hépato bilio pancréatique AP-HPGroupe Hospitalier La Pitié-SalpétrièreMedecine Sorbonne UniversitéParis 75013France Center for HIV and Retrovirology Department of Infectious DiseasesRobert Koch InstituteBerlin 13353Germany Département d'Hépatologie AP-HPGroupe Hospitalier CochinUniversitéde ParisParis 75014France

BACKGROUND Liver fibrosis can result in end-stage liver failure and *** To examine human liver fibrogenesis and anti-fibrotic therapies,we evaluated the three dimensional ex vivo liver slice(LS)*** Fibrotic liver samples(F0 to F4 fibrosis stage according to the METAVIR score)were collected from patients after liver *** liver slices(HLS)were cultivated for up to 21 *** C virus(HCV)infection,alcohol(ethanol stimulation)and steatosis(palmitate stimulation)were examined in fibrotic(F2 to F4)liver slices infected(or not)with HCV.F0-F1 HLS were used as *** day 0,either ursodeoxycholic acid(choleretic and hepatoprotective properties)and/or α-tocopherol(antioxidant properties)were added to standard of care on HLS and fibrotic liver slices,infected(or not)with *** of the biomarkers of fibrosis and the triglyceride production were checked by quantitative reverse transcription polymerase chain reaction and/or enzymelinked immunosorbent *** The cultures were viable in vitro for 21 days allowing to study fibrosis inducers and to estimate the effect of anti-fibrotic *** of the biomarkers of fibrosis and the progression to steatosis(estimated by triglycerides production)was increased with the addition of HCV and/or ethanol or *** day 15 of the follow-up studies,a significant decrease of both transforming growth factorβ-1 and Procol1A1 expression and triglycerides production was observed when a combined anti-fibrotic treatment was applied on HCV infected F2-F4 LS *** These results show that the human three dimensional ex vivo model effectively reflects the in vivo processes in damaged human liver(viral,alcoholic,nonalcoholic steatohepatitis liver diseases)and provides the proof of concept that the LS examined model permits a rapid evaluation of new anti-fibrotic therapies when used alone or in combination.

关键词： Human liver fibrosis Hepatitis C virus Alcoholic liver disease Nonalcoholic steatohepatitis Ex vivo model Drugs

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Visceral Leishmaniasis at the National Reference University Hospital Center of N’Djamena (Chad): Epidemiological, Clinical, Diagnostic, Therapeutic and Prognostic Aspects

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Advances in Infectious Diseases 2024年第2期14卷 478-486页

作者： Joseph Mad-Toïngué Mahamat Ali Ahmat Oumaïma Mahamat Djarma Alifa Adjibera Philippe Ali Mahamat Moussa Ngakoutou Rangar Choua Ouchemi Mahamat Ali Bolti Djiddi Ali Sougoudi Mamissou Didi Mahamat Doungous Atim service des Maladies Infectieuses CHU de Référence Nationale N’Djamena Chad service de Gastroentérologie et Médecine Interne CHU de Référence Nationale N’Djamena Chad service de Pneumologie et Phtisiologie CHU de Référence Nationale N’Djamena Chad service de chirurgie viscérale CHU de Référence Nationale N’Djamena Chad service de Médecine CHU de la Renaissance N’Djamena Chad

Introduction: leishmaniasis is a group of parasitic diseases caused by a parasite of the genus Leishmania transmitted by the bite of an infected vector called a sandfly. There are four forms. Visceral leishmaniasis is the most severe form. The aim of our work is to study the epidemiological, clinical, diagnostic, therapeutic and prognostic aspects of the disease in the Infectious Diseases department of the Centre Hospitalier Universitaire de Référence Nationale in N'Djaména. Methodology: Patients were recruited on the basis of clinical signs suggestive of visceral leishmaniasis, i.e. prolonged fever, splenomegaly and altered general condition. Biological confirmation was performed with a rapid diagnostic test using recombinant K39 parasite antigen, which is known to have good specificity and sensitivity. Epidata version 3.1 software was used to process patient data. Results: From 05/04/21 to 15/12/23, 153 positive cases were managed. The mean age of patients was 18 years, with a sex ratio of 9.2. Of these patients, 103 (67.3%) had recently stayed at gold mining sites. Patients testing positive were treated with sodium stibogluconate combined with paromomycin for 17 days. The mortality rate was 13.2%. Conclusion: Leishmaniasis is a serious and little-known disease in Chad. In order to respond to the disease, it is necessary to reinforce the capacities of health structures and to carry out appropriate actions in the outbreaks.

关键词： Visceral Leishmaniasis Gold Mining Sites Chad

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Surgical Management of Recent Traumatic Epiphyseal Fractures-detachments of the Distal Femur at Gabriel TouréUniversity Hospital

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Surgical Science 2023年第2期14卷 61-71页

作者： Mahamadou Diallo Abdoul Kadri Moussa Layes Toure Kalifa Coulibaly Mamadou Bassirou Traoré Cheick Oumar Sanogo Terna Traoré Mamadou Diallo Amadou Maiga Adégné Togo service d’Orthopédie-Traumatologie CHU Gabriel Touré Bamako Mali service d’Orthopédie-Traumatologie Etablissement Hospitalier Publique Sikasso Sikasso Mali service d’orthopédie traumatologie CHU de Kati Kati Mali service de Neurochirurgie CHU Gabriel Touré Bamako Mali service de chirurgie générale CHU Gabriel Touré Bamako Mali

Traumatic epiphyseal detachment fractures of the distal end of the femur are a rare lesion whose severity is linked to disabling sequelae such as limb length inequality or most often axial deviation. In this report, surgical treatment aims to reconstruct the anatomy of the distal femur, to avoid secondary displacements and to allow early mobilization of the knee. Surgery carried out mainly by the technique of plugging in or screwing, opened or better still closed, can be a source of complications including migration of pins, infections, knee stiffness, and growth disorders. The aim of this work was to describe their epidemiological, anatomo-clinical, therapeutic and evolutionary aspects in the department of Orthopedics-Traumatology at the CHU Gabriel TOURE. It was a retrospective study over 30 months from July 2019 to december 2021. In fact, it concerned 42 patients with traumatic epiphyseal detachment of the distal femur occurring within 21 days or less, on a healthy knee with cartilage fertile treated surgically and followed in the department. However, the diagnosis of traumatic epiphyseal detachment of the distal femur was retained thanks to the clinical examination and supplemented by radiographic images of the knee from the front and from the side. The treatment was surgical. The functional results were evaluated according to the functional criteria of the Eastern Orthopedic Traumatology Society (SOTEST). Forty-two patients included 32 boys and 10 girls of average age of 12 years with extremes of 8 years and 16 years. The lesions were classified according to the Salter Harris classification. We noted 24% type I (n = 10), type II 71% (n = 30), type III 2% (n = 1), type IV 2% (n = 1). Union was achieved in all patients within an average of 6 weeks with extremes of 4 and 12 weeks. The functional result was considered good in 20% of cases and very good in 80%. Traumatic epiphyseal detachment fractures of the distal end of the femur are a rare lesion whose severity

关键词： Epiphyseal detachment Distal Femur Treatment Surgical

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Advancing immunosuppression in liver transplantation: A narrative review

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Hepatobiliary & Pancreatic Diseases International 2024年第5期23卷 441-448页

作者： Samuele Iesari Francesca Laura Nava Ilaria Elena Zais Laurent Coubeau Mariano Ferraresso Evaldo Favi Jan Lerut General Surgery and Kidney Transplantation Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico15 Via della Commenda20122 MilanItaly Institut de Recherche Expérimentale et Clinique Universitécatholique de Louvain10 Avenue Hippocrate1200 BrusselsBelgium service de chirurgie et Transplantation Abdominale Cliniques Universitaires Saint-Luc55 Avenue Hippocrate1200 BrusselsBelgium department of Clinical Sciences and Community Health Universitàdegli Studi di Milano19 Via della Commenda20122 MilanItaly

Immunosuppression is essential to ensure recipient and graft survivals after liver transplantation(LT). However, our understanding and management of the immune system remain suboptimal. Current immunosuppressive therapy cannot selectively inhibit the graft-specific immune response and entails a significant risk of serious side effects, i.e., among others, de novo cancers, infections, cardiovascular events, renal failure, metabolic syndrome, and late graft fibrosis, with progressive loss of graft function. Pharmacological research, aimed to develop alternative immunosuppressive agents in LT, is behind other solidorgan transplantation subspecialties, and, therefore, the development of new compounds and strategies should get priority in LT. The research trajectories cover mechanisms to induce T-cell exhaustion, to inhibit co-stimulation, to mitigate non-antigen-specific inflammatory response, and, lastly, to minimize the development and action of donor-specific antibodies. Moreover, while cellular modulation techniques are complex, active research is underway to foster the action of T-regulatory cells, to induce tolerogenic dendritic cells, and to promote the function of B-regulatory cells. We herein discuss current lines of research in clinical immunosuppression, particularly focusing on possible applications in the LT setting.

关键词： Liver transplantation Immunosuppression Drug development Long-term results Clinical operational tolerance

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World Journal of Gastroenterology 2016年第2期22卷 490-500页

作者： Hussein Akil Aurélie Perraud Marie-Odile Jauberteau Muriel Mathonnet Laboratoire Homéostasie Cellulaire et Pathologies(LHCP-EA3842) Facultéde Médecine et de PharmacieFédération de Recherche GEIST87025 LimogesFrance service de chirurgie Digestive Générale et EndocrinienneCHU de Limoges87042 LimogesFrance service d’Immunologie CHU de Limoges87042 LimogesFrance

Colorectal cancer(CRC) is the second most common cause of cancer-related death in western countries. Approximately one-quarter of newly diagnosed patients for CRC have metastases, and a further 40%-50% experience disease recurrence or develop metastases after all standard therapies. Therefore, understanding the molecular mechanisms involved in the progression of CRC and subsequently developing novel therapeutic targets is crucial to improve management of CRC and patients' long-term survival. Several tyrosine kinase receptors have been implicated in CRC development, progression and metastasis, including epidermal growth factor receptor(EGFR) and vascular EGFR. Recently, tropomyosin-related kinase B(Trk B), a tyrosine kinase receptor, has been reported in CRC and found to clearly exert several biological and clinical features, such as tumor cell growth and survival in vitro and in vivo, metastasis formation and poor prognosis. Here we review the significance of Trk B and its ligand brain derived-neurotrophic factor in CRC. We focus on their expression in CRC tumor samples, and their functional roles in CRC cell lines and in in vivo models. Finally we discuss therapeutic approaches that can lead to the development of novel therapeutic agents for treating Trk B-expressing CRC tumors.

关键词： Colorectal cancer Tyrosine kinase receptor B Brain-derived neurotrophic factor Therapeutic targets Cell survival

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How to deal with right hepatic artery coming from the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: A systematic review

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Hepatobiliary & Pancreatic Diseases International 2023年第2期22卷 121-127页

作者： Andrea Chierici Antonio Castaldi Mohamed El Zibawi Edoardo Rosso Antonio Iannelli service de chirurgie Digestive Centre Hospitalier d’Antibes Juan-les-PinsAntibesFrance department of Digestive Surgery and Liver Transplantation University Hospital Center of NiceNiceFrance department of Radiology University Hospital Center of NiceNiceFrance department of Surgery Centre Hospitalier de LuxembourgLuxembourgLuxembourg Faculty of Medicine UniversitéCôte d’AzurNiceFrance Inserm U1065Team 8’Hepatic Complications of Obesity and Alcohol’NiceFrance

Background: Anatomical variations in the liver arterial supply are quite common and can affect the surgical strategy when performing a minimally invasive pancreaticoduodenectomy(MIPD). Their presence must be preemptively detected to avoid postoperative liver and biliary complications. Data sources: Following the PRISMA guidelines and the Cochrane protocol we conducted a systematic review on the management of an accessory or replaced right hepatic artery(RHA) arising from the superior mesenteric artery when performing an MIPD. Results: Five studies involving 118 patients were included. The most common reported management of the aberrant RHA was conservative(97.0%);however, patients undergoing aberrant RHA division without reconstruction did not develop liver or biliary complications. No differences in postoperative morbidity or long-term oncological related overall survival were reported in all the included studies when comparing MIPD in patients with standard anatomy to those with aberrant RHA. Conclusions: MIPD in patients with aberrant RHA is feasible without increase in morbidity and mortality. As preoperative strategy is crucial, we suggested planning an MIPD with an anomalous RHA focusing on preoperative vascular aberrancy assessment and different strategies to reduce the risk of liver ischemia.

关键词： Pancreatic cancer Pancreaticoduodenectomy Hepatic artery Superior mesenteric artery

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First Cases of Amygdaloid Cyst in Adults in Djibouti: Case Report of Two Patients

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International Journal of Otolaryngology and Head & Neck Surgery 2023年第3期12卷 124-134页

作者： Abdallah Witti Adou Awaleh Ahmed Awaleh Goumaneh Omar Kamil Ahmed Kamil service ORL et chirurgie cervico-faciale Centre médico-chirurgical de la Police Nationale Djibouti Africa service de cancérologie Centre médico-chirurgical de la Police Nationale Djibouti Africa service d’anatomopathologie H&#244pital de la CNSS Djibouti Africa service d’anesthésie et réanimation Centre médico-chirurgical de la Police Nationale Djibouti Africa

Amygdaloid cysts are rare cystic benign tumors due to congenital malformations resulting from an anomaly of embryonic development of the upper laterocervical region, originating from the second branchial cleft. They represent approximately 2% of all laterocervical tumors and 6% to 85% of anomalies of the second branchial cleft. This anomaly of the second branchial cleft is a frequent reason for consultation in the pediatric population but is relatively rare in adults. We report the cases of two patients aged 23 and 34 years with no particular pathological history. They were presenting a laterocervical swelling, one right and the other left, painless, evolving for two years for the first and for 10 years for the second, gradually increasing in volume without any other associated signs the diagnosis of which after radiological exploration (ultrasound and CT scan) was that of an amygdaloid cyst. A cervicotomy with anatomopathological examination of the surgical specimen confirmed the diagnosis of the amygdaloid cyst. The objective is to analyze the anatomo-clinical and therapeutic particularities of this pathology and to compare it with data from the literature.

关键词： Amygdaloid Cyst Second Branchial Cleft Surgery Djibouti

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Diagnosis of Acute Appendicitis in Sub-Saharan Africa

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Open Journal of Medical Imaging 2018年第1期8卷 1-9页

作者： Nina-Astrid Nde Ouedraogo Souleymane Ouedraogo Bénilde Marie Ange Tiemtore Kambou Adams Ouedraogo Adama Sanou service de Radiodiagnostic H&ocirc pital de District de Bogodogo Ouagadougou Burkina Faso Unité de Formation et de Recherche des Sciences de la Santé Université Ouaga 1 Pr Joseph Ki-Zerbo Ouagadougou Burkina Faso service de chirurgie Générale Centre Hospitalier Universitaire Blaise Compaore Ouagadougou Burkina Faso

Objective: The aim of our study was to propose a solution for rationalizing requests for ultrasound examination and CT scan in suspected acute appendicitis, based on use of the Alvarado score. Patients and Methods: We included in our study all patients consulting for pain of the right iliac fossa, whatever their age and sex, who had been diagnosed with acute appendicitis and who had undergone appendectomy. We used the Alvarado scoring system, based on clinical items and laboratory measurements, to diagnose appendicitis. Results: One hundred eleven patients, of whom 77 were men (69.4%) and 34 were women (30.6%), with a sex ratio of 2:2.6, were included. Mean age was 31.29 ± 1.31 years, with a range of 1 to 81 years. The diagnosis of definite appendicitis was established in 54 patients (48.6%). Abdominal ultrasound examination had been performed in 80 patients (72.1%). It established a diagnosis of appendicitis in 69 patients (86.2%), while in 11 patients (13.8%) the appendix was described as normal or was not visualized. Conclusion: Our study demonstrated good agreement between peroperative diagnosis and the result of the Alvarado score applied a posteriori. Ultrasound was not always contributory to the diagnosis of acute appendicitis. It could be reserved for patients whose clinical and laboratory score indicated that appendicitis was unlikely.

关键词： Acute Appendicitis Diagnosis Ultrasound Examination Burkina Faso Alvarado Score

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