This comprehensive review explores the intricate relationship between nutrition,the gut microbiome,steroid hormones,and Parkinson's disease within the context of the gut-brain axis.The gut-brain axis plays a pivot...This comprehensive review explores the intricate relationship between nutrition,the gut microbiome,steroid hormones,and Parkinson's disease within the context of the gut-brain axis.The gut-brain axis plays a pivotal role in neurodegenerative diseases like Parkinson's disease,encompassing diverse components such as the gut microbiota,immune system,metabolism,and neural pathways.The gut microbiome,profoundly influenced by dietary factors,emerges as a key player.Nutrition during the first 1000 days of life shapes the gut microbiota composition,influencing immune responses and impacting both child development and adult health.High-fat,high-sugar diets can disrupt this delicate balance,contributing to inflammation and immune dysfunction.Exploring nutritional strategies,the Mediterranean diet's anti-inflammatory and antioxidant properties show promise in reducing Parkinson's disease risk.Microbiome-targeted dietary approaches and the ketogenic diet hold the potential in improving brain disorders.Beyond nutrition,emerging research uncovers potential interactions between steroid hormones,nutrition,and Parkinson's disease.Progesterone,with its anti-inflammatory properties and presence in the nervous system,offers a novel option for Parkinson's disease therapy.Its ability to enhance neuroprotection within the enteric nervous system presents exciting prospects.The review addresses the hypothesis thatα-synuclein aggregates originate from the gut and may enter the brain via the vagus nerve.Gastrointestinal symptoms preceding motor symptoms support this hypothesis.Dysfunctional gut-brain signaling during gut dysbiosis contributes to inflammation and neurotransmitter imbalances,emphasizing the potential of microbiota-based interventions.In summary,this review uncovers the complex web of interactions between nutrition,the gut microbiome,steroid hormones,and Parkinson's disease within the gut-brain axis framework.Understanding these connections not only offers novel therapeutic insights but also illuminates the origins of neurodegenerative diseases such as Parkinson's disease.展开更多
BACKGROUND Many studies have addressed safety and effectiveness of non-anaesthesiologist propofol sedation(NAPS)for gastrointestinal(GI)endoscopy Target controlled infusion(TCI)is claimed to provide an optimal sedatio...BACKGROUND Many studies have addressed safety and effectiveness of non-anaesthesiologist propofol sedation(NAPS)for gastrointestinal(GI)endoscopy Target controlled infusion(TCI)is claimed to provide an optimal sedation regimen by avoiding under-or oversedation.AIM To assess safety and performance of propofol TCI sedation in comparison with nurse-administered bolus-sedation.METHODS Fouty-five patients undergoing endoscopy under TCI propofol sedation were prospectively included from November 2016 to May 2017 and compared to 87 patients retrospectively included that underwent endoscopy with NAPS.Patients were matched for age and endoscopic procedure.We recorded time of sedation and endoscopy,dosage of medication and adverse events.RESULTS There was a significant reduction in dose per time of propofol administered in the TCI group,compared to the NAPS group(8.2±2.7 mg/min vs 9.3±3.4 mg/min;P=0.046).The time needed to provide adequate sedation levels was slightly but significantly lower in the control group(5.3±2.7 min vs 7.7±3.3 min;P<0.001),nonetheless the total endoscopy time was similar in both groups.No differences between TCI and bolus-sedation was observed for mean total-dosage of propofol rate as well as adverse events.CONCLUSION This study indicates that sedation using TCI for GI endoscopy reduces the dose of propofol necessary per minute of endoscopy.This may translate into less adverse events.However,further and randomized trials need to confirm this trend.展开更多
<span style="font-family:Verdana;">Pyothoraxes, also called thoracic empyemas, are defined by the presence between the two layers of the pleura, of a frankly purulent liquid, or of a shady or clear liq...<span style="font-family:Verdana;">Pyothoraxes, also called thoracic empyemas, are defined by the presence between the two layers of the pleura, of a frankly purulent liquid, or of a shady or clear liquid but containing a majority of altered polynuclear cells with germs direct examination. They are said to be traumatic when they follow a </span><span style="font-family:Verdana;">thoracic trauma whatever the mechanism;usually a pre-existing post-traumatic</span><span style="font-family:Verdana;"> pleural effusion. The general objective of this study was to help identify the epidemiological and prognostic factors in the management of post-traumatic pyothorax in the Thoracic Surgery Department of the Donka National Hospital.</span><b><span style="font-family:Verdana;"> Methodology: </span></b><span style="font-family:Verdana;">This was a descriptive retrospective study covering a period of 2.5 years from 01/06/2016 to 31/12/2018 carried out in the Thoracic Surgery Department of the Donka National Hospital.</span><b><span style="font-family:Verdana;"> Results</span></b><b><span style="font-family:Verdana;" "="">:</span><span "=""> </span></b><span "=""><span style="font-family:Verdana;">During the study period, 17 cases of post-traumatic pyothorax were observed among the 288 files of admitted and hospitalized patients. In the course of this study, a rate was 5.90%. The most affected age group was 1 to 5 years old. The male sex was in the majority (76.5%). The most common occurrence was the fall, </span><i><span style="font-family:Verdana;">i.e.</span></i><span style="font-family:Verdana;"> 41.2%. 47% of patients consult after 60 days. Chest pain and dyspnea were the main symptoms during our study (82.3%). Antibiotics and analgesics dominated the medical treatment used in 100% of the cases and pleural drainage was the first line surgical treatment practiced in 88.2% of the cases. The prognosis is favorable without sequelae in 52.9% of cases with an average hospital stay of 9 days. Post-traumatic pyothorax is a serious pathology involving the vital and functional respiratory prognosis, hence the need to diagnose and treat it early.</span></span>展开更多
Pancreatic neuroendocrine neoplasms are a rare and complex group of neoplastic lesions that develop from pancreatic islet cells.Their incidence has dramatically increased during the last two decades.Due to its complex...Pancreatic neuroendocrine neoplasms are a rare and complex group of neoplastic lesions that develop from pancreatic islet cells.Their incidence has dramatically increased during the last two decades.Due to its complex nature and pathophysiological behaviour,surgical management continues to evolve.Surgery remains the cornerstone of treatment for most non-functional and functional pancreatic neuroendocrine tumours,while lymphadenectomy remains a controversial subject.Different techniques,such as pancreas-preserving and minimally invasive approaches,continue to evolve and offer the same overall outcomes as open surgery.This comprehensive review describes in detail the current and most up-todate classification and staging of pancreatic neuroendocrine tumours,explores the rationale for nonsurgical and surgical management,and focuses on surgical treatment and more specifically,on minimally invasive approaches.展开更多
AIM:To assesse the rate of bile duct injuries(BDI)and overall biliary complications during single-port laparoscopic cholecystectomy(SPLC)compared to conventional laparoscopic cholecystectomy(CLC).METHODS:SPLC has rece...AIM:To assesse the rate of bile duct injuries(BDI)and overall biliary complications during single-port laparoscopic cholecystectomy(SPLC)compared to conventional laparoscopic cholecystectomy(CLC).METHODS:SPLC has recently been proposed as an innovative surgical approach for gallbladder surgery.So far,its safety with respect to bile duct injuries has not been specifically evaluated.A systematic review of the literature published between January 1990 and November 2012 was performed.Randomized controlled trials(RCT)comparing SPLC versus CLC reporting BDI rate and overall biliary complications were included.The quality of RCT was assessed using the Jadad score.Analysis was made by performing a meta-analysis,using Review Manager 5.2.This study was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.A retrospective study including all retrospective reports on SPLC was also performed alongside.RESULTS:From 496 publications,11 RCT including 898patients were selected for meta-analysis.No studies were rated as high quality(Jadad score≥4).Operative indications included benign gallbladder disease operated in an elective setting in all studies,excluding all emergency cases and acute cholecystitis.The median follow-up was 1 mo(range 0.03-18 mo).The incidence of BDI was 0.4%for SPLC and 0%for CLC;the difference was not statistically different(P=0.36).The incidence of overall biliary complication was 1.6%for SPLC and 0.5%for CLC,the difference did not reached statistically significance(P=0.21,95%CI:0.66-15).Sixty non-randomized trials including 3599 patients were also analysed.The incidence of BDI reported then was 0.7%.CONCLUSION:The safety of SPLC cannot be assumed,based on the current evidence.Hence,this new technology cannot be recommended as standard technique for laparoscopic cholecystectomy.展开更多
AIM:To examine the long-term results of endoscopic treatment in a prospective study conducted over a period of 10 years,1997 to January 2007.METHODS:A total of 25 patients(20 female and five male:aged 18-75 years),wit...AIM:To examine the long-term results of endoscopic treatment in a prospective study conducted over a period of 10 years,1997 to January 2007.METHODS:A total of 25 patients(20 female and five male:aged 18-75 years),with at least one symptom of stricture not passable with the standard colonoscope and with a confirmed scarred Crohn's stricture of the lower gastrointestinal tract,were included in the study.The main symptom was abdominal pain.The endoscopic balloon dilatation was performed with an 18 mm balloon under endoscopic and radiological control.RESULTS:Eleven strictures were located in the colon,13 at the anastomosis after ileocecal resection,three at the Bauhin valve and four in the ileum.Four patients had two strictures and one patient had three strictures.Of the 31 strictures,in 30 was balloon dilatation successful in a single endoscopic session,so that eventually the strictures could be passed easily with the standard colonoscope.In one patient with a long stricture of the ileum involving the Bauhin valve and an additional stricture of the ileum which were 15 cm apart,sufficient dilatation was not possible.This patient therefore required surgery.Improvement of abdominal symptoms was achieved in all cases which had technically successful balloon dilatation,althoughin one case perforation occurred after dilatation of a recurrent stricture.Available follow-up was in the range of 54-118 mo(mean of 81 mo).The relapse rate over this period was 46%,but 64% of relapsing strictures could be successfully dilated again.Only in four patients was surgery required during this follow-up period.CONCLUSION:We conclude from these initial results that endoscopic balloon dilatation,especially for short strictures in Crohn's disease,can be performed with reliable success.Perforation is a rare complication.It is our opinion that in the long-term,the relapse rate is probably higher than after surgery,but usually a second endoscopic treatment can be performed successfully,leading to a considerable success rate of the endoscopic procedure.展开更多
Liver transplantation represents the only curative option for patients with endstage liver disease,fulminant hepatitis and advanced hepatocellular carcinoma.Even though major advances in transplantation in the last de...Liver transplantation represents the only curative option for patients with endstage liver disease,fulminant hepatitis and advanced hepatocellular carcinoma.Even though major advances in transplantation in the last decades have achieved excellent survival rates in the early post-transplantation period,long-term survival is hampered by the lack of improvement in survival in the late post transplantation period(over 5 years after transplantation).The main etiologies for late mortality are malignancies and cardiovascular complications.The latter are increasingly prevalent in liver transplant recipients due to the development or worsening of metabolic syndrome and all its components(arterial hypertension,dyslipidemia,obesity,renal injury,etc.).These comorbidities result from a combination of pre-liver transplant features,immunosuppressive agent side-effects,changes in metabolism and hemodynamics after liver transplantation and the adoption of a sedentary lifestyle.In this review we describe the most prevalent metabolic and cardiovascular complications present after liver transplantation,as well as proposing management strategies.展开更多
Alpha-fetoprotein(AFP) is the main tumor biomarker available for the management of hepatocellular carcinoma(HCC). Although it is neither a good screening test nor an accurate diagnostic tool for HCC, it seems to be a ...Alpha-fetoprotein(AFP) is the main tumor biomarker available for the management of hepatocellular carcinoma(HCC). Although it is neither a good screening test nor an accurate diagnostic tool for HCC, it seems to be a possible prognostic marker. However, its contribution in liver transplantation for HCC has not been fully determined, although its use to predict recurrence after liver transplantation has been underlined by international societies. In an era of organ shortages, it could also have a key role in the selection of patients eligible for liver transplantation. Yet unanswered questions remain. First, the cut-off value of serum AFP above which liver transplantation should not be performed is still a subject of debate. We show that a concentration of 1000 ng/m L could be an exclusion criterion, whereas values of < 15 ng/m L indicate patients with an excellent prognosis whatever the size and number of tumors. Monitoring the dynamics of AFP could also prove useful. However, evidence is lacking regarding the values that should be used. Today, the real input of AFP seems to be its integration into new criteria to select patients eligible for a liver transplantation. These recent tools have associated AFP values with morphological criteria, thus refining pre-existing criteria, such as Milan, University of California, San Francisco, or "up-to-seven". We provide a review of the different criteria submitted within the past years. Finally, AFP can be used to monitor recurrence after transplantation, although there is little evidence to support this claim. Future challenges will be to draft new international guidelines to implement the use of AFP as a selection tool, and to determine a clear cut-off value above which liver transplantation should not be performed.展开更多
BACKGROUND Inflammatory myofibroblastic tumors of the liver(IMTL)are extremely rare neoplasms and very little is known about their clinical presentation,pathogenesis,and biological behavior.Due to their absolute rarit...BACKGROUND Inflammatory myofibroblastic tumors of the liver(IMTL)are extremely rare neoplasms and very little is known about their clinical presentation,pathogenesis,and biological behavior.Due to their absolute rarity,it is almost impossible to obtain a definite diagnosis without histological examination.Because of their intermediate biological behavior with the risk for local recurrence and metastases,surgical resection is recommend whenever IMTL is suspect.CASE SUMMARY We herein present a case of an otherwise healthy 32-year-old woman who presented with intermittent fever,unclear anemia,malaise and right flank pain 4 mo postpartum.The liver mass in segment IVa/b was highly FDG avid in the positron emission tomography-computed tomography.Hepatic resection was performed achieving a negative resection margin and an immediate resolution of all clinical symptoms.Histological analysis diagnosed the rare finding of an inflammatory myofibroblastic tumor of the liver and revealed cytoplasmic anaplastic lymphoma kinase expression by immunohistochemistry.Twelve months follow-up magnetic resonance imaging showed no recurrence and no metastases in the fully recovered patient.CONCLUSION IMTLs are extremely rare and difficult to diagnose.Due to their intermediate biological behavior,surgical resection should be perform whenever feasible and patients should be followed-up in order to detect recurrence and metastasis as early as possible.展开更多
AIM To identify a preoperative blood marker predictive of alveolar echinococcosis(AE) recurrence after hepatectomy.METHODS All consecutive patients who underwent operation for liver AE at the Lausanne University Hospi...AIM To identify a preoperative blood marker predictive of alveolar echinococcosis(AE) recurrence after hepatectomy.METHODS All consecutive patients who underwent operation for liver AE at the Lausanne University Hospital(CHUV) between January 1992 and December 2015 were included in this retrospective study. Preoperative laboratory values of leukocytes, mean corpuscular volume(MCV), red blood cell distribution width(RDW), thrombocytes, C-reactive protein(CRP) and albumin were collected and analyzed. Univariate and multivariate Cox regression analyses were performed to determine the risk factors for AE recurrence after liver resection. A receiver operating characteristic(ROC) curve was used to define the best discrimination threshold of the blood marker. Moreover, recurrencefree survival curves were calculated using the KaplanMeier method.RESULTS The cohort included 68 adult patients(37 females) with median age of 61 years [interquartile range(IQR): 46-71]. Eight of the patients(12%) presented a recurrence over a median follow-up time of 76 mo(IQR: 34-128). Median time to recurrence was 10 mo(IQR: 6-11). Median preoperative leukocyte, MCV, RDW,thrombocyte and CRP levels were similar between recurrent and non-recurrent cases. Median preoperative albumin level was 43 g/L(IQR: 41-45) for nonrecurrent cases and 36 g/L(IQR: 33-42) for recurrent cases(P = 0.005). The area under the ROC curve for preoperative albumin level to predict recurrence was 0.840(95%CI: 0.642-1, P = 0.002). The cutoff albumin level value was 37.5 g/L for sensitivity of 94.5% and specificity of 75%. In multivariate analysis, preoperative albumin and surgical resection margins were independent predictors of AE recurrence(HR = 0.099, P = 0.007 and HR = 0.182, P = 0.045 respectively).CONCLUSION Low preoperative albumin level was associated with AE recurrence in the present cohort. Thus, preoperative albumin may be a useful biomarker to guide follow-up.展开更多
Objective: To describe the etiological, clinical and therapeutic aspects of adults’ intussusception at Yalgado Ouedraogo University Hospital in Ouagadougou (CHU-YO), Burkina Faso. Patients and method: This descriptiv...Objective: To describe the etiological, clinical and therapeutic aspects of adults’ intussusception at Yalgado Ouedraogo University Hospital in Ouagadougou (CHU-YO), Burkina Faso. Patients and method: This descriptive cross-sectional study was conducted between May 2011 and April 2016 at CHU-YO. All patients with 16 years of age and older operated on for intussusception were included. Results: Thirty patients were identified, 15 men and as many women. Their average age was 37.3 years. A higher frequency was noted between 30 and 39 years. The installation of the symptomatology was insidious in 22 cases and brutal in 8 cases. The reasons for consultation were abdominal pain (30 cases), vomiting (19 cases), intestinal transit stop (18 cases) and rectorrhagia (9 cases). Physical examination noted an abdominal mass in 11 cases and a localized abdominal tenderness in 7 cases. An intussusception coil was identified on ultrasound in 9 cases. All patients underwent surgery under general anesthesia and the approach was laparotomy. Intraoperatively, the intussusception was ileocolic in 15 cases;a right hemi-colectomy was performed. It was colo-colic intussusception in 10 cases and the treatment thus consisted of a left hemi-colectomy. In other 5 cases, intussusception was ileal, requiring ileal resection. The average hospital stay was 11.7 days. Pathologically, the examination was normal in 2 cases. A colic tumor was found in 14 cases and an ileum tumor in 6 cases. In the other 8 cases, it was an inflammatory aspect of the intestine. Conclusion: In tropical Burkina Faso, adult intussusception often occurs on an intestinal tumor. The symptomatology is atypical.展开更多
Over the past decades, cancer has become one of the toughest challenges for health professionals. The epidemiologists are increasingly directing their research efforts on various malignant tumor worldwide. Of note, in...Over the past decades, cancer has become one of the toughest challenges for health professionals. The epidemiologists are increasingly directing their research efforts on various malignant tumor worldwide. Of note, incidence of cancers is on the rise more quickly in developed countries. Indeed, great endeavors have to be made in the control of the life-threatening disease. As we know it, pancreatic cancer(PC) is a malignant disease with the worst prognosis. While little is known about the etiology of the PC and measures to prevent the condition, so far, a number of risk factors have been identified. Genetic factors, pre-malignant lesions, predisposing diseases and exogenous factors have been found to be linked to PC. Genetic susceptibility was observed in 10% of PC cases, including inherited PC syndromes and familial PC. However, in the remaining 90%, their PC might be caused by genetic factors in combination with environmental factors. Nonetheless, the exact mechanism of the two kinds of factors, endogenous and exogenous, working together to cause PC remains poorly understood. The fact that most pancreatic neoplasms are diagnosed at an incurable stage of the disease highlights the need to identify risk factors and to understand their contribution to carcinogenesis. This article reviews the high risk factors contributing to the development of PC, to provide information for clinicians and epidemiologists.展开更多
BACKGROUND Pancreaticoduodenectomy(PD)-induced morbidity, consisting mainly of the pancreatic fistula and its hemorrhagic and infectious consequences, is well described in the literature, in terms of its definition, r...BACKGROUND Pancreaticoduodenectomy(PD)-induced morbidity, consisting mainly of the pancreatic fistula and its hemorrhagic and infectious consequences, is well described in the literature, in terms of its definition, risk factors, preventive measures, and standardized management of complications. However, some lifethreatening complications remain atypical and undescribed. CASE SUMMARY We report here the case of a 69-year-old patient with Budd-Chiari syndrome that occurred after arterial embolization of postpancreatectomy hemorrhage. Diagnosis was established with biological findings(i.e., acute liver failure) and radiological findings(i.e., compressive hematoma of the retrohepatic vena cava). Emergency surgical revision was performed to evacuate the hematoma. The postoperative course was uneventful, with rapid recovery of liver function. To our knowledge, post-PD Budd-Chiari syndrome has never been described in the literature. CONCLUSION Acute liver failure in early post-PD should prompt investigation to rule out Budd-Chiari syndrome.展开更多
BACKGROUND Focal nodular hyperplasia(FNH)and hepatocellular adenoma(HCA)are wellknown benign liver lesions.Surgical treatment is usually chosen for symptomatic patients,lesions more than 5 cm,and uncertainty of diagno...BACKGROUND Focal nodular hyperplasia(FNH)and hepatocellular adenoma(HCA)are wellknown benign liver lesions.Surgical treatment is usually chosen for symptomatic patients,lesions more than 5 cm,and uncertainty of diagnosis.CASE SUMMARY We described the case of a large liver composite tumor in an asymptomatic 34-year-old female under oral contraceptive for 17-years.The imaging work-out described two components in this liver tumor;measuring 6 cm×6 cm and 14 cm×12 cm×6 cm.The multidisciplinary team suggested surgery for this young woman with an unclear HCA diagnosis.She underwent a laparoscopic left liver lobectomy,with an uneventful postoperative course.Final pathological examination confirmed FNH associated with a large HCA.This manuscript aimed to make a literature review of the current management in this particular situation of large simultaneous benign liver tumors.CONCLUSION The simultaneous presence of benign composite liver tumors is rare.This case highlights the management in a multidisciplinary team setting.展开更多
The realm of extended criteria liver transplantation created the'adjacent possible'for dynamic organ preservation.Machine perfusion of the liver greatly expanded donor organ preservation possibilities,reaching...The realm of extended criteria liver transplantation created the'adjacent possible'for dynamic organ preservation.Machine perfusion of the liver greatly expanded donor organ preservation possibilities,reaching before unattainable goals,including the mitigation of ischemia-reperfusion injury,viability assessment,and organ reconditioning prior to transplantation.However,current scientific evidence lacks uniformity between studies,perfusion protocols,and acceptance criteria.Construction of collaborative research networks for sharing knowledge should,therefore,enable the development of high-level evidence and guidelines for machine perfusion utilization,including donor acceptance criteria.Finally,this approach shall guarantee conditions for further progress to occur.展开更多
Refractory ascites(RA)is a frequent and life-threatening complication of cirrhosis.In selected patients with RA,transjugular intrahepatic portosystemic shunt(TIPS)placement and liver transplantation(LT)are currently c...Refractory ascites(RA)is a frequent and life-threatening complication of cirrhosis.In selected patients with RA,transjugular intrahepatic portosystemic shunt(TIPS)placement and liver transplantation(LT)are currently considered the best therapeutic alternatives to repeated large volume paracentesis.In patients with a contraindication to TIPS or LT,the alfapump®system(Sequana Medical,Ghent,Belgium)has been developed to reduce the need for iterative paracentesis,and consequently to improve the quality of life and nutritional status.We report here recent data on technical progress made since the first implantation,the efficacy and tolerance of the device,the position of the pump in the therapeutic arsenal for refractory ascites,and the grey areas that remain to be clarified regarding the optimal selection of patients who are potential candidates for this treatment.展开更多
Hepatic hydatid cyst is a rare parasitic affection which constitutes a major health problem in countries endemic to hydatidosis. Rupture of hydatid cyst into gallbladder is an exceptional complication first described ...Hepatic hydatid cyst is a rare parasitic affection which constitutes a major health problem in countries endemic to hydatidosis. Rupture of hydatid cyst into gallbladder is an exceptional complication first described in 1952 by Atlas and Kamenear. We report the case of a hepatic hydatid cyst rupture into gallbladder in a 31-year-old patient with no history of disease.展开更多
Textiloma is a rare pathological entity which can possibly complicate any surgery. Its incidence, reported in literature, is estimated between 1/1000 and 1/15,000. Abdominal and gynecological surgeries are responsible...Textiloma is a rare pathological entity which can possibly complicate any surgery. Its incidence, reported in literature, is estimated between 1/1000 and 1/15,000. Abdominal and gynecological surgeries are responsible for the vast of majority of intra abdominal textiloma. Very few cases of spontaneous rectal expulsion of textiloma have been reported. We report the case of rectal expulsion of textiloma in a 26-year-old female who had undergone a C section for dynamic dystocia a year prior to her admission.展开更多
Objective: Sentinel lymph node biopsy (SLNB) is a validated staging technique for breast carcinoma. Some women are exposed to have a second SLNB due to breast cancer recurrence or a second neoplasia (breast or other)....Objective: Sentinel lymph node biopsy (SLNB) is a validated staging technique for breast carcinoma. Some women are exposed to have a second SLNB due to breast cancer recurrence or a second neoplasia (breast or other). Due to modified anatomy, it has been claimed that previous axillary surgery represents a contra-indication to SLNB. Our objective was to analyse the literature to assess if a second SLNB is to be recommended or not. Methods: For the present study, we performed a review of all published data during the last 10 years on patients with previous axilla surgery and second SLNB. Results: Our analysis shows that second SLNB is feasible in 70%. Extra-axillary SNs rate (31%) was higher after radical lymph node dissection (ALND) (60% - 84%) than after SLNB alone (14% - 65%). Follow-up and complementary ALND following negative and positive second SLNB shows that it is a reliable procedure. Conclusion: The review of literature confirms that SLNB is feasible after previous axillary dissection. Triple technique for SN mapping is the best examination to highlight modified lymphatic anatomy and shows definitively where SLNB must be performed. Surgery may be more demanding as patients may have more frequently extra-axillary SN only, like internal mammary nodes. ALND can be avoided when second SLNB harvests negative SNs. These conclusions should however be taken with caution because of the heterogeneity of publications regarding SLNB and surgical technique.展开更多
Neuroendocrine tumors (NET) of the gallbladder are a rare entity with only 0.2% of all NET located in the gall bladder. Well-differentiated NETs occur at a relatively lower age group unlike other gallbladder tumors, w...Neuroendocrine tumors (NET) of the gallbladder are a rare entity with only 0.2% of all NET located in the gall bladder. Well-differentiated NETs occur at a relatively lower age group unlike other gallbladder tumors, whereas neuroendocrine carcinoma (NEC) occurs in an older category of patients. The aim of our study is to discuss the current level of evidence regarding this pathological entity by means of a rare case report on a neuroendocrine carcinoma of the gall bladder in a 63-year-old patient with a history of diabetes. Patient underwent cholecystectomy for acute cholecystitis. Pathology findings on surgical specimen came back for neuroendocrine tumour.展开更多
文摘This comprehensive review explores the intricate relationship between nutrition,the gut microbiome,steroid hormones,and Parkinson's disease within the context of the gut-brain axis.The gut-brain axis plays a pivotal role in neurodegenerative diseases like Parkinson's disease,encompassing diverse components such as the gut microbiota,immune system,metabolism,and neural pathways.The gut microbiome,profoundly influenced by dietary factors,emerges as a key player.Nutrition during the first 1000 days of life shapes the gut microbiota composition,influencing immune responses and impacting both child development and adult health.High-fat,high-sugar diets can disrupt this delicate balance,contributing to inflammation and immune dysfunction.Exploring nutritional strategies,the Mediterranean diet's anti-inflammatory and antioxidant properties show promise in reducing Parkinson's disease risk.Microbiome-targeted dietary approaches and the ketogenic diet hold the potential in improving brain disorders.Beyond nutrition,emerging research uncovers potential interactions between steroid hormones,nutrition,and Parkinson's disease.Progesterone,with its anti-inflammatory properties and presence in the nervous system,offers a novel option for Parkinson's disease therapy.Its ability to enhance neuroprotection within the enteric nervous system presents exciting prospects.The review addresses the hypothesis thatα-synuclein aggregates originate from the gut and may enter the brain via the vagus nerve.Gastrointestinal symptoms preceding motor symptoms support this hypothesis.Dysfunctional gut-brain signaling during gut dysbiosis contributes to inflammation and neurotransmitter imbalances,emphasizing the potential of microbiota-based interventions.In summary,this review uncovers the complex web of interactions between nutrition,the gut microbiome,steroid hormones,and Parkinson's disease within the gut-brain axis framework.Understanding these connections not only offers novel therapeutic insights but also illuminates the origins of neurodegenerative diseases such as Parkinson's disease.
文摘BACKGROUND Many studies have addressed safety and effectiveness of non-anaesthesiologist propofol sedation(NAPS)for gastrointestinal(GI)endoscopy Target controlled infusion(TCI)is claimed to provide an optimal sedation regimen by avoiding under-or oversedation.AIM To assess safety and performance of propofol TCI sedation in comparison with nurse-administered bolus-sedation.METHODS Fouty-five patients undergoing endoscopy under TCI propofol sedation were prospectively included from November 2016 to May 2017 and compared to 87 patients retrospectively included that underwent endoscopy with NAPS.Patients were matched for age and endoscopic procedure.We recorded time of sedation and endoscopy,dosage of medication and adverse events.RESULTS There was a significant reduction in dose per time of propofol administered in the TCI group,compared to the NAPS group(8.2±2.7 mg/min vs 9.3±3.4 mg/min;P=0.046).The time needed to provide adequate sedation levels was slightly but significantly lower in the control group(5.3±2.7 min vs 7.7±3.3 min;P<0.001),nonetheless the total endoscopy time was similar in both groups.No differences between TCI and bolus-sedation was observed for mean total-dosage of propofol rate as well as adverse events.CONCLUSION This study indicates that sedation using TCI for GI endoscopy reduces the dose of propofol necessary per minute of endoscopy.This may translate into less adverse events.However,further and randomized trials need to confirm this trend.
文摘<span style="font-family:Verdana;">Pyothoraxes, also called thoracic empyemas, are defined by the presence between the two layers of the pleura, of a frankly purulent liquid, or of a shady or clear liquid but containing a majority of altered polynuclear cells with germs direct examination. They are said to be traumatic when they follow a </span><span style="font-family:Verdana;">thoracic trauma whatever the mechanism;usually a pre-existing post-traumatic</span><span style="font-family:Verdana;"> pleural effusion. The general objective of this study was to help identify the epidemiological and prognostic factors in the management of post-traumatic pyothorax in the Thoracic Surgery Department of the Donka National Hospital.</span><b><span style="font-family:Verdana;"> Methodology: </span></b><span style="font-family:Verdana;">This was a descriptive retrospective study covering a period of 2.5 years from 01/06/2016 to 31/12/2018 carried out in the Thoracic Surgery Department of the Donka National Hospital.</span><b><span style="font-family:Verdana;"> Results</span></b><b><span style="font-family:Verdana;" "="">:</span><span "=""> </span></b><span "=""><span style="font-family:Verdana;">During the study period, 17 cases of post-traumatic pyothorax were observed among the 288 files of admitted and hospitalized patients. In the course of this study, a rate was 5.90%. The most affected age group was 1 to 5 years old. The male sex was in the majority (76.5%). The most common occurrence was the fall, </span><i><span style="font-family:Verdana;">i.e.</span></i><span style="font-family:Verdana;"> 41.2%. 47% of patients consult after 60 days. Chest pain and dyspnea were the main symptoms during our study (82.3%). Antibiotics and analgesics dominated the medical treatment used in 100% of the cases and pleural drainage was the first line surgical treatment practiced in 88.2% of the cases. The prognosis is favorable without sequelae in 52.9% of cases with an average hospital stay of 9 days. Post-traumatic pyothorax is a serious pathology involving the vital and functional respiratory prognosis, hence the need to diagnose and treat it early.</span></span>
文摘Pancreatic neuroendocrine neoplasms are a rare and complex group of neoplastic lesions that develop from pancreatic islet cells.Their incidence has dramatically increased during the last two decades.Due to its complex nature and pathophysiological behaviour,surgical management continues to evolve.Surgery remains the cornerstone of treatment for most non-functional and functional pancreatic neuroendocrine tumours,while lymphadenectomy remains a controversial subject.Different techniques,such as pancreas-preserving and minimally invasive approaches,continue to evolve and offer the same overall outcomes as open surgery.This comprehensive review describes in detail the current and most up-todate classification and staging of pancreatic neuroendocrine tumours,explores the rationale for nonsurgical and surgical management,and focuses on surgical treatment and more specifically,on minimally invasive approaches.
文摘AIM:To assesse the rate of bile duct injuries(BDI)and overall biliary complications during single-port laparoscopic cholecystectomy(SPLC)compared to conventional laparoscopic cholecystectomy(CLC).METHODS:SPLC has recently been proposed as an innovative surgical approach for gallbladder surgery.So far,its safety with respect to bile duct injuries has not been specifically evaluated.A systematic review of the literature published between January 1990 and November 2012 was performed.Randomized controlled trials(RCT)comparing SPLC versus CLC reporting BDI rate and overall biliary complications were included.The quality of RCT was assessed using the Jadad score.Analysis was made by performing a meta-analysis,using Review Manager 5.2.This study was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.A retrospective study including all retrospective reports on SPLC was also performed alongside.RESULTS:From 496 publications,11 RCT including 898patients were selected for meta-analysis.No studies were rated as high quality(Jadad score≥4).Operative indications included benign gallbladder disease operated in an elective setting in all studies,excluding all emergency cases and acute cholecystitis.The median follow-up was 1 mo(range 0.03-18 mo).The incidence of BDI was 0.4%for SPLC and 0%for CLC;the difference was not statistically different(P=0.36).The incidence of overall biliary complication was 1.6%for SPLC and 0.5%for CLC,the difference did not reached statistically significance(P=0.21,95%CI:0.66-15).Sixty non-randomized trials including 3599 patients were also analysed.The incidence of BDI reported then was 0.7%.CONCLUSION:The safety of SPLC cannot be assumed,based on the current evidence.Hence,this new technology cannot be recommended as standard technique for laparoscopic cholecystectomy.
文摘AIM:To examine the long-term results of endoscopic treatment in a prospective study conducted over a period of 10 years,1997 to January 2007.METHODS:A total of 25 patients(20 female and five male:aged 18-75 years),with at least one symptom of stricture not passable with the standard colonoscope and with a confirmed scarred Crohn's stricture of the lower gastrointestinal tract,were included in the study.The main symptom was abdominal pain.The endoscopic balloon dilatation was performed with an 18 mm balloon under endoscopic and radiological control.RESULTS:Eleven strictures were located in the colon,13 at the anastomosis after ileocecal resection,three at the Bauhin valve and four in the ileum.Four patients had two strictures and one patient had three strictures.Of the 31 strictures,in 30 was balloon dilatation successful in a single endoscopic session,so that eventually the strictures could be passed easily with the standard colonoscope.In one patient with a long stricture of the ileum involving the Bauhin valve and an additional stricture of the ileum which were 15 cm apart,sufficient dilatation was not possible.This patient therefore required surgery.Improvement of abdominal symptoms was achieved in all cases which had technically successful balloon dilatation,althoughin one case perforation occurred after dilatation of a recurrent stricture.Available follow-up was in the range of 54-118 mo(mean of 81 mo).The relapse rate over this period was 46%,but 64% of relapsing strictures could be successfully dilated again.Only in four patients was surgery required during this follow-up period.CONCLUSION:We conclude from these initial results that endoscopic balloon dilatation,especially for short strictures in Crohn's disease,can be performed with reliable success.Perforation is a rare complication.It is our opinion that in the long-term,the relapse rate is probably higher than after surgery,but usually a second endoscopic treatment can be performed successfully,leading to a considerable success rate of the endoscopic procedure.
文摘Liver transplantation represents the only curative option for patients with endstage liver disease,fulminant hepatitis and advanced hepatocellular carcinoma.Even though major advances in transplantation in the last decades have achieved excellent survival rates in the early post-transplantation period,long-term survival is hampered by the lack of improvement in survival in the late post transplantation period(over 5 years after transplantation).The main etiologies for late mortality are malignancies and cardiovascular complications.The latter are increasingly prevalent in liver transplant recipients due to the development or worsening of metabolic syndrome and all its components(arterial hypertension,dyslipidemia,obesity,renal injury,etc.).These comorbidities result from a combination of pre-liver transplant features,immunosuppressive agent side-effects,changes in metabolism and hemodynamics after liver transplantation and the adoption of a sedentary lifestyle.In this review we describe the most prevalent metabolic and cardiovascular complications present after liver transplantation,as well as proposing management strategies.
文摘Alpha-fetoprotein(AFP) is the main tumor biomarker available for the management of hepatocellular carcinoma(HCC). Although it is neither a good screening test nor an accurate diagnostic tool for HCC, it seems to be a possible prognostic marker. However, its contribution in liver transplantation for HCC has not been fully determined, although its use to predict recurrence after liver transplantation has been underlined by international societies. In an era of organ shortages, it could also have a key role in the selection of patients eligible for liver transplantation. Yet unanswered questions remain. First, the cut-off value of serum AFP above which liver transplantation should not be performed is still a subject of debate. We show that a concentration of 1000 ng/m L could be an exclusion criterion, whereas values of < 15 ng/m L indicate patients with an excellent prognosis whatever the size and number of tumors. Monitoring the dynamics of AFP could also prove useful. However, evidence is lacking regarding the values that should be used. Today, the real input of AFP seems to be its integration into new criteria to select patients eligible for a liver transplantation. These recent tools have associated AFP values with morphological criteria, thus refining pre-existing criteria, such as Milan, University of California, San Francisco, or "up-to-seven". We provide a review of the different criteria submitted within the past years. Finally, AFP can be used to monitor recurrence after transplantation, although there is little evidence to support this claim. Future challenges will be to draft new international guidelines to implement the use of AFP as a selection tool, and to determine a clear cut-off value above which liver transplantation should not be performed.
文摘BACKGROUND Inflammatory myofibroblastic tumors of the liver(IMTL)are extremely rare neoplasms and very little is known about their clinical presentation,pathogenesis,and biological behavior.Due to their absolute rarity,it is almost impossible to obtain a definite diagnosis without histological examination.Because of their intermediate biological behavior with the risk for local recurrence and metastases,surgical resection is recommend whenever IMTL is suspect.CASE SUMMARY We herein present a case of an otherwise healthy 32-year-old woman who presented with intermittent fever,unclear anemia,malaise and right flank pain 4 mo postpartum.The liver mass in segment IVa/b was highly FDG avid in the positron emission tomography-computed tomography.Hepatic resection was performed achieving a negative resection margin and an immediate resolution of all clinical symptoms.Histological analysis diagnosed the rare finding of an inflammatory myofibroblastic tumor of the liver and revealed cytoplasmic anaplastic lymphoma kinase expression by immunohistochemistry.Twelve months follow-up magnetic resonance imaging showed no recurrence and no metastases in the fully recovered patient.CONCLUSION IMTLs are extremely rare and difficult to diagnose.Due to their intermediate biological behavior,surgical resection should be perform whenever feasible and patients should be followed-up in order to detect recurrence and metastasis as early as possible.
文摘AIM To identify a preoperative blood marker predictive of alveolar echinococcosis(AE) recurrence after hepatectomy.METHODS All consecutive patients who underwent operation for liver AE at the Lausanne University Hospital(CHUV) between January 1992 and December 2015 were included in this retrospective study. Preoperative laboratory values of leukocytes, mean corpuscular volume(MCV), red blood cell distribution width(RDW), thrombocytes, C-reactive protein(CRP) and albumin were collected and analyzed. Univariate and multivariate Cox regression analyses were performed to determine the risk factors for AE recurrence after liver resection. A receiver operating characteristic(ROC) curve was used to define the best discrimination threshold of the blood marker. Moreover, recurrencefree survival curves were calculated using the KaplanMeier method.RESULTS The cohort included 68 adult patients(37 females) with median age of 61 years [interquartile range(IQR): 46-71]. Eight of the patients(12%) presented a recurrence over a median follow-up time of 76 mo(IQR: 34-128). Median time to recurrence was 10 mo(IQR: 6-11). Median preoperative leukocyte, MCV, RDW,thrombocyte and CRP levels were similar between recurrent and non-recurrent cases. Median preoperative albumin level was 43 g/L(IQR: 41-45) for nonrecurrent cases and 36 g/L(IQR: 33-42) for recurrent cases(P = 0.005). The area under the ROC curve for preoperative albumin level to predict recurrence was 0.840(95%CI: 0.642-1, P = 0.002). The cutoff albumin level value was 37.5 g/L for sensitivity of 94.5% and specificity of 75%. In multivariate analysis, preoperative albumin and surgical resection margins were independent predictors of AE recurrence(HR = 0.099, P = 0.007 and HR = 0.182, P = 0.045 respectively).CONCLUSION Low preoperative albumin level was associated with AE recurrence in the present cohort. Thus, preoperative albumin may be a useful biomarker to guide follow-up.
文摘Objective: To describe the etiological, clinical and therapeutic aspects of adults’ intussusception at Yalgado Ouedraogo University Hospital in Ouagadougou (CHU-YO), Burkina Faso. Patients and method: This descriptive cross-sectional study was conducted between May 2011 and April 2016 at CHU-YO. All patients with 16 years of age and older operated on for intussusception were included. Results: Thirty patients were identified, 15 men and as many women. Their average age was 37.3 years. A higher frequency was noted between 30 and 39 years. The installation of the symptomatology was insidious in 22 cases and brutal in 8 cases. The reasons for consultation were abdominal pain (30 cases), vomiting (19 cases), intestinal transit stop (18 cases) and rectorrhagia (9 cases). Physical examination noted an abdominal mass in 11 cases and a localized abdominal tenderness in 7 cases. An intussusception coil was identified on ultrasound in 9 cases. All patients underwent surgery under general anesthesia and the approach was laparotomy. Intraoperatively, the intussusception was ileocolic in 15 cases;a right hemi-colectomy was performed. It was colo-colic intussusception in 10 cases and the treatment thus consisted of a left hemi-colectomy. In other 5 cases, intussusception was ileal, requiring ileal resection. The average hospital stay was 11.7 days. Pathologically, the examination was normal in 2 cases. A colic tumor was found in 14 cases and an ileum tumor in 6 cases. In the other 8 cases, it was an inflammatory aspect of the intestine. Conclusion: In tropical Burkina Faso, adult intussusception often occurs on an intestinal tumor. The symptomatology is atypical.
文摘Over the past decades, cancer has become one of the toughest challenges for health professionals. The epidemiologists are increasingly directing their research efforts on various malignant tumor worldwide. Of note, incidence of cancers is on the rise more quickly in developed countries. Indeed, great endeavors have to be made in the control of the life-threatening disease. As we know it, pancreatic cancer(PC) is a malignant disease with the worst prognosis. While little is known about the etiology of the PC and measures to prevent the condition, so far, a number of risk factors have been identified. Genetic factors, pre-malignant lesions, predisposing diseases and exogenous factors have been found to be linked to PC. Genetic susceptibility was observed in 10% of PC cases, including inherited PC syndromes and familial PC. However, in the remaining 90%, their PC might be caused by genetic factors in combination with environmental factors. Nonetheless, the exact mechanism of the two kinds of factors, endogenous and exogenous, working together to cause PC remains poorly understood. The fact that most pancreatic neoplasms are diagnosed at an incurable stage of the disease highlights the need to identify risk factors and to understand their contribution to carcinogenesis. This article reviews the high risk factors contributing to the development of PC, to provide information for clinicians and epidemiologists.
文摘BACKGROUND Pancreaticoduodenectomy(PD)-induced morbidity, consisting mainly of the pancreatic fistula and its hemorrhagic and infectious consequences, is well described in the literature, in terms of its definition, risk factors, preventive measures, and standardized management of complications. However, some lifethreatening complications remain atypical and undescribed. CASE SUMMARY We report here the case of a 69-year-old patient with Budd-Chiari syndrome that occurred after arterial embolization of postpancreatectomy hemorrhage. Diagnosis was established with biological findings(i.e., acute liver failure) and radiological findings(i.e., compressive hematoma of the retrohepatic vena cava). Emergency surgical revision was performed to evacuate the hematoma. The postoperative course was uneventful, with rapid recovery of liver function. To our knowledge, post-PD Budd-Chiari syndrome has never been described in the literature. CONCLUSION Acute liver failure in early post-PD should prompt investigation to rule out Budd-Chiari syndrome.
文摘BACKGROUND Focal nodular hyperplasia(FNH)and hepatocellular adenoma(HCA)are wellknown benign liver lesions.Surgical treatment is usually chosen for symptomatic patients,lesions more than 5 cm,and uncertainty of diagnosis.CASE SUMMARY We described the case of a large liver composite tumor in an asymptomatic 34-year-old female under oral contraceptive for 17-years.The imaging work-out described two components in this liver tumor;measuring 6 cm×6 cm and 14 cm×12 cm×6 cm.The multidisciplinary team suggested surgery for this young woman with an unclear HCA diagnosis.She underwent a laparoscopic left liver lobectomy,with an uneventful postoperative course.Final pathological examination confirmed FNH associated with a large HCA.This manuscript aimed to make a literature review of the current management in this particular situation of large simultaneous benign liver tumors.CONCLUSION The simultaneous presence of benign composite liver tumors is rare.This case highlights the management in a multidisciplinary team setting.
文摘The realm of extended criteria liver transplantation created the'adjacent possible'for dynamic organ preservation.Machine perfusion of the liver greatly expanded donor organ preservation possibilities,reaching before unattainable goals,including the mitigation of ischemia-reperfusion injury,viability assessment,and organ reconditioning prior to transplantation.However,current scientific evidence lacks uniformity between studies,perfusion protocols,and acceptance criteria.Construction of collaborative research networks for sharing knowledge should,therefore,enable the development of high-level evidence and guidelines for machine perfusion utilization,including donor acceptance criteria.Finally,this approach shall guarantee conditions for further progress to occur.
文摘Refractory ascites(RA)is a frequent and life-threatening complication of cirrhosis.In selected patients with RA,transjugular intrahepatic portosystemic shunt(TIPS)placement and liver transplantation(LT)are currently considered the best therapeutic alternatives to repeated large volume paracentesis.In patients with a contraindication to TIPS or LT,the alfapump®system(Sequana Medical,Ghent,Belgium)has been developed to reduce the need for iterative paracentesis,and consequently to improve the quality of life and nutritional status.We report here recent data on technical progress made since the first implantation,the efficacy and tolerance of the device,the position of the pump in the therapeutic arsenal for refractory ascites,and the grey areas that remain to be clarified regarding the optimal selection of patients who are potential candidates for this treatment.
文摘Hepatic hydatid cyst is a rare parasitic affection which constitutes a major health problem in countries endemic to hydatidosis. Rupture of hydatid cyst into gallbladder is an exceptional complication first described in 1952 by Atlas and Kamenear. We report the case of a hepatic hydatid cyst rupture into gallbladder in a 31-year-old patient with no history of disease.
文摘Textiloma is a rare pathological entity which can possibly complicate any surgery. Its incidence, reported in literature, is estimated between 1/1000 and 1/15,000. Abdominal and gynecological surgeries are responsible for the vast of majority of intra abdominal textiloma. Very few cases of spontaneous rectal expulsion of textiloma have been reported. We report the case of rectal expulsion of textiloma in a 26-year-old female who had undergone a C section for dynamic dystocia a year prior to her admission.
文摘Objective: Sentinel lymph node biopsy (SLNB) is a validated staging technique for breast carcinoma. Some women are exposed to have a second SLNB due to breast cancer recurrence or a second neoplasia (breast or other). Due to modified anatomy, it has been claimed that previous axillary surgery represents a contra-indication to SLNB. Our objective was to analyse the literature to assess if a second SLNB is to be recommended or not. Methods: For the present study, we performed a review of all published data during the last 10 years on patients with previous axilla surgery and second SLNB. Results: Our analysis shows that second SLNB is feasible in 70%. Extra-axillary SNs rate (31%) was higher after radical lymph node dissection (ALND) (60% - 84%) than after SLNB alone (14% - 65%). Follow-up and complementary ALND following negative and positive second SLNB shows that it is a reliable procedure. Conclusion: The review of literature confirms that SLNB is feasible after previous axillary dissection. Triple technique for SN mapping is the best examination to highlight modified lymphatic anatomy and shows definitively where SLNB must be performed. Surgery may be more demanding as patients may have more frequently extra-axillary SN only, like internal mammary nodes. ALND can be avoided when second SLNB harvests negative SNs. These conclusions should however be taken with caution because of the heterogeneity of publications regarding SLNB and surgical technique.
文摘Neuroendocrine tumors (NET) of the gallbladder are a rare entity with only 0.2% of all NET located in the gall bladder. Well-differentiated NETs occur at a relatively lower age group unlike other gallbladder tumors, whereas neuroendocrine carcinoma (NEC) occurs in an older category of patients. The aim of our study is to discuss the current level of evidence regarding this pathological entity by means of a rare case report on a neuroendocrine carcinoma of the gall bladder in a 63-year-old patient with a history of diabetes. Patient underwent cholecystectomy for acute cholecystitis. Pathology findings on surgical specimen came back for neuroendocrine tumour.
